Mastoid abscess: underlying disease and management.

Despite a reduction in the incidence, subperiosteal mastoid abscesses (MAs) are still seen today with significant potentials for morbidity and even mortality. I present a series of 19 patients, seen over a 5-year period, with particular emphasis on the underlying disease and management. Ten abscesses (52.6%) succeeded acute suppurative otitis media (AOM); and nine (47.4%) resulted from chronic suppurative otitis media (CSOM). Eighty percent of those with AOM were younger than 10 years, whereas 77.8% of those with CSOM were older than 10 years. Fifty percent of the MAs that resulted from AOM had cortical mastoidectomy. The other five patients were treated with a less invasive method: antibiotics and incision and drainage without mastoid surgery. In eight MA cases caused by CSOM, the management of the abscess as well as the underlying disease was performed in one stage. Two-stage treatment occurred in one case. The study supports the recently recognized increasing role of CSOM in the etiology of MA, especially in adolescents and young adults. The controversy over the management of this disorder is discussed.