Mastoiditis is an inflammation of the mastoid process of the temporal bone, located in the inner ear. It plays an important role in the proper functioning of the inner ear. The disease usually occurs against the background of a middle ear infection, the treatment of which was not carried out in a timely manner. The mastoid process of the temporal bone is made up of air sacs and although it is bone, it has a spongy consistency and also receives air from all other structures of the ears.

According to the medical website Healthline, this pathology most often occurs in children. Treatment of the disease must be timely, otherwise it can lead to hearing loss in the affected ear. In addition, the mastoid process of the temporal bone is located in the skull, which means that it can impinge on the skull and lead to the development of a brain abscess. In this case, a person may experience swelling behind the eyes - another serious complication of mastoiditis.

Mastoiditis most often occurs in children because their eustachian tube is not yet formed and therefore is not able to drain all the accumulated fluid. This can lead to the development of inflammation of the mastoid process of the temporal bone. Today, this disease is very rare, since in most countries antibiotics are used for timely treatment of ear infections even before they affect the mastoid process of the temporal bone. The good news is that for mastoiditis to develop, the infection must be really serious and advanced.

The incidence rate of mastoiditis is very low, about 0.004%. In most cases, the disease affects children between 2 and 13 months of age, when their eustachian tubes are not yet fully developed. The prevalence of the disease is the same among boys and girls.

• Ear pain
• Fluid discharge from the affected ear
• Fever
• Headache
• Redness of the affected area
• Swelling
• Painful sensitivity

• During a general physical examination, an otolaryngologist examines a person's ears to make sure they do not have other ear infections.
• The doctor asks the patient about previous ear infections.
• Signs of infection can be detected through a blood test.
• The doctor specifically conducts imaging studies of the skull and middle ear to more thoroughly examine the mastoid process of the temporal bone, as well as to exclude the possibility of developing an abscess (in advanced cases). The doctor may do imaging tests such as X-rays, MRIs, and CT scans.
• The doctor may also perform a lumbar puncture, which will allow them to examine the spine, which will help rule out the possibility of infection.

• Conservative treatment involves taking antibiotics (intravenously or orally) to fight the infection.
• Radical mastoidectomy is a surgical procedure aimed at removing pus from the mastoid process of the temporal bone and draining fluid from the inner ear.

Inflammatory lesion of the mastoid process of the temporal bone of infectious origin. Most often, mastoiditis complicates the course of acute otitis media. Clinical manifestations of mastoiditis include a rise in body temperature, intoxication, pain and pulsation in the mastoid region, swelling and hyperemia of the postauricular area, ear pain and hearing loss. An objective examination for mastoiditis consists of examination and palpation of the area behind the ear, otoscopy, audiometry, radiography and CT scan of the skull, and bacteriological culture of discharge from the ear. Treatment of mastoiditis can be medicinal and surgical. It is based on antibiotic therapy and rehabilitation of purulent foci in the tympanic cavity and mastoid process.

General information

The mastoid process is a protrusion of the temporal bone of the skull located behind the auricle. The internal structure of the process is formed by communicating cells, which are separated from each other by thin bone partitions. The mastoid process may have a different structure in different people. In some cases it is represented by large air-filled cells (pneumatic structure), in other cases the cells are small and filled with bone marrow (diploetic structure), in third cases there are practically no cells (sclerotic structure). The course of mastoiditis depends on the type of structure of the mastoid process. Those with a pneumatic structure of the mastoid process are most prone to the appearance of mastoiditis.

The inner walls of the mastoid process separate it from the posterior and middle cranial fossae, and a special opening connects it with the tympanic cavity. Most cases of mastoiditis occur as a consequence of the transfer of infection from the tympanic cavity to the mastoid process, which is observed in acute otitis media, in some cases in chronic purulent otitis media.

Causes of mastoiditis

Depending on the cause, otolaryngology distinguishes between otogenic, hematogenous and traumatic mastoiditis.

