Practice Essentials
A purist's definition of mastoiditis includes all inflammatory processes of the mastoid air cells of the temporal bone. As the mastoid is contiguous to and an extension of the middle ear cleft, virtually every child or adult with acute otitis media (AOM) or chronic middle ear inflammatory disease has mastoiditis. In most cases, the symptomatology of the middle ear predominates (eg, fever, pain, conductive hearing loss), and the disease within the mastoid is not considered a separate entity (see the image below). [1, 2] (See Etiology and Presentation.)
Acute mastoiditis is associated with AOM. In some patients, the infection spreads beyond the mucosa of the middle ear cleft, and they develop osteitis within the mastoid air-cell system or periosteitis of the mastoid process, either directly by bone erosion through the cortex or indirectly via the emissary vein of the mastoid. These patients have acute surgical mastoiditis (ASM), an intratemporal complication of otitis media. (See Etiology.)
Chronic mastoiditis is most commonly associated with chronic suppurative otitis mediaand particularly with cholesteatoma formation. Cholesteatomas are benign aggregates of squamous epithelium that can grow and alter normal structure and function of surrounding soft tissue and bone. This destructive process is accelerated in the presence of active infection by the secretion of osteolytic enzymes by the epithelial tissue.
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Mastoiditis with subperiosteal abscess. Note the loss of the skin crease and the pointed abscess.
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Cortical mastoidectomy in a densely sclerosed mastoid.
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Preoperative preparation of the patient.
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Draping the surgical area.
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Injection of the area with 2% Xylocaine and 1:100,000 adrenaline to reduce bleeding.
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Marking the incision site.
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Placement of the incision, a few mm behind the postauricular sulcus.
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Deepening the incision down to the bone.
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Elevation of the periosteum to expose the mastoid cortex to the mastoid tip.
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Mastoid drilling in progress with simultaneous saline irrigation.
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Creation of the initial groove and the vertical line.
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Exposure of the antrum and exenteration of the mastoid air cells.
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Curetting the aditus to enlarge it.
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Further exposure.
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Healed postaural scar.
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Extent of cortical mastoidectomy in a well-pneumatized mastoid.