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PubMed2002

Acute mastoiditis: a 10 year retrospective study.

This retrospective study reviews our experience in the management of acute otomastoiditis over 10 years. During the study period we identified 40 cases in children aged 3 months-15 years with a peak incidence in the second year of life. Sixty per cent of them had a history of acute otitis media (AOM). All the children were already receiving oral antibiotic therapy. Otalgia, fever, poor feeding and vomiting were the most common symptoms, all the children had evidence of retroauricolar inflammation. Computerized tomography (CT) and magnetic resonance imaging (MRI) were used to support the diagnosis and to evaluate possible complications. Streptococcus pneumoniae was the most common isolated bacterium. All the patients received intravenous antibiotics, 65% of children received only medical treatment, 35% also underwent surgical intervention. Mean length of hospital stay was 12.3 days. Cholesteathoma was diagnosed in one child. We conclude from our study that acute otomastoiditis is a disease mainly affecting young children, that develops from AOM resistant to oral antibiotics. Adequate initial management always requires intravenous antibiotics, conservative surgical treatment with miryngotomy is appropriate in children not responding within 48 h from beginning of therapy. Mastoidectomy should be performed in all the patients with acute coalescent mastoiditis or in case of evidence of intracranial complications.

Acute Disease↗
PubMed1994

Localized mastoiditis simulating a facial nerve schwannoma on MRI.

A case of a single inflamed mastoid air cell is described. This was initially interpreted as a facial nerve schwannoma on MRI examination. Careful evaluation of the signal characteristics and additional findings from the high resolution CT examination helped to establish the correct diagnosis.

Adult↗
PubMed1990

[Aspergillus mastoiditis in infected granulomatosis--a case report].

An 11-year old boy with chronic granulomatous disease due to cytochrome B deficiency developed pulmonary aspergillosis proven by culture in his upper right lobe (upper lobe resection). In spite of maximum doses of flucytosin/amphotericin B combination, he developed focal seizures associated with three intracerebral lesions and a lesion in the area of the right mastoid. Imaging methods (X-ray Schüller, CT, MRT) demonstrated the defects. Mastoidectomy showed blue purulent but sterile necrosis. The antimycotic therapy with the Flucytosin/Amphotericin B combination was stopped and replaced by a new drug, itraconazole. After a short time the boy felt much better. Even the intracerebral lesions became smaller. We conclude that both the surgical and the conservative therapy with a new antimycotic are the reason for this result.

Antifungal Agents↗
PubMed1997

Granuloma inguinale (donovanosis): an unusual cause of otitis media and mastoiditis in children.

Granuloma inguinale (donovanosis) is seen predominantly in adults (it rarely occurs in children) and mainly affects genital skin and mucosa. Infection occurs at other skin and mucosal sites, and hematogenous dissemination to bone also has been described. The infection responds dramatically to appropriate antibiotic treatment. We present two cases of granuloma inguinale occurring in children (8 months and 5 months of age) causing mastoiditis and external ear discharges. A temporal lobe abscess also developed in the 8-month-old child. Subsequent computed tomography scans showed marked improvement in the brain lesion after treatment. The second child had a polypoid mass in the middle ear that on biopsy showed the features of granuloma inguinale. The mother of this child had biopsy-proven granuloma inguinale of the uterine cervix. These cases indicate that granuloma inguinale can be transmitted during vaginal delivery, and careful cleansing of neonates born to infected mothers is recommended.

Anti-Bacterial Agents↗
PubMed2000

A clinicopathological study of 15 patients with neuroglial heterotopias and encephaloceles of the middle ear and mastoid region.

OBJECTIVES/HYPOTHESIS: Heterotopic masses of neuroglial tissue involving non-midline structures, specifically, the middle ear region, are exceptional. The pathogenesis of these lesions and, in particular, their relation to encephaloceles, is uncertain. STUDY DESIGN AND METHODS: H&E-stained sections from 15 lesions diagnosed as neuroglial heterotopias or encephaloceles involving the middle ear region were reviewed. Radiographic or operative evidence of a central nervous system (CNS) relation and clinical factors possibly related to pathogenesis were analyzed. RESULTS: All 15 lesions (from six men and nine women; mean age, 49 y; range, 16-67 y), regardless of their relation to the CNS, were composed of varying proportions of neurons and glia with associated chronic inflammatory cells and reactive gliosis. No significant ependymal or choroid plexus component was present. Operative findings revealed that two lesions had definite CNS connections and two were unrelated to the CNS; this relation could not be determined in the remaining cases. Seven of 10 patients for whom clinical information was available had a history of chronic otitis media or mastoiditis or both; four of these seven patients also had a history of previous trauma or surgery. Three patients, including both patients whose lesions had no demonstrable CNS attachment, had no predisposing factors. CONCLUSIONS: Most neuroglial heterotopias of the middle ear are probably acquired encephaloceles. These lesions occur in older patients than do their midline counterparts. Determination of the relation of these lesions to adjacent CNS structures must be done radiographically or using operative findings, because histology alone cannot be reliably used to render an accurate diagnosis.

