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Abstract:
With the advent of broad-spectrum antibiotics, the clinical course of middle ear disease has been altered. One result has been the occasional suppression of the presenting signs and symptoms of mastoiditis secondary to acute middle ear disease, causing the clinician to have a false sense of security following apparent resolution of the middle ear infection. The course may be so insidious that the first awareness of the mastoiditis may be following presentation of an intracranial complication such as meningitis, lateral sinus thrombosis, or brain abscess. The authors report 9 patients seen in the past 5 years with masked mastoiditis, ranging in age from 4 months to 43 years. The presenting symptoms were all vague and non-classical; however, intracranial complications of meningitis, facial paralysis, brain abscess, and papilledema were present on admission in 7 patients, and another 2 patients had unsuspected epidural abscess upon surgical exploration. The mastoid radiographs were uniformly positive, while the CT scan was positive in 3/9 patients. All patients recovered following mastoidectomy and intracranial therapy except one patient who expired after brain herniation. The clinician is urged to maintain a high suspicion of masked mastoiditis in the high-risk patient, including newborn, diabetic, elderly, immunosuppressed or debilitated patients.
Insights
Broad-spectrum antibiotics can mask mastoiditis, leading to dangerous intracranial complications. Clinicians must suspect this "masked mastoiditis," especially in high-risk patients, to ensure timely treatment and prevent severe outcomes.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Neurology
Background:
- Broad-spectrum antibiotics have altered the presentation of middle ear infections.
- This can lead to suppressed symptoms of secondary mastoiditis, creating a false sense of security.
- Mastoiditis may present insidiously, with intracranial complications as the first sign.
Purpose of the Study:
- To report on cases of masked mastoiditis.
- To highlight the diagnostic challenges and clinical outcomes.
- To emphasize the importance of high clinical suspicion in at-risk populations.
Main Methods:
- Retrospective review of 9 patients with masked mastoiditis over 5 years.
- Analysis of presenting symptoms, diagnostic findings (radiographs, CT scans), and treatment.
- Evaluation of patient demographics and outcomes.
Main Results:
- Patients (4 months to 43 years) presented with vague, non-classical symptoms.
- Intracranial complications (meningitis, brain abscess, etc.) were present in 7/9 patients on admission.
- Mastoid radiographs were positive in all cases; CT scans were positive in 3/9. All patients recovered except one who expired.
Conclusions:
- Masked mastoiditis is a significant risk, often presenting with severe intracranial complications.
- High index of suspicion is crucial, particularly in newborns, diabetics, the elderly, and immunocompromised individuals.
- Prompt mastoidectomy and intracranial therapy are vital for favorable outcomes.