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PubMed1983

Acute mastoiditis in children: a review of 54 cases.

Fifty-four children with acute mastoiditis were managed at the Los Angeles County-University of Southern California Medical Center from 1972 through 1982. Our criteria for the diagnosis of acute mastoiditis are acute or subacute otitis media, postauricular swelling and erythema, protrusion of the auricle, and clouding of mastoid air cells on radiographs. Thirty-one (57%) recovered with conservative therapy consisting of early myringotomy and intravenous antibiotic, usually ampicillin. Twenty-three patients were managed surgically. The indication for surgery in each case was the clinical diagnosis of subperiosteal abscess; mastoid radiographs played no part in the decision to operate. Two of the 23 patients managed surgically had only incision and drainage of abscess; simple mastoidectomy was performed on 20 and radical mastoidectomy on one. Etiologic bacteria were cultured in 21 instances, S. pyogenes was cultured in 9, S. pneumoniae was cultured in 6, H. influenzae in 1, enterococci in 1, anaerobes in 2, and M. tuberculosis in 2.

Acute Disease↗
PubMed1995

Acute mastoiditis in pediatric age.

The object of the present paper is to review 39 cases of acute mastoiditis treated surgically at the 2nd and 4th ENT Clinics of the University of Rome 'La Sapienza'. The aetiological factors were investigated observing an association of the acute mastoid abscess with cholesteatoma. Moreover 5 patients developed mastoiditis after previous mastoid surgery. The rationale of surgical management is discussed.

Abscess↗
PubMed1996

[Follow-up of mastoiditis and mastoidectomy].

BACKGROUND: To analyse the late results of mastoiditis and operative intervention as well as critical classification of our own indication for operation we invited 298 operated patients to follow-up examinations. PATIENTS AND METHODS: 218 of 298 patients operated on, took part in these examinations. The follow-up time ranged between 2 and 18 years. RESULTS: Altogether 311 ears were operated. Out of these, 69 patients had presented with classical mastoiditis and 242 with "masked" type. Microscopic examination of the operated ears showed that 284 (91.3%) had normal tympanic membranes, 13 (4.2%) had central tympanic membrane perforations with mucosal inflammation and 14 (4.5%) had residual retraction pockets or attic cholesteatomas. Hearing tests showed that 242 (77.8%) were normal, 56 (18%) had conductive deafness (with 32 of these ears having normal tympanic membranes), 10 (3.2%) had sensorineural deafness and 3 (1%) combined deafness. Schüller's radiographic views demonstrated compact mastoid processes in 48.7% of the reexamined ears and re-pneumatisation in 53%. CONCLUSION: The presented data of our re-examinations support our principle that prompt surgical treatment of all forms of mastoiditis is imperative.

Adolescent↗
PubMed1998

The facial ridge and the discharging mastoid cavity.

This study evaluates the causes for a persistently discharging mastoid cavity and attempts to weight the importance of each identified factor. It consists of a temporal bone dissection to evaluate the anatomy of the facial nerve and a clinical prospective study measuring the factors that contribute to a wet cavity. The factors measured were height of the facial ridge, the size of the meatus, state of the tympanic membrane, and size of the mastoid cavity. The height of the facial ridge and the kidney shape of the cavity were found to be the most significant factors contributing to the state of the cavity. The tympanic membrane and size of the meatus were also found to significantly influence the state of the cavity, whereas the size of the cavity was not significant. These results illustrate the importance of the facial ridge in mastoid surgery and that most poor results in mastoid surgery are due to the surgeon, not the disease.

Clinical Competence↗
PubMedDate not supplied

Acute mastoiditis and cholesteatoma.

Acute coalescent mastoiditis is an uncommon sequela of acute otitis media. It occurs principally in the well-pneumatized temporal bone. The findings of fever, pain, postauricular swelling, and otorrhea are classic. Cholesteatoma, on the other hand, being associated with chronic infection, usually occurs in the sclerotic temporal bone. The signs and symptoms are isidious in nature and consist of chronic discharge and hearing loss which result from its mass, bone erosion, and secondary infection. Of 17 consecutive cases of acute mastoiditis over a six-year period, four were atypical because they were complications of chronic otitis media and cholesteatoma, yet they had the physical findings of acute mastoiditis-subperiosteal abscess and purulent otorrhea, plus radiographic evidence of mastoid coalescence.

Acute Disease↗
PubMed2003

Mastoiditis in children.

