A case of masked mastoiditis with Bezold's abscess

Abstract

A thirty-year-old female with Bezold's abscess as well as untreated diabetes presented with a right otalgia and otorrhea at the end of December 2011. However, she did not seek medical consult because she thought she couldn't pay the medical fees. She had been an unemployed person and she had no health insurance or welfare for over 10 years. 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. CT scan showed a right neck abscess and it seemed to develop through a bone defect of the posterior-inferior part of the mastoid tip, which was compatible with Bezold's abscess. A bone defect of the sigmoid sinus was also observed. She had no symptoms of acute mastoiditis like otorrhea, standing auricle and otalgia. We diagnosed Bezold's abscess caused by the masked mastoiditis. Further, she was diagnosed to have untreated diabetes (HbA1c was over10%).
After admission, she got intravenous antibiotic therapy and treatment for diabetes in collaboration with the internal medicine specialists. The next day after admission, she underwent mastoidectomy and abscess drainage under the condition of controlling high blood glucose level by insulin. 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.
With the advent of advanced antibiotic therapy, the complications of otitis media such as Bezold's abscess had been rare. However, the abscess can be made and get larger without any sign in such a case like masked mastoiditis. Therefore, we should include this disorder in a differential diagnosis.