[Brain abscesses of otogenic origin]

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.