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Multiple myeloma (MM) is usually a disease of the elderly and only less than 1% are young individuals below 35 years of age. Central nervous system (CNS) manifestations of MM are even rarer, the most common being leptomeningeal involvement. We report a case of a 35-year-old male who presented with a fever of 3 weeks duration associated with slurring of speech, nasal regurgitation, hearing loss, and decreased urine output. CNS examination showed IX, X, and XII cranial nerve palsies with right otitis media and bilateral mastoiditis with conductive hearing loss. Renal biopsy showed cast nephropathy. The kappa--lambda ratio was 18, with β2 microglobulin measuring 12 mg/L. Bone marrow showed 90% plasma cells, and skeletal survey had bony lytic lesions. He responded well to dexamethasone, bortezomib, and thalidomide. His renal functions returned to normal, and palsies have improved completely. This report shows that MM should be suspected even in young patients with classical features of myeloma and CNS involvement is very rare in MM. [ABSTRACT FROM AUTHOR]

Objective: Acute mastoiditis, the most common complication of acute otitis media, is approached in our study, focused on children from the Autonomous Community of Cantabria, Spain. The aim is to analyze its clinical-epidemiological characteristics and propose diagnostic and treatment recommendations., Study Design/setting: We conducted a 30-year retrospective study on patients under 18 years of age diagnosed with acute mastoiditis in Cantabria., Methods: We analysed epidemiological data, clinical presentation, causes, treatment, and follow-up., Results: We included 111 patients, 60.4 % of which were under 2 years old. The average incidence was 3.9/100,000 children per year. Streptococcus pneumoniae was the most common microorganism. Third-generation cephalosporins and amoxicillin-clavulanic acid were the most frequently used antibiotics. 19 % of patients underwent temporal bone CT scans. Twenty-nine children required surgical intervention, primarily myringotomy and mastoidectomy. Only 5.4 % developed retroauricular abscesses. During follow-up, 32 % experienced new acute otitis media cases., Conclusions: The incidence of acute mastoiditis in Cantabria is similar to that of other developed countries. Imaging studies are reserved for cases with poor progression. Conservative management with antibiotics is suitable for many patients, with surgery reserved for poor responders. Complications are rare in our setting., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Introduction and Importance: Acute internal carotid artery (ICA) thrombosis is a rare complication of mastoiditis, which can spread to intracranial vessels, leading to thrombosis and infarction., Case Presentation: An 83-year-old man presented to the neurologist with progressive left-sided ear swelling and peripheral facial palsy lasting several weeks. Intravenous antibiotic was prescribed for chronic mastoiditis. Sudden consciousness disturbance and right hemiplegia occurred during treatment. Brain magnetic resonance imaging revealed acute ICA occlusion with hemispheric cerebral infarction. Surgical intervention for complicated mastoiditis was planned after the acute phase of the cerebral infarction. However, the patient's condition deteriorated due to sepsis, ultimately leading to death., Clinical Discussion: Mastoiditis may lead to skull base osteomyelitis, which can directly involve the ICA and cause acute thrombosis. In complicated mastoiditis, early surgical intervention may prevent severe complications., Conclusion: This case highlights mastoiditis as a potential precursor to ICA territory infarction, and delayed aggressive management can result in severe complications., Competing Interests: Conflict of interest statement The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: An increasing number of pediatric patients with mastoiditis and a consequent increase in mastoidectomy rates was noted in 2022 and 2023., Objective: This study aimed to analyze the increase in the number of children presenting with mastoiditis and subsequent mastoidectomy, to assess correlations with prior antibiotic treatment or COVID-19 infection, and to provide an overview of involved pathogens, treatment, and disease course., Materials and Methods: A retrospective analysis of all patients with mastoidectomy since 2012 was conducted. Data collected comprised type and duration symptoms, prior antibiotic therapy, diagnostic tests and disease course, causal pathogens, length of hospitalization, and complications., Results: A highly significant increase in mastoidectomies in children could be demonstrated from 2022. Neither the pathogens involved nor the course of disease or complications showed differences. An increase in the number of patients with prior outpatient antibiotic therapy could be shown. About a half of the patients becoming ill after fall 2022 had a positive history of COVID. Hyperplasia of adenoid tissue was a far less frequent causal mechanism than in the years before COVID., Conclusion: No clear correlation with reduced outpatient antibiotic therapy could be found. Whether there exists an association with prior COVID infection cannot be judged at this time, due to the high number of asymptomatic and therefore unknown COVID infections., (© 2024. The Author(s).)

