Mastoiditis is paid. Mastoidectomy: types, indications, surgical technique. Acute mastoiditis treatment

Inflammatory lesion of the mastoid process temporal bone infectious genesis. Most often, mastoiditis complicates the course of acute otitis media. Clinical manifestations mastoiditis include a rise in body temperature, intoxication, pain and pulsation in the mastoid region, swelling and hyperemia of the postauricular area, ear pain and hearing loss. An objective examination for mastoiditis consists of examination and palpation of the area behind the ear, otoscopy, audiometry, radiography and CT scan of the skull, and bacteriological culture of discharge from the ear. Treatment of mastoiditis can be medicinal and surgical. It is based on antibiotic therapy and rehabilitation of purulent foci in the tympanic cavity and mastoid process.

General information

The mastoid process is a protrusion of the temporal bone of the skull located behind auricle. The internal structure of the process is formed by communicating cells, which are separated from each other by thin bone partitions. U different people the mastoid process can have a different structure. In some cases it is represented by large air-filled cells (pneumatic structure), in other cases the cells are small and filled bone marrow(diploetic structure), thirdly, there are practically no cells (sclerotic structure). The course of mastoiditis depends on the type of structure of the mastoid process. Those with a pneumatic structure of the mastoid process are most prone to the appearance of mastoiditis.

The inner walls of the mastoid process separate it from the posterior and middle cranial fossae, and a special hole communicates it with the tympanic cavity. Most cases of mastoiditis occur as a consequence of the transfer of infection from the tympanic cavity to the mastoid process, which is observed in acute otitis media, in some cases in chronic purulent otitis media.

Causes of mastoiditis

Depending on the cause, otolaryngology distinguishes between otogenic, hematogenous and traumatic mastoiditis.

  1. Otogenic. Most often, secondary mastoiditis occurs, caused by the spread of infection into the mastoid process from the tympanic cavity of the middle ear. Its causative agents can be influenza bacillus, pneumococci, streptococci, staphylococci, etc. The transfer of infection from the middle ear cavity is facilitated by a violation of its drainage during late perforation eardrum, untimely paracentesis, too small a hole in the eardrum or its closure with granulation tissue.
  2. Hematogenous. In rare cases, mastoiditis is observed, which developed as a result of hematogenous penetration of infection during sepsis, secondary syphilis, tuberculosis.
  3. Traumatic. Primary mastoiditis occurs when traumatic injuries cells of the mastoid process due to impact, gunshot wound, traumatic brain injury. Favorable environment for development pathogenic microorganisms in such cases, it is blood that has poured into the cells of the appendix as a result of injury.

The appearance of mastoiditis is promoted by:

  • increased virulence of pathogenic microorganisms
  • weakened general condition chronic diseases(diabetes mellitus, tuberculosis, bronchitis, hepatitis, pyelonephritis, rheumatoid arthritis, etc.)
  • pathology of the nasopharynx (chronic rhinitis, pharyngitis, laryngotracheitis, sinusitis)
  • the presence of changes in the structures of the ear due to previous diseases (ear trauma, aerootitis, external otitis, adhesive otitis media).

Pathogenesis

The onset of mastoiditis is characterized by inflammatory changes in the mucous layer of the mastoid cells with the development of periostitis and the accumulation of fluid in the cavities of the cells. Due to the pronounced exudation, this stage of mastoiditis is called exudative. Inflammatory swelling of the mucous membrane leads to the closure of the holes connecting the cells with each other, as well as the hole connecting the mastoid process with the tympanic cavity. As a result of disruption of ventilation in the cells of the mastoid process, the air pressure in them drops. Along the pressure gradient, transudate from the dilated cells begins to flow into the cells. blood vessels. The cells are filled with serous and then serous-purulent exudate. The duration of the first stage of mastoiditis in adults is 7-10 days, in children it is often 4-6 days. Ultimately, in the exudative stage of mastoiditis, each cell has the appearance of an empyema - a cavity filled with pus.

