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Tuberculosis (TB) remains a global health concern, with extrapulmonary TB (EPTB) comprising 15–20% of cases. Diagnosis is challenging due to nonspecific imaging findings, necessitating consideration in high-risk populations. Understanding TB's pathogenesis, including lymphatic and hematogenous spread, is crucial for accurate diagnosis. Radiological assessments play a pivotal role in diagnosis and treatment planning. A 25-year-old male presented with left ear discharge and progressive pre- and infra-auricular swelling. Imaging revealed extensive involvement of the parotid and mastoid regions, posing diagnostic dilemmas. Microbiological confirmation via USG-guided aspiration confirmed mycobacterial TB with Rifampicin resistance, prompting prompt initiation of anti-tubercular therapy. TB extending to the parotid and mastoid regions is rare but warrants consideration in ITF lesions. This case emphasizes the importance of maintaining a high index of suspicion for TB, utilizing advanced imaging modalities, and obtaining microbiological confirmation for precise diagnosis and timely intervention. Further research is needed to optimize diagnostic and therapeutic approaches for atypical ITF infections. [ABSTRACT FROM AUTHOR]

A significant change in the seasonal patterns of ear infections has been observed due to the modification of aquatic leisure habits, also altering the etiology of the most frequently causing otitis in its various forms of presentation. This work aims to become the largest series documenting ear infections by this bacterium, carrying out a characterization and considering the possibility that the mechanism of action occurs both through contact with contaminated waters and colonization of the middle ear. [ABSTRACT FROM AUTHOR]

Mastoid fistula is a rare condition, its causes include chronic suppurative otitis media and repeated ear surgeries. Management is challenging, simple closure typically leads to recurrence due to surrounding necrotic skin edges. Several surgical techniques have been described. In this paper, we present a case of a 60 year old lady who presented with chronic right ear discharge post radical mastoidectomy due to acquired cholesteatoma. At presentation, there was a mastoid opening found over her auricular sulcus, endoscopic examination showed a well epithelized mastoid cavity with mucopurulent discharge, CT of temporal bone correlated with physical findings. The fistula was surgically closed with a three-layer pedicled flap and the fistula was fully healed at the 1-month follow up. [ABSTRACT FROM AUTHOR]

Aim: After the relaxation of COVID‐19 mitigation measures, we observed a dramatic increase in pyogenic infections. Based on this observation, we retrospectively analysed all cases of invasive bacterial infections of brain, lung and complicated ear–nose–throat (ENT) infections, in the period from 1 August to 31 March from the years 2018–2019 to 2022–2023. Methods: The study was conducted in two Paediatric Emergency Departments, at IRCCS 'Burlo Garofolo' of Trieste and at Treviso Hospital. Electronic medical records were searched for all cases with a definitive diagnosis at discharge of mastoiditis, suppurative cervical lymphadenitis, retropharyngeal, parapharyngeal and peritonsillar abscess (ENT group), bacterial brain abscesses, epidural empyema, subdural empyema (central nervous system group), thoracic empyema and necrotising pneumonia (lung group). Results: In 2022–2023, we observed an increase in infections compared to the previous years. Total number of cases were 22, 29, 8, 27 and 63 in 2018–2019, 2019–2020, 2020–2021, 2021–2022 and 2022–2023, respectively. The greater increase occurred in thoracic empyema, with a peak incidence of +120% in 2022–2023 in respect of 2021–2022. Conclusion: We reported an important increase in paediatric bacterial complicated infections in two North East Italian regions, possibly correlated with the relaxation of COVID‐19 social distancing measures. [ABSTRACT FROM AUTHOR]

BACKGROUND: Paecilomyces spp. are thermo-tolerant fungi found in decaying vegetables and soil. They can cause ocular, cutaneous, and miscellaneous infections. In otorhinolaryngology, most infections occur in the paranasal sinuses, while otological infection is uncommon. METHODS: We report a case of 41-year-old diabetic, male army officer with warm, fluctuant left temporal swelling and reduced hearing. Otoscopy revealed an edematous external auditory canal (EAC) with posterior wall sagging and bulging tympanic membrane. Computed tomography revealed subperiosteal temporal abscess extending intracranially. The pus was drained surgically via an otological and a neurosurgical approach, and pus sent for culture grew paecilomyces. He showed clinical improvement after receiving oral antifungal treatment postoperatively. Retrospectively, his occupation as an army officer and his diabetic immunocompromised state may have predisposed him to the infection. RESULTS: Paecilomyces middle ear infection leading to intracranial involvement of such magnitude is yet to be reported, and we showcase its successful management through a combined surgical neuro-otology approach and oral antifungal therapy. Fungal ear infections can lead to severe extracranial and intracranial complications if inadequately treated. Differentiating it from cholesteatoma also presents a diagnostic challenge clinically and radiologically. While both can lead to intracranial complications, our patient's brief history and lack of prior ear symptoms contrast with that of cholesteatoma. CONCLUSION: The rarity of neuro-otological paecilomyces infections emphasizes the need for awareness and early identification. It is vital to recognize such infections, and prompt surgical management with appropriate antifungal drugs is warranted to prevent disastrous outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Head and neck emergencies in children are frequent cause of visits to the hospital. Imaging plays a critical role in the management of these patients. This review article aims to familiarize radiologists with the common clinical presentations encountered, imaging characteristics of nontraumatic pediatric head and neck emergencies, and improve their ability to recognize associated complications as well as be aware of common mimics. Methods: We researched our database for commonly encountered nontraumatic head and neck emergencies in children. A literature search was done to compare and complete the list of conditions to be discussed in this review. Results: The review was organized according to anatomical location of the emergent condition. Relevant anatomy has been discussed along with clinical presentation, imaging characteristics and complications. We have presented common mimics with each set of disorders. Key imaging characteristics have been delineated using radiology images. Conclusion: Familiarity with the known complications of head and neck emergencies allows the radiologist to actively search for such findings, encourage early institution of appropriate therapy, and improve outcomes. [ABSTRACT FROM AUTHOR]

