Síndrome de Lemierre / Lemierre's Syndrome

Paciente masculino de 32 años de edad sin comorbilidades, acude a servicio de urgencias con cuadro clínico caracterizado por dolor en región cervical anterior, tos con expectoración de color marrón de mal olor y dolor torácico. Refiere como antecedente, diagnóstico de faringoamigdalitis hace un mes, para el cual recibió tratamiento antibiótico intramuscular que no especifica. Al examen físico presenta masa palpable a nivel de región cervical anterior, dolor a la palpación torácica en séptimo espacio intercostal izquierdo. A la auscultación frote pericárdico, murmullo vesicular bilateral disminuido y frote pleural. Los estudios de laboratorio demostraron leucocitosis (17230 k/ul), neutrofilia (79,25%), anemia leve (Hb 11 g/dl, Hcto 35,5%). La tomografía computarizada contrastada de tórax, demostró presencia de edema y líquido en los tejidos blandos superficiales anteriores infrahioideos del cuello por encima de la horquilla esternal, y, en la fase contrastada trombosis de la vena yugular interna izquierda

Complicaciones de la otitis media con parálisis del sexto par craneal contralateral en pediatría / Cranial complications of otitis media with paralysis of the contralateral sixth cranial pair in pediatrics

Resumen. La otitis media es una infección frecuente en la infancia, la cual puede producir complicaciones, incluidas las neurológicas graves, en cuatro de cada 100 niños en países en desarrollo. Se presenta el caso de una niña de nueve años sin antecedentes de enfermedad que consultó por otitis media derecha, otorrea, síndrome de hipertensión intracraneal y parálisis del VI nervio craneal contralateral a la lesión. La tomografía computarizada de cráneo y la resonancia magnética cerebral revelaron otomastoiditis crónica, apicitis petrosa, y trombosis de los senos transverso y sigmoide, el bulbo yugular y la vena yugular interna derecha. Recibió tratamiento antibiótico y quirúrgico. Este caso refleja el espectro de complicaciones intracraneales y extracraneales asociadas con la otitis media aguda en la era antibiótica. El examen físico permite la detección precoz de la hipertensión intracraneal, con signos como el papiledema y la parálisis del VI par contralateral como hallazgo inusual.

Abstract. 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.

Actinomicosis en el hueso temporal. Reporte de un caso pediátrico / Actinomycosis in temporal bone. A pediatric case report

La actinomicosis es una infección causada por un bacilo anaerobio Gram-positivo, filamentoso, ramificado, no esporulado. Integra la flora habitual de la orofaringe y coloniza transitoriamente el tracto gastrointestinal, genital femenino y el árbol bronquial. Es poco frecuente en el hueso temporal. Por su semejanza a un hongo, es difícil su reconocimiento, lo que hace necesaria la sospecha clínica para obtener los cultivos apropiados en condiciones anaeróbicas en forma prolongada. Los hallazgos microscópicos típicos incluyen necrosis con gránulos de azufre amarillento y la presencia de filamentos que se asemejan a infecciones fúngicas. El tratamiento requiere de elevadas y prolongadas dosis de antibiótico con penicilina o amoxicilina, entre 6 y 12 meses. La duración de la terapia antimicrobiana podría ser reducida en pacientes que han sido operados quirúrgicamente. Se presenta, a continuación, un caso clínico de actinomicosis en el hueso temporal en un paciente pediátrico que requirió tratamiento quirúrgico para su resolución.

Actinomycosis is an infection caused by a Gram-positive, filamentous anaerobic bacillus. Mainly belonging to the human commensal flora of the oropharynx, it normally colonizes the human digestive and genital tracts and the bronchial tree. It is slightly frequent in the temporal bone. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened in patients in whom optimal surgical resection of infected tissues has been performed. A pediatric patient with actinomycosis in temporal bone who needed surgery resolution is reported.