Abstract Background Trichosporon asahii is an opportunistic fungus that causes infections in immunosuppressed patients. It is rarely seen in children and immunocompetent hosts. The mortality rates are still high despite early treatment with proper antifungal drugs. Trichosporon asahii mastoiditis in an immunocompetent child makes this case challenging. Case presentation This report presents a case of Trichosporon asahii mastoiditis which was complicated by transverse sinus thrombosis, in an otherwise healthy 21-month-old girl, and successfully treated with voriconazole. Trichosporon asahii was isolated, in three different occasions, from ear discharge of an immunocompetent healthy child, who presented with prolonged history of fever and received appropriate dosages of multiple types of antimicrobials as an outpatient but without improvement. After 48 h of starting the Voriconzole; post auricular swelling and ear discharge improved significantly. Conclusion A high index of clinical and microbiological suspicion is needed for optimal diagnosis of Trichosporon infection. Trichosporon asahii can also cause infection in immunocompetent individual even without previous history of hospitalization or intervention. We emphasize the importance of early pediatric infectious evaluation and intervention.

The article describes a clinical case of acute otitis media in an 8-year-old child complicated by mastoiditis, antibodies to SARS-CoV-2 and IgG coronovirus were detected in the child's blood. The data available today indicate that children make up up to 10% in the structure of infected SARS-CoV-2 and up to 2% in the structure of patients with diagnosed clinical cases of COVID-19. In the Russian Federation, children account for 6-7% of the registered cases of COVID-19. At the beginning of the pandemic, it was revealed that children have a lighter course of the disease and complications and unfavorable outcomes are much less common. However, in the following months, clinicians began to note a multiple increase in the frequency of hospitalization of children for COVID-19. The described case shows the rapid development of acute mastoiditis with the destruction of the outer plate of the temporal bone in a child, as a complication of acute otitis media, after a new coronavirus infection. The article presents information on the relevance of epidemiology, clinical picture, diagnosis and treatment of acute otitis media complicated by mastoiditis in children. It should be emphasized that in order to achieve the most effective tactics of introducing patients, close cooperation of doctors of narrow specialties with pediatricians is necessary, mass testing of the child population, further research to obtain reliable data on the impact of a new coronavirus infection on the child's body. Currently, there is insufficient data in the available literature on the effect of COVID-19 on ENT organs in children. In this regard, further studies on ENT diseases in this category of patients are needed on the background of or after a COVID-19 infection.

We present the case of a 13-year-old boy who unexpectedly needed to be resuscitated at home after an assumed uncomplicated otitis media. Imaging at our clinic showed mastoiditis and a cystoid mass in the left cerebellopontine angle compressing the brainstem, as well as an Arnold-Chiari-Malformation. Both the laboratory examination of cerebrospinal fluid (CSF) and surgical biopsy with pathological evaluation of the mastoid supported the inflammatory etiology of the mass. Microbiologically, Streptococcus intermedius was detected in the blood culture and CSF. Due to brain death, which most likely already existed preclinically, the organs were released for donation during the course. Our case demonstrates a very rare lethal complication of acute otitis media on the basis of a cerebral malformation and emphasizes the need to stay alert when patients complain of symptoms after assumed resolution.

Introduction: The purpose of this study was to investigate the relationship between the pneumatization of mastoid air cells (MACs) and isolated unilateral concha bullosa (CB) using computed tomography (CT) scans of the paranasal sinuses (PNS). Material and Methods: A retrospective review of PNS CT scans from 53 patients was performed. Cases with nasal septum angulation >5° were excluded from the study. CT evaluations were made with a 128-slice multislice CT scanner in two projections, axial and coronal. Slice thickness was taken as 1 mm for volumetric analysis. Volume measurements were calculated using the syngo.via software program by selecting the relevant anatomical region and using step-by-step addition and expansion processes. Volumes of the MACs (right and left) and isolated unilateral CB (right and left) were obtained and compared using statistical analysis. Results: The volume of MACs and isolated unilateral CB did not change with age; however, the volumes of male participants were larger than that of women. It was observed that the pneumatization of MACs on the side with isolated unilateral CB was significantly greater than for opposing MACs. Discussion and Conclusion: In our study, it was concluded that the isolated unilateral CB caused a significant increase in the MACs volume on the same side of CB. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical data,imaging,diagnosis,treatment and prognosis of venous sinus thrombosis with brain abscess secondary to mastoiditis in children. Methods The clinical data of a child with venous sinus thrombosis secondary to mastoiditis and brain abscess were analyzed retrospectively, and the relevant literature were reviewed. Results The patient was a 12-year-old boy with fever, headache, vomiting and weakness of the left limb. Multiple brain abscesses with venous sinus thrombosis caused by mastoiditis were considered.Drainage of subdural abscess was performed through right frontal burr hole. The microbial culture of pus after operation suggested Staphylococcus aureus. It improved after more than 3 weeks of treatment with vancomycin +meropenem + metronidazole, and it recovered well after 2 months of anti infection treatment with linezolid.Conclusions Infective venous sinus thrombosis is very rare, and more in children than in adults. Nearly half of them have recent infection. Diagnosis and treatment should be judged in combination with medical history, imaging characteristics and microbiological test. Surgery and active anti infection treatment can be considered. [ABSTRACT FROM AUTHOR]

Mucormycosis is a dreaded clinical entity caused by filamentous fungi of the order Mucorales mainly affecting immunocompromised individuals. Usually seen involving paranasal sinuses, orbit, lungs and gastrointestinal system, it is extremely rare in other areas. Herein we report a rare presentation of Mucormycosis affecting the ear and neck where early detection, timely intervention, multidisciplinary involvement and judicious use of local antibiotics apart from the mainstay treatment regimen like surgical debridement and intravenous Amphotericin B has saved the patient and given him a reasonably good quality of life devoid of morbidity. [ABSTRACT FROM AUTHOR]

Objective: Hypertrophic pachymeningitis (HP) is a rare disorder that causes localized or diffuse inflammatory fibrosis and thickening of the dura mater. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)-related HP is the most frequent form of HP. Otitis media with AAV (OMAAV) patients with HP are associated with higher rates of both ANCA-negative phenotypes and disease-related mortality. However, few studies have reported the imaging characteristics of HP due to AAV/OMAAV. Therefore, we investigated this issue in the present study.Methods: This retrospective study included patients diagnosed with HP between 2011 and 2020 at our hospital. Age, sex, causative disease, serum C-reactive protein (CRP) level, and MRI data were collected from medical records. We compared the locations of MRI enhancement depending on the causative diseases.Results: Of the 18 included patients with HP (mean age, 64.1 ± 2.6 years; range, 33-77 years), 10 (55.6%) were female, 12 (66.7%) were diagnosed with AAV/OMAAV, four (22.2%) were diagnosed as idiopathic, two (11.1%) were diagnosed with invasive Aspergillus mastoiditis. Eleven (61.1%) had cranial neuropathies. Facial nerve paralysis was common in AAV/OMAAV, while abducent nerve paralysis was common in idiopathic HP. Cranial fossa enhancement was most common presentation in patients with HP, whereas inner acoustic canal (IAC) enhancement was seen only in patients with AAV/OMAAV, while HP involving the cavernous sinus was seen only in patients with idiopathic and mastoiditis.Conclusion: HP involving the IAC may be a key factor in diagnosing AAV/OMAAV. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to present a series of 6 patients with facial nerve palsy and masked mastoiditis which constituted as revelators of localized granulomatosis with polyangiitis (GPA) and to evaluate the utility of the ACR/EULAR 2017 provisional classification criteria for GPA in such cases. Methods: Study group included 58 patients with GPA. Cases with facial nerve palsy and masked mastoiditis were thoroughly analyzed. Results: The mean age of patients was 37 years. All manifested unilateral facial nerve palsy and hearing loss, while only 2 reported aural complaints suggesting inflammatory cause of the disease. All cases were qualified for surgical intervention. Intraoperative findings were similar: granulation tissue in tympanic cavity and/or pneumatic spaces of the mastoid process. Only 50% of histopathological results suggested vasculitis. In all cases, elevated levels of antineutrophil cytoplasmic antibodies (ANCA) against peroxidase 3 (PR3-ANCA) were determined. Two patients presented rapid progression of the disease and died within 1 week and 2 months, respectively. Four other patients manifested gradual improvement of hearing and facial nerve function after treatment. Conclusion: GPA should be included into differential diagnosis in all cases of persistent facial nerve palsy especially when otological symptoms coexist. Even localized GPA could be very aggressive, revelating generalized form of the disease. Rapid systemic treatment of GPA can protect hearing and facial nerve from permanent severe dysfunction. The ACR/EULAR 2017 provisional classification criteria for GPA seem to be valuable tool in diagnosing ENT patients with localized otological form of the disease. [ABSTRACT FROM AUTHOR]

