Otogenic Brain Abscess Research Articles

Risk Factors Associated With Mortality in Patients With Otogenic Brain Abscess.

Otogenic brain abscess is a well-recognized clinical condition that describes brain abscess secondary to an ear infection or mastoiditis. Current evidence remains limited on risk factors associated with mortality as most data are from case series. We aimed to 1) report the mortality rate among patients who did and did not receive mastoidectomy 2) identify factors associated with inpatient mortality. Retrospective cohort study. Multi-institutional. We identified a cohort of patients for years 2008 to 2014 who in their inpatient hospitalization carried the diagnoses of both brain abscess and infectious ear disease. Inpatient neurotology and neurosurgical procedures. A multivariable logistics regression model was built to identify the factors associated with inpatient mortality. The final analysis included 252 patients, of which 84 (33.3%) underwent mastoidectomy. The rate of inpatient morbidity and mortality were 17.5% and 4.0%, respectively. The rate of mortality in patients without mastoidectomy versus those with mastoidectomy was 4.2% versus 3.6%, respectively (p > 0.99). The odds of inpatient mortality were significantly increased for every 10-year increase in age (odds ratio [OR] 2.73, 95% confidence interval [CI]: 1.39-7.01, p = 0.011) and for Black compared to White patients (OR: 45.81, 95% CI: 4.56-890.92, p = 0.003). Older age and Black race were associated with increased odds of inpatient mortality and there were no significant differences in mortality between mastoidectomy cohorts. This research serves to generate further hypotheses for larger observational studies to investigate the association between sociodemographic factors and surgical variables with outcomes among this surgical population.

Otogenic brain abscess - a pause to step forward

Otogenic brain abscess - a pause to step forward

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.

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

Otogenic brain abscess and its management with review of literature

<p class="abstract"><strong>Background:</strong> Proper management of chronic otitis media may reduce the incidence of otogenic brain abscess. The objective of this study is to present our experience in the management of otogenic brain abscess by neurosurgical and otolaryngological surgery simultaneously<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> It is a retrospective study conducted between 2006-2015. 20 patients with otogenic brain abscess were admitted to neurosurgery and ENT wards for management were included in the study. On admissions patients had ENT, neurosurgery and neurological examinations. All the patients underwent neurosurgery followed by mastoidectomy. Repeat CT scanning/ MRI scanning done after 1 week to check for the success of the surgery and discharged on the 10th day after suture removal. Patients were followed up for 1-2 years<span lang="EN-IN">. </span></p><p class="abstract"><strong>Results:</strong> The study included sixteen males and four females. Their age ranged between 4-32 years with mean of 18 years. Their chief complaints were severe headache, vomiting and fever with unilateral and or bilateral foul smelling discharge. <span>Brain and HRCT temporal bone CT scanning showed equal incidence of abscess on the sides with 8 cerebellar, 6 temporal, 5 tempero parietal and 1 fronto parietal abscess. After completion of surgery, eighteen patients improved and two patents expired due to septic shock</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> This is technically more feasible technique with an added advantage of single anaesthesia, short stay of patient in the hospital and early disease clearance in the same procedure<span lang="EN-IN">.</span></p>

Single stage procedure to drain otogenic brain abscess using the transmastoid approach

Single stage procedure to drain otogenic brain abscess using the transmastoid approach

Otogenic brain abscess: A report of three cases

Otogenic brain abscess: A report of three cases

Simultaneous Management of Otogenic Brain Abscess and Suppurative Otitis Media: Retrospective analysis

Intracranial complications of Chronic Suppurative Otitis Media(CSOM) are common. Brain abscess is the commonest intracranial complication. Traditionally, life threatening brain abscess was managed first and the causative otitis dealt later. However, with the aim of dealing with both at the outset, we have started treating these problems in the same anesthesia setting. Retrospective analysis of the consecutive patients treated simultaneously is presented.Nepal Journal of Neuroscience 13:19-22, 2016

