How inflammation develops
The mastoid process communicates with the tympanic cavity, therefore, in acute purulent otitis media, the mucous membrane of its cells almost always reacts with inflammation. Usually, after restoration of outflow through the auditory tube or perforation of the eardrum, everything goes away. But if the pus is not evacuated, the pressure in the cells increases, the thin bone partitions are destroyed, and small cavities merge into one large one filled with pus. Further, the pus can break through under the periosteum to form an abscess behind the ear or towards the cranial cavity.
- Transfer of infection from the tympanic cavity
- Impaired outflow of pus
- Destruction of bone cell walls
- Formation of a purulent cavity
- Subperiosteal abscess behind the ear
- Risk of intracranial complications
Causes and risk factors
The main reason is untreated or severe acute purulent otitis media. The risk is increased by early childhood, when the cells of the appendix are still forming, frequent otitis media, adenoids that interfere with the ventilation of the auditory tube, as well as self-medication, premature cessation of antibiotics and instillation of questionable drugs in the ear. The likelihood of complications is higher in people with diabetes, immunodeficiency, as well as with an aggressive pathogen or microbial resistance to the drugs used.
- Acute purulent otitis media
- Incomplete course of antibacterial therapy
- Early childhood
- Adenoids and frequent otitis
- Diabetes mellitus and immunodeficiency
- Pathogen resistance to antibiotics
- Chronic otitis with cholesteatoma
Symptoms
Characteristic dynamics help to suspect a complication: against the background of otitis, the condition improved, and then the temperature rose again and the pain in the ear resumed. There is pain behind the ear, the skin over the mastoid process turns red and swells, pressure is sharply painful. The auricle moves forward and downward and looks protruding, this is especially noticeable in children. Suppuration from the ear and hearing loss persist, and there is a throbbing headache, weakness, and lack of appetite.
- Resumption of pain and fever after otitis media
- Pain and swelling behind the ear
- Redness of the skin over the mastoid process
- Protruding ear
- Suppuration from the ear
- Hearing loss
- Throbbing headache and weakness
Diagnostics
The doctor examines the ear and behind-the-ear area, evaluates the eardrum, the presence of pus, and pain when pressed. Computed tomography of the temporal bones is of decisive importance: it shows the filling of the cells, destruction of the bone partitions, the presence of an abscess and the involvement of neighboring structures. Blood tests show signs of inflammation. Ear discharge is sent for culture to select an antibiotic. In case of headache, vomiting or neurological symptoms, a brain examination is additionally prescribed.
- Examination of the ear and post-auricular area
- Otoscopy and eardrum evaluation
- CT scan of the temporal bones is the main method
- Complete blood count and C-reactive protein
- Culture of ear discharge
- Hearing assessment
- MRI of the brain for suspected intracranial complications
Treatment and prevention
Treatment begins immediately and, as a rule, in a hospital: broad-spectrum intravenous antibiotics are prescribed, pain relief is provided, pus is drained from the tympanic cavity, and, if necessary, an incision is made into the eardrum and drainage is installed. If there is no improvement or an abscess has already formed, an operation is performed on the mastoid process - the affected cells are removed and an outflow is created. Prevention consists of complete treatment of otitis media, completion of the prescribed course of antibiotics and a follow-up examination after recovery.
- Hospitalization and intravenous antibiotics
- Ensuring the drainage of pus from the ear
- Eardrum incision and drainage
- Opening a subperiosteal abscess
- Surgery on the mastoid process if ineffective
- Full course of treatment for otitis without unauthorized withdrawal
- Follow-up examination by an ENT doctor after recovery
