Mastoiditis coalescent acute : Nofru ɓuuɓndu yeeso e yaasi, ɓuuɓri caggal noppi, e baasal ɓuuɓri ngaandi¶

Mastoiditis coalescent acute ko ñawu bonngu, baawngu bonnude nguurndam, nguu ñawu nguu ina waawi bonnude nguurndam, ngu process mastoïde (ɓuuɓri henndu nanndundi e njuumri e nder ɓalndu nduu, tawa ina woni caggal noppi yaajɗi) ngu feeñata so ñawu nguu ina jokki e nofru hakkundeeru (**acute draks media otitis the acute draks media otige (aditus ad antrum) e mahde ɓuuɓri ɓuuɓndi ndi ɓuuɓnata ƴiye ɓutte ceertuɗe e ƴiye henndu (koolondiral ƴiye). Sabu ƴiyal mastoid ina renndini ƴiye ɓutte ɗe kaayitaaji e fosaaji ɓalndu caggal e hakkundeeji ngaandi, sinus ƴiiƴam sigmoid (ƴiyal mawngal ɓuuɓngal ngaandi e nder ƴiiƴam jugular nder), ƴiyal yeeso (ƴiyal ɓalndu VII) ma.tis, e latis ina yaawi ɓuuɓde caggal noppi ngam waɗde ɓuuɓri gonndi e ɓalndu caggal noppi WALLA ɓuuɓde e nder ɓalndu ngam saabaade trombose septik sinus sigmoïde, ɓuuɓri epidural walla temporal lobe/cerebellar cerebral, meningitis bakteriyeldefanisialparagoni, (ɓuuɓri gite nerve jeegom e ɓuuɓri yeeso luggiɗndi ummoraade e apicitis petrous). So tawii cukalel walla mawɗo mo ñawu noppi mum woni jooni walla ko ɓooyaani ina heɓa boɗewol, ɓuuɓri boggy, walla ɓuuɓri ƴiiƴam laaɓtundi to bannge noppi, majjugol ɓuuɓri ɓalndu tawaandi caggal noppi, walla noppi yaajɗi (pinna) ɗi ɓuuɓnaaka no feewi e yaasi, yeeso, e les ca"true, proek)re nokkuure limooje caɗtuɗe jonta. Nde peewnito-ɗaa ngam yah-ngartaa e opitaal, ƴeewto-ɗaa ko yowitii e infection e neurologique guides on meninjitis e septisemiya meningokook ɓuuɓri ɓuuɓri, sellulit orbital, trombose sinus kavernous, e tatiire kulɓiniinde yeeso, e Bell's palsy vs stroke droop yeeso.

Sabu haa 50 e nder teemedere sukaaɓe wonduɓe e mastoiditis coalescent acute ina ƳEƳƳA ƳEEWDE antibiotikuuji gonɗi e hunuko ngam ñawndude noppi (ɗum firti ko amoksisiliin gonɗo e hunuko ina waawi maskude nguleeki puɗɗiiki tawa ɓuuɓri ina jokki e ɓuuɓnude ƴiyal mastoid les ɓuuɓri), ƴeewndo maa ɓurngo teeŋtude e kala cukalel gonngel e ɓuuɓri direct to fever e cukalel e ƴeewndo noppi ɗiɗi ɗii fof gila e caggal : so noppi gootol yaltii bannge e les no koppi nii, tawa ƴiiƴam ɗam ina ɓuuɓna, ina ɓuuɓna, walla ina ɓuuɓna so taƴaama no feewi, antibiotikuuji gonɗi e hunuko ina ŋakki, cukalel ngel ina sokli antibiotikuuji gonɗi e nder ƴiiƴam ko yaawi, CT/MRI imaging, e ENT surgi.

