Common Intracranial Complication Research Articles

Intracranial complications of acute mastoiditis: Surgery not always necessary

IntroductionAcute mastoiditis (AM) can rapidly become life-threatening with various intracranial complications. The standard care includes antibiotics, mastoidectomy, and drainage. Reports show varying preferences for conservative and surgical treatments, with a more conservative approach gaining popularity. In this study we aim to evaluate the presenting symptoms, management and outcomes of patients presenting with intracranial complications secondary to acute mastoiditis. MethodsRetrospective review for all children admitted for acute mastoiditis for 12 years period (January 2010–December 2021). Children who had mastoiditis associated with intracranial complications were included in the study. STROBE guidelines were followed in this study. Results23 patients were diagnosed with acute mastoiditis with intracranial complications. The mean age was 2.1 years. The most common presenting sign was fever, followed by otalgia. The most common pathogens were Fusobacterium necrophorum and Streptococcus pneumoniae. The most common intracranial complication was sinus vein thrombosis (SVT) affecting 13 patients. Eventually, 10 patients underwent cortical mastoidectomy during 1–6 days upon admission, with an average of 3.2 days. During the follow-up period patients were monitored for clinical progression. Patients who did not show clinical improvement such as persistent fever, worsening symptoms, or the presence of neurological symptoms were treated surgically. The length of stay was an average of 15.5 days overall, with no significantly longer hospital stay in patients who were treated surgically compared to patients who were treated conservatively (17.1 days vs. 14.2 days, P = .26). ConclusionIntracranial complications of acute mastoiditis remain a significant challenge. Selected patients with intracranial complications can be treated conservatively with close monitoring, without increasing the risk of immediate or long-term complications. Initial antimicrobial treatment should cover anaerobic bacteria, as it correlates with severe complications.

A Multicenter Epidemiological and Pathogenic Characteristics Study of Community-Acquired Bacterial Meningitis Children in China: Results from the Chinese Pediatric Bacterial Meningitis Surveillance (CPBMS) 2019-2020.

To explore the epidemiological and pathogenic characteristics of children with community-acquired bacterial meningitis. A multicenter, retrospective study was conducted among CABM patients under 15 years old from 33 hospitals in China from 2019 to 2020. The medical record, laboratory, and microbiological data were collected and analyzed. A total of 1610 children with CABM were identified and presented at a median onset age of 45 days of whom 955 (59.3%) were males. CABM occurred mostly in infants <1 year of age (84.0%, 1352/1610). In etiology-confirmed cases, the pathogens were isolated from CSF culture in 515 (32.0%), 400 (24.8%) in blood culture, and 186 (11.6%) both in CSF and blood culture. In total, 126 pathogens were identified through CSF mNGS in 330 CABM cases; 21 S. pneumoniae isolates were detected in 83 CABM cases by antigen detection method. Major pathogens were E. coli (195, 24.7%), GBS (170, 21.5%), and S. pneumoniae (157, 19.9%). GBS (29.3%, 22/75) was the first pathogen of CABM in neonates aged 0-6 days old, while E. coli (44.7%, 76/170) in 7 to 28 days of age; S. pneumoniae (96.2%, 151/157) was the most common pathogen in >3 months old cases. About 9.7% (19/195) strains of E. coli produced ultra‑broad‑spectrum β‑lactamases. The common intracranial imaging complications were subdural effusion and (or) empyema in 349 (21.7%), hydrocephalus in 233 (14.5%), and cerebral abscess in 178 (11.1%). A total of 389 (24.2%) cases were completely cured and 1088 (67.6%) cases improved. Among 166 patients (10.3%) with adverse outcomes, 32 cases (2.0%) died, and 37 cases (2.3%) relapsed. The onset age of CABM in children is usually within 1 year of age, especially <3 months. The primary pathogens in infants less than 3 months old are E. coli and GBS, and the dominant pathogen in children older than 3 months old is S. pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. CABM should not be excluded even if CSF leukocyte counts are within normal range. Due to the low detection rate of pathogens in children with CABM, standardized CSF bacteriological examination should be paid more attention to increase the pathogen detection rate. Non‑culture CSF detection methods may facilitate pathogenic diagnosis.

