Mastoiditis surgery: Difference between revisions

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=== Surgical treatment indications in mastoiditis: ===
=== Surgical treatment indications in mastoiditis: ===
* Intracranial complications.
** Intracranial complications.
* Cholesteatoma.
** Cholesteatoma.
* Not achieving adequate response after 24 to 48 hours of starting treatment
** Not achieving adequate response after 24 to 48 hours of starting treatment
* Evidence of postauricular fluctuation and subperiosteal abscess.
** Evidence of postauricular fluctuation and subperiosteal abscess.
* Diagnosis of acute coalescent mastoiditis.
** Diagnosis of acute coalescent mastoiditis.
* 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: ===
=== Surgical procedures and indications: ===

Revision as of 18:20, 30 June 2017

Mastoiditis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Mastoiditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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
  • 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

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