Retroauricular Abscess in Adults

Abstract

Objectives: To describe the clinical course and outcome of a group of adults who presented with a subperiosteal abscess (SPA) MATERIALS and METHODS: A retrospective chart review of patients with SPA.

Results: Between 2001 and 2015, 7 such patients-5 men and 2 women-were identified. Their age ranged from 18 to 62 years. Six of them suffered from chronic otitis media (COM) and presented with signs and symptoms of otalgia, pain, and swelling around the mastoid. Five of the patients underwent a previous mastoidectomy for cholesteatoma (4- canal wall down and 1 had canal wall up). One of the non-operated patients had cholesteatoma and the other one had chronic suppurative otitis media without cholesteatoma. One patient developed peripheral facial nerve palsy that resolved after surgery, otherwise, no other intratemporal or intracranial complications were observed. Management included a canal wall down mastoidectomy, abscess drainage, and parenteral wide-spectrum antibiotics. One patient suffered cardiovascular and respiratory comorbidities, requiring the delay of surgery for 6 days. This patient underwent incision and drainage of the abscess before surgery. Pathogens were recognized in 4 of the patients and included Streptococcus pneumoniae, Candida albicans, Staphylococcus aureus, and Corynebacterium.

Conclusion: SPA in adults is rare but may be seen in cases of neglected COM, whether previously operated or not. Comorbidities in older population group may require postponing surgery, so immediate incision and drainage may be warranted, as well as post-surgical intensive care.

Figure 1

An axial head CT with contrast of a patient with a subperiosteal abscess on the right, several years after a mastoidectomy for cholesteatoma (patient 6). Notice the soft tissue swelling with abscess and the incomplete mastoid cortex, due to a previous mastoidectomy. The right sigmoid sinus fills normally with contrast material. CT: computed tomography.