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).

Diagram of skull bones. The mastoid process is shown in red.

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

Subperiosteal abscess as a complication of mastoiditis

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 .

Links

Source

• BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 2009]. <http://jirben2.chytrak.cz/materialy/orl_jb.doc>.

References

• KLOZAR, Jan, et al. Speciální otorinolaryngologie. 1. edition. Praha : Galén, 2005. 224 pp. ISBN 80-7262-346-X.

• VOKURKA, Martin – HUGO, Jan, et al. Velký lékařský slovník. 8. edition. Praha : Maxdorf, 2009. 1144 pp. ISBN 978-80-7345-166-0.

• ŠLAPÁK, Ivo, et al. Doporučené postupy pro praktické lékaře : Bolest ucha [online] . 1. edition. 2001. Available from <http://www.cls.cz/dokumenty2/postupy/r078.rtf>.