mastoiditis

Mastoiditis: description

Mastoiditis (also called mastoiditis) is a purulent inflammation of the cooking that is behind the ear. This bone (referred to medically as Os mastoideum) has an oblong, tapering shape that remotely resembles a wart, hence its name as a mastoid (Pars mastoidea). The inside of the mastoid is not completely filled with bone, its interior is partially filled with mucous cells lined cavities. Mastoiditis is characterized by inflammation.

The mastoid is behind the ear, he is palpable behind there as a bead. He is directly connected to the tympanic cavity (Cavum tympani). The tympanic cavity is the part of the middle ear where the ossicles are located. If inflammation takes place there, this is known as “middle ear inflammation”. Due to the close proximity, the mastoiditis is usually always a secondary disease or complication of otitis media.

Mastoiditis is the most common complication of otitis media today. Children and adolescents are especially affected by otitis media, but adults are less likely to get sick. Therefore, the mastoiditis occurs more often in childhood. Nevertheless, it is due to the good treatability of otitis media a rare disease. 1.2 to 1.4 children of 100,000 children are considered to be affected by this complication.

Chronic mastoiditis

To distinguish from acute mastoiditis is chronic mastoiditis. Chronic mastoiditis is less common than acute mastoiditis, but more dangerous. Chronic mastoiditis also causes the mastoid process to become inflamed. However, this inflammation is not noticeable by the symptoms that traditionally occur with mastoiditis (fever or pain). That’s why it can go undetected for many weeks and even months. Physicians call this form therefore also masked mastoiditis. If chronic mastoiditis persists for a long time, the bacteria continue to multiply. You also have plenty of time to continue to expand your body and invade other areas. Chronic mastoiditis often causes considerable consequential damage.

Mastoiditis: symptoms

The symptoms of mastoiditis occur about two to four weeks after the onset of acute otitis media. Most of their symptoms are already subsiding again and then suddenly flare up again. Reason may be a mastoiditis.

In general, the symptoms of mastoiditis resemble those of otitis media. For a layman, it is therefore very difficult to distinguish the two diseases from each other. Either way, they should be treated as quickly as possible. In general, therefore, a precautionary doctor should be consulted if one or more of the following symptoms occur:

• Pain in and around the ear. Typical is a constant, throbbing pain.
• Longer lasting fever
• Hearing deteriorates
• Restlessness, insomnia, violent screaming
• fatigue

In addition, mastoiditis results in externally palpable swelling and hypersensitivity over the mastoid, which does not occur in middle ear inflammation. If the swelling is severe, push the ear sideways down. As a result, the auricle is clearly off. In addition, the ear often empties large quantities of a milky fluid. It may be that the patient refuses to eat and is apathetic.

In infants, it is difficult to determine which complaints exist exactly. One symptom of otitis media and mastoiditis is when children often touch their ears or shake their heads. Many infants also suffer from nausea and vomiting. In babies, mastoiditis is often less severe than in older children. Parents should therefore pay close attention to the smallest changes in their child’s behavior.

Mastoiditis: causes and risk factors

The causative agents of mastoiditis in babies and children are mostly bacteria such as pneumococci, streptococci and Haemophilus influenzae type b, in babies often also staphylococci. Since there is no way from the outside that leads directly into the mastoid, mastoiditis is usually a result of other diseases.

In most cases, mastoiditis is preceded by a veritable chain of infection. Children become infected quickly and frequently with various types of viruses, which then cause inflammation of the throat and throat area. The viral infection lowers the body’s defenses. So easily creates an additional infection with bacteria (superinfection). Bacteria can enter the middle ear directly from the pharynx via the Eustachian tube (which connects the pharynx and middle ear), triggering inflammation as well. Mastoiditis often develops on the basis of late or not treated otitis media. Also, if a middle ear infection is treated too short, bacteria can spread from the middle ear into the mastoid.

Complicated discharge of secretions in infections favors mastoiditis. This can happen, for example, with a heavily swollen nose or stuffy ears. Even a weakened immune system favors infections. A weakening of the immune defense occurs, for example, in the context of a therapy with antibiotics or corticosteroids (for example cortisone) as well as in certain chronic diseases (for example HIV or diabetes mellitus).

Mastoiditis: examinations and diagnosis

If a mastoiditis is suspected, an ear, nose and throat doctor is the right person to contact. In an initial conversation, the latter will record the medical history (anamnesis). You have the opportunity to describe your complaints exactly. For children, parents usually provide information. The doctor can ask questions like:

• Have you (or your child) been suffering from an infection recently?
• Since when do the complaints exist?
• Did you notice discharge from the ear?

Following the anamnesis, a physical examination is carried out. At first, the doctor looks for external changes. For example, he may notice redness as well as pain and pressure sensations above or behind the ear. An ear mirror (otoscope) is used to examine the eardrum and the inner auditory canal. This examination is also called ear reflexology (otoscopy). If there is a swelling of the eardrum, this is determined inter alia by a light reflex, which is elsewhere on the eardrum than a healthy ear. In addition, the ear is red from the inside.

