Mastoiditis is paid. Mastoidectomy: types, indications, surgical procedure

Mastoiditis refers to the presence of a purulent inflammatory process in the tissues of the mastoid process of the temporal bone. A number of fascia, ligaments and large muscles of the head and neck are attached to the process. And its cavities are connected to the canals of the temporal bone and the middle ear. Most often, mastoiditis develops against the background of inflammation of the middle ear or other ENT organs, when the infection spreads through the canals of the temporal bone.

The consequences of such a spread are fraught with serious complications - meningitis, encephalitis, abscess or phlegmon of adjacent tissues. Therefore, the treatment of mastoiditis in Israel is a complex of urgent therapeutic and surgical measures.

Symptoms of mastoiditis

A characteristic sign of acute inflammation of the mastoid process of the temporal bone (mastoiditis) is intense pain behind the ear, which increases with head movement (turn, tilt) and radiates to the ear, neck or head. Other symptoms due to which mastoiditis can be suspected:

headache that gets worse at night
body temperature above 38 degrees;
signs of general intoxication (weakness, dizziness);
discharge from the ear (clear, cloudy or yellow);
redness of the skin behind the ear;
neck pain, swallowing disorder.

Given the fact that mastoiditis almost always develops against the background of inflammation of the middle ear, an important sign of the onset of the disease is a sudden exacerbation of symptoms against the background of previous treatment. Usually this consists in an increase in temperature after a few days of its normalization and the further addition of the above symptoms.

The development of mastoiditis against the background of otitis media always occurs if the treatment of the latter was incorrect. This is either the wrong choice of antibiotic (its dose and frequency of administration) or there was no treatment at all. Due to the high risk of developing life-threatening complications, a clear algorithm for diagnosing and treating mastoiditis has been established in Israel.

Diagnostic methods

The main goal of examining a patient with suspected mastoiditis in Israel is not so much a differential diagnosis as finding out the exact localization of the process and determining the prevalence of purulent exudate in the cavities of the temporal bone and adjacent tissues. This is important for choosing further treatment tactics and determining the degree of surgical intervention.

At the Tel Aviv First Medical Center, the decision to treat mastoiditis is made in close cooperation between the otolaryngologist, the maxillofacial surgeon and the head and neck specialist. Diagnostic methods for mastoiditis in Israel include:

bacteriological analysis of discharge from the ear, followed by seeding (to control the sensitivity of the antibiotic).

The most effective methods of treating mastoiditis

Treatment of mastoiditis in Israel can be conservative or radical. First of all, broad-spectrum antibiotics are prescribed with a mandatory audit of the history of antibiotic therapy for the last year. To reduce the risk of developing dangerous complications, additional medication is required in the form of desensitizing agents, anti-inflammatory therapy, agents that improve blood rheology, and so on.

If there is no effect from conservative treatment of mastoiditis decision on surgical intervention is made. Depending on the extent of the process and the involvement of surrounding tissues in Israel perform a sparing or radical mastoidectomy.

With a sparing operation, the cavity of the process is opened and the focus of infection is drained with additional formation of an outflow of pus by dissecting the tympanic septum. In the event that the formation of the middle ear and the temporal bone are involved in the process, a radical mastoidectomy is performed with the removal of the tympanic membrane and surrounding tissues. To further preserve ear function in Israel unique reconstructive surgeries are carried out.

Innovative methods of treatment of mastoiditis in the clinic

Tel Aviv First Medical Center performs gentle procedures of myringotomy, dissection of the tympanic membrane to drain pus from the middle ear and temporal bone canals. Often this manipulation can help to avoid surgery and be limited only to conservative treatment.

Procedure in Israel is carried out using the latest equipment, the whole process is controlled by a computer. Microtubules of a special material are inserted into the holes to prevent fusion. Unique in its kind, operations for the reconstruction of the bones of the middle ear in order to restore hearing function and treatment deafness after radical surgery treatment of mastoiditis.