Evaluation of treatment approaches for sinogenic intracranial abscess in children.

This study aimed to evaluate the management practices and outcomes in children with sinogenic intracranial suppuration. This was a retrospective cohort study in a single paediatric tertiary unit that included patients younger than 18 years with radiologically confirmed intracranial abscess, including subdural empyema and epidural or intraparenchymal abscess secondary to sinusitis. Main outcomes studied were rate of return to the operating theatre, length of hospital stay, death in less than 90 days and neurological disability at 6 months. A cohort of 39 consecutive patients presenting between 2000 and 2020 were eligible for inclusion. Subdural empyema was the most common intracranial complication followed by extradural abscess and intraparenchymal abscess. Mean length of hospital stay was 42 days. Sixteen patients were managed with combined ENT and neurosurgical interventions, 15 patients underwent ENT procedures alone and 4 patients had only neurosurgical drainage. Four patients initially underwent non-operative management. The rates of return to the operating theatre, neurological deficits and 90-day mortality were 19, 9 and 3, respectively, and were comparable across the 4 treatment arms. In the univariate logistic regression, only the size of an intracranial abscess was found be associated with an increased likelihood of return to the operating theatre, whereas combined ENT and neurosurgical intervention did not result in improved outcomes. Sinogenic intracranial abscesses are associated with significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.

Complications of squamosal type of chronic otitis media- its management in a tertiary care centre

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic otitis media of squamosal type is inflammation of the middle ear cleft presenting with recurrent ear discharge through a tympanic membrane perforation. The disease spectrum ranges from mild to severe forms of complications. The aim is to find the incidence of complications of unsafe CSOM, its management and the demographic profile associated with it.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This hospital-based observational study was carried out on 25 patients admitted in the ENT department of a tertiary care centre during a period of 1 year. Diagnosis was made by taking a thorough history, clinical, audiological and radiological investigations. The data collected were tabulated in Microsoft excel worksheet and the variables were summarized as percentages and proportions.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 25 patients, 9 patients had complications and the most common extracranial and intracranial complications were mastoid abscess and brain abscess respectively. Complications were more common in the age group of 11-20 years. In all the patients, multiple intravenous antibiotics were given covering gram positive, gram negative and anaerobic organisms. The intracranial complications were managed by neurosurgery or neurology followed by mastoidectomy to eradicate the disease at source.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Significant decrease has been seen in the incidence of complications and mortality due to availability of newer and effective antibiotics along with early diagnosis and intervention. However, they are still prevalent among the lower socio-economic strata, poor hygiene and overcrowding communities. This study was aimed at creating awareness among the population to avail medical treatment at the earliest possible to avoid complications.&lt;/p&gt;

CHRONIC SUPPURATIVE OTITIS MEDIA COMPLICATIONS SCENARIO DURING COVID 19 PANDEMIC Authors

Introduction: In December 2019, world health organisation (WHO) declared corona virus disease (COVID 19) led to disruption in routine and non-emergency medical facilities. This increased the morbidity risk associated with some of the preventable conditions, one of them being chronic suppurative otitis media (CSOM). Methods: Retrospective data was collected between March’s 2019- 2021 in the department of ENT and head neck surgery, BRLSABVM medical college, Rajnandgaon, CG,.India.. All chronic otitis media patients with or without complications were included Results: In our study the number of complicated cases which were 30 patients out of the 402 patients, the rate comes out to be 7.4%. In this study, before the pandemic that is form march 2019 to march 2020 the percentage of complicated cases were found to be 7 (23.6%) and during the pandemic that is from April 2020- March 2021 it was 23(76.3 %) that shows increase in number of complications during pandemic. Most common age group involved was 21 to 40 years. The most common Extra cranial complication was mastoid abscess (36.6%), followed by facial nerve palsy (FNP) 20% The most common Intracranial complication was meningitis (16.6%) followed by brain abscess (6.6%) and extradural abscess (3.3%). Conclusion: In our study we could find that there was a change in CSOM behaviour in terms of complications in prepandemic and pandemic period. Study shows rise in complication rate from 7 cases during the prepandemic times to 23 cases during pandemic times. This shows the importance of timely intervention which should be available to treat common diseases like CSOM to avoid the possible complications and their sequelae.

Intracranial complication of acute paranasal sinusitis during active COVID-19 infection – a case report

According to various sources, complications of sinusitis occur with a frequency of between 3 and 17%. Intracranial complications include: meningitis, epidural abscess, subdural abscess, brain abscess, and thrombophlebitis of the dura mater and the brain. The most common intracranial complications are inflammations of the frontal, ethmoid and sphenoid sinuses. A brain abscess is the second most common intracranial complication in the course of sinusitis after meningitis. The presented case concerns a 16-year-old patient treated for brain abscesses and CNS sinus thrombosis in the course of acute purulent inflammation of the frontal and maxillary sinus on the right side. The management of intracranial complications of acute paranasal sinusitis according to EPOS 2022 is high doses of intravenous antibiotics used for a long period, neurosurgical surgical treatment consisting in drainage of abscesses through craniotomy, drainage of the frontal sinus from external or endoscopic access. The prognosis of intracranial complications most often depends on the severity of neurological symptoms and appropriate prompt treatment implementation.

Assessment of germinal matrix hemorrhage on head ultrasound with deep learning algorithms

Germinal matrix hemorrhage-intraventricular hemorrhage is among the most common intracranial complications in premature infants. Early detection is important to guide clinical management for improved patient prognosis. The purpose of this study was to assess whether a convolutional neural network (CNN) can be trained via transfer learning to accurately diagnose germinal matrix hemorrhage on head ultrasound. Over a 10-year period, 400 head ultrasounds performed in patients ages 6months or younger were reviewed. Key sagittal images at the level of the caudothalamic groove were obtained from 200 patients with germinal matrix hemorrhage and 200 patients without hemorrhage; all images were reviewed by a board-certified pediatric radiologist. One hundred cases were randomly allocated from the total for validation and an additional 100 for testing of a CNN binary classifier. Transfer learning and data augmentation were used to train the model. The median age of patients was 0weeks old with a median gestational age of 30weeks. The final trained CNN model had a receiver operating characteristic area under the curve of 0.92 on the validation set and accuracy of 0.875 on the test set, with 95% confidence intervals of [0.86, 0.98] and [0.81, 0.94], respectively. A CNN trained on a small set of images with data augmentation can detect germinal matrix hemorrhage on head ultrasounds with strong accuracy.

Pseudomonas Pseudoalcaligenes Caused Otogenic Cerebellar Brain Abscess In Indonesian Child

Otogenic brain abscess is a common intracranial complication from chronic supurative otitis media.Pseudomonas pseudoalcaligenes is a rare cause of brain abscess. Prompt diagnosis and decision making issignificant in order to decrease the mortality rate from this type of abscess. We described A 13-year-old boypresented with decreased consciousness, positive meningeal signs, and pathological reflexes. There was ahistory of chronic suppurative otitis media. A head CT scan revealed multiple left cerebellar abscesses andbrain edema. The abscess wall culture revealed P. pseudoalcaligenes. After being managed with surgicalabscess drainage, mastoidectomy, ear flushing, and antimicrobial therapy for six weeks, his consciousnesslevel improved. Cerebellar neurological impairment was still observed. Physical and neurologicalrehabilitation was performed in order to improve the patient’s condition.

Germinal Matrix-Intraventricular Hemorrhage: A Tale of Preterm Infants.

Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.

Complications of Acute and Chronic Otitis Media in a Tertiary Referral Center in Nepal.

