Intracranial Complications Of Otitis Media Research Articles

Sigmoid sinus thrombosis with recurrence of cholesteatoma in a patient after Bondy operation – case report

Introduction: Sigmoid sinus thrombosis (SST) is a rare intracranial complication of otitis media. The incidence of suppurative otitis media is estimated at about 6%, with a mortality rate of 5–10%. Aim: Presentation of the case of a 43-year-old female patient who was diagnosed with left-sided SST due to recurrence of chronic otitis media with cholesteatoma. Case report: Patient hospitalized due to recurrence of middle ear cholesteatoma. The patient had undergone bilateral Bondy operation in childhood because of cholesteatomas. Faulty surgical treatment and inadequate post-operative care resulted in a recurrence of the disease and the development of SST. On admission, radiological diagnostics were performed and confirmed the diagnosis. Broad-spectrum antibiotic therapy, antithrombotic therapy and a lateral petrosectomy were administered, achieving clinical improvement. Conclusions: Despite existing controversies in the choice of surgical technique, it is necessary to perform it indefectibly. Faulty performance is a risk factor for recurrence of the disease and development of complications.

Intracranial Complications of Otitis Media - The Menace of Discharging Ears in Children.

Background: In developing nations, otitis media is widespread among people of low socioeconomic backgrounds. Chronic otitis media is a potentially fatal condition due to its consequences. Gradualbone erosion in chronic otitis media leads to serious intracranial complication.Objective: The objective of this study was to determine the frequency of intracranial complications of otitis media in children.Material and Methods: This was a prospective, descriptive & cross-sectional study conducted at the Department of ENT -----from 1st October 2018 to 30th September 2019 on 120 patients to determine the frequency of intracranial complications of otitis media in children. Children with ages ranging from 1 to 14 years were included in the study. Patients with suspicion of intracranial complications were admitted to ward for management and investigated. The types of complications occurring were noted to determine their frequencies.Results: A total of 120 children were included in the study. The male to female ratio was 3:2. Patients with age range of 3 and 5 years was the commonest group presenting with intracranial complications constituting 30.8% of all. Brain abscess was the commonest complication observed in 13(10.8%) of patients. Conclusion: Intracranial complication of chronic otitis media is common clinical problem faced by ENT surgeon affecting children of 3 to 5 years age, predominantly brain abscess.Keywords: Frequency, Intracranial Complications, Otitis Media, Children, Brain Abscess.

Foudroyant middle-ear pneumococcal inflammation with meningoencephalitis in a six-year-old girl

Introduction. Intracranial complications of otitis media still occur, despite great progress in the treatment of all forms of inflammation. These are serious conditions which are still life-threatening and require a fast and accurate diagnosis and an adequate treatment. We present an illustrative case of an acute, foudroyant, pneumococcal, suppurative otitis media with infection spreading into endocranium and development of meningoencephalitis and otic hydrocephalus. Case report. A 6-year-old girl was admitted to the University Children's Clinic because of fever, headache, vomiting and disorder of consciousness. Computed tomography scan of the endocranium and temporal bone has revealed brain edema and hypodense content in the left mastoid and timpanic cavity. The diagnosis of acute otitis media with meningoencephalitis was made and we started with intensive antibiotic treatment. Lumbar puncture and haemoculture were confirmed a pneumococcal infection. Otosurgical treatment was conducted too due to an inadequate reaction to conservative treatment. Firstly, left mastoidectomy with the implantation of ventilation tube has been performed, followed by radical tympanomastoidectomy because there was no improvement. Three weeks after the second operation, a magnetic resonance imaging of the endocranium was performed and an otic hydrocephalus was diagnosed. A neurosurgical operation was performed on the same day with the setting of the ventriculo-peritoneal shunt. Conclusion. Intracranial complications of acute otitis media in children are extremely rare and they require multidisciplinary treatment. Surgical treatment of the ear shouldn't be postponed and the choice of the type of otosurgical intervention should be individually adapted. Audiological and neurological complications of the disease are frequent and they further prolong and impair the treatment.

Adult Otogenic Meningitis in the Pneumococcal Conjugated Vaccines Era.

Introduction Streptococcus pneumoniae is a major pathogen of otogenic meningitis (OgM), the most commonly reported intra-cranial complication of otitis media (OM). Objectives To study the changes in adult OgM patients in the pneumococcal conjugated vaccines (PCVs) era. Methods Retrospective cohort of adults presenting with concurrent OM and meningitis in a secondary medical care center between 2005 and 2015. Data collected included demographics, OM-related symptoms, cerebrospinal fluid (CSF) and ear culture results, pre- and during hospitalization antibiotic treatment, imaging findings, and complications. We compared the pre-PCV years (2005–2009) with the post-PCV years (2010–2015). Outcomes were 1) incidence of all-cause adult OgM from the total meningitis cases; 2) impact of PCVs on the clinical presentation of OgM and bacteriology. Results Otogenic meningitis was diagnosed in 26 out of 45 (58%) cases of all-cause meningitis admissions. Of those, 10 (38%) were male, with a mean age of 62.4 years old. Ear-related signs and symptoms were documented in 70% of the patients, and OgM was diagnosed following imaging studies in 6 out of 26 (23%) patients. All of the patients received intravenous antibiotic therapy, and 7 (27%) patients required surgical interventions: 6 required myringotomy and 1 required mastoidectomy. There were 12 (46%) patients in the pre-PCV years and 14 (56%) in the post-PCV years. The positive pneumococcal CSF and ear culture rates remained high and unchanged (∼ 75%). There were no significant changes in the clinical presentation or mortality rates. Conclusion Micro-otoscopy should be included in the routine work-up of any suspected adult meningitis, because OgM is underdiagnosed. Unlike their impact on pediatric otitis media, PCVs did not change the epidemiology and bacteriology of OgM.

Complicações Intracranianas de Otite Média: A Experiência de 7 Anos do Hospital de Braga

INTRODUÇÃO: As complicações intracranianas de otite média representam uma situação relacionada com alta taxa de mortalidade, manifestando-se de forma aguda e constituindo urgências médicas e cirúrgicas. São definidas como disseminação do processo inflamatório/infecioso para além dos espaços pneumatizados do ouvido médio, tendo variadas formas de apresentação.MATERIAL E MÉTODOS: Consulta dos processos clínicos dos doentes com patologia otológica e patologia intracraniana entre 2008 e 2014 admitidos no Hospital de Braga. Características dos pacientes, diagnósticos otológicos e neurológicos, resultados microbiológicos, abordagem terapêutica e evolução clínica foram os parâmetros analisados.RESULTADOS: Obteve-se um total de 19 doentes, com uma idade média de 40,4 anos. Febre persistente e cefaleias foram os principais sintomas encontrados. Otite média aguda foi o diagnóstico otológico mais associado a complicação intracraniana. Seis pacientes apresentavam mais do que uma complicação, resultando num total de 28, quase metade das quais correspondendo a meningite.DISCUSSÃO: Após comparação com estudos semelhantes da literatura, verificamos que os nossos resultados são semelhantes aos já encontrados, exceto no que diz respeito à principal etiologia das complicações intracranianas.CONCLUSÃO: As complicações intracranianas de otite média devem ser consideradas situações de alto risco que requerem intervenção médica imediata.

Early signs and symptoms of intracranial complications of otitis media in pediatric and adult patients: A different presentation?

ObjectivesThe aim of this study was to review the clinical presentation and early signs and symptoms of otogenic intracranial complications (OIC) in children and adults.Methods: retrospective chart review. The medical records of all children and adults admitted in our center with OIC during the period 2008–2017 were reviewed. Data concerning clinical presentation, treatment and outcomes were reviewed and analyzed. ResultsWe included 47 patients with OIC: 21 children (range 1–13 years) and 26 adults (range 22–71 years). We included more patients with acute otitis media than with chronic otitis media (children 5% adults 19%, all with cholesteatoma).In children; the most common OIC was central cerebral venous thrombosis. In both children and adults; otogenic symptoms such as otalgia and otorrhea were present. Children presented more frequently with headache and nausea. Adults presented more frequently with decreased consciousness. Hearing loss was the most common long-term sequel. Three adults died. ConclusionsIn our series, we found that OIC in children present as ‘mimicking meningitis’ (e.g. nausea and vomiting). Adults on the other hand have a clinical presentation ‘mimicking stroke’ (e.g. neurological deficits and decreased level of consciousness). In children, sinus thrombosis was observed more frequently than in adults.Despite the low mortality rate, death still occurs. Long -term sequelae most frequently include hearing loss in children as well as in adults.

Otogenic Lateral Sinus Thrombosis: A Review of Fifteen Patients and Changing Trends in the Management.

