Mastoiditis is a special type of inflammatory lesion of the mastoid process of the temporal bone, having an infectious genesis. Usually mastoiditis further complicates the course of acute otitis media.
The content of the article:
Pathogenesis of mastoiditis
Classification of mastoiditis
Causes of mastoiditis
Symptoms of mastoiditis
Diagnosis of mastoiditis
Complications of mastoiditis
Treatment of mastoiditis
Prevention of mastoiditis
Mastoiditis
Clinical manifestations of mastoiditis suggest an increase in body temperature, pain, as well as pulsation in the mastoid process, intoxication, swelling, ear pain, possible hearing loss. Examination of a patient diagnosed with mastoiditis includes examination and palpation of the ear part, audiometry, otoscopy, X-ray, CT of the skull, as well as bacteriological seeding of the ear contents. Treatment of mastoiditis can be both medicamental and surgical. The basis of treatment is antibiotic therapy, possible rehabilitation of purulent foci concentrated in the tympanic region and in the area of the mastoid process.
What is the mastoid process? This is the protrusion of the temporal bone of the skull, which is located in the back of the auricle. The internal structure of the process is such that the cells communicating with each other are separated by thin partitions of bone nature. Each person’s mastoid process has its own individual structure. For some, it is a large-sized cell filled with air. This is the so-called pneumatic structure. In others, such cells may be small, while they are filled with bone marrow. The latter is a diploetic structure. There are cases when there are no cells at all. In this case, the mastoid process has a sclerotic structure. The course of mastoiditis directly depends on the type of structure of the mastoid process. Usually, the tendency to mastoiditis is more inherent in those who have a pneumatic type of mastoid process structure.
As is known, the internal walls of the mastoid process separate the posterior and middle cranial fossa. A special hole makes it possible to communicate between the pits and the tympanic cavity. Many cases of mastoiditis are a consequence of the development of infection from the tympanic cavity to the area of the mastoid process. The latter is most often observed during the course of acute otitis media, and sometimes in the chronic form of purulent otitis media.
Pathogenesis of mastoiditis
Mastoiditis begins with inflammatory changes in the mucous layer of the cells of the mastoid process, accompanied by developed periostitis and accumulated fluid in the cavity of the cells. This stage of mastoiditis development is called the exudative stage. Further inflammatory swelling of the mucous membrane can lead to blockage of the holes that are located between the cells, as well as between those holes that connect the mastoid processes and the tympanic cavity. During such a violation of ventilation, air pressure usually drops in the cells of the mastoid process itself, after which transudates begin to flow into the cells, traveling through the blood vessels. First, the cells are filled with serous exudate, and then with serous-purulent. Usually, the duration of the very first stage reaches up to 10 days in adults and up to 6 days in children. At the final stage of the exudative stage of mastoiditis, almost all cells become empyema in their appearance, that is, cavities that are filled with pus. After that, mastoiditis develops into the second stage, which is called proliferative-alternative, in which purulent inflammation also spreads to the bone walls, as well as the septum into the mastoid process with the further development of osteomyelitis (purulent melting of the bone). In parallel with the development of this stage, the appearance of granulation tissue is observed. Over time, the partitions located between the cells may collapse, after which a single large cavity will be formed. Such a cavity is filled with pus and granulations. The result of mastoiditis is empyema of the mastoid process. In the case of a breakthrough of pus from the destroyed walls of the mastoid process, purulent inflammation spreads to all neighboring structures, which leads to the further development of a complicated form of mastoiditis.
Classification of mastoiditis
All types of mastoiditis are divided into primary and secondary. According to another classification, hematogenic, otogenic and traumatic mastoiditis are distinguished. As for the classification of mastoiditis at the stage of the inflammatory process, there are true (or proliferative-alternative) and exudative mastoiditis. There are also typical and atypical forms of mastoiditis. Unlike the typical, atypical (or latent) form has a slow and sluggish course, without any particularly pronounced symptoms, so characteristic of mastoiditis. Also, experts distinguish a special group of mastoidites of the apical type. These include Orleans mastoidite, Bezold mastoidite and Mouret mastoidite.
Causes of mastoiditis
The main cause of mastoiditis is the spread of otogenic infection from the tympanic cavity of the middle ear. The causative agent can be both a stick of influenza, and streptococci, pneumococci and staphylococci. The transition of infection from the middle ear area is the main cause of drainage disorders during late perforation of the eardrum. Another reason for the development of the disease is an untimely paracentesis procedure. Sometimes mastoiditis is observed, which develops as a consequence of the penetration of a hematogenic infection into the mastoid process, with secondary syphilis, sepsis and tuberculosis. As a rule, primary mastoiditis is formed during traumatic damage to cells characteristic of the mastoid process due to a blow or traumatic brain injury. The best environment for the development of pathogenic microorganisms is considered to be blood, which is poured into the cells of the mastoid process due to trauma.
Possible causes of mastoiditis are virulence of pathogenic microorganisms, general weakness of the body and immunity in general in various chronic diseases (tuberculosis, diabetes mellitus, bronchitis, pyelonephritis, nepatitis, arthritis and others), with possible pathology of the nasopharynx (including pharyngitis, sinusitis, chronic rhinitis), in the presence of changes in the structure of the ear itself from-for such diseases as aeratitis, adhesive otitis media and ear injuries.
Symptoms of mastoiditis
As a rule, mastoiditis appears in parallel with the purulent otitis media that has arisen. However, more often it develops only on the 7th day from the moment of the onset of otitis. If we talk about the development of the disease among newborn children, it manifests itself in the form of otoantritis. The latter is explained by the structural features of the mastoid process. Mastoiditis in adults is accompanied by a deterioration of the general condition, a rise in temperature to febrile figures, as well as headache, intoxication and sleep disturbance.
