Mastoiditis

Subject: Medical and Surgical Nursing II (Theory)

Overview

It is an inflammation of the cells and mastoid antrum. Otitis media is the most typical consequence. Pneumococcus, hemophilic influenza, and beta-hemolytic streptococci staphylococci are the main causes of mastoiditis. Acute otitis media, hyperglycemia, low patient resistance, dehydration, and discomfort are mastoiditis risk factors. Clinical signs of mastoiditis include pain and swelling in the area around the mastoid, conductive hearing loss, a high fever, and headaches. Simple radical mastoidectomy and modified radical mastoidectomy are the surgical treatments for acute conditions.

Mastoiditis

An infection of the air cells in the mastoids is called mastoiditis. An infection of the middle ear causes (a tiny, air-filled cavity situated in the mastoids process, a protrusion in the skull behind the ear). It could be acute or ongoing.

Aetiology

  • Bacterial causes (streptococcus, staphylococcus, e-Coli, pneumococcus)

Predisposing factor

  • Repeated attacks of acute otitis media
  • Inadequate drainage of pus and fluids
  • Immune suppression

Pathology

  • Pus production when under stress
  • Acute suppurative otitis media with hyperaemic decalcification and osteoclastic resorption of the bone wall
  • Pus production increased as the inflammation spread to the mucoperiosteal lining of the air cell system.
  • Complete pus discharge through a tiny tympanic membrane perforation
  • Hyperemia and mucosal engorgement
  • Mastoids' air cells' bony walls dissolve in calcium
  • Mastoid air cells combine and disintegrate.
  • Transformation into a single, pus-filled, uneven cavity

Clinical features

Symptoms

  • Ear discharge
  • Hearing loss
  • Perforation
  • Pain behind the ear
  • Fever

Signs

  • Mastoids tenderness
  • Ear discharge
  • Sagging of posterior superior metal wall
  • Perforation of tympanic membrane
  • Swelling over the mastoids
  • Deafness

Diagnosis

  • History taking
  • Otoscopic examination
  • X-ray of mastoids

Investigation

  • Blood counts
  • ESR
  • X-Ray mastoid
  • Ear swab for culture and sensitivity

Treatment

Medical treatment

  • Administer antibiotic orally eg. Penicillin, erythromycin
  • Analgesic to relief pain
  • Cleaning of ear cavity and instillation of ear drop

Surgical treatment

  • Acute mastoiditis
  • Myringotomy- to drain the fluid from the middle ear
  • Simple mastoidectomy- to remove the infected bone behind the ear
  • Antibiotic must be given adequately
  • Chronic mastoiditis
  • Modified radical mastoidectomy

Nursing Consideration

Pre-op care

  • Keep external ear clean and dry
  • Skin preparation around mastoids area. The scalp is saved 2 cm around the affected ear post auricle and cleaned thoroughly
  • General pre-operative care.
  • Consent
  • Maintain personal hygiene
  • Psychological support to reduce patient fear
  • Routine investigation
  • The patient is examined by an anesthetist to make sure the patient is fit for the operation

Post-operative care

  • Head of bed is elevated at least 30 degree
  • To lie with operative ear up after surgery
  • Monitor vital sign and observe for the signs of bleeding should be reported immediately to the doctor
  • Blow nose gently one side at a time for 1 week after surgery
  • Sneeze and cough with the mouth open for a few weeks after the surgery
  • Avoid heavy lifting, straining, and bending
  • Popping and crackling sensation are normal in the ear after 3 to 5 wks after the corrective surgery
  • Temporary hearing loss and some discharge from the ear is common after surgery
  • Report excessive or purulent discharge from the ear however
  • Change the cotton ball in the ear as directed
  • Avoid water in the ear up to 2 wks after the surgery

Complication

  • Hearing loss
  • Blood cloth
  • Meningitis
  • Brain abscess
  • Wound infection
  • Mastoids infection
  • Mastoids abscess
  • Facial nerve injury

 

 

 
Things to remember
  • It is an inflammation of the mastoid antrum and cells. It is most common complication otitis-media.
  • The major causes of mastoiditis are Pneumococcus, Hemophilic influenza, and Beta-hemolytic streptococci staphylococci.
  • Predisposing factors of mastoiditis are acute otitis media, low resistance of the patient – diabetes mastoidectomy, dehydration, and tenderness.
  • Pain in the mastoid region and swelling, conductive hearing loss, severe fever, and headache are clinical features of mastoiditis.
  • Surgical management for acute is simple mastoidectomy and chronic- modified radical mastoidectomy.
Questions and Answers

It is a mastoid antrum and cell inflammation. Otitis media is the most common complication.

Causes

  • Pneumococcus
  • Hemophilic influenza
  • Beta-hemolytic streptococci staphylococci

Predisposing factors

  • Acute otitis media
  • Inadequate drainage
  • Low resistance of the patient – diabetes, dehydration, and tenderness
  • Pain in the mastoid region and swelling
  • Otorrhoea- creamy yellow in color
  • Conductive hearing loss
  • Severe fever and headache

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