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Case Reports in Otolaryngology
Volume 2015, Article ID 897239, 4 pages
http://dx.doi.org/10.1155/2015/897239
Case Report

Pediatric Masked Mastoiditis Associated with Multiple Intracranial Complications

1ENT Department, “P. & A. Kyriakou” Children’s Hospital of Athens, Athens, Greece
2Imaging Department, “Agia Sophia” Children’s Hospital of Athens, Athens, Greece

Received 30 April 2015; Accepted 15 June 2015

Academic Editor: Wolfgang Issing

Copyright © 2015 Charalampos Voudouris et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Masked mastoiditis is a distinct form of mastoiditis with little or no symptomatology, characterized by its potential to generate severe otogenic complications. Therefore, suspected masked mastoiditis should be diagnosed and treated without delay. This study reports a rare case of masked mastoiditis, manifested by multiple intracranial complications in an immunocompetent girl. The child exhibited headache and neurological symptomatology. Imaging studies revealed an epidural and a large cerebellar abscess and the patient was immediately treated with a triple antibiotic therapy. Mastoid surgery and drainage of the epidural abscess took place after the stabilization of the patient’s neurologic status, on the 3rd hospitalization day. The cerebellar abscess was treated by craniectomy and ultrasound-guided needle aspiration in the 3rd week of hospitalization. The girl was finally discharged in excellent condition. Two years later, she is still in good health, without otological or neurological sequelae. Masked mastoiditis is an insidious disease which requires increased clinical awareness and adequate imaging. Should clinical and/or radiological findings be positive, mastoidectomy must follow in order to prevent severe otogenic complications that can be triggered by masked mastoiditis.