Pathology of chronic mastitis

2021-01-31 12:00 AM

Chronic inflammation of the mastoiditis is an acute episode of inflammation with the same manifestations as acute mastoiditis, which easily causes dangerous complications.


Long-term bleeding, hearing loss are the two main symptoms. The eardrum is punctured, the daughter skeletal system is damaged, the mastoid cells become inflamed. If there is cholesteatoma, it is easy to cause complications and recurrence. X-rays of the mastoid bone can reveal pathological images.

Chronic inflammation of the mastoiditis is an acute episode of inflammation with the same manifestations as acute mastoiditis, which can easily cause dangerous complications.


Common chronic mastitis. 

Chronic inflammatory mastitis.

Chronic mastitis with cholesteatoma.

Common chronic mastitis


Chronic persistent purulent otitis media.

Due to acute mastoiditis is not completely treated.

Good condition:

The bodies have weak resistance.

Inflammation of the middle ear after injury.

The mastoid bone is a low-celled type.


Function: Similar to chronic purulent otitis, but to a more severe degree.

Ear pain, dull pain spread to the first half of the disease.

Hearing loss increases markedly: conduction type hearing loss.




Frequent discharge of ear pus is the main symptom, thick pus, and a stench.

Ear microscopy: the hole is usually wide, the edge is rough, close to the skeleton, polyps can be seen in the eardrum or the cholesteatoma. There is a lot of rotten pus, there may be white fragments of the cholesteatoma.

Schuller postural radiographs: mastoid bone loss of synovial cells, bone dense image or resorption (polycyclic circle: in chronic mastitis with cholesteatoma).

Progression and complications

Chronic mastoiditis is difficult to resolve on its own, often leading to episodes of inflammation and excretion. Today, due to the development of antibiotics, complications such as peripheral facial paralysis due to nerve damage No. VII, atrial inflammation, intracranial complications such as meningitis, brain abscess or phlebitis side has decreased significantly ...


The current trend is surgery early to preserve hearing and avoid complications.

Chronic inflammatory mastitis

An episode of acute inflammation in a patient with chronic mastoiditis and threatening complications.



High, prolonged fever.

Fatigue, bacterial infection.


Ear pain increasingly intensified, pain spread to the first half, pain into a pain reliever that did not work.

Hearing loss increases.




Latex discharge increased more than before, thick pus, stench.

The mastoid bone behind the ear becomes red and painful.

Tympanometry, wide perforation, close bone, congestive red base of the ear canal, can see the collapsed posterior wall of the ear canal.

X-ray: Schuller posture sees pictures:

The dense translucent loses all the information.

Or there are bright areas due to bone loss.

It can be seen that the cholesteatoma image is round irregularly bright, the surrounding clear edge is dull.


Implementing the quadrants:

Based on a history of purulent discharge (frequent thick discharge and rotting).

Ear pain, headache spreading to the temples.

Hearing loss increases quickly.

Need complete and meticulous ear exam.

Photograph main postures: Schuller, Chaussé III. 

Differential diagnosis:

Inflammation of the middle ear has a cavernous reaction (presses on the painful mastoidal area, but the pus does not rot). Normal X-ray image.

Boils or inflammation of the outer ear canal.

Acute mastoiditis.

Inflammation of lymph nodes, lymphatic organization behind the ear.


Osteomyelitis or temporal bone.

Facial paralysis.

Abscess of the cerebellum and cerebellum.


Complications of lateral phlebitis, sepsis.

Complications of atrial anaesthesia.

Complications of discharge.

The most common signs of post-ear discharge include:

Swelling of the cymbals behind the ears.

Ear rim is pushed forward.

Loss of fold behind the ear, called Jacques's sign.

The pubic area feels soft, dull and has a pronounced pain response.

Excessive cymbals (Bezold body): common in adults, swelling of the muscles below the cymbals, the sternum muscle. Painful neck rotation, twisting of the neck, presses on the sore cymbals.

Outward discharge in the temporomandibular areas is common in infants under 12 months:

Swelling in the temples above or above the ears.

The ear rim is pushed down and out.

The upper wall behind the ear canal often collapses.

Outward into the ear canal (Gellé body): with a hole in the posterior wall of the bone of the outer ear canal close to the eardrum using a probe to see:

Pus flows out through the bone stoma.