Mastoiditis aguda con complicación intracraneal. Reporte de un caso pediátrico / Acute mastoiditis with intracranial complication in a pediatric patient

La mastoiditis aguda es una infección de las celdillas mastoideas, generalmente, secundaria a la progresión de una otitis media aguda. Las bacterias aisladas con más frecuencia en las mastoiditis son Streptococcus pneumoniae, Streptococcus pyogenes y Staphylococcus aureus. La infección mastoidea puede extenderse por contigüidad, afectar a estructuras vecinas y dar lugar a complicaciones intra- o extracraneales. Las más frecuentes son las intracraneales, entre las que se incluyen la meningitis, el absceso cerebeloso o del lóbulo temporal, el absceso epi- o subdural y la trombosis de senos venosos.Se presenta el caso de una niña de 4 años que desarrolló dos complicaciones intracraneales (absceso epidural y trombosis de senos venosos transverso y sigmoideo) a partir de una mastoiditis aguda producida por Streptococus pyogenes

Acute mastoiditis is an infection that affects the mastoid air-cell system, usually due to the progression of an acute otitis media. The bacteria most frequently isolated in acute mastoiditis are Streptococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus. The mastoid infection can extend affecting contiguous structures and producing intra or extracranial complications. The most frequent ones are intracranial complications, including meningitis, temporal lobe or cerebellar abscess, epidural or subdural abscess and venous sinus thrombosis.We present the case of a 4-year-old girl who developed two intracranial complications (intracranial epidural abscess and transverse and sigmoid sinus thrombosis) initiated in an acute mastoiditis produced by Streptococcus pyogenes.

Therapeutic approach to pediatric acute mastoiditis - an update / Abordagem terapêutica da mastoidite aguda pediátrica - uma atualização

Abstract Introduction: Acute mastoiditis remains the most common complication of acute otitis media. It may rarely appear also in cochlear implant patients. However, the treatment recommendations for this disease are not precisely defined or employed, and in the current literature the differences regarding both the diagnosis and management are relatively substantial. Objective: The aim of this study was to determine a standard and safe procedure to be applied in case of pediatric acute mastoiditis. Methods: A retrospective chart review of 73 patients with 83 episodes of acute mastoiditis hospitalized at our tertiary-care center between 2001 and 2016 was conducted. Bacteriology, methods of treatment, hospital course, complications, and otologic history were analyzed. Based on our experience and literature data, a protocol was established in order to standardize management of pediatric acute mastoiditis. Results: All the patients treated for acute mastoiditis were submitted to an intravenous antibiotic regimen. In the analyzed group pharmacological treatment only was applied in 11% of children, in 12% myringotomy/tympanostomy was added, and in the vast majority of patients (77%) mastoidectomy was performed. In our study recurrent mastoiditis was noted in 8% of the patients. We also experienced acute mastoiditis in a cochlear implant child, and in this case, a minimal surgical procedure, in order to protect the device, was recommended. Conclusions: The main points of the management protocol are: initiate a broad-spectrum intravenous antibiotic treatment; mastoidectomy should be performed if the infection fails to be controlled after 48 h of administering intravenous antibiotic therapy. We believe that early mastoidectomy prevents serious complications, and our initial observation is that by performing broad mastoidectomy with posterior attic and facial recess exposure, recurrence of acute mastoiditis can be prevented.

Resumo Introdução: A mastoidite aguda continua a ser a complicação mais comum da otite média aguda. Pode ocorrer também, embora raramente, em pacientes com implante coclear. Entretanto, as recomendações de tratamento para essa doença não são bem definidas ou usadas e, na literatura corrente, as diferenças em relação ao diagnóstico e ao manejo são relativamente significativas. Objetivo: O objetivo deste estudo foi determinar um procedimento padrão e seguro a ser aplicado em caso de mastoidite aguda pediátrica. Método: Foi realizada uma revisão retrospectiva de prontuários de 73 pacientes com 83 episó-dios de mastoidite aguda hospitalizados em nosso centro terciário entre os anos de 2001 a 2016. Foram analisados a bacteriologia, métodos de tratamento, evolução hospitalar, complicações e histórico otológico. Com base em nossa experiência e dados da literatura, foi estabelecido um protocolo para padronizar o tratamento da mastoidite aguda pediátrica. Resultados: Todos os pacientes tratados para mastoidite aguda foram submetidos a antibioticoterapia endovenosa. No grupo analisado, o tratamento farmacológico só foi aplicado em 11% das crianças, em 12% a miringotomia/timpanostomia foi adicionada e na maior parte dos pacientes (77%) foi feita a mastoidectomia. Em nosso estudo, mastoidite recorrente foi observada em 8% dos pacientes. Também observamos mastoidite aguda em criança usuária de implante coclear e, nesse caso, foi recomendada a minimização de procedimentos cirúrgicos, a fim de proteger o dispositivo. Conclusões: Os principais pontos do protocolo de conduta são: iniciar um tratamento antibiótico endovenoso de amplo espectro; a mastoidectomia deve ser feita caso a infecção não seja controlada após 48 horas da administração de antibioticoterapia intravenosa. Acreditamos que a mastoidectomia precoce previne complicações graves e nossa observação inicial é que, com uma mastoidectomia ampla com exposição do ático posterior e do recesso facial, a recorrência de mastoidite aguda pode ser evitada.