Fifty-two children with mastoiditis were treated at the Federal Government Services Hospital over a period of 15 years (from 1986 to 2000). The salient feature in these cases was the presence of a post-auricular swelling and mastoid abscess. Extensive cholesteatoma was seen in 80.7 per cent of cases and 19.3 per cent had granulations in the mastoid cavity. Significantly, all patients had a history of chronic ear discharge prior to abscess formation. These children belonged to poor communities, were malnourished and attended hospital in a state of emergency. The presentation and course of the disease confirms the aggressive and potentially serious nature of the pathology requiring early medical attention in order to avert impending complications. It appears that in our environment acute mastoiditis with abscess formation develops from chronic otitis media and the cholesteatoma. The surgical procedures conducted in these cases were radical and modified radical mastoidectomy.

Abscess↗
PubMed1985

Acute mastoiditis: a review of 34 patients.

A review of 34 patients presenting with acute mastoiditis was undertaken. Prior treatment was noteworthy for lack of medical or surgical drainage at the time of initial otitis media. Typical findings, in hospital, included postauricular edema and tenderness, displaced auricle, and distorted tympanic membrane. X-rays were not diagnostic, nor were they helpful in determining who was a surgical candidate. Treatment was individualized. Patients with obvious subperiosteal abscesses, and those who did not respond rapidly to enteric antibiotics, underwent early mastoid surgery. The remaining patients received enteric antibiotics, had drainage established, and were carefully followed. Most resolved without mastoid surgery. Patients with a history of antecedent ear disease were examined separately from those without such history. The former group required mastoid surgery more often than the latter and had poorer outcome.

Acute Disease↗
PubMed1976

Neonatal meningitis and mastoiditis caused by Hemophilus influenzae.

A newborn infant developed Hemophilus influenzae meningitis associated with acute coalescent mastoiditis and a cutaneous abscess in the mastoid region. Mastoidectomy was followed by prompt recovery from the meningitis, which had failed to clear previously despite antibiotic therapy. Mastoiditis may exist as an infective focus in neonatal meningitis more frequently than has been appreciated. Mastoid roentgenograms are usually the only clue to diagnosis of this infection and should be obtained in patients with neonatal meningitis responding poorly to antibiotic therapy.

Acute Disease↗
PubMed1975

[Radical mastoidectomy in the treatment of masked mastoiditis (author's transl)].

Endocranial complications, which are undiagnosed or diagnosed late, present the greatest danger in masked mastoiditis. Inadequate treatment will inevitably result in irreversible and progredient loss of conductive hearing. In children, deterioration of the general condition and disturbances in physical development are frequently the first symptoms indicating mastoid infection. Because its pathohistological specifity, a reliable interruption and elimination of the mastoid infection can only be achieved by radiacal mastoidectomy. Negative criticism of mastoidectomy is not supported by recent clinical results. This paper suggests an early indication of radical mastoidectomy in masked mastoiditis.

Anti-Bacterial Agents↗
PubMed2001

[Intact-bridge tympanomastoidectomy procedure: a reasonable option in the surgery of chronic otitis media and mastoiditis with cholesteatoma and/or granulation tissue].

OBJECTIVE: To study and evaluate a surgical option for the treatment of otitis media and mastoiditis with cholesteatoma and/or granulation tissue. METHODS: The procedure is called intact-bridge tympanomastoidectomy (IBM). There are some modifications for the treatment of patients suffered from chronic otitis media and mastoiditis with cholesteatoma and/or granulation tissue. The features of IBM include: 1. the aditus, mastoid and attic opened and the intractable pathological tissues eradicated thoroughly. 2. the posterior tympanal space opened through the facial recess if necessary. 3. a widened middle ear space by lowering bony bridge established. 4. the adults blocked. 5. immediate or staging tympanoplasties conducted according to the conditions of mucosa in the tympanum. RESULTS: The modified IBM procedure was performed on 62 ears from 61 cases. The follow-up has been 12-38 months and more than two years in 51 ears. The dry ear was obtained within 5-13 weeks with an average of 6 weeks. In 24.2% of ears the air-bone gap(ABG) was 20dB HL or less and within 21-30 dB HL in 41.9% of ears, the ABG over 31 dB HL was 16.1%. CONCLUSION: Our results indicate that IBM procedure fulfills the desired purposes of both open- and close-cavity techniques, the thorough eradication of diseased tissue allow to get a dry ear and restoration of hearing. IBM, therefore, is a reasonable choice for the surgery of otitis media and mastoiditis with cholesteatoma and/or granulation tissue.