As a rule, patients diagnosed with mastoiditis complain of painful sensations and tinnitus. They often have hearing problems. It happens that they experience intense pain in the area behind the ear. There may also be a feeling of pulsation in the plane of the mastoid process. Usually, the pain spreads along the trigeminal nerves, reaching the temporal and parietal areas, as well as the upper part of the jaw. There are cases when the pain is felt throughout the head.
All of the above symptoms of mastoiditis, as a rule, are accompanied by copious discharge of pus from the external auditory canal. The amount of pus secreted is usually greater than the tympanic cavity itself. The latter indicates the spread of purulent processes already beyond the middle ear. However, there are cases when there is no suppuration or it is insignificant. This can happen even with an intact eardrum. This becomes possible in the case of closure of the perforating hole in the eardrum, as well as in case of violation of the outflow of pus from the mastoid process directly into the middle ear.
Other symptoms of mastoiditis: redness, swelling of the ear region, smoothed skin fold in the area behind the ear, possible protrusion of the auricles. In the case of a breakthrough of pus into the subcutaneous part of the adipose tissue, a subperiosteal abscess is formed, which is accompanied by painful sensations, especially during probing the area behind the ear. There may also be symptoms of fluctuation. Pus can also spread from the mastoid process to the occipital and even parietal (or temporal) parts. The characteristic thrombosis of the vessels, which also supply blood to the cortical layer of the mastoid bone, can lead to the onset of periosteal necrosis with a further breakthrough of pus on the skin surface of the head. The latter leads to the formation of an external fistula.
Diagnosis of mastoiditis
Diagnosis of mastoiditis is a simple matter for otolaryngologists. Difficulties arise only if doctors are faced with a low-symptomatic form of an atypical type of mastoiditis. The entire diagnosis of this disease is based on the presence of specific complaints specific to mastoiditis, as well as anamnestic information about the injury (or inflammation) of the middle ear, which took place in the patient. The examination data, the palpation of the behind—the-ear part, the results of microctoscopy and otoscopy, as well as audiometry and the taking of a backposev from the middle ear are all parts of one diagnosis. In addition, computed tomography and X-rays are important in the diagnosis of mastoiditis.
It is with the help of otoscopy that it is possible to identify typical inflammatory processes localized in the middle ear. Usually such processes develop on the side of the eardrum. If there is also a hole in the eardrum, then pus flows out from there. As is known, the pathognomonic otoscopic sign of this disease will be the overhang of the posterior wall of the auditory canal. With the help of audiometry and a tuning fork, it is possible to determine what the patient’s degree of hearing loss is together with mastoiditis.
Complications of mastoiditis
Purulent inflammation usually spreads in the very center of the mastoid process. This happens in cells covered by pneumatized mastoidite. The latter explains the variety of complications that appear, as well as the dependence of the structure of the mastoid process itself. Usually, inflammation of the cells of the perisinuous group causes further damage to the sigmoid sinus and the development of thrombophlebitis or phlebitis. Purulent processes in the peripheral cells are accompanied by neuritis of the facial nerve, whereas the same processes in the perilabirint cells may have the development of a purulent labyrinth. The main complication of the apical type of mastoiditis is the leakage of pus into the area of the interfascial spaces of the neck, which results in the penetration of purulent microorganisms into the mediastinum. The latter, in turn, causes purulent mediastinitis. If this process is not stopped, it will spread into the cranial cavity, which will lead to intracranial complications of mastoiditis, including brain abscess, meningitis, encephalitis and more. If the pyramid of the temporal bone is touched, petrositis may develop. A dangerous complication of purulent inflammation can be the spread of infection into the eyeball with the further appearance of panophthalmitis, endophthalmitis and phlegmon of the eye socket. As a rule, in children, the occurrence of a pharyngeal abscess is a frequent complication. Another possible complication may be the hematogenous spread of infection with developing sepsis.
Treatment of mastoiditis
Treatment of mastoiditis depends, first of all, on its etymology, on the stage of the developing inflammatory process and on the presence of complications. If the doctor prescribes drug therapy, then this involves taking antibiotics of the widest spectrum of action, including ceftibutene, ceflakor, cefixime, cefotaxime, amoxicillin and others. In addition, anti-inflammatory, antihistamines, immunocorrecting and detoxifying drugs can be prescribed.
In the case of mastoiditis of an otogenic nature, a sanitizing operation on the middle ear is prescribed. According to the indications, this will be a general cavity operation. If there is no hole in the eardrum, which is necessary in order to ensure normal drainage, doctors prescribe a procedure for paracentesis. In this case, the middle ear is washed through the opening of the eardrum using special medications. It is also possible to use a conservative type of mastoiditis treatment. If mastoiditis has reached a proliferative-alternative stage, then a mandatory opening of the mastoid process is required, which is only possible surgically. The latter is necessary to eliminate pus, as well as postoperative drainage.
Prevention of mastoiditis
If the symptoms and treatment of mastoiditis are clear, then it is necessary to say about the prevention of this disease. Prevention, as a rule, is based on the prevention of mastoiditis of the otogenic form, which is possible thanks to the timely diagnosis of inflammatory processes in the middle ear. Proper treatment of otitis media and timely paracentesis of the tympanic membrane are also part of the prevention of mastoiditis. Promptly eliminate the foci of infection and conduct correct therapy will help prevent possible mastoiditis in a timely manner. Great importance in prevention is also given to the quality of the working capacity of the immune mechanisms of the human body. The latter is achieved by leading a healthy lifestyle, observing the basics of proper nutrition.
