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PubMed2002

[Acute mastoiditis: an increasing entity].

BACKGROUND: Mastoiditis used to be the most common complication of acute otitis media. However, once antibiotics became widely available, it was rarely reported. Recently, this complication has become more frequent. OBJECTIVES: To determine the frequency of acute mastoiditis in our center in the last few years and to analyze the clinical and bacteriologic characteristics of the patients with this diagnosis. METHODS: Retrospective analysis of all patients admitted to our hospital with a diagnosis of acute mastoiditis from 1994-2001. RESULTS: One hundred patients were diagnosed with acute mastoiditis during the study period. The mean age was 2 years and 10 months (range: 2 months-13 years) and the median age was 15 months. The mean number of episodes was 12.5 cases of acute mastoiditis per year, but 52 % of the cases occurred from 1999-2001. Culture of middle ear effusions was performed in 47 patients, revealing Streptococcus pneumoniae in 17, Haemophilus influenzae in 3, and other pathogens in 10 children. Cultures were sterile in 17 patients. Three children did not respond to medical therapy and required mastoidectomy. CONCLUSIONS: In the last few years, the incidence of acute mastoiditis in our population has increased considerably. This complication is more common in children aged less than 2 years.

Acute Disease↗

PubMed1992

[Mastoiditis--a forgotten disease?].

The symptoms and clinical course of latent mastoiditis in 18. children treated in Polish-American Children's Hospital in Cracow were presented. The ultimate diagnosis of mastoiditis was based on typical findings on antrotomy and the presence of granulation on histology of the tissue obtained during the operation. The main symptoms of latent mastoiditis were: a lack of appetite, chronic or recurrent fever and failure to thrive. 11 children (61%) had experienced more than 3 episodes of acute otitis media before the diagnosis of mastoiditis was established. Bacteria most commonly isolated from the middle ear were those of Staphylococcus, Streptococcus and Proteus species. Radiograms of mastoid processes were negative in up to 45% of those children. The mean duration of antibiotic therapy was 10.7 weeks. After antrotomy complete dissolution of symptoms were observed in 14 patients (78%). It is concluded, that in the presence of symptoms suggesting latent mastoiditis, the possibility of antrotomy, which may shorten the period of ineffective antibiotic therapy, should be considered earlier.

Humans↗

PubMed1998

5-year series of constricted (lop and cup) ear corrections: development of the mastoid hitch as an adjunctive technique.

Despite the multitude of corrective procedures described, adequate surgical correction of the congenital constricted ear remains a challenge. The maintenance of the shape and elevation of the reconstructed upper neohelix poses a particular problem. In the present series, experiences with lop ear correction utilizing standard techniques and the use of the mastoid hitch as a useful adjunct to these procedures are described. A total of 19 ears were reconstructed. There were three type 1, eight type 2a, seven type 2b, and one type 3 deformities (Tanzer classification). A graded sequence of procedures was adopted. Mild deformities were corrected by cartilage scoring techniques; a V-Y advancement of the helical root was added for moderate deformities. Cartilage expansion by a banner flap was required for more severe deformities. A mastoid hitch, whereby the refashioned upper neohelix is sutured to the mastoid fascia, should be used as an adjunct to these procedures to maintain helical elevation and prevent recurrence. Severe type 3 deformities may require autologous auricular reconstruction. Mean follow-up time was 1 year. There were six excellent, seven good, four fair, and two poor results. Two patients who had not had mastoid hitch procedures developed a recurrence of the lop deformity. Adequate surgical correction of constricted ear deformities requires a variety of surgical techniques. The mastoid hitch being used for constricted ear correction has not been described elsewhere. The mastoid hitch is a useful adjunctive procedure that may be used effectively in combination with other procedures.

Adolescent↗

PubMed2007

[Acute mastoiditis today].

