A complication of acute suppurative otitis media in the form of atypical apical cervical mastoiditis: treatment experience

Background. Acute suppurative otitis media is a common form of otitis media, involving all the compartments of the middle ear. Without appropriate management, acute suppurative otitis media extends to adjacent anatomical structures, resulting in complications such as facial nerve palsy, mastoiditis, labyrinthitis, petrositis, meningitis, brain abscess, lateral and cavernous sinus thrombosis and hearing loss. Since the advent of antibiotic therapy, which has become a cornerstone of management of acute otitis media, the incidence of complications has markedly declined. However, complications of acute suppurative otitis media may present atypically, without exhibiting classic clinical signs. Apical cervical mastoiditis is a rare complication of acute suppurative otitis media, which can have an atypical and unique course without developing classic manifestations.
Objective. The aim of this study was to describe the experience of treating patients with acute suppurative otitis media complicated by atypical apical cervical mastoiditis.
Results. A retrospective analysis of the medical records of patients with ASO from 2022 to 2024 was conducted. Over a three-year period, 144 of 470 patients with ASO were diagnosed with atypical apical cervical mastoiditis, confirmed by CT of the temporal region. Moreover, characteristic pain and induration upon palpation of the mastoid process were detected in only 16% of patients.
Conclusion. Apical cervical mastoiditis requires a thorough medical history and daily monitoring of the patient's condition and otoscopic findings. A combination of predisposing factors, such as advanced age and comorbidities, along with poor otoscopic progression, should prompt a more extensive laboratory and instrumental examination, despite the absence of pronounced clinical symptoms of apical cervical mastoiditis.

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