Mastoiditis surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
=== Surgical treatment in mastoiditis | === Surgical treatment indications in mastoiditis: === | ||
* Intracranial complications. | * Intracranial complications. | ||
* Cholesteatoma. | * Cholesteatoma. | ||
Line 16: | Line 16: | ||
* Otorrhoea persisting for more than 2 weeks despite adequate antibiotic treatment. | * Otorrhoea persisting for more than 2 weeks despite adequate antibiotic treatment. | ||
=== | === Surgical procedures and indications: === | ||
:* 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. | ||
:* Myringotomy: | :* 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. | :** 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.<sup>[[Otitis media surgery#cite note-pmid18697973-3|[3]]]</sup> | |||
: | |||
* 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== | ==References== |
Revision as of 20:18, 29 June 2017
Mastoiditis Microchapters |
Diagnosis |
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Treatment |
Case Studies |
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.
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
- Incision and drainage of the mastoid abscess:
- 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.
- Myringotomy accompanied by the additional insertion of a tympanostomy tube is indicated by the following :
- 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.