Mastoiditis surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
=== Surgical treatment indications in mastoiditis: === | === Surgical treatment indications in mastoiditis: === | ||
** Intracranial complications. | ** Intracranial complications. | ||
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** 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.<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> | ||
=== Surgical procedures and indications: === | === 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 : | ** [[Myringotomy]] accompanied by the additional insertion of a [[tympanostomy tube]] is indicated by the following : | ||
*** [[Eustachian tube]] dysfunction. | *** [[Eustachian tube]] dysfunction. | ||
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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> | ||
* 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. | ||
** Cortical mastoidectomy is the best choice of therapy; however | ** Cortical mastoidectomy is the best choice of therapy; however | ||
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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 | ||
* Coalescent mastoiditis in CT scan (regardless of other clinical features) | * Coalescent mastoiditis in CT scan (regardless of other clinical features) | ||
* 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. | ||
Revision as of 18:30, 30 June 2017
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Mastoiditis Microchapters |
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Diagnosis |
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Treatment |
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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.[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.