The aim of this study was to report the incidence of complications in otitis media and to determine the frequencies of various extracranial and intracranial complications at a tertiary care hospital. We retrospectively reviewed the clinical records of patients of all ages and genders who were treated in a tertiary care hospital in Nepal from May 2015 to May 2020 for complications of acute and chronic otitis media. The complications were broadly classified as extracranial and intracranial. The details of patient profiles, histories, examination findings, investigations and treatments were reviewed from the charts. The mean age of 164 patients with complications of otitis media was 47.44±18.58 years. There were 79 (48.2%) male and 85 (51.8%) female patients. The overall incidence of otitis media complications was 0.78%. The incidences of the complications from acute otitis media, chronic otitis media without cholesteatoma, and chronic otitis media with cholesteatoma were 0.5%, 0.06% and 5.6%, respectively. Extracranial complications, intracranial complications and combined extracranial and intracranial complications were seen in 80%, 11% and 9% of the patients, respectively. The most common extracranial and intracranial complications were subperiosteal abscesses and brain abscesses, respectively. There was one mortality due to complication. The incidences of complications and mortality from otitis media have declined with the availability of suitable antibiotics, improved imaging, and multidisciplinary management. Antibiotic resistance and masking of signs and symptoms, however, could pose challenges in the future.

Profile of Chronic Suppurative Otitis Media Complication in Indonesian Patients: Review of 25 Cases

Background: The number of CSOM complications is increasing every year, especially in developing countries. Indonesia is a developing country with a large population and a large number of CSOM cases. Objectives: Analysing the profile of CSOM patients with complications in 2017 - 2018. Methods: Participants in this study were CSOM patients with complications who underwent surgery in the 2017-2018 period. Participants in this study were divided into 2 groups based on the year of complications. They were identified for demographic data, types of complications, clinical symptoms and comorbid symptoms at admission, radiology, intraoperative findings, and complications. The statistical tests used in this study included Chi Square test, Mann-Withney test, and Kruslkal-Wallis. Results: The average participant’s age was 28.84 ± 15.40 years (p = 0.468), with the most in the age range of 11-25 years (48.00%). Most of them were male (76.00%) (p = 0.364), high school-educated (48.00%), came from Western Indonesia (76.00%), and students (40.00%). Clinical symptoms were otorrhea and ear pain (68.00%). All participants had cholesteatoma and 60.00% had atticoantral perforation in eardrum. Most CSOM complications in 2017 and 2018 was extracranial (55.56%; p = 1.000 and 70.59%; p = 0.785, respectively). There was no significant comparison between the number of CSOM complications in 2017 and 2018 (p = 0.326). Surgical procedures used canal wall down tympanoplasty. Conclusion: Subperiosteal abscess is the most common extracranial complication, while brain abscess is the most common intracranial complication of CSOM in this study.

Intracranial complications of pediatric rhinosinusitis: Identifying risk factors and interventions affecting length of hospitalization

ObjectiveTo identify risk factors and interventions affecting length of hospitalization (LOH) and clinical outcome in children with intracranial complications of rhinosinusitis. MethodsRetrospective chart review of 12 children hospitalized at 2 academic medical centers for intracranial complications of rhinosinusitis over the past 5 years. Results12 patients were identified with an average age at presentation of 13 years old. 92% were male and 75% were African American. The most common presenting symptoms were fever and headache. Localizing neurological symptoms including hemiparesis and aphasia, in addition to seizures occurred in 33% of patients and increased LOH significantly (33 versus 15 days, p = 0.03). Epidural (EA) and subdural abscesses (SA) were the most common intracranial complications. 58% of patients were initially treated with a combination of open neurosurgical (ON) intervention and endoscopic sinus surgery (ESS) and LOH was significantly shorter for these patients compared to those treated otherwise (14 versus 31 days, p = 0.02). Streptococcus species were the most common group of bacteria identified in 75% of cases, with S. anginosus accounting for 42% of cases. The overall average LOH was 21 days with 92% of patients having complete resolution of symptoms by time of discharge. ConclusionsTreatment of intracranial complications of acute rhinosinusitis can have favorable outcomes after appropriate surgical management. Localizing neurologic symptoms and seizures portend longer hospital stay and recovery time. Shorter hospital stay was seen in those undergoing early combined ON and ESS interventions.

