Conservative management of otogenic brain abscess with surgical management of attico antral ear disease: a review

Abstract

Otological intra cranial complications are still a major problem in developing countries. Otogenic brain abscess is a serious, life-threatening complication of otitis media and it usually occurs due to attico antral ear disease. Treatment of otogenic brain abscess is immediate surgical drainage, and mastoidectomy is done to remove the source of infection. This article describes three cases of otogenic brain abscess secondary to attico antral ear disease, which were less than 1.6 cm in size and were treated conservatively with antibiotic therapy. All the patients were started on intravenous antibiotic therapy and serial CT scan was done to monitor the progression of the brain abscess. Canal wall down mastoidectomy was done for the removal of otogenic source of infection. Antibiotic therapy was continued for 6 weeks. Post operative CT scan was done after 8 weeks and it showed complete resolution of the abscess. This study showed that small otogenic brain abscess, which are less than 1.6 cm in size responded to treatment with antibiotics, could be managed by medical therapy. Surgery was required only for the management of attico antral ear disease. To best of our knowledge this is the first review on conservative management of small otogenic brain abscess secondary to attico antral ear disease.

Keywords: Attico antral ear disease; Conservative management; Otogenic brain abscess.

Fig. 1

CT scan of brain showing (arrow) non-enhancing hypodense lesion in the right temporal lobe

Fig. 2

CT scan with contrast showing (arrow) ring enhancing lesion in the right temporal lobe

Fig. 3

CT scan of brain showing dilated ventricles

Fig. 4

Pre-operative fundus photograph showing papilledema

Fig. 5

Patient photograph showing right facial palsy

Fig. 6

Patient photograph showing recovery from facial palsy

Fig. 7

Post-operative fundus photograph showing reduction in papilledema

Fig. 8

Plain CT scan and CT with contrast showing ring enhancing lesion in the right temporal lobe

Fig. 9

CT scan of brain showing (arrow) ring enhancing lesion in the temporal lobe and its attachment to the petrous bone