Primary liposarcoma of the mastoid.
A unique case of liposarcoma of the mastoid in a 4-year-old child presenting as acute mastoiditis and subperiosteal abscess has been reported.
Abscess↗
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Role of surgery in tuberculous mastoiditis.
A study was undertaken in 43 patients to determine the role of surgery in tuberculous mastoiditis. Cortical mastoidectomy was performed on five patients (Group I). Incision and drainage of a post-auricular abscess, removal of sequestrum and meatoplasty in eight (Group II). Thirty patients had no ear surgery (Group III). Of the 17 patients with facial palsy, three were in Group I, two in Group II, 12 in Group III. The patients in all three groups were treated with anti-tuberculous drugs for a period of no less than six months. The average time taken for the otorrhoea to subside and granulation tissue to resolve completely was two months in all three groups. The facial nerve recovery in the non-operated ears (Group III) was 92 per cent and in the operated ears (Group I and II) 80 per cent. The conclusion is that chemotherapy is the management of choice in tuberculous mastoiditis. The only role of surgery is incision and drainage of a post-auricular abscess and removal of sequestrum if present.
Adolescent↗
Bone scintigraphy in the diagnosis of mastoiditis.
Bone scintigraphy has proven utility in the early diagnosis of osteomyelitis, but the authors were unable to find any report of its specific application to mastoiditis. Three cases of mastoiditis are presented in which the bone scan findings predicted the histopathologic findings.
Aged↗
Mastoid surgery in childhood.
The presenting features and operative findings in 105 patients aged 16 years or less undergoing mastoid surgery are reviewed. In 94% surgery was for chronic otomastoiditis, usually acquired, and associated with cholesteatoma in 64%. Post-operative otorrhoea persisted beyond 6 months in 44% and contralateral disease required some form of surgical procedure in 20%. Post-operative hearing thresholds were improved or unchanged in the majority of patients, most of whom underwent cortical or modified radical mastoidectomy. An improvement in the therapeutic results of mastoid surgery in childhood is clearly necessary, but requires a greater understanding of the aetiology of chronic middle ear disease.
Adolescent↗
Postauricular needle aspiration of subperiosteal abscess in acute mastoiditis.
To test the hypothesis that subperiosteal abscess, a complication of acute mastoiditis, can be treated equally well by needle aspiration as by cortical mastoidectomy, we performed a retrospective analysis of 78 pediatric patients hospitalized between 1995 and 2003 and performed an analysis of published data on types and outcomes of treatment approaches for acute mastoiditis. Postauricular pus aspiration resolved the subperiosteal abscess in 14 of 17 patients. The length of the hospital stay of patients who underwent aspiration was shorter than that of patients who underwent cortical mastoidectomy. We conclude that postauricular pus aspiration, a simple and minimally invasive procedure, is an effective treatment modality for subperiosteal abscess. Mastoidectomy should be reserved for nonresponsive cases or those with more serious complications. Broad-spectrum antibiotics, myringotomy with daily toilet of the ear, and postauricular aspiration, when required, minimize the indications for surgery and reduce the hospital stay.
Abscess↗
Mastoid surgery: effect of retained mucosa on healing.
Variation in the quality of healing in mastoid cavities has never been clearly understood. It is the author's contention that the factor responsible for the wide variation in healing, even though all chronic disease has been removed, is buried mucosa which leads to cystic formation. Over the past 20 years the author has followed the principle of removing all mucosa from the mastoid segment and has been rewarded with dry ears routinely in open cavity surgery. For the past 12 years he has removed cholesteatoma through tympanoplasty and modified radical mastoidectomy. These cases, also, have been consistently free of cavity problems. In the late 50s and early 60s closed cavity operations were tried in radical mastoidectomy, fenestration and tympanoplasty with mastoidectomy. Postoperative healing difficulties were encountered then that are similar to those being reported now with intact canal wall operation. No conclusions are drawn in the controversy between open and closed cavity techniques. The observation may be made, nevertheless, that the problems of closed cavity operations have not been solved. It is the thesis of this paper that the main objection to open cavity operations, ie, poor quality of healing, has been resolved.
Cholesteatoma↗
Acute coalescent mastoiditis.
A retrospective review of 11 cases of acute coalescent mastoiditis from 1974 to 1979 is presented. The common historical data include the recent onset of purulent otitis media, which was often incompletely treated with antibiotics, and fever, lethargy, and irritability. The eardrums were red, bulging, and usually intact. A postauricular abscess was present, and the affected ear protruded downward and outward. The mastoid radiographs invariably showed cloudiness and dissolution of the air cell septations. Initial therapy included paracentesis for culture and sensitivity, and initiation of parenteral antibiotics. Surgical therapy consisted of wide myringotomy, drainage of the postauricular abscess, and complete mastoidectomy. Hearing was normal postoperatively in all cases.
Acute Disease↗
[Two pediatric cases of facial palsy caused by masked mastoiditis].
Two children with otogenic facial palsy are reported. The tympanic membranes of a 15-month-old boy and a girl of the same age were hyperemic, dull, and bulging, and the children suffered from masked mastoiditis. The facial palsy had not been improved by myringotomy, and parenteral administration of antibiotics and steroids. Finally, tympanomastoidectomy and facial nerve decompression was performed and a tympanostomy tube was inserted. Both patients completely recovered facial nerve function within two months after the operation. On the basis of the results of those operations tympanomastoidectomy and the facial nerve decompression may become necessary in such cases as those caused by masked mastoiditis.
Facial Nerve↗
[Neoplastic "acute mastoiditis" in childhood (author's transl].
Report of two cases with "acute mastoiditis" which was due to secondary malignant disease in the mastoid as shown postoperatively. One was the metastisis of an embryonic lung tumor previously diagnosed as histologically benign, the other one was the first sign of acute myeloid leukemia.
Child↗
[Protracted otitis and subacute mastoiditis in children. A prospective study apropos of 118 cases].
Antibiotherapy has lead to a substantial decrease in the number of infants with acute mastoiditis or complications thereof. However, the non-negligible incidence of protracted otitis currently observed has caused one to raise several pathogenid hypotheses, among which subacute mastoiditis figures as one needing to be detected early. This prospective study was conducted on 118 children treated for protracted otitis in the ENT Service at Hopital Trousseau, during the period from january 1987 to december 1988. It allowed us to develop diagnostic and therapeutic strategies to cope with the difficult problem of protracted otitis, taking into account bacteriologic findings and risk factors, among other things.
Adenoidectomy↗
[Restoration of external auditory canal by filling mastoid cavity with carbon pellet].
To prevent infection of an open mastoid cavity after mastoidectomy and improve hearing, the external auditory canal had been maintained on 72 cases (73 ears) by filling mastoid cavity with carbon pellet. The average duration of dry ear after operation was 25 days with a dry ear rate being 98.6%. No phenomenon of rejection and falling out appeared within 1-7 years follow-up. Carbon pellet has advantages of chemical stability, nontoxicity, good histocompatability, anti-fatigue characteristic in body fluid, and anti-corrosive effect against acid, base and salt.
Adolescent↗
Fungal mastoiditis in immunocompromised children.
The immunocompromised host is subject to a variety of opportunistic infections. Mycotic infections, including invasive fungal sinusitis, are a dreaded complication in immune deficient children. Fungal mastoiditis has rarely been described in this population. Our experience with 2 cases of fungal mastoiditis in immunocompromised children is reviewed. Case histories describing aggressive medical management with and without surgical intervention and a review of the literature are presented.
Adolescent↗
Analysis of mastoid findings at surgery to treat middle ear cholesteatoma.
OBJECTIVES: To analyze mastoid findings, such as facial nerve dehiscence (FND), labyrinthine fistula, and dural exposure; to review its incidence at cholesteatoma surgery; to analyze its association with semicircular canal fistula; and to elucidate its relationship with dural exposure. DESIGN: One hundred fifty-two patients (65 males and 87 females; 155 ears) were enrolled in a retrospective study of tympanoplasty with or without mastoidectomy. SETTING: Medical university center hospital. RESULTS: The incidence of FND after exenteration of disease was 29.7% (46/155 ears) for total surgical procedures, 29.7% (43/145 ears) for initial procedures, and 30% (3/10 ears) for revision procedures. The prevalence of FND in the tympanic segment only was 87%, with 8.7% in the vertical segment only and 4.3% in both segments. Three patients (2.0%) developed facial palsy postoperatively, with 8 lateral semicircular canal fistulas (5.2% of total ears operated on), half of these with concomitant FND. The incidence of dural exposure of the mastoid tegmen in the entire surgical group was 16.8% (26 ears), 38.5% with concomitant FND. CONCLUSIONS: The overall incidence of FND in our sample was high at 29.7%, with rates of lateral semicircular canal fistula and dural exposure of 5.2% and 16.8%, respectively. The relationship between FND incidence and presence of lateral semicircular canal fistula was positive in our study. The surgeon should bear in mind that the location of FND with cholesteatoma coincides with the most common area of iatrogenic facial nerve injury during otologic surgery.
Adolescent↗
Porencephalic cyst of the mastoid.
A 10-year-old boy developed a porencephalic cyst of the mastoid in conjunction with otitic meningitis and cerebrospinal otorrhea. A defect of the tegmen tympani allowed extrusion of the cyst into the antrum and the mesotympanum. The otorrhea was controlled by closure of the defect. Our review of 251 cases in the literature showed no prior incidence of mastoid involvement by a porencephalic cyst.
Brain Diseases↗
The mastoid air cell system in ear surgery.
Despite the overall high success rate of myringoplasty, the long-term results in ears with preoperative dysfunction of the Eustachian tube and with a small mastoid air cell system are disappointing. In this communication, we report an 83% healing rate after myringoplasty that included mastoidectomy with posterior and anterior tympanotomy in a selected group of patients with poor tubal function and small mastoids.
Air↗
Ear surgery and mastoid air cell system.
Opinion differ whether simple myringoplasty should be combined with mastoidectomy, which is claimed to provide a large air reservoir for the middle ear. Data are reported on 61 ears, 55 of which had reasonably normal tympanic mucosa but distinct chronic mastoid or epitympanic ear disease. Obliteration of the cavity was performed, combined with tympanoplasty, and the patients were followed up for an average of three years. Normal aeration of the middle ear was seen in all cases with normal middle ear mucosa regardless of whether the posterior canal wall was saved or reconstructed in connection with obliteration. It is concluded that there is no reason for mastoidectomies in small mastoid cell systems in simple myringoplasties.
Air↗
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↗
Spontaneous extracranial pneumatocele associated with mastoid hyperpneumatization.
Spontaneous extracranial pneumatoceles unassociated with trauma are rare. We report a case of spontaneous extracranial mastoid pneumatocele associated with exuberant pneumatization of the calvarium and mastoid. The patient presented with a compressible bulge over the base of the zygoma and superior to the pinna. Surgical exploration demonstrated a large air sac in continuity with nontraumatic bony defects of the tympanosquamous and tympanomastoid sutures.
Air↗