HIV, Tuberculosis, and Otogenic Intracranial Sepsis: A Devastating Disease With a Subtle Presentation.

To undertake a large-scale review of otogenic intracranial sepsis in an area of highly prevalent HIV and tuberculosis (TB) to re-examine and inform early diagnosis and treatment efforts. Seventy-seven consecutive cases of otogenic intracranial sepsis in KwaZulu-Natal, South Africa were reviewed for demographics, presentation, imaging, HIV status, culture results, and outcomes. The most common intracranial complications were intracranial abscess (46.8%), hydrocephalus (31.2%), subdural empyema (28.6%), and epidural empyema (26.0%). Ear discharge (87.0%), postauricular abscess (29.9%), and hearing loss (29.9%) were notable presenting symptoms. Overall mortality was 15.6%. Of the 45.5% of patients with HIV testing, 54.2% were HIV+, Mortality among HIV+ patients was 15.8% but only 6.3% in HIV- patients (p = 0.61, OR = 2.8). Eight patients (10.4%) had culture or histological evidence of TB infection. Otogenic intracranial complications continue to present late and are associated with significant mortality and morbidity, despite advances in diagnostic and treatment modalities. This study represents one of the largest case-series in the literature, and the first to specifically evaluate the effects of HIV and TB infection.Patient presentation and severity of illness varied; however, a majority of patients presented with ear discharge and no focal neurological signs. An effect size for higher mortality among HIV+ patients compared with HIV- patients was noted but was not significant. Tuberculosis infection was prevalent compared with previous studies.This study reinforces the need for enhanced screening and early treatment of ear disease to minimize associated mortality and morbidity, particularly in immunocompromised patients.

Intra and extracranial complications of middle earths: literature review

Otitis media (OM) has several forms and among the main are otitis media (AOM), OM with effusion and chronic otitis media (COM) (cholesteatomatous or not). For the most part, the OM progressed well, but there are risks of complications and sequelae. These are divided into extra and intracranial, the first being the most common, but less lethal. Among the extracranial are: labyrinthine fistula, subperiosteal abscess, mastoiditis, temporozigomatic abscess, Bezold's abscess, parapharyngeal abscess, facial palsy, petrositis and labyrinthitis. Among the intracranial are: meningitis, epidural abscess, subdural empyema, brain abscess, the sigmoid sinus thrombophlebitis and otological hydrocephalus. The aim of this study is to identify the main complications of otitis media, distinguishing them from the incidence, degree of morbidity and mortality and analyze the development, management and treatment required for each entity. Brain abscess is the most common entity and subperiosteal abscess is the most common extracranial complication. Labyrinthine fistula occurs most often related to OMC. This has the physiopathology erosion of the bone covering the semicircular canal, usually the lateral semicircular canal. Labyrinthitis results from the spread of infection from the cochlear window membrane and can be presented in two ways: serous or suppurative labyrinthitis. The most common intracranial complication is meningitis, rarely associated with cholesteatoma and most often associated with AOM, of higher incidence in children. CT with contrast is the gold standard when you suspect any complications in patients with otitis media after undergoing a thorough history and physical examination. When the physician knows the possible complications and their signs and symptoms, the diagnosis is early and the prognosis best. Treatment of complications in general is based on patient hospitalization, myringotomy with culture and sensitivity, intravenous antibiotic therapy as early as possible and mastoidectomy in all cases related to COM or recurrent complications.

Dilemmas in Current Management of Complicated Chronic Otitis Media.

