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Inflammatory diseases of the mastoid ear. Mastoiditis: what is this disease and how is it treated? How dangerous can the disease be? The most common complications

Articles 37 and 38

Disease schedule article
Disease schedule article		graph	II Count	III Count
	Diseases of the external ear (including congenital):
	a) congenital absence of the auricle
	b) bilateral microtia
	c) unilateral microtia, eczema of the external auditory canal and auricle, chronic diffuse external otitis, external otitis with mycoses, congenital and acquired narrowing of the external auditory canal	B-3
	Diseases of the middle ear and mastoid process:
	a) bilateral or unilateral chronic otitis media, accompanied by polyps, granulations in the tympanic cavity, bone caries and (or) combined with chronic diseases of the paranasal sinuses			(B - IND)
	b) bilateral or unilateral chronic otitis media, not accompanied by polyps, granulations in the tympanic cavity, bone caries and (or) not combined with chronic diseases of the paranasal sinuses
	c) residual effects of previous otitis media, diseases with persistent ear barofunction disorder	B-3

TO Paragraph “a” also includes:

- bilateral or unilateral chronic purulent otitis media, accompanied by persistent difficulty in nasal breathing;

— conditions after surgical treatment of chronic diseases of the middle ear with incomplete epidermization of the postoperative cavity in the presence of pus, granulations, cholesteatoma masses;

- bilateral persistent dry perforations of the eardrum, the condition after radical operations on both ears or the condition after open tympanoplasty with complete epidermization of the postoperative cavities - in relation to persons examined under columns I, II of the disease schedule.

Persistent dry perforation of the eardrum should be understood as the presence of perforation of the eardrum in the absence of inflammation of the middle ear for 12 months or more.

The presence of chronic purulent otitis media must be confirmed by otoscopic data (perforation of the tympanic membrane, discharge from the tympanic cavity), culture of discharge from the tympanic cavity for microflora, radiography of the temporal bones according to Schüller and Mayer, or computed tomography of the temporal bones.

TO Point “c” includes unilateral persistent dry perforations of the tympanic membrane, adhesive otitis media, tympanosclerosis, as well as the condition after a radical operation or open tympanoplasty performed 12 or more months ago on one ear with complete epidermization of the postoperative cavity.

Persistent impairment of ear barofunction is determined based on repeated studies.

Article 39

Disease schedule article	Name of diseases, degree of dysfunction
Disease schedule article	Name of diseases, degree of dysfunction	graph	II Count	III Count
	Vestibular function disorders:
	a) persistent, significant vestibular disorders
	b) unstable moderate vestibular disorders			(B - IND)
	c) persistent and significantly pronounced sensitivity to vestibular stimulation	B-3

In case of vestibular disorders, examination data are assessed together with a neurologist.

TO Point “a” includes pronounced vestibulopathies, attacks of which were observed during examination in an inpatient setting and confirmed by medical documents.

TO Point “b” includes cases of vestibulopathy, attacks of which last a short time with moderately expressed vestibular-vegetative reactions.

TO Point “c” includes cases of sharply increased sensitivity to motion sickness in the absence of symptoms of vestibular disorders and diseases of other organs.

The results of vestibulometry are assessed together with a neurologist. If the temporary nature of vestibular disorders is indicated, a comprehensive examination and treatment in an inpatient setting is necessary.

Article 40

Disease schedule article	Name of diseases, degree of dysfunction
Disease schedule article	Name of diseases, degree of dysfunction	graph	II Count	III Count
	Deafness, deaf-muteness, hearing loss:
	a) deafness in both ears or deaf-muteness
	b) persistent hearing loss in the absence of perception of whispered speech in one ear and when perceiving whispered speech at a distance of up to 3 m in the other ear or persistent decrease in hearing when perceiving whispered speech at a distance of up to 1 m in one ear and at a distance of up to 2 m in the other ear			(B - IND)
	c) persistent hearing loss in the absence of perception of whispered speech in one ear and when perceiving whispered speech at a distance of more than 3 m in the other ear or persistent decrease in hearing when perceiving whispered speech at a distance of up to 2 m in one ear and at a distance of up to 3 m in the other ear

Deafness in both ears or deaf-muteness must be certified by medical organizations, organizations or educational institutions for the deaf. Deafness should be considered the lack of perception of screams at the auricle.

