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PubMed1987

Bacteriology in acute mastoiditis.

During the period from July 1979 to December 1979, the bacteriology of 35 consecutive patients undergoing surgery for acute mastoiditis was studied. The patients' ages ranged from 3 to 13 years. All patients presented with a purulent otorrhea and a postauricular subperiosteal abscess and were subjected to a mastoidectomy within 12 hours of presentation. Specimens were obtained intraoperatively from the mastoid cavity and, using appropriate technology, were cultured for aerobic and anaerobic organisms. Bacteria were isolated from specimens of 32 patients (91.4%); specimens from three patients (8.6%) yielded no growth. Aerobes alone were cultured from four patients (11.4%); six patients' cultures (17.1%) yielded only anaerobes; and 22 patients' cultures (62.8%) had both aerobic and anaerobic organisms. Thus, anaerobes were cultured from a total of 28 patients (80.0%).

Acute Disease↗
PubMed2001

[Acute external mastoiditis in children: report of a series of 48 cases].

DESIGN: To determine the impact of the emergence of penicillin-resistant strains of pneumococci on the frequency of acute mastoiditis in children, and to assess the importance of laboratory and imaging studies in the treatment of acute mastoiditis. METHOD: Retrospective review of the medical records of children with postauricular swelling and otoscopic signs of acute otitis media from January 1993 through December 2000. RESULTS: Forty-eight children aged three months to 14 years (median 17 months) were identified. The number of cases was almost the same from one year to another. All children had bacteriological examinations. The mastoid pus and the otorrhea was sterile in 22 cases. The most frequent pathogen was Streptococcus pneumoniae (17 cases), which was resistant to penicillin in 71% of cases. The initial body temperature, the number of polymorphonuclears and the CRP were not different between the group of 18 children with periostitis, which required medical treatment alone, and the group of 30 children who had a mastoid abscess which required surgery. The difference between periostitis and mastoid abscess was seen on clinical examination and CTscan.

Abscess↗
PubMed2006

Preservation of the mastoid aeration and prevention of mastoid dimpling in chronic otitis media with cholesteatoma surgery using hyaluronate-based bioresorbable membrane (Seprafilm).

During mastoidectomy a hollow-cavity is formed within the mastoid bone after its cortex and air cells are removed. Postoperatively, the aerated cavity is usually filled with soft tissues. Also it is not so uncommon to see cases with retraction of the mastoid area skin into the cavity causing a cosmetic problem termed as mastoid dimpling. In order to achieve an aerated mastoid cavity and minimizing the mastoid dimpling, an adhesion barrier was utilized to prevent fibrous tissue formation within the cavity. Twenty-one patients with middle ear and/or mastoid cholesteatoma, who underwent tympanoplasty with mastoidectomy (canal wall-up) with staged procedures, were included in the study. The mastoid cavity was tented and covered with an adhesion barrier (hyaluranic acid and carboxymethylcellulose, Seprafilm, (Seprafilm, GENZYME Inc., Cambridge, MA, USA) at the end of the surgery. Postoperatively, in two cases serohemorrhagic fluid collected between the adhesion barrier membrane and the subcutaneous tissues requiring drainage. Second stages were performed 4-6 months after the first stage. Two residual cholesteatoma cases were present. Patients were followed for a minimum of 2 years after the second stage. Mean follow-up was 2 years and 5 months. No wound infection was encountered postoperatively. Late follow-up of minimum 2 years after the second surgery revealed cosmetically acceptable retroauricular area with no dimpling. Mild retraction in two cases and two micro-central perforations in the neotympanic membrane were found. CT scans obtained both prior to the second stage and at the end of the second year of second stage revealed fully aerated mastoid cavities covered with periosteum in its natural position. Mastoid cortex plasty with seprafilm offers a rapid and effective solution to the preservation of mastoid space and the preservation of the contours of the mastoid bone.

Air↗
PubMed1977

Eustachian tube function and size of the mastoid air cell system in middle ear surgery.

Myringoplasty results in patients with poor tubal function and small cell systems are often disappointing, to both patient and surgeon. Surgical procedures to improve tubal function have been introduced but they all have the disadvantage of being rather elaborate and difficult to perform. The mastoid air cell system on the other hand does not offer the same problems of access. With the concept of creating an air-filled cavity in connection with the middle ear, mastoidectomy was performed in myringoplasty cases with poor tubal function and small (less than 9 cm2 lateral area) cell systems. Preliminary results show a healing rate of 82% in patients managed according to these principles, against 50% in corresponding cases when myringoplasty alone was done.

Eustachian Tube↗
PubMed2006

Posterior canal wall reconstruction with a composite cartilage titanium mesh graft in canal wall down tympanoplasty and revision surgery for radical cavities.