Waɗde ɗum jooni¶

1. Darto-ɗaa caggal ñawɗo oo e nder annoore moƴƴere, mbaɗaa "From-Behind Ear Alignment and Crease Check." Ƴeewde gila yeeso ina heewi suuɗde ɓuuɓri mastoid arano. Darto-ɗaa caggal cukalel walla mawɗo, ƴeewndoɗaa noppi nano e ñaamo bannge-bannge :
2. Protrusion de l’Auricle (Pinna): Mbele noppi gooti yaajɗi ina ɓuuɓtoo yaasi ina woɗɗitoo ɓalndu, yeeso, e les (haa teeŋti e sukaaɓe tokosɓe e sukaaɓe tokosɓe ɓe duuɓi mum en njahrata e 2, ɗo ɓuuɓri ɓuuɓnata noppi ɗii no feewi les e yaasi)?
3. Obliteration du Sulcus Post-Auriculaire : Ƴeewee ɓuuɓri ɓalndu nattundi (retroauriculaire groove) ɗo caggal noppi jokkondirta e ɓalndu. E nder mastoiditis coalescent acute walla abscess subperiosteal, ɓuuɓri ina hebbina, ina ɓuuɓna ndeeɗoo ɓuuɓri haa laaɓa cer (so tawii noon e nofru ɓuuɓndu [otitis externa], ɓuuɓri ndii ina heddii ina reena walla ina ɓeydoo luggiɗde).
4. Noddu limoore emergency nokkuure maa ɗoon e ɗoon so tawii ɓuuɓri caggal noppi ina wondi e kala bannge boɗeejo Intracranial walla Cranial Nerve. Noddu 911 e nder leyɗeele dentuɗe Amerik e Kanadaa, 112 e nder Dental Orop, 999 e nder leydi Angalteer, 000 e nder Ostarali, walla ƴeew doggol amen limooje caɗtuɗe so tawii ñawɗo oo ina jogii:
5. Naafigaagal hoore tiiɗngal sahaa kala, wutte tiiɗɗo, ɓuuɓɗo e annoore, ɓuuɓgol, ɓuuɓgol, walla ɓuuɓgol (maale meninjaasi, ɓuuɓri ngaandi, walla trombose sinus venous sigmoïde).
6. Yiytere ɗiɗmere walla yitere nde waawaa ruttaade caggal feewde e noppi bannge gooto (paralysie nerveuse sixième / syndrome de Gradenigo).
7. Lowre yeeso bannge wootere walla waasde uddude gite walla ɓuuɓde no fotiri (nerve facial [CN VII] palsy).
8. Vertigo ɓuuɓɗo, nistagmus (gite ɓuuɓɗe), walla muusde ɗoon e ɗoon (labirintitis ɓuuɓɗo).
9. Spiking "picket-fence" ɓuuɓri toowndi e ɓuuɓri dimmbotoondi walla ɓuuɓri ɓuuɓndi nanndundi e ɓoggol les bannge wuddu (Tromboflebitis septik nder ƴiiƴam jugular nannduɗo e Lemierre / maande Griesinger).
10. So tawii alaa banngeeji boɗeeji neurologique, nawtu ñawɗo oo ɗoon e ɗoon to Departemaa Emergency to suudu safrirdu tawa ina waɗi ballal e nder safaara sukaaɓe/mawɓe (ENT) (hay sahaa gooto e kilinik toppitiiɗo ko yaawi). Kala ñawɗo mo tuumaama ina wondi e mastoiditis ɓuuɓɗo ina ɗaɓɓi antibiyotikuuji ɓuuɓɗi e nder ƴiiƴaman MRICT/V.d caɗeele nder reedu ina tuuma)**, e miringotomi (ɓurtugol noppi) e/walla mastoidektomi kortikaal.
11. Waɗde ñawɗo oo ina tiiɗi NPO (alaa ko woni e hunuko: ñaamde alaa, kosam alaa, ndiyam alaa) e laawol feewde safrirde. Fotde sukaaɓe e mawɓe heewɓe wonduɓe e mastoiditis coalescent acute ina ɗaɓɓi ɓuuɓri ɓuuɓri (**miringotomie avec insertion de tube tympanostomique anestesi kuuɓtodinɗo e nder waktuuji seeɗa caggal nde o naati ; resde reedu ina haɗa leeltude anestetik.
12. WOTO waɗ hay huunde e nder ɓuuɓri noppi (alaa toɓɓe noppi galle, alaa peroksiid hidrojen, alaa nebam ngulɗam, alaa ɓuuɓri cotton, e alaa buubaaji noppi). E nder mastoiditis coalescent, ɓuuɓri noppi ina heewi ɓuuɓde e les ɓuuɓri mawndi walla already thick perforated and drai waɗde ndiyam walla ɓuuɓri ndi yamiraaka e nder kanndaa ina waawi naatnude kemikaaji tooke e nder noppi hakkundeeji e nder noppi (ototoxicity) walla ustude ɓuuɓri e dow ƴiye. So tawii ɓuuɓri ina yalta e noppi, tan ko ɓuuɓnude yaasi noppi ɗii no feewi e ɓuuɓri laaɓndi.
13. Ƴeewto no feewi so tawii "Boggy Fluctuance" ina woodi e dow ƴiyal mastoid e torticollis wuddu tawa aɗa toɓɓa no feewi. Huutoraade ƴiyal gootal, memo-ɗaa e seeɗa ƴiyal gonngal dow ngal, ngal woni caggal feccere toownde noppi (taari MacEwen). So tawii ɓalndu dow ƴiyal ina nanndi e ɓuuɓri, ina ɓuuɓna, walla ina ɓuuɓna no ballon ndiyam nii (fluctuance), ɓuuɓri ndii ina taƴa tawo e nder ɓalndu yaajndu nduu, ina waɗa abscess subperiosteal. Ƴeewto kadi so tawii cukalel ngel ina jogii hoore mum ina tiiɗi feewde e ɓalndu wooturu (torticollis), ɗum jeertina abscess Bezold ina rewi e nder ƴiye luggiɗe.

Lekki pellital : ɓuuɓri noppi tiiɗndi, ɓuuɓri caggal noppi, e triage noppi yaltuɗi¶

flowchart TD
    Start["Cukalel walla mawɗo mo noppi, ɓuuɓri noppi, walla Otitis Media ɓooyɗo ina ƴellitoo ɓuuɓri, ɓuuɓri, walla ɓuuɓri caggal noppi"] --> StandBehind{"Ɗatal 1: Darto caggal ñawɗo & ƴeewto noppi ɗiɗi ɗii fof: Mbele noppi yaajɗi (Pinna) ina puɗɗii yeeso/yaasi/les, Mbele ɓuuɓri caggal noppi ina ɓuuɓna, WALLA ko ƴiiƴam mastoid ina ɓuuɓna/ina ɓuuɓna?"}

    StandBehind -->|"EEY : Pinna yaltuɗo, ɓuuɓri caggal noppi ɓuuɓndi, ɓuuɓri mastoid, walla ɓuuɓri ɓuuɓndi"| CheckNeuro{"Ɗatal 2: Ekran ngam nerf nder hoore & nerve cranial Banngeeji boɗeeji: Ɓuuɓri hoore tiiɗndi, ɓuuɓri/ɓuuɓri, daande tiiɗnde, yiytere ɗiɗmere (CN VI Palsy), ɓuuɓri yeeso (CN VII), ɓuuɓri, walla ɓuuɓri daande?"}

    CheckNeuro -->|"EEY to KALA Banndiraawo Boɗeejo"| IntracranialMast["MASTOIDIT COALESCENT ACUT COMPLICAT (Tuumaaɗo wonde ko trombose sinus sigmoïde, ɓuuɓri ngaandi/epidural, ɓuuɓri Gradenigo, walla ɓuuɓri bezold) : Noddu 911 / 112 / 999 Ɗoon e ɗoon ; NPO tiiɗɗo"]

    CheckNeuro -->|"NO Neuro Red Flags: Ɓuuɓri nokkuure caggal noppi/Eritemaaji & Pinnaaji yaltuɗi"| AcuteMast["MASTOIDITIS COALESCENT ACUT / ABSCESS SUBPERIOSTEAL : Yah ɗoon e ɗoon to Departemaa Emergency Hospitaal (E nder njuɓɓudi opereeji ENT); NPO tiiɗɗo ngam Anestesi"]

    StandBehind -->|"NO Ɓoornugol walla Ɓoornugol Ɓoggol Mastoid : Nafoore ina ɓeydoo bonde no feewi so aɗa pullo e Pinna noppi yaajɗi walla aɗa toɓɓa Tragus ; Noppi ina ɓuuɓi"| OtitisExterna["Ina gasa tawa ko Otitis Externa Acute (‘Noppi njuumri’) walla Limfadenitis caggal noppi : Ƴeewto ƴeewndo safaara ñalnde wootere (Tesko: So tawii ko jabet walla immunocompromised e ɓuuɓri luggiɗndi/tissu granulation, woppu Otitis Externa bonɗo/nekrotisant)"]

    IntracranialMast --> HospitalBundle["Vankomisin Stat IV + Abkomisin IV Seftriakson/Sefepim (walla Piperasilin-Tazobaktam), 2. CT gonɗo e ƴeewndo toowngo e ƴiye wakkatiije + MRI ngaandi/MR venogaraafi (MRV), 3. Mastomisin ENT yaawɗo e seppo/Miktomi"]
    AcuteMast --> HospitalBundle

Anatomi e patofisiyoloji : gila e ndiyam noppi hakkundeeji koyɗi haa e ɓuuɓri ƴiye e ɓuuɓri ɓalndu¶

Ngam faamde hol ko waɗi kala cukalel ngel wondi e ñawu noppi hakkundeeji ina jogii ndiyam e nder geese mum henndu mastoid e nder CT scan, kono tan ko seeɗa tan yahrata e acute coalescent mastoiditis seppo goonga, ina wallita e rewindaade tolnooji joy anatomiiji ñawu nguu :

1. Aditus ad Antrum : Ko ɓuuɓri ɓuuɓri caggal noppi hakkundeeji¶

E nder anatomi ɓalndu neɗɗo, ɓuuɓri noppi hakkundeeri (ɓuuɓri timpanik, caggal ɓuuɓri noppi) ina jokkondiri e ŋoral mum toowngal caggal e suudu henndu mawndu hakkundeeru e nder ƴiyal ɓalndu nduu, ina wiyee mastoid antrum rewrude e damal ƴiyal tokosal, ɓuuɓngal wiyeteengal wi**ant a **ditus ad). Yaajde e yaasi ummoraade e antrum mastoid no sponge walla njuumri nii, ko defte keewɗe jokkondirɗe e ɓuuɓri henndu, ina wiyee cellules henndu mastoid. - Daawe 1 : Otomastoiditis akut simple (Normal e kala ñawu noppi): Sabu ɓuuɓri gonndi e noppi hakkundeeji ina jokkondiri e ɓuuɓri ƴiiƴam mastoid, ko ina wona 100 e nder teemere sukaaɓe wonduɓe e otir akut ordinateer ina njogii ndiyam ɓuuɓɗam e nder ƴiiƴam masto mum en. So tawii damal aditus ad antrum** ngal ina udditii, oon ndim ina yalta e nofru hakkundeeru nduu, ina ɓuuɓtoo tawa bonnaani ƴiye. - Daawe 2 : Mastoitis ɓuuɓɗo e Periostitis :* So tawii muus ɓuuɓɗo,ƴiiƴam ɓuuɓɗam, walla ƴiiƴam ɓuuɓɗam ɓuuɓɗam ina ɓuuɓna *aditus ad antrum** ɓuɓri ndii haa laaɓa cer, ƴiiƴam henndu mastoid nduu wonta ɓuuɓri ɓuuɓndi. Bakteriiji (*ko ɓuri heewdeStreptokokku pneumonae, *Streptokokku pyogenes* Streptokokku mo fedde A], tafilokokku oo*, *Hemofilus iluenzae e *Fusobabakterium nekroforum*) ina keewi e nder ɓuuɓri mawndi, a doga e ɓuuɓri ƴiiƴam rewrude e ɓuuɓri ƴiiƴam rewrude e ɓuuɓri ƴiiƴam ɓuuɓri periosteal caggal noppi (boɗewol e ɓuuɓ caggal noppi). - **Daawe 3: Mastoiditis coalescent acute (Osteitis e halkaare ƴiye):** E nd balɗe ɓuuɓɗe timmuɗe, ɓuuɓri cellal, asidosis, e tooke bakteriiji ina kuutoroo osteoklasteeji** ɗi ɓuuɓnata e ɗi ɓuuɓnata ƴiye kalsiyom-fostofaat diƴƴe ɓuuɓɗeƁowɗi njuumri tokoosi ɗii ina kawra (ina kawra) e nder ɓuuɓri mawndi, ɓuuɓndi, ndi ɓuuɓri e ƴiye nekrotik. E ƴeewndo ƴiye wakkatiije rewrude e otoskoop, doktoor oo yiyataa tan ko ɓuuɓri noppi, kono ko maande pathognomonique classique mastoiditis coalescent : "sagging" (ɓuuɓri les) e ɓalndu posterosuperior e nder ƴiiƴam yaajɗam luggiɗɗam, saabi ɗum ko ɓuuɓri ɓuuɓndi e nder thiard mastoid e ñaamo les.

2. To Pus Pressurized yaltata : Laabi 6 ɓuuɓri ƴiye¶

So tawii ɓuuɓri coalescent ndii ina heewi ɓuuɓri, ina ɓuuɓtoo e kala ɓuuɓri mastoid ɓurndi tiiɗde :

1. Erosion lateral rewrude e ɓalndu yaajndu (Triangle de MacEwen) -> Abscess subperiosteal post-auriculaire (Complication extracranienne plus commune) : Pus ina taƴa e ɓalndu yaajndu ƴiyal mastoid ngal, ina ƴetta ɓalndu tiiɗndu nduu, ina waɗa periosteum boggy e periosteum boggy (abcès subpériosteal) ɓuuɓnoowo pinndi noppi yaajɗi ** yeeso, yaasi, e les**.
2. Erosion les par le tippe mastoïde (Incisura Mastoidea) -> Abscess bezold: E nder sukaaɓe mawɓe e mawɓe wonduɓe e tippudi mastoid ɓuuɓndi no feewi, ɓuuɓri ina yalta e ɓuuɓri gonndi e ɓuuɓri les ndi, ina rutta luggiɗde e nder ɓuuɓri fascial dimuscle e SCnoïde) ko wutte. Sabu ɓuuɓri ndii ina jooɗii haa les ɓuuɓri wuddu tiiɗndi, ina waawi tawa ko ɓuuɓri seeɗa tan woni caggal noppi ɗii ; e nder ɗuum, ñawɗo oo ina hollira ɓuuɓri muusndi, tiiɗndi e bannge toowɗo wuddu, ɓuuɓri wuddu tiiɗndi (torticollis), e baasal ɓuuɓri rewrude e ɓuuɓri gonndi e ɓalndu (mediastinitis). (So ​​tawii ɓuuɓri ina rewi caggal les ɓuuɓri splenius capitis feewde caggal ɓalndu, ina wiyee abscess Citelli; so tawii ina ɓuuɓtoo yeeso rewrude e ɗaɗol gonngol e yeeso noppi, ina wiyee abscess Luc).
3. Erosion hakkundeejo e nder ƴiyal petrous -> Apicitis petrous e sindrom Gradenigo: Pus ina rewi haa juuti feewde e ŋorol hakkundeewol ƴiyal petrous (petrous petrous), ɗo ganglion trigeminal (CN V) e nerf abducens rewata e DonalVI.' Ɗuum ina addana Triad de Gradenigo : (1) Otitis media / ɓuuɓri noppi, (2) Nafoore luggiɗnde, mettunde caggal gite e nder ɓalndu (irritation CN V), e (3) Ɓooygol gonngol e banngeeji gonɗi e nder reedu e nder reedu (CNye VI palsy outward the outward the outside the canye feewde e nofru, ina addana yiytere ɗiɗmere horizontal).
4. Erosion caggal rewrude e ɓuuɓri sigmoid -> Trombose septique sinus sigmoïde ("Fever picket-fence"): Koɗorɗe caggal ɓuuɓri mastoid ko ɓuuɓri ƴiiƴam ɓuuɓndi no kaayitaaji nii, seerndi ƴiiƴam henndu mastoid e sinus venous dural sigmoid. Erosion walla tromboflebitis e nder ndeeɗoo lefol ina addana ƴiiƴam ɓuuɓɗam e nder sinus sigmoid e nder ƴiiƴam jugular nder, ina addana ɓuuɓri "picket-fence" ɓuuɓndi, ɓuuɓri hoore tiiɗndi, maande Griesinger (ɓuuɓri ɓuuɓndi e teddeendi ɓuuɓndi e dow ɓalndu throid ƴiiƴam), papilledema ummoraade e ɓeydagol nguleeki nder reedu (hidrosefali otitik), e emboli pulmonaire septik feewde e ɓuuɓri.
5. Erosion toowɗo rewrude e dow suudu (Tegmen Tympani / Tegmen Mastoideum) -> Ɓoornugol epidural, Empyema subdural, Meninjitis, walla Lobe Temporal / Ɓoornugol ngaandi cerebellar: Pus ina ɓuuɓta dow rewrude e dow suudu ƴiye ɓuuɓndu seerndude mastoid e cavi ngaandi.
6. Erosion anterior-médial dans le canal facial ou les canals semi-circulaires -> Palsy nerve facial (CN VII) walla labyrinthitis suppuratif: Pus ina ɓuuɓna walla ina ɓuuɓna nerf yeeso nder kanaal Fallopian (ina addana ɓalndu fof ɓuuɓde e nder tiinde semi-circulaire) walla eroro vertigo, ɓuuɓri, nistagmus, e ŋakkere nanɗe sensorineural duumiinde).

Seerndude mastoiditis ɓuuɓɗo e noppi njuumri (Otitis Externa), Limfadenitis, e Infeksiyoŋ Nofru mo ŋakkaani¶

Sabu ƴiye tokoose ina njooɗii e dow ƴiyal mastoid caggal noppi (limfatik posterior auriculaire) ina ɓuuɓta kala nde cukalel heɓi ɓuuɓri ƴiiƴam, ɓuuɓri ɓuuɓri, walla noppi ɓuuɓri, huutoroo ndeeɗoo tabalde leeso ngam anndude mastoiditis goonga so wonaa mimik moƴƴo :

Sindromuuji 5 nder reedu e caggal reedu ngam ƴeewndaade e sara leeso¶

E nder faddaade yah-ngartaa to departemaa urgency opitaal, mbaɗon ndeeɗoo ƴeewndo neurobiyoloji 60 sekon, ciftor kala ko moƴƴi e ko njiy-ɗaa e infirmiye triage e cafroowo ɗoon e ɗoon :

1. Ƴeewndo dille gite ngam ƴeewde so tawii ko ñawu Gradenigo (Cranial Nerve VI Palsy): Jogaade jolngo walla junngo maa yeeso ñawɗo oo, ɓuuɓna ɗum seeɗa seeɗa e dow nano e ñaamo tawa aɗa ɓuuɓna hoore maɓɓe. So tawii gite gonɗe e bannge gooto e noppi gonɗi e ñawu nguu waawaa wirnude yaasi feewde e temple (ina addana gite ɗee taƴde, ñawɗo oo yiytoo ko ɗiɗi, walla addande cukalel ngel ɓuuɓde hoore mum walla suddaade gite mum goote tawa ina ndaara tele), tawa ina hawra e mette caggal ndeen gite, ñawu nguu yettiima apex (G.ra)to sinus kavernous e ƴiiƴam nder ɓalndu.
2. Ƴeewndo ƴattooje e gite ngam ƴeewde so tawii ko nerf yeeso (Cranial Nerve VII): Ñaago-ɗaa ñawɗo oo yo ƴattooje mawɗe, ɓuuɓna gite mum, udda gite mum ɗiɗi ɗee no feewi, ƴetta gite mum. So tawii bannge yeeso mo ɓuuɓri noppi oo ina ɓuuɓtoo (ina heen ŋorol hunduko ngol E tiinde/yitere ndee fof), ɓuuɓri nder noppi hakkundeeji walla mastoid ina ɓuuɓna nerf yeeso nder ɓuuɓri ƴiiƴam Fallopian. Ɗum noon ina ɗaɓɓi miringotomi (e ko heewi e decompression mastoïde) ko yaawi, tawa ina ɓeydee heen antibiotik e kortikosteroid e nder waktuuji seeɗa ngam haɗde ɓuuɓri yeeso duumiindi.
3. Ƴeewndo ƴiiƴam ƴiiƴam mastoid ngam ƴeewde maande Griesinger (Trombose sinus sigmoïde): Ƴeew e nanngu seeɗa caggal laawol mastoid (dow keeri caggal mastoid ɗo ƴiiƴam ƴiiƴam ƴiiƴam yaltata e ɓalndu). Edema pittaali (ɓuuɓri dogdu ndi accata ɓuuɓri so ɓuuɓnaama) e ɓuuɓri ɓuuɓndi dow mastoid caggal, tawa ina wondi e ɓuuɓri toowndi, ɓuuɓri hoore, walla ɓuuɓri, ko maande Griesinger, maande yaajnde trombose septique du sin signous.
4. Ƴeewndo bannge daande ngam anndude so tawii ko ɓuuɓri Bezold: Ƴeew no daande ñawɗo oo woniri, njiyto-ɗaa no feewi e dow ɓalndu nduu, ɓuuɓndu nduu ina doga gila caggal noppi haa e ɓalndu nduu (ɓalndu sternocleidomastoid). So tawii ñawɗo oo saliima wirnude wutte mum (torticollis) tawa ina jogii keewal luggiɗngal, ɓuuɓngal e nder daande toownde les ɓuuɓri ƴiiƴam, ɓuuɓri ndii ina ruttii e ɓuuɓri ƴiiƴam hakkundeeri, ina naata e nokkuuji wuddu luggiɗɗi ɗii (Bezold abscess).
5. Ƴeewndo jabet / immunocompromisé ngam yiytude Otitis Externa bonɗo (nekrotisant): E nder mawɗo mo jabet, kemikal, VIH, walla safaara cemmbinoowo, mo ƴiiƴam mum ɓuuɓnata, mo ɓuuɓnataa, mo luggiɗi jamma e nofru ɓuuɓndu, ɓuuɓndu e XII nerve dralent e VII walla XII palsies), ko ɓuri heewde e sahaaji ko Pseudomonas aeruginosa osteomiyelitis gonɗo e ɓalndu ɓalndu (Otitis Externa bonɗo), ina ɗaɓɓi safaara gonɗo e nder ƴiiƴam ko yaawi (**cefepime, piperasilin-tazobastadibaktam, walla ceft) CT/MRI.

Diagnostic opitaal laaɓtuɗo e njuɓɓudi seppooji ENT¶

So cukalel walla mawɗo arii e safrirde tooñannge ina wondi e mastoiditis ɓuuɓɗo, njuɓɓudi ndii ina rewi laawol safaara, radiyoloji, e otolaryngoloji :

1. Antibiyotikuuji keewɗi gonɗi e nder ƴiiƴam (ina ɓuuɓna Pneumococcus mo penisilin waawataa haɓtaade, Strep mo fedde A, S. aureus, e Fusobacterium)¶

Sabu antibiyotikuuji gonɗi e hunuko mbaawaa naatde e ɓuuɓri mastoid coalescent, tee haa feccere e ñawɓe ɓee ina mbaawi heɓde amoksisiliin gonɗo e hunuko, safrooɓe ɓee ina ƴetta ɗoon e ɗoon pine ƴiiƴam, ina puɗɗoo antibiyotikuuji empirik gonɗi e nder ƴiiƴam baawɗi taccude ƴiiƴam-ngaandi : e ƴiiƴam : e ƴiiƴam : - Rejim IV gadano (IDSA / AAP / ENT UK) : Vankomisin gonɗo e nder ƴiiƴam (15 to 20 mg/kg IV every 6 to 8 hours) (ngam suɗaade Stafilokokus mo metisilin waawataa [MRSA] e Streptokokkus pneumoniae mo penisilin waawataa haɓtaade) PLUS Ceftriaxone (50 to 100 mg/kg/day e doseeji meningeal) WALLA Cefepime / Piperasilin-Tazobaktam / Meropenem gonɗo e nder ƴiiƴam (ngam suɗaade Streptokokkus piyojen, Hemofilus grippe, Fusobabakterium nekroforum mo alaa henndu, e Pseudomonas aeruginosa/perper ngam suɗaade ekronik). - Ɓeydude Metronidazol: So tawii ko ɓuuɓri epidural/ngaandi nder reedu walla Fusobacterium trombose sinus sigmoïde tuumaama, seftriakson huutoraama, metronidazol nder ƴiiƴam ina ɓeydee ngam naatde e nder ƴiiƴam caɗtuɗam anaerobiik tiiɗɗam.