When determining the degree of hearing loss, special research methods are required using whispered and spoken speech, tuning forks, pure-tone threshold audiometry with the obligatory determination of barofunction of the ears.

In case of hearing loss, which determines a change in the category of fitness for military service, these studies are carried out repeatedly (at least 3 times during the examination period).

If deafness is suspected in one or both ears, the experiments of Govseev, Lombar, Shtenger, Khilov and other experiments or methods of objective audiometry (registration of auditory evoked potentials, otoacoustic emissions, etc.) are used. If the interaural difference in the perception of whispered speech is more than 3 meters, an X-ray of the temporal bones according to Stenvers or a computed tomography of the temporal bones is performed.

Article 41

A good result of tympanoplasty is considered to be restoration of the integrity of the eardrum and improvement of hearing. After tympanoplasty on one ear with good results, citizens upon initial military registration, conscription for military service (military training) and upon entry into military service under a contract or into military educational institutions are recognized as temporarily unfit for military service for a period of 12 months after the operation performed. After this period, a conclusion on the category of fitness for military service is made taking into account the impairment in the perception of whispered speech. In the absence of hearing impairment, citizens are considered fit for military service. If there is hearing loss, the examination is carried out taking into account the requirements of Article 40 of the disease schedule.

Disease schedule article
Disease schedule article
	Diseases of the external ear (including congenital):
	a) congenital absence of the auricle
	b) bilateral microtia
	c) unilateral microtia, eczema of the external auditory canal and auricle, chronic diffuse external otitis, external otitis with mycoses, congenital and acquired narrowing of the external auditory canal
	Diseases of the middle ear and mastoid process:
	a) bilateral or unilateral chronic otitis media, accompanied by polyps, granulations in the tympanic cavity, bone caries and (or) combined with chronic diseases of the paranasal sinuses	B (V - IND)
	b) bilateral or unilateral chronic otitis media, not accompanied by polyps, granulations in the tympanic cavity, bone caries and (or) not combined with chronic diseases of the paranasal sinuses
	c) residual effects of previous otitis media, diseases with persistent ear barofunction disorder

Point "a" also includes:

bilateral or unilateral chronic purulent otitis media, accompanied by persistent difficulty in nasal breathing;
conditions after surgical treatment of chronic diseases of the middle ear with incomplete epidermization of the postoperative cavity in the presence of pus, granulations, cholesteatoma masses;
bilateral persistent dry perforations of the eardrum, the condition after radical operations on both ears or the condition after open tympanoplasty with complete epidermization of postoperative cavities - in relation to persons examined under columns I, II of the disease schedule.

Persistent dry perforation of the eardrum should be understood as the presence of perforation of the eardrum in the absence of inflammation of the middle ear for 12 months or more.

Point “c” includes unilateral persistent dry perforations of the eardrum, adhesive otitis media, tympanosclerosis, as well as the condition after a radical operation or open tympanoplasty performed 12 or more months ago on one ear with complete epidermization of the postoperative cavity.

Persistent impairment of ear barofunction is determined based on repeated studies.

In case of vestibular disorders, examination data are assessed together with a neurologist.

Point “a” includes pronounced vestibulopathies, attacks of which were observed during examination in an inpatient setting and confirmed by medical documents.

Point “b” includes cases of vestibulopathy, the attacks of which last a short time with moderately pronounced vestibular-vegetative reactions.

Point “c” includes cases of sharply increased sensitivity to motion sickness in the absence of symptoms of vestibular disorders and diseases of other organs.

