Two Cases of Intracranial Complications Associated with Chronic Silent Otitis Media in Immune-Competent Adults / 대한이비인후과학회지

Chronic otitis media is defined as a condition associated with a perforation of the tympanic membrane with a history or existence of otorrhea. Chronic silent otitis media refers to chronic pathologic condition behind an intact tympanic membrane, which may be clinically undetected or undetectable. Because this chronic pathology is undetected, there is a lack of clinical treatment, which increases the risk of complications and sequelae. Otogenic intracranial complications in intact tympanic membrane are usually reported in pediatric patients with acute otitis media and are rare in immune-competent adult patients. We report two cases of immune-competent patients who suffered from intracranial complications of chronic silent otitis media, one leading to a lateral sinus thrombophlebitis and the other leading to meningitis.

A Case of Epidural Abscess Formation and Lateral Sinus Thrombophlebitis Complicating Chronic Otitis Media with Cholesteatoma / 대한이비인후과학회지

The incidence of intracranial complications of otitis media, including lateral sinus thrombophlebitis, has been significantly reduced since the advent of antibiotics. This entity is rarely encountered in clinical practice, and delay in its diagnosis and institution of appropriate therapy may lead to serious, or even fatal, consequences. The signs and clinical course of lateral sinus thrombophlebitis are non-specific and the final diagnosis rests upon radiological investigations including CT-scans and MRI. We have experienced a case of middle fossa and posterior fossa epidural abscess formation, lateral sinus thrombophlebitis that has developed secondary chronic otitis media with cholesteatoma in a 47 year-old female patient. We report this case which was successfully treated by middle fossa dura and posterior fossa dura drainage, lateral sinus thrombectomy with open mastoidectomy.

Lateral Sinus Thrombophlebitis Caused by Isolated Sphenoid Sinusitis

Lateral sinus thrombophlebitis is a very rare complication of paranasal sinusitis. This disease can result in a fatal outcome if not treated with proper antibiotics or surgical intervention. Recently, the authors came across a case of lateral sinus thrombophlebitis resulting from cavernous sinus thrombophlebitis complicated by isolated sphenoid sinusitis. Because of a severe and persistent headache, the case was initially admitted and managed as though the patient was suffering from Tolosa-Hunt syndrome. Hemifacial hypoesthesia, periorbital swelling and meiosis on the right side developed during tentative treatment. High resolution computed tomography showed isolated sphenoid sinusitis with partial bony dehiscence on the roof of left sphenoid sinus. Magnetic resonance images showed multiple thrombosis in the cavernous sinus, internal carotid artery, sigmoid sinus and lateral sinus on the right side. Antibiotics, thrombolytics and endoscopic surgical intervention of sinusitis prevented a fatal outcome in spite of remaining hemifacial hypoesthesia and ptosis on the right side.

A Case of Cerebellar Abscess after Treatment of Lateral Sinus Thrombophlebitis Associated with Cholesteatoma / 대한이비인후과학회지

The incidence of otogenic intracranial complication has decreased markedly following the advent of modern chemotherapy. Less is it a disease of children in association with acute otitis media. More often it is seen in the adult after a long history of chronic ear disease, especially cholesteatoma. In the modern literature on lateral sinus thrombosis, meningitis and cerebral abscess are listed as the most common concomitant complications and cerebellar abscess is poorer prognosis than any other complications. Recently we experienced a case of cerebellar abscess after treatment of lateral sinus thrombophlebitis associated with cholesteatoma, and reported this case along with literature survey.