Background: IgG4-related disease (IgG4-RD) is an inflammatory process. The literature on IgG4-RD is rather limited, with mastoid involvement being uncommon. In such cases, presentation may mimic other middle ear and mastoid cavity pathologies. Objective: To summarize findings of patients with IgG4-RD involving the mastoid. Methods: Description of two new cases and summary of findings with previous reports. Results: Nineteen cases of IgG4-RD with mastoid bone involvement were reported in the literature, the earliest appearing at the beginning of the previous decade. Most frequent symptoms included hearing deterioration, tinnitus and otalgia. In 58% of the cases, the process was restricted to otologic manifestations. In 7 out of 19 cases, tissue IgG4 levels were elevated. In all histopathologic samples taken from the operative sites, a dense lymphoplasmacytic cell infiltration was observed. Following definitive pathological diagnosis, the most common treatment was corticosteroids. Generally, the time from onset to final diagnosis was usually more than six months. The treatment is corticosteroids, followed by immunosuppressive agents such as rituximab, cyclophosphamide, and methotrexate. Conclusions: IgG4-RD involving the mastoid is a challenging condition, both in diagnosis and treatment. Hence, IgG4-RD should be included in the differential diagnosis of middle ear pathologies and include a multi-disciplinary team for treatment. [ABSTRACT FROM AUTHOR]

Purpose: To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) following surgical treatment. Methods: A retrospective chart review of children diagnosed with CAM who underwent mastoid surgery during 2012–2019 in a tertiary care university hospital. 33 patients, divided into 2 groups: 17 patients with sub-periosteal abscess (SPA) alone–single complication group (SCG) and 16 patients with SPA and additional complications: sigmoid sinus thrombosis (SST), peri-sinus fluid/abscess, epidural/subdural abscess, and acute meningitis-multiple complications group (MCG). Results: 33 patients belong to the SCG 17(51%) and 16(49%) belonged to the MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P = 0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P = 0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings; a total of 18 positive cultures were reported. Fusobacterium necrophorum counted for 8/18(44.5%) of all positive cultures, 7/9(77.8%) in the MCG vs. 1/9(11.1%) in the SCG, P = 0.004. Streptococcus pneumoniae was reported only in SCG (5/9, 55.5%, vs. 0/9, P = 0.008). Conclusion: Post-mastoidectomy fever due to CAM is not unusual and seems to be a benign condition for the first 5–6 days, following surgery. MCG patients are more prone to develop POF. F. necrophorum is more likely to be associated with MCG, and S. pneumoniae is common in SCG patients. [ABSTRACT FROM AUTHOR]

The aim of this report is to document a very rare case of Blastomycosis dermatitidis mastoiditis with extension into the retromastoid soft tissue and surrounding muscle. Blastomycosis dermatitidis is a dimorphic fungus of endemic areas which classically infiltrates the lungs; however, dissemination presenting as otomastoiditis is exceedingly rare. The patient was an immunocompetent 27-year-old male with no significant preexisting health conditions. He had significant work exposure to dust and soil and was referred to our department for evaluation of otalgia with headaches, hearing loss, and intermittent facial paralysis. Initially, the extent of the infection was unknown. Based on extensive disease on magnetic resonance imaging, the patient was scheduled for urgent tympanoplasty and mastoidectomy. Postoperative treatment with itraconazole resolved any further manifestations and halted further soft tissue invasion. It is important to consider uncommon fungal infections in the workup of persistent otalgia, especially when presenting with facial paralysis and a history of environmental exposure to soil and dust. This type of infection should be considered regardless of immunodeficiency status. Early detection may prevent hearing loss and local invasion into surrounding structures. [ABSTRACT FROM AUTHOR]

This case illustrates the rare cause of failure to thrive (FTT) that initially presented with recurrent ear discharge. A five-year-old boy with a history of recurrent ear infections for the past year was treated for acute symptoms during each visit. He later was diagnosed with acute mastoiditis secondary to otitis media by a private otorhinolaryngologist and was referred to a tertiary hospital for admission and parenteral antibiotic commencement. The anthropometric evaluation noted he fell under the group of FTT and had an incidental finding of lower tract respiratory infection that turned out to be tuberculosis infection. Multiple complications occurred during his admission, including candidemia, disseminated tuberculosis, and deep-seated collections. Hence, he was worked up for primary immunodeficiency and was given extensive supportive treatment. [ABSTRACT FROM AUTHOR]

Septic arthritis of the temporomandibular joint as a complication of acute otitis media is rare in the Western world. This report describes the case of a 7-year-old boy who had pain in his right ear and limited mouth opening, following the onset of acute otitis media. A contrast-enhanced computed tomography scan revealed right-sided mastoiditis and hydrops of the right temporomandibular joint, suggesting septic arthritis. Real-time PCR and microbiologic analysis identified Streptococcus pyogenes and Staphylococcus epidermidis in the joint aspirate. Treatment with arthrocentesis and antibiotics led to full recovery of temporomandibular joint function. [ABSTRACT FROM AUTHOR]

