[Managements of masked mastoiditis]

To appreciate clinically of masked mastoiditis to explored how to reduce the incidence and associated morbidity of otogenic complications.

Between January 1998 and February 2005, 11 cases of masked mastoiditis were collected retrospectively. Their clinical presentation, results of investigations, and response to treatment were reviewed.

Of 11 cases, there were 8 cases with hearing impairment, 5 cases with otalgia, 4 cases with facial nerve palsy, one patient with postauricular subperiosteal abscess, one case with meningitis, and one with thrombosis of the lateral sinus. Computed tomography (CT) scan revealed blurring (haziness) of the mastoid air-cells. After admission, intravenous antibiotics were prescribed and antro-mastoidectomy or mastoidectomy was performed for eradication of infection source. The predominant finding at mastoidectomy was granulation tissue filling the mastoid cavity and antrum. A varying amount of pus and osteitis was found in the 5 cases. The granulations into the antrum were severe, obstructing the drainage into the attic and the middle ear. The mastoid tip cells were filled with granulation tissue which spared the antrum. The patients recovered excellently postoperative, without facial palsy, vertigo or other complications.

To be a contemporary otologist, such severe complications of otologic diseases should not be overlooked. Appropriate intravenous antibiotics and adequate surgeries, as soon as possible, were recommended. Advanced CT scans of the temporal bone were necessary. Failure to identify associated concomitant pathology might result in treatment failure or persistent neurological deficit.