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Objectives: Streptococcus pneumoniae is the leading bacterial etiologic agent in acute otitis media (AOM), and it produces a more severe inflammatory response than other otopathogens. Additionally, the presence of multidrug-resistant (MDR) S. pneumoniae is an important issue in the management of AOM. The present pilot study aimed to ascertain whether MDR S. pneumoniae is associated with a higher inflammatory response and/or a more severe disease.Methods: This was a prospective, single-center study on nonpneumococcal conjugate vaccine-immunized pediatric patients with severe AOM. Demographic and clinical characteristics were recorded. Middle ear fluid was obtained and cultured for each patient; antibiotic-resistance profiling was tested for S. pneumoniae isolates. The C-reactive protein (CRP) level and complete blood count were determined. Patients with positive middle ear fluid culture for S. pneumoniae were divided into 2 groups according to antibiotic resistance profile: MDR and non-MDR.Results: MDR S. pneumoniae was identified in 15 (35.7%) of the 42 eligible patients. Children in this group had significantly higher CRP levels (72.23 ± 62.92 vs. 14.96 ± 15.57 mg/L, p < 0.001), higher absolute neutrophil count (8.46 ± 3.97 vs. 5.22 ± 4.5 × 103/mm3, p = 0.004), higher percentage of neutrophils (52.85 ± 13.49% vs. 38.34 ± 16.16%, p = 0.004), and were more prone to develop acute mastoiditis (p = 0.01). Receiver operating characteristic analysis identified CRP as the best biomarker to discriminate between the 2 groups of patients (AUC = 0.891).Conclusion: MDR S. pneumoniae was associated with a more severe inflammatory response and a higher incidence of mastoiditis. [ABSTRACT FROM AUTHOR]

Objective: A small proportion of children with otitis media develop acute mastoiditis, which has the potential to spread intracranially and result in significant morbidity and mortality. The aim of this study was to evaluate the incidence and management of complications related to pediatric acute mastoiditis using a national database. Study Design: Retrospective review of 2016 Kids' Inpatient Database, part of the Healthcare Cost and Utilization Project. Setting: Academic, community, general, and pediatric specialty hospitals in the United States. Methods: International Classification of Diseases, Tenth Revision, Clinical Modification code H70.XXX was used to retrieve records for children admitted with a diagnosis of mastoiditis. Data included patient demographics, intracranial infections, procedures (middle ear drainage, mastoidectomy, and intracranial drainage), length of stay (LOS), and total charges. Results: In total, 2061 children aged ≤21 years were identified with a diagnosis of acute mastoiditis. Complications included subperiosteal abscess (6.90%), intracranial thrombophlebitis/thrombosis (5.30%), intracranial abscess (3.90%), otitic hydrocephalus (1.20%), encephalitis (0.90%), subperiosteal abscess with intracranial complication (0.60%), petrositis (0.60%), and meningitis (0.30%). Children with intracranial abscesses were more likely (P <.001) to undergo myringotomy ± ventilation tube insertion (63.7%), mastoidectomy (53.8%), mastoidectomy with ventilation tube or myringotomy (42.5%), intracranial drainage procedure (36.3%), or all 3 key procedures (15.0%). Children with any type of intracranial complication had a significantly longer LOS (P <.001) and higher total charges (P <.001). Both a diagnosis of bacterial meningitis and undergoing an intracranial drainage procedure (P <.001) contributed significantly to LOS and total charges. Conclusion: Patients with intracranial complications are more likely to undergo surgical procedures; however, there is still wide variability in practice patterns, illustrating that controversies in the management of otitis media complications persist. [ABSTRACT FROM AUTHOR]