Mycoplasma pneumoniae, a frequent respiratory pathogen, can cause neurological disease manifestations. We here present a case of M. pneumoniae as cause of meningitis and occurrence of an intracranial abscess as a complication of mastoiditis with septic cerebral venous sinus thrombosis in a patient with multiple sclerosis on anti-CD20 therapy. [ABSTRACT FROM AUTHOR]

Otitis media, a common childhood disease, can lead to serious complications such as acute mastoiditis and, rarely, Luc’s abscess, with life-threatening consequences. Luc’s abscess, a rare but severe complication, can occur without acute mastoiditis. This case report details a case of Luc’s abscess in a 14-year-old girl with acute otitis media, presenting with ear pain, facial swelling, and hearing loss. Treatment involves a multidisciplinary approach, considering factors like age and abscess extent. Though there is no established standard treatment, this case emphasizes the need for prompt recognition and appropriate intervention to prevent severe complications. This case report emphasizes the importance of tailored, timely interventions for optimal outcomes in affected children.

Abstract Hypertrophic pachymeningitis (HP) is a rare disorder marked by thickening of the dura mater due to diverse etiologies. MPO-ANCA-positive HP represents a variant of AAV confined to the central nervous system, distinguished by the presence of serum MPO antibodies. Distinguishing HP triggered by MPO-ANCA from other causes can be challenging. In this study, we present two cases of MPO-ANCA-positive HP initially misdiagnosed as intracranial infections. Case 1 underwent surgery for chronic suppurative otitis media, with histopathological findings revealing inflammatory changes without definitive suppuration. He was presumed to have a secondary intracranial infection resulting from the surgery. However, his condition deteriorated despite two weeks of antibiotic and antiviral treatment. Case 2 presented with headache and was initially suspected of having intracranial Brucellosis given his serum Brucella positivity. Despite treatment for brucellosis, his symptoms persisted, and he developed visual and hearing impairments. Both patients were ultimately diagnosed with MPO-ANCA-positive HP, exhibiting serum MPO antibody positivity. Their symptoms showed improvement with glucocorticoid and immunosuppressive therapy. Based on these observations, we propose that MPO-ANCA-positive HP may initially present as intracranial infection. For HP patients presenting with headache, mastoiditis, otitis media, and visual loss, it is imperative to conduct ANCA antibody-related tests to enhance diagnostic precision.

Objectives: To study the predisposing factors, treatment, and complications of Aspergillus otitis externa. Methods: A retrospective analysis of patients diagnosed with Aspergillus otitis externa at the Department of Otorhinolaryngology, Helsinki University Hospital, between January 2010 and December 2018 was performed. Results: Of the 269 Aspergillus otitis externa (OE) patients, 96 developed otitis media (OM) and 7 developed mastoiditis. Antibiotic and steroid treatment and otological history were risk factors for Aspergillus OE. Systemic diseases and immunocompromising states were more common in mastoiditis patients. Repetitive ear cleaning and topical drugs are primary treatments, but systemic drugs and surgery were needed in resistant and invasive cases. Forty‐five novel tympanic membrane (TM) perforations were reported. A strong association between Aspergillus species and final infection types was found; A. niger was the dominant species in OM and in novel TM perforations, whereas A. flavus and A. fumigatus caused mastoiditis. Some of the TM perforations persisted despite treatment. Permanent hearing impairment was associated with OM and mastoiditis. Conclusion: As Aspergillus OE has the potential to cause acute and chronic complications, fungal OE should be suspected early on if the infection persists after conventional treatment. The identification of Aspergillus species could aid in spotting patients at risk for more severe disease and complications. Intensive local treatment is sufficient in most cases of OE and OM but effective topical antifungals are limited. Patients with Aspergillus OM and mastoiditis should be followed up for hearing impairment and permanent TM perforations after the infection resolves. Level of evidence: Level 4 (The Oxford 2011 Levels of Evidence). Aspergillus otitis externa may lead to a wide range of frequent and rare complications, including tympanic membrane perforations, otitis media, mastoiditis, permanent hearing loss, and cranial nerve palsies. Aspergillus niger causes most otitis media and tympanic membrane perforations, whereas A. flavus, A. fumigatus, and immunocompromising states are predispoding factors for mastoiditis. Careful local treatment is efficient in most cases but surgery and systemic antifungals are needed in profound infections. [ABSTRACT FROM AUTHOR]

