Specialist ENT BEZOLDS ABSCESS

BEZOLD’S ABSCESS

Definition: It is a complication of acute mastoiditis when the disease passes inferiorly through the medial aspect of the mastoid tip into the sheath of sternomastoid muscle. Aetiology:  Acute mastoiditis usually follows an attack of Acute suppurative otitis media due to:
  1. Lowered resistance of patient due to measles, exanthematous fever, poor nutrition and immunocompromising systemic disease.
  2. High virulence of organism. The most common organism infecting children is beta haemolytic streptococcus.
Pathology:  If an acute suppurative otitis media is untreated, or fails to respond, the inflammatory process persists and there is accumulation of pus in the mastoid air cells. The eustachian tube or perforation in the tympanic membrane is not sufficient to drain the pus produced.This results in necrosis of the bony walls of mastoid air cells inferiorly producing Bezolds abscess. The abscess may
  1. Lie deep to sternocleidomastoid, pushing the muscle outwards.
  2. Follow the posterior belly of digastric and present as a swelling between the tip of mastoid and angle of jaw.
  3. Present in upper part of posterior triangle.
  4. Reach the parapharyngeal space.
  5. Track down along the carotid vessels.
Specialist ENT Screenshot 2020 11 19 Ear final book document
Clinical features:
Symptoms:
    1. Fever and malaise: Fever is persistent, in spite of adequate antibiotics. It can be as high as 40-degree Celsius.
    2. Pain: It is present in the upper part of the neck and the sternomastoid. Neck movements are restricted.
    3. Ear discharge: The discharge is purulent, profuse and foul smelling.
 Signs: 
  1. Sagging of postero-superior canal wall.
  2. Perforation of the tympanic membrane.
  3. Mastoid tenderness elicited by pressure over the Macewan’s triangle.
  4. Conductive hearing loss.
  5. There is usually no fluctuation felt.
  6. Generalize tender swelling below the pinna.
  7. This swelling often conceals the contours of the mastoid process.
Investigations:
  1. Routine blood counts show polymorphonuclear leukocytosis with raised Erythrocyte sedimentation rate (ESR).
  2. X-ray mastoid lateral oblique view shows clouding of air cells, lysis of bony partitions between air cells, but the sinus plate is seen as a distinct outline. In later stages, a cavity may be seen in the mastoid.
  3. HRCT temporal bone indicates the extent of the disease, status of the middle ear, mastoid, ear ossicles, and the facial nerve. It also gives idea of impending complications.
  4. Ear swab for culture and sensitivity.
Specialist ENT Screenshot 2020 11 19 Ear final book document
Treatment:  Surgical treatment is necessary when abscess is well formed.
  1. Drainage of the abscess formed.
  2. Mastoidectomy is required to eradicate the disease in chronic mastoiditis.
Differential diagnosis:
  1. Acute upper jugular lymphadenitis.
  2. Abscess or a mass in the lower part of the parotid gland.
  3. An infected branchial cyst.
  4. Parapharyngeal abscess.
  5. Jugular vein thrombosis.

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