Mastoiditis Complications: A Modern Clinical and Radiographic Review of a Critical Skull Base Infection

Introduction: Mastoiditis, inflammation of mastoid air cells of the temporal bone, remains a significant medical concern due to its potential to give rise to severe and even life-threatening intracranial complications. We present the clinical encounters and diagnostic outcomes of mastoiditis complications by describing a modern-era surgeon’s experiences in both adult and pediatric patients.

Methods: With a retrospective review of a multi-site academic institution from 2020 to 2023, we examined a cohort of nine patients, comprising five adults and four pediatric cases, all presenting with mastoiditis complications. Comprehensive data, including initial presenting symptoms, relevant laboratory values, preoperative imaging data, culture results, and intraoperative pathology reports, were collected.

Results: This case series of pediatric and adult patients includes the full spectrum of mastoiditis complications, including intracranial infections, in diverse patient populations. The present study offers a comprehensive review describing the presenting clinical scenario, lab findings, diagnostic imaging, and intraoperative reports of each distinct complication, thus spanning a range of severity. We specifically elaborate on the clinical presentations and key CT and MR characteristics of each complication, encompassing meningitis, intracranial abscesses, labyrinthitis, Bezold abscesses, facial nerve paralysis, and osteomyelitis. We even include processes initially resembling mastoiditis with related neurologic complications, including skull base tumors and Langerhans Cell histiocytosis.

Conclusion: This review offers skull base surgeons a focused perspective on the nuances of managing mastoiditis-related complications across a range of patient populations in the modern era. Our study illustrates the spectrum of severity within which mastoiditis complications can present. Through comprehensive clinical encounters, precise interpretation of imaging, and surgical insights, we depict each complication as a recognizable clinical pattern, contributing to a comprehensive understanding of mastoiditis manifestations in the modern era ([Figs. 1]–[4]).

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Publication History

Article published online:
05 February 2024