Under a mastoiditis is an acute inflammation in the mastoid ( mastoid process ) of the temporal bone with Knocheneinschmelzung. Mastoiditis is a complication of acute otitis media .
Origin and course
With every severe acute otitis media, the mucous membrane of the mastoid cells also participates in the inflammation. As a rule, this inflammation of the mucous membrane heals with otitis media and does not require any special therapeutic measures.
In mastoiditis, however, the inflamed mucous membrane leads to an osteoclastic focal bone fusion. The foci of fusion combine to form one or more large abscess cavities . At the same time, there is an osteoblastic (bone-forming) bone inflammation, so that the cultivation and degradation of the bone take place side by side. These changes almost always only affect the walls of the mastoid cells and do not cross the pneumatic cells, so that osteomyelitis does not occur.
However, when the cortex of the mastoid process melts, the inflammation spreads to the soft tissues in the vicinity or to the inside of the skull. The melting process is relatively slow, so that the mastoiditis usually only becomes apparent in the third or fourth week after the otitis media. The incipient breakthrough to the outside becomes noticeable in a tender edematous swelling behind the ear, which quickly turns into a fluctuating subperiosteal abscess. The auricle stands out in a typical way. If the pneumatization extends into the zygomatic arch , the breakthrough can also occur here, which leads to swelling of the face. At the same time, there is often a breakthrough of the pus through the bony wall of the ear canal , which lifts the skin of the ear canal, which appears as a depression of the posterior upper wall of the ear canal. If the tip of the mastoid process is pneumatized, the breakthrough into the muscles attached here ( sternocleidomastoid muscle ) can occur. This so-called Bezold mastoiditis leads to large subsidence abscesses in the neck muscles and even into the mediastinum . A particularly complicated consequence of mastoiditis is the pyramidal tip dilatation ( petrositis ).
The breakthroughs to the outside usually precede the breakthrough into the interior of the skull, so that the diagnosis can be made before the life-threatening intracranial complications. The consequences of a breakthrough in the interior of the skull include epidural abscess , meningitis , sinus thrombosis and brain abscess .
In some cases, the described classic clinical picture has changed - apparently under the influence of antibiotic treatment - the granulating inflammation in the mastoid process sometimes only takes place in a circumscribed manner , without any tangible symptoms such as pain or fever. In these cases, one speaks of “chronic mastoiditis” or “masked mastoiditis”, which can often persist for months. Chronic mastoiditis can, however, also lead to endocranial complications; an acute otitis media that does not heal properly should therefore be regarded as suspicious until the eardrum and hearing have normalized.
Diagnosis and symptoms
Typical of mastoiditis is the renewed increase in ear pain in an acute otitis media after initial improvement or the unchanged persistence of the symptoms beyond the third week of illness. The purulent discharge from the ear canal persists or occurs again and the eardrum continues to show thickening and reddening. The sensitivity to pressure behind the ear and a lowering of the posterior upper wall of the auditory canal make the diagnosis certain, a swelling behind the ear with protruding the auricle leaves no room for doubt. An x-ray and especially the computed tomography show a bony focus of destruction.
In the typical form of mastoiditis, surgery in the form of a mastoidectomy (see radical cavity ) is mandatory. The mastoid process is exposed behind the ear, milled open and the mastoid process is removed. In chronic mastoiditis, if there are no signs of complications, high-dose and broad-spectrum antibiotic treatment can be carried out for at least one week. However, if there is no complete healing, a mastoidectomy is also indicated here.
- Erhard Lüscher: Textbook of ear medicine. Springer, Vienna 1952.
- K. Fleischer: Otitis Complications Today , in: ENT Practice Today, Vol. 9, ed. by H. Ganz and W. Schätzle, Springer, Berlin 1989.
- Michael E. Glasscock , George E. Shambaugh Jr .: Surgery of the Ear . WB Saunders, Philadelphia 1990.
- Alexander Rauchfuss : The mastoiditis and its complications , in: Microbiological aspects in diseases in the ENT area. Modern diagnostics and therapy . Gustav Fischer Verlag, Stuttgart New York 1990.