Mastoiditis

Mastoiditis (from the Latin “mastoiditis”) is a purulent inflammation of the cellular structures of the mastoid process of the temporal bone. This condition develops primarily as a complication of acute or chronic otitis media, arising from infection that spreads from the tympanic cavity.

The mastoid process has a porous structure composed of air-filled cells that communicate with the middle ear cavity. During inflammation, the drainage mechanism is disrupted, creating favorable conditions for pus accumulation, increased pressure, and subsequent destruction of bony septa.

Aetiology and Pathophysiology

Bacterial infection is the primary cause. Most often, the pathogens are the same microorganisms responsible for otitis media: Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes. Reduced immunity and inappropriate treatment of otitis media are key risk factors.

The pathological process begins when the mucous membrane lining the mastoid cells develops edema, which blocks communication with the middle ear. Exudate accumulates in the closed cavities, that subsequently suppurate. The pressure of the pus leads to necrosis and resorption of bony trabeculae, transforming the cellular structure into a single empyema.

Clinical significance

Clinical manifestations of mastoiditis include severe pain in the ear and postauricular region, fever, general malaise, and hearing loss. A characteristic external sign is swelling and hyperemia of the skin over the mastoid process, as well as protrusion of the auricle, which is displaced laterally and downward.

Diagnosis is based on medical history (history of otitis media), clinical examination, and otoscopy. The key instrumental diagnostic method is computed tomography (CT) of the temporal bones, which helps assess the degree of bone destruction and detect any possible intracranial complications.

In such cases, inpatient care is required. High-dose intravenous antibiotic therapy is typically prescribed. If ineffective or if destructive changes develop, surgical intervention is indicated. The procedure, known as antromastoidotomy, is aimed at opening, sanitizing, and draining the affected cells.

Differential Diagnosis

Mastoiditis should be differentiated from external otitis, furuncle of the external auditory canal, and postauricular lymphadenitis. Otitis media symptoms and characteristic CT findings are of fundamental importance. Untimely treatment of mastoiditis is dangerous due to possible severe complications such as meningitis, brain abscess, sinus thrombosis, and facial nerve paresis.