Acute mastoiditis is an acute inflammation of the mastoid process with bone erosion. It is a complication of acute otitis media, which is rare but with increasing incidence. Distinct characteristics are an erythema and oedematous swelling of the skin of the mastoid process. A fluctuant swelling points to a subperiosteal abscess. Laboratory examination and imaging only support the diagnostics. Therapy involves obligatory systemic antibiotic treatment. At the beginning of the inflammation a paracentesis can be sufficient. A mastoidectomy must be carried out if clear signs of an osseous necrolysis, such as a subperiosteal abscess, are present. The most frequent causative agents are gram positive cocci. Intraoperative smears are best suitable for microbiological diagnostics. Complications of acute mastoiditis are encroachments of the inflammation on neighbouring structures of the mastoid. In such cases a tomography is indicated and therapy is usually surgical.

Acute Disease↗

PubMed1984

Acute myelogenous leukemia presenting as atypical mastoiditis with facial paralysis.

Symptomatic otologic involvement by leukemic infiltration is unusual, most often occurring in the already-diagnosed leukemic patient as postauricular mass, acute hemorrhagic otitis media, mastoiditis, cranial neuropathy, vertigo, hearing loss, or leptomeningitis. We think ours is the first reported patient whose leukemia presented as atypical mastoiditis and facial paralysis due to granulocytic sarcoma (chloroma). At mastoidectomy, tan lobulated rubbery tumor filled the mastoid antrum and middle ear cleft. Complete remission and full return of facial nerve function was achieved with 2500 R local radiation and systemic chemotherapy. We discuss the role and extent of surgery in atypical acute mastoiditis when unsuspected middle ear and mastoid tumor, with inconclusive intra-operative histopathologic data, is found.

Adolescent↗

PubMed1991

Mastoid surgery at the Red Cross War Memorial Children's Hospital 1986-1988.

Eighty-three children between ages 0-12 years had mastoid surgery in the three year period 1986-88. The indications were acute mastoiditis (30 children), uncontrolled chronic suppurative otitis media (CSOM) (24 children), cholesteatoma (22 children) and a miscellaneous group (7 children). Forty-seven per cent of those with acute mastoiditis were under one year but the 27 per cent with cholesteatoma as the precipitating cause were 4-12 years. Twenty-three per cent had significant complications. Typmano-mastoid surgery was employed to resolve uncontrolled CSOM. Children were between 2-12 years and 62 per cent were below the 25th centile for weight. Seventy-nine per cent of the tympanic membrane grafts were successful. The children with cholesteatoma were between 3-12 years and 76 per cent were below the 25th centile for weight. Eight of them only presented after the onset of acute mastoiditis. One child had a definite congenital cholesteatoma. Only one had a pars flaccida origin of the cholesteatoma sac and only eight an origin from the postero-superior pars tensa. All had open cavity surgery. When the cavity was lined by temporalis fascia, healing was improved markedly.

Acute Disease↗

PubMed2002

[Therapy of acute mastoiditis].

BACKGROUND: Acute otitis media is a common disease, mostly contracted at childhood. The development of acute mastoiditis has been decreased since the introduction of antibiotics. Currently it is only developed in 0.004 % cases of acute otitis media. But despite of this fact, even today one should not neglect this condition as the complications such as intracranial spread and lateral sinus thrombosis are still life threatening. METHODS AND PATIENTS: In a retrospective study from 01/96 - 09/00 we reviewed the cases of acute mastoiditis as a result of acute otitis media at our department. Additionally we compared study results out of 1972 until 1989 with our current results. RESULTS: Altogether mastoidectomy has been carried out at 157 patients. The cases have steadily increased since 1996. This is confirmed by comparison with study results of previous years. The majority of the patients were between 8 months and 3 years old (60 %). When the patients first presented at our department, the first signs of otitis media were 19.5 days ago in average. 38 % of the patients received no antibiotic treatment before admission. A thickened mucous membrane was seen by the mastoidectomy mostly (58 %). A subperiostal abscess we noted in 8.5 %. The most common isolated bacteria were Streptococcus pneumoniae (33 %) and Streptococcus pyogenes (11 %). The patients stayed at the department about 10 days. In comparison to recent study results the "typical" mastoiditis has decreased. The causative pathogens have not changed. CONCLUSIONS: In the last years we realised an increasing number of mastoiditis at our department. The isolated bacteria are the same as presented in the literature. Early surgery combined with an effective antibiotic treatment can avoid the known complications of mastoiditis.

