Acute Coalescent Mastoiditis: Aso a Wɔpia Kɔ Anim ne Abɔnten, Aso Akyi Ahohoro, ne Asiane a Ɛwɔ Amemene Mu Akisikuru¶

Acute coalescent mastoiditis yɛ ɔyare mmoawa a ɛyɛ aniberesɛm, a ebetumi de nkwa ato nnompe mu yare a ɛwɔ mastoid process (mframa nkwammoaa a ɛte sɛ ɛwo a ɛwɔ ti nhwi no dompe a ɛwɔ akyi aso no akyi pɛɛ) a ɛba bere a mfinimfini aso mu yare a emu yɛ den (acute otitis media) siw nsu a ɛkɔ mastoid apon teateaa no mu (aditus) kwan no ad antrum) na ɛma akisikuru a wɔahyɛ no den a ɛma nnompe afasu a ɛyɛ tratraa a ɛtetew mframa nkwammoaa no mu no tew (bony coalescence). Esiane sɛ mastoid dompe no kyɛ nnompe afasu a ɛyɛ tratraa te sɛ krataa ne amemene no akyi ne mfinimfini ti nhwi ntini, sigmoid venous sinus (ntini titiriw a ɛtwe amemene no kɔ jugular ntini a ɛwɔ mu no mu), anim ntini (cranial nerve VII), ne aso mu labyrinth, mastoiditis a wɔanhwɛ so tumi ntɛmntɛm sɛe kɔ akyi wɔ aso no akyi ma ɛyɛ post-auricular subperiosteal abscess ANAA ɛtwetwe kɔ mu kɔ ti nhwi no mu ma ɛde sigmoid sinus septic thrombosis, epidural anaa temporal lobe/cerebellar amemene mu akisikuru, bacterial meningitis, anim a ɛyɛ mmerɛw, anaa **Gradenigo syndrome ba (ntini a ɛto so asia aniwa a ɛyɛ mmerɛw a anim yɛ yaw kɛse a efi petrous apicitis mu ba). Sɛ abofra anaa ɔpanyin bi a ɔwɔ aso mu yare mprempren anaa nnansa yi no nya kɔkɔɔ, boggy swelling, anaa dompe a ɛyɛ fɛ a ɛyɛ mmerɛw wɔ aso no akyi tẽẽ, abɔde mu honam ani a ɛyɛ mmerɛw a ɛwɔ aso no akyi no yera, anaasɛ akyi aso (pinna) a wɔpia no ma ɛda adi sɛ ɛkɔ abɔnten, kɔ anim, ne fam ("lop-ear" protrusion) a, hwehwɛ ayaresabea a wɔhwɛ no ntɛm ara anaa frɛ wo mpɔtam hɔfo nɔma ahorow a egye ntɛmpɛ prɛko pɛ. Bere a woresiesie wo ho ama ayaresabea akwantu no, hwɛ ɔyare mmoawa a ɛfa ho ne ntini ho akwankyerɛ ahorow a ɛfa meningitis ne meningococcal septicemia akisikuru a wɔpaw, . orbital cellulitis, cavernous sinus thrombosis, ne anim asiane ahinanan, na Bell’s palsy vs. stroke anim a ɛtɔ.

Esiane sɛ mmofra a wonya acute coalescent mastoiditis no mu bɛyɛ ɔha biara mu nkyem 50 nom nnuru a wɔde kum ɔyare mmoawa a wɔnom a wɔakyerɛw ama aso mu yare no DƐDAN (a ɛkyerɛ sɛ amoxicillin a wɔnom no betumi akata atiridiinini a ɛba ntɛm so bere a akisikuru kɔ so ma mastoid dompe a ɛwɔ soro no nwene) nti, w’ani a wobɛhwɛ a ɛho hia sen biara wɔ abofra biara a ɔwɔ aso mu yaw anaa atiridiinini no mu ne sɛ wubegyina abofra no akyi tẽẽ na wode aso abien no nyinaa atoto ho efi akyi: sɛ aso biako pue kɔ nkyɛnkyɛn na ɛkɔ fam te sɛ kuruwa na nnompe a ɛwɔ n’akyi no yɛ kɔkɔɔ, ɛho ahuru, anaasɛ ɛyɛ mmerɛw bere a wɔbɔ no brɛoo a, nnuru a wɔde kum ɔyare mmoawa a wɔnom no adi nkogu na abofra no hia nnuru a ekum ɔyare mmoawa a wɔde fa ntini mu ntɛm ara, CT/MRI mfonini, ne ENT oprehyɛn nsu a wɔde ma**.