2. CT ƴeewndo toowngo e ƴiye waktuuji + MRI ngaandi / Venography MR (MRV)¶

• Tomogaraafi limtilimtinɗo (HRCT) e ƴiye wakkatiije e mbaydi gonndi e nder ƴiiƴam: Kartal laawol seppo adanngol. Windooji ƴiye ɓutte ɗe ngalaa mbaydi ina kollita ɓuuɓri e majjugol septaaji ƴiye nder hakkunde ƴiye henndu mastoid (coalescence bone), ɓuuɓri ɓalndu mastoid yaajndu, walla ɓuuɓri ɓalndu sigmoid/tegmen nder suudu, tawi ɓuuɓri nder ƴiiƴam ina teeŋtina ahan-post pocket of - ɓuuɓri les ɓuuɓri, ɓuuɓri daande Bezold, walla ɓuuɓri hebbingol ("maande delta meho") nder sinus ƴiiƴam sigmoid.
• MRI ngaandi ɓeydaandi e MR venographie (MRV): Yamiraama e sara CT kala nde kala ɓuuɓri hoore, ɓuuɓri ƴiiƴam, ɓuuɓri gonndi e ƴiiƴam, ɓuuɓri gonndi e ƴiiƴam, walla tuumeede ɓuuɓri sinus sigmoid, ɓuuɓri epidural, empiyema superdural, walla lobe farbelre temporal ina woodi to MRI CT ngam yiytude ɓeydagol dural nder reedu ko yaawi, trombose ƴiiƴam, e cerebritis).

3. Ƴeewndorɗe ENT (Udditgol lowre ɓuuɓnde)¶

E nder porotokol Akademi Ameriknaajo Otolaryngologie-Operation de la tête et du cou (AAO-HNS) e ENT UK, ɓuuɓri seppooji ina yahdi e tolno ñawu nguu : 1. Miringotomi yaajɗo e naatgol tuuba timpanostomi (Grommet) (Waɗetee ko e ko famɗi fof e sahaa kala): E nder anestesi kuuɓtodinɗo juutɗo (walla anestesi topikal e ñawɓe mawɓe), doktoor ENT oo huutortoo ko mikroskoop gollorɗo ngam waɗde taƴre e nder ƴiiƴam noppi ɓuuɓɗam, suusa miarcteri in pressurized, pine aerobiik/anaerobiik, e ƴeewndo sensitivite antibiotik, e waɗde tuuba ɓuuɓɗo (grommet timpanostomi) mbele noppi hakkundeeji e antrum mastoid ina mbaawa ɓuuɓde jokkondirde e yaasi e heɓde toɓɓe noppi antibiotik-steroid topikal (siprofloksasin-deksametason). E nder mastoiditis gadano mo alaa ko woni e mum, antibiyotikaaji gonɗi e nder ƴiiƴam tawa ina ɓeydoo heen myringotomi ina safra ñawu nguu e nder 70 haa 80 e nder teemedere ñawɓe e nder waktuuji 48. 2. Dinage abscess subperiosteal e mastoidektomi kortikal (Mastoidektomi koyɗol): So tawii ñawɗo oo ina jogii ɓuuɓri les ɓalndu caggal noppi, ɓuuɓri ƴiiƴam e CT, ɓuuɓri Bezold, ɓuuɓri nerf yeeso.ORsindrom Gradenigo,**sindrom moƴƴitinde caggal 24 haa 48 hojom e antibiyotik IV e miringotomi, seppo ENT waɗata ko taƴre tufnde no moƴƴi caggal noppi, ɓuuɓna ɓuuɓri gonndi e les ɓuuɓri, huutoroo ɓuuɓri seppo diamant toowndi e les mikroskoop ngam udditaade ɓalndu yaajndu necroctomy mastoid (necroctomy all). partiiji, lootde ƴiiƴam mastoid, e udditaade aditus ad antrum mo ɓuuɓnaaka oo, mbele ƴiiƴam celluɗam ina artira haa abada tawa bonnaani ƴiye nanɗe (ossicles).

Limooje emergency diiwaan e porotokolle agence¶

Mastoiditis coalescent acute tuumaaɗo ina ɗaɓɓi ƴeewndo ko yaawi to Departemaa Emergency opitaal jogiiɗo CT/MRI waktuuji 24 e Opereeji Otolaryngologie (ENT) sukaaɓe / mawɓe :

• Leyɗeele dentuɗe Amerik e Kanadaa: Noddu 911 so tawii won banngeeji boɗeeji neurobiyoloji, gite, nerve yeeso, walla sepsis ina ngoodi, walla yah to suudu safrirdu mawndu (ko ɓuri moƴƴude ko Ospitaal sukaaɓe ED keeriiɗo wonande ñawɓe sukaaɓe). Njuɓɓudi mum ko e les njiimaandi Akademi Ameriknaajo ko faati e safaara sukaaɓe (AAP) e Akademi Ameriknaajo ko faati e Otolaryngologie-Opereeji Hoore e Wuddu (AAO-HNS).
• Dental Leyɗeele: Noddu 999 ngam heɓde banngeeji boɗeeji nder reedu walla yah ɗoon e ɗoon to opitaal ɓurɗo ɓadaade Departemaa Emergency (A&E) e noddaango Operation ENT. Njuɓɓudi mum ko e les Duɗal ngenndiwal ngam cellal e toppitagol (NICE NG91: Laawol Otitis Media, Akut, Mastoiditis) e ENT UK tolnooji safaara.
• Dental Orop: Noddu 112. Njuɓɓudi mum ko e les njiimaandi Akademi Oropnaajo Otoloji e Neurotoloji (EAONO) e Fedde Oropnaare Otorinolaringoloji Sukaaɓe (ESPO) laabi mastoiditis ɓuuɓɗo.
• Ostraali e Nuwel Selannde: Noddu 000 to Ostarali walla 111 to Nuwel Selannde. Njuɓɓudi mum ko e les Fedde Ostarali toppitiinde ko fayti e seppooji hoore e wuddu (ASOHNS) e Ospitaal sukaaɓe laamɗo (RCH) to Melbourne, kuule kuutoragol safaara mastoiditis ɓuuɓɗo.
• Inndo e Asii-Pacifik: Noddu 112 (walla 108 to Inndo), 995 to Singapuur, 119 to Japon e Koree worgo, walla 999 to Malesi e Hong Kong. Ɗaɓɓu opitaal tergal jogiiɗo sarwisaaji ENT e neurochirurgie.

