NCLEX Review Guide: Mastoiditis

Understanding Mastoiditis

• Mastoiditis is an infection of the mastoid air cells located in the temporal bone behind the ear, typically occurring as a complication of untreated or inadequately treated acute otitis media.
• The infection spreads from the middle ear through the eustachian tube blockage, causing inflammation and potential bone destruction in the mastoid process.
• Most commonly affects children under 2 years old, but can occur in adults with compromised immune systems or chronic ear infections.

Assessment Findings

• Classic triad: ear pain, fever, and tenderness over the mastoid process with possible swelling and erythema behind the affected ear.
• Purulent otorrhea (drainage from ear) that may be foul-smelling, along with hearing loss on the affected side.
• Red flag symptoms: severe headache, altered mental status, or neck stiffness indicating possible intracranial extension.

Diagnostic Workup

• CT scan of temporal bones is the gold standard for diagnosis, showing fluid in mastoid air cells and possible bone erosion.
• Culture and sensitivity of ear drainage to identify causative organism and guide antibiotic therapy.
• Complete blood count typically shows elevated WBC count with left shift indicating bacterial infection.

Treatment Interventions

1. IV antibiotics are first-line treatment, typically high-dose penicillin or cephalosporins for 2-3 weeks
2. Surgical intervention (mastoidectomy) may be required if medical management fails or complications develop
3. Pain management with analgesics and warm compresses to affected area
4. Monitor for complications including meningitis, brain abscess, or facial nerve paralysis

Priority Nursing Interventions

• Monitor neurological status every 2-4 hours for signs of intracranial complications including changes in level of consciousness, pupil response, and motor function.
• Administer prescribed antibiotics on schedule and monitor for therapeutic response and adverse effects.
• Provide pain relief measures and assess effectiveness using appropriate pain scales.
• Educate patient/family about importance of completing full antibiotic course even if symptoms improve.