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PubMed2000

Prevention of acute mastoiditis: fact or fiction?

Acute mastoiditis is the most common complication of acute otitis media (AOM). In recent years routine antibiotic treatment for acute middle ear infections was questioned and even abandoned in some countries. The goal of our study was to investigate the influence of antibiotic treatment on the occurrence and clinical outcome of acute mastoiditis and to analyze the bacteriological findings. A retrospective case record study of 48 patients with 50 episodes of acute mastoiditis hospitalized at our tertiary-care center between 1992 and 1999 was performed. Twenty-three patients (48%) received antibiotic treatment before admission whereas 25 (52%) did not. The group of patients without antibiotic pretreatment were younger (mean, 6 years) than patients with antibiotics (mean, 18 years) and their referral was delayed. The most common isolated single pathogen was Streptococcus pneumoniae. All pneumococci were sensitive to penicillin. Acute mastoiditis may be the first clinical sign of a middle ear infection, especially in very young children. Adequate antibiotic pretreatment cannot invariably prevent the development of acute mastoiditis even in the absence of penicillin resistant pathogens.

Acute Disease↗
PubMed2002

Mastoid subperiosteal abscess management in children.

The management of a mastoid subperiosteal abscess has traditionally required mastoidectomy. With the improvement of antibiotic therapy current literature supports the treatment of uncomplicated acute mastoiditis with myringotomy and intravenous antibiotics. Treatment of a mastoid subperiosteal abscess with tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage of the abscess avoids the morbidity and potential complications of mastoid surgery in young children. Three patients diagnosed with a mastoid subperiosteal abscess were managed in this way. The outcome of their treatment has been documented with lengthy otologic follow-up. Complete resolution of the acute infectious process was achieved in all cases with no evidence of recurrent disease.

Abscess↗
PubMed1997

Acute mastoiditis in children: a 12-year retrospective study.

We undertook a retrospective study to examine our experience with acute mastoiditis over a 12-year period. Fifty-eight cases were identified in children aged 3 months to 15 years. Acute mastoiditis was the first evidence of otitis media in 54% of our patients. Pain and fever lasting for more than a median period of 4 days were most likely to be the harbingers of incipient acute mastoiditis. Streptococcus pneumoniae was the most common organism recovered from the cultures. All children were treated with intravenous antibiotics; 41 children were managed with an adjunctive drainage procedure. No statistically significant differences were observed between the cure rates and failure rates for children treated surgically with myringotomies with or without tubes and children managed more aggressively with mastoidectomies. One infant had bacterial meningitis. Cholesteatoma was diagnosed in two children. We conclude from our study that acute mastoiditis occurs mainly in young children and may be the first evidence of ear disease. Pain and fever that persist despite appropriate treatment for acute otitis media are the two most important symptoms. Intravenous antibiotics combined with myringotomy with or without tube insertion are as appropriate as intravenous antibiotics with mastoidectomy for initial management of acute mastoiditis in the absence of a subperiosteal abscess or central nervous system extension.

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↗
PubMed1989

Anthropological study of the mastoid air cell system in Pakistani races.

This is an anthropological study of the development of the mastoid process in the four ethnic groups of Pakistani races: Turko-Iranian, Indo-Aryan, Scytho-Dravidian, and Aryo-Dravidian. Cephalometric studies have established that the majority of Pakistanis are brachio to ultra-brachiocephalic (Cephalic Index 82-x). Radiological evaluation of normal mastoids and their planimetric measurements show that the mastoid process is smaller (Av: 10.24 sq.cm. +/- 0.8) than the Caucasian Western races (Av: 12-15 sq.cm.). Neither combined approach tympanoplasty, nor mastoid obliteration technique may be required, nor technically possible in a small mastoid. Natural epithelization of a small 'peanut size' mastoidectomy cavity does not justify these procedures. A modified radical mastoidectomy and tympanoplasty reconstruction provides a satisfactory result in chronic discharging ears.

Adolescent↗
PubMed2006

Delayed facial nerve palsy following tympano-mastoid surgery: incidence, aetiology and prognosis.