Adolescent↗
PubMed2005

Fibromatosis presenting as acute mastoiditis: a case report.

We describe the case of a middle-aged man who presented with manifestations of acute mastoiditis caused by fibromatosis of the mastoid region. A lesion of the right mastoid bone had eroded its wall and extended toward the middle and posterior cranial fossae. The macroscopic and microscopic appearance of an excised portion of the lesion established the diagnosis of mastoid fibromatosis. After a more detailed work-up, a second procedure involving extensive removal of the tumor was performed, and the diagnosis was confirmed. The patient's postoperative period was uneventful, and he showed no evidence of recurrence during 3 years of follow-up.

Acute Disease↗
PubMed1981

Prevalence of mastoid infection in prehistoric Arizona Indians.

In view of th reported high prevalence of otitis media and mastoiditis in the present-day Indian inhabitants or Arizona, when an opportunity arose to examine the skulls of prehistoric Indians in the collection of the Arizona State Museum, University of Arizona, Tucson, Arizona, it was thought that determining the prevalence of mastoiditis in them might be helpful in the treatment and prevention of mastoid infections in the present-day population. Our findings are compared with those of two other studies of mastoiditis in prehistoric Indians in another area of the United States.

Adolescent↗
PubMed1996

Anatomical relationship between position of the sigmoid sinus and regional mastoid pneumatization.

In order to examine the relationship between the location of the sigmoid sinus (SS) and mastoid pneumatization, 25 adult temporal bones were dissected. Pneumatization was evaluated according to findings during dissections of three separate regions of the mastoid: i.e., the sinodural angle (SDA) area, inter-sinofacial area and mastoid apex. In addition, the SDA and distance between the SS and vertical portion of the facial nerve, were measured at the second genu (G) of the facial nerve, the junction (J) of the nerve and digastric ridge and the midpoint between G and J.A good correlation was observed between pneumatization of the cells surrounding the SDA and the distance between the SS and facial nerve at the mid-point of its vertical segment. However, pneumatization of the inter-sinofacial air cell tract could not be correlated with this distance. A significant decrease in the values of the SDA was found when the air cells surrounding the SDA were poorly pneumatized. This study indicated a correlation between the position of the SS and pneumatization of the mastoid in the area of the SDA.

Adult↗
PubMed1990

Acute mastoiditis: clinical, microbiological, and therapeutic aspects.

The charts of 73 children (31 girls, 42 boys) aged 4 months to 14 years (mean 4.5 years) with acute mastoiditis managed during a 16-year period were reviewed. Of the patients 36% were less than 24 months old. Retro-auricular swelling was described in 63 of the 73 children, tenderness in 59, erythema in 58, and protrusion of the auricle in 45. A pathological tympanic membrane was noted in 33% of the patients and fever in only 29%. Apart from local inflammation, the most frequent complaints and symptoms were otalgia (n = 42), recent upper respiratory tract infections (n = 22), and fever alone (n = 22). A subperiosteal abscess was found in 36 patients, and CNS involvement in 5. Nearly half of the patients (48%) were on antibiotic therapy at admission. The isolation rates in bacterial cultures from subperiosteal aspirated (81%) and from mastoid mucosa (68%) were considerably higher than from blood cultures (14%) and were not influenced by previously administered antibiotics. Pneumococci (9/32) and Staphylococcus epidermidis (6/32) were the agents most often isolated. The incidence of the bacteria isolated from patients pre-treated with antibiotics differed from the incidence in patients not previously treated. In 24 patients (33%) the lesion healed with antibiotic therapy without mastoid surgery. Myringotomy and the insertion of a ventilation tube is indicated initially, if acute otitis media with effusion is found. In the absence of a subperiosteal abscess and of CNS involvement, a 48-hour trial of intravenous antibiotic therapy, directed also against staphylococci, is justified before mastoid surgery is considered.

Abscess↗
PubMed2006

Canal wall reconstruction and mastoid obliteration with composite multi-fractured osteoperiosteal flap.

