title: Brain abscess secondary to the middle ear cholesteatoma: a report of two cases.
abstract: We experienced two cases of brain abscess secondary to middle ear cholesteatoma. One, a 61-year-old woman, presented with left otalgia, appetite loss and nausea. The computed tomography obtained on admission revealed a middle ear cholesteatoma. The magnetic resonance image showed the presence of a brain abscess in the cerebellum. The brain abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. Part of the cholesteatoma invaded the posterior cranial fossa was could not be removed from the otological surgical field. The patient has been under observation as an outpatient for 6 months already and no abnormal signs have been detected. The other patient, a 55-year-old man, was admitted to our hospital for a detailed examination because he had right otalgia and progressive headache. The examination of spinal fluid obtained by lumbar puncture showed marked elevation of the white blood cells count. Computed tomography revealed a middle ear cholesteatoma. The magnetic resonance image obtained on admission showed an area of low-intensity encapsulated by an area of high-intensity in the right temporal lobe. The abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. The patient has been under observation for 1 year already and has presented no signs of recurrence.
authors.affiliation: Department of Oto-Rhino-Laryngology, Nippon Medical School, Kosugi-cho 1-396, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan. bxp02646@nifty.ne.jp
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Watanabe
authors.forename: Gin-Ya
authors.initials: GY
authors.lastname: Hatano
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Fukada
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kawasaki
authors.forename: Hideharu
authors.initials: H
authors.lastname: Aoki
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Yagi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002531:Cerebellum / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D018424:Cholesteatoma, Middle Ear / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D014433:Tympanoplasty
chemical_list: D000900:Anti-Bacterial Agents