Mastoiditis

Mastoiditis (empyema of the mastoid process) is a destructive osteo-periostitis 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 Petrosit.
  • H 70.8 Other mastoiditis and related conditions.
  • H 70.9 Mastoiditis, unspecified.

Epidemiology of mastoiditis

Mastoiditis predominantly develops against the background of acute purulent otitis media, much less often - with exacerbation of chronic purulent otitis media.

Screening

Due to the pronounced characteristic inflammatory changes in the behind-field area with mastoiditis, its diagnosis does not cause difficulties at any stage of medical care, even in the absence of X-ray diffraction data.

Classification of mastoiditis

Distinguish primary mastoiditis, in which the process in the mastoid process develops without a prior otitis media, and secondary as a complication of otitis media.

Causes of mastoiditis

In secondary mastoiditis, the infection in the cellular structure of the mastoid process predominantly occurs in the otogenic manner with acute or chronic otitis media. In the case of primary mastoiditis, a direct traumatic lesion of the cellular structure of the mastoid process occurs in the case of bumps, bruises, gunshot wounds, exposure to the blast wave, fractures and fissures of the skull bones, including fractures of the skull base, hematogenous metastatic pathogenesis of septicopyemia, from the lymph nodes of the region of the mastoid process to the bone tissue; isolated lesion of the mastoid process in specific infections (tuberculosis, infectious granulomas). The microflora with mastoiditis is quite diverse, but the coccal flora prevails.

Mastoiditis - Causes and pathogenesis

Symptoms of mastoiditis

In mastoiditis, there are subjective and objective symptoms. Subjective symptoms include spontaneous pain associated with involvement in the inflammatory process of the periosteum behind the auricle in the region of the mastoid process with irradiation to the parietal, occipital region, orbit, the alveolar process of the upper jaw, and the pain extends over the entire half of the head. A sensation of pulsation in the mastoid process, synchronous with the pulse, is characteristic. Objective signs are acute onset with fever, deterioration in general condition, intoxication, headache. Expressed a protrusion of the auricle, swelling and reddening of the skin of the behind-the-ear area, smoothening of the bovine skin fold along the attachment line of the auricle. When forming a subperiosteal abscess, fluctuation is noted, sharp painfulness upon palpation. As a result of involvement in the inflammatory process of the periosteum, the pain irradiates along the branches of the trigeminal nerve into the region of the temple, crown, occiput, teeth, orbit.

Mastoiditis - Symptoms

Diagnosis of mastoiditis

It is based on the characteristic general and local otoscopic signs, given palpation and percussion of the mastoid process, radiography of temporal bones in the Schuiller projection; in doubtful cases, if necessary differential diagnosis with lesion of the mastoid process of another etiology, CT or MRI is performed. The changes in the hemogram, the results of bacteriological examination of the discharge from the ear and the cavity of the subperiosteal abscess on the microflora and the sensitivity to antibiotics have a certain significance in the diagnosis.

In an anamnesis, the ear is diagnosed. Treatment, the frequency of exacerbation of otitis in recurrent or chronic course, the circumstances and causes of the development of the disease, the severity of the general disorder, the temperature response, the volume of previous 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, 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.

Mastoiditis - Treatment

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