Contemporary management of intracranial complications of otitis media.
OBJECTIVE
Intracranial complications as a result of otogenic infections occur even in the antibiotic era. Meningitis is the most common reported intracranial complication, followed by brain abscess and lateral sinus thrombosis. The purpose of this study is to review our experience and management of these serious complications.


METHODS
A retrospective chart review was performed at a tertiary referral medical center for the period from 1998 to 2007. Charts with acute or chronic otitis media as primary diagnosis were reviewed, and intracranial complications secondary to either were included in the study. Age, sex, clinical presentation, radiographic findings, management, and outcome were studied. Patients with meningitis or petrous apicitis were not included in the study.


RESULTS
Ten cases reviewed had intracranial complications. Five patients had brain abscesses, 1 patient had a subdural empyema, and 4 patients had lateral sinus thrombosis. All patients received broad-spectrum intravenous antibiotics for 6 weeks. Mastoidectomy was performed in all patients, but not all patients were treated with direct drainage of the intracranial abscess, especially if clinical and serial radiographic response was favorable.


CONCLUSIONS
Otogenic intracranial complications can be fatal if not managed appropriately. Broad-spectrum intravenous antibiotics for 6 weeks is usually sufficient treatment. Management of the intracranial disease takes precedence, but direct drainage of the abscess may not be necessary if a patient's symptoms, neurologic status, and radiographic findings progress favorably. A high index of suspicion should be maintained on all patients presenting with symptoms not typically seen with routine otitis media.
Wanna
George B
GB
Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. george.wanna@vanderbilt.edu
Dharamsi
Latif M
LM
Moss
Jonathan R
JR
Bennett
Marc L
ML
Thompson
Reid C
RC
Haynes
David S
DS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001922:Brain Abscess / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D007758:Ear, Inner / Q000601:surgery*; D013354:Empyema, Subdural / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications*; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
D000890:Anti-Infective Agents