Yɛ eyi mprempren¶

1. Gyina ɔyarefo no akyi tẽẽ wɔ hann pa mu na yɛ "From-Behind Ear Alignment and Crease Check." Sɛ wohwɛ fi anim a, ɛtaa de mastoid a ɛho ahonhon ntɛm sie. Gyina abofra anaa ɔpanyin no akyi pɛpɛɛpɛ na fa benkum ne nifa aso toto ho:
2. Protrusion of the Auricle (Pinna): So wɔpia akyi aso biako kɔ akyi fi ti nhwi no ho, kɔ anim, na ɛkɔ fam (titiriw wɔ nkokoaa ne mmofra nkumaa a wonnii mfe 2 mu, baabi a akisikuru pia aso no ma ɛda adi sɛ ɛkɔ fam ne akyi)?
3. Obliteration of the Post-Auricular Sulcus: Hwɛ abɔdeɛ mu honam ani a ɛyɛ nnam (retroauricular groove) a aso no akyi ka ti nhwi no ho. Wɔ acute coalescent mastoiditis anaa subperiosteal abscess mu no, ɔfe hyɛ saa crease yi ma na ɛma ɛyɛ petee koraa (bere a wɔ simple swimmer’s ear [otitis externa] mu no, crease no kɔ so tra hɔ anaasɛ emu dɔ).
4. Frɛ wo mpɔtam hɔ nɔma a egye ntɛmpɛ ntɛm ara sɛ Intracranial anaa Cranial Nerve Red Flags biara ka ho a, frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara a. Trɛ 911 wɔ United States ne Canada, 112 wɔ European Union nyinaa, 999 wɔ United Kingdom, 000 wɔ Australia, anaa hwɛ yɛn list of nɔma ahorow a egye ntɛmpɛ sɛ ɔyarefo no wɔ:
5. Tiyɛ a emu yɛ den bere nyinaa, kɔn a ɛyɛ den, hann ho nkate, ɔbrɛ, abufuw, anaasɛ ɔfe (meningitis, amemene mu akisikuru, anaa sigmoid venous sinus thrombosis ho sɛnkyerɛnne).
6. Aniwa mmɔho abien anaa aniwa a entumi nkɔ abɔnten nkɔ aso no so wɔ ɔfã koro (sixth-nerve palsy / Gradenigo syndrome).
7. Anim mmerɛwyɛ wɔ ɔfã biako anaasɛ entumi nto aniwa no mu anaasɛ ɛnserew pɛpɛɛpɛ (facial nerve [CN VII] palsy).
8. Akisikuru a emu yɛ den a ɛma obi twetwe ne ho, nystagmus (ani a ɛtwetwe), anaasɛ asotiw a ɛyɛ mpofirim (suppurative labyrinthitis).
9. Spiking "picket-fence" atiridii kɛse a awɔw a ɛwosow anaasɛ tender hama te sɛ ɔfe a ɛba fam wɔ kɔn no nkyɛn (Lemierre-te sɛ internal jugular vein septic thrombophlebitis / Griesinger's sign).
10. Sɛ ntini mu frankaa kɔkɔɔ biara nni hɔ a, fa ɔyarefo no kɔ ayaresabea ntɛm ara kɔ ayaresabea a Ɛho Hia Ntɛmntɛm a ɛwɔ Pediatric/Adult Otolaryngology (ENT) oprehyɛn a wɔde tua ho ka (ɛnyɛ ayaresabea a wɔhwɛ no ntɛm da). Ɔyarefo biara a wosusuw sɛ ɔwɔ mastoiditis a emu yɛ den no hia intravenous broad-spectrum antibiotics, emergent contrast CT scan (ne MRI/MRV sɛ wosusuw sɛ nsɛnnennen a ɛwɔ atiridiinini mu), ne oprehyɛn mu myringotomy (aso sanku a wɔde fa nsu mu) ne/anaasɛ cortical mastoidectomy.
11. Ma ɔyarefo no sie NPO katee (biribiara nni hɔ a ɛnam ano: aduan biara nni hɔ, nufusu biara nni hɔ, nsu biara nni hɔ) wɔ kwan a ɛkɔ ayaresabea no so. Ɛkame ayɛ sɛ mmofra nyinaa ne mpanyimfo pii a wɔwɔ acute coalescent mastoiditis nyinaa hia oprehyɛn a wɔde ma ntɛm (myringotomy with tympanostomy tube insertion, subperiosteal abscess incision and drainage, or cortical mastoidectomy) wɔ ase aduru a wɔde kum nipadua no nyinaa wɔ nnɔnhwerew kakraa bi akyi bere a wɔde no akɔ ayaresabea no; sɛ woma yafunu no da mpan a, ɛmma aduru a wɔde kum nipadua no nkyɛ.
12. MMFA biribiara nhyɛ aso no mu (nhyɛ ofie aso mu nsuo, hydrogen peroxide, ngodua ngo a ɛyɛ hyew, cotton swabs, ne aso kyɛnere biara nni hɔ). Wɔ coalescent mastoiditis mu no, aso mu ntini no taa butuw wɔ nhyɛsoɔ a ano yɛ den ase anaasɛ atokuru dedaw na ɛretu akisikuru a ɛyɛ den nsuo anaa nsuo a wɔankyerɛw bɛhyɛ asuten no mu a, ɛbɛtumi ama nnuru a awuduru wom akɔ aso no mfimfini ne mu (ototoxicity) anaasɛ ɛbɛpia nneɛma a asɛe no akɔ nnompe no mu. Sɛ akisikuru retu afi aso no mu a, fa gauze pad a ɛho tew popa aso no akyi brɛoo kɛkɛ.
13. Hwɛ brɛoo sɛ "Boggy Fluctuance" wɔ mastoid dompe ne kɔn torticollis no so a wunmia denneennen. Fa nsateaa biako di dwuma, fa ka dompe a ɛyɛ tratraa a ɛwɔ aso no fã a ɛwɔ soro no akyi pɛɛ (MacEwen's triangle) no brɛoo. Sɛ honam ani hwɛbea a ɛwɔ dompe no so no te nka sɛ ɛyɛ mmerɛw, ɛyɛ spongy, anaasɛ ɛyɛ squishy te sɛ nsu balloon (fluctuance) a, akisikuru no abubu dedaw wɔ ti nhwi no akyi cortex mu ma ayɛ subperiosteal abscess. Hwɛ nso sɛ abofra no kura wɔn ti a wɔadan no denneennen akɔ mmati biako so (torticollis), a ɛbɔ kɔkɔ sɛ Bezold abscess bi di akyi kɔ kɔn mu ntini a emu dɔ no mu anaa.

Gyinaesi dua: aso mu yaw a emu yɛ den, aso akyi a ɛhoa, ne aso a ɛpuepue¶

flowchart TD
    Start["Abofra anaa Ɔpanyin a N’aso Tew, Aso Mu Nsu a Ɛtwetwe, Anaa Nnansa Yi Otitis Media Nya Aso Akyi Ahohoro, Ɛyɛ Kɔkɔɔ, anaa Ɛyaw"] --> StandBehind{"Anamɔn 1: Gyina Ɔyarefo Akyi Tẽẽ & Hwɛ Aso Abien no Nyinaa: So Wɔpia Akyi Aso (Pinna) no Kɔ Anim/Akyi/Akɔ fam, So Post-Auricular Crease no ayɛ tratraa, ANAA So Mastoid Dompe no Tender/Boggy?"}

    StandBehind -->|"YIW: Pinna a Ɛpue, Obliterated Post-Auricular Crease, Mastoid a ɛyɛ mmerɛw, anaa Boggy Fluctuance"| CheckNeuro{"Anamɔn 2: Screen for Intracranial & Cranial Nerve Red Flags: Tiyɛ a Ɛyɛ Den, Ɔbrɛ/Ɔfe, Kɔn a Ɛyɛ Den, Anisoadehu Mmienu (CN VI Palsy), Anim a ɛtɔ (CN VII), Vertigo, anaa Kɔn Torticollis?"}

    CheckNeuro -->|"YIW ma Frɛko Kɔkɔɔ BIARA"| IntracranialMast["MASTOIDITIS A ƐYƐ NSƐM A ƐYƐ MMƆDENBƆ (Wɔsusu sɛ Sigmoid Sinus Thrombosis, Amemene/Epidural Abscess, Gradenigo Syndrome, anaa Bezold Abscess): Frɛ 911 / 112 / 999 Ntɛm ara; NPO a ɛyɛ katee"]

    CheckNeuro -->|"NO Neuro Red Flags: Mpɔtam Hɔ Post-Auricular Swelling/Erythema & Pinna a Ɛpue"| AcuteMast["ACUTE COALESCENT MASTOIDITIS / SUBPERIOSTEAL ABSCESS: Kɔ Ayaresabea Dwumadibea a Ɛhwɛ Ntɛmntɛm So Ntɛm ara (Wɔde ENT Oprehyɛn Ho Kataso); NPO a ɛyɛ katee ma Anesthesia"]

    StandBehind -->|"NO Mastoid Bone Tenderness anaa Protrusion: Ɛyaw no Kɛse Kɛse Bere a Woretwe Aso a Ɛwɔ Akyi Pinna anaa Woremia Tragus no; Aso Nsuo Ahohoro"| OtitisExterna["Ɛbɛyɛ sɛ Acute Otitis Externa (‘Asuguarefo Aso’) anaa Post-Auricular Lymphadenitis: Hwehwɛ Aduruyɛ mu Nhwehwɛmu Da Koro (Hyɛ no nsow: Sɛ Asikreyare anaasɛ Nkwammoaa a Ɛko Tia Nyarewa a Ɛyaw a Ɛyɛ Den/Granulation Tissue a Ɛwɔ Ntini a Ɛyɛ Nnua a Ɛyɛ Nnua a Ɛwɔ Ntini a Ɛyɛ Nnua a Ɛwɔ Nkwammoaa a Ɛyɛ Nnuadewa Mu a, Yi Otitis Externa a Ɛyɛ Hu/Necrotizing Fi hɔ)"]

    IntracranialMast --> HospitalBundle["Ntɛm ara Ayaresabea Nhwehwɛmu & Oprehyɛn Bundle: 1. Stat IV Vancomycin + IV Ceftriaxone/Cefepime (anaa Piperacillin-Tazobactam), 2. Nsonsonoe a ɛkorɔn CT a ɛwɔ Temporal Bones + Amemene MRI/MR Venography (MRV), 3. Ntɛmntɛm ENT Oprehyɛn Myringotomy +/- Cortical Mastoidectomy & Abscess Drainage"]
    AcuteMast --> HospitalBundle

Anatomy ne pathophysiology: efi Simple Mfinimfini Aso Nsu so kosi Bony Coalescence ne Skull Perforation so¶

Sɛnea ɛbɛyɛ na yɛate nea enti a abofra biara a ɔwɔ mfinimfini aso mu yare no wɔ nsu wɔ wɔn mastoid mframa nkwammoaa mu wɔ CT scan mu ase, nanso kuw ketewaa bi pɛ na ɛkɔ anim kɔ oprehyɛn ankasa acute coalescent mastoiditis mu no, ɛboa ma wohu yare no nipadua mu fã anum no:

1. Aditus ad Antrum: Nsuo a Ɛyɛ Teateaa a Ɛwɔ Mfinimfini Aso no Akyi¶

Wɔ onipa ti nhwi nipadua mu no, wɔde mfinimfini aso mu (tympanic cavity, aso no akyi pɛɛ) bata n’akyi atifi ntwea so ne mfinimfini mframa dan kɛse bi a ɛwɔ bere dompe no mu a wɔfrɛ no mastoid antrum denam nnompe pon ketewaa bi a ɛyɛ teateaa a wɔfrɛ no aditus ad antrum (a ne tɛtrɛtɛ yɛ milimita kakraa bi pɛ) so. Mframa kotoku du du pii a ɛwɔ mucosal-lined a ɛka bom a wɔfrɛ no mastoid air cells a ɛhyerɛn fi mastoid antrum no mu te sɛ sponge anaa ɛwo. - Stage 1: Simple Acute Otomastoiditis (Normal in Every Ear Infection): Esiane sɛ mucous membrane a ɛkata mfinimfini aso no so no kɔ so ne mastoid mframa nkwammoaa no kata so nti, ɛkame ayɛ sɛ mmofra a wɔwɔ acute otitis media a ɛyɛ mmerɛw no mu ɔha biara mu nkyem 100 wɔ nsu a ɛma ɔhyew wɔ wɔn mastoid mframa nkwammoaa mu. Bere tenten a aditus ad antrum pon no bue no, saa nsu no san kɔ mfinimfini aso no mu kwa na ɛsan kɔ Eustachian tube no mu, na ɛsiesie a nnompe nsɛee. - Stage 2: Acute Mastoiditis with Periostitis: Sɛ mucosa a ahonhon, granulation tissue, anaa thick purulent exudate siw aditus ad antrum bottleneck no ano koraa a, mastoid mframa nkwammoaa no bɛyɛ pressure cooker a wɔatoto mu. Mmoawa (a wɔtaa yɛ Streptococcus pneumoniae, Streptococcus pyogenes [Kuw A Strep], Staphylococcus aureus, Haemophilus influenzae, ne Fusobacterium necrophorum) dɔɔso wɔ nhyɛso kɛse ase, na ɛhyɛ ɔyare mmoawa a ɛnam ntini nketenkete a ɛwɔ dompe no mu so ma ɛyɛ hyew periosteal a ɛkata aso no akyi (post-auricular redness ne tenderness). - Ɔfã 3: Acute Coalescent Mastoiditis (Osteitis and Bony Destruction): Wɔ nna kakraa bi mu bere a asiw kwan koraa no, akisikuru a wɔahyɛ no den, acidosis, ne mmoawa awuduru ma osteoclasts a ɛpete na ɛma calcium-phosphate nnompe mu septa a ɛyɛ mmerɛw a ɛkyekyɛ mastoid mframa nkwammoaa ankorankoro no mu no yɛ adwuma. Ɛwo nkwammoaa nketenkete no ka bom (ka bom) yɛ akisikuru kɛse biako a nhyɛso wom a ɛyɛ akisikuru ne dompe a awu. Wɔ bere mu nnompe mu nhwehwɛmu denam otoscope so no, ɛnyɛ aso a ɛyɛ mmerɛw nko na oduruyɛfo no hu, na mmom ɔyare ho sɛnkyerɛnne a wɔtaa hu a ɛkyerɛ sɛ ɛyɛ coalescent mastoiditis: "sagging" (bulging down) of the posterosuperior wall of the deep external auditory canal, a ɛnam nhyɛso a ɛwɔ mastoid antrum no mu a ɛpia dompe a ɛyɛ tratraa no wɔ eardrum akyi pɛɛ no ​​kɔ fam.