Successful management of a cerebral abscess secondary to chronic cholesteatoma caused by Prevotella melaninogenica and Peptococcus anaerobius – A case report and literature review

Abstract Cerebral abscess following cholesteatomatous otomastoiditis is a life-threatening complication and poses diagnostic and therapeutic challenges. We report a case of life-threatening cerebritis and cerebral abscess due to a collection of pus from an aerobic super infections occurring months after the apparent resolution of an otogenic brain abscess in a 67-year-old immunocompetent Italian female. Two gram-positive anaerobic pathogens were isolated during secondary neurosurgical procedures and antibiotic treatment was adopted to resolve the complications. Another objective of this study was to review the literature on gram-positive anaerobic pathogens and brain abscess complications in patients with fistula, and to highlight the importance of short imaging in monitoring treatment during long-term antibiotic therapy for otogenic brain abscess to avoid abscess recurrence. Isolating the strain and monitoring response to treatment with magnetic resonance imaging may improve the prognosis. The study also highlights the need for a close cooperation between infectious disease consultants and neurosurgeons.

Disruption of posteromedial large-scale neural communication predicts recovery from coma.

Editors' Note: Commenting on “Disruption of posteromedial large-scale neural communication predicts recovery from coma,” Rosazza et al. share their own experience with disorders of consciousness (DOC) and propose further research with longer follow-up and different DOC etiology. In response, Dr. Silva adds that future studies should explore brain-functional networks from acute to chronic DOC states throughout the recovery process and that the DOC etiology may not be as important as the alteration of coordination between the posterior cingulate cortex and medial prefrontal cortex. Drs. Nabavizadeh and Mamourian challenge the diagnosis in the NeuroImage “Calcified otogenic brain abscess” and propose that the correct diagnosis should be calcifying pseudoneoplasm of the neuraxis. Ye et al., …

Calcified otogenic brain abscess.

We read with interest the recent NeuroImage presented by Ye et al.1 as an example of calcified otogenic brain abscess. The authors described a patient with a 2-year history of recurrent episodes of purulent discharge from the left ear and an incidental calcified brain mass in the ipsilateral temporal lobe.1 In the largest case series of calcifying pseudoneoplasm of the neuraxis (CAPNON), all …

Single-Stage Trans-mastoid Drainage of Otogenic Brain Abscess: A Single-Institution Experience.

Brain abscess is the ultimate otogenic complication, both in severity and difficulty of management. In developing countries with high incidence of cholesteatoma, brain abscess is not a rare complication. In India, brain abscesses constitute about 8% of all intracranial lesions. The surgical treatment of brain abscess is very controversial. This prospective study was done in ENT department of a tertiary care hospital in Kolkata, during the period from May 2009 to April 2014. 22 such cases of otogenic brain abscess managed by single-stage trans-mastoid drainage along with meticulous mastoid clearance. On the basis of clinical, radiological and operative findings, data of all patients with otogenic brain abscess were analyzed. There was male predominance and 9 (40.91%) of them were younger than 20years. 15 (68.18%) cases were of cerebellar abscess and in 7 (31.82%) cases were of the temporal abscess. Lateral sinus thrombosis was the most common associated complication found (22.73%) in our study. All the patients peri-operatively revealed cholesteatoma. All the patients recovered well and there was no recurrence of symptoms on a minimum 15months follow-up. This approach suits the otologists in clearing the cause and effect of pathology, at the same sitting. This single-stage approach decreases the peri-operative morbidity and mortality of the two-stage procedure. It also decreases the hospital stay and financial burden.

Calcified otogenic brain abscess

A 33-year-old man presented with a 2-year history of recurrent episodes of purulent discharge from the left ear. Examination revealed eardrum perforation. CT and MRI (figures 1 and 2) suggested left otitis media and mastoiditis associated with a temporal lobe calcified otogenic brain abscess. Radical mastoidectomy and tympanoplasty were performed; however, removal of the asymptomatic calcified mass was not performed. The mass was stable at 2-year follow-up.