Disease schedule article	Name of diseases, degree of dysfunction
Disease schedule article	Name of diseases, degree of dysfunction
	Deafness, deaf-muteness, hearing loss:
	a) deafness in both ears or deaf-muteness
	b) persistent hearing loss in the absence of perception of whispered speech in one ear and when perceiving whispered speech at a distance of up to 3 m in the other ear or persistent decrease in hearing when perceiving whispered speech at a distance of up to 1 m in one ear and at a distance of up to 2 m in the other ear	B (V - IND)
	c) persistent hearing loss in the absence of perception of whispered speech in one ear and when perceiving whispered speech at a distance of more than 3 m in the other ear or persistent decrease in hearing when perceiving whispered speech at a distance of up to 2 m in one ear and at a distance of up to 3 m in the other ear

In case of hearing loss, which determines a change in the category of fitness for military service, these studies are carried out repeatedly (at least 3 times during the examination period).

A good result of tympanoplasty is considered to be restoration of the integrity of the eardrum and improvement of hearing. After tympanoplasty on one ear with good results, citizens upon initial military registration, conscription for military service (military training) and upon admission to military service under a contract or to military educational institutions are recognized as temporarily unfit for military service for a period of 12 months after the operation performed. After this period, a conclusion on the category of fitness for military service is made taking into account the impairment in the perception of whispered speech. In the absence of hearing impairment, citizens are considered fit for military service. If there is hearing loss, the examination is carried out taking into account the requirements of Article 40 of the disease schedule.

Disease schedule article
Disease schedule article		I Count	II Count	III Count
37	Diseases of the external ear (including congenital):
	a) congenital absence of the auricle	D	D	D
	b) bilateral microtia	IN	IN	B
	c) unilateral microtia, eczema of the external auditory canal and auricle, chronic diffuse external otitis, external otitis with mycoses, congenital and acquired narrowing of the external auditory canal	B-3	B	B
38	Diseases of the middle ear and mastoid process:
	a) bilateral or unilateral chronic otitis media, accompanied by polyps, granulations in the tympanic cavity, bone caries and (or) combined with chronic diseases of the paranasal sinuses	IN	IN	B (V - IND)
	b) bilateral or unilateral chronic otitis media, not accompanied by polyps, granulations in the tympanic cavity, bone caries and (or) not combined with chronic diseases of the paranasal sinuses	IN	IN	B
	c) residual effects of previous otitis media, diseases with persistent ear barofunction disorder	B-3	B	A

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Point "a" also includes:

bilateral or unilateral chronic purulent otitis media, accompanied by persistent difficulty in nasal breathing;
conditions after surgical treatment of chronic diseases of the middle ear with incomplete epidermization of the postoperative cavity in the presence of pus, granulations, cholesteatoma masses;
bilateral persistent dry perforations of the eardrum, the condition after radical operations on both ears or the condition after open tympanoplasty with complete epidermization of postoperative cavities - in relation to persons examined under columns I, II of the disease schedule.

Persistent dry perforation of the eardrum should be understood as the presence of perforation of the eardrum in the absence of inflammation of the middle ear for 12 months or more.

Persistent impairment of ear barofunction is determined based on repeated studies.

Disease schedule article	Name of diseases, degree of dysfunction	Category of suitability for military service
Disease schedule article	Name of diseases, degree of dysfunction	I Count	II Count	III Count
39	Functional disorders: vestibular
	a) persistent severe disorders, significant vestibular disorders	D	D	D
	b) unstable moderate vestibular disorders	IN	IN	B (V - IND)
	c) persistent and significantly pronounced sensitivity to vestibular stimulation	B-3	B	A

Be careful: the presence of a disease in the Schedule of Diseases does not guarantee exemption from military service.

Thousands of clients of the Conscript Assistance Service received military ID cards for health reasons. Consult us and find out your chances of being exempt from conscription.

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In case of vestibular disorders, examination data are assessed together with a neurologist.

Point “a” includes pronounced vestibulopathies, attacks of which were observed during examination in an inpatient setting and confirmed by medical documents.

Point “b” includes cases of vestibulopathy, the attacks of which last a short time with moderately pronounced vestibular-vegetative reactions.

Point “c” includes cases of sharply increased sensitivity to motion sickness in the absence of symptoms of vestibular disorders and diseases of other organs.