Introduction: Acute pediatric mastoiditis is a bacterial infection of the mastoid bone most commonly associated with acute otitis media. Complicated mastoiditis is traditionally characterized by intracranial complications or subperiosteal abscess, but definitions are inconsistent in the literature. Surgical intervention is identified as the main treatment for complicated mastoiditis, but there is some evidence to support medical management of uncomplicated mastoiditis. This study sought to clarify the diagnostic criteria and management of uncomplicated acute mastoiditis. Methods: All cases of acute pediatric mastoiditis were identified from a single institution over a 16-year period and reviewed for demographic and clinical data. Two different definitions of uncomplicated mastoiditis were compared; the traditional one that excluded patients with intracranial complications or subperiosteal abscess (SPA) and the proposed definition that also excluded patients with any evidence of bony erosion including coalescence, not just SPA. Univariate and multivariate analysis was conducted. Results: Eighty cases were identified. Using the traditional definition of uncomplicated mastoiditis, 46.3% of cases were uncomplicated, compared to 36.2% when using the proposed definition. Truly uncomplicated patients, categorized with the proposed definition, were treated more consistently: no patients underwent mastoidectomy and they were less likely to receive a long term course of antibiotics. On multivariate regression analysis, only categorization with the proposed definition of uncomplicated mastoiditis was independently associated with less long-term antibiotic therapy and non-surgical management. Conclusion: Uncomplicated acute mastoiditis should be defined using clinical criteria and exclude any cases with evidence of bony erosion, including coalescence or subperiosteal abscess. These truly uncomplicated patients often do not require mastoidectomy and can be prescribed a shorter course of antibiotics. Further research into treatment pathways is necessary to optimize the management of uncomplicated acute pediatric mastoiditis. [ABSTRACT FROM AUTHOR]

Cone beam computed tomography (CBCT) frequently captures unexpected structural abnormalities unrelated to the original intent of the diagnostic test. Once identified by dentists, these findings often require appropriate clinical referral for further investigation. This study reviewed recent literature using a comprehensive search to identify and curate common CBCT incidental findings (1Fs). Studies were included if they reported CBCT IFs and included more than 10 cases. The review included 16 primary studies in addition to 4 studies described in recent relevant systematic reviews. A total of 51 descriptive terms used to describe key IFs across studies were identified, and terms were organized semantically into 15 core finding categories. Recommendations for management and referral acuity were derived from otolaryngologic clinical practice guidelines and input from practicing otolaryngologists, and the results were integrated into a clinical management algorithm for acuity of referral. This comprehensive review offers practical recommendations to facilitate appropriate clinical management of CBCT IFs via otolaryngologic referral. [ABSTRACT FROM AUTHOR]

Study Design: Descriptive cross-sectional study. Background: The greater auricular nerve (GAN) courses over the sternocleidomastoid muscle (SCM) to supply the area of skin over the parotid gland (PG), the lower auricle and over the mastoid. It is vulnerable to injury during rhytidectomies and parotidectomies, resulting in sensory losses and pain. Although previous studies have identified suitable landmarks, injury to the GAN in the Kenyan setting still occurs. This study therefore aimed at identifying specific landmarks for the GAN and describing its branching pattern. Objective: To determine the anatomical landmarks of the GAN and its branching patterns. Methods: Forty six nerves were studied. The skin and fascia of the neck was carefully dissected to reveal the platysma muscle, which was reflected to expose the GAN. The distance of the emergence of the GAN on the posterior border of the sternocleidomastoid muscle as measured from the mastoid process (MP) was measured. Its perpendicular distance from the tragus to the point of branching was also measured. Its distance to the external jugular vein (EJV) was taken using a ruler and a pair of dividers. Finally, the nerve was described according to McKinney's point. The pattern of branching was described as either type 1 (no branching), type 2 (2 branches) or type 3 (3 branches). The position of branching was classified as either anterior, posterior or middle. Collected data was coded into SPSS software (Version 21.0, Chicago, Illinois), and means ± standard deviation were calculated. Representative photos were taken. Results: The mean distance of the point of emergence of the nerve was 9.13 cm +/− 1.66 cm from the MP, while its distance from the tragus was 6.93 cm +/− 1.55. It was also located at a distance of 1.67 cm from the EJV. It mainly bifurcated into two branches (55.6%) and trifurcated in 4.4% of the cases. It remained undivided in 40% of the cases. In our study, the nerve mainly bifurcates in the anterior third of the SCM (22.2%). Conclusions: The GAN in our population mainly bifurcates, and it is more likely to divide closer to the parotid gland. The data presented in the study may be helpful in avoiding its iatrogenic injury. [ABSTRACT FROM AUTHOR]

