an infection that affect the mastoid bone, located behind the ear. this sideshare contained detailed information about the definition,causes and risk factor, pathophiology, management both medical and nursing management

1. Mastoiditis

2. • SUBMITTED TO:
Mamta Toppo
Associate professor
RIMSCON Ranchi
• SUBMITTED BY:
Rashmi Toppo
3rd year Basic BSc. Nursing
RIMSCON Ranchi

3. content
• Mastoid process
• Introduction
• Definition
• Causes and risk factors
• Pathophysiology
• Clinical manifestations
• Diagnostic evaluations
• Medical management
• Surgical management
• Nursing management
• Preoperative care
• Postoperative care
• Complications
• Research
• summary
• Evaluations
• Reference
• Bibliography

4. Mastoid process
• The mastoid process is a pyramidal bony projection from the
posterior section of the temporal bone.
• The superior border of the mastoid portion of the temporal bone
articulates with the parietal bone.
• It is easily palpable just behind the ear.
• It contains air filled spaces called mastoid air cells.
• Many vital structures pass through the mastoid , so infection may
spread outside the mastoid bone and cause serious health
complications

5. Fig: mastoid part of the temporal bone

6. Fig: right medial wall of the middle ear

7. introduction
• Mastoiditis is any inflammatory process of the mastoid cellular
system or posterior process of the temporal bone of the skull that
is behind the ear which contain open, air containing spaces.
• Acute mastoiditis is also known as classic mastoiditis,is a rare
complication of acute otitis media(AOM)
• It is the bacterial infection of the mastoid air cells surrounding the
inner and middle ear.

8. Fig: mastoiditis

9. DEFINITION
• Mastoiditis is define as the inflammation of the mastoid, which
often occur secondarily to ear infection.

10. CAUSES AND RISK FACTORS
• Middle ear infection (otitis media)
• Bacterial infection- streptococcus pneumoniae, Haemophilus
influenzae, moraxella catarrhalis, rarely myobacterium species
• Cholesteatoma: it is the in growth of skin of the external layer of the
eardrum into the middle ear
• Weak immune
• Allergy
• Upper respiratory tract infection
• Recent surgery

11. Fig: cholesteatoma

12. Fig: cholesteatoma

13. pathiphysiology
– Due to infection of middle ear
– Acute otitis media
– Infection reaches at mastoid air cells
– Which damages bony structure of this bony
– Inflammations of the mastoid process

14. Clinical manifestation
• Fever , irritability , and lethargy
• Swelling of ear lobe
• Redness and tenderness behind the ear (erythematous)
• drainage from the ear (profuse, purulent or creamy in serious
cases)
• bulging and drooping of the ear
• Otalgia
• Hearing loss

15. Fig: mastoiditis

16. Diagnostic evaluation
• Medical history
• Physical examination
• Laboratory test: CBC,blood culture, tympanocentesis
• Plain radiography
• CT scan
• MRI
• Audiography to asssses for hearing loss

17. Medical management
• Goal of pharmacotherapy is to eradicate infection, reduce morbidity, and
prevent cmplications.
ANTIBIOTICS: penicillin , clindamycin
ANTIPYRETICS: acetaminophen
ANTIHISTAMINES
ANALGESICS
ANTI-INFLAMMATORY: Ibuprofen
Bedrest
Plenty of oral fluids

18. SURGICAL MANAGEMENT
MASTOIDECTOMY :
Mastoidectomy is surgical removal of infected mastoid air cells.
Through this surgeon remove the infected bone and growth from the
middle ear.
TYPES:
• Radical mastidectomy : it is the removal of tympanic membrane ,
most middle ear structures , and closing the eustachian tube
opening

19. Fig: cholesteatomy infecting mastoid bone
• Modified radical mastoidectomy: it preserve the ossicles and
tympanic membrane remnants.
• Cortical mastoidectomy: it involves the removal of all the
accessible mastoid air cells without disturbing the middle ear

20. Fig: mastoidectomy

21. Fig: myringotomy
MYRINGOTOMY:
It is a small incision of the tympanum to express fluid from the
middle ear in chronic or recurrent otitis media

22. TYMPANOSTOMY:
it is the tube insertion is done to allow for continued drainage and t
administer therapeutic otic drops reach the middle ear
These serve to drain the pus from the middle ear, helping to treat
infection

23. Fig: tympanostomy

24. Fig: tympanoplsty
• TYMPANOPLASTY:
It is the surgical operation performed for the reconstruction of the
eardrum ( tympanic membrane) and / or the small bones of the
middle ear(ossicles).

