Intracranial Complications of Chronic Otitis Media: Why Does It Still Occur?

Abstract

Intracranial complications secondary to chronic otitis media (COM) include otogenic brain abscess and sinus thrombosis. Intravenous antibiotics and imaging have significantly reduced the incidence of intracranial complications secondary to COM. However, the same does not apply to a developing country like Malaysia, which still experiences persisting otogenic complications. This case series describes 3 patients with COM and intracranial complications. All 3 patients had COM with mastoiditis, with 1 of the 3 having a cholesteatoma. Postulated reasons for the continued occurrence include poor access to health care, poor compliance with medication, and the lack of pneumococcal vaccination during childhood. In conclusion, public awareness and a timely specialty referral can reduce the incidence of intracranial complications of COM.

Fatal Otitic Hydrocephalus Due to Sinus Thrombosis: A Case Report

“…Factors that influence the development of intracranial complications include age (first decade or elderly), immunosuppression, and presence of cholesteatoma. 9 In this case, presence of cholesteatoma due to neglected chronic ear disease and non-recognition of the warning signs of intracranial extension contributed to the vicious cycle of infection.…”

“…However, the triad of fever, headache and focal neurological symptoms were only present in 20% of patients. 9 Sometimes, patients may be asymptomatic and analysis of CSF shows no abnormality. 4,11 Our patient presented with fever, headache, vomiting, altered level of consciousness, abducens nerve palsy, sluggish pupillary light reflex, papilledema, and weak extremities which worsened in the course of the disease.…”

“…11,18 There is little benefit from anticoagulants unless the clots are extensive. 9 If there is no peri sinus abscess and in the absence of symptoms of sepsis, coagulation of the sigmoid sinus should not be removed. However, if there is a peri sinus abscess and clinical signs of septicemia, the sinus should be opened, the clot removed, and the internal jugular vein ligated.…”

“…11 Regarding prognosis of OH, most cases resolved spontaneously 15 and patients usually recover after antibiotic therapy with or without mastoidectomy and ventriculostomy. 2,3,4,9,11 Three cases of otitic hydrocephalus were reported in which two patients had CSF otorrhoea temporarily relieved by repeated epidural catheterization which later required a VP shunt. Another patient had 5 lumbar punctures with withdrawal of 5-10 ml of CSF per session, as therapeutic measure to lower CSF pressure.…”

Development of Mastoid Air Cell System Extraction Method on Temporal CT-scan Image

“…The mastoid bone is located behind the temporal bone. Imaging examination aims to determine abnormalities in the Temporal bone which can be done with photos or by looking at the results of CT-scan or Magnetic Resonance Imaging (MRI) examination images [10,11]. Medical experts diagnose this disease Mastoiditis by looking at the air cells contained in the image of the cavity of the Temporal bone resulting from the acquisition of a CT-scan or MRI and given to a doctor for analyze and further medical action [12].…”