chronic mastoiditis
Introduction
Introduction to chronic mastoiditis Chronic mastoiditis is caused by repeated episodes of 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. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: vertigo, cerebrospinal fluid leakage
Cause
Cause of chronic mastoiditis
Otitis media (35%):
Chronic suppurative otitis media is the main cause of chronic otitis media. It is mainly caused by acute suppurative otitis media not treated or treated incompletely, or delayed; or a direct continuation of acute necrotizing otitis media.
Chronic inflammation of the nasopharynx (40%):
Some chronic lesions of the nose and pharynx such as chronic rhinitis, sinusitis, tonsillitis or adenoid hypertrophy are also important causes. Most of the pathogenic bacteria are Proteus, Staphylococcus aureus, Pseudomonas aeruginosa, etc., of which Gram-negative bacilli are more. An infection of anaerobic bacteria or a mixed infection of various bacteria can also be seen.
Prevention
Chronic 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
Chronic mastoiditis complications Complications, vertigo, cerebrospinal fluid leakage
1 Bleeding.
2 infection.
3 dizziness.
4 hearing loss.
5 facial nerve damage.
6 intracranial complications: cerebrospinal fluid leakage, intracranial infection.
Symptom
Chronic mastoid inflammation symptoms Common symptoms Ear pus bone destruction Deafness Hearing hearing decreased eardrum perforation
Clinical symptoms: long-term or intermittent pus in the ear, tympanic membrane perforation and hearing loss. According to pathology and clinical manifestations can be divided into three types:
Type:
(1) Simple type: the most common. In the case of recurrent acute upper respiratory tract infections, the pathogenic bacteria invade the tympanic cavity through the eustachian tube. The inflammatory lesions are mainly located in the tympanic mucosa. The clinical features are: intermittent pus in the ear, pus discharge or pus in the cold; pus is mucous or purulent, no odor; tympanic membrane perforation is located in the tension, round or oval or Centralized perforation of the kidney; tympanic mucosa is reddish or pale, thickened; deafness is mildly conductive deafness.
(2) Type of bone and ulcer: more often caused by acute necrotizing otitis media. The lesion can reach the bone, and the necrosis can occur in the small bone and the sinus. After the destruction of the epithelium of the middle ear mucosa, there are many local granulation or polyps. Its clinical features are: continuous viscous pus in the ear, often odor; tympanic membrane is a large perforation or marginal perforation; through the perforation, there is granulation or polyp in the drum; the polyp of the long pedicle is taken out from the perforation, Blocking the external auditory canal, obstructing drainage; there are more heavy conductive deafness. The papillary X-ray film can be found in the light-transmissive area with blurred edges. CT scan of the humerus showed soft tissue shadows in the upper tympanic cavity, sinus sinus and mastoid, with minor bone destruction. This type of otitis media can have a variety of complications.
(3) cholesteatoma type: cholesteatoma is a non-true tumor, but a cystic structure located in the middle ear and mastoid cavity. The inner wall of the capsule is a stratified squamous epithelium. The components in the capsule are exfoliated epithelium, keratinized material and cholesterol crystal. The fibrous tissue outside the capsule is connected to its adjacent bone wall or tissue. After the formation of cholesteatoma, direct compression of the surrounding bone, or the action of a variety of enzymes and prostaglandins produced by the inflammatory granulation tissue of the matrix, resulting in decalcification of the surrounding bone, destruction of the bone wall, and inflammation spread to the surrounding Can lead to a series of intracranial and extracranial complications. The clinical features of this type are: long-term continuous pus in the ear, more or less, special odor; hearing loss is conductive sputum or mixed sputum; tympanic membrane perforation is mostly loose or marginal perforation; visible from the perforation There is a bean curd-like substance in the drum room, and it has a strange smell. The mastoid X-ray film or the CT scan of the humerus showed a bone destruction area in the upper tympanic cavity, sinus sinus or mastoid, and the edges were thick and tidy.
Examine
Examination of chronic mastoiditis
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 diagnosis of chronic mastoiditis
Diagnostic criteria
(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.