Hypertrophic pachymeningitis (HP) is a rare disorder marked by thickening of the dura mater due to diverse etiologies. MPO-ANCA-positive HP represents a variant of AAV confined to the central nervous system, distinguished by the presence of serum MPO antibodies. Distinguishing HP triggered by MPO-ANCA from other causes can be challenging. In this study, we present two cases of MPO-ANCA-positive HP initially misdiagnosed as intracranial infections. Case 1 underwent surgery for chronic suppurative otitis media, with histopathological findings revealing inflammatory changes without definitive suppuration. He was presumed to have a secondary intracranial infection resulting from the surgery. However, his condition deteriorated despite two weeks of antibiotic and antiviral treatment. Case 2 presented with headache and was initially suspected of having intracranial Brucellosis given his serum Brucella positivity. Despite treatment for brucellosis, his symptoms persisted, and he developed visual and hearing impairments. Both patients were ultimately diagnosed with MPO-ANCA-positive HP, exhibiting serum MPO antibody positivity. Their symptoms showed improvement with glucocorticoid and immunosuppressive therapy. Based on these observations, we propose that MPO-ANCA-positive HP may initially present as intracranial infection. For HP patients presenting with headache, mastoiditis, otitis media, and visual loss, it is imperative to conduct ANCA antibody-related tests to enhance diagnostic precision. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to form astute deductions regarding the presentation, treatment and mortality of otogenic brain complications. Methods: A systematic literature search of four medical databases (PubMed, Embase, Web of Science and Scopus) was conducted. Studies associated with otogenic brain complications were considered eligible. Fixed- and random-effects model meta-analysis was developed to assess the proportion estimate for each outcome individually. Results: Twenty-eight studies, with 1650 patients in total, were included. In 66 per cent of patients there was a known history of chronic otitis media. The most common symptoms were purulent otorrhoea (84 per cent), headache (65 per cent) and otalgia (45 per cent). A brain abscess was observed in 49 per cent of patients, followed by meningitis (34 per cent) and sinus thrombosis (22 per cent). A combination of surgical and conservative therapy was chosen in 84.3 per cent of cases and the mortality rate approached 11.1 per cent. Conclusion: Otogenic brain complications are a possibly life-threatening condition. Prompt imaging examination may set the final diagnosis and lead to an effective treatment. [ABSTRACT FROM AUTHOR]

Background: Group A streptococcal(GAS) meningitis is a severe disease with a high case fatality rate. In the era of increasing GAS meningitis, our understanding about this disease is limited. Purpose: To gain a better understanding about GAS meningitis. Methods: Five new cases with GAS meningitis were reported. GAS meningitis related literatures were searched for systematic review in PUBMED and EMBASE. Case reports and case series on paediatric cases were included. Information on demographics, risk factors, symptoms, treatments, outcomes, and emm types of GAS was summarized. Results: Totally 263 cases were included. Among 100 individuals, 9.9% (8/81) had prior varicella, 11.1% (9/81) had anatomical factors, and 53.2% (42/79) had extracranial infections. Soft tissue infections were common among infants (10/29, 34.5%), while ear/sinus infections were more prevalent in children ≥ 3 years (21/42, 50.0%). The overall case fatality rate (CFR) was 16.2% (12/74). High risk of death was found in patients with shock or systemic complications, young children(< 3 years) and cases related to hematogenic spread. The predominate cause of death was shock(6/8). Among the 163 patients included in case series studies, ear/sinus infections ranged from 21.4 to 62.5%, while STSS/shock ranged from 12.5 to 35.7%, and the CFR ranged from 5.9 to 42.9%. Conclusions: A history of varicella, soft tissue infections, parameningeal infections and CSF leaks are important clinical clues to GAS in children with meningitis. Young children and hematogenic spread related cases need to be closely monitored for shock due to the high risk of death. [ABSTRACT FROM AUTHOR]

The article describes the case of a three-year-old child reported to the ear, nose and throat (ENT) outpatient department of a hospital with the chief complaints of left ear discharge for the last six months and post-auricular swelling gradually increasing over a period of time for the past four months. Topics include description of the ear discharge, findings on ear examination, and a final diagnosis of Langerhans cell histiocytosis (LCH) of mastoid.

The article describes two cases of glial choristoma of epitympanum or middle ear and the mastoid cavity. A 65-year old male patient with recurrent vertigo and history of chronic otitis media with cholesteatoma treated with mastoidectomy demonstrated mild hearing loss on the right ear. A 68-year old female with a history of fever, vomiting, right-sided otalgia and drowsiness was diagnosed with otitis media and mastoidotis of the right ear and she underwent myringotomy and mastoidectomy.

Tuberculous otomastoiditis, a rare manifestation of tuberculosis in the head and neck region, poses diagnostic and therapeutic challenges due to its non-specific clinical features and potential debilitating complications. While typically arising from direct spread from adjacent organs, the coexistence of tuberculous otomastoiditis and cervical spondylitis is rarely reported. We present the case of a 14-year-old male with a 3-month history of painless bilateral ear discharge resistant to antibiotic therapy. The clinical and radiological findings raised suspicions of tuberculous otomastoiditis and spondylitis, which was later confirmed by histopathological examination despite negative microbiological cultures. This case underscores the significance of considering tuberculosis in conditions involving multiple organs, especially when persistent extensive damage is observed despite optimal initial treatments.

Abstract Background Mastoiditis frequently occurs in children as they are more susceptible to middle ear infections, but infrequently occurs in adults. A rare complication that results from mastoiditis and an obstructing cholesteatoma is a Bezold’s abscess, of which there are less than 100 reported cases in literature to date. Case presentation Here, we present a case of a 72-year-old Caucasian man who has had no history of prior ear infections and was found to have a cholesteatoma and advanced acute coalescent mastoiditis complicated by a Bezold’s abscess. Conclusions Bezold’s abscess is a rare entity infrequently encountered in the modern era, likely owing to more prompt treatment of otitis media. Cholesteatoma poses a great risk for both the development of otitis media and further progression to mastoiditis and its associated complications, such as Bezold’s abscess. Knowledge of said abscess is crucial; without prompt recognition, further spread of infection can occur with vascular or mediastinal involvement.

