Mastoiditis

This is an inflammatory disease of the sockets of the mastoid process of the temporal bone. It most often arises as a complication of otitis media. The infection moves from the mucous membrane of the mastoid process to the bony partitions with their subsequent melting ( coalescence = melting, hence coalescent mastoiditis ). Rarely, the infection can spread to this location hematogenously or traumatically.

Forms
We distinguish 3 basic forms of mastoiditis:


 * 1) acute (occurs 2-4 weeks after mesotitis, accounts for approximately 50% of all mastoiditis);
 * 2) subacute (usually occurs as part of latent otitis media);
 * 3) latent (also as part of latent otitis media).



Clinical signs

 * Acute mastoiditis : fever, palpation soreness, retroauricular leakage, protruding pinna, purulent discharge from the ear canal, worsening of hypacus, tinnitus , osteoclastic bone destruction;
 * Subacute and latent mastoiditis (symptoms are less pronounced): vague soreness - rather a feeling of pressure in the ear, modest exudation, profuse proliferation of granulation tissue filling the sockets, the bone reacts rather osteoplastically, the septa thicken and sclerotize.

Diagnostics

 * History, physical examination (see symptoms);
 * Otoscopy - the image indicates some form of otitis media ;
 * X-ray (projection according to Schüller) – obscuration and disintegration of the pneumatic system;
 * CT.

Differential diagnosis

 * Circumscribed external otitis with retroauricular infiltration;
 * Dermatitis in the ear with subsequent retroauricular lymphadenitis;
 * Palpable soreness can be caused by vertebral irritation of the nervus occipitalis minor.

Complications
Complications of mastoiditis arise from the possibility of infection spreading. It is about:


 * mastoid fistula ;
 * subperiosteal, Mouret's (under the attachment of the digastricus muscle ) or Bezold's (under the attachment of the sternocleidomastoid muscle ) abscess ;
 * thrombophlebitis (by extension of the inflammation medially to the sphincter );
 * infectious disease of the brain or cerebellum.

Therapy

 * ATB ;
 * antromastoidectomy.