Otogenic intracranial complications. A 7-year retrospective review

Hafidh, Maky A.; Keogh, Ivan; Walsh, Rory Mc Conn; Walsh, Michael; Rawluk, Daniel

doi:10.1016/j.amjoto.2006.03.004

« Previous Next »American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 27, Issue 6 , Pages 390-395, November 2006

Otogenic intracranial complications. A 7-year retrospective review

Presented at The International Federation of Otolaryngology Society (IFOS), Rome 28th June 2005, and at The Royal Academy of Medicine, Otolaryngology Meeting, Killarney, Ireland, April 2004.

Maky A. Hafidh, MD, FRCSI (OTOL)
- The Department of Otolaryngology, Head and Neck Surgery, Beaumont University Hospital, Dublin, Ireland
- Department of Otolaryngology, Head and Neck Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
- Corresponding author. 12 Limelawn Green, Clonsilla, Dublin 15, Ireland. Tel.: +353 86 6068941.
Ivan Keogh, MD, FRCS (ORL-HNS)
- The Department of Otolaryngology, Head and Neck Surgery, Beaumont University Hospital, Dublin, Ireland
- Department of Otolaryngology, Head and Neck Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
Rory Mc Conn Walsh, MD, FRCS (ORL-HNS)
- The Department of Otolaryngology, Head and Neck Surgery, Beaumont University Hospital, Dublin, Ireland
- Department of Otolaryngology, Head and Neck Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
Michael Walsh, MD, FRCS
- The Department of Otolaryngology, Head and Neck Surgery, Beaumont University Hospital, Dublin, Ireland
- Department of Otolaryngology, Head and Neck Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
Daniel Rawluk, MD, FRCS
- Department of Neurosurgery, Beaumont University Hospital, Dublin, Ireland

Abstract

Objectives

The objectives of this study were to review our experience on intracranial complications secondary to otitis media (OM), and to compare the results to those occurring 10–15 years ago. We also reviewed the timing of both otologic and neurosurgical treatments.

Material and methods

All patients with intracranial complications secondary to OM over a 7-year period were identified. A retrospective chart review was undertaken at Beaumont University Hospital, Dublin, Ireland. Clinical presentation, radiological findings, microbiology, surgical management, and antibiotic use were studied. We compare our findings to those of other international investigators.

Results

Twelve cases were identified. Five had brain abscesses, 4 had lateral sinus thrombosis, and 3 had petrous apicitis. Eight of these cases were secondary to chronic OM and 4 were secondary to acute OM. Malodorous otorrhea, otalgia, headache, fever, and vertigo were the primary symptoms. Anaerobic bacteria were the most commonly isolated organisms followed by Staphylococcus aureus, Proteus mirabilis, and Pseudomonas aeruginosa. Patients with cholesteatoma underwent modified radical or radical mastoidectomy, and those who did not have cholesteatoma underwent cortical mastoidectomy. Two brain abscesses were drained before mastoid surgery; 2 were drained after mastoid surgery and 1 at the same time as otologic surgery. All patients received broad-spectrum intravenous antibiotics targeted at individual culture and sensitivity results. The mortality rate was zero.

Conclusion

Clinical presentation and the frequency of occurrence of intracranial complications are similar to those occurring 10 years ago. The choice of antibiotics should include adequate anaerobic cover. We recommend that otologic surgery be performed at the same time as intracranial surgery for patients with mature brain abscesses.