Mastoiditis

MASTOIDITIS
BY
BWALYA MUNJILI
Definition
• Mastoiditis is an inflammation of the mastoid process

behind the ear and of the air space connecting it to the
cavity of the middle ear.
Etiology
• Acute Otitis media

• Chronic suppurative otitis media
• Inadequate drainage of exudate in otitis media
• Inadequate treatment of AOM
• Cholesteatoma;skin cyst in te middle ear may block
drainage of the ear
CLASSIFICATION OF MATOIDITIS
• Acute mastoiditis
• chronic mastoiditis
1Acute mastoiditis;This is a rare complication of acute
otitis media.
i,Catarrhal mastoiditis;this stage follows the stages of
suppuration in ASOM.there will be congestion of the
mucosa of the mastoid which leads to aggravation of
symptoms.
Types cont.....
ii.Coalescent mastoiditis;the air cells of the
mastoid coalesce and mastoid cavity becomes
converted in to a bag of pus.
2.Chronic mastoiditis;this occurs with CSOM or
with cholesteatoma formation
PATHOPHYSIOLOGY
• Otitis media/cholesteatoma
• Inadequate drainage of exudate
• spread of exudate into mastoid air cells
• extension of infection to mastiod air cells.
• congestion of mucosa of the mastoid bone
• pus collection in mastoid air cells
• aggravation of symptoms
CLINICAL MANIFESTATIONS
• Severe pain in the mastoid region

• Redness in the mastoid region
• Swelling in the mastoid region
• Tenderness in the mastoid region
• Otalga
• Feeling of fulness
• Perforation of te ear drum.
• Dizziness,Otorrhoea,Deafness
Management
• Medical mnagement
• investigations
• history taking will review the predisponsing factors
• physcal examination will present swollen and redness
of the mastoid
• mastoid bone x ray
• CT scan
• CBC,bloood culture
INVESTIGATION CONT...
• Tympanocentesis;ear culture,fluid from middle ear.

• Audiography;to assess hearing loss
• Lumbar puncture;to identify the extension of
infections to CNS
• Ear irrigation to remove purulent discharge
Medical mgt.....
• Treatment
• Antibiotics
• ceftriaxone 1 g bd 7/7
• side effects;Hypersenstivity reaction
• Nursing implication
• I will monitor the side effects of the drug to promote
nutrition status of the patient
• I will give drugs as prescribed by the doctor to
Treatment cont...
• Gentamicin 80mg tds 7/7 iv,im
• sid effects;nephrotoxicity or pain to the injection site.
• I will provide divesion therapy to divate the patient
mind from pain from the injection site.
• I will give prescribed drugs on time to promote quick
recovery.
TREATMENT CONT.....
• Analgesics
• Acetaminophen 1g tds 3/7
• Side effects;liver failure
• I will monitor the side effects of the drug to prevent
complications
• I will give drugs in time to promote quick recovery of
the patient.
SURGICAL MGT...
• Mastoidectomy;this is a surgical procedure that removes
diseased mastoid air cells.
1.Simple mastoidectomy;the incision is made behind the
ear to remove the infected air cells by appoaching through
th ear.
2,Radical mastoidectomy; a radical mastoidectomy
removes the tympanic membranes and is indicated for
extensive spread of a cholesteatoma.The eardrum and
middle ear structures may be completely removed.Usually
the stapes is spread if possible to help preserve some
SURGICAL MGT CONT...
3,Cortical mastoidectomy;removal of the mastoid air

cells without distubing the middle ear.
4,Myringotomy; this is a surgical procedure in which a
tiny incision is created in the eardrum relieves pressure
caused by excessive building of fluids or pus
chronic mastoiditis
• Radical mastoidectomy, is seldom necessary because

of antibiotic therapy, and does not drastically affect the
patient's hearing because significant hearing loss
precedes surgery.
• With either surgical procedure, the patient continues
oral antibiotic therapy for several weeks after surgery
and hospital discharge.
Surgical mgt cont...
• A chronically inflamed mastoid bone requires radical
mastoidectomy - excision of the posterior wall of the ear
canal, remnants of the tympanic membrane, and the malleus
and incus (although these bones are usually destroyed by
infection before surgery). The stapes and facial nerve remain
intact.
• Radical mastoidectomy, is seldom necessary because of
antibiotic therapy, and does not drastically affect the patient's
hearing because significant hearing loss precedes surgery.
• With either surgical procedure, the patient continues oral
antibiotic therapy for several weeks after surgery and hospital
discharge.
MYRINGOTOMY
• Myringotomy -a small incision of the tympanum to

express the fluid from the middle ear in chronic or
recurrent otitis media , to relieves the pressure.
• Tympanostomy
• A tube is inserted into the tympanic membrane to
continue drainage of pus from the middle ear.
Nursing mgt
• AIMS
• To relieve pain
• T o prevent infection
• To prevent complication
NURSING MGT
• Nursing Diagnoses
i. Acute pain related to mastoid surgery.
ii. Risk for infection related to mastoidectomy&
surgical trauma to surrounding tissues & structures.
iii. Disturbed auditory sensory perception related to ear
disorder , surgery.
iv. Anxiety related to surgical procedure.
v. Knowledge deficit related to mastoditis , surgical
procedure & postoperative care.
Pre operative care
• ELECTIVE OR PLANNED PREOPERATIVE

CARE
• This the surgery which is done in days, weeks, or
months
• a)Environment/Admission of the patient
• b)Observations – recorded on the TPR chart to monitor
the condition of the patient
• c)Investigations
Pre operative cont..
• d)Nutrition
• e)Hygiene
• f)Psychological care
• g)Informed consent signing
• h)Pre-medication
Physical preparation
• Cannulation
• NGT insertion
• Bladder preparation - Catheterisation
• Bowel preparation – Enema
• Skin preparation – shaving, removal of nail polish,
cutting of long nails
Final preparation
This is done the morning before the patient goes to

theatre
• Bath the patient
• Gowning and labelling
• Observations to act as baseline data
• Removal of dentures, jewelleries and any prosthesis
• Gather all the necessary documents, patient’s file and
lab or X-ray results and escort the patient to theatre.
Final preparation cont..
• Be on head side of the trolley while pushing it for

close monitoring and continuity of psychological care.
Leave the theatre only when the patient is
anaesthetised. Go and make a post-operative bed and
have all the equipment required ready in the acute bay.
COMPLICATIONS
• Hearing loss
• Facial nerve palsy
• Cranial nerve involvement
• petrositis
• Osteomyelitis
• Meningitis
• Cerebral abscessSubdural empyema

Mastoiditis - B.M

Uploaded by

Copyright:

Available Formats

Mastoiditis - B.M

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Mastoiditis - B.M

Uploaded by

Copyright:

Available Formats

• Mastoiditis is an inflammation of the mastoid process

• Acute Otitis media

• Severe pain in the mastoid region

• Tympanocentesis;ear culture,fluid from middle ear.

3,Cortical mastoidectomy;removal of the mastoid air

• Radical mastoidectomy, is seldom necessary because

• Myringotomy -a small incision of the tympanum to

• ELECTIVE OR PLANNED PREOPERATIVE

This is done the morning before the patient goes to

• Be on head side of the trolley while pushing it for

You might also like