To evaluate the distribution of complications of chronic otitis media, dilemma of how soon to operate a seriously ill patient with CSOM and treatment outcomes. A retrospective study was done in a tertiary care centre. Clinical data from 2013 to 2015 was compiled, surgical management with outcome was analysed. A total of 425 patients with chronic otitis media were evaluated. Single/multiple complications were seen in 147 (34.5%) patients. Majority of the complications were seen in active squamosal type of chronic otitis media i.e. 137 (59.5%) cases out of the 147. Meningitis (3.3%) was the most common intracranial complication. Patients with intracranial complications were referred from other departments and did not primarily present to ENT, indicating a major fact that treatment was sort for the complication and not for chronic otitis media. Headache with or without ear discharge was the most common presenting complaint. Fever and pain were not prominent indicators of complications, posing a diagnostic dilemma as patients were already receiving antibiotics and analgesics before reaching tertiary care centre. The patients with severe intracranial complications were promptly taken up (within 3-5days) for canal wall down mastoidectomy with intravenous broad spectrum antibiotic (vancomycin) and mannitol with high risk consent. However ill the patients were, especially children with very poor general conditions, there was dramatic recovery as soon as the mastoidectomy was done. There were no deaths due to the complications of chronic otitis media in our 3years study period. Delay in resorting to surgical management of chronic otitis media was the main reason for patients going into complications. Timely mastoidectomy in patients with poor general condition with high risk of mortality, the surgery actually had a major role in reducing the morbidity and mortality. Lack of awareness that chronic otitis media is a condition that can lead to life threatening complications resulted in procrastination of surgery. Chronic otitis media requires speedy surgical management i.e. as soon as patient is fit to tolerate anaesthesia: Tympanoplasty and Canal wall up or down Mastoidectomy to prevent complications from arising or to resolve the present complication.

A Case of Chronic Otitis Media Complicated with Cerebellar Abscess

Introduction:Intracranial complications are a known sequale of chronic otitis media. Meningitis is the most common intracranial complication, followed by otogenic brain abscess. Temporal lobe abscesses are more frequently reported in the literature as compared to cerebellar abscesses.Case Report: We present a case of chronic otitis media with cerebellar abscess that need drainage of the abscess twice. The mastoidectomy was done few days later once the patient stable.Conclussion: The case report highlights the increasing incidence of cerebellar abscess as an intracranial complicationwith literatures review. Besides that, we also discuss about the appropriate timing of ear surgery and neurosurgical drainage, as well as its outcome.Bangladesh Journal of Medical Science Vol.17(1) 2018 p.149-151

Intracranial complications of chronic otitis media

The objective of this study was to review our experience on intracranial complications (ICC) secondary to chronic otitis media (COM), and to investigate its clinical characteristics and treatment approaches. From January 1996 to December 2012, 17 patients with ICC secondary to COM were identified and included in this study, and were analyzed retrospectively. 13 out of these 17 cases (76.4 %) have cholesteatoma. The most common intracranial complication is brain abscesses (52.9 %), followed by meningitis (29.4 %), perisinus abscess (11.7 %), and epidural abscess (6 %). All patients underwent emergency mastoidectomy within the first 24 h after clear diagnosis. 7 patients underwent brain abscess drainage or abscess excision at the time of ear surgery. The mortality rates are 0 %. No recurrence was found in the 24-month follow-up period. Cholesteatoma was strongly associated with ICC. An early diagnosis and active surgical intervention in collaboration with proper antibiotic treatment is the key to cure.

Paranasal Sinus CT Scan Changes in Children with Meningitis: A Cross Section Study, Tehran, IRAN