1. Otogenic. Most often, secondary mastoiditis occurs, caused by the spread of infection into the mastoid process from the tympanic cavity of the middle ear. Its causative agents can be influenza bacillus, pneumococci, streptococci, staphylococci, etc. The transfer of infection from the middle ear cavity is facilitated by disruption of its drainage due to late perforation of the eardrum, untimely paracentesis, too small a hole in the eardrum or its closure with granulation tissue.
2. Hematogenous. In rare cases, mastoiditis is observed, which developed as a result of hematogenous penetration of infection during sepsis, secondary syphilis, tuberculosis.
3. Traumatic. Primary mastoiditis occurs with traumatic damage to the cells of the mastoid process due to a blow, gunshot wound, or traumatic brain injury. A favorable environment for the development of pathogenic microorganisms in such cases is the blood spilled into the cells of the appendix as a result of injury.

The appearance of mastoiditis is promoted by:

• increased virulence of pathogenic microorganisms
• weakened general condition in chronic diseases (diabetes mellitus, tuberculosis, bronchitis, hepatitis, pyelonephritis, rheumatoid arthritis, etc.)
• pathology of the nasopharynx (chronic rhinitis, pharyngitis, laryngotracheitis, sinusitis)
• the presence of changes in the structures of the ear due to previous diseases (ear trauma, aerootitis, external otitis, adhesive otitis media).

Pathogenesis

The onset of mastoiditis is characterized by inflammatory changes in the mucous layer of the mastoid cells with the development of periostitis and the accumulation of fluid in the cavities of the cells. Due to the pronounced exudation, this stage of mastoiditis is called exudative. Inflammatory swelling of the mucous membrane leads to the closure of the holes connecting the cells with each other, as well as the hole connecting the mastoid process with the tympanic cavity. As a result of disruption of ventilation in the cells of the mastoid process, the air pressure in them drops. Along the pressure gradient, transudate from dilated blood vessels begins to flow into the cells. The cells are filled with serous and then serous-purulent exudate. The duration of the first stage of mastoiditis in adults is 7-10 days, in children it is often 4-6 days. Ultimately, in the exudative stage of mastoiditis, each cell has the appearance of an empyema - a cavity filled with pus.

Next, mastoiditis passes into the second stage - proliferative-alterative, in which purulent inflammation spreads to the bone walls and septa of the mastoid process with the development of osteomyelitis - purulent melting of the bone. At the same time, granulation tissue is formed. Gradually, the partitions between the cells are destroyed and one large cavity is formed, filled with pus and granulations. Thus, as a result of mastoiditis, empyema of the mastoid process occurs. The breakthrough of pus through the destroyed walls of the mastoid process leads to the spread of purulent inflammation to adjacent structures and the development of complications of mastoiditis.

Classification

There are two clinical forms of mastoiditis: typical and atypical. The atypical (latent) form is characterized by a slow and sluggish course without pronounced symptoms characteristic of mastoiditis. A separate group of apical mastoiditis is distinguished, which includes Bezold's mastoiditis, Orleans mastoiditis and Mouret's mastoiditis. According to the stage of the inflammatory process, mastoiditis is classified as exudative and true (proliferative-alterative).

Symptoms of mastoiditis

Mastoiditis can appear simultaneously with the occurrence of purulent otitis media. But most often it develops 7-14 days from the onset of otitis media. In children of the first year of life, due to the structural features of the mastoid process, mastoiditis manifests itself in the form of otoanthritis. In adults, mastoiditis manifests itself as a pronounced deterioration in general condition with a rise in temperature to febrile levels, intoxication, headache, and sleep disturbances. Patients with mastoiditis complain of noise and pain in the ear, hearing loss, intense pain behind the ear, and a feeling of pulsation in the mastoid area. Pain radiates along the branches of the trigeminal nerve to the temporal and parietal region, orbit, and upper jaw. Less commonly, mastoiditis causes pain in the entire half of the head.

These symptoms of mastoiditis are usually accompanied by profuse suppuration from the external auditory canal. Moreover, the amount of pus is noticeably greater than the volume of the tympanic cavity, which indicates the spread of the purulent process beyond the middle ear. On the other hand, suppuration with mastoiditis may not be observed or may be insignificant. This occurs while maintaining the integrity of the eardrum, closing the perforation in it, and disrupting the outflow of pus from the mastoid process to the middle ear.

