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Chronic Suppurative Otitis Media leading to cerebellar brain abscess, still a problem in 21st century: A case report
Rana Uzair Ahmad1, Muhammad Fawad Ashraf1, Muhammad Ahmad Qureshi1
1Mayo Hospital, Anarkali, Lahore, 54000, Punjab, Pakistan.
Introduction And Importance:
Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear associated with tympanic membrane rupture and purulent discharge for at least 6 weeks. Owing to the proper use and easy availability of antibiotics, these types of cases are rare in developed regions, but they are still occasionally seen in the developing world with poor hygiene and a lack of availability of antibiotics and immunizations.
Case Presentation:
Patient presented with complaints of headache, yellow-colored discharge from ear, fever and vomiting. The patient's Glasgow Coma Scale (GCS) was 12/15, neck stiffness and positive Kernig's sign, horizontal nystagmus and exaggerated deep tendon reflexes. Positive CSF findings and Magnetic Resonance Imaging showing right sided cerebellar abscesses, led to the diagnosis of right-sided CSOM leading to cerebellar brain abscess. Patient was treated with anti-pyrectics, intravenous mannitol, IV and topical antibiotics and IV-dexamethasone. Abscess evacuation was performed in neurosurgery department while mastoidectomy was performed in ENT department. Patient's condition improved quickly and was discharged with regular follow-up.
Discussion:
CSOM is a long-standing middle ear infection, associated with ear discharge and permanent perforation of the tympanic membrane. Divided into two main types, a) Tubo tympanic b) Atticoantral. CSOM occasionally presents with severe intracranial complications, especially in developing countries.
Conclusion:
CSOM is a chronic inflammation of the middle ear. Without early and effective management, it can lead to serious intracranial complications. So, diagnosis of complications like cerebellar abscess should be on the differential while dealing with patients with CSOM in developing countries.
Insights
Chronic suppurative otitis media (CSOM) can lead to serious brain abscesses, particularly in developing nations. Early diagnosis and management of CSOM are crucial to prevent severe intracranial complications like cerebellar abscess.
Area of Science:
- Otolaryngology
- Neurology
- Infectious Diseases
Background:
- Chronic suppurative otitis media (CSOM) is a persistent middle ear infection characterized by tympanic membrane perforation and discharge.
- While less common in developed countries due to antibiotic availability, CSOM remains prevalent in regions with poor hygiene and limited access to immunizations.
Observation:
- A patient presented with symptoms including headache, ear discharge, fever, and vomiting, alongside neurological signs such as a reduced Glasgow Coma Scale score, neck stiffness, and nystagmus.
- Diagnostic investigations, including cerebrospinal fluid analysis and MRI, revealed right-sided cerebellar abscesses, confirming a diagnosis of CSOM leading to intracranial complication.
Findings:
- The case highlights a rare but severe intracranial complication of CSOM: cerebellar brain abscess.
- Prompt medical and surgical interventions, including antibiotics, abscess evacuation, and mastoidectomy, led to the patient's recovery.
Implications:
- This case underscores the importance of considering intracranial complications, such as cerebellar abscess, in the differential diagnosis of CSOM patients, especially in developing countries.
- Effective management of CSOM is critical to prevent potentially life-threatening neurological sequelae.
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