ACUTE MASTOIDITIS
Acute mastoiditis is a complication of acute suppurative otitis media, where the infection spreads from the mucosal lining of the antrum to involve the bony walls of the mastoid air system.
Two main pathological processes are responsible for Acute Mastoiditis:
- Production of pus under tension:
If an Acute suppurative otitis media is untreated, or fails to respond, the inflammatory process persists and there is an accumulation of pus in the mastoid air cells. The Eustachian tube or perforation in the tympanic membrane is not sufficient to drain the pus produced.
- Hyperemia decalcification:
Hyperemia and engorgement of mucosa causes dissolution of calcium from the bony walls of mastoid air cells. Both these processes combine and cause the destruction and coalescence of mastoid air cells, converting them into a single irregular cavity filled with pus (Empyema of mastoid).
Symptoms:
- Fever and malaise: Fever is persistent, despite adequate antibiotics. It can be as high as 40 degrees Celsius.
- Pain: It is usually post-aural. The presence of unilateral headache is suggestive of impending intracranial complications.
- Ear discharge: The discharge is purulent, profuse, and foul-smelling.
Signs:
- Sagging of posterosuperior canal wall.
- Perforation of the tympanic membrane.
- Mastoid tenderness elicited by pressure over the Macewan’s triangle.
- Conductive hearing loss.
- Protuberance of the pinna.
