Two Cases of Acute Mastoiditis with Subperiosteal Abscess
A 41 year old male visited the emergency department suffering from right otalgia for 1 month. The patient had no known medical history and complained of hearing impairment and otalgia on the right side. Physical examination showed injected bulging tympanic membrane associated with right postauricular swelling, redness and tenderness (). Further evaluation through pure tone audiometry revealed a mixed hearing loss on the right side with 60 dB air conduction level and 30 dB air-bone gap. Radiologic examinations of temporal bone CT and MRI showed soft tissue density filling the right middle ear and mastoid cavity with cortical bone erosion. Subperiosteal abscess was also detected over the cortical bone (). The patient was admitted and treated with I & D and antibiotics. Culture study that was processed during I & D revealed penicillin-sensitive Streptococcus pneumoniae. Even after 7 days of hospitalization, there were no signs of improvement. Thus, on the 8th day of hospitalization, right canal wall up mastoidectomy and tympanoplasty were performed. During the operation, granulation tissue in the mastoid cavity and middle ear cavity was detected and removed completely (). The patient was discharged after a week of surgery with significant improvement of previous symptoms and physical findings. No suspicious signs of recurrence were encountered during the 1 year follow up.