Otogenic Abscess Research Articles

Otogenic abscess: rarity and reality

Introduction: Otogenic abscess is a complication commonly arising from active squamous chronic otitis media. It is rare (1:10000) but in fact are a dangerous reality to be managed promptly. Materials and Methods: A retrospective study of 82 cases of otogenic abscesses were studied over a period 24 years by simple random sampling. Cases of ear malignancy, previously operated mastoidectomy were excluded from study. All postop cases were analysed. Result: Most commonly affected were male (63.4%) in the second decade (34.1%) of life. Commonest bacterial infection was staphylococcus aureus (31.7%). Conclusion: Otogenic abscess though rare, are a reality and should be suspected when the patient with chronic ear discharge has high grade fever, severe headache and does not respond to best medical line of treatment. All these patients were subjected to imaging neurosurgical I&D of brain abscess followed by canal wall down tympano-mastoidectomy.

Pediatric brain abscess clinical profile, management and outcome at tertiary care centre in Nepal

ABSTRACTBackground: Brain abscess in pediatric population is serious life threatening problem. Many risk factors are associated with this entity like congenital heart disease, ear infection and immunocompromised state. Early diagnosis and treatment with minimal invasive procedure has good outcome. Materials and Methods: This is a hospital based cross-sectional study conducted at institute of Medicine (IOM), Tribhuvan University Teaching Hospital Kathmandu, Nepal over the period of 3 years between September 2014 to August 2017. Clinical profile, management and outcome were analyzed. Results: A total of 27 cases were taken for the surgical management in the present study. There were 18 male and 9 female with the male to female ratio of 2:1. Mean age of the study population was 7.08 years. Otogenic Abscess was the most common 37.03% (n=10) and the temporal lobe was the most common site (37.5%). Headache was the most common clinical presentation seen in 74.07 %. All the cases were initially managed with the burrhole and aspiration. Only 14.8 %( n=4) of cases subsequently required surgical excision of the abscess wall. Only18.5 %( n=5) of the cases required multiple session aspiration. Positive culture was seen in 25.9% (n=7). Pseudomonas aeruginosa and E.coli were the commonest organisms grown. Mortality rate was 3.7%.Conclusion: Modern advances in radio imaging and multidisciplinary team involvement has decreased the morbidity and mortality.Keywords: otogenic brain abscess; pediatric brain abscess; tubercular abscess.

Otogenic brain abscesses: A systematic review.

ObjectiveOtogenic brain abscesses are one of the most significant life‐threatening complications of otologic infections. Given their low prevalence, otogenic brain abscesses require a high index of suspicion for diagnosis. In this systematic review, we aim to provide an analysis of otogenic brain abscesses and describe common clinical signs and symptoms, bacteriology, location, treatment options, morbidity, and mortality.Data SourcesPubMed, Cochrane CENTRAL database, Google Scholar, and Scopus.MethodsA systematic review of literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses recommendations. Variables assessed included clinical signs and symptoms, bacteriology, location, treatment, morbidity, and mortality.ResultsTwenty‐nine studies met inclusion and exclusion criteria, corresponding to a total of 1307 otogenic abscess cases for review. Fifty‐five percent of abscesses were found in the temporal lobe and 28% in the cerebellum. Most patients (88.3%) had a history of suppurative chronic otitis media. The most common symptoms were headache, altered mental status, papilledema, and meningeal irritation. Fever, nausea, and vomiting affected about 40% of patients. The most commonly cultured bacterial species was Proteus mirabilis. In addition to antibiotics, most otogenic brain abscesses were treated by burr hole aspiration. Average mortality following advent of computed tomography was 8.11%.ConclusionAlthough rare, otogenic brain abscesses may occur as a complication of suppurative otitis media and require a high index of suspicion. Appropriate imaging studies and multidisciplinary expertise are crucial in the diagnosis and management.Level of Evidence4.

Otogenic Temporal Lobe Abscess: A Mini-review

Temporal lobe abscess is a rare, life threatening complication of inflammation of the middle ear. Signs of intracranial tension or focal neurological deficits at the time of presentation in patients with chronic or acute otitis media should raise concerns for temporal lobe abscess. Immediate surgical intervention along with antibiotics is necessary for good outcome.

