The Patient Undergoing Mastoid Surgery
- During the health history, collect data about the ear problem, including infection, otalgia, otorrhea, hearing loss and vertigo, duration and intensity, causation, prior treatments, health problems, current medications, family history, and drug allergies.
- During the physical assessment, observe for erythema, edema, otorrhea, lesions, and odor and color of discharge.
- Review results of audiogram.
Nursing Diagnoses
- Anxiety related to surgical procedure, potential loss of hearing, potential taste disturbance, and potential loss of facial movement
- Acute pain related to mastoid surgery
- Risk for infection related to mastoidectomy, placement of grafts, prostheses, or electrodes; surgical trauma to surrounding tissues and structures
- Disturbed auditory sensory perception related to ear disorder, surgery, or packing
- Risk for trauma related to impaired balance or vertigo during the immediate postoperative period, or from dislodgment of the graft or prosthesis
- Disturbed sensory perception related to potential damage to facial nerve (cranial nerve VII) and chorda tympani nerve
- Deficient knowledge about mastoid disease, surgical procedure, and postoperative care and expectations
Major goals for the patient undergoing mastoidectomy include reduction of anxiety; freedom from pain and discomfort; prevention of infection; stable or improved hearing and communication; absence of vertigo and related injury; absence of, or adjustment to, sensory or perceptual alterations; and increased knowledge regarding the disease, surgical procedure, and postoperative care.
Reducing Anxiety
- Reinforce information that the otologic surgeon has discussed: anesthesia, the location of the incision (postauricular), and expected surgical results (hearing, balance, taste, and facial movement).
- Encourage patient to discuss any anxiety or concerns.
Relieving Pain
- Administer prescribed analgesic agent for the first 24 hours postoperatively and then only as needed.
- If a tympanoplasty is also performed, inform patient that he or she may have packing or a wick in the external auditory canal and may experience sharp shooting pains in the ear for 2 to 3 weeks postoperatively.
- Inform patient that throbbing pain accompanied by fever may indicate infection and should be reported to the physician.
Preventing Infection
- Explain the prescribed prophylactic antibiotic regimen to the patient; ear packing may contain antibiotic.
- Instruct patient to keep water from entering the ear for 6 weeks and to keep postauricular incision dry for 2 days; a cotton ball or lamb's wool covered with a water-insoluble substance (e.g., petroleum jelly) and placed loosely in the ear canal usually prevents water contamination during exposure.
- Observe for and report signs of infection (fever, purulent drainage).
- Inform patient that some serosanguineous drainage is normal postoperatively.
Improving Hearing and Communication
- Initiate measures to improve hearing and communication: Reduce environmental noise, face patient when speaking, and speak clearly and distinctly without shouting. Provide good lighting if patient must speech-read (also called lip-reading), and use nonverbal clues.
- Instruct family that patient will have temporarily reduced hearing from surgery as a result of edema, packing, and fluid in middle ear; instruct family in ways to improve communication with patient.
Preventing Injury
- Administer antiemetic or antivertiginous medications (e.g., antihistamine agents) as prescribed if a balance disturbance or vertigo occurs.
- Assist patient with ambulation to prevent falls and injury.
- Instruct patient to avoid heavy lifting, straining, exertion, and nose blowing for 2 to 3 weeks after surgery; this will help to prevent dislodging of the tympanic membrane graft or ossicular prosthesis.
Preventing Altered Sensory Perception
- Reinforce to patient that a taste disturbance and dry mouth may be experienced on the operated side for several months, until the nerve regenerates.
- Instruct patient to immediately report any evidence of facial nerve (cranial nerve VII) weakness, such as drooping of the mouth on the operated side.
Promoting Home- and Community-Based Care
- Provide instructions about prescribed medications: analgesic medications, antivertiginous agents, and antihistamine drugs for balance disturbance.
- Inform patient about the expected effects and potential side effects of the medications.
- Instruct patient about any activity restrictions.
- Educate patient to monitor for possible complications, such as infection, facial nerve weakness, or taste disturbances, including specific signs and symptoms; report these immediately to the surgeon.
- Refer patients, particularly elderly patients, for home care nursing.
- Caution caregiver and patient that patient may experience some vertigo and will therefore require help with ambulation to avoid falling.
- Stress the importance of scheduling and keeping follow-up appointments.
Expected Patient Outcomes
- Demonstrates reduced anxiety about surgical procedure
- Remains free of discomfort or pain
- Demonstrates no signs or symptoms of infection
- Exhibits signs that hearing has stabilized or improved
- Remains free of injury and trauma
- Adjusts to, or remains free of, altered sensory perception
- Verbalizes the reasons for, and methods of, care and treatment
For more information, see Chapter 64 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.