MANAGEMENT OF OTOGENIC BRAIN ABSCESS
Abstract
Background: The relationship between otitis media and intracranial disease has long been established. Intracranialcomplications from Otitis Media can be quite devastating to the patient if an early diagnosis is not made. Brain abscess
is one of the most dreadful complications of middle ear disease. The epidemiological presentation, clinical features
and results of treatment are discussed in this study. Methods: This is a two years' prospective study of 20 cases of
otogenic brain abscess carried out at PGM I, LRH Peshawar. The data on history and management of these patients
were collected and are reported. Results: There were 12 (60%) males and 6 (40%) females with a ratio of 3:2. Majority
of the patients were teenagers; however, the age range was from 5 to 40 years. Chronic suppurative otitis media was
the main cause of otogenic brain abscesses. The commonest site was cerebellum. The commonest organism isolated
was proteus (20%) followed by anaerobes (15%) and pseudomonas (10%). The commonest organism reported from
ear discharge was also proteus. CT scan of the brain with contrast was the investigation on which further management
was based. Burr-hole aspiration was the main neurological procedure adapted in this study. There was no neurological
deficit and epilepsy post operatively. Repeated aspiration was sometimes needed and recurrence was a problem (15%).
Radical mastoidectomy was performed to eradicate focus of infection and make the ear safe (95%). The mortality was
10% in this study.
References
Weiner G.M. Benard Williams. Prevention of intracranial
problems in our ear and sinus surgery: a possible role of
Cefotaxime. J. Laryng Otology. 1993; 107(11): 1005-7.
Mumtaz M. Former, J.P. Auger. L. O'Gorman-Schloss. Otitis
media and CNS complications. J. Larry Otology. 1992; June
(3): 24-6
Rafiq, KM., Iflikhar A. Abdullah. J., Shaeeb K... Shahdin.
Otogenic brain abscess in Peshawar. Pak. J. Otolaryngology.
; (2): 140-3.
Sharm H., Dayal, D. Otogenic intracranial complications:
review of 10 years' experience. Pak. J. otolaryngology. 1990;
: 146-9.
JAMC, Vol. 12, No. 3, 2000
Singh B., Muhaaraaaj TJ. Radical mastoidectomy: its place in
otogenic intracranial complications. J. Laryngol Otology.
; 103(12): 1113-18.
Mathew TJ. Marus G. Otogenic intradural complications, (a
review of 37 patients) J. layng Otol. 1985; 102(2): 181.
Zia Mr. Butt MI. Butt Zi Result of mastoidectomies for otitis
media. Pak. J. Otolaryngology. 1994; 10: 220-23.
Sadler JW. The ear. in Longman's and Wilkins. 1989: