Subperiosteal Mastoid Abscess in the Otolaryngology Practice in Sokoto

Aims: Audit intent and review of the management.

Study Design: Retrospective descriptive cross-sectional study.

Place and Duration of Study: Ear, Nose and Throat Department of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria between August 2006 and September 2018.

Methodology: The case files of the patients managed for subperiosteal mastoid abscess were retrieved and reviewed. Data extracted from the case files were biodata, symptoms including duration of otorrhoea, signs elicited, radiological findings of the petromastoid bone and brain, microbial isolates, treatment, operative findings, follow-up, and the outcome. The data analysed with IBM SPSS version 21.0.

Results: A total of 11 patients comprising 5 (45.5%) male and 6 (54.5%) female, with a male to female ratio of 1:1.2, had subperiosteal mastoid abscess during the 12 years under review. Mean age was 13 years, and the mean duration of otorrhoea was 8 years. Eight (72.7%) patients had mucopurulent otorrhoea and fluctuant posterior auricular mass which yielded thick pus on tap aspiration. Three patients (27.3%) had a tympanocutaneous fistula. Two of the patients had cholesteatoma. The most common bacteria isolate was Pseudomonas aeruginosa. Six (54.5%) of the patients had initial incision and drainage before the definitive surgery. The definitive surgical intervention was cortical mastoidectomy 6 (54.5%) and modified radical mastoidectomy 5(37.5%). The treatment outcome was the resolution of abscess in 8 (72.7%) and persistent discharging mastoid cavity in 3 (27.3%) patients. The average length of hospitalisation was 12.6 days, and the mean follows up period was 19 months.

Conclusion: Subperiosteal mastoid abscess usually occurs as a complication of chronic suppurative otitis media in children and adults with very long history of otorrhoea. It requires cortical or modified radical mastoidectomy. Early diagnosis and treatment of chronic suppurative otitis media may prevent the development of a subperiosteal mastoid abscess.