La otitis media es una infección frecuente en la infancia, la cual puede producir complicaciones, incluidas las neurológicas graves, en cuatro de cada 100 niños en países en desarrollo. Se presenta el caso de una niña de nueve años sin antecedentes de enfermedad que consultó por otitis media derecha, otorrea, síndrome de hipertensión intracraneal y parálisis del VI nervio craneal contralateral a la lesión. La tomografía computarizada de cráneo y la resonancia magnética cerebral revelaron otomastoiditis crónica, apicitis petrosa, y rombosis de los senos transverso y sigmoide, el bulbo yugular y la vena yugular interna derecha. Recibió tratamiento antibiótico y quirúrgico. Este caso refleja el espectro de complicaciones intracraneales y extracraneales asociadas con la otitis media aguda en la era antibiótica. El examen físico permite la detección precoz de la hipertensión intracraneal, con signos como el papiledema y la parálisis del VI par contralateral como hallazgo inusual.

Abstract Background Otomastoiditis is a very frequent affection and a current complication of mal-treated benign ear infections in children. However, this a very rare case of the association of two rare complications of otomastoiditis in a newborn. On the one hand, septic arthritis of the temporomandibular joint which is a very rare condition that is difficult to diagnose, and when unrecognized or not treated accordingly, it can resolve in serious infectious complication and or definitive injury to the temporomandibular joint. On the other hand, osteomyelitis of the clavicle is also very rare, and only a few cases have been cited in the literature concerning infants. Case presentation This 46-day-old infant was brought to pediatric emergency consultation for 2 swelling inflammatory bulges, one in the right mastoid and pre-auricular regions, and another in the right basi-cervical area. The infant was hypertrophic febrile, hypotonic, and pale. He had preserved archaic reflexes. Besides, blood test showed an inflammatory syndrome, inflammatory anemia, and no other abnormalities. Upon supplementary computed tomodensitometry exam, the diagnosis of a combination of septic arthritis of the right temporomandibular joint and sub-periosteal abscess of the ipsilateral clavicle in a context of hypotrophy and malnutrition was suspected. A pus sample was obtained for bacteriological evaluation, after which the infant had a course of intravenous associated antibiotics, along with nutritional assessment and management. Surgical drainage of both collections was performed. The 6-month follow-up was satisfactory, without clinical signs of functional impact on temporomandibular joint, or acromioclavicular joint. Conclusion This work stresses the necessity of thorough clinical examination of infants even in cases of benign ear infections, as well as the importance of adapted treatment and follow-up, which could allow early diagnosis, appropriate treatment, or even prevention of severe complications that can be associated with such benign conditions.

Paediatric ureteric calculi are an uncommon conditions encountered occasionally by adult urologists. Endoscopic treatment is the mainstay treatment of such cases. Nevertheless, a significant percentage of children with ureteric calculi present with other comorbidities which is usually overlooked by urologists. In this article, we describe a rare case of paediatric ureteric calculi associated with deep venous sinuses thrombosis of the brain evaluated through a multidisciplinary approach that led to the final diagnosis of Behçet's disease which is also a rare condition in paediatrics. The complexity of the case in view of the rarity of both diseases encouraged us to report it. We present an eight-year-old male referred to a tertiary centre as a case of mastoiditis, complaining of severe headache, diplopia, and high-grade fever. Magnetic resonance venography "MRV" with intravenous "IV" contrast showed left transverse sigmoid and internal jugular dural venous sinus thrombosis but no evidence of mastoiditis. Computed tomography "CT" scan of the abdomen and pelvis showed a large left distal ureteric stones up to 4 cm collectively associated with hydronephrosis in addition to a few stones in the left kidney. He was managed by different teams such as urology, otorhinolaryngology, neurology, and ophthalmology to sort out his mysterious presentation over a lengthy hospital admission. Upon further evaluation and multi-disciplinary approach, a diagnosis of Behçet's disease has been made. Paediatric ureteric calculi are an uncommon problems and frequently presented with other comorbidities. Multi-disciplinary team approach to such cases is recommended and may uncover a serious underlying disease or concomitant comorbidities. [ABSTRACT FROM AUTHOR]