In Israel such operations are carried out by professional transplantologists, and the smallest bones are created using 3D modeling. In addition, plastic surgeons take an active part in reconstruction operations. Indeed, if the process was running, and the operation required a radical removal of tissues, the appearance of the patient changes. In such a situation, plastic surgery of the mastoid process, ear and scalp is performed.

How to choose a specialist for treatment

On the site, the patient can familiarize himself with the dossiers of all the doctors of the departments of ENT, maxillofacial surgery and head and neck surgeries. All doctors have many years of experience in performing operations on the ear, neck and temporal bone and are the best specialists in Israel. And after acquaintance, the patient can choose treatment from one or another doctor.

Mastoiditis is a pathology of bacterial origin that complicates the course and is manifested by local pain behind the auricle, fever and.

The mastoid process or mastoidus is a bone formation to which muscles are attached, designed to turn and tilt the head. This bony protrusion has a cavity inside that communicates with the middle ear and is separated from the skull by a thin bone plate. The process has a spongy structure: it consists of cavities filled with air and jumpers arranged like a honeycomb. In children, it is finally formed only by the age of 6.

The mastoid process differs in structure:

Pneumatic structure - the cells of the process are filled with air,
Diploetic structure - cells contain bone marrow,
Sclerotic - lack of cells.

The pathological process usually develops in the processes of the pneumatic structure.

Etiology

The causative agents of mastoiditis are conditionally pathogenic and saprophytic microorganisms that live in the human body. When exposed to adverse internal and external factors, they begin to actively multiply, the number of bacteria increases, which leads to the development of pathology. These include:

In addition to bacteria, viruses, fungi, intracellular microbes - mycoplasmas and chlamydia can cause pathology.

Ways of infection:

Otogenic- from the tympanic cavity through a special opening. Mastoiditis is the most common complication of otitis media. This is the main route of infection of the appendix.
Hematogenous- the introduction of microbes with the blood stream in persons who have had syphilitic, septic, diphtheritic, tuberculosis infections.
Traumatic- as a result of injuries, blows, wounds.
Lymphogenic- infection of the process through the lymphatic vessels with purulent lymphadenitis.

Factors that provoke mastoiditis:

Weakened immunity;
Endocrine pathology;
Rheumatoid arthritis;
Chronic diseases of the ENT organs -,;
Previously transferred otitis media;
tuberculosis infection.

Pathogenesis

Stages of development of mastoiditis:

Exudative- inflammation of the mucous cells, periostitis - inflammation of the periosteum, filling the cells with serous-purulent exudate.
destructive- the development of osteomyelitis - inflammation of the bone, destruction of bone tissue, the formation of pus and granulations.
Stage of purulent fusion of the bone accompanied by the development of empyema, necrosis of the bone bridges and the fusion of cells with each other.

There are 5 pathomorphological stages in the development of the inflammatory process in mastoiditis:

Classification

An independent pathology that develops as a result of traumatic injury to the process is primary mastoiditis.

Inflammation of the mastoid process, occurring against the background of diseases of the middle ear, septic or tuberculosis infection - secondary mastoiditis.

Depending on the method of infection, mastoiditis is divided into:

According to the localization of the pathological process, mastoiditis is distinguished:

left hand,
right hand,
Bilateral.

Mastoiditis happens:

Typical with characteristic clinical manifestations,
Atypical, proceeding slowly and sluggishly without the classic symptoms of pathology.

Symptoms

Symptoms of acute mastoiditis are divided into general and local.

Common clinical signs include the following:

Fever,
Signs of intoxication - weakness, fatigue, fatigue,
decreased appetite,
Insomnia,
muscle and joint pain,
A characteristic change in blood counts.

Local signs of pathology:

Bursting and throbbing pain behind the ear, worse at night,
Pastosity and swelling of the skin over the affected area,
The smoothness of the contours of the process,
inflammation of the tympanic membrane,
The exit of purulent contents through the perforation,
Hearing loss.

