A postauricular subperiosteal abscess forms when pus penetrates through a defect or destruction in the bony wall or the cortical bone at the tip of the mastoid, accumulating beneath the periosteum behind the ear. This condition is more common in children or individuals with well-pneumatized mastoids and occurs frequently in patients with middle ear cholesteatoma.
Clinical manifestations
A prior history of middle ear infection or middle ear cholesteatoma is often present.
Ear pain, high fever, and systemic malaise are present, particularly in children.
Examination reveals redness, swelling, and significant bulging behind the ear, with undulation on palpation. The swelling is typically located in the upper posterior region behind the auricle, causing the auricle to be displaced forward and downward. The postauricular groove disappears due to the swelling.
Aspiration of the abscess can yield purulent fluid, confirming the diagnosis. If the abscess ruptures through the periosteum and skin, it may result in the formation of a sinus tract or fistula.
Treatment
For patients with complicated acute mastoiditis, simple mastoidectomy can be performed to address the abscess.
For chronic suppurative otitis media with mastoiditis, depending on the specific condition, procedures such as radical mastoidectomy, modified radical mastoidectomy, and tympanoplasty should be performed.
Antibiotics can be administered appropriately to manage the infection effectively.