Introduction Otogenic lateral sinus thrombosis is a rare intracranial complication of otitis media in the modern age of antibiotic treatment, but it is potentially a dangerous complication. Objectives The aim of this study is to focus on the various clinical presentations, management options and sequelae in a series of fifteen patients with otogenic lateral sinus thrombosis. Methods Retrospective chart review of inpatients treated for otogenic lateral sinus thrombosis at our tertiary care institution between 2010 and 2015. Results A total of 15 patients (11 males and 4 females) with ages ranging from 9 to 60 years were diagnosed with otogenic lateral sinus thrombosis. The most commonly reported symptoms were headache, ear discharge and hard of hearing, which were experienced by all 15 (100%) patients. In contrast to previous studies found in the literature, 7 (47%) patients in our series presented with neck pain and neck abscess. Imaging studies and microbiological cultures were performed for all patients, who also underwent a mastoidectomy procedure. Internal jugular vein ligation was performed on 5 (33%) patients. Incision and drainage of the neck abscess was performed on 7 (47%) patients. All patients had a satisfactory resolution of their symptoms, and the mortality rate was of 0%. Conclusions Otogenic lateral sinus thrombosis, though a rare complication, can still occur; therefore, keeping a high level of suspicion is important, especially in developing countries. We also describe the patients with neck abscess associated with this rare condition. Combining parenteral antibiotics with surgical intervention is the treatment of choice.

급성 중이염에 합병된 뇌경막하 농양

The incidence of intracranial complications of otitis media have been reduced by use of antibiotics. Therefor subdural abscess caused by otitis media is extremely rare. However, it still represents a challenging situation because of its high mortality rate. We describe a 54-year-old patient diagnosed with acute otitis media. In this case, we experienced ipsilateral subdural abscess as complication of otitis media and incidental contralateral hemiparesis. We present this disease and the treatment course which has been successfully treated by antibiotics. Furthermore, we discuss its symptoms, physical examinations through literature review. (J Clinical Otolaryngol 2016;27:301–305)

Otogenic lateral sinus thrombosis: Case series and controversies

ObjectivesThe aim of this study is to (1) report the clinical presentation, treatment, and sequelae in a series of pediatric patients with otogenic lateral sinus thrombosis and (2) to review the most controversial aspects of management of this rare intracranial complication of otitis media. MethodsRetrospective chart review of inpatients treated for central venous thrombosis at a tertiary care facility between 1996 and 2012. ResultsFive pediatric patients (four male, one female) were identified with otogenic lateral sinus thrombosis. Age at presentation ranged from 13 months to 15 years. All underwent a surgical procedure, ranging from a simple myringotomy with tympanostomy tube placement to tympanomastoidectomy and internal jugular vein ligation or craniotomy. Three were anticoagulated with unfractionated heparin with subsequent transition to low molecular weight heparin of variable duration. One patient developed a non-life-threatening intracranial hemorrhage while on long-term anticoagulation. Follow-up imaging, when available, did not directly correlate complete thrombus resolution with use of anticoagulation or with persistent symptoms. ConclusionsOtogenic lateral sinus thrombosis is a rare intracranial complication of otitis media with significantly reduced morbidity and mortality in the modern era of antibiotic treatment, surgical intervention, and anticoagulation therapy. Due to the rarity of this condition today, the recommended extent of surgical intervention and need for routine anticoagulation are unclear, and requires further data to determine definitively.

Ciągle aktualny problem zapalenia opon mózgowo-rdzeniowych i innych powikłań wewnątrzczaszkowych zapalenia ucha środkowego i zatok przynosowych u dzieci

The most frequent primary infections causing purulent meningitis in older children are both acute and chronic otitis media and sinusitis or upper and lower airways infections. In these cases sometimes purulent meningitis is accompanied with other intracranial complications. Pharmacological treatment of intracranial complications without surgical intervention concerning primary source of infection increases risk of complications including death of a patient and also recurrences of bacterial meningitis. In the paper authors present two uncommon cases of children with purulent meningitis and other intracranial complications of otitis media and sinusitis diagnosed by pediatricians.

Extracranial and intracranial complications of otitis media: 22-year clinical experience and analysis

Conclusion: The morbidity of the complications has had a decreased tendency in recent decades, but the category of the complications was rather diverse. There are still many serious complications that require our attention. Surgery is still the most important treatment option. Objective: To investigate otogenic extracranial and intracranial complications in patients with acute and chronic otitis media. Methods: A retrospective study investigated 285 patients with extracranial and intracranial complications among the 2346 inpatients with acute or chronic otitis media with or without cholesteatoma admitted to the Department of Otolaryngology, AnHui Medical University Hospital between 1987 and 2008. Results: In the 285 patients with cranial complications, 253 had a single complication, 29 had two complications, and 3 had more than two complications. Intracranial complications included meningitis (16 cases), brain abscess (42 cases), sigmoid sinus involvement (29 cases), extradural abscess (8 cases), subdural abscess (1 case), and hydrocephalus (2 cases). Extracranial complications included labyrinthitis (90 cases), mastoid abscess (79 cases), facial paralysis (47 cases), Bezold abscess (5 cases), and apicitis pyramidalis (1 case). In all, 267 patients were cured or improved without recurrence. Five patients died from complications, of whom four died of cerebral hernia and one died of multiple abscesses.