Objective: To predict risks for complications and determine the type of operation, several studies developed the grading system based on clinical assessment. However, there is no evidence regarding the score for tomographic opacification and bone erosion of temporal bone on computed tomography (CT) scan. Therefore, the aim of this study was primarily to design a new computerized tomography staging system for the evaluation of chronic otitis media (COM) and mastoiditis. Materials and Methods: Between August 1, 2020, and December 30, 2021, 40 patients with the clinical diagnosis of COM (males and females) have received temporal bone CT scans at medical institutions. The patients were retrospectively evaluated and verified the correlation of the score of CT imaging in preoperative evaluation with the clinical picture and surgical planning. Descriptive statistics, one-way ANOVA analysis, and Spearman's correlation test were employed to evaluate the accumulated data. The P values were calculated for all tests and its outcome <0.05 was considered statistically significant. Results: There are significant correlations between the total score and the size of perforation, the type of surgical intervention, and low-frequency air-bone gap (ABG) (P < 0.05) while no correlation between the total score and high-frequency ABG was revealed. Conclusion: The abnormal landmarks of the temporal bone are presented, and scored systematically and there is an excellent way to analyze and make a decision not only in diagnosis but also in the choice of surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: Acute mastoiditis (AM) is the most common complication associated with acute otitis media and plays a key role in the development of further complications. We identify the clinical characteristics, management, and outcome of patients with AM and to investigate the relationship between the development of recurrence and the treatment protocol of the first episode. Methods: Children hospitalized in our clinic due to a diagnosis of AM were retrospectively reviewed. Demographic data, disease-related symptoms, types of complications accompanied by AM, medical/surgical treatment modalities, culture results, laboratory findings, and presence of recurrence were screened. Laboratory findings were compared between those with and without accompanying complications, and between those with and without accompanying intracranial complications. Results: Of the 58 patients with AM, 24 (41.3%) had isolated AM. Complications associated with AM include subperiosteal abscess (61.7%), sigmoid sinus thrombosis (11.7%), facial paralysis (8.8%), petrositis with subperiosteal abscess (5.8%), meningitis (5.8%), facial paralysis with subperiosteal abscess (2.9%) and, epidural abscess with sigmoid sinus thrombosis (2.9%). Seven patients developed intracranial complications (12%), of whom one had more than one complication. Hemoglobin and hematocrit levels were found to be significantly lower in the presence of accompanying complications (p values, respectively p=0.000, p=0.000). C-reactive protein (CRP) levels were found to be significantly higher in the presence of intracranial complications (p=0.028). Recurrent AM developed in 9 patients (15.5%) during follow-up. There was no statistically significant relationship between the treatment protocol of the first episode and the development of recurrence (p=0.332). Conclusion: A conservative approach may be preferred for surgical treatment in patients without accompanying intratemporal or intracranial complications. Low hemoglobin and hematocrit levels, with the symptoms and imaging of the patients, may be a warning of the development of accompanying complications, and high CRP values may be a warning of accompanying intracranial complications. [ABSTRACT FROM AUTHOR]

Abstract Background Extramedullary involvement of leukemia usually occurs in the skin and central nervous system. Isolated leukemic involvement of the temporal bone is a very uncommon situation, and it is seen frequently concomitant to hematologic or molecular relapse. Case presentation An 8-year-old male with acute myeloid leukemia (AML) M2 with t (8,21) (FAB classification) in remission for 2 years was referred to our clinic with severe ear pain, persistent ear discharge, and hearing loss with left facial paralysis for 4 days. Physical examination revealed purulent ear discharge with severe edema of the left ear canal. The temporal computed tomography revealed otomastoiditis. However, temporal magnetic resonance imaging demonstrated a 9 × 6 × 5 mm contrast-enhancing lesion in the internal acoustic canal and thickening in VIIth and VIIIth cranial nerves. Mastoidectomy was performed for exploration and biopsy. The histopathological results of the mastoid bone and soft tissue samples revealed a relapse of AML. One month after the first chemotherapy regime, ear discharge stopped and facial palsy recovered totally. However, the patient died 9 months after the diagnosis of relapse. Conclusion Temporal bone relapse should be suspected in AML patients with symptoms of otomastoiditis and facial palsy. Further investigations including radiological examinations, surgery, and biopsy for avoiding misdiagnosis and delay in treatment are needed.

Otitis media is an inflammation of mucoperiosteal layer of the middle ear cleft which occurs mostly due to eustachian tube dysfunction superadded with an infective aetiology. It is said that younger children are more commonly affected due to the anatomical difference of eustachian tube in children from an adult, but adults are affected as well. Usually acute otitis media may settle following a course of antibiotics, however, it can lead to persistence of infection or becoming chronic and may lead to severe intra and extracranial complications. This report is of a 16-year-old male who presented with a painful swelling in right postauricular region for two weeks duration. The right ear had a diffuse swelling of size 6×1×5 cm in the postauricular region, tender on palpation, firm in consistency, and was fluctuant. Otoscopic examination of the right ear showed bulge out and intact tympanic membrane without active discharge and congestion. High Resolution Computed Tomography (HRCT) of temporal bone showed right otomastoiditis with erosion of the lateral cortex of the right mastoid. He underwent right cortical mastoidectomy under general anaesthesia. The patient was on follow-up for six months and no recurrence was noted.