Next, mastoiditis passes into the second stage - proliferative-alternative, in which purulent inflammation spreads to the bone walls and septa of the mastoid process with the development of osteomyelitis - purulent melting of the bone. At the same time, granulation tissue is formed. Gradually, the partitions between the cells are destroyed and one large cavity is formed, filled with pus and granulations. Thus, as a result of mastoiditis, empyema of the mastoid process occurs. The breakthrough of pus through the destroyed walls of the mastoid process leads to the spread of purulent inflammation to neighboring structures and the development of complications of mastoiditis.

Classification

There are two clinical forms of mastoiditis: typical and atypical. The atypical (latent) form is characterized by a slow and sluggish course without pronounced symptoms characteristic of mastoiditis. A separate group of apical mastoiditis is distinguished, which includes Bezold's mastoiditis, Orleans mastoiditis and Mouret's mastoiditis. By stage inflammatory process mastoiditis is classified as exudative and true (proliferative-alterative).

Symptoms of mastoiditis

Mastoiditis can appear simultaneously with the occurrence of purulent otitis media. But most often it develops 7-14 days from the onset of otitis media. In children of the first year of life, due to the structural features of the mastoid process, mastoiditis manifests itself in the form of otoanthritis. In adults, mastoiditis manifests itself as severe deterioration general condition with a rise in temperature to febrile levels, intoxication, headache, sleep disturbance. Patients with mastoiditis complain of noise and pain in the ear, hearing loss, intense pain behind the ear, and a feeling of pulsation in the mastoid area. Pain radiates through the branches trigeminal nerve into the temporal and parietal region, orbit, upper jaw. Less commonly, mastoiditis causes pain in the entire half of the head.

These symptoms of mastoiditis are usually accompanied by profuse suppuration from the external ear canal. Moreover, the amount of pus is noticeably greater than the volume of the tympanic cavity, which indicates the spread of the purulent process beyond the middle ear. On the other hand, suppuration with mastoiditis may not be observed or may be insignificant. This occurs while maintaining the integrity of the eardrum, closing the perforation in it, and disrupting the outflow of pus from the mastoid process into the middle ear.

Objectively, with mastoiditis, redness and swelling of the area behind the ear, smoothness of the skin fold located behind the ear, and protrusion of the auricle are noted. When pus breaks through into the subcutaneous fatty tissue a subperiosteal abscess forms, accompanied by severe pain when palpating the postauricular area and a symptom of fluctuation. From the area of ​​the mastoid process pus, stratifying soft fabrics head, can spread to the occipital, parietal, and temporal regions. Thrombosis of the vessels supplying the cortical layer of the mastoid bone, which occurs as a result of inflammation, leads to necrosis of the periosteum with the breakthrough of pus to the surface of the scalp and the formation of an external fistula.

Complications

The spread of purulent inflammation in the mastoid process itself occurs along the most pneumatized cells, which determines the variety of complications that arise with mastoiditis and their dependence on the structure of the mastoid process. Inflammation of the perisinous group of cells leads to damage to the sigmoid sinus with the development of phlebitis and thrombophlebitis. Purulent destruction of the perifacial cells is accompanied by neuritis of the facial nerve, and of the perilabyrinthine cells by purulent labyrinthitis. Apical mastoiditis is complicated by the flow of pus into the interfascial spaces of the neck, as a result of which pyogenic microorganisms can penetrate into the mediastinum and cause the appearance of purulent mediastinitis.

The spread of the process into the cranial cavity leads to intracranial complications of mastoiditis (meningitis, brain abscess, encephalitis). Damage to the pyramid of the temporal bone causes the development of petrositis. The transition of purulent inflammation to the zygomatic process is dangerous due to further introduction of infection into eyeball with the occurrence of endophthalmitis, panophthalmitis and orbital phlegmon. In children, especially younger age, mastoiditis can be complicated by the formation of a retropharyngeal abscess. In addition, with mastoiditis, hematogenous spread of infection with the development of sepsis is possible.

Diagnostics

As a rule, diagnosing mastoiditis does not present any difficulties for an otolaryngologist. Difficulties arise in the case of asymptomatic atypical shape mastoiditis. Diagnosis of mastoiditis is based on the patient’s characteristic complaints, anamnestic information about trauma or inflammation of the middle ear, examination and palpation of the behind-the-ear area, results of otoscopy, microotoscopy, audiometry, culture of ear discharge, computed tomography and x-ray examination.

  • Otoscopy. With mastoiditis, inflammatory changes typical of otitis media are detected on the side of the eardrum; if there is a hole in it, profuse suppuration is noted. A pathognomonic otoscopic sign of mastoiditis is the overhang of the posterior superior wall of the auditory canal.
  • Study auditory function . Audiometry and hearing testing with a tuning fork can determine the degree of hearing loss in a patient with mastoiditis.
  • X-ray of the temporal bone. In the exudative stage of mastoiditis, it reveals cells veiled as a result of inflammation and unclearly distinguishable partitions between them. X-ray picture The proliferative-alterative stage of mastoiditis is characterized by the absence of a cellular structure of the mastoid process, instead of which one or several large cavities are determined. Better visualization is achieved by performing a CT scan of the skull in the area of ​​the temporal bone.

The presence of complications of mastoiditis may require additional consultation with a neurologist, neurosurgeon, dentist, ophthalmologist, thoracic surgeon, MRI and CT of the brain, ophthalmoscopy and biomicroscopy of the eye, radiography of organs chest.

Treatment of mastoiditis

Therapeutic tactics for mastoiditis depend on its etiology, the stage of the inflammatory process and the presence of complications. Drug therapy mastoiditis is treated with antibiotics wide range actions (cefaclor, ceftibuten, cefixime, cefuroxime, cefotaxime, ceftriaxone, amoxicillin, ciprofloxacin, etc.). Additionally, antihistamines, anti-inflammatory, detoxification, and immunocorrective drugs are used. Complications are treated.

With the otogenic nature of mastoiditis, sanitizing surgery on the middle ear is indicated; if indicated, general cavity surgery is indicated. The absence of a hole in the eardrum that provides adequate drainage is an indication for paracentesis. The middle ear is washed through the opening of the eardrum. medicines. Mastoiditis in the exudative stage can be treated conservatively. Mastoiditis of the proliferative-alterative stage requires surgical opening of the mastoid process (mastoidotomy) to eliminate pus and postoperative drainage.

Prevention of mastoiditis

Prevention of otogenic mastoiditis comes down to timely diagnosis inflammatory lesion middle ear, adequate treatment otitis, timely paracentesis of the eardrum and sanitizing operations. Correct treatment of nasopharyngeal diseases and quick liquidation infectious foci also contribute to the prevention of mastoiditis. In addition, it is important to improve performance immune mechanisms body, which is achieved by maintaining a healthy lifestyle, proper nutrition, if necessary - immunocorrective therapy.

ENT - Otolaryngology - Оtolaryngology.ru – 2007

Mastoiditis is an infectious-inflammatory process in the mastoid process. This is a bony process that is located behind the ear. The mastoid process has air cavities in its thickness. It is the attachment point for the sternocleidomastoid, splenius and longissimus capitis muscles. Structure bone tissue mastoid process is cellular, like a honeycomb.

The most common cause of mastoiditis is a middle ear infection.(otitis media), which extends to the mastoid process. In this case, the infectious process can lead to the destruction of the tender bone structure cells of the mastoid process. With further distribution infectious process it can move into the cranial cavity and brain, which is fraught with serious consequences: inflammation meninges(meningitis), brain abscess (due to the anatomically close location of the sinuses and meninges) and purulent inflammation inner ear(labyrinthitis), which can lead to deafness.

Causes and risk factors of mastoiditis

As already mentioned, the cause of mastoiditis is the transition of the inflammatory process from the middle ear to the mastoid process. Typically with mastoiditis the following are found: pathogens: pneumococci, Hemophilus influenzae (hemophilus influenza), beta-hemolytic streptococcus and gram-negative microflora.

Manifestations of mastoiditis

Mastoiditis begins to manifest itself with an increase in temperature and a deterioration in general condition. In the area of ​​the mastoid process behind the ear, pain when pressed and swelling appears. In addition, there is pain in the ear, which is often pulsating. There is discharge of pus from the ear and protrusion of the auricle. In addition, there may be decreased hearing, as well as swelling of the eardrum.

Complications of mastoiditis

Complications of mastoiditis can be either extracranial or intracranial. Extracranial complications of mastoiditis, as well as acute otitis media, primarily include hearing impairment, labyrinthitis (with severe dizziness), facial nerve. In addition, mastoiditis can be complicated by a subperiosteal abscess or a breakthrough of pus through the inner wall of the apex of the mastoid process under the sternocleidomastoid muscle (the so-called Bezold's mastoiditis).

TO intracranial complications include epidural abscess (abscess in the area of ​​the meninges), thrombophlebitis of the dural sinuses (most often the sigmoid sinus), meningitis and brain abscess.

Diagnosis of mastoiditis

Diagnosis of mastoiditis is primarily based on collecting patient complaints, clarifying the history of otitis media, as well as examining the patient. To clarify the diagnosis, radiography is used, CT scan. To clarify the nature of the pathogen, a study of purulent discharge is usually carried out.

Treatment of mastoiditis

The basis of treatment for mastoiditis is powerful antibiotic therapy. With minimal damage to the bone tissue of the mastoid process, a myringotomy is performed - a puncture of the eardrum in order to ensure the outflow of pus, and in addition, to examine the pus for the nature of the microflora. If antibiotic therapy is ineffective or the process is chronic, and even more so if complications from the brain or skull are suspected, the question is raised about the need surgical treatment– mastoidectomy – removal back wall auditory canal, remnants of the tympanic membrane, as well as the malleus and incus - auditory ossicles middle ear, which by the time of surgery are usually already destroyed by infection. The stapes and facial nerve are usually not affected.

Sometimes, due to the complete ineffectiveness of antibiotics, radical mastoidectomy is necessary. In this case, the patient’s hearing impairment is noted due to previous changes.

Mastoiditis is inflammatory disease bone tissue of the mucous membrane of the mastoid process of the temporal bone, accompanied by suppuration.

The causes of mastoiditis are the same as those that cause inflammation of the middle ear. Most often, mastoiditis is a complication of acute otitis media. The danger of the disease is that the purulent course of the disease is real threat development of severe intracranial complications.

Symptoms of mastoiditis

The symptoms of mastoiditis are similar to the signs of acute otitis media - elevated temperature bodies, bad feeling, pain in the ear area, changes in blood composition. Suppuration may be present if the drainage of pus from the middle ear is not impaired. An experienced otolaryngologist, analyzing the dynamics of the development of acute otitis media, can diagnose early stages mastoiditis. To avoid an unfavorable course of the disease, treatment of otitis should be carried out under the supervision of qualified doctors.

Treatment of mastoiditis

Treatment of mastoiditis by our specialists is carried out according to the stage of the disease and is carried out using both conservative and surgical methods. The development of a treatment strategy occurs after diagnosing the disease and determining its stage. In cases where conservative treatment gives positive results, surgery may not be necessary. However, often surgery mastoiditis may be the only way to solve difficult medical situations. In any case, at any stage of mastoiditis, treat it serious disease should be done in a hospital setting. The experience of doctors, their skill, modern medical equipment and attentive attitude medical personnel always at the service of patients.

Consultation and doctor's appointment

More detailed information You can find out by calling the numbers listed on the website or contact our Medical Center. We are working No Weekends from 8.00 to 22.00 at the address: Moscow Eastern Administrative District (East Administrative District) Lilac Boulevard 32A

Shchelkovskaya

Mastoiditis is an inflammatory lesion that covers the area of ​​the temporal bone and has infectious origin. Most often, this disease occurs as a complication of otitis media. The most common symptoms are painful sensations in the area of ​​the mastoid process of the ear, the presence of edema and decreased hearing function.

The mastoid process is the protrusion of the temple bones in the skull and is located behind the concha of the external ear. Its structure consists of many cells that are separated by partitions. They can be filled with air, bone marrow, or have a sclerotic type structure. The course of the disease depends on the type of affected cells. The disease can be right-sided or left-sided.

Causes of the disease

Mastoiditis usually occurs due to the spread of infections (pneumococcus, and others) from the middle ear. An infection can get into the mastoid process if the hole in the eardrum is too small or for other reasons. Rarely, patients are diagnosed with a disease that occurs due to infection due to the presence of or.

The main causes of the disease are:

  • gunshot wound;
  • mechanical damage;
  • traumatic brain injury;
  • other changes in the ear structure due to illness (external, intermediate or aerootitis);
  • chronic diseases (tuberculosis,);
  • nasopharyngeal diseases (,).

Types of illness

There are such forms of the disease depending on the causes of its occurrence:

  • primary(occurs after mechanical damage);
  • secondary(formed against the background of other diseases).

According to the stages, the following types of disease are distinguished:

  • exudative(with release of liquid);
  • true(with the formation of bone processes).

According to clinical form, highlight:

  • typical manifestations: headache, pain in the ear area;
  • atypical manifestations, in which the disease proceeds almost unnoticed or is present atypical signs illness.

In addition, a distinction is made between chronic mastoiditis and acute mastoiditis. In the first case, all symptoms appear rather sluggishly, and some are completely absent. In the second case, the patient complains of several signs of the disease, which appear quite clearly.

Separately allocate Bezold's mastoiditis- a type that also causes swelling of the neck, purulent exudate is formed in the area of ​​the eardrum or the sternocleidomastoid muscle.

Symptoms of the disease

The symptoms of mastoiditis are different, and it usually manifests itself together with moderate purulent (at 2 or 3 weeks). Mastoiditis in children can develop even in the absence of a formed bone process (up to 3 years the process does not yet have time to form).

The usual symptoms of the disease are:

  • decreased perception of sounds;
  • increased body temperature;
  • headache;
  • sharp pain behind the ear;
  • suppuration that is observed from the external ear canal.

If the volume of suppuration significantly exceeds the size of the eardrum or it is damaged, then this indicates the spread of the disease beyond the middle ear. If the amount of pus is insignificant, the infection does not spread further and the integrity of the eardrum is preserved. The patient can observe protruding ear, the formation of smoothness behind the ear instead of the skin fold usually located there. Pus can spread to all parts of the skull, causing blood clots, necrosis of the periosteum and the formation of an external fistula.

Complications of the disease can be:

  • intracranial diseases (encephalitis, blood clots);
  • facialles();
  • damage to the functionality of the neck;
  • eye damage (panophthalmitis);
  • sepsis.

Diagnosis of the disease

A qualified otolaryngologist can diagnose acute mastoiditis within a few minutes. An exception may be an atypical type of illness. Diagnosis is based on the patient's testimony, obtaining a history of life and illnesses, as well as palpation of the area located behind the ear. The otolaryngologist will also prescribe otoscopy, audiometry, bacterial culture, and, in some cases, radiography of the skull. This will help detect the stage of development of the disease. Based on these studies, a diagnosis is made and a treatment plan is drawn up.

