A Bezold's abscess occurs as a complication of acute otomastoiditis and is currently an uncommon medical condition, due to the advent of antibiotics. It develops when suppuration products escape through the mastoid process (medial side) at the digastric fossa [1]. The initial site where the abscess can be formed is the chin, and can then progress to an abscess formation in the sternocleidomastoid, splenius or trapezius muscles.

Due to its location being deep in the cervical muscles, a Bezold's abscess may not always present as a palpable mass and it is frequently misdiagnosed. A typical presentation involves symptoms related to an otitis media complicated by mastoiditis, such as otalgia, otorrhea, post auricular pain or fever. Neck pain is frequent and in some cases, a mass can be palpated or seen either on the chin, or at some part of the course of the sternocleidomastoid muscle. Hearing loss may also complicate the clinical picture, accompanied by enlarged cervical lymph nodes, facial paralysis, and cephalalgia.

Due to the difficulties in assessing and diagnosing a Bezold's abscess, the condition may develop over even years, before it is diagnosed. A case study presented the possibility of a Bezold's abscess manifesting without a prior history of ear suppuration, with the symptoms being tinnitus, torticollis, fever, postauricular swelling and periodic pain in the region of the mastoid [2]. A patient presenting solely with a medical history of an ear infection and a cervical mass is also a potential clinical manifestation [3]. Prior to the advent of antimicrobial drugs, a Bezold's abscess could extend to the spinal cord, causing compression, coma, and death [4]. This clinical picture is not to be seen today, given that the patient receives standard medical care.

• Fever

  A typical presentation involves symptoms related to an otitis media complicated by mastoiditis, such as otalgia, otorrhea, post auricular pain or fever. [symptoma.com]

  1) Fever and malaise: Fever is persistent, in spite of adequate antibiotics. It can be as high as 40oC 2) Pain: It is present in the upper part of the neck and the sternomastoid. [specialist-ent.com]

  Acute mastoiditis, resulting in the deep neck abscess known as Bezold's abscess, has become very rare Symptoms: Fever and malaise: Fever is persistent, in spite of adequate antibiotics. [medigoo.com]

  It is a rare complication of acute otitis media.[1] Symptoms[edit] Symptoms may include: Severe pain in perimastoid region Difficulty in swallowing (dysphagia) Sore throat Difficulty in breathing (dyspnoea) Nuchal rigidity Fever Diagnosis[edit] CT scan [en.wikipedia.org]

  Three months later, she developed pain and a swelling in the right neck and fever. On ENT examinations, her right ear canal was stenotic and the audiogram showed a mixed hearing loss in the right ear. [jstage.jst.go.jp]

• Malaise

  1) Fever and malaise: Fever is persistent, in spite of adequate antibiotics. It can be as high as 40oC 2) Pain: It is present in the upper part of the neck and the sternomastoid. [specialist-ent.com]

  Acute mastoiditis, resulting in the deep neck abscess known as Bezold's abscess, has become very rare Symptoms: Fever and malaise: Fever is persistent, in spite of adequate antibiotics. [medigoo.com]

  Clinical features: The earliest stage where the brain tissue is invaded (stage of encephalitis) is marked by the presence of headache, fever, malaise and vomiting. Drowsiness eventually follow. [drtbalu.co.in]

  Clinically, these patients present with tender, enlarged cervical lymph nodes, fever, and malaise. Approximately 10% of patients develop overlying erythema and fluctuant lymph nodes that require drainage. [appliedradiology.com]

  Case report A 19-year-old male laborer presented to the outpatient department with a painful left-sided neck swelling, fever, anorexia, and malaise. [ejo.eg.net]

• Camping

  County Judge-Executive: Steve Pendery of Fort Thomas and Anna Zinkhon of Camp Springs. (Both Republican). County Attorney: Steven J. Franzen of Wilder. (Republican) County Clerk: Jim Luersen of Cold Spring. [nkytribune.com]

  Boot Camp Translation Part V: Governance, Evaluation, And Ethics In Stakeholder-Engaged Research Holly L. Peay, Elizabeth L. Cope, Elizabeth Horn, Madelaine E. Faulkner, Thomas W. Carton, Megan O’Boyle, Lorraine B. Johnson 17. [us.sagepub.com]

  Camp, Wisdom and the Feminine in the Book of Proverbs (Sheffield: Almond Press, 1985). [cambridge.org]

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• High Fever

  The doctor said that her throat was red and sore and that’s why she wasn’t eating. had her 18 month needles and since yesterday has suffered from high fever and vomiting. Add raw honey to taste. [master-kmkh.eu]

  However, methicillin-resistant S. aureus (MRSA) species have been seen with increasing prevalence. 11 Patients commonly present with high fevers and appear acutely ill. The overlying skin of the affected tissue may be erythematous and tender. [appliedradiology.com]

• Acutely Ill Patient

  In the emergency setting, timely interpretation of radiologic images is critical to the care of acutely ill patients, namely those with a threatened airway. REFERENCES Peters T, Edwards K. Cervical lymphadenopathy and adenitis. [appliedradiology.com]

• Abdominal Pain

  Disturbances of the gut such as diarrhoea nausea abdominal pain or wind. What is a tonsillectomy and why do I need this operation? You may need to undergo some routine tests before your operation. [pareja-ideal.eu]

  Severe generalized abdominal pain with Question Punched in the stomach Reflux Sore Throat Swollen Glands however that is of little marvel why others. [master-kmkh.eu]

• Choking

  Clinically, patients with retropharyngeal space infection often present with fever, neck pain, sore throat and neck mass. 7 The patients may also complain of a choking feeling and difficulty in swallowing. [appliedradiology.com]

• Neck Pain

  Neck pain is frequent and in some cases, a mass can be palpated or seen either on the chin, or at some part of the course of the sternocleidomastoid muscle. [symptoma.com]

  Three months later, she developed pain and a swelling in the right neck and fever. On ENT examinations, her right ear canal was stenotic and the audiogram showed a mixed hearing loss in the right ear. [jstage.jst.go.jp]

  Clinically, patients present with fever, neck pain, restricted neck motion, a nd otalgia. Due to the close proximity to the internal jugular vein, internal jugular vein thrombosis is a recognised commonly associated complication. [abcradiology.blogspot.com]

  ENT specialists treat conditions such as ear infection, hearing loss, dizziness, ringing in the ears (called tinnitus), ear, face, or neck pain, and more. [entnet.org]

  The affected patient often presents with fever, neck pain, sore throat and neck mass[ 11 ]. [wjgnet.com]

• Postauricular Pain

  Any patient that reports a prior otitis media, postauricular pain, otorrhea and cervical pain should be suspected of suffering from Bezold's abscess. A history of an untreated otitis or mastoiditis should raise suspicion. [symptoma.com]

• Benign Paroxysmal Positional Vertigo

  Benign Paroxysmal Positional Vertigo (BPPV) Benign paroxysmal positional vertigo, or BPPV, is the most common inner ear problem and cause of vertigo, or false sense of spinning. [entnet.org]

• Neck Stiffness

  Bezold's abscess should be considered in the setting of complicated otitis media with neck stiffness and immunocompromised, specifically untreated HIV. [ncbi.nlm.nih.gov]

  The patient did present with swelling the region of the mastoid and neck stiffness and tenderness to palpation as predicted with a history of mastoiditis and deep neck abscess. [docslide.com.br]

  When neck stiffness is marked the patient may manifest poitive kernigs sign. The stiffness may become more severe enough to cause opisthotonus. [drtbalu.co.in]

• Aphasia

  If dominant lobe is involved aphasia develops. The site of fits and the pattern of localising signs suggests the area of empyema. Papilloedema is highly uncommon, and similarly palsies involving individual cranial nerves are also rare. [drtbalu.co.in]

The first step towards a successful diagnosis is a thorough medical history. Any patient that reports a prior otitis media, postauricular pain, otorrhea and cervical pain should be suspected of suffering from Bezold's abscess. A history of an untreated otitis or mastoiditis should raise suspicion.

Imaging modalities such as a computed tomography scan (CT scan) or a magnetic resonance imaging scan (MRI scan) are those that can establish the diagnosis of a Bezold's abscess. A CT scan illustrates findings compatible with an inflammation of the mastoid and subsequent escape of pus. A middle ear and mastoid filled with fluid, alongside demineralized trabeculae and thickening of the skin in the area overlying the abscess, are typical findings [5] [6]. The CT scan also helps to delineate the location and exclude its extension into the thoracic cavity or vertebra as well as to plan surgical strategy. An MRI scan can be used to confirm the diagnosis if the CT scan should yield negative results and it is also more effective in assessing cerebral damage induced by otitis media [7].

Dural sinus thrombosis is relatively more common, and treatment of the underlying cause is essential. The diagnosis and rapid, aggressive treatment of these conditions are essential for an optimal clinical outcome. [ncbi.nlm.nih.gov]

[…] for Purulent Ear Discharge 258 Intravenous Antibiotics for Otorrhea 261 Evaluation and Treatment of Recurrent PostTympanostomy Otorrhea 266 Workup and Management of Chronic Otorrhea 271 MethicillinResistant Staphylococcus aureus Otorrhea 278 [books.google.de]

Treatment: Surgical treatment is necessary when the abscess is well formed.Surgical line:Drainage of the abscess formed. Mastoidectomy is required to eradicate the disease in chronic mastoiditis. [medigoo.com]

The treatment of cholesteatoma is mainly by surgical exploration namely mastoidectomy. The aim of treatment is to eradicate the diseased mastoid and to prevent subsequent complications. [scirp.org]

If left untreated, the abscess may spread as far as the larynx and mediastinum, which results in a poor prognosis. Clinically, patients present with fever, neck pain, restricted neck motion, a nd otalgia. [abcradiology.blogspot.com]

Cutaneous abscess Suppurative lymphadenoapthy Malignancy Parotid lymphoepithelial cyst Parotid malignancy Suppurative parotitis Tuberculosis Coalescent mastoiditis Prognosis The prognosis is good if the infection has not spread beyond the temporal bone [ncbi.nlm.nih.gov]

