Symptoms of inflammation of the mastoid process. Symptoms and treatment of chronic, right- and left-sided mastoiditis. The structure of the temporal bone and the causes of mastoiditis

Mastoiditis is called infectious inflammation located on temporal bone mastoid process. Most often, this disease is complicated by the acute form of otitis media. As it develops, the temperature rises, intoxication of the body occurs, throbbing pain and swelling in the area of the mastoid process appear, the ear hurts, and hearing deteriorates.

Structure of the mastoid process

Behind auricle In humans, the mastoid process is located in the form of a protrusion on the temporal bone of our skull.

Its internal structure consists of communicating cells separated by thin partitions. The structure of this growth has some differences in different individuals.

It can be represented by large air-filled cells or small ones that have inside Bone marrow. It also happens that there are practically no voids.

The course of mastoiditis directly depends on the structure of this process.

People who have large cells with air inside are most at risk of developing the disease.

In most cases, the disease develops after infection enters the mastoid process from tympanic cavity.

This is possible with acute course otitis media or purulent chronic inflammation middle ear.

Causes, symptoms, complications

The causative agents of the disease are usually:

staphylococci;
pneumococci;
influenza stick;
streptococci.

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Sometimes mastoiditis occurs, which develops due to infection due to tuberculosis, secondary syphilis, and sepsis.

The root cause of the disease can be skull injuries, gunshot wounds, traumatic injuries due to impact.

In such situations, the blood that gets into the cells of the appendix becomes a favorable development environment for microorganisms.

Promotes the appearance of mastoiditis:

increased ability to become infected by pathogenic microorganisms;
pathologies of the nasopharynx (pharyngitis, laryngotracheitis,);
structural changes in the ear due to past diseases (otitis and trauma);
chronic disease that weakens the immune system ( diabetes, hepatitis, bronchitis, pyelonephritis, tuberculosis, rheumatoid arthritis).

Mastoiditis can develop in parallel with purulent otitis, although more often it appears a week or two after its onset.

In infants, due to the peculiarity of the mastoid process, the disease manifests itself as otoanthritis.

Adults with illness complain of:

hearing impairment;
pain in the ear and behind it (the reasons are written about);
pulsation felt behind the ear.

The pain radiates through trigeminal nerve and is felt in the temple and crown, upper jaw. Much less often it spreads to the entire half of the head.

In parallel, the above symptoms are accompanied by copious discharge pus from the ear.

Moreover, its quantity significantly exceeds the capacity of the tympanic cavity, so it is clearly visible that the purulent process has spread beyond the boundaries of the middle ear.

There are cases when there is no outflow of pus at all or it is very insignificant. Such situations are possible with an intact eardrum.

Also, with mastoiditis, swelling of the area behind the ear is noticeable (read about the reasons for the appearance of scrofula behind the ears), thin skin fold, existing there, is smoothed out, the auricle is removed from the skull at some distance.

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When pus breaks into the fatty tissue under the skin, an abscess forms. Its presence is accompanied by a feeling of sharp pain when pressing on the area behind the ear.

Having accumulated behind the ear, pus can spread through the tissues to the temple, crown and back of the head. The spread of the process causes complications of the disease:

Encephalitis;
Brain abscess;
Meningitis.

In addition, damage to the temple bone can cause the development of petrositis.

When purulent inflammation reaches the zygomatic process, there is a danger of infection getting inside eyeball. In young children, mastoiditis causes a retropharyngeal abscess.

There is always a danger of hematogenous spread of microorganisms, fraught with the development of sepsis.

Treatment methods

The treatment tactics for mastoiditis depend entirely on the presence of complications, the stage of inflammation and the etiology of the disease.

Otogenic mastoiditis requires a cleansing procedure performed in the middle ear; sometimes a general cavity operation is necessary.

When sealing eardrum carry out paracentesis- rinsing the middle ear with medications. When the exudative stage of the disease is observed, it is treated conservatively.

The acute course of the disease requires hospital treatment. The chronic form of mastoiditis is treated at home with antibiotics.

When the disease has subsided, you can begin to restore the immune system by rationalizing nutrition, hardening, and consuming all kinds of strengthening decoctions of medicinal plants.

