{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:29:07Z","timestamp":1794324547410,"version":"4.9.0"},"reference-count":140,"publisher":"ScopeMed","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.scopemed.org\/?page=license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018]]},"DOI":"10.5455\/medarh.2018.72.295-296","type":"journal-article","created":{"date-parts":[[2018,8,7]],"date-time":"2018-08-07T19:17:45Z","timestamp":1533669465000},"source":"Crossref","is-referenced-by-count":5,"title":["Actinomycosis of the Middle Ear and Mastoid"],"prefix":"10.5455","member":"3407","reference":[{"key":"ref1","unstructured":"1. Olson TS, SeidAB, Pransky SM. Actinomycosis of the middle Ear. In-"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"ternational Journal of Pediatric Otorhinolaryngology. 1989; 17: 51-55.","DOI":"10.1016\/0165-5876(89)90293-0"},{"key":"ref3","unstructured":"2. Shelton C, Brackmann DE. Actinomycosis Otitis Media. Arch"},{"key":"ref4","unstructured":"Otolarnyngology Head Neck Surg. 1988; 111: 88-89."},{"key":"ref5","unstructured":"3. Leek JH. Actinomycosis of the Tympanomastoid. Laryngoscope."},{"key":"ref6","unstructured":"1974; 184: 290-301."},{"key":"ref7","unstructured":"4. Shaheen SO, Ellis FG. Actinomycosis of the larynx. J R Soc Med."},{"key":"ref8","unstructured":"1983; 76: 226."},{"key":"ref9","unstructured":"5. Bartels LJ, Vrabec DP. Cervicofacial Actinomycosis: a Variable"},{"key":"ref10","unstructured":"Disorder. Arch Otolaryngol. 1978; 110: 705."},{"key":"ref11","unstructured":"6. Samuels RHA, Martin MV. A Clinical and Microbiological Study"},{"key":"ref12","unstructured":"of Actinomycetes in Oral and Cervicofacial lesions. Br J Oral Max -"},{"key":"ref13","unstructured":"illofac Surg. 1988; 126: 458."},{"key":"ref14","unstructured":"7. Harris LF, Kakani PR, Selah CE. Actinomycosis: Surgical Aspects."},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Am J Surg. 1985; 51: 262.","DOI":"10.3186\/jjphytopath.51.262"},{"key":"ref16","unstructured":"ACTINOMYCOSIS OF THE MIDDLE EAR AND MASTOID"},{"key":"ref17","unstructured":"Mohammed ALSheikh ,SaadAlenzi, Asma Al Ahmadi , Ali Mashragi , HodaAlsayi d, Abdullah Alamri"},{"key":"ref18","unstructured":"Saudi Board of Otorhinolaryngology"},{"key":"ref19","unstructured":"Department of Otorhinolaryngology, Head and Neck Surgery"},{"key":"ref20","unstructured":"King Fahad General H ospital  -ALMusaedeah  Center"},{"key":"ref21","unstructured":"Jeddah  - Saudi  Arabia"},{"key":"ref22","unstructured":"Introduction:"},{"key":"ref23","unstructured":"Actinomycosis is a saprophytic infection caused by actinomycetes . Actinomycetes  is agram positive ,"},{"key":"ref24","unstructured":"anaerobic,non  acid-fast, filamentous bacterium. U sually considered as apart of the normal flora. In"},{"key":"ref25","unstructured":"humen, actinomycosisisraeli  is the most common pathogenic species of this bacteria ."},{"key":"ref26","unstructured":"There are many  important factors to be considered in pathogenesis of actinomycosis infections, such"},{"key":"ref27","unstructured":"astrauma due to dental ex traction,manipulation or caries. These f actors provide an entry for these"},{"key":"ref28","unstructured":"organisms  to go deep into  tissue where anaerobic conditions are necessary for their growth."},{"key":"ref29","unstructured":"It is commonly seen after minor trauma  in cervicofacial region(55%) as well as the abdomen and"},{"key":"ref30","unstructured":"thorax.Involvement of the middle e ar and mastoid is rare and might be cau sed by direct spread  via the"},{"key":"ref31","unstructured":"eustachian  tube from the nasopharynx."},{"key":"ref32","unstructured":"Case Report:"},{"key":"ref33","unstructured":"A24 years old male arrived to  our outpatient department complaining  of right -sided otalgia and"},{"key":"ref34","unstructured":"hearing loss for  8 years ,no history  of otorreah,vertigo or dizziness."},{"key":"ref35","unstructured":"He had ahistory of right -sided  chronic suppurative"},{"key":"ref36","unstructured":"otitis media with ahistory of two operations at the"},{"key":"ref37","unstructured":"same side , which  were  right side atticotomy"},{"key":"ref38","unstructured":"combined with tympanoplasty in 2002 and right side"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"tympanoplasty in  2007.","DOI":"10.1016\/S1041-892X(07)70095-1"},{"key":"ref40","unstructured":"Examination showed dull,  intact tympanic membrane."},{"key":"ref41","unstructured":"Tuning  fork show ed mild conductive hearing loss. The"},{"key":"ref42","unstructured":"rest of the examination was within normal."},{"key":"ref43","unstructured":"Audio -tympanogram showed mild conductive"},{"key":"ref44","unstructured":"hearing loss  in the right side  and type B"},{"key":"ref45","unstructured":"tympanogram.Acomputed tomography(CT) scan showed opacification of the right middle ear and"},{"key":"ref46","unstructured":"mastoid  as shown in figure  1."