Otogenic Intracranial Complications Research Articles

Identification of Risk Factors for Mortality and Prolonged Hospitalization in Patients Treated With Surgical Drainage for Otogenic Intracranial Complications: A Nationwide Study Using a Japanese Inpatient Database.

Data on risk factors for otogenic intracranial complications including cerebral abscess have been limited. Using a nationwide database, the aim was to identify the factors related to mortality and delayed discharge. Retrospective. Nationwide database using the Diagnostic Procedure Combination database. Data of 145 patients were extracted from a Japanese inpatient database between 2012 and 2020. The main outcome was survival at discharge. In a subgroup analysis of the 137 surviving patients, the second outcome was delayed discharge. The mortality rate was 5.5% (8 of 145). Logistic regression analyses identified intracerebral complications (adjusted odds ratio [OR], 3.09) and more than 2-day delay of the first surgery after admission (adjusted OR, 4.68) as risk factors for mortality. Specifically, consciousness level evaluated by the Japan Coma Scale (JCS) was significantly related to prolonged hospitalization or mortality: JCS I (adjusted OR, 3.40) and JCS ≥II (adjusted OR, 25.1). Although otogenic intracranial complications are rare, and their mortality is decreasing because of the progress in imaging and clinical strategies, they remain the most severe complications of suppurative otitis media and/or cholesteatoma. Consciousness level at admission, comorbid diabetes mellitus, and a greater than 2-day delay of surgical intervention were related to prolonged hospitalization or mortality.

Rare Case Report: Serratia Liquefaciens and Enterococcus Species as a Cause of Otogenic Brain Abscess Secondary to Active Epithelial Chronic Suppurative Otitis Media (CSOM) in a 12-Year Old Male Patient with Hemiparesis

Developing countries face the problem of Otogenic intracranial complications especially in paediatric population because of poor hygiene, malnutrition and low immunity. Active epithelial type Chronic Suppurative Otitis Media (CSOM) can be the cause of potentially fatal complications. One of these is otogenic brain abscess. Having an estimated annual incidence to be approximately 0.5 per 100,000 children, it is associated with high mortality. We describe a unique case of otogenic brain abscess secondary to Active epithelial CSOM being neglected for two years and finding an unexpected foreign body in the right ear canal in a 12-year-old boy. The consultation was sought when the headache became intense and hemiparesis appeared. Our case is unique regarding both the clinical presentation and the causative organism. The patient underwent craniotomy, with elective capsulotomy, drainage of abscess and placement of a ventriculoperitoneal shunt. This was followed by a modified radical mastoidectomy two weeks later and an uneventful recovery.

耳性頭蓋内合併症の3例

耳性頭蓋内合併症の3例

Клинико-патогенетические особенности и исходы отогенных внутричерепных осложнений при остром и хроническом гнойном среднем отите

Introduction. To date, there are conflicting data on the frequency, structure, and severity of the clinical course of otogenic intracranial complications in various ear diseases. Objective. Investigation of the features of pathogenesis, clinic, and outcomes of otogenic intracranial complications in acute purulent otitis media and exacerbation of chronic purulent otitis media. Patients and methods. The gender, age, ways of infection of the cranial cavity, the timing of the prodromal period and the prehospital stage of observation, the level of consciousness at admission, the structure and outcomes of intracranial complications in 32 (62,7%) patients with acute purulent otitis media and in 19 (37,3%) patients with exacerbation of chronic purulent otitis media were studied. Conclusions/Results. In the groups of patients with acute purulent otitis media and exacerbation of chronic purulent otitis media, the hematogenic pathway of infection of the meninges was found, respectively, in 87,5% and 47,4%; fulminant and acute course of otogenic purulent meningitis, in 75% and 47,4%; the development of coma and sopor at the prehospital stage, in 81.3% and 47.4%; and fatal outcomes, in 31,3% and 26,3% of cases. The development of coma at the prehospital stage and hospitalization later than 24 hours after the onset of the manifestation of symptoms of otogenic purulent meningoencephalitis significantly increased the number of deaths, to a greater extent in acute purulent otitis media than in exacerbation of chronic purulent otitis media.