Disease prevention

Prevention of mastoiditis is real when timely diagnosis otitis media, performing adequate treatment. Preventive actions also include:

Brief list of medicines

Drug therapy is performed with the following antibiotics:

Cefaclor or Ceftibuten;
Cefuroxime or Cefotaxime;
Ciprofloxacin or Cefixime;
Amoxicillin or Ceftriaxone.

Additionally, antihistamines that correct immunity, relieve intoxication and inflammation are prescribed.

Conclusion

It is important not to forget that mastoiditis is a fairly serious complication. purulent otitis, therefore it is important to promptly treat inflammatory processes in order to prevent the development of such dangerous disease.

You will learn what an otogenic brain abscess is by watching the video.

Mastoiditis is inflammation, followed by purulent melting of the mastoid area in the area of the temporal bone.

The mastoid process is a special zone in the area of the skull bones, connected to the cavity of the middle ear and acting as an air duct and resonator. Therefore, mastoiditis is usually a complication of otitis media, and is rarely an independent pathology.

Total information

The mastoid process is the site of attachment of the muscles that turn the head laterally. It is located behind the auricle, slightly downwards and sticks out slightly if you feel it. Inside, the mastoid process is filled with bony partitions in the form of a honeycomb, but it acquires this structure as the body grows, by about six years.

It is at this age that typical manifestations of destructive processes in the periosteum and bone tissue process. The mastoid process is separated from the cranial cavity by a thin bone plate, which makes inflammatory process extremely dangerous in his zone.

Kinds

The occurrence of infection varies:

primary mastoiditis, with initial entry of the inflammatory agent into the mastoid cavity,
secondary mastoiditis, which occurs as a complication of inflammatory processes in the body.

Secondary mastoiditis can occur:

as a result of otitis media, it is called otogenic,
as a result of head injuries,
as a focus during sepsis (septicopyemic focus).

Along the way, mastoiditis can be:

typical, with all the classic symptoms present,
atypical or latent, sluggish inflammatory process without pronounced symptoms.

Causes

With mastoiditis, the infection is mainly microbial, penetrating from the middle ear. Most often this is pneumococcal flora, staphylococcal or hemophilic. Fungal (otomycosis) is less common.

There may also be:

traumatic mastoiditis (from blows, bruises, wounds),
transmission of infection with a number of lying lymph nodes,
tuberculous lesion,
granulomas in the area of the process.

Development mechanism

During the first stage of the process - exudative - inflammation of the mucous membrane and periosteum occurs, filling the cavity with pus. As we move into the second stage - alterative, the bone partitions are destroyed, the cavity is filled with granulations and growths connective tissue, a single purulent cavity is formed. In a complicated course, the pus melts the back plate and breaks into the area of the meninges.

Manifestations of mastoiditis

Mastoiditis occurs in stages; there are two stages of the disease:

exudative,
alternative (destructive).

At the exudation stage, an inflammatory process forms in the area of the appendix, and usually does not differ much from the manifestations of acute otitis media. More often, processes develop in parallel. arise

sharp pain in the ear,
headache, especially when moving the head,
severe fever with a temperature of up to 40 degrees,
discharge from the ear that occurs spontaneously or after medical perforation of the membrane.

If there is no adequate treatment for this stage of otitis and mastoiditis, antibiotics are stopped too early and there is no outflow of pus, symptoms of deterioration appear:

there is a rise in temperature again,
the pus from the ear becomes very thick,
sharp pain appears in the ear area, especially behind the auricle,
redness appears behind the ear,
inside the appendage at this time, pus destroys the partitions and accumulates.

The second stage of mastoiditis is characterized by the breakthrough of pus into any cavities:

pus penetrates under the periosteum, under the skin and breaks out. In this case, redness forms, an increase in the volume of the purulent cavity and the fistulous tract opens outward with the flow of pus
pus may burst into the area inner ear. Labyrinthitis develops with dizziness, tinnitus and hearing loss, twitching of the eyeballs

Diagnostics

With typical symptoms of mastoiditis, the diagnosis is made based on clinical manifestations, but with an atypical course, diagnosis is difficult. Additional research:

general and biochemical analysis blood,
X-ray of the head and mastoid area, a picture with areas of melting and purulent cavity,
if necessary, MRI or CT is performed to clarify complications.

It is important to distinguish mastoiditis from a boil in the area back wall ear canal.

Treatment of mastoiditis

ENT doctors diagnose and treat mastoiditis. Hospitalization to the otolaryngology department is required. Conservative and surgical treatment.

For conservative treatment, the following is prescribed:

antibiotics intramuscularly or intravenously,
creating an outflow of pus from the ear (myringotomy or self-opening of the membrane),

If such treatment is not successful within 1-2 days, surgical treatment is prescribed. In this case the following is carried out:

opening of the bony septum in the area of the mastoid process behind the ear, while the affected tissue is removed with instruments or with the help of special medications.
a drainage tube is placed to drain the pus,
washing the purulent cavity,
introduction of anti-inflammatory drugs into the cavity.

Not timely treatment mastoiditis threatens with fatal complications, or in the most favorable cases - transition to chronic form with complex treatment.

Complications

The most serious complications of mastoiditis are lesions of the facial nerve:

facial asymmetry occurs
the corner of the mouth or eye moves downwards,
the face becomes like a mask,
the eyelid does not close well.

Second dangerous complication Mastoiditis becomes a breakthrough of pus into the cranial cavity with the formation of inflammation of the meninges or brain matter. In this case, there arise general symptoms infections:

fever with inflammatory changes in the blood,
sleep and appetite disturbances,
nausea and even vomiting,
refusal to eat due to ear pain.

Chronic mastoiditis is a purulent inflammation of the bone tissue of the mastoid process. The chronic form of the disease is characterized by a duration of more than 3 months. In turn, chronic mastoiditis is divided into:

Primary mastoiditis is an inflammatory process that initially forms in the cavity of the mastoid process. This occurs due to injuries, skull fractures, and tuberculosis.
Secondary mastoiditis is formed due to complications of chronic purulent otitis media.

It is in this area that mastoiditis develops, which without timely treatment becomes chronic.

Clinical picture the disease looks like this:

Pain in the ear, radiating to the occipital region, eye socket and upper jaw.
Characteristic protruding auricle.
Pulsation in the mastoid region.
Hearing impairment.
General malaise, weakness.
Suppuration from the ear.
Swelling in the area behind the ear.

When examined by a specialist, the following characteristic signs are noted:

Hyperemia of edematous tissues behind the ear.
Smoothness of the postauricular fold.
Pain on palpation.
Profuse suppuration - discharge of pus is synchronous with the pulse.
Perforation of the eardrum is noted.
Protrusion of the ear.
Hearing loss.

Diagnosis of chronic mastoiditis

It is not possible to diagnose this disease on your own at home. Diagnosis should be carried out by a qualified otolaryngologist. What activities does he carry out to establish an accurate diagnosis:

toskopiya;
radiography of the temporal bones;
MRI of the brain and temporal bones;
a smear of discharged fluid from the ear for sensitivity to antibiotics and microflora.

What diseases with similar symptoms should be separated from:

Diffuse otitis of the external ear.
Furuncle of the external auditory canal.
Purulent lymphadenitis of the parotid region.

Treatment

Taking antibiotics is mandatory.

Treatment of chronic mastoiditis is carried out in two ways:

Surgical – anthrotomy (surgical opening of the mastoid cave), mastoidotomy (trepanation of the mastoid process) is performed.
Medication – taking antibiotics, hyposensitizing and detoxification therapy.

Hospitalization in this case is mandatory. The patient is observed in a special otolaryngology department. Only a specialist doctor has the right to prescribe treatment after passing full examination and confirmation of an accurate diagnosis.

Which medications may be prescribed by a doctor:

Antibacterial agent – Tsiprolet, 500 mg orally. 2 times a day. The duration of treatment is 4-6 weeks.
Antimicrobial agent – Abaktal, taken intravenously as an infusion.
Detoxification agent – Reopoliglyukin, administered intravenously in a single dose.
Hyposensitizing agent – Pipolfen, taken intramuscularly, 25 mg. 1 per day.