Otomastoiditis por mycobacterium tuberculosis: un diagnóstico desafiante / Tuberculous otomastoiditis: a challenging diagnosis

RESUMEN La otomastoiditis tuberculosa es una presentación extremadamente rara de la forma extrapulmonar de la enfermedad y puede ser difícil llegar a su diagnóstico. Presentamos el caso de una paciente de 35 años con otomastoiditis tuberculosa bilateral acompañado de vértigo, hipoacusia mixta bilateral y paresia del nervio facial bilateral, como debut de una tuberculosis. Cultivos de Mycobacterium tuberculosis (MTB) y prueba de reacción en cadena de la polimerasa (PCR) de otorrea fueron inicialmente negativos. La tomografía computarizada de oídos y resonancia magnética mostraron cambios inflamatorios otomastoídeos bilaterales sin evidencia de erosión ósea ni extensión a partes blandas. Se realizó una mastoidotomía, las muestras del tejido obtenido evidenciaron osteomielitis crónica, bacterias ácido-alcohol resistentes y PCR positiva para MTB. La paciente recibió tratamiento con drogas antituberculosas durante 12 meses logrando una recuperación completa de la otalgia y vértigo, y mejoría parcial de audición y paresia facial. En resumen, los hallazgos clínicos e imagenológicos de la otomastoiditis tuberculosa son inespecíficos por lo cual se requiere de un alto índice de sospecha clínica para lograr el diagnóstico adecuado e iniciar el tratamiento de la infección subyacente.

ABSTRACT Tuberculous otomastoiditis is an extremely rare form of extrapulmonary disease that can be easily misdiagnosed. We hereby report the case of a previously healthy 35-yearold female with bilateral tuberculous otomastoiditis associated with vertigo, bilateral mixed hearing loss, and bilateral facial nerve palsy as the initial clinical presentation. Repeated Mycobacterium tuberculosis (MTB) culture and molecular testing of otorrhea aspirates were initially negative. High-resolution temporal bone computed tomography and magnetic resonance imaging showed partial opacification of the mastoid air cells without signs of bone erosion. A mastoidotomy was performed with mastoid tissue showing chronic osteomyelitis, positivity in acid-fast staining and MTB PCR. The patient was treated with a 12 month antituberculous treatment, with complete recovery of otalgia and vertigo, and improvement in hearing levels and facial nerve palsy. In summary, clinical and imaging findings for tuberculous otomastoiditis are non-specific, hence a high degree of suspicion is required in order to diagnose and promptly treat the underlying infection.

Influencia terapeútica en la evolución de la otitis media aguda / Therapeutic influence on the evolution of acute otitis media

Introducción: La otitis media aguda (OMA) es una de las infecciones más comunes y primera causa de administración de antibioterapia en la infancia. En ocasiones pueden tener una evolución tórpida y dar lugar a complicaciones, siendo la mastoidi-tis aguda la más frecuente. Según algunos estudios se está produciendo un aumento en la incidencia de esta patología y de su gravedad, sin saberse claramente su causa.Métodos: Se realiza un estudio retrospectivo de pacientes ingresados en el Hospital Virgen de la Salud de Toledo, durante un periodo de 64 meses, de 2012 a 2017. Los criterios de inclusión fueron pacientes que fueron diagnosticados con mastoiditis aguda y/o complicaciones derivadas de ésta. Resultados: Se identificaron un total de 22 pacientes con mastoiditis aguda, correspondiendo a una media anual de 4,125 casos/año. El 63,63% de los casos tenían entre 0-2 años. Sólo el 50% de los casos recibieron antibioterapia oral, antes del ingreso hospitalario. Se aisló el germen en el 60% de los casos, siendo el Streptococcus pneumoniae el causante más frecuente. Se detectaron un total de 4 casos de mastoiditis complicada suponiendo el 18,18% de los pacientes; todos fueron varones, y ninguno tenía supuración espontánea a su llegada a Urgencias. Conclusiones: El uso de antibioterapia oral para el tratamiento de la OMA no ha demostrado que disminuya la incidencia de mastoiditis aguda. Sin embargo, es posible que las complicaciones derivadas de una OMA con evolución tórpida sean más graves cuando no se ha empleado antibiótico sistémico para el tratamiento de la OMA.

Introduction: Acute otitis media (AOM) is one of the most common infections and the first cause of administration of antibiotic therapy in childhood. Sometimes they may have a torpid evolution and lead to complications, such as acute mastoiditis more frequently. According to some studies, there is an increase its incidence and severity, but its cause has not been well understood. Methods: A retrospective study was performed, including the patients who were admitted to the Virgen de la Salud Hospital of Toledo, during a period of 64 months, from 2012 to 2017. The inclusion criteria were patients who were diagnosed with acute mastoiditis and or compli-cations derived from it. Results: A total of 22 patients with acute mastoiditis were identified, corresponding to an annual average of 4.125 cases/year. Additionally, 63.63% of the cases were between 0-2 years old. Only 50% of the patients received oral antibiotherapy prior to hospital admission. The germ was isolated in 60% of the cases, Streptococcus Pneumoniae was the most frequent cause. A total of 4 cases of complicated mastoiditis were detected, accounting for 18.18% of the patients; all were male, and none had spontaneous suppuration upon their arrival to the Emer-gency Department. Conclusions: The use of oral antibiotic therapy for the treatment of AOM has not been shown to reduce the incidence of acute mastoiditis. However, it is possible that the complications derived from an AOM with torpid evolution are more serious when systemic antibiotic has not been used for the treatment of AOM

Epidural Abscess Caused by Eikenella corrodens in a Previously Healthy Child

Eikenella corrodens rarely causes invasive head and neck infections in immunocompetent children. We report a case of epidural abscess caused by E. corrodens in a previously healthy 13-year-old boy who presented with fever, headache, and vomiting. On physical examination upon admission, there was no neck stiffness, but discharge from the right ear was observed. Brain magnetic resonance imaging (MRI) revealed approximately 4.5-cm-sized epidural empyema on the right temporal lobe as well as bilateral ethmoid and sphenoid sinusitis, right mastoiditis, and right otitis media. During treatment with vancomycin and cefotaxime, purulent ear discharge aggravated, and on follow-up brain MRI, the empyema size increased to 5.6×3.4 cm with interval development of an abscess at the right sphenoid sinus. Burr hole trephination was performed, and foul-smelling pus was aspirated from the epidural abscess near the right temporal lobe. Pus culture yielded E. corrodens. Endoscopic sphenoidotomy was also performed with massive pus drainage, and the same organism was grown. The patient was treated with intravenous cefotaxime for 3 weeks and recovered well with no other complications. Therefore, E. corrodens can cause serious complications in children with untreated sinusitis.

Aspectos clínicos y bacteriológicos de las mastoiditis agudas como complicación de otitis media aguda y crónica en pediatría, Experiencia en 10 años / Clinical and bacteriological features of acute mastoiditis as a complication of acute and chronic otitis media in pediatrics. A 10-years experience

Antecedentes. Cualquier paciente pediátrico o adulto que presente otitis media aguda (OMA) u otitis media crónica (OMC), particularmente colesteatomatosa, puede desarrollar complicaciones intratemporales y endocraneales, especialmente mastoiditis aguda (MA). Objetivo. Describir las características clínicas y bacteriología de los pacientes asistidos por MA como complicación de OMA y OMC. Lugar de aplicación: Servicio de Otorrinolaringología. Hospital de Pediatría Juan P. Garrahan. Diseño. Descriptivo, retrospectivo, transversal y observacional. Población. Pacientes con mastoiditis aguda por OMA y por OMC asistidos en el Servicio de ORL durante 10 años. Material y métodos. Revisión de historias clínicas de todos los pacientes tratados entre enero de 1999 y diciembre de 2008. Resultados. Se estudiaron 57 pacientes con MA, 40/57 por OMA y 17/57 por OMC. Hubo 40 niños hospitalizados con signos y síntomas de MA por OMA. Se diagnosticó complicación endocraneal en el 12,5% (5/40) de los casos. Los aislamientos bacterianos más frecuentes fueron Streptococcus pyogenes, Streptococcus pneumoniae, H. influenzae y Turicella otitidis. Se registraron 17 casos de niños hospitalizados con diagnóstico de MA y OMC. Ocurrieron complicaciones supurativas intracraneales en el 35,3% (6/17) de los casos. Los aislamientos bacterianos más frecuentes fueron las enterobacterias, P. aeruginosa y los gérmenes anaerobios. Conclusión. El diagnóstico de tipo y estadio de otitis media previa o coexistente a la complicación es fundamental para encarar el tratamiento antimicrobiano empírico inicial, sospechar complicaciones endocraneales asociadas y proponer procedimientos quirúrgicos menores, medianos o mayores oportunamente (AU)

