Management of Intracranial Complications of Otitis Media: Clinical Perspective from a Regional Otolaryngology Program

Abstract

Objective: Analyze the problems, methods, and outcomes encountered in treating intracranial complications of otitis media in an underserved region by an otolaryngology program distributed over 3 cities up to 130 miles apart with limited neurosurgical availability. Suggest systems-based improvements in optimizing care and cost-effectiveness of complicated otologic patients. Method: A retrospective review of intracranial complications of otitis media managed by the LSUHSC Otolaryngology program in public and private hospitals with variable neurosurgical availability from July 2008 to January 2011. Limitations of access to sub specialty evaluations, medical therapy, and surgical therapy are discussed. Outcomes for 8 patients with intracranial otologic complications are described. Results: In our retrospective review, 2 patients with petrous apicitis (25%), 3 patients with meningitis (37.5%), 2 patients with brain abscess (25%), and 1 patient with sigmoid sinus thrombophlebitis (12.5%) were encountered. A total of 75% of patients (6/8) received intravenous antibiotics as initial treatment, while 2 patients (25%) underwent urgent otologic surgery. All patients initiated on conservative protocol improved clinically. Of these, 3 patients underwent outpatient combined otologic-neurosurgical surgery and 1 patient required an urgent neurosurgical intervention, while 2 patients could be managed without surgical intervention. Three of 8 patients (37.5%) were lost to long-term follow-up. There were no known patient deaths. Conclusion: In a regional otolaryngology program, concerns in managing emergent otologic conditions include limited access to subspecialty surgeons, diagnostic studies, and patient transportation. Antibiotic therapy is often effective as a single treatment modality or in stabilizing patients until definitive elective surgery, which may reduce the need for costly urgent patient transportation.