Definition

Usually in otiatrics the term “mastoiditis” refers to purulent inflammation in the cells of the mastoid process. It has been established that when acute otitis media the inflammatory process often spreads to the mucous membrane that lines the cells of the mastoid process. In this case, the phenomena of mastoiditis can be insignificant and, of course, stop simultaneously with the elimination of acute otitis.

Therefore, many of the otiatrists use the definition of L.T. Levin and by mastoiditis they understand such a complication of acute purulent otitis, in which the affected bone structure mastoid process and often requires surgical intervention.

Causes

In the overwhelming majority, mastoiditis develops as a result of the transition of acute purulent inflammation tympanic cavity on the cells of the mastoid process. This is facilitated by the reduced resistance of the body and the pathogenicity of the flora that has penetrated into the mastoid process from the tympanic cavity. The pneumatic structure of the mamillary process is favorable for the development of the inflammatory process in it.

IN purulent discharge From the ear with mastoiditis, different microflora are found: streptococci, staphylococci, pneumococci, etc. Mucous streptococcus has a particularly virulent property. Exudate, having developed in the cells of the mastoid process, often does not have sufficient exit through the antrum and antrum-tympanic passage into the tympanic cavity due to swelling of the mucous membrane, which is also one of the factors that contributes to the development of mastoiditis.

Under unfavorable conditions for the outflow of exudate, the purulent-inflammatory process in the mastoid process progresses and leads to empyema of the mastoid process with further melting and necrosis of the bone, which requires active and urgent therapeutic measures.

Symptoms

With mastoiditis, patients experience poor sleep and appetite, general weakness, pain in the ear and in the surrounding area, which often affects the entire half of the head, radiating to the back of the head and other parts of the skull. There is congestion in the affected ear, noise and hearing loss. The patient experiences pulsation in the ear, synchronous with the pulse.

In most patients, hearing loss depends on impaired sound conduction. Conversational speech is perceived by the affected ear at a distance of 1-2 meters, whispered speech is perceived near the auricle or is not perceived at all.

When examining the area of the ear, pain, pastiness, swelling and redness of the integument of the mastoid process are detected. Sometimes a subperiosteal abscess with fluctuation appears in the postauricular area, as a result of which the auricle protrudes.

Otoscopic data are very characteristic: the upper-posterior wall of the bony part of the auditory canal is lowered, as a result of which the auditory canal in this part is narrowed. This sign, one of the most basic in mastoiditis, is a consequence of periostitis, resulting from the transition of the inflammatory process from the antrum.

To avoid mistakes, you should always compare both ear canals and both mastoid processes - the diseased and healthy ear.

On otoscopy, the eardrum is thickened and hyperemic. The perforation is of course central, suppuration may be insignificant; for profuse, sometimes it is not there at all.

When percussing the mastoid process, a dullness of sound is detected on it; often, when tapping on the mastoid processes, the patient himself notes a dullness of sound on the affected side.

The temperature often rises and reaches 38-40° in children, 37.5-38° in adults. Mastoiditis in adults is characterized by a moderate increase in temperature - up to 37.5°.

There may be changes in white blood: leukocytosis up to 10,000 - 14,000, neutrophilia with a slight shift leukocyte formula to the left. However, the picture of white blood does not always reflect the inflammatory process in the mastoid process.

Pathological changes in acute mastoiditis have the following features: the mucous membrane of the mastoid cells in initial stages mastoiditis swells, thickens, and is infiltrated with lymphocytes. Bone walls alveoli are destroyed as a result of the activity of multinucleated giant cells - osteoclasts. Cell destruction gradually spreads deeper into the bone canals and bone marrow cavities. Along with this, the bone venous vessels are thrombosed and the infection through them cannot spread to the large main venous vessels (up to the sinuses). The described changes occur within a week; this stage is called exudative. During the second week, the exudative stage turns into a proliferative one.

Pus, being under pressure in the mastoid process, gets its way out through the cortical layer of the mastoid process, forming a subperiosteal abscess, or penetrates into the cranial cavity, localizing between the hard meninges and temporal bone.