Each stage of the disease corresponds to a certain symptom complex:

At the first stage, patients are dominated by pain, fever, and the appearance of mucous discharge from the ear. If mastoiditis is not treated, the discharge will become thicker and purulent, and pain and intoxication will increase.
In the second stage, signs of complications of pathology appear.

Chronic mastoiditis complicates the course of the acute form of the disease, and also develops in people who have undergone surgical treatment of acute mastoiditis. The first manifestations may occur several years after the operation.

The disease usually lasts more than three months. The main and sometimes the only clinical sign of chronic mastoiditis are periodically appearing meager with a specific unpleasant odor. In patients, hearing is reduced by the type of sound conduction, the headache becomes constant.

With an exacerbation of the disease, it appears behind the ear with irradiation to the back of the head, upper teeth, parietal region, cheekbones. Then other signs of acute inflammation join. There is profuse suppuration with a characteristic symptom of the "reservoir" - the amount of pus exceeds the volume of the middle ear cavity.

Features of the disease in children

Since the mastoid process is underdeveloped in infants, pus with otitis media penetrates only into the cave of the temporal bone - antrum and leads to the development of purulent anthrite.

Otitis and anthritis are diagnosed in children with reduced body resistance, premature and rickety.

A distinctive feature of the pathology in babies is the rapid development of a subperiosteal abscess, often without destruction of the bone.

Clinical symptoms of mastoiditis in children:

Fever,
Cry,
capriciousness,
restless dream,
Bad appetite
Symptoms of meningism
Profuse purulent discharge.

Otoscopic manifestations: bulging of the tympanic membrane, change in its color, swelling, the appearance of a pulsating reflex at the site of perforation.

Complications

Extracranial consequences of mastoiditis are:

Phlebitis,
thrombophlebitis,
Neuritis and paralysis of the facial nerve,
Inflammation of the inner ear
Purulent mediastinitis.

Intracranial consequences of mastoiditis:

inflammation of the meninges,
meningoencephalitis,
Petrositis - inflammation of the pyramid,
Endophthalmitis and panophthalmitis,
phlegmon of the eye socket,
pharyngeal abscess,
Sepsis.

If the pus breaks out, then the pain intensifies and a fistula appears in the affected area.

If pus breaks into the inner ear, it develops, patients develop dizziness, nystagmus of the eyes, unsteadiness of gait.

The penetration of pus into the cranial cavity leads to the development of severe conditions requiring emergency care - abscess, meningoencephalitis, thrombosis of the sigmoid sinus.

The spread of the pathological process to the facial nerve leads to its inflammation, and in some cases - paralysis. Clinically, this is manifested by an asymmetric mask-like face, omission of the corners of the eyes and mouth on the side of the lesion.

Diagnostics

The diagnosis of mastoiditis is made by an ENT doctor after examination, questioning the patient and obtaining the results of additional research methods.

The doctor palpates the mastoid process otoscopy, microotoscopy and audiometry.
X-ray examination- the main diagnostic method that allows you to determine the degree of damage to the process by the intensity of pneumatization of its cells. The exudative stage is radiologically characterized by a decrease in pneumatization and veiled cells and antrum. At the destructive stage, the X-ray reveals areas of enlightenment due to the formed cavities filled with pus and the destruction of bone tissue.
More accurate and reliable information can be obtained magnetic resonance and computed tomography.
General blood analysis- leukocytosis and increased erythrocyte sedimentation rate.
Microbiological examination of the detachable ear with isolation, complete identification of the pathogen and determination of its sensitivity to antibacterial drugs.

Treatment

Treatment of mastoiditis is carried out in the ENT department under the supervision of a specialist. The volume of therapeutic measures is determined by the stage of pathology and the general condition of the patient.

Patients are given powerful antibiotic therapy with a wide spectrum of antimicrobial agents:

For topical use, it is prescribed with an antibacterial and antiseptic component - "Anauran", "Tsipromed".

In addition to antibiotic therapy, treatment is carried out with sensitizing, detoxifying and immunocorrective drugs, NSAIDs.

With a slight lesion of the bone tissue, patients are prescribed a myringotomy - a puncture of the tympanic membrane to improve the release of the contents and study its bacterial composition.

In the absence of the expected result from antibiotic therapy, they switch to surgical treatment, which consists in the behavior of trepanation of the process - mastoidotomy or its complete removal - mastoidectomy.

During mastoidectomy, the cells and antrum of the temporal bone are opened, the tympanic cavity is drained, pathologically altered elements are removed. With a mastoidectomy, the mastoid process is removed along with the anvil, malleus and remnants of the membrane.

Management of the postoperative period:

Local and systemic administration of antibiotics,
vitamin therapy,
local UFO,
Daily wound care.

Prevention

Preventive measures for mastoiditis include:

Video: mastoiditis in the program “Live healthy”

is an inflammatory lesion of the mastoid process of the temporal bone of infectious origin. Most often, mastoiditis complicates the course of acute otitis media. Clinical manifestations of mastoiditis include an increase in body temperature, intoxication, pain and pulsation in the mastoid process, swelling and hyperemia of the behind-the-ear region, ear pain and hearing loss.

Depending on the cause of occurrence in otolaryngology, primary and secondary are distinguished; otogenic, hematogenous and traumatic mastoiditis.
According to the stage of the inflammatory process, mastoiditis is classified as exudative and true (proliferative-alterative).
Allocate a typical and atypical clinical form of mastoiditis. The atypical (latent) form of mastoiditis is characterized by a slow and sluggish course without pronounced symptoms characteristic of mastoiditis. Separately, a group of apical mastoiditis is distinguished, which includes Bezold's mastoiditis, Orleans' mastoiditis and Mouret's mastoiditis.

Etiology and pathogenesis. The mastoid process is a protrusion of the temporal bone of the skull, located behind the auricle. The internal structure of the process is formed by communicating cells, which are separated from each other by thin bony septa. In different people, the mastoid process may have a different structure. In some cases, it is represented by large air-filled cells (pneumatic structure), in other cases, the cells are small and filled with bone marrow (diploetic structure), in still others, there are practically no cells (sclerotic structure). The course of mastoiditis depends on the type of structure of the mastoid process. The most prone to the appearance of mastoiditis are persons with a pneumatic structure of the mastoid process.The inner walls of the mastoid process separate it from the posterior and middle cranial fossae, and a special opening communicates it with the tympanic cavity. Most cases of mastoiditis occur as a result of the transfer of infection from the tympanic cavity to the mastoid process, which is observed in acute otitis media, in some cases with chronic suppurative otitis media.

Most often, secondary mastoiditis occurs due to the otogenic spread of infection from the tympanic cavity of the middle ear. Its causative agents can be influenza bacillus, pneumococci, streptococci, staphylococci, etc. The transfer of infection from the middle ear cavity is facilitated by a violation of its drainage with late perforation of the eardrum, untimely paracentesis, too small a hole in the eardrum or its closure with granulation tissue.

In rare cases, mastoiditis is observed, which has developed as a result of hematogenous penetration of infection into the mastoid process with sepsis, secondary syphilis, and tuberculosis. Primary mastoiditis occurs when traumatic injuries of the cells of the mastoid process due to a blow, gunshot wound, traumatic brain injury. A favorable environment for the development of pathogenic microorganisms in such cases is the blood that has poured into the cells of the process as a result of injury.

The appearance of mastoiditis is promoted by increased virulence of pathogenic microorganisms, a weakened state of general and local immunity in chronic diseases (diabetes mellitus, tuberculosis, bronchitis, hepatitis, pyelonephritis, rheumatoid arthritis, etc.) and pathology of the nasopharynx (chronic rhinitis, pharyngitis, laryngotracheitis, sinusitis), the presence changes in the structures of the ear due to previous diseases (ear trauma, aerootitis, otitis externa, adhesive otitis media).

The beginning of mastoiditis is characterized by inflammatory changes in the mucous layer of the cells of the mastoid process with the development of periostitis and the accumulation of fluid in the cell cavities. Because of the pronounced exudation, this stage of mastoiditis is called exudative. Inflammatory swelling of the mucosa leads to the closure of the holes that communicate the cells to each other, as well as the hole that connects the mastoid process with the tympanic cavity. As a result of violation of ventilation in the cells of the mastoid process, air pressure drops in them. Along the pressure gradient, transudate from dilated blood vessels begins to flow into the cells. The cells are filled with serous, and then serous-purulent exudate. The duration of the first stage of mastoiditis in adults is 7-10 days, in children more often 4-6 days. Ultimately, the exudative stage of mastoiditis, each cell looks like an empyema - a cavity filled with pus.

Further, mastoiditis passes into the second stage - proliferative-alterative, in which purulent inflammation spreads to the bone walls and septa of the mastoid process with the development of osteomyelitis - purulent fusion of the bone. At the same time, granulation tissue is formed. Gradually, the partitions between the cells are destroyed and one large cavity is formed, filled with pus and granulations. So, as a result of mastoiditis, an empyema of the mastoid process occurs. A breakthrough of pus through the destroyed walls of the mastoid process leads to the spread of purulent inflammation to neighboring structures and the development of complications of mastoiditis.

Clinical picture. Mastoiditis can appear simultaneously with the occurrence of purulent otitis media. But most often it develops on the 7-14th day from the onset of otitis media. In children of the first year of life, due to the peculiarity of the structure of the mastoid process, mastoiditis manifests itself in the form of otoantritis. In adults, mastoiditis manifests as a pronounced deterioration in the general condition with a rise in temperature to febrile numbers, intoxication, headache, and sleep disturbance. Patients with mastoiditis complain of noise and pain in the ear, hearing loss, intense pain behind the ear, a feeling of pulsation in the mastoid process. The pain radiates along the branches of the trigeminal nerve to the temporal and parietal region, orbit, and upper jaw. Less often, with mastoiditis, pain is observed in the entire half of the head.These symptoms with mastoiditis are usually accompanied by profuse suppuration from the external auditory canal. Moreover, the amount of pus is noticeably greater than the volume of the tympanic cavity, which indicates the spread of the purulent process beyond the middle ear. On the other hand, suppuration with mastoiditis may not be observed or be insignificant. This occurs while maintaining the integrity of the tympanic membrane, closing the perforation in it, disrupting the outflow of pus from the mastoid process into the middle ear.

Objectively, with mastoiditis, there is redness and swelling of the behind-the-ear area, smoothness of the skin fold located behind the ear, protrusion of the auricle. With a breakthrough of pus into the subcutaneous fatty tissue, the formation of a subperiosteal abscess occurs, accompanied by severe pain when probing the behind-the-ear region and a symptom of fluctuation. From the region of the mastoid process, pus, exfoliating the soft tissues of the head, can spread to the occipital, parietal, temporal region. The thrombosis of the vessels that supply the cortical layer of the mastoid bone as a result of inflammation leads to necrosis of the periosteum with a breakthrough of pus to the surface of the scalp and the formation of an external fistula.

The spread of purulent inflammation in the mastoid process itself occurs along the most pneumatized cells, which causes a variety of complications arising from mastoiditis and their dependence on the structure of the mastoid process. Inflammation of the perisinus group of cells leads to damage to the sigmoid sinus with the development of phlebitis and thrombophlebitis. Purulent destruction of perifacial cells is accompanied by neuritis of the facial nerve, perilabyrinthine - purulent labyrinthitis. Apical mastoiditis is complicated by the flow of pus into the interfascial spaces of the neck, as a result of which pyogenic microorganisms can penetrate the mediastinum and cause the appearance of purulent mediastinitis.