OBJECTIVES: To investigate posterior external ear canal wall reconstruction with a composite cartilage titanium mesh graft in canal wall down tympanoplasty and revision surgery for open mastoids. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral centre. METHODS: As a preliminary study, 15 selected patients underwent reconstruction of a posterior ear canal wall defect with titanium mesh. Large defects of the posterior external auditory canal wall, resulting from canal wall down tympanoplasty or present in revision surgery, were eliminated by reconstruction using a titanium mesh. The mesh was covered with conchal cartilage and attached to the cortical mastoid bone using 3-mm titanium screws. RESULTS: All patients maintained a normal contour of the external ear canal, without depression, extrusion or infection. There were no failures, based on short-term post-operative controls. However, two procedures had to be revised due to incomplete coverage of the titanium mesh. CONCLUSIONS: This study shows that reconstruction of the posterior ear canal wall with a composite cartilage titanium mesh is a valuable method for preserving the morphology of the external auditory canal in selected cases. Problems occurring in canal wall down tympanomastoidectomy and radical cavities may therefore be avoided. However, long-term results have yet to be evaluated.

Adult↗
PubMed1996

Residual bacterial infection in the tympanic cavity following surgery for ears with chronic discharge.

In surgical treatment of ears with chronic discharge, pathogenic microorganisms may remain in the middle ear even after meticulous tympanomastoidectomy, and cause recurrent infection unless an appropriate antimicrobial agent is administered. The present study was conducted to determine the incidence of residual bacterial infection in the tympanic cavity by examining secretions from a drainage tube placed there via the mastoid cavity during surgery. Comparison of the bacterial flora before and after surgery demonstrated that some of the microorganisms continued to be present in the tympanic cavity for up to 2 weeks despite medication, and that the incidence of Pseudomonas aeruginosa and Staphylococcus epidermidis remained fairly high.

Adolescent↗
PubMed2001

Bone-anchored hearing aid quality of life assessed by Glasgow Benefit Inventory.

OBJECTIVE/HYPOTHESIS: The bone-anchored hearing aid (BAHA) is a well established mode of treatment and many studies show the audiological benefit, but none has assessed the benefit to the quality of life of patients. This study uses the validated Glasgow Benefit Inventory to quantify the changes in quality of life. STUDY DESIGN: Retrospective questionnaire study. METHODS: Sixty consecutive patients receiving treatment with BAHA were enrolled in the study. The male/female ratio was 1.26 to 1; mean patient age was 45 years. The most common indication was hearing loss secondary to mastoid disease and surgery followed by congenital atresia and chronic discharge from the ear. RESULTS: The response rate was 85%, which is high and adds weight to the results. The general benefit score was +34 (range, +27-+48), which is comparable to middle ear surgery but just below benefit from cochlear implantation. The social benefit was +21 (range, +12-+37) with only +10 (range, +2-+26) for the physical score. This pattern mirrors that reported for other ear interventions. Maximum benefit was noted in patients with congenital atresias followed by discharging mastoid cavities. CONCLUSION: This study is the first to demonstrate significant quality of life benefit from BAHA surgical intervention as measured by the Glasgow Benefit Inventory.

Adolescent↗
PubMedDate not supplied

Intracranial complications following mastoidectomy.

Mastoidectomy is a common surgical procedure in otology. However, postoperative complications of various degrees of severity may occur. We present 4 children who underwent mastoidectomy for middle ear and mastoid disease and developed postoperative intracranial complications. One child was operated on for brain abscess 1 week after the initial mastoidectomy. Another child appeared with seizures 5 days after the initial mastoidectomy and a subdural empyema was drained during revision surgery. Large bone defects with exposed middle cranial fossa dura were found at revision surgery in both cases and Proteus vulgaris and methicillin-resistant Staphylococcus aureus were isolated from the mastoid and abscess cavities in these children. A small epidural collection was diagnosed in the third patient 2 days after initial mastoid surgery and was managed with intravenous antibiotics only. The other child was found to have sigmoid sinus thrombosis the day after mastoidectomy that was performed for nonresponsive acute mastoiditis. This child received both intravenous antibiotics and anticoagulants. Timely revision surgery, combinations of third- or fourth-generation cephalosporins with vancomycin or metronidazole and the addition of anticoagulants in cases of sinus thrombosis can lead to full recovery.

Adolescent↗
PubMed1980

Middle ear tuberculosis.

Fourteen cases of tuberculous otitis media are reported. With the declining incidence of pulmonary tuberculosis, the number of reported cases of tuberculous otitis media has become scanty. Nowadays the so-called classical signs of the lesion such as a profuse discharge, profound hearing loss, facial paralysis and multiple perforations, are hardly ever seen. Surgical intervention when done under cover of anti-tubercular drugs has no deleterious effect on the result of surgery. In order not to miss tuberculous otitis media, whenever the otologist is dealing with chronic middle ear disease, the following points should always be kept in mind: (a) A dull ache in the ear without obvious inflammatory signs. (b) A whitish-grey appearance of the mucosa. (c) Bulging of granulation tissue from the mastoid cells during surgery.

Adolescent↗
PubMed1983

Tympanoplasty with mastoidectomy: present status.

