Mastoidit — inflammatory defeat of a mastoidal shoot of a temporal bone of infectious genesis. Most often mastoidit complicates the course of sharp average otitis. Clinical manifestations of a mastoidit include rise in body temperature, intoxication, pains and a pulsation in the field of a mastoidal shoot, puffiness and hyperaemia of zaushny area, ear pain and decrease in hearing. Objective inspection at a mastoidita consists in survey and a palpation of zaushny area, an otoskopiya, an audiometriya, a X-ray analysis and KT of the skull, bacteriological crops separated from an ear. Treatment of a mastoidit can be medicamentous and surgical. Antibiotic treatment and sanitation of the purulent centers in a drum cavity and a mastoidal shoot is its cornerstone.
The mastoidal shoot represents the ledge of a temporal bone of a skull located behind an auricle. The internal structure of a shoot is created by the reported cells which are divided among themselves by thin bone partitions. At different people the mastoidal shoot can have various structure. In one cases it is presented by the large cells (a pneumatic structure) filled with air, in other cases of a cell small and are filled with marrow (a diploetichesky structure), in the third — there are practically no cells (a sclerous structure). The current of a mastoidit depends on type of a structure of a mastoidal shoot. Are most inclined to emergence of a mastoidit of the person with a pneumatic structure of a mastoidal shoot.
Internal walls of a mastoidal shoot separate it from back and average cranial poles, and the special opening reports it with a drum cavity. The majority of cases of a mastoidit arises as a result of transition of an infection from a drum cavity in a mastoidal shoot that is observed at sharp average otitis, in some cases at chronic purulent average otitis.
Causes of a mastoidit
Most often there is secondary mastoidit, caused by otogenny spread of an infection from a drum cavity of a middle ear. The influenza stick, pneumococci, streptococci, staphylococcus, etc. can be its activators. Transition of an infection from a cavity of a middle ear is promoted by violation of its drainage at a late perforation of an eardrum, untimely carrying out a paratsentez, too small opening in an eardrum or its closing with granulyatsionny fabric.
It is in rare instances observed mastoidit, developed in a consequence of hematogenic penetration of an infection into a mastoidal shoot at sepsis, secondary syphilis, tuberculosis. Primary mastoidit arises at traumatic damages of cells of a mastoidal shoot owing to blow, a gunshot wound, a craniocereberal trauma. The favorable environment for development of pathogenic microorganisms in such cases is the blood which streamed in shoot cells as a result of a trauma.
Emergence of a mastoidit is promoted by the increased virulence of pathogenic microorganisms, the weakened condition of the general and local immunity at chronic diseases (diabetes, tuberculosis, bronchitis, hepatitis, pyelonephritis, rheumatoid arthritis and so forth) and nasopharynx pathologies (chronic rhinitis, pharyngitis, laryngotracheitis, sinusitis), existence of changes in structures of an ear in connection with the diseases (ear injuries, aero otitis, external otitis, adhesive average otitis) postponed earlier.
Pathogenesis of a mastoidit
The beginning of a mastoidit is characterized by inflammatory changes of a mucous layer of cells of a mastoidal shoot with development of a periostit and a congestion of liquid in cavities of cells. Because of the expressed ekssudation this stage of a mastoidit received the name of ekssudativny. Inflammatory puffiness of mucous leads to closing of the openings reporting cells among themselves and also the opening connecting a mastoidal shoot to a drum cavity. As a result of violation of ventilation in cells of a mastoidal shoot, in them air pressure falls. On a gradient of pressure begins to come to cells from expanded blood vessels. Cells are filled with serous, and then serous and purulent exudate. Duration of the first stage of a mastoidit at adults makes 7-10 days, at children 4-6 days are more often. Finally an ekssudativny stage of a mastoidit each cell has an empiyema appearance — the cavity filled with pus.
Further mastoidit passes into the second stage — proliferative in which the purulent inflammation extends to bone walls and partitions of a mastoidal shoot with development of osteomyelitis — purulent fusion of a bone. Along with it there is a formation of granulyatsionny fabric. Gradually partitions between cells collapse and one big cavity filled with pus and granulations is formed. So, the mastoidita results from an empiyem of a mastoidal shoot. The break of pus through the destroyed walls of a mastoidal shoot leads to distribution of a purulent inflammation on the next structures and to development of complications of a mastoidit.
Classification of a mastoidit
Depending on the cause in otolaryngology distinguish primary and secondary; otogenny, hematogenic and traumatic mastoidit. On a stage of inflammatory process mastoidit it is classified as ekssudativny and true (proliferative ).
Allocate a typical and atypical clinical form of a mastoidit. The atypical (latent) form of a mastoidit differs in a slow and sluggish current without pronounced symptoms, characteristic of a mastoidit. Separately allocate group of top mastoidit which treats mastoidit Betsold, mastoidit Orleans and mastoidit Mouret.
Symptoms of a mastoidit
Mastoidit can appear along with developing of purulent average otitis. But most often it develops for 7-14 day from the beginning of otitis. At children of the first year of life because of feature of a structure of a mastoidal shoot mastoidit it is shown in the form of an otoantrit. At adults mastoidit demonstrates the expressed deterioration in the general state with rise in temperature to febrilny figures, intoxication, a headache, a sleep disorder. Patients mastoidity complain of noise and ear pain, deterioration in hearing, intensive pain behind an ear, feeling of a pulsation in the field of a mastoidal shoot. Pain irradiates on branches of a trigeminal nerve to the temporal and parietal area, an orbit, the top jaw. Less often at a mastoidita pain in all half of the head is observed.
