Extradural Abscess Research Articles

High-Voltage Electrical Burn Requiring Urgent Scalp Reconstruction after Developing a Brain Abscess

Electrical burn injuries to the scalp are at risk of extensive tissue damage and neurological complications. We present the case of a patient who came into contact with a high-voltage power line while cherry picking, resulting in a large full-thickness scalp defect. Early on in his presentation, he developed progressive global weakness which remained relatively static during his admission. An incidental finding of an extradural abscess complicated his management, requiring urgent surgical intervention with definitive tissue coverage. The scalp was reconstructed using a free myocutaneous anterolateral thigh flap. There were no postoperative complications. Following rehabilitation, the patient was discharged home with limited functional recovery. He mobilises independently with a wheelchair and requires full-time carers.

Akut mastoidite ikincil nadir görülen bir otojenik beyin apsesi tablosu

Otogenic brain abscess, precipitated by acute mastoiditis, is a rare but potentially fatal condition. It constitutes an intracranial complication that can further develop due to meningitis and sigmoid sinus thrombosis. This case underscores the critical importance of early detection and therapeutic intervention, which often pose substantial clinical challenges. This report elucidates the case of a 35-year-old female who arrived with severe otalgia, noted predominantly on the right side, coupled with discharge and vertigo. Subsequent neuroimaging unveiled the presence of basal meningitis in the right cerebellar hemisphere, accompanied by an extradural abscess and coalescent mastoid air cells. The patient's treatment protocol entailed a rigorous antibiotic regimen, continually adjusted based on symptomatic improvement. The rapid diagnosis and immediate treatment of otogenic brain abscesses are paramount. As observed in our case, factors such as limited medical knowledge, oversight in medical care, and socio-economic disadvantages contributed to the severity of the intracranial complication. These elements highlight the necessity of addressing systemic factors in healthcare to ensure effective prevention and management of such conditions.

Late Infection of Cranioplasty Presenting with Extradural Abscess Thirty Years After Surgery: a Case Report

Late Infection of Cranioplasty Presenting with Extradural Abscess Thirty Years After Surgery: a Case Report

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.

Outcomes of Complications of Chronic Otitis Media in Tertiary Care Facilty in Western Uttar Pradeh

Objectives: This study aims to investigate the frequency and management of complications of chronic suppurative otitis media(CSOM).Patients and Methods: Out of 376 patients with CSOM, 44 patients (25 males, 19 females; mean age 48.5±3.5 years; range 21to 76 years) meeting study criteria were enrolled in this descriptive cross sectional study which was conducted at the Department of Ear Nose and Throat, Head and Neck Surgery. All newly diagnosed patients having CSOM with complications were enrolled. The complications were treated first. Intracranial abscesseswere evacuated by neurosurgeons. Radical and modified radical mastoidectomy were performed.Results: Majority of the patients presented in the second and third decade of life (21-30 years: 27.27%, 31-40 years: 18.18%).Most of the patients (59.1%) had lower socioeconomic status. Canal wall down mastoidectomy was the most common (79.5%) procedure performed. Cholesteatoma was the most common operative finding (100%). Among extracranial complications, subperiosteal abscess was the most common finding (38.63%), while extradural abscess outnumbered (22.72%) in intracranial complications.Conclusion: Complications of CSOM commonly affect younger people with low socioeconomic status. Collaborating withneurosurgeons may assist in the successful management of this infection.

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.

A True Experimental study to Evaluate the effect of Ice Gel Pack Application on Peri Orbital Edema among patients after Craniotomy Surgery

