Acute purulent mastoiditis

Acute purulent mastoiditis is usually develops as a result of acute suppurative otitis media (see, sometimes when entering infection hematogenous route. In connection with the successful treatment of purulent medium otitis antibiotics frequency of complications, including mastoiditis, fell sharply.
Causes of mastoiditis: high virulence of pathogens otitis media (most often hemolytic Streptococcus), the weakening of the body's resistance after prior or concomitant acute infectious diseases, poor conditions drainage of purulent in the tympanic cavity in the absence of a perforation of the eardrum, closing her granuloma or late paracentesis.
The development of mastoiditis and nature of morphological changes in the mastoid process depends largely on its structure - the degree of pneumatization, aceitoso. Thin bone partitions between the cells in pneumaticians the process of the break easily, and pus widely distributed systems, pneumatic cells; in diplomaticheskim the process of purulent process develops slowly, mainly in bone marrow spaces by type of osteomyelitis; in sclerotic shoot octet proceeds more slowly and hidden.
Symptoms and course. Symptoms and mastoid process: pain when pressed on the front upper section of the Appendix, or on the top of it; hyperemia, swelling, pastoznost the skin in the process, the smoothness of its contours that is easily detected when compared with healthy bone; subperiosteal abscess in the field playgrounds process usually by drawing them away ear forward and down.
With well pronounced pneumatization pneumatic cells come up to the thinning of the outer bone plate, which creates conditions predisposing to a breakthrough pus out. When distributing pneumatization on zygomatic process it also can develop purulent inflammation with swelling of soft tissues and subperiosteal abscess - zygomaticus (see).
With sharply expressed pneumatization the top of the mastoid process possible breakthrough of pus through the walls outside the top and the development of top-cervical mastoiditis with abscess, located deep under the neck muscles in the immediate neighborhood of the neurovascular bundle. Typical symptoms of this form of mastoiditis include: forced position of a patient's head (the head is tilted to the side of the patient ear), pain in the neck, radiating to the shoulder, swelling, and then swelling (mainly the tops of the mastoid process, which extends down the sternoclavicular-liners muscles. This form of mastoiditis is more common in older persons and in later period of otitis media with irrational treatment.
The pyramid of the temporal bone and the top of it usually consists of a sponge or a compact bone tissue; in the presence of the auriferous cells purulent process can on them to spread and cause Petrosa (see).
When otoscopy often seen inflammation and swelling of the front wall of antrum expressed in omission of rear-upper wall of the bony part of the outer ear canal. Eardrum usually thickened, hyperemic, infiltrated; gnetaceae significant, and sometimes abundant. The ear is reduced. The temperature is raised, the children she reaches up to 39-40 degrees. The elderly often normal.
In children of early age cellular system is not developed, but has antrum; they acute purulent otitis complicated by entrycom (see).
The diagnosis. The development of mastoiditis usually 3-4 weeks after the onset of acute otitis media. If at this time there is a significant gnetaceae, as well as fever and tenderness to palpation of the Appendix, the omission of rear-upper wall of bone external ear canal, the diagnosis of mastoiditis is very likely. BTE abscess is a very important symptom of mastoiditis; however, it must be borne in mind that sometimes it can be etiological connected not with mastoiditis, and boil external ear canal. Important the following differential diagnostic signs: when mastoiditis swelling is usually located in the upper part of the pad process, somewhat away from the line of attaching the ear, when you boil this line smoothed, swelling captures her; when mastoiditis no pain during zatragivanija to the ear and trestle, when you boil it; hearing boils normal or slightly decreased, while mastoiditis significantly lowered; M narrowing of the external ear canal is only in the bone part, at the external otitis - webbed-cartilaginous Department; boils eardrum has more or less normal, and when M. it is changed. Small children sometimes there is a festering pozadini lymph nodes with the formation of an abscess. If there purulent otitis media, to differentiate from the Meters can be used the following symptoms: when lymphadenitis abscess formed in the posterior part of the Appendix, skin thinning and bright redness, often shines pus; against mastoiditis says the presence of enlarged lymph nodes in the mastoid bone ear or in other places.
For the differential diagnosis between top-cervical form M. and cervical lymphadenitis are set by the following signs: when lymphadenitis otoskopia picture and hearing normal, mastoiditis are more or less noticeable changes in the eardrum and significant decrease of the hearing; in top form M swelling top goes without borders on the neck, when lymphadenitis same infiltrate distinguished from the top; when M swelling pressing on the top of the mastoid process is often accompanied by pus from the ear, which may not be at lymphadenitis.
The diagnosis is often difficult, if mastoiditis or otitis flow atypical,- expressed little changes in the eardrum, no perforation, pain and swelling in the mastoid. At purulent otitis media caused slimy Streptococcus (otitis mucosa), the symptoms usually erased, perforation of the eardrum and gnetaceae are rare, eardrum only thickened, muddy or more hyperemic. When operations often find in the process of large destructive changes.
Atypical for M. there often and in cases when the antibiotic treatment of acute otitis media is haphazard. If antibiotics are prescribed in small doses and for long enough time, suppurative focus in the cavities of the middle ear is not fully eliminated, but the symptoms Meters less pronounced or temporarily disappear. The process is hidden, often after discontinuation of treatment, is observed flash, sometimes accompanied by severe complications.
An important additional method in the diagnosis of mastoiditis is radiography of the temporal bone (see below). In addition to direct evidence of disease, it gives an idea of localization center in the temporal bone.
The forecast. Prolonged inflammatory process may lead to a permanent growths in the tympanic cavity; it is also possible toxic damage endings auditory nerve in the inner ear. All this can cause persistent lowering of hearing. Rational treatment prognosis is good; gnetaceae from ear stopped, hearing restored.