mastoiditis: mastoiditis Kirandeep randhawa MASTOIDITIS: MASTOIDITIS DEFINITION: DEFINITION Mastoiditis is an infection of mastoid process , the portion of the temporal bone of the skull that is behind the ear which contains open, air-containing spaces. CAUSES: CAUSES OTITIS MEDIA – inflammation may spread from ear to mastoid bone of skull. Bacteria – haemophilus influenzae Cholesteatoma – it occur due to repeated middle ear infection. If untreated Cholesteatoma can erode into mastoid process & produce mastoditis. PATHOPHYSIOLOGY: PATHOPHYSIOLOGY bacteria spread from the middle ear to the mastoid air cells , where the inflammation causes damage to the bony structures. Inflammation \ infection occur Cont….d: Cont….d Blockage of antrum by inflamed mucosa prevents drainage of fluid. Mucopurulent build up increases air cell pressure. Demineralization of cell walls Cont….d: Cont….d Abscess formation Spreads to surrounding structures i.e. middle ear fossa , sinus area . Mastoditis. CLINICAL MANIFESTATION: CLINICAL MANIFESTATION Pain behind the ear Mastoid tenderness Protrusion of pinna Fever Redness over the mastoid region Loss of hearing Drainage from ear ( purulent) DIAGNOSTIC EVALUATION: DIAGNOSTIC EVALUATION History Physical examination Tympanocentesis – fluid from middle ear send for culture. CT SCAN – collection of fluid in middle ear & mastoid region , abscess formation. MRI – evaluation of tumor , soft tissue. AUDIOGRAPHY – to assess hearing loss. MANAGEMENT: MANAGEMENT ANTIBIOTICS – cephalosporin ANTIPYRETICS - acetaminophen SURGICAL MANAGEMENT: SURGICAL MANAGEMENT MASTOIDECTOMY – It is the surgical removal of infected mastoid air cells. SIMPLE MASTOIDECTOMY - The incision is made behind the ear to remove the infected air cells by approaching through the ear. RADICAL MASTOIDECTOMY: RADICAL MASTOIDECTOMY A radical mastoidectomy removes the tympanic membrane and is indicated for extensive spread of a cholesteatoma. The eardrum and middle ear structures may be completely removed. Usually the stapes (the "stirrup" shaped bone) is spared if possible to help preserve some hearing. CORTICAL MASTOIDECTOMY: CORTICAL MASTOIDECTOMY Removal of mastoid air cells without disturbing the middle ear. 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: TYMPANOSTOMY A tube is inserted into the tympanic membrane to continue drainage of pus from the middle ear. NURSING MANAGEMENT: NURSING MANAGEMENT NURSING DIAGNOSIS: NURSING DIAGNOSIS Acute pain related to mastoid surgery. Risk for infection related to mastoidectomy& surgical trauma to surrounding tissues & structures. Disturbed auditory sensory perception related to ear disorder , surgery. Anxiety related to surgical procedure. Knowledge deficit related to mastoditis , surgical procedure & postoperative care. PREOPERATIVE CARE: PREOPERATIVE CARE Before surgery assess the hearing acuity. Provide comfortable position. Advise the patient to keep the ear dry & avoid inserting anything in ear canal. Administer antibiotics. Psychological support. Explain the procedure to the patient & family members . POST-OPERATIVE CARE: POST-OPERATIVE CARE Place the patient on bed rest for 24 hours. Provide comfortable position i.e. the patient lies with operated ear up. Elevate the head of bed to reduce swelling & pressure on operated ear. Instruct the patient to keep the ear dry for 4 – 6 weeks after surgery. Cont….d: Cont….d Apply dressing or place loose cotton in outer ear. Avoid heavy lifting , straining , exertion , do not blow nose for 2- 3 weeks after surgery to prevent dislodging tympanic membrane graft. Apply warm compression Administer antibiotics , analgesics & antihistamines. Assess hearing acuity by using whisper test , Rinne’s test & Weber test postoperatively.