Treatment for mastoiditis begins after necessary examination, through which the type of disease, stage, and nature of its course become known. Inflammatory phenomena in the appendix can provoke serious exacerbations. On initial stage the development of mastoiditis is predominant conservative treatment, and to carry out the operation, strong arguments are needed.
At the moment, in the treatment of mastoiditis, doctors focus on two points: the duration of the disease from the moment, the symptoms present.
Surgeon intervention is allowed from 3 weeks after the onset of mastoiditis, when the lack of fruitfulness of conservative treatment is stated. It would be a mistake to carry out the operation earlier than such a period, arguing this only with fears of exacerbations, without having constructive evidence of such a phenomenon.
On early periods, if the inflammatory phenomenon is not localized within a specific area, it will not be possible to eliminate all the matter affected by the infection. This may have negative consequences.
The relevance of conservative treatment may be determined by age. In the first year of life external manifestations mastoiditis are expressed too clearly - this is explained by the incomplete formation of bone tissue and the baby’s weak protective system. Internal deviations will occur moderately, and it is quite possible to eliminate them through non-surgical treatment.
At the first stage of the disease, if the examination does not foresee a threat of exacerbations, the patient is prescribed conservative treatment, which includes:
Antibiotic therapy is dangerous due to its ability to mask the symptoms of the disease, which can lead to unforeseen exacerbations.
The question of surgical intervention for mastoiditis should be raised immediately if the following points exist:
The key point when deciding whether to undergo surgery should be not only the presenting symptoms of ear disease, but also the condition of the patient as a whole. The doctor needs to study what chronic, hereditary ailments the patient has, what infectious diseases and when they took place, the age of the sick person:
Surgical treatment of the disease in question is carried out through trephination of the appendix, elimination of purulent masses and granulation materials. This variety surgical intervention difficult to perform and requires high skills from the surgeon.
This operation is called mastoidectomy and has 3 options:
Stages of mastoidectomy surgery:
ENT - Otolaryngology - Оtolaryngology.ru – 2007
Mastoiditis is an infectious-inflammatory process in the mastoid process. This is a bony process that is located behind the ear. The mastoid process has air cavities in its thickness. It is the site of attachment of the sternocleidomastoid, splenius and longissimus capitis muscles. Bone structure mastoid process cellular, like a honeycomb.
The most common cause of mastoiditis is a middle ear infection.(otitis media), which extends to the mastoid process. In this case, the infectious process can lead to the destruction of the tender bone structure cells of the mastoid process. With further distribution infectious process it can move into the cranial cavity and brain, which is fraught with serious consequences: inflammation meninges(meningitis), brain abscess (due to the anatomically close location of the sinuses and meninges) and purulent inflammation inner ear(labyrinthitis), which can lead to deafness.
Causes and risk factors of mastoiditis
As already mentioned, the cause of mastoiditis is the transition inflammatory process from the middle ear to the mastoid process. Typically with mastoiditis the following are found: pathogens: pneumococci, Hemophilus influenzae (hemophilus influenza), beta-hemolytic streptococcus and gram-negative microflora.
Manifestations of mastoiditis
Mastoiditis begins to manifest itself with an increase in temperature, worsening general condition. In the area of the mastoid process behind the ear, pain when pressed and swelling appears. In addition, there is pain in the ear, which is often pulsating. There is discharge of pus from the ear, bulging auricle. In addition, there may be decreased hearing, as well as swelling eardrum.
Complications of mastoiditis
Complications of mastoiditis can be either extracranial or intracranial. Extracranial complications of mastoiditis, as well as acute otitis media, primarily include hearing impairment, labyrinthitis (with severe dizziness), and damage to the facial nerve. In addition, mastoiditis can be complicated by a subperiosteal abscess or breakthrough of pus through inner wall the apex of the mastoid process under the sternocleidomastoid muscle (the so-called Bezold's mastoiditis).
To intracranial complications include epidural abscess (abscess in the area of the meninges), thrombophlebitis of the dural sinuses (most often the sigmoid sinus), meningitis and brain abscess.