Background: Mastoiditis frequently occurs in children as they are more susceptible to middle ear infections, but infrequently occurs in adults. A rare complication that results from mastoiditis and an obstructing cholesteatoma is a Bezold's abscess, of which there are less than 100 reported cases in literature to date. Case presentation: Here, we present a case of a 72-year-old Caucasian man who has had no history of prior ear infections and was found to have a cholesteatoma and advanced acute coalescent mastoiditis complicated by a Bezold's abscess. Conclusions: Bezold's abscess is a rare entity infrequently encountered in the modern era, likely owing to more prompt treatment of otitis media. Cholesteatoma poses a great risk for both the development of otitis media and further progression to mastoiditis and its associated complications, such as Bezold's abscess. Knowledge of said abscess is crucial; without prompt recognition, further spread of infection can occur with vascular or mediastinal involvement. [ABSTRACT FROM AUTHOR]

Objective: To describe characteristics of pediatric patients with recurrent acute mastoiditis, and to identify risk factors for this condition. Study design: A retrospective cohort study. Setting: Data based on electronic medical records of the largest Health Maintenance Organization in Israel. Methods: Children hospitalized due to acute mastoiditis during the years 2008–2018 were identified, and their diagnosis was verified. Patients with recurrent acute mastoiditis were identified and grouped, and their characteristics were outlined and compared to those of the original group to identify risk factors for recurrence. Results: During the 11-year period, a total of 1115 cases of children hospitalized due to acute mastoiditis were identified with a weighted incidence rate of 7.8/100,000. Of this group, 57 patients were diagnosed with recurrence following a full clinical recovery. The incidence proportion of recurrent acute mastoiditis was 5.1% (57/1115), male-to-female ratio was 27:30, 73.4% were younger than 24 months, the median period from the first episode was 3.4 months (IQR 2.0;10.0), and 82.5% of the patients (n = 47) had a single recurrence, whereas 18.5% (n = 10) had two recurrences or more. Mastoidectomy and swelling over the mastoid area during the first episode were identified as the main risk factors for recurrent mastoiditis HR = 4.7 [(2.7–8.2), p < 0.001] and HR = 2.55 [(1.4–4.8), p = 0.003], respectively. Mastoidectomy was the only independent significant risk factor for recurrence in a multivariate analysis. Conclusions: Mastoidectomy and swelling over the mastoid area during the first episode of acute mastoiditis were found strongly related independent risk factor for future recurrent episodes of acute mastoiditis. [ABSTRACT FROM AUTHOR]

Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of mastoiditis, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Acute mastoiditis most commonly affects pediatric patients and is a suppurative infection of the mastoid air cells. It is often associated with otitis media, and common bacteria include Streptococcus and Staphylococcus. History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise. The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms. Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis. Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis. CT may also demonstrate complications. Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation. Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures. An understanding of acute mastoiditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease. [ABSTRACT FROM AUTHOR]

Abstract Objectives To study the predisposing factors, treatment, and complications of Aspergillus otitis externa. Methods A retrospective analysis of patients diagnosed with Aspergillus otitis externa at the Department of Otorhinolaryngology, Helsinki University Hospital, between January 2010 and December 2018 was performed. Results Of the 269 Aspergillus otitis externa (OE) patients, 96 developed otitis media (OM) and 7 developed mastoiditis. Antibiotic and steroid treatment and otological history were risk factors for Aspergillus OE. Systemic diseases and immunocompromising states were more common in mastoiditis patients. Repetitive ear cleaning and topical drugs are primary treatments, but systemic drugs and surgery were needed in resistant and invasive cases. Forty‐five novel tympanic membrane (TM) perforations were reported. A strong association between Aspergillus species and final infection types was found; A. niger was the dominant species in OM and in novel TM perforations, whereas A. flavus and A. fumigatus caused mastoiditis. Some of the TM perforations persisted despite treatment. Permanent hearing impairment was associated with OM and mastoiditis. Conclusion As Aspergillus OE has the potential to cause acute and chronic complications, fungal OE should be suspected early on if the infection persists after conventional treatment. The identification of Aspergillus species could aid in spotting patients at risk for more severe disease and complications. Intensive local treatment is sufficient in most cases of OE and OM but effective topical antifungals are limited. Patients with Aspergillus OM and mastoiditis should be followed up for hearing impairment and permanent TM perforations after the infection resolves. Level of evidence Level 4 (The Oxford 2011 Levels of Evidence).

Mucocele is a benign epithelial-lined mucoid-filled sac that may sound harmless but has the potential of expanding at the expense of its surrounding bony architecture. The incidence of its emergence from the mastoid bone is relatively rare, whereas one that results in intracranial complications is almost unheard of. We present the case of a patient presenting with the symptoms of a middle ear infection, which was initially treated as refractory acute otitis media with intracranial complication. However, intraoperative findings revealed an infected mucocele within the mastoid bone. [ABSTRACT FROM AUTHOR]

Case Presentation: A 57-year-old man with a history of bronchial asthma and eosinophilic sinusitis presented to the emergency department with an exacerbation of otitis media. His primary complaints were otopyorrhea, headache, and neck pain with redness. Contrast-enhanced computed tomography revealed a posterior neck abscess contiguous with the mastoid process. The patient underwent mastoidectomy and received antimicrobial therapy. Eosinophilic granulation tissue in the middle ear obstructed the middle ear aditus and directed the inflammatory process toward the mastoid tip. Discussion: Bezold abscess is a rare extracranial complication of acute mastoiditis. Therefore, clinicians should consider neck pain with redness as an important physical sign that suggests Bezold abscess in patients with otitis media. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Identifying myeloid sarcoma in rare locations is a diagnostic challenge and requires careful evaluation. The optimal management of extramedullary disease requires further investigation, but tissue biopsy and a personalized approach are crucial. Herein, we describe an unusual case of acute myeloid leukemia presenting with an isolated involvement of the temporal bone after a complete remission of systemic disease for more than a year. The clinical, radiological, and pathological features are discussed, highlighting the importance of considering differential diagnoses and appropriate management. [ABSTRACT FROM AUTHOR]