The specified symptoms at a mastoidita usually are followed by a plentiful gnoyetecheniye from external acoustical pass. And the amount of pus is much more, than the volume of a drum cavity that demonstrates distribution of purulent process out of limits of a middle ear. On the other hand, the gnoyetecheniye at a mastoidita can not be observed or be insignificant. It comes at preservation of integrity of an eardrum, closing of a perforative opening in it, violation of outflow of pus from a mastoidal shoot in a middle ear.
Objectively at a mastoidita reddening and puffiness of zaushny area, a smoothness of the skin fold located behind an ear, an auricle ottopyrennost is noted. At break of pus in hypodermic fatty cellulose there is a formation of the subperiostalny abscess which is followed by sharp morbidity when probing zaushny area and a fluctuation symptom. From area of a mastoidal shoot pus, stratifying soft tissues of the head, can extend to occipital, parietal, temporal area. Resulting from an inflammation trombirovany vessels, krovosnabzhayushchy a kortikalny layer of a bone of a mastoidal shoot, leads to a periosteum necrosis with break of pus on the surface of head skin and formation of external fistula.
Complications of a mastoidit
Distribution of a purulent inflammation in the most mastoidal shoot happens on the most pneumatitized cells that causes a variety of the complications arising at a mastoidita and their dependence on a structure of a mastoidal shoot. The inflammation of perisinuozny group of cells leads to defeat of a sigmovidny sine with development of phlebitis and thrombophlebitis. Purulent destruction of perifatsialny cells is followed by neuritis of a facial nerve, perilabirintny — a purulent labirintit. Top mastoidita are complicated by pus flowing in mezhfastsialny spaces of a neck therefore gnoyerodny microorganisms can get into a sredosteniye and cause emergence of a purulent mediastinit.
Distribution of process to a cavity of a skull leads to emergence of intra cranial complications of a mastoidit (meningitis, abscess of a brain, encephalitis). Defeat of a pyramid of a temporal bone causes development of a petrozit. Transition of a purulent inflammation to a malar shoot is dangerous by a further drift of an infection in an eyeball with emergence of an endoftalmit, panoftalmit and phlegmon of an eye-socket. At children, especially younger age, mastoidit can be complicated by formation of zaglotochny abscess. Besides, at a mastoidita perhaps hematogenic spread of an infection with development of sepsis.
Diagnostics of a mastoidit
As a rule, diagnostics of a mastoidit does not represent any difficulties for the otolaryngologist. Difficulties arise in case of a malosimptomny atypical form of a mastoidit. Diagnostics of a mastoidit is based on characteristic complaints of the patient, anamnestichesky data on the postponed trauma or an inflammation of a middle ear, this survey and a palpation of zaushny area, results of an otoskopiya, mikrootoskopiya, audiometriya, bakposev of allocations from an ear, a computer tomography and a radiological research.
Otoskopiya at a mastoidita reveals inflammatory changes, typical for average otitis, from an eardrum, at existence of an opening in it the plentiful gnoyetecheniye is noted. The Patognomonichny otoskopichesky sign of a mastoidit is the overhang of the back and top wall of acoustical pass. Audiometriya and a research of hearing allow to establish by a tuning fork relative deafness degree at the patient with mastoidity.
The aim X-ray analysis of a skull (X-ray analysis of a temporal bone) in an ekssudativny stage of a mastoidit finds the cells and indistinctly distinguishable partitions veiled as a result of an inflammation between them. The radiological picture proliferative stages of a mastoidit is characterized by absence of cellular structure of a mastoidal shoot instead of which one or several big cavities are defined. The best visualization is reached when carrying out KT of a skull in a temporal bone.
Existence of complications of a mastoidit can demand additional consultation of the neurologist, the neurosurgeon, the stomatologist, the ophthalmologist, the thoracic surgeon, carrying out MPT and KT of a brain, an oftalmoskopiya and biomicroscopy of an eye, KT and a X-ray analysis of bodies of a thorax.
Treatment of a mastoidit
Medical tactics at a mastoidita depends on its etiology, a stage of inflammatory process and existence of complications. Medicamentous therapy of a mastoidit is carried out by antibiotics of a broad spectrum of activity (a tsefaklor, , tsefiksy, tsefuroksy, tsefotaksy, , amoxicillin, ciprofloxacin, etc.). In addition apply antihistaminic, anti-inflammatory, detoksikatsionny, immunokorregiruyushchy medicines. Carry out treatment of complications.
At the otogenny nature of a mastoidit the sanifying a middle ear operation, according to indications — obshchepolostny operation is shown. Absence in an eardrum of the opening providing adequate drainage is the indication to carrying out a paratsentez. Through an opening of an eardrum make washings of a middle ear medicines. Mastoidit in an ekssudativny stage it can be cured in the conservative way. Mastoidit proliferative a stage demands surgical opening of a mastoidal shoot (mastoidotomiya) for elimination of pus and postoperative drainage.
Prevention of a mastoidit
The prevention of an otogenny mastoidit comes down to timely diagnostics of inflammatory damage of a middle ear, adequate treatment of otitises, timely carrying out a paratsentez of an eardrum and the sanifying operations. Correct therapy of diseases of a nasopharynx and bystry elimination of the infectious centers also promote prevention of a mastoidit. Besides, increase in operability of immune mechanisms of an organism matters that is reached by maintaining a healthy lifestyle, healthy nutrition, if necessary — immunokorregiruyushchy therapy.