Disease schedule article	Name of diseases, degree of dysfunction	Category of suitability for military service
Disease schedule article	Name of diseases, degree of dysfunction	I Count	II Count	III Count
40	Deafness, deaf-muteness, hearing loss:
	a) deafness in both ears or deaf-muteness	D	D	D
	b) persistent hearing loss in the absence of perception of whispered speech in one ear and when perceiving whispered speech at a distance of up to 3 m in the other ear or persistent decrease in hearing when perceiving whispered speech at a distance of up to 1 m in one ear and at a distance of up to 2 m in the other ear	IN	IN	B (V - IND)
	c) persistent hearing loss in the absence of perception of whispered speech in one ear and when perceiving whispered speech at a distance of more than 3 m in the other ear or persistent decrease in hearing when perceiving whispered speech at a distance of up to 2 m in one ear and at a distance of up to 3 m in the other ear	IN	IN	B

Be careful: the presence of a disease in the Schedule of Diseases does not guarantee exemption from military service.

Thousands of clients of the Conscript Assistance Service received military ID cards for health reasons. Consult us and find out your chances of being exempt from conscription.

Get help

In case of hearing loss, which determines a change in the category of fitness for military service, these studies are carried out repeatedly (at least 3 times during the examination period).

Be careful: the presence of a disease in the Schedule of Diseases does not guarantee exemption from military service.

Thousands of clients of the Conscript Assistance Service received military ID cards for health reasons. Consult us and find out your chances of being exempt from conscription.

Get help

In the absence of hearing impairment, citizens are considered fit for military service. If there is hearing loss, the examination is carried out taking into account the requirements of Article 40 of the disease schedule.

Represents the lower part of the temporal bone. If we talk about its location, it is located below and behind the main part of the skull.

The mastoid process has the shape of an inverted cone with the apex facing downwards and the base facing upwards. The shape and size of the process are very diverse. It distinguishes between the outer and inner surfaces.

Its outer surface (planum mastoideum) is more or less smooth, only the apex is rough from the attached m. sterno-cleido-mastoideus. The upper boundary of the process is the linea temporalis, which forms a posterior continuation of the zygomatic arch and corresponds to the bottom of the middle cranial fossa.

Below the linea temporalis, at the level of the external auditory canal and immediately behind it, on the planum there is a small flat fossa - fossa mastoidea. The upper-posterior wall of the external auditory canal almost always has a spine - spina supra meatum seu spina Henle, and behind it a fossa - fossa supra meatum. They are very important reference points during mastoid surgery.

The mastoid process is absent at birth. The bony walls of the tympanic cavity and antrum consist of infantile diploetic bone, i.e. bone with red lymphoid bone marrow. From the growth of this bone the mastoid process is formed.

Lymphoid bone marrow turns into mucous: lymphoid cellular elements disappear in it. Mucous bone marrow is completely similar to myxoid tissue. When the bone walls are reabsorbed, the mucous bone marrow finds itself in the same conditions as the embryonic myxondal tissue immediately after birth.

In the walls of the air cavities, under the influence of irritation, the epithelial cover is disrupted, deep air gaps are formed - the beginning of new air cavities. This process moves gradually deeper along with the growth of the mastoid process.

In weakened children (rickets, tuberculosis, etc.), the course of the process is slowed down; remnants of myxoid tissue in the form of a layer of loose connective tissue on the walls of the cavity, preservation of diploetic bone and delayed pneumatization are also observed at a later date. In most cases, myxoid tissue disappears in the first year or early years of life.

With age, myxoid tissue becomes significantly denser, forming cords and bridges in the tympanic cavity and antrum. With purulent inflammation, these cords and bridges create significant obstacles to the free outflow of pus from the ear and therefore can be one of the reasons for the transition of acute otitis to chronic.

These structural features of the mucous membrane of the middle ear in newborns are of great practical importance. The presence of myxoid tissue, which provides a favorable environment for microorganisms and is easily subject to purulent decay, determines the frequency of purulent otitis in newborns and infants.

Types of mastoid

According to their internal structure, the mastoid processes are divided into three types:

pneumatic - with a predominance of large or smaller cells containing air;
diploetic - with a predominance of diploetic tissue;
mixed - diploetic - pneumatic.