},{"key":"ref47","unstructured":"Patient was admitted to the hospital and all pre -operative  hematological,biochemical and serological"},{"key":"ref48","unstructured":"invest igations were within normal."},{"key":"ref49","unstructured":"Figure 1: Pre -operative CT scan showing middle ear and"},{"key":"ref50","unstructured":"mastoid opacification Figure 1. Pre-operative CT scan showing middle ear and mastoid"},{"key":"ref51","unstructured":"opacificationPatient underwent exploratory right tympanatomy combined with right cortical mastoidectomy. Tissue"},{"key":"ref52","unstructured":"specimens were sent for histopathology and comprehensive microbiology  for aerobic,anaerobic,fungal"},{"key":"ref53","unstructured":"and acid -fast bacillus cultures ."},{"key":"ref54","unstructured":"Histopathology showed acute and chronic"},{"key":"ref55","unstructured":"inflammation  with diffuse fibrosis.  Acid -fast bacillus"},{"key":"ref56","unstructured":"staining was negative and all microbiological"},{"key":"ref57","unstructured":"cultures  failed to grow any organisms.  A Grocott -"},{"key":"ref58","unstructured":"Gomori'smethenamine silver -nitrate stain (GMS"},{"key":"ref59","unstructured":"stain) showed branching bacterial filaments  as seen"},{"key":"ref60","unstructured":"in figure 2, allowing the diagnosis of actinomycosis"},{"key":"ref61","unstructured":"to be established ."},{"key":"ref62","unstructured":"Patient had ahistory of Penicillin  allergy."},{"key":"ref63","unstructured":"Consultation s for both  infectious disease s and"},{"key":"ref64","unstructured":"allergy\/immunology specialties  were obtained to"},{"key":"ref65","unstructured":"determine an optimal management strategy.  He"},{"key":"ref66","unstructured":"was started  on Augmentin  1g and Doxycycline"},{"key":"ref67","unstructured":"200mg\/day .  Then, discharged in a stable condition on"},{"key":"ref68","unstructured":"same medications  with regular outpatient clinic"},{"key":"ref69","unstructured":"appointments ."},{"key":"ref70","unstructured":"During regular  follow -up visits in outpatient c linic till up"},{"key":"ref71","unstructured":"to date patient  has no complaint , tympanic membrane"},{"key":"ref72","unstructured":"looked  normal. CT was done  showed normal right"},{"key":"ref73","unstructured":"middle ear and mastoid opacification as shown in figure"},{"key":"ref74","unstructured":"Discussion:"},{"key":"ref75","unstructured":"Actinomycosis is a subacute or chronic disease due to"},{"key":"ref76","unstructured":"infection by actinomyces Israeli, which is usually characterized by abscessformation, tissue  fibrosis and"},{"key":"ref77","unstructured":"draining sinuses."},{"key":"ref78","unstructured":"This commensal organism is found normally in high concentration in tonsil s and carious teeth. It  is"},{"key":"ref79","unstructured":"considered as an opportunistic pathogen."},{"key":"ref80","unstructured":"In 1878, a ctinomycosis in human was first described  by Israel iand Wlfeand . First, they  isolated the"},{"key":"ref81","unstructured":"causative agent in a culture. Then they defined the organism\u2019 s anaerobic nature."},{"key":"ref82","unstructured":"Before antibiotic era, diagnosi s was often made at autopsy, as most of these infections were fatal"},{"key":"ref83","unstructured":"because of their intracranial  complications.  Currently these cases usually presented as a chronic"},{"key":"ref84","unstructured":"suppurative otitis media with prolonged course of treatment."},{"key":"ref85","unstructured":"In literature, most of these cases need ed an  intact canal wall tympanomastoidectomy followed by"},{"key":"ref86","unstructured":"prolonged antibiot ic treatment ."},{"key":"ref87","unstructured":"Isolating actinomyces  species from cultures of surgical specimen  makes most accurate"},{"key":"ref88","unstructured":"diagnosis .However,70 % of these cultures  are negative because it is fastidious organism. Granules  of"},{"key":"ref89","unstructured":"actinomycosis strongly support the diag nosis, which are usually seen in histological  examination .It is"},{"key":"ref90","unstructured":"rarely visible on hematoxylin -eosin stained sections but can be seen as round or oval basophili c masses Figure 3: Post -operative CT scan showing normal"},{"key":"ref91","unstructured":"opacification of middle ear and mastoid"},{"key":"ref92","unstructured":"Figure 2: Grocott -gomorimethenamine -silver nitrate stain"},{"key":"ref93","unstructured":"showing cluster of branching  bacterial filaments of"},{"key":"ref94","unstructured":"actinomycosis Figure 2. Grocott-Gomori\u2019s methenamine-silver nitrate stain showing"},{"key":"ref95","unstructured":"cluster of branching  bacterial filaments of actinomycosisPatient underwent exploratory right tympanatomy combined with right cortical mastoidectomy. Tissue"},{"key":"ref96","unstructured":"specimens were sent for histopathology and comprehensive microbiology  for aerobic,anaerobic,fungal"},{"key":"ref97","unstructured":"and acid -fast bacillus cultures ."