Case of Chronic Otitis Media with Intracranial Complication and Contralateral Extracranial Presentation

Intracranial complications of chronic otitis media have been on the decline with advent of antibiotics. Septic thrombosis of the sigmoid sinus is rarer compared to commoner complications such as otogenic brain abscesses and meningitis. This patient presented with recurrent infection after left mastoidectomy secondary to cholesteatoma and a contralateral internal jugular vein thrombosis with parapharyngeal abscess, which was drained. He recovered well postoperatively with antibiotics.

Demographic, clinical and epimiological features of otogenic intracranial complications at the present stage

The importance of the intracranial complications problem in acute and chronic focal processes of ENT organs is determined by their dominating position among the reasons of the fatal outcomes. The authors made retrospective analysis of all the clinical cases of inpatient treatment of 127 adult patients with acute and chronic otitis media, complicated with pyoinflammatory cerebral pathology. Chronical suppurative otitis media predominated in the general structure of the revealed otitis media pathology structure – 75 (59.0%) cases. Purulent meningitis was diagnosed in 52 (40.9%) received patients, in acute otitis it constituted 63.5% of the total intracranial complications, and in chronic otitis media – only 25.3%. Meningocephalitises have been diagnosed with equal frequency both in acute otitis media – 15.4%, and in chronic otitis media – 22.7%. Otogenic brain abscesses have been diagnosed only in 13.5% cases of acute suppurative otitis media, whilst in chronic suppurative otitis media they have been revealed twice more frequent – 33.3%. 124 (98%) patients underwent surgery due to otogenic intracranial complications. For the purpose of sanation of the primary focus of infection in the ear the following therapy was conducted: in acute supportive otitis media – extended mastoidotomy, antromastoidotomy; in chronic suppurative otitis media – extended radical ear surgery. In surgical therapy of otogenic brain abscess, craniotomy and complete removing of the brain abscess using advanced neuronavigation systems proved higher clinical efficacy compared to transtemporal access in the course of sanation intervention in the ear with the abscess incision and drainage. Nowadays, the main clinical features of otogeneous intracranial complications are: severe central nervous system inflammatory damage with prevalence of cerebral and meningeal symptoms, high severity of the general state of the patients with the development of purulent septic complications with mortality level.

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.

Otogenic Brain Abscess Mimicking as Stroke.

Otogenic Brain Abscess Mimicking as Stroke.

English

OBJECTIVE: To share our experience about otogenic brain abscess and to provide information about diagnosis and treatment of otogenic brain abscess (OBA). MATERIALS & METHODS: Eight patients with an average age of 20.62years (range of 8 to 51 years) were diagnosed with OBA. All patients had cholesteatoma except one. Six had cerebral and 2 had cerebellar abscess. All underwent medical & surgical treatment. No mortality was reported in our study with the mean follow up period of 11 months. CONCLUSION: OBA is a life threatening condition, which requires early diagnosis and aggressive treatment. Combined approach by ENT surgeon and neurosurgeon reduces morbidity and mortality to a great extent.

Otogenic brain abscess: A rising trend of cerebellar abscess an institutional study

Chronic inflammation of the middle ear is the most frequent cause of otogenic complications. Meningitis is the most frequent intracranial complications, followed by otogenic brain abscess in neglected otitis media. Although temporal lobe abscesses are more common than cerebellar abscesses, the converse was found to be true in our series of 17 cases. 16 cases of cerebellar abscess and 1 case of temporal lobe abscess were reported as a complication of chronic otitis media (COM). In our group of patients, otogenic brain abscesses were more frequent in male patients of age group 5–20 years with mean age of 14 years. Diagnostic procedure included history, clinical, otorhinolaryngological examination, audiological, microbiological, neurological, ophthalmological, and radiological examinations. The treatment included primary neurosurgical approach (abscess drainage) followed by radical otosurgical treatment.