title: Complications of otitis media - a potentially lethal problem still present.
abstract: BACKGROUND
  It is an erroneous but commonly held belief that intracranial complications (ICCs) of chronic and acute otitis media (COM and AOM) are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care.
  
  
  OBJECTIVE
  This paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM).
  
  
  METHODS
  Retrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period.
  
  
  RESULTS
  80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention.
  
  
  CONCLUSIONS
  ICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil. Electronic address: nopenido@terra.com.br.
authors.forename: Norma de Oliveira
authors.initials: Nde O
authors.lastname: Penido
authors.affiliation: FACS, New York Otology, New York Head and Neck Institute, New York, NY, USA.
authors.forename: Sujana Sreedevi
authors.initials: SS
authors.lastname: Chandrasekhar
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil.
authors.forename: Andrei
authors.initials: A
authors.lastname: Borin
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil.
authors.forename: André Souza de Albuquerque
authors.initials: AS
authors.lastname: Maranhão
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil.
authors.forename: José Ricardo
authors.initials: JR
authors.lastname: Gurgel Testa
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Abscesso cerebral; Brain abscess; Complicações intracranianas; Intracranial complications; Meningite; Meningitis; Otite média; Otitis media