The first type is observed in 36%, the second in 20%, and the third in 44% (according to Zuckerkandl). Often there are mastoid processes with dense bone, or so-called sclerosed, without cells and without diploeticity. Many authors do not see such processes isolated into a special type, and they are considered as a consequence of long-term, chronic inflammation in the middle ear and in the process.

Diseases that cause mastoid pain

In acute purulent inflammation of the middle ear, the process sometimes spreads to the cells of the mastoid process, melting their septa and forming cavities filled with granulations or pus: acute mastoiditis develops.

Bone destruction can occur both towards the surface of the cortical layer of the mastoid process, and towards the middle and posterior cranial fossae. In the last 10-15 years, mastoiditis has become less common due to the highly successful treatment of acute inflammation of the middle ear with antibiotics.

Increased temperature (from low-grade to 39-40°), pain in the mastoid process, headache, insomnia, pulsating noise and ear pain. In the ear canal, a lot of thick, viscous pus is found, released through a perforation of the eardrum, as well as hanging down of the posterior superior wall of the bony part of the ear canal; There is pain on palpation of the mastoid process.

When the outer bone plate is destroyed, pus from the mastoid process penetrates under the periosteum and soft integument. Subsequently, a subperiosteal abscess of the mastoid process is formed. Complications: facial paralysis, inflammation of the inner ear, intracranial complications and sepsis.

When recognizing, it is necessary to exclude a furuncle of the auditory canal, in which the hearing is not changed, the outer cartilaginous part of the auditory canal is narrowed and sharp pain is observed when pressing on the tragus or when pulling on the auricle, which does not happen with acute mastoiditis.

Treatment is the same as for acute purulent inflammation of the middle ear. The use of antibiotics is mandatory. In case of failure - surgery in a hospital setting

Mastoid soreness may be a symptom

Questions and answers on the topic "Mastoid process"

Question:Good afternoon For the past year I have had sharp pain above the ear on the right, with pain radiating to the right back of the head. CT conclusion: “CT picture of the formation of a fatty structure in the mastoid process, probably a lipoma.” What is it and can it cause severe pain. Is surgery required? Thank you.

Answer: Lipoma (fat) is a benign tumor that develops from adipose tissue. A lipoma is a capsule filled with adipose tissue. Conservative treatment is not suitable in this case. A surgical removal operation is performed. Subcutaneous lipomas are removed under local anesthesia along with the capsule, deeper lipomas are removed under general anesthesia.

Question:Hello, I have pain on palpation at the site of attachment of the muscle to the mastoid process, but there are no other symptoms yet.

Answer: You need an in-person consultation with an ENT specialist for an examination.

Question:MRI signs of inflammatory changes in the mastoid process of the left temporal bone, 6 year old child, can this be treated with medication?

Answer: Mastoiditis is an acute purulent inflammation of the mastoid process of the temporal bone, in the area behind the ear. Treatment of mastoiditis in children is carried out based on the following important points: the age of the child; medical history; general health; course of the disease. In most cases, the child is given a course of antibiotics. If conservative treatment is ineffective and complications are present, surgery is performed.

Question:Hello, my X-ray revealed sclerosis of the mastoid process, and there is noise in my left ear. Tell me how to remove the noise? Thank you.

Answer: Hello. Tinnitus can be associated with various diseases; for diagnosis and treatment, it may be necessary to contact not only an ENT specialist, but also an audiologist, psychiatrist, angiosurgeon, neurosurgeon, or neurologist.

Question:Hello. An MRI gave the diagnosis: right-sided mastoiditis. Is it necessary to go to the doctor? How should it be treated?

Answer: Hello. Indeed, this is a dangerous disease that must be treated while it is not yet fully developed in a person. Mastoiditis can cause serious pain, suppuration, and hearing problems. It has several stages, the earlier it is diagnosed, the easier and faster it is treated.

Question:Hello! I was admitted to the hospital with a diagnosis of acute suppurative otitis media. It turned into mastoiditis, surgery was performed, the wound was kept open for 5 weeks, then bioglass was inserted. A week later, the cartilage of the auricle swelled. They pulled out the bioglass and kept the wound open for a month, then simply stitched it up. A day after being discharged, I had perichondritis again. Is this disease even curable?

Answer: Hello. Inflammation of the mastoid process of the temporal bone and air cells, including the mastoid cave (mastoid antrum), which communicates with the cavity of the middle ear. The cause of inflammation is usually a bacterial infection spreading from the middle ear. Treatment is usually carried out with antibiotics, but in advanced cases, surgery is sometimes necessary. This disease can be treated. You must strictly follow your doctor's recommendations. If you doubt that the treatment was not provided to you properly, I advise you to contact another attending physician, who, after examining you, will diagnose you and prescribe treatment for you.

Question:Hello! Can I get mastoiditis after a head injury?

Answer: Hello. In case of injury, there is a high probability of damage to the periosteum covering the mastoid process, which can cause pain.

Question:Hello! My mother is 69 years old, she has had headaches for 45 years, and has been on painkillers all her life. Twice a year there is an exacerbation: the pain is very strong, paroxysmal, this can last a month, then it gets easier. Who has not been examined and what diagnoses have not been made, from migraine to Arnold Chiari Syndrome. Yesterday, after another MRI, I was diagnosed with right-sided mastoiditis. As long as I remember, she always complained of pain behind her ear during an exacerbation. Can such a diagnosis be hidden like that? Has mastoiditis really not shown itself in decades? Thank you!

Answer: Hello. To accurately diagnose ear pathology and detect mastoiditis, the CT (computed tomography) method of the temporal bones is used. Your mother probably had an MRI (magnetic resonance imaging) of her brain; these images can lead to an erroneous conclusion. In any case, the diagnosis can only be established by a clinical doctor, in your case an ENT-otosurgeon, based on the patient’s complaints, his medical history, examination data of the ENT organs, as well as test results (blood, etc.). Mastoiditis is a complication of otitis media, when the inflammatory process extends beyond the middle ear into the cells of the mastoid process of the temporal bone. As a result of bone destruction, the inflammatory process can spread to the membranes of the brain and cause complications such as meningitis, encephalitis, and brain abscess. Treatment is only surgical.

Question:Hello! My mother (47 years old) developed noise in her ear about 10 years ago. She went to the hospital and was told there was inflammation of the Eustachian tube and otitis media. We treated it, the noise did not go away. After 3 years, she again went to the same hospital under a scalpel, because... pus accumulated in the mastoid process of the temporal bone of the skull, which was removed surgically. Nothing has changed in terms of hearing: both the noise and weak hearing remain. They carried out catheterization, but the catheter simply came out on its own after a few days, and nothing came out of the ear through it. For the last 2 weeks, she began to have pus coming out of her ear; this symptom was also supplemented, as the doctor said, with inflammation of the facial nerve, her mouth, eye, eyebrow, and the entire left side of her face (there was an operation on this bone on the left) was “distorted.” Yesterday I had an MRI, which showed inflammation in the mastoid process of the temporal bone of the skull - mastoiditis. She is currently being treated for inflammation of the facial nerve. prescribed antibiotics. Question: if damage to the facial nerve is a complication of inflammation of the middle ear, then why is the complication treated, and not the cause of the disease? What treatment should she receive at this time? After neuralgia, where is she now, does she need to see an ENT doctor and what is the likelihood that she will need surgery again?

Answer: Hello. Repeated surgery on the mastoid process will be necessary if purulent swelling of this area persists. In case of neuritis of the facial nerve, timely treatment is necessary - a delay in treatment can lead to irreversible consequences. We are unable to assess the adequacy of the treatment provided for objective reasons.

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 a rise in body temperature, intoxication, pain and pulsation in the mastoid region, swelling and hyperemia of the postauricular area, ear pain and hearing loss. An objective examination for mastoiditis consists of examination and palpation of the area behind the ear, otoscopy, audiometry, radiography and CT scan of the skull, and bacteriological culture of discharge from the ear. Treatment of mastoiditis can be medicinal and surgical. It is based on antibiotic therapy and rehabilitation of purulent foci in the tympanic cavity and mastoid process.

