Mastoiditis

 Mastoiditis

Mastoiditis is inflammation of mastoid process.

Mastoid process is posterior process of temporal bone of skull behind the ear contains open, air-containing spaces.

Mastoiditis usually caused by middle ear infection (otitis media). This infection spread from ear to mastoid bone of skull. 

Mastoid bone are honeycomb-like structure and fill with infected material.

Type of Mastoiditis

1. Acute mastoiditis/ Classic mastoiditis 

2. Chronic mastoiditis

Commonly associated with chronic suppurative otitis media or with cholesteatoma formation.

Etiology

1. Middle ear infection (otitis media)

2. Bacterial infection;

Streptococcus pneumonia, Haemophilus influenzae, Moraxella catarrhalis.

3. Cholesteatoma (sac of keratinizing squamous epithelium in middle ear), result from repeated middle ear infection.

Pathophysiology

Bacteria spread from middle ear to mastoid air cells.

Inflammatory process cause damage to bony structures, these air cells  lined with respiratory epithelium.

Infection spread, inflamed mucosa prevent drainage of fluid from middle ear cavity.

Abscess formation within surrounding structure.

Clinical Manifestations

1. Pain behind ear

2. Mastoid tenderness

3. Swelling in mastoid region

4. Otalgia

5. Mastoid region become red (erythematous)

6. Fever, headache, vomiting

7. Vertigo

8. Loss of hearing

9. Purulent drainage from ear

10. Ear turned forward

Diagnostic Evaluation

1. Blood culture

2. Tympanocentesis;  Culture of drainage from ear.

3. CT scan; reveals fluid collection in middle ear, mastoid region, abscess formation, demineralization of mastoid bone.

4. MRI Scan; used for detailed evaluation 

5. Audiography; assess for hearing loss

Management

1. Antibiotics

2. Antipyretic; acetaminophen 

Surgical Management 

1. Mastoidectomy

Surgical removal of infected mastoid air cells.

2. Myringotomy

Small incision made in tympanic membrane to drain fluid from middle ear in chronic and recurrent otitis media.

3. Tympanostomy

Surgical procedure to insert ear tubes, allow for continued drainage.

Used for administered therapeutic otic drop reach middle ear.

Ear tube drain the pus from middle ear.

Nursing Diagnosis

1. Acute pain related to mastoid process inflammation 

2. Risk of infection related to pus formation in middle ear/infection in mastoid bone cells

3. Disturbed auditory sensory perception related to ear disorder, surgery or packing.

4. Anxiety related to surgical procedure

5. Risk for trauma related to vertigo