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Mastoid abscess: underlying disease and management
1Department of Otorhinolaryngology, King Abdul Aziz University Hospital, Riyadh, Saudi Arabia.
Abstract:
Despite a reduction in the incidence, subperiosteal mastoid abscesses (MAs) are still seen today with significant potentials for morbidity and even mortality. I present a series of 19 patients, seen over a 5-year period, with particular emphasis on the underlying disease and management. Ten abscesses (52.6%) succeeded acute suppurative otitis media (AOM); and nine (47.4%) resulted from chronic suppurative otitis media (CSOM). Eighty percent of those with AOM were younger than 10 years, whereas 77.8% of those with CSOM were older than 10 years. Fifty percent of the MAs that resulted from AOM had cortical mastoidectomy. The other five patients were treated with a less invasive method: antibiotics and incision and drainage without mastoid surgery. In eight MA cases caused by CSOM, the management of the abscess as well as the underlying disease was performed in one stage. Two-stage treatment occurred in one case. The study supports the recently recognized increasing role of CSOM in the etiology of MA, especially in adolescents and young adults. The controversy over the management of this disorder is discussed.
Insights
Subperiosteal mastoid abscesses (MAs) can lead to severe complications. This study highlights the increasing role of chronic suppurative otitis media (CSOM) in MA etiology, particularly in younger populations.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Infectious Diseases
Background:
- Subperiosteal mastoid abscesses (MAs) remain a significant clinical concern despite declining incidence.
- These abscesses carry substantial risks of morbidity and mortality.
Purpose of the Study:
- To analyze the underlying causes and management strategies for subperiosteal mastoid abscesses.
- To investigate the changing etiological patterns of MAs, focusing on acute versus chronic otitis media.
Main Methods:
- Retrospective case series of 19 patients with subperiosteal mastoid abscesses over a 5-year period.
- Analysis of patient demographics, preceding ear infections (acute suppurative otitis media [AOM] and chronic suppurative otitis media [CSOM]), and treatment approaches.
Main Results:
- Ten MAs (52.6%) followed AOM, primarily in children under 10. Nine MAs (47.4%) resulted from CSOM, predominantly in patients over 10.
- Treatment varied: 50% of AOM-related MAs underwent cortical mastoidectomy; others received antibiotics and incision/drainage.
- CSOM-related MAs were often managed in a single stage, addressing both the abscess and the underlying disease.
Conclusions:
- Chronic suppurative otitis media (CSOM) is increasingly implicated in the etiology of mastoid abscesses, especially in adolescents and young adults.
- Management strategies require careful consideration based on the underlying otitis media type and patient age.
- Further discussion is warranted regarding optimal treatment protocols for subperiosteal mastoid abscesses.