Naamne keewɗe naamneede¶

Hol no mbaawir mi anndude seerndi ɓuuɓri noppi no woorunoo e mastoiditis ɓuuɓɗo so mi ƴeewii noppi ɓiɗɗo am?¶

E nder ñawu noppi hakkundeeji gaadoraaɗi (otitis media acute), ñawu nguu ina heddii e nder noppi : cukalel ngel ina wondi e ɓuuɓri noppi e ɓuuɓri, kono yaasi noppi ɗii e ƴiye ɓalndu caggal noppi ɗii ina njiyloo, ina nanndi e no woorunoo haa laaɓi. Ngam ƴeewde so tawii ko mastoiditis ɓuuɓɗo, daraade caggal ɓiɗɗo maa e nder annoore moƴƴere, ƴeewto noppi ɗiɗi ɗii fof gila e caggal : e nder mastoiditis, ɓalndu nduu ina wonta boɗeejo, ina ɓuuɓna, ina ɓuuɓna no feewi e toɓɓere, ɓuuɓol nattungol ɓuuɓngol ɗo ɓalewol noppi ngol hawrata e flattshed ina hebbina, e) ina teskaa e yaasi, yeeso, e les no koppi ɓuuɓɗi nii.

Mbele cukalel ina waawi heɓde mastoiditis acute haa jooni hay so tawii ina ƴetta antibiotik (hono Amoxicillin) balɗe ?¶

Oho. E nder wiɗtooji safaara, hakkunde 35 e 50 e nder teemedere sukaaɓe naatɓe e safrirde ɓee, tawi ina ngondi e mastoiditis coalescent acute walla abscess subperiosteal post-auriculaire, ina ƴetta tawo antibiotikuuji gonɗi e hunuko, ɗi ɓe ndokkata ngam ñawndude noppi. Anndiraango « mastoiditis masked », antibiyotikuuji gonɗi e hunuko ina keewi ustude nguleeki e ɓuuɓri noppi e nder sahaa gooto, tawi ina mbaasa naatde e ƴiye henndu mastoid ɓuuɓndu, keewndu ɓuuɓri (walla ina mbaasa sabu bakteriiji ɗii ina mbaawi haɓtaade amoksisiliin gonɗo e hunuko). So tawii cukalel ƴettuɗo antibiotik e hunuko ngam ñawu noppi, ina wondi e ɓuuɓri walla ɓuuɓri caggal noppi, noppi ina ɓuuɓtoo, walla ɓuuɓri e ɓuuɓri hoore ina ngarta, yah to suudu safrirdu ngam heɓde antibiotik e nder ƴiiƴam.

Hol no safrooɓe nganndirta seerndi mastoiditis ɓuuɓɗo e "nofru ɓuuɓndu" (otitis externa) walla ɓuuɓri ƴiiƴam caggal noppi ?¶

Ko adii fof, ɓuuɓna no feewi e ɓalndu noppi yaajɗi walla ɓuuɓna taƴre tokosere gonnde e ŋoral noppi (tragus) : e nder noppi njuumri (otitis externa), diwde noppi yaajɗi ina addana ɗum mette mawɗe sabu ɓalndu noppi yaajɗi ina ɓuuɓna, tawi noon ƴiiƴam mastoid e hoore mum wonaa ɓalndu no feewi. Ɗiɗaɓere, e nder ɓuuɓri ɓuuɓndi ndi alaa ko bonnata caggal noppi (ina heewi ummoraade e ɓuuɓri ɓuuɓri, eksema, walla ɓuuɓri ɓuuɓri e dow hoore), aɗa waawi nande ɓuuɓri tokosiri, ceertundi, diwndi, ndi njuuteendi mum tolnii e ƴiyal, ina jooɗii e dow ƴiyal, ɓuuɓri caggal noppi ina heddii ina tiiɗi, nofru nduu ina ndaara no feewi, nofru nduu ina ndaara no feewi.

Hol ko woni mboros Gradenigo e hol ko waɗi mboros noppi ina addana neɗɗo yiyde laabi ɗiɗi walla gite taƴɗe ?¶

E nder luggiɗde hoore, wuttulo ƴiyal temporal (petrous apex) ina jooɗii sara nerf hoore jeegom (nerf abducens, jogorɗo jogaade ɓalndu ɓuuɓndu gite yaasi feewde e temple) e nerf hoore joyaɓo (nerf trigeminal, jogorɗo jogaade senngooji yeeso). So tawii ɓuuɓri ummoriindi e ɓuuɓri mastoid ina rewi e ɓuuɓri ɓalndu (apicitis petrous), ina ɓuuɓna ƴiye ɗiɗi ɗee kala, ina addana ɗum tatiire Gradenigo : (1) noppi ɓuuɓɗi, ɓuuɓɗi, (2) ɓuuɓri luggiɗndi, tiiɗndi caggal yitere ndee e saraaji ɓalndu nduu e oon bannge, e (3) palsy e, in-vesing to bannge gite taƴɗe e gite ɗiɗi). Ko maande jeertinaande yaawnde wonande naatgol e nder ɓalndu e sinus cavernous ina ɗaɓɓi antibiotik IV ko yaawi e seppo ENT.