Cat-scratch disease can be transmitted from cats and dogs in winter. It is usually self-limited and caused by Bartonella henselae. It may cause serious symptoms, including neurological findings, especially in immune-deficient patients. A female patient was referred to our outpatient clinic at the age of 3 years and 10 months with a preliminary diagnosis of neurodegenerative metabolic disease. Her complaints began after a stray cat scratched her. We found out that the hospital to which she was admitted provided only local wound care due to her history of contact with a cat and that she was vaccinated against rabies. Her body temperature increased, her neck lymph nodes became swollen, and she developed otitis and mastoiditis after 1 month. Additionally, we discovered that she had deteriorated in her walking ability after 6 weeks and developed hand tremors after 10 weeks. It was discovered that previous centers to which the patient applied did not question cat contact. All metabolic tests performed for the differential diagnosis of last admission findings were considered nonspecific. Considering cat-scratch disease due to her clinical history, she was referred to the pediatric infection unit for a Bartonella henselae test, and the test result was 1/256 positive. Failure to follow basic medical rules might be costly in diagnosis and treatment. Cat scratch disease is a zoonosis and a major public health problem. In differential diagnosis, these medical procedures should always be considered before rare metabolic diseases. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics, diagnostics, treatment, and outcome of severe acute otitis media (AOM) and acute mastoiditis (AM) caused by group A beta‐hemolytic streptococcus (GAS). Study design: A retrospective cohort study. Methods: The yearly incidence of inpatient care‐needing GAS AOM/AM patients in our hospital catchment area between 2002 and 2018 was investigated. A detailed analysis was performed for cases treated during the last GAS epidemic in 2017‐2018. Anamnesis, signs and symptoms, pure‐tone audiometry results, treatment, complications, and outcome were collected from medical charts. Patients responded to an otology‐specific health‐related quality of life survey (EOS‐16) 1.5 to 3 years after their treatment. Results: The number of GAS infections peaks at approximately 7‐year intervals. During 2017 and 2018, altogether 37 patients (29 adults and 8 children) were hospitalized due to GAS AOM/AM. AM was diagnosed in 14 (38%) patients. The disease progression was typically very rapid. At presentation, all patients had severe ear pain, 68% tympanic membrane perforation and discharge, 43% fever, and 43% vertigo. In pure‐tone audiometry, there was usually a marked mixed hearing loss at presentation. There was a significant recovery in both air and bone conduction thresholds; the pure tone average improvement from presentation was 32.3 ± 14.8 dB. Rapid strep tests (RST) proved to be more sensitive than bacterial culture in identifying GAS as a cause of AOM/AM. Conclusion: GAS AOM/AM has a rapid onset. Hearing loss usually includes a sensorineural component, which is usually reversible with adequate treatment. RST seems to be useful in detecting GAS from middle ear discharge. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: Although cochlear implantation (CI) is a relatively safe operation, postoperative complications sometimes occur. We reviewed the frequency and severity of complications of CI at our hospital. We compared our results with previously reported complications and considered measures to improve patient outcomes.Methods: This retrospective study examined the medical records of 70 patients who received CI between March 2005 and December 2018. We collected the following data: age at the time of the first surgery, etiology of hearing impairment, date of implantation, type of implanted devices, and complications. Surgical complications were divided by time into perioperative, early, and late, and by severity into major or minor.Results: Records of 38 adults and 32 children were analyzed. Bilateral CI was performed in 16 patients, 8 of whom were sequential, and unilateral CI was performed in 54 patients. The total number of operations was 78 for 86 CI. Complications were observed in 15 of 78 operations (19%), and the rates of minor and major complications were 15% and 4%, respectively. Complication rates were 21% (8/39) for children and 10% (4/39) for adults. All of the perioperative and early complications were minor. There were three major complications, all of which were infections presenting with mastoiditis and subcutaneous or subperiosteal abscesses. One case required reimplantation twice because of recurrent mastoiditis and temporal abscess.Conclusions: There was no significant difference in the incidence of complications between children and adults, but all major complications were infection in pediatric cases. Careful attention is needed to prevent postoperative infection. [ABSTRACT FROM AUTHOR]

Objectives: Characterisation of clinical manifestations in children who had acute mastoiditis (AM) -related intracranial complications (ICCs) and to determine the incidence of ICCs in the study group. To define children with a higher risk of ICCs and gain new information on aetiological microbial agents of AM. Methods: A retrospective analysis of 137 paediatric patients with AM treated at a tertiary centre using standard dia-gnostic and therapeutic protocol between 2002 and 2019. Results: Altogether 137 patients with AM were hospitalised at our centre between 2002 and 2019. During this time, the occurrence of ICC in children with AM was low (n = 3, incidence 2.19%). Due to the low number of patients with ICC with AM in our patient group, we were unable to define a specific group of patients with a higher risk of ICC development in AM. Despite this fact, the average value and median of CRP were considerably higher in patients with AM-associated ICCs. The most frequent aetiological agent was Streptococcus pneumoniae. Conclusions: The low incidence of ICC in patients with AM in our patient group might be caused by routinely performed paracentesis in developed acute otitis, rational antibio-tic therapy and the good availability of an ENT specialist in the Czech Republic. The most common aetiological agent of AM was Streptococcus pneumoniae. [ABSTRACT FROM AUTHOR]

A middle-aged woman presented with two months of left ear pain and hearing loss. She had previously been admitted to an outside hospital for left-sided otomastoiditis and was treated with antibiotics without resolution. After failing outpatient management with pressure equalization tube placement and developing new neck pain, she was admitted to the hospital to rule out meningitis. Lumbar puncture was normal and the patient started on broad-spectrum intravenous antibiotics. Computed tomography and magnetic resonance imaging showed persistent fluid in the left middle ear and mastoid without bony erosion as well as a mass in the left nasopharynx and right parotid gland. The patient did not improve and was taken for biopsy of masses and left tympanomastoidectomy. Multiple blood and tissue samples were negative for infection or malignancy. Ultimately, autoimmune labs were obtained showing elevated cANCA and serine proteinase 3 (PR3), consistent with granulomatosis with polyangiitis and she improved with steroid treatment. This is the first report of GPA with focal simultaneous involvement of the nasopharynx and parotid, which made the diagnosis challenging to establish.

