Two probable cases of mastoiditis in a cemetery from the Warring States to Han Dynasty (475 BCE-220 CE) in Qufu, Shandong Province, China.

In modern clinical medical practice, middle-ear infection is a frequently reported condition. If untreated, persistent inflammation caused by infection may lead to perforation of the mastoid process or other portions of the temporal bone. When the middle-ear abscess penetrates the surrounding bone and invades the mastoid process, it causes mastoiditis. Abnormal osseous fistulae were observed on the temporal bones of individuals M137 and M199, which were unearthed in Qufu Olympic Sports Center Cemetery in Qufu City, Shandong Province, and date to the Warring States to the Han Dynasty (475 BCE-220 CE). Microscopic observation and CBCT were used to examine the lesions. A differential diagnosis suggests that the lesions were related to mastoiditis, and based on reference studies, burial information, and paleopathological observation, pollution in the living environment and poor living conditions may be potential factors that caused individuals M137 and M199 to suffer from mastoiditis. The two examples from Qufu are the earliest reported cases of mastoiditis from China; however, infections in the middle ear often go unnoticed in archaeological samples.

Histomorphological study on hypocellularity in mastoid processes from archaeological human skeletons.

OBJECTIVE: To evaluate processes causing two types of mastoid hypocellularity (Type 1 and Type 3), and to provide histomorphological criteria for a differential diagnosis in archaeological human bone. MATERIALS AND METHODS: Eight human crania from the early medieval cemetery in Dirmstein (Rhineland-Palatinate, Germany) displaying secondary obliteration of mastoid air cells were analyzed using light-microscopy and backscattered electron imaging. RESULTS: In Type 1 hypocellularity, obliteration starts in the non-pneumatized portion of the mastoid process and extends into the pneumatized portion. The findings could represent a chronic, maybe recurrent condition related to a pathologically altered middle ear mucosa in early childhood. In Type 3, a sequence of resorptive and proliferative processes are present and are consistent with a healing stage of mastoiditis. CONCLUSIONS: Using histomorphology, in vivo processes resulting in different types of mastoid hypocellularity can be assessed, even in bones that have undergone some degree of diagenesis. SIGNIFICANCE: The study provides methods to evaluate the etiology of histomorphological changes of the mastoid process, which potentially provides insight into the presence of infection and inflammation in past populations. LIMITATIONS: Diagenetic modifications of archaeological bone can hinder assessment of histomorphological change, requiring careful evaluation during analysis. SUGGESTIONS FOR FURTHER RESEARCH: Including histomorphology in future studies on archaeological human crania can contribute to an improved differential diagnosis of pathological conditions in the middle ear region.

An innovative method to visualise mastoiditis using a hand-held X-ray system.

OBJECTIVE: We explore the utility of using a hand-held X-ray system to diagnose mastoiditis in archaeological populations. MATERIALS: A sample (n = 56) of hunter-fisher-gatherers from the Early Neolithic (8,000-7,000/6,800 cal. BP) Cis-Baikal cemetery of Shamanka II (Russia) were examined. METHODS: Images were taken medio-laterally, approximately 90° to a sensor temporarily affixed to the lateral surface of the mastoid process. Digital radiographs were analysed for signs of mastoiditis occurring pre- and/or post-puberty. RESULTS: Two thirds of individuals (39/56) exhibited evidence of mastoiditis. Chronic mastoiditis and chronic sinusitis co-occurred in 61.5% (24/39) of observable individuals. CONCLUSIONS: This method was found to be an effective, convenient, and versatile non-destructive alternative to sectioning and traditional radiographic imaging. SIGNIFICANCE: This is the first project to adapt a hand-held X-ray system for imaging and diagnosis of mastoiditis and this approach encourages future analyses of this infection. LIMITATIONS: The cost of the imaging system is limiting and there are few comparative images taken in the same plane. SUGGESTIONS FOR FURTHER RESEARCH: Further research should create a larger catalogue of comparative radiographs and assess the diagnostic potential of imaging the mastoid process to rather than imaging the entire pneumatized portion of the temporal bone.

Reemergence of the Natural History of Otolaryngologic Infections: Lessons Learned from 2 American Presidents.

Presidents George Washington and Theodore Roosevelt suffered complications of epiglottitis and otomastoiditis, respectively. The introduction of antibiotics and vaccinations against Haemophilus influenzae and Streptococcus pneumoniae has significantly reduced the incidence of these otolaryngologic infections, such that the natural history of the disease is rarely encountered. However, antibiotic resistance and pathogenic evolution has raised concern about increased virulence of these common organisms. A retrospective evaluation of the complications suffered by Washington and Roosevelt provides valuable insight to the natural history of common otolaryngologic infections that may reemerge as a result of organism evolution in response to antibiotics and vaccines.

Anesthesia, antisepsis, microscope: the confluence of neurotology.

Neurotology and skull base surgery slowly emerged out of a confluence of interrelated disciplines and technologies over the past century to become the field that we know today. Its formation required the marriage of neurosurgery and otology, the introduction of the operating microscope, and advances in surgical technique, anesthesia, and radiology. Along the way, the field also began involving specialists within ophthalmology and craniofacial and plastic and reconstructive surgery. Lastly, and perhaps most importantly, the formation of neurotology and skull base surgery required pioneering surgeons who were willing to push the boundaries of their training, sometimes under the ridicule or scorn of the medical establishment. This historical overview focuses upon the origins of the specialty, from the birth of otology and neurosurgery up through the last quarter century.