The spread of the process into the cranial cavity leads to the occurrence of intracranial complications of mastoiditis (meningitis, brain abscess, encephalitis). The defeat of the pyramid of the temporal bone causes the development of petrositis. The transition of purulent inflammation to the zygomatic process is dangerous by further infection in the eyeball with the occurrence of endophthalmitis, panophthalmitis and phlegmon of the orbit. In children, especially younger ones, mastoiditis can be complicated by the formation of a pharyngeal abscess. In addition, with mastoiditis, hematogenous spread of infection with the development of sepsis is possible.

Diagnostics. HIt presents no difficulties for the otolaryngologist. Difficulties arise in the case of an asymptomatic atypical form of mastoiditis. Diagnosis of mastoiditis is based on the characteristic complaints of the patient, anamnestic information about the trauma or inflammation of the middle ear, examination and palpation of the behind-the-ear region, the results of otoscopy, microotoscopy, audiometry, bacteriological discharge from the ear, computed tomography and X-ray examination.

Otoscopy with mastoiditis reveals inflammatory changes typical of otitis media on the part of the tympanic membrane, if there is a hole in it, profuse suppuration is noted. The pathognomonic otoscopic sign of mastoiditis is the overhang of the posterior-upper wall of the auditory canal. Audiometry and a hearing test with a tuning fork make it possible to determine the degree of hearing loss in a patient with mastoiditis.

Aiming radiography of the skull in the exudative stage of mastoiditis reveals cells veiled as a result of inflammation and indistinctly distinguishable partitions between them. The radiological picture of the proliferative-alterative stage of mastoiditis is characterized by the absence of a cellular structure of the mastoid process, instead of which one or more large cavities are determined. The best visualization is achieved with a CT scan of the skull in the region of the temporal bone.

The presence of complications of mastoiditis may require additional consultation with a neurologist, neurosurgeon, dentist, ophthalmologist, thoracic surgeon, MRI and CT of the brain, ophthalmoscopy and biomicroscopy of the eye, CT and X-ray of the chest.

Mastoiditis Treatment.Therapeutic tactics for mastoiditis depends on its etiology, the stage of the inflammatory process and the presence of complications. Drug therapy of mastoiditis is carried out with broad-spectrum antibiotics (cefaclor, ceftibuten, cefixime, cefuroxime, cefotaxime, ceftriaxone, amoxicillin, ciprofloxacin, etc.). Additionally, antihistamine, anti-inflammatory, detoxifying, immunocorrective drugs are used. Complications are treated.With the otogenic nature of mastoiditis, a sanitizing operation on the middle ear is indicated, according to indications, a general cavity operation. The absence of a hole in the tympanic membrane that provides adequate drainage is an indication for paracentesis. Through the opening of the tympanic membrane, the middle ear is washed with drugs. Mastoiditis in the exudative stage can be cured in a conservative way. Mastoiditis of the proliferative-alterative stage requires surgical opening of the mastoid process (mastoidectomy) to eliminate pus and postoperative drainage.

Prevention of otogenic mastoiditis is reduced to the timely diagnosis of inflammatory lesions of the middle ear, adequate treatment of otitis media, timely paracentesis of the tympanic membrane and sanitizing operations. Correct therapy of diseases of the nasopharynx and the rapid elimination of infectious foci also contribute to the prevention of mastoiditis. In addition, it is important to increase the efficiency of the body's immune mechanisms, which is achieved by maintaining a healthy lifestyle, proper nutrition, and, if necessary, immunocorrective therapy.

Without surgical intervention. For this, various groups of antibiotics are used. If conservative treatment is useless, a mastoidectomy is prescribed.

