Acute Mastoiditis Research Articles

Langerhans cell histiocytosis involving bilateral temporal bones in infant patient: a case report

Langerhans' cell histiocytosis (LCH) is a rare pediatric disease of unknown etiology. The mastoid and skull base are common sites of involvement in LDH. We present a case of bilateral langerhans histiocytosis in 9-month-old infant presented with bilateral post auricular swelling for 2 month mimic the picture of acute mastoiditis. Patient diagnosed after CT scan and open biopsy from mastoid cavity.

PaediatricMastoid Subperiosteal Abscess: Diagnostic and Treatment Essentials

Mastoid subperiosteal abscess (SA) is the most common complication of acute mastoiditis. Today, no uniformly accepted diagnostic or treatment protocols exist. Imaging studies for all patients and mastoidectomy plus myringotomy, traditionally constitute the gold-standard of treatment methods. However, more conservative approaches viewed as safe and reliable alternative options for the clinician have recently gained popularity. In this review authors try to answer some vital questions regarding the diagnosis and management of SA in children, based on the relevant literature and their personal experience.

Acute mastoiditis in children with a cochlear implant

ObjectivesCochlear implantation is performed at a young age, when children are prone to acute otitis media. Acute mastoiditis is the most common complication of otitis media, but data on its management in the presence of a cochlear implant are sparse. The objective of this study was to assess the characteristics, treatment, and outcome of acute mastoiditis in children with a cochlear implant. MethodsThe medical files of all children who underwent cochlear implantation at a pediatric tertiary medical center in 2000–2014 were retrospectively reviewed. Those diagnosed with acute mastoiditis after implantation were identified, and data were collected on demographics, history, presentation, method of treatment, complications, association with untreated otitis media with effusion, and long-term middle-ear sequelae. ResultsOf the 370 children (490 ears) who underwent cochlear implantation, 13 (3.5%) were treated for acute mastoiditis (median age at acute mastoiditis, 32 months). Nine had a pre-implantation history of chronic secretory or acute recurrent otitis media, and 5 had been previously treated with ventilation tubes. In all 9 children who had unilateral cochlear implant, the acute mastoiditis episode occurred in the implanted ear. The time from implantation to mastoiditis was 5–61 months. The same treatment protocol as for normal-hearing children was followed, with special attention to the risk of central nervous system complications. Primary treatment consisted of myringotomy with intravenous administration of wide-spectrum antibiotics. Surgical drainage was performed in 8 out of 13 patients, with (n=7) or without (n=1) ventilation-tube insertion, to treat subperiosteal abscess or because of lack of symptomatic improvement. There were no cases of intracranial complications or implant involvement or need for a wider surgical approach. No middle-ear pathology was documented during the average 3.8-year follow-up. ConclusionsThe relatively high rate of acute mastoiditis and subperiosteal abscess in children with a cochlear implant, predominantly involving the implanted ear, supports the suggestion that recent mastoidectomy may be a risk factor for these complications. Despite the frequent need for drainage, more extensive surgery is usually unnecessary, and recovery is complete and rapid. As infections can occur even years after cochlear implantation, children with otitis media should be closely followed, with possible re-introduction of ventilation tubes.

Acute Mastoiditis in Children During the 7-Valent Pneumococcal Conjugate Vaccine (PCV-7) Era

Acute Mastoiditis in Children During the 7-Valent Pneumococcal Conjugate Vaccine (PCV-7) Era

Lateral Sinus Thrombosis--A Rare Complication of an Acute Mastoiditis or Infected Cholesteatoma

Lateral sinus thrombosis (LST) is a rare but threatening complication of an acute mastoiditis or infected cholesteatoma. Currently only very few papers are available in the literature dealing with the systematic investigation of patients with suspected LST. The purpose of the present study was to evaluate the clinical, intraoperative and therapeutic findings of patients with particular disease. For this retrospective study the clinical records of 7 patients which were admitted for a suspected LST were evaluated. All patients underwent mastoidectomy with exposition of the lateral sinus and investigating of its blood flow. A LST was confirmed in 4 patients, 3 patients had a phlebitis. Patients with a LST presented additional symptoms beside otalgia, i. e., dizziness, cephalgia, meningism, deafness of the affected ear, and facial nerve paresis. Postoperative MRI scans revealed a recanalization of the sinus in all cases. Although immediate surgery, 2 patients developed a 2-staged brain abscess in the cerebellum. Clinical symptoms of the SVT are unspecific. In cases of an acute mastoiditis, neurological signs might be pathognomonic and can direct to a LST. Therapeutic concepts comprise intravenous antibiotics and operative elimination of disease. The exposition of the lateral sinus should be performed in any mastoidectomy for a LST in order to scrutinize its blood flow. In case of a thrombosis additional anticoagulative therapy might be indicated. To exclude a 2-staged brain abscess control MRI scans 7 through 14 days postoperatively are recommended.

A prospective study of seven patients with chronic mastoiditis

Introduction: Chronic mastoiditis is generally a result of chronic suppurative otitis media; it is rarely a result of failure of treatment of acute mastoiditis. Case presentation: Seven patients with chronic mastoiditis were investigated. Four patients had bilateral mastoiditis. The duration of illness ranged from 1 to 45 years. A comparison between operative and external auditory canal cultures was performed. The operative specimens were obtained directly from the infected mastoids. The external ear and mastoid specimens were inoculated and cultivated immediately by bedside. All cases showed positive bacterial cultures. The growth was monomicrobial in two cases and polymicrobial in five cases. Seventeen isolates were recovered (11 aerobes and six anaerobes). Pseudomonas aeruginosa was the most predominant isolate (23.5 %) and was recovered from four patients (57 %). This high prevalence may be related to misuse of ear drops that transmit this organism from skin flora towards the mastoid. The anaerobes were isolated from four patients. This may indicate a significant role of anaerobic bacteria in producing chronic mastoiditis that would not respond to usual treatment measures. Conclusion: Cultures from external ear canal discharge might be used as a source for isolation of bacteria causing chronic mastoiditis and chronic otitis media provided that the specimen was collected and cultivated properly. They revealed sensitivity (88 %), specificity (100 %), positive predictive value (100 %) and negative predictive value (66 %). In anaerobic cultures, the sensitivity was 66.7 %. No previous studies were found with regard to evaluation of the reliability of external ear culture for isolation of the causative agents of chronic mastoiditis or chronic otitis media.

Paediatric acute mastoiditis, then and now: is it more of a problem now?

Acute mastoiditis is a significant cause of morbidity in the paediatric population. This paper reviews our experience with this condition over the last 10 years and compares it with historical data from Alder Hey Children's Hospital, Liverpool, UK. A retrospective case note review of patients who presented between 2003 and 2012 was performed. Forty-six patients with acute mastoiditis were identified. Imaging with computed tomography and magnetic resonance imaging was carried out in 14 cases (30.4 per cent). Intracranial complications were identified in six patients (13.0 per cent), one of whom required neurosurgical intervention. In 27 cases (58.7 per cent), a surgical procedure was performed. Data from 1995 to 2000 revealed similar rates of imaging (30.0 per cent), but significantly lower rates of surgical intervention (23 per cent). A lower rate of intracranial complications (4.8 per cent) in the historical cohort did not prove to be statistically significant (p = 0.419). The numbers of paediatric patients presenting with acute mastoiditis appears essentially unchanged. Improvement in imaging technology and aids to interpretation may explain the apparent increase of intracranial complications.

A Novel Radiographic Sign and a New Classifying System in Mastoiditis-Related Epidural Abscess.

To describe a novel radiographic sign ("halo") and a new classification method of an evolving perisigmoid epidural abscess and present its correlation with intraoperative findings. Retrospective and prospective cohort study in a tertiary academic children's hospital. The retrospective arm (15 children) was conducted between 1998 and 2007 and the prospective arm (11 children) between 2008 and 2013. The computerized tomographic appearance of the perisigmoid region was classified into four groups: Class I, normal; Class II, smooth halo; Class III, nodular halo 4 mm or less in diameter; and Class IV, gross nodular halo more than 4 mm in diameter. Intraoperative findings of the perisigmoid region were compared with the preoperative scan results. The correlation between preoperative imaging and intraoperative findings of the retrospective arm was highly significant (p = 0.007). The correlation between the preoperative imaging studies and intraoperative findings of the prospective arm was also highly significant (p = 0.005). The interobserver agreement for the proposed classification method was high (Cohen kappa score, 0.76; weighted kappa score, 0.84). A novel radiographic sign ("halo") and a new classification method for an evolving perisigmoid epidural abscess in acute mastoiditis are described. A thin and smooth halo sign is not indicative of a true abscess formation. Gross perisigmoid granular changes, however, are highly suggestive of an epidural abscess that warrants surgical intervention.