Easy to cause facial paralysis.

Mouret background exudate: rare because of an internal discharge that causes unclear signs to appear slowly.

Pus often spread far to the corner of the jaw, nape, in the throat.

Easy to cause complications of thrombophlebitis.


Surgical eradication of mastoid bone, solving complications.

High dose antibiotics.

Body support.

Chronic mastitis with cholesteatoma

In otitis media and mastoiditis, the cholesteatoma is a special type of lesion that needs attention because:

The bone is destroyed very quickly and strongly, so it reduces the hearing clearly and easily leads to complications.

Almost only encountered in mastoid pathology, especially in our country with a high rate.


Although cholesteatoma is known for a long time, until now, the pathogenesis has not been clear. Theories mentioned are:

Primary theory: Given that the cholesteatoma is born from the epithelial fragments of the remaining fetus, it is sometimes found that the cholesteatoma is localized in the stone bone without damage to the mastoid bone, in fact these cases are very rare.

Secondary theory.

Because of the irritating inflammation that transforms the epithelium of the ear cavity into the cholesteatoma, little is known today.

Due to migration: the epidermis in the ear canal and eardrum through the eardrum entry, the horn turns into cholesteatoma. Therefore, it is common to see the cholesteatoma when puncturing the upper posterior angle, the slack membrane or wide perforation close to the skeleton in the stretch membrane, especially when the Eustachi nozzle is blocked, causing the slack to be concave easily causing immigration.

Pathological anatomy

Cholesteatoma like a cyst.

The outside is a rather thick, chewy, white shell consisting of 2 layers: the slice epithelium, sticking to the connective organizational layer, in the middle there are cholesteryl crystals, so it is shiny white. It is thought that this shell encroaches and destroys bones, so it is called the roof membrane (matrice).

Inside is a soft, white pea-like mass consisting of epithelial cells mixed with fat cells and cholesteryl.

The cholesteatoma block can be dry, odourless, but often mixed with pus, then there is a stench.


Symptoms usually occur with cholesteatoma:

Visible hearing loss, even in cases of a hole in the small eardrum. Hearing loss due to cholesteatoma block interferes with oscillation of the daughter bone chain or disrupts sound conduction due to the destruction of the daughter.

Pus rotten discharge: in ear infections, mastoidal pus cholesteatoma can flow more or less but always has a stench, very unpleasant smell. Typically, pus is white and white like bean pulp, with white fragments, shining like nacre, due to the break of cholesteatoma shell, when dropped into the water, the yellow is shimmering like scum, drop into acetic aldehydes solution to turn into green Blue.

Upper posterior perforation: cholesteatoma often found in cases of small punctures behind the slack membrane, especially a hole in the posterior corner of the eardrum: the hole is close to the skeleton, possibly partially deepening the ear canal at the edge of the hole. The hole is usually covered by thick pus or scale, making it difficult to detect.

If the perforated eardrum is wide or total, the hole is close to the skeleton, the bruises, the bottom of the hole has a white, shiny film.

X-ray: on Schuller or Chaussé III film, the cholesteatoma image can be seen through an irregular, cloudy, smoke-like bright area, usually round, a bold border on a mastoid informed.

Most forms of osteomyelitis, inflammatory, external or have complications as mentioned above have cholesteatoma lesions.

To solve

Surgery: Because the cholesteatoma destroys bones quickly and strongly, it can lead to complications, impaired hearing, if surgery cannot get all back, it will quickly recur, so it is necessary to do:

Eradication surgery: When the daughter bone mass has been damaged, the cholesteatoma mass can be found in both the ear canal and mastoid bone. It should be noted: cholesteatoma often encroaches into small niches in the bone, so when surgery, it is necessary to remove the roof membrane (cholesteatoma shell), open the bone cavities, wide drainage.

Joint mastoid opening: when cholesteatoma mass is localized. After opening the atrial rod to remove the cholesteatoma, it is necessary to open the posterior bar of the ear canal to be able to examine the ear canal because cholesteatoma is often present in the ear canal.

Conservation: only performed when the cholesteatoma block is dry, small and well-located.

Must ensure:

Get all the cholesteatoma through washing, smoking, pay attention to remove the shell.

Allow the hole to drain well and not be covered by scabs or polyps.

Burning the cavity of the skin with silver nitrate to ensure no recurrence.