Radical mastoidectomy: its place in otitic intracranial complications

AbstractStandard recommended treatment for patients with intracranial complications from otitis media, has been radical mastoidectomy, whether cholesteatoma is present or not. This was established in the pre-antibiotic era to improve survival. Over a six-year period, from January 1985 to December 1990, 268 patients were admitted with intracranial and extracranial complications of otitis media. The prospective treatment consisted of antibiotics and surgery. Surgery entailed mastoidectomy and drainage of intracranial collections of pus in all patients.However, prospectively in these patients the ear pathology and not the complication dictated the type of mastoidectomy performed. Cortical mastoidectomy was performed in non-cholesteatomatous ears and radical mastoidectomy in cholesteatomatous ears.Recurrence of intracranial complications occurred in only four patients (two per cent), a temporal lobe cerebritis in the non-cholesteatomatous ear group, and, a temporal lobe abscess, posterior fossa abscess and subdural empyema in the cholesteatomatous ear group. The temporal lobe cerebritis settled on intravenous antibiotics whilst the temporal lobe abscess, posterior fossa abscess and subdural empyema required redrainage. In none of these was the ear surgery revised.There were 15 deaths (eight per cent), all occurring in patients with intracranial complications, 12 associated with brain abscess, two with subdural empyema and one with meningitis. Eight were from the non-cholesteatomatous group and seven from the cholesteatomatous group. The mortality was directly related to the patients consciousness level on admission and not to the type of ear pathology.It can therefore be concluded that radical mastoidectomy is unwarranted in the non-cholesteatomatous ear, even with an otogenic intracranial complication.

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Intracranial Complications of Chronic Otitis Media: Why Does It Still Occur?

Ear Nose & Throat Journal ◽

10.1177/0145561319840166 ◽

2019 ◽

Vol 98 (7) ◽

pp. 416-419

Author(s):

Hardip Singh Gendeh ◽

Asma binti Abdullah ◽

Bee See Goh ◽

Noor Dina Hashim

Keyword(s):

Otitis Media ◽

Access To Health Care ◽

Sinus Thrombosis ◽

Public Awareness ◽

Case Series ◽

Pneumococcal Vaccination ◽

Chronic Otitis Media ◽

Poor Access ◽

Intravenous Antibiotics ◽

Intracranial Complications

Intracranial complications secondary to chronic otitis media (COM) include otogenic brain abscess and sinus thrombosis. Intravenous antibiotics and imaging have significantly reduced the incidence of intracranial complications secondary to COM. However, the same does not apply to a developing country like Malaysia, which still experiences persisting otogenic complications. This case series describes 3 patients with COM and intracranial complications. All 3 patients had COM with mastoiditis, with 1 of the 3 having a cholesteatoma. Postulated reasons for the continued occurrence include poor access to health care, poor compliance with medication, and the lack of pneumococcal vaccination during childhood. In conclusion, public awareness and a timely specialty referral can reduce the incidence of intracranial complications of COM.

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The complications of chronic otitis media: report of 93 cases

The Journal of Laryngology & Otology ◽

10.1258/0022215001905012 ◽

2000 ◽

Vol 114 (2) ◽

pp. 97-100 ◽

Cited By ~ 105

Author(s):

Ustun Osma ◽

Sebahattin Cureoglu ◽

Salih Hosoglu

Keyword(s):

Brain Abscess ◽

Otitis Media ◽

Chronic Otitis Media ◽

Morbidity Rate ◽

Media Report ◽

Mortality And Morbidity ◽

Subperiosteal Abscess ◽

Intracranial Complications ◽

The Common ◽

Extracranial Complications

The aim of this study was to investigate the incidence, mortality and morbidity of complications due to chronic otitis media (COM). During the nine-year period 1990–1999, 2890 cases of COM were reviewed, 93 (3.22 per cent) having 57 (1.97 per cent) intracranial complications (IC) and 39 (1.35 per cent) extracranial complications (EC). In three patients more than one complication was observed. Meningitis and brain abscess were common in the IC group. Subperiosteal abscess (mastoid and Bezold’s abscess) was a common complication in the EC group. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both groups. Fifteen patients died from IC. Overall, the mortality rate was 16.1 per cent in all patients having complications, and in patients with IC it was 26.3 per cent. In all of the patients with complications, the morbidity rate was 11.8 per cent. Our study supports the finding that meningitis and brain abscess are the common complications of COM and the main reason for mortality.

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Acute Mastoiditis in Children: Susceptibility Factors and Management

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2007.3066 ◽

2007 ◽

Vol 7 (2) ◽

pp. 129-133 ◽

Cited By ~ 1

Author(s):

Slobodan Spremo ◽

Biljana Udovčić

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Acute Otitis Media ◽

Tympanic Membrane Perforation ◽

Acute Mastoiditis ◽

Middle Ear Mucosa ◽

Susceptibility Factors ◽

Intravenous Antibiotics ◽

Intracranial Complications

The objective was to review our experience with clinical course, diagnostic and therapeutic profile of children treated for acute mastoiditis, and to investigate for possible susceptibility factors. Study was designed as retrospective review of pediatric patients presenting with acute mastoiditis secondary to acute otitis media over the last 6 years, from 2000 to 2006. The study involved children aged from 1 to 16 years treated for acute mastoiditis and subsequent intratemporal and intracranial complications in Clinic for otorhinolaryngology, Clinic Center Banja Luka. Selected clinical parameters, mastoid coalescence and risk factors for necessity of surgical intervention were analyzed. Medical history review of a total of 13 patients with acute mastoiditis was analyzed. Acute coalescent mastoiditis occurred 11 patients (84%) while noncoalescent form of acute mastoiditis occurred in 2 cases (16%). Intracranial complication occurred in 3 patients (2 meningitis and 1 peridural intracranial abscess), while 2 patients had intratemporal complication (subperiostal abscess) associated to coalescent mastoiditis. We observed clinical profile of acute mastoiditis in regard to pathology found on the tympanic membrane, middle ear mucosa and destructions on the bony wall of the middle ear and mastoid. The main signs of progressive infection were tympanic membrane perforation, pulsatile suppurative secretion from the mucosa, and intratemporal abscess. All patients with coalescent mastoiditis required mastoidectomy, while noncoalescent mastoiditis was treated conservatively with broad-spectrum intravenous antibiotics and myringotomy. In conclusion acute mastoiditis is uncommon but serious complication of acute otitis media in children associated with significant morbidity. Coalescent mastoiditis concomitant with subperiostal abscess, intracranial complications and mastoiditis not responsive after 48 hours to intravenous antibiotics should urge clinician to timely mastoid surgery.

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Mastoiditis and Citelli’s abscess: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20214686 ◽

2021 ◽

Vol 7 (12) ◽

pp. 1919

Author(s):

Amin M. A. Siddig

Keyword(s):

Case Report ◽

Ct Scan ◽

Otitis Media ◽

Surgical Intervention ◽

Learning Difficulties ◽

Neck Abscess ◽

Cortical Mastoidectomy ◽

Intracranial Complications ◽

The Right

<p>Citelli’s abscess is a rare often undocumented complication of otitis media. This is a case of a 52-year-old lady with learning difficulties, who presented with right sided mastoid swelling. On initial consultation the patient denied any otological symptoms but after being discharged and returning with her mother it was revealed she suffered with otalgia the previous month. On her return, the mastoid swelling had increased in size and there was also a large swelling across the right side of the neck. CT scan showed mastoiditis with Citelli’s abscess. The patient underwent a cortical mastoidectomy and myringotomy as well as drainage of the neck abscess. The report emphasises the importance of a clear, concise history and urgent surgical intervention to prevent further spread of the infection and potential intracranial complications.</p>

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Coalescent mastioditis as a complication of acute otitis media

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v51i1.443 ◽

2021 ◽

Vol 51 (1) ◽

Author(s):