Children hospitalized due to acute otitis media: How does this condition differ from acute mastoiditis?

ObjectivesTo evaluate the clinical picture and microbiological findings of children hospitalized due to acute otitis media and to analyze how it differs from acute mastoiditis. MethodsA retrospective review of the medical records of all children (0–16 years) hospitalized due to acute otitis media in the Department of Otorhinolaryngology at the Helsinki University Hospital, between 2003 and 2012. Comparison with previously published data of children with acute mastoiditis (n=56) from the same institute and period of time. ResultsThe most common pathogens in the children hospitalized due to acute otitis media (n=44) were Streptococcus pneumoniae (18%), Pseudomonas aeruginosa (16%), Streptococcus pyogenes (14%), and Staphylococcus aureus (14%). One of the most common pathogens of out-patient acute otitis media, Haemophilus influenzae, was absent. Otorrhea was common in infections caused by S. pyogenes and otorrhea via tympanostomy tube in infections caused by P. aeruginosa. In children under 2 years-of-age, the most common pathogens were S. pneumoniae (43%), Moraxella catarrhalis (14%), and S. aureus (7%). S. pyogenes and P. aeruginosa were only found in children over 2 years-of-age. Previous health problems, bilateral infections, and facial nerve paresis were more common in children hospitalized due to acute otitis media, compared with acute mastoiditis, but they also demonstrated lower CRP values and shorter duration of hospital stay. The number of performed tympanostomies and mastoidectomies was also comparatively smaller in the children hospitalized due to acute otitis media. S. aureus was more common and S. pneumoniae, especially its resistant strains, was less common in the children hospitalized due to acute otitis media than acute mastoiditis. ConclusionsAcute otitis media requiring hospitalization and acute mastoiditis compose a continuum of complicated acute otitis media that differs from common out-patient acute otitis media. The bacteriology of children hospitalized due to acute otitis media resembled more the bacteriology of acute mastoiditis than that of out-patient acute otitis media. The children hospitalized due to acute otitis media needed less surgical treatment and a shorter hospitalization than those hospitalized due to acute mastoiditis.

Subperiosteal abscesses in acute mastoiditis in 115 Swedish children

ObjectivesTo study the outcome of different surgical methods of treating subperiosteal abscesses resulting from acute mastoiditis. MethodsMedical records for all children from a Swedish retrospective multicentre study, conducted between 1993 and 2007, with acute mastoiditis and subperiosteal abscess, but without predisposing diseases or other complications, were studied. A total of 115 children aged 0–16 years were identified. All patients had received intravenous antibiotics and most had undergone myringotomy. ResultsThirty-three children had been treated with only minor interventions such as retroauricular needle aspiration and/or incision, while 67 had undergone mastoidectomy. Fifteen had undergone both needle aspiration and mastoidectomy. The group treated with needle aspiration/incision was compared with those treated with mastoidectomy. One of the few significant differences found between the groups was a longer hospital stay in the group that had undergone mastoidectomy. ConclusionsRetroauricular needle aspiration and/or incision combined with intravenous antibiotics and myringotomy was an effective first-line treatment for subperiosteal abscesses resulting from acute mastoiditis. In this retrospective study, no greater risk of further complications was seen in this group compared to the group in which mastoidectomy was performed.

The impact of the Italian guidelines on antibiotic prescription practices for acute otitis media in a paediatric emergency setting.

