Mastoiditis in Children

What is Mastoiditis in Children?

Mastoiditis is an inflammatory damage to the mastoid of the temporal bone (behind the ear), has an infectious origin. Mastoiditis can develop with infection or be a complication of acute otitis media. Clinically, mastoiditis is manifested by an increase in body temperature, intoxication, pain and pulsation in the site of the mastoid process, swelling, hyperemia of the ear, ear pain, and hearing loss. Mastoiditis occupies 5-10% of otolaryngological diseases in children.

Causes of Mastoiditis in Children

The causes of mastoiditis include:

  • The appearance of secondary mastoiditis due to the otogenic spread of infection from the tympanic cavity of the middle ear. The causative agents of infection are: influenza bacillus, pneumococci, streptococci, staphylococci, etc. Transition of the infection from the middle ear occurs due to drainage during late perforation of the eardrum, untimely paracentesis, too small a hole in the eardrum or its closure with granulation tissue.
  • Rarely, mastoiditis develops with hematogenous (through blood) penetration of the infection into the mastoid process, when the patient develops sepsis, secondary syphilis, and tuberculosis.
  • Primary mastoiditis is possible with injury to the cells of the mastoid process. When injured, pathogenic microorganisms develop in the blood, which flows into the cells of the appendix.
  • Mastoiditis can develop against a background of weakened immunity in chronic diseases such as bronchitis, diabetes, rheumatoid arthritis, tuberculosis, pyelonephritis, hepatitis.
  • Mastoiditis appears in the pathology of the nasopharynx (sinusitis, chronic rhinitis, laryngotracheitis, pharyngitis).
  • It can be a complication of previous injuries (otitis externa, aerootitis, otitis media adhesive, etc.) that were poorly treated.

Pathogenesis during Mastoiditis in Children

In children under the age of 6, the mastoid process is not developed, so in its place there is only an elevation, inside which a cave is located.

The mastoid process expands the temporal bone of the skull and performs the structural function of the reference point for the muscles of the neck. It contains several air cells, which in their appearance resemble honeycombs and come from the antrum. The lining of the mastoid process is the mucous membrane, which interacts directly with the eardrum. During the course of the disease, pus from the tympanic cavity enters the antrum (cave).

The tympanic cavity of the middle ear is connected to the mastoid process through a small canal that passes through the temporal bone. Mastoid air cells are connected with the middle cranial fossa, and posteriorly with the cranial fossa. This means that suppuration in the mastoid region can (rarely) cause meningitis or cerebral abscess.

Mastoiditis occurs when a purulent infection passes from the middle ear affected by otitis media to the mastoid air cells. The infectious process causes inflammation of the mastoid process and surrounding tissues, and can lead to bone destruction.

Mastoiditis is divided into acute (classic), when mastoiditis is a complication of acute otitis media, and chronic (latent) occurs in connection with chronic purulent otitis media or cholesteatoma. Chronic mastoiditis develops for more than three months, and acute mastoiditis – less than three weeks.

In acute mastoiditis, the body has a direct bacterial infection in the mastoid process. The skin covering the mastoid process behind the ear becomes inflamed and, as a result, turns red, and the place itself is swollen. If the infection develops for 10-14 days, then the small, bone walls that form the honeycombs filled with air are destroyed. Such bone destruction is called coalescent mastoiditis. If the infection continues to affect the body and leads to the direct accumulation of pus under the skin behind the ear, an abscess appears, and then the infection can spread to the lateral sinuses, causing the appearance of a blood clot (thrombosis). The infection can also spread directly downward, creating an abscess in the muscle that is attached to the mastoid process.

Chronic mastoiditis is formed when there is a chronic inflammatory process that affects the mastoid process. As a rule, this is a chronic inflammation of the middle ear, in which there is perforation in the eardrum. In chronic mastoiditis, there is no bone destruction.

Inflammation in the mastoid process is quite rare. It is almost always the result of inflammation or infection in the middle ear.

Symptoms of Mastoiditis in Children

Symptoms of mastoiditis are mild. The symptoms of mastoiditis include: pain in the ear and behind the ear, redness behind the ear, fever up to 38-39 ºС, lethargy, anxiety, changes in mental state, refusal to eat, irritability, frequent crying.

As mastoiditis progresses, significant edema can form behind the ear, protruding it forward. The hard bone under the skin becomes quite soft and pliable, which indicates an abscess. If the infection has become severe, then dangerous symptoms may appear, for example, facial paralysis, deafness, dizziness, meningitis and thrombosis in the lateral sinus, fever.

With mastoiditis, the behind-the-ear area becomes swollen, and the child complains of pain during palpation.

The respiratory and nervous systems of a child are affected by mastoiditis. The condition of the child can be either lethargic or hyper-excited – the child can cry, sleep poorly, and appetite is deteriorating sharply.

During the disease, the skin becomes pale and moist. The pulse quickens, shortness of breath appears, heart sounds are muffled.

In chronic mastoiditis, there is no change other than irregular pain behind the ear. Usually the chronic form is rather asymptomatic, with the exception of the time of exacerbation of the disease, then the pain becomes more profuse.

Symptoms of mastoiditis may coincide with the clinical picture of other diseases, therefore, differential diagnosis is necessary.

Diagnosis of Mastoiditis in Children

The diagnosis is made after:

  • Symptom analysis.
  • Inspection and palpation of the behind-the-ear area (swelling and redness of the skin behind the ear indicate the disease).
  • Otoscopy (examination of the outer part of the ear and eardrum using an otoscope).
  • Tympanometry (a test that measures the functioning of the middle ear. Helps detect any changes in pressure in the middle ear). This test is a difficult test for young children, because the child must sit very quietly, not cry, not speak, and not move.
  • Radiography – a diagnostic method using a radiographic dye, is used to detect an abscess under the skin or to determine the spread of infection in the brain.
  • Audiometry – a study of hearing acuity using a tuning fork, is carried out to establish the presence or absence of hearing loss.
  • Radiography – shows inflamed cells and the destruction of bone walls, forming air-filled cells in the mastoid cavity.
  • Computed tomography of the skull – used to view cross-sectional images horizontally and vertically. CT shows detailed images of any part of the body, including bones, muscles, fat and organs.
  • Magnetic resonance imaging (MRI) is a diagnostic procedure that uses a combination of large magnets, radio frequencies and computer technology to obtain detailed images of organs and structures in the body.
  • Analysis of cerebrospinal fluid (cerebrospinal fluid to determine the presence of infection)
  • Bacteriological culture of secretions from the ear – is taken to determine the type of pathogen.

Treatment of Mastoiditis in Children

The treatment of mastoiditis is determined by the doctor on the basis of the child’s age, general health, medical history, disease duration. Treatment takes place only in a hospital setting.

Treatment of mastoiditis usually requires hospitalization and a full assessment of the condition of the otolaryngologist. The child, in most cases, is prescribed antibiotics through an intravenous catheter. The doctor must make sure that the patient completes his course of antibiotics, which are selected depending on the pathogen.

In severe cases, surgery is necessary to drain the fluid from the middle ear. For this, a surgical procedure is used – myringotomy – placing a tube through a small hole in the eardrum to drain the fluid and reduce pressure from the middle ear. The tube is placed to prevent the accumulation of purulent fluid, and appropriate antibiotic therapy is prescribed. With myringotomy, the infection usually recedes easily. The tube is placed for a period of 6-12 months.

If the infection is serious, the doctor prescribes a mastidectomy – it is performed to remove the infected bone behind the ear. Hearing loss can occur due to a severe infection, especially if a cholesteatoma is present.

If the infection continues to spread despite antibiotic treatment, the following complications may occur: sigmoid sinus thrombosis – a clot in a large vein near the mastoid process, meningitis, brain abscess – an accumulation of pus and infection that can occur in the brain.

Early and proper treatment of mastoiditis is necessary to prevent the development of these life-threatening complications, which can lead to the following disorders: facial paralysis, deafness, dizziness, meningitis and brain abscess and their resulting diseases.

Prevention of Mastoiditis in Children

Preventive measures include the following:

  • Increased immunity, especially in those children who have chronic diseases.
  • Early and complete treatment of otitis media, the exact implementation of the recommendations of the attending physician.
  • Observation and management of treatment with one doctor. This allows the doctor to evaluate the effectiveness of the treatment over time. He will be able to adjust it if necessary.