OBJECTIVE: To establish the frequency of occurrence of delayed facial nerve paralysis following tympano-mastoid surgery in our department and to determine the aetiological factors and long term prognosis. SETTING: Tertiary care academic centre. MATERIALS AND METHODS: A retrospective review of all patients who had undergone tympano-mastoid surgery in our department over the previous five years was carried out. A total of 219 patients were included in the study. Only two patients were identified as having delayed onset facial nerve palsy over this period of time. The patients' medical records were reviewed and the patients clinically assessed. RESULTS: The frequency of delayed onset facial nerve palsy following tympano-mastoid surgery in our series was 0.91 per cent. Facial weakness set in on day eight and day 14 in the two patients. Serological investigations in both patients revealed raised titres of immunoglobulin (Ig) M and IgG to varicella-zoster virus, confirming the presence of varicella-zoster infection. In our experience, the combined use of prednisone and acyclovir was an effective form of treatment for both patients, whose facial nerve function fully recovered within six months of onset. CONCLUSION: The incidence of delayed facial nerve palsy following tympano-mastoid surgery is low. It can occur up to two weeks after the surgery. Our two cases confirm viral reactivation to be an important aetiological factor in the development of delayed onset facial nerve palsy. The overall prognosis for delayed facial nerve palsy following tympano-mastoid surgery appears to be good.

Acyclovir↗
PubMed2000

Acute mastoiditis in children: an increase in frequency in Northern Virginia.

BACKGROUND: Acute mastoiditis is reported to occur 2 or 3 times annually in the largest children's hospitals. We encountered an average of 1 case annually at our hospital from 1986 to 1991. During an 8-year period ending October 31, 1999, 22 patients were diagnosed and treated at our hospital. Of these, 17 presented during the last 34 months. METHODS: Retrospective chart review from office and hospital records of children from infancy to age 12 years with a discharge diagnosis of acute mastoiditis who were treated from 1992 through 1999. RESULTS: All children were referred to one of the two pediatric otolaryngologists in our community because of forward protrusion of the auricle and retroauricular cellulitis. Eleven (50%) were <14 months old. Ninety-five percent had a concomitant ipsilateral, inflamed, bulging, immobile eardrum. Computerized tomographic imaging, performed on all patients, revealed universal cortical destruction, subperiosteal abscess or bone destruction in four and dural venous thrombosis in two. Mastoidectomy was necessary for eight children (36%) because of complications of mastoiditis (n = 4) or for failure to improve with antibiotics and myringotomy drainage (n = 4). Streptococcus pneumoniae or Streptococcus pyogenes was recovered from 10 of 17 children (59%) from whom cultures were obtained. CONCLUSION: Cases of acute mastoiditis have markedly increased in our suburban children's hospital. The disease was most common during infancy. Serious complications of mastoiditis occurred in four (18%) of the children in this series.

Anti-Bacterial Agents↗
PubMed2001

Demineralized bone matrix as an alternative for mastoid obliteration and posterior canal wall reconstruction: results in an animal model.

HYPOTHESIS: This study was conducted to evaluate the use of Grafton human demineralized bone matrix as a graft material for mastoid cavity obliteration and canal wall reconstruction in an animal model. BACKGROUND: Canal wall down procedures in the treatment of cholesteatoma may result in a problematic mastoid cavity. Elimination of the mastoid cavity by obliteration or canal wall reconstruction can prevent or correct this problem. Many techniques and implant materials have been used for this application, yet no single material has proven to be ideal. METHODS: Athymic rats received tympanic bulla obliteration and lateral bulla wall reconstruction utilizing the Grafton Putty and Flex formulations, respectively. Wound healing was monitored twice a week. Auditory brainstem evoked responses were obtained 8 weeks after implantation. Nine weeks after implantation, the animals were killed, and histologic sections were prepared. A histologic bone formation score (range 0-4) was determined for each implant. RESULTS: Wound healing occurred without complication. Auditory brainstem response thresholds (average 23.5) fell within the normal range for all ears tested. The average histologic bone formation score for all implants was 3.7. The average scores for obliteration implants and wall reconstruction implants were 3.5 and 3.9, respectively. All wall reconstruction implants underwent partial or total collapse into the bulla. CONCLUSIONS: The high level of bone formation obtained by the use of Grafton implants in this study makes this material a promising resource for use in mastoid obliteration. The use of the material for canal wall reconstruction will likely require a sturdier preparation to prevent collapse into the mastoid cavity.

Animals↗
PubMed2002

Bioactive glass ceramic particles as an alternative for mastoid obliteration: results in an animal model.

