Mastoiditis surgery

Mastoiditis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Surgery

Surgical treatment indications in mastoiditis:

• Intracranial complications.
• Cholesteatoma.
• Not achieving adequate response after 24 to 48 hours of starting treatment
• Evidence of postauricular fluctuation and subperiosteal abscess.
• Diagnosis of acute coalescent mastoiditis.
• Otorrhoea persisting for more than 2 weeks despite adequate antibiotic treatment.

Surgical procedures and indications:

• 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

• • 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]

• Definitive surgery is mastoidectomy, which is the surgical removal of the mastoid cortical bone and underlying air cells.
  • 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.