The facial nerve is the most common cranial nerve to have a disorder. In adults, the incidence has been reported to be as high as 40 cases per 100,000 patients annually. In the pediatric population, the frequency of facial nerve palsy is much less. It is estimated that children over the age of 10 have an incidence of 10 per 100,000 annually and those under the age of 10 to be less than 3 per 100,000 annually. Nonetheless, when children are affected, it has a tremendous impact on the child and can cause great distress to the family. As with adults, the most common etiology of facial palsy in children is idiopathic (Bell's Palsy). However, the most frequent identifiable causes of facial palsy in children are different from that in adults. In children, when not idiopathic, infection followed by trauma and congenital conditions are the most commonly etiologies of facial nerve palsy. The diagnosis, evaluation, treatment and outcomes of facial palsy in children will be reviewed. In addition, a series of representative cases of pediatric facial palsy at our children's hospital will be presented.

Abstract Severe complications may not always present with “classic” signs and symptoms. In the setting of recent mastoiditis, complications including cerebral venous sinus thrombosis, skull base osteomyelitis, and retropharyngeal abscess should be considered, particularly with persistent or worsening symptoms. A broad differential can lead to prompt diagnosis and treatment, thereby reducing the likelihood of morbidity and mortality.

Introduction: The incidence of acute mastoiditis, a common complication of otitis media, has significantly decreased with the emergence of antibiotic therapy [1]. Classical symptoms of acute mastoiditis include fever, irritability, otalgia, swelling of the mastoid area, and retroauricular erythema [2]. Delay in appropriate antibiotic treatment of mastoiditis may lead to intracranial and extracranial complications. Facial nerve paralysis is a rare complication of otomastoiditis with different pathophysiologic mechanisms postulated [3]. Extensive literature search showed cases of lower motor neuron involvement of the facial nerve in affected patients. We report an unusual case of mastoiditis without fever complicated by epidural abscess and upper motor neuron facial nerve palsy in a previously healthy adolescent. Case Presentation: A 13-year-old male presented with painful progressive swelling behind his left ear of 5 days duration. Symptoms had started 2 weeks prior with complaints of left ear pain, and he was diagnosed with impacted cerumen and prescribed topical hydrogen peroxide. There was no history of fever, ear discharge, hearing loss or change in neurologic status. On admission, physical examination showed 4x4 cm tender swelling over the left mastoid region with forward displacement of the pinna and cerumen impaction. Neurological assessment was normal. Laboratory investigations showed peripheral leukocytosis (12,200 cells/uL) with neutrophilia (74%), and elevated c-reactive protein (87 mg/L). Head CT scan showed acute coalescent left mastoiditis with small left epidural abscess formation, displacing the left sigmoid sinus medially, and a developing left mastoid subperiosteal abscess (see 'Figure 1'). A diagnosis of acute mastoiditis was made, and he was commenced on intravenous ceftriaxone and vancomycin with resultant decrease in size of the swelling and normalization of inflammatory markers. On the third day of admission, the patient developed mild right-sided facial asymmetry with sparing of the upper part of the face. Ceftriaxone was changed to piperacillin-tazobactam for broader-spectrum anerobic and gram-negative coverage. Otolaryngology evaluation revealed Bezold’s abscess requiring mastoidectomy. The father initially declined, given improvement in the patient’s symptoms, but consented to wide myringotomy and placement of a short-term myringotomy tube for further drainage and middle ear irrigation. Samples of pus collected were sent for aerobic, anaerobic, mycobacterial, and fungal cultures which all came back negative except for scant growth of Staphylococcus epidermidis. MRI done on the second post-operative day showed severe coalescent left otomastoiditis, mild meningeal enhancement compatible with meningitis along the left lateral temporal lobe, and a small sliver of epidural abscess along the left infratemporal fossa (see 'Figure 2'). Antibiotic treatment was escalated from Piperacillin-tazobactam to meropenem to provide a broader gram-negative and anaerobic coverage. At this point, father consented, and patient underwent mastoidectomy with craniotomy and epidural abscess drainage. Patient received 14 days of parenteral antibiotics. He showed clinical and radiological improvement on repeat MRI, facial asymmetry resolved and patient was discharged home in stable condition to complete 1-month of oral antibiotics (levofloxacin + amoxicillin-clavulanate) with subsequent outpatient follow-up. Conclusion: Mastoiditis is a complication of otitis media that can lead to potentially life-threatening intracranial complications. Interestingly, the patient developed rightsided facial asymmetry sparing the upper part of the face suggesting a left upper motor neuron facial nerve palsy with involvement of the contralateral face. This finding is unique to our case, and to our knowledge has not been described in literature. A plausible anatomic explanation is the involvement of ipsilateral corticobulbar tract with subsequent interruption of the main input to the lower portion of contralateral facial nerve nucleus which controls the muscles of the lower face [4]. This results in sparing of the upper facial muscles characteristic of upper motor neuron lesion. Appropriate antibiotic treatment with surgical intervention led to complete resolution of symptoms.

