Mastoiditis surgery: Difference between revisions

Jump to navigation Jump to search
(5 intermediate revisions by the same user not shown)
Line 5: Line 5:


==Overview==
==Overview==
Different [[surgical procedures]] may be done in mastoiditis. [[Myringotomy]] is surgical perforation of the [[tympanic membrane]]. It should be considered as a primary treatment in all cases of [[infectious]] mastoiditis following [[otitis media]], particularly when there is an unperforated [[tympanic membrane]] or inadequate drainage. [[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 in some cases such as [[eustachian tube]] dysfunction, [[suppurative]] complication requiring additional drainage and repair the [[tympanic membrane]] from [[eustachian tube]] dysfunction. Definitive surgery is [[mastoidectomy]], which is the surgical removal of the [[mastoid]] cortical bone and underlying air cells. Indications for [[mastoidectomy]] may include: subperiosteal [[abscess]], such as postauricular fluctuance or mass; 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]].
Different [[surgical procedures]] may be done in mastoiditis. [[Myringotomy]] is surgical perforation of the [[tympanic membrane]]. It should be considered as a primary treatment in all cases of [[infectious]] mastoiditis following [[otitis media]], particularly when there is an unperforated [[tympanic membrane]] or inadequate drainage. [[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 in some cases, such as [[eustachian tube]] dysfunction, [[suppurative]] complications requiring additional drainage and repair the [[tympanic membrane]] from [[eustachian tube]] dysfunction. Definitive surgery is [[mastoidectomy]], which is the surgical removal of the [[mastoid]] cortical bone and underlying air cells. Indications for [[mastoidectomy]] may include: subperiosteal [[abscess]], such as postauricular fluctuance or mass; 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]].


== Surgical procedures and indications ==
== Surgical procedures and indications ==
Different [[surgical procedures]] may be done in mastoiditis:<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><ref name="urlPediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF">{{cite web |url=http://idmp.ucsf.edu/pediatric-guidelines-head-and-neck-infections-mastoiditis |title=Pediatric Guidelines: Head and Neck Infections - Mastoiditis &#124; Infectious Diseases Management Program at UCSF |format= |work= |accessdate=}}</ref><ref name="pmid197344392">{{cite journal|year=2010|title=Clinical strategies for the management of acute mastoiditis in the pediatric population|url=|journal=Clin Pediatr (Phila)|volume=49|issue=2|pages=110–5|doi=10.1177/0009922809344349|pmid=19734439|vauthors=Lin HW, Shargorodsky J, Gopen Q}}</ref><ref name="pmid197587112">{{cite journal|year=2009|title=Mastoiditis in a paediatric population: a review of 11 years experience in management|url=|journal=Int. J. Pediatr. Otorhinolaryngol.|volume=73|issue=11|pages=1520–4|doi=10.1016/j.ijporl.2009.07.003|pmid=19758711|vauthors=Pang LH, Barakate MS, Havas TE}}</ref>
Different [[surgical procedures]] may be done in mastoiditis:<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><ref name="urlPediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF">{{cite web |url=http://idmp.ucsf.edu/pediatric-guidelines-head-and-neck-infections-mastoiditis |title=Pediatric Guidelines: Head and Neck Infections - Mastoiditis &#124; Infectious Diseases Management Program at UCSF |format= |work= |accessdate=}}</ref><ref name="pmid197344392">{{cite journal|year=2010|title=Clinical strategies for the management of acute mastoiditis in the pediatric population|url=|journal=Clin Pediatr (Phila)|volume=49|issue=2|pages=110–5|doi=10.1177/0009922809344349|pmid=19734439|vauthors=Lin HW, Shargorodsky J, Gopen Q}}</ref><ref name="pmid197587112">{{cite journal|year=2009|title=Mastoiditis in a paediatric population: a review of 11 years experience in management|url=|journal=Int. J. Pediatr. Otorhinolaryngol.|volume=73|issue=11|pages=1520–4|doi=10.1016/j.ijporl.2009.07.003|pmid=19758711|vauthors=Pang LH, Barakate MS, Havas TE}}</ref>
=== [[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 to achieve complete drainage of the pus.
 
