1/17. Clinical experiences with acute mastoiditis--1988 through 1998.The incidence of acute mastoiditis has declined dramatically during the postantibiotic era. Even so, antibiotic-resistant or unusual pathogens can still cause this disease entity. At our hospital, we documented an increase in antibiotic-resistant and atypical pathogens such as actinomyces spp. and mycobacterium tuberculosis. In this paper, we discuss the optimal diagnosis and treatment strategy for acute mastoiditis, and we describe our retrospective review of 13 patients with mastoiditis who were treated at our hospital from 1988 through 1998. Eight of these patients recovered following treatment with intravenous antibiotics, with or without myringotomy, and five who had complications of disease were managed surgically. Among these five, one developed chronic otitis media and one developed cholesteatoma 3 years later. For patients with acute mastoiditis, we emphasize the need to be aware of any unusual pathogens that do not respond to empiric antibiotic therapy.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
2/17. Acute mastoiditis and cholesteatoma.Acute coalescent mastoiditis is an uncommon sequela of acute otitis media. It occurs principally in the well-pneumatized temporal bone. The findings of fever, pain, postauricular swelling, and otorrhea are classic. cholesteatoma, on the other hand, being associated with chronic infection, usually occurs in the sclerotic temporal bone. The signs and symptoms are isidious in nature and consist of chronic discharge and hearing loss which result from its mass, bone erosion, and secondary infection. Of 17 consecutive cases of acute mastoiditis over a six-year period, four were atypical because they were complications of chronic otitis media and cholesteatoma, yet they had the physical findings of acute mastoiditis-subperiosteal abscess and purulent otorrhea, plus radiographic evidence of mastoid coalescence.- - - - - - - - - - ranking = 5keywords = cholesteatoma (Clic here for more details about this article) |
3/17. Fungal mastoiditis in an immunocompetent adult.Manifest fungal infection of the middle ear, fungal mastoiditis, is a very rare entity, which is almost exclusively seen in immunocompromised patients. The authors present a case of fungal mastoiditis in a 52-year-old woman without immunocompromise. The patient presented with acutely progressing symptoms of hearing loss and dysequilibrium. Bony fistula of the semicircular canal was noted on CT scans and a marginal perforation of the tympanic membrane was also seen. Her hearing recovered following the surgery, which revealed massive granulations and proliferation of fungi but no cholesteatoma in the mastoid cavity. Fungal infection of the middle ear is rare, but can cause serious complications. The possibility should be considered even in immunocompetent patients.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
4/17. Intracranial complications of acute and chronic mastoiditis: report of two cases in children.OBJECTIVE: The clinical picture of mastoiditis, sigmoid sinus thrombosis and brain abscess has changed with the advent of antibiotics. A delay in the recognition of intracranial complications in children and in the institution of appropriate therapy may result in morbidity and mortality. Increased mortality of the children has been correlated with the neurological status of the patient on admission to hospital. METHOD: A retrospective study was made of two children with acute mastoiditis and sigmoid sinus thrombosis and chronic mastoiditis with cerebellar abscess treated in 1997 in the ENT Department of the Medical University of Gdansk. RESULTS: We present two cases of intracranial complications in children (13 and 11 years old) originating from acute and chronic otitis media. The first case, of a 13-year-old boy with sigmoid sinus thrombosis as a complication of acute otitis media took its course as a typical Symonds syndrome. Mastoidectomy, thrombectomy and jugular vein ligation associated with antibiotics and edema-reducing drugs and anticoagulants proved to be successful. The second case of an 11-year-old boy with exacerbated chronic otitis media with cholesteatoma and mastoiditis, was complicated by suppurative meningitis, cerebellar abscess, perisinual abscess and sigmoid sinus thrombophlebitis. Neurosurgical approach by suboccipital craniotomy and abscess drainage was ineffective. Otological treatments of modified radical mastoidectomy, thrombectomy, jugular vein ligation, perisinual and cerebellar abscess drainage associated with wide-spectrum antibiotics and edema-reducing drugs were performed with a very good outcome. After 3 years of follow-up the patients remain without any neurological and psychiatric consequences. CONCLUSION: The authors show different courses of both presented complications and imaging techniques and surgical procedures performed in these children. The sigmoid sinus trombosis with Symonds syndrome may be difficult to diagnose due to previous antibiotics valuable in establishing the diagnosis and the extent of disease. The successful therapy is based on understanding of pathogenesis of the intracranial complication and the cooperation of an otolaryngologist, a neurologist, a neurosurgeon and an ophthalmologist.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