Adolescent↗
PubMed2001

Recurrent infestation of the mastoid cavity with Caloglyphus berlesei: an occupational hazard.

Mite infestation of the ear is an unusual clinical problem that is easily cured with simple measures and recurrent infestation has not been reported till date. We present here a patient who developed recurrent infestation of otherwise healthy mastoid cavities with the storage mite Caloglyphus berlesei, secondary to occupational exposure. This kind of recurrent mite infestation of the ear has not been described before.

Agricultural Workers' Diseases↗
PubMed1975

Infection of the mastoid bone with a Paragonimus-like trematode.

Three unusual cases of mastoid abscess are described. Case histories and the clinical, laboratory, radiological, surgical, and histopathological findings in the patients are reported. Operculated eggs measuring about 60 mu times 40 mu were seen in pus obtained from two cases, but no adult worm was recovered. The findings suggest that the infections could have been caused by either Paragonimus species or Poikilorchis (Achillurbania) species.

Adolescent↗
PubMedDate not supplied

[Does mastoiditis still exist? (author's transl)].

The authors report 382 cases of mastoidectomy verified by histological examination and draw certain conclusions: There were 5 errors in diagnosis, i.e. 1.3 per cent. Most cases were aged between 4 and 12 months. Below the age of two years it was usually bilateral, exceptionally so after the age of two years. Diagnosis was mainly clinical and based on the following axiom: "All infants with acute otitis who, in spite of proper medical treatment, have at the end of one month of a weight curve either stationary or falling, and eardrums not strictly normal, have mastoiditis". This therefore implies close and prolonged supervision by the same observer throughout the period antibiotic treatment and at least one week after stopping the latter. The treatment is still mastoidectomy and not antrotomy but one may hope with more accurate diagnosis that new methods of treatment may be developed to the extent where immediate and long term supervision of the child may be ensured.

Anti-Bacterial Agents↗
PubMed1982

Assessment of postoperative hearing in 528 middle ear and mastoid surgery cases in Tokai University Hospital.

The postoperative hearing results in cases of tympanoplasty, radical mastoidectomy, modified radical mastoidectomy and tympanoplasty combined with modified radical mastoidectomy on 528 ears, performed in the Tokai University Hospital between 1975 and 1980 were assessed. The assessment was based on pure-tone audiograms taken 3 months to 5 years after the operation. Out of 528 cases 70.5% gained better postoperative hearing, 6% showed no change of hearing and 23.5% showed deterioration of hearing. Auditory success of those who attained social hearing, air-bone gap closure to within 20dB or gained hearing of 20 dB or more was 53.4%. The results in cholesteatoma cases were poorer than those of non-cholesteatoma cases. In 44% of the cases, ossiculoplasty was performed, and the most successful ossiculoplasty results were obtained when the malleus was repositioned to the head of the stapes. Fairly good results were achieved when an artificial prosthesis, such as a Teflon-piston, Gelfoam-wire or platinum-piston, was used. The least successful results were found when the incus was transpositioned. In the non-ossiculoplasty group, type I tympanoplasty produced 59.5% auditory success whereas 37.3% auditory success was achieved in radical mastoidectomy. Better auditory success rates were obtained when the bony bridge was preserved than when it was removed. The results were identical in cases where the mastoid cavity was obliterated or when it was kept open. A new technique, "scutumplasty", was used for reconstructing the scutum. Revision surgery was required in only 3.4% of the cases.

Hearing↗
PubMed1980

[Trans-tympanic aeration in mastoiditis. Study of 42 cases (author's transl)].

The authors review the diagnostic protocol of mastoiditis based upon 382 cases with 1.3% errors (histological confirmation). Up to the present time, mastoidectomy was the only treatment which could be envisaged. In a new series of 90 cases, 48 constituted the control group and 42 the study group, trans-tympanic drains were inserted routinely in the latter. It was thus possible to avoid mastoidectomy in 62% of cases in the study group (evaluation based upon the number of ears). The period of postoperative observation was on average 8 months. No complications related to the drain were seen. Up to the present time, there exist no precise criteria which may be used to decide between insertion of a drain or mastoidectomy from the outset. Insertion of a drain must thus be considered as a therapeutic test, justified by its harmlessness and simplicity.

