Mastoid subperiosteal abscess as a first sign of unnoticed cholesteatoma in children.

Aim: To present children who underwent mastoidectomy for congenital cholesteatoma presented as a subperiosteal abscess.

Results: All seven children (age range 7-14 years, six boys) presented with retroauricular swelling, erythema and fluctuation in the mastoid area, and one child also had a mastoid-cutaneous fistula. Five children had otorrhoea, while the other two had normal-appearing tympanic membranes. None of the children had a history of middle ear disease. Four children were treated with antibiotics for a recent episode of otitis media prior to admission. The main findings at surgery were pus, granulations and erosion of the mastoid cortex. Pseudomonas aeruginosa and Proteus sp. were isolated from the abscess in two patients, and the other five cultures were negative. All the patients demonstrated some degree of hearing impairment after surgery.

Conclusion: Surgical eradication of a mastoid SA in older children is essential as it may be the first indication of an underlying CC.