[Chronic otitis media complicated by Bezold's abscess and lateral sinus thrombophlebitis]

Mastoiditis is a complication of otitis media and is defined as inflammation (usually infectious) of the mastoid air cells. Its incidence is 1.2 cases per 100,000 in children under 15 years of age, with a higher incidence in infants and a slight male predominance.

This was a 15-year-old girl, a student living in Bamako, with a history of recurrent otitis suppurativa since childhood. The onset of symptoms was seven weeks after her admission, marked by a left purulent otorrhea of medium abundance of progressive onset associated with unquantified fever, anterior rhinorrhea and hypoacusis without vertigo or tinnitus. The general examination on admission revealed a vigilant patient with a fair general condition, the conjunctiva were well stained with a temperature of 39°c and good hemodynamic constants. The ENT clinical examination revealed a cervico-facial and left retro auricular swelling without disappearance of the retro auricular groove with pre-toric and latero-cervical extension, painful to palpation, firm consistency, skin in front of it with an infiltrated aspect (figure 1). Left otoscopy revealed an obstructive inflammatory stenosis of the external auditory canal (EAC). Cervical CT scan revealed a large phlegmonous abscess in the laterocervix and left pharynx measuring 108 x 58.5 mm (Figure 2 a and b). The patient had received intravenous (IV) bi-antibiotic therapy and effective anticoagulation with low molecular weight heparin. The evolution was marked at one week after the cervicotomy by a significant regression of the left laterocervical swelling and of the clinical and biological inflammatory syndrome.

The diagnostic and therapeutic delay of chronic otitis media and ear washing can have often serious complications. In front of any latero-cervical mass in a context of otitis, it is necessary to think of a Bezold abscess. The management is well codified according to the literature.