A craniotomy is a cornerstone for the management of the traumatic brain injury worldwide and it is estimated that more than 60000 craniotomy surgeries are performed per year in Tamil Nadu. The postoperative complications related to craniotomy are hematoma formation, cerebral edema, subgaleal collection, per orbital edema, wound/bone flap infection, extra dural abscesses, and herniation. Ice gel pack application is one of the non- pharmacological approach to reduce per orbital edema, after craniotomy. The study was aimed to assess the Effect of Ice Gel Pack Application on Periorbital Edema among Patient after Craniotomy. True experimental pre-test-post-test control group design was adopted and the purposive sampling technique, 30 samples were selected based on inclusion and exclusion criteria, experimental group [n=15] and the Control group [n=15]. The demographic variable, medical history, surgeon periorbital rating edema scale in both experimental and control group. Intervention was given to experimental group and routine treatment was given to control group. It was identified that the mean level of periorbital edema after craniotomy surgery in experimental and control group was 1.33 and 0.36 respectively with a mean difference of 1.73. Likewise the standard deviation of the experimental and control group was 0.36 and 0.59 respectively. The calculated t’ value 27.8 was greater than the table value 3.67at 0.001 level of significance. Hence, it was concluded that ice gel pack application was an effective method to reduce the grade of periorbital edema after craniotomy surgery.

Concurrent management of suppurative intracranial complications of sinusitis and acute otitis media in children

ObjectiveIntracranial complications of sinusitis and acute otitis media (AOM) are rare but life-threatening events. In children with suppurative intracranial complications, concurrent neurosurgical and otolaryngological (ORL) intervention has been recommended to optimize outcomes. The aim of this study was to investigate outcomes following concurrent neurosurgical and ORL intervention. MethodsA retrospective cohort study of children undergoing neurosurgical intervention for intracranial complications of sinusitis or AOM in two neurosurgical centres in Ireland was conducted. Results65 children were identified. Mean age was 11.9 years. The most prevalent symptoms were headache, pyrexia, altered level of consciousness, facial swelling, and vomiting. Subdural empyema (n = 24, 36.9%) and extradural abscess (n = 17, 26.2%) were the most common complications. 54 underwent same admission ORL intervention; 47 (87%) were performed concurrently or earlier. For rhinogenic infections, 35 (64.8%) underwent endoscopic sinus surgery (ESS), 13 (24.1%) underwent frontal sinus trephine, and 5 (9.3%) underwent maxillary sinus washout alone. For otogenic infections, 10 (90.9%) underwent mastoidectomy and 7 (63.6%) underwent tympanostomy tube placement. 19 (29.2%) had post-operative neurological deficits, of which 2 (3.1%) were permanent. Streptococcus intermedius was the most common pathogen (n = 30, 46.2%). Concurrent intervention reduced the prevalence of residual collection (p = 0.018) and the need for revision neurosurgical intervention (p = 0.039) for sinogenic complications. The same trends did not achieve statistical significance for the otogenic group. Mortality was 0%. ConclusionIntracranial complications of sinusitis and AOM are best managed in a specialist centre with multidisciplinary input. Concurrent ORL and neurosurgical intervention reduces abscess recurrence and requirement for revision neurosurgery in sinogenic complications and should represent the standard of care. ESS is the ORL modality of choice in experienced hands.

