Mastoiditis

The aim of this study is to define the clinical and bacteriological characteristics of acute mastoiditis (AM) in children in order to optimize diagnostic work-up and treatment. In this retrospective study, 188 children between 3 months and 15 years of age (15±24 months; median±SD) were referred to our pediatric ENT emergency center for AM during a 7-year period (December 2001-January 2008). Fifty seven percent were male and 43% were female. Clinical follow-up duration was 3.9±0.7 months (mean±SEM). The incidence of AM remained stable during the whole study period. Microbiological samples (n=236) were negative in 33% of cases. The most frequently isolated germs were Streptococcus pneumoniae (51%), Streptococcus pyogenes (11.5%), Anaerobes (6.5%), and coagulase-negative Staphylococcus (6.5%). Paracentesis, puncture of retro auricular abscess under local anesthesia, and peroperative samples all contributed to isolate the involved germ(s). All the patients were hospitalized and received...

This paper presents an bioarchaeological case study from Shirakavan. The skeletal remains belong to a male aged 40-45 years of age at death, with a stature above the average (177 cm). The presence of a horse skeleton in the discussed burial suggests that the human skeleton may have belonged to a horse rider. At the proximal end of the femur, there are some enthesopathies previously noted as common in horse riders. Analyses revealed a variety of pathologies, allowing inferences about the lifestyle and well-being of individual from Late Iron Age. The male suffered two cranial fractures, in nasal bones and frontal bone. Accidental falls involving facial injury may have contributed to antemortem tooth loss. Fractures ribs in the individual may be the result of direct blows to the chest or/from falling off of a horse. The clavicle injury observed in the individual discussed here can also be caused by a fall. There is degenerative pitting of the body of the neck vertebras indicating disc damage. Several vertebrae were asymmetrical (scoliosis). Perhaps mastoiditis was the leading cause of death at the individual from Shirakavan.

Introduction: Chronic mastoiditis is generally a result of chronic suppurative otitis media; it is rarely a result of failure of treatment of acute mastoiditis. Case presentation: Seven patients with chronic mastoiditis were investigated. Four patients had bilateral mastoiditis. The duration of illness ranged from 1 to 45 years. A comparison between operative and external auditory canal cultures was performed. The operative specimens were obtained directly from the infected mastoids. The external ear and mastoid specimens were inoculated and cultivated immediately by bedside. All cases showed positive bacterial cultures. The growth was monomicrobial in two cases and polymicrobial in five cases. Seventeen isolates were recovered (11 aerobes and six anaerobes). Pseudomonas aeruginosa was the most predominant isolate (23.5 %) and was recovered from four patients (57 %). This high prevalence may be related to misuse of ear drops that transmit this organism from skin flora towards the mastoid. The anaerobes were isolated from four patients. This may indicate a significant role of anaerobic bacteria in producing chronic mastoiditis that would not respond to usual treatment measures. Conclusion: Cultures from external ear canal discharge might be used as a source for isolation of bacteria causing chronic mastoiditis and chronic otitis media provided that the specimen was collected and cultivated properly. They revealed sensitivity (88 %), specificity (100 %), positive predictive value (100 %) and negative predictive value (66 %). In anaerobic cultures, the sensitivity was 66.7 %. No previous studies were found with regard to evaluation of the reliability of external ear culture for isolation of the causative agents of chronic mastoiditis or chronic otitis media.

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 recomm...

Introduction: Chronic mastoiditis is generally a result of chronic suppurative otitis media; it is rarely a result of failure of treatment of acute mastoiditis.
Case presentation: Seven patients with chronic mastoiditis were investigated. Four patients had bilateral mastoiditis. The duration of illness ranged from 1 to 45 years. A comparison
between operative and external auditory canal cultures was performed. The operative specimens were obtained directly from the infected mastoids. The external ear and mastoid
specimens were inoculated and cultivated immediately by bedside. All cases showed positive bacterial cultures. The growth was monomicrobial in two cases and polymicrobial in five cases. Seventeen isolates were recovered (11 aerobes and six anaerobes). Pseudomonas aeruginosa was the most predominant isolate (23.5 %) and was recovered from four patients (57 %). This high prevalence may be related to misuse of ear drops that transmit this organism from skin
flora towards the mastoid. The anaerobes were isolated from four patients. This may indicate a significant role of anaerobic bacteria in producing chronic mastoiditis that would not respond to usual treatment measures.
Conclusion: Cultures from external ear canal discharge might be used as a source for isolation of bacteria causing chronic mastoiditis and chronic otitis media provided that the specimen was collected and cultivated properly. They revealed sensitivity (88 %), specificity (100 %), positive predictive value (100 %) and negative predictive value (66 %). In anaerobic cultures, the
sensitivity was 66.7 %. No previous studies were found with regard to evaluation of the reliability of external ear culture for isolation of the causative agents of chronic mastoiditis or
chronic otitis media.

To study how antibiotic treatment and an early decision to aspirate subperiosteal abscesses can reduce hospitalization periods and costs in patients with acute mastoiditis. During a 10-year period, 134 patients were diagnosed with acute mastoiditis at the Department of Ear, Nose, and Throat and Head and Neck Surgery (Kaplan Medical Center, Rehovot, Israel). The diagnoses was based on physical findings of retroauricular swelling and erythema and tenderness, with protrusion of the auricle forward and downward. The majority of patients (77) reached medical treatment during the first 3 days of their disease. Wide myringotomy and intravenous antibiotic treatment, aspiration, and complete cortical mastoidectomy were the treatment options. With the administration of wide myringotomy and intravenous antibiotic treatment, 115 patients recovered; nine received aspiration and did not need surgery; and only 15 patients who received the antibiotic treatment needed a complete cortical mastoidectomy. With the wise use of antibiotics and early decision to aspirate subperiosteal abscesses, the hospitalization period, the cost, and the need for surgery can be reduced.