Hol ko waɗi trombose sinus sigmoïde ko baasal mawngal e nder mastoiditis ɓuuɓɗo ?¶

Koɗol caggal ƴiye henndu mastoid ngol seerndi ɗum tan ko e ƴiye ɓuuɓɗe no kaayitaaji nii, ummoraade e sinus sigmoid dural venous, woni ƴiye mawɗe ɗe ƴiiƴam yaltata e ngaandi, naata e ƴiye jugular ndernderiije e nder wuddu. So mastoiditis coalescent ina ɓuuɓtoo walla ina ɓuuɓna oon ɓalndu ɓuuɓndu, ƴiiƴam ɓuuɓɗam (trombose septique) ina waɗa e nder sinus sigmoid. Ɗum ina haɗa ƴiiƴam ƴiiƴam yaltude e ngaandi, ina ɓeyda ɓuuɓri nder ɓalndu (ina addana ɗum ɓuuɓri hoore, ɓuuɓri, ɓuuɓri gite sabu ɓuuɓri ƴiiƴam, e ɓuuɓri ƴiiƴam) e ɓuuɓnude ƴiiƴam ɗam les e nder ƴiiƴam, ina ɗaɓɓi antibiyotikaaji gonɗi e nder ƴiiƴam ɗoon e ɗoon, ɓuuɓri mastoin thiblood drainage, ɓuuɓri ƴiiƴam.

Mbele kala cukalel gonngel e mastoiditis ɓuuɓɗo ina foti waɗde opereeji udditiiɗi (mastoidectomie) ?¶

Wonaa sahaa kala. So tawii mastoiditis ɓuuɓɗo nanngaama ko yaawi (ko adii nde ƴiye ndernderiije ɗee ɓuuɓtata, mbaɗta ɓuuɓde walla waɗde poos ɓuuɓɗo les ɓuuɓri caggal noppi), 70 haa 80 e nder teemedere sukaaɓe ina cella haa laaɓa cer, tawa ina mbaɗa antibiyotikaaji keewɗi e nder ƴiiƴam, tawa ina mbaɗa e mum en minor e naatgol grommet (tube ventilateur) ngam ɗaccude ɓuuɓol ngol yalta e ɓuuɓri noppi. So tawii CT hollitii wonde abscess subperiosteal ina waɗi tawo caggal noppi, so tawii ƴiye henndu ƴiye ɗee ina kawri, walla so tawii cukalel ngel moƴƴaani e nder waktuuji 24 haa 48, ENT oo waɗata ko mastoidectomie cortical caggal noppi ɗii, tawa ina reena ƴiye ɗee.

Fuɗɗoode e ardorde laawɗunde¶

• Duɗal ngenndiwal toppitiingal cellal e toppitagol (NICE) & ENT UK (Royaume-Uni): Otitis Media (Acute): Restoraaji antimikrobiyaal e neldugol e nder safaara ngam tuumeede wonde ina wondi e mastoiditis ɓuuɓɗo (NICE Guideline NG91) (kuulal jolngo e opitaal ko yaawi ngam ustude nerve, proswecraculaire post-aurinaire, proswecraculaire banndiraaɓe).
• Akademi Ameriknaajo ko faati e safaara sukaaɓe (AAP) & Akademi Ameriknaajo ko faati e cafrooɓe ɓesngu (AAFP, Amerik): Laabi gollorɗi safaara: ƴeewndo e njuɓɓudi ñawu nguu (Safaara sukaaɓe, yahrude yeeso e mastoiditis coalescent akute e nder mastoiditis otoŋ e masko amoksiyoloji hunduko ɓuuɓri seppo).
• Akademi Ameriknaajo Otolaryngologie-Opereeji Hoore e Wuddu (AAO-HNS, Amerik): Konondiral e laabi gollorɗi e nder safrirde ko fayti e caɗeele ɓuuɓɗe e nder ƴiiƴam (mastoiditis coalescent, absces subperiosteal, absces bezold, apicitid sidrog siusgen petrous / sinmede Trombose).
• Fedde ñawuuji mborosaaji Amerik (IDSA, Amerik): Laabi gollorɗi safaara ngam ƴellitde meninjitis jokkondirɗo e cellal e otogenik, ɓuuɓri epidural, e ɓuuɓri ngaandi (vankomisin empirik gonɗo e nder ƴiiƴam e mefalorinzoporinzomen e cephalos jibinannde tataɓere/nayaɓere).
• Ospitaal sukaaɓe laamɗo (RCH) Melbourne & Fedde Ostarali ngam Otolaryngologie Opereeji Hoore e Wuddu (ASOHNS, Ostarali): *Laabi gollorɗi : Mastoiditis ɓuuɓɗo e sukaaɓe (Triage Diagnostic, Proseftriaxone/Flucloxacillin/V.an)

Ardiiɓe jokkondirɓe¶

• Meninjitis e septisemiya meningokok ko ɓuuɓri ndi ɓuuɓnataa
• Selilit orbital, trombose sinus kavernous, e mborosaaji tati kulɓiniiɗi e yeeso
• Bell's palsy vs. stroke ina ɓuuɓna yeeso, ina ɓuuɓna tiinde, ina ɓuuɓna gite
• Ko ɗoon e ɗoon ŋakkere nanɗe sensorineural (stroke noppi) e toppitagol noppi ruppitɗi
• Sepsis e septik shock anndinde e ballal gadanal