Acute Mastoiditis Complicated with Concomitant Bezold’s Abscess and Lateral Sinus Thrombosis

Abstract

Bezold's abscess is a very rare extracranial complication of acute mastoiditis. Lateral sinus thrombosis is another intracranial complication of acute mastoiditis that can occur, but there are only few reports of concomitant ispilateral Bezold's abscess and lateral sinus thrombosis with favorable outcome. We diagnosed and treated successfully a 14-year-old girl suffering from Streptococcus pneumoniae acute mastoiditis complicated with Bezold's abscess and lateral sinus thrombosis. Surgical treatment included myringotomy, cortical mastoidectomy, and Bezold's abscess incision and drainage. During the course of treatment, we concluded that lateral sinus thrombosis was not caused from mastoiditis by direct spread but from pressure on internal jugular vein caused from Bezold's abscess.

A Systematic Review of Cases with Bezold’s Abscess

“…Other complications include seizures, cerebral herniation, and permanent cognitive deficits (53). Through a similar mechanism, patients with Bezold’s may develop meningitis, as shown by two patients in the current review and one excluded postmortem case (33,50,54).…”

“…Additionally, it has been postulated that pathogens may travel directly through eroded bone or via the small venules arising from the mastoid and ascend intracranially to the dural sinuses (51,52). Although this otologic complication is not specific to Bezold’s abscess, 10 patients in the current review manifested with dural sinus thrombosis (13,15,24,26,33,37,38,47–49). This is an important complication for clinicians to be aware of due to the potentially devastating sequelae, as demonstrated by one patient who developed a right-sided cerebellar infarction (48).…”

“…Of manuscripts written in non-English language, three had no abstracts available, and five provided abstracts with insufficient data regarding baseline demographics, clinical presentation, and management. Finally, 45 studies were included in this systematic review, with 49 patients being pulled from case reports or series (1,3,8–50).…”

“…Initial antibiotic therapy should offer broad coverage since infections were found to often be polymicrobial in nature, and may be narrowed after information on sensitivities and strains are acquired. Increasing the range of coverage may be necessary with the development of severe complications, including Lemierre's syndrome, thoracic necrotizing fasciitis, paraspinal abscess, or dural sinus thrombosis (33,44,47,48,50). Additionally, newer antibiotic options reduce the renal and audiovestibular risks of aminoglycosides.…”

Bezold’s abscess: An extremely rare complication of suppurative mastoiditis: Case report and literature review

“…If there is no improvement, a mastoidectomy should be performed. In the case of complications, surgical treatment should be carried out urgently [ 15 ].…”