MASTOIDITIS

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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.