Symptoms
Acute mastoiditis manifests as redness, swelling, and tenderness in the area behind the ear. It is often accompanied by ear pain, fever, and a discharge because it is a concomitant or secondary disease of otitis media. Like the latter, mastoiditis occurs mainly in children. The ear may protrude due to pus accumulation and abscess formation. Since antibiotics are now available for the treatment of otitis media, the disease has become rare. Mastoiditis should be adequately treated medically because if it continues to spread, it can lead to serious and sometimes even life-threatening complications, for example, hearing loss, thrombosis, facial paralysis, meningitis, and abscesses. This due to the close proximity to the central nervous system, ear and blood vessels.
Causes
Mastoiditis is a usually bacterial, infectious, and inflammatory disease of the mastoid process (processus mastoideus, mastoid), which is part of the temporal bone, a lateral bone of the skull. Skeletal muscle cords of the neck originate from the mastoid. Inside it, there are numerous cavities lined with a mucous membrane. They communicate with the middle ear through a small canal (aditus ad antrum). The discomfort arises due to the inflammation of the mucosa, suppuration and melting of the bone, which leads to the breakthrough into the surrounding tissues. Typical pathogens include streptococci (, ), staphylococci, pseudomonas and .
Diagnosis
Diagnosis is made on the basis of the patient’s history, clinical picture, physical examination, with otoscopy (eardrum), laboratory methods, and imaging techniques such as computed tomography or magnetic resonance imaging. Otolaryngologists are specialists in the disease. Differential diagnoses include trauma, cellulitis, and swelling of the parotid gland (parotitis).
Nonpharmacologic treatment
Local intervention, such as paracentesis with aspiration, is often required. Paracentesis involves making a small incision in the tympanic membrane to allow secretions to empty. Mastoidectomy involves partial or total removal of the mastoid process. However, it is less commonly performed today.
Drug treatment
Antibiotics:
- Such as cephalosporins (ceftriaxone i.v.) are effective against the causative bacteria. If pathogen detection is available, antibiotic therapy can be adjusted accordingly.
Analgesics:
- Such as the non-steroidal anti-inflammatory drugs and paracetamol for the treatment of pain and / or inflammation.
Other medications:
- To alleviate the symptoms can also be used supportively, for example, decongestant nasal sprays, inhalations, sympathomimetics and cold balms. Ear drops are usually not suitable, however, due to the often perforated eardrum.