Objectively, with mastoiditis, redness and swelling of the area behind the ear, smoothness of the skin fold located behind the ear, and protrusion of the auricle are noted. When pus breaks through into the subcutaneous fatty tissue, a subperiosteal abscess forms, accompanied by severe pain when palpating the postauricular area and a symptom of fluctuation. From the area of ​​the mastoid process, pus, exfoliating the soft tissues of the head, can spread to the occipital, parietal, and temporal regions. Thrombosis of the vessels supplying the cortical layer of the mastoid bone, which occurs as a result of inflammation, leads to necrosis of the periosteum with the breakthrough of pus to the surface of the scalp and the formation of an external fistula.

Complications

The spread of purulent inflammation in the mastoid process itself occurs along the most pneumatized cells, which determines the variety of complications that arise with mastoiditis and their dependence on the structure of the mastoid process. Inflammation of the perisinous group of cells leads to damage to the sigmoid sinus with the development of phlebitis and thrombophlebitis. Purulent destruction of the perifacial cells is accompanied by neuritis of the facial nerve, and of the perilabyrinthine cells by purulent labyrinthitis. Apical mastoiditis is complicated by the flow of pus into the interfascial spaces of the neck, as a result of which pyogenic microorganisms can penetrate into the mediastinum and cause the appearance of purulent mediastinitis.

The spread of the process into the cranial cavity leads to intracranial complications of mastoiditis (meningitis, brain abscess, encephalitis). Damage to the pyramid of the temporal bone causes the development of petrositis. The transition of purulent inflammation to the zygomatic process is dangerous due to further introduction of infection into the eyeball with the occurrence of endophthalmitis, panophthalmitis and orbital phlegmon. In children, especially young children, mastoiditis can be complicated by the formation of a retropharyngeal abscess. In addition, with mastoiditis, hematogenous spread of infection with the development of sepsis is possible.

Diagnostics

As a rule, diagnosing mastoiditis does not present any difficulties for an otolaryngologist. Difficulties arise in the case of a low-symptomatic atypical form of mastoiditis. Diagnosis of mastoiditis is based on the patient’s characteristic complaints, anamnestic information about trauma or inflammation of the middle ear, examination and palpation of the behind-the-ear area, results of otoscopy, microotoscopy, audiometry, culture of ear discharge, computed tomography and x-ray examination.

• Otoscopy. With mastoiditis, inflammatory changes typical of otitis media are detected on the side of the eardrum; if there is a hole in it, profuse suppuration is noted. A pathognomonic otoscopic sign of mastoiditis is the overhang of the posterior superior wall of the auditory canal.
• Hearing function test. Audiometry and hearing testing with a tuning fork can determine the degree of hearing loss in a patient with mastoiditis.
• X-ray of the temporal bone. In the exudative stage of mastoiditis, it reveals cells veiled as a result of inflammation and unclearly distinguishable partitions between them. The X-ray picture of the proliferative-alterative stage of mastoiditis is characterized by the absence of a cellular structure of the mastoid process, instead of which one or several large cavities are determined. Better visualization is achieved by performing a CT scan of the skull in the area of ​​the temporal bone.

The presence of complications of mastoiditis may require additional consultation with a neurologist, neurosurgeon, dentist, ophthalmologist, thoracic surgeon, MRI and CT scan of the brain, ophthalmoscopy and biomicroscopy of the eye, and chest radiography.

Treatment of mastoiditis

Therapeutic tactics for mastoiditis depend on its etiology, the stage of the inflammatory process and the presence of complications. Drug therapy for mastoiditis is carried out with broad-spectrum antibiotics (cefaclor, ceftibuten, cefixime, cefuroxime, cefotaxime, ceftriaxone, amoxicillin, ciprofloxacin, etc.). Additionally, antihistamines, anti-inflammatory, detoxification, and immunocorrective drugs are used. Complications are treated.

With the otogenic nature of mastoiditis, sanitizing surgery on the middle ear is indicated; if indicated, general cavity surgery is indicated. The absence of a hole in the eardrum that provides adequate drainage is an indication for paracentesis. The middle ear is washed with medications through the opening of the eardrum. Mastoiditis in the exudative stage can be treated conservatively. Mastoiditis of the proliferative-alterative stage requires surgical opening of the mastoid process (mastoidotomy) to eliminate pus and postoperative drainage.

