Mastoidits

[cpp]

I have had a pressure like pain behind my left ear for a couple of months.  The doctor has diagnosed mastoiditis and i am taking keflex.  I have not had any earache, nor any pain in my ear.  This would conflict with the diagnoses.  Could my pain be neuralgic.  I am concerned because I am due to take a four hour flight on Saturday which the doc knows about and hasnt advised against.

[Quixotic1]

I agree with your skepticism here,  Mastoiditis is a very, very unusual occurrence in this day and age.  It is also VERY serious when it does occur.  When it is acute there is a red, swollen, and very tender area behind the ear.  Usually the ear drum shows an acute middle ear infection (red and bulging).  The risk factors for developing mastoiditis are 1) being immune-compromised, 2) being very young 0 to 2 years of age, 3) chronic otitis media, 4) presences of a cholesteatoma.

Have you been otherwise ill, had a fever, loss of hearing, dizziness.  What is the headache like?

Diagnosis of mastoiditis is an indication for immediate hospitalization and IV antibiotics until marked improvement - 24 to 48 hours.  If the patient is not terribly ill  (unlikely) they may opt for outpatient IV antibiotic infusions.  In this case the drug of choice would be a THIRD generation cephalosporin coupled with another to hit the entire range of possiblilities.  Keflex is a 1st generation cephalosporin and has limited effectiveness against current bacteria and a large degree of resistance.  (ie. not a good choice if this really is mastoiditis.)

Along with IV antibiotics, anyone suspecting mastoiditis, should obtain a CT or MRI of the head to ascertain how deep the infection has gone.  The real dangers are 1) brain abcess (abscess), 2) loss of hearing, 3) chronic infection of the bone, 4)rapid spread of the infection into the face or neck.  Also an initial hearing exam should be done and an ENT consult is mandatory (in my training).

Mastoiditis can be chronic or latent.  In that case there is usually at least a history of fever.  The white cell count will be high and the ESR will be high.  It still requires documentation by CT or MRI and IV antibiotics. And an ENT consult.

Mastoiditis can also be TB or fungal.  Both are very serious and neither is treated by Keflex.

Now, to answer your real question.  Yes, there are headache syndromes that appear as pain behind the ear.  I'm not aware of a true neuralgia - maybe a variant of occipital neuralgia.  Geniculate neuralgia is characterized by excruciating pain IN the ear.

Is it a headache  or actually a tenderness of the scalp behind the ear?  

In either case, I can't see that a flight would be a problem.  I cannot, of course, tell you that you do not have mastoiditis.  If you do, you aren't being treated appropriately for it at all!  I have to seriously question the judgment of the physician who thought outpatient treatment with a 1st gen'n cephalosporin was adequate.  I am a pediatrician and I don't usually say something like that.  Also, I realize that I don't have all your facts.

Depending on the severity of your headache and how ill you have been, you might seek a second opinion before your flight.  This is probably more than you wanted to know.  Quix