BackgroundAcute otitis media (AOM) is one of the most common childhood infectious diseases. The recent Italian Pediatric Guidelines for the treatment of AOM constitutes a step forward in the management of children with uncomplicated AOM. The aim of this study was to evaluate antibiotic prescription patterns for AOM in a Pediatric Emergency Department (PED) after those guidelines were introduced and to assess the relationship between implementation of the “watchful waiting” strategy and the incidence of acute mastoiditis in the PED.MethodsThis retrospective study was conducted between 1st January 2007 to 31st December 2013 at the PED of the University of Modena and Reggio Emilia in Modena (Italy). All children between 0 and 14 years who were examined because of symptoms and/or signs of AOM and acute mastoiditis were enrolled. Pearson’s chi-squared test was used to evaluate if introduction of the Italian Paediatric Guidelines was associated with a reduction in the antibiotic prescription pattern in children with AOM and/or with an increase in mastoiditis frequency.Results4,573 (89.4%) patients were included in our analysis, antibiotics were prescribed to 81% cases of the children diagnosed with AOM. The frequency of antibiotic prescribing continued to be stable after the Italian guidelines were introduced (82% versus 81%).Forty children were admitted to hospital with a diagnosis of acute mastoiditis. Our study did not find any association between the number of cases of acute mastoiditis and the percentage of patients treated with antibiotics; the annual incidence of mastoiditis before and after the new guidelines were published was, in fact, stable.ConclusionsDespite the diffusion of clinical guidelines recommending a “watchful waiting” approach for children with AOM, the antibiotic prescription rate continues to be high. It appears to be more difficult to impact the percentage of cases for which antibiotics are prescribed than the type of antibiotic that is utilized. In view of these findings, a close follow-up control by the primary care paediatrician or a scheduled follow-up appointment at the PED and incisive campaigns to promote parents’ awareness of proper antibiotic use appear to be warranted.

Challenges in the management of acute mastoiditis in children.

Acute mastoiditis (AM) is a rare but serious complication of otitis media. Recent studies consolidated the role of Streptococcus pyogenes as the second most important etiologic agent of AM and suggested an increased involvement of a relatively new pathogen (Fusobacterium necrophorum). The recently accumulated evidence on AM epidemiology in children is conflicting and not convincing in demonstrating clear trends during the last years. While a significant decrease was recorded in the incidence of pneumococcal invasive disease and complicated AOM following the introduction of the pneumococcal conjugate vaccines, data on the efficacy of these vaccines in the prevention of AM are limited and did not show any remarkable changes in the dynamics of disease caused by Streptococcus pneumoniae. The clinical findings in AM may differ according to the causative pathogen and different patient age subgroups. Together with computerized tomography, magnetic resonance imaging became frequently used, particularly in the diagnosis of AM complications. Simple mastoidectomy remains the most reliable and effective surgical intervention for the treatment of subperiosteal abscesses.

Chronic lymphocytic leukemia relapse presenting as acute otitis media with facial palsy

ObjectiveTo describe a case of chronic lymphocytic leukemia relapses presenting as bilateral acute otitis media with left facial paralysis. MethodsCase report and review of the literature. IntroductionChronic lymphocytic leukemia is the most common leukemia in adults predominantly the elderly. Despite advances in treatment still chronic Lymphocytic leukemia is an incurable disease; relapse of leukemia may occur several months to years after a complete remission. Extramedullary manifestations of relapsed chronic lymphocytic leukemia (CLL) present with a wide range of symptoms and signs yet involvement of temporal bone is a rare presentation of the disease.9,10We present a patient who was diagnosed with chronic lymphocytic leukemia (CLL) who presented with bilateral acute otitis media and mastoiditis with left facial paralysis.

Skull Base Osteomyelitis Presenting with Facial Paralysis, Low Cranial Nerve Palsies and Bilateral Carotid Involvement: A Case Report

Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Murat Mert Atmaca MD, Istanbul University Faculty Of Medicine, Department Of Neurology, Istanbul, Turkey Phone: +90 212 414 20 00-32578 E-mail: drmuratmertatmaca@hotmail.com Re cei ved/Ge lifl Ta ri hi: 27.09.2013 Ac cep ted/Ka bul Ta ri hi: 16.05.2014 Skull base osteomyelitis (SBO) typically presents with severe otalgia and unilateral otorrhea in immune-compromised, particularly in elderly diabetic patients. Skull base osteomyelitis usually presents with external otitis but it can also occur as a complication of acute otitis media and mastoiditis. Complications of SBO are venous sinus thrombosis, meningitis, abscess, cranial neuropathies and carotid invasion with or without ischemic stroke. Here we report a case with SBO presenting with facial paralysis, lower cranial nerve palsies and bilateral carotid involvement which occurred following sore throat and bilateral otalgia. (Turkish Journal of Neurology 2015; 21:27-30)

The Case Files

FigureA 65-year-old man presented to the ED via EMS with symptoms of stroke. The paramedics stated his right-sided weakness and speech difficulty started 40 minutes prior to presentation in the ED. En route to the hospital, paramedics observed four episodes of facial twitching. Vitals signs were significant for a rectal temperature of 100.2°F and a fingerstick blood sugar of 220 mg/dL. History of present illness was significant for a diagnosis of left otitis media treated with Augmentin and Vicodin at an urgent care center one day prior to presentation. Past medical history included hypertension, hypercholesterolemia, and diet-controlled borderline diabetes mellitus. He appeared confused and did not follow commands. He had a right lateral gaze, a right pronator drift, and global aphasia. Left tympanic membrane was perforated with purulent discharge. No mastoid tenderness or overlying skin changes were noted. A head CT scan without contrast was performed, and revealed an ill-defined low attenuation lesion within the posterior left temporal lobe with associated pneumocephalus. Given ipsilateral opacification of the mastoid air cell and middle ear, findings were concerning for otomastoiditis complicated by intracerebral abscess. A follow-up maxillofacial CT scan with contrast showed thinning of the overlying roof of the temporal bone with dehiscence at multiple locations. A focus of associated pneumocephalus was identified. No definite abnormal parenchymal enhancement was identified, but the findings were consistent with intracerebral abscess complicating otomastoiditis. Laboratory studies including complete blood count with differential showed WBC 11.54 with 88.2% neutrophils. Pre-operative labs and blood cultures were drawn; the patient was given Levetiracetam, ceftriaxone, and vancomycin, and taken to the operating room by neurosurgery and ENT. A left ear culture grew Pseudomonas oryzihabitans and Streptococcus pneumoniae. An intracranial abscess grew S. pneumoniae. The patient did well post-operatively, and was discharged home on IV antibiotics. A brain abscess is a focal, suppurative collection in the brain parenchyma resulting from an infection, trauma, or neurosurgery. Approximately 1,500 to 2,000 cases of brain abscesses are diagnosed in the United States annually, with an estimated one in 10,000 being hospitalized. (Int J Infect Dis 2006;10[2]:103.) Rates are higher in certain high risks groups, including patients with HIV/AIDS. (N Engl J Med 2014;371[5]:447.) Bacterial invasion is from direct or hematogenous spread. Direct spread makes up 20 to 60 percent of all abscesses, which are caused by otitis media, mastoiditis, dental and other oropharyngeal diseases, or sinusitis, and usually result in a single abscess. (Laryngoscope 1998;108[11]:1635.) Ear infections are decreasing as a cause of brain abscesses in developed countries, but sinus infections continue to be an important consideration. (Laryngoscope 1998;108[11]:1635.) When infection spreads from the mastoids or middle ear to the CNS, the cerebellum, temporal lobes, or both are most often involved. (Laryngoscope 1998;108[11]:1635.) The most frequently isolated pathogen in acute mastoiditis is S. pneumoniae, with a prevalence of approximately 30 percent with minimal variation worldwide. (Laryngoscope 1998;108[11]:1635; QJM 2002;95:501.) Common symptoms and signs include headache in 70 percent of cases, mental status changes in 65 percent, focal neurological deficits in 65 percent, fever in 50 percent, seizures in 25 to 35 percent, nausea and vomiting in 40 percent, nuchal rigidity in 25 percent, and papilledema in 25 percent. (N Engl J Med 2014;371[5]:447; QJM 2002;95[8]:501.) The classic triad of fever, headache, and a focal neurological finding is only present in 20 percent of patients. Fever is absent in about 50 percent of patients with brain abscess at the time of the initial presentation. (N Engl J Med 2014;371[5]:447; QJM 2002;95[8]:501.) A lesion in the temporal lobe may lead to an ipsilateral headache, aphasia, and possibly a visual field defect. Hematogenous spread from bacteremia usually leads to multiple abscesses, usually in the territory of the middle cerebral artery. (N Engl J Med 2014;371[5]:447; QJM 2002;95[8]:501.) As many as 85 organisms have been cultured from blood, CSF, or infection sites of patients with brain abscesses. The most common organisms are Streptococcus spp. and Staphylococcus spp. (N Engl J Med 2014;371[5]:447.) A meta-analysis by Brouwer, et al. found Pseudomonas spp in only two percent of all cultured bacteria. P. oryzihabitans is rare and opportunistic, and is an interesting isolate in our case. It is most commonly associated with catheters, other foreign body causes of bacteremia, and is interesting because this patient had no previous implantation of surgical objects. (Microb Ecol 2011;62[3]:505.)FigureCase fatality rates from brain abscesses have decreased from 40 to 10 percent, with rates of full recovery increasing from 33 to 70 percent over the past 50 years. These improvements have been attributed to advancement in antibiotics, stereotactic biopsies, and advanced imaging techniques such as MRIs and CT scans. (N Engl J Med 2014;371[5]:447.) Access the linksin EMN by reading this on our website or in our free iPad app, both available atwww.EM-News.com. Comments?Write to us at[email protected].

