GROUP 11

MASTOIDITIS

DIFINITION

• Inflammation of the mastoid process or the mastoid bone(located just behind the ear)which is a portion of the temporal bone.

• Infection of the membranes of the mastoid air cells with formation of pus within the cavities and inflammation of the surrounding tissues and bone.

• Mastoiditis is an infection of the mastoid bone. The mastoid bone sits behind the ear and consists of air spaces that help drain the middle ear.

CLASSIFICATIONS

• Acute mastoiditis, which follows otitis media with rapid onset

• Chronic mastoiditis, which is often subclinical and secondary to partial treatment with antibiotics or as a result of chronic otitis media.

ETIOLOGY

• Mastoiditis is usually a result of an extension of infection of the ear usually the middle ear (otitis media) into the mastoid process.

COMMON CAUSES

• Streptococcus pneumoniae• Haemophilus influenzae• Moraxella catarrhalis• Staphylococcus aureus• Streptococcus pyogenes• Gram-negative organisms such as

Escherichia coli and Pseudomonas are more common in chronic mastoiditis.

RARE CAUSES

• Mycobacterium spp.

CONTRIBUTORY OR PREDISPOSING FACTORS

• Recent or recurrent otitis media(Infection of the middle ear)

• Cholesteatoma(a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process.)

• Immunosuppressive Patients• Leukemia(cancer of the blood or bone marrow)• Sarcoma of the temporal bone• Kawasaki's disease( is an autoimmune disease

in which the medium-sized blood vessels throughout the body become inflamed)

INCIDENCE

• Age;

Most common between 2 months and 18 years of age, peaking between 6 and 13 months of age.

• Gender

Occurs equally in both males and females.

PATHOPHYSIOLOGY

• Acute mastoiditis is a natural extension of middle ear infections because the mastoid air cells are generally inflamed during an episode of AOM(Acute Otitis Media). The aditus ad antrum is a narrow connection between the middle ear and mastid air cell. If this connection become blocked, a close space is formed, with the potential for abscess development and bone destruction. The infection may spread from the mastoid air cell by venous channels,

PATHOPHYSIOLOGY CON'T

• resulting in inflammation of the overlying periosteum. Progression results in the destruction of the mastoid bone and air cells resulting in acute mastoiditis. The resulting pus may tract through many routes; (1) through the aditus ad antrum with resultant spontaneous resolution; (2) lateral to the surface of the mastoid bone resulting in subperiosteal abscess; (3) anteriorly forming an abscess below the pinna or behind the sternocleidomastoid

PATHOPHYSIOLOGY CON'T

• muscle of the neck resulting in an abscess often called Bezold abscess; (4) medial to the petrous air cells of the temporal bone resulting in a rare condition known as petrositis and (5) posterior to the occipital bone, resulting in osteomylitis of the calvaria.

• Chronic mastoiditis is generally a complication of chronic OM where there is extensive invasion of granulation tissue from the middle ear into the mastoid air cells or secondary to partial treament.

CLINICAL MANIFESTATION

• Fever• Anorexia• Vertigo• Headache and ear pain• Redness and Tenderness behind the ear (over

the mastoid)• Fever, irritability, and lethargy• Swelling of the ear lobe• Otorrhea (Drainage from the ear)• Bulging and drooping of the ear (in acute

mastoiditis)

DIAGNOSIS

• History(previous ear infection)• Physical Examination(with an auroscope)• Ear culture (removal of fluid or other substances

from the ear to check for infection)• Blood tests(FBC may show leukocytosis,ESR

may be elevated)• If severe infection is suspected, CT scan and

MRI maybe done. • Lumber Punture may also be done in serious

cases to rule out Meningitis as a result of Mastoiditis.

DIFFERENTIAL DIAGNOSIS

• Otitis media or externa.

• Trauma to the ear/mastoid.

• Cervical lymph node enlargement.

• Meningitis.

• Cellulitis.

• Parotid gland swelling.

• Bone cysts or tumours.

• Basal skull fracture.

MEDICAL TREATMENT

• Mastoiditis is treated with oral antibiotics, eardrops, and regular ear cleanings by a specialist.

• Patients with serious mastoiditis should be managed in a hospital setting.

• Appropriate clinical suspicion and prompt diagnosis are important to reduce the likelihood of complications.

• The usual initial therapy for severe cases is high-dose, broad-spectrum intravenous (IV) antibiotics, given for at least 1-2 days (eg Ceftriaxone [Rocephin],Cefuroxime [Zinnat])

• Oral antibiotics(eg Amoxi-Clav) are usually used afterwards

• Paracetamol, Ibuprofen and other agents may be given as antipyretics and/or painkillers

SURGICAL TREATMENT

• Myringotomy(ear tube insertion thro the ear drums) may be performed in some cases as a therapeutic procedure, or to collect middle ear fluid for culture.

• Surgical intervention, usually in the form of mastoidectomy ± tympanoplasty(surgical repair of the ear drum or tympanic membrane and/or the small bones of the middle ear (ossicles)., is suggested if there is severe mastoiditis, Intracranial extension ,abscess formation or limited improvement after IV antibiotics

SURGICAL TREATMENT CON'T

• Mastoidectomy can be

• -Simple: only infected mastoid air cells are removed.

• -Radical: the tympanic membrane, the ossicles and most middle ear structures are removed.

• -Modified: the ossicles and part of the tympanic membrane is preserved.

NURSING MANAGEMENT

• Psychlogical- reassurance, explaing causes,explaining treatment regimen, explaining possible out come, give patient chance to express fears.

• Nutrition- High nutritious diet, liquid diet if patient has difficulty in swallowing solid diet, feed frequently in bits.

• Personal Hygiene- encourage proper personal hygiene, freqeunt ear cleaning.

• Ensure Adequate rest and sleep• Checking of vitals to monitor level of fever• Serve medications (antibiotics, antipyretics, painkillers)

and observe for adverse reactions• Check drainage tubes for bleeding and patency post

surgery if any

COMPLICATIONS

• If left untreated can result in serious life threatening complications such as

• -Meningitis• -Hearing Loss• -Brain Abcess• -The infection may also spread to the facial

nerve (cranial nerve VII), causing facial-nerve palsy

• -Dizziness or vertigo• - Bezold abscess ( abscess the

sternocleidomastoid muscle of the neck)

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