HYPOTHESIS: This study was conducted to evaluate the use of the bioactive glass ceramic particulate NovaBone Bioglass as a graft material for mastoid cavity obliteration in an animal model. BACKGROUND: Canal wall down procedures in otologic surgery may result in a problematic mastoid cavity. Mastoid cavity obliteration can potentially prevent or correct this problem. Many techniques and implant materials have been used for mastoid obliteration, but no single graft material has proved to be ideal. METHODS: Mongolian gerbils received tympanic bulla obliteration using the NovaBone Bioglass particulate. Nine weeks after implantation, the animals were killed, and histologic sections were prepared. Histologic evaluation was performed to evaluate new bone formation within the implant. RESULTS: Wound healing occurred without complication. Mature trabecular bone was observed throughout the entire thickness of the implant material. Extensive neovascularity was observed within the graft material. There was no histologic evidence of inflammatory reaction or short-term resorption. CONCLUSIONS: The extensive new bone formation obtained with bioactive glass ceramic particles in this study makes this material a potential alternative resource as a graft material for mastoid obliteration.

Animals↗
PubMed2003

Mastoid obliteration: autogenous cranial bone pAte reconstruction.

OBJECTIVE: To review the outcome in consecutive patients who have undergone complete epitympanic and mastoid obliteration and concurrent tympanic membrane reconstruction over a 53-month period. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: Sixty-two ears in 56 sequential patients undergoing mastoid obliteration with major indications including recurrent infection, debris trapping in the canal wall-down cavity, intolerance of water exposure, calorically induced vertigo in an existing cavity, a semicircular canal fistula, and inability to wear a hearing device. Thirty-six ears in 33 patients who underwent second-stage surgery for ossicular reconstruction during the same time period are also reviewed. INTERVENTION: Transplanted autogenous cranial bone is used to induce osteoneogenesis resulting in complete obliteration of the epitympanic and mastoid spaces while maintaining a mesotympanic space. MAIN OUTCOME MEASURES: Success of obliteration, incidence of symptoms prompting intervention, hearing outcome, incidence of recurrent cholesteatoma, and incidence of eustachian tube dysfunction necessitating treatment and need for revision surgical procedures.RESULTS Complete take of the bony obliteration occurs in over 95% of cases; 90% of treated patients enjoy complete absence of original symptoms, whereas symptoms improved in the remainder. For over 95% of patients, existing eustachian tube function has been adequate after obliteration. To date, no patient has required revision surgical intervention. CONCLUSION: Mastoid obliteration with autogenous cranial bone is a safe and extremely effective option for treatment of problematic canal wall-down mastoid cavities. Surgical techniques that include sterile harvest of the cranial bone graft mixed with antibiotic, revision of the cavity to expose viable native bone, inclusion of the epitympanic spaces in the obliteration, and complete coverage of the pAte with autogenous fascia have proven critical to successful outcome.

Adult↗
PubMed2004

Mastoid obliteration with hydroxyapatite cement: the Ipswich experience.

OBJECTIVE: This article reports the outcomes of a series of patients who underwent obliteration of the mastoid cavity using hydroxyapatite cement. A comparison is made with a group of patients who underwent similar surgery in the same period using hydroxyapatite granules. STUDY DESIGN: Nonrandomized observational analysis. SETTING: Tertiary otology unit. PATIENTS AND INTERVENTIONS: All patients requiring mastoid surgery and primary obliteration or revision mastoid surgery and obliteration. MAIN OUTCOME MEASURES: Dry cavity with full epithelialization and good tolerance to swimming at 1 year postoperatively. RESULTS: In four of eight patients who had obliteration using hydroxyapatite cement, there was infection of the obliteration site, requiring revision. All of the patients who had obliteration with hydroxyapatite granules had dry and well-epithelialized mastoid cavities at 1-year follow-up, with ears that tolerated swimming. CONCLUSION: The use of hydroxyapatite cement is not recommended in mastoid obliteration surgery.

Adolescent↗
PubMed2006

Titanium mesh for functional reconstruction of the mastoid cortex after mastoidectomy.

