Two Cases of Acute Mastoiditis with Subperiosteal Abscess
A 2 year old female admitted to the emergency department due to 2 days of right postauricular area swelling. The patient was previously treated with antibiotics for a week at a local clinic for acute otitis media. Despite antibiotic treatment, the patient suffered from right otalgia and fever upon admission. Through physical examination, bulging of the tympanic membrane and erythematous change and swelling of the right postauricular area with tenderness were noticed. Further evaluation by temporal bone CT revealed soft tissue density filling the right middle ear and mastoid cavity with erosion of the cortical bone along with formation of subperiosteal abscess (). Under the impression of acute mastoiditis with subperiosteal abscess, percutaneous aspiration was performed on the postauricular area resulting in 3 cc of purulent fluid. The procedure was followed by incision and drainage (I & D) and oral antibiotics were prescribed to the patient. On third day after I & D, the patient showed persistent redness, tenderness, and swelling of the postauricular area () and injected bulging tympanic membrane, regardless of the treatment. Therefore, it was postulated that I & D and oral antibiotics were inadequate and the patient was admitted to our department for intravenous antibiotics therapy.\nOn the second day of hospitalization, the patient underwent surgical treatment of right simple mastoidectomy and ventilation tube insertion because of consistent symptoms and physical findings in spite of 2 days of intravenous antibiotic treatment. Intraoperative finding showed massive granuloma beneath the postauricular area and in the mastoid cavity (). Erosion of cortical bone was also noticed after Palva flap elevation. Intraoperative culture study resulted in Streptococcus pneumoniae which was only susceptible to vancomycin. Intravenous antibiotic treatment with vancomycin was immediately initiated and the child was discharged after 13 days of surgery without any postoperative complications. During the 5 month follow up, the patient showed no signs or symptoms of recurrence.