PC3 - 129 Primary Intracranial Round Cell Sarcoma in an HIV Patient: A Case Report and a Review of Literature

Primary intracranial sarcoma among patients diagnosed with HIV is rare. Case reports published have shown that there is an increasing number of cases of leiomyosarcoma, hemangiopericytoma and rhabdomyosarcoma among these patients. Further, there are also few reports that sarcomas may present atypically, sometimes mimicking a brain abscess. We report a case of a 26 year old male, newly diagnosed HIV, who presented with bilateral chronic suppurative otitis media associated fever, headache and vomiting. Neuroimaging showed with multiple rim enhancing masses on the left temporal, parietal and occipital areas and bilaterally sclerosed mastoid air cells. Initial impression was an otogenic abscess. Burrhole craniotomy and evacuation of the cystic masses was done. Histopathologic examination revealed a small round blue cell sarcoma. Different immunostains were done to differentiate the various subtypes of sarcomas possible. Patient was discharged improved but did not consent to chemotherapy or radiotherapy.

Suppurative chronic otitis media complicated with meningoencephalitis and cerebral abscess. Case report

Although cerebral otogenic abscess is a rare complication of chronic otitis media, it is the second most frequent complication after otogenic meningitis. This paper presents a case of cerebral otogenic abscess in the temporal lobe, in a patient who suffered from suppurative chronic otitis media.

CLINICAL AND EPIDEMIOLOGICAL FEATURES OF INTRACRANIAL COMPLICATIONS OF INFLAMMATORY DISEASES OF THE ENT ORGANS IN CONDITIONS OF THE EAST-SIBERIAN REGION OF RUSSIAN FEDERATION

The authors investigated the epidemiological and clinical features of otogenic and rhinosinusogenic intracranial complications in East-Siberian region of Russian Federation. The rate of intracranial complications consisted of 0,2±0,1% in patients of ENT hospitals in Sakha- Yakutia, Krasnoyarsk Territory, Irkutsk Region, Republic of Tuva. The intracranial inflammatory pathology of otogenic nature was diagnosed two times more frequent than rhinosinusogenic. Meningitis was revealed at the same rate as lesions of brain substance (encephalitis, epi- and subdural abscesses). The high clinical efficacy was shown in surgical treatment of purulent polysinusitis using W. Messerklinger method of functional endoscopic rhinosinusosurgery (FESS). The method of transtemporal incision and drainage of otogenic abscess of the brain temporal lobe has a number of essential defects, because of them, the indications for application of this method should be considered and specified. It is necessary to have an interdisciplinary approach and use the modern achievements of medical science in order to develop the efficacy of treatment of given category of patients.

FEATURES OF OTOGENIC INTRACRANIAL COMPLICATIONS AT THE PRESENT STAGE

A retrospective analysis of treatment was made in 127 adult patients with acute and chronic otitis media complicated by suppurative-inflammatory pathology of the brain. Purulent meningitis was revealed in 52 (40.9%) of hospitalized patients. Meningoencephalitis was often diagnosed in the cases of acute otitis media (15.4%) and in cases of chronic otitis (22.7%). The otogenic brain abscess was detected in 13.5% of otitis media cases and it was noted to be twice frequent (33.3%) in cases of purulent otitis media. The patients 124 (97.6%) have been operated. An extended mastoidotomy and antromastoidotomy were performed in the acute purulent otitis media. An extended radical operation on the ear was applied in case of chronic otitis media. Performance of craniotomy and complete removal of the abscess using modern systems of neuronavigation showed a higher clinical efficacy as compared with transtemporal approach during sanitizing intervention on the ear including the opening and abscess drainage in surgery of otogenic abscesses of the brain.

Tubercular cerebellar abscess in a child

Tubercular abscess of the brain are rare lesions and usually occur in the supratentorial compartment in immune-compromised hosts. We report an uncommon case 12-year-child with otogenic tubercular cerebellar abscess that was managed successfully with surgical excision and anti-tubercular treatment and review the literature.

Management and Treatment of Otogenic Temporal Lobe Abscess Secondary to Mastoiditis: A Case Report and Review of Literature

Temporal lobe abscess is a rare complication of mastoiditis or other otogenic infections. Signs and symptoms are caused by tissue damage or displacement, and the presentation includes fever, headache, meningeal signs, and altered mental/sensory status. In the setting of acute mastoiditis, the rate of occurrence of a cerebral abscess is very rare, and therefore poses a diagnostic challenge for the physician. Here, a case of temporal lobe abscess is presented, and radiological findings, surgical treatment, and outcome are discussed.

