Diagnosis CT
For diagnosis and especially for preoperative imaging of mastoiditis a CT is the cranial tool of choice. Compared to conventional x-rays, CT offers a number of advantages in the treatment of mastoiditis. Dangerous intracranial complications, which occur when the inflammation breaks through into the skull, can be ruled out.
By imaging all adjacent structures, the surgeon can gain important information about the best course of action should surgery be necessary. In acute mastoiditis, the mastoid cells appear cloudy due to the purulent inflammatory process. If the inflammation attacks the bone, the fine septa that divide the individual small chambers of the mastoid process perish. This can also be easily visualized on CT and is called bone fusion. In contrast, the diagnosis of a creeping chronic mastoiditis is much more difficult.
Diagnosis MRT
In addition to the CT, another form of imaging is available with the MRT. However, since this technique is inferior to CT in the imaging of solid tissue such as bone due to its mode of operation, it is rarely used specifically to exclude mastoiditis. Nevertheless, it can happen that an MRI is performed because of symptoms such as headaches, in which case mastoiditis is detected.
The main indication is an increased accumulation of fluid in the mastoid cells. However, this is not yet sufficient as clear evidence of mastoiditis. Further indications are, for example, an increase in contrast of the mucosa or visible disturbances of the flow in the mastoid cavities.
Therapy Mastoiditis
Inflammation-induced melting of the bone in the air-filled system of the middle ear makes immediate surgical treatment necessary and cannot be treated with medication alone. This involves removing the inflamed cells and ensuring the patency of the connection to the middle ear.
Operation
If a mastoiditis is already advanced, the administration of antibiotics and an opening of the eardrum is no longer sufficient for treatment. In this case, mastoiditis is treated surgically. This involves opening the bone behind the ear under general anesthesia to remove infected areas and clear the purulent inflammation.
The pus is drained through thin tubes, so-called drains. A distinction is made between simple or radical mastoidectomy. In simple mastoidectomy, only the affected part of the bone is removed, while surrounding structures remain intact.
In cases of severe purulent mastoiditis, this procedure alone may not be sufficient. In this case the surgeon performs a radical mastoidectomy. In addition to the mastoid, parts of the tympanic cavity and the posterior wall of the external auditory canal are removed.
This creates a larger cavity with connection to the external auditory canal, which can be cleaned more easily by the surgeon. However, since the structures of the middle ear usually have to be removed as well, this can result in severe hearing loss on the affected side. Thanks to modern surgical methods, normal hearing function can be maintained in certain cases, even in cases of radical mastoiditis.
Regardless of the required surgical technique, additional in-patient treatment with antibiotics is always carried out. This serves to kill any bacteria still present in the body. A mastoidectomy is always performed as an in-patient at the hospital.
Even though the actual operation usually lasts relatively short and leads quickly to improvement, it is necessary to stay in hospital for about one week due to the postoperative treatment with antibiotics.The antibiotics are normally administered via a venous access and must be highly dosed to kill all bacteria still present. Due to its small size, the surgical wound usually heals very quickly. When discharged from hospital, most patients are already free of symptoms.
