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Indian Journal of Otolaryngology and... Dec 2023Mastoid cysts are a rare condition that occurs either congenitally or secondary to chronic otological diseases with poor ventilation of the middle ear and mastoid...
Mastoid cysts are a rare condition that occurs either congenitally or secondary to chronic otological diseases with poor ventilation of the middle ear and mastoid cavity. In this presenting case, the authors report a case of secondary mastoid cyst with evidence of bony destruction and fistulous tract formation into adjacent structures. Concurrently, we reviewed other similar cases reported in the literature. A 12-year-old Malay boy with partially controlled allergic rhinitis presented with right-sided postauricular swelling and intermittent fever for three months. Examination revealed a non-tender bony swelling over the mastoid area. High-resolution computed tomography of the temporal bone revealed a large bony lytic lesion at the inferior aspect of the mastoid bone. Multidirectional fistulous tracts towards the splenius capitis muscle were seen extending from the lesion. Right mastoid exploration was done and revealed an infected mastoid cyst. Complete removal of the cyst wall and saucerization of the mastoid cavity were performed. Our patient showcases the potential of mastoid cysts to cause bony erosion, fistulation and abscess formation. Complete removal of mastoid cysts is therefore advocated to prevent its potential complications and unwarranted recurrence.
PubMed: 37974688
DOI: 10.1007/s12070-023-04047-y -
Emergency Medicine Practice Apr 2024Though the vast majority of conditions associated with otalgia are not life-threatening, there are nuances and controversies in the diagnosis and management of even the...
Though the vast majority of conditions associated with otalgia are not life-threatening, there are nuances and controversies in the diagnosis and management of even the most common diseases, such as acute otitis media and otitis externa. For more severe disease processes, such as necrotizing otitis externa, acute mastoiditis, and perichondritis, early recognition and timely management are paramount in reducing morbidity and mortality. A systematic approach to the evaluation of these patients is key to establishing an accurate diagnosis, identifying patients who are at high risk for dangerous etiologies or complications, and providing optimal patient care. This issue summarizes the most recent guidelines and presents a systematic, evidence-based approach to the emergency department evaluation and management of patients with otalgia.
Topics: Humans; Earache; Otitis Externa; Otitis Media; Emergency Service, Hospital; Acute Disease
PubMed: 38507217
DOI: No ID Found -
The American Journal of Emergency... May 2024Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality. (Review)
Review
INTRODUCTION
Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality.
OBJECTIVE
This review highlights the pearls and pitfalls of mastoiditis, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
DISCUSSION
Acute mastoiditis most commonly affects pediatric patients and is a suppurative infection of the mastoid air cells. It is often associated with otitis media, and common bacteria include Streptococcus and Staphylococcus. History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise. The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms. Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis. Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis. CT may also demonstrate complications. Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation. Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures.
CONCLUSIONS
An understanding of acute mastoiditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
Topics: Humans; Child; Mastoiditis; Abscess; Prevalence; Otitis Media; Acute Disease; Erythema
PubMed: 38368849
DOI: 10.1016/j.ajem.2024.02.009 -
Neurology and Therapy Aug 2023Cerebral venous thrombosis (CVT) is a rare entity that remains a diagnostic challenge due to various clinical manifestations and a wide variety of causative agents.... (Review)
Review
Cerebral venous thrombosis (CVT) is a rare entity that remains a diagnostic challenge due to various clinical manifestations and a wide variety of causative agents. Local infections, such as acute (AOM) or chronic otitis media, can play a role in the pathogenesis of CVT. The proximity of the tympanic cavity and temporal bone air cells to the dural venous sinuses predisposes them to secondary thrombosis. The release of inflammatory cytokines and activation of the coagulation pathway in the middle ear space in response to infection may trigger the thrombotic mechanism in venous sinuses of the central nervous system. There is no consensus in the literature concerning the treatment of otogenic cerebral venous sinus thrombosis (CVST). Both the extent of the surgery and the use of anticoagulants are disputable. The aim of the study was to provide a thorough analysis of the literature concerning CVST in patients with AOM and acute mastoiditis (AM). The current surgical and conventional treatment strategies are presented. Special attention has been attached to the predisposing factors, the extent of the surgery, and the role of anticoagulants in the treatment of septic otogenic CVST.
PubMed: 37266793
DOI: 10.1007/s40120-023-00499-0 -
Operative Neurosurgery (Hagerstown, Md.) Dec 2023The retrosigmoid intradural suprameatal approach is mostly indicated for tumors in the cerebellopontine angle extending toward the Meckel cave and supratentorial...
