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5th calss.pptx
1.
2.
3. Revision
• Fill in the blanks.
1. Otitis media is the inflammation of_____ear.
2. Tubotympanic is ________ type as true is no
danger to the life the patient.
3. Cholesteatoma can give rise to serious
complication like________.
4. ________is common bacterial infection affecting
mucosa of the middle ear.
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4. Fill in the blanks.
1. Otitis media is the inflammation of middle ear.
2. Tubotympanic is safe type as true is no danger to
the life the patient.
3. Cholesteatoma can give rise to serious
complication like meningitis, brain abscess, etc.
4. Acute suppurative otitis media is common
bacterial infection affecting mucosa of the middle
ear.
6. Disorder of Middle ear
Mastoiditis
Prepared by
Amita Shrestha
Student Teacher
Roll no:01
Bns 2nd year
9th batch
7. General objective
At the end of the session the BSN 2nd year students
will be able to explain about the middle ear
disorder;
8. Specific objective
At the end of the session the BSN 2nd year students will
be able to explain about ;
• definition mastoiditis
• types
• etiology
• Predisposing factor
• pathophysiology
• clinical feature
• diagnosis
• management
9. Mastoiditis
• Mastoiditis is an inflammation of the
mucosal lining of the mastoid antrum and
mastoid air cell.
• It is usually caused by untreated acute otitis
media in which the infection extends to
mastoid antrum.
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13. Acute Mastoiditis
• An acute inflammation of the mucosal lining
of the mastoid ear cells osteitis (i.e. the
involvement of the body walls of the mastoid
ear cell system) associated with sign and
symptoms of mastoid involvement.
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14. Latent Mastoiditis
• It is a condition of slow destruction of
mastoid ear cells but without the signs and
symptoms often seen in acute mastoiditis.
• This condition often result from inadequate
antibiotic therapy in term of dose, frequency
and duration of administration.
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15. Chronic Mastoiditis
• This is the condition of chronic infection of mastoid
antrum and an air cell characterized by the
destruction of mastoid bone.
• It is associated with dangerous chronic suppurative
otitis media with cholesteatoma.
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16. Contd…
• In this condition the
mastoid cavity becomes
filled with cholesteatoma
and granulation .
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17. Etiology
• Usually develops as the complication of
acute suppurative otitis media.
• The most common causative organisms
pneumococcus, haemophilus influenza,
beta haemolytic streptococci and
staphylococci.
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18. Pre-disposing factor
• Untreated or inadequate treatment of
acute otitis media.
• Virulence of Organisms: infection may
spread if the organism is virulent.
• Inadequate drainage of exudate or
discharge from the ear.
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19. Contd..
• Low immune response of the body due to
poor nutritional status and disease
condition such as diabetes.
• Continue use of steroids and
chemotherapeutic drugs reduces the
patient's immune response and prone to
infection.
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20. Pathophysiology
Otitis media
Spread of inflammation to mastoid air cell.
Swollen mucosa of antrum and attic inhibits
drainage resulting in accumulation of pus.
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21. Cont…
Hyperaemia and engorgement of mucosa
Dissolution of calcium from bony wall of
mastoid air cell.
Destruction of mastoid air cell
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22. Contd..
• Empyema of mastoid (irregular cavity filled
with pus (brushing of abscess formed )
Mastoid fistula.
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24. Clinical Features
• Pain, tenderness, and swelling in the mastoid
region but there is no pain and acute sign and
symptoms in chronic and latent mastoiditis.
• Mastoid region may be red (erythematous).
• Persistent or recurrent fever.
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25. Contd…
• Profuse otorrhoea and become creamy yellow in color,
later may become foul smelling and decrease in
amount due to obstruction to the drainage.
• Deafness may increase further (conductive type)
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26. Contd…
• On examination ear drum shows congestion
and perforation due to infection.
• A whitish or brownish mass (cholesteatoma)
may see through tympanic membrane in
chronic condition.
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27. Diagnostic Procedure
• History of pain and tenderness over the mastoid
area.
• Examination by otoscope shows: a dull, thickened
and edematous tympanic membrane.
• Persistent oozing of external auditory canal
indicates perforation of membrane.
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28.
29. Contd..
• Culture and sensitivity of ear discharge.
• X-ray of mastoid shows cloudiness in the mastoid
air cells.
• CT (computerized tomogram) scan or (magnetic
resonance imaging)
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32. Treatment
• In acute condition, mastoiditis can be treated
by symptomatic treatment and adequate
antibacterial therapy but chronic condition
with cholesteatoma should be treated with
surgical procedure.
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33. Medical Management
• Hospitalization of patient in acute condition.
• Aural toilet for cleaning of auditory canal by
suctioning or syringing
• Analgesics (Ibuprofen, tramadol) for pain and
antipyretics (paracetamol) for fever.
4/9/2023 33
34. Contd..
• Antibiotics according to culture of discharge,
amoxicillin or ampicillin. Chloramphenicol
or metronidazole need to be added for
anaerobic organism.
• Treatment of predisposing factor of otitis
media
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35. Surgical Management
• Surgical management includes removal of
affected mastoid bone. This is done by
mastoidectomy.
• Mastoidectomy is the incision, drainage and
removal of diseased mucosa and bone from
mastoid process of the temporal bone.
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36. Cont..
• Types of mastoidectomy done according to
condition of disease.
1. Simple Mastoidectomy
2. Radical Mastoidectomy
3. Modified Radical Mastoiditis
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37. Simple Mastoidectomy
• A simple mastoidectomy is a procedure that
involves the removal of the mastoid air cells
and infected or damaged tissue in the mastoid
bone.