Severe complications may not always present with "classic" signs and symptoms. In the setting of recent mastoiditis, complications including cerebral venous sinus thrombosis, skull base osteomyelitis, and retropharyngeal abscess should be considered, particularly with persistent or worsening symptoms. A broad differential can lead to prompt diagnosis and treatment, thereby reducing the likelihood of morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Tuberculous mastoiditis is a rare case of chronic otitis media disease and extrapulmonary tuberculosis, caused by Mycobacterium tuberculosis. Case Presentation: Four cases of tuberculous mastoiditis were reported, ranging in age from 16 to 66 years. All patients presented with chronic discharge with signs of mastoiditis with intra and extratemporal complications. Two patients only manifested in the mastoid and two other patients had symptoms of tuberculosis in other organs, especially the lungs. All patients underwent radical mastoidectomy and histopathological examination showed tuberculosis. All patients received category 1 and category 2 antituberculosis drugs. Conclusion: The clinical features of tuberculous mastoiditis vary. Diagnosis of tuberculous mastoiditis can be done by histopathological examination and geneXpert. Surgical therapy and administration of antituberculosis are the main options in the management of tuberculous mastoiditis. [ABSTRACT FROM AUTHOR]

A foreign body in the ear, nose or throat' is a common condition in otolaryngology and emergency clinics. Sometimes this situation can cause serious complications. A few of foreign bodies may need to be removal under operating room conditions and it is important to perform the first examination by otolaryngologists in reducing complications. In this case report, a 9-year-old patient who applied to our clinic with symptoms of bleeding and discharge in the external auditory canal after trauma is presented. The foreign body in the mastoid cavity was removed by simple mastoidectomy. With this case, complications of foreign body in the temporal bone will be discussed in the light of the literature. [ABSTRACT FROM AUTHOR]

Otitis media is a frequent infection during childhood. Complications may be present in up to 4 of 100 children including serious neurological complications, particularly in developing countries. We report the case of a 9-year-old girl with no disease history who presented with otitis media, otorrhea, intracranial hypertension syndrome, and paralysis of the VI cranial nerve contralateral to the lesion. A computed tomography scan of the skull and a brain magnetic resonance imaging revealed chronic otomastoiditis, petrous apicitis, and thrombosis of the transverse and sigmoid sinus, the jugular bulb, and the right internal jugular vein. She received antibiotics and surgical treatment. This case shows the spectrum of intra and extracranial complications associated with acute otitis media in the antibiotic era. The physical examination allows early identification of intracranial hypertension with signs such as papilledema and sixth contralateral nerve palsy as an unusual finding. [ABSTRACT FROM AUTHOR]

Copyright of Rheuma Plus is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Otitis media is an inflammation of mucoperiosteal layer of the middle ear cleft which occurs mostly due to eustachian tube dysfunction superadded with an infective etiology. It is said that younger children are more commonly affected due to the anatomical difference of eustachian tube in children from an adult, but adults are affected as well. Usually acute otitis media may settle following a course of antibiotics, however, it can lead to persistence of infection or becoming chronic and may lead to severe intra and extracranial complications. This report is about a 16-year-old male who presented with a painful swelling in right postauricular region for two weeks duration. The right ear had a diffuse swelling of size 6x1x5 cm in the postauricular region, tender on palpation, firm in consistency, and was fluctuant. Otoscopic examination of the right ear showed bulge out and intact tympanic membrane without active discharge and congestion. High Resolution Computed Tomography (HRCT) of temporal bone showed right otomastoiditis with erosion of the lateral cortex of the right mastoid. He underwent right cortical mastoidectomy under general anaesthesia. The patient was on follow-up for six months and no recurrence was noted. [ABSTRACT FROM AUTHOR]

Subperiosteal abscess (SPA) is a known sequel of acute mastoiditis typically afflicting children and less often the elderly, caused by Streptococcus, Staphylococcus, and anaerobes. Atrophic rhinitis is a progressive disease with nasal mucosal and turbinate atrophy, thick dried crusts, and foul odor called ozaena, caused by Klebsiella ozaenae. We present an interesting case of SPA in the mastoid in a patient with atrophic rhinitis, astonishingly caused by a common pathogen, K. ozaenae, and a review of literature. The presence of coexistent atrophic rhinitis and mastoiditis should always compel otolaryngologists to consider K. ozaenae as the common etiology. [ABSTRACT FROM AUTHOR]

The article presents a case of a 25-year-old woman who was rushed to a hospital's ear, nose and throat (ENT) outpatient department due to left ear discharge, hearing loss and left facial nerve palsy to discuss a rare case of candida mastoiditis in an immunocompetent patient with cholesteatoma ear disease. She was diagnosed with right chronic suppurative otitis media cholesteatoma ear disease with grade II facial nerve palsy and was treated with modified radical mastoidectomy.