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE
The retrosigmoid intradural suprameatal approach is mostly indicated for tumors in the cerebellopontine angle extending toward the Meckel cave and supratentorial regions, most frequently meningiomas and schwannomas. This approach was first established by the senior author in 1982.
ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT
Nervous structures: cranial nerves III to XII, cerebellum, and brainstem. Vascular structures: anterior inferior cerebellar artery, posterior inferior cerebellar artery, superior cerebellar artery, basilar artery, vertebral artery, transverse, sigmoid, and petrous sinus, petrosal vein/veins, basilar plexus, and the mastoid emissary vein. Bony structures: petrous bone with internal auditory canal, jugular foramen and suprameatal tubercle, petrous apex, dorsum sellae, and posterior clinoid process. Structures within the petrous bone: vestibule, semicircular canals, and jugular bulb.
ESSENTIALS STEPS OF THE PROCEDURE
After a suboccipital retrosigmoid craniectomy in the semisitting position and debulking of the tumor mass in the cerebellopontine angle, extension is achieved by drilling suprameatal tubercle above cranial nerve VII and VIII toward the petrous apex. The extent of bone drilling is tailored for each patient.
PITFALLS/AVOIDANCE OF COMPLICATIONS
Avoid damage to cranial nerves, arteries, and veins during drilling, dissection, and tumor removal or by retraction.
VARIANTS AND INDICATIONS FOR THEIR USE
In case of extreme supratentorial extensions laterally and dorsally, the opening of the tentorium may be helpful. For inferior extensions toward the upper spinal canal, opening of the foramen magnum and hemilaminectomy of C1 may be necessary.The patient consented to the procedure and to the publication of his/her image. Institutional logo in title slide, © 2023, INI Hannover. Used with permission.
PubMed: 38084947
DOI: 10.1227/ons.0000000000001030 -
JAMA Pediatrics Apr 2024Diagnostic delays are common in the emergency department (ED) and may predispose to worse outcomes.
IMPORTANCE
Diagnostic delays are common in the emergency department (ED) and may predispose to worse outcomes.
OBJECTIVE
To evaluate the association of annual pediatric volume in the ED with delayed diagnosis.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study included all children younger than 18 years treated at 954 EDs in 8 states with a first-time diagnosis of any of 23 acute, serious conditions: bacterial meningitis, compartment syndrome, complicated pneumonia, craniospinal abscess, deep neck infection, ectopic pregnancy, encephalitis, intussusception, Kawasaki disease, mastoiditis, myocarditis, necrotizing fasciitis, nontraumatic intracranial hemorrhage, orbital cellulitis, osteomyelitis, ovarian torsion, pulmonary embolism, pyloric stenosis, septic arthritis, sinus venous thrombosis, slipped capital femoral epiphysis, stroke, or testicular torsion. Patients were identified using the Healthcare Cost and Utilization Project State ED and Inpatient Databases. Data were collected from January 2015 to December 2019, and data were analyzed from July to December 2023.
EXPOSURE
Annual volume of children at the first ED visited.
MAIN OUTCOMES AND MEASURES
Possible delayed diagnosis, defined as a patient with an ED discharge within 7 days prior to diagnosis. A secondary outcome was condition-specific complications. Rates of possible delayed diagnosis and complications were determined. The association of volume with delayed diagnosis across conditions was evaluated using conditional logistic regression matching on condition, age, and medical complexity. Condition-specific volume-delay associations were tested using hierarchical logistic models with log volume as the exposure, adjusting for age, sex, payer, medical complexity, and hospital urbanicity. The association of delayed diagnosis with complications by condition was then examined using logistic regressions.
RESULTS
Of 58 998 included children, 37 211 (63.1%) were male, and the mean (SD) age was 7.1 (5.8) years. A total of 6709 (11.4%) had a complex chronic condition. Delayed diagnosis occurred in 9296 (15.8%; 95% CI, 15.5-16.1). Each 2-fold increase in annual pediatric volume was associated with a 26.7% (95% CI, 22.5-30.7) decrease in possible delayed diagnosis. For 21 of 23 conditions (all except ectopic pregnancy and sinus venous thrombosis), there were decreased rates of possible delayed diagnosis with increasing ED volume. Condition-specific complications were 11.2% (95% CI, 3.1-20.0) more likely among patients with a possible delayed diagnosis compared with those without.
