The term mastoiditis refers to the association of a destructive acute mastoiditis with a subperiosteal abscess that is usually located on the lateral surface of the mastoid or, more rarely, in the neck from the medial cells of the mastoid tip and that typically appears two weeks after the onset of acute otitis media, although it is true that a persistent infection in the mastoid and the presence of granulation tissue in it can cause highly osteolytic lesions without necessarily spreading to the subperiosteal space.
On the other hand, more than 50% of subperiosteal abscesses are due to extensions of soft tissue infections and vascular spread and not due to defects in the mastoid cortex.
Causes of mastoiditis
The most common germ that produces it is pneumococcus, although group A streptococci, Staphylococcus epidermidis, Haemophilus influenzae and anaerobes are also isolated.
In all otitis there is an inflammatory reaction of the mastoid cells, which heals with otitis. When the evolution of an acute suppurative otitis, pus is retained in the mastoid antrum due to the closure of the tympanic perforation, insufficient drainage or because the attic is blocked, the disappearance of the normal communication between the antrum and the layer is caused, which may cause a mastoiditis.
Symptoms of mastoiditis
The patient presents high fever and poor general condition with edema and local erythema that, in 86% of cases, displaces the pinna anteriorly, local symptoms of otitis, ear discharge and spontaneous pain and pressure on mastoids appear.
Almost 50% of acute mastoiditis are associated with a subperiosteal abscess. The presence of a lateral subperiosteal abscess should be suspected in the presence of a zone of retroauricular fluctuation, but it can extend to the root of the zygoma.
Mastoiditis exteriorizations are:
- External, it is the most common with a retroauricular location.
- Anterior, the so-called Gellé fistula, which drains into the posterior wall of the EAC (external auditory canal).
- Lower: Bezold’s mastoiditis between the sternocleidomastoid and digastric muscles and Mouret’s mastoiditis between the digastric and jugular.
How is it diagnosed?
After the symptoms are suspected by the symptoms and the examination, different complementary tests can be performed:
- Otoscopy, the anterior superior wall of the auditory canal falls forward, with a bulging eardrum that drains insufficiently.
- Schuller, Chaussé III and Guillén transorbital projection radiography. The diffuse glaze of all the mastoid cells is seen, and in more advanced cases the rupture of their walls. A typical finding of Schuller is the great dilatation of the mastoid emissary vein.
- CT is the mandatory diagnostic test, since it is capable of identifying very incipient osteolytic lesions in the mastoid but it is not reliable in detecting the presence of intracranial complications.
Treatment of mastoiditis
Treatment is based on a surgical incision of the tympanic membrane with insertion of a transtympanic drainage and culture collection, and on the systemic administration of broad-spectrum parenteral antibiotics for two or three weeks.
In cases of poor evolution, resection of the simple mastoid cortex is indicated.
The evolution should be followed by a control CT to rule out the silent cantonment of purulent material in the mastoid.
How can I avoid it?
Mastoiditis is the most common complication of acute otitis media and always occurs after it.
The clinical detection and examination of AOM (acute otitis media) characterized by fever, general malaise, greater severity the younger age, throbbing pain in the affected ear, decreased hearing, and pressure pain at the tip of the mastoid without sign swallow except in infants and in a second phase with spontaneous tympanic perforation followed by non-fetid suppuration and cessation of earache allows treatment with systemic antibiotics avoiding the appearance of complications such as mastoiditis.
Mastoiditis should be suspected if acute otitis media does not respond to treatment within a week, if there is retroarticular edema, or if local pain appears, even mild, two or three weeks after the onset of otitis.
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.