2. Baabi a Nhyɛso Ahorow no Pae: Akwan 6 a Nnompe Mu Nsɛe¶

Sɛ akisikuru hyɛ abura a ɛka bom no ma pɛ a, ɛnam mastoid no nnompe fasu biara a ɛyɛ teateaa sen biara mu:

1. Lateral Erosion through the Outer Cortex (MacEwen’s Triangle) -> Post-Auricular Subperiosteal Abscess (Most Common Extracranial Complication): Pus bubu fa mastoid dompe no akyi akyi wɔ aso no akyi pɛɛ, na ɛma periosteum a ɛyɛ den no so fi ti nhwi no so na ɛyɛ pus kotoku a ɛyɛ den na ɛyɛ atɛkyɛ (subperiosteal abscess) a ɛpia aso akyi pinna kɔ anim, akyi, ne fam.
2. Inferior Erosion through the Mastoid Tip (Incisura Mastoidea) -> Bezold Abscess: Wɔ mmofra a wɔanyinyin ne mpanyimfo a wɔwɔ mastoid tips a mframa wom yiye mu no, akisikuru pae fa mastoid dompe no ase ano no mfinimfini ɔfasu a ɛyɛ tratraa no mu na ɛhwie **hwie kɔ akyiri wɔ fascial sheath a ɛwɔ sternocleidomastoid (SCM) ne digastric no mu ntini a ɛwɔ kɔn mu. Esiane sɛ akisikuru no te kɔn mu ntini a ɛyɛ den no ase tɔnn nti, ebia ɛho ntew kakraa bi wɔ aso no akyi tẽẽ; mmom no, ɔyarefo no de ɛyaw, ahonhon a ɛyɛ den wɔ ne kɔn no atifi, ne kɔn mu ayɛ den kɛse (torticollis), ne asiane a ɛwɔ hɔ sɛ akisikuru no bɛdi akyi tẽẽ akɔ carotid kotoku no mu akɔ ne koko mu (mediastinitis) ba. (Sɛ akisikuru no di akyi kɔ akyi wɔ splenius capitis ntini no ase kɔ ti nhwi no akyi a, wɔfrɛ no Citelli abscess; sɛ ɛbubu kɔ n’anim fa zygomatic arch ntini a ɛwɔ aso no anim no mu a, wɔfrɛ no Luc abscess).
3. Medial Erosion into the Petrous Apex -> Petrous Apicitis ne Gradenigo Syndrome: Pus no di akyi kɔ akyiri kɔ petrous temporal bone (petrous apex) no mfinimfini ano, baabi a trigeminal ganglion (CN V) ne abducens nerve (CN VI) fa Dorello canal mu no ara. Eyi ma wonya Gradenigo's Triad a wɔtaa de di dwuma: (1) Suppurative otitis media / aso mu nsu a ɛkɔ mu, (2) Ɛyaw a emu dɔ a ɛyɛ yaw a ɛba akyi wɔ aniwa no akyi ne asɔredan no atifi (CN V abufuw), ne (3) Ipsilateral lateral rectus palsy (CN VI palsy, baabi a aniwa a ɛwɔ ɔfã a ɛka no no dan kɔ mu na entumi nhwɛ abɔnten nkɔ aso no so, a ɛde anisoadehu abien a ɛkɔ soro ba).
4. Posterior Erosion through the Sigmoid Plate -> Sigmoid Sinus Septic Thrombosis ("Picket-Fence Fever"): Mastoid cavity no akyi fasu yɛ nnompe mprɛte a ɛyɛ tratraa te sɛ krataa a ɛtetew mastoid mframa nkwammoaa no mu fi sigmoid dural venous sinus no ho. Erosion anaa thrombophlebitis a ɛwɔ saa mprɛte yi so no kanyan mogya a ɛwɔ sigmoid sinus no mu ne jugular vein a ɛwɔ mu no mu, na ɛde spiking "picket-fence" fevers a ɛyɛ nwonwa, tiyɛ a emu yɛ den, Griesinger sɛnkyerɛnne (pitting edema ne tenderness wɔ mastoid no akyi a thrombosis of the mastoid emissary vein de ba) ba, papilledema a efi nhyɛso a ɛkɔ soro wɔ atiridii mu (otitic hydrocephalus), ne septic pulmonary emboli a ɛkɔ ahurututu mu.
5. Superior Erosion through the Roof (Tegmen Tympani / Tegmen Mastoideum) -> Epidural Abscess, Subdural Empyema, Meningitis, anaa Temporal Lobe / Cerebellar Brain Abscess: Pus no bubu kɔ soro fa nnompe dan atifi a ɛyɛ tratraa a ɛtetew mastoid no ne amemene no mu no mu.
6. Anterior-Medial Erosion into the Facial Canal anaa Semicircular Canals -> Facial Nerve Palsy (CN VII) anaa Suppurative Labyrinthitis: Pus mia anaa ɛhyew anim ntini a ɛwɔ Fallopian canal no mu (ɛma anim fã mũ no nyinaa yɛ mmerɛw a moma so ka ho) anaasɛ ɛtwetwe kɔ akyi fã a ɛyɛ kurukuruwa no mu (ɛma basabasayɛ vertigo, . ɔfe, nystagmus, ne sensorineural aso a ɛyɛ mmerɛw daa).

Nsonsonoe a ɛda Acute Coalescent Mastoiditis ne Asuguarefo Aso (Otitis Externa), Lymphadenitis, ne Aso mu Nyarewa a Ɛnyɛ Den Ho¶

Esiane sɛ ntini nketenkete te mastoid dompe a ɛwɔ aso no akyi no so tẽẽ (posterior auricular lymph nodes) na ɛhohoro bere biara a abofra bi benya ti nhwi mu mmoawa a wɔaka no, cradle cap, anaa asuguarefo aso nti, fa mpa ho pon yi kyerɛ mastoiditis ankasa a ɛda nsow wɔ nea ɛnyɛ bɔne a wosuasua no ho:

5 Intracranial ne Extracranial Red Flag Syndromes a Ɛsɛ sɛ Wohwɛ wɔ Mpa Ho¶

Bere a woretwɛn sɛ wode wo bɛkɔ ayaresabea dwumadibea a wɔhwɛ ntɛmpɛ so no, yɛ ntini mu nhwehwɛmu a egye sikɔne 60 yi na bɔ adepa biara a wubehu ho amanneɛ kyerɛ ɔyarehwɛfo ne oduruyɛfo a ɔhwɛ nnipa a wɔpaw wɔn no ntɛm ara:

1. The Eye-Movement Check for Gradenigo Syndrome (Cranial Nerve VI Palsy): Fa agode anaa wo nsateaa bi hyɛ ɔyarefo no anim na fa brɛoo kɔ benkum ne nifa a worenhinhim wɔn ti. Sɛ aniwa a ɛwɔ ɔfã koro no ara ne aso a ɔyare no wɔ no ntumi nsan nkɔ abɔnten nkɔ asɔredan no mu (ɛma aniwa no twa na ɔyarefo no hu mmɔho abien, anaasɛ ɛma abofra bi dan ne ti anaasɛ ɔkata n’ani biako so bere a ɔrehwɛ TV), de ɛyaw a ɛwɔ saa aniwa no akyi ka ho a, ɔyare no adu petrous apex (Gradenigo syndrome) a ɛbɛn cavernous sinus ne internal carotid no pɛɛ ntini mu ntini.
2. The Smile-and-Blink Check for Facial Nerve Palsy (Cranial Nerve VII): Bisa ɔyarefo no sɛ ɔnserew kɛse, ɔnhohoro n’afono mu, nto n’ani abien no nyinaa mu denneennen, na ɔmma n’ani so. Sɛ anim no fã a aso mu yare no wɔ no so tew (a ano no ntwea NE moma so/aniwa anim no nyinaa ka ho), akisikuru a ɛwɔ mfinimfini aso anaa mastoid mu no remia anim ntini a ɛwɔ nnompe Falopian canal no mu. Eyi hwehwɛ sɛ wɔyɛ myringotomy ntɛm ara oprehyɛn (na mpɛn pii no mastoid decompression) ne nnuru a ekum ɔyare mmoawa ne corticosteroids a wɔde fa ntini mu** wɔ nnɔnhwerew bi mu na wɔasiw anim a ɛyɛ obubuafo daa ano.
3. Mastoid Emissary Vein Check for Griesinger’s Sign (Sigmoid Sinus Thrombosis): Hwɛ na te nka kakra wɔ mastoid kwan no akyi (wɔ mastoid no akyi hye so baabi a mastoid emissary vein no fi ti nhwi no mu). Pitting edema (doughy swelling a ɛma dent bere a wɔahyɛ no) ne exquisite tenderness wɔ posterior mastoid, a wɔde ka ho ne spiking fevers kɛse, tiyɛ, anaa ɔfe, yɛ Griesinger sɛnkyerɛnne, classic abɔnten agyiraehyɛde septic thrombosis of the sigmoid dural venous sinus.
4. The Side-of-Neck Check for Bezold Abscess: Hwɛ sɛnea ɔyarefo no kɔn gyina hɔ na te nka brɛoo wɔ diagonal muscle a ɛyɛ den a efi aso no akyi kɔ fam kosi collarbone (sternocleidomastoid muscle) no so. Sɛ ɔyarefo no pow sɛ ɔbɛdan wɔn kɔn (torticollis) na ne kɔn a ɛwɔ soro no ayɛ ma a emu dɔ na ɛyɛ mmerɛw wɔ mastoid dompe no ano ase a, akisikuru no mu apaapae afa mastoid no ano a ɛwɔ mfinimfini no mu akɔ kɔn no mu mmeae a emu dɔ no (Bezold abscess).
5. The Diabetes / Immunocompromised Check for Malignant (Necrotizing) Otitis Externa: Wɔ ɔpanyin a ne mfe akɔ anim a ɔwɔ asikreyare, nnuru a wɔde sa yare, HIV, anaa nnuru a wɔde siw nipadua no mu tumi a ɛko tia nyarewa ano a onya ɛyaw a ennyae, ɛyɛ mfonoe, emu dɔ anadwo aso ne ti nhwi-gyinabea (mpɛn pii no aso mu nsu a ɛyɛ kurukuruwa ne ti nhwi ntini VII, IX, X, anaa XII palsies), ɛkame ayɛ sɛ bere nyinaa na nea odi fɔ no yɛ Pseudomonas aeruginosa osteomyelitis a ɛwɔ temporal bone skull base (Malignant Otitis Externa), a ɛhwehwɛ sɛ wɔde nnuru a ekum pseudomonal fa ntini mu ntɛm ara (cefepime, piperacillin-tazobactam, ceftazidime, anaa ciprofloxacin a wɔde di dwuma kɛse) ne nea ɛne no bɔ abira CT/MRI a wɔde yɛ adwuma.

Ayaresabea mu nhwehwɛmu a edi mũ ne ENT oprehyɛn a wɔde di dwuma¶

Sɛ abofra anaa ɔpanyin bi du ayaresabea dwumadibea a wɔhwɛ ntɛmpɛ so a ɔwɔ mastoiditis a emu yɛ den a, wɔn a wɔhwɛ so no di aduruyɛ, radiologic, ne otolaryngologic kwan a wɔayɛ no biako akyi:

1. Nnuru a Ɛko Tia Ɔyare mmoawa a Ɛtrɛw Fa Ntini Mu Ntɛm ara (A Ɛkata Penicillin-Resistant Pneumococcus, Kuw A Strep, S. aureus, ne Fusobacterium so) .¶

Esiane sɛ nnuru a wɔde kum ɔyare mmoawa a wɔnom ntumi nkɔ mastoid akisikuru a ɛka bom mu na ayarefo no mu fã adi nkogu dedaw wɔ amoxicillin a wɔnom no mu nti, ayaresabea adwumayɛfo twetwe mogya mu amammerɛ ntɛm ara na wofi ase de nnuru a ekum ɔyare mmoawa a wɔde fa ntini mu a wɔde di dwuma kɛse** a etumi twa mogya-amemene akwanside no na ɛhyɛn dompe mu no ase: - Aduru a Edi Kan a Wɔde Di Dwuma IV (IDSA / AAP / ENT UK Akwankyerɛ): Vancomycin a Wɔde Fa Ntini Mu (15 to 20 mg/kg IV every 6 to 8 hours) (sɛ wɔde bɛkata Staphylococcus aureus [MRSA] a ɛko tia methicillin ne Streptococcus pneumoniae a ɛko tia penicillin so) PLUS Ceftriaxone a wɔde fa ntini mu (50 to 100 mg/kg/day wɔ aduru a wɔde ma wɔ meningeal mu) ANAA Cefepime / Piperacillin-Tazobactam / Meropenem a wɔde fa ntini mu (de kata Streptococcus pyogenes, Haemophilus influenzae, Fusobacterium necrophorum a mframa nnim, ne Pseudomonas aeruginosa so wɔ aso a enni sabea/a wɔato mu). - Metronidazole a wɔde bɛka ho: Sɛ wosusuw sɛ ɛwɔ intracranial epidural/brain abscess anaa Fusobacterium sigmoid sinus thrombosis na wɔde ceftriaxone di dwuma a, wɔde intravenous metronidazole ka ho ma anaerobic central nervous system penetration a ɛyɛ katee.

