ENT: Mastoiditis



Definition: Inflammation of the mucosal lining of mastoid antrum and mastoid air cells. Infection has spread from mucosal lining to the bone


The reported rate in the past 20 years has been 0.24%

The rate of intracranial complications due to matsoiditis 4-16.6%


Acute mastoiditis

Masked / latent mastoiditis

Acute mastoiditis

            Inflammation of mucosal lining of mastoid antrum and mastoid air cells.


·         Streptococcus    

·         Acute and chronic otitis media

·         Staphylococcus

·         Poor nutrition

·         Pneumococcus  

·         Associated systemic disease- diabetes, blood borne diseases

·         Hemophilus influenza             

·         Pseudomonas  

·         Penetrating trauma



Acute infection of mastoid air cells


Persistent hyperaemia, congestion & edema of mucous membrane of the air cells + osteitis


obstruction of aditus


Purulent exudate in air cells


Pressure effect


Venous stasis


Absorotion of Ca++ 

Hvoeraemic decalcification


Local acidosis


Breaking down of the partition of air cells


Tract down to various sites



(post auricular abscess, pharyngeal abscess, Benzold’s abscess, zygomatic abscess, Luc’s abscess, apical abscess)


 Clinical Menifestation


·         Pain and swelling in the mastoid region

·         Fever

·         Ear discharges: mucopurulent Deafness: conductive type



Mastoid tenderness: apply pressure on mastoid area patient will complaints of pain

Sagging of posterior-superior meatal wall: it is due to the inflammation of bony wall between antrum and deep part of meatal wall.

Perforation of tympanic membrane: there will be Sinall perforation in the pars tensa.

Swelling over mastoid: initially there will be oedema of periosteum, later retroauricular sulcus becomes obliterated and pinna is pushed forward and downward.

Hearing loss: conductive type hearing loss

General findings: patient will feel sick and have low grade fever, and in children fever will be high



·         Complete Blood Count- shows leucocytosis

·         ESR is usually raised

·         Ear swab for culture and sensitivity

·         Radiographic evaluation: Inflammation and fluid within the air spaces/ cloudiness


Medical Management


·         Intravenous antibiotic therapy should be maintained for at least 24-48 hrs after the resolution of symptoms

·         Then followed with oral antibiotic for 2 weeks

·         It should be based on the culture and sensitivity report

Surgical management

1.Incision and drainage of the pus


·         Radical mastoidectomy: Radical Mastoidectomy is a procedure to eradicate disease from the middle ear and mastoid without any attempt to reconstruct hearing.

·         Modified Radical Mastoidectomy: It is a modification of radical mastoidectomy where as much of the hearing mechanism as possible is preserved.

·         Cortical Mastoidectomy (Also known as schwartze procedure) - Removal of Mastoid air cells is undertaken without affecting the middle ear.



·         Subperiosteal abscess                   

·         Facial paralysis     

·         Extradural abscess            

·         Meningitis 

·         Brain abscess                    

·         Petrositis                           

·         Labrynthitis


Nursing management:

Pre operative care:

·         Before surgery an audiogram and tympanogram are obtained to assess the hearing acuity

·         Knowledge about the procedure and psychological readiness

·         Educate about the duration of procedure, post op duration of hospital stay

Post op care:

·         Positioning: operated ear should be up for several hours after surgery

·         Nose blow should be avoided, if at all doing it should be gentle

·         The client should sneeze or cough with the open mouth

·         Participation in water sports or activities in water are prohibited

·         Change the cotton ball in ear daily as prescribed  

·         Keep ear dry for 4 to 6 weeks after surgery


Masked (Latent) Mastoiditis:

It is a condition of slow destruction of mastoid air cells but without the acute signs and symptoms often seen in acute mastoiditis

ETIOLOGY: Inadequate antibiotic therapy in terms of dose, frequency, and duration of administration In case of acute otitis media

Clinical Manifestation:

·         Mild pain behind year

·         Tympanic membrane appears thick

·         Slight tenderness over the mastoid

·         Audiometry shows conductive hearing loss

·         X-ray mastoid shows clouding of the air cells

TREATMENT: cortical mastoidectomy with full doses of antibiotic

Patient teaching:

·         Teach patient and family how to change dressing

·         Tel them to avoid wetting of the dressing

·         Teach about the instillation of ointment or ear drops

·         Regular follow-up



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notes.nursium.com: ENT: Mastoiditis
ENT: Mastoiditis
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