Intracranial otogenic complications in adults: new factors that influenced its onset, frequency and nature

BackgroundTo compare the clinical features of two time cohorts of patients: “pre-COVID-19” and “COVID-19”—admitted as emergency with intracranial otogenic complications, with special regard to sigmoid sinus thrombosis (CVST).MethodsRetrospective analysis of patients documentation concerning urgent procedures of intracranial otogenic complications at tertiary-referral otolaryngology department. Analysed database—pre-COVID-19 cohort (January–February 2019/2020): 1434 otological outpatient visits, 509 planned otosurgeries and 17 urgent otological procedures; COVID-19 cohort (March–April 2020/2021): 1150, 566 and 20 respectively. Overall intracranial complications: 5 and 9 respectively. Analysed outcome measures: incidence proportion of otogenic intracranial complications in relation to planned and urgent otosurgical procedures; incidence proportion of intracranial complications in relation to the total number of emergency and planned outpatient consultations and the total number of planned surgical procedures.ResultsThere were 14 intracranial complications, 5 in the pre-COVID and 9 in the COVID cohort, including 1 and 5 sigmoid sinus thrombosis, respectively. Out of them, 3 and 5 patients reported a prior history of chronic otitis media, respectively. In COVID period, CVST was more prevalent, with 2 cases (22.2%) presenting solitary CVST, and 3 cases (33.3%) CVST and a simultaneous brain abscess or meningitis. CVST was much more frequent in the COVID period (p < 0.01).ConclusionsDespite the published data which suggest that CVST is a rare event associated with COVID-19 infection, based on our experience, CVST can be expected as a frequent component of intracranial otogenic complications during COVID-19 pandemic time.Trial registration This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the Bioethics Committee at Poznan University of Medical Sciences who determined that our study did not need ethical approval. An official waiver of ethical approval was granted from the Bioethics Committee at Poznan University of Medical Sciences.Graphical abstract

Otogenic brain abscess – a case report

Otogenic intracranial complications - although less common than before - should always alert otolaryngologists and other specialists, including those in the field of outpatient healthcare. Due to their life-threatening consequences, early detection and appropriate management, including surgical treatment, is crucial for a prompt recovery. Below we present a case of a patient in whom the brain abscess has progressed despite the surgical treatment, and describe what strategy was adopted and what followed its choice.

The experience of the tympanoplasty in Volyn region

Introduction: In Volyn middle ear microsurgical interventions were first performed in the early 60s in the previous century. Stapedioplasty, different types of myringoplasty and cholesteatoma middle ear surgery were introduced in the mid 70s. In 1983 a drill as a replacement to a chisel and a mallet, which were traditionally used to perform the bone stage of the ear surgery in the USSR, was introduced by Shchuruk Z.S. Aim: to share the experience of the development of otosurgery in Volyn and the results of the middle ear microsurgery operations in the Department of Otolaryngology in Volyn regional clinical hospital. Materials and methods: For the last twenty years (from 1999 to 2019) 1008 middle ear surgeries which can be divided into three main types: canal-wall-down tympanoplasty – 608 operations, canal-wall-up tympanoplasty – 94 ones and 306 myringoplasty were performed in the Department of Otolaryngology in Volyn regional clinical hospital. In addition, 35 mastoidectomies for acute and latent mastoiditis, 33 extended mastoidectomies with otogenic intracranial complications, 27 extended radical surgeries with otogenic intracranial complications and 560 tympanostomy tube insertion procedure were performed. Results: Complete elimination of air-bone gap after myringoplasty was observed in 20% of patients, the airbone gap in about 80% of patients was about 8dB. After a canal-wall-down tympanoplasty in the late postoperative period the average air conduction thresholds in 35,4% of the patients was less than 30dB. 92% of our patients had a complete wound healing and a positive morphological result in the early postoperative period after different types of tympanoplasty. Conclusions 1. Having evaluated the results of microsurgery operations for the last 20 years (1008 operations), we noted the high rate of positive clinical and functional outcomes. 2. The experience of Volyn otolaryngologists who began to perform middle ear surgeries in the 60-70s of the previous century was transferred to younger generation of otolaryngologists. 3. The performance of tympanoplasty demands in-depth knowledge of the anatomy of temporal bone and a burning desire to perform these complicated surgery interventions.

Epidural Abscess and Sigmoid Sinus Thrombosis as Intracranial Complications of the Middle Ear Cholesteatoma

Abstract The otogenic intracranial complications are rare manifestations in modern era of antibiotics. An early antibiotic therapy often covers typical clinical signs and symptoms for each complication. A sigmoid sinus thrombosis is often associated with other intracranial complications, as in this case, an epidural abscess. We are presenting a case of 12-year-old girl with the sigmoid sinus thrombosis and epidural abscess as complications of chronic infection to the middle ear with cholesteatoma. In the active phase of chronic inflammation of the middle ear she was treated with the antibiotic therapy that covered early symptoms of intracranial complication development. A humid attic perforation of the tympanic membrane with protrusion of choleastoma and evident signs of bony wall destruction to the external auditory canal was noticed by performing routine otomicroscopy and otoendoscopic examination. Assuming intracranial complication, magnetic resonance imaging (MRI) of the endocranium was undertaken. The MRI showed inflammatory changes of both middle ears with intracranial complications: the right sigmoid sinus thrombosis and epidural abscess of the same side. During the surgery we have noticed an extensive middle ear cholesteatoma with significant destruction of the bony tissue and purulent collection between sigmoid sinus changed with granulation and respective dural segment of the posterior cranial cavity. Timely diagnosis, multidisciplinary approach with an adequate choice of the antibiotic therapy and surgical technique have a crucial prognostic significance.

Otogenic intracranial complications: a 10-year retrospective review in KwaZulu-Natal, South Africa.

To analyse the data for patients with otogenic intracranial complications during the study period and draw a comparison with internationally published literature. A retrospective, observational study was conducted, covering a 10-year period between 1 January 2002 and 31 December 2012. The study comprised 108 patients (66 males (61.1 per cent) and 42 females (38.9 per cent)), of which 75 per cent were aged less than 20 years. Post-auricular swelling, otorrhoea and a decreased level of consciousness were the most frequently reported symptoms in patients with otogenic intracranial complications. Patients with human immunodeficiency virus did not show any different patterns in terms of presentation and outcome. A triad of post-auricular swelling, otorrhoea and a decreased level of consciousness should make the clinician more heedful of otogenic intracranial complications. Patients with human immunodeficiency virus and human immunodeficiency virus negative patients were equally affected and had similar presentations. Early surgical management of patients was associated with shorter hospital stays and better outcomes.

Массивная холестеатома височной кости у пациентов, перенесших санирующую операцию открытого типа

Potential recurrence is a key challenge of the surgical interventions for temporal bone cholesteatoma. It manifests with the residual or recurrent cholesteatoma. Open surgical techniques reduce the recurrence of cholesteatoma due to the better visualization of temporal bone cavities both intraoperatively and postoperatively and also prevent otogenic intracranial complications. However, even despite open-cavity surgeries, cholesteatoma recurrences are still common in ENT practice while their asymptomatic course often results in the late diagnosis. This article describes three case reports of cholesteatoma recurrences with significant destructive lesions of the temporal bone and intracranial complications after prior open-cavity surgical interventions. These case reports are of interest due to the latent course of cholesteatoma and the lack of disease recurrence signs revealed by the standard ENT examination using otomicroscopy and endoscopy. Finally, these case reports highlight the importance of diffusion-weighed magnetic resonance imaging of the middle ear in patients with temporal bone cholesteatoma both in the preoperative and postoperative period. KEYWORDS: cholesteatoma, middle ear, temporal bone, surgical strategy, trephination, radical mastoidectomy. FOR CITATION: Anikin I.A., Khamgushkeeva N.N., Knyazev A.D., Bokuchava T.A. Massive cholesteatoma of the temporal bone after opencavity surgery. Russian Medical Inquiry. 2020;4(4):247–253. DOI: 10.32364/2587-6821-2020-4-4-247-253.

Retrospective clinical analyses of otogenic intracranial infections

Objective: To investigate the clinical characteristics and treatment options for otogenic intracranial infections. Method: Clinical records of all the patients of otogenic intracranial infections admitted to the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were retrospectively analyzed. Their clinical presentations, radiological findings, culture results, and medical and surgical therapy modalities, as well as treatment outcomes were studied. Results: Sixteen cases were identified. The majority of the otogenic patients had a history of cholesteatoma, other rare events included congenital cerebrospinal fluid otorhinorrhea, Gorham-Stout disease and after radiation therapy for nasopharyngeal carcinoma. Meningitis, cerebral venous thrombosis and brain abscess were the primary intracranial infection. Eight patients had received modified radical mastoidectomy at least one time. Results of routine culture for cerebrospinal and pus samples had high negative rate. All patients received initial empirical broadspectrum intravenous antibiotics therapy. Four cases of brain abscesses were drained or excised at the same time for otologic surgery. The mortality rate was 6.25% (1 case). Conclusions: Cholesteatoma is still the most commonly primary disease of otogenic intracranial complications. Diagnosis and treatment of otogenic intracranial infections require multidisciplinary cooperation. Surgical intervention for primary ear lesions and intracranial abscess is still the main option in the treatment of otogenic intracranial infections.

Otogenic Intracranial Complications in Bir Hospital; an Eight Years Retrospective Review

Objectives: To review our experiences on intracranial complications secondary to otitis media and to compare the results with other studies.Material and Methods: A retrospective chart review of all patients with intracranial complications secondary to otitis media over eight years period in Bir hospital was done. Clinical presentation, radiological findings, microbiology, surgical management and antibiotics used were studied.Results: Forty eight cases were included in this study of which 23 had meningitis, 15 had brain abscess, 7 had lateral sinus thrombosis and 3 had petrositis. 37 of these were secondary to chronic otitis media and 11 were secondary to acute otitis media. Otorrhoea, headache, earache, fever, vertigo and vomiting were the main symptoms. Staphylococcus aureus was the most common bacteria isolated followed by Pneumococcus, Haemophilus influenzae and Klebsiella.Conclusion: Early recognition, multi drug treatment with broad spectrum antibiotic and multi disciplinary approach are the mainstay of management of otogenic intracranial complications.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Otogenic intracranial pyo-inflammatory complications

Otogenic intracranial pyo-inflammatory complications

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.