2. CT a Ɛyɛ Nsonsonoe a Ɛkorɔn a Wɔde Hwɛ Nnompe a Ɛwɔ Bere Mu + Amemene MRI / MR Venography (MRV) .¶

• High-Resolution Computed Tomography (HRCT) a ɛfa Temporal Bones a ɛwɔ Intravenous Contrast ho: Oprehyɛn kwan titiriw. Nnompe mfɛnsere a ɛyɛ tratraa a ɛnyɛ nea ɛne ne ho bɔ abira no kyerɛ nnompe mu septa a ɛwɔ mastoid mframa nkwammoaa ntam no a ɛyera na ɛyera (nnompe a ɛka bom), akyi mastoid cortex no a ɛporɔw, anaasɛ sigmoid mprɛte/tegmen dan atifi a ɛwɔ mu no asɛe, bere a nsonsonoe a wɔde fa ntini mu no si post-auricular subperiosteal kotoku a ɛma rim yɛ kɛse no so dua abscess, Bezold kɔn mu abscess, anaasɛ sintɔ a ɛhyɛ ma ("empty delta sign") wɔ sigmoid venous sinus no mu.
• Contrast-Enhanced Brain MRI with MR Venography (MRV): Wɔhyɛ ka CT ho bere biara a tiyɛ biara, ɔbrɛ, atiridiinini a ɛkɔ so yɛ kɛse, sixth-nerve palsy, anaasɛ wosusuw sɛ sigmoid sinus thrombosis, epidural abscess, subdural empyema, anaa temporal lobe/cerebellar brain abscess biara wɔ hɔ (sɛnea MRI korɔn sen no koraa CT a wɔde hu intracranial dural enhancement ntɛm, venous thrombosis, ne cerebritis).

3. ENT Oprehyɛn Nsu a Wɔde Fa Anammɔn Nyinaa (Sɛ Wosan Bue Pressure Cooker no) .¶

Wɔ American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) ne ENT UK nhyehyɛe ahorow ase no, wɔayɛ oprehyɛn mu nsu a wɔde ma no sɛnea yare no fã te: 1. Wide Myringotomy with Tympanostomy Tube (Grommet) Insertion (Performed in Nearly All Cases): Wɔ aduru a wɔde kum nipadua no nyinaa bere tiaa bi (anaasɛ aduru a wɔde kum ayarefo a wɔn mfe akɔ anim) ase no, ENT oprehyɛn ho ɔbenfo no de oprehyɛn afiri a wɔde hwɛ nneɛma nketenkete di dwuma de twa aso a ayɛ kɛse no mu, twe mfinimfini aso a wɔde nhyɛso ahyɛ mu no ma bacterial Gram stain, aerobic/anaerobic cultures, ne antibiotic sensitivity testing, na ɔde mframa a wɔde fa mu (tympanostomy grommet) si hɔ sɛnea ɛbɛyɛ a mfinimfini aso ne mastoid antrum no betumi akɔ so akɔ abɔnten na wɔanya antibiotic-steroid aso a wɔde gu nipadua no so (ciprofloxacin-dexamethasone). Wɔ mastoiditis a ɛnyɛ nea ɛka bom a edi kan a enni akisikuru mu no, nnuru a ekum ɔyare mmoawa a wɔde fa ntini mu ka myringotomy ho no siesie ɔyare no wɔ ayarefo ɔha biara mu nkyem 70 kosi 80 mu wɔ nnɔnhwerew 48 ntam. 2. Subperiosteal Abscess Drainage ne Cortical Mastoidectomy (Simple Mastoidectomy): Sɛ ɔyarefo no wɔ post-auricular subperiosteal abscess, nnompe a ɛka bom wɔ CT so, Bezold abscess, anim ntini a ɛyɛ mmerɛw, Gradenigo syndrome, intracranial complications, ANAA ɛnyɛ yiye a sɛnea ɛbɛyɛ a obetu mpɔn wɔ ** nnɔnhwerew 24 kosi 48** a wɔde IV nnuru a ekum ɔyare mmoawa ne myringotomy akyi no, ENT oprehyɛn ho ɔbenfo no yɛ ntwitwiridii a wɔde ahyɛ aso no akyi fɛfɛɛfɛ, yi nsu a ɛwɔ subperiosteal pus no mu, na ɔde diamond oprehyɛn burr a ɛkɔ ntɛmntɛm di dwuma wɔ microscope ase de bue mastoid dompe no akyi cortex (cortical mastoidectomy), na oyi necrotic bone no nyinaa mpaapaemu, mastoid antrum a wɔhohoro, na wɔsan bue aditus ad antrum a asiw ano no ma enti nsu a ɛkɔ apɔwmuden no san ba daa a ɛnsɛe nnompe a wɔte (ossicles).

Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

Sɛ wosusuw sɛ ɛyɛ acute coalescent mastoiditis hwehwɛ sɛ wɔyɛ nhwehwɛmu ntɛm ara wɔ ayaresabea Dwumadibea a Ɛho Hia Ntɛmntɛm a wɔde Nnɔnhwerew 24 CT/MRI mfoninitwa ne Mmofra / Mpanyimfo Aso ne Mpanyimfo Aso ne Mpanyimfo Aso Ho Adesua (ENT) Oprehyɛn ahyɛ mu ma:

• United States ne Canada: Sɛ ntini, aniwa, anim ntini, anaa sepsis frankaa kɔkɔɔ biara wɔ hɔ a, frɛ 911, anaa kɔ ayaresabea dwumadibea kɛse bi a wɔhwɛ ntɛmpɛ so tẽẽ (sɛ ɛbɛyɛ yiye a, Mmofra Ayaresabea ED a wɔahyira so ama mmofra ayarefo). Wɔhwɛ so wɔ American Academy of Pediatrics (AAP) ne American Academy of Otolaryngology-Ti ne Kɔn Oprehyɛn (AAO-HNS) akwankyerɛ ase.
• United Kingdom: Frɛ 999 ma frankaa kɔkɔɔ a ɛwɔ atiridiinini mu anaa kɔ ayaresabea a ɛbɛn wo a wɔhwɛ wɔn a wɔyare denneennen no ntɛm ara Emergency Department (A&E) a wowɔ on-call ENT Surgery. Wɔhwɛ so wɔ Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ So (NICE NG91: Otitis Media, Acute, Mastoiditis Pathway) ne ENT UK ayaresabea gyinapɛn ahorow ase.
• Europa Aman Nkabom: Dial 112. Wɔhwɛ so wɔ Europa Adesuabea a Ɛhwɛ Anom ne Ntini Ho Adesua So (EAONO) ne Europa Fekuw a Ɛhwɛ Mmofra Aso ne Ntini Ho Adesua So (ESPO) mastoiditis a emu yɛ den akwankyerɛ ase.
• Australia ne New Zealand: Frɛ 000 wɔ Australia anaa 111 wɔ New Zealand. Wɔhwɛ so wɔ Australia Society of Otolaryngology Ti ne Kɔn Oprehyɛn (ASOHNS) ne Ahemfo Mmofra Ayaresabea (RCH) Melbourne Acute Mastoiditis Ayaresa mu Adeyɛ Akwankyerɛ ase.
• India ne Asia-Pacific: Trɛ 112 (anaasɛ 108 wɔ India), 995 wɔ Singapore, 119 wɔ Japan ne South Korea, anaa 999 wɔ Malaysia ne Hong Kong. Bisa ayaresabea a ɛto so abiɛsa a ɛwɔ ENT ne ntini mu oprehyɛn adwumayɛbea ahorow.

Nsɛm a wɔtaa bisa¶

Mɛyɛ dɛn ahu nsonsonoe a ɛda aso mu yare a ɛfata ne mastoiditis a emu yɛ den ntam denam me ba aso a mɛhwɛ so?¶

Wɔ aso mfinimfini yare a ɛyɛ mmerɛw (acute otitis media) mu no, ɔyare no tra aso no mu: abofra no wɔ aso mu yaw ne atiridiinini, nanso aso akyi ne ti nhwi dompe a ɛwɔ aso no akyi no hwɛ na ɛte sɛ nea ɛteɛ koraa. Sɛ wopɛ sɛ wohwɛ sɛ mastoiditis a emu yɛ den a, gyina wo ba no akyi tẽẽ wɔ hann pa mu na fa aso abien no nyinaa toto n’akyi: wɔ mastoiditis mu no, honam ani a ɛwɔ dompe a ɛwɔ aso no akyi no so tẽẽ no dan kɔkɔɔ, ɛhohoro, na ɛyɛ mmerɛw kɛse bere a wode wo nsa aka no, abɔde mu nsensanee a ano yɛ nnam a aso no akyi hyia ne ti no hyɛ mu ma na ɛyɛ petee, na wɔpia akyi aso (pinna) no kɔ abɔnten ma ɛda adi, . anim, na ɛkɔ fam te sɛ kuruwa a ɛpuepue.

So abofra betumi akɔ so anya mastoiditis a emu yɛ den sɛ wɔanom nnuru a wɔde kum ɔyare mmoawa a wɔnom (te sɛ Amoxicillin) nna pii mpo a?¶

Aane. Wɔ ayaresabea nhwehwɛmu ahorow mu no, na mmofra a wɔde wɔn kɔɔ ayaresabea a wɔwɔ acute coalescent mastoiditis anaasɛ post-auricular subperiosteal abscess no mu ɔha biara mu nkyem 35 kosi 50 renom nnuru a wɔde kum ɔyare mmoawa a wɔkyerɛw ma wɔn sɛ wɔmfa aso mu yare no dedaw. Wonim no sɛ "masked mastoiditis," nnuru a wɔde kum ɔyare mmoawa a wɔnom taa brɛ atiridii ne aso mu yaw ase bere tiaa bi bere a entumi nkɔ mastoid no mu nnompe nkwammoaa a asiw a akisikuru ahyɛ mu ma no mu (anaasɛ entumi nyɛ adwuma efisɛ mmoawa no tumi ko tia amoxicillin a wɔnom no). Sɛ abofra a ɔnom nnuru a wɔde kum ɔyare mmoawa a wɔnom ma n’aso mu yare no ho yɛ kɔkɔɔ anaasɛ ɛho ahonhon wɔ n’aso akyi, n’aso a ɛpuepue, anaasɛ atiridiinini ne tiyɛ a ɛsan ba a, kɔ ayaresabea dwumadibea a wɔhwɛ ntɛmpɛ so tẽẽ kɔhwehwɛ nnuru a ekum ɔyare mmoawa a wɔde fa ntini mu.

Ɔkwan bɛn so na nnuruyɛfo hu nsonsonoe a ɛda acute mastoiditis ne "swimmer's ear" (otitis externa) anaasɛ lymph node a ahonhon wɔ aso no akyi ntam?¶

Nea edi kan no, twe aso no akyi ntini no brɛoo anaa pia tab ketewa a ɛyɛ ahinanan no kɔ aso no anim (tragus): wɔ asuguarefo aso mu (otitis externa) no, aso a ɛwɔ akyi a wɔde tu no ma ɛyaw a emu yɛ den ba efisɛ aso akyi ntini no honam ani yare, bere a mastoid dompe no ankasa nyɛ mmerɛw na aso no mu ntini no yɛ nea ɛfata. Nea ɛto so abien no, wɔ ntini a ahonhon a asiane biara nni ho a ɛwɔ aso no akyi (mpɛn pii no efi mmoawa a wɔaka wɔn, akisikuru, anaasɛ cradle cap a ɛwɔ ti nhwi so) mu no, wubetumi ate akutu ketewaa bi a ɛda nsow, a ne kɛse te sɛ pea a wotumi tu te dompe no atifi, aso no akyi a ɛyɛ mmerɛw no kɔ so yɛ nnam, aso no ntumi nkɔ n’anim, na aso a ɛwɔ mu no te sɛ nea ɛteɛ koraa.

Dɛn ne Gradenigo syndrome na dɛn nti na aso mu yare ma obi hu ade mprenu anaasɛ aniwa a ɛtwam?¶

Wɔ ti nhwi no mu tɔnn no, temporal bone (petrous apex) no ano te cranial nerve a ɛto so asia (abducens nerve, a ɛhwɛ ntini a ɛdannan aniwa no kɔ abɔnten kɔ asɔredan no so) ne cranial nerve a ɛto so anum (trigeminal nerve, a ɛhwɛ anim nkate so) nkyɛn pɛɛ. Sɛ akisikuru a efi mastoid yare mu ba no di akyi kɔ mfinimfini kɔ petrous apex (petrous apicitis) no mu a, ɛtwetwe ntini abien no nyinaa, na ɛma Gradenigo triad ba: (1) aso a ɔyare no ayɛ no, (2) ɛyaw a emu dɔ, a emu yɛ den a ɛba aniwa no akyi ne asɔredan no atifi wɔ saa ɔfã no, ne (3) entumi nsan saa aniwa no nkɔ abɔnten (sixth-nerve palsy, causing aniwa a wɔatwa ne anisoadehu abien). Ɛyɛ kɔkɔbɔ sɛnkyerɛnne a egye ntɛmpɛ a ɛkyerɛ sɛ ti nhwi no ase ne cavernous sinus a ɛka ho a ɛhwehwɛ sɛ wɔyɛ nnuru a ekum ɔyare mmoawa a wɔde fa IV mu ntɛm ara ne ENT oprehyɛn.