Treatment of the disease

Treatment of mastoiditis depends on the cause of its occurrence, the nature of the course, as well as the stage of the process of inflammation of the post-auricular space. There are the following main treatment methods:

  • taking antibiotics, the action of which is aimed at destroying the source of infection (Ceftriaxone, Cefixime, Cefotaxime);
  • receiving others medications(antihistamine, detoxifying type);
  • surgical intervention;
  • physiotherapy;
  • traditional methods.

Taking medications is also called conservative method treatment, but its use is reasonable in initial stages mastoiditis, when the disease has not yet penetrated the tissues of the ear and the skull area. The patient is prescribed medications various types actions (to adjust immunity, eliminate the consequences and causes of inflammation, and others).

The surgical method is more effective method fight the disease. The operation is performed on the middle ear, and if there is no hole in the area of ​​the eardrum that provides drainage, paracentesis is performed. During the operation, which takes place under anesthesia, the doctor rinses the ear opening with various medicines, cuts the periosteum, removes the top plate of bone behind the ear, and then sutures the wound. The patient must be hospitalized and bandaged daily until the wound is completely healed.

Treatment of mastoiditis with physiotherapy involves the application of warm compresses, UHF therapy, as well as ultraviolet irradiation patient. Traditional methods, like physical therapy, are usually auxiliary, but not primary.

There are a lot folk recipes getting rid of illnesses, including:

  • hot onion treatment. It is supposed to bake the onion until soft, place a piece on cheesecloth butter and bulb, wrap and insert into the ear canal for 1–2 minutes. Afterwards, wrap the patient’s head with a warm blanket or scarf;
  • bread crust treatment. It is supposed to be heated on both sides using a water bath, and then applied to the ear, insulating it.

Disease prevention

This disease can be prevented if:

  • promptly detect signs of inflammatory damage;
  • qualitatively treat emerging otitis;
  • carry out sanitizing manipulations (cleanse the ear of dirt, excess wax, etc.);
  • lead healthy image life;
  • eat right (maintain a balance of proteins, fats, carbohydrates and vitamins);
  • carry out immunoregulatory therapy.

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Usually develops as a complication after suffering from otitis media.

Mastoiditis symptoms and treatment

Mastoiditis of the ear, as mentioned above, it appears due to the spread of infection, which remains as a result of insufficient cure for otitis media and against the background of a weakened immune system. The disease manifests itself immediately, and its symptoms become clearly noticeable quite quickly:

  • increase in body temperature
  • discharge of pus from the ear
  • right-handed / left-sided mastoiditis leads to hearing loss
  • weakness
  • noises in the head
  • decreased performance
  • throbbing pain behind the ear when pressing.

Mastoiditis diagnosis

Ear mastoiditis diagnosed by a specialist in medical institution based on a comprehensive examination and collection of tests to obtain an accurate picture of the course of the disease. In acute mastoiditis it is performed X-ray and the patient receives additional consultations with a surgeon and dentist.

Only the attending physician is responsible for determining treatment methods and possible surgical intervention. Ear mastoiditis enough insidious disease and has many life-threatening complications. The patient may be prescribed:

  • antibacterial agents
  • antibiotics
  • drainage auditory tube for the drainage of pus.

Acute mastoiditis treatment

In this case, the patient should be in the hospital. Treatment methods can be conservative, each case is individual. However, when paralysis of the facial nerve occurs or pus breaks through the border with the middle ear, they resort to surgical intervention. The purpose of the operation is to get rid of pus. Subsequent rehabilitation, among other things, will include daily dressings, taking vitamins and local treatment ultraviolet.

In order to protect yourself from of this disease it is necessary to promptly treat any diseases of the nasopharynx and ears, take care of injuries and periodically undergo preventive examination at the otolaryngologist.

Make an appointment with an otolaryngologist at the Semeynaya clinic. Here you can undergo diagnostics of ENT diseases and receive outpatient care.

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