Mastoiditis enmascarada: Reporte de caso en un hospital pediátrico de alta complejidad / Masked mastoiditis: case report in a high-complexity pediatric hospital

La mastoiditis enmascarada es una forma poco frecuente dentro de las complicaciones de las otitis medias, ya sean aguda o crónicas. Su principal característica es presentar poca o mínima sintomatología ótica y tener un curso larvado en el tiempo. Este diagnóstico debe ser correctamente sospechado, ya que eventualmente puede generar consecuencias otológicas graves y presentar complicaciones mayores a nivel intra o extratemporal. En este trabajo se presenta el caso clínico de una paciente pediátrica sana, a la cual se diagnostica mastoiditis enmascarada de tres meses de evolución complicada con absceso de Bezold. Se inicia desde el ingreso hospitalario esquema antibiótico bi-asociado y se realiza mastoidectomía simple, evolucionando de forma satisfactoria.

Masked mastoiditis is a rare complication of acute or chronic otitis media. Its main characteristic is to present little or minimal otic symptoms and has a slowly progressive course over time. This diagnosis must be suspected correctly because it can eventually generate serious otological consequences and present major complications at intra or extratemporal levels. We report the clinical case of a healthy pediatric patient, who was diagnosed with masked mastoiditis complicated with a Bezold's abscess. A bi-associated antibiotic scheme was started from admission and a timpanomastoidectomy was performed, with a satisfactory outcome.

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.

Mastoiditis at Red Cross War Memorial Children's Hospital; Cape Town; 1999-2003

During the 5-year period 1999 - 2003; we treated 36 children with a clinical diagnosis of mastoiditis. Post-auricular tenderness; swelling or abscess was the presenting feature in all cases. Twenty of these children had acute mastoiditis; 12 had acute-onchronic mastoiditis and 4 had a post-auricular abscess and no signs of mastoiditis on mastoid exploration (pseudomastoiditis). No pathogenic organisms were cultured from 25of cases overall; but among those with positive culture Streptococcus pyogenes and Staphylococcus aureus were the commonest organisms in the acute mastoiditis group and Proteus mirabilis was the commonest in the acute-on-chronic group. In the acute mastoiditis group (20 patients) only 1 patient was successfully treated with antibiotics; the rest requiring cortical mastoidectomy. In the acute-on-chronic mastoiditis group (12 patients) 9 children had cholesteatoma and underwent an open cavity procedure and the other 3; who underwent cortical mastoidectomy; all had positive histology/culture for tuberculosis

Clinical experiences with acute mastoiditis

To discuss the optimal diagnosis and treatment strategy for acute mastoiditis. Retrospective review of 12 patients with mastoiditis [6 males, 6 females] aged 12 to 20 years who were treated at our military hospitals from 1996 through 2001. Three diagnostic criteria were used to identify acute mastoiditis. Among our patients the most common abnormal findings on physical examination was an abnormal tympanic membrane, which was observed in the 12 patients. The second most common finding was swelling and erythema in the postauricular area. Radiological examination showed abnormal pneumatization of 8 of them. Eight of our patients were cured within 3 weeks by intravenous antibiotics, two of them underwent myringotomy. Surgery was performed on the 4 patients who did not respond to medical treatment. Our experience suggests that an accurate early diagnosis and appropriate antibiotic therapy are usually sufficient to cure acute mastoiditis. When the inflammation does not respond to medical treatment, the physician should suspect that the infection might be caused by antibiotic tolerant organisms or a typical pathogen. If complications ensue, we believe it is best to carry out surgical treatment as soon as possible