Mastoiditis – causes, symptoms & therapy

In principle, bone-changing processes take place in the mastoid process in mastoiditis. This leads to a melting of bone tissue and at the same time to bone-building processes. Foci of pus develop, which lead to one or more abscess cavities.

The mastoid is located behind the ear and appears as a bony protrusion. It contains an air-filled cavity with pneumatic cells (bone marrow cells), which remain unaffected by the inflammatory processes. In mastoiditis, only the cortalis (outer layer of the bones) is affected by the bone melts.

causes

Mastoiditis always results from an acute middle ear infection. Acute otitis media also regularly causes inflammation of the mucous membranes of the mastoid process. As a rule, however, these inflammations heal as the middle ear infection subsides.However, it can also happen that the outer bone cells are affected by purulent, inflammatory processes, with considerable complications being possible under certain circumstances. Since mastoiditis is basically an extended course of an acute otitis media, its pathogenesis should also be considered in connection with the causes of acute otitis media.

Acute otitis media can be caused by bacterial pathogens such as pneumococci , streptococci , staphylococci or by a variety of viral pathogens. The continuation of the disease processes in the context of mastoiditis is always caused by bacteria. However, that doesn’t mean that viral otitis media can’t cause mastoiditis. Otitis media prepares the ground for a new disease, so to speak, which can also be caused in part by a new infection with bacteria.

Prerequisites for this complication are a weakened immune system , particularly aggressive pathogens, obstructed secretion drainage in the middle ear infection or insufficient antibiotic treatment of the otitis. However, mastoiditis has become relatively rare today due to the intensive treatment of bacterial middle ear infections with antibiotics.

symptoms and course

Typical symptoms of mastoiditis:

• earache

• pounding in the ear

• deafness ,

• Fever

Symptoms of mastoiditis are similar to those of an acute middle ear infection. Her symptoms are much more pronounced. The patient suffers from severe ear pain, pounding in the ear, hearing loss, purulent discharge from the ear and fever. There is also significant swelling and tenderness of the mastoid process behind the ear.

Normally, the acute middle ear infection should heal on its own after about two weeks. In the case of mastoiditis, however, after the first symptoms have subsided, the same symptoms reappear to a much greater extent.

There are also progressive forms where the symptoms of the disease remain unchanged for many weeks. Since several foci of pus form, the disease process can continue in a dangerous manner. If the pus cannot drain away unhindered, swelling initially occurs on the mastoid process, sometimes also on the neck or face. Ultimately, however, mastoiditis also threatens a breakthrough into the interior of the skull, which can lead to life-threatening complications such as meningitis , sinus thrombosis or brain abscess.

Diagnose

The doctor can diagnose mastoiditis relatively easily based on the symptoms. Especially if a middle ear infection that has already subsided develops similar symptoms again, this is a very strong indication of mastoiditis. Even with a long, never-ending course of the disease, the doctor will very often make this suspected diagnosis. However, tenderness and swelling behind the ear makes the diagnosis certain. Using imaging methods such as MRI or computer tomography , the doctor can determine the location of the abscess foci that have arisen in the mastoiditis .

treatment and therapy

Acute mastoiditis must be treated surgically to stop the life-threatening process. Typically, the mastoidectomy procedure is mostly used. Here the doctor exposes the bone of the mastoid process, mills it open and clears out the pus. At the same time, sufficient intravenous antibiotic treatment is given to completely kill the bacterial pathogens.Chronic forms of the disease with milder symptoms can also be treated without surgery using high-dose and broad-spectrum antibiotics . However, if this is unsuccessful, a mastoidectomy is also indicated here.

Antipyretics and painkillers can be used for the accompanying symptomatic treatment. It is important to ensure that antibiotic treatment is not discontinued too early. Because if the bacteria are not completely eliminated, there is a risk of serious complications as well as the emergence of resistant bacterial strains in mastoiditis.

prevention

There is no way to specifically prevent mastoiditis. A healthy lifestyle with a balanced diet and physical exercise ensures a strong immune system, which then represents sufficient protection against infectious diseases. This also indirectly serves to prevent mastoiditis.