Symptom searches for co-occurring symptoms for Hoarse cancer of the tonsil prognosis tonsillenstein behandlung voice in children Hoarse voice in children and Sore throat with cough (2 causes). [pareja-ideal.eu]

[…] abscess. [22] Because of location and rarity Bezold abscess requires a high index of suspicion, with contrast enhanced computed tomography imaging of the temporal bone and neck providing vital information for diagnosis and surgical intervention. [23] Prognosis [indianjotol.org]

Mastoiditis: Practice Essentials, Etiology, Epidemiology ; Feb 15, 2018 ... (See Etiology and Presentation.) ... Note the loss of the skin crease and the pointed abscess. .... Inferior extension to form a Bezold abscess. [ypovdwfc.gq]

Otolaryngology-Head and Neck Surgery, University of Padua, Via Giustiniani 2, 35128, Padua, Italy. [email protected] Export Citation: APA/MLA Format Download EndNote Download BibTex MeSH Terms Descriptor/Qualifier: Abscess / diagnosis, drug therapy, etiology [biomedsearch.com]

Bacterial infections are the most common cause of suppurative cervical adenitis with staphylococcus aureus and Group A streptococcus being the most common etiologic agents[ 5, 6 ]. [wjgnet.com]

Reticulation of the adjacent fat surrounding a suppurative lymph node, or the presence of a circumferential rim of soft tissue, may be indicative of an inflammatory etiology as the cause of the abnormal node—as opposed to metastases. [appliedradiology.com]

If P waves are detectable, consider sinus tachycardia or atrial fibrillation or flutter as a potential etiology. [ncbi.nlm.nih.gov]

(bezold abscess) and thrombosis of the ipsilateral ... whether presentation and epidemiology of acute. [ypovdwfc.gq]

Epidemiologically there was a masculine predominance confirming previous reports (22,24). [arquivosdeorl.org.br]

While this infection is exceedingly rare in modern times, immunosuppressed patients and patients in areas without access to antibiotic treatments remain at higher risk. [1] Epidemiology Many factors have been shown to play a role in the development of [ncbi.nlm.nih.gov]

The following is a case presentation of a Bezold's abscess followed by a discussion detailing the pathophysiology, presentation, diagnosis, and treatment of this disease process. [ncbi.nlm.nih.gov]

We report a rare case of Bezold’s abscess, as a complication of otitis media and discuss its pathophysiology and management. [plu.mx]

Renewed familiarity with the clinical presentations and pathogenesis of this now uncommon condition may prevent delay in diagnosis and initiation of therapy. [ncbi.nlm.nih.gov]

[…] of Acute Otitis Media 134 Mucosal Immunity and Nasal Immunization in the Treatment of Infectious Diseases of the Upper Respiratory Tract 138 Allergy TestingTreatment for Otitis Media 146 Prevention of Acute Otitis Media during the Common Cold 152 Rhinosinusitis [books.google.de]

Surgical approach and wide spectrum antibiotics are mandatory to eradicate the infection and prevent consequent complications. References Bezold F. [casereports.in]

The aim of treatment is to eradicate the diseased mastoid and to prevent subsequent complications. Beside surgical intervention, the patient will also require intensive systemic and topical antibiotic therapy. [scirp.org]

Learn how to stay ENT healthy, prevent problems, and manage existing conditions to improve your, or a loved one’s, daily life Find out more about the community of physician experts who can help you to Be ENT Smart and how the information was developed [entnet.org]

1. Jose J, Coatesworth AP, Anthony R, Reilly PG. Life-threatening complications after partially treated mastoiditis. BMJ. 2003 Jul 5; 327(7405): 41–42.
2. Janardhan N, Indeevar P, Suresh P, Arunkumar C, Kuldeep S. Congenital Cholesteatoma of Temporal Bone with Bezold’s Abscess: Case Report. Indian J Otolaryngol Head Neck Surg. 2012 Mar; 64(1): 97–99.
3. Ludman H. Complications of suppurative otitis media. In: Booth JB, ed. Scott-Brown's Otolaryngology. 6th ed. Vol 3. Oxford: Butterworth-Heinemann, 1997: 1-29.
4. Castillo M, Albernaz VS, Mukherji SK, et al. Imaging of Bezold's abscess. AJR. 1998;171: 1491-1495.
5. Marioni G, Fillipis CD, Tregnaghi A, Ragona RM, Stafferi A. Bezold’s Abscess in Children: Case Report and Review in Literature. International Journal of Paediatric Otorhinolaryngology. 2001;61(2): 173-177.
6. Castillo M, Albernaz VS, Mukherji SK, Smith MM, Weissman JL. Imaging of Bezold’s Abscess. American Journal of Roentgenology. 1998; 171(6): 1491-1495.
7. Irving RM, Jones NS, Hall-Craggs MA, Kendall B. CT and MR imaging in lateral sinus thrombosis. J Laryngol Otol 1991;105: 693-5.