5/17. All that drains is not infectious otorrhea.It has been said that, 'All that wheezes is not asthma.' Thus, is also so of otorrhea. Bacterial infection most often causes otorrhea which, in turn, generally responds to treatment with ototopical antimicrobial therapy. When it persists, non-infectious etiologies must be considered. Although allergic causes of otorrhea have been described in the literature, inhalant environmental allergens (Type I Allergy) causing eustachian tube dysfunction or ototopical drops, most notoriously neomycin containing formulations, causing contact dermatitis are those usually mentioned. Further, most reports of contact allergic reactions of the ear have involved the external auditory canal skin or pinna and have been attributed to non-medicinal triggers like shampoos and metals used in ear rings. A search of the literature failed to reveal a reported case of recurrent or chronic otorrhea without cholesteatoma due to an allergic reaction to the components of a tympanotomy tube (TT). Such a case is presented here.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
6/17. otitis media and CNS complications.Intracranial complications from otitis media can be quite devastating to the patient if an early diagnosis is not made. patients may develop meningitis, venous sinus thrombosis or cranial nerve palsies, as well as intracranial abscess. The presenting features in such cases may be subtle and include headache, nausea, vomiting, personality changes and signs of increased intracranial pressure as well as focal neurological deficits. A case of intracranial brain abscess is presented in a patient with a history of chronic otitis media with cholesteatoma. Delay in the diagnosis of intracranial complications of otitis media can lead to improper treatment with increased morbidity and mortality. The etiology and treatment of complications affecting the CNS is discussed.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
7/17. Molecular confirmation of transmission route of staphylococcus intermedius in mastoid cavity infection from dog saliva.We report a case of infection of a mastoid cavity after mastoidectomy had been performed for chronic otitis media with cholesteatoma. The infection was caused by staphylococcus intermedius after a pet dog had licked the patient's ears. Bacterial strains from the dog's saliva and the otorrhea in the patient were confirmed to be identical by pulsed-field gel electrophoresis analysis. The possibility of an oral transmission route of S. intermedius from pets to humans should be noted.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
8/17. Gradenigo's syndrome: successful conservative treatment in adult and paediatric patients.A triad of retro-ocular pain, discharging ear and abducens nerve palsy, as described by Gradenigo, has been recognized for 150 years. It has traditionally been treated with surgery, but recent advances in imaging, allied with improved antibiotic treatment, allow conservative management of these cases. We present two cases of Gradenigo's syndrome: a 6-year-old child and a 70-year-old man, both without cholesteatoma, who were managed without mastoidectomy. They both had full recovery of abducens nerve function, although this took 6 and 12 weeks, respectively. In order to manage patients with Gradenigo's syndrome safely, accurate diagnostic radiology is essential, and our findings are presented and discussed. With changing medical technology, a review of the diagnostic and treatment options for this rare but serious condition, is timely.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
9/17. Iatrogenic cholesteatoma of the neck.Epidermal cysts of the upper neck may appear years after ipsilateral radical mastoidectomy for cholesteatoma. Three patients are presented, and the etiological factors operating in the development of such tumors in these patients and others cited in the literature are discussed.- - - - - - - - - - ranking = 5keywords = cholesteatoma (Clic here for more details about this article) |
10/17. Subperiosteal and Bezold's abscesses complicating cholesteatoma: a case report.A case of subperiosteal and Bezold's abscesses that occurred in a 60-year-old man with cholesteatoma has been described and the literature reviewed. Bezold's abscess is rarely seen in the current era of antibiotics. The simultaneous occurrence of a subperiosteal abscess in association with cholesteatoma, particularly in an adult, makes this case even more unusual. Although antibiotics have reduced the complications associated with acute otitis media, rare complications still occur and should be recognized by the otolaryngologist.- - - - - - - - - - ranking = 6keywords = cholesteatoma (Clic here for more details about this article) |
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