CONCLUSIONS AND RELEVANCE
EDs with fewer pediatric encounters had more possible delayed diagnoses across 23 serious conditions. Tools to support timely diagnosis in low-volume EDs are needed.
Topics: Child; Humans; Male; Female; Retrospective Studies; Delayed Diagnosis; Emergency Service, Hospital; Pregnancy, Ectopic; Venous Thrombosis
PubMed: 38345811
DOI: 10.1001/jamapediatrics.2023.6672 -
Annales de Chirurgie Plastique Et... Jan 2024The main and more frequent problem in face lift is recurrence of neck bands. To improve face lift stability, a new aging analysis is proposed. The visible sign of face...
The main and more frequent problem in face lift is recurrence of neck bands. To improve face lift stability, a new aging analysis is proposed. The visible sign of face aging is skin excess. Superficial musculo aponeurotic system (SMAS) retraction is a much less visible sign. Nevertheless, botulinum toxin injections elongate muscles of the SMAS and rejuvenate the face. In the Face Recurve Concept, MRI studies prove the mimic muscles retraction that comes with aging. Face lift techniques include SMAS plication, traction or excision, which increases discrepancy between the envelope, the skin and the core, the SMAS. As skin excision is poorly efficient because performed posteriorly, far from the anterior skin excess located at the medial neck, the association to SMAS retraction exacerbates the gradient difference between envelop and core. This analysis shows that it is paramount to preserve the SMAS. (1) The sub-skin dissection has to be executed moving beyond the marionette fold and the paramedian neck bands; (2) no action is performed on the SMAS, only an horizontal section of the platysma at the hyoid height that will avoid platysma band recurrence. A botulinum toxin injection performed herein just after, blocks muscle regeneration; (3) the skin is pulled backward with a clear posterior transposition to the platysma. The skin at the cervico-mental angle and all along the cervico-mental crease is fixed to the deep cervical fascia, in the gap between the edges of the sectioned platysma, blocking muscle recreation. A resorbable barbed thread is used, with a first bite made at the cervico-mental angle through the deep cervical fascia then in the direction of the mastoid, with long bites through the deep cervical fascia versus short subcutaneous bites. Thanks to this strong shift, the cervico-mental crease is definitely recreated with no need of pre-auricular skin tension. Thirty-two patients have been operated with this technique on a one-year period. The results are a lot more stable and swelling is lowered down to the minimum.
Topics: Humans; Neck; Superficial Musculoaponeurotic System; Rhytidoplasty; Fascia; Botulinum Toxins
PubMed: 37723043
DOI: 10.1016/j.anplas.2023.07.006 -
Otolaryngology--head and Neck Surgery :... Oct 2023To assess the effect of the pneumococcal vaccine (PCV) toward the surgical management and complications of otitis media. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the effect of the pneumococcal vaccine (PCV) toward the surgical management and complications of otitis media.
DATA SOURCES
MEDLINE, EMBASE, PubMed, Scopus, and clinicaltrial.gov.
REVIEW METHODS
A systematic search was performed using a combination of keywords and standardized terms about PCV and surgical management or complications of otitis media. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies were screened by 3 independent reviewers. Risk of bias assessment, followed by meta-analysis in only randomized-controlled trials was conducted. Vaccine efficacy (VE) and 95% confidence interval (CI) were reported.
RESULTS
Of the 2649 abstracts reviewed, 27 studies were included in the qualitative analysis and were categorized into 6 outcomes: tympanostomy tube insertion, otitis media with effusion (OME), mastoiditis, spontaneous tympanic membrane (TM) perforation, recurrent acute otitis media (AOM), and severe AOM. Fifteen studies were included in the meta-analysis to evaluate the rate of tympanostomy tube insertion, OME, and recurrent AOM. PCV was significantly more effective in lowering the rate of tympanostomy tube insertion (VE, 22.2%; 95% CI, 14.6-29.8) and recurrent AOM (VE, 10.06%; 95% CI, 7.46-12.65) when compared with the control group, with no significant difference in reducing the incidence of OME. The qualitative analysis revealed that PCV had efficacy in preventing severe AOM and spontaneous TM perforation but the effect on mastoiditis remained unclear.
CONCLUSION
The PCV was effective in reducing the rate of tympanostomy tube insertion and the incidence of recurrent AOM with a nonsignificant effect in preventing OME in children.
Topics: Child; Humans; Infant; Pneumococcal Vaccines; Mastoiditis; Otitis Media; Otitis Media with Effusion; Middle Ear Ventilation
PubMed: 36924215
DOI: 10.1002/ohn.327