Complication of otitis media is defined as a spread of infection beyond the pneumatised area of temporal bone and associated mucosa. Though introduction of antibiotics has decreased the incidence of intracranial complications, they still occur in unrecognized, poorly managed or resistant cases which lead to morbidity and mortality. Here we report a case of chronic otitis media with recurrent temporal lobe abscess leading to mortality. INTRODUCTION: Complications of acute and chronic otitis media have become a rare event these days. Nevertheless, unrecognized, poorly managed or resistant infections can potentially lead to such complications. 1 Brain abscess as second most common intracranial complication of otitis media after meningitis accounting for mortality rate ranging 7-60%. 2, 3 The commonest organism causing brain abscess following an otogenic source include Staphylococcus aureus, Streptococcus pneumonia, Haemophilus influenza, Escherichia coli, proteus & Pseudomonas species. We report a case of recurrent temporal lobe abscess secondary to chronic otitis media leading to mortality. CASE HISTORY: A thirteen year old boy was first admitted with an eight days history of fever, drowsiness, lethargy and poor oral intake. He also had on and off discharge from left ear for the past three months. Clinically he was conscious, alert, and confused, had temperature 39.4 0 and tachycardia (108 beats/min). No signs of meningeal irritation observed. His pupils and fundus examination were normal. His left ear examination showed characteristic foul smelling, non-blood stained purulent discharge and attic cholesteatoma. His cardiovascular, respiratory and abdominal examinations were within normal limits. With the above picture left chronic otitis media with cholesteatoma with intracranial complication was suspected clinically. His investigations revealed Hemoglobin 12gm/dl, white blood cell count 17000/mm 3 with neutrophil count 80%. Biochemical parameters were within normal limits. CT brain with contrast showed two thin walled ring enhancing lesions in left temporal lobe(size of the largest lesion is 42mmx33mmx25mm) with mild mass effect suggesting an abscess(Fig. I). Patient was referred to neurosurgeon for further management. At neurosurgery craniotomy done and abscess was drained. The follow up CT brain taken on seventh postoperative day showed reduced left temporal lobe abscess (Fig. II). Patient was discharged on tenth postoperative day after recovering from neurological symptoms. Patient was advised to undergo ear surgery. However patient did not turn up for follow up.
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