Treating mastoiditis

Treatment. Expressed forms of mastoiditis often be cured by antibiotics without surgery. However, treatment with antibiotics has a negative side: it can almost asymptomatic be developed intracranial complications during the period of apparent recovery, it can be also observed a sharp decline in hearing persistent pathological changes in the middle ear, which are not susceptible to antibiotics. Indications for surgery for mastoiditis sharply narrowed, frequency of transactions has fallen by 15-20 times, but in some cases it still remains a required component of treating mastoiditis and prevention against intracranial and systemic complications.
Indications for surgery: long, despite antibiotic treatment, excessive gnetaceae (more than 3-4 weeks), lowering of upper-back walls of the ear canal and subperiosteal abscess. Operation urgently shown at the first signs of transition of infection in the maze (dizziness, nausea, vomiting), meninges (severe headache, meningeal symptoms) or cross-venous sinus (stunning chills, sweat, temperature rise up to 40 degrees during the day and lowering her to the evening to normal and below).
The operation about mastoiditis is a simple trepanation of the mastoid process (synonym: antrotomy, mastoidectomy, mastoidectomy) - produce more often under local anesthesia. The operation consists of three stages. 1. Produce a behind-bow-shaped incision of soft tissue to the bone, some distance of 0.5 cm from the insertion of the ear, usepreview the periosteum anterior and posterior, guided identification paragraphs linea temporalis and spina suprameatum (beyond them not exit when removing the bones). 2. Remove bits or chisels cortical layer process and deepen operating cavity towards antrum. 3. Open antrum and purulent foci in the process. After the operation, instead of a complex system of pneumatic cells form one cavity. The operation is significantly easier if subperiosteal abscess (fistula), and if after removing the cortical layer is shown pus. Focusing on the course of the fistula, easy to find antrum. Postoperative cavity filled with a gauze pad or impose primary closure and enter sulfa or penicillin pasta.
At the top-cervical mastoiditis remove the top of the ridge and advanced widely open the abscess under the neck muscles. When zygomycete continue to cut anterior to the ear and reveal cell zygomatic bone.
In children under 2 years are necessary in a simple trepanation of the mastoid process to follow some precautions: should not cut soft tissue down to the bone, as soft bones, and even more so when its defects could injure meninges (in this regard, it is recommended to make the cut in layers.) The periosteum usepreview ordinary raspatory. Identification items may be poorly expressed; in such cases, need to focus on the rear and top walls of the ear canal. Antrum is superficial, and its easy to open with a sharp spoons or chisels. Due to the soft bones of the use of a hammer is usually unnecessary.
First ligation and removing rollers are produced, as a rule, on 5-6-th day after operation, afterwards - in day, and then and less. In the normal course of healing healthy granulation cover evenly all walls of the cavity. If the granulation process is very slow and sluggish, then used Vishnevsky ointment, sulfa and penicillin ointments, fish oils, ointments with vitamins, ultraviolet radiation, and so on, the Patient is considered cured, when fully closed operating cavity, stopped the ear discharge and restored hearing.
Relapse of mastoiditis may develop at different times after the surgery. Causes of recurrence: incomplete removal during operation the diseased bone; the gaping widely open antrum; sluggish granulation in operating cavity, premature closing it. Children are of great importance low power, rickets, exudative diathesis, tuberculous intoxication.
The rapid development of mastoiditis, swelling of the scar and breakthrough pus observed in cases where the postoperative cavity is made of fibrous tissue; however, there are repeated relapses. Treatment: with festering scars in most cases you can do incision and draining the abscess. At a deeper lesions require reoperate.