Spiegel J H, Lustig L R, Lee K C, Murr A H, Schindler R A
Department of Otolaryngology/Head and Neck Surgery, University of California at San Francisco, 94143-0342, USA.
Laryngoscope. 1998 Jun;108(6):822-8. doi: 10.1097/00005537-199806000-00009.
The incidence of complications resulting from suppurative otitis media has significantly decreased since the introduction of antibiotics. At the start of the 20th century 50% of all cases of otitis media developed a coalescent mastoiditis. By 1959, the incidence had fallen to 0.4%. Recent studies suggest a current incidence of only 0.24%. Additionally, during the time of Friedrich Bezold (1824-1908), 20% of patients with mastoiditis developed subperiosteal abscess. Interestingly, this has incidence increased; today nearly 50% of patients diagnosed with coalescent mastoiditis have subperiosteal abscess.
To review the contemporary presentation, diagnosis, and management of a spectrum of mastoid abscesses.
Retrospective case series.
Hospitals associated with the Department of Otolaryngology/Head and Neck Surgery at the University of California, San Francisco.
Three patients with mastoid abscesses are reported. One patient displayed "classic" Bezold's abscess, with pus escaping the mastoid near the incisura digastrica and tracking along the digastric and sternocleidomastoid muscles into the neck. The second and third patients exhibited temporoparietal swelling secondary to mastoid abscess eroding the root of the zygomatic process, a complication noted by Bezold in 1908 as occurring "in only very rare cases."
Since only one third of patients show pathologic tympanic membrane changes, and since complaints of otalgia, fever, and tenderness are inconstant, subperiosteal mastoid abscess is frequently a delayed diagnosis. The clinical presentation, pathogenesis, and routes of abscess spread are presented with photographic and radiographic illustration. Medical and surgical management is reviewed, and methods for accurate diagnosis are emphasized.
自抗生素问世以来，化脓性中耳炎所致并发症的发生率已显著下降。在20世纪初，所有中耳炎病例中有50%会发展为融合性乳突炎。到1959年，这一发生率已降至0.4%。近期研究表明，目前的发生率仅为0.24%。此外，在弗里德里希·贝佐尔德（1824 - 1908年）所处的时代，20%的乳突炎患者会发生骨膜下脓肿。有趣的是，这一发生率有所上升；如今，近50%被诊断为融合性乳突炎的患者会出现骨膜下脓肿。
回顾一系列乳突脓肿的当代临床表现、诊断及治疗方法。
回顾性病例系列研究。
加利福尼亚大学旧金山分校耳鼻喉科/头颈外科相关医院。
报告了3例乳突脓肿患者。1例患者表现为“典型”的贝佐尔德脓肿，脓液从乳突靠近二腹肌切迹处流出，沿二腹肌和胸锁乳突肌进入颈部。第2例和第3例患者表现为颞顶部肿胀，这是由于乳突脓肿侵蚀颧突根部所致，贝佐尔德在1908年指出这种并发症“仅在极少数情况下发生”。
由于仅有三分之一的患者出现病理性鼓膜改变，且耳痛、发热和压痛等症状并不持续，骨膜下乳突脓肿常常延迟诊断。通过照片和影像学图片展示了临床表现、发病机制及脓肿扩散途径。回顾了药物和手术治疗方法，并强调了准确诊断的方法。