Background: IgG4-related disease (IgG4-RD) is an inflammatory process. The literature on IgG4-RD is rather limited, with mastoid involvement being uncommon. In such cases, presentation may mimic other middle ear and mastoid cavity pathologies. Objective: To summarize findings of patients with IgG4-RD involving the mastoid. Methods: Description of two new cases and summary of findings with previous reports. Results: Nineteen cases of IgG4-RD with mastoid bone involvement were reported in the literature, the earliest appearing at the beginning of the previous decade. Most frequent symptoms included hearing deterioration, tinnitus and otalgia. In 58% of the cases, the process was restricted to otologic manifestations. In 7 out of 19 cases, tissue IgG4 levels were elevated. In all histopathologic samples taken from the operative sites, a dense lymphoplasmacytic cell infiltration was observed. Following definitive pathological diagnosis, the most common treatment was corticosteroids. Generally, the time from onset to final diagnosis was usually more than six months. The treatment is corticosteroids, followed by immunosuppressive agents such as rituximab, cyclophosphamide, and methotrexate. Conclusions: IgG4-RD involving the mastoid is a challenging condition, both in diagnosis and treatment. Hence, IgG4-RD should be included in the differential diagnosis of middle ear pathologies and include a multi-disciplinary team for treatment.

Abstract Background Central nervous system (CNS) infections caused by Actinomyces spp. including brain abscess, actinomycoma, subdural empyema and epidural abscess are well described, however reports of Actinomyces-associated meningitis are scarcely reported. Case report We present the case of a 43-year-old Hungarian male patient with poor socioeconomic status who developed acute bacterial meningitis caused by Actinomyces turicensis originating from the left side mastoiditis. The bacterial cultures of both cerebrospinal fluid (CSF) and purulent discharge collected during the mastoid surgery showed slow growing Gram-positive rods that were identified by automated systems (API, VITEK) as A. turicensis The bacterial identification was confirmed by 16S rRNA PCR and subsequent nucleic acid sequencing. No bacterial growth was detected in blood culture bottles after 5 days of incubation. Hence, multiple antibacterial treatments and surgical intervention the patient passed away. Conclusions Anaerobes are rarely involved in CNS infections therefore anaerobic culture of CSF samples is routinely not performed. However, anaerobic bacteria should be considered as potential pathogens when certain risk factors are present, such as paranasal sinusitis, mastoiditis in patients with poor socioeconomic condition. To the best of our knowledge, our case report is the first description of A. turicensis meningitis that has been diagnosed as consequence of purulent mastoiditis.

Copyright of Polish Otorhinolaryngological Review / Polski Przegląd Otorynolaryngologiczny (Index Copernicus) is the property of Index Copernicus International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Implementation of the Haemophilus influenzae type B (Hib) conjugate vaccine brought about a reduction in the number of cases and morbidity from type B but an increase in nontypeable strain infections. Nontypeable Haemophilus influenzae (NTHi) commonly colonizes children's upper respiratory tract and causes otitis media, sinusitis, and bronchitis. Invasive NTHi diseases, such as meningitis and septicemia, have rarely been reported. Herein, we discuss a previously healthy, fully immunized 3-year-old girl presented with otitis media and mastoiditis leading to meningitis caused by NTHi complicated with central venous thrombosis. She was treated with antibiotics, mastoidectomy and ventilation tube insertion, and anticoagulation therapy and recovered uneventfully. Through this case, we wish to share our unique clinical experience that NTHi should be born in mind as a potential pathogen that can cause meningitis in previously healthy children, which may be helpful in future cases. [ABSTRACT FROM AUTHOR]

