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