A Unique Case of Bezold???s Abscess Associated With Multiple Dural Sinus Thromboses (original) (raw)
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An Unusual Complication of Otitis Media: Luc's Abscess
The Journal of International Advanced Otology
Otitis media is one of the most frequently diagnosed and treated childhood diseases. Although it is often self-limited, there are important complications of the disease due to its proximity to the intracranial and intratemporal compartments. Subperiosteal abscesses are extracranial and extratemporal complications of otitis media, which are termed according to location. When the infection spreads deep to the sternocleidomastoid muscle, it is called Bezold's abscess, and when located in the digastric triangle, it is called Citelli's abscess. In the case of Luc's abscess, the infection is located beneath the temporal muscle [1]. Many clinicians have a little experience in the diagnosis and treatment of this disease due to its rare nature. Subperiosteal abscesses of otitic origin usually occur following the spread of infection to the subperiosteal area from the cortical bone destruction often secondary to acute mastoiditis. Luc's abscess is different from the other subperiosteal abscesses in that respect. It usually occurs not through the mastoid bone but by spreading of the middle ear infection through a pre-existing pathway in the external ear canal. Therefore, the disease may not be accompanied by acute mastoiditis [2]. A rare route of infection spreading to the temporal fossa is by the pneumatized zygomatic arch. Under this condition, subperiosteal abscesses may be observed along with acute mastoiditis [3]. Computed tomography (CT) of the temporal bone would give very useful information under such conditions. Here, we present a case of Luc's abscess with mastoid bone involvement associated with acute otitis media, following parental approval. CASE PRESENTATION An 11-year-old boy presented to the emergency department with complaints of painful swelling on the right half of the face, difficulty in opening his mouth, and high fever, which started a day before. He also presented with complaints of right ear pain and hearing loss for the past 2 days. There was no previous medical history of any ear disease or trauma. Physical examination revealed that the patient had trismus and that the swelling originating from the right temporal region extended toward the cheek and inferior palpebra. The tympanic membrane was not clearly evaluated due to severe edema in the right external ear canal, as observed on otoscopic examination. Laboratory analysis revealed leukocytosis (26.84 K/uL), neutrophilia (%87.5), and increased C-reactive protein (CRP: 21.74 mg/dL; normal<0.5). Pure tone audiogram revealed a moderate conductive-type hearing loss in the right ear. After obtaining these findings, the patient was scheduled for CT of the paranasal sinuses and temporal bone and cranial magnetic resonance imaging (MRI).
Presentation, treatment, and clinical course of otogenic lateral sinus thrombosis
Acta Oto-laryngologica, 2009
Conclusions. Otogenic lateral sinus thrombosis (OLST) is almost always associated with other complications of chronic otitis media (COM) and did not present a distinct clinical expression. In our experience, OLST exhibits a benign course if the underlying disease is controlled. Mastoidectomy in combination with broad-spectrum antibiotics provided effective treatment. Anticoagulation therapy is no longer used routinely. Recanalization is rare and is independent of the use of anticoagulants. Objectives. This study aimed to contribute to the understanding of the clinical aspects and evolution of OLST. Patients and methods. The study investigated a retrospective case series in a tertiary teaching hospital. From 1993 to 2007, eight cases of OLST were treated. The clinical and imaging data, treatments, and outcomes were analyzed. The follow-up period ranged from a minimum of 6 months to 5 years. Results. In all eight patients, the lateral sinus thrombosis was detected by imaging studies performed to evaluate complications and symptoms related to COM. Fever, headache, and cranial nerve paralysis were the main clinical manifestations associated with coexisting mastoiditis, meningitis, and cerebellar and epidural abscess. We could not identify features specific to lateral sinus thrombosis in any case. All patients underwent mastoidectomy and were given broad-spectrum antibiotics for 2 months. Four cases were anticoagulated and all eight cases experienced complete clinical recovery without sequelae.
Management of otogenic lateral sinus thrombosis
American Journal of Otolaryngology, 2004
Purpose: Lateral sinus thrombosis (LST) is a rare but potentially devastating complication of otitis media. We review the clinical presentation, evaluation, management, operative findings, and outcomes of this serious complication. Material and Methods: A retrospective chart review was performed at a teaching hospital of all patients diagnosed with an otogenic lateral sinus thrombosis between 1992 and 2002. Data on patients with otogenic LST were collected and analyzed. Results: Eleven patients were identified with a diagnosis of lateral sinus thrombosis, and all had a chronic otitis media. The most common presenting symptoms were headache, otalgia, and fever. Radiologic evaluation included computed tomography scan, magnetic resonance imaging, or magnetic resonance venography. All patients had radiographic evidence of LST preoperatively. The thrombosed sinus was on the right side in 6 patients and on the left side in 5 patients. The majority of patients (8 of 11) had a second concomitant intracranial complication. All patients underwent a mastoidectomy. The thrombus was removal in 7 cases, whereas only needle aspiration of the sinus was performed in 4 cases. Gram-negative bacilli and anaerobes were the most common organisms. There were no deaths but sequelae included VI nerve palsy, ataxia, and dead ear. Conclusion: LST as a complication of otogenic infections may still pose a serious threat that warrants immediate attention and care. It is frequently associated with other intracranial complications. Contrast-enhanced computed tomography scan and magnetic resonance imaging plays a major role in determining diagnosis and treatment plans. The availability of broad-spectrum antibiotics has improved our management significantly. Conservative surgical intervention including eradication of all perisinus infection and needle aspiration of the sinus seems to be effective. (Am J Otolaryngol 2004;25:329-333.
International Archives of Otorhinolaryngology
Introduction Otogenic lateral sinus thrombosis is a rare intracranial complication of otitis media in the modern age of antibiotic treatment, but it is potentially a dangerous complication. Objectives The aim of this study is to focus on the various clinical presentations, management options and sequelae in a series of fifteen patients with otogenic lateral sinus thrombosis. Methods Retrospective chart review of inpatients treated for otogenic lateral sinus thrombosis at our tertiary care institution between 2010 and 2015. Results A total of 15 patients (11 males and 4 females) with ages ranging from 9 to 60 years were diagnosed with otogenic lateral sinus thrombosis. The most commonly reported symptoms were headache, ear discharge and hard of hearing, which were experienced by all 15 (100%) patients. In contrast to previous studies found in the literature, 7 (47%) patients in our series presented with neck pain and neck abscess. Imaging studies and microbiological cultures were per...
A rare and serious complication of chronic otitis media: lateral sinus thrombosis
Auris Nasus Larynx, 2003
Before the antibiotic era, lateral sinus thrombosis (LST) was the most frequent complication of otitis media. With the widespread usage of antibiotics, its occurrence is rare. Nevertheless, it is still a major complication of middle ear disease. LST mortality fluctuates between 5 and 35%. The major clinical symptoms of patients with LST are pain in the mastoid region, spiking fever, anemia and general health disorders. Computed tomography, magnetic resonance imaging and angiography are the most helpful in diagnosis, but the final diagnosis is made by surgical exploration. Three cases with LST are presented, and signs, diagnosis and treatment of disease are discussed.
2000
Bezold's abscess is a deep cervical abscess arising from an acute case of mastoiditis. With the advent of antibiotics, this disease has become extremely uncommon in our region. This paper has the objective of reporting a case of Bezold's abscess in a patient seen at the otorhinolaryngology emergency service of Universidade Federal de São Paulo, and to carry out a review of literature on the topic. resUMo O abscesso de Bezold é um abscesso cervical profundo originado de uma mastoidite aguda. Com o advento dos antibióticos, essa afecção tornouse extremamente incomum em nosso meio. Este trabalho tem por objetivo relatar um caso de abscesso de Bezold em um paciente atendido no pronto-socorro de otorrinolaringologia da Universidade Federal de São Paulo, e realizar uma revisão da literatura sobre o tema.
Luc abscess: an extraordinary complication of acute otitis media
The American Journal of Emergency Medicine, 2016
Luc abscess is an uncommon suppurative complication of otitis media. Unfamiliarity of this complication leads to delayed diagnosis and treatment. This abscess is usually benign. Infection in the middle ear spreads via anatomic preexisting pathways, and this process results with subperiosteal pus collection. Conservative treatment with drainage under empirical wide spectrum antibiotic is efficient. Here, we present a 9-year-old boy who had left facial swelling after a period of otalgia, diagnosed as Luc abscess without mastoiditis.
Management of Lateral Sinus Thrombosis in Chronic Otitis Media
Otology & Neurotology, 2006
Objective: To present our experience with the diagnosis and treatment of lateral sinus thrombosis (LST) secondary to otogenic disease. Patients and Methods: We have retrospectively reviewed all the cases of LST caused by chronic otitis media in ten years. Results: In our series of five patients, four patients were succesfully treated by surgery without opening the sigmoid sinus. On the other hand, one of our patients developed hy-drocephalus and ataxia during preoperative antibiotic treatment. Conclusion: Most patients with thrombotic/nonabscessed sinuses will have successful outcomes with this approach, but careful observation is needed, given the possibility of advancing disease.