Definition
Mastoiditis occurs when the purulent infection extends from the middle ear (already affected by otitis media) to the mastoid air cells: this infectious process is responsible, precisely, for the inflammation of the mastoid and surrounding tissues.
A degeneration of the mastoiditis could lead to the destruction of the bone: from what has been said, it is understood that immediate medical intervention is essential to minimize the risk of complications, often irreversible.
Glossary
Terminology
- Mastoid process: inferior extension of the petrous rock of the temporal skull bone; its function is to act as an anchor for the neck muscles
- Air cells: they are contained in the mastoid process and, within the two years of life, they develop starting from the antrum (the only main cavity). The air cells are connected posteriorly to the posterior cranial fossa, and superiorly to the middle cranial fossa.
- Tympanic cavity of the ear: it puts the middle ear in communication with the antrum mastoid (thanks to a small channel that crosses the petrous storm)
Causes
Acute or chronic otitis media is one of the most common etiopathological factors involved in the appearance of mastoiditis. The infection can spread from one ear through the mastoid bone of the skull which, filling up with infected material, could undergo deterioration.
In addition to otitis media, other diseases that may predispose a patient to mastoiditis have been identified. Among all, we remember:
- intracranial abscess
- meningitis (especially the one supported by pneumococcus)
- facial nerve paralysis
- cavernous sinus thrombosis
The pathogens most involved in mastoiditis are: Streptococcus pneumoniae, S. pyogenes, Staphylococcus spp., Haemophilus influenzae, Pseudomonas aeruginosa . Aspergillus and other fungi are pathogens which only rarely promote inflammation of the mastoid cells.
Mastoiditis can be classified into two variants:
- Acute mastoiditis: a pathological process of a suppurative nature, due essentially to acute otitis media
- Chronic or latent mastoiditis: inflammation of the mastoid cells secondary to a chronic inflammatory-suppurative process of the ear or to a cholesteatoma
Terminology
- Suppurative process: pathological process in which there is the formation of purulent material (pus) in an inflamed tissue
- Cholesteatoma: squamous epithelium that originates during chronic otitis media
Since the air cells are connected posteriorly to the posterior cranial fossa, and superiorly to the middle cranial fossa, a possible suppuration of the mastoide can cause meningitis or cerebral abscess.
Risk factors
Some risk factors have been identified that may predispose the patient to the appearance of mastoiditis. Infant age (especially children aged 6-13 months), impaired immune system and a past history of cholesteatoma can make the patient more susceptible to mastoiditis. It has also been observed that patients with speech difficulties or those with mental disabilities tend to be more affected by mastoiditis, probably due to their inability to communicate symptoms properly and to express themselves.
Incidence
Currently, mastoiditis is a rather rare infectious-inflammatory process. However, before the entry of antibiotics into therapy, the disease was a fairly common condition, especially in children. In the past, mastoiditis - diagnosed in 5-10% of children with acute otitis media - had an average incidence of 2 children per 100, 000 healthy. Currently, it is estimated that the mortality rate is extremely low (0.01 children per 100, 000).
Clearly in developing countries, where drugs (especially antibiotics) are scarcely available, the mortality rate from mastoiditis is significantly higher.
Symptoms
To learn more: Mastoiditis symptoms
In general, the symptoms that are often associated with mastoiditis are: mood alteration (irritability), headache, fever lasting more than 4 days, otalgia, gastrointestinal symptoms (often, in affected newborns vomiting and diarrhea are the only observable prodromes ).
In addition to these symptoms, mastoiditis is accompanied by a series of characteristic signs, such as retro-auricular edema associated with erythema and mastoid fluctuation. The clinical picture of mastoiditis is also marked by all the characteristic symptoms of otitis media.
Acute and chronic mastoiditis
The table shows the typical symptoms of the acute and chronic form of mastoiditis in more detail.
| Acute mastoiditis | Chronic mastoiditis |
| Basal temperature alteration Abnormal protrusion of the outer ear forward (fluctuation) Swelling and redness in the back of the ear Swelling and erythema of the tympanic membrane lack of appetite Irritability Otalgia Perforation of the eardrum Weeping (in the child) Past history of otitis media (acute or recurrent) | Hearing impairment Recurrent attacks of otalgia and retro-auricular pain Recurrent headache Fever (sporadic episodes) Infection (obvious or not) of the tympanic membrane Irritability and crying in newborns Lack of obvious inflammation of the peri-mastoid |
Complications
When not treated in time, mastoiditis can create various complications:
- septic arthritis
- brain abscess
- abscess of Bezold (diffusion of the purulent material from the mastoid process - along the digastric muscle - up to the muscles of the neck)
- abscess between the periosteum and the mastoid bone ("protruding eye" cause)
- bone erosion
- zygomatic mastoiditis (extension of infection at the level of the cheekbone)
- osteomyelitis
- cranial nerve paralysis
- hearing loss
- spasm of the carotid artery
- death (rare)
Diagnosis
For the diagnosis of mastoiditis, examination of the head may reveal the characteristic signs; to ascertain the infection to the mastoid cells, it is essential to verify the retro auricular swelling, the cervical stiffness and the fluctuation of the auricle. The most used diagnostic tests are: complete blood count with formula (to highlight leukocytosis) and mastoid RX. The CT scan is reserved for serious cases, where a spread of infection is suspected in other locations. The antibiogram is instead useful in case of presumed hearing loss.
In patients suspected of having mastoiditis, differential diagnosis of infectious cellulitis, bone cysts, fever of unknown origin, fractures of the lower skull, swelling of the parotids, enlargement of the cervical lymph nodes, otitis media or external, intracranial sepsis and trauma is required. headset.
Care
Being a mostly bacterial infection, antibiotics are the treatment of choice for mastoiditis; in general, penicillins, cephalosporins and macrolides are the most effective drugs. Possibly, in case of moderate-severe pain and inflammation, it is recommended to administer therapeutic aids such as opioids or NSAIDs (eg ibuprofen). Paracetamol is also used in therapy to lower fever in the context of mastoiditis.
In addition to antibiotic therapy, some patients must undergo a stronger treatment: surgical drainage or mastoidectomy (useful in the case of mastoid osteitis, abscesses, intracranial extension of the infection and cholesteatoma). The surgery is necessary in the case of ascertained disappearance of the mastoid intracellular septa, developed during the suppurative process of mastoiditis.
