Have you ever suffered from otitis media? If you have had an ear disease, it is very likely!

Acute mastoiditis

It is an acute suppurative inflammation of mastoid air cell mucoperiosteum, especially mastoid bone. Acute mastoiditis mainly occurs in the gasification mastoid process, which is more common in children. Infants under 2 ~ 3 years old only have otitis media, because the mastoid process has not yet developed.

The cause of disease

1. Patients with poor resistance, such as acute infectious diseases (measles, scarlet fever, etc. ) or systemic chronic diseases (diabetes, chronic nephritis, etc. ).

2. Pathogenic bacteria are highly toxic, drug-resistant, and insensitive to commonly used antibiotics, such as pneumococcus type ⅲ and hemolytic streptococcus type B..

3. The drainage of middle ear pus is not smooth, such as the perforation of tympanic membrane is too small or the perforation is blocked by pus and foreign bodies.

pathology

In acute suppurative otitis media, if the suppurative inflammation centered on the tympanum is not controlled, and further develops and spreads to the tympanic sinus and mastoid, the mucoperiosteum of mastoid air chamber is congested, swollen, necrotic and exfoliated, the bone is decalcified, the atrial septum is broken and the air chamber is empyema. At this time, if the population at the ostium of the tympanum is blocked by swollen mucosa, pus in the air chamber cannot be discharged smoothly through the antrum-tympanum, the atrial septum is widely destroyed, the mastoid process is fused into a large cavity, and a large amount of pus is accumulated in the cavity, which is called "acute fused mastoiditis". The pathogen is hemolytic streptococcus or Haemophilus influenzae, and the mastoid is full of bloody exudate, which is called "hemorrhagic mastoiditis". In cancellous bone or mixed mastoid, because mastoid bone contains bone marrow, it can be manifested as mastoid osteomyelitis. Due to the wide application of antibiotics, some acute mastoiditis has very mild systemic and local symptoms, and it is often not easy to be found before complications occur, which is called "recessive mastoiditis".

If acute mastoiditis continues to develop and the mastoid bone wall breaks through, it can cause intracranial and extracranial complications.

clinical picture

1. In the recovery period of acute suppurative otitis media, about 3 ~ 4 weeks after onset, when various symptoms do not continue to relieve, but worsen, the possibility of this disease should be considered, such as; After tympanic membrane perforation, the earache is not relieved, or it is aggravated day by day after once relieved; Listening comprehension is not improved but decreased; Ear pus does not decrease, but gradually increases (it can suddenly decrease when pus drainage is blocked); At the same time, the systemic symptoms get worse, and the body temperature rises again, reaching above 40℃.

2. The mastoid skin is slightly swollen and red, and the groove behind the ear can disappear. There is tenderness in tympanic sinus area and mastoid apex area.

3. The posterior superior wall of bony external auditory canal is swollen and collapsed. The tympanic membrane is congested, and the loose part can swell out; Tympanic membrane perforation is generally small, and there is pus pulsation at the perforation.

4. CT scan of temporal bone showed that mastoid air content decreased, atrial septum was destroyed, and liquid-gas surface was visible.

5. Leukocytosis and polymorphonuclear leukocytosis.

general treatment

Early, systemic and local treatment is the same as acute suppurative otitis media, especially referring to the results of bacteriological examination, early application of large doses of appropriate antibiotics and intravenous administration; And pay attention to improving local drainage, such as myringotomy, removing the blockage at the perforation to avoid blowing powder into people's ears. If the infection is not controlled or suspicious complications occur, simple mastoidectomy should be performed immediately.