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Bezold's Abscess

Mastoiditis Acute with Neck Abscess

A Bezold's abscess is an organized collection of pus located deeply in the neck, in the sternocleidomastoid muscle and the infratemporal fossa. It occurs as a complication of otomastoiditis.


Presentation

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]
  • Symptoms may include: Severe pain in perimastoid region Difficulty in swallowing (dysphagia) Sore throat Difficulty in breathing (dyspnoea) Nuchal rigidity Fever CT scan of mastoid and swelling of the neck.[en.wikipedia.org]
  • 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]
  • 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]
  • 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]
Severe Pain
  • Symptoms may include: Severe pain in perimastoid region Difficulty in swallowing (dysphagia) Sore throat Difficulty in breathing (dyspnoea) Nuchal rigidity Fever CT scan of mastoid and swelling of the neck.[en.wikipedia.org]
  • Twenty-four hours later the patient was seen to be still experiencing severe pain, and a repeat CT scan revealed progression of the cavitation in the neck abscess.[ejo.eg.net]
Intravenous Administration
  • Intravenous administration of antibiotics was continued after surgery. The CT performed a month later showed resolution of the infection. Revision of right mastoidectomy conducted a year later demonstrated no recurrence of cholesteatoma.[casereports.in]
Hypotension
  • He was afebrile, but slightly tachycardic and mildly hypotensive. Neurologically, he was lethargic but oriented and his cranial nerves were intact.[docslide.com.br]
Tinnitus
  • 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.[symptoma.com]
  • Learn More About Topic Tinnitus Over 50 million Americans have experienced tinnitus, or ringing in ears, which is the perception of sound without an external source being present.[entnet.org]
Delayed Wound Healing
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]
  • After the operation, her neck pain became alleviated and her hearing level got better. Six months after the surgery, there has been no sign of recurrence. However, her diabetes has not been well treated, because she missed periodical examination.[jstage.jst.go.jp]
  • Despite its rarity, given the ever-increasing population of immunocompromised HIV patients, clinicians must have a high index of suspicion for this disease in the setting of chronic otitis media and neck pain.[docslide.com.br]
  • 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]
Facial Spasm
  • Beginning with an introduction to the anatomy and neurophysiology of the facial nerve and nerve regeneration, the text then discusses surgery for a range of conditions including Bell's palsy, hemi facial spasm and tumours causing facial palsy.[books.google.com]
Dyspareunia
  • Bartholin abscess acute infection of a Bartholin gland with symptoms including pain, swelling, cellulitis of the vulva, and dyspareunia. Treatment is incision and drainage of the abscess.[medical-dictionary.thefreedictionary.com]

Workup

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].

Chlamydia
  • Cultures should be obtained to rule out infections by Neisseria gonorrhoeae or Chlamydia. Bezold's abscess one deep in the neck resulting from a complication of acute mastoiditis.[medical-dictionary.thefreedictionary.com]
Entamoeba Histolytica
  • Abscess, cross section. alveolar abscess a localized suppurative inflammation of tissues about the apex of the root of a tooth. amebic abscess an abscess cavity of the liver resulting from liquefaction necrosis due to entrance of Entamoeba histolytica[medical-dictionary.thefreedictionary.com]
Neisseria Gonorrhoeae
  • Cultures should be obtained to rule out infections by Neisseria gonorrhoeae or Chlamydia. Bezold's abscess one deep in the neck resulting from a complication of acute mastoiditis.[medical-dictionary.thefreedictionary.com]

Treatment

  • 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]
  • CT of the neck and temporal bone can help the surgeon determine appropriate treatment.", author "M. Castillo and Albernaz, {V. S.} and Mukherji, {S. K.} and Smith, {M. M.} and Weissman, {J. L.[scholars.opb.msu.edu]

Prognosis

  • Prognosis The prognosis is good if the infection has not spread beyond the temporal bone and, if antibiotic intervention occurs early on.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • 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, and otalgia[ 16, 17 ].[wjgnet.com]

Etiology

  • Otolaryngology-Head and Neck Surgery, University of Padua, Via Giustiniani 2, 35128, Padua, Italy. g_marioni@virgilio.it Export Citation: APA/MLA Format Download EndNote Download BibTex MeSH Terms Descriptor/Qualifier: Abscess / diagnosis, drug therapy, etiology[biomedsearch.com]
  • 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]
  • 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]
  • In our study the anaerobes didn't play an important etiologic role. (3,24) This result disagrees with the research carried out by Mathews and Oliver (30), that isolated anaerobes in 40% of the cholesteatomas managements.[arquivosdeorl.org.br]

Epidemiology

  • (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]
  • Bezold abscesses include gram-positive aerobes : Streptococcus, Staphylococcus, and Enterococcus species ; gram-negative aerobes: Klebsiella, Pseudomonas, and Proteus species and anaerobes, particularly Peptostreptococcus and Fusobacterium species. [1] Epidemiology[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • The pathophysiology, clinical presentation, and treatment of subperiosteal and Be-.Spontaneous drainage of a Bezold neck abscess into the middle-ear ... ; Bezold's abscess is a neck abscess, arising as a complication of acute mastoiditis ... and had become[ypovdwfc.gq]

Prevention

  • 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]

References

Article

  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.

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Last updated: 2019-06-28 12:17