Mastoidectomy: the essence of the procedure

The operation is used to remove from the mastoid process. There are three large groups of such surgical intervention:

Simple. Manipulations are carried out through the ear canal or a small incision behind the ear. After opening the mastoid process, the pus is removed. Then a little is done to ensure.
Radical. Includes complete removal of the eardrum. Almost all structures of the middle ear are eliminated except for the stirrup. This allows the surgical method in the future to carry out surgical intervention.
Modified. In the process of treatment, the integrity of the tympanic membrane and structures is preserved. This has a positive effect on the recovery prognosis.

Indications

The main goal of the operation is to preserve hearing and sanitize the ear. It is carried out in those patients who have pathogenic resistant microflora in the ear canal. can lead to ingrowth of the skin of the ear canal through the damaged area in the eardrum.

Preparation includes:

examination and palpation of the ear area,
otoscopy,
microotoscopy,

Process description

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 steps of the operation are:

The person is immersed in general anesthesia, the head is firmly fixed in the right direction.
An arcuate incision is made at a distance of 1 cm from the sink. If the patient is a child under two years old, then the skin is dissected immediately to the bone.
After layer-by-layer cutting, the bone is visualized. With the help of a special tool, the doctor begins to hollow the bone until the cells of the process appear. In children, the hammer is not used, mostly manipulations are carried out using sharp spoons.
After opening the cells, the purulent masses are removed, drainage is introduced, which contributes to the outflow of pus.
After the operation, they are used, the tampon is fixed and sutured.

Mastoidectomy of the temporal bone in our video:

Postoperative care and recovery

Hospitalization lasts about 5-7 days. A person can return to work 1-3 weeks after discharge.

Sometimes there is a need for 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 the remaining areas of the focus 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 can not:

lift weights,
swim in the pool and ponds,
do not allow water to enter the ear canal,
blow your nose
travel by train and plane.

Immediately after the operation, the bandage is changed for the first time on the fifth day. If there is or after a dressing, you should immediately inform the doctor about this. With slow wound healing, various ointments or are used.

Treatment after surgery

In order to completely get rid of the problem, additional treatment is prescribed.

Medically

Previously, a course of antibiotics was necessarily continued for 5-7 days. Anemization is mandatory, that is, the introduction of vasoconstrictor drugs into the pharyngeal mouth of the auditory tube. The wound, if necessary, is treated with antiseptic solutions.

Dressing changes may include additional administration.

Folk recipes

Folk methods are mainly aimed at strengthening immunity. Cannot be used during the recovery period, but after removing the bandage, chamomile can be used to treat external wounds. Inside, anti-inflammatory decoctions are used, for example, from chamomile. They help speed up the healing process.

Physiotherapy

If the wound does not heal well, ultraviolet irradiation is prescribed. All procedures are prescribed by a doctor. For faster treatment, they may be prescribed, but its use is relevant only for the healing of external wounds.

How to treat mastoiditis without surgery in our video:

What is possible, what is not

You can not blow your nose, get into a situation of a sharp change in atmospheric pressure. Doctors strongly recommend avoiding open water bodies and pools. It is allowed to make various antiseptic dressings with drugs prescribed by a doctor.

Headache, swallowing disorder. Fever, shortness of breath, nausea, and other signs of intoxication may indicate the development of inflammation.

Mastoiditis is an inflammatory type of lesion that covers the region of the temporal bone and has an infectious origin. Most often, this disease occurs as a complication of otitis media. The most common symptoms are pain in the area of the mastoid process of the ear, the presence of edema and a decrease in auditory function.

The mastoid process is a protrusion of the temple bones in the skull and is located behind the shell of the outer ear. Its structure is a set of 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 is right-sided or left-sided.

Causes of the disease

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 eardrum has a too small opening 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:

gunshot wound;
mechanical damage;
traumatic brain injury;
other changes in the ear structure due to an illness (external, middle or aerootitis);
chronic diseases (, tuberculosis,);
nasopharyngeal diseases (,).