After the pus has broken out or in, the destructive activity of osteoclasts decreases and is replaced by the restorative activity of osteoblasts. However, completely normal mastoid structure is never restored. The purulent-inflammatory process can spread beyond the mastoid process.

Diagnostics

When the picture of the disease is atypical, radiography is used. The Schüller method is most often used, which allows one to observe the condition of the external and internal auditory canals, antrum and mastoid cells. In the initial stages of mastoiditis, radiographs reveal mild degree veiling of the pneumatic system and some blurring of cellular contours, depending on the accumulation of exudate. Further, the cellular contours disappear and instead of individual clearly defined alveoli, a homogeneous darkening of the mastoid process is noted. For comparison, it is necessary to take x-rays of both mastoid processes.

The prognosis of acute mastoiditis, when timely treatment is not carried out, is serious. Only occasionally does self-healing occur as a result of an abscess breaking through the bone into soft fabrics in the behind-the-ear area. Clinicians sometimes observe scarring behind the auricle as a result of the mastoid abscess opening outward. If there are indications, timely surgical intervention always gives good effect both to eliminate the purulent-inflammatory process and to restore auditory function.

Acute mastoiditis must be differentiated from acute external otitis, limited and diffuse, as well as from tumors of this area.

The classic, typical form of mastoiditis, which is accompanied by infiltration of the postauricular area or subperiosteal abscess, is observed mainly in children.

What is mastoiditis? The disease is rare, however, it is dangerous because it affects those organs that are close to the brain. With timely measures taken, the prognosis for recovery is positive, however, with the development purulent process negative consequences may occur.

Causes of the disease

Mastoiditis of the ear is a complication after otitis in acute form. From the eardrum, the infection spreads further along the mastoid process. Several factors may help the infection spread further, including:

Infection can penetrate to the appendix along with blood during sepsis or secondary syphilis. All this refers to the secondary manifestation of the disease, but mastoiditis can also be a primary disease; it can be triggered by damage to the cells in the appendix, this can occur due to the following factors:

A strong blow was received.
Gunshot wound.
Brain injuries.

In these cases, blood will get to the appendix, and this, as you know, is the best breeding ground for harmful bacteria.

How does the disease manifest itself?

The symptoms of mastoiditis are very specific and it is simply impossible not to notice their appearance, especially for adults. So, the signs of mastoiditis are as follows:

Body temperature rises.
The general condition is weakened, performance decreases.
Bilateral mastoiditis may be accompanied by loud noise in the head on both sides.
Right-sided or left-sided mastoiditis can lead to a unilateral decrease in hearing acuity.
Purulent discharge from the ear.

As for the first symptoms, they are the same as with otitis media. The temperature can rise very strongly, and can fluctuate between 37-38.

In addition to pain, soreness may be felt when pressing on the mastoid process. When pus accumulates, the ear may bulge.

Atypical forms of mastoiditis are associated with the following factors:

The patient is many years old.
The structure of the cellular structure of the temporal bone is special.
Acute otitis media was not completely cured, or there was no treatment at all.

This form of the disease is distinguished by the fact that the symptoms are not clearly expressed, the stages of inflammation are either there or not, suppuration is either minimal or completely absent. At the same time, the patient should know that this particular form of the disease contributes to severe bone destruction.

There are other forms of the disease: chronic mastoiditis (up to three months), acute mastoiditis (up to three weeks), Bezold's mastoiditis. In adults, the disease is not as severe as in children.

Diagnostics

Diagnosis of mastoiditis should be carried out by a doctor in medical institution. Based on the collected medical history and test results, the specialist will be able to make an accurate diagnosis. During the examination, you need to pay attention to the following:

Is the ear protruding?
There is swelling or redness.
When performing an otoscopy, check whether there is pus, what consistency it has, how filled the ear canal is.
Hyperemia.

Particular attention should be paid to the general blood test, or rather its results:

Leukocyte level.
Increase in ESR.

