Mastoiditis is an inflammation of the mastoid process behind the ear that can result from untreated or inadequately treated otitis media. It is classified as either acute or chronic mastoiditis. Acute mastoiditis develops as a complication of acute otitis media, while chronic mastoiditis occurs with chronic suppurative otitis media or cholesteatoma formations. Symptoms include severe pain, swelling and tenderness in the mastoid region, fever, and otorrhea. Diagnosis involves tests like CT scans, ear cultures and audiograms. Treatment consists of antibiotics, analgesics, and may require surgical drainage of pus via procedures like mastoidectomy if infection spreads to

1. Mastoiditis
Mr. Binu Babu
M.Sc. Nursing
Mrs. Jincy Ealias
M.Sc. Nursing

2. Definition
• It is an inflammation of mastoid process behind
the ear and of the air space connecting it to the
cavity of the middle ear.

3. Etiology
• Otitis media
• CSOM
• Inadequate drainage of exudate in otitis media
• Inadequate treatment of AOM
• Cholesteatoma : skin cyst in the middle ear may
block drainage of the ear.

4. Types
Mastoidtis
Acute
Catarrhal
mastoiditis
Coalescent
mastoiditis
Chronic

5. Types
1. Acute mastoidtis : It is a rare complication of
acute otitis media.
i. Catarrhal mastoiditis : This stage follows the
stage of suppuration in ASOM. There will be
congestion of the mucosa of the mastoid which
leads to aggravation of symptoms.
ii. Coalescent mastoiditis : The air cells of the
mastoid coalesce & mastoid cavity becomes
converted in to a bag of pus
2. Chronic mastoidtis : It occurs with CSOM or
with cholesteatoma formations.

7. Pathophysiology
Otitis media/ cholesteatoma
Inadequate drainage of exudate
Spread of exudate into mastoid air cells
Extension of infection to mastoid air cells
Congestion of mucosa of mastoid bone
Pus collection in mastoid air cells
Aggravation of symptoms

8. Clinical manifestations
• Severe pain in the mastoid region
• Redness in the mastoid region
• Swelling in the mastoid region
• Tenderness in the mastoid region
• Otalgia
• Feeling of fullness
• Perforation of the ear drum.
• Fever
• Dizziness
• Otorrhoea
• Deafness

9. Diagnostic measures
• History collection
• Physical examination.
• Mastoid bone x ray.
• CT scan
• CBC, Blood culture
• Tympanocentesis : ear culture, fluid from middle
ear send for culture.
• Audiography: to assess hearing loss.
• Lumbar puncture: to identify the extension of
infection to CNS.

10. Complications
• Hearing loss
• Meningitis
• Brain abscess

11. Management
MEDICAL MANAGEMENT
• Antibiotic for infection and inflammation. Both
systemic and topical. e.g. Ciplox-D, tetracycline,
cephalosporin
• Analgesics
• Systemic decongestants: phenylephrine HCl
• Corticosteroids
• Antipyretics
• Ear-irrigation: For removing purulent discharge.

12. SURGICAL MANAGEMENT
• Mastoidectomy: It is a surgical procedure that
removes diseased mastoid air cells.
Mastoidectomy
Simple
CorticalRadical

13. • Simple mastoidectomy - The incision is
made behind the ear to remove the infected air
cells by approaching through the ear.
• Radical mastoidectomy- A radical
mastoidectomy removes the tympanic
membrane and is indicated for extensive spread
of a cholesteatoma. The eardrum and middle ear
structures may be completely removed. Usually
the stapes is spared if possible to help preserve
some hearing.
• Cortical mastoidectomy - Removal of
mastoid air cells without disturbing the middle
ear.

14. • 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.

15. 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.

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

17. 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.