SEMINAR

ON
MASTOIDITIS
 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 contains open air containing
spaces. It is an complication of otitis media
when the treatment is ineffective and pus
remains in the mastoid cells. The bacterial
infection of the mastoid process may
develop.”
 DEFINITION
‘’ According to Medical Dictionary ‘’
Mastoiditis is an infection of the spaces
within the mostoid bone. It is almost always
associated with otitis media, an infection of
the middle ear. In most serious cases the bone
itself become infected or inflammed.
‘’ According to Bailleres Nurses Dictionary”
Mastoiditis is the inflammation of the
mastoid antrum and cells.
“ According to Darla burke”
If an infection develops in middle ear &
blocks the eustachian tube, it may
subsequently lead to an infection in the
mastoid bone. This serious infection is known
as mastoid bone infection of the skull or
mastoiditis.
ANATOMY
 Etiology
1. Otitis media
2. Bacteria :-
• Streptococcus pneumoniae
• Pseudomonas aeruginosa
• Hemophilus influenzae
• Mycobacterium species
• Morexalla catarrhalis
3. Cholesteatoma
CHOLESTEATOMA
 MEDICAL MANAGEMENT

1 Antibiotic
2 Antipyretics
3 Analgesics

SURGICAL MANAGEMENT
1. Mastoidectomy :- It is surgical removal of
infected mastoid air cells.
a. Simple mastoidectomy:-
Surgeon makes an incision behind the ear
to acess the mastoid region or remove the
infected mastoid air cells.
b. Radical & modified radical mastoidectomy
 C. Cortical mastoidectomy

It involve the removal of all accessible mastoid air

cells without disturbing the middle ear.
2.Myringotomy:-
3. Tympanostomy:-
 NURSING MANAGEMENT
Nursing Assessment :-

1 History of onset & progression of

symptoms.
2 Extent of hearing loss via audiometery.
3 Obtain history of pain.
4 Obtain history of any other infection in ear.
5 Determine the presence of pain with
swallowing.
6 Assess vital signs of patient.
Nursing Diagnosis :-

1 Acute pain related to inflammation process.

2 Alteration in thermoregulation related to
infection.
3 Altered nutrition less than body requirement
related to nausea, vomiting.
4 Risk for trauma related to vertigo.
5 Risk for infection related to mastoidectomy .
6 Impaired verbal communication related to
hearing deficit.
7 Deficit knowledge related to mastoiditis
surgical procedures.
 Nursing Intervention:-
1 Goal:- To relieve pain
1 Assess & document the location, intensity &
frequency of pain.
2 Observe the ear canal for inflammation &
swelling & the tympanic membrane for redness,
bulging & bubbles.
3 Encourage the patient to sit up raises head on
pillows or lie on unaffected ear.
4 Applying hearing pad or warm hot water bottle. Heat
increase blood supply & reduces discomfort.
5 Give analgesic such as acetaminophen. Use analgesic
eardrops. Analgesic alter perception or response to pain.
4 Applying hearing pad or warm hot water
bottle. Heat increase blood supply & reduces
discomfort.
5 Give analgesic such as acetaminophen. Use
analgesic eardrops. Analgesic alter
perception or response to pain.

2 Goal:- To reduce Body Temperature

1 To assess the patient general condition.
2 To provide comfortable position.
3 To check the vital signs.
4 To give sponge bath.
5 To provide cold drinks.
6 To give Antipyretic as per physician.
3 Goal:- To maintain nutritional level.

1 To assess the patient condition.

2 To check the patient nutritional status.
3 To assess intake & output as indicated.
4 Encourage fluids & small feeding while patient
feeling batter.
5 Diets can include fresh meats, vegetables, &
fruits.
6 Patient are advised to avoid caffeine, alcohol &
tobacco.
7 To administer intravenous fluid as order by
physician.
8 Plan to administer antiemetics.

4 Goal:- To preventing injury

1 Assess the patient for any pattern of dizziness
or vertigo.
2 Encourage rest during severe episodes &
gradually increase activity.
3 Encourage the patient to lie down during
attack in safe place. Put side rails up on bed if
the patient in hospital.
4 Avoiding hazardous activity such as driving,
operating heavy machinery, climbing, &
similar activities until 1week after symptoms
disapear.
5 Avoid sudden movement that may aggravate
symptoms. Avoid bright light, TV, & reading
during attacks, which may make symptoms
worse.
5 Goal:- To prevent infection.
1 Obtain the patients otologic history, such as
previous ear infections exposure to water,
allergies and use of earphones or hearing
aids.
2 Perform an otoscopic Examination. Check for
drainage or debris in the ear canal. Note the
colour & appearance of the tympanic
membrane & check for fluid in the middle
ear.
3 Administer antibiotic, antipyretics, & anti-
inflammatory drugs are ordered to prevent
infection & reduce inflammation. Examine
ear for 3-4 days after the completion of
antibiotic treatment.
4 Eliminate allergens & upper respiratory
irritants & allergens may decrease
susceptibility to respiratory infections.
5 Encourage optimal nutrition, rest & exercice.
Physical well-being helps the body fight
disease.
6 Teach family members to cover mouth &
noses when sneezing or coughing & to wash
hands frequently. Good hygiene prevents
spread of pathogens.
6 Goal:- Improving hearing &
communication.
1 Assess change in hearing activity, assess the
audiogram or tympanogram for hearing
impairement.
2 Face patient in good light & keeps hands
away from mouth. This enhances patient’s
use of lip- facial expressions, & gesturing.
3 Avoid shouting or yelling. This prevents
humiliation. Use simple language & short
sentances speak slowly.
4 Use an adequate alternative method of
communication. Use grease boards,
computers or other writing tools. These help
communicate with profoundly hearing –
impaired individuals.
5 Prepare patient for ear surgery.
Tympanoplasty & mastoidectomy are
common surgical treatments for hearing loss.
7 Goal:- To provide knowledge about
disease & surgical procedure.
1 Assess the patient knowledge level about
disease.
2 Encourage the patient to ask quesion about
mastoiditis.
3 Give knowledge about mastoiditis.
4 Give knowledge about sign & symptoms of
mastoiditis.
3 Encourage activity during vertigo is minimal &
rest during acute attack.
4 Explain methods to minimize symptoms during
acute episodes such as decreasing movement.
5 Explain medication regimen to help control
symtptoms.
6 Teach stress reduction techniques such as deep
breathing, talking & asking question &
distraction.
7 Teach safety measures during vertigo
attacks.
 PRE-OPERATIVE CARE
1 Before surgery, an audiogram and
tympanogram are obtain to assess
preoperative hearing activity.
2 Provide comfortable position with affected
ear down.
3 Advice patient to keep ear dry & avoid
inserting anything in the ear canal.
4 Advice patient to avoid sudden movement.
5 Instruct the patient not to blow nose which
could cause nasopharyngeal secretions to be
forced up eustachian tube into middle ear.
6 Administer local or systemic antibiotics,
analgesic & steroid nasal drops to treat
infection and reduce inflammation.
7 Provide psychological support & prepare the
patient emotionally for surgery.
8 Teach the patient & family members about
surgery & post operative care.
 POST OPERATIVE CARE
1 Place the patient on bed rest for first 24
hours. Provides comfortable position, the
patient lies with operative ear up.
2 Assess the patient on ambulation because
dizziness & vertigo May occur for first several
days after surgery.
3 Encourage the patient to move slowly
because sudden movements may exacerbate
vertigo.
4 Elevate the head of the be to reduce swelling &
pressure on operated ear.
5 Instruct the patient to protect ear, perform
dressing change or place loose cotton in outer
ear.
6 Instruct the patient to avoid sudden pressure
changes in the ear, heavy lifting, straining, &
exertion, do not blow nose, cough or sneeze
with mouth open for 2-3 weeks after surgery to
prevent dislodging the tympanic membrane
graft or ossicular prosthesis.
7 Non –pharmacologic measures such as
application of heat by warm compress &
relaxation technique may help to reduce post
operative ear pain.
8 Administer medication, antibiotics, analgesics,
anti-emetics & anti-histamines as prescribed by
doctors.
9 Assess hearing acuity by using the whisper voice
test, Rinne’s test & weber test post-operatively.
THANK
YOU