CONTEMPORARY PRESENTATION AND MANAGEMENT OF A SPECTRUM OF MASTOID ABSCESSES

Background: The incidence of complications resulting from suppurative otitis media has significantly decreased since the introduction of ant ibiotics. At the start of the 20th century 50% of all eases of otitis media developed a coalescent mastoiditis, By 1959, the incidence had f allen to 0.4%. Recent studies aug gest a cut-rent incidence of only 0. 24%. Additionally; during the time of Friedrich Bezold (1824-1908), 20 % of patients with mastoiditis developed subperiosteal abscess, Intere stingly, this has incidence increased; today nearly 50% of patients di agnosed with coalescent mastoiditis have subperiosteal abscess. Object ive: To review the contemporary presentation, diagnosis, and managemen t of a spectrum of mastoid abscesses. Design: Retrospective case serie s. Setting Hospitals associated with the Department of Otolaryngology/ Head and Neck Surgery at the University of California, Sail Francisco. Patients: Three patients with mastoid abscesses are reported. One pat ient displayed ''classic'' Bezold's abscess, with pus escaping the mas toid near the incisura digastrica and tracking along the digastric and sternocleidomastoid muscles into the neck. The second and third patie nts exhibited temporoparietal swelling secondary to mastoid abscess er oding the root of the zygomatic process, a complication noted by Bezol d in 1908 as occurring ''in only very rare cases,'' Results and Conclu sions: Since only one third of patients show pathologic tympanic membr ane changes, and since complaints of otalgia, fever, and tenderness ar e inconstant, subperiosteal mastoid abscess is frequently a delayed di agnosis. The clinical presentation, pathogenesis, and routes of absces s spread are presented with photographic and radiographic illustration , Medical and surgical management is reviewed, and methods for accurat e diagnosis are emphasized.