Mastoiditis

Under a Mastoiditis is an acute inflammation in the mastoid process ( mastoid process ) of the temporal bone with Knocheneinschmelzung. The mastoiditis is a complication of acute otitis media.

The onset and progression

In any stronger acute otitis media and the mucosa of the mastoid cells in inflammation participates. Usually this mucositis heals with otitis media and requires no specific therapeutic measures.

However, when it comes mastoiditis from the inflamed mucosa in a herd osteoclastic shaped Knocheneinschmelzung. The Einschmelzungsherde unite to form one or more large abscess cavities. At the same time there is an osteoblastic ( bone-forming ) inflammation of the bone, so run that attachment and removal of the bone next to each other. These changes affect almost only the walls of the mastoid air cells, and do not exceed the pneumatic cells so that there is no osteomyelitis.

However, due to melting of the cortical bone of the mastoid process there will be a spread of the inflammation to the soft tissues of the neighborhood or on the inside of the skull. The Einschmelzungsvorgänge go relatively slowly, so that the mastoiditis usually only in the third or fourth week will significantly after the otitis media. The incipient breakthrough outward makes in a pressure- painful edematous swelling behind the ear noticeable, which is rapidly becoming a fluctuating subperiosteal abscess. The auricle is characterized as typically. Presented to the pneumatization in the zygomatic arch, the breakthrough can be done here as well, which leads to a swelling of the face page. There is often also a breakthrough of the pus through the bony wall of the meatus, so that the ear canal skin is lifted, what appears as a reduction of the posterior superior wall of the meatus. In pneumatized mastoid tip of the breakthrough can be made in tackling the problem here musculature ( sternocleidomastoid muscle ). This so-called Bezold mastoiditis resulting in large Senkungsabszessen in the neck muscles, and even up into the mediastinum. A particularly promising complications result of mastoiditis is the Pyramidenspitzeneiterung ( petrositis ).

The openings to the outside to go to the break in the cranial cavity usually ahead of time, so the diagnosis before the life-threatening intracranial complications can be provided. The consequences of an opening in the cranial cavity include epidural abscess, meningitis, sinus thrombosis and brain abscess.

In part, has described the classic clinical picture - apparently under the influence of antibiotic treatment - modified, the granulating inflammation in the mastoid process takes place only occasionally paraphrased from, without any tangible symptoms such as pain or fever. We speak in these cases of " chronic mastoiditis " or a " masked mastoiditis ," which can often remain for months. However, the chronic mastoiditis can also lead to endocranial complications, an improperly ausheilende acute otitis media is therefore to be considered until normalization of the tympanic membrane findings and hearing as suspicious.

Diagnosis and Symptoms

Typical of the mastoiditis is the recent increase in ear pain in acute otitis media after initial improvement, or the unchanged continuation of the complaints about the third week of illness beyond. The purulent discharge from the ear canal persists or occurs again and the eardrum is unchanged thickening and redness. The tenderness behind the ear and a reduction of the posterior superior wall of the meatus make the diagnosis sure a swelling behind the ear with protrusion of the auricle leave no doubt. A radiograph and computed tomography in particular show a bony focus of destruction.

Treatment

In the typical form of mastoiditis the operation is in the form of a mastoidectomy (see radical cavity ) imperative. Here, the bone of the mastoid is exposed behind the ear, milled and dispelled the mastoid. In chronic mastoiditis can - if no complication characters are - high-dose broad-band antibiotic treatment be carried out at least over a week. However, remains a complete recovery from the mastoidectomy is also displayed here.