Mastoiditis: what is it? Symptoms of mastoiditis, symptoms and treatment

An infectious disease that affects the elements of the temporal bone of the human skull as a result of purulent inflammation of the middle ear is a mastoiditis. What is it, for what reasons arises and what consequences can it lead to - all the issues will be considered in our article. However, in order to understand the nature of the origin of the disease, it is necessary to understand the definition of the mastoid process and the anatomical structure of the human skull.

The structure of the skull. Temporal bone

The human skull is formed by a combination of bones, which are conventionally divided into two large groups - the bones of the brain and the bones of the facial section. In addition to these bones, in the middle ear cavity there are three kinds of paired bones - a hammer, stapes and an anvil. The temporal bone is a bone from the group of the brain that forms the base of the skull. In the temporal bone a whole complex of nerve trunks:

• Pre-door and cochlea,
• facial,
• Node of the trigeminal nerve,
• wandering,
• Glossopharyngeal nerve.

The temporal bone consists of three areas: scaly, drum and rocky. The scaly region forms the lateral walls of the skull; The drum part is an element that surrounds the auditory canal on all sides; The rocky part looks like a pyramid and functions as a receptacle for the middle and inner ear, through which blood vessels also pass. The pyramid includes three surfaces - front, back and bottom. The lower region forms the mastoid process.

The concept and structure of the mastoid process

The ovoid process is a conical shape located behind the ear. The internal structure of the mastoid process is a set of bone cavities filled with air and communicating with the middle ear (with a drum cavity) through the mastoid cave. The cave (antrum) is the largest cell of the mastoid process. To the mastoid process is attached a muscle, consisting of three components - the sternum, clavicle and mastoid.

The structure of the process is individual for each person. There are three types of its structure. Pneumatic structure - mastoid process consists of large cells filled with air. Diploetic structure - the structure is a small cell filled with bone marrow. Sclerotic structure - cellular structure is very poorly expressed.

It should be noted that the course of mastoiditis depends very strongly on the type of mastoid process. And in most cases, mastoiditis develops in persons with a pneumatic structure of the mastoid process.

Mastoiditis: what is it?

Mastoiditis is an inflammatory process that occurs in the mucosa of the cave (antrum) or in cellular structures of the temporal bone. Classify the pathology by various signs. Usually, two forms of the disease are distinguished - primary and secondary mastoiditis.

As noted earlier, the mastoid process is associated with the tympanic cavity. Most cases of mastoiditis occur because of infection in the mastoid process on the background of inflammation of the middle ear. This clinical picture suggests secondary mastoiditis as a complication of chronic otitis media.

The most common cause of acute mastoiditis are streptococci and staphylococci, less often Pseudomonas aeruginosa and other aerobic and anaerobic bacteria. Very rare cases in which the disease cause mycobacteria.

Primary mastoiditis is a pathology that can develop:

• Due to injury caused by gunshot wound or skull fracture.
• When the purulent process passes to the bone tissue of the mastoid process from the lymph nodes.
• Due to specific diseases - tuberculosis or infectious granulomas.

The process of the disease is as follows. When injuries occur Multiple fractures of thin bones into bones, resulting in the formation of small fragments, which together with the spilled blood create a favorable environment for melting bone fragments and the development of progressive inflammation.

Stages of the disease course

As a rule, the development of mastoiditis undergoes two stages:

• Exudative,
• Proliferative-alternative.

The initial stage of development of mastoiditis is exudative, it lasts 7-10 days. During this time, inflammation of the mucosa of the mastoid process develops. Mucous swelling, the cells of the structure of the mastoid process are closed, filled with purulent mass and are separated from the mastoid cave. The X-ray at this stage of the disease course illustrates the subtle discrepancies between the cells.

Proliferative-alternative stage of the disease is characterized by the destruction of partitions that separate cells and the appearance of separate groups of cells that merge into voluminous cavities. Changes also occur in bone marrow and vascular structures.

Sometimes the development in the middle ear of cholesteatoma can cause various pathological processes in the body, including mastoiditis. What it is? Cholesteatoma is a capsule, consisting of keratinized cells of the epithelium.

Mastoiditis: symptoms

Treatment of mastoiditis is a long and time consuming process. Therefore, in order to achieve success in this matter, it is very important to identify the disease at the earliest stages. Depending on how the symptoms of mastoiditis manifest themselves, the typical and atypical forms of the disease are distinguished. For an atypical or latent form of the disease, a flaccid current without pronounced symptoms is characteristic.

With a typical form of mastoiditis, patients can complain of severe pain in the ear and in the head that spreads to the back of the head or to the forehead; Swollen region of mastoid process. With a sharp swelling of the tissues, especially with the formation of a purulent process in them, the auricle noticeably protrudes.

In this case, the presence of the disease can be evidenced by altered blood test parameters as a result of the inflammatory process that has arisen.

The course of mastoiditis can be accompanied by the development of the Gradenigo syndrome, in which there is paralysis of the abnormal nerve. The patient has limited mobility of the eyeball from the side of the patient's ear. Can develop photophobia. These symptoms often indicate a limited inflammation of the meninges, the symptoms of which are manifested in vomiting, dizziness, unilateral headaches.

The signs of mastoiditis are similar to the symptoms of furunculosis of the external ear, as well as inflammation of the lymph nodes located behind the auricle. Since these nodes are in the central region of the mastoid process, they provide movement of the lymph of the entire ear. In a healthy state, each lymph node is easily probed. When the disease, all lymph nodes are smoothed. When mastoid pressure on the nodes does not cause painful sensations, the mastoid process - causes; With adenite everything is exactly the opposite.

In comparison with the course of the disease in an adult, mastoiditis in children can be characterized by nonspecific signs and can be expressed in loss of appetite, diarrhea, increased excitability, secretions from the external ear.

Atypical forms of mastoiditis

In addition to the typical forms of the disease, in medicine, atypical forms of mastoidite are distinguished. The most common forms are:

• Zygomatzit,
• Apical-cervical mastoiditis, which has four subspecies,
• Squamite,
• Petrosite.

Zygomatitis is a type of mastoiditis, in which the inflammatory process extends to the zygomatic process, the swelling of the cheek arises in the area in front of the auricle. After an edema the abscess is formed.

In childhood, "false" forms of zygomatocytes can arise - an abscess that does not affect the cells of the root of the zygomatic process. Since the children are well developed only cave, they often develop anthritis - an inflammatory process on the mucosa of the antrum of the mastoid process. Previously, this disease led to high infant mortality.

Squamid is a purulent process that affects the temporal bone.

In case the inflammatory process begins in the pyramidal region of the temporal bone, petrositis occurs. By the way, petrosites develop slowly.

Types of apical-cervical mastoiditis

The apical-cervical mastoiditis is:

• Bezoldovsky mastoiditis is a pathology in which the pus spreads to the region of the sternocleidomastoid muscle, and a swelling appears in the apex of the mastoid process. The focus of the pathology may be invisible on the lateral projection of the tomography of the temporal bone. Symptom of this form of mastoiditis at the initial stage is poor mobility of the neck.
• Mastoidite Cetelli is a pathology in which pus penetrates the posterior surface of the mastoid process.
• Mastoiditis Moure - a disease in which pus spreads between the neck muscles due to inflammation of the cervical lymph nodes, an abscess is formed. There is a swelling of the neck, and fistulas can subsequently form.
• Mastoiditis of Orléansky is a pathology in which an edema develops in the upper region of the sternocleidomastoid muscle, with pain when pressed. However, there is no evidence of pus from the ear, in contrast to Bezold's mastoiditis.

Diagnostics

As a rule, the diagnosis of "mastoiditis" is established based on the patient's medical history. This takes into account the transferred ear pathologies, the therapy, the presence / absence of complications; The violation of the general state of health is assessed. In addition, the complaints of the patient, examination and palpation of the ear area, the results of otoscopy, audiometry, laboratory studies of secretions from the ear, ophthalmoscopy and biomicroscopy of the eyes play an important role in the diagnosis. Computer tomography is the standard method by which mastoiditis is diagnosed. What it is? This type of diagnosis allows you to clearly examine all structures of the skull and assess the extent of development of purulent processes and their range from the brain and facial nerve. This technique is based on a step-by-step study of the structure of an object - compares the effect of X-ray radiation on different tissues. The data obtained undergoes complex computer processing.

