INTRODUCTION

Mastoiditis is an inflammation of the mastoid resulting from an infection of the middle ear (otitis
media). Since the discovery of antibiotics, acute mastoiditis has been rare. Chronic otitis media
may cause chronic mastoiditis. Chronic mastoiditis can lead to the formation of cholesteatoma
(ingrowth of the skin of the external layer of the eardrum into the middle ear). If mastoiditis is
untreated, osteomyelitis may occur.

It is an inflammation of the mastoid. Although it’s called a bone, it does not have the typical
structure associated with other bones in the body.

The most common cause is a middle ear infection that has been left untreated.

INCIDENCE

Although the condition is most common in children, it can also occur in adults.

PATHOPHYSIOLOGY

Bacteria spread from the middle ear to the mastoid air cells, where the inflammation causes
damage.

Clinical Manifestations

• Pain and tenderness behind the ear (postauricular)

• Discharge from the middle ear (otorrhea)

• Mastoid area that becomes erythematous and edematous

Medical Management

General symptoms are usually successfully treated with antibiotics; occasionally, myringotomy
is required.
Surgical Management

If recurrent or persistent tenderness, fever, headache, and discharge from the ear are evident,
mastoidectomy may be necessary to remove the cholesteatoma and gain access to diseased
structures. mastoidectomy is a surgery that removes diseased mastoid air cells. These air cells
form in the hollow spaces within your mastoid — a sponge-like, honeycomb-shaped bone that
sits just behind your ear.

DIAGNOSTIC MEASURES

The diagnosis of mastoiditis is clinical—based on the medical history  and physicalexamination.

Imaging studies provide additional information; The standard method of diagnosis is via MRI
scan although a CT scan is a common alternative as it gives a clearer and more useful image to
see how close the damage may have gotten to the brain and facial nerves. Planar (2-D) X-rays
are not as useful. If there is drainage, it is often sent for culture, although this will often be
negative if the patient has begun taking antibiotics. Exploratory surgery  is often used as a last
resort method of diagnosis to see the mastoid and surrounding areas

Nursing Management
Assess  pain for location, intensity etc. • Administer analgesics as prescribed to relieve
pain. • Administer medications as ordered. • Provide plenty of fluids. • Encourage patient
and family to use signs of non verbal communication such facial expression, pointing,
body movement in case of hearing difficulties.

Nursing Diagnosis
Pain relate to inflammatory process. • Impaired auditory sensory perception related to
perforation of tympanic membrane. • Impaired verbal communication related to hearing
deficit.

Post operative care

Place  the patient on bed rest for 24 hours. • Provide comfortable position i.e. the patient
lies with operated ear up. • Elevate the head of bed to reduce swelling & pressure on
operated ear. • Instruct the patient to keep the ear dry for 4 – 6 weeks after surgery. •
Avoid heavy lifting , straining , exertion , do not blow nose for 2- 3 weeks after surgery
to prevent dislodging tympanic membrane graft. • Administer antibiotics , analgesics &
antihistamines. • Assess hearing acuity by using whisper test , Rinne’s test & Weber test
postoperatively.