Acute and chronic mastoiditis and chronic suppurative otitis media

An innovative method to visualise mastoiditis using a hand-held X-ray system

OBJECTIVE

We explore the utility of using a hand-held X-ray system to diagnose mastoiditis in archaeological populations.

MATERIALS

A sample (n = 56) of hunter-fisher-gatherers from the Early Neolithic (8,000-7,000/6,800 cal. BP) Cis-Baikal cemetery of Shamanka II (Russia) were examined.

METHODS

Images were taken medio-laterally, approximately 90° to a sensor temporarily affixed to the lateral surface of the mastoid process. Digital radiographs were analysed for signs of mastoiditis occurring pre- and/or post-puberty.

RESULTS

Two thirds of individuals (39/56) exhibited evidence of mastoiditis. Chronic mastoiditis and chronic sinusitis co-occurred in 61.5% (24/39) of observable individuals.

CONCLUSIONS

This method was found to be an effective, convenient, and versatile non-destructive alternative to sectioning and traditional radiographic imaging.

SIGNIFICANCE

This is the first project to adapt a hand-held X-ray system for imaging and diagnosis of mastoiditis and this approach encourages future analyses of this infection.

LIMITATIONS

The cost of the imaging system is limiting and there are few comparative images taken in the same plane.

SUGGESTIONS FOR FURTHER RESEARCH

Further research should create a larger catalogue of comparative radiographs and assess the diagnostic potential of imaging the mastoid process to rather than imaging the entire pneumatized portion of the temporal bone.

The role of anaerobic bacteria in acute and chronic mastoiditis

Mastoiditis (M) is the most common intratemporal complication of otitis media. The incidence of M has decreased since the advent of antimicrobial agents. In the last decade, however, there has been a marked increased in the incidence of acute M in several communities, sometimes in association with the growing resistance of pneumococci. Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus and Haemophillus influenzae are the most common organisms recovered in acute M. Several recent studies demonstrated the predominance of Pseudomonas aeruginosa in this infection. However, because P. aeruginosa colonizes the ear canal it can contaminate specimens obtained through the non-sterile ear canal. P. aeruginosa, Enterobacteriaceae, S. aureus and anaerobic bacteria are the most common isolates in chronic M. Anaerobes predominate in studies where adequate methods for their isolation are employed. Management of uncomplicated M requires the administration of parenteral antimicrobial therapy and myringotomy with or without tympanostomy tube placement. If no improvement occurs within 48 h, surgical intervention and drainage may be necessary. The procedure generally employed is simple mastoidectomy, and tympanostomy tube placement. Radical mastoidectomy is performed only if there is no improvement after simple mastoidectomy.

Efficacy of ofloxacin and other ototopical preparations for chronic suppurative otitis media in children

The safety and efficacy of ototopical preparations, such as ofloxacin, in the treatment of CSOM in infants and children do not currently have approval by the FDA even though ofloxacin is FDA-approved for treatment of CSOM that occurs in adults. However, treatment with ofloxacin is FDA-approved when AOM occurs in children who have a tympanostomy tube in place, and effective treatment of this acute infection should prevent the subsequent development of CSOM.