OBJECTIVE: To describe a rapid and effective means of reconstructing the mastoid cortex after mastoidectomy for chronic otitis media with and without cholesteatoma. STUDY DESIGN: Retrospective. SETTING: Tertiary referral otology clinic. PATIENTS: Those undergoing tympanoplasty and mastoidectomy for chronic otitis media. INTERVENTION: After tympanoplasty and mastoidectomy, the mastoidectomy defect was reconstructed using titanium mesh with subsequent closure as routine. MAIN OUTCOME MEASURES: Evaluation of soft-tissue ingrowth into the mastoid 12 to 24 months after surgery and clinical evaluation of the postauricular surgical site for accentuation of the postauricular sulcus. RESULTS: In 99 patients, the mastoidectomy defect was reconstructed using titanium mesh. None was found to have pitting of the postauricular sulcus. One patient had partial extrusion of the mesh through the ear canal. No instance of wound infection was observed. Soft-tissue growth into the mastoid cavity was found to be minimized. CONCLUSION: Titanium mesh is a rapid and effective means of minimizing soft-tissue ingrowth into the mastoid and preventing accentuation of the postauricular sulcus after mastoid surgery.

Adolescent↗
PubMed2005

Mastoid and epitympanic obliteration in canal wall up mastoidectomy for prevention of retraction pocket.

OBJECTIVE: To evaluate the surgical outcome in patients who have undergone mastoid and epitympanic obliteration technique. STUDY DESIGN: : Retrospective review. SETTING: Tertiary care referral center. PATIENTS: The study group included 151 patients with cholesteatoma who underwent mastoid and epitympanic obliteration technique. This technique was applied to cases who had a strong chance of recurrent retraction pocket and cholesteatoma formation, including those patients with an adhesive drum indicating poor eustachian tube function (n = 52) and patients with a destructive scutum (n = 68). Thirty-one patients had both an adhesive drum and a destructive scutum. INTERVENTION: The connection between the mastoid cavity and the middle ear was blocked by obliterating the epitympanum and antrum with bone pate and the remaining mastoid cavity with abdominal fat. MAIN OUTCOME MEASURES: The postoperative drum state, the incidence of retraction pocket formation and cholesteatoma recurrence, the surgical complications of obliteration, and the hearing outcome. RESULTS: In 114 of 151 patients (75.4%), the middle ear was well healed and well aerated. The retraction pocket formation or cholesteatoma recurrence did not develop in any subject. Postauricular skin depression was the most common complication of this technique (n = 31 [20.5%]). In three patients (2.0%), the bone pate used for obliteration was infected. Of the 56 cases who underwent a staged operation to regain their hearing, 37 resulted in a postoperative air-bone gap less than 20 dB hearing level. CONCLUSION: Mastoid and epitympanic obliteration is an effective option for preventing a retraction pocket and cholesteatoma recurrence in patients with a poorly functioning eustachian tube or a defective scutum, while preserving the same advantage of the canal wall up technique.

Adolescent↗
PubMed2006

Prospective randomised single-blind controlled trial of glacial acetic acid versus glacial acetic acid, neomycin sulphate and dexamethasone spray in otitis externa and infected mastoid cavities.

OBJECTIVES: The literature reports the merits of antibacterial, antibiotic and steroid agents in treating otological infections but no controlled clinical trial has directly compared 2% glacial acetic acid (EarCalm; Stafford-Miller Ltd, Brentford, UK) against 2% glacial acetic acid, 0.1% dexamethasone and 3250 U/ml of neomycin sulphate (Otomize; Stafford-Miller Ltd) in the treatment of otitis externa and infected mastoid cavities. DESIGN: Prospective, single-blind randomised controlled trial. SETTING: Outpatients, Derby Royal Infirmary, Derby, UK. PATIENTS: Emergency and GP referrals with acute otitis externa (n = 53) and infected mastoid cavities (n = 56). MAIN OUTCOME MEASURES: Otoscopy was performed at initial randomisation and then at 2 and 4 weeks, the ear assessed for active and inactive disease. RESULTS: Patients with active otitis externa, 71% (15/21) resolved with glacial acetic acid, dexamethasone and of neomycin sulphate after 2 weeks, increasing to 86% (18/21) after 4 weeks treatment. Patients on glacial acetic acid had only 38% (12/32) resolution after 4 weeks (P < 0.0005). Two per cent glacial acetic acid, dexamethasone and neomycin sulphate resolved only 30% (8/27) of infected mastoid cavities compared to only 10% (3/29) on glacial acetic acid (P < 0.07). A further 2 weeks treatment this increased to 67%, (18/27) with glacial acetic acid, dexamethasone and neomycin sulphate and 48% (14/29) with glacial acetic acid. These results are not statistically significant. CONCLUSION: Glacial acetic acid, dexamethasone and neomycin sulphate is significantly more effective in treating otitis externa when compared with glacial acetic acid. This effect failed to be significant in the infected mastoid cavities group. We therefore recommend that in conjunction with aural toilet, antibiotic/steroid combination is more effective than an antibacterial agent for otitis externa. Larger numbers of infected mastoid cavities are required to be studied.