264. A 20-year Study of Intracranial Pyogenic Complications of Sinusitis in Children

Abstract Background Intracranial pyogenic complications of sinusitis in children are relatively uncommon but can lead to serious sequelae. The objective of this study was to characterize the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period (2000- 2019). Methods Single-center retrospective chart review. Cases were identified based on International Classification of Diseases (ICD)-10 diagnostic codes (intracranial abscess or granuloma, extradural and subdural abscess, Pott’s puffy tumor, acute or chronic sinusitis) and by reviewing all microbiological samples of intracranial pus, tissue or fluid. Results 108 cases of clinically and/or radiologically diagnosed sinusitis were included after review of 1591 charts. The majority were adolescents (median age 12, IQR 9-14); 72 were male (67%). The most common presenting symptoms were fever (84%), headache (87%) and symptoms of upper respiratory tract infection (57%). Median symptom duration was 10 days (IQR 5-21) and 55 cases (51%) received oral antibiotics prior to admission. The most frequent complications were epidural empyema (n=50, 46%), subdural empyema (n=46, 43%) and Pott’s puffy tumor (n= 31, 29%). 50% (n=54) underwent neurosurgery, of which 20% (n=11) required multiple craniectomies. 38% (n=41) underwent otolaryngological surgery. Microbiological data from sterile specimens demonstrated single organisms in 36 cases (59%) and polymicrobial growth in 25 cases (41%). The most frequently identified pathogens were Streptococcus anginosus (n=40, 66%) followed by Fusobacterium species (n=10, 16%) and Prevotella species (n=10,16%). Most cases were treated with combination antibiotic therapy (n=68, 63%) and 14% (n=15) with a carbapenem. The median duration of intravenous antibiotic therapy was 51 days (IQR 42-80). One child died and 23% (n=25) suffered neurological sequelae (median follow-up 344 days). 48 cases (44%) occurred between 2014-2019. Conclusion Intracranial complications of sinusitis continue to cause significant morbidity in children. The predominant causative pathogen was Streptococcus anginosus. Polymicrobial infections are common, confirming the need for prolonged broad-spectrum antibiotic treatment. Disclosures Sharon Cushing, MD, MSc, FRCSC, Cochlear Corporation (Research Grant or Support)Cochlear Corporation (Speaker’s Bureau)Interacoustics (Speaker’s Bureau)Plural publishing (Other Financial or Material Support, Royalties: editor: manual of pediatric balance disorders)

STUDY OF MRI MORPHOLOGY OF SPINAL TUBERCULOSIS

OBJECTIVE: To study the morphology of tuberculosis of spine on MRI. METHODS AND MATERIALS: A retrospective study was done in the department of Radiodiagnosis, PESIMSR, Kuppam.This study includes 37 patients with suspected Spinal Tuberculosis, who were referred to the department of Radiodiagnosis between 2019 Jan to 2021 July. Informed consent was taken from all the patients. This study was done on GE Signa Explorer 1.5 Tesla. RESULTS: A total of 37 cases were included in the study. Of these 37 cases, 31 were males and 6 were females. The most common age group involved was between 20-40 years, seen in 15 cases followed by 41-60 yrs seen in 14 cases and 61-90 yrs seen in 8 cases. Lumbar vertebrae were commonly affected accounting for 86% of total cases (32cases) followed by dorsal and cervical vertebrae accounting for 8% and 5 % respectively (3 and 2 cases respectively). Intervertebral disc involvement (Discitis) was most commonly seen in 32 cases followed by vertebral endplate involvement (27 cases) in our study. Prevertebral & paravertebral involvement were found in 20 and 23 cases respectively . In our study,19 cases had shown the involvement of posterior elements .Epidural soft tissue component was seen in 22 cases. Psoas abscess and paraspinal involvement were seen in 9 and 8 cases respectively. CONCLUSION: MRI helps in the early assessment of the extent and severity of disease compared to X-ray and CT scan. It is valuable in detecting early marrow changes, intervertebral disc involvement, extradural abscess and cord compression.

Pott’s Puffy Tumor - Overview of case series

Pott’s puffy tumor (PPT) is rare and usually seen as a complication of frontal sinusitis that has been neglected or partially treated, resulting in subperiosteal abscess of the frontal bone with underlying osteomyelitis, which can lead to life-threatening intracranial complications, such as epidural/subdural empyema, cerebral abscess and meningitis. Given this, the purpose of the present study was to gather the most diverse cases reported together to highlight the main treatment methods. Methods: It is a narrative review, starting from the search in the database PubMed, Lilacs and Scielo from 2010 to 2020, which resulted in 34 scientific articles. The search focused on obtaining data on new approaches and treatments established for Pott’s puffy tumor. Results: 34 articles were included which described 58 patients with a swollen Pott tumor, occurring predominantly in male adolescents, with streptococci (26,1%) as the main etiologic agent. Approximately 84% of all patients were male subjects. The most prevalent intracranial complication was an epidural or extradural abscess (84,2%). Regarding PTT therapy, all patients received antibiotic therapy (ATB), and the main empirical antimicrobial scheme used was cephalosporin third generation, with vancomycin and metronidazole. In most cases, surgery was performed using several techniques, mainly an external surgical approach, external drainage (ED) of the subperiosteal abscess associated with endoscopic sinus surgery (ESS). In general, the prognosis is favorable, even if neurological symptoms are present at admission. Conclusion: Based on available literature, PPT is a profoundly serious complication, which can be easily avoided if treated with the ATB, ED and ESS triad immediately, and, if necessary, craniotomy.