Acute Disease↗

PubMed2004

Bacteriology of mastoid subperiosteal abscess in children.

OBJECTIVE: Subperiosteal abscess (SA) is the most frequent complication of acute mastoiditis (AM). Of pathogens cultured from the external auditory canal or middle ear during myringotomy, 15% may be different from microorganisms isolated from the SA. We suggest, therefore, that only cultures obtained from the abscess cavity can truly reflect the bacteriology of this complication of AM. The purpose of our study was to analyze the infectious agents which cause SA and mastoid cortex erosion in children. MATERIAL AND METHODS: The medical records of 35 children who underwent mastoidectomy for SA between May 1984 and April 2002 were evaluated. RESULTS: Mastoid cortex erosion was found at surgery in 72.7% of abscesses Purulent discharge was obtained from the SA cavity in 28 cases. The commonest pathogens isolated in these cases, as well as in 18 cases of mastoid cortex erosion, were Staphylococcus aureus and Streptococcus pyogenes, followed by Streptococcus pneumoniae. Hemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae. Sterile culture was found in 25% of cases. CONCLUSIONS: Mastoid SA is a unilateral disease that can recur. Early administration of anti-Staphylococcus medications should be considered for patients with SA as a complication of AM.

Abscess↗

PubMed1999

A technique of mastoidectomy and meatoplasty that minimizes factors associated with a discharging mastoid cavity.

OBJECTIVES: To present and assess a surgical technique designed to minimize the known causes of a discharging mastoid cavity. STUDY DESIGN: A temporal bone dissection to establish the anatomical relationships on which the surgical technique is based. A presentation of the proposed surgical technique and a prospective assessment of the technique in twenty consecutive mastoidectomies. METHODS: Five temporal bone dissections were performed to establish the relationship between the chorda tympani and the facial nerve when these structures are approached from above. The surgical technique is presented and the mastoid cavities of twenty consecutive patients assessed. The assessment included measurement of the facial ridge height, "kidney-shape" of the cavity, size of the cavity, size of the meatus, and state of the tympanic membrane. RESULTS: In the temporal bone dissections the vertical height between the chorda tympani and the facial nerve at 3/9 o'clock was a mean of 2.01 mm. Nineteen of the 20 consecutive mastoid cavities (95%) performed with the presented technique remained well healed and dry. The mean facial ridge height was 2.7 mm at 3/9 o'clock and 4.8 mm at 6 o'clock. The kidney-shaped measurement was 1.45 mm. The mean size of the cavities was 2.6 mm and 18 of the 20 patients (90%) had an intact tympanic membrane. The mean largest diameter of the meatus was 10.1 mm. CONCLUSIONS: The surgical technique presented produces a mastoid cavity with a low facial ridge and oval shape. These two factors have been previously identified as important in the outcome of mastoid surgery.

Adolescent↗

PubMed2000

Mastoiditis and acute otitis media in children with cochlear implants: recommendations for medical management.

Acute otitis media (OM) or mastoiditis is a very dangerous condition for the ear after cochlear implantation. However, acute OM is very common in childhood and can occasionally occur in an implanted ear. Most cases of acute OM can be successfully treated with intravenous high-dosage antibiotics. In cases of mastoiditis and clinical signs of mastoid abscess, retroauricular drainage is necessary to prevent infection of the implant bed. In a series of 366 children given implants (1 to 14 years), acute OM occurred in 5.6% during a follow-up period of 1 to 8 years. Seven ears had to be opened by means of myringotomy. Five ears were opened by retroauricular incision with mastoid revision on the implanted side. Adenoidectomy and use of ventilation tubes before cochlear implantation, as well as careful subtotal mastoidectomy during the implantation, can reduce the incidence of acute OM in children after implantation. Early and subsequent treatment with operative mastoid drainage can prevent implant loss and should be performed at the implantation center.

Acute Disease↗

PubMedDate not supplied

Primary carcinoma of the mastoid bone.

