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  1. 1. MASTOIDITIS INTRODUCTION The mastoid process is the portion of the temporal bone of the skull that is behind the ear which contains open, air-containing spaces. DEFINITION It is an inflammation of the mastoid process behind the ear and of the air space connecting it to the cavity of the middle ear. CLASSIFICATION 1. Acute mastoiditis: It is a rare complication of acute otitis media. 2. Chronic mastoiditis: It is most commonly associated with CSOM or with cholesteatoma formations. CAUSES & RISK FACTORS 1. Infection of the middle ear. 2. Injury of the mastoid bones and cells. 3. Cholesteatoma. 4. Upper respiratory infection. SIGNS AND SYMPTOMS 1. Otalgia. 2. Swelling on the mastoid bone. 3. Perforation of the ear drum. 4. Loss of hearing. 5. Severe pain at eating time. 6. Increased cranial pressure. 7. Painless discharge from the affected ear. 8. Otorrhoea(purulent discharge) may be odorless or foul smelling. 9. Nausea, vomiting.
  2. 2. PATHOPHYSIOLOGY Due to infection of middle ear Acute otitis media Infection reaches at mastoid air cells Inflammation of mastoid process DIAGNOASTIC EVALAUTION 1. History collection. 2. Physical examination. 3. Mastoid bone x ray. 4. CT scan. 5. Lab: CBC, DLC, Blood culture, tympanocentesis. 6. Audiography. MEDICAL MANAGEMENT 1. Antibiotic and steroid eardrop for infection and inflammation, e.g. Ciplox-D. 2. Ear-irrigation: For removing purulent discharge. 3. Analgesics drugs: Aspirin, Nimuslide. SURGICAL MANAGEMENT 1. Mastoidectomy: It is a surgical procedure that removes diseases mastoid air cells. 2. Myringotomy: It is a surgical procedure in which a tiny incision is created in the eardrum relieves pressure caused by excessive buildup of fluid or pus. 3. Tympanoplasty: also called eardrum repair. It is the surgical reconstruction of the perforated eardrum or the small bones of the middle ear. NURSING MANAGEMENT  Assess pain for location, intensity etc.  Administer analgesics as prescribed to relieve pain.
  3. 3.  Administer antibiotics as ordered.  Administer antipyretics as prescribed.  Provide plenty of fluids.  Use coolwater sponging to reduce bodytemperature,  Encourage patient and family to use signs of non verbal communication such facial expression, pointing, bodymovement. NURSING DIAGNOSIS  High risk for infection relate to tissue destruction.  Pain relate to physical factors.  Altered auditory sensory perception related to partial/total perforation of tympanic membrane.  Impaired verbal communication related to hearing deficit.  High risk for trauma realted to balance difficulty.