25. Nursing management
• Nursing diagnosis :
• anxiety related to surgical procedure , potential loss of hearing,
potential taste disturbance ,and potential loss of facial movement
• Acute pain related to mastoid surgery
• Risk for infection related to mastoidectomy,placement of grafts,
protheses, electrodes
• Disturbed auditory sensory perception related to ear disorder

26. • risk of trauma related to vertigo during the immediate
postoperative period
• Disturbed sensory peception related to potential damage to the
facial nerve
• Impaired skin intigerity related to surgery
• Knowledge deficit related to mastoiditis

27. Preoperative care
• An audiogram and tympanogram are obtain to assess preoperative
hearing acquity
• Provide comfortable position with affected ear down
• Advise the patient to keep ear dry avoid inserting anything In the ear
canal
• Advise patient to avoid sudden movement
• Administer local or systemic antibiotics, analgesics , and steroid
nasal drop to treat infection and educe inflammation

28. • Provide psychological support and prepare the patient
emotionally for surgery
• Teach the patient and family members about surgery and
postoperative care

29. Postoperative care
• Place the patient on bed rest for first 24hours.
• Provide comfortable position ,the patient lie with operated ear up
• Assist the patient on ambulation because dizziness and vertigo may
occur for first several days after surgery
• Encourage the patient to move slowly because sudden movement
may exacerbate vertigo
• Elevate the head of the bed to reduce swelling and pressure on
operated ear

30. • Instruct the patient to keep ear dry for 4-6 weeks after surgery
• Advise the patient to protect the ear, perform dressing changes or
place loose cotton in outer ear
• Instruct the patient to avoid sudden pressure changes in the
ear,heavy lifting,straining and exertion
• Do not blow nose, cough or sneeze with mouth open for 2 to 3
weeks after surgery to prevent dislodging the tympanic
membrane graft or ossicular prosthesis

31. • Warm compress and relaxation technique to reduce pain
• Administer medication; antibiotics ,analgesics, antiemitics and
antihistamines as precribed by physician
• Assess hearing acuity by using the whisper voice test, Rinne’s
testand Weber test postoperatively

32. COMPLICATIONs
• Subperiosteal abscess
• Labyrinthitis
• Facial palsy
• Extradural abscess
• Subdural abscess
• Meningitis
• Brain abscess
• Otitic hydrocephalus

33. RESEARCH
• Mastoiditis in adults: a 19-year retrospective study
• S. Palma R. Bovo A. Benatti - C. Almani AL. Raslgnoll - M. Libanore A. Martin
• Abstract :The objective of our study was to review ret. respectively the
clinical radiological and therapeutic findings in 62 adults with acute
mastoiditis treated at the ENT Department of Ferrara from 1992 to 2010. 62
adult cases fulfilled the following inclusion criteria: otoscopic evidence of
co-existent or recent otitis media: postauricular swelling, erythema or
tenderness: protrusion of the auricle; fever and/or significant radiological
findings of mastoiditis. Conservative treatment comprehended antibiotic +
venti latina tube. Surgical procedures comprehended mastoid ectomy or
mastoido-tympanoplasty. The incidence of adult mastoiditis in our district
(0.99 cases/year/100.000 inhabitants) has maintained quite stable during
the con sidered 19-year period. The typical clinical presentation was
observed in 48 % of cases.

34. • Complications were men meningitis (15 cases), meningo-encephalitis
(1), meningitis associated with lateral sinus thrombosis (1), facial nerve
paralysis (11), and labyrinthitis (8). In all cases except one, the facial
palsy recovered completely and no mortality was observed due to
these complications. Complete cure was obtained with conservative
treatment in 69 % of income plicated cases and in 24% of patients with
intracranial complications. Mastoiditis in adults may present as the
acute classical form, as well as latent forms which often have
prolonged and insidious development followed by a rapid clinical
deterioration. Clinical features are frequently atypical, while incidence
of meningitis and other complications is still high particularly in the
most elderly. Thus, great care is required for clinicians to make an early
diagnosis in order to promote adequate treatment.

35. SUMMARY
• Mastoiditis is a bacterial infection of the mastoid air cells
surrounding the inner and middle ear.
• It is generally a secondary infection, cause due to unresolved
middle ear infection (otitis media)
• Signs and symptoms: Pain behind the ear, mastoid tenderness,
protrusion of pinna as the result of swelling of mastoid region.
• Medically it is treated with antibiotic, antipyretics,
antiinflammatory, analgesics
• Surgical treatments are mastoidectomy, myringotomy,
tympanostomy

36. evaluations
• What is mastoiditis?
• What are its causes and risk factors?
• What is the pathophysiology of mastoiditis?
• Signs and symptoms of mastoiditis?
• Its diagnostic evaluation.
• What are the finding of radiography?
• When should audiography be performed?
• Medical management of mastoiditis.
• Surgical management of mastoiditis.

37. REFERENCE
• Books
• Internet
• Teacher

38. BIBLIOGRAGHY
•Ansari javed , a text book of medical surgical nursing –II publication page
no- 36-40
•Brunner and suddarth s text book of medical surgical nursing voll- south
Asian edition, Wolters Kluwer, page no-
•www.Wikipedia.com
•www.kenhub.com

39. ThaNk y0u