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.

Transverse sinus thrombosis associated with otitis media and mastoiditis

A case of transverse sinus thrombosis is described in an adolescent male with antecedent meningomyelocele corrected by surgery, and ventriclo-peritoneal derivation. Four months before the occurrence of thrombosis, he presented with bilateral otitis media and mastoiditis, and was treated with antibiotic. Magnetic resonance images were not obtained before referral to our hospital. The patient received full anticoagulation and his clinical course was uneventful. He remains asymptomatic under outpatient surveillance till this report. The aim of reporting the case is to emphasize the role of otologic infections in the origin of intracranial thrombotic phenomena, and highlights the findings of magnetic resonance venography for characterization of intracranial sinus thrombosis

Abducens Nerve Palsy Complicated by Inferior Petrosal Sinus Septic Thrombosis Due to Mastoiditis

We present a very rare case of a 29-month-old boy with acute onset right abducens nerve palsy complicated by inferior petrosal sinus septic thrombosis due to mastoiditis without petrous apicitis. Four months after mastoidectomy, the patient fully recovered from an esotropia of 30 prism diopters and an abduction limitation (-4) in his right eye.

A Case of Atypical Skull Base Osteomyelitis with Septic Pulmonary Embolism

Skull base osteomyelitis (SBO) is difficult to diagnose when a patient presents with multiple cranial nerve palsies but no obvious infectious focus. There is no report about SBO with septic pulmonary embolism. A 51-yr-old man presented to our hospital with headache, hoarseness, dysphagia, frequent choking, fever, cough, and sputum production. He was diagnosed of having masked mastoiditis complicated by SBO with multiple cranial nerve palsies, sigmoid sinus thrombosis, and septic pulmonary embolism. We successfully treated him with antibiotics and anticoagulants alone, with no surgical intervention. His neurologic deficits were completely recovered. Decrease of pulmonary nodules and thrombus in the sinus was evident on the follow-up imaging one month later. In selected cases of intracranial complications of SBO and septic pulmonary embolism, secondary to mastoiditis with early response to antibiotic therapy, conservative treatment may be considered and surgical intervention may be withheld.

Acute parapharyngeal abscess secondary to streptococcal mastoiditis

A rare case of parapharyngeal abscess caused by Streptococcus pneumoniae presenting as neck abscess is reported. The patient had 20 days history of cough, fever and swelling behind right ear. He had not responded to multiple antibiotic treatments given earlier. On the basis of clinical examination and CT scan finding, he was diagnosed as having parapharyngeal abscess pointing in the neck. The abscess was drained and the patient was treated with injectable Ceftriaxone, due to identification of penicillin - resistant Streptococcus pneumoniae

Petrositis with inferior cranial nerves involvement: a case report

Petrositis, osteomyelitis of temporal bone, is a rare complication of middle ear infection or mastoiditis. Symptoms reported in patients with petrositis are otalgia, deep facial pain, headache, otorrhea, fever, coma and cranial nerve paralysis. Current diagnostic tests for this complication include high-resolution CT scan, brain MRI and bone scan with Technetium, Gallium and Indium 1-11. A 34 years old lady with left multiple cranial nerves palsies of VII, VIII, IX, X, XII is presented. She had a history of otitis media and then mastoiditis in left side 6 months ago which was underwent tympanomastoidectomy. In radiological studies there was involvement of parameninge tissue next to petrous bone. Gallium scan was highly suggestive for petrous osteomyelitis. She was treated with empiric parenteral antibiotics and her symptoms resolved completely

Mastiodite masquée : à propos de deux observations

La mastoïdite masquée (MM) se définit comme un état inflammatoire latent de la muqueuse et de l'os mastoïdien avecun tympan normal. Elle est révélée par une complication généralement endocrânienne. Le traitement est une mastoïdectomie associée à une antibiothérapie intraveineuse.Nous rapportons deux observations de mastoïdites masquées dont le diagnostic a été évoqué par l'examen tomodensitométrique qui a rattaché les complications endocrâniennes à leur origine mastoïdienne. Le but de notre travail est de discuter les circonstances diagnostiques, les investigations paracliniques et le traitementdes mastoïdites masquées

