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Updated: Aug 7, 2026
Endaural Endoscopic Atticoantrotomy (Retrograde Mastoidectomy) using a Constant Suction Bone-drilling Technique
Published on: May 23, 2021
Surgical management of acute mastoiditis with epidural abscess
Hongju Park1, Hyunjong Jang, Daebo Shim
1Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea. hpark@kuh.ac.kr
Abstract:
The prevalence of intracranial complications of acute coalescent mastoiditis in children has decreased significantly; however, this clinical problem persists, with a relatively high mortality. The common practice for management of acute mastoiditis with epidural abscess is mastoidectomy, drainage and placement of a ventilation tube, which means that the main pathology is confined to the mastoid cavity. We suggest that tympanic exploration is mandatory in certain cases, an example of which we present here. We report one case of acute mastoiditis with epidural abscess, in which mastoidectomy with tympanic exploration was needed to ensure drainage throughout the cavities and to prevent pressure rebuilding in the mastoid and tympanic cavities. We stress that if the tympanic membrane is thickened and no fluid is drained when placing a pressure equalization tube, there could be granulation tissue in the tympanum and tympanic exploration is mandatory, especially in a case of acute mastoiditis with intracranial complications accompanied by prolonged symptoms.
Insights
Acute coalescent mastoiditis can cause serious intracranial complications. Tympanic exploration during mastoidectomy is crucial for effective drainage and preventing pressure buildup in certain cases, especially with prolonged symptoms.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Neurosurgery
Background:
- Acute coalescent mastoiditis, though less common, still presents a significant mortality risk due to intracranial complications.
- Current management for mastoiditis with epidural abscess typically involves mastoidectomy and drainage, focusing solely on the mastoid cavity.
Observation:
- A case of acute mastoiditis with epidural abscess required mastoidectomy with tympanic exploration for comprehensive drainage.
- Thickened tympanic membranes and lack of fluid drainage during ventilation tube placement indicate potential tympanic cavity involvement.
Findings:
- Tympanic exploration is essential in specific acute mastoiditis cases to ensure complete drainage and prevent pressure recurrence in both mastoid and tympanic cavities.
- The presented case highlights the necessity of tympanic exploration when initial management of acute mastoiditis with intracranial complications is prolonged.
Implications:
- This approach may improve outcomes for children with complex mastoiditis by addressing pathology beyond the mastoid.
- Highlights the importance of considering tympanic cavity involvement in refractory or complicated mastoiditis cases.
- Suggests a refinement in surgical protocols for acute mastoiditis with intracranial complications.
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