What is mastoiditis? Is a mastoidectomy the preferred treatment? What is involved in a mastoidectomy?
Thank you
Reply: -------------------------
Mastoiditis is an infection involving the mastoid. The mastoid is an area in the temporal bone of the skull. The temporal bone houses the middle and inner parts of the ear. The mastoid is pneumatized meaning it has a labyrinth of air cells similar to the inside of a honeycomb. These air cells communicate with the middle ear that contains the small ear bones that conduct sound from the ear drum to the inner ear. The middle ear in turn communicates with the eustachian tube. When infection develops in the middle ear, it can extend into the mastoid. When infection becomes trapped in the mastoid it is known as mastoiditis. Fortunately, mastoiditis is uncommon in this day and age because of antibiotic therapy.
Some of the characteristic findings with mastoiditis include high fever, ear pain, hearing loss, and significant swelling behind the ear such that the outer ear appears to be sticking outward. Occasionally the face may become paralyzed because of involvement of the facial nerve which courses through the mastoid. A diagnosis of mastoiditis warrants hospitalization with CT scan assessment and administration of IV antibiotics. If the ear drum is intact, a myringotomy is generally performed to allow drainage of the infection. It is occasionally necessary to do a more involved operation known as a mastoidectomy if complications develop such as epidural abscess or meningitis.
A mastoidectomy involves making an incision behind the ear and lifting the ear forward. The bone overlying the mastoid is then removed with a drill and the infection is then removed. The operation is fairly complex and is performed largely under a microscope. Risks include injury to the facial nerve or inner ear although these are uncommon. An outer pressure dressing is then worn for 1-2 days after surgery. The surgery is occasionally performed as an outpatient in adults but usually involves hospitalization.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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