Aim: The pneumococcal conjugate vaccine, which covered seven serotypes of Streptococcus pneumoniae (PCV7), was introduced in Stockholm, Sweden, in 2007. It was replaced by a 13‐valent vaccine (PCV13) in 2011. We previously reported a decreased incidence of pneumonia and sinusitis among young children 4 years after the introduction of the PCV7. This study followed the incidence of pneumonia, sinusitis, mastoiditis and meningitis for four more years. Methods: We studied validated hospital registry data covering children up to 17 years of age, who were hospitalised in the Stockholm region from 2003 to 2016, when the child population peaked at 485 687. All 11 115 cases diagnosed with pneumonia, coded as bacterial pneumonia, sinusitis, mastoiditis, bacterial meningitis or empyema, were identified. The controls had viral pneumonia or pyelonephritis. Results: The incidence rates for children under 2 years of age hospitalised for sinusitis, mastoiditis and meningitis decreased significantly by 61%–79% during the eight‐year post‐vaccination period. Hospitalisations for bacterial pneumonia decreased by 19%–25% in the same age group. These changes were probably due to both the vaccines and changes in diagnosis routines. Conclusion: The effect of vaccination on children under 2 years of age was sustained 8 years after the introduction of the pneumococcal conjugate vaccines. [ABSTRACT FROM AUTHOR]

Acute mastoiditis, a complication of otitis media, poses significant challenges in diagnosis and treatment, particularly in pediatric populations. This study aims to comprehensively evaluate the demographic characteristics, clinical features, and prognostic factors associated with acute mastoiditis in pediatric patients in Saudi Arabia. Analysis of a multicenter dataset was conducted to assess demographic variables, symptomatology, disease course, and predictors of acute mastoiditis in pediatric patients. Significant associations were found between demographic variables (age group, gender, nationality) and acute mastoiditis risk. Symptomatology analysis revealed consistent frequencies of otalgia across age groups and genders. Disease course analysis highlighted a mean duration from symptom onset to diagnosis of 14.11 days, with frequent complications like mastoid abscess and meningitis. Predictor identification identified symptoms (otalgia, fever, otorrhea), duration of illness, and complications as significant predictors of disease severity. These findings contribute valuable insights into the epidemiology and clinical management of acute mastoiditis, informing targeted interventions to improve patient outcomes. [ABSTRACT FROM AUTHOR]

The article presents a case of pediatric Mycobacterium abscessus mastoiditis resistant to standard treatments, emphasizing the importance of considering M. abscessus in treatment-resistant chronic otitis media and mastoiditis, especially in children with tympanostomy tubes. Topics include challenges in diagnosing M. abscessus infections, treatment strategies, and the effectiveness of tigecycline in multidrug regimens.

Objectives: Acute mastoiditis (AM) and its associated intra and extracranial complications are rare complications of acute otitis media. However, they are associated with a high morbidity. The management of AM with complications carries significant variations in approach. We aimed to evaluate the presentation of children with AM with complications to a tertiary referral centre in the United Kingdom and describe evolution of the treatment approaches. Methods: We undertook a retrospective chart review of all children admitted with AM to the University Hospitals of Leicester between 2013 and 2022. Results: Twenty‐seven children were included in this study: 7 patients had sigmoid sinus thrombosis (SST), 4 had an intracranial collection, 3 had cranial nerve palsy and 16 had a subperiosteal abscess (SPA); some patients had more than 1 complication. In this study, treatment of SPA with incision and drainage (I&D) and grommet insertion was effective, as all patients treated with grommet insertion and I&D recovered well and did not require a subsequent cortical mastoidectomy. All patients with SST received anticoagulation and intravenous (IV) antibiotics; surgical input consisted of grommet insertion alone and cortical mastoidectomy was not routinely performed in these patients. Conclusion: In our series, management of SPA with grommet insertion and drainage had good outcomes. SST management mainly consisted of IV antibiotics, anticoagulation and grommet insertion with good recovery. The evidence to guide the management of complications of mastoiditis is of poor quality and further research is needed to clarify the optimal management of these complications. [ABSTRACT FROM AUTHOR]

The universal use of computed tomography (CT) has opened up new possibilities in the noninvasive examination of human mummies, and particularly the detailed study of the fine structures of the temporal bone. The aim of this study was to describe the morphological changes, as seen on CT, found in the right temporal bone of Djed-Hor, an around 2300 year old Heidelberg's Egyptian mummy, and to discuss their possible causal relation to his death. Here we showed the presence of a compress on the auricle, and of probable pus in the mastoid, middle ear, and external ear with erosion of the tegmen tympani probably related to a fatal acute mastoiditis. These typical morphological changes of such a disease were demonstrated in the same way as in living patients of today. This would be the first depiction of a compress on an auricle associated with pus in the ear of an Egyptian mummy. [ABSTRACT FROM AUTHOR]