 To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs).  Cohort study.  610 UK general practices from the UK Clinical Practice Research Datalink.  Registered patients with 45.5 million person years of follow-up from 2005 to 2014.  Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients.  Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice.  From 2005 to 2014 the proportion of RTI consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% ...

A total of 64 isolates of Klebsiella ozaenae were recovered from 36 patients during a 40-month period. Over 7,500 isolates of K. pneumoniae were isolated during the same time period. Before this decade, K. ozaenae was considered to be only a colonizer of the nasopharynx or a putative cause of ozena (atrophic rhinitis). K. ozaenae was recovered most frequently from sputum in mixed culture but was associated with infection in 12 patients (2 with bacteremia, 3 with urinary tract infection, 1 with soft tissue infection, and 6 with mucopurulent nasal discharge). The spectrum of disease caused by this organism is more extensive than has been appreciated previously.

Langerhans cell histiocytosis (LCH) is a rare disease that may affect multiple organs. The etiology of LCH remains unclear to date. It is currently believed that clonal accumulation and proliferation of CD1a-positive Langerhans cells are causative. The term LCH or histiocytosis X refers to three separate illnesses (listed in order of increasing severity): eosinophilic granuloma, Hand-Schüller-Christian disease and Letterer-Siwe disease. A seven-month-old boy presented with history of recurrent bilateral otitis media and rash and seborrheic areas on his scalp. Two days prior, his mother noticed a small lump over the right mastoid. Lateral skull X-ray (Schüller) was evidence for lytic lesion on right temporal bone. The computerized tomography scan showed inflammatory changes with bone erosion. During surgical exploration, fragile slightly yellowish tissue with necrotic areas was found that was determined as LCH on histology. Chemotherapy was subsequently initiated. The initial present...

The incidence of complications resulting from suppurative otitis media has significantly decreased since the introduction of antibiotics. At the start of the 20th century 50% of all cases of otitis media developed a coalescent mastoiditis. By 1959, the incidence had fallen to 0.4%. Recent studies suggest a current incidence of only 0.24%. Additionally, during the time of Friedrich Bezold (1824-1908), 20% of patients with mastoiditis developed subperiosteal abscess. Interestingly, this has incidence increased; today nearly 50% of patients diagnosed with coalescent mastoiditis have subperiosteal abscess. To review the contemporary presentation, diagnosis, and management of a spectrum of mastoid abscesses. Retrospective case series. Hospitals associated with the Department of Otolaryngology/Head and Neck Surgery at the University of California, San Francisco. Three patients with mastoid abscesses are reported. One patient displayed "classic" Bezold's abscess, with pus escaping the mastoid near the incisura digastrica and tracking along the digastric and sternocleidomastoid muscles into the neck. The second and third patients exhibited temporoparietal swelling secondary to mastoid abscess eroding the root of the zygomatic process, a complication noted by Bezold in 1908 as occurring "in only very rare cases." Since only one third of patients show pathologic tympanic membrane changes, and since complaints of otalgia, fever, and tenderness are inconstant, subperiosteal mastoid abscess is frequently a delayed diagnosis. The clinical presentation, pathogenesis, and routes of abscess spread are presented with photographic and radiographic illustration. Medical and surgical management is reviewed, and methods for accurate diagnosis are emphasized.

Langerhans cell histiocytosis (LCH) is a rare disease that may affect multiple organs. The etiology of LCH remains unclear to date. It is currently believed that clonal accumulation and proliferation of CD1a-positive Langerhans cells are causative. The term LCH or histiocytosis X refers to three separate illnesses (listed in order of increasing severity): eosinophilic granuloma, Hand-Schüller-Christian disease and Letterer-Siwe disease. A seven-month-old boy presented with history of recurrent bilateral otitis media and rash and seborrheic areas on his scalp. Two days prior, his mother noticed a small lump over the right mastoid. Lateral skull X-ray (Schüller) was evidence for lytic lesion on right temporal bone. The computerized tomography scan showed inflammatory changes with bone erosion. During surgical exploration, fragile slightly yellowish tissue with necrotic areas was found that was determined as LCH on histology. Chemotherapy was subsequently initiated. The initial present...

Acute mastoiditis (AM) is an uncommon but serious complication of acute otitis media (AOM). In the pre-antibiotic era, AM was seen more frequently than it is today, but it was rare in infants. However, in the last two decades an increase in the incidence of AM in infancy has been reported in the literature. During the years 1990-2002, we treated 113 patients with 128 episodes of AM; of them, 24 were infants (median age 6 months; 18 males) who suffered from 26 episodes of AM. Twenty developed AM as a complication of their first episode of AOM. One of the four infants with a prior history of AOM suffered from common variable immunodeficiency. A significant increase in the incidence of AM in infants was recorded during the study period (P = 0.01). The most common presenting clinical signs were post-auricular swelling and fever >38 degrees C (77% and 77%, respectively, of all patients). Seventeen episodes of AM were not treated with prior antibiotics. Tympanocentesis was performed in...

Three case reports of mastoiditis caused by atypical mycobacteria are discussed and a review of the world literature is given. Our aim is to focus the attention of the ENT specialist and the pediatrician on these pathological agents in unilateral recurrent otitis media. The case reports illustrate the importance of histologic and microbiologic examination. Difficulties in the differential diagnosis are mentioned. The therapy is slightly different from lymphadenitis caused by atypical mycobacteria because for mastoiditis we prefer the combination of surgery with medical treatment.