Intracranial Abscesses: Changes in Epidemiology and Management Over Five Decades in Merseyside

To review the changing patterns in incidence, etiology, management, morbidity, and mortality for intracranial abscesses over the last decade and compare them with two previous studies spanning four decades, conducted at the regional neurological surgical unit on Merseyside. A retrospective review of case notes and laboratory records of all cases of intracranial abscess admitted to the regional neurosurgical unit between January 1995 and January 2005 was performed. Forty-seven cases of intracranial abscesses were identified. The incidence of these, in our study, was an average of five cases per year as opposed to eight cases per year in the previous decades. The mean age at presentation was 46 years, and the male-to-female ratio was 4:1. Diagnosis by computerized tomography scan was performed in majority of patients (85.1%) within 48 h of presentation. The incidence of otogenic abscess was 12.8% (6/47), much lower than that seen in previous decades. An association with previous neurosurgical procedures was noted in 19.1% of cases, similar to that seen in the previous decade. In 73.4% (36/49) of samples, organisms were isolated. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from two patients (4.3%); an isolate not reported in the previous two studies. Nine patients (19.1%) died during their hospital stay as compared to the overall mortality of 43%and 24%seen in the earlier reviews. Of the 38 who survived, 47.3% had a good outcome at discharge. In comparison with the two previous studies, the overall incidence of intracranial abscesses is decreasing on Merseyside. Moreover, the predisposing factors for intracranial abscesses have changed over the decades. The number of otogenic cases has declined. The incidence of brain abscesses following neurosurgical procedures is still a major cause for concern, as is the emergence of MRSA, as a significant pathogen.

Otogenic cerebellar abscess due to purulent labyrinthitis and defect of the superior semicircular canal and its propagation through the endolymphatic sac

The otogenic cerebellar abscess still is one of the most dangerous complications of otitis media and implicates a high risk of mortality. Early diagnosis and therapy are decisive factors for the chances of rehabilitation. Radiologic imaging (CT/MRI) plays an important role. A broad-spectrum antibiotic according to antibiogram is indispensable. The type of surgical intervention depends on the cause and localization of the abscess. In this case the cerebellar abscess was a complication resulting from labyrinthitis, which was propagated through the endolymphatic duct and sac to the posterior fossa dura. Consequently, it could be cured ultimately only after petrosectomy and abscess drainage toward the mastoid cavity. It is mandatory to completely sanitize the infection surgically in order to avoid lethal complication especially in case of a delayed clinical course or recurrent symptoms of labyrinth involvement. Close interdisciplinary collaboration between ORL, neurosurgery and neuroradiology is desirable for successful therapy.

Neurological Symptoms as a Primary Manifestation of Otogenic Abscess of the Temporal Lobe

Neurological Symptoms as a Primary Manifestation of Otogenic Abscess of the Temporal Lobe

Otogenic brain abscess: diagnostic and treatment experience

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

Otogenic brain abscess

Chronic inflammation of the middle ear is the most frequent cause of otogenic complications. Meningitis is the most frequent otogenic intracranial complication, followed by otogenic brain abscesses, while other complications are significantly less frequent. The study is aimed at presenting clinical causitry of otogenic brain abscesses consequential to chronic suppurative otitis in order to evaluate modern diagnostic and therapeutic possibilities. The study was retrospective and included the patients treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery of the Clinical Centre of Serbia diagnosed with otogenic brain abscess during a five-year period (1996-2000). A total of 9 patients (male to female ratio 8:1), aged 16-68 years, were assessed. The following parameters were analyzed: sex, age groups, place of living, occupation, number of hospitalizations, diagnostic procedures, symptoms and clinical signs of otogenic complications, other otogenic complications associated with brain abscess, endocranial localization of otogenic abscess, therapeutic procedures (oto-surgical treatment) and intraoperative otological findings. In our group of patients, otogenic brain abscesses were significantly more frequent in male patients in their forties, with median age of 33.5 years. As for the place of living, the patients from the provinces were more frequent, while with respect to their level of education, those with elementary or high school degrees were predominant. The inflammatory process most frequently spread into the endocranium through direct destruction of the bone walls of the middle ear. Diagnostic procedures included history, clinical otorhinolaryngological examination, audiological and vestibulological assessment, neurological ophthalmologic and radiographic examinations (CT, MRI). CT is the most reliable diagnostic tool enabling localization of the change, timing of surgical treatment and monitoring of surgical success. Presence of other otogenic complications associated with brain abscess was evidenced in six of our patients. Cerebral localization of abscess was more frequent (7). Four patients underwent previous oto-surgical treatment. The treatment included primary neurosurgical approach (radical extirpation or abscess drainage), followed by radical oto-surgical treatment after improvement of the patient's general condition.