},{"key":"ref98","unstructured":"Histopathology showed acute and chronic"},{"key":"ref99","unstructured":"inflammation  with diffuse fibrosis.  Acid -fast bacillus"},{"key":"ref100","unstructured":"staining was negative and all microbiological"},{"key":"ref101","unstructured":"cultures  failed to grow any organisms.  A Grocott -"},{"key":"ref102","unstructured":"Gomori'smethenamine silver -nitrate stain (GMS"},{"key":"ref103","unstructured":"stain) showed branching bacterial filaments  as seen"},{"key":"ref104","unstructured":"in figure 2, allowing the diagnosis of actinomycosis"},{"key":"ref105","unstructured":"to be established ."},{"key":"ref106","unstructured":"Patient had ahistory of Penicillin  allergy."},{"key":"ref107","unstructured":"Consultation s for both  infectious disease s and"},{"key":"ref108","unstructured":"allergy\/immunology specialties  were obtained to"},{"key":"ref109","unstructured":"determine an optimal management strategy.  He"},{"key":"ref110","unstructured":"was started  on Augmentin  1g and Doxycycline"},{"key":"ref111","unstructured":"200mg\/day .  Then, discharged in a stable condition on"},{"key":"ref112","unstructured":"same medications  with regular outpatient clinic"},{"key":"ref113","unstructured":"appointments ."},{"key":"ref114","unstructured":"During regular  follow -up visits in outpatient c linic till up"},{"key":"ref115","unstructured":"to date patient  has no complaint , tympanic membrane"},{"key":"ref116","unstructured":"looked  normal. CT was done  showed normal right"},{"key":"ref117","unstructured":"middle ear and mastoid opacification as shown in figure"},{"key":"ref118","unstructured":"Discussion:"},{"key":"ref119","unstructured":"Actinomycosis is a subacute or chronic disease due to"},{"key":"ref120","unstructured":"infection by actinomyces Israeli, which is usually characterized by abscessformation, tissue  fibrosis and"},{"key":"ref121","unstructured":"draining sinuses."},{"key":"ref122","unstructured":"This commensal organism is found normally in high concentration in tonsil s and carious teeth. It  is"},{"key":"ref123","unstructured":"considered as an opportunistic pathogen."},{"key":"ref124","unstructured":"In 1878, a ctinomycosis in human was first described  by Israel iand Wlfeand . First, they  isolated the"},{"key":"ref125","unstructured":"causative agent in a culture. Then they defined the organism\u2019 s anaerobic nature."},{"key":"ref126","unstructured":"Before antibiotic era, diagnosi s was often made at autopsy, as most of these infections were fatal"},{"key":"ref127","unstructured":"because of their intracranial  complications.  Currently these cases usually presented as a chronic"},{"key":"ref128","unstructured":"suppurative otitis media with prolonged course of treatment."},{"key":"ref129","unstructured":"In literature, most of these cases need ed an  intact canal wall tympanomastoidectomy followed by"},{"key":"ref130","unstructured":"prolonged antibiot ic treatment ."},{"key":"ref131","unstructured":"Isolating actinomyces  species from cultures of surgical specimen  makes most accurate"},{"key":"ref132","unstructured":"diagnosis .However,70 % of these cultures  are negative because it is fastidious organism. Granules  of"},{"key":"ref133","unstructured":"actinomycosis strongly support the diag nosis, which are usually seen in histological  examination .It is"},{"key":"ref134","unstructured":"rarely visible on hematoxylin -eosin stained sections but can be seen as round or oval basophili c masses Figure 3: Post -operative CT scan showing normal"},{"key":"ref135","unstructured":"opacification of middle ear and mastoid"},{"key":"ref136","unstructured":"Figure 2: Grocott -gomorimethenamine -silver nitrate stain"},{"key":"ref137","unstructured":"showing cluster of branching  bacterial filaments of"},{"key":"ref138","unstructured":"actinomycosis"},{"key":"ref139","unstructured":"Figure 3. Post-operative CT scan showing normal opacification of middle"},{"key":"ref140","unstructured":"ear and mastoid"}],"container-title":["Medical Archives"],"original-title":[],"link":[{"URL":"https:\/\/ejmanager.com\/mnstemps\/10\/10-1533473840.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:55:57Z","timestamp":1791482157000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejmanager.com\/mnstemps\/10\/10-1533473840.pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018]]},"references-count":140,"URL":"https:\/\/doi.org\/10.5455\/medarh.2018.72.295-296","relation":{},"ISSN":["0350-199X"],"issn-type":[{"value":"0350-199X","type":"print"}],"subject":[],"published":{"date-parts":[[2018]]}}}