Purulent masses are taken from the lesion to carry out bacteriological research, the doctor will be able to identify the infection and determine how sensitive the drugs are to them. As a supplement, it is carried out instrumental study- X-ray of the temporal bones. The results should be compared with the results of a healthy ear.

An MRI image is taken, so you can see how full the temporal bone is. If acute mastoiditis develops, then pus fills all the cells, thereby completely destroying them. On the x-ray you can see that this area is cloudy.

Additionally, the patient is referred for examination to other specialists - a dentist, a surgeon, so more serious complications can be identified. Only a doctor can treat the disease.

Treatment of the disease

If you have mastoiditis, symptoms and treatment should be identified and prescribed by your healthcare provider. The thing is that the disease often causes complications that are life-threatening for the patient. Even the slightest suspicious symptoms should be a reason for you to urgently visit a doctor.

In the exudative stage of development of the disease, the bone is still broken, and the outflow of inflamed fluid continues; treatment of mastoiditis can be carried out in a hospital setting by an ENT specialist. Bilateral mastoiditis is more difficult to treat, but if therapy is started in a timely manner, then you can get rid of it.

The patient may be prescribed the following:

Antibiotics, they must be wide range actions.
Antibacterial drugs.
For mastoiditis, treatment may include drainage auditory tube, thus, the outflow of pus will be improved.

First of all, treatment of mastoiditis is aimed at improving the patient’s health, after which it will be possible to carry out conservative therapy. If after a day the patient does not feel better, the body temperature continues to remain high, pain on palpation persists, the second stage of the disease can be diagnosed, surgical treatment in this case it cannot be avoided.

There are absolute indications for the operation:

Abscess.
Squamite, Petrosit.
Pus breaks through the tip of the appendix.
Labyrinthitis.
The facial nerves are paralyzed.

The operation in which the mastoid process will be opened has its own name in medicine - anthromastoidotomy. If pathological process is in an advanced stage and covers the entire process, it will have to be removed.

The main goal of the operation is to get rid of pus, as well as drainage of the tympanic cavity. Before the procedure, the patient is given anesthesia. Rehabilitation period after treatment proceeds as follows:

The patient needs to take vitamins and antibiotics.
The wound is bandaged daily. When removing the bandage, the doctor will remove the turunda, dry everything well, and then rinse with an antiseptic. After completing the procedures, the turunda will be reinserted, and a clean bandage will be applied on top.
Local treatment is carried out using ultraviolet light.

With proper and timely treatment of the wound, it will heal completely after 20-25 days.

Traditional methods of treatment

Mastoiditis - we found out what it is. Many patients are interested in the question: “Is it possible to treat the disease? folk remedies?. Therapy in this case involves the use various means, thanks to which the pain will be reduced. You can wash your ears useful tinctures or infusions, such as those made from rose petals.

Can be used for throbbing pain steam inhalations, they have a warming effect. Under the influence of heat, the pain will not be as pronounced, and the process of rinsing the ear will be easier. In addition, you can instill a wormwood-milk solution, covering the top of the ear with a piece of cotton wool.

Warmth is the best remedy, which allows you to relieve or reduce pain. For the same purpose, it is recommended to place it over a bag of hot salt, or over a bottle in which hot water. And remember that any warming procedures can be carried out only after the doctor allows it. If carried out incorrectly, the cell with suppuration may burst, which will ultimately lead to dangerous consequences.

Prevention

After treatment, patients need to take medications to accelerate tissue regeneration, thus avoiding recurrence of the disease. It is at this stage that it is important to adhere to all the recommendations that the doctor gives you, and first of all this concerns wound treatment. Don’t forget about strengthening your immune system, take vitamins, eat well and properly.

In order to avoid the development of such a dangerous disease, you need to promptly seek help from the hospital if there are even the slightest warning symptoms. In addition, you must adhere to the following recommendations:

Protect your head from injury.
In case of suppuration, paracentesis must be performed; this cannot be postponed.
Treat any diseases of the nasopharynx or otitis media in a timely manner.

These seem to be simple rules, can protect you from developing such a dangerous disease as mastoiditis. Be sure to pass preventive examinations see an otolaryngologist several times a year. Play sports, lead an active lifestyle and then you will always be healthy.