[Conservative therapy of mastoiditis and therapeutical indications of mastoidectomy until the end of XIX century. The achievements of Varsovian physicians]. / Leczenie zachowawcze zapalen wyrostka sutkowatego oraz wskazania do jego otwarcia do konca XIX stulecia. Dokonania lekarzy warszawskich.

The problem of treatment of the mastoiditis was discussed long ago--in XVII and XVIII centuries by Jean Riolan (1580-1657), Werner Rolfinck (1599-1673), Jean L. Petit (1674-1750), Jasser and the others. The therapeutic indications of mastoidectomy in 1873 by Hermann Schwartze (1837-1910) is mentioned. The achievements of such German physicians as Friedrich Bezold (1842-1908) and Ernst Küster (1839-1930) are described in detail. The achievements of such Varsovian physicians as Teodor Heiman (1848-1917), Andrzej Alfred Heiman (1984-1933), Edmund Modrzejewski (1849-1893), Samuel Meyerson (1851-1939) and Ludwik Guranowski (1853-1926) are also presented.

Acute otitis media: the evolution of surgical management.

OBJECTIVE: Acute suppurative otitis media has been a common disease since time immemorial and, until the late nineteenth century, was followed by a high complication rate, major morbidity, and frequent mortality. Since then, the overall incidence of the disease has changed little; however, in less than a century, progressively more sophisticated surgery and the introduction of antimicrobials have reduced the mortality, at least in developed countries, to a rarity. Complications such as chronic perforation of the tympanic membrane or cholesteatoma, although much less frequent than in the past, are not uncommon. The evolution of mastoid surgery into the antibiotic era is reviewed. CONCLUSION: There is concern that with the increasing frequency of bacterial resistance to antibiotics and the decreasing familiarity of family practitioners with the clinical presentation of complicated otitis media that we may be faced with a resurgence of mastoid disease.

Contemporary presentation and management of a spectrum of mastoid abscesses.

BACKGROUND: The incidence of complications resulting from suppurative otitis media has significantly decreased since the introduction of antibiotics. At the start of the 20th century 50% of all cases of otitis media developed a coalescent mastoiditis. By 1959, the incidence had fallen to 0.4%. Recent studies suggest a current incidence of only 0.24%. Additionally, during the time of Friedrich Bezold (1824-1908), 20% of patients with mastoiditis developed subperiosteal abscess. Interestingly, this has incidence increased; today nearly 50% of patients diagnosed with coalescent mastoiditis have subperiosteal abscess. OBJECTIVE: To review the contemporary presentation, diagnosis, and management of a spectrum of mastoid abscesses. DESIGN: Retrospective case series. SETTING: Hospitals associated with the Department of Otolaryngology/Head and Neck Surgery at the University of California, San Francisco. PATIENTS: Three patients with mastoid abscesses are reported. One patient displayed "classic" Bezold's abscess, with pus escaping the mastoid near the incisura digastrica and tracking along the digastric and sternocleidomastoid muscles into the neck. The second and third patients exhibited temporoparietal swelling secondary to mastoid abscess eroding the root of the zygomatic process, a complication noted by Bezold in 1908 as occurring "in only very rare cases." RESULTS AND CONCLUSIONS: Since only one third of patients show pathologic tympanic membrane changes, and since complaints of otalgia, fever, and tenderness are inconstant, subperiosteal mastoid abscess is frequently a delayed diagnosis. The clinical presentation, pathogenesis, and routes of abscess spread are presented with photographic and radiographic illustration. Medical and surgical management is reviewed, and methods for accurate diagnosis are emphasized.

Ambroise Paré and the king's mastoiditis.

In 1560, François II, King of France, died of mastoiditis. Ambroise Paré was among his attendants. Paré was technically capable of draining the king's post-auricular abscess; this paper examines some of the reasons why he did not attempt any surgical procedure. This was a time of extreme tension between Catholics and Huguenots in France. Paré was a Huguenot, and the king was Catholic. Paré was a "barber-surgeon" which was the lowest level in the medical hierarchy at that time. Paré believed in the humoral theory of disease and may have been discouraged by air in the mastoid sinus. He was also very worried about being accused of poisoning the king. There is no evidence to suggest that the king's mother refused to allow Paré to operate because she wanted to achieve power as Regent of France.

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 rare. A case of Bezold's abscess is presented with special reference to the clinical presentation and pathogenesis of this now uncommon condition. The variations in the routes of spread of the abscess in the fascial planes of the neck are described in detail. The difference between what is known today as a Bezold's abscess and the abscess that Bezold described in the early part of this century are presented.

Prevalence of mastoid infection in prehistoric Arizona Indians.

In view of th reported high prevalence of otitis media and mastoiditis in the present-day Indian inhabitants or Arizona, when an opportunity arose to examine the skulls of prehistoric Indians in the collection of the Arizona State Museum, University of Arizona, Tucson, Arizona, it was thought that determining the prevalence of mastoiditis in them might be helpful in the treatment and prevention of mastoid infections in the present-day population. Our findings are compared with those of two other studies of mastoiditis in prehistoric Indians in another area of the United States.

Histologic processing and examination of a 4,000-year-old human temporal bone.

We believe this is the first report of a mummy temporal bone successfully processed by decalcification and serial sectioning. The condition of the bone required modifications of standard processing technique. Examination of the sections revealed evidence of antemortem otitis media and mastoiditis. The technique described should prove useful in otopathological studies of other paleontological specimens.