mastoiditis

Mastoiditis (empyema of the mastoid process) is a destructive osteoperiostitis of the cellular structure of the mastoid process.

ICD-10 code

• H 70.0-H 70.9 Mastoiditis and related conditions.
  • H 70.0 Acute mastoiditis.
  • H 70.1 Chronic mastoiditis,
  • H 70.2 Petrosite.
  • H 70.8 Other mastoiditis and related conditions.
  • H 70.9 Mastoiditis, unspecified.

Epidemiology of mastoiditis

Mastoiditis mainly develops against the background of acute purulent otitis media, much less often - during an exacerbation of chronic purulent otitis media.

Screening

Due to the clearly expressed characteristic inflammatory changes in the parotid region in mastoiditis, its diagnosis does not cause difficulties at any stage of medical care, even in the absence of X-ray data.

Mastoiditis classification

A distinction is made between primary mastoiditis, in which the process in the mastoid process develops without previous otitis media, and secondary mastoiditis as a complication of otitis media.

Causes of Mastoiditis

In secondary mastoiditis, the infection penetrates the cellular structure of the mastoid process mainly through the otogenic route in acute or chronic otitis media. In primary mastoiditis, direct traumatic damage to the cellular structure of the mastoid process is significant due to blows, bruises, gunshot wounds, blast waves, fractures and cracks in the bones of the skull, including fractures of the base of the skull; hematogenous metastatic spread of pathogenic infection is possible in septicopyemia, the transition of the purulent process from the lymph nodes of the mastoid process to bone tissue; isolated damage to the mastoid process in specific infections (tuberculosis, infectious granulomas). The microflora in mastoiditis is quite diverse, but coccal flora predominates.

Mastoiditis - Causes and pathogenesis

Symptoms of Mastoiditis

Mastoiditis is characterized by subjective and objective symptoms. Subjective symptoms include spontaneous pain associated with the involvement of the periosteum behind the auricle in the mastoid process area in the inflammatory process, radiating to the parietal, occipital region, orbit, alveolar process of the upper jaw; much less often, the pain spreads to the entire half of the head. A characteristic sensation of pulsation in the mastoid process, synchronous with the pulse, is typical. Objective symptoms include acute onset with fever, deterioration of the general condition, intoxication, and headache. Prominence of the auricle, swelling and redness of the skin in the retroauricular region, and smoothing of the retroauricular skin fold along the line of attachment of the auricle are pronounced. Fluctuation and sharp pain on palpation are noted during the formation of a subperiosteal abscess. As a result of the involvement of the periosteum in the inflammatory process, pain radiates along the branches of the trigeminal nerve to the area of the temple, crown, back of the head, teeth, and eye socket.

Mastoiditis - Symptoms

Diagnosis of mastoiditis

Based on characteristic general and local otoscopic signs, palpation and percussion data of the mastoid process, radiography of the temporal bones in the Schuller projection; in doubtful cases, if differential diagnostics with damage to the mastoid process of another etiology is necessary, CT or MRI is performed. Changes in the hemogram, the results of a bacteriological study of discharge from the ear and from the cavity of the subperiosteal abscess for microflora and sensitivity to antibiotics are of certain importance in diagnostics.

The anamnesis reveals previous ear diseases, treatment, frequency of exacerbation of otitis in its recurrent or chronic course, circumstances and causes of the development of this disease, the degree of severity of the general condition disorder, temperature reaction, the volume of previously provided emergency medical care.

Mastoiditis - Diagnosis

Treatment of mastoiditis

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 cephalosporins of the II-III generation (cefaclor, cefixime, ceftibuten, cefuroxime, ceftriaxone, cefotaxime, etc.).

Mastoiditis - Treatment

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