Definition

A Bezold abscess is a collection of pus on the side of the neck, generally resulting from complications of middle ear infection. An infected middle ear can spread to the mastoid bone (which forms the rear wall of the middle ear) and then to the neck muscles. Further, the infection can extend to the inner layers of the neck, forming a collection of pus and leading to a Bezold abscess.

The incidence of Bezold abscess has significantly decreased since the discovery of antibiotics. However, recently, the incidence has been rising. This is suspected to be due to undetected middle ear infections that do not receive proper treatment, which can develop into a Bezold abscess.

Causes

The bacteria causing a Bezold abscess are similar to those causing mastoiditis or inflammation of the mastoid bone. Both gram-positive and gram-negative bacteria can cause this condition. Some examples of aerobic gram-positive bacteria that can cause a Bezold abscess include Streptococcus, Staphylococcus, and Enterococcus species. Gram-negative anaerobic bacteria that can cause a Bezold abscess include Klebsiella, Pseudomonas, and Proteus species.

Risk Factor

Several risk factors can lead to a Bezold abscess, including:

1. Low socioeconomic status: It is known that children living in poverty are more likely to develop a Bezold abscess.
2. Medical conditions affecting Eustachian tube function: The Eustachian tube connects the middle ear to the outside world and balances the pressure in the middle ear. Conditions such as cleft palate, immune system disorders, or structural abnormalities in the middle ear or Eustachian tube can increase the risk of middle ear and mastoid infections, thus increasing the risk of a Bezold abscess.
3. Acquired immune system disorders: In adults, conditions like HIV, uncontrolled diabetes, kidney failure, and other causes of immune system impairment should be considered.
4. Chronic ear disease: Patients with chronic ear conditions that are not properly treated are at higher risk.

Symptoms

Symptoms of a Bezold abscess include:

• Neck pain
• Swelling on the side of the neck
• Ear pain
• Tenderness behind the upper part of the ear
• Ear discharge
• Hearing loss

If you experience these symptoms along with fever and neck swelling, it may indicate the spread of infection to the head and neck, requiring further evaluation.

Diagnosis

Anamnesis A Bezold abscess can occur at any age. During anamnesis, your doctor will ask about the symptoms you are experiencing and your history of recurring ear infections, such as recurrent otitis media or chronic otitis media with tympanic membrane perforation. Your doctor will also inquire about any surgeries you have had on the mastoid area.

Physical Examination During the physical examination, your doctor will find abnormalities in your outer ear canal. They may also perform a cranial nerve examination to check if the infection has spread to the head and neck.

Additional Examinations Several additional tests may be conducted to diagnose the condition, including:

• Laboratory tests: Blood samples will be taken to identify the underlying cause of the Bezold abscess. Your doctor may also perform a bacterial culture to identify the bacteria causing the abscess, especially if you have a compromised immune system.
• CT scan of the neck: This is done if there is an indication or suspicion of an abscess in the deeper layers of the neck, as CT scans provide more detailed and specific results.
• X-ray of the temporal bone: If a CT scan is not feasible, this can be performed to check the bones around the ear.

Management

If your doctor diagnoses you with a Bezold abscess, antibiotic therapy will be administered based on the bacterial culture results. If a CT scan reveals fluid accumulation, surgery will remove it.

In addition to treating the Bezold abscess, your doctor will address the underlying cause. If the abscess is due to Chronic Suppurative Otitis Media (CSOM), your doctor will insert a grommet in your ear. A grommet is a small tube placed in the tympanic membrane to treat recurrent CSOM.

The prognosis for a Bezold abscess is generally good if the infection has not spread to the temporal bone and appropriate antibiotic treatment is initiated early.

Complications

Potential complications of a Bezold abscess include:

• Spread of the infection to the sinuses and meninges if not properly treated.
• If the infection spreads to the head, it often affects the inner layers of the neck, potentially causing jugular vein thrombosis, cranial neuropathy, and trismus.
• Long-term abscess cases can lead to meningitis, hearing loss, and even death.

Prevention

If you have an ear infection, promptly seek medical treatment. Proper and timely treatment can prevent a Bezold abscess. If you have a compromised immune system due to conditions like HIV/AIDS or diabetes, ensure regular check-ups with your doctor.

When to see a doctor?

See a doctor immediately if you experience an ear infection or any of the above mentioned symptoms.