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Despite the availability of safe, reliable, and cost-effective measles vaccine, we continue to experience dreadful measles outbreaks with devastating multisystem complications, especially in the pediatric age group. In most instances, the complications arise from a late presentation or delayed institution of appropriate care. With co-existence of measles virus and bacteria in the middle ear, suppurative otitis media can involve the mastoid process and causes fatal complications that manifest late when the patient is in a dire state. This short review highlights the pathogenic mechanisms leading to mastoiditis, facial paralysis, and neck abscess following acute infection with the measles virus, and outlines some useful diagnostic tips. In this review, we searched the international electronic database (PubMed, Web of Science, and Embase) and Google Scholar for articles published on complications of acute measles infection. The keywords used were "mastoiditis", "mastoid antrum", "middle ear", "otitis media", "Bezold's abscess", "facial paralysis" with an operator "OR"; "AND" measles; with restriction to the English language. Also, we searched for similar information in the local clinical and virology journals databases. Thereafter, we reviewed the publications and we described the findings qualitatively. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis (LCH) is a rare nonmalignant entity commonly seen in the pediatric population which encompasses a variety of clinical presentations. Otological involvement in LCH is uncommon which can be manifested as symptoms similar to otomastoiditis or malignancy, thus diagnosis is often delayed. Herein, we report a 1-year 7-month-old boy presented with unresolving left otorrhea complicated with left postauricular swelling. Otoscopic examination revealed granulation tissue in the left external auditory canal. Initial diagnosis of left otomastoiditis was made until high-resolution contrast-enhanced computed tomography of the temporal bone showed soft-tissue masses occupying bilateral mastoids with bony destruction. Histopathological examination with immunohistochemical staining expressed CD1a cytoplasmic immunoreactivity. The diagnosis of LCH was made. This report serves to highlight such a rare clinical entity which often masquerades as other otological diseases and hence becomes a diagnostic challenge in the pediatric population. [ABSTRACT FROM AUTHOR]

In modern clinical medical practice, middle-ear infection is a frequently reported condition. If untreated, persistent inflammation caused by infection may lead to perforation of the mastoid process or other portions of the temporal bone. When the middle-ear abscess penetrates the surrounding bone and invades the mastoid process, it causes mastoiditis. Abnormal osseous fistulae were observed on the temporal bones of individuals M137 and M199, which were unearthed in Qufu Olympic Sports Center Cemetery in Qufu City, Shandong Province, and date to the Warring States to the Han Dynasty (475 BCE–220 CE). Microscopic observation and CBCT were used to examine the lesions. A differential diagnosis suggests that the lesions were related to mastoiditis, and based on reference studies, burial information, and paleopathological observation, pollution in the living environment and poor living conditions may be potential factors that caused individuals M137 and M199 to suffer from mastoiditis. The two examples from Qufu are the earliest reported cases of mastoiditis from China; however, infections in the middle ear often go unnoticed in archaeological samples. [ABSTRACT FROM AUTHOR]

The topic of the current article demonstrates, on one hand, the global trend of prevalence in the aetiology and pathogenesis of purulent intracranial complications of acute otitis media over chronic, yet on the other hand, emphasizes the possibility of a combined not related course of inflammatory changes in the middle ear cavities and in the brain. A rare case is described with contact mastoiditis combined with destruction of bone structures adjacent to the cranial cavity was secondary to multiple, huge, long-lasting, latent epidural abscesses. And only the appearance of symptoms, even not so much of acute otitis media, but rather tubootitis, became the only sign of manifestation and, with timely and adequate treatment, led to recovery. [ABSTRACT FROM AUTHOR]