Objective  The role of anticoagulation (AC) in the management of otogenic cerebral venous sinus thrombosis (OCVST) remains controversial. Our study aims to better define when AC is used in OCVST. Methods  MEDLINE, EMBASE, and The Cochrane Library were searched from inception to February 14, 2019 for English and English-translated articles. References cited in publications meeting search criteria were searched. Titles and abstracts were screened and identified in the literature search, assessing baseline risk of bias on extracted data with the methodological index for nonrandomized studies (MINORS) scale. Random effects meta-regression followed by random forest machine learning analysis across 16 moderator variables between AC and nonanticoagulated (NAC) cohorts was conducted. Results  A total of 92% of treated patients were free of neurologic symptoms at the last follow-up (mean 29.64 months). Four percent of AC and 14% of NAC patients remained symptomatic (mean 18.72 and 47.10 months). 3.5% of AC patients experienced postoperative wound hematomas. AC and NAC recanalization rates were 81% (34/42) and 63% (five-eights), respectively. OCVST was correlated with cholesteatoma and intracranial abscess. Among the analyzed covariates, intracranial abscess was most predictive of AC and cholesteatoma was most predictive of NAC. Comorbid intracranial abscess and cholesteatoma were predictive of AC. Conclusion  The present study is the first to utilize machine learning algorithms in approaching OCVST. Our findings support the therapeutic use of AC in the management of OCVST when complicated by thrombophilia, intracranial abscess, and cholesteatoma. Patients with intracranial abscess and cholesteatoma may benefit from AC and surgery. Patients with cholesteatoma can be managed with NAC and surgery. [ABSTRACT FROM AUTHOR]

Purpose: To stratify differences in visual semantic and quantitative imaging features in intensive care patients with nonspecific mastoid effusions versus patients with acute mastoiditis (AM) requiring surgical treatment. Methods: We included 48 patients (male, 28; female, 20; mean age, 59.5 ± 18.1 years) with mastoid opacification (AM, n = 24; control, n = 24) who underwent clinically indicated cerebral CT between 12/2007 and 07/2018 in this retrospective study. Semantic features described the extend and asymmetry of mastoid and middle-ear cavity opacification and complications like erosive changes. Minimum, maximum and mean Hounsfield unit (HU) values were obtained as quantitative features. We analyzed the features employing univariate testing. Results: Compared to intensive care patients, AM patients revealed asymmetric mastoid or middle-ear cavity opacification (likelihood-ratio (LR) < 0.001). Applying a dedicated threshold of the extent of opacification, AM patients reached significance levels of LR = 0.042 and 0.002 for mastoid and middle-ear cavity opacification. AM cases showed higher maximum and mean HU values (p = 0.009, p = 0.024). Conclusions: We revealed that the extent and asymmetry of mastoid and middle-ear cavity opacification differs significantly between AM patients and intensive care patients. Multicenter research is needed to expand our cohort and possibly pave the way to build a non-invasive predictive model for AM in the future.

We report a case of primary temporal bone diffuse B-cell non-Hodgkin lymphoma, which is a rare entity. A 71-year-old male with a history of dementia and hemicraniectomy presented due to 1 month of a pronounced left ulcerative mastoid lesion. Strikingly, there were no cranial nerve deficits which was unexpected due to the degree of the lesion. Initially, infectious mastoiditis was suspected based on physical examination alone. Due to the patient being a poor historian, it was difficult to determine whether this was an acute or chronic issue. Temporal bone squamous cell carcinoma, infectious mastoiditis, and actinomycosis were on the differential, but biopsies revealed non-Hodgkin lymphoma. [ABSTRACT FROM AUTHOR]

Bezold abscess (BZ) is defined as a deep neck abscess as the result of mastoiditis with mastoid tip erosion after otitis media (OM). Despite its rare occurrence due to the early intervention of ear infection with antibiotics, diligently looking for this complication is important, especially in the immunodeficient population. The utilization of radio imaging remains crucial in the management of acute OM with complications. The contrast-enhanced computed tomography facilitates the diagnosis and provides a glimpse of the disease extension. Early recognition and intervention are vital for a good outcome. The authors present a case report of a mastoiditis complicated with a BZ in the only hearing ear. The risk factors, presentations, and treatment options are discussed, along with the review of the literature. [ABSTRACT FROM AUTHOR]

We report an extremely low-birth-weight neonate with new onset unilateral facial palsy on ninth day of life. The child had neonatal sepsis, meningitis was ruled out and ear discharge was noted from the ipsilateral ear. Otoscopy suggested acute suppurative otitis media, while magnetic resonance imaging was suggestive of mastoiditis. The facial weakness improved with physiotherapy over next two weeks. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the incidence of mastoid effusion on temporal bone magnetic resonance imaging (MRI) in patients with Bell's palsy (BP) and Ramsay Hunt syndrome (RHS), and evaluate the usefulness of mastoid effusion in early differential diagnosis between BP and RHS. The incidence of mastoid effusion on 3.0 T—temporal bone MRI, which was conducted within 10 days after the onset of acute facial nerve palsy, was compared between 131 patients with BP and 33 patients with RHS. Findings of mastoid cavity on temporal bone MRI were classified into three groups as normal mastoid, mastoid effusion, and sclerotic change, and the incidence of ipsilesional mastoid effusion was significantly higher in RHS than BP (P < 0.001). Tympanic membrane was normal in 7 of 14 RHS patients with mastoid effusion, and injected without middle ear effusion in 7 patients. This study highlights significantly higher incidence of ipsilesional mastoid effusion in RHS than BP, and suggests that the presence of mastoid effusion may provide additional information for differential diagnosis between RHS and BP. [ABSTRACT FROM AUTHOR]