Types of illness

There are such forms of the disease, depending on the causes of its occurrence:

primary(occurs after mechanical damage);
secondary(formed against the background of other diseases).

According to the stages, the following types of the disease are distinguished:

exudative(with the release of liquid);
true(with the formation of bone processes).

According to the clinical form, there are:

typical manifestations: headache, pain in the ears;
atypical manifestations in which the disease proceeds almost imperceptibly or there are atypical signs of the disease.

In addition, there are 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 variety that also causes swelling of the neck, a purulent exudate is formed in the area of \u200b\u200bthe eardrum or sternocleidomastoid muscle.

Symptoms of the disease

Symptoms of mastoiditis are different, and it manifests itself, as a rule, along with an average 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 have time to form yet).

The usual symptoms of the disease are:

decreased perception of sounds;
increased body temperature;
headaches;
acute pain behind the ear;
suppuration, which is observed from the external ear canal.

If the volume of suppuration significantly exceeds the size of the tympanic membrane, or if 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 protrusion of the 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, periosteal necrosis, and external fistula formation.

Complications of the disease can be:

intracranial diseases (, encephalitis, blood clots);
facial injuries ();
damage to the functionality of the neck;
eye damage (panophthalmitis);
sepsis.

Diagnosis of the disease

A qualified otolaryngologist can diagnose acute mastoiditis within a few minutes. An exception may be an atypical variety of the disease. Diagnosis is based on the patient's testimony, obtaining an anamnesis of life and illness, as well as palpation of the area located behind the ear. Also, the otolaryngologist will prescribe otoscopy, audiometry, bacterial culture and, and in some cases, x-ray of the skull. This will help to determine the stage of development of the disease. Based on these studies, a diagnosis is made and a treatment plan is drawn up.

Treatment of the disease

Treatment of mastoiditis depends on the cause of occurrence, the nature of the course, as well as the stage of the process of inflammation of the behind-the-ear space. There are such main methods of treatment:

taking antibiotics, the action of which is aimed at destroying the source of infection (Ceftriaxone, Cefixime, Cefotaxime);
taking other medications (antihistamine, detoxification type);
surgical intervention;
physiotherapy;
folk methods.

Taking drugs is also called a conservative method of treatment, but its use is reasonable in the initial stages of mastoiditis, when the disease has not yet penetrated into the tissues of the ear and the skull area. The patient is prescribed drugs of various types of action (to correct immunity, eliminate the consequences and causes of inflammation, and others).

The surgical method is a more effective method of dealing with the disease. The operation is performed on the middle ear, and in the absence of a hole in the tympanic membrane that provides drainage, paracentesis is performed. During the operation, which takes place under anesthesia, the doctor flushes the ear opening with various medications, cuts the periosteum, removes the upper bone plate behind the ear, and then sews up the wound. The patient must be hospitalized and dressed daily until the wound is completely healed.

Treatment of mastoiditis with the help of physiotherapy involves the application of warm compresses, UHF therapy, and ultraviolet irradiation of the patient. Folk methods, like physiotherapy, are usually auxiliary, but not basic.

There are many folk recipes for getting rid of the disease, including:

hot onion treatment. It is supposed to bake the onion until soft, put a piece of butter and onion on cheesecloth, wrap and insert into the ear canal for 1-2 minutes. After wrapping the patient's head with a warm blanket or scarf;
bread crust treatment. It is supposed to be heated from both sides with a water bath, and then applied to the ear, warming it.

Disease prevention

You can prevent this disease if:

timely detect signs of an inflammatory type of lesion;
qualitatively treat emerging otitis media;
carry out sanitizing-type manipulations (clean the ear from dirt, excess sulfur, etc.);
live a healthy life;
eat right (keep the balance of proteins, fats, carbohydrates and vitamins);
to carry out immunoregulatory therapy.

Is everything correct in the article from a medical point of view?

Answer only if you have proven medical knowledge