Prevention of mastoiditis

Prevention of otogenic mastoiditis comes down to timely diagnosis of inflammatory lesions of the middle ear, adequate treatment of otitis media, timely paracentesis of the eardrum and sanitizing operations. Correct treatment of nasopharyngeal diseases and rapid elimination of infectious foci also help prevent mastoiditis. In addition, it is important to increase the efficiency of the body’s immune mechanisms, which is achieved by maintaining a healthy lifestyle, proper nutrition, and, if necessary, immunocorrective therapy.

Usually develops as a complication after suffering from otitis media.

Mastoiditis symptoms and treatment

Mastoiditis of the ear, as stated above, it appears due to the spread of infection, which remains as a result of insufficient cure for otitis media and against the background of a weakened immune system. The disease manifests itself immediately, and its symptoms become clearly noticeable quite quickly:

• increase in body temperature
• discharge of pus from the ear
• right-handed / left-sided mastoiditis leads to hearing loss
• weakness
• noises in the head
• decreased performance
• throbbing pain behind the ear when pressing.

Mastoiditis diagnosis

Ear mastoiditis diagnosed by a specialist in a medical institution based on a comprehensive examination and collection of tests to obtain an accurate picture of the course of the disease. In case of acute mastoiditis, an x-ray is taken and the patient receives additional consultations with a surgeon and dentist.

Only the attending physician is responsible for determining treatment methods and possible surgical intervention. Ear mastoiditis It is a rather insidious disease and has many life-threatening complications. The patient may be prescribed:

• antibacterial agents
• antibiotics
• drainage of the auditory tube for the outflow of pus.

Acute mastoiditis treatment

In this case, the patient should be in the hospital. Treatment methods can be conservative, each case is individual. However, when paralysis of the facial nerve occurs or pus breaks through the border with the middle ear, surgical intervention is resorted to. The purpose of the operation is to get rid of pus. Subsequent rehabilitation, among other things, will include daily dressings, taking vitamins and local ultraviolet treatment.

In order to protect yourself from this disease, it is necessary to promptly treat any diseases of the nasopharynx and ears, protect yourself from injuries and periodically undergo preventive examinations by an otolaryngologist.

Make an appointment with an otolaryngologist at the Semeynaya clinic. Here you can undergo diagnostics of ENT diseases and receive outpatient care.

Mastoiditis is an inflammatory lesion that covers the area of ​​the temporal bone and is of infectious origin. Most often, this disease occurs as a complication of otitis media. The most common symptoms are pain in the mastoid process of the ear, swelling and decreased hearing function.

The mastoid process is the protrusion of the temple bones in the skull and is located behind the concha of the external ear. Its structure consists of many cells that are separated by partitions. They can be filled with air, bone marrow, or have a sclerotic type structure. The course of the disease depends on the type of affected cells. The disease can be right-sided or left-sided.

Causes of the disease

Mastoiditis usually occurs due to the spread of infections (pneumococcus, and others) from the middle ear. An infection can get into the mastoid process if the hole in the eardrum is too small or for other reasons. Rarely, patients are diagnosed with a disease that occurs due to infection due to the presence of or.

The main causes of the disease are:

• gunshot wound;
• mechanical damage;
• traumatic brain injury;
• other changes in the ear structure due to illness (external, intermediate or aerootitis);
• chronic diseases (tuberculosis,);
• nasopharyngeal diseases (,).

Types of illness

There are such forms of the disease depending on the causes of its occurrence:

• primary(occurs after mechanical damage);
• secondary(formed against the background of other diseases).

According to the stages, the following types of disease are distinguished:

• exudative(with release of liquid);
• true(with the formation of bone processes).

According to the clinical form, there are:

• typical manifestations: headache, pain in the ears;
• atypical manifestations, in which the disease proceeds almost unnoticed or there are atypical signs of the disease.

In addition, a distinction is made between chronic mastoiditis and acute mastoiditis. In the first case, all symptoms appear rather sluggishly, and some are completely absent. In the second case, the patient complains of several signs of the disease, which appear quite clearly.

