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MASTOIDITIS -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. - It is an inflammation of the mucosal lining of the mastoid antrum and mastoid air cells(that help drain the middle ear) inside the mastoid process, which is a portion of the temporal bone of the skull that is behind the ear. -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 -Chronic mastoiditis, which is often subclinical and secondary to partial treatment with antibiotics 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)

(3) anteriorly. resulting in acute mastoiditis. with the potential for abscess development and bone destruction. Progression results in the destruction of the mastoid bone and the air cells. The aditus ad antrum is a narrow connection between the middle ear and mastoid air cells. a closed space is formed. (2) lateral to the surface of the mastoid process. (4) medial to the petrous air cells of the temporal bone. resulting in an abscess (often called a Bezold abscess). The infection may spread from the mastoid air cells by venous channels. The resulting pus may track through many routes: (1) through the aditus ad antrum with resultant spontaneous resolution.) 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. and (5) posterior to the occipital bone. peaking between 6 and 13 months of age. resulting in a subperiosteal abscess. There may be extensive invasion of granulation tissue from the middle ear into the mastoid air cells. resulting in osteomyelitis of the calvaria or a Citelli abscess Chronic mastoiditis is generally a complication of chronic OM. forming an abscess below the pinna or behind the sternocleidomastoid muscle of the neck. Clinical Manifestation Fever . 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. resulting in inflammation of the overlying periosteum. Most common between 2 months and 18 years of age.Cholesteatoma(a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. resulting in a rare condition known as petrositis. If this connection becomes blocked.

Bone cysts or tumours. and lethargy Swelling of the ear lobe Otorrhea (Drainage from the ear) Bulging and drooping of the ear (in acute mastoiditis) Diagnosis Medical History(previous ear infection) Physical Examination(with the auroscope) Ear culture (removal of fluid or other substances from the ear to check for infection) Blood tests(FBC may show leukocytosis. Mastoiditis is treated with oral antibiotics. and regular ear cleanings by a .Anorexia Vertigo Headache and ear pain Redness and Tenderness behind the ear (over the mastoid) Fever. Meningitis. Lumber Punture may also be done in serious cases to rule out Meningitis as a result of Mastoiditis.ESR may be elevated) If severe infection is suspected. Differential diagnosis Otitis media or externa. Medical Treatment. Parotid gland swelling. irritability. eardrops. Trauma to the ear/mastoid. Cervical lymph node enlargement. Basal skull fracture. Cellulitis. CT scan and MRI maybe done.

given for at least 1-2 days (eg Ceftriaxone [Rocephin]. explaining possible out come.. Personal Hygiene. Patients with serious mastoiditis should be managed in a hospital setting. ibuprofen and other agents may be given as antipyretics and/or painkillers.abscess formation or limited improvement after IV antibiotics. Ensure Adequate rest and sleep checking of vitals to monitor level of fever serve medications (antibiotics.encourage proper personal hygiene. explaing causes. Surgical intervention. -Radical: the tympanic membrane. feed frequently in bits. antipyretics. -Modified: the ossicles and part of the tympanic membrane is preserved. Mastoidectomy can be -Simple: infected mastoid air cells are removed. The usual initial therapy is high-dose. Appropriate clinical suspicion and prompt diagnosis are important to reduce the likelihood of complications.explaining treatment regimen. liquid diet if patient has difficulty in swallowing solid diet. freqeunt ear cleaning.High nutritious diet. is suggested if there is severe mastoiditis.Cefuroxime [Zinnat]) Oral antibiotics(eg Amoxi-Clav) are usually used afterwards Paracetamol. give patient chance to express fears etc Nutrition.reassurance. Nursing Management Psychlogical. painkillers) and observe for adverse .specialist. or to collect middle ear fluid for culture. broad-spectrum intravenous (IV) antibiotics. the ossicles and most middle ear structures are removed. 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). Surgical Treatment Myringotomy(ear tube insertion thro the ear drums) may be performed in some cases as a therapeutic procedure. Intracranial extension .

Bezold abscess ( abscess the sternocleidomastoid muscle of the neck) .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 facialnerve palsy -Dizziness or vertigo .