Mastoiditis surgery: Difference between revisions
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== Surgical procedures and indications == | == Surgical procedures and indications == | ||
Different surgical procedures may be done in mastoiditis:<ref name="pmid16413617">{{cite journal |vauthors=Zanetti D, Nassif N |title=Indications for surgery in acute mastoiditis and their complications in children |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=70 |issue=7 |pages=1175–82 |year=2006 |pmid=16413617 |doi=10.1016/j.ijporl.2005.12.002 |url=}}</ref><ref name="urlPediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF">{{cite web |url=http://idmp.ucsf.edu/pediatric-guidelines-head-and-neck-infections-mastoiditis |title=Pediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF |format= |work= |accessdate=}}</ref><ref name="pmid197344392">{{cite journal|year=2010|title=Clinical strategies for the management of acute mastoiditis in the pediatric population|url=|journal=Clin Pediatr (Phila)|volume=49|issue=2|pages=110–5|doi=10.1177/0009922809344349|pmid=19734439|vauthors=Lin HW, Shargorodsky J, Gopen Q}}</ref><ref name="pmid197587112">{{cite journal|year=2009|title=Mastoiditis in a paediatric population: a review of 11 years experience in management|url=|journal=Int. J. Pediatr. Otorhinolaryngol.|volume=73|issue=11|pages=1520–4|doi=10.1016/j.ijporl.2009.07.003|pmid=19758711|vauthors=Pang LH, Barakate MS, Havas TE}}</ref> | |||
=== Incision and drainage of the mastoid abscess: === | === Incision and drainage of the mastoid abscess: === | ||
When fluctuation presents drainage must be done immediately and the pus should be to achieve complete drainage of the pus. | When fluctuation presents drainage must be done immediately and the pus should be to achieve complete drainage of the pus. | ||
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*Necessity to repair the [[tympanic membrane]] from [[eustachian tube]] dysfunction. | *Necessity to repair the [[tympanic membrane]] from [[eustachian tube]] dysfunction. | ||
[[Otorrhea]] is a possible complication of performing a [[myringotomy]] with a tympanostomy tube, affecting up to 17% of intubated ears.<sup>[[Otitis media surgery#cite note-pmid18697973-3|[3]]]</sup> | [[Otorrhea]] is a possible complication of performing a [[myringotomy]] with a tympanostomy tube, affecting up to 17% of intubated ears.<sup>[[Otitis media surgery#cite note-pmid18697973-3|[3]]]</sup> | ||
=== Mastoidectomy === | === Mastoidectomy === | ||
Definitive surgery is mastoidectomy, which is the surgical removal of the mastoid cortical bone and underlying air cells. | Definitive surgery is mastoidectomy, which is the surgical removal of the mastoid cortical bone and underlying air cells. | ||
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* Simple mastoidectomy is performed to clean out the mastoid infection and provide external drainage | * Simple mastoidectomy is performed to clean out the mastoid infection and provide external drainage | ||
* Radical mastoidectomy is performed only when there is no clinical response to simple mastoidectomy, as evidenced by continued otorrhea or pain | * Radical mastoidectomy is performed only when there is no clinical response to simple mastoidectomy, as evidenced by continued otorrhea or pain | ||
==== Indications for mastoidectomy may include: ==== | ==== Indications for mastoidectomy may include: ==== | ||
* Subperiosteal abscess, such as postauricular fluctuance or mass | * Subperiosteal abscess, such as postauricular fluctuance or mass | ||
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* Chronic suppurative otitis media or cholesteatoma | * Chronic suppurative otitis media or cholesteatoma | ||
* Progression of postauricular swelling or fluctuance, fever, and other clinical findings or continuous drainage despite parenteral antimicrobial therapy and Myringotomy. | * Progression of postauricular swelling or fluctuance, fever, and other clinical findings or continuous drainage despite parenteral antimicrobial therapy and Myringotomy. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 14:26, 3 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]
Overview
Surgical procedures and indications
Different surgical procedures may be done in mastoiditis:[1][2][3][4]
Incision and drainage of the mastoid abscess:
When fluctuation presents drainage must be done immediately and the pus should be to achieve complete drainage of the pus.
Myringotomy
Myringotomy is surgical perforation of the tympanic membrane
- It should be considered as a primary treatment in all cases of mastoiditis when there is an unperforated tympanic membrane or inadequate drainage.
- Myringotomy may be done with or without tympanostomy tube placement.
Tympanocentesis
Should be done in all mastoiditis patients to obtain middle ear fluid for culture and susceptibility testing
tympanostomy tube
Myringotomy accompanied by the additional insertion of a tympanostomy tube is indicated by the following:
- Eustachian tube dysfunction.
- Suppurative complication requiring additional drainage via the tympanostomy tube.
- Necessity to repair the tympanic membrane from eustachian tube dysfunction.
Otorrhea is a possible complication of performing a myringotomy with a tympanostomy tube, affecting up to 17% of intubated ears.[3]
Mastoidectomy
Definitive surgery is mastoidectomy, which is the surgical removal of the mastoid cortical bone and underlying air cells.
Methods
- Cortical mastoidectomy is the best choice of therapy; however
- open mastoidectomy should be performed if cholesteatoma is present
- Simple mastoidectomy is performed to clean out the mastoid infection and provide external drainage
- Radical mastoidectomy is performed only when there is no clinical response to simple mastoidectomy, as evidenced by continued otorrhea or pain
Indications for mastoidectomy may include:
- Subperiosteal abscess, such as postauricular fluctuance or mass
- Coalescent mastoiditis in CT scan (regardless of other clinical features)
- Chronic suppurative otitis media or cholesteatoma
- Progression of postauricular swelling or fluctuance, fever, and other clinical findings or continuous drainage despite parenteral antimicrobial therapy and Myringotomy.
References
- ↑ Zanetti D, Nassif N (2006). "Indications for surgery in acute mastoiditis and their complications in children". Int. J. Pediatr. Otorhinolaryngol. 70 (7): 1175–82. doi:10.1016/j.ijporl.2005.12.002. PMID 16413617.
- ↑ "Pediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF".
- ↑ Lin HW, Shargorodsky J, Gopen Q (2010). "Clinical strategies for the management of acute mastoiditis in the pediatric population". Clin Pediatr (Phila). 49 (2): 110–5. doi:10.1177/0009922809344349. PMID 19734439.
- ↑ Pang LH, Barakate MS, Havas TE (2009). "Mastoiditis in a paediatric population: a review of 11 years experience in management". Int. J. Pediatr. Otorhinolaryngol. 73 (11): 1520–4. doi:10.1016/j.ijporl.2009.07.003. PMID 19758711.