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Updated: Jun 9, 2026

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Bilateral mastoiditis from red tide exposure.

Samantha Honner1, Raphael M Kudela, Ethan Handler

  • 1Department of Emergency Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA.

The Journal of Emergency Medicine
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Summary

A rare case of bilateral mastoiditis occurred in a healthy adult after scuba diving in a red tide. Elevated bacterial counts from harmful algal blooms may be the cause of this infection.

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Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Environmental Health

Background:

  • Bilateral mastoiditis in adults is typically linked to diabetes or compromised immunity.
  • This presentation details a rare occurrence in an otherwise healthy individual.

Observation:

  • A 53-year-old woman developed bilateral otitis externa and mastoiditis post-scuba diving.
  • The dive occurred during a harmful algal bloom with high coliform bacteria counts exceeding safety limits.

Findings:

  • The patient's atypical culture results correlated with the environmental bacterial levels.
  • This suggests a potential link between environmental bacterial exposure and mastoiditis.

Implications:

  • Harmful algal blooms may harbor bacterial pathogens capable of causing rare infections like mastoiditis.
  • This case highlights the importance of environmental monitoring in aquatic recreational areas.