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

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.

Otitic Hydrocephalus: A Report of 2 Cases

Otitic hydrocephalus is a rare intracranial complication of otitis media. It is characterized by elevated cerebrospinal fluid (CSF) pressure with normal CSF biochemistry and without any focal neurologic abnormality other than those related to the increased intracranial pressure. The pathophysiology of this rare condition is unknown. The incidence of intracranial complications was reduced dramatically with the introduction of newer antibiotics, but complicated cases still occur. Serious consequences can ensue if complications are not identified and treated properly. The author reviews the literature on otitic hydrocephalus and describes 2 new cases.

Severe Visual Loss After Ear Surgery

Sigmoid sinus thrombosis was once one of the most common intracranial complications of otitis media, but this has become less common since the advent of antibiotics. The frequency of sigmoid sinus hypoplasia reported in the literature is about 17%. Considering the possibility of postoperative intracranial hypertension, sigmoid sinus and jugular bulb surgeries were contraindicated in this case.We present a case with sigmoid sinus thrombosis of the sinus due to compression flowing surgical injury. This is a unique case, which presents with contralateral sigmoid sinus hypoplasia. Eventually, the patient presented to us with otitic hydrocephalus, increased intracranial pressure, papilledema, oculomotor and abducens nerve palsy, and severe right-side visual loss are prominent features.

Contemporary Management of Intracranial Complications of Otitis Media

Intracranial complications as a result of otogenic infections occur even in the antibiotic era. Meningitis is the most common reported intracranial complication, followed by brain abscess and lateral sinus thrombosis. The purpose of this study is to review our experience and management of these serious complications. A retrospective chart review was performed at a tertiary referral medical center for the period from 1998 to 2007. Charts with acute or chronic otitis media as primary diagnosis were reviewed, and intracranial complications secondary to either were included in the study. Age, sex, clinical presentation, radiographic findings, management, and outcome were studied. Patients with meningitis or petrous apicitis were not included in the study. Ten cases reviewed had intracranial complications. Five patients had brain abscesses, 1 patient had a subdural empyema, and 4 patients had lateral sinus thrombosis. All patients received broad-spectrum intravenous antibiotics for 6 weeks. Mastoidectomy was performed in all patients, but not all patients were treated with direct drainage of the intracranial abscess, especially if clinical and serial radiographic response was favorable. Otogenic intracranial complications can be fatal if not managed appropriately. Broad-spectrum intravenous antibiotics for 6 weeks is usually sufficient treatment. Management of the intracranial disease takes precedence, but direct drainage of the abscess may not be necessary if a patient's symptoms, neurologic status, and radiographic findings progress favorably. A high index of suspicion should be maintained on all patients presenting with symptoms not typically seen with routine otitis media.

Complications of otitis media in Indigenous and non‐Indigenous children

In Australia, three to five children die each year because of otitis media complications, and 15 children will suffer permanent hearing loss each year as a result of otitis media. Extracranial complications occur most commonly, and include mastoiditis, cholesteatoma and otitis media with perforation. Intracranial complications are less common, and include meningitis, brain abscess and lateral sinus thrombosis. In Australia, approximately 60% of extracranial and intracranial complications of otitis media occur in children. The contrasting rates of childhood otitis media among Indigenous and non-Indigenous children have implications for the frequency and types of complications occurring in both groups. Otitis media with effusion and acute otitis media predominate among non-Indigenous children, whereas chronic suppurative otitis media (CSOM) occurs most commonly among Indigenous children. The incidence of mastoiditis in Australia is low by international standards (2/100,000 children), but cholesteatoma rates among Indigenous children in Australia are higher than previously estimated (up to 10% in CSOM). A high rate of chronic tympanic membrane perforation occurs among Indigenous children, estimated to be as high as 80%. Intracranial complications of otitis media are uncommon, but are potentially life-threatening and are more likely to occur among Indigenous than non-Indigenous children. Reduced access to medical care, lower socioeconomic status and remote living conditions mean that levels of early childhood hearing loss among Indigenous children are likely to be underestimated. This has implications for early childhood speech and language development and education.

Lateral Sinus Thrombosis as a Complication of Otitis Media: 10-Year Experience at the Children's Hospital of Philadelphia

Lateral sinus thrombosis is a rare intracranial complication of otitis media that is traditionally described in countries with poor access to medical care. Our goal was to describe the clinical presentation, management, and outcome of patients diagnosed with lateral sinus thrombosis in a US tertiary care center and to highlight the clinically relevant differences in presentation between these patients and those described in previous reports. The medical charts of 13 patients diagnosed with otogenic lateral sinus thrombosis were reviewed. These patients were identified from a manual search of 156 subjects with International Classification of Diseases, Ninth Revision codes corresponding with a diagnosis of mastoiditis or thromboembolism over a 10-year period (1997-2007) at the Children's Hospital of Philadelphia. In contrast to previous reports in the literature, the majority of patients in this series exhibited cranial neuropathies and signs of raised intracranial pressure. Nearly all of the patients had a history of acute otitis media treated with antibiotics in the weeks preceding admission. However, many patients denied high fevers or active otomastoid symptoms, which are classically associated with lateral sinus thrombosis. The diagnosis was made in all of the children by using computed tomography and MRI/venography. Treatment strategies included myringotomy tube placement, simple mastoidectomy, intravenous antibiotics, and anticoagulation. Posthospitalization follow-up data revealed no significant long-term complications. Despite appropriate antibiotic therapy, lateral sinus thrombosis and other intracranial complications of otitis media are still a threat to children in the modern era. Neurologic, rather than otologic, symptoms may dominate the presentation of otogenic lateral sinus thrombosis. Thus, a high index of suspicion may be critical for ensuring timely diagnosis of this rare condition.

Congenital arhinia

Lateral sinus thrombosis is a well-known complication of otitis media. The classical picture is often modified by previous antibiotic therapy, making the diagnosis and management difficult.A 14-year-old male patient with attico antral type of otitis media presented with fever, headache, deviation of left eye and deviation of tongue to left on protrusion. On investigation patient was found to have lateral sinus thrombosis, petrous apicitis, meningitis and internal jugular vein thrombosis along with cranial nerves palsies. Patient underwent radical mastoidectomy and intravenous antibiotics were given for 2 weeks. Patient recovered well in 1 month.Lateral sinus thrombosis is now a rare intracranial complication of otitis media. The presence of lateral sinus thrombosis mandates further investigation for additional complication.Here a case of lateral sinus thrombosis with internal jugular vein thrombosis, petrous apicitis, abducent and hypoglossal nerves palsies is presented for its rarity.

Lateral sinus thrombosis with cranial nerves palsies

Lateral sinus thrombosis is a well-known complication of otitis media. The classical picture is often modified by previous antibiotic therapy, making the diagnosis and management difficult. A 14-year-old male patient with attico antral type of otitis media presented with fever, headache, deviation of left eye and deviation of tongue to left on protrusion. On investigation patient was found to have lateral sinus thrombosis, petrous apicitis, meningitis and internal jugular vein thrombosis along with cranial nerves palsies. Patient underwent radical mastoidectomy and intravenous antibiotics were given for 2 weeks. Patient recovered well in 1 month. Lateral sinus thrombosis is now a rare intracranial complication of otitis media. The presence of lateral sinus thrombosis mandates further investigation for additional complication. Here a case of lateral sinus thrombosis with internal jugular vein thrombosis, petrous apicitis, abducent and hypoglossal nerves palsies is presented for its rarity.

Der otogene Kleinhirnabszess - zwei Kasuistiken

The otogenic brain abscess remains a serious intracranial complication of otitis media despite advantages in diagnostics and antibiotic treatment during the last decades. We discuss the clinical picture and the possible ways of treatment by the example of two case histories. Case 1: We report about a 38-year-old man, who was suffering in cholsteatoma since 30 years. The surgical revision was restricted by the patient since this time. The acute symptoms of meningitis were caused by intracranial involvement and cerebellar abscess due to cholesteatoma. After surgical revision we observed a period of clinical improvement. A repeated surgery became necessary because of renewed brain abscess at the cerebellar region five weeks after primary operation. Case 2: A 6-year-old girl was already treated with antibiotics because of subacute mastoiditis since three weeks. She was entering the ENT department because of headache and otorrhoea. During mastoidectomy the bone destruction leads to a cerebellar abscess. The neurological symptoms were regredient immediately after the surgical revision. Both case histories underline the importance of cerebellar abscess as an intracranial complication of chronic otitis media. The neurologic symptoms and the CT-scan were essential for the exact diagnosis. The following treatment includes the surgical revision of the middle ear, the abscess-drainage as well as the lavage of the cavity with antibiotics.