Contemporary presentation and management of a spectrum of mastoid abscesses.
BACKGROUND
The incidence of complications resulting from suppurative otitis media has significantly decreased since the introduction of antibiotics. At the start of the 20th century 50% of all cases of otitis media developed a coalescent mastoiditis. By 1959, the incidence had fallen to 0.4%. Recent studies suggest a current incidence of only 0.24%. Additionally, during the time of Friedrich Bezold (1824-1908), 20% of patients with mastoiditis developed subperiosteal abscess. Interestingly, this has incidence increased; today nearly 50% of patients diagnosed with coalescent mastoiditis have subperiosteal abscess.


OBJECTIVE
To review the contemporary presentation, diagnosis, and management of a spectrum of mastoid abscesses.


METHODS
Retrospective case series.


METHODS
Hospitals associated with the Department of Otolaryngology/Head and Neck Surgery at the University of California, San Francisco.


METHODS
Three patients with mastoid abscesses are reported. One patient displayed "classic" Bezold's abscess, with pus escaping the mastoid near the incisura digastrica and tracking along the digastric and sternocleidomastoid muscles into the neck. The second and third patients exhibited temporoparietal swelling secondary to mastoid abscess eroding the root of the zygomatic process, a complication noted by Bezold in 1908 as occurring "in only very rare cases."


CONCLUSIONS
Since only one third of patients show pathologic tympanic membrane changes, and since complaints of otalgia, fever, and tenderness are inconstant, subperiosteal mastoid abscess is frequently a delayed diagnosis. The clinical presentation, pathogenesis, and routes of abscess spread are presented with photographic and radiographic illustration. Medical and surgical management is reviewed, and methods for accurate diagnosis are emphasized.
Spiegel
J H
JH
Department of Otolaryngology/Head and Neck Surgery, University of California at San Francisco, 94143-0342, USA.
Lustig
L R
LR
Lee
K C
KC
Murr
A H
AH
Schindler
R A
RA
D000038:Abscess / Q000266:history / Q000382:microbiology / Q000601:surgery*; D000328:Adult; D005260:Female; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D008297:Male; D008417:Mastoiditis / Q000266:history / Q000382:microbiology / Q000601:surgery*; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed