Often when otitis is started, complications occur - ear mastoiditis, usually accompanied by fever and suppuration. Often the disease of mastoiditis causes a strong noise in the ears, in neglected form the ailment is fraught with a partial loss of hearing. After a complete examination, depending on how strongly the symptoms of the disease are expressed, an operation is prescribed for the treatment of mastoiditis or a conservative way of getting rid of this complication is chosen.
Complication of otitis mastoiditis of the ear: clinic of the disease
Mastoiditis of the ear is the most frequent complication of acute otitis media. Common symptoms are worsening of the general condition, an increase in body temperature, a change in the composition of the blood. They do not differ significantly from the manifestations of acute purulent otitis media. An analysis of the dynamics of these signs is of diagnostic significance in case of suspected involvement in the inflammatory process of the mastoid process. Often there are 1-2 weeks from the onset of acute otitis media, and against the background of the improvement in the clinical picture, the general well-being of the patient worsens again, the temperature rises, pain and suppuration from the ear renew. Sometimes, suppuration due to disturbed outflow of pus from the middle ear is absent. In some cases, the clinic of mastoiditis is fixed not after, but together with acute middle otitis media. The rise in temperature can be insignificant, but even the subfebrile temperature attracts attention after its normalization, which occurred as a result of perforation of the tympanic membrane with acute otitis media. The peripheral blood reveals a mild leukocytosis, a shift in the leukocyte formula to the left, a gradual increase in ESR.
Otitis-induced mastoiditis leads to a worsening of the general condition of the patient and a decrease in appetite. The pain is often localized in the ear and in the region of the mastoid process, in some patients it covers half the head on the side of the lesion and intensifies at night. An important sign of mastoiditis is soreness in palpation and percussion of the mastoid process, more often in the region of the apex or in the area of the mastoid process. There are also complaints about noise in the ear or in the head on the side of the patient's ear and pronounced hearing loss.
Purulent inflammation of the mastoiditis of the ear: stages of the disease
Mastoiditis of the temporal bone is caused by a purulent inflammation of the mucous membrane and bone tissue of the mastoid process. The causative agents of purulent mastoiditis are the same microorganisms that contribute to the development of acute purulent otitis media.
Changes in the mastoid process in this disease depend on the stage of the disease. At the first exudative stage, the mucosa and the periosteum of the cells of the mastoid process are involved in the process, the cells are filled with exudate, the mucosa is inflamed and sharply thickened. In the second stage, proliferative-alternative changes predominate, extending to the bony structures of the mastoid process, which is an alterative, or destructive, stage. In inflammation of mastoiditis, bones are destroyed by osteoclasts, granulations are formed. Bony bridges between cells are necrotic. The cells merge, forming one common cavity filled with pus, - an empyema of the mastoid process is formed. The process of bone destruction can affect the dura mater of the middle or posterior cranial fossa and cause various intracranial complications. When one of the walls of the mastoid process is destroyed, pus can break through to its surface and form a subperiosteal abscess in the zygomatic process or in the scales of the temporal bone, into the stony part of the temporal bone pyramid, through the apex of the procession into the interfascial spaces of the neck. Sometimes there are several ways outflow of pus. Most often, the disease develops in patients with a pneumatic type of mastoid process, a number of factors contribute to its development: high virulence of the causative agent of the infection, reduction of resistance of the organism( for example, in diabetes, nephritis, other chronic diseases), obstruction of outflow from the antrum and the tympanic cavity. One of the causes of mastoiditis is the irrational treatment of acute otitis media.
Pathological anatomy .Sometimes there is hyperemia and infiltration of the skin of the mastoid process due to periostitis. Look at the photo: with mastoiditis of the ear, there may appear a flattening of the bovine fold and protrusion of the auricle anteriorly. When otoscopy draw attention to suppuration from the ear. It is often profuse, pulsating. Creamy pus fills the external ear canal right after cleaning the ear. Often the abundant secretion of pus through the posterior wall of the external auditory canal attaches to the usual suppuration through perforation in the tympanic membrane. It happens that there is no otorrhoea, which is a sign of a violation of the outflow of pus when the defect of the tympanic membrane is closed or when the cave entrance block is closed. An important otoscopic sign of the disease is the overhang of the posterior-upper wall of the external auditory canal in its bone marrow. This is due to the development of periostitis and pressure of pathological contents in the area of the anterior wall and the entrance to the cave. In the same place often there is a fistula, through which pus penetrates into the external auditory canal.
The tympanic membrane of the disease is often hyperemic, infiltrated.
How to treat the mastoiditis of the ear
Before you treat the mastoiditis of the ear, you need to undergo a complete examination. Only after this, conservative or surgical treatment is prescribed in an ENT hospital. Conservative treatment, as a rule, is successful in the exudative stage of mastoiditis, when bone destruction( alteration) has not yet occurred and the outflow of exudate has not been disturbed. Antibiotic therapy is indicated, preference is given to p-dactam antibiotics. It is necessary to ensure free outflow of pus from the middle ear and local application of antibacterial drugs taking into account the sensitivity of flora from the ear. If the main symptoms did not decrease significantly during the day after the onset of conservative treatment( body temperature, pain in palpation of the behind-the-ear area, reactive phenomena in the ear region, etc.), surgical treatment is required. Partial improvement of the condition allows prolonging conservative treatment with its specific optimization. But when the main symptoms remain after the second day of treatment, the operation is shown in urgent terms. If at the primary examination the signs of the second stage of the ear disease of mastoiditis are found, urgent surgical treatment is required.
Absolute indications for urgent surgical treatment are the appearance of signs of intracranial complications, the appearance of complications in the areas bordering with the middle ear( subperiosteal abscess, pus penetration in the apex of the mastoid process, development of zygomatzite, squamite, petrosite).Also, surgery is necessary when the patient has signs of otogenic paresis or paralysis of the facial nerve, a labyrinth has developed. An anthromastoidotomy is performed - an antrum opening and trephination of the mastoid process. The pathological tissues are completely removed, so sometimes the operation ends with the removal of the whole process together with its apex - mastoidectomy. In children under three years old the mastoid process is not developed, therefore the operation is called anthrotomy. It eliminates purulent-destructive process in the mastoid process with simultaneous drainage of the tympanic cavity. With a favorable course of the postoperative period, healing of the wound and complete cure comes, as a rule, by the 20th day.