Primary tuberculous otomastoiditis is a rare condition. Mastoiditis is an infection of the mastoid part of the temporal bone that often happens as a complication of otitis media. The spread of infection from the middle ear and mastoid to adjacent structures might result in rare but serious complications. We present a case of an 8-year-old female with recurrent episodes of acute otitis media and foul-smelling yellowish discharge with hearing loss. Imaging revealed multiple abscesses. Intraoperatively, samples were taken from the abscesses and sent for complete analysis revealing a tuberculous infection. A diagnosis of primary Mycobacterium tuberculosis (MTB) otomastoiditis was made using MTB polymerase chain reaction from the Bezold's abscess. The patient was started on anti-MTB therapy. Follow-up imaging showed resolution of abscesses and otomastoiditis. An indolent course of otitis media along with poor response to conventional antibiotics regimen should raise the suspicion of rare and unusual infectious etiologies. [ABSTRACT FROM AUTHOR]

Paragangliomas (PGs) are rare, benign neuroendocrine tumors that originate from neuroectodermal tissues. PGs arising from the ear canal are extremely rare, with only a few cases reported to date. The common symptoms of ear canal PGs include ear discharge, ear fullness, and hearing loss. This article describes unusual manifestations of ear canal PGs otitis media with Bezold and Luc’s abscesses, in an immunocompromised young adult. The pathogenesis of the disease is described. In addition, determining the origin of PG in this case was not straightforward compared to previously reported ear canal PGs. The derivation of the diagnosis is further discussed. [ABSTRACT FROM AUTHOR]

We describe the use of calcium sulfate beads as antibiotic carrier in a patient, who suffered from chronic mastoiditis with consecutive otogenic meningitis due to Burkholderia cenocepacia. Our findings suggest a possible role of calcium sulfate matrix as a local antibiotic carrier in the mastoid in complicated mastoiditis cases. [ABSTRACT FROM AUTHOR]

Purpose: Cerebral sinus vein thrombosis (CSVT) associated with acute mastoiditis is a rare complication of acute otitis media. Elevated intracranial pressure (ICP) frequently occurs secondary to CSVT. The study aims to review the 5 years of experience of four medical centres to treat sigmoid sinus thrombosis and elevated intracranial pressure in children. Methods: Patients with CSVT that developed secondary mastoiditis from 2016 through 2021 were evaluated in four centres from Turkey. Patients diagnosed with a preceding or synchronous mastoiditis and intracranial sinus thrombosis were included in the study. Magnetic resonance imaging (MRI), magnetic resonance venography (MRV), ICP measurements, ophthalmological examinations, thrombophilia studies and treatments for increased ICP have also been recorded. Results: The study group comprises 18 children. Twelve patients were diagnosed with right-sided, six patients with left-sided sinus vein thrombosis. All of the patients had ipsilateral mastoiditis. The most common presenting symptoms were fever, ear pain, headache, visual disorders and vomiting. The most encountered neurologic findings were papilledema, strabismus and sixth cranial nerve palsy. ICP was over 20 cm H2O in eleven patients. Anticoagulant treatment, antibiotics, pressure-lowering lumbar puncture and lumboperitoneal shunt were among the treatment modalities. Conclusion: Elevated ICP can damage the brain and optic nerve irreversibly, without treatment. For treating elevation of ICP associated with cerebral sinus thrombosis, pressure-lowering lumbar puncture (LP), acetazolamide therapy, optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF)-shunting procedures are suggested in case of deteriorated vision. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) of the middle ear cleft (MEC) is a rare extra-pulmonary manifestation. Signs and symptoms of tuberculous otitis media are indistinguishable from that of non-tuberculous otitis media making early diagnosis difficult. Objectives: To study the clinical presentations, complications and effective diagnostic modalities in tuberculosis of middle ear cleft. Methods: We retrospectively studied 10 patients diagnosed with chronic otitis media, unresponsive to 2 months conventional treatment. Pure tone audiogram, High resolution computed tomography (HRCT) of temporal bone, and AFB staining of ear discharge were done. All patients underwent mastoid surgery. AFB staining and histopathological examination of granulation tissue removed from the middle ear and mastoid were also done. Results: Clinical findings were mastoid swelling, facial palsy and post-aural fistula 3,4 & 2 patients respectively. All patients had persistent ear discharge and three had vertigo. Hearing loss was of moderate conductive type in five, sensorineural type in three and mixed type in two. HRCT of temporal bone revealed soft tissue density in MEC in 9 and evidence of bone destruction in 6 cases. Diagnosis of TB was confirmed either by (a) demonstration of AFB in ear discharge (4 patients)/tissue removed during surgery (4 patients) or (b) by demonstration of tuberculous granulomas with necrosis on histopathological examination of tissue from MEC (8 patients). Conclusion: Tuberculosis should be suspected in all cases of chronic otitis media unresponsive to conventional treatment particularly in endemic areas. Histopathological examination and AFB staining of tissue removed during mastoid surgery are reliable diagnostic methods.

