The age of our patients was between 3 months and 10 years old,
with a clear female predominance.
All of the patients in this series were seen clinically because of otalgia; most patients also had otorrhea and mastoid tenderness; some had fever and headache.
Radiographic findings of mastoiditis ranged from subtle changes of mastoid air cell opacification to the more profound changes of osseous destruction,
subperiosteal abscess formation and,
in some cases,
dural sinuses thrombophlebitis as well as empyemas and parenchymal abscesses.
The distribution of mastoiditis and its complications in our study are displayed in the following table (fig.1).
Otitis media and mastoid bone lysis (fig.
2,
3 and 4)
Middle ear infection may spread to the mastoid cells through the aditus ad antrum.
Mastoid septae destruction with coalescent mastoiditis may develop with complicating intracranial and/or extracranial subperiosteal abscesses.
Ossicular chain erosion (Fig.
4)
Ossicular erosion is a frequent complication of Chronic Suppurative Otitis Media that may lead to total failure of middle ear mechanics and resulting in substantial hearing loss.
It is most of the time related to a cholesteatoma.
Soft tissue collections
CT scans shows stages of disease progression when infection has spread by way of soft tissue,
blood,
and bone pathways into the dural venous sinuses,
meninges,
labyrinth,
facial nerves,
epidural and other intracranial spaces.
- Peri-auricular abscesses (fig.
5 and 6)
- Extensive collection of the scalp (fig.
7 and 8)
Cerebral thrombophlebitis (fig.
9 and 10)
In about half the cases in which epidural abscesses are seen,
dural venous thrombophlebitis can occur.
Symptoms include signs of sepsis,
hydrocephalus,
and intracranial hypertension.
Empyemas and cerebral abscesses (fig.
11 and 12)
In severe cases,
we observe intracranial spread of disease.
Intracranial extension has a propensity to form epi- and/or subdural empyemas.
The posterior fossa is the most common intracranial location to encounter the complications of mastoiditis,
with the middle cranial fossa the next most common.