The disease usually become: Staphylococcus; pneumococci; influenza bacillus; streptococci. Sometimes there is mastoiditis, which develops due to the penetration of infection with tuberculosis, secondary syphilis, sepsis.
What it is?
Mastoiditis - inflammation of the mucous lining of caverns (antrum) and cellular structures mastoid process of the temporal bone located behind the ear and comprising air-filled bone cavity. Mastoiditis develops due to the spread of infection in the mastoid cells.
Most often develop secondary mastoiditis, which occurs as a complication of untreated acute or chronic otitis media caused by infection of the middle ear. Occasionally primary mastoiditis observed when the pathological process initially develops in the structures of the mastoid process (e.g., due to trauma).
Classification
On occurrence of infection are different:
- primary mastoiditis, with the original hit inflammatory agent in the mastoid cavity,
- secondary mastoiditis occurring as a complication of inflammatory processes of the body.
Secondary mastoiditis may occur:
- as a result of otitis media, it is called otogenny,
- as a result of head injuries,
- as a focus for the flow of sepsis (septikopiemichesky hearth).
Adrift mastoiditis can be:
- typical, with the presence of all the classic symptoms,
- Atypical or latency, sluggish flowing inflammation without obvious symptoms.
Causes of
In most cases, mastoiditis as a complication of acute otitis media - inflammation of the middle ear. The infection in this case extends from the tympanic cavity in the mastoid region. Consequently, the cause mestoidit the same bacteria that cause otitis media, namely:
- Streptococcus pneumoniae,
- Haemophilus influenzae,
- Moraxella catarrhalis.
The spread of the middle ear infection is facilitated by:
- reduced immune status of the organism;
- lack of adequate treatment of otitis media (delayed drainage of the tympanum, held late paracentesis, the small-diameter hole in the eardrum or early closing it, preventing outflows purulent masses).
Infection can penetrate the mastoid hematogenous route (with blood) in tuberculosis, secondary syphilis, sepsis.
All cases mastoiditis described above are the secondary (t. e. arose against the backdrop of another disease). Possible primary and mastoiditis. He appears when damaged cells mastoid due to:
- shock;
- gunshot wound;
- traumatic brain injury.
In these cases, the mastoid cavity enters the blood, is an excellent breeding ground for many species of bacteria.
On the background of chronic somatic diseases (tuberculosis, diabetes, rheumatic disease, hepatitis, etc. D.) And pathological processes in the nasopharynx (chronic rhinitis, sinusitis, pharyngitis, laryngitis, tracheitis), as well as changes in existing ear structure (due to injury, previously carried otitis), acute mastoiditis occurs frequently and occurs heavier.
symptoms of mastoiditis
Symptoms mastoiditis is different, and it is shown, as a rule, with an average purulent otitis (for 2 or 3 weeks). Mastoiditis in children may occur even in the absence of formed bone ridge (up to 3 years old process still does not have time to form).
The usual symptoms of the disease are:
- decrease in perception of sounds;
- fever;
- headache;
- acute pain behind the ear;
- suppuration, which is observed from the external ear canal.
If the amount of suppuration significantly exceeds the size of the tympanic membrane, or is damaged, then it suggests further spread of the disease of the middle ear. If the amount of pus slightly - the infection has not spread further and the integrity of the tympanic membrane is stored.
The patient can be seen protruding ear, forming smooth behind the ear instead of the usually located there skinfold. Pus can spread to all parts of the skull, causing blood clots, periosteum necrosis and the formation of external fistula.
Characteristics of the disease in children
Since the mastoid underdeveloped in infants, pus with otitis media only penetrates into the cave of the temporal bone - antrum and leads to the development of purulent antrita. Otitis and antritis diagnosed in children with reduced resistance, premature and rickety.
A distinctive feature of the pathology in children - the rapid development of subperiosteal abscess, often without bone destruction.
Clinical symptoms of mastoiditis in children:
- Fever,
- Cry,
- moodiness,
- Restless sleep,
- Poor appetite,
- Symptoms meningism,
- Copious purulent discharge.
Oto- symptoms: bulging tympanic membrane, changing its color, puffiness and the appearance of a pulsating reflex in place of perforation.
Diagnostics
Diagnose explicit mastoiditis is not difficult. It is considered to be more severe diagnosis of atypical type of the disease when clear symptoms (edema, abscess, pain) is not observed.
An important method for studying the disease have X-rays. But the most effective considered CT and MRI of the temporal bone area.
The doctor examines the ear drum and the area behind the ear. Also, blood tests can be assigned. In this case, the parameter of interest to a doctor - it is ESR. This characteristic may indicate inflammation in the body and its intensity.
Effects
The most serious complications are mastoiditis lesion of the facial nerve:
- facial asymmetry occurs,
- angle of the mouth or eye drops down,
- the face is like a mask,
- bad eyelid closes.
Another dangerous complication of mastoiditis is becoming a breakthrough of pus in the cranial cavity with the formation of the inflammation of the meninges, or brain matter. Thus there are general symptoms of infection:
- fever with blood inflammatory changes,
- disturbance of sleep and appetite,
- nausea and even vomiting,
- refusal to eat because of pain in the ear.
How to treat mastoiditis?
mastoiditis symptoms treatment is given only after a full examination of the patient. It is conservative and surgical, is performed in a hospital (in the ENT department).
Conservative treatment of mastoiditis can only be successful on exudative stage of the disease, as long as not develop bone degradation and not disturbed outflow of exudate. In this antibiotics for mastoiditis displayed without fail, often intravenously. It should also ensure free drainage of pus from the middle ear cavity and the required use of topical antibiotics. Selection of these preparations is carried out taking into account the sensitivity of the ear flora. The prognosis for this form of mastoiditis is positive only if timely initiation of therapy and compliance with all the doctor's appointments.
Partially, but a clear improvement of the patient is a good indication and can extend and optimize the conservative treatment. In that case, if within 24 hours after the start of treatment the main symptoms of the disease, such as fever, pain BTE region and on palpation reactive conditions in the ear, not decrease, the patient is sent for surgical treatment.
Forecast
Mastoiditis cure is possible with immediate medical intervention. Hence the importance of early care-seeking. But because antibiotics have difficulty penetrating into the structure of the mastoid infection amenable to cure with difficulty; not excluded relapses. There are various complications associated with the spread of infection to adjacent anatomical structures. Likely to develop hearing disorders, inflammation of the inner ear labyrinth (labyrinthitis) causing dizziness; Tinnitus can progress along with hearing loss, making it difficult to communicate.
Infection can affect the facial nerve (cranial nerve VII), resulting in weakness or paralysis of facial muscles on the affected side. Among other complications occur Bezold abscess (collection of pus under the sternocleidomastoid muscle of the neck), abscess Chitelli, subperiosteal (subperiosteal) abscess mastoid process of the temporal bone, typically leads to a shift of protrusion and ear shell.
Severe complications occur in the spread of infection in the brain tissue. These complications include meningitis (inflammation of the meninges), epidural abscess (between bones skull and dura), cerebral venous sinus thrombosis, brain abscess brain.
prevention
Preventive measures with mastoiditis include:
- Moderate exercise,
- The elimination of the body's centers of a chronic infection,
- Stimulation of the immune system,
- Proper, healthy eating,
- Restful sleep,
- Maintaining a healthy lifestyle,
- Prevention of disease is a complication which mastoiditis - otitis, tuberculosis, diabetes, rhinitis, sinusitis.
- Timely diagnosis and treatment of inflammatory diseases of the middle ear.
