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Mastoiditis

Pain on palpation or percussion of the mastoid, more often in the area of ​​the antrum and apex, is noted. Tissue pastility, flattening of the ear fold or protrusion of the auricle anteriorly may be observed, depending on the severity of inflammation in the appendix and soft tissue infiltration.

When otoscopy is observed suppuration. The pus becomes more dense, enters the ear canal in portions under pressure (the pulsating light reflex resumes). After removal of pus, it again accumulates in large quantities in the ear canal (symptom of a “reservoir”). The eardrum is infiltrated, may have a copper-red color. A pathognomonic symptom of mastoiditis is an overhang of the posterior upper wall of the auditory meatus in the bone section due to periostitis. At this point, a fistula sometimes forms through which pus enters the ear canal.

To confirm mastoiditis, X-ray of the temporal bones according to Schuller is performed. On the roentgenogram, shading (veil) of the cells of the mastoid process, thickening or thinning of their bone walls with periostitis and destruction of the jumpers up to the formation of a cavity during empyema of the process can be noted.

When pus breaks out of the mastoid process through the cortical layer, a subperiosteal abscess occurs. The swelling and pastiness of the skin preceding it in the behind-the-ear area, the flattening of the behind-the-ear fold and the protrusion of the auricle are intensified.

If pus from the apical cells of the mastoid process breaks into the interfascial spaces of the neck, then they speak of apical cervical mastoiditis. There are several forms of apical mastoiditis, named after the authors (mastoiditis of Bezold, Chitelli, Orleans and Moore). They differ in the place of breakthrough of pus in the apex. With Bezold mastoiditis, pus spreads through the inner wall of the mastoid process under the neck muscles, can reach the mediastinum and cause mediastinitis. In other forms, the differences relate to the spread of pus relative to the incisura digastrica of the apical process.

If the inflammatory process extends to the zygomatic process, then this form of mastoiditis is called zygomatitis, on the scales of the temporal bone - squamite. They are characterized by an inflammatory reaction of the skin of the corresponding area (swelling, soreness, sometimes hyperemia).

Involvement in the process of the stony part of the temporal bone pyramid causes petrozite, which is characterized by the Gradenigo triad: acute otitis media, trigeminitis, paresis or paralysis of the abducent nerve.

The mastoid process is formed by three years. Up to three years, children have only a large permanent cell - the antrum, so they have anthritis - inflammation of the mucous membrane of the cave of the mastoid process and osteomyelitis of the periantral region. Antrum in children lies more superficially, so they often have a subperiosteal abscess. In a sluggish course, toxic phenomena prevail. In this case, the process is often bilateral in nature. In older people and with the sclerotic type of the mastoid process, the cortical layer is denser, so bone destruction can occur in the direction of the brain.

Cases of latent course of mastoiditis with serous otitis media are sometimes noted. With all the uncertainty of the symptoms, there is still a decrease in hearing, dull pain in the ear, a feeling of stuffiness and the presence in the history of inflammation of the middle ear.
The eardrum is color-coded and infiltrated, but can even be intact, as perforation either did not occur or was already closed. In contrast to the overhanging of the posterior upper wall of the external auditory canal, only smoothness of the corus between it and the membrane is noted. With latent mastoiditis, osteitis with the growth of granulations, without a pronounced purulent process, is predominant.

Mastoiditis can be complicated by labyrinthitis or various intracranial complications, the most common of which are sigmoid sinus thrombosis and an abscess of the cerebellum or temporal lobe of the brain. The infection is spread by contact. Peripheral paresis of the facial nerve is also observed.

Treatment of mastoiditis is most often surgical. Patients require urgent hospitalization in the otolaryngological department of the garrison hospital.

Conservative treatment in the initial stage of mastoiditis corresponds to the active treatment of acute otitis media. Massive antibacterial and anti-inflammatory therapy is combined with a frequent ear toilet and the introduction of drugs into it.

For diagnostic and therapeutic purposes, anthropunction is used - a puncture of the cave of the mastoid process from the side of its site, which was previously carried out only in children. With the help of this operation, it is sometimes possible to eliminate the block of entrance to the cave. When washing, the fluid through aditus ad antrum enters the tympanum and from there flows through the perforation of the tympanic membrane into the ear canal. Wash the antrum with solutions of antibiotics, antiseptics and enzymes. The otolaryngologist in the hospital should perform a mastoid operation, since anthropuncture is associated with possible technical errors and intracranial complications.

Absolute indications for emergency surgical treatment of mastoiditis are intracranial complications, subperiosteal abscess and a breakthrough of pus in the apex of the mastoid process. In other cases, the operation is performed immediately after the diagnosis of mastoiditis, as well as otogenic peripheral paresis of the facial nerve. The operation is performed in the absence of the effect of conservative treatment with an increase in symptoms. The decision is made within a few days.

A mastoid operation (mastoidotomy) is done, which sometimes ends even with the complete removal of the process along with its apex - mastoidectomy. In children under three years of age, the operation is called an antrotomy.

The essence of the operation is to open all the affected cells of the mastoid process and the cave through planum mastoideum. It is performed behind the ear. The bone part is produced by chisels, chisels of Voyachek or cutters. Curettage of pathological contents is carried out by bone spoons. At the end of the operation, a single cavity is formed at the site of the antrum and the removed cells of the mastoid process. After the final rinse, the operating cavity is loosely swabbed with a gauze swab soaked in liquid paraffin or antibiotic solutions. Postoperative wounds are open. One seam is applied to the skin incision in the upper and lower corners, and late deferred seams are used as it is granulated.

The cure is the complete closure of the postoperative cavity, the cessation of purulent discharge from the ear, and the restoration of hearing.
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Mastoiditis

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