Acute mastoiditis without an apparent otitis media has frequently been reported. The conclusion has been that most of these cases of acute mastoiditis arose from transient otitis media evidences of which had disappeared when the mastoiditis was recognized, the infection having passed via the tube, the middle ear and the aditus to the antrum. Then the aditus became choked off with thickened mucosa, allowing the infection of the middle ear to subside, while the infection persisted in the mastoid. If at operation no evidence of infection is found in the antrum, then one may question the possibility of the mastoid infection having arisen from the middle ear.
I have been able to find but two cases of this sort reported in the English and American literature. In 1911, Crockett1 reported a case of acute mastoiditis with an extradural abscess over the cerebellum. There was no history of otitis media
ROBERTS GJ. ACUTE MASTOIDITI WITHOUT INVOLVEMENT OF THE MIDDLE EAR OR THE ANTRUM. Arch Otolaryngol. 1932;16(5):719–720. doi:10.1001/archotol.1932.00630040732007
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