Trombosis de los senos venosos, complicación tardía post mastoiditis en una preescolar / Venous sinus thrombosis: A late complication of mastoiditis in preschoolar girl

Introducción: La trombosis del seno lateral (seno sigmoídeo) secundaria a mastoiditis aguda cada vez es más infrecuente en nuestro medio y aún más si se habla de lesiones más extensas que comprometan a otros senos como el transverso. Sin duda el diagnóstico precoz y el manejo adecuado de la otitis media aguda han influido de manera importante para que esto suceda. Lo habitual es que se trate de pacientes sépticos con una sintomatología otológica manifiesta y repercusión sistémica. Hoy día comenzamos a ver casos en que el cuadro clínico es muy poco llamativo y a veces el diagnóstico se realiza de manera casual en el transcurso de la cirugía matoídea. Caso: Presentamos una niña de 5 años con trombosis de los senos lateral y transverso que tuvo como presentación clínica un signo de focalización neurológica (diplopia) sin otro hallazgo otoscópico ni otorrinolaringológico de interés. Se empleó sólo tratamiento médico, tuvo una evolución favorable y lenta, pero quedó sin secuelas. Discusión: Revisamos la literatura y la comparamos con nuestra decisión terapéutica.

Temoromandibular joint ankylosis caused by mastoiditis: Presentation of rare case and literature review

Ankylosis is Greek word meaning a stiff joint. Temporomandibular joint ankylosis is the development of complete or incomplete limitation of movement of the temporomandibular joint by bone or fibrous tissue. There are many predisposing factors that contribute to ankyiosis, including age of the patient, trauma to the mandible, damage to the articular disc and duration of immobilization following fracture of the mandible. The articular disc can be damaged by trauma, infection or neoplasm. The etiology and treatment of temporomandibular joint ankylosis have been well documented in the literature, with trauma and infection being the leading causes. A rare case of temporomandibuiar joint ankylosis in a young girl is presented, it was an infection sequela following otitis media and mastoiditis. Treatment consisted of resecting the ankylosed joint, bilateral coronoidectomy and replacement of the resected condyle with a costochondral graft and an interpositional temporalis muscle graft. Treatment outcome was satisfactorily successful with a mouth opening of 3.2cm two years following the surgery

Bilateral otogenic cerebellar abscesses.

An unusual presentation of bilateral otogenic cerebellar abscesses observed in two of our patients is reported. Both gave a history of otorrhoea, fever, headache, vomiting and had bilateral cerebellar signs and conductive hearing loss. The abscesses were detected on computerised tomography. X-rays revealed bilateral mastoiditis. The therapy followed was excision of abscesses, mastoidectomy and antibiotic therapy.

La otitis media aguda en el niño / Acute otitis media in children

La otitis media aguda constituye una patología frecuente en el niño. La calidad de su tratamiento influirá no sólo en la curación de la infección, sino también en el buen estado futuro del oído medio, en la tendencia o no a recidivar y en la predisposición a evolucionar a otitis crónica, eventualmente colesteatomatosa. El autor analiza la incidencia y gérmenes implicados, importancia del estado de la rinofaringe, senos paranasales y mastoides y su relación con episodios de otitis media aguda. Se revisan conceptos y se proponen medidas terapéuticas, de acuerdo a diversos estudios realizados estos últimos años

Otitis medias crónicas en el infancia: formas de presentación / Otitis media chronic in the infancy: presentation forms

Se analizaron historias clínicas de niños con otitis medias crónicas, observando que este tipo de proceso en nuestro medio, hace su debut al 1er. año de vida con picos de máxima frecuencia, variables según la forma de presentación. Las otitis medias crónicas tipo II y III con grave compromiso de la estructura y función y con mayor índice de complicaciones fueron los más frecuentes (64%) y de aparición más temprana. Las imágenes radiológicas oscilaron entre lesiones mínimas en las otitis medias crónicas tipo I a trastornos morfológicos severos en las tipo II y III