The diagnosis of carcinoma primary in the mastoid bone is usually made while performing a mastoidectomy in an effort to control presumed chronic mastoiditis. The association of chronic infection, serosanguineous otorrhea, and severe otalgia, common warning signs of carcinoma of the middle ear or external auditory canal, may or may not be present with a carcinoma primary in the mastoid bone. If the amount of bony mastoid destruction seen by roentgenography is out of proportion to the degree of clinical infection, malignancy should be strongly suspected. The authors present a case of primary carcinoma of the mastoid bone, and review the diagnosis and treatment.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

[Problems of diagnosis and treatment of atypical mastoiditis].

The specific features of the diagnosis and therapy of the dry form of atypical mastoiditis are discussed. Of great diagnostic importance were local changes in the mastoid area, otoscopic signs in the posterior-superior tympanic membrane and bone compartment of the auditory meatus, hearing impairment, thermographic signs of purulent-destructive lesions in the antrum and other cells of the mastoid process, and X-ray symptoms of bone destruction of the mastoid process. It is obvious that the clinical picture and development of atypical mastoiditis are closely related to the age and reactivity of the patient, irrational use of antibiotics and physiotherapy, concomitant diseases, especially endocrine pathologies.

Acute Disease↗

PubMed1995

[Latent, non-suppurative mastoiditis. Apropos of 62 cases].

The term masked mastoiditis defines a subclinical infectious inflammatory process of the mucosal lining and bony structures of the mastoid air cells with an intact tympanic membrane. The disease follows an apparently well treated recent acute otitis media. Probably due to an anaerobic colonizing flora, the developing bone infection is of low grade without pus formation. The clinical features of the disease are not overt as those in coalescent mastoiditis. The intact ear drum does not reflect the severity of bone eroding disease which is characterized by non-exudative but proliferative changes. Hence there is no pus formation. The incidence of complications is high. Plain X-ray film and CT scan do not specifically define the disease process. Bone scan indicates the bone invading nature of the mastoid infection. The osteoblastic reaction secondary to osteitis is demonstrated by the high uptake of the isotope in the involved mastoid. Antibiotics may cure the disease process but in most of the cases surgery in unavoidable.

Adolescent↗

PubMed1980

Acute mastoiditis after a combined approach tympanoplasty operation.

Four of 112 ears on which a combined approach tympanoplasty (CAT) operation was performed had acute mastoiditis six to 24 months after operation. All four patients were younger than 13 years. This represents 12.5% of acute mastoiditis cases after CAT operations in this age group, or 3.5% of the total group. On reoperation, all four ears expressed pus under pressure in the mastoid cavity. There was also fibrosis and granulation tissue blocking the attic inlet. It is probable that the cause of the acute mastoiditis may be related to this partial or total stenosis. Two of the patients were found to have an aerated, noninflamed tympanic cavity, and only in two was the acute mastoiditis associated with residual cholesteatoma.

Acute Disease↗

PubMed1996

A contemporary analysis of acute mastoiditis.

BACKGROUND: Acute mastoiditis persists as a serious infection despite a dramatic decline in incidence coincident with the introduction of antibiotic therapy. OBJECTIVE: To assist the contemporary practitioner in the recognition and management of acute mastoiditis through the assessment of a large series of patients. DESIGN: Retrospective case series comprising 124 patients with acute mastoiditis. SETTING: Pediatric and adult otology referral center. MAIN OUTCOME MEASURES: Selected clinical parameters. Risk factors for necessity of surgical intervention and for increased length of hospitalization were analyzed by a stepwise logistic regression model. RESULTS: A history of antecedent acute otitis media was absent in 45% of patients. Pain (98%) was the most common presenting symptom. Physical signs included an abnormal-appearing tympanic membrane (88%), fever (83%), a narrowed external auditory canal (80%), and postauricular edema (76%). Streptococcus pneumoniae was the most commonly isolated organism. Mastoid surgery was required in 62% of the patients. An elevated white blood cell count (relative risk [RR], 7.4; P < .01), proptosis of the auricle (RR, 4.5; P = .03), and fever on admission (RR, 7.3; P = .05) were risk factors for surgical intervention. All 33 patients with complications (27%) proceeded to surgical intervention. The average length of hospital stay was 7.9 days. The strongest predictor for an increased length of hospital stay was whether the patient required surgery (RR, 3.7; P = .002). CONCLUSIONS: Acute mastoiditis remains a potentially serious otologic infection. Not all patients present with a classic history or physical examination. Therapeutic mastoidectomy is often required.

Acute Disease↗

PubMed1994

Mastoid pneumatization in patients with unilateral aural atresia.

Debate continues regarding theories of the control of temporal bone pneumatization. The "hereditary theory" holds that mastoid size is independent of status of the mesotympanum. The "environmental theory" holds that the size of the mastoid air cell system is determined by the degree of pathological involvement of the middle ear during childhood: that is, an abnormal middle ear prompts a small mastoid. This report concerns the volume of temporal bone pneumatization in patients with unilateral aural atresias, involving a malformed mesotympanum and absence of the external ear canal. Computed tomograms of the temporal bones were available for 16 patients. The mastoid pneumatization volumes of the atretic/non-atretic sides were approximately equal (Spearman's r = 0.80, P < 0.01) but not symmetrical. In 12 patients, the atretic side had less pneumatization than did the non-atretic side; in 3, the atretic side had more pneumatization; and, in 1 patient, neither mastoid had any pneumatization. Such a non-symmetrical pattern is unlikely by chance (P < 0.04). These data can be interpreted to endorse both the hereditary and environmental theories of temporal bone pneumatization.

Adolescent↗

PubMed2006

Acute mastoiditis in infants.

We present a retrospective study of 37 infants who were operated for acute mastoiditis during the period 2000-2004 in Mother and Child Health Care Institute, Belgrade, Serbia and Montenegro. About 23 patients (62.2%) were male and 14 (37.8%) were female. Acute mastoiditis developed just after the first infection of the middle ear in 26 patients (70.3%). All patients had local and general symptoms. The most common local symptoms were blurred tympanic membrane in all patients, painful tenderness of mastoid in 21 (57%) and redness of tympanic membrane in 13 (36%). General signs of infection were loss of body weight in 28 (75.7%) patients, fever in 21 (56.8%), vomiting in 19 (51.3%), diarrhea in 19 (51.3%) and severe anemia that requested red blood cell transfusion in 6 (16.2%). Suppuration did not appear in any of the patients. Tympanocentesis had been performed prior to surgery in all patients. The most frequently isolated causative microorganism was Streptococcus pneumoniae which was found in 12 (32.5%) patients, Staphylococcus aureus was found in 8 (21.5%) and Hemophilus influenzae in 2 (5.5%). In 15 (405%) patients there was no bacterial isolation. Eleven patients (29.7%) who had previously had acute otitis media were implanted ventilation tubes during the surgical intervention. All patients were treated with antibiotics prior and after the surgical intervention. The finding on mastoidectomy was positive in all cases. According to the results of our study the combination of antibiotic and surgical treatment is optimal in treating acute mastoiditis. Making a diagnosis of acute mastoiditis might not be easy since there are no specific symptoms. We emphasize that it should always be considered as a differential diagnosis in cases of prolonged acute otitis media with no improvement after 10 days of antibiotic treatment, especially when accompanied with weight loss and general condition worsening.

Acute Disease↗

PubMed1982

Complications of mastoiditis with special emphasis on venous sinus thrombosis.

Two children with intracranial venous sinus thrombosis complicating mastoiditis prompted review of the experience with these disorders at the The Children's Memorial Hospital in Chicago over the past decade. Fifteen patients, 1.5 to 14 years of age, with mastoiditis were identified, including nine cases categorized as acute and six as chronic, the latter without fever but with chronic otorrhea. All six patients with chronic, but none with acute, mastoiditis were found to have cholesteatomas. Venous sinus thrombosis developed in four children and intracerebellar abscess in one child. Contrast-enhanced computerized tomography has proved valuable in the diagnosis of these rare, serious complications of mastoiditis in recent patients. Arteriography is still desired to confirm venous patency or occlusion prior to surgery because of well-documented developmental variations in venous drainage patterns. Optimal therapy of mastoiditis and its complications generally requires surgical drainage in addition to administration of antibiotics.

Adolescent↗