Intracranial spread of chronic middle ear suppuration

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.