Bezold’s Abscess

What is Bezold's Abscess?

Bezold's abscess is a complication of acute mastoiditis when the disease passes inferiorly through the medial aspect of the mastoid tip into the sheath of the sternomastoid muscle.

What is the aetiology of Bezold's abscess?

Acute mastoiditis which usually follows an attack of acute suppurative otitis media when:
1) Lowered resistance of patient due to measles, exanthematous fever, poor nutrition and immune-compromising systemic disease
2) High virulence of organism. The most common organism infecting children is pneumococci

What is the pathology of Bezold's abscess?

If an attack of acute suppurative is untreated or fails to respond, the inflammatory process persists and there is accumulation of pus in the mastoid air cells. The eustachian tube or a perforation in the tympanic membrane is not sufficient to drain the pus produced. This results in necrosis of the bony walls of the cells inferiorly producing Bezold's abscess.

What are the symptoms of Bezold's abscess?

1) Fever and malaise: Fever is persistent, in spite of adequate antibiotics. It can be as high as 40oC
2) Pain: It is present in the upper part of the neck and the sternomastoid. Neck movements are restricted
3) Ear discharge: The discharge is purulent, profuse and foul smelling
4) Mastoid tenderness is elicited by pressure over the Macewan's triangle

What are the signs on examination?

Following are the signs seen on examination of Bezold's abscess:

1) Sagging of the postero-superior canal wall
2) Perforation of the tympanic membrane
3) Mastoid tenderness elicited by pressure over the Macewan's triangle
4) Conductive type of hearing loss
5) There is usually no fluctuation felt
6) Generalized tender swelling below the pinna
7) This swelling often conceals the contours of the mastoid process.

What investigations are required for the diagnosis of Bezold's abscess?

1) Routine blood counts: Cells show polymorphonuclear leucocytosis with raised ESR
2) X-ray mastoid – Schuller's view: It may show lysis and destruction of the mastoid air cells.
3) HRCT temporal bone: This indicates the extent of the disease, status of the middle ear, ossicles, and the facial nerve. It also gives an idea of any impending complications.

What is the treatment for Bezold's abscess?

Surgical treatment is necessary when the abscess is well formed.

Surgical line:

1) Drainage of the abscess formed
2) Mastoidectomy is required to eradicate the disease in chronic mastoiditis.