What it is (overview)

XR Mastoids 3+ views Bilateral is an X-ray (radiology) exam that takes multiple images of the mastoid bones on both sides of the skull. The mastoid is the bony area behind each ear that contains small air-filled spaces (mastoid air cells) and sits next to the middle and inner ear structures. “3+ views” means the technologist captures several angles to better show ear anatomy and subtle bone changes that may not appear on a single image.

This test looks at the bony structures around the ear, including:

• The mastoid air cells and overall mastoid structure
• Bony changes from infection, inflammation, or long-term ear disease
• Signs of fluid, blocked air cells, or bone breakdown
• Fractures or other trauma-related changes involving the temporal bone region

What the results may mean: A radiologist reviews the skull imaging for patterns that suggest disease. Findings may be described as “normal” (well-aerated mastoids), “opacification” or “clouding” (which can indicate fluid/inflammation), “sclerosis” (thickened bone often seen with chronic ear problems), or “erosion” (bone damage that can occur with more aggressive infection or certain growths). Because X-rays are a 2D form of diagnostic imaging, your clinician may recommend a CT scan (which provides more detailed, near-3D views) if additional detail is needed or complications are suspected.

When & why it's usually done

Your clinician may order bilateral mastoid X-rays when symptoms or exam findings suggest a problem involving the mastoids or nearby middle/inner ear structures. It may be used to help evaluate both ears, especially when symptoms are on one side but comparison is helpful.

Common reasons include:

• Persistent or recurrent ear infection (especially chronic otitis media) that is not improving as expected
• Suspected mastoiditis, including pain, swelling, or redness behind the ear
• Ear pain with fever or worsening symptoms after an ear infection
• Drainage from the ear (otorrhea), particularly if long-standing
• Hearing changes (muffled hearing, conductive hearing loss) that may relate to chronic ear disease
• Dizziness/vertigo or balance issues when ear anatomy needs evaluation in context
• Trauma to the side of the head/behind the ear where a fracture is a concern
• Pre- or post-treatment evaluation of known mastoid or middle ear disease, depending on your care plan

In many modern settings, a CT scan is often preferred for detailed assessment of the mastoids and temporal bone. However, multi-view mastoid radiology can still be used as an initial test or when CT is not immediately available or not appropriate for a particular patient.

Common diseases related to it

• Mastoiditis (acute or chronic)
• Acute otitis media and chronic otitis media (chronic ear infection)
• Cholesteatoma (abnormal skin growth in the middle ear/mastoid that can erode bone)
• Mastoid effusion or mastoid air-cell opacification related to inflammation
• Temporal bone fracture (skull/ear-region trauma)
• Chronic mastoid sclerosis associated with long-standing ear disease
• Post-surgical or post-procedure changes (when relevant to the patient’s history)

Health goals where it may help

• Confirming or ruling out complications of an ear infection, including suspected mastoiditis
• Guiding next steps in care (for example, deciding whether a CT scan, ENT referral, or additional treatment is needed)
• Monitoring chronic ear disease and supporting long-term hearing and ear health planning
• Evaluating ear-region pain or swelling to help reach a clear diagnosis
• Assessing for injury after head/ear trauma using targeted diagnostic imaging