Sinogenic Intracranial Suppuration in Children: Systematic Review and Meta-analysis.

To evaluate temporal trends in the management of sinogenic intracranial suppuration and its outcomes in children. A systematic search of databases was performed (Medline, Embase, Cochrane, ClinicalTrials.gov). Studies in children (age <18 years) with sinogenic subdural empyema, extradural abscess, and intraparenchymal abscess were included. Data on treatment strategies were extracted. Primary outcome was death <90 days. Secondary outcomes were return to theater, neurologic disability at 6 months, and length of stay. Random effects meta-analysis and meta-regression were performed to investigate the effect of time and endoscopic sinus surgery (ESS) on these outcomes. A total of 32 retrospective observational studies involving 533 patients recruited across a 45-year period (1975-2020) were included. The pooled estimates for 90-day mortality, permanent neurologic disability, and return to theater were 2.3% (95% CI, 1.1%-3.6%; I2 = 0, P > .99), 21.3% (95% CI, 15.3%-27.3%; I2 = 75.2%, P < .001), and 37.3% (95% CI, 29.5%-45%; I2 = 71.2%, P < .001), respectively, with no significant differences found across the study period. The pooled estimate for ESS was 58.4% (95% CI, 44.2%-72.6%; I2 = 97.1%, P < .001) with a significantly increasing trend in its use in the more recent years. ESS was not associated with improved mortality, reduced need for revision surgery, or neurologic disability. The outcomes of sinogenic intracranial complications have not changed over the last 45 years, and ESS was not associated with improved patient outcomes. Further high-quality studies are required to determine the most appropriate treatment modalities to improve the burden of morbidity associated with sinogenic intracranial suppuration in children.

Pott's puffy tumor: as a very rare and unpredicted complication of ipsilateral pan sinusitis - case presentation and review of articles

Pott's puffy tumor is considered as a rare clinical entity. It is developed as a rare complication of frontal sinusitis. In addition, the trauma to the frontal area is another suggested cause. The Pott's puffy tumor is presented as a forehead swelling due to sub-periosteal collection. Although, the Pott's puffy tumor is a rare condition but at the same time, it can be serious because it may lead to life threatening complications namely, extradural abscess, subdural abscess, meningitis, encephalitis, and brain abscess. Thus, the Pott's puffy tumor is classified as a very significant surgical emergency.

English

An 18 years old female patient came to emergency medicine department on 3rd July 2020 in the evening hours with massive swelling extending in front, above and behind left ear. Associated with severe, throbbing, intermittent headache since past 4 days patient also had high grade fever. Patient also had a history of left ear foul smelling discharge, scanty in amount, non-blood tinged, not aggravated or relieved with upper respiratory tract infection (URTI), not relieved with medications and not associated with giddiness. Clinical examination revealed a swelling in left preauricular region extending to temporoparietal region displacing left pinna downwards and outwards. Bilateral periorbital swelling was present (Figure 2, 3). Mastoid tenderness was conspicuous. Whitish foul smelling, non-blood-tinged discharge was present in left external auditory meatus. Further ear examination was not possible due to oedema, swelling and thick discharge in external auditory canal (EAC). In view of extensive swelling with its epicenter in mastoid region, left unsafe chronic otitis media (COM) with complication was suspected and was admitted to ENT ward. General investigations were normal except leucocytosis. While patient was put on antibiotics, neurosurgical opinion was sought and magnetic resonance imaging (MRI) brain with contrast was planned to map the abscess. MRI (Figure 1) which was suggestive of left squamosal COM and mastoiditis with intracranial extradural abscess in left temporoparietal region. MRI also uncovered large subgaleal abscess in the left temporo-occipito-parietal region along the sternocleidomastoid (SCM) muscle with thrombosis of left transverse and sigmoid sinus. Neurosurgeons found no need for intervention from their side.

