Mastoiditis - Causes, symptoms and treatment. MF.

Mastoiditis is an inflammation of the mastoid process of the temporal bone. The joint-shaped process is the place of attachment of the muscles, which allow to make turns and inclinations of the head. Anatomically, it is located immediately behind the auricle and represents a bone outgrowth having inside the cavity connected with the cavity of the middle ear. Only a small bone plate this cavity is separated from the cavity of the skull. Inside the mastoid process there are thin bone bridges, located like honeycombs. The formation of these jumpers occurs gradually after birth by 5-6 years.

Causes of mastoiditis

The penetration of infection into the cavity of the mastoid process in the vast majority of cases occurs from the cavity of the middle ear. That is, mastoiditis is a complication of acute otitis media. Infiltration of infection from the outside is possible with a directly injured mastoid process, sepsis( infection of the blood) or suppuration of the lymph nodes located in close proximity to the mastoid process.

Symptoms of mastoiditis

Symptoms of mastoiditis depend on the prevalence of the process, the causative agent that caused the lesion, and the treatment performed.

The first stage, when there is only a process of inflammation in the mucosa of the mastoid process, is indistinguishable from acute otitis and develops in parallel with it. Symptoms predominate in earache, fever, headaches and the appearance of secretions from the external auditory canal with independent or artificial perforation of the tympanic membrane.

In the absence of proper treatment of otitis at this stage( most often this is the previous cessation of antibiotics and the lack of proper drainage of the middle ear cavity), after the improvement of the general condition, a rise appears again, and the pus becomes thicker. There is soreness and redness behind the ear in the region of the mastoid process. At this stage, a purulent secretion occurs in the cells inside the shoot. Pus destroys the thin bone bridges and fills the whole cavity( empyema of the mastoid process).

The second stage of mastoiditis

Symptoms of the next stage are already symptoms of complications. They depend on the site of the breakthrough pus of the wall of the mastoid process and spread it to neighboring organs and tissues.

The most favorable current at this stage is the penetration of pus under the outer shell of the bone( periosteum) and, after its rupture, under the skin. This option is favorable, of course, conditionally, in view of the minimal consequences in comparison with the rest. In this case, there is redness, an increase in the volume and pain in the area of ​​the appendix and under it, sometimes the appearance of a hole( fistula) and the release of pus through it.

A breakthrough of pus inside the middle and inner ear will lead to a labyrinthitis. The patient appears severe dizziness, persistent hearing loss, tinnitus, rhythmic twitching of eyeballs for no apparent reason( nystagmus).

In the immediate vicinity of the cavity of the middle ear and mastoid process passes the facial nerve. If the inflammation penetrates into this area, then its functions suffer. The patient or his associates note the asymmetry of the face, the lowering of the corner of the mouth and eye from the diseased side, the inability to close eyelids, the face becomes masklike.

The most formidable complication of mastoiditis is the breakdown of pus in the cranial cavity. This can lead to such conditions as the development of cerebral abscess, inflammation of the meninges and brain substance( meningitis and meningoencephalitis), as well as thrombosis of the sigmoid sinus.

Sigmoid sinus is a special vessel that drains blood from the brain. Unlike the vein, its walls are more dense, do not have valves and never fall off. Penetration of infection in it leads to inflammation of its walls and the formation of blood clots on them, which leads to fatal consequences in the form of sepsis, blockage of blood vessels and disruption of blood circulation of the brain.

Diagnosis of mastoiditis

In order to suspect and confirm the diagnosis of mastoiditis, consultation of a physician or an otorhinolaryngologist( ENT - doctor) is necessary. After examination and questioning the patient, the patient will receive directions for a general blood test and a radiology study.

A general blood test will have a picture of an inflammatory reaction, such as an increase in ESR and leukocytes.

X-ray examination( computed tomography or roentgenography of the mastoid process) will reveal signs of inflammatory changes inside the mastoid process, the area of ​​bone melt and the localization of pus penetration, if any. In case of suspicion of complications of mastoiditis, a decision on further follow-up is taken individually.

Treatment of mastoiditis

After confirmation of the diagnosis, depending on the stage of the process, treatment is prescribed. It is worth noting that in this situation preference is given to a stationary mode. Mandatoryly, massive antibiotic therapy is prescribed, most often intravenously, creating an adequate outflow of contents from the area of ​​inflammation through the external auditory canal. If the process is caught at an early stage, then conservative treatment is possible under the constant supervision of a physician.

If the conservative treatment is ineffective for 1-2 days and immediately after the development of complications, an operation is performed. It consists in the opening of the bone wall of the mastoid process outside( behind the ear) and mechanical( with the help of tools) and chemical( with the help of medicines) removal of affected tissues and installation of a drainage system. The latter allows not only timely remove the newly formed inflammatory effusion, but also conduct local treatment. Anti-inflammatory drugs are injected through the drainage tubes into the appendix cavity.

Self-treatment, failure to follow a doctor's recommendation and lack of follow-up of treatment can lead to a blurred picture of the process, the transition of mastoiditis to a chronic stage, which greatly complicates the diagnosis and treatment.

Prevention of mastoiditis

It should be noted that mastoiditis is most often diagnosed in children, the elderly, patients with diabetes, HIV infection. In children, the mastoid process is not yet filled with bridges and represents a single cavity( antrum), which is easily enveloped by inflammation during otitis media. In addition, the imperfection of immunity and frequent catarrhal diseases increase the probability of penetration of the infection in the middle ear.

Elderly people and people with diabetes often have an erased picture of the disease, reduced sensitivity, lack of first symptoms or underestimation against the background of age-related immunity decline can lead to complications. Often with age, elderly patients regularly take painkillers, suffer from hearing loss, making it difficult for primary diagnosis.

Thus, the following measures can be called prevention of mastoiditis:
- timely and complete treatment of otitis, with the exact implementation of the recommendations of the treating doctor.
- observation from one specialist constantly allows you to evaluate the treatment over time and in time to notice the onset of complications of
- the use of antibiotic therapy by a doctor recommended medications and recommended by a doctor course.

Mastoiditis is a rather dangerous disease. But in our time, when medical help and antibacterial drugs are so available, it does not occur very often. And it's very easy to avoid if you follow the doctor's instructions exactly. Take care of yourself.

Therapist physician Moskvina AM