Otolaryngology >>>> Mastoiditis - signs and treatment

Mastoiditis - signs and treatment.

Inflammation of the cellular structures and mucous membrane lining the cavity of the mastoid process of the temporal bone of the skull is called "mastoiditis". Mastoiditis usually develops as a secondary disease (as a complication), which is preceded by infections of the middle ear (acute or chronic otitis media). As an independent disease, the occurrence of mastoiditis is possible as a result of trauma (blow, craniocerebral injury, gunshot wound) of the mastoid process of the temporal bone, located behind the auricle, or as a result of sepsis, when the infection penetrates the structures of the mastoid process by hematogenous route.

Depending on what features of the structure of the mastoid process are observed in the patient, the complexity of the course of mastoiditis is determined. There are three options for the structure of the mastoid process:

With large hollow cells filled with air - the pneumatic structure of the bone,
With small cells filled with bone marrow - the diploetic structure of the bone,
With a minimum number of cells or their complete absence and filling with dense bone tissue.

With the pneumatic structure of the mastoid bone, the development of mastoiditis is most likely.

Mastoiditis in its development goes through two stages of inflammation:

Exudative, when fluid accumulates in the cavity of the cells, edema of the mucous membrane lining the cavity leads to the overlap of messages between the cells, as well as the overlap of communication with the tympanic cavity of the ear. As a result, the ventilation of air in the cells is disturbed, there is a difference in pressure inside the cells and outside. As a result of the pressure difference, the transudate from the blood vessels begins to seep into the cells and fill them with serous - purulent contents.

Purulent inflammation melts the bone structures (septa and walls) of the mastoid process and enters the proliferative - alterative stage with the development of osteomyelitis. At the same time, granulations grow, which fill, along with pus, the entire combined space of the mastoid bone. When the bone structure of the mastoid wall melts, there is a high likelihood of a breakthrough of purulent contents outward with the formation of an abscess, sometimes several abscesses, if several pathways for the outflow of purulent contents have formed.

Signs of mastoiditis:

Against the background of treatment of purulent otitis media, deterioration of health begins, pain syndrome resumes, body temperature rises, suppuration from the auricle continues (the volume of pus is much greater than with purulent otitis media). The pain syndrome extends to the area of the mastoid process and to half the head. Pain can radiate along the branches of the trigeminal nerve. Palpation and percussion (tapping) of the mastoid process causes pain. Congestion appears in the ear, hearing decreases, and noise in the head and ear may appear.

On otoscopic examination after removal of pus from the ear canal, perforation of the tympanic membrane may be found. In the area behind the ear, there is redness, swelling. The auricle may protrude. On the surface of the head in the area adjacent to the mastoid process, a fistula may be observed.

Treatment of mastoiditis is carried out in a complex with antibacterial drugs of a wide spectrum of action, anti-inflammatory, immunostimulating drugs, according to indications, antihistamines are prescribed. General detoxification measures are carried out. When an abscess is found, surgical intervention is required in order to open the mastoid process and create pathways for the outflow of purulent contents. The middle ear is washed with antiseptic drugs, proteolytic enzymes.