Objectives: Several studies have reported that younger children suffer from increased incidence and more severe episodes of acute mastoiditis (AM) than older children, whereas other researchers have found the opposite. The aim of our study was to describe the occurrence, clinical, and microbiological aspects of AM in children 6 months or younger, and compare them with the results in an older reference age band. Methods: The medical files of children hospitalized with a diagnosis of AM during 2001–2016 were retrospectively reviewed. Diagnosis of AM was based on the presence of clinical signs of acute otitis media (AOM) accompanied by two or more of the following: auricle protrusion, retro-auricular erythema, swelling, and local tenderness. Children were divided into two age bands, 6 months or younger, and older than 6 months. Results: Fifty patients in the young age band and 335 in the older reference age band were included. Bilateral AOM was identified in 14 (28%) children under 6 months, and 50 (14.9%) in the reference age band (p < 0.001). Fever, mean WBC, and CRP values were similar in both age bands; 4 (8%) children under 6 months had pre-auricular/zygomatic area swelling, as compared to 1(0.02%) in the reference age band (p < 0.001). Complication rates (subperiosteal abscess, sinus vein thrombosis, and epidural abscess) were similar in both age bands. All children were treated with myringotomy and IV antibiotics. Cortical mastoidectomy with the insertion of ventilation tube was performed in 10 (20%) children in the younger age band and 58(17.3%) in the reference age band. Streptococcus pneumoniae was the most common (38%) isolated bacteria in the younger age band, and Group A streptococcous (GAS) (20.6%) in the reference age band. Conclusions: AM in children 6 months or younger has similar presentation and characteristics as in older children. Pre-auricular swelling and bilateral AOM are more typical in the younger age band; Streptococcus pneumoniae is the most common pathogen in the younger children. We suggest that the treatment approach should be the same for both groups. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the clinical course and outcome of a group of adults who presented with a subperiosteal abscess (SPA) MATERIALS and METHODS: A retrospective chart review of patients with SPA. RESULTS: Between 2001 and 2015, 7 such patients--5 men and 2 women--were identified. Their age ranged from 18 to 62 years. Six of them suffered from chronic otitis media (COM) and presented with signs and symptoms of otalgia, pain, and swelling around the mastoid. Five of the patients underwent a previous mastoidectomy for cholesteatoma (4-canal wall down and 1 had canal wall up). One of the non-operated patients had cholesteatoma and the other one had chronic suppurative otitis media without cholesteatoma. One patient developed peripheral facial nerve palsy that resolved after surgery, otherwise, no other intratemporal or intracranial complications were observed. Management included a canal wall down mastoidectomy, abscess drainage, and parenteral wide-spectrum antibiotics. One patient suffered cardiovascular and respiratory comorbidities, requiring the delay of surgery for 6 days. This patient underwent incision and drainage of the abscess before surgery. Pathogens were recognized in 4 of the patients and included Streptococcus pneumoniae, Candida albicans, Staphylococcus aureus, and Corynebacterium. CONCLUSION: SPA in adults is rare but may be seen in cases of neglected COM, whether previously operated or not. Comorbidities in older population group may require postponing surgery, so immediate incision and drainage may be warranted, as well as post-surgical intensive care. [ABSTRACT FROM AUTHOR]

Objective: To analyze the cases of acute mastoiditis, characteristics, management and complications in children attended in the emergency department., Methods: Retrospective study of acute mastoiditis in a Spanish tertiary hospital over a 6-year period (2018-2023)., Results: One hundred two episodes of acute mastoiditis were analyzed (54% males, median age 1.8 years). Microorganisms were isolated in one third of cases, mainly Streptococcus pyogenes (64% of ear secretion cultures). Complications occurred in 27.5%, primarily subperiosteal abscess. A younger age, absence of vaccination schedule, previous history of otitis, cochlear implant carriers or white blood cell counts and C-reactive protein levels were not associated with complications. Complicated cases had longer hospitalizations. Treatment included antibiotics, corticosteroids, and surgery in 50% of cases., Conclusions: This study shows an increase of acute mastoiditis during 2023, with a relevant role of S. pyogenes. A younger age, absence of vaccination, personal history of otitis or cochlear implant, blood cell counts and C-reactive protein levels were not associated with complications., (Copyright © 2024 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality., Objective: This review highlights the pearls and pitfalls of mastoiditis, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence., Discussion: Acute mastoiditis most commonly affects pediatric patients and is a suppurative infection of the mastoid air cells. It is often associated with otitis media, and common bacteria include Streptococcus and Staphylococcus. History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise. The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms. Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis. Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis. CT may also demonstrate complications. Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation. Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures., Conclusions: An understanding of acute mastoiditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease., Competing Interests: Declaration of competing interest None. None of the authors have submitted a review on this topic or published previously on this topic. No AI program was utilized in the construction of this manuscript., (Published by Elsevier Inc.)