Separately allocate Bezold's mastoiditis- a type that also causes swelling of the neck, purulent exudate is formed in the area of ​​the eardrum or the sternocleidomastoid muscle.

Symptoms of the disease

The symptoms of mastoiditis are different, and it usually appears together with moderate purulent (at 2 or 3 weeks). Mastoiditis in children can develop even in the absence of a formed bone process (up to 3 years the process does not yet have time to form).

The usual symptoms of the disease are:

• decreased perception of sounds;
• increased body temperature;
• headaches;
• sharp pain behind the ear;
• suppuration that is observed from the external ear canal.

If the volume of suppuration significantly exceeds the size of the eardrum or it is damaged, then this indicates the spread of the disease beyond the middle ear. If the amount of pus is insignificant, the infection does not spread further and the integrity of the eardrum is preserved. The patient can observe a protruding ear, the formation of smoothness behind the ear instead of the skin fold usually located there. Pus can spread to all parts of the skull, causing blood clots, necrosis of the periosteum and the formation of an external fistula.

Complications of the disease can be:

• intracranial diseases (encephalitis, blood clots);
• facialles();
• damage to the functionality of the neck;
• eye damage (panophthalmitis);
• sepsis.

Diagnosis of the disease

A qualified otolaryngologist can diagnose acute mastoiditis within a few minutes. An exception may be an atypical type of illness. Diagnosis is based on the patient's testimony, obtaining a history of life and illnesses, as well as palpation of the area located behind the ear. The otolaryngologist will also prescribe otoscopy, audiometry, bacterial culture, and, in some cases, radiography of the skull. This will help detect the stage of development of the disease. Based on these studies, a diagnosis is made and a treatment plan is drawn up.

Treatment of the disease

Treatment of mastoiditis depends on the cause of its occurrence, the nature of the course, as well as the stage of the process of inflammation of the post-auricular space. There are the following main treatment methods:

• taking antibiotics, the action of which is aimed at destroying the source of infection (Ceftriaxone, Cefixime, Cefotaxime);
• taking other medications (antihistamine, detoxification type);
• surgical intervention;
• physiotherapy;
• traditional methods.

Taking medications is also called a conservative method of treatment, but its use is reasonable in the initial stages of mastoiditis, when the disease has not yet penetrated the tissues of the ear and the skull area. The patient is prescribed drugs of various types of action (to adjust immunity, eliminate the consequences and causes of inflammation, and others).

The surgical method is a more effective method of combating the disease. The operation is performed on the middle ear, and if there is no hole in the area of ​​the eardrum that provides drainage, paracentesis is performed. During the operation, which takes place under anesthesia, the doctor rinses the ear opening with various medications, cuts the periosteum, removes the upper plate of the bone behind the ear, and then sutures the wound. The patient must be hospitalized and bandaged daily until the wound is completely healed.

Treatment of mastoiditis with physiotherapy involves the application of warm compresses, UHF therapy, and ultraviolet irradiation of the patient. Traditional methods, like physiotherapy, are usually auxiliary, but not primary.

There are many folk recipes for getting rid of the disease, including:

• hot onion treatment. It is supposed to bake the onion until soft, place a piece of butter and the onion on gauze, wrap it and insert it into the ear canal for 1-2 minutes. Afterwards, wrap the patient’s head with a warm blanket or scarf;
• bread crust treatment. It is supposed to be heated on both sides using a water bath, and then applied to the ear, insulating it.

Disease prevention

This disease can be prevented if:

• promptly detect signs of inflammatory damage;
• qualitatively treat emerging otitis;
• carry out sanitizing manipulations (cleanse the ear of dirt, excess wax, etc.);
• lead a healthy lifestyle;
• eat right (maintain a balance of proteins, fats, carbohydrates and vitamins);
• carry out immunoregulatory therapy.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

Mastoiditis means the presence of a purulent inflammatory process in the tissues of the mastoid process of the temporal bone. A number of fascia, ligaments and large muscles of the head and neck are attached to the process. And its cavities connect with the canals of the temporal bone and the middle ear. Most often, mastoiditis develops against the background of inflammation of the middle ear or other ENT organs, when the infection spreads through the canals of the temporal bone.

