Petrositis

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Computed tomography of petrositis. Gas (black spots) can be seen as a complication in the adjacent interior of the skull

Under a Petrositis or pyramids (peaks) suppuration is an acute inflammation in the rock portion ( petrous ) of the temporal bone as a rare but dangerous complication of acute otitis media .

Origin and course

If, in the course of a purulent acute otitis media , mastoiditis , a granulating inflammation of the mastoid process of the temporal bone, occurs, pneumatic cavities ("cells") around the bony labyrinth block and in the tip of the temporal bone pyramid can also be removed from the temporal bone Inflammation may be affected. As long as the inflammation is limited to the mucous membrane of the cells and the bony walls between the cells, there are no additional symptoms besides the signs of mastoiditis . However, if the inflammation travels through the bony borders of the petrous pyramid, there is a risk of complications of various kinds due to the close proximity of several cranial nerves , such as the trigeminal nerve and the abducent nerve , as well as venous and arterial blood conductors ( Mastoidectomy ) persist. It then manifests itself in a persistent suppuration from a perforation of the eardrum or a suppurating fistula in the area of ​​the surgical wound behind the ear.

Diagnosis and symptoms

Typical for the pyramidal apex dilatation are intense neuralgiform pains in the vertex, teeth and eyes (supply area of ​​the trigeminal nerve) in the initial phase , often together with paralysis of the abducent nerve ( abducent nerve palsy ). These symptoms, along with persistent suppuration from the ear, are known as gradenigo syndrome . As the inflammation continues to spread, signs of meningitis , brain abscess, or sinus thrombosis may appear. The diagnosis is confirmed by a computed tomography of the temporal bone.

treatment

If there are symptoms of the cranial nerves or there are indications of other complications, surgical treatment with simultaneous antibiotic therapy is required. The aim of the operation is to allow the pus to drain out of the pyramidal apex cells by performing a mastoidectomy (if this has not already been done) and opening the cells around the labyrinth block.

literature

  • Th. Hünermann, D. Plester: The operations on the ear. (= The ear, nose and throat specialist's surgery course. Volume 1). JA Barth, Leipzig 1970, DNB 457736348 .
  • Erhard Lüscher: Textbook of ear medicine. Springer, Vienna 1952.
  • K. Fleischer: Otitis Complications Today. In: H. Ganz, W. Schätzle: ENT practice today. Volume 9, Springer-Verlag, Berlin 1989.
  • ME Glasscock, GE Shambaugh: Surgery of the Ear. WB Saunders, Philadelphia 1990, ISBN 0-7216-2063-9 .