MASTOIDITIS

Mastoiditis refers to the inflammation of the mastoid bone, specifically its air cells. The mastoid bone is located at the temporal portion of the skull, which is a paired bone. 

Infection of the mastoid air cells is closely related to the occurrence of otitis media due to its proximity to the middle ear. There may be redness of the lining of the air cells, pus formation within the air cells, loss of mastoid bone structure and extension into the adjacent structures the most important of which is the brain. 

TYPES 

  • Coalescent Mastoiditis- A type of infection that involves the air cells of the mastoid and affects the mastoid bone.
  • Acute Mastoiditis- a kind of disease that is caused by pathogens such as Streptococcus pyogenes and Staphylococcus aureus which are present in the healthy flora of the skin. These organisms only become pathogenic if the host response is impaired
  • Chronic Mastoiditis- Is the type of infection that lasts more than six weeks and is caused by the pathogens which are opportunistic and are those organisms which resist common antibiotics

SYMPTOMS

Mastoiditis initially presents with fever in immunocompetent hosts (these are persons who have an excellent immune system) but can be asymptomatic until the later stages of the disease among immunocompromised individuals). 

Common symptoms that point to mastoiditis include: 

  • Pain radiating to the jaw from the back of the ear
  • Pain perceived during application of minimal pressure on the area behind the earlobe
  • Presence of foul-smelling discharge in the ear canal
  • Throbbing pain on one side of the head corresponding to the affected area.
  • In severe cases, a patient can present with a decrease in sensorium or more commonly known as coma because the infection already has reached the brain causing it to malfunction. It is otherwise named and managed as brain abscess. 

DIAGNOSIS

Diagnosis of this condition begins by history and physical examination. 

  • Use of otoscope for better visualization of the ear canal to check for the presence of pus
  • Computed tomography scan of the skull (Cranial CT scan) can visualize the formation of the abscess on the mastoid area. 
  • Complete blood count- Shows predominance of neutrophils and an elevated white blood cell count which signifies an active infection
  • Culture of the fluid from the ears – Swabbing of the liquid and subjecting them to incubation will reveal the offending organism.
  • Spinal tap – Refers to the procedure of removing cerebrospinal fluid for culture.

TREATMENT

  • Appropriate antibiotic therapy based on the sensitivity testing for the isolated organism
  • Incision and drainage- removal of the focus is the first step in the eradication of infection
  • Surgical removal of the mastoid bone- This may not be necessary in cases which are controlled by antibiotics alone.
  • Prevention of inner and middle ear infection- This is more common among children that spend a lot of time in public swimming pools, especially during the summer season.

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