There are many problem areas in tympanoplasty surgery. For the most part the extent of the problems relates directly to how vigorously one pursues a good functional result: the harder the surgeon tries, the more problems he may have. There are also many controversial areas in tympanoplasty, most of which relate to technique. In regard to tympanic membrane grafting and management of the sound pressure transfer mechanism, how well the surgeon performs the operation is far more important than which of the variety of techniques he uses. In relation to obtaining an air-containing mucous membrane-lined middle ear space and the management of the mastoid, there are many philosophical and emotional factors. There are many ways to manage the mastoid in cholesteatoma surgery, all of which can be successful if properly performed. We use all procedures but prefer the intact canal wall technique. The major advantage of the intact canal wall procedure is that the surgeon may avoid a post-operative mastoid cavity. The main disadvantages of this technique are the problems of recurrent and residual cholesteatoma, problems that necessitate a two-stage procedure in the majority of patients.

Cholesteatoma↗
PubMedDate not supplied

Actinomycosis of the central nervous system.

Actinomyces species are rare but treatable causes of CNS infection. Differentiation of actinomycosis from nocardiosis is crucial to the selection of appropriate antimicrobial therapy. A review of 70 cases of CNS actinomycosis was conducted in an effort to characterize clinicopathologic features and identify patients with a high risk of death from infection. Types of lesions included brain abscess (67%), meningitis or meningoencephalitis (13%), actinomycoma (7%), subdural empyema (6%), and epidural abscess (6%). Most infections developed from distant sites (lung, 19 cases; abdomen, four; pelvis, three) or contiguous foci (ear, sinus, and cervicofacial region, 21 cases). For nonmeningitic infection, signs and symptoms were generally those of a space-occupying lesion and were indistinguishable from the manifestations of other pyogenic infections except for a longer interval before diagnosis. Risk factors included dental caries; dental infection; recent tooth extraction; head trauma; gastrointestinal tract surgery; chronic otitis, mastoiditis, or sinusitis; chronic osteomyelitis; tetralogy of Fallot; and actinomyces infection of an intrauterine device. Optimal management combined adequate surgical drainage with prolonged antibiotic therapy (mean duration, 5 months). Overall mortality from treated infection was 28%; 54% of survivors had neurologic sequelae. Features correlated with a poor prognosis were disease onset greater than 2 months before diagnosis and treatment, no antibiotic treatment, no surgery, and needle aspiration drainage of abscess lesions.

Actinomycosis↗
PubMed1998

Combined mastoid/middle cranial fossa repair of temporal bone encephalocele.

Temporal bone encephalocele (TBE) has become less common as the incidence of chronic mastoid infection and surgery for this condition has decreased. Due to its declining incidence, the diagnosis of TBE may be delayed and result in the development of serious complications such as cerebrospinal fluid leak, meningitis, epidural or subdural abscess. Six cases of large (>1 cm) TBE of diverse etiology are described. Two patients had suffered previous temporal bone fractures, two had had prior mastoidectomy, and two patients had long-standing chronic mastoiditis. Two patients had undergone prior unsuccessful transmastoid repair. All patients underwent successful tegmen-dural repair with autogenous fascia, bone, and/or cartilage, primarily via a combined mastoid-middle fossa approach. Accurate dural closure and support of intacranial contents are imperative to prevent recurrence. We find that permanent repair can best be performed with a combined mastoid middle cranial fassa approach.

Journal Article↗
PubMed2004

[Management and prevention of persistent cerebrospinal fluid otorrhea induced by lateral skull base surgery].

OBJECTIVE: To summarize the pathogenesis, operative management and prevention of persistent cerebrospinal fluid otorrhea induced by lateral skull base surgery. METHOD: Based on the primary diseases and operations, different surgeries for the otorrhea repair were performed as follows: three cases by the mastoidal approach; one case by post-aural combined with translabyrinthine approach; one case by post-aural combined with middle cranial fossaa access; two cases by retrosigmoidal approach; one case by the original incision approach. RESULT: The leak locations were mastoidale in four cases, internal auditory meatus in three cases, external auditory meatus in three cases due to dural defect of middle cranial fossa and post-infra wall of external auditory meatus of one case. All cases were repaired successfully, including one case repaired twice. CONCLUSION: Management and prevention of CSF otorrhea are different according to different skull base surgeries. Mastoid air cells should be focused for retrosigmoidal approach, internal auditory meatus for translabyrinthine approach, the repair of dura defect and closure of eustachium for total and subtotal petrosal removal.

Adult↗
PubMed1996

Vestibular nerve section following previous mastoidectomy.

Vestibular neurectomy is an effective procedure in the management of vertigo due to active labyrinthine disease. Various approaches have been developed for selectively sectioning the vestibular nerve, in order to preserve serviceable hearing and avoid facial nerve injury. In patients who have a mastoid cavity, from previous surgery for chronic otitis media, the approach to the vestibular nerve has to be modified. Considerations taken into account are cavity infection, hearing status, and the presence of associated loud tinnitus. Vestibular or vestibulo-cochlear nerve section has been undertaken, by the senior author, in eight patients with a mastoid cavity from previous surgery for chronic otitis media. Translabyrinthine, retrosigmoid and middle fossa approaches have all been used; strategies for selection of each specific technique are considered, and the aetiology of post-chronic suppurative otitis media (CSOM) peripheral vestibular disease discussed.

Adult↗