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 impairment
• 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.

is an 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.

• Depending on the cause, otolaryngology distinguishes between primary and secondary; otogenic, hematogenous and traumatic mastoiditis.
• According to the stage of the inflammatory process, mastoiditis is classified as exudative and true (proliferative-alterative).
• There are typical and atypical clinical forms of mastoiditis. The atypical (latent) form of mastoiditis 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.

Etiology and pathogenesis. 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 others 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.

Most often, secondary mastoiditis occurs, caused by the otogenic spread of infection 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 a violation 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.

In rare cases, mastoiditis is observed, which has developed as a result of hematogenous penetration of infection into the mastoid process during sepsis, secondary syphilis, and tuberculosis. 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 facilitated by the increased virulence of pathogenic microorganisms, a weakened state of general and local immunity in chronic diseases (diabetes mellitus, tuberculosis, bronchitis, hepatitis, pyelonephritis, rheumatoid arthritis, etc.) and pathology of the nasopharynx (chronic rhinitis, pharyngitis, laryngotracheitis, sinusitis), the presence changes in ear structures due to previous diseases (ear trauma, aerootitis, otitis externa, adhesive otitis media).

The onset of mastoiditis is characterized by inflammatory changes in the mucous layer of the mastoid cells with the development of periostitis and 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 neighboring structures and the development of complications of mastoiditis.

Clinical picture. 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 into 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.

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 the perilabyrinthine cells are accompanied 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 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. Ndoes not present any difficulties for the 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, bacterial culture of ear discharge, computed tomography and x-ray examination.

Otoscopy for mastoiditis reveals inflammatory changes on the side of the eardrum, typical for otitis media; 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. Audiometry and hearing testing with a tuning fork can determine the degree of hearing loss in a patient with mastoiditis.

Sight radiography of the skull in the exudative stage of mastoiditis 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 of the brain, ophthalmoscopy and biomicroscopy of the eye, CT and chest x-ray.

Mastoiditis Treatment.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 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.

A purulent, infectious, inflammatory disease of the mastoid process, which is located behind the auricle, is called mastoiditis. This disease can have serious complications, such as meningitis, encephalitis, sepsis, so do not underestimate it.

The mastoid process is part of the temporal bone, which forms an important part of the facial skeleton. It has a specific bone structure because it contains a space filled with air. This is very important for the proper functioning of the adjacent appendage of the middle and inner ear. Unfortunately, the proximity of these anatomical structures makes it possible for inflammatory processes to spread from the ear to the mastoid process. In turn, inflammation of the mastoid tissue can spread to the cranial structures of the central nervous system. This is a serious illness that requires intensive hospital treatment.

Most often, mastoiditis occurs due to complications of inflammation of the middle ear. It is also one of the two most common complications of otitis media. The disease most often affects children, especially those under 10 years of age, but can also occur in adults.

Diagnosis of mastoiditis is usually based on a physical examination and computed tomography, sometimes x-ray. These methods make it possible to establish inflammation of the air space, as well as bone tissue. In the case of oily discharge from the ear canal, a culture can be collected to determine the bacteria causing the infection.

The most common symptoms that occur during mastoiditis include: pain in the back of the ear; discharge from the ear canal; headache; periodic or constant increase in body temperature; hearing impairment; redness and swelling of the tissues of the mastoid process.

Treatment of mastoiditis is often difficult and lengthy, as it affects bone tissue, into which antibiotics penetrate slowly and spread ineffectively. Therefore, it is often difficult to achieve immediate therapeutic concentrations in diseased tissues. However, antibiotics are the main medications used in treatment.

Doctors often choose what is called sequential therapy, or administering the drug initially by injection and then using the oral route. This allows you to quickly achieve the desired concentration of the drug in the blood.

If antibiotic therapy is ineffective, surgical incision and drainage of the inflamed tissue may be required.

In most cases, treatment is effective and leads to complete recovery. Mastoiditis does not have a strong tendency to recur. Only in the case of complications, especially those burdened by additional factors such as systemic diseases or disorders of the immune system, the course of treatment may be unfavorable.

