Mastoiditis - Treatment

Treatment of mastoiditis is carried out depending on the etiology of the disease, the stage of development of mastoiditis and the presence of various complications. In mastoiditis that has developed against the background of exacerbation of chronic purulent otitis media, according to absolute indications, a sanitizing operation on the middle ear is performed.

Mastoiditis that developed against the background of acute otitis media is treated conservatively or surgically. At the first exudative uncomplicated stage, conservative treatment is carried out in the first days of the disease, primarily paracentesis of the eardrum and oral antibiotic therapy. When empirically determining the nature and volume of antibacterial therapy, it is considered appropriate to use amoxicillin + clavulanic acid (a beta-lactamase inhibitor) or second- and third-generation cephalosporins (cefaclor, cefixime, ceftibuten, cefuroxime, ceftriaxone, cefotaxime, etc.). This combination of antibiotics is assessed as universal for suppressing the most likely pathogens of acute otitis media complicated by mastoiditis. Subsequent correction of antibacterial therapy is carried out taking into account the results of a bacteriological study of the discharge obtained during paracentesis of the eardrum.

In the destructive stage of development of the inflammatory process in the mastoid process and especially in its complicated forms, urgent surgical intervention is indicated - antromastoidectomy with the administration of fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) and parenteral cephalosporins in the postoperative period.

In children under 10 years of age, the use of fluoroquinolones is contraindicated due to the possibility of a destructive effect on the skeletal system: they are mainly given parenteral therapy with cephalosporins. In the postoperative period, detoxic intravenous therapy, immune drugs, and, if indicated, modern antifungal agents are used.

Goals of treatment for mastoiditis

Localization of the inflammatory process, stopping its spread through the system of air cavities of the middle ear and beyond the temporal bone, alleviation of subjective and objective symptoms; prevention of the development of persistent hearing impairment and the formation of a purulent focus as a cause of subsequent relapse.

Indications for hospitalization

All patients with mastoiditis, regardless of the etiology of the disease and the stage of the inflammatory process, must be hospitalized.

Non-drug treatment

In conservative management of initial forms of mastoiditis that developed against the background of acute otitis media, at its uncomplicated exudative stage, physiotherapy (UHF, microwave, etc.) is included in the complex of treatment. Warming or cold compresses on the area behind the ear are recommended.

Drug treatment

Antibacterial therapy is started immediately after confirmation of the diagnosis of mastoiditis at the initial stages of its development and is especially intensively carried out in the postoperative period along with active detoxification, hyposensitizing and immunocorrective treatment and local therapeutic measures. In case of thrombophlebitis of the sigmoid sinus, which complicated the course of the Chitelle form of mastoiditis, anticoagulants are necessarily included in the complex of the treatment. Of the direct anticoagulants, sodium heparin is used, of the indirect ones - acenocoumarol, phenindione and others, necessarily under the control of a thromboclastogram with simultaneous local use of the following drugs: lyoton-1000, heparin or troxevasin ointment.

Surgical treatment

In case of mastoiditis that has complicated the course of chronic otitis media, according to urgent indications, a sanitizing operation on the middle ear is performed: in case of mastoiditis that has developed during acute otitis media, antromastoidotomy.

Further management

Observation of the patient at the place of residence, implementation of treatment measures to prevent relapse of the disease, general strengthening therapy, correction of immunological disorders.

Forecast

With timely and rational treatment - conservative and surgical - in the overwhelming majority of cases the prognosis is favorable. With late diagnosis and unfavorable course of the disease, severe intracranial complications and facial nerve paresis may develop.

Prevention of mastoiditis

Prevention of mastoiditis is closely related to prevention of acute otitis media, the need for qualified treatment of chronic otitis media, if necessary, with timely sanitation operations on the middle ear that preserve hearing. It is important to increase the body's resistance, timely sanitation of the nasal cavity, nasopharynx and pharynx, care of the nasal cavity and mouth and treatment of inflammatory diseases arising in them, early diagnosis of inflammatory diseases of the middle ear and the implementation of full-fledged rational anti-inflammatory therapy.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]