The universal use of computed tomography (CT) has opened up new possibilities in the noninvasive examination of human mummies, and particularly the detailed study of the fine structures of the temporal bone. The aim of this study was to describe the morphological changes, as seen on CT, found in the right temporal bone of Djed-Hor, an around 2300 year old Heidelberg's Egyptian mummy, and to discuss their possible causal relation to his death. Here we showed the presence of a compress on the auricle, and of probable pus in the mastoid, middle ear, and external ear with erosion of the tegmen tympani probably related to a fatal acute mastoiditis. These typical morphological changes of such a disease were demonstrated in the same way as in living patients of today. This would be the first depiction of a compress on an auricle associated with pus in the ear of an Egyptian mummy., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Bezold's abscess is a very rare complication of mastoiditis, where the infection erodes through mastoid cortex and causes deep neck abscess. Bezold's abscess with concomitant intracranial complications of mastoiditis is even rarer.We reported a 19-year-old man with retroauricular pain and bilateral ear discharge for 10 years. Mastoid high-resolution CT (HRCT) showed opacification in middle-ear cavity and destruction of both right mastoid and occipital bone. Contrast-enhanced neck CT showed deep neck abscess, extending to thoracic region. Contrast-enhanced cerebral CT showed right sigmoid sinus thrombosis, fluid collection in infratentorial subdural space, pneumocephalus, and hydrocephalus. Diagnosis was mastoiditis with Bezold's abscess and intracranial complications. Patient underwent surgical drainage. Microbiological culture showed Enterococcus faecalis and Proteus mirabilis.Imaging is important to diagnose mastoiditis and evaluate both intracranial and extracranial complications. CT is the imaging modality of choice for mastoiditis. HRCT is preferable because it can show temporal bone lesions in more detail. Contrast-enhanced neck CT is useful to evaluate soft tissue involvement, while contrast-enhanced cerebral CT can evaluate intracranial complications.

Objective: To report a rare case of masked mastoiditis and bilateral lateral sinus thrombosis in a pediatric patient. Case report: A previously healthy 4-year-old male presented to the emergency department with fever in the setting of bilateral acute otitis media (AOM) and exam findings consistent with right sided mastoiditis. He underwent bilateral tympanostomy tube placement and was started on intravenous ampicillin-sulbactam and ciprofloxacin-dexamethasone drops. Despite this, symptoms and fevers persisted, prompting a computed tomography (CT) scan, which demonstrated bilateral mastoiditis with bilateral lateral sinus thrombosis (LST). Lumbar puncture and bilateral cortical mastoidectomy were performed. Subsequent magnetic resonance venography (MRV), obtained to assess the extent of thrombosis, demonstrated complete occlusion of the right sigmoid sinus and portions of the right transverse sinus with right inferior cerebellar hemisphere venous infarction. There was also a nonocclusive thrombus within the left transverse and sigmoid sinus. Antibiotics were switched to cefepime following culture sensitivities. Therapeutic enoxaparin was initiated. The patient had no long-term complications. Conclusion: Lateral sinus thrombosis is a rare but serious complication of acute mastoiditis and can present in the setting of masked mastoiditis. The development of LST following AM may have an insidious course. Worsening symptoms or lack of improvement in patients with AM should necessitate imaging, as prompt recognition and treatment may prevent thrombus evolution and neurological sequelae. Clinicians should maintain a high index of suspicion for LST in children with AM and a low tolerance for symptoms when considering acquiring imaging studies. While no LST treatment algorithms exist, this case supports the role of aggressive intervention with antibiotics, tympanostomy tube placement, mastoidectomy, and anticoagulation.

Mycobacterium tuberculosis affects the middle ear in rare cases and is a challenging diagnosis. In this case, we present a 57-year-old patient diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-negative granulomatosis with polyangiitis (GPA) following a biopsy result of nasal granulomas, who was immediately started on immunosuppressive treatment. Years later, she developed progressive hypoacusis. Magnetic resonance imaging (MRI) revealed an extensive mass in the tympanic cavity extending to the mastoid. A biopsy of the mass was positive for Mycobacterium tuberculosis. Immunosuppressants were weaned and the patient was started on anti-tuberculous therapy with resolution of the complaints and findings. Tuberculous infections are difficult to diagnose and frequently mimic other illnesses, but in our case, we believe that an indolent tuberculous process was present from the beginning and evolved under immunosuppressive therapy.