This article provides a modern clinical and radiographic review of mastoiditis complications, a serious infection of the mastoid air cells in the temporal bone. The study examines a cohort of nine patients, including both adults and children, who presented with various complications of mastoiditis. The article describes the clinical presentations, laboratory values, imaging findings, and surgical reports of each complication, ranging from intracranial infections to facial nerve paralysis. The review aims to provide skull base surgeons with a comprehensive understanding of the manifestations of mastoiditis in the modern era. [Extracted from the article]

Abstract Background Acute mastoiditis is an intratemporal complication due to acute otitis media (AOM). Common risk factors include young age (often

A 3-year-old boy developed otitis media, mastoiditis, papilledema, sixth nerve palsy, and increased intracranial pressure. The initial diagnosis was idiopathic intracranial hypertension, but doubt about that diagnosis at such a young age led to imaging reevaluation. When the abnormalities from multiple pulse sequences were aggregated with this clinical input, the correct diagnosis of otitic hydrocephalus emerged, allowing prompt implementation of appropriate treatment to avoid the risk of venous stroke.

Key Clinical Message Identifying myeloid sarcoma in rare locations is a diagnostic challenge and requires careful evaluation. The optimal management of extramedullary disease requires further investigation, but tissue biopsy and a personalized approach are crucial. Abstract Herein, we describe an unusual case of acute myeloid leukemia presenting with an isolated involvement of the temporal bone after a complete remission of systemic disease for more than a year. The clinical, radiological, and pathological features are discussed, highlighting the importance of considering differential diagnoses and appropriate management.

Nontuberculous mycobacteria (NTM) are ubiquitous in nature and most commonly cause pulmonary infections and cervicofacial lymphadenitis in children. Here we report a rare case of NTM mastoiditis in a 3-year-old immunocompetent patient who presented with left mucoid otorrhea refractory to two months of ciprofloxacin/dexamethasone drops. The patient underwent left cortical mastoidectomy and treatment with 7 months of triple antibiotic therapy. Infection remained localized to the middle ear with signs of resolution. Early bacterial culture with acid-fast bacilli staining should be considered in immunocompetent patients presenting with refractory otorrhea.

Background: HRCT, a modification of routine CT, provides a direct visual window into the temporal bone providing minute structural details. Purpose of the present study is to evaluate the normal variations, pathological processes (infections, tumors and congenital anomalies) and their extent involving the temporal bone.

This article discusses a case of a fatal infratentorial subdural empyema in a young adult with chronic suppurative otitis media and mastoiditis. Infratentorial empyemas are rare but serious complications of ear infections, and they can be more problematic and have higher morbidity and mortality rates due to limited space in the posterior cranial fossa. Early diagnosis and prompt management are crucial for saving lives. Surgical evacuation, along with clearance of the source of infection and long-term antibiotics, is the treatment of choice. The article also mentions previous case reports and reviews on infratentorial empyemas and emphasizes the importance of timely neuroimaging for identification and appropriate management. [Extracted from the article]

Rationale: Acute otitis media is a common disease in early childhood, and is usually caused by Streptococcus pneumoniae (S. pneumoniae). Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone (acute coalescent mastoiditis). In addition, the infection can extend through the surrounding bones or the emissary veins beyond the mastoid's air cells, leading to subperiosteal abscesses. Patient's Concern: A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis (swelling and redness of the skin). Diagnosis: Bilateral acute coalescent mastoiditis caused by S. pneumoniae infection. The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides. Interventions: The patient underwent intravenous antibiotic therapy and surgical treatment. Outcomes: The patient was discharged 14 days after hospitalization with an improved condition. Lessons: Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications, sometimes serious and even life-threatening. Complications are prevalent in children under 2 years, in whom the disease progresses more rapidly and severely. The vaccination with a 13-valent vaccine may not result in sufficient immunity against S. pneumoniae, a predominant pathogen in children affected by acute coalescent mastoiditis. [ABSTRACT FROM AUTHOR]

The optimal timing for surgery to promote postoperative recovery in children with congenital stenosis of the external auditory canal with external auditory canal cholesteatoma, who are susceptible to exudative inflammation of middle ear and mastoid process, is still uncertain. To investigate the treatment of congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with exudative inflammation. A retrospective analysis of 45 patients with congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with mastoiditis. Based on whether effusion had resolved at the time of surgery, the patients were divided into two groups. Pure-tone audiometry tests were performed before and after surgery for both groups. The average postoperative duration of dry ear was 36.38 days in Group 1 and 47.90 days in Group 2 (p < 0.05). Among patients who underwent hearing reconstruction, the average air conduction threshold decreased by 15–36 dBHL in Group 1 and by 7–22 dBHL in Group 2 (p < 0.05). The postoperative outcomes of dry ear and hearing improvement can be enhanced by performing operation after effusion resolution in cases of congenital external auditory canal stenosis with external auditory canal cholesteatoma exudative inflammation. [ABSTRACT FROM AUTHOR]

