TABLE OF CONTENTS:

 INTRODUCTION …………….

 SURGICAL PROCEDURE …………….

 DEFINITION OF TERMS .…………..

 ANATOMY AND PHYSIOLOGY …………....

 PATHOPHYSIOLOGY ………......
 NURSING RESPONSIBILITIES ……………

 INSTRUMENTATION PICTURE ……………

 REFERENCE …………..
 INTRODUCTION
The mastoid bone is a bone located behind the ear (felt as a hard bump
behind the ear). Inside it looks like a honeycomb, with the spaces filled with
air. These air cells are connected to the middle ear through an air filled
cavity called the mastoid antrum. Although the mastoid bone serves as a
reserve air supply to allow normal movement of the eardrum, its connection
to the middle ear may also result in the spread of middle ear infections to the
mastoid bone (mastoiditis).

A mastoidectomy is a surgical procedure designed to remove infection or

growths in the bone behind the ear (mastoid bone). Its purpose is to create a
"safe" ear and prevent further damage to the hearing apparatus
mastoidectomy is indicated for MASTOIDITIS that does not respond to
antibiotics. A mastoidectomy is also helpful in preventing further
complications of mastoiditis. These include meningitis (infection in the fluid
surrounding the brain), brain abscess (pocket of infection in the brain), or
blood clots in the veins of the brain.
Mastoidectomy is often indicated for other diseases that spread to the
mastoid bone, such as CHOLESTEATOMA. This procedure allows complete
removal of these benign yet destructive growths. Occasionally, a
mastoidectomy may be used to help find and repair an injured FACIAL
NERVE.

Morbidity and mortality rates In the United States, death from

intracranial complications of cholesteatoma is uncommon due to earlier
recognition, timely surgical intervention, and supportive antibiotic therapy.
Cholesteatoma remains a relatively common cause of permanent, moderate,
and conductive hearing loss. According to the American Society for
Microbiology, middle ear infections increased in the United States from
approximately three million cases in 1975 to over nine million in 1997.
Middle ear infections are now the second leading cause of office visits to
physicians, and this diagnosis accounts for over 40% of all outpatient
antibiotic use. Ear infections are also very common in children between the
ages of six months and two years. Most
children have at least one ear infection
before their eighth birthday.
 SURGICAL PROCEDURE

Mastoidectomy ( Mastoid Surgery ):

A mastoidectomy is performed with the patient fully asleep (under

general anesthesia). A surgical cut (incision) is made behind the ear.
The mastoid bone is then exposed and opened with a surgical drill. The
infection or growth is then removed. The incision is closed with stitches
under the skin. A drainage tube may also be placed.

Depending on the amount of infection or cholesteatoma present,

various degrees of mastoidectomies can be performed.

In a simple mastoidectomy, the surgeon opens the bone and removes

any infection. A tube may be placed in the eardrum to drain any pus or
secretions present in the middle ear. Antibiotics are then given
intravenously (through a vein) or by mouth.

A radical mastoidectomy removes the most bone and is indicated for

extensive spread of a cholesteatoma. The eardrum and middle ear
structures may be completely removed. Usually the stapes (the
"stirrup" shaped bone) is spared if possible to help preserve some
hearing.

A modified radical mastoidectomy means that some middle ear bones

are left in place and the eardrum is rebuilt (TYMPANOPLASTY). Both a
modified radical and a radical mastoidectomy usually result in less than
normal hearing.

A hospital stay is usually required overnight for children.

Bleeding and/or infection of the wound area are possible complications

with any incision. Antibiotics and good surgical technique help prevent
this. Some blood-tinged drainage is common in the first two days.

Other complications can include injury to the balance system, hearing

loss, or FACIAL NERVE INJURY. Dizziness or a ringing in the ear
(tinnitus) could also result.

Your doctor will discuss the possibility of these complications with you
prior to your child's surgery.

A mastoidectomy is the surgical removal of these mastoid air cells; the

surgery may extend into the middle ear.

A mastoidectomy is performed with the patient fully asleep under

general anesthesia. There are several different types of mastoidectomy
procedures, depending on the amount of infection present:

• Simple (or closed) mastoidectomy. The operation is performed

through the ear or through a cut (incision) behind the ear. The
surgeon opens the mastoid bone and removes the infected air
cells. The eardrum is incised to drain the middle ear. Topical
antibiotics are then placed in the ear.
• Radical mastoidectomy. The procedure removes the most bone
and is usually performed for extensive spread of a cholesteatoma.
The eardrum and middle ear structures may be completely
removed. Usually the stapes, the "stirrup" shaped bone, is spared
if possible to help preserve some hearing.
• Modified radical mastoidectomy. In this procedure, some middle
ear bones are left in place and the eardrum is rebuilt by
tympanoplasty.
•

After surgery, the wound is stitched up around a drainage tube and a

dressing is applied.
 DEFINITION OF TERMS:

 MaStoidectomy = an operation to remove some or all of the air

cells in the bone behind the air when they have been infected or
invaded by cholesteatoma

 Mastoiditis = inflammation of the mastoid process and mastoid

cell

 Cholesteatoma= ear condition caused by cholesterol mass: a

potentially dangerous condition of the middle ear in which a mass
of cholesterol and skin scaleforms, grows, and invades the local
structures including bone

 Tympanoplasty= eardrum surgery; surgical repair of the

eardrum, usually in order to close a perforation

 Facial nerve= 7th cranial nerve controlling face muscles

 Meninges= the three membranes that surround and protect he

brain and the spinal cord, called the arachnoid mater, dura mater
and pia mater

 Aditus ad antrum= opening of the tympanic cavity to the air

spaces of the mastoid process

 Pneumatization= presence of air-filled cavities in bone, such as

the sinuses of the skull

 Antrum= a cavity within a bone, especially a sinus cavity

 ANATOMY AND PHYSIOLOGY:

An infection of the mastoid air

cells that cannot be controlled with antibiotics may call for surgical treatment.
 A mastoidectomy is the
surgical removal of these mastoid air cells; the surgery may extend into the middle
ear.

The temporal (mastoid) bone sits at the back of the ear and is composed of 4
portions

1. The petrous temporal bone

2. The squamous temporal bone (mastoid)
3. The styloid process
4. The tympanic ring

The mastoid air cells exist within the squamous and petrous temporal bone.
There is variation in the pneumatisation (aeration) of these air cells but they
are in continuity with the middle ear via a connection called the aditus ad
antrum. Within the mastoid the facial nerve runs a course firstly in the middle
ear then descending down in the mastoid to exit in the stylomastoid foramen
and then to enter into the parotid gland.

The mastoid air cells not only run close to the facial nerve but are also
intimate with a thin plate of bone superiorly (tegmen) that abuts the
meninges and posteriorly bone overlying the sigmoid sinus that drains into
the internal jugular vein.
PATHOPHYSIOLOGY:

Host factors include

mucosal immunology,
temporal bone anatomy,
and systemic immunity

microbial factors include the

protective coating,
antimicrobial resistance, and
ability of the pathogen
Penetrate local tissue or
vessels
 Mastoiditis

NURSING RESPONSIBILITIES:
 Postoperative instructions for a patient who ay vary a
undergone middle ear and mastoid surgery may vary among
otolaryngologists. General teaching guidelines for the patient
may include:

• Take antibiotics and other medications as prescribed

• Avoid nose blowing for 2 to 3 weeks after surgery

• Sneeze and cough with mouth open for a few weeks

after surgery

• Avoid heavy lifting(>10lb), straining and bending over a

few weeks after surgery

• Popping and crackling sensations in the operative ear

are . normal for approximately 3 to 5 weeks after
surgery

• Temporary hearing loss is normal in the operative ear

due to fluid, blood, or packing in the ear .
• Report excessive or purulent ear drainage to the
physician

• Avoid getting water in the operative ear for 2 weeks

after surgery. You may shampoo the hair for 2 to 3 days
postoperatively if the ear is protected from water by
saturating a cotton ball with petroleum jelly and loosely
p lacing it in the ear . if the post auricular suture line
becomes wet, pat the area and cover it with a thin layer
of antibiotic ointment.

