Acute mastoiditis results from acute or chronic otitis media. In some
cases the otitis media may have been only a mild attack.
=Diagnosis.=—There is no one symptom that is positively diagnostic but
a number of signs and symptoms must be considered as follows:
1. Always suspect mastoid complications in acute otitis media and watch
for this complication daily. Most cases have some mastoid inflammation.
2. Pain or swelling over mastoid. Pain may not be present, but usually
is, sometimes radiating over temples and eye on affected side.
3. Tenderness on pressure not always present. May be very marked.
Tenderness extending to tip or above ear means extension of infection.
If persistent tenderness over tips with marked swelling and
discoloration—operation is indicated.
4. Swelling, not always present, but sometimes very marked. If extreme
swelling and bluish discoloration—usually means operation.
5. Temperature varies from normal to 104° or 105° F. Temperature of
more than one or two degrees means systemic absorption and suggests
surgical drainage. Streptococcus or staphylococcus infections cause
higher temperatures and require drainage earlier than other infections.
6. Transillumination not positive, but of some value. Like X-ray,
usually shows dark, because of inflammation, but must rely upon
symptoms, as above.
7. =Microscopic.=—Stain for pus, bacteria and bone debris. Hematoxylin
stain shows dark bone particles if there is bone disintegration.
8. =Blood Count.=—If absorption, there will be some variation in
proportions of leucocytes. Any high leucocytosis shows systemic
absorption and the natural attempt to overcome the infection.
=Non-Surgical Treatment.=—1. Drainage must be maintained from middle
ear through tube or drum or both. Catheter aspiration through tube.
Sometimes gentle inflation to clear the tube, followed by aspiration is
effective.
2. If drum is ruptured, aspirate middle ear by catheter or by Moore’s
method or both. =This is very important.= If no aspirating machine, use
syringe and pump meatus and tube persistently. Dry meatus and keep well
open.
3. Patient should be kept in bed if symptoms are marked, with light
diet and bowels well open.
4. =Heat.=—Apply oil or other lubricant over whole side of face and
head and apply heat by means of “therapeutic” lamp intermittently.
Thirty minutes light on and fifteen minutes light off. The light-heat
(any electric lamp with reflecting shade will do) is much better than
hot water bottle or electric pad or sand bag. The heat must be kept
going day and night if symptoms are marked until the pain has entirely
subsided. Heat is most efficient in the early stages. After symptoms
are well marked, the ice pack is more desirable.
5. If drum is not ruptured, heat may be applied by means of Deason’s
continuous irrigating cup. Start at 116° F. and gradually increase to
123° F. if patient can bear it.
=Surgical.=—If drum has not ruptured and symptoms continue, it is best
to make free incision of drum,—keep open and apply (2) above.
=Indications for Mastoid Operation.=—There are no definite signs,
symptoms or tests that will determine positively when operation should
be done. If the above non-surgical methods are practiced, few cases
will require operation, but many will develop into chronic mastoiditis
and so it is very difficult to decide whether a mastoid operation
should or should not be done. It is best to explain thoroughly the
possible complications to the patient and relatives and request them to
assume responsibility. Mastoid operations are attended by very little
danger when properly done.
=Signs and Symptoms Suggesting Operation.=—Acute otitis media with
mastoiditis.
(1) Persistent pain and swelling not relieved by non-surgical treatment.
(2) Marked protruding of posterior wall or meatus.
(3) Marked tenderness, swelling and discoloration above ear or over tip
of mastoid.
These with temperature of more than 102° usually are enough to demand
immediate drainage.
(4) Any evidence of extension of pus under skin of neck below tip. A
positive indication for drainage.
(5) Any indications of brain or meningeal involvement such as very
marked and persistent headache, partial or total loss of consciousness,
etc.
(6) Indications of labyrinthine involvement such as marked vertigo, etc.
(7) Sudden cessation of discharge means obstructed drainage from middle
ear or from mastoid into middle ear and if drainage cannot be restored
by aspiration, this means operation.
(8) The whole clinical picture must be carefully considered at all
times. Take no chances. Advise operation before someone else finds it
too late.