Ratna Dwi Restuti ◽

Harim Priyono ◽

Dora A Marpaung ◽

Ayu Astria Sriyana ◽

Rangga Rayendra Saleh

Keyword(s):

Antibiotic Therapy ◽

Otitis Media ◽

Acute Otitis Media ◽

Evidence Based ◽

Antibiotic Administration ◽

Intravenous Antibiotic ◽

Literature Searches ◽

Intravenous Antibiotics ◽

Intracranial Complications ◽

Common Infections

ABSTRACTBackground: Acute otitis media (AOM) is one of the most common infections in children. AOM disease can lead to complications such as coalescent mastoiditis. Mastoidectomy surgery in cases of coalescent mastoiditis in children is still a debate. Purpose: To convey the management of coalescent mastoiditis in pediatric patients as complication of AOM using an evidence-based literature search. Case Report: A 10-month patient with a diagnosis of AOM and coalescent mastoiditis, who was given antibiotic therapy and abscess drainage incision. Clinical question: In a child with coalescent mastoiditis as a complication of otitis media, could the disease be cured with intravena antiobitic therapy only without mastoidectomy operation? Review methods: Evidence-based literature searches through Pubmed, Proquest and Cochrane, were performed using the keywords mastoidectomy, antibiotics and coalescent mastoiditis. Result: The search resulted in 277 literatures, and 12 were relevant with the case, and two journals stating that in cases of uncomplicated coalescent mastoiditis, mastoidectomy operation could be delayed and intravenous antibiotic administration could be conducted by monitoring the patient's condition for 48 hours. Conclusion: Intravenous antibiotics are the main therapy in cases of coalescence mastoiditis accompanied by clinical monitoring for 48 hours. Additional mastoidectomy and other surgeries were performed in cases of clinical deterioration after intravenous antibiotic therapy, and in cases of intratemporal or intracranial complications.

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OTOGENIC BRAIN ABSCESS MANAGEMENT STRATEGY : AN INSTITUTIONAL EXPERIENCE.

UP STATE JOURNAL OF OTOLARYNGOLOGY AND HEAD AND NECK SURGERY ◽

10.36611/upjohns/volume8/issue2/2 ◽

2020 ◽

Vol VOLUME 8 (ISSUE 2) ◽

pp. 6-12

Author(s):

Ravi Sankar Manogaran

Keyword(s):

Brain Abscess ◽

Otitis Media ◽

Temporal Lobe ◽

Imaging Techniques ◽

Presenting Symptoms ◽

Intravenous Antibiotics ◽

Institutional Experience ◽

Study Population ◽

Prompt Diagnosis

Abstract: Otogenic brain abscess is a potentially lifethreatening complication of otitis media, which requires a high index of suspension for prompt diagnosis and management. This study is a retrospective analysis of 20 cases of otogenic brain abscess that has been managed at our institute from 2000 to 2018. Although the prevalence has decreased signicantly due to the use of antibiotics, the problem still persists. Headache, fever and vomiting are the most common presenting symptoms. The use of advanced imaging techniques has contributed a lot in making the diagnosis faster. In contrast to previous studies where the temporal lobe is the most common site, both cerebellar and temporal lobe involvement has been seen to occur equally among our study population. . Pseudomonas was found to be the most common organism as compared to Proteus mirabilis in most of the recent studies. Immediate therapy with intravenous antibiotics was found responsible for 32% of the sterile cultures. Twelve(60%) of our patients underwent interval mastoidectomy, of which seven patients underwent mastoidectomy at two weeks, and ve patients were intervened at six weeks and rest eight were managed in the same sitting. No change was observed in these groups in terms of outcome after six weeks of follow-up. Although rare brain abscess continues to be a serious complication of otitis media which needs immediate attention with a multidisciplinary approach. Keywords: Brain abscess; Otogenic infection; Otitis media; Magnetic resonance imaging; Computed tomography

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Complications of Chronic Suppurative Otitis Media

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.3-01.46 ◽

2016 ◽

Vol 3 (01) ◽

pp. 32-37

Author(s):