Acetic Acid↗
PubMed2005

Complications of mastoiditis in children at the onset of a new millennium.

The aim of the present study was to review our recent experience in the diagnosis and treatment of acute mastoiditis and its complications in a single tertiary-care, university-affiliated pediatric center. Ninety-eight children with 101 episodes of acute mastoiditis were included in the study. The mean interval from onset of illness to mastoiditis was 4.5 days. Ear cultures most often grew Streptococcus pneumoniae and Pseudomonas aeruginosa (23.7% each). Complications occurred in 15.8% of episodes. The only factor differentiating children with and without complications was white blood cell count. These findings indicate that acute mastoiditis not only is a complication of prolonged infection of the middle ear, but may also present as an acute infection of the mastoid bone that can progress within 48 hours. The complication rate remains high, and antibiotic treatment at the onset of symptoms does not prevent complications. A high white blood cell count on admission may serve as a predictive factor of complicated cases.

Acute Disease↗
PubMed2004

Acute mastoiditis in children: epidemiologic, clinical, microbiologic, and therapeutic aspects over past years.

Recent studies have indicated possible changes in the incidence of acute mastoiditis. A retrospective review of children discharged with a diagnosis of acute mastoiditis was undertaken to describe the epidemiology, clinical presentation, microbiology, and treatment of acute mastoiditis over past years. Demographic historic, clinical, and laboratory data were collected. Eighty-six children (88 episodes of acute mastoiditis) were identified (1 month-16 years) (median 3.3 years). Almost half had a history of middle ear disease; 8% recurrent episodes and 68.2% received antibiotics preadmission, 91.2% for acute otitis media. Bacterial etiology was established in 43 patients (68.2% isolation rate). Pseudomonas aeruginosa and Streptococcus pneumoniae were the most frequently isolated agents. This review showed a significant increase (150%) in the number of patients with acute mastoiditis.

Acute Disease↗
PubMed1986

Development of paranasal and mastoid sinuses: a computed tomographic pilot study.

Paranasal sinus and mastoid disease in children is an important potential source of intracranial sepsis. Cranial computed tomographic (CT) scans are a primary imaging modality for assessment of the paranasal sinuses and mastoids. Radiographic assessment of paranasal sinus development has largely been confined to plain radiographs and polytomographic examination. We report a pilot, quantitative analysis of 30 CT scans obtained from patients without known ear, nose, or throat disease, and aged from 3 weeks to 13.8 years. Ethmoid, sphenoid, and mastoid sinus development was assessed by a "pneumatization index" (PI) derived from each CT scan. At all ages, the rank order of sinus development was ethmoid greater than mastoid greater than sphenoid. Individual developmental rates showed considerable variation. In the newborn, mastoid and sphenoid sinus development was minimal, whereas ethmoid sinuses showed substantial aeration. The data suggest that, for children older than 5 years of age, an ethmoid sinus PI less than or equal to 0.714 is highly suspicious of paranasal sinus disease.

Child↗
PubMed2000

Measurement of surface area in human mastoid air cell system.

The total surface areas of human mastoid air cells were measured using digital CT scans. Using 24 normal ears, the lining of the mastoid air cells was digitally scanned, traced and analysed. The mean surface area of the mastoid air cell system was 167.0 cm2 and ranged from 74.78 to 330.01 cm2. The volume was also measured, the mean being 10.43 cm3 ranging from 6.25 to 20.52 cm3. The correlation coefficient between surface area and volume was 0.95. These results indicate that well pneumatized mastoid air cells serve to provide an extremely large surface area in the temporal bone which in normal mastoid air cells is proportional to the volume.

Adult↗