General information

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 bone partitions. The mastoid process may have a different structure in different people. 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 third cases there are practically no cells (sclerotic structure). The course of mastoiditis depends on the type of structure of the mastoid process. Those with a pneumatic structure of the mastoid process are most prone to the appearance of mastoiditis.

The inner walls of the mastoid process separate it from the posterior and middle cranial fossae, and a special opening connects it with the tympanic cavity. Most cases of mastoiditis occur as a consequence of the transfer of infection from the tympanic cavity to the mastoid process, which is observed in acute otitis media, in some cases in chronic purulent otitis media.

Causes of mastoiditis

Depending on the cause, otolaryngology distinguishes between otogenic, hematogenous and traumatic mastoiditis.

Otogenic. Most often, secondary mastoiditis occurs, caused by the spread of infection into the mastoid process 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 disruption of its drainage due to late perforation of the eardrum, untimely paracentesis, too small a hole in the eardrum or its closure with granulation tissue.
Hematogenous. In rare cases, mastoiditis is observed, which developed as a result of hematogenous penetration of infection during sepsis, secondary syphilis, tuberculosis.
Traumatic. Primary mastoiditis occurs with traumatic damage to the cells of the mastoid process due to a blow, gunshot wound, or traumatic brain injury. A favorable environment for the development of pathogenic microorganisms in such cases is the blood spilled into the cells of the appendix as a result of injury.

The appearance of mastoiditis is promoted by:

increased virulence of pathogenic microorganisms
weakened general condition in chronic diseases (diabetes mellitus, tuberculosis, bronchitis, hepatitis, pyelonephritis, rheumatoid arthritis, etc.)
pathology of the nasopharynx (chronic rhinitis, pharyngitis, laryngotracheitis, sinusitis)
the presence of changes in the structures of the ear due to previous diseases (ear trauma, aerootitis, external otitis, adhesive otitis media).

Pathogenesis

The onset of mastoiditis is characterized by inflammatory changes in the mucous layer of the mastoid cells with the development of periostitis and the accumulation of fluid in the cavities of the cells. Due to the pronounced exudation, this stage of mastoiditis is called exudative. Inflammatory swelling of the mucous membrane leads to the closure of the holes connecting the cells with each other, as well as the hole connecting the mastoid process with the tympanic cavity. As a result of disruption of ventilation in the cells of the mastoid process, the air pressure in them drops. 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 it is often 4-6 days. Ultimately, in the exudative stage of mastoiditis, each cell has the appearance of an empyema - a cavity filled with pus.

Next, mastoiditis passes into the second stage - proliferative-alternative, in which purulent inflammation spreads to the bone walls and septa of the mastoid process with the development of osteomyelitis - purulent melting 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. Thus, as a result of mastoiditis, empyema of the mastoid process occurs. The breakthrough of pus through the destroyed walls of the mastoid process leads to the spread of purulent inflammation to adjacent structures and the development of complications of mastoiditis.

Classification

There are two clinical forms of mastoiditis: typical and atypical. The atypical (latent) form is characterized by a slow and sluggish course without pronounced symptoms characteristic of mastoiditis. A separate group of apical mastoiditis is distinguished, which includes Bezold's mastoiditis, Orleans mastoiditis and Mouret's mastoiditis. According to the stage of the inflammatory process, mastoiditis is classified as exudative and true (proliferative-alterative).

Symptoms of mastoiditis

Mastoiditis can appear simultaneously with the occurrence of purulent otitis media. But most often it develops 7-14 days from the onset of otitis media. In children of the first year of life, due to the structural features of the mastoid process, mastoiditis manifests itself in the form of otoanthritis. In adults, mastoiditis manifests itself as a pronounced deterioration in general condition with a rise in temperature to febrile levels, intoxication, headache, and sleep disturbances. Patients with mastoiditis complain of noise and pain in the ear, hearing loss, intense pain behind the ear, and a feeling of pulsation in the mastoid area. Pain radiates along the branches of the trigeminal nerve to the temporal and parietal region, orbit, and upper jaw. Less commonly, mastoiditis causes pain in the entire half of the head.

