--- title: "Abscesses in relation to Mastoid" description: "ENT notes on Abscesses in relation to Mastoid - Postauricular, Zygomatic, Bezold, Citelli and Luc’s Abscess." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/mastoid-abscess-bezold-citelli" categories: ["Otology"] video: "https://www.youtube.com/watch?v=dLDjfFG_818" image: "https://media.theentresident.com/og-images/mastoid-abscess-bezold-citelli.png" --- # Abscesses in relation to Mastoid ENT notes on Abscesses in relation to Mastoid - Postauricular, Zygomatic, Bezold, Citelli and Luc’s Abscess. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=dLDjfFG_818 ## 🦻 Abscesses in Relation to the Mastoid Complications of **Chronic Suppurative Otitis Media (CSOM)** can include various abscesses in relation to the mastoid. This topic is important for **viva questions, NEET-PG MCQs**, and clinical practice. --- ### 📋 Types of Abscess related to Mastoid There are **six** important abscesses in relation to the mastoid: 1. **Postauricular abscess** – behind the pinna 2. **Zygomatic abscess** – in front and above the pinna at root of zygoma 3. **Bezold abscess** – upper part of the neck 4. **Luc’s abscess** *(Meatal abscess)* – in the external auditory canal 5. **Citelli’s abscess** – occipital/retromastoid area 6. **Parapharyngeal / Retropharyngeal abscess** >Which is the most common abscess occuring as a result of mastoiditis? --- ### 1️⃣ 🦻 Postauricular Abscess **Definition:** Collection of pus in the postauricular region, usually as a complication of acute mastoiditis. **🧬 Etiopathogenesis** - Usually follows **acute mastoiditis** - Spread of infection from middle ear → mastoid air cells → breakdown of mastoid cortex → pus tracks into postauricular soft tissue. **🩺 Clinical Features** **General:** - Irritability, flushed face, mild fever, ↑ pulse rate **Local:** - Pinna displaced **forwards, outwards, downwards** - Swelling, redness, warmth behind ear - **Obliteration of postauricular groove** - **Ironed-out appearance** of mastoid (loss of bony ridges due to periostitis) - Tenderness over mastoid tip - Fluctuant skin; may rupture spontaneously **Ear Examination:** - Mucopurulent discharge - **Severe EAC edema** with **sagging posterior-superior canal wall** - TM congested with **central perforation** - Tuning fork test → **conductive hearing loss** **🧪 Investigations** - CBC: ↑ total & differential count - Pus culture & sensitivity - X-ray mastoid (Law’s / Schüller’s view) - HRCT temporal bone - MRI if intracranial complication suspected - PTA → conductive hearing loss **💊 Treatment** - Immediate hospitalization - **IV antibiotics** >Which is the Drug of choice in Post auricular abscess? - Analgesics - Daily ear toileting - Incision & drainage - **Myringotomy** ± grommet - **Cortical mastoidectomy** >What are the indications of Cortical mastoidectomy in Postauricular abscess? --- ### 2️⃣ 😮‍💨 Zygomatic Abscess **Definition:** Collection of pus in the temporal fossa over the zygomatic arch due to spread from mastoid through **root of zygoma**. Common in children, especially when **zygomatic cells are pneumatized**. **🩺 Clinical Features** - Swelling **above & in front of pinna** - Upper half of pinna displaced - Possible **edema of upper eyelid** - Painful trismus - Common ear findings: mucopurulent discharge, congested Tympanic membrane with central perforation >When does trismus develop in Zygomatic abscess? **🧪 Investigations** - CBC: ↑ counts - Pus C&S - HRCT → mastoiditis with extension into zygomatic root, soft tissue swelling - PTA → conductive hearing loss **💊 Treatment** - Hospitalization - IV antibiotics, analgesics - Daily ear toileting - Incision & drainage - **Cortical mastoidectomy** to remove infected mastoid & zygomatic cells >What is the differential diagnosis of Zygomatic abscess? --- ### 3️⃣ 🫱 Bezold Abscess **Definition:** Deep neck abscess from pus eroding **medial aspect of mastoid tip** and tracking along **sternocleidomastoid muscle**. **🧬 Spread Pathways** 1. Deep to sternocleidomastoid (SCM) 2. Along posterior belly of digastric 3. Upper posterior triangle 4. Parapharyngeal space 5. Along carotid vessels >What is the most common pathway of spread for Bezold's abscess? **🩺 Clinical Features** - Sudden painful, tender swelling in upper neck (deep to sternocleidomastoid) - Torticollis - Fever, purulent otorrhea - Ear findings: congested Tympanic membrane, central perforation **🧪 Investigations** - CBC: ↑ counts - Pus C&S - CT temporal bone & neck → mastoid erosion + deep neck abscess **💊 Treatment** - Hospitalization, IV antibiotics, analgesics - Drainage via separate incision + dependent drain - Cortical mastoidectomy exploring mastoid tip for fistula >What is the differential diagnosis of Bezold abscess? --- ### 4️⃣ 👂 Luc’s Abscess (Meatal Abscess) **Definition:** Subperiosteal abscess in EAC wall without bony destruction of mastoid cortex. **🧬 Etiology** - Acute Otitis Media or acute mastoiditis - Pus breaks through wall between antrum & bony EAC **🩺 Clinical Features** - Localized swelling in posterior-superior EAC wall - Tenderness, otalgia, otorrhea, blocked ear - No postauricular swelling or pinna displacement **🧪 Investigations** - Clinical diagnosis on otoscopy - CT temporal bone → normal mastoid cortex, no bony erosion **💊 Treatment** - IV antibiotics - I&D of abscess - Mastoidectomy only if mastoiditis develops --- ### 5️⃣ 🌀 Citelli’s Abscess **Definition:** Deep neck abscess from posterior spread of pus in acute mastoiditis via **posterior digastric groove** & **Citelli’s tract** to occipital/retromastoid area. **🩺 Clinical Features** - Swelling & tenderness **below & behind mastoid** → may extend to occipital region - Symptoms of acute mastoiditis **🧪 Investigations** - Clinical diagnosis - CT temporal bone & neck → confirms posterior pus tracking **💊 Treatment** - IV antibiotics - Incision & drainage via posterior neck/occipital approach - Cortical mastoidectomy --- ### 6️⃣ 🗣 Parapharyngeal / Retropharyngeal Abscess Result from infection of **peritubal cells** in acute coalescent mastoiditis. --- ## About This Note This free ENT note on Abscesses in relation to Mastoid was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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