Intracranial abscesses associated with chronic suppurative otitis media

Abstract

Intracranial abscesses are serious complications of chronic suppurative otitis media (COM). This study included 32 patients presenting with intracranial abscesses from 780 patients hospitalized for treatment of COM. The 32 patients had 59 intracranial complications. Perisinus abscess (13 of 32) was the most common intracranial abscess, followed by temporal lobe abscess (8 of 32), epidural abscess (7 of 32), cerebellar abscess (6 of 32) and subdural empyema (2 of 32). Headache (93%), fever (87%) and altered mental status (62%) were the most common presenting symptoms and signs, along with symptoms of COM. All patients were treated with intravenous antibiotics and canal wall down mastoidectomy. Cholesteatoma with granulation tissue and bony defects at the sinus plate and/or dural plate were seen in most of the patients. Gram negative bacilli and anaerobes were the most common organisms cultured from the abscesses. Three patients had neurological sequels. One patient died. The early diagnosis of these complications requires a high index of suspicion and imaging studies. A multidisciplinary and coordinated approach is important for the management of these patients.

Complications of chronic otitis media: a retrospective analysis of 1293 cases

“…3), but has been reported as the third or fourth most common in other studies. [2,11,12] However, Mostafa et al also found that LST was the most common intracranial complication of COM, which is consistent with our series. [13] The gold standard radiological method for the diagnosis of LST is MR venography (Fig.…”

“…[13][14][15] Seven et al claimed that there was no difference between these two approaches. [2] The latest studies have revealed that removal of the infected granulation tissue, without thrombus, is sufficient for recanalization of the sinus. [2,14] In our study, all four patients with LST underwent radical mastoidectomy together with removal of the infected thrombus through an incision in the sinus wall.…”

“…[2] The latest studies have revealed that removal of the infected granulation tissue, without thrombus, is sufficient for recanalization of the sinus. [2,14] In our study, all four patients with LST underwent radical mastoidectomy together with removal of the infected thrombus through an incision in the sinus wall. The use of anticoagulant therapy after surgery for LST is controversial, and many authors have advocated that this therapy should not be used because of the risk of septic embolus.…”

“…[1] Complications of COM may be extracranial or intracranial, [2,3] and most of these complications occur secondary to the cholesteatoma component of COM. These complications can present during the acute phase of COM or during topical or systemic medical treatment.…”

Surgery for pyogenic brain abscess over 30 years: evaluation of the roles of aspiration and craniotomy

“…The most common predisposing factor was infection of the middle ear and mastoid process (21.9%). PBA secondary to mastoiditis can be seen in recurrent fashion (25). Our experience of PBA secondary to mastoiditis treatment necessitated a team approach with otolaryngologists.…”