acute mastoiditis
Introduction
Introduction to acute mastoiditis Acute mastoiditis (acutemastoiditis) is an acute suppurative inflammation of the mucosa of the mastoid airway and its bone, which is often developed from acute suppurative otitis media. Mainly occurs in gasified mastoids. More common in children. If the acute mastoiditis is not controlled, the inflammation continues to develop and can penetrate the wall of the mastoid, causing intracranial and extracranial complications. In the recovery period of acute suppurative otitis media, earache does not decrease at about 3 to 4 weeks, or it is aggravated daily after being relieved. Early disease, control of infection and smooth drainage for the treatment of this disease. Sensitive antibiotics can be used according to the results of drug susceptibility. In the case of intracranial complications, antibiotics that pass through the blood-brain barrier are selected. At the same time improve local drainage. If the drainage is not smooth, the inflammation is not controlled, and a suspicious complication should be performed immediately. basic knowledge Sickness ratio: 0.1% Susceptible people: more common in children Mode of infection: non-infectious Complications: abscess, labyrinthitis, sigmoid sinus thrombophlebitis, meningitis, brain abscess
Cause
Cause of acute mastoiditis
Cause (65%):
Patients with poor resistance are associated with acute infection or chronic systemic disease. Pathogenic bacteria are highly toxic (such as pneumococcus, hemolytic streptococcus, etc.). Treatment is not timely or incomplete.
Pathogenesis (25%):
In the mastoid air chamber adhesion - tympanic membrane congestion, swelling, necrosis, shedding, bone decalcification, swelling of the sinus sinus mucosa or granulation obstruction, resulting in pus can not drain through the sinus tympanic or tympanic - eustachian tube pathway Poor drainage leads to accumulation of pus in the air chamber to further destroy the bone and form acute suppurative mastoiditis. Gasified mastoids often form larger abscesses, because the walls of the air chamber are thin, susceptible to necrosis due to compression and inflammation, and the air chambers fuse with each other to form a fusion mastoiditis or mastoid empyema. Hemolytic stria microstitis or influenza bacillus causes hemorrhagic mastoiditis. The mastoid bone wall remains intact and the air chamber is filled with bloody exudate. Barrier mastoids can often manifest as mastoid osteomyelitis.
Prevention
Acute mastoiditis prevention
1. Prevention of acute mastoiditis occurs in the treatment of acute otitis media in a timely and timely manner.
2. After the occurrence of acute mastoiditis, it will collapse and expand outward within a certain period of time. It is necessary to go to the hospital for a simple mastoidectomy and remove the purulent material drainage in the ear and mastoid to prevent it. External expansion, the formation of post-abdominal abscess, inward expansion to form intracranial complications such as meningitis.
3. Should improve the patient's physical health, strengthen nutrition, provide adequate protein and vitamin diet, and strengthen resistance.
Complication
Acute mastoiditis complications Complications abscess labyrinth sigmoid sinus thrombophlebitis meningitis brain abscess
Extracranial complications: subtymnosus abscess after the ear, Bezo abscess, peripheral facial paralysis, labyrinthitis and rock inflammation.
Intracranial complications: epidural abscess, subdural abscess, sigmoid sinus thrombophlebitis, meningitis, brain abscess.
Precautions:
1. Close observation of complications, mastoiditis, especially in the acute episodes of otitis media and cholesteatoma otitis media, due to drainage disorders, infection can be through the destruction of the bone wall, expansion or through the bone scale, The vestibular window, snail window and other natural channels, or blood vessels and bone thrombophlebitis, spread the infection to neighboring tissues and organs, causing various complications.
2. All patients with suppurative otitis media with ear pain and headache gain, chills, fever, dizziness, nausea and vomiting, changes in consciousness, etc., should consider the possibility of complications. Early detection, timely treatment can reduce the pain and save lives.
Symptom
Acute mastoid inflammation symptoms common symptoms earache ear flow pus mastoiditis deafness
1. In the recovery period of acute suppurative otitis media, the ear pain is not relieved after about 3 to 4 weeks, or it is aggravated day by day, the hearing is not improved or even worse, the ear pus does not decrease or even increase, and the pus suddenly decreases when the drainage is blocked. And with the same side of the sputum area headache and re-fever and other systemic symptoms, severe cases up to 40 ° C or more, should consider the possibility of this disease. Children have severe systemic symptoms, high fever, pulse rate, lethargy, and convulsions. Often accompanied by gastrointestinal symptoms, such as vomiting, diarrhea and so on. At the same time, because the children's rock scales have not been closed, and inflammation can stimulate the adjacent meninges through the surrounding abundant blood vessels and lymphatic vessels, causing meningeal irritation, called pseudomeningitis, and no abnormal changes in cerebrospinal fluid can help identify.
2. The skin of the mastoid is slightly swollen, the back of the ear is red and swollen, and the auricle is swung forward and outward. The outer wall of the sinus and the mastoid tip have obvious tenderness.
3. The upper wall of the external part of the external auditory canal is red and swollen and collapsed. The tympanic membrane is congested and the slack is bulged. Generally, the perforation of the tympanic membrane is small, and the perforation has pus pulsation and the amount of pus is high
4. Hearing tests show conductive hearing loss.
5. High-resolution CT of mastoid X-ray or tibia: high-density shadow of the mastoid air chamber, after the formation of the abscess cavity, the space is formed, forming one or more large cavities, sometimes showing the gas-liquid plane.
6. Leukocytosis, polymorphonuclear leukocytes increase.
Examine
Examination of acute mastoiditis
External ear canal edema external ear canal can have ear and other ear trauma history, generally no fever and other obvious systemic symptoms, ear pain often worsened when chewing or mouth opening. The auricle is pulling pain, the tragus is tender, but there is no mastoid tenderness. Hearing is generally normal, and patients with significant redness and obstruction in the external auditory canal may have mild conductive hearing loss. There is pus in the ear, without a lot of mucus, and the amount is small. The tympanic membrane is intact, and the humeral CT shows no high-density shadow in the mastoid and middle ear, but the soft tissue of the external auditory canal is thickened.
1. Hearing tests show conductive hearing loss.
2. High-resolution CT of mastoid X-ray or tibia: high-density shadow of the mastoid air chamber, after the formation of the abscess, the septum fuses to form one or more large cavities, sometimes showing a gas-liquid plane.
3. Leukocytosis, polymorphonuclear leukocytes increase.
Diagnosis
Diagnosis and differentiation of acute mastoiditis
Differential diagnosis
Acute mastoiditis and the identification of external auditory canal.
Acute mastoiditis, external auditory canal.
History: There is a history of otitis media, and there is a history of traumatic injuries.
Body temperature: Generally, the increase in body temperature is generally normal.
Earache: deep ear pain, often accompanied by ipsilateral headache and earache, increased when chewing or opening.
Tenderness: The tenderness of the mastoid tip and the sinus sinus area has traction pain and tenderness of the tragus.
Hearing: Conductive paralysis, normal hearing or mildly conductive paralysis.
Ear pus: sticky pus, a large amount, pure pus, a small amount.
Tympanic membrane: hyperemia, perforation, no perforation.
Posterior auricle: Can disappear, exist or disappear.
X-ray film: The air chamber is blurred or has a translucent area, normal.
