Subperiosteal abscess behind ear
Introduction
Introduction to subperiosteal abscess Abscess refers to an acute suppurative infection in which the tissue is necrotic and liquefied due to the invasion of Staphylococcus aureus into the tissue or blood vessels. In the acute exacerbation of chronic suppurative otitis media or acute fusion mastoiditis, the pus accumulated in the mastoid cavity flows into the posterior periosteum of the ear through the parenchyma of the lateral cortical bone of the mastoid, forming a subperiosteal abscess. The abscess penetrates the periosteum and the skin to form the posterior tibial tube, which can be cured for a long time. Children with this disease are more common. Sinusitis is the main cause of the disease, especially inflammation of the ethmoid sinus and frontal sinus. Subperiosteal abscess is sometimes associated with a cold, which can cause sinusitis due to a cold. Adult submucosal abscess is associated with ethmoid sinus, maxillary sinus and frontal sinus inflammation. The pathogens are often Streptococcus, Staphylococcus, Streptococcus pneumoniae, Haemophilus influenzae and anaerobic bacteria. basic knowledge The proportion of illness: 0.003% Susceptible people: adult males who are mostly in 20 to 50 years old Mode of infection: non-infectious Complications: periostitis
Cause
Causes of subperiosteal abscess
Sinusitis is the main cause of disease, especially inflammation of the ethmoid sinus and frontal sinus. Subperiosteal abscess is sometimes associated with a cold, which can cause sinusitis due to a cold. Adult submucosal abscess is associated with ethmoid sinus, maxillary sinus and frontal sinus inflammation. The pathogens are often Streptococcus, Staphylococcus, Streptococcus pneumoniae, Haemophilus influenzae and anaerobic bacteria.
Prevention
Prevention of subperiosteal abscess
The disease is a common extracranial complication of acute and chronic suppurative otitis media. Active treatment is urgent. Chronic suppurative otitis media is the key to prevention. Once suffering from this disease, it is necessary to be hospitalized as soon as possible for anti-inflammatory and surgical treatment. Keep the external auditory canal clean, disinfect the external auditory canal with alcohol, take out the soil, foreign matter, blood stasis or sputum remaining in the ear canal, and place the sterile cotton ball on the external ear canal. Do not rinse or drop the medicine in the ear to avoid bringing the outer ear canal bacteria into the middle ear to cause middle ear infection. Antibiotics are applied throughout the body, swimming is prohibited, and sewage is prevented from entering the ear. The disease is more than ten times more common in men than in women, and is more common in adult males between the ages of 20 and 50.
Complication
Post-periosteal abscess complications Complications periostitis
It can be accompanied by systemic symptoms such as ipsilateral headache and fever.
1. Cerebrospinal meningitis: Coronary inflammation may occur in the auricle trauma, insect bites, and incision of superficial infections, which causes the accumulation of pus between the cartilage and the perichondrium. The blood supply to the cartilage is provided by the perichondrium. If the perichondrium is separated from both sides of the cartilage, the auricle will be deformed due to ischemic necrosis. The same effect can occur with septic necrosis. Perichondritis tends to be painless, prolonged, and destructive, often caused by Gram-negative bacilli.
2. Cartilage necrosis: After infection with suppuration, pus accumulates between the perichondrium and the perichondrium, and the cartilage gradually necrosis due to blood supply disorders.
3. Auricular deformity: acquired factors such as auricular trauma, infection, etc. can also cause severe auricular deformities, and some can be complicated by external ear canal stenosis or atresia, but generally without middle ear malformation.
4. Auricle contusion: The ear is a part of our body that is more likely to be injured, and it is also a part that we are more likely to ignore. And some traumas are very easy to focus on our ears, so we must protect ourselves, but also realize that in the event of a disease like auricle trauma, we must do timely treatment, but not for reasons like this. It has provoked its related complications and aggravated the patient's suffering.
Symptom
Post-periosteal abscess symptoms Common symptoms Intermittent ear pain, leukocytosis, local burning fever
(1) may have a history of acute suppurative infection.
(2) Local redness and pain and a sense of fluctuating, try to have pus. After the ear is red, swollen, fluctuating, the auricle is pushed forward and outside, there is a sense of fluctuating, puncture can draw pus.
(3) Systemic symptoms include fever, fatigue, etc.
(4) Blood: The number of white blood cells and neutrophils increased, and the mastoid phase often has bone destruction.
(5) Deep abscess can be in liquid dark area after B-ultrasound examination.
(6) Diagnostic puncture of abscess, pus can be withdrawn.
Examine
Examination of subperiosteal abscess
Deep abscess can be seen in the dark area by B-ultrasound; X-ray shows papillary inflammation or bone destruction shadow; abscess diagnosis puncture, pus can be extracted.
(1) Tympanic membrane:
Relaxation or full tympanic membrane invagination, manifested as shortening of the light cone, deformation or disappearance, the hammer stem is displaced backwards, upward displacement, the humerus short protrusion is obvious, the angle between the front and the back fold becomes smaller, and the tympanic membrane loses normal when the tympanic effusion Gloss, single yellow, orange red oil or amber, light cone deformation or displacement, chronic may be gray orchid or milky white, tympanic membrane has dilated microvessels, short protrusion is more than ochre, humeral stem is embossed, if liquid It is serous and does not fill the tympanic cavity. The liquid level can be seen through the tympanic membrane. The liquid surface is like a hairline, which is called the hairline. The concave surface faces upward. When the head position changes, its relationship with the ground is the same. The air bubbles can be seen through the tympanic membrane, the air bubbles can be increased after the eustachian tube is blown, and the tympanic membrane activity of the tympanic membrane is limited.
(2) The sound of the cork stopper:
After pressing the tragus and then releasing the amps separately, the ears were tested separately, and the patient consciously had ears that sounded like a cork.
(3) Hearing examination:
The tuning fork test and pure music listening valve test results show that the conductivity is flawed, the hearing loss is different from the government, and the heavy one can reach about 40dBHL. Because the amount of fluid accumulation often changes, the hearing threshold may have certain fluctuations, and the hearing loss is generally low frequency. However, due to the structure of the middle-ear ship and the impedance changes of the two springs, the high-frequency air conduction and bone conduction hearing can also be objectively reduced. The hearing is improved after the effusion is discharged. The acoustic guide is valuable for diagnosis. Flat type (B type) It is a typical curve of secretory otitis media; high negative force type (C3 type) shows dysfunctional pharyngeal tube, some have tympanic effusion, and hearing impairment is significant. Auditory brainstem response and otoacoustic emission examination should be performed to determine Whether it has an effect on the inner ear.
(4) CT scan: It can be seen that the air cavity of the middle ear system has different degrees of density increase.
Diagnosis
Diagnosis and diagnosis of subperiosteal abscess
diagnosis
Diagnosis can be based on the cause, symptoms and related tests.
Differential diagnosis
Subperiosteal abscesses are easily confused with the following diseases:
1. Ear root sputum: more common in Western medicine refers to the perioral suppurative lymphadenitis, the symptoms of the ear around the ear, the nucleus redness and swelling, the superficial position, tenderness, followed by redness and swelling, rupture and pus, short course, easy to break Healing, generally does not form a fistula.
2. Cervical sputum: The lesions are mostly located in the middle and upper part of the neck. The local redness and swelling are obvious, and the tenderness is obvious. Then the pus is broken and the course of disease is short, so the fistula is not formed.
