Intracranial complications of middle ear disease and mastoid surgery

Abstract

The intracranial complications that may develop in chronic middle ear disease and, in particular, after mastoid surgery, have been studied. An intracranial abscess may exist in the absence of localizing features either clinically or on investigation, although headache and a deteriorating conscious level are to be expected. In contrast, clinical signs suggestive of a focal neurological lesion, even when supported by a focal EEG abnormality or abnormal brain scan, do not necessarily indicate the presence of an intracranial abscess requiring surgical intervention. Of the 11 illustrative cases that have been presented, it is likely that 6 developed intracranial complications as a direct result of middle ear surgery. The prime object of mastoid surgery, which is to prevent the development or extension of intracranial sepsis is not therefore always achieved. Dural damage incurred at operation is an important factor in determining the development of neurological sequelae in these cases. Possible mechanisms are discussed.