=== [[Myringotomy]] ===
=== [[Myringotomy]] ===
[[Myringotomy]] is surgical perforation of the [[tympanic membrane]]
[[Myringotomy]] is surgical perforation of the [[tympanic membrane]]
* It should be considered as a primary treatment in all cases of [[infectious]] mastoiditis when there is an unperforated [[tympanic membrane]] or inadequate drainage.  
* It should be considered as a primary treatment in all cases of [[infectious]] mastoiditis , when there is an unperforated [[tympanic membrane]] or inadequate drainage.  
* [[Myringotomy]] may be done  with or without [[tympanostomy tube]] placement.
* [[Myringotomy]] may be done  with or without [[tympanostomy tube]] placement.
=== [[Tympanocentesis]] ===
=== [[Tympanocentesis]] ===
[[Tympanocentesis]] should be done in all mastoiditis patients to obtain [[middle ear]] fluid for culture and susceptibility testing
[[Tympanocentesis]] should be done in all mastoiditis patients to obtain [[middle ear]] fluid for culture and susceptibility testing
===[[Tympanostomy tube]]===
===[[Tympanostomy tube]]===
[[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 in the following:
*[[Eustachian tube]] dysfunction.
*[[Eustachian tube]] dysfunction.
*[[Suppurative]] complication requiring additional drainage via the [[tympanostomy tube]].
*[[Suppurative]] complications requiring additional drainage via the [[tympanostomy tube]].
*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 infected ears.<sup>[[Otitis media surgery#cite note-pmid18697973-3|[3]]]</sup>
 
=== [[Mastoidectomy]] ===
=== [[Mastoidectomy]] ===
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.

Revision as of 18:23, 26 July 2017

Mastoiditis Microchapters

Home

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: Mehrian Jafarizade, M.D [2]

Overview

Different surgical procedures may be done in mastoiditis. Myringotomy is surgical perforation of the tympanic membrane. It should be considered as a primary treatment in all cases of infectious mastoiditis following otitis media, particularly when there is an unperforated tympanic membrane or inadequate drainage. 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 in some cases, such as eustachian tube dysfunction, suppurative complications requiring additional drainage and repair the tympanic membrane from eustachian tube dysfunction. Definitive surgery is mastoidectomy, which is the surgical removal of the mastoid cortical bone and underlying air cells. Indications for mastoidectomy may include: subperiosteal abscess, such as postauricular fluctuance or mass; 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.

Surgical procedures and indications

Different surgical procedures may be done in mastoiditis:[1][2][3][4]

Incision and drainage of the mastoid abscess:

When fluctuation presents, drainage must be done immediately to achieve complete drainage of the pus.

Myringotomy

Myringotomy is surgical perforation of the tympanic membrane

Tympanocentesis

Tympanocentesis should be done in all mastoiditis patients to obtain middle ear fluid for culture and susceptibility testing

Tympanostomy tube

Myringotomy accompanied by the additional insertion of a tympanostomy tube is indicated in the following:

Otorrhea is a possible complication of performing a myringotomy with a tympanostomy tube, affecting up to 17% of infected ears.[3]

Mastoidectomy

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

Methods

Indications for mastoidectomy may include:

The following video presents surgical procedures for mastoiditis:

{{#ev:youtube|jnonLwxW2Cg}}

References

  1. 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.
  2. "Pediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF".
  3. Lin HW, Shargorodsky J, Gopen Q (2010). "Clinical strategies for the management of acute mastoiditis in the pediatric population". Clin Pediatr (Phila). 49 (2): 110–5. doi:10.1177/0009922809344349. PMID 19734439.
  4. Pang LH, Barakate MS, Havas TE (2009). "Mastoiditis in a paediatric population: a review of 11 years experience in management". Int. J. Pediatr. Otorhinolaryngol. 73 (11): 1520–4. doi:10.1016/j.ijporl.2009.07.003. PMID 19758711.

Template:WH Template:WS