Primary otological manifestations of granulomatosis with polyangiitis: a case series

A primary otological presentation of granulomatosis with polyangiitis is rare. We present four cases of granulomatosis with polyangiitis with different otological manifestations. A literature review of granulomatosis with polyangiitis cases presenting to otolaryngologists was undertaken. A case series review of four patients presenting within a 12-month period was also performed. One patient had serous otitis media which worsened after myringotomy. Two patients presented with acute ear infection and facial palsy and one with acute mastoiditis. All were positive for antineutrophilic cytoplasmic antibody, and three had positive findings upon histological analysis. When acute supposed ear infections fail to respond to treatment (antibiotics or surgery), rarer causes of the symptoms should be considered. By reporting this case series, we aim to improve the early diagnosis of granulomatosis with polyangiitis to enable timely treatment and prevent systemic involvement.

Changing trends of acute otitis media bacteriology in central Israel in the pneumococcal conjugate vaccines era.

The widespread use of 7-valent pneumococcal conjugate vaccine (PCV7) has changed acute otitis media (AOM) bacteriology. Only scattered data with regard to this effect of PCV13 have been published so far. We retrospectively identified children <6 years of age who presented to our hospital with AOM, and had middle ear fluid (MEF) cultures obtained during tympanocentesis or from spontaneous otorrhea during 2008-2013, when PCV7 (2009) and PCV13 (2010) were gradually introduced in the Israeli National Immunization Program. Data were extracted for demographics, clinical and microbiologic parameters, according to vaccination status. Of the 295 eligible AOM episodes reported in 279 children, 224 (76%) had MEF cultures from tympanocentesis and 71 (24%) from spontaneous otorrhea. Boys and children <2 years of age contributed 178 (60%) and 219 (74%) AOM episodes, respectively. Acute mastoiditis complicated 58 (20%) of these episodes. None of the children were PCV immunized in 2008, but >90% had received ≥1 PCV dose(s) by 2011 or later. Of the 106 (36%) MEF cultures which tested positive for otopathogens, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and multiple bacteria grew in 60 (57%), 39 (37%), 2 (2%) and 5 (5%) episodes, respectively. S. pneumonia-positive MEF culture rate in unimmunized children (31, 69%) was significantly higher than in PCV7-immunized children (22, 59%) or PCV13-immunized children (12, 50%), P = 0.04 and P = 0.02, respectively. PCV7 and PCV13 implementations in the Israeli National Immunization Program were associated with a rapid reduction of "severe" pneumococcal AOM episodes.

Langerhans Cell Histiocystosis of Temporal Bone: Case Reports

Histiocytosis X or Langerhans cell histiocytosis (LCH), is a rare disease that highly varied clinical presentation ranging from single system to multisystem involvement. In otolaryngologic practice temporal bone presentation is clinically similar to otitis externa, otitis media, acute mastoiditis, chronic mastoiditis. We diagnosed and treated 3 temporal bone LCH cases. In this paper these cases are presented and their optimum treatment is discussed in detail.

Complications of Acute Mastoiditis in a Child in this Era of Antibiotics

Complications of Acute Mastoiditis in a Child in this Era of Antibiotics

9개월된 영아에서 발생한 급성 융합성 유양동염과 동반된 Bezold 농양 1예

Complications of acute otitis media are greatly decreased since the introduction of antibiotics. However, inappropriate antibiotic therapy leads to complications of acute otitis media in children associated with significant morbidity. Among the complication of acute otitis media, Bezold’s abscess is an abscess in the sternocleidomastoid muscle where pus from a mastoiditis escapes into the sternocleidomastoid. It is a rare complication of acute otitis media in these days. The authors report a case of Bezold’s abscess with acute coalescent mastoiditis occurring in 9-month-old infant with review of literatures. To our knowledge, this is the youngest case report of Bezold’s abscess in Korea. (J Clinical Otolaryngol 2014;25:185–190)