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39. Radical Mastoidectomy:
• A radical mastoidectomy is a surgical
procedure that involves the complete removal
of the mastoid bone, the middle ear structures,
and the tympanic membrane (eardrum).
• The procedure is usually performed to treat a
severe or chronic infection of the middle ear,
called cholesteatoma, which can cause bone
erosion, hearing loss, and other complications.
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40. Contd…
• This operation should not be done if the
patient has conductive type hearing loss
which can be improved or preserved.
• This does not preserve hearing.
• Nowadays everyone wants to preserve
hearing after surgery so that this operation is
not common.
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41. Modified Radical Mastoiditis
• The aim of this procedure is to eradicate disease in
order to make ear safe as well as dry and preserve
hearing.
• It is usually done in atticoantral type chronic
suppurative otitis media with adequate cochlear
function, in other words patient should not have
sensorineural hearing loss.
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42. Nursing Management
• The nurse is one of the responsible and
supportive person for every patient. She
should provide pre- operative and post-
operative nursing management to the patient
planning for operation.
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43. Pre-operative Management
• Check and collect investigation:
• Collect all the investigation necessary to
confirm if the patient is fit for general
anesthesia or not.
• Investigations include;
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44. Contd…
• Routine blood test such as hemoglobin, Total
blood cells count, Liver function test, Renal
function test, Blood clotting time and
bleeding time, Prothrombin time, chest x-ray,
ECG etc.
• Sent the patient with all investigation report
to anesthesiologist the day before surgery.
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45. Contd…
•Keep the patient nil per oral from
midnight of the day before surgery.
•Bowel preparation should be done by
giving Ezevac enema in the morning of
surgery day as per hospital policy.
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46. Contd..
• Pre-operative vital sign to be taken and recorded
and if any abnormality immediately inform the
surgeon.
• Prepare the patient in operating gown.
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47. Contd…
• Report documentation with explanation of all
patient preparation, collected investigation
report, patient general condition, vital sign
etc. for legal purpose.
• Handover to OT nurse.
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48. Post Operative Management
• Receive patient from OT nurse with all patient
documents, observe surgical site for bleeding drainage
or drainage tube if placed.
• Maintain the head of bed at 30 degree to promote the
drainage of secretion and keep the patient's head in
side with operating ear up after surgery.
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49. Contd…
• Monitor vital sign and document it and if any
abnormality found, immediately.
• Monitor intravenous fluid infusion, check IV
site.
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50. Contd..
• Post-operative medication should be given in time,
antibiotics to prevent secondary infection, sedatives
and analgesics to control pain and restlessness.
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51. Contd…
• Diet: usually fluids are given after regain
fully consciousness and soft regular diet
is given as soon as it is tolerated.
• Nausea, vomiting and vertigo may be
present after surgery, so assist the patient
in getting out of bed.
• Remove mastoid (head) dressing after 24
hours.
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52. Contd…
• Patient is observed closely for signs of facial
paralysis such as dropping of mouth, inability
to close eye lids and who have injury to the
nerve are informed immediately and taken
back to OT for nerve repair.
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53. Prevent injury
• Vertigo may be present after surgery if semi-circular
canal or other organs of the inner ear are
traumatized.
• Assist the patient in ambulation and prevent falls
and other injuries.
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54. Improving hearing
• Reducing environmental noise, facing the
patient when speaking, speaking clearly
and distinctly without shouting, provide
good lighting if the patient relies on speech
reading and using non verbal clues
• Assistive hearing aids can be used in the
unaffected ears.
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55. Discharge Teaching
• Hand washing before and after touching
the ear and changing dressing.
• External dressing should be changed
daily for 3-5 days and Bacitracin
ointment daily to the incision site for 7
days. The sutures used are absorbable and
will heal from the inside.
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56. Contd…
• Avoid heavy lifting, straining and bending .
• Popping and crackling sensation and normal
in the ear after 3 to 5 weeks after the surgery,
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57. Contd..
• Change the cotton ball in your ear after 2-3
days and then daily use bacitracin ointment
on the cotton ball.
• After ten to fourteen days of surgery the
drainage is normal.
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58. Contd..
• Each day it will be less in amount. The color
of the drainage will change from red to
yellow to clear, and then stop, report any
change in color of drainage such as bright
red, purulent.
• Do not take bath until the pack is inside the
ear.
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59. Contd…
• Prevent water entering in the ear by putting a
Vaseline layer over the outside of the cotton ball
for about 6 weeks.
• Never put the oil and never scratch the ear.
• Blow nose gently one side at a time and sneeze
or cough with mouth open.
4/9/2023 59
60. Contd..
• Avoid flying for 2 month following
operation.
• Take medication as prescription and follow
up regularly
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62. References
• Basavan thapa BT. A text book of medical surgical nursing
(3rd edition) Karnataka , India health sciences publisher, New
Delhi
• Black J.M, Hawaks JH, A textbook of medical surgical (8th
edition) Elsevier India Pvt.
• Pl dhingra dhingra.s(2014),A textbook of ear, nose and
throat and head and neck surgery(6th edition). Reed elsevier
india private limited
• Sharma M, Poudel K and Gautam R (2076) Comprehensive
text book of medical surgical nursing management.
Samiksha Publication Pvt.Ltd.
• Singh A. and tulik Navneet(2013),A textbook of ear,Nose
and throat(2nd edition),Madhya pradesh, Jaypee Brother
Medical publisher.
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The mastoid air cells are thought to protect the delicate structures of the ear, regulate ear pressure and possibly protect the temporal bone during trauma.