If symptoms of mastoiditis occur, you should consult a doctor. An estimated 75% of cases of mastoiditis are treated with conventional conservative treatment, and about 30% may require surgery. However, precisely because of the risk of complications, this disease is one that should not be underestimated at all.

No surgical intervention. For this purpose, various groups of antibiotics are used. If conservative treatment proves futile, mastoidectomy is prescribed.

Mastoidectomy: the essence of the procedure

Surgery is used to remove the mastoid process. There are three large groups of such surgical interventions:

1. Simple. The procedure is performed through the ear canal or a small incision behind the ear. After opening the mastoid process, the pus is removed. Then a little is done to ensure .
2. Radical. Involves complete removal of the eardrum. Almost all structures of the middle ear except the stapes are eliminated. This allows surgical intervention to be carried out in the future.
3. Modified. During the treatment, the integrity of the eardrum and structures is maintained. This has a positive effect on the recovery prognosis.

Indications

The main purpose of the operation is to preserve hearing and sanitize the ear. It is carried out in those patients who have pathogenic stable microflora in the ear canal. can lead to skin ingrowth of the ear canal through a damaged area in the eardrum.

Preparation includes:

• examination and palpation of the behind-the-ear area,
• otoscopy,
• microotoscopy,

Process Description

Carrying out the operation requires high precision and professionalism from the surgeon, since the actions themselves are quite complex. The operation takes an average of 1.5 hours.

The stages of the operation are as follows:

1. The person is immersed in general anesthesia, the head is firmly fixed in the desired direction.
2. An arcuate incision is made at a distance of 1 cm from the shell. If the patient is a child under two years old, then the skin is cut straight to the bone.
3. After layer-by-layer cutting, the bone is visualized. Using a special tool, the doctor begins to chisel the bone until the cells of the process appear. In children, a hammer is not used; manipulations are mainly carried out using sharp spoons.
4. After opening the cells, the purulent masses are removed, drainage is introduced to facilitate the flow of pus.
5. After the operation, they are used, the tampon is fixed and sutures are applied.

Temporal bone mastoidectomy in our video:

Postoperative care and recovery

Hospitalization lasts about 5-7 days. A person can return to work 1-3 weeks after discharge.

Sometimes there is a need for a second operation aimed at restoring hearing. It is carried out after 6-12 months.

The need for it may arise if it is necessary to re-examine the cavities and identify remaining areas of inflammation.

The recovery period is quite easy. Immediately after the operation, swelling appears, and partial numbness of the face may develop. In the first few months you cannot:

• lift weights
• swim in the pool and ponds,
• do not allow water to enter the ear canal,
• blow your nose
• travel on trains and planes.

Immediately after the operation, the bandage is changed for the first time on the fifth day. If during dressing there is or after it arises, you should immediately inform your doctor about it. When the wound heals slowly, various ointments or ointments are used.

Treatment after surgery

In order to completely get rid of the problem, additional treatment is prescribed.

Medication

Previously, a course of antibiotics was required to continue for 5-7 days. Anemization is required, that is, the introduction of vasoconstrictor drugs into the pharyngeal mouth of the auditory tube. If necessary, the wound is treated with antiseptic solutions.

Dressing changes may include additional administration.

Folk recipes

Traditional methods are mainly aimed at strengthening the immune system. Cannot be used during the recovery period, but after removing the bandage, chamomile can be used to treat external wounds. Anti-inflammatory decoctions, such as chamomile, are used internally. They allow you to speed up the healing process.

Physiotherapy

If the wound does not heal well, ultraviolet irradiation is prescribed. All procedures are prescribed by a doctor. For faster treatment, they may be prescribed, but its use is only relevant when healing external wounds.

How to treat mastoiditis without surgery in our video:

What is possible, what is not

You should not blow your nose or get into a situation of sudden changes in atmospheric pressure. Doctors strongly recommend avoiding open water and swimming pools. It is allowed to make various antiseptic dressings with medications prescribed by the doctor.

Headache, difficulty swallowing. Fever, shortness of breath, nausea and other signs of intoxication may indicate the development of inflammation.