mastoiditis
Introduction
Introduction to mastoiditis Mastoiditis is an acute suppurative inflammation of the mucosa and bone of the mastoid air, mostly developed from acute suppurative otitis media. More common in children. Due to the weak resistance of the body, the virulence of the disease, or the improper treatment, the inflammation of the middle ear continues to develop, the entrance of the sinus is blocked by the swollen mucosa, the drainage of the pus in the mastoid is not smooth, and it accumulates in the mastoid air chamber. Inside, the mucous membrane of the air chamber is necrotic and detached. The bone wall is affected by pus hydraulic pressure and autoinflammatory lesions. Decalcification and necrosis occur. The septum is broken and the air chamber is fused. A large abscess is formed, which is called a fusion mastoid. Inflammation or mastoid pus. If acute mastoiditis caused by hemolytic streptococcus or influenza bacilli, the wall of the mastoid bone remains intact, and the air chamber is filled with bloody secretions, called hemorrhagic mastoiditis. Although acute otitis media has been treated, but due to insufficient use of antibiotics, or incomplete treatment, mastoid inflammatory lesions continue to develop, but the systemic and local symptoms are not obvious, so that they are not found, called recessive mastoiditis. If acute mastoiditis cannot be controlled, the inflammation continues to develop and can penetrate the wall of the mastoid, causing intracranial and extracranial complications. Acute mastoiditis is an acute suppurative inflammation of the mucosa and bone of the mastoid air chamber, which is often developed from acute suppurative otitis media. basic knowledge The proportion of illness: 0.001% Susceptible people: more common in children Mode of infection: non-infectious Complications: tinnitus
Cause
Cause of mastoiditis
First, acute mastoiditis
More common in children. The pathogenic bacteria are highly toxic, the patient's resistance is low, the otitis media is not treated in time or the middle ear is not smooth, which is the cause of the disease. The infection spreads to the mastoid, causing empyema in the air chamber, bone fusion and necrosis; the clinical symptoms are more severe than acute suppurative otitis media, or the symptoms are not relieved after ear pus, the redness and tenderness of the mastoids after the ear, X-ray mastoids can help diagnosis. In addition to the active use of antibiotics, some cases should be treated with tympanotomy or mastoid sclerotomy to avoid serious complications.
Second, chronic mastoiditis
For the development of chronic suppurative otitis media, simple type of mastoid airway developmental disorders, mastoid sclerosis. Dangerous type can cause mastoid bone destruction, in which the bone type can cause bone sinus and mastoid bone necrosis, granulation tissue formation, mastoid sinus enlargement, mastoid bone destruction. In patients with cholesteatoma, cholesteatoma spreads to the mastoid through the upper tympanic cavity and sinus sinus, and the X-ray film shows a clear cavity with a typical edge. Mastoid lesions erode the surrounding adjacent bone, which can cause damage to the mastoid cortex, posterior wall of the ear canal, semicircular canal, facial nerve canal, meningeal plate and sigmoid sinus plate. When acute, it causes severe extracranial and cranial Internal complications, therefore, once the mastoid bone destruction is diagnosed, mastoid surgery should be performed immediately to remove the lesion and prevent complications.
Third, occult mastoiditis
It mainly occurs in children, characterized by progressive inflammatory lesions hidden behind the intact tympanic membrane. Most of the pathogenic bacteria are Haemophilus influenzae. Most of them are not completely cured due to acute otitis media. Suppurative lesions invade bone and often missed diagnosis. Causes complications, should be vigilant.
Prevention
Mastoiditis prevention
1. First, treat acute otitis media actively and promptly.
2, secondly, after the occurrence of acute mastoiditis, within a certain period of time will collapse and expand outward, should go to the hospital in a timely manner to perform simple mastoidectomy, remove the purulent material drainage in the ear, mastoid In order to prevent outward expansion, form an abscess behind the ear, and expand inward to form intracranial complications such as meningitis.
3, should improve the patient's physical health, strengthen nutrition, provide adequate protein and vitamin diet. Strengthen the resistance to the emergency mountain material, keep the dressing clean and tidy until the wound heals.
Complication
Mastoid complication Complications, tinnitus
1. Hearing loss: hearing loss and self-listening. When the head is leaning forward or leaning to the healthy side, the hearing can be temporarily improved (displacement hearing improvement) due to the effusion leaving the snail. When the effusion is thick, the hearing may not change due to head position changes. Children often have a slow response to the voice, lack of concentration, and the academic performance is reduced and the parents receive medical treatment. If one ear is sick, the other ear hearing is normal, and it can be undetected for a long time, but it is found at the time of physical examination.
2, earache: acute people may have faint earache, often the first symptom of the patient, which may be persistent or painful. Chronic ear pain is not obvious. This disease is often accompanied by occlusion or swell in the ear, which can be temporarily relieved after pressing the tragus.
3, tinnitus: mostly low-key intermittent, such as "" sound, snoring and running water sound. When the head is moving or yawning or blowing your nose, there may be a sound of gas over the ear.
Symptom
Symptoms of mastoid inflammation Common symptoms Leukocytosis, earache, external ear canal pain, post-acupuncture, mastoid edema, ear discharge, hearing loss
(1) The skin of the mastoid is swollen and flushed with obvious tenderness.
(2) The upper ear wall of the external auditory canal is red and swollen and collapsed; the perforation of the tympanic membrane is small, the pus is pulsating at the perforation, and the amount of pus is high; sometimes the pus penetrates the outer wall of the mastoid and forms an abscess under the periosteum.
(3) The mastoid X-ray film showed that the sinus sinus and the mastoid air chamber were cloudy and cloudy, showing a cloud-like shape.
(4) leukocytosis, increased polymorphonuclear cells.
Examine
Mastoid examination
Patients can usually check blood, mastoid thickening and agricultural bacterial culture or drug sensitivity.
Routine examination of mastoiditis If the mastoiditis patient needs to undergo a mastoiditis surgery, the box limits "A" and "B" are required. The suspected intracranial complication should be "C".
If the symptoms of the tympanic membrane perforation of the tympanic membrane are more serious due to mastoiditis, the X-ray film or CT scan should be performed. The audiology and X-ray examination are more helpful in diagnosing the condition.
Diagnosis
Diagnosis and differentiation of mastoiditis
(1) The main symptoms of acute suppurative otitis media, such as fever, earache, hearing loss, pus in the ear, etc. in the perforation of the tympanic membrane, the purulent secretion in the middle ear should disappear soon after the flow, but if in the perforation 1 After ~2 days, the symptoms that have already subsided reappeared or become more serious. Children with severe gastrointestinal symptoms such as vomiting and diarrhea should consider the possibility of acute mastoiditis.
(2) The skin of the mastoid is swollen and flushed, and there is obvious tenderness.
(3) The posterior superior wall of the external auditory canal is red and swollen and collapsed; the perforation of the tympanic membrane is small, there is pus pulsation at the perforation, and the amount of pus is high; sometimes the pus penetrates the outer wall of the mastoid and forms an abscess under the periosteum.
(4) The mastoid X-ray film showed that the sinus sinus and the mastoid air chamber were cloudy and cloudy in the early stage.
(5) Leukocytosis, increased polymorphonuclear cells.