Background. Any pediatric or adult patient presenting with acute otitis media (AOM) or chronic otitis media (COM), especially cholesteatomatous, may develop intratemporal and intracranial complications, mainly acute mastoiditis (AM). Objective. To describe the clinical and bacteriological features of patients seen for AM as a complication of AOM and COM. Setting: Department of Otolaryngology, Hospital de Pediatría Juan P. Garrahan. Design. A descriptive, retrospective, cross-sectional, observational study. Population. Patients with AM because of AOM and COM seen at the Department of Otolaryngology over a 10-year period. Material and methods. Review of the clinical charts of all patients treated between January 1999 and December 2008. Results. 57 Patients with AM, 40/57 due to AOM and 17/57 due to COM, were evaluated. Forty children were admitted to hospital with signs and symptoms of AOM-related AM. Intracranial complications were observed in 12.5% (5/40) of the patients. The most frequently isolated pathogens were Streptococcus pyogenes, Streptococcus pneumoniae, H. influenzae, and Turicella Otitidis. Seventeen children were hospitalized because of COM-related AM. Suppurative intracranial complications occurred in 35.3% (6/17) of the cases. The most frequently isolated pathogens were Enterobacteriaceae, P. aeruginosa, and anaerobic bacteria. Conclusion. The diagnosis of type and stage of otitis media prior to or coexisting with the complication is essential to address the initial empirical antimicrobial treatment, associated intracranial complications should be suspected and minor, intermediate, or major surgical procedures should be proposed at the appropriate time (AU)

Zygomatic Mastoiditis with Extracranial Complications: An Extremely Rare Cause of Cheek Swelling / 대한이비인후과학회지

Zygomatic mastoiditis is an extremely rare cause of an inflamed, swollen cheek. We encountered a 10-year-old girl with left preauricular swelling, pain, and mild trismus. Temporal bone computed tomography revealed a zygomatic root abscess with bone defects and a scanty amount of soft tissue lesion in Prussak's space. After antibiotic therapy for 2 weeks, her pain subsided, but the swelling persisted. All inflamed air cells, including the lesion in the zygomatic root, were eradicated. The swelling subsided after the surgery. The patient has not experienced any postoperative complications or shown any evidence of relapse for more than 1 year.

Artritis infecciosa de la articulación temporomandibular consecutivo a otitis necrotizante: reporte de un caso / Septic arthritis of the temporomandibular joint: Report of one case

Septic arthritis of the temporomandibular joint (TMJ) is an uncommon condition, caused by hematic bacterial migration or direct migration of other head and neck infections. We report a 41 year old female who presented a right temporomandibular joint involvement, with bone destruction of the mandibular condyle and an infectious process spreading to the temporal space, following a necrotizing medial and external otitis with associated mastoiditis. A septic arthritis of the TMJ by continuity was diagnosed and treated with antimicrobials, TMJ arthrocentesis and occlusal stabilization, with a positive evolution. However, the patient remains in control due a secondary TMJ osteoarthritis caused by the septic arthritis.

Facial palsy and mastoiditis from fibrous dysplasia

@#This young adult man presented to ENT clinic with a complaint of left facial weakness and persistent left retro-auricular pain. High resolution CT of the mastoids was performed following clinical assessment. In this case, there is extensive sclerotic bony expansion with a ground-glass appearance involving the left zygoma, sphenoid and petrous temporal bone. The bony expansion is centred on the medullary bone and has an abrupt zonal transition (Figure 1). The bone involvement encompasses almost complete bony stenosis of the left external auditory meatus down to 1-2mm with consequential fluid in the external auditory canal and middle ears (Figure 2). The bony expansion involves both the tympanic and mastoid segments of the facial canal which are stenosed. The ossicular chain remains intact. The left mastoid air cells are under-pneumatised and completely occupied by fluid.

Clinical analysis of otogenic extracranial and intracranial complications / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinical feature and treatment of extracranial and intracranial complications caused by otitis media.@*METHOD@#Three hundred and twenty patients of acute and chronic otitis media were admitted to our department between 2005 and 2014. Among them, 34 patients were diagnosed with extracranial and intracranial complications. The clinical features and treatment outcome were retrospectively studied. Of the 34 patients associated with complications, 25 had a single complication,8 had two complications and 1 had three complications. Complications included labyrinthitis in 14 cases, facial paralysis in 11, postauricular subperiosteal abscess in 6, Bezold abscess in 1, thrombophlebitis of sigmoid sinus in 2, otitis meningitis in land otogenic brain abscess in 8.@*RESULT@#Thirty-three patients were cured or improved and 1 patient died.@*CONCLUSION@#Due to the widespread use of antibiotics, the clinical manifestations of extracranial and intracranial complications of otitis media become more hidden and atypical. The surgery is the primary treatment method.

An Unusual Complication of Chronic Suppurative Otitis Media: Bezold Abscess Progressing to Scapular Abscess

Introduction: Suppurative otitis media is still the most common ear disease in developing countries. Otogenic complications of this disease have decreased considerably because of the advent of antibiotics, and few rare complications have been encountered. Objective: To report a case of a patient with scapular abscess and lumber cellulitis that had progressed from Bezold abscess as a complication of squamous-type chronic suppurative otitis media. Resumed Report A 14-year-old girl presented with foul-smelling, purulent, left ear discharge of 1-year duration and decreased hearing on same ear of 6-month duration. She developed painful swelling in left side of neck with restricted neck movement and high-grade fever of 3-day duration and swelling over the left scapular area of 1-day duration. The examination and investigation diagnosed squamous-type chronic suppurative otitis media with Bezold abscess progressing to scapular abscess and lumber cellulitis. Final: Comment Chronic suppurative otitis media can lead to abscess in any part of body...

Thirteen cases with tuberculous otitis media and mastoiditis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical features and treatment of tuberculous otitis media and mastoiditis.@*METHOD@#Thirteen patients with tuberculous otitis media and mastoiditis were retrospectively analyzed and the related literatures were reviewed. One case was treated by surgery only, and anti-tuberculosis treatment was given to another one patient, and surgical removal of disease lesions in combination with anti-tuberculosis treatment were given to 12 patients.@*RESULT@#One patient received surgery only was found to recur after follow-up for seven months. The patient did not recur after seven months' follow-up after antituberculosis therapy,and other patients did not recur.@*CONCLUSION@#Although the regular anti-tuberculosis chemotherapy treatment was the main treatment for tuberculous otitis and mastoiditis, surgical treatment was helpful to achieved more rapid healing of the ear.

A Case of Epidural Abscess Complicated from Acute Mastoiditis Caused by Streptococcus pneumoniae / 소아감염

Acute otitis media (AOM) is one of the most common childhood infectious diseases. Despite antibiotic treatment for AOM, AOM and its complication still continue to develop. Acute mastoiditis is a serious complication of AOM and epidural abscess constitutes the commonest of all intracranial complication of AOM. Neurological complication of acute mastoiditis are rare but can be life threatening. Their presentation may be masked by the use of antibiotics. We report the rare case of acute otitis media progressing to acute mastoiditis, epidural abscess formation and lateral sinus thrombophlebitis caused by Streptococcus pneumoniae in a child. She was admitted with acute otitis media with fever. Despite proper antibiotics, acute mastodititis and epidural abscess were developed, and after surgical drainage and antibiotics therapy she was recovered without sequalae.

A brief history of mastoidectomy

AIM: To describe to the new generation of otologists the origins of mastoidectomy as well as the difficulties our predecessors encountered and the solutions they devised to improve otologic surgery. METHODS: Retrospective literature review-based study. RESULTS: Before the mid-19th century, mastoidectomy was performed only sporadically and in most cases as a desperate attempt to save the lives of people suffering from complications of infectious otitis. The drainage of acute abscesses became a common procedure at the beginning of the 20th century, within the pre-antibiotic era. The first documented surgical incision to drain an infected ear was described by the French physician Ambroise Paré in the 16th century. The credit for performing the first mastoidectomy for the removal of purulent secretions went to Jean-Louis Petit. Mastoidectomies were normally performed to treat infections. However, mastoidectomies were also carried out for other purposes, particularly for the treatment of deafness and tinnitus, during various periods. Sir Charles Ballance credited Johannes Riolanus with recommending mastoidectomy for the treatment of tinnitus. William Wilde began the era of modern mastoidectomy with his introduction of the eponymous retroauricular incision. CONCLUSION: Mastoidectomy has evolved significantly throughout its history. Improvements in mastoidectomy have relied on the introduction of more elaborate surgical procedures, especially the advances in surgical equipment during the last century. Mastoidectomy continues to be a life-saving surgical procedure.