Dɛn nti na sigmoid sinus thrombosis yɛ asiane kɛse wɔ mastoiditis a emu yɛ den mu?¶

Dompe a ɛyɛ tratraa te sɛ krataa nkutoo na ɛtetew mastoid mframa nkwammoaa no akyi ɔfasu no mu fi sigmoid dural venous sinus, ntini kɛse a ɛma mogya fi amemene no mu kɔ jugular ntini a ɛwɔ kɔn no mu no mu. Sɛ mastoiditis a ɛka bom no sɛe fa saa nnompe fasu a ɛyɛ tratraa no mu anaasɛ ɛma ɛyɛ hyew a, mogya a ɛtɔ (septic thrombus) a ɔyare no ayɛ no ba sigmoid sinus no mu. Eyi siw ntini mu mogya kwan sɛ ebefi amemene no mu, na ɛma nhyɛso kɔ soro wɔ ti nhwi no mu (ɛma ne ti yɛ no yaw kɛse, ɔfe, ɛma obi nhu ade yiye fi aniwa ntini a ɛho ahonhon, ne akisikuru) na ɛde mogya a ɛtɔ a ɔyare mmoawa wom no gu ahurututu no mu, na ɛhwehwɛ sɛ wɔde nnuru a ekum ɔyare mmoawa fa ntini mu ntɛm ara, mastoid a wɔde ma oprehyɛn, ne mpɛn pii no nnuru a ɛma mogya yɛ mmerɛw.

So abofra biara a ɔwɔ mastoiditis a emu yɛ den hia mastoid dompe a wɔabue mu oprehyɛn (mastoidectomy)?¶

Ɛnyɛ bere nyinaa na ɛte saa. Sɛ wɔkyere mastoiditis a emu yɛ den ntɛm (ansa na nnompe afasu a ɛwɔ mu no bɛbɔ abom ayɛ akisikuru a ɛka bom anaasɛ ayɛ kotoku a ɛyɛ akisikuru wɔ honam ani wɔ aso no akyi) a, mmofra ɔha biara mu 70 kosi 80 ho tɔ wɔn koraa denam nnuru a ekum ɔyare mmoawa a wɔde fa ntini mu a wɔde simma 10 yɛ ketewaa bi a wɔfrɛ no myringotomy ne grommet (mframa afiri) a wɔde hyɛ mu no so sɛnea ɛbɛyɛ a nhyɛso no bɛfa aso no mu akɔ. Sɛ CT scan kyerɛ sɛ subperiosteal abscess ayɛ aso no akyi dedaw, sɛ nnompe mu mframa nkwammoaa no ayɛ biako, anaasɛ sɛ abofra no nnya nkɔso wɔ nnɔnhwerew 24 kosi 48 mu a, ENT oprehyɛn ho oprehyɛn no yɛ cortical mastoidectomy wɔ aso no akyi de hohoro dompe a ɔyare no wom no bere a ɔkora abofra no aso so.

Fibea ne aban akwankyerɛ¶

• National Institute for Health and Care Excellence (NICE) & ENT UK (United Kingdom): Otitis Media (Acute): Antimicrobial Prescribing and Emergency Referral for Suspected Acute Mastoiditis (NICE Akwankyerɛ NG91) (aduru a wɔde kɔ ayaresabea ntɛm ara ma aso akyi a ɛho ahonhon, pinna a ɛpue, ne ti nhwi ntini anaa ti nhwi mu kɔkɔɔ frankaa ahorow).
• American Academy of Pediatrics (AAP) & American Academy of Family Physicians (AAFP, United States): Ayaresa mu Nneyɛe Ho Akwankyerɛ: Acute Otitis Media a Wɔhwehwɛ ne Nea Wɔhwɛ So (Mmofra, nkɔso a ɛkɔ so kɔ acute coalescent mastoiditis, amoxicillin a wɔnom a entumi nyɛ adwuma wɔ masked mastoiditis mu, ne otolaryngology oprehyɛn a wɔde yi nsu a egye ntɛmpɛ).
• American Academy of Otolaryngology-Ti ne Kɔn Oprehyɛn (AAO-HNS, United States): Ayaresa mu adwene a ɛwɔ hɔ ne nneyɛe ho akwankyerɛ a ɛfa Suppurative Nsɛnnennen a ɛwɔ Otitis Media (Coalescent Mastoiditis, Subperiosteal Abscess, Bezold Abscess, Petrous Apicitis / Gradenigo Syndrome, ne Otogenic Sigmoid Sinus Thrombosis) ho.
• Infectious Diseases Society of America (IDSA, United States): Ayaresabea Nneyɛe Akwankyerɛ a Ɛfa Akwahosan Ho Nneyɛe a Ɛfa Akwahosan Ho ne Otogenic Meningitis, Epidural Abscess, ne Brain Abscess (empiric intravenous intravenous vancomycin plus cephalosporin ne metronidazole awo ntoatoaso a ɛto so abiɛsa/anan ho).
• Ahemfie Mmofra Ayaresabea (RCH) Melbourne & Australian Society of Otolaryngology Ti ne Kɔn Oprehyɛn (ASOHNS, Australia): Ayaresa mu Adeyɛ Akwankyerɛ: Acute Mastoiditis wɔ Mmofra mu (Diagnostic Triage, IV Ceftriaxone/Flucloxacillin/Vancomycin Protocols, ne Oprehyɛn ho Nsɛnkyerɛnne).

Akwankyerɛ ahorow a ɛfa ho¶

• Meningitis ne meningococcal septicemia a ɛnyɛ blanching rash triage
• Orbital cellulitis, cavernous sinus thrombosis, ne asiane triangle anim nyarewa
• Bell’s palsy vs. stroke anim a ɛtɔ, moma so a wɔkora so, ne aniwa a wɔde kyere aniwa
• Sensoneural aso a ɛyera mpofirim (aso a ɛyɛ mmerɛw) ne aso a ɛpaapae hwɛ
• Sepsis ne septic shock a wohu ne mmoa a edi kan