Background: Meningitis is the most common intracranial complication of sinusitis. Objective: Determine the frequency of sinusitis using CT scans in children with documented meningitis. Methods and materials: A prospective, cross sectional study was done in pediatric infectious ward of Rasul Hospital in Tehran, Iran during 2010-2011. In this study 65 cases with meningitis were evaluated for presence of sinusitis (according to symptoms, criteria and paranasal CT scan). Results: CSF obtained in 112 cases. Cases with meningitis aged 1 month-16 years old with a mean of 4.2 years. Definite bacterial meningitis was the final diagnosis in 40/112 patients (35.7%; missing=5). Second step: Paranasal sinus CT scan had been performed in 65 cases with final diagnosis of meningitis. Cases were between 1 month to 16 years old (mean age of 4.2 y). 51% of the patients were male and 49% were female. Bacterial meningitis was diagnosed in 55.3% (36/65) and aseptic meningitis in 44.7% (29/65). Sinuses were reported to be undeveloped in 7.6% (n=5) of younger than 4 months old cases. Sinusitis was diagnosed in 30.7% (20/65) of all cases with meningitis; 3.4% (1/29) in those with aseptic meningitis and 52% (19/36) in those with bacterial meningitis which shows significant difference between the 2 groups (P<0.05). The involved sinuses included: pan sinusitis with 15% (3/20) case. Maxillary sinusitis the most common type observed (16/20); on the next places comes; sphenoid sinusiti (7/20); ethmoeid sinusitis (4/20) and finally isolated frontal sinusitis was seen in 0% of cases. Chronic type of sinusitis was reported in 50% (n=10) of all cases. Conclusion: The prevalence of sinusitis in documented cases of meningitis (septic & aseptic meningitis) was 31%, and was more common (25%) in bacterial meningitis. Meningeal manifestations (e.g. meningeal signs and symptoms; or CSF changes) might be due to bacterial sinusitis. Most cases of meningitis in children are accompanied with sinusitis. Differentiation between the two sources and definition of the initial site of infection is always problematic. Appropriate bacterial sinusitis treatment is needed to prevent meningitis. We recommend sinus tract to be evaluated in every meningitis patient (septic or aseptic). Furthermore, adequate treatment in chronic sinusitis would help prevent readmission.

A Case of Acute Mastoiditis Complicated with Epidural Abscess

Received October 31, 2012 Revised January 20, 2013 Accepted January 22, 2013 Address for correspondence Young Ho Kim, MD Department of Otolaryngology, Seoul National University, Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Korea Tel +82-2-870-2442 Fax +82-2-870-3863 E-mail yhkiment@gmail.com Epidural abscess is the most common intracranial complication of acute mastoiditis and may lead to a life-threatening condition if an appropriate treatment is not performed. The treatment of choice is a surgical eradication of lesion, drainage of the abscess, and intravenous antibiotic therapy. We report a case of acute mastoiditis followed by an epidural abscess in the posterior cranial fossa in a 32-month male patient. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:516-21 Key WordsZZAcute mastoiditis ᆞEpidural abscess ᆞOtitis media.

Complications of chronic suppurative otitis media: a retrospective review

The purpose of this study was to review our patients with complications of chronic suppurative otitis media (CSOM) and compare with literature. This retrospective study was performed over 10 years in our tertiary referral university hospital. During this period 4,630 patients with CSOM were admitted to the department and 906 patients underwent a surgery. From the records of the 4,630 patients, 121 patients (2.6%) with complications were identified. Of the 906 CSOM patients that underwent a surgery, 511 had cholesteatoma, and 395 had granulation and/or polyp tissue. Ninety-four of 511 (18.4%) patients with cholesteatoma and 27 of 395 (6.8%) patients with granulation and/or polyp tissue had a complication. Of the 121 complicated CSOM patients, 57 extracranial (47.1%) and 37 intracranial (30.6%). Multiple combined complications were occurred in 27 (22.3%) patients. The mastoid abscess was the commonest extracranial complication (28.3%); it was followed by labyrinthitis (9%), facial nerve paralysis (8.4%), and Bezold's abscess (1.3%). The most common intracranial complication was lateral sinus thrombophlebitis (19.5%), followed by perisigmoid sinus abscess (13.5%), meningitis (9%), brain abscess (6.5%), and extradural abscess (4.5%). Most frequent intraoperative finding of complicated CSOM patients was cholesteatoma, with the exception of patients with facial nerve paralysis. There was no mortality in any of our patients. The additional morbidities were recorded in 25 patients (20.6%). In this study, we emphasize the importance of an accurate and early diagnosis, followed by adequate surgical therapy and a multidisciplinary approach.