Mastoiditis: treatment
Last reviewed: 23.04.2024
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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, which developed against a background of exacerbation of chronic purulent otitis media, according to absolute indications, a sanitizing operation is performed on the middle ear.
Mastoiditis, developed against a background of acute otitis media, is treated conservatively or surgically. At the first exudative uncomplicated stage in the first days of the disease conservative treatment is carried out, first of all the paracentesis of the tympanic membrane and oral antibiotic therapy. When empirically determining the nature and extent of antibacterial therapy, use of amoxicillin + clavulanic acid (beta-lactamase inhibitor) or cephalosporin II-III generation (cefaclor, cefixime, ceftibutene, cefuroxime, ceftriaxone, cefotaxime, etc.) is considered advisable. This combination of antibiotics is evaluated as universal for suppressing the most likely pathogens of acute otitis media, complicated by mastoiditis. The subsequent correction of antibacterial therapy is carried out taking into account the results of bacteriological examination of the eardrum obtained from paracentesis.
In the destructive stage of the development of the inflammatory process in the mastoid process, and especially in its complicated forms, urgent surgical intervention is indicated-anthro- mastoidotomy with the appointment in the postoperative period of fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxanin) and cephalosporins parenterally.
In children under 10 years, the appointment of fluoroquinolones is contraindicated in connection with the possibility of a destructive effect on the bone system: they are mainly administered parenteral therapy with cephalosporins. In the postoperative period, use detoxic intravenous therapy, immune preparations, with appropriate indications - modern antifungal agents.
Objectives of treatment of mastoiditis
Localization of the inflammatory process, suspension of its spread through the system of air cavities of the middle ear and beyond the temporal bone, softening of subjective and objective symptoms; prevention of the development of persistent hearing impairment and the formation of a purulent focus as a cause of the subsequent recurrent course.
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
With conservative management of the initial forms of mastoiditis that develops against the background of acute otitis media, physiotherapy (UHF, SHF, etc.) is recommended on the uncomplicated exudative stage of the treatment complex. It is recommended that warming or cold compresses be applied to the BTE area.
Medication
Antibacterial therapy begins 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. With thrombophlebitis of the sigmoid sinus, which complicated the course of Chitel's form of mastoiditis, anticoagulants are necessarily included in the complex of treatment. From direct anticoagulants use heparin sodium, from indirect - acenocumarol, fenindion and others, necessarily under the control of thrombolysis with simultaneous local use of drugs: lyoton-1000, heparin or troxevasin ointment.
Surgery
In mastoiditis, which complicated the course of chronic otitis media, urgent surgery is performed by a sanitizing operation in the middle ear: with mastoiditis, which developed with acute otitis media, anthromastoidotomy.
Further management
Observation of the patient at the place of residence, holding of medical measures to prevent relapse of the disease, general restorative therapy, correction of immunological disorders.
Forecast
With timely and rational treatment - conservative and surgical - in the vast majority of cases the prognosis is favorable. With late diagnosis and unfavorable course of the disease, it is possible to develop severe intracranial complications, paresis of the facial nerve.
Prevention of mastoiditis
Prevention of mastoiditis is closely related to the prevention of acute otitis media, the need for skilled treatment of chronic otitis media, if necessary with timely, sanitizing, hearing-preserving operations in the middle ear. It is important to increase the body's resistance, timely sanation of the nasal cavity, nasopharynx and pharynx, care of the nasal cavity and mouth and treatment of inflammatory diseases that arise in them, early diagnosis of inflammatory diseases of the middle ear and the conduct of full-fledged rational anti-inflammatory therapy.
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