and contains air cells which

INSTRUMENTAL
PICTURE A
mastoidectomy is the
removal of bone from the

drain into
the
middle
ear.
mastoid process. This process There
is located behind the ear canal removal
becomes necessary if they are
iseased or if a cholesteato
a, an in fected skin cyst in
he m i
le ear and mastoid,  is present.
The operation first involves e
osure of the mastoid tip using
a periosteal elevator and re
oval of the mast d bone using a
utting bur.  The picture to
he right shows a cutting b
rr with everal flutes.  A wire
brush will sometimes be requi
ed to remove bone dust from t
e flutes.   The picture on the
eft shows a diamond burr whic
has been us ed
during surgery.  Note the loss
of some of the diamonds on th
burr's head.  Diamond bur
s are us ed in approaching vita
structures such as t
r l often rip or damage the eardru
a .    At the end of the oper
erves and the dur
. A blunt probe is oft
n used to palpate area
to determine i
they are mucos
ontaining mastoi
air cells or dura (th
lining of the bra
n).          While
the surgeon dril
water irrigation
ill bathe the bone to
revent it from becomi
g burnt.   Some
rills have water riga
ion built into them, if not,
uction irrigators will have to
be used.  These are suctions with
two ports one for suction and the
other for water -- see pictur
on right.   The st ength of the
ater flow is titrated with a val
the valve.  Otherwise you will ha
e to re-titrate the wate
every
me d
illing
rest
rts.
The ossi
les often
ave to b
rem
ved and
joint knif
s or a ta
knif
is u ed to remove the incus. 
If possible, the stapes is le
t intact.  The head of t
e malleusis removby cutting t
e neck of the malleus.  The manubr
um is thattachment of the ma
leus to the eardrum and this is n
t removed because to do so wi
tion a mastoid dressing
is applied which cons
st of fluffs placed
over the ear and held i
place by Kerlix or Klin
auze.  The most im
ortant thing to re
ember about a mastoid
dressing is not to place it too
tight r skin necrosis ofthe f
rehead and scal
m
y occur
mastoid dressing is applied
which consist of fluffs placed
over the ear and held in place
by Kerlix or Kling Gauze. The
most important thing to
remember about a mastoid
dressing is not to place it too
tight or skin necrosis of the
forehead and scalp may occur

REFERENCE:

BOOKS

Fisch, H. and J. May. Tympanoplasty, Mastoidectomy, and

Stapes Surgery. New York: Thieme Medical Pub., 1994.

Cristobal, F., Gomez-Ullate, R., Cristobal, I., Arcocha, A.,

and R. Arroyo. "Hearing results in the second stage of open
mastoidectomy: A comparison of the different techniques."
Otolaryngology - Head and Neck Surgery 122 (May 2000):
350-351.

Garap, J. P., and S. P. Dubey. "Canal-down mastoidectomy:

experience in 81 cases." Otology & Neurotology 22 (July
2001): 451-456.

Jang, C. H. "Changes in external ear resonance after

mastoidectomy: open cavity mastoid versus obliterated
mastoid cavity." Clinical Otolaryngology 27 (December
2002): 509-511.

Kronenberg, J., and L. Migirov. "The role of mastoidectomy

in cochlear implant surgery." Acta Otolaryngologica 123
(January 2003): 219-222.

ORGANIZATIONS

American Academy of Otolaryngology-Head and Neck

Surgery, Inc. One Prince St., Alexandria VA 22314-3357.
(703) 836-4444. http://www.entnet.org .

American Hearing Research Foundation. 55 E. Washington

St., Suite 2022, Chicago, IL 60602. (312) 726-9670.
http://www.american-hearing.org/ .
www.surgeryencyclopedia.com

www.pediatric-ent.com/learning/

www.entusa.com/mastoid_surgery.htm

:
http://www.nlm.nih.gov/medlineplus/ency/article/003016.ht
m

BRUNNER & SUDDDARTH’ S (MED-SURG)

Case study
‘‘MASTOIDECTOMY’’’

Submitted by:

NECESITO, WINDY MAE D

STUDENT

Submitted to: