OBJECTIVE:
Mastoid abscess is one of most common complaint
presented to an otolaryngologist. Our study aimed to evaluate the mastoid
abscess cavity wound healing by use of local irrigation with gentamicin.
METHODOLOGY:
A total of 37 patients with mastoid abscess were
selected. Full ENT and general examination was done. Abscess cavity was drained
using universal precautions. Patients were divided into three groups using
random number table’s first packing of ear cavity with plain gauze second
povidone-iodine and third povidone-iodine with gentamicin. All patients were
given injectable ceftriaxone and followed on day3, 7, 15, 20 and 30 days.
RESULT:
The 37 patients aged between 2-57
years. Acute mastoiditis was more commonly the cause than chronic otitis media.
Post auricular abscess was most commonly reported. Average time for healing of
wound on clinical assessment with plain gauze was 27days,with povidone-iodine
was 22days and povidone-iodine with gentamicin was 19 days.16 patients needed
surgery at later days.
CONCLUSION:
Use of local gentamicin irrigation reduces the
bacterial load in abscess cavity and thus provides faster healing of mastoid
abscess cavity.
INTRODUCTION
Mastoid
abscess is one of the most common complaints presented to a otorhinolaryngologist.
Types:
v
Post auricular
v
Zygomatic
v
Bezold’s
v
Citelli’s
v
Luc’s
v
Para or retropharyngeal
Causes:
Ø
Acute Mastoiditis
Ø
Chronic Otitis Media With
Cholesteatoma
ü
Acute mastoiditis is more common in children
and immunocompromised and chronic in adults.
ü
Age, socio-economic status,
virulence of organism, immunity and Cholesteatoma influence its occurrence.
Clinical features mainly include pain, swelling, fever and ear discharge.
Though incidence declined in post antibiotic era its incidence is increasing
again as reported by many authors. Large multicentre study was done by LUNTZ et
al (2001) reported ~ 85% cases less than 8 years of age. Multicentre studies, vaccination,
proper nutrition, epidemiology, more insight to its pathophysiology, culture
guided treatment protocols and prevention of hearing mechanism is demand of
time in INDIA.
METHODOLOGY
ü
37 patients were selected from
ENT OPD with mastoid abscess.
Ø
Inclusion
criterion:
All patients
with mastoid abscess were included.
Ø
Exclusion
criterion:
Patients
having any intracranial complication were not part of the study.
ü
Patients were assessed on
basis of history, full ENT head and neck and general examination.
ü
Otoscopy, otoendoscopy, otomicroscopy, CT scan
and required blood investigations were performed.
ü
Abscess was drained following universal
precautions.
Patients were divided into three groups using
random number table and abscess cavity was packed
ü
All patients were given injection ceftriaxone and
metronidazole.
ü
Sample was sent for culture sensitivity reports.
ü
Follow up was done on day 3, 7, 15, 20 and 30 days.
ü
Obliteration of abscess cavity was considered as
treatment.
RESULT
v
Post auricular abscess was
reported most commonly (24/37) 65%. 3 had luc’s abscess. Zygomatic abscess was
2nd
most common.
v
CT scan confirmed Cholestotoma
in all cases of CSOM.
v
Vertigo was reported by 7
cases.
v
Tinnitus was reported by 3
patients.
v
Hard of hearing in all CSOM
cases, surgery was done at later dates in all such cases.
v
Fever, post auricular swelling
and pain was present in all cases.
v
19% cases acute mastoiditis
required cortical mastoidectomy.
v
35% females reported to our
study.
CONCLUSION
•
Mastoid abscess affects both
extremes of life commonly.
•
Post auricular abscess is most
common variety.
•
Acute mastoiditis is more
common a cause.
•
Patients with low socio-economic
status and rural background are more commonly affected.
•
CT scan should be performed in
all cases of CSOM presenting with mastoid abscess.
•
Packing the mastoid abscess
cavity after I& D with ribbon gauze soaked in povidone-iodine and gentamicin
heals the abscess cavity almost equal in time as primary intension healing.
Reduction of the local bacterial load appears to be the cause.
REFERENCES
•
Strangerup SE, Tos M.
Epidemiology of acute suppurative otitis media. American Journal Of Otolaryngology
1986;7:47-54.
•
Van –Zuijlen DA, SchilderAG ,
Van-Balen FA , Hoes AW. National differences in incidence of acute mastoiditis
:relationship to prescribing patterns of
antibiotics for acute otitis media. Pediatrics infectious
disease journal.2001;20:140-4.
•
LuntzM,BrodskyA,NusemS,KronenbergJ,Keren
G, Migirov L et al. Acute mastoiditis multicentre study. International journal
of pediatric otorhinolaryngology.2001;57:1-9.
