mastoiditis

mastoiditis

Mastoiditis is a purulent inflammation of the mucous membrane of the cells and bone tissue of the mastoid process of the temporal bone. Atypical forms of mastoiditis include zygomatitis (zygomatitis), squamite, petrositis. Petrositis is characterized by the development of the Gradenigo triad: acute otitis media, trigeminitis, paresis or paralysis of the abducens nerve.

The reasons

• • High virulence of pathogens of otitis media
  • Decreased body resistance
  • Poor conditions for drainage of a purulent focus in the tympanic cavity in the absence of perforation
  • Irrational treatment of acute otitis media (late myringotomy, paracentesis). Classification of mastoiditis
  • Acute and chronic (recurrent)
  • Primary – an independent disease without previous acute inflammation of the middle ear (rarely encountered mastoiditis)
  • Secondary
  • Typical, developing against the background of acute purulent inflammation of the middle ear, incl. apical-cervical (bezoldovst)
  • Atypical, developing with acute inflammation of the middle ear, occurring without perforation of the eardrum. Pathogenesis. The process takes place in several stages
  • Inflammation of the mucous membrane and periosteum of the process cells – mucoid swelling of the mucous membrane, small cell infiltration and circulatory disorders, filling the cells with serous-purulent, purulent or bloody-purulent exudate
  • Osteitis – bone bridges between cells are involved in the process, which are further destroyed and melted
  • A cavity filled with pus is formed – the process empyema.

The clinical picture develops at the stage of resolution of acute otitis media (after 2-3 weeks from its onset)

• • Repeated rise in body temperature, throbbing headache
  • Pain and tenderness in the mastoid region
  • Sensation of pulsation in the ear
  • Hearing loss
  • Swelling and pastosity of the skin in the area of ​​the mastoid process
  • The smoothness of the behind-the-ear fold, protrusion of the auricle anteriorly.

Otoscopy. Overhang of the posterior upper wall of the external auditory canal in the bone section, increased suppuration (a symptom of the reservoir), the resumption of pulsation of pus, the tympanic membrane is congestive, copper-red in color.

Diagnostics

• • X-ray of the temporal bone in the projection according to Schüller
  • Skull CT.

Treatment

• • Conservative therapy – see Otitis
  • Surgical treatment – trepanation of the mastoid process (antrotomy, antromastoidotomy).

Prevention

• • Timely rehabilitation of the upper respiratory tract, especially the nasal and nasopharyngeal cavities
  • Adequate treatment of acute purulent otitis media
  • hardening.

See also Anthritis (nl), Acute suppurative otitis media ICD H70 Mastoiditis and related conditions Note. The Schuscher projection – a lateral survey projection – allows you to visualize the structure of the mastoid process well, clearly define the roof of the tympanic cavity and the anterior wall of the sigmoid sinus.