We used inferior pedicled composite multi-fractured osteoperiosteal flap (CMOF), our original and new surgical approach, to obliterate the mastoid cavity and reconstruct the external auditory canal (EAC) to prevent the open cavity problems. CMOF was used to obliterate the mastoid cavity and reconstruct the EAC in 24 patients (13 women, 11 men; age span 12-51 years) who underwent radical mastoidectomy to treat the chronic otitis media between 1998 and 2004. Small meatoplasty was done in all 24 patients to relieve their aesthetical concerns. Temporal bone CT scanning was done to observe the neo-osteogenesis in the mastoidectomy cavity and the CMOF, and the EAC volume was measured postoperatively. All our patients were followed-up for 2 years. The epithelization of the new EAC in our patients was complete at the end of the second month. Cholesteatoma, granulation, and recurrence of osteitis did not occur in any of the patients. We saw the new bone formation filling the mastoid cavity in the postoperative temporal bone CT scanning images. The mean volume of the new EAC on the 24th month was 1.83 +/- 0.56 cm(3). We had an almost natural EAC, which owed its existence to the neo-osteogenesis that grows behind the CMOF, which we use to obliterate the mastoid cavity and to reconstruct the EAC.

Adolescent↗
PubMed1999

Mastoid pneumatization and aging in children with Pierre-Robin syndrome and in the cleft palate population out of syndrome.

We examined the characteristics of mastoid pneumatization in the Pierre-Robin syndrome (PRS) and non-PRS cleft palate population in relation to age. There were 14 patients with PRS (median age, 5 years), 7 patients with bilateral cleft lip-palates (BCLP: median age, 6 years), 29 patients with unilateral cleft lip-palates (UCLP: median age, 6 years) and 15 patients with isolated cleft palates (ICP: median age, 7 years). All had secretory otitis and ventilation tubes inserted. Pneumatization was assessed by standard computerized planimetric methods. Temporal bone (Schüller view) X-rays were obtained. Areas of bone pneumatization were outlined and measured separately for each ear. The median pneumatized area of the mastoid (MBP) in PRS patients (6.73 cm2) was significantly lower than in non-PRS cleft patients (7.29 cm2). It was also lower than in UCLP (7.35 cm2; P = 0.01) and ICP (7.19 cm2; P = 0.02). MBP did not change significantly with age in PRS (Spearman rs = 0.11) and BCLP (Spearman rs = 0.11), but did increase significantly in the ICP group (Spearman rs = 0.23; P = 0.04). Cubic regression showed the best fit in the BCLP (r2 = 0.61; P = 0.01) and ICP (r2 = 0.10; P = 0.05). It was not significant for PRS (r2 = 0.132) or UCLP (r2 = 0.049). We concluded that pneumatization in all cases increases with age, but it is statistically significant only in ICP. PRS patients have a lower area of mastoid air-cell size than the non-PRS cleft palate population. The extent of mastoid pneumatization in PRS patients does not correlate with age because of the negative influence of the mandibular hypoplasia and glossoptosis present.

Adolescent↗
PubMed1993

Secretory otitis media and mastoid air cell development.

Controversy continues over the factors involved in the development of the mastoid air cell system (MACS). This study examines the effect of persistent secretory otitis media with effusion (SOME) on the development of the MACS. Thirty-one children, aged 4, were drawn from a cohort of cleft palate children in a multi-centre, prospective otological study set up in 1984. The initial presence of SOME was assessed by otoscopy, tympanometry and bilateral myringotomy, performed under the same anaesthetic as surgical repair of the cleft lip or palate. Only one ear in each child was ventilated with a tube and the other, the control ear, was assessed by regular follow-up otoscopy and tympanometry. The persistence of SOME after palate repair in over 70% of the non-ventilated ears in 4 years olds and the presence of a contralateral ventilated middle ear provides the perfect model for assessing the effect of SOME on MACS development. Plain, lateral mastoid X-rays were assessed by planimetry to give a well accepted measurement of mastoid pneumatization. Nine children were excluded from analysis as they did not meet the strict criteria of one persistently ventilated middle ear and one with persistent SOME. 22 children (44 ears) were available for analysis, 9 children were tubed at 3 months and 13 were tubed at 12 to 16 months. In 19 of the 22 ears the mastoid air cell system was larger on the tubed side.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed2006

Pneumocephalus secondary to mastoid surgery: a case report.

Pneumocephalus secondary to mastoid surgery is uncommon. Serious sequelae and central nervous system infection may result from inadequate management. It is diagnosed by careful history, physical examination and imaging studies. Treatments of pneumocephalus secondary to mastoid surgery are conservative treatment or surgery. The aim of surgery is to detect communication between mastoid cavity and brain, and to correct it. We present a case of pneumocephalus secondary to mastoid surgery in 22-year-old man, which was treated with surgery.

Adult↗