Otogenic Brain Abscess: Judicious Management in a Case of Chronic Suppurative Otitis Media

Abstract

Intracranial consequences from chronic otitis media can be dreadful. Meningitis is the most frequent complication followed by a cerebral abscess. In this pre-antibiotic era, otogenic brain abscess is rare, but it poses one of the life-threatening complications of otitis media. In recent years, brain abscess was noticed almost only in patients of chronic Otitis media with cholesteatoma. A case of a 36-year-old non-diabetic male patient with an otogenic cerebellar abscess, who presented with no cerebellar signs and unique intraoperative ossicular chain status was successfully managed by a combined approach of otolaryngology and neurosurgery, is presented in this report.

Keywords: burr hole drainage; cerebellar abscess; chronic suppurative otitis media; intracranial complication; modified radical mastoidectomy; otogenic brain abscess.

Figure 1. Microscopic examination image

Examination under a microscope showing the right external auditory canal with fleshy mass (white arrow).

Figure 2. CT brain (axial section)

The arrow shows hypodensity in the right hemisphere of the cerebellum

Figure 3. T2 weighted MRI brain (axial section)

The image is showing a peripherally rim-enhancing altered signal intensity lesion in the right cerebellar hemisphere (arrow).

Figure 4. Right otogenic cerebellar abscess drained by burr hole technique