Neuromelioidosis: A Single-Center Experience with Emphasis on Imaging.

Introduction Infection with Burkholderia pseudomallei , a gram-negative bacterium found in soil and surface water, is termed melioidosis and is commonly reported to occur in Southeast Asia and Northern Australia, where it is endemic. It is being increasingly reported in India, and transmission occurs through inhalation, inoculation, and ingestion. The neuroparenchyma, the adjacent soft tissue, and bone are known to be affected in both the acute and chronic disease forms. Involvement of these structures is rare but causes significant mortality and morbidity. Material and Methods Eighteen culture-proven cases of neuromelioidosis were identified between January 2008 and December 2019. The patients were retrospectively identified via search of the hospital’s electronic database. Results Cranial disease was in the form of parenchymal abscesses ( n = 4), cerebritis/encephalitis ( n = 5), and extradural ( n = 4) and dural disease ( n = 1). Acute myelitis ( n = 1) and spondylodiscitis ( n = 3) were seen in the spinal disease form. Neuroparenchymal involvement ranged from cerebritis/encephalitis to early and mature parenchymal abscesses. Extradural involvement was in the form of extradural abscesses and/or thick irregular enhancement in the extradural region. Early diagnosis and initiation of appropriate therapy had favorable outcomes in 15 out of 18 patients. Two patients with parenchymal abscesses and one with myelitis succumbed to the illness. Conclusion Neuromelioidosis is a rare manifestation of melioidosis with significant morbidity and mortality, necessitating a high index of clinical suspicion, especially if there has been travel to endemic regions. Imaging plays a key role in facilitating early diagnosis and initiation of therapy.

Trends of Complications of Chronic Otitis Media in Tertiary Care Facilty in Western Uttar Pradesh

Objectives: This study aims to investigate the frequency and management of complications of chronicsuppurative otitis media(CSOM).Patients and Methods: Out of 376 patients with CSOM, 44 patients (25 males, 19 females; mean age48.5±3.5 years; range 21to 76 years) meeting study criteria were enrolled in this descriptive cross sectionalstudy which was conducted at the Department of Ear Nose and Throat, Head and Neck Surgery. All newlydiagnosed patients having CSOM with complications were enrolled. The complications were treated first.Intracranial abscesses were evacuated by neurosurgeons. Radical and modified radical mastoidectomy wereperformed.Results: Majority of the patients presented in the second and third decade of life (21-30 years: 27.27%,31-40 years: 18.18%).Most of the patients (59.1%) had lower socioeconomic status. Canal wall downmastoidectomy was the most common (79.5%) procedure performed. Cholesteatoma was the most commonoperative finding (100%). Among extracranial complications, subperiosteal abscess was the most commonfinding (38.63%), while extradural abscess outnumbered (22.72%) in intracranial complications.Conclusion: Complications of CSOM commonly affect younger people with low socioeconomic status.Collaborating with neurosurgeons may assist in the successful management of this infection.

Acute nonsuppurative otitis media as a marker for detecting the latent course of multiple extradural abscesses

The topic of the current article demonstrates, on one hand, the global trend of prevalence in the aetiology and pathogenesis of purulent intracranial complications of acute otitis media over chronic, yet on the other hand, emphasizes the possibility of a combined not related course of inflammatory changes in the middle ear cavities and in the brain. A rare case is described with contact mastoiditis combined with destruction of bone structures adjacent to the cranial cavity was secondary to multiple, huge, long-lasting, latent epidural abscesses. And only the appearance of symptoms, even not so much of acute otitis media, but rather tubootitis, became the only sign of manifestation and, with timely and adequate treatment, led to recovery.

351 The Diagnosis of Carotid and Vertebral Artery Dissections by Emergency Physicians is Rare

Carotid and vertebral artery dissections are rare events. The most frequent symptoms are head and neck pain and neurological deficits, but these are common emergency department (ED) chief complaints and other diseases causing these occur much more often. Furthermore, about one-third of patients have no headache, one-third have no neck pain and over 10% have no neurologic deficits. For these reasons, diagnosing dissections is challenging. We wished to quantify the magnitude of this problem in a large ED database. Our goal was to determine the number of total ED visits for every carotid and vertebral artery dissection diagnosed by ED physicians. Design: Multicenter retrospective cohort. Setting: 27 suburban and urban New York and New Jersey EDs with annual visits between 20,000 and 119,000. Participants: Patients seen by ED physicians in the four-year period from 11-1-2015 through 10-31-2019. Observations: We identified carotid and vertebral artery dissections using ICD-10 codes. We then calculated the number of ED visits for every carotid and vertebral artery dissection, along with 95% confidence intervals (CIs). From a database of 6,223,499 ED visits, we identified 115 carotid artery dissections and 97 vertebral artery dissections. The median ages (with interquartile ranges) and percent female of carotid and vertebral artery dissection patients were 54 years (41, 64), 47 years (38, 63), 55% and 51%, respectively. Of the total ED visits there was one carotid artery dissection for every 54,117 (95% CI 45,089 to 64,953) visits and one vertebral artery dissection for every 64,160 (95% CI 52,599 to 78,261) visits. The diagnosis of carotid and vertebral artery dissections by ED physicians is rare. An ED physician seeing 3,000-4000 patients a year would diagnose one carotid artery dissection every 13 to18 years and one vertebral artery dissection every 16 to 21 years.Tabled 1Row LabelsCount of Billed ICD DescriptionNumber of visits for each diagnosisDissection of carotid artery11554117.38Dissection of renal artery23111750Dissection of vertebral artery9764159.78Extradural and subdural abscess, unspecified7286437.49Intraspinal abscess and granuloma12649392.85total visits622349927 hospitals Open table in a new tab

Paediatric periorbital cellulitis: A 10-year retrospective case series review.

To identify the predictors of poor outcome and need for surgical management in paediatric patients with periorbital cellulitis. To assess the adherence to local guidelines in the management of periorbital cellulitis. Retrospective descriptive analysis of clinical, laboratory and radiological characteristics of 175 paediatric periorbital cellulitis presentations at a UK teaching hospital over a 10-year period. Regression investigated correlations for continuous and categorical variables. A total of 175 paediatric presentations were diagnosed as periorbital infections over the 10-year period. Of these, 139 had pre-septal cellulitis, 27 had a subperiosteal abscess, 6 had an orbital cellulitis, 1 had an orbital abscess, 1 a cavernous sinus thrombosis and 1 an extradural abscess. Median age at presentation was 5 years (range: 1 month-17 years). In total, 169 (97%) cases received systemic antimicrobial treatment. Cross-sectional imaging occurred in 30% of cases and 18% required surgical intervention. Increasing C-reactive protein was associated with greater risk of post-septal disease and requiring surgery. The best predictors of post-septal disease in the multivariate analysis (R2 = 0.49, P = ≤0.001) were ophthalmoplegia (P = 0.009), proptosis (P = 0.016) and pain on eye movement (P = 0.046). Proptosis was the single most significant predictor of surgical management (R2 = 0.53, P = <0.001). Multidisciplinary involvement and early medical management can improve outcomes for most patients. Those who deteriorate despite medical management should be considered for prompt imaging and surgical management to avoid serious life-threatening or sight-threatening complications.

Extradural Abscess in Case of extended cholesteatoma

Cholesteatoma is life-threatening disease due to its extracranial and intracranial complications. Extradural abscess is one of them and linked to pus and granulation tissue accumulation between the dura mater and temporal bone. The otogenic extracranial and intracranial complications are rare manifestations in modern era of antibiotics, that’s why we present a 44 old man with successfully treated extradural abscess in retrosigmoid region as a consequence of probably secondary infected through erosion of the external auditory canal extended congenital cholesteatoma.