Child↗
PubMed1999

Lemierre syndrome and acute mastoiditis.

Lemierre syndrome seldom follows an episode of pharyngotonsillitis. Characteristically, it is comprised of septic thrombosis of the internal jugular vein and bacteremia, leading to lung emboli and metastatic abscess formation. We describe Lemierre syndrome that complicates an acute mastoiditis, with considerations regarding its pathogenesis and management. Despite its sporadic occurrence, awareness of Lemierre syndrome is important, since early recognition reduces both the morbidity and mortality associated with it.

Acute Disease↗
PubMed1976

Maggot therapy for subacute mastoiditis.

We describe a patient with intractable subacute mastoiditis who was treated successfully by maggot therapy. Maggot debridement of intractable wounds was very successful before the introduction of antibiotics. We describe the indications for use, materials and methods for the rearing of sterile larvae, the modes of action, and the complications of maggot debridement.

Aged↗
PubMed1980

Drill- and suction-generated noise in mastoid surgery.

The air-conduction noise levels in the external and middle ear generated by drilling and suction during temporal bone surgery were measured. Variables included diamond burrs, cutting burrs, two different air drills (Hall and Stryker) an electric drill (Emesco), and drilling with and without suction irrigation. The results show that the single factor contributing the highest noise level is suction irrigation, which exposes the ipsilateral ear to noise levels averaging up to 107 dB (A). The average noise levels of drilling range from 65 to 96 dB (A) varying with the drill and burr used. Simultaneous drilling and suction irrigation generated noise levels ranging from 91 to 108 dB (A). Cutting burrs were found to be up to 9 dB (A) more intense than diamond burrs. Exposure to these noise levels may account for shifts in the hearing thresholds sometimes apparent in postoperative audiograms of mastoid surgery patients.

Humans↗
PubMed1982

Mycobacterium fortuitum as a cause of mastoiditis and wound infection.

Mycobacterium fortuitum is uncommonly pathogenic for man. When implicated, this organism usually infects soft-tissue structures. Therapy necessitates surgical excision and prolonged antimicrobial therapy. A patient had a mastoiditis and wound infection due to this organism. Her successful treatment included radical debridement and prolonged therapy with several antimicrobials. The necessity for including mycobacteria in the differential diagnosis of ear, nose, and throat diseases is emphasized by our experience. The complexities of management of these infections are reviewed.

Female↗
PubMed1984

Mastoid pneumatization. Evidence of the environmental theory.

Forty-one randomized, otherwise healthy children with tympanometry were observed from birth until the age of 6 years. At a total of 13 trials, tympanometry and otoscopy were performed. The tympanometric profile was correlated to the size of the mastoid air cell system, as determined by planimetric measurement of roentgenograms taken at age 6 years. There was a notable correlation between the size of the cell system and the tympanometric profile. Thus, the least affected ears with mostly normal or slightly abnormal tympanometry had considerably larger cell systems than the most affected ears with secretory otitis and tubal dysfunction. The findings support the environmental theory of pneumatization.

Acoustic Impedance Tests↗
PubMed1985

Large cholesterol granuloma cysts in the mastoid. Clinical and histopathologic findings.

Large cholesterol cysts were found in revision surgery in six patients with previous ear surgery one to 28 years ago. The cysts mimicked brain herniation in open cavities, filled the mastoid and ear canal in closed cavities, or caused postauricular swelling. Bone around the cysts was soft and granulomatous. Secretory cells were scarce in the epithelial lining of the lumen, but subepithelial glands were frequent. Cholesterol granulomas and hemosiderin-laden macrophages were present inside the wall. The cyst lining and the glands under it showed cytokeratin staining typical for simple and glandular epithelia. Antiprekeratin antibodies showed no decoration of the lining but reacted positively with the meatal skin. These findings prove that respiratory-type epithelium separated from an aerated middle ear does not undergo changes into keratin-forming epithelium.

Adult↗
PubMed1988

Fungal mastoiditis in the immunocompromised host.

An immunocompromised patient is subject to unusual, severe opportunistic infections. We report a case of Aspergillus fumigatus mastoiditis in a patient with leukemia who also had cryptococcal meningitis. A fatal outcome ensued, despite extensive surgical and antimicrobial intervention.

Aged↗