These symptoms of 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 may be insignificant. This occurs while maintaining the integrity of the eardrum, closing the perforation in it, and disrupting the outflow of pus from the mastoid process to the middle ear.

Objectively, with mastoiditis, redness and swelling of the area behind the ear, smoothness of the skin fold located behind the ear, and protrusion of the auricle are noted. When pus breaks through into the subcutaneous fatty tissue, a subperiosteal abscess forms, accompanied by severe pain when palpating the postauricular area and a symptom of fluctuation. From the area of the mastoid process, pus, exfoliating the soft tissues of the head, can spread to the occipital, parietal, and temporal regions. Thrombosis of the vessels supplying the cortical layer of the mastoid bone, which occurs as a result of inflammation, leads to necrosis of the periosteum with the breakthrough of pus to the surface of the scalp and the formation of an external fistula.

Complications

The spread of purulent inflammation in the mastoid process itself occurs along the most pneumatized cells, which determines the variety of complications that arise with mastoiditis and their dependence on the structure of the mastoid process. Inflammation of the perisinous group of cells leads to damage to the sigmoid sinus with the development of phlebitis and thrombophlebitis. Purulent destruction of the perifacial cells is accompanied by neuritis of the facial nerve, and of the perilabyrinthine cells by 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 into the mediastinum and cause the appearance of purulent mediastinitis.

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

Diagnostics

As a rule, diagnosing mastoiditis does not present any difficulties for an otolaryngologist. Difficulties arise in the case of a low-symptomatic atypical form of mastoiditis. Diagnosis of mastoiditis is based on the patient’s characteristic complaints, anamnestic information about trauma or inflammation of the middle ear, examination and palpation of the behind-the-ear area, results of otoscopy, microotoscopy, audiometry, culture of ear discharge, computed tomography and x-ray examination.

Otoscopy. With mastoiditis, inflammatory changes typical of otitis media are detected on the side of the eardrum; if there is a hole in it, profuse suppuration is noted. A pathognomonic otoscopic sign of mastoiditis is the overhang of the posterior superior wall of the auditory canal.
Hearing function test. Audiometry and hearing testing with a tuning fork make it possible to determine the degree of hearing loss in a patient with mastoiditis.
X-ray of the temporal bone. In the exudative stage of mastoiditis, it reveals cells veiled as a result of inflammation and unclearly distinguishable partitions between them. The X-ray 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 several large cavities are determined. Better visualization is achieved by performing a CT scan of the skull in the area 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 scan of the brain, ophthalmoscopy and biomicroscopy of the eye, and chest radiography.

Treatment of mastoiditis

Therapeutic tactics for mastoiditis depend on its etiology, the stage of the inflammatory process and the presence of complications. Drug therapy for mastoiditis is carried out with broad-spectrum antibiotics (cefaclor, ceftibuten, cefixime, cefuroxime, cefotaxime, ceftriaxone, amoxicillin, ciprofloxacin, etc.). Additionally, antihistamines, anti-inflammatory, detoxification, and immunocorrective drugs are used. Complications are treated.

With the otogenic nature of mastoiditis, sanitizing surgery on the middle ear is indicated; if indicated, general cavity surgery is indicated. The absence of a hole in the eardrum that provides adequate drainage is an indication for paracentesis. The middle ear is washed with medications through the opening of the eardrum. Mastoiditis in the exudative stage can be treated conservatively. Mastoiditis of the proliferative-alterative stage requires surgical opening of the mastoid process (mastoidotomy) to eliminate pus and postoperative drainage.

Prevention of mastoiditis

Prevention of otogenic mastoiditis comes down to timely diagnosis of inflammatory lesions of the middle ear, adequate treatment of otitis media, timely paracentesis of the eardrum and sanitizing operations. Correct treatment of nasopharyngeal diseases and rapid elimination of infectious foci also help prevent 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.