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A Potential Source of Danger in Ear Disease
By its liability to septic infection and its proximity to the brain and other important structures the portion of the temporal bone.known as the mastoid process is of great importance. Infection spreads to cavities in the bone from the middle ear, and is always to be apprehended when this organ is infected. Surgical interference may become urgent at any time.
The skull bone known as the mastoid is in reality part of the temporal bone, one of the most important of the bones which articulate together to form the cranium, or brain pan. The temporal bone contains the organ of hearing. At birth this bone is easily separable into three parts, the squamous (or scale-like) part, the petrous (stony) part and the mastoid part. The most striking external feature of the mastoid bone is the mastoid process, a solid triangular and conical process of bone which extends to an apex downwards and forwards from the rest of the mastoid.
At birth the mastoid process is undeveloped. It grows after birth, and assumes a nipple-like form about the second year of life. Towards puberty its spongy internal subst,ance (diploe) becomes permeated with air spaces, and sometimes this condition is met with in quite early childhood. These air spaces receive the name of mastoid cells, the name mastoid (Greek, mastos, breast. and eidos, like) referring to the characteristic shape of this process.
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The mastoid process is composed of a dense outer plate or table of bone. Beneath this in the interior of the mastoid; is a network, or labyrinth of little cells communicating with each other. The deep aspect of the bony cone is bounded by another more or less dense inner plate of bone. as the cells within the mastoid process run torwards towards the tympanic cavity of the ear they open eventually into a relatively large cavity within the mastoid; known as the mastoid antrum.
The question of the function of the mastoid cells and the precise purpose they serve is rather obscure. They are lined with a mucous; membrane which secretes mucus. The cells communicate with one another, and all the fluid they secrete is passed on eventually to the mastoid antrum, thence to the tympanic cavity, and thence to the Eustachian tube and so into the throat. The secretion in health is very slight and scanty, but in disease it may become very much increased.
The upper most part of the cavity of the middle ear, the epitympanic recess or attic, communicates directly with the tympanic, or mastoid, antrum, so that infection can pass backwards, and hence through the many openings into the mastoid cells.
Disease of the Mastoid
Smokh   The tympanic antrum, a cavity in the mastoid bone, lies behind the middle ear, with which it is connected by an opening, the aditus-ad-antrum, within the floor of which is the facial nerve. Internal to the antrum, merely seperated by a plate of bone, are the lateral or transverse sinus and the brain.

The mastoid process in children is more vulnerable than in adults, and the acute specific fevers of childhood are a frequent cause of mastoid disease. In adults disease is more frequently limited to the cavities of the tympanum and antrum. A mastoid abscess frequently points externally. An abscess may point and rupture internally, with very grave consequence: to the brain and brain membranes, and even to life itself.
In a typical case symptoms referable to the mastoid do not as a rule appear until after the middle ear has become diseased, and after the drum has ruptured and discharge has made its appearance at the external meatus. It must be remembered, however that this rule is by no means a rigid one, and the whole mastoid process may undergo suppuration while the tympanic membrane is still intact.
The pyramidal piece of bone projecting downwards behind the ear is called the mastoid process and is of great importance because the antrum and cells contained within it are readily infected from the middle ear when it is diseased, as after measles, septic throat, etc.
Among the most important symptoms are mastoid pain and tenderness; irregular, raised temperaturc, especially at night; headache; general malaise, and sometimes vomiting and giddiness There is nearly always a visible discharge from the ear. In young children some degree of neck stiffness is nearly a1ways present, and, indeed it is not uncommon to find a clinical picture very suggestive of meningitis. In most cases there is partial deafness and subjective noises and sleep may be disturbed by pain.
The above symptoms would be those of a moderate degree of mastoiditis, with antrum and cells in a state of inflammation. In advanced stages symptoms are naturally more severe.
Complications of Mastoid Disease
The liability to complication of one kind or another is very frequent. In the presence of complication the symptoms of a pure mastoiditis become confused or masked, and the clinical signs corresponding to the perhaps graver condition tend to predominate.
Medical advice and attention should be sought at the earliest sign of mastoiditis, as it is only by the employment of proper measures without delay that grave and complicating conditions may be averted. Only the more serious and common complications of mastoiditis can be dealt with here. They include thrombosis of the lateral sinus; brain abscess; labyrinthitis; and meningitis.
By thrombosis of the lateral sinus (q.v.) is meant a clotting of the blood in one of the great veins of the brain which lie in close relation with the mastoid process. Disease gradually extends from the process to the vein wall. If disease extends further the blood within the vein clots. The clot itself then becomes infected and pus forms in it. Pus so formed may be carried away in the venous circulation to the heart and thence to almost any part of the body.
Left, the mastoid antrum, enlarged by destruction of bone through sepsis; an abscess may form at the tip of the mastoid process, or septic mischief may spread to the lateral sinus, beneath he covering of the brain or even into the brain itself. Right, infection may spread by the Eustachian tube to the middle ear and beyond.
Wherever the purulent clot is carried an abscess is likely to forrn. It is these facts that make thrombosis of the lateral sinus such a very dangerons condition.
The treatment is by surgical operation. This is frequently successful in saving Life if undertaken early and before the purulent clot has begun to disseminate about the circulation. The object of the operation is to cut into the sinus and turn out all infected clot, and later to complete the obliteration of the sinus as a blood channel. This object can be successfully attained in many cases, provided always that the thrombosis of the sinus is not itself complicated by other dangerous conditions.
Brain abscess is a not infrequent complication of mastoid disease, The abscess may develop in the middle part or in the back part of the brain. It is due to a direct extension of disease from the mastoid into the brain, through the lateral sinus, through the labyriuth, or through the inner bony wall of the mastoid process itself. Here, again, the only hope lies in early operation.
By labyrinthitis as a complication of mastoid disease is meant an infection of the labyrinth by direct extension from some part of the diseased mastoid. The condition is highly danerous. It is accompanied by intense giddiness, headache and vomiting, and characterised by a peculiar movement of the eyes known as nystagmus. The great danger of the condition is the possibility at any time of further spread of infection from the labyrinth inwards to the meninges, when meningitis (q.v.) is set up.
A Fatal Complication
Of all the complications of mastoid disease meningitis, of greater or less degree, is perhaps the most common. It is a very fatal condition if not recognized and dealt with early by efficient surgical operation. The patient dies of toxaemia (poisoning) and exhaustion.
The more simple operations devised for dealing with pure, uncomplicated mastoid disease may be referred to.
In infants and very young children where acute mastoid disease is present, with, perhaps, an external mastoid abscess, the operation known as Wilde's incision may lae done. The incision in most cases is enough to allow pus to escape, and in favourable instances the mastoid thereafter begins to heal.
In older children, a more extensive procedure is necessary, and in acute diseases the so-called cortical mastoid, operation will have to be done. The operation consists in chiselling open the mastoid antrum and cells by means of a gouge and mallet. The antrum must be thoroughly laid open and all diseased cells must be entered and drained. No part of the essential structure of hearing is touched by this operation, and in favourable cases perfect hearing is recovered.