Intracranial otogenic complications: inspite of therapeutic progress still a serious problem

Abstract

High-imaging modalities, antibiotics and improved microsurgical procedures have decreased morbidity and mortality of intracranial otogenic complications in the western hemisphere nowadays. However, they do occur and the resulting mortality is still about 10%. We report our experiences with 22 patients, who were treated for intracranial otogenic complications (15 x meningitis, 5 x brain abscess, 1 x subdural empyema, 1 x Gradenigo's syndrome) due to cerebrospinal fluid leak in 2 patients, chronic otitis in 9 patients (5 with cholesteatoma), acute otitis media in 11 patients, between 1981 and September 1999. Five patients with acute otitis media have had predisposing anatomic pathology: 1 x inner ear malformation, 1 x status after duraplasty, 2 x dura-brain-prolapse due to temporal bone fractures and 1 x dura-brain-prolapse after antrotomy. Streptococcus pneumoniae was a common cause of intracranial-complicating acute otitis media (64%). Residual neurologic impairment was noted in 3 patients at the time of discharge. 3 patients (13.6%) died due to the otogenic intracranial complication. Otogenic intracranial complications are potentially life threatening conditions. Early diagnosis is essential to allow appropriate antimicrobial and surgical treatment. The necessity of close cooperation between otorhinolaryngologist, pediatrician, neurologist, radiologist and neurosurgeon is stressed.