Diagnosis of mastoiditis
Diagnosis of mastoiditis is primarily based on collecting patient complaints, clarifying the history of otitis media, as well as examining the patient. To clarify the diagnosis, radiography is used, computed tomography. To clarify the nature of the pathogen, a study of purulent discharge is usually carried out.
Treatment of mastoiditis
The basis of treatment for mastoiditis is powerful antibiotic therapy. With minimal damage to the bone tissue of the mastoid process, a myringotomy is performed - a puncture of the eardrum in order to ensure the outflow of pus, and in addition, to examine the pus for the nature of the microflora. If antibiotic therapy is ineffective or the process is chronic, and even more so if complications from the brain or skull are suspected, the question is raised about the need for surgical treatment - mastoidectomy - removal back wall auditory canal, remnants of the tympanic membrane, as well as the malleus and incus - auditory ossicles middle ear, which by the time of surgery are usually already destroyed by infection. Stirrup and facial nerve usually they are not affected.
Sometimes, due to the complete ineffectiveness of antibiotics, radical mastoidectomy is necessary. In this case, the patient’s hearing impairment is noted due to previous changes.
Mastoiditis - defeat inflammatory type, which covers the area temporal bone and has infectious origin. Most often, this disease occurs as a complication of otitis media. The most common symptoms are pain in the mastoid process of the ear, swelling and decreased hearing function.
The mastoid process is the protrusion of the temple bones in the skull and is located behind the concha of the external ear. Its structure consists of many cells that are separated by partitions. They can be filled with air, bone marrow or have a sclerotic type structure. The course of the disease depends on the type of affected cells. The disease can be right-sided or left-sided.
Mastoiditis usually occurs due to the spread of infections (pneumococcus, and others) from the middle ear. An infection can get into the mastoid process if the hole in the eardrum is too small or for other reasons. Rarely, patients are diagnosed with a disease that occurs due to infection due to the presence of or.
The main causes of the disease are:
There are such forms of the disease depending on the causes of its occurrence:
According to the stages, the following types of disease are distinguished:
According to clinical form, highlight:
In addition, a distinction is made between chronic mastoiditis and acute mastoiditis. In the first case, all symptoms appear rather sluggishly, and some are completely absent. In the second case, the patient complains of several signs of the disease, which appear quite clearly.
Separately allocate Bezold's mastoiditis- a type that also causes swelling of the neck, purulent exudate is formed in the area of the eardrum or the sternocleidomastoid muscle.
The symptoms of mastoiditis are different, and it usually appears together with moderate purulent (at 2 or 3 weeks). Mastoiditis in children can develop even in the absence of a formed bone process (up to 3 years the process does not yet have time to form).
The usual symptoms of the disease are:
If the volume of suppuration significantly exceeds the size of the eardrum or it is damaged, then this indicates the spread of the disease beyond the middle ear. If the amount of pus is insignificant, the infection does not spread further and the integrity of the eardrum is preserved. The patient can observe protruding ear, the formation of smoothness behind the ear instead of the skin fold usually located there. Pus can spread to all parts of the skull, causing blood clots, necrosis of the periosteum and the formation of an external fistula.
Complications of the disease can be:
A qualified otolaryngologist can diagnose acute mastoiditis within a few minutes. An exception may be an atypical type of illness. Diagnosis is based on the patient's testimony, obtaining a history of life and illnesses, as well as palpation of the area located behind the ear. The otolaryngologist will also prescribe otoscopy, audiometry, bacterial culture, and, in some cases, radiography of the skull. This will help detect the stage of development of the disease. Based on these studies, a diagnosis is made and a treatment plan is drawn up.
Treatment of mastoiditis depends on the cause of its occurrence, the nature of the course, as well as the stage of the process of inflammation of the post-auricular space. There are the following main treatment methods:
Taking medications is also called a conservative method of treatment, but its use is reasonable in initial stages mastoiditis, when the disease has not yet penetrated the tissues of the ear and the skull area. The patient is prescribed medications various types actions (to adjust immunity, eliminate the consequences and causes of inflammation, and others).