Radiography of the skull, for example, helps to identify indistinctly visible septal cells as a result of the inflammatory process, which clearly indicates the development of mastoiditis. In addition, with suspicions of mastoiditis, a clinical analysis of blood and pus from the ear for a sensitivity to antibiotics.

In order to diagnose "mastoiditis", it may be necessary to consult not only the otolaryngologist, but also other specialists - neurologist, dentist, ophthalmologist, surgeon.

Conservative treatment

Usually pathology can be stopped at the initial stage. If a person immediately applies for help to a specialist and receives timely therapy (use of antibiotics), the spread of infection stops and it can be assumed that the patient will not have any complications in the future that cause mastoiditis.

Treatment is performed according to the following scheme. At first antibiotics of a wide spectrum of action are applied . Further, in accordance with the results of laboratory studies of biological material, specific antibiotics are prescribed that exert a narrowly directed effect on the detected aerobic and anaerobic bacteria. Complete elimination of infection may require long-term antibiotic therapy. This is due to the fact that antibiotics hardly penetrate into the structures of the mastoid process. In addition, recurrences of the disease are not excluded, chronic mastoiditis may occur.

At the initial stage of treatment of mastoiditis, in the absence of complicating factors, physiotherapy (UHF, SHF) may be prescribed in conjunction with the therapy. A good therapeutic effect is applied to compresses the BTE area. By the way, they can be both warming and cold.

The widespread use of antibiotics in developed countries has drastically reduced the incidence of mastoiditis and has led to the advantage of conservative therapies over surgical ones.

Surgery

Often, drug therapy does not improve the patient's health. In such cases, resort to surgical treatment of the pathological processes that causes mastoiditis. The operation, however, does not cancel the parallel conservative treatment.

Among the surgical methods, the most common are myringotomy - an incision of the tympanic membrane - and the introduction of a tympanostomic tube that provides the excretion of pus from the ear. After a certain period of time - from two weeks to several months - the tube is spontaneously eliminated from the tympanic membrane, and the incision naturally heals.

Antrumastoidotomy - surgical intervention, in which an antrum is opened and the mastoid process is fluttered. The goal of surgery in this case is complete removal of the affected tissue. It is not uncommon for cases when surgical intervention removes the entire process together with its apex. This manipulation is called mastoidectomy. It is quite complicated and resorts to it in the event of complications or in the absence of positive dynamics in treatment. Children under three years of age perform anthotomy - manipulation on the antrum, as they have a poorly developed mastoid process.

Complications of mastoiditis. Prevention

If there is no or insufficient treatment, the infection passes to neighboring tissues, which can lead to various complications, for example, hearing loss, labyrinthitis and as a result - dizziness, hearing loss. Infection can affect the facial nerve and cause paralysis of the facial muscles. Mastoiditis is often the cause of subperiosteal abscess, a trigger mechanism in the development of zygomatitis, squamitis, petrositis, otogenous paresis. In case the inflammatory process affects the membranes of the brain, meningitis develops. The presence of any of the aforementioned complications in the patient is an indication for surgical intervention.

The task of both the medical specialist and the patient is to prevent the development of mastoiditis. Prevention of the disease is closely related to the prevention of the abscess of the middle ear - a pathology called "otitis." Mastoiditis is a disease that can not be started. Its symptoms and causes must be eliminated in the early stages. Treatment should be qualified and sufficient.

Not the least role here is played by human immunity, its ability to resist infection. It is important to take care of the nasal cavity and mouth, not to allow inflammatory diseases in the nasopharynx. It helps in the prevention of mastoiditis early diagnosis of ear diseases and proper antibacterial therapy.

The article highlights information about what is mastoiditis; Symptoms, treatment of the disease and its prevention. However, I want to note that the material outlined above is purely introductory. Therefore, for any suspicion of the disease, you should immediately seek medical help from a specialist.