Background. Acute mastoiditis (AM) is a severe infection of the mastoid air cells that occurs in cases of acute, sub-acute, or chronic middle ear infections. No definitive consensus regarding the management of AM has been identified. The current guidelines include a conservative approach (parenteral antibiotics alone, antibiotics plus minor surgical procedures such as myringotomy with a ventilation tube inserted or drainage of the subperiosteal abscess through retro-auricolar incision or needle aspiration) or surgical treatment (mastoidectomy). The main aim of this review was to evaluate and summarize the current knowledge about the management of pediatric AM by analyzing the current evidence in the literature. Methods. We examined the following bibliographic electronic databases: Pubmed and the Cochrane Library, from the inception date until February 2023. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISM). The key words used for the search across electronic databases were: 'mastoiditis' and 'management'; 'mastoiditis' and 'surgery'; 'mastoiditis' and 'conservative'; 'mastoiditis' and 'antibiotics'; 'mastoiditis' and 'myringotomy'; 'mastoiditis' and 'grommet'; 'mastoiditis' and 'drainage'; and 'mastoiditis' and 'mastoidectomy'. Results. We selected 12 articles involving 1124 episodes of mastoiditis. Some of these studies considered medical therapy alone as a valid first step, whereas others considered a minor surgical intervention as an initial approach along with antibiotic therapy. Considering the studies that evaluated medical therapy as the initial sole treatment option, the success rate of antibiotics alone was 24.6%. Overall, the success rate of minor surgical procedures, excluding mastoidectomy, was 87.7%, whereas the mastoidectomy success rate was 97%. Conclusions. Overall, there is no shared consensus on the diagnostic or therapeutic approach to mastoiditis. Conservative therapy has gained considerable ground in recent times, quite limiting the predominant role of mastoidectomy. Further studies will be necessary to definitely develop standardized protocols shared in the scientific community. [ABSTRACT FROM AUTHOR]

Introduction: The benign nature of Bell's palsy has led to a lack of a standardized work-up, and dangerous underlying mimics are at risk of being missed. Case Report: An 84-year-old female with a history of vertigo presented to the emergency department with a left-sided facial droop consistent with Bell's palsy. After further work-up, the patient was diagnosed with bilateral necrotizing mastoiditis. Conclusion: Unilateral facial weakness involving the forehead and palpebral fissures is often diagnosed as idiopathic Bell's palsy. Various pathologies can present with unilateral facial weakness, and the differential needs to remain broad. [ABSTRACT FROM AUTHOR]

Introduction: Multifocal Langerhans' cell histocytosis is a rare condition that can affect multiple organs and manifest in various scenarios. While the condition is more commonly found in children, it can also occur in adults. Case Report: A 43-year-old female presented with refractory otorrhea and had a rubbery neck mass in the left mid-cervical area, as well as an itchy eczematoid lesion in the left parietal area. The otic lesion was eventually resected, and histopathologic examination confirmed the diagnosis of Langerhans histiocytosis. Conclusions: Although rare in adults, Langerhans histiocytosis should be considered as one of the differential diagnoses for ear canal polyps. If diagnosed, medical treatment should be pursued.

Abstract Cerebral venous thrombosis (CVT) is a rare entity that remains a diagnostic challenge due to various clinical manifestations and a wide variety of causative agents. Local infections, such as acute (AOM) or chronic otitis media, can play a role in the pathogenesis of CVT. The proximity of the tympanic cavity and temporal bone air cells to the dural venous sinuses predisposes them to secondary thrombosis. The release of inflammatory cytokines and activation of the coagulation pathway in the middle ear space in response to infection may trigger the thrombotic mechanism in venous sinuses of the central nervous system. There is no consensus in the literature concerning the treatment of otogenic cerebral venous sinus thrombosis (CVST). Both the extent of the surgery and the use of anticoagulants are disputable. The aim of the study was to provide a thorough analysis of the literature concerning CVST in patients with AOM and acute mastoiditis (AM). The current surgical and conventional treatment strategies are presented. Special attention has been attached to the predisposing factors, the extent of the surgery, and the role of anticoagulants in the treatment of septic otogenic CVST.

The article presents a case study of a 75-year-old man with left facial nerve paralysis following treatment for a dural arteriovenous fistula (dAVF). Topics include diagnostic imaging and examination approaches to differentiate between upper and lower motor neuron injuries, management strategies for the resulting facial paralysis, and a multidisciplinary rehabilitation plan addressing speech, eye protection, and psychological support.

Objective: To evaluate the image quality of low-dose temporal bone computed tomography (CT) in otitis media and mastoiditis patients by using deep learning reconstruction (DLR). Materials and methods: A total of ninety-seven temporal bones from 53 consecutive adult patients who had suspected otitis media and mastoiditis and underwent temporal bone CT were prospectively enrolled. All patients underwent high resolution CT protocol (group A) and an additional low-dose protocol (group B). In group A, high resolution data were reconstructed by filter back projection (FBP). In group B, low-dose data were reconstructed by DLR mild (B1), DLR standard (B2) and DLR strong (B3). The objective image quality was analyzed by measuring the CT value and image noise on the transverse image and calculating the signal-to-noise ratio (SNR) on incudomallear joint, retroauricular muscle, vestibule and subcutaneous fat. Subjective image quality was analyzed by using a five-point scale to evaluate nine anatomical structures of middle and inner ear. The number of temporal bone lesions which involved in five structures of middle ear were assessed in group A, B1, B2 and B3 images. Results: There were no significant differences in the CT values of the four reconstruction methods at four structures (all p > 0.05). The DLR group B1, B2 and B3 had significantly less image noise and a significantly higher SNR than group A at four structures (all p 0.05), however, the group B3 had lower subjective image quality than group A in modiolus, spiral osseous lamina and stapes (all p 0.05), however, the number of temporal bone lesions which involved in mastoid for group B3 images were significantly more than group A (p