The surgical method is more effective method fight the disease. The operation is performed on the middle ear, and if there is no hole in the area of the eardrum that provides drainage, paracentesis is performed. During the operation, which takes place under anesthesia, the doctor rinses the ear opening with various medicines, cuts the periosteum, removes the top plate of bone behind the ear, and then sutures the wound. The patient must be hospitalized and bandaged daily until the wound is completely healed.
Treatment of mastoiditis with physiotherapy involves the application of warm compresses, UHF therapy, and ultraviolet irradiation of the patient. Traditional methods, like physical therapy, are usually auxiliary, but not primary.
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Mastoiditis is inflammatory disease bone tissue of the mucous membrane of the mastoid process of the temporal bone, accompanied by suppuration.
The causes of mastoiditis are the same as those that cause inflammation of the middle ear. Most often, mastoiditis is a complication of acute otitis media. The danger of the disease is that the purulent course of the disease is real threat development of severe intracranial complications.
The symptoms of mastoiditis are similar to the signs of the development of acute otitis media - increased body temperature, poor health, pain in the ear, changes in blood composition. Suppuration may be present if the drainage of pus from the middle ear is not impaired. An experienced otolaryngologist, analyzing the dynamics of the development of acute otitis media, can diagnose early stages mastoiditis. To avoid an unfavorable course of the disease, treatment of otitis should be carried out under the supervision of qualified doctors.
Treatment of mastoiditis by our specialists is carried out according to the stage of the disease and is carried out as conservative methods, and surgical. The development of a treatment strategy occurs after diagnosing the disease and determining its stage. In cases where conservative technique gives treatment positive results, surgery may not be necessary. However, often surgical treatment mastoiditis may be the only way to solve difficult medical situations. In any case, at any stage of mastoiditis, treat it serious illness should be done in a hospital setting. The experience of doctors, their skills, modern medical equipment and attentive attitude medical personnel always at the service of patients.
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No surgical intervention. For this purpose they are used various groups antibiotics. If conservative treatment proves futile, mastoidectomy is prescribed.
Surgery is used to remove the mastoid process. There are three large groups of such surgical interventions:
The main purpose of the operation is to preserve hearing and sanitize the ear. It is carried out in those patients who have pathogenic stable microflora in the ear canal. can lead to skin ingrowth ear canal through a damaged area in the eardrum.
Preparation includes:
Carrying out the operation requires high precision and professionalism from the surgeon, since the actions themselves are quite complex. The operation takes an average of 1.5 hours.
The stages of the operation are as follows:
Temporal bone mastoidectomy in our video:
Hospitalization lasts about 5-7 days. A person can return to work 1-3 weeks after discharge.
Sometimes it becomes necessary to perform a second operation aimed at restoring hearing. It is carried out after 6-12 months.
The need for it may arise if it is necessary to re-examine the cavities and identify remaining areas of inflammation.
The recovery period is quite easy. Immediately after the operation, swelling appears, and partial numbness of the face may develop. In the first few months you cannot:
Immediately after the operation, the bandage is changed for the first time on the fifth day. If during dressing there is or after it arises, you should immediately inform your doctor about it. When the wound heals slowly, various ointments or ointments are used.
In order to completely get rid of the problem, additional treatment is prescribed.
Previously, a course of antibiotics was required to continue for 5-7 days. Anemization is required, that is, the introduction vasoconstrictor drugs into the pharyngeal mouth auditory tube. If necessary, the wound is treated with antiseptic solutions.
Dressing changes may include additional administration.
Traditional methods are mainly aimed at strengthening the immune system. Cannot be used during the recovery period, but after removing the bandage, chamomile can be used to treat external wounds. Anti-inflammatory decoctions, such as chamomile, are used internally. They allow you to speed up the healing process.
If the wound does not heal well, it is prescribed ultraviolet irradiation. All procedures are prescribed by a doctor. For more quick treatment may be prescribed, but its use is only relevant for the healing of external wounds.
How to treat mastoiditis without surgery in our video:
You should not blow your nose or find yourself in a situation where there is a sudden change in atmospheric pressure. Doctors strongly recommend avoiding open water and swimming pools. It is allowed to make various antiseptic dressings with medications prescribed by the doctor.
Headache, difficulty swallowing. Fever, shortness of breath, nausea and other signs of intoxication may indicate the development of inflammation.
