Bezolds abscess

Bezold's abscess: Description, Causes and Risk Factors:An abscess deep to the superior part of the sternocleidomastoid muscle due to suppurative destruction of the mastoid tip cells in mastoiditis.Bezold's abscess is a deep cervical abscess arising from acute mastoiditis. It was first described in 1881, by a study in cadavers in which purulent secretion was observed draining from the medial surface of the mastoid process through the digastric groove. In the neck, this suppurative process extends between the digastric and sternocleidomastoid muscles. Bezold's abscess is different from the other more common forms of abscesses, such as the subperiosteal that appears from erosion of the external surface of the mastoid cortex.Acute mastoiditis which usually follows an attack of acute suppurative otitis media when:
  • Lowered resistance of patient due to measles, exanthematous fever, poor nutrition and immune-compromising systemic disease.
  • High virulence of organism. The most common organism infecting children is pneumococci
If an attack of acute suppurative is untreated or fails to respond, the inflammatory process persists and there is accumulation of pus in the mastoid air cells. The eustachian tube or a perforation in the tympanic membrane is not sufficient to drain the pus produced. This results in necrosis of the bony walls of the cells inferiorly producing Bezold's abscess.Since the introduction of antibiotics for the treatment of suppurative otitis media the incidence of complications from this disease has been greatly diminished. Acute mastoiditis, resulting in the deep neck abscess known as Bezold's abscess, has become very rareBezold's abscessSymptoms:Fever and malaise: Fever is persistent, in spite of adequate antibiotics. It can be as high as 40 C
  • Pain: It is present in the upper part of the neck and the sternomastoid. Neck movements are restricted.
  • Ear discharge: The discharge is purulent, profuse and foul smelling.
  • Mastoid tenderness is elicited by pressure over the Macewen triangle or suprameatal triangle.
Diagnosis:Following are the signs seen on examination of Bezold's abscess:Sagging of the posterosuperior canal wall.
  • Perforation of the tympanic membrane.
  • Mastoid tenderness elicited by pressure over the Macewan's triangle.
  • Conductive type of hearing loss.
  • There is usually no fluctuation felt.
  • Generalized tender swelling below the pinna.
  • This swelling often conceals the contours of the mastoid process.
What investigations are required for the diagnosis of Bezold's abscess?Routine blood counts: Cells show polymorphonuclear leukocytosis with raised ESR.
  • X-ray mastoid - Schüller view: It may show lysis and destruction of the mastoid air cells.
  • HRCT temporal bone: This indicates the extent of the disease, status of the middle ear, ossicles, and the facial nerve. It also gives an idea of any impending complications.
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.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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