Arifullah . ◽

Syed Zafar Hasan ◽

Islam Gul ◽

Waqar -Ud- Din ◽

Aftab Ahmad

Keyword(s):

Otitis Media ◽

Teaching Hospital ◽

Sinus Thrombosis ◽

Chronic Suppurative Otitis Media ◽

Lateral Sinus ◽

Suppurative Otitis Media ◽

Lateral Sinus Thrombosis ◽

Intracranial Complications ◽

History Of ◽

Extracranial Complications

OBJECTIVEThe aim of the study was to find the complications of chronic suppurative otitis media.MATERIAL AND METHODSThe study was descriptive study conducted from 1st January 2008 to 31 December 2010 (3 years duration) at ENT department Khyber Teaching Hospital Peshawar. Total 250 patients of all age having complications due to chronic suppurative otitis media enrolled from admitted patients in ENT department Khyber Teaching Hospital Peshawar were included in the study, using convenience (non-probability) sampling.RESULTSIn total of 250 patients, all (100%) were having history of discharging ear, decreased hearing 250 (100%), earache in 75 (30%), fever in 31(12.4%), headache in 28 (11.2%), nausea and vomiting in 23 (9.2%) patients. The extracranial complications were found in 204/250 (81.6%) patients with mastoiditis being the most common in 155/204 (75.98%) patients followed by sensory reural hearing loss, post auricular abscess, facial paralysis, petrositis, labynthitis, Bezold’s abscess and cetili’s abscess in 7.84%, 6.37%, 5.88%, 1.7%, 0.98%, 0.98% and 0.49% patients respectively. While the intracranial complications were found in 46/250 (18.4%) patients with meningitis being the most common in 28/46 (60.9%) followed by brain abscess in 26%, lateral sinus thrombosis in 8.7% and otitic hydrocephalus in 4.4% patients.CONCLUSIONEarly detection and treatment of complications as a result of chronic suppurative otitis is vital to prevent morbidity and mortality.

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Intracranial Suppurative Complications of Sinusitis

Scandinavian Journal of Surgery ◽

10.1177/1457496915622129 ◽

2016 ◽

Vol 105 (4) ◽

pp. 254-262 ◽

Cited By ~ 9

Author(s):

T. K. Nicoli ◽

M. Oinas ◽

M. Niemelä ◽

A. A. Mäkitie ◽

T. Atula

Keyword(s):

Epidural Abscess ◽

Sinus Thrombosis ◽

Nasal Congestion ◽

Subdural Empyema ◽

University Hospital ◽

Tertiary Referral Hospital ◽

Neck Stiffness ◽

Correct Treatment ◽

Intracranial Infection ◽

Intracranial Complications

Background: Intracranial complications of paranasal sinusitis have become rare due to widespread and early use of antibiotics. Potentially life-threatening intracranial complications of sinusitis include subdural empyema, epidural and intracerebral abscess, meningitis, and sinus thrombosis. Patients with intracranial complication of sinusitis can present without neurological signs, which may delay diagnosis and correct treatment. Aims: Our aim was to evaluate the diagnostics, treatment, and outcome of sinusitis-related intracranial infections at our tertiary referral hospital with a catchment area of 1.9 million people. Materials and Methods: We retrospectively collected data on all patients diagnosed and treated with an intracranial infection at the Helsinki University Hospital, Helsinki, Finland, during a 10-year period between 2003 and 2013. Results: Six patients were diagnosed to have a sinusitis-related intracranial infection. Four patients had an epidural abscess, one both an epidural abscess and a subdural empyema and one a subdural empyema. The most common presenting complaint was headache (100%) followed by fever (83%), vomiting (50%), nasal congestion (50%), forehead lump (34%), and neck stiffness (17%). All patients were managed surgically. Most (83%) patients recovered to premorbid state without neurological sequelae. One patient died intraoperatively. Conclusion: Patients with a sinusitis-related intracranial suppuration typically present with signs of raised intracranial pressure rather than signs of sinusitis. Most are likely to need neurosurgical intervention and evacuation of the abscess without delay.

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