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Pseudomonas mastoiditis.

Opportunistic infections of the external auditory canal or the middle ear due to Pseudomonas aeruginosa occurring in patients with low resistance to infection have a 35 percent mortality rate. Once the process extends into the pneumatized temporal bone, eradication becomes more difficult and the mortality rate increases to 72 percent because of the high incidence of involvement of cranial nerves, adjacent intracranial vessels, and meningitis. Treatment is directed towards the underlying condition, administration of systemic carbenicillin and gentamicin, topical colistin therapy, and judicious surgical debridement. Pseudomonas vaccine may be of help. Fifteen cases are presented. Nine follow the pattern of malignant external otitis and six began as a primary acute otitis media.

Adult↗

Anaerobic mastoiditis: a report of two cases with complications.

Aerobic bacteria are responsible for most cases of suppurative otitis media/mastoiditis (OM/M). As many as 20-30% of middle ear aspirates in acute otitis media, however, are reported to be sterile on aerobic culture. Some of these cases may be due to anaerobic bacteria. Two cases of OM/M due to anaerobic bacteria are reported. The first patient had no antecedent ear disease and developed a large Bezold abscess caused by Fusobacterium varium. The second patient had attic retraction pouches bilaterally and a history of otorrhea. This patient developed labyrinthitis and meningitis due to B. fragilis. The clinical progression of disease in both cases indicates that anaerobic OM/M can follow a deceptively asymptomatic course. By contrast, complications of OM/M occur abruptly and extend rapidly in a manner typical of acute aerobic disease. Both cases required surgery for cure.

Adolescent↗

Reclassification of aggressive adenomatous mastoid neoplasms as endolymphatic sac tumors.

The emerging concept that aggressive adenomatous tumors of the temporal bone arise from the endolymphatic sac and constitute a distinct clinicopathologic entity merits wider recognition. These tumors share a common clinical pattern and exhibit consistent imaging and histopathologic features. Endolymphatic sac tumors (ELSTs) have been mistaken for other neoplasms such as paragangliomas, adenomatous tumors of mixed histology, ceruminomas, and choroid plexus papillomas. A review of the literature shows similarities among case studies of these aggressive adenomatous lesions. An analysis of the data supports the endolymphatic sac as an origin for these tumors. This report also presents an additional case of a less differentiated variant of this rare but important clinicopathologic entity.

Adenoma↗