ABSTRACT
OBJECTIVE: The aim of the study was to review the pathogenesis and the result of management of the intracranial complications of chronic middle ear suppuration. METHODS: This was a retrospective review of charts of 32 cases with intracranial complications due to chronic middle ear infection managed between 1993 and 2007. The symptoms, clinical findings, and medical and surgical management were reviewed and analyzed. RESULTS: There were 10 (31.2%) patients in the age group of 0 to 10 years, 9 (28.1%) patients in the age group of 11 to 18 years, and 13 (40.6%) patients older than 18 years. Males were involved twice as much as females. Among the 32 patients, 18 (56.3%) had a single intracranial complication, whereas 14 (43.7%) had multiple intracranial complications. Among all the intracranial complications in the 32 patients, otitic meningitis was the commonest intracranial complication and was seen in 14 (43.7%) patients; it was followed by lateral sinus thrombosis in 10 (31.2%), cerebellar abscess in 6 (18.7%), epidural abscess in 7 (21.8%), and perisinus abscess in 5 (15.6%). Other less common but serious intracranial complications encountered were cerebral abscess and interhemispheric abscess in 2 (6.2%) each, and subdural abscess, otitic hydrocephalus, and otogenic cavernous sinus thrombosis in 1 (3.1%) each. Upon admission, all patients received a combination of parenteral antibiotics. Canal wall down mastoidectomy was performed in all but 1 patient. In addition, lateral sinus was explored in 13 (40.6%) and cerebellar abscesses were drained in 5 (15.6%) patients. The overall mortality rate of 31.2% was found in our series. CONCLUSION: The prognosis was worse with delayed presentation because of overwhelming intracranial infection due to multiple pathways of extension from chronic otitis media. Infected thrombus in the dural venous sinus should be removed to prevent dissemination of septic emboli.
Subject(s)
Brain Diseases/etiology , Otitis Media, Suppurative/complications , Adolescent , Adult , Brain Abscess/etiology , Brain Diseases/diagnostic imaging , Brain Diseases/mortality , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Intracranial Thrombosis/etiology , Male , Meningitis/etiology , Prognosis , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: The objective of this is to determine the incidence of otogenic complications of chronic suppurative otitis media (CSOM) and its management. STUDY DESIGN: The authors conducted a retrospective study. METHODS: The study was conducted at the tertiary referral and teaching hospital. An analysis was made about the clinical and operative findings, surgical techniques and approaches, the overall management and recovery of the patients. The data were then compared with the relevant and available literature. RESULTS: Of the 70 cases, 47 (67%) had a single complication, of which eight (11%) had intracranial and 39 (56%) had extracranial complications. Twenty-three (33%) had two or more complications. The commonly encountered intracranial complications were otitic meningitis, lateral sinus thrombosis, and cerebellar abscess, which were seen in 13 (19%), 10 (14%), and 6 (9%) cases, respectively. Among the extracranial complications, mastoid abscess, postauricular fistula, and facial palsy were encountered in 26 (37%), 17 (24%) and 10 (14%) patients, respectively. Surgeries were the main mode of treatment for these conditions. According to severity, we found four different types of the lateral sinus involvement. Three patients with otitic facial palsy failed to regain full facial function despite surgery. A total of nine patients with the diagnosis of otitic meningitis, lateral sinus thrombosis and interhemispheric abscess expired. It constituted the mortality rate of 13% in our study. CONCLUSION: CSOM complications, despite its reduced incidence, still pose a great challenge in developing countries as the disease present in the advanced stage leading to difficulty in management and consequently higher morbidity and mortality.
Subject(s)
Otitis Media, Suppurative/complications , Abscess/etiology , Abscess/surgery , Adolescent , Adult , Aged , Bone Diseases/etiology , Bone Diseases/surgery , Brain Abscess/etiology , Brain Abscess/surgery , Cause of Death , Cerebellar Diseases/etiology , Cerebellar Diseases/surgery , Child , Child, Preschool , Chronic Disease , Facial Paralysis/etiology , Facial Paralysis/therapy , Female , Fistula/etiology , Fistula/surgery , Humans , Infant , Male , Mastoid/pathology , Mastoid/surgery , Meningitis/etiology , Meningitis/surgery , Middle Aged , Recovery of Function/physiology , Retrospective Studies , Sinus Thrombosis, Intracranial/etiology , Sinus Thrombosis, Intracranial/surgeryABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the incidence, causes, management, and complications of the different head and neck space infections in a Melanesian population. STUDY DESIGN AND SETTING: We conducted a retrospective study in a tertiary referral and teaching hospital. RESULTS: Of the total 103 patients with deep neck space infections (DNSI), odontogenic causes and suppurative lymphadenitis were responsible in 62 (60%) patients. A wide range of DNSI was encountered in our series. Ludwig's angina was the most commonly encountered infection seen in 38 (37%) patients, whereas prevertebral abscess was only seen in 1 (1%) patient. A combination of surgical drainage and medical treatment was the main mode of treatment. Nine (8.7%) patients with DNSI with upper airway obstruction underwent tracheostomy; 9 (8.7%) patients with DNSI succumbed to their infection. CONCLUSION: DNSI needs early detection and aggressive management in order to evade dreaded complications.
