gms | German Medical Science

Objectives: Aimed to review our 10-year experience on intracranial complications (ICC) secondary to chronic otitis media (COM), and to investigate its clinical characteristics treatment approaches. Study Design Retrospective analysis.

Methods: From Jan, 1996 to Dec, 2006,17 patients with ICC secondary to COM were identified and included in this study. A retrospective chart review was undertaken to analyze the clinical presentation, radiological findings, microbiology, and surgical management information.

Results: 13 out of these 17 cases (76.4%) have cholesteatoma. The most common intracranial complication is brain abscesses (52.9%), followed by meningitis (29.4%), perisinus abscess (11.7%), and epidural abscess (6%). Malodorous otorrhea (100%), headache (94.1%) and fever (64.7%) were the most common presenting symptoms and signs. CT (Computed Tomography) scanning was done on all patients. All patients underwent emergency mastoidectomy within the first 24 hours after clear diagnosis. 7 patients underwent brain abscess drainage or abscess excision at the time of ear surgery. An early treatment with antibiotics, i.e. third generation Cephems in combination with Metronidazole, was adopted. Treatment protocols were adjusted timely according to the bacterial culture and drug sensitivity test. Both the intraoperative and postoperative mortality rates are 0%. No recurrence was found in the 24-month follow-up period.

Conclusion: Cholesteatoma was strongly associated with ICC. CT and MRI play critical roles in the diagnosis of ICC. An early diagnosis and active surgical intervention in collaboration with proper antibiotic treatment is the key to cure.