The further diagnosis is made in case of a reasonable suspicion of mastoiditis in a hospital. This makes sense, as the therapy should start as soon as possible and under certain circumstances an operative intervention may be necessary. If the doctor has not done that yet, a blood count will be made here first. Inflammation in the body increases certain levels of blood testing. These include, among others, the number of white blood cells (leukocytes), the value of the C-reactive protein and the rate of blood cell killing. To determine the causative agent of inflammation, a smear is taken from the ear. In the laboratory, a culture is created from it. The result is available within one to two weeks. As a rule, the treatment of mastoiditis is started before the final result is available.

An X-ray or computed tomography will further confirm the diagnosis. On the resulting images, the doctor can detect any complications – for example, if pus has accumulated in surrounding areas. In small children, making an X-ray and computed tomography can be difficult. In case of clear findings that support the suspicion of mastoiditis, physicians in some cases refrain from these additional examinations.

Mastoiditis: treatment

Mastoiditis, like other bacterial infections, is treated with antibiotics. Depending on which pathogens are responsible for the mastoiditis, different antibiotics help especially well. If the exact pathogens are not (yet) determined, in most cases a broad-spectrum antibiotic, a drug from the penicillin group, is used. They work against a variety of different bacteria, but especially against staphylococci and streptococci, the most common causative agents of mastoiditis.

For babies and young children, antibiotics are most easily administered via the vein (via infusion). This ensures that the drugs really land in the bloodstream and are not spit out again. In adolescents and adults, antibiotics are given in the form of tablets. In addition, analgesics may be prescribed to relieve earache.

Mastoiditis – when is surgery necessary?
If the mastoiditis is very pronounced or does not improve after a few days of treatment, surgical removal of the swelling is required. For this, the inflamed areas of the mastoid are removed (mastoidectomy). There are two methods of surgery, simple and radical mastoidectomy. In simple mastoidectomy, only the cells of the mastoid process affected by the inflammation are removed. In radical mastoidectomy, however, other structures are taken out. These include the posterior wall of the external auditory canal and the upper part of the tympanic cavity of the middle ear. This massive procedure creates a large cavity between the mastoid process and the external auditory meatus. This cavity makes it easier to monitor ear and mastoid spaces and care. Radical mastoidectomy is indicated for mastoiditis associated with severe pus formation and accumulation.

In order for the fluid (usually pus) to escape from the ear, a thin tube (drainage) is drained during the operation, through which the pus is drained. The operation is always stationary. Behind the ear a small incision is made, through which the operation takes place. The cut heals quickly. After surgery, those affected need to stay in the hospital for about a week. After that, however, they are usually symptom-free. Accompanying the operation is a therapy with antibiotics to kill any remaining bacteria in the body.

Mastoiditis: disease course and prognosis

The prognosis of mastoiditis depends on the time when the infection is detected. To avoid complications, mastoiditis should be treated as soon as possible. The later the therapy starts, the more time the bacteria have to spread in the body and the more likely it will be complications.

If therapy is used in a timely manner, complications of mastoiditis can usually be avoided. With a consistent treatment mastoiditis heals within a few days to weeks. Meanwhile, the complaints are increasingly decreasing. Permanent damage such as hearing loss rarely occurs.

Complications of mastoiditis

If left untreated mastoiditis, however, serious complications may arise. If the pus build-up can not flow outward, it seeks alternative options around the mastoid process. Thus, an encapsulated pus accumulation can arise below the mastoid in the periosteum. In addition, pus can penetrate between the bones and the outermost meninges (epidural abscess). The pus can also penetrate into the lateral neck and neck muscles (Bezold abscess). Particularly dangerous is an encapsulated pus accumulation in the brain (brain abscess), as this can move and so pinch off or squeeze various structures in the brain.

The bacteria can also spread further from the mastoid in the body. It is particularly dangerous if they spread to the meninges (meningitis) or to the inner ear (labyrinthitis). If the bacteria enter the bloodstream, sepsis will occur. Near the mastoid also runs the facial nerve, which is responsible among other things for the facial muscles. If this is damaged, permanent numbness and facial paralysis can occur. In extreme cases, mastoiditis can take such a life-threatening course!

It is not possible to specifically prevent mastoiditis. But you can reduce the risk of disease by trying to prevent infections and inflammation in general. Strengthen your or your child’s defenses, by ensuring a balanced diet and move a lot in the fresh air.

It is important that you treat an occurring otitis media immediately. You should absolutely follow the instructions of the doctor. If you do not take the antibiotic regularly or too briefly, it may be that some bacteria survive in the ear and reproduce again after the antibiotic has been discontinued. If symptoms of otitis media have not subsided after two weeks, if they increase despite treatment or reoccur after some time, you should consult a doctor again and thus the risk for a mastoiditis to reduce.