Intracranial Complications of Chronic Suppurative Otitis Media with Cholesteatoma – A Retrospective Study

Background: Chronic suppurative otitis media is a common problem in our part of the world and few end up with intracranial complication. Brain abscess, meningitis and lateral sinus thrombosis are the most common intracranial complications. Emergency Multi-specialty Intervention can prevent mortality. Aim: The objective of the study is to determine various types of intracranial complications affecting adult population with of Chronic Suppurative Otitis Media with Cholesteatoma in our institution. Methods: All admitted cases of intracranial complications due to chronic suppurative otitis media with cholesteatoma of any age and gender were included. Results: The most common age group was between 11 and 20 years and males were 80% more affected than females. And 90% of patients presented with unilateral disease of ear and 73% of cases had attic pathology. Incidence of intracranial complication in patients with CSOM with cholesteatoma was 1%. The most common complication was brain abscess (20%) followed by meningitis (20%), lateral sinus thrombosis (13.3%) and extradural abscess (16%). Conclusion: Brain abscess is the commonest intracranial complication of chronic suppurative otitis media with cholesteatoma followed by Meningitis. Early surgical intervention in combination with broad spectrum antibiotics provides a good outcome.

A Case of Simultaneous Orbital Cellulitis and Intracranial Complication

PURPOSE: To report a case of simultaneous orbital cellulitis and intracranial complications of acute sinusitis in a young patient. CASE SUMMARY: The 11-year-old male presented with a one-day history of left periorbital erythematous swelling, fever and headache. He was diagnosed with acute sinusitis at the department of otorhinolaryngology, and endoscopic sinus drainage of pus was performed. However, the patient's symptoms did not improve. The next day, a subdural abscess was found on brain computed tomography. He was treated by external drainage of the periosteal abscess via a subbrow incision and systemic antibiotics, as well as anticonvulsant medication. CONCLUSIONS: Twenty days after external drainage and beginning systemic antibiotics and anticonvulsant treatment, he was discharged with improved orbital cellulitis symptoms and a resolved subdural abscess.

Descrição de 34 pacientes com otite média crônica colesteatomatosa complicada / Description of 34 patients with complicated cholesteatomatous chronic otitis media

Introdução: Os colesteatomas são lesões císticas destrutivas que acometem qualquer área pneumatizada do osso temporal. Podem causar complicações intracranianas e extracranianas. Objetivo: Documentar os pacientes com otite média crônica colesteatomatosa complicada, que foram internados na enfermaria de otorrinolaringologia do Hospital das Clínicas de São Paulo, entre os anos de 2001 e 2008. Método: Estudo retrospectivo envolvendo 34 pacientes com otite média crônica colesteatomatosa complicada que foram internados na enfermaria de Otorrinolaringologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período de 2001 a 2008. Resultados: A idade dos pacientes variou de 7 a 83 anos, com predominância do sexo masculino (76%). As complicações extracranianas foram mais freqüentes do que as complicações intracranianas, e alguns pacientes apresentaram os dois tipos de complicação. Todos os pacientes receberam antibiótico endovenoso, e apenas um paciente não foi submetido a procedimento cirúrgico. Nenhum paciente foi a óbito, e no acompanhamento por seis meses não ocorreram seqüelas neurológicas incapacitantes. Conclusão: O tratamento precoce e agressivo das otites médias crônicas colesteatomatosas complicadas diminui a morbimortalidade da doença.

Introduction: Cholesteatomas are cystic destructive lesions that affect any pneumatized area of the temporal bone. They can cause intracranial and extracranial complications. Objective: To register the patients with complicated cholesteatomatous chronic otitis media, who were interned in the otorhinolaryngology nursing of the Clinical Hospital of São Paulo, between the years of 2001 and 2008. Method: Retrospective study involving 34 patients with complicated cholesteatomatous chronic otitis media, who had been otorhinolaryngology nursing in the Clinical Hospital of the Medicine College of the University of São Paulo, from 2001 through 2008. Results: The age of the patients ranged from 7 to 83 years, with predominance of the masculine sex (76%). The extracranial complications were more frequent than the intracranial complications, and some patients presented both types of complication. All the patients received endovenous antibiotic, and only one patient was not submitted to surgical procedure. No patient died, and in the six-month follow-up no incapacitating severe neurological sequels occurred. Conclusion: The precocious and aggressive treatment of the complicated cholesteatomatous chronic otitis media diminishes the disease morbimortality.

Clinical Manifestations of Intracranial Complication Associated With Paranasal Sinus Infection

BACKGROUND: Intracranial complications of paranasal sinus infection are rare and may be misdiagnosed during an initial evaluation because they often show subtle symptoms, which include elusive physical and neurological findings and imaging. The late recognition of these conditions and the delayed treatment can increase morbidity and mortality rates. We aimed to characterize the typical clinical features of intracranial complications associated with sinusitis. METHODS: Twelve patients who visited the Eulji Medical Center from 1994 to 2000, with sinogenic suppurative intracranial lesions were reviewed. Medical records and radiological studies were reviewed retrospectively. RESULTS: There were 12 cases with 15 sinogenic intracranial complications. The ratio of males to female was 2 : 1. The ages of patients ranged from 16 to 81 (average: 46.7). Four cases had meningitis, four had focal cerebritis, three had cavernous sinus throm-bophlebitis, two had subdural empyema, and two had epidural abscess or empyema. The primary lesions of paranasal sinusitis were located at the sphenoid in three, ethmoid sinus in two, frontal sinus in one and the multiple sinus in six. The outcome revealed complete recovery in six cases, mild neurologic sequelae in three cases, death in two cases and recurrence in one case. CONCLUSIONS: The type of intracranial complication and origin of paranasal sinusitis may be changing. Cases in which such complications are suspected, in order for an early diagnosis, a MRI should be considered. The successful management of intracranial complications consists of timely antibiotics therapy combined with surgical drainage of the loculated infection. (J Korean Neurol Assoc 19(5):457~463, 2001)

Subtentorial Empyema: Report of 2 Cases

Intracranial subdural empyema is a neurosurgical emergency and an unusual condition which carries a serious incidence of mortality and morbidity if untreated. The subdural empyema developes from varied sources, but paranasal sinus, the ear and the mastoid process are predominantly affected and subtentorial empyema usually originates from otogenic intracranial complication. Its manifestations are variable such as impaired consciousness, headache, hemiparesis, acute fits, pyrexia, meningism, vomiting, papilledema. ophthalmoplegia, hemianopsia and dysphasia. Subtentorial empyema has additional cerebellar dysfunction syndromes. Early accurate diagnosis and surgical drainage are the most important factors affecting the prognosis. Recently, we experienced two cases of subtentorial empyema which were very rare otogenic intracranial complications. These patients were treated with suboccipital craniectomy, but reaccumulations of empyema and subsequent cerebellar abscess in one case occurred. Finally these patients were recovered without neurologic deficits. Reviewing our two cases and the literature, we are going to describe about causes, symptoms and signs, method of diagnosis, treatment and prognosis of subtentorial empyema.