MASTOIDITIS presentation notes simplified.pdf

ENT notes

1. MASTOIDITIS
BY
A.C MBULO

3. MASTOIDITIS
•Abacterialinfectionandinflammationoftheaircellsof
themastoidantrum.
•Usually,itoccursasacomplicationofchronicOtitis
media.
•Mastoiditiscanbeeitheracuteorchronic
•Mastoiditisgenerallyoccursinchildren.
•Anaccumulationofpusunderpressureinthemiddleear
cavityresultsinnecrosisofadjacenttissueandextension
oftheinfectionintothemastoidcells.

4. CAUSATIVE ORGANISMS
•Streptococcuspneumoniae
•GroupAbeta-hemolyticstreptococci
•Staphylococcusaureus
•Streptococcuspyogenes
•Moraxellacatarrhalis

5. •Haemophilusinfluenzae
•Pseudomonasaeruginosa
•Mycobacteriumspecies
•Aspergillusfumigatusandotherfungi
•Nocardiaasteroides

6. Pathophysiology
•Mastoiditisiscommonlycausedbybacterialinfection
whichcommonlyentersthecellsbyspreadingfromthe
tympanicmembraneandmastoidantrum.Followingthe
initialvascularengorgement,thereisrapidswellingof
themucosafromoedemaandfiltrationofpussycells
withtheproductionofmucopurulentexudates
degenerationofthecellsandvascularthrombosiswhich
bringsaboutactualdestructionofthemucosaby
ulcerationtheunderlyingbonethusdeprivedofitsblood
supplyandisopentothebacterialinfection.

7. •Inthewallpneumonitisedmastoidprocess,the
infectionspreadsrapidlyfromthecellstocellsand
theseptabecomethinandpusanddebrisfromwhich
mayleadtoformationofabscessesinthevarious
areasoftheskullbone.

8. SIGNSANDSYMPTOMS
•Athick,purulentdischargefromtheearthat
graduallybecomesmoreprofuse,possiblyleadingto
otitisexterna.
•Dullacheandtendernessintheareaofthemastoid
process.
•Rednessoftheearorbehindtheear
•Postauricularerythemaandoedema

9. •Swellingbehindear,maycauseeartostickout
•Fever,maybehighorsuddenlyincrease
•Otoscopymayshowswellingandobstructionofthe
externalearcanalcausedbypressurewithinthe
mastoidantrum.
•Hearinglossduetoobstructionoftheexternal
auditorycanal.

10. DIAGNOSTICTESTS
•X-Raysconfirmthediagnosis,therewillbeclouding
ofaircellsanddecalcificationofthebonywall
betweenthecells.
•Cultureandsensitivityofdrainagefromtheear
revealsthecausativeagent.
•Audiometrictestmaydemonstrateaconductive
hearingloss.

11. TREATMENT
MEDICALINTERVATION
•Antibiotictreatment(Broadspectrumantibiotics)
•Analgesicstoreducepain.
SURGICALINTERVATION maybeneededif
antibiotictherapyisnotsuccessful.
•Mastoidectomytoremovepartoftheboneanddrain
themastoid

12. COMPLICATIONS
•Hearing loss which can be partial or complete
•Facial paralysis
•Cranial nerve involvement
•Osteomyelitis
•Petrositis

13. •Labyrinthitis
•Intracranialextension-Meningitis,cerebralabscess,
epiduralabscess,subduralempyema
•Destructionofthemastoidbone
I.E.C
•Encouragepromptandcompletetreatmentofear
infectionstoreducetheriskofmastoiditis.

14. MASTOIDECTOMY
•Mastoidectomyisasurgicalproceduretoremovean
infectedportionofthebonebehindtheearwhen
medicaltreatmentisnoteffective
INDICATIONS
Mastoiditiswhenmedicaltreatmentisnoteffective
Cholesteatoma
approachtootherstructuresintheearsuchas
CochlearImplants
asanapproachtotumorsofthemiddleearoreven
deeperstructuressuchasnervetumors(acoustic
neuromas)orfacialnervetumors.

15. PREOPCARE
SPECIFIC
•Explaintopatientandfamilytheneedforsurgeryto
alleyanxiety.
•Informpatientthatanincisionwillbemadebehindthe
earortheoperationmaybedonethroughtheear.
•Incaseofanincision,informthepatientthatthewound
isthenstitcheduparoundadrainagetube,whichis
removedadayortwolatersoastoalleyanxietyand
gainpatientcooperationpostoperatively.

16. •Thedoctorwillgivethepatientathoroughear,nose,
andthroatexaminationaswellasadetailedhearing
testbeforesurgery.
•Anyinfectionoftheear,noseandthroatwillhaveto
betreatedbeforesurgerytopreventpostoperative
complications.

17. Obtainconsent
•Onthenightbeforesurgery,limitthepatienttoalight
diettohelppreventvomitingduringandaftersurgery.
•Patientwillthenbenilorallyfrommidnightunless
instructedbythepreopnursetoeatordrink.
•Shaveortrimthehairbehindtheearifitwillbeinor
closetothesurgicalsite.
•Patientsaregivenaninjectionbeforesurgerytomake
themdrowsy.
•NB:CONTINUEASGENERALPREOPCARE.

18. POSTOPERATIVECARE
•Informpatientthathearingwillbedecreaseddueto
packingintheearandsoifabletowriteandread,can
communicateusingapaperandpen.
•Checkdressingforbleeding
•Resumenormaldietonthedayaftersurgery.
•Giveprescribedmedicationsuchasanalgesicstorelieve
painandantibioticstocombatinfection
•NB;continueasgeneralpostopcare
•patientmaystayadayortwoafterwhicharedischarged.

19. PATIENTTEACHING
•Onearcare,informthepatientandfamilythat
Theyshouldleavethebandageonasdirectedby
thedoctor.
Ifthedressingcomesoff,pleasecall.Itmayneed
tobereplaced.
Nohairwashinguntilyourfirstvisitaftersurgery
(about1week).

20. •Informthepatientandfamilythatifadditional
bleedingisnotedonthedressingafteryouleavethe
hospital,donothesitatetocomebackorcallusat
thisnumber.Providethenumber.
•TellthepatientthatDizzinessand/orvomitingare
NOTnormal,socomebackorcallusiftheyoccur.

21. •Informthepatientthatdrainagefromtheearor
passingofsmallbitsofpackingMAYpersistforup
to6weeksaftersurgery.Sometimes,thedrainage
willappearbloodtinged.He/sheshouldnotworry
foritisanormalprocess.
•Tellpatienttocomebackifhe/shehasneckstiffness
ordisorientation.Thesemaybesignsofmeningitis

22. •Informparentsthatifthechildhasfevergreaterthan
39
oc
orincreasingpain,theyshouldcomebackorcall
us.
•Informthepatientandfamilythatdrainagefromthe
woundbehindtheearisabnormal.Comebackorcall
immediately
•Tellthepatientandfamilythathearingwillbedecreased
duetopackingintheearandsocanuseothernonverbal
waystocommunicate.

23. •Tellthepatienttotakemedicationasprescribedand
avoiddrugssuchasAspirinorBrufenasthey
contributetobleeding.
•Keepreviewdates
•NOphysicaleducationclasses,competitivesports,or
swimminguntilclearedbyyourdoctor.
•Noheavyliftingorstraining.
•Limitnoseblowing.

24. ASSIGNMENT
Readonthedifferenttypesofmastoidectomy
END