Abstract Background The anterior epitympanic plate (cog) and Köerner’s septum are gaining more importance since the introduction of transcanal mastoidectomy as these anatomical structures are serving landmarks for the attic. Moreover, different morphological types of cog and Köerner’s septum revealed embryological relation to the development of the isthmic membrane; the latter is linked to aeration of the attic and thus affects the pathological development of the cholesteatoma. Results A retrospective review of CT images of 86 patients proved by surgical biopsies revealed: 49 cholesteatomas and 37 non-cholesteatomatous CSOM. The type-I “cog” had a higher incidence (n = 40) and was statistically more prevalent in non-cholesteatomatous CSOM (n = 30, 81.1%). Type-II was the second commonest and was statistically more prevalent in cholesteatomatous CSOM (n = 22, 44.9%). Type-III was the third commonest, seen in (n = 18, 20.9%) and was statistically more prevalent in cholesteatomatous CSOM (n = 17, 34.7%). Köerner’s septum was more prevalent in non-cholesteatomatous CSOM (70.3%) with statistical significance (p value = 0.002). Conclusions The difference in the distribution of different morphological types of anterior epitympanic plate “cog,” as well as the difference in Köerner’s septum existence amongst cholesteatomatous and non-cholesteatomatous CSOM are suggested as risk factors for the development of cholesteatoma and may predict a cholesteatoma on CT images.

We report an extremely low-birth-weight neonate with new onset unilateral facial palsy on ninth day of life. The child had neonatal sepsis, meningitis was ruled out and ear discharge was noted from the ipsilateral ear. Otoscopy suggested acute suppurative otitis media, while magnetic resonance imaging was suggestive of mastoiditis. The facial weakness improved with physiotherapy over next two weeks.

Abstract We describe the use of calcium sulfate beads as antibiotic carrier in a patient, who suffered from chronic mastoiditis with consecutive otogenic meningitis due to Burkholderia cenocepacia. Our findings suggest a possible role of calcium sulfate matrix as a local antibiotic carrier in the mastoid in complicated mastoiditis cases.

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)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest. Outside of this study, R. Saarinen is employed by Bayer Pharmaceuticals., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Although Luc's abscess represents a rare complication of otitis media, it is an important complication to be considered by clinicians, by which infection spreads from the middle ear and can result in subperiosteal collection beneath the temporal muscle. Because of its rare occurrence, the diagnosis and treatment might be delayed. Here, we report the case of a 48-year-old female with Luc's abscess with the involvement of the mastoid bone and discuss its clinical presentation and successful management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Syed Afandi et al.)

A report book unearthed in our archives contained 352 operative reports from the otorhinolaryngology department of the Armand-Trousseau Children's Hospital in Paris, dated from January 1912 to August 1920. These documents provide a snapshot of surgical activity in this field at the time. Mastoidectomy for mastoiditis was by far the most common procedure. This incomplete but original snapshot bears witness to the habits and working conditions of our predecessors, as well as to the progress made in just over a century., (Copyright © 2024. Published by Elsevier Masson SAS.)

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., Competing Interests: Author’s NoteThis article was presented at the American Society of Pediatric Otolaryngology Spring Meeting, Boston, MA, May 5 to 7, 2023. There are no conflicts of interest to report. Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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., (© 2024. The Author(s).)

Although the cavernous sinus and internal carotid artery are in close proximity to the sphenoid sinus, vascular complications in sphenoid sinusitis are rare due to the intervening mucosa and bone. Variations like dehiscence or aggressive infection can cause vascular complications, leading to cavernous sinus thrombosis, while perivascular inflammation of the internal carotid artery can result in stenosis or occlusion. Untreated or aggressive sphenoid sinusitis can cause neurological complications such as cerebral infarcts, meningitis, subdural empyema, cerebral abscess, and cranial nerve injuries. Magnetic resonance imaging (MRI) of the brain with angiography can depict these complications at an early stage. Additionally, mastoiditis can cause dural venous sinus thrombosis, which, if left untreated, can result in venous infarcts. We report a case of an 11-year-old male with sphenoid sinusitis who developed a left middle cerebral artery (MCA) territory infarct, cavernous sinus thrombophlebitis, subdural empyema, and meningitis. He also developed left transverse and sigmoid sinus thrombosis due to left mastoiditis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khaladkar et al.)

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.

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., (© 2024. The Author(s).)