The consequences of such spread are fraught with serious complications - meningitis, encephalitis, abscess or phlegmon of adjacent tissues. Therefore, treatment of mastoiditis in Israel is a complex of immediate therapeutic and surgical measures.

Symptoms of mastoiditis

A characteristic sign of acute inflammation of the mastoid process of the temporal bone (mastoiditis) is intense pain behind the ear, which intensifies with head movement (turning, tilting) and radiates to the ear, neck or head. Other symptoms that may suggest mastoiditis:

• headache that gets worse at night;
• body temperature above 38 degrees;
• signs of general intoxication (weakness, dizziness);
• discharge from the ear (clear, cloudy or yellow);
• redness of the skin behind the ear;
• neck pain, difficulty swallowing.

Considering the fact that mastoiditis almost always develops against the background of inflammation of the middle ear, an important sign of the onset of the disease is a sudden exacerbation of symptoms against the background of previous treatment. Usually this consists of an increase in temperature after several days of its normalization and the further addition of the above symptoms.

The development of mastoiditis against the background of otitis media always occurs if the treatment of the latter was incorrect. This is either the wrong choice of antibiotic (its dose and frequency of administration) or there was no treatment at all. Due to the high risk of developing life-threatening complications, Israel has established a clear algorithm for diagnosing and treating mastoiditis.

Diagnostic methods

The main purpose of examining a patient with suspected mastoiditis in Israel is not so much a differential diagnosis as determining the exact localization of the process and determining the extent of purulent exudate in the cavities of the temporal bone and adjacent tissues. This is important for choosing further treatment tactics and determining the extent of surgical intervention.

At Tel Aviv First Medical Center, decisions regarding the treatment of mastoiditis are made in close collaboration between an otolaryngologist, an oral surgeon, and a head and neck specialist. Diagnostic methods for mastoiditis in Israel include:

bacteriological analysis of ear discharge followed by culture (to monitor antibiotic sensitivity).

The most effective methods for treating mastoiditis

Treatment of mastoiditis in Israel can be conservative and radical. First of all, broad-spectrum antibiotics are prescribed with a mandatory audit of the history of antibiotic therapy over the past year. To reduce the risk of developing dangerous complications, additional medication is required in the form of desensitizing agents, anti-inflammatory therapy, agents that improve blood rheology, and so on.

If there is no effect from conservative treatment of mastoiditis a decision is made about surgical intervention. Depending on the extent of the process and the involvement of surrounding tissues in Israel a sparing or radical mastoidectomy is performed.

During a gentle operation, the cavity of the appendix is ​​opened and the source of infection is drained with the additional formation of an outflow of pus by dissecting the tympanic septum. If the process involves the formation of the middle ear and the temporal bone, a radical mastoidectomy is performed with the removal of the eardrum and surrounding tissues. To further preserve ear function in Israel unique reconstructive operations are performed.

Innovative methods for treating mastoiditis in the clinic

At the First Medical Center in Tel Aviv, gentle myringotomy procedures are performed, cutting the eardrum to drain pus from the middle ear and the canals of the temporal bone. Often this manipulation can help avoid surgery and limit only conservative treatment.

Procedure in Israel carried out using the latest equipment, the entire process is controlled using a computer. Microtubules made of a special material are inserted into the holes to prevent clogging. Unique operations to reconstruct the bones of the middle ear in order to restore hearing function and treatment deafness after radical surgery treatment of mastoiditis.

In Israel Such operations are performed by professional transplantologists, and the smallest bones are created using 3D modeling. In addition, plastic surgeons take an active part in reconstruction operations. After all, if the process was neglected, and the operation required radical removal of tissue, the patient’s appearance changes. In such a situation, plastic surgery of the mastoid process, ear and scalp is performed.

How to choose a specialist for treatment

On the website, the patient can familiarize himself with the dossiers of all doctors in the departments of ENT, maxillofacial surgery and head and neck surgery. All doctors have many years of experience in performing operations on the ear, neck and temporal bone and are the best specialists in Israel. And after familiarization, the patient can choose treatment from one doctor or another.