Signs & Investigations Pinhole perforation + otorrhoea Light house sign: intermittent reflection of light Decreased mastoid tenderness High (mass effect) + low frequency (stiffness effect of thick periosteum) Conductive deafness Clouding of air cells in mastoid X-ray
4. Stage of Coalescent Mastoiditis Otorrhoea > 2 weeks, otalgia & deafness Mastoid reservoir sign: pus fills up on mopping Sagging of postero-superior canal wall caused by peri-osteitis due to pus in adjacent mastoid antrum Ironed out appearance of skin over mastoid due to thickened periosteum Mastoid cavity in X-ray & CT scan
Pathogenesis Aditus Blockage Failure of drainage Stasis of secretions Hyperemic decalcification Resorption of bony septa of air cells Coalescence of small air cells to form cavity Empyema of mastoid cavity
On review after 48 hours Earache + fever persists: change to higher antibiotic. If T.M. is bulging perform myringotomy. Send ear discharge for C/S. Earache + fever subside: continue same treatment for 10-14 days Review after 3 months
On review after 3 months No effusion: no further treatment Effusion persists: treat as Otitis Media with Effusion Presence of abscess or coalescent mastoiditis: do cortical mastoidectomy
Myringotomy in A.S.O.M. Curvilinear incision made in postero-inferior quadrant. Incision is curvilinear & not radial (as in OME), to cut fibres of TM. This keeps opening patent for long time.
Why make incision in PIQ? Least vascular area T.M. bulge is maximum Ossicles not damaged Easily accessible
Luc: swelling in external auditory canal Zygomatic: swelling antero-superior to pinna + upper eyelid oedema Retro-mastoid: swelling over occipital bone (? Citellis abscess) Parapharyngeal & Retropharyngeal: due to spread of pus along Eustachian tube