Predictors of poor outcome in treatment of patients with pyoinflammatory otogenic and rinosinusogenic intracranial complications

OBJECTIVE. The authors would like to reveal preoperative and intraoperative predictors of lethal outcome in patients with otogenic and rhinosinusogenic pyoinflammatory intracranial complications. The study assessed an efficacy of specialized medical care of this category of patients. MATERIAL AND METHODS. Тhis research included 303 patients (199 (65,68 %) men and 104 (34,32 %) women) aged from 39,3 ± 17,4 years on average who underwent operation concerning intracranial pyoinflammatory oto- and rinosinusogenic complications in multidisciplinary hospitals of different subjects of the Russian Federation at the period from 2000 to 2014. RESULTS. Multiple logit regression analysis of predictors of lethal outcome showed the presence of higher number of factors and errors which influenced on treatment during preoperative period. These factors and errors caused an extension of preoperative period and increase of unfavorable outcome. CONCLUSIONS. While planning the management of primary and specialized care, doctors should take into account the identified predictors for patients of this category.

Otogenic Intracranial Complications - A Case Series

Background: Intracranial complications of otogenic origin is now a rarity. Advent of antibiotics are both blessings if used intelligently and curse if used indiscriminately especially by quacks. Antibiotic resistance and cross resistance have given adverse results. Methods: A total of twenty cases were studied in the Department of ENT at Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh Results: Maximum number of cases belonged to 10 to 20 years age group, i.e eight cases (40%) followed by six cases (30%) in the age group greater than 30 years, four cases (20%) in 20 to 30 years age group, and 2 cases (10%) below 10 years. Males were affected more than females in the ratio of 4:1. The commonest presenting symptom was otorrhea, headache, fever and hearing loss. About half of the patients had vomiting, some had vertigo, otalgia and one patient had facial weakness. Conclusions: Almost all the intracranial complications encountered were intensively and meticulously treated by medical and surgical exercise which gave excellent results with collective team approach.

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.

The diagnostics and treatment of otogenic intracranial complications

We have undertaken the analysis of medical records of the patients presenting with major otogenic intracranial complications (OICC) including purulent meningitis, brain or cerebellum abscess, and thrombosis of sigmoid sinus. The presence of isolated and combined variants of otogenic intracranial complications was documented in 112 (43%) and 148 (56.9%) patients, respectively. The development of OICC in 80% of the patients was associated with exacerbation of chronic suppurative otitis media; in the remaining 20% of the patients OICC were the consequences of acute suppurative otitis media. Thrombosis of sigmoid sinus as an independent otogenic intracranial complication was documented in 17.5% of the patients while 42.5% of the cases required the treatment by an interdisciplinary team of specialists with the participation of an otorhinolaryngologist, neurologist, intensive care and other professionals. Such approach partly accounts for the relatively low (10.6%) mortality rate among our patients with OICC.

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.

The specific clinical features of otogenic intracranial complications: the current views

The objective of the present study was to elucidate the specific clinical features of otogenic intracranial complications (ICC) encountered in the current otorhinolaryngological practice. The work is based on the results of the retrospective analysis of 106 adult patients presenting with otogenic intracranial complications admitted for the treatment to multidisciplinary clinics of Sankt-Peterburg and Krasnoyarsk. Forty six (42.5%) patients presented with acute otitis media. 90% of them had suppurative destructive mastoiditis. In sixty (56.6%) patients, chronic suppurative otitis media (epitympanophonia) was associated with the extensive destructive process spreading toward dura mater of the medial and posterior cranial fossae and onto the sigmoid sinus. The prevalence of intracranial complications among the adult patients suffering from suppurative otitis media and treated in the otorhinolaryngological clinics amounted to 3.17%. The overall structure of otogenic intracranial complications was as follows: meningitis 42.5%, brain and cerebellum abscess 24.5%, suppurative meningoencephalitis 19.8%, sinus thrombosis 5.7%, epidural and subdural empyemas 4.7%, the combined suppurative brain lesions 2.8%. Systemic inflammatory response syndrome (sepsis) was diagnosed in 33 (31%) patients with otogenic ICC. The high intrahospital mortality rate among the patients with this condition (20.8%) is emphasized. The main causes of the fatal outcome in the patients with otogenic intracranial complications are supposed to be brain oedema with the concomitant development of dyslocation syndrome and sepsis.