Brain Abscesses of Ear, Nose, and Throat Origin: Comparison between Otogenic and Sinogenic Etiologies

This retrospective study analyzed 29 cerebral abscesses of ear, nose, and throat (ENT) origin. The mean follow-up of patients was 37 months. ENT etiologies included 45% otitis media (n = 13), 48% sinusitis (n = 14), and 7% ethmoidal sinus tumors (n = 2). Thirty-eight percent (n = 5) of otogenic abscesses occurred within 15 days after a mastoidectomy. Sinogenic abscesses were never due to surgery but were associated in 31% of cases (n = 5) with anterior skull base defects. The main locations of otogenic abscesses were the temporal lobe (54%; n = 7) and the cerebellum (23%; n = 3), whereas sinogenic abscesses were located in the frontal lobe in 75% of cases (n = 12). Because of this location, sinogenic abscesses were less symptomatic than otogenic ones and had greater size and encapsulation at the time of diagnosis. Thus, they required longer antibiotic treatment (p = 0.05) and more numerous surgical drainages (p = 0.02). Bacteriologic abscesses samples were positive in 90% of cases. Bacteria found in brain abscesses were different from the ones found in ENT samples in 62% of cases. Thus, the results of ENT bacteriologic samples were not helpful for choosing adequate antibiotic agents in case of negative brain abscess samples. Although mortality was not significantly higher in otogenic abscesses (31%; n = 4) than in sinogenic ones (6%; n = 1, p = 0.08), otogenic abscesses appeared more threatening. Indeed, they represented 80% (n = 4) of lethal cases and encompassed more clinical or radiological prognosis pejorative factors than sinogenic ones (p = 0.006). In conclusion, higher danger of otogenic abscesses mainly resulted both from their temporal or cerebellous locations and from the bacteria that were more frequently resistant to antibiotics.

Otogenic abscesses — our experience

Otogenic abscesses are the result of acute or chronic suppurative inflammation of the middle ear cleft caused by pus forming organisms, which lead to extracranial or intracranial abscesses. When it leads to intracranial abscesses, it may be life- threatening. Otogenic abscesses are commoner in India than in the Western countries due to many factors which have been discussed in this paper.

耳性小脳膿瘍の1症例と最近の耳性頭蓋内合併症について

耳性小脳膿瘍の1症例と最近の耳性頭蓋内合併症について

Ultrasound; a method of brain abscess drainage monitoring

Ultrasound guided percutaneous aspiration was performed in fourteen patients with multiple brain abscesses. A bone defect in the skull served as the site of needle insertion and served to sonographically evaluate the abscesses. Antibiotic therapy was administered in all cases. Repeat drainage was required in 5 cases. There were no complications. In 10 patients complete improvement without CNS lesions was achieved. Three patients suffered from headaches and seizures for a period of 6 weeks following the aspiration. One patient with multiple otogenic abscesses died in spite of multiple efforts to drain the abscesses. Our results demonstrate sonography to be very effective for monitoring brain abscess drainage and follow-up.

Non-traumatic brain abscess. Epidemiology, clinical symptoms and therapeutic results.

Two groups of patients with non-traumatic focal intracranial suppurative diseases were studied retrospectively to illustrate epidemiology, clinical symptoms and therapeutic results. The first group consists of 87 patients treated for brain abscess in the Department of Neurosurgery in Lund. During the 36-year period investigated (1947-1982) marked epidemiological changes occurred. Thus otogenic abscesses, constituting 33% of the cases below the age of 30 during the first 12 years of the study, virtually disappeared. During the third 12-year period of this study a marked increase in the number of abscesses was noted. The increase was caused particularly by the number of cryptogenic abscesses amounting to 51% of the material during 1971-1982. The second group of patients consists of all patients with pre- or post-mortem diagnosed brain abscess in the city of Malmö during 1960-1981. Since during this period 85% of all persons who died in this city were subjected to post-mortem examination this material offers a unique possibility of epidemiological studies. The combined study of these two groups of patients lends no support to the view that a real increase in the number of brain abscesses has occurred. We conclude that in patients with cryptogenic brain abscess the clinical symptoms do not usually indicate the presence of an infectious disease. In the majority of these patients a correct diagnosis has presumably not been obtained until the last decade. Furthermore, the investigation confirms the view that a mortality below 10% is nowadays feasible in unselected cases of brain abscess.