Objective: Bibliographic data for the management of acute mastoiditis in infants aged six months or less are very limited. This study investigated the presenting symptomatology, diagnostic and treatment options, and final outcomes in this age group. Method: A retrospective review was conducted of all infants aged six months or less suffering from acute mastoiditis, admitted to our department between 2007 and 2017. Results: Eleven infants were identified. All of them developed the typical symptomatology of acute mastoiditis, while a higher rate of subperiosteal abscess formation was observed. Imaging was necessary in three cases only. Parenteral antibiotics and myringotomy were applied in all infants. A drainage procedure was also included in the infants with a subperiosteal abscess. Antrotomy was reserved for non-responsive cases. No intracranial complications were observed. All infants were cured without further complications or sequelae. Conclusion: Acute mastoiditis in infants aged six months or less can be safely diagnosed and treated using a standardised algorithmic approach, similar to that used for older children. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to analysis the boundaries of suprameatal triangle by morphometrically. Introduction: The temporal bone consists of squamous, mastoid, tympanic, petrous, and styloid parts. Among that, the petrous is highly complexed part which consists of middle and inner ear and related anatomical structures. In case of mastoiditis, otitis, and other neurovascular conditions related to the auricular region, it is important to approach through surgically. The infectious condition of mastoid antrum, i.e., mastoiditis, is highly a risk clinical condition which may spread into the cranial cavity and/or head-andneck regions. The reasons for this mastoiditis condition are chronic suppurative condition of otitis media. Hence, the drainage of infected mastoid is very important. The drainage is achieved through suprameatal triangle. Materials and Methods: The present study collected 50 South Indian dry human skulls from the Department of Anatomy in Saveetha Dental College and Hospitals. The digital Vernier caliper has used to measure the triangle which was used to understand the morphometric analysis of suprameatal triangle using Vernier caliper. The study adopted t-test for two independent means (online) for statistical analysis with P < 0.05 (95%) with the current observations. Results: The present study observed that the length of the upper border of suprameatal triangle is 13.71 ± 1.86 mm and 13.76 ± 1.74 mm on the right and left sides, respectively (P = 0.437358) [Figure 1 and Graph 1]. The length of the anteroinferior border of suprameatal triangle was measured to be 14.46 ± 1.63 mm and 14.30 ± 1.46 mm on the right and left sides, respectively (P = 0.310597) [Figure 2 and Graph 2], and also the length of the posterior border of the suprameatal triangle was measured to be 14.12 ± 2.02 mm and 17.73 ± 1.74 mm on the right and left sides, respectively (P = 0.85613) [Figure 3 and Graph 3]. There were no significant differences between the right and left sides which were observed in all the parameters. Conclusion: The present study thus concluded that the morphometrical knowledge of suprameatal triangle is most important for neurological and otological emergencies. [ABSTRACT FROM AUTHOR]

Background: Mastoiditis is the most common intra-temporal complication of acute otitis media. Despite potentially lethal sequelae, optimal management remains poorly defined. Method: A retrospective case review was conducted of children diagnosed with mastoiditis at a tertiary referral centre, in North East England, between 2010 and 2017. Results: Fifty-one cases were identified, 49 without cholesteatoma. Median patient age was 42 months (2 months to 18 years) and median hospital stay was 4 days (range, 0–27 days). There was no incidence trend over time. Imaging was conducted in 15 out of 49 cases. Surgery was performed in 29 out of 49 cases, most commonly mastoidectomy with (9 out of 29) or without (9 out of 29) grommets. Complications included sigmoid sinus thrombosis (3 out of 49) and extradural abscess (2 out of 51), amongst others; no fatalities occurred. Conclusion: A detailed contemporary description of paediatric mastoiditis presentation and management is presented. The findings broadly mirror those published by other UK centres, but suggest a higher rate of identified disease complications and surgical interventions. [ABSTRACT FROM AUTHOR]

Objectives: Luc's abscess is a rare complication of acute otitis media, with a challenging diagnosis and a controversial surgical treatment. The aim of the present study was to review the published literature in order to clarify the clinical features and the surgical management of those patients.Methods: A systematic review of the literature was carried out for published reports or case series in English language, describing a temporo-zygomatic (or Luc's) abscess which complicated an acute or chronic otitis media and/or mastoiditis, confirmed through CT scan or MRI of the petrous bone. The collected clinical and radiological data were merged and critically appraised.Results: Eighteen reports of Luc's abscess were included. Adding our case report, a total of 21 cases were included in the analysis. Abscess drainage plus myringotomy alone vs. abscess drainage plus myringotomy and mastoidectomy were the two surgical management approaches described in the literature. Patients undergoing first line mastoidectomy were successfully treated in all cases, while among those undergoing a more conservative approach, one failure required subsequent mastoidectomy.Conclusions: The clinical features of Luc's abscess are rather constant and help in rising the suspicion before the radiological diagnosis. Although cases with associated intra-cranic complications have been reported, the limited existing data do not permit to advocate the mastoidectomy over a more conservative surgical approach. However, the decision to avoid mastoidectomy as the first line surgical treatment should be based on the clinical and radiologic assessment, after an accurate counseling, particularly in the case of a pediatric patient. [ABSTRACT FROM AUTHOR]

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Extracranial complications of Acute Otitis Media (AOM) are uncommon but usually associated with severe adverse outcomes. Here we report the case of an 8-year-old Saudi boy who presented with left-sided facial oedema and proptosis, with ear pain and fever. Clinically, the patient had severe oedema in his left eye, confirmed by redness, and otitis media diagnosed by tympanometry. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed a left mastoiditis and middle-ear collection of fluid, associated with severe soft-tissue oedema involving the orbit, zygomatic arch and temporoparietal region, without abscess formation. The diagnosis was AOM complicated by mastoiditis and soft-tissue oedema, and left eye proptosis. Considering the bodyweight of the patient, intravenous ceftriaxone and clindamycin were administered, followed by direct improvement. Oedema subsided 2 weeks later with the resolution of symptoms and, ultimately, complete healing. Clinicians should apply caution with complicated or refractory cases of AOM because of the potential lethal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate in children the clinical severity and evolution of otogenic lateral sinus thrombosis (OLST) due to Fusobacterium necrophorum compared with other bacterial otogenic thrombosis and propose a specific management flowchart for Fusobacterium OLST. Design: A retrospective multicentre cohort study. Settings: Four French ENT paediatric departments. Participants: A total of 260 under 18 years old admitted for acute mastoiditis were included. Initial imaging was reviewed to focus on complicated mastoiditis and 52 OLST were identified. Children were then divided into two groups according to bacteriological results: 28 in the "OLST Fusobacterium group" and 24 in the "OLST other bacteria group". Results: There was a significant association between F necrophorum and OLST (P <.001). When compared to the OLST other bacteria group, children in the OLST Fusobacterium group were significantly younger (61 months vs 23 months, P <.01) and had a more severe clinical presentation: higher CRP (113 mg/L vs 175.7 mg/L, P =.02) and larger subperiosteal abscess (14 mm vs 21 mm, P <.01). Medical management was also more intensive in the OLST Fusobacterium group than in the OLST other bacteria group: increased number of conservative surgeries (66.7% vs 92.9%, P =.03) and longer hospital stay (13.7 days vs 19.8 days, P =.02). At the end of follow‐up, the clinical course was good in both groups without any neurological sequelae. Conclusions: Thrombotic complications are very frequent in case of Fusobacterium mastoiditis and clinicians should be aware of the initial severity of the clinical presentation. Under appropriate management, the clinical course of Fusobacterium OLST is as good as that of other bacterial otogenic thrombosis. [ABSTRACT FROM AUTHOR]

Background Few data on intracranial group A Streptococcus (GAS) infection in children are available. Here, we describe the demographic, clinical, and diagnostic characteristics of 91 children with intracranial GAS infection. Methods Cases of intracranial GAS infection in persons ≤18 years of age reported between 1997 and 2014 were identified by the Centers for Disease Control and Prevention's population- and laboratory-based Active Bacterial Core surveillance (ABCs) system. Medical charts were abstracted using a active, standardized case report form. All available isolates were emm typed. US census data were used to calculate rates. Results ABCs identified 2596 children with invasive GAS infection over an 18-year period; 91 (3.5%) had an intracranial infection. Intracranial infections were most frequent during the winter months and among children aged <1 year. The average annual incidence was 0.07 cases per 100000 children. For 83 patients for whom information for further classification was available, the principal clinical presentations included meningitis (35 [42%]), intracranial infection after otitis media, mastoiditis, or sinusitis (34 [41%]), and ventriculoperitoneal shunt infection (14 [17%]). Seven (8%) of these infections progressed to streptococcal toxic shock syndrome. The overall case fatality rate was 15%. GAS emm types 1 (31% of available isolates) and 12 (13% of available isolates) were most common. Conclusions Pediatric intracranial (GAS) infections are uncommon but often severe. Risk factors for intracranial GAS infection include the presence of a ventriculoperitoneal shunt and contiguous infections in the middle ear or sinuses. [ABSTRACT FROM AUTHOR]

Background: Hypertrophic pachymeningitis (HP) is a rare disorder that involves localized or diffuse thickening of the dura mater. HP is associated with various inflammatory, infectious, and malignant diseases, such as rheumatic arthritis, sarcoidosis, anti-neutrophil cytoplasmic antibody-associated vasculitis, IgG4-related disorders, syphilis, tuberculosis, bacterial and fungal infections, cancer, and idiopathic diseases, when evaluation fails to reveal a cause. Among them, chronic infection with Propionibacterium acnes is a rare etiology of HP, and its pathology remains unclear.Case Presentation: An 80-year-old man having refractory otitis media with effusion of the right ear presented with progressive right-sided headache and nausea. Post-contrast brain magnetic resonance imaging revealed right mastoiditis and remarkable thickening of the dura mater and enhancement of pia mater extending from the right middle cranial fossa to the temporal lobe. HP secondary to middle ear infection was suspected, and a biopsy of the right mastoid was performed. An anaerobic culture of the biopsied right mastoid showed the growth of P. acnes, and histopathological examination using P. acnes-specific monoclonal antibody (PAB antibody) revealed the infiltration of inflammatory cells with P. acnes. Moreover, using PAB antibody, P. acnes was detected in the biopsy specimen of the thickening dura mater. No granulomas were identified in either specimen. HP was resolved with long-term administration of antibiotics and steroids.Conclusion: This is the first documentation of pathologically demonstrated chronic HP associated with P. acnes infection followed by refractory otitis media. This report showed that chronic latent P. acnes infection induces chronic inflammation. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the data for patients with otogenic intracranial complications during the study period and draw a comparison with internationally published literature. Method: A retrospective, observational study was conducted, covering a 10-year period between 1 January 2002 and 31 December 2012. Results: The study comprised 108 patients (66 males (61.1 per cent) and 42 females (38.9 per cent)), of which 75 per cent were aged less than 20 years. Post-auricular swelling, otorrhoea and a decreased level of consciousness were the most frequently reported symptoms in patients with otogenic intracranial complications. Patients with human immunodeficiency virus did not show any different patterns in terms of presentation and outcome. Conclusion: A triad of post-auricular swelling, otorrhoea and a decreased level of consciousness should make the clinician more heedful of otogenic intracranial complications. Patients with human immunodeficiency virus and human immunodeficiency virus negative patients were equally affected and had similar presentations. Early surgical management of patients was associated with shorter hospital stays and better outcomes. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 5-year-old male with mastoiditis. Topics discussed include patient having erythematous, bulging tympanic membrane and tender fluctuant mass behind the left ear with protrusion of the ear; postauricular abscess in the soft tissue from bone erosion through the mastoid; and treating mastoiditis with penicillin.

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Cerebral venous sinus occlusion is an exceptional presentation in the emergency department. Otitis and mastoiditis are rarely associated with cerebral venous sinus occlusion. It is considered as a redoubtable complication with potentially severe outcomes. Symptoms that may indicate this thrombosis are variable and include progressive headache, intracranial hypertension, seizures, focal neurological deficits, and ophthalmologic symptoms. In this article, we report a case of a young female patient presenting with otitis and mastoiditis complicated with intracranial thrombosis. She was successfully treated with antibiotics, anticoagulants, and analgesics. Furthermore, we provide a brief review on cerebral venous sinus thrombosis with a focus on its risk factors and its management. Finally, we emphasize the need for better awareness about this potential intracranial complication. [ABSTRACT FROM AUTHOR]

Pneumococcal conjugate vaccines (PCV) have been widely used in high-income countries for more than a decade, resulting in a dramatic reduction in pneumococcal disease caused by vaccine serotypes. PCV has been included in Turkey’s National Immunization Programme since 2009 with PCV7 and continued with PCV13 from 2011. We presented a three-month-old infant who developed mastoiditis secondary to S. pneumoniae serotype 19A after acute otitis media.

History of present illness: A 45-year-old male presented to the emergency department with chief complaint of left ear pain with yellow discharge for several days. He had associated decrease in appetite. The patient denied any history of fever, headache, dizziness, hearing loss, or tinnitus. On physical exam, the patient was found to have yellow discharge in the left ear canal with a perforated tympanic membrane. He was also found to have significant tenderness to palpation over the left mastoid bone. Significant findings: The patient underwent computed tomography (CT) of the head which revealed opacification of the left middle ear (red arrow) and mastoid air cells (red circles). Additionally, there was thickening of the soft tissues of the external auditory canal (blue arrowhead), likely reflecting concurrent otitis externa. Based on the imaging, he was admitted for findings consistent with acute otomastoiditis. Discussion: Mastoiditis is an infection of the mastoid air cells of the temporal bone often secondary to undertreated or untreated otitis media. On CT, purulent material and mucosal swelling cause opacification of the air cells, as seen in this patient.1 The inflammation can erode into the mastoid septae causing acute coalescent otomastoiditis. Mastoiditis can invade intracranially leading to sigmoid sinus thrombosis, perisinus empyema, epidural abscess, subdural abscess or meningitis.1 Presentation of mastoiditis includes fever, otalgia and otorrhea. Patients may also have erythema and swelling overlying the mastoid process.2 Most patients presenting with acute mastoiditis will require hospital admission for intravenous (IV) antibiotics. Antibiotics should cover the common causative agents of otitis media including H influenzae, M catarrhalis, S pneumoniae as well as S aureus. Mastoidectomy is reserved for cases where medical management fails.3 In the antibiotic era, the incidence of clinically significant acute mastoiditis has decreased to 1.2-2 per 100,000.2 However, it is important to recognize that acute mastoiditis may present with severe intracranial complications resulting in significant morbidity and mortality.3 Therefore, patients with suspected mastoiditis should receive a thorough physical examand cranial imaging studies to evaluate for bone erosion and other sequelae.4 The patient in this case remained afebrile without leukocytosis throughout hospitalization. A final blood culture yielded gram positive cocci, gram negative cocci, gram positive rods and methicillin resistant staph aureus with Clindamycin susceptibility. The otolaryngologist (ENT) started the patient on IV ceftriaxone and IV clindamycin for 72 hours. He was discharged with ENT follow-up on an oral regimen of clindamycin and cefuroxime for two weeks. He was also administered ofloxacin otic solution throughout his hospitalization and at discharge. Topics: Mastoiditis, otomastoiditis, otitis externa, CT

Background: Unnecessary prescribing of antibiotics in primary care is contributing to the emergence of antimicrobial drug resistance. Objectives: To develop and evaluate a multicomponent intervention for antimicrobial stewardship in primary care, and to evaluate the safety of reducing antibiotic prescribing for self-limiting respiratory infections (RTIs). Interventions: A multicomponent intervention, developed as part of this study, including a webinar, monthly reports of general practice-specific data for antibiotic prescribing and decision support tools to inform appropriate antibiotic prescribing. Design: A parallel-group, cluster randomised controlled trial. Setting: The trial was conducted in 79 general practices in the UK Clinical Practice Research Datalink (CPRD). Participants: All registered patients were included. Main outcome measures: The primary outcome was the rate of antibiotic prescriptions for self-limiting RTIs over the 12-month intervention period. Cohort study: A separate population-based cohort study was conducted in 610 CPRD general practices that were not exposed to the trial interventions. Data were analysed to evaluate safety outcomes for registered patients with 45.5 million person-years of follow-up from 2005 to 2014. Results: There were 41 intervention trial arm practices (323,155 patient-years) and 38 control trial arm practices (259,520 patient-years). There were 98.7 antibiotic prescriptions for RTIs per 1000 patient-years in the intervention trial arm (31,907 antibiotic prescriptions) and 107.6 per 1000 patient-years in the control arm (27,923 antibiotic prescriptions) [adjusted antibiotic-prescribing rate ratio (RR) 0.88, 95% confidence interval (CI) 0.78 to 0.99; p = 0.040]. There was no evidence of effect in children aged

Objectives: We aimed to examine the adherence of large language models (LLMs) to bacterial meningitis guidelines using a hypothetical medical case, highlighting their utility and limitations in healthcare., Methods: A simulated clinical scenario of a patient with bacterial meningitis secondary to mastoiditis was presented in three independent sessions to seven publicly accessible LLMs (Bard, Bing, Claude-2, GTP-3.5, GTP-4, Llama, PaLM). Responses were evaluated for adherence to good clinical practice and two international meningitis guidelines., Results: A central nervous system infection was identified in 90% of LLM sessions. All recommended imaging, while 81% suggested lumbar puncture. Blood cultures and specific mastoiditis work-up were proposed in only 62% and 38% sessions, respectively. Only 38% of sessions provided the correct empirical antibiotic treatment, while antiviral treatment and dexamethasone were advised in 33% and 24%, respectively. Misleading statements were generated in 52%. No significant correlation was found between LLMs' text length and performance (r=0.29, p=0.20). Among all LLMs, GTP-4 demonstrated the best performance., Discussion: Latest LLMs provide valuable advice on differential diagnosis and diagnostic procedures but significantly vary in treatment-specific information for bacterial meningitis when introduced to a realistic clinical scenario. Misleading statements were common, with performance differences attributed to each LLM's unique algorithm rather than output length., Conclusions: Users must be aware of such limitations and performance variability when considering LLMs as a support tool for medical decision-making. Further research is needed to refine these models' comprehension of complex medical scenarios and their ability to provide reliable information., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

According to the literature, acute otitis media is complicated by mastoiditis in 0.15-1% of cases. In turn, mastoiditis can be complicated by meningitis, encephalitis, abscess of temporal lobe of brain and cerebellum, epidural and subdural abscesses, facial nerve paresis, labyrinthitis, phlegmon of soft tissues of neck, as well as subperiosteal abscess, which makes 7% in the structure of mastoiditis complications. Nowadays, when doctors have a wide range of antibacterial preparations at their disposal, a complicated course of acute otitis media and further mastoiditis is caused both by an aggressive atypical infectious agent and immunocompromised status of a patient. The article deals with a clinical case of a prolonged course of acute otitis media complicated by mastoiditis and subperiosteal abscess against the background of outpatient courses of antibacterial therapy. The examination revealed an atypical pathogen of otitis media Pseudomonas aeruginosa and HIV-positive status of the patient, previously unknown. Timely surgical intervention and the right combination of antibacterial drugs, meropenem and ciprofloxacin, prevented the development of intracranial and septic complications, despite the presence of multiple foci of bone destruction of the mastoid process and temporal bone pyramid, bordering the middle fossa and sigmoid sinus, according to multispiral head computed tomography. As a part of additional examination in the Center for AIDS and Infectious Diseases Prevention and Control, the patient was diagnosed with HIV infection, clinical stage 4C, progressing phase on the background of absence of antiretroviral therapy, and the necessary amount of treatment was prescribed.

Objective: To report a case of petrous apicitis that manifested as chronic migraine without aura and to discuss the pathophysiological mechanisms behind this presentation. Background: Petrous apicitis is a rare complication of acute otitis media with varied clinical presentations that stem from the close proximity of the petrous apex to numerous neurovascular structures. Headache is among the common symptoms of petrous apicitis. Methods: A case of new onset headache in the setting of petrous apicitis with symptomatic response to antibiotic therapy was reported. We provided a brief review of peripheral pathophysiological mechanisms of migraine and correlated to mechanism of headache in petrous apicitis. Results: A 65‐year‐old man with chronic otitis externa/media presented with ongoing headache fulfilling International Classification of Headache Disorders 3rd edition (ICHD‐3) criteria for chronic migraine without aura that persisted despite undergoing right mastoidectomy and tympanoplasty with multiple courses of oral antibiotic therapy for his chronic otitis. MRI brain revealed petrous apicitis, otomastoiditis, and clival osteomyelitis. His imaging findings improved and his migraine‐like headache completely resolved after treatment with a prolonged course of antibiotics. Conclusions: Petrous apicitis can present as a headache with features of migraine, and in this case in particular, as chronic migraine without aura. The pathophysiological mechanisms that may underlie the generation of migraine‐like headache in petrous apicitis may include the activation of nociceptive fibers within the periosteum of the petrous apex and clivus whose cell bodies originate in the trigeminal ganglion and upper cervical dorsal root ganglia. By treating the peripheral pathology, resolution of the headache may be achieved. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical course of children with acute mastoiditis (AM) who required surgical intervention. Material and methods: Clinical and biochemical characteristics at the moment of hospital admission were reviewed for patients who required surgery for AM. Children who were successfully managed conservatively during the last 3 years of study were chosen as a comparison group. Results: During 2008–2017, 570 children were admitted with AM: 82(14%) underwent cortical mastoidectomy, including 31(38%) with decompression of epidural space and sigmoid sinus. The comparison group consisted of 167 children with AM who did not require surgery. The surgical group had a higher rate of acute otitis media before admission. At the time of hospital admission, the surgical group had a higher rate of prolonged fever, otorrhea, and sub-periosteal abscess. Their average temperature, WBC, neutrophil count, and CRP were significantly higher (39.2 vs. 37.9°. C, 20 K vs. 16.5 K, 67 vs. 55.8 percent, 17 vs. 8.8, respectively, p = 0.0001). Fusobacterium necrophorum was the most common pathogen in the surgical group (50%), and group A streptococcus in the comparison group (22%). Sub-periosteal abscess, sinus venous thrombosis, and epidural involvement were diagnosed in 95, 35, and 38 percent of patients, respectively. Average length of IV antibiotic treatment was 20 days in operated children, compared to 5.6 days in the comparison group (p = 0.0001). Since 2013, a significantly higher percentage of children were diagnosed with Fusobacterium mastoiditis (p = 0.0001) who required surgery (p = 0.008). Conclusion: In children with AM presenting with, high fever, leukocytosis, elevated CRP, and sub-periosteal abscess, early CT and surgical intervention were frequently required. The increase in Fusobacterium infection might be an explanation for the increase in complicated AM requiring surgery. [ABSTRACT FROM AUTHOR]

To characterize the clinical presentation of pediatric patients who, upon AM diagnosis, also had imaging-diagnosed ICCs (ID-ICCs); to define the group of AM patients at risk of developing ID-ICCs; and to update knowledge about organisms causing AM. Analysis of all AM patients admitted between 1997 and 2018 and treated according to an obligatory protocol including both brain imaging and sampling for bacterial culture upon clinical diagnosis of AM. Of 166 admitted patients (0.5–19 years old) 22 (13%) already had ID-ICCs. In patients who, on admission, had already received antibiotics for acute otitis media (AOM) and also had CRP (C-reactive protein) levels above 93.5 mg/L, the risk of ID-CC was increased by 22.5-fold (P < 0.0001). Bacterial culture results were available for all patients and were positive in 115 (69%). Organisms most commonly found in patients without prior antibiotic treatment were group A Streptococcus pyogenes (53%), Streptococcus pneumoniae (23%), and Haemophylus influenzae (11%), while with prior antibiotic treatment they were Fusobacterium necrophorum (21%), Streptococcus pyogenes (18%) and Pseudomonas aeruginosa (18%). Since the risk of ID-ICC in patients with the abovementioned CRP and prior antibiotic treatment was significantly higher than in the others, these high-risk patients should undergo diagnostic imaging on admission. Antibiotic treatment prior to AM development may promote growth of non-AOM pathogen. [ABSTRACT FROM AUTHOR]

Background: Mastoiditis is an otological emergency, and cross-sectional imaging has a role in the diagnosis of complications and surgical planning. Advances in imaging technology are becoming increasingly sophisticated and, by the same token, the ability to accurately interpret findings is essential. Methods: This paper reviews common and rare complications of mastoiditis using case-led examples. A radiologist-derived systematic checklist is proposed, to assist the ENT surgeon with interpreting cross-sectional imaging in emergency mastoiditis cases when the opinion of a head and neck radiologist may be difficult to obtain. Results: A 16-point checklist (the 'mastoid 16') was used on a case-led basis to review the radiological features of both common and rare complications of mastoiditis; this is complemented with imaging examples. Conclusion: Acute mastoiditis has a range of serious complications that may be amenable to treatment, once diagnosed using appropriate imaging. The proposed checklist provides a systematic approach to identifying complications of mastoiditis. [ABSTRACT FROM AUTHOR]

Intracranial complications secondary to chronic otitis media (COM) include otogenic brain abscess and sinus thrombosis. Intravenous antibiotics and imaging have significantly reduced the incidence of intracranial complications secondary to COM. However, the same does not apply to a developing country like Malaysia, which still experiences persisting otogenic complications. This case series describes 3 patients with COM and intracranial complications. All 3 patients had COM with mastoiditis, with 1 of the 3 having a cholesteatoma. Postulated reasons for the continued occurrence include poor access to health care, poor compliance with medication, and the lack of pneumococcal vaccination during childhood. In conclusion, public awareness and a timely specialty referral can reduce the incidence of intracranial complications of COM. [ABSTRACT FROM AUTHOR]

Background: Acute mastoiditis is a clinically diagnosed suppurative infection of the mastoid air cells and is the most common complication of acute otitis media. Opacification of the mastoid air cells is a commonly reported radiological finding and patients are often erroneously diagnosed with acute mastoiditis when this is present. Objectives: This study aimed to quantify incidental findings of mastoid opacification in the asymptomatic paediatric population and contribute to the epidemiological data. Method: A retrospective cohort study was conducted of all paediatric patients who underwent relevant computed tomography imaging for a non-otological indication. Results: Data were collected from 767 patients in total. Mastoid opacification was reported in 82 patients. The prevalence was highest in patients aged zero to one year (n = 25, prevalence = 20.3 per cent), followed by those aged two to three years (n = 17, prevalence = 19.5 per cent). Conclusion: Mastoid opacification is a common incidental finding in the asymptomatic paediatric population, with prevalence rates between 5 per cent and 20 per cent depending on age. The prevalence peaks in patients aged zero to four years (19–20 per cent) and is inversely correlated with increasing age. [ABSTRACT FROM AUTHOR]

Objective: To evaluate mastoid pneumatisation and facial canal dimensions. Method: In this retrospective study, 169 multidetector computed tomography scans of temporal bone were reviewed. Facial canal dimensions were evaluated at the labyrinthine, tympanic and mastoid segments using axial and coronal multidetector computed tomography scans of temporal bone. Mastoid pneumatisation and facial canal dehiscence were evaluated. Facial canal dehiscence was measured if it was found to be present. Results: This study showed that facial canal dimensions decreased in pneumatised mastoids. Facial canal dimensions in females were smaller than in males. Facial canal dehiscence was detected in 5.9 per cent and 6.5 per cent of the patients on the right and left sides, respectively. No correlations were found between facial canal dehiscence and mastoid pneumatisation. The length of dehiscence was 1.92 ± 0.44 mm (range, 0.86–2.51 mm) on the left side. In older subjects, left facial canal dehiscence was detected more, and the length of the dehiscence increased. Conclusion: This study concluded that during surgery, facial canal dehiscence should be kept in mind in order to avoid complications. [ABSTRACT FROM AUTHOR]