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[Otogenic brain abscess]
H G Kempf1, J Wiel, P R Issing
1HNO-Klinik der Medizinischen Hochschule Hannover.
Background:
Otogenic complications are rare but typical following acute or chronic ear infections like mastoiditis and cholesteatoma. A life-threatening sequela is the otogenic brain abscess located in the temporal lobe or cerebellum.
Patients:
At the ENT Department of the Medical University of Hannover/Germany we treated 8 patients suffering from otogenic brain abscesses in the temporal lobe during the last three years. The average age of the 6 male and 2 female patients was 48 years. In 5 patients the abscess developed due to a cholesteatoma with superinfection. Three cases showed acute mastoiditis. All patients were operated using an otosurgical retroauricular approach, in five cases a classical radical mastoidectomy was performed. In two cases the abscess was reached via mastoidal approach and was subsequently drained. In two other cases the abscess was drained some days later by neurosurgical approach due to increased neurological symptoms. The other patients were treated with high-dosed antibiotics under regular clinical and radiological control.
Results:
In 7 cases complete regression of the abscess was achieved. Five patients were discharged without further otological or central-nervous problems. One female patient developed severe meningitis with generalized thrombosis of the central blood sinus system and died in central circulatory failure. Two other patients developed a moderate psychopathologic syndrome and were admitted to rehabilitation institutions.
Conclusions:
The analysis of our patients shows that otogenic brain abscesses should be regarded especially as a severe complication of the untreated cholesteatoma. It is important to use modern imaging modalities like computer tomography or MRI for early detection of the intracerebral lesion and to perform an early otosurgical intervention. Under antibiotics and CT control, healing of this severe complication can be achieved in most cases. However, the danger of acute and chronic ear diseases has to be kept in mind in all medical disciplines.
Insights
Otogenic brain abscesses, a severe complication of ear infections like cholesteatoma, require early detection via imaging and prompt surgical or antibiotic treatment for most patients to achieve regression.
Area of Science:
- Otolaryngology and Neurosurgery
- Infectious Diseases
- Neurology
Context:
- Otogenic brain abscesses are rare but serious complications of acute or chronic ear infections, such as mastoiditis and cholesteatoma.
- These intracranial lesions, typically located in the temporal lobe or cerebellum, pose a life-threatening risk.
- Untreated cholesteatoma is a significant risk factor for developing otogenic brain abscesses.
Purpose:
- To analyze treatment outcomes for patients with otogenic brain abscesses.
- To evaluate the effectiveness of surgical intervention and antibiotic therapy in managing these complications.
- To emphasize the importance of early diagnosis and intervention.
Summary:
- Eight patients with temporal lobe otogenic brain abscesses underwent treatment, with 5 cases stemming from cholesteatoma with superinfection and 3 from acute mastoiditis.
- Treatment involved otosurgical retroauricular or mastoidal approaches for drainage, neurosurgical intervention in some cases, and high-dose antibiotics with regular monitoring.
- Complete abscess regression was achieved in 7 cases, with most patients recovering without neurological sequelae, though one patient died from meningitis and two developed psychopathologic syndromes.
Impact:
- Early detection using advanced imaging (CT, MRI) and prompt otosurgical intervention are crucial for managing otogenic brain abscesses.
- Successful treatment in most cases highlights the efficacy of combined surgical and antibiotic approaches.
- Underscores the need for vigilance regarding potential complications of acute and chronic ear diseases across all medical disciplines.