Otogenic brain abscess: diagnostic and treatment experience

Abstract

The authors report 25 years of experience in diagnosing and treatment of patients with otogenic brain abscesses. The study comprised 42 patients, of whom 28 had cerebral and 14 cerebellar abscesses. Otogenic abscess is usually accompanied by meningitis (45%). Headache and fever usually suggested otogenic intracranial complications. In the middle ear, active chronic otitis with cholesteatoma was commonly present. Inflammatory process usually expanded into the endocranium destroying the middle ear walls. Computerized tomography (CT) is the most reliable way to diagnose brain abscess. The method can help localize abscess, plan the surgery and monitor the postoperative course. Neurological and ophthalmologic examinations are not always sufficient for detection of brain abscess. The authors suggest initial neurosurgical removal of abscess, which after improvement of general condition of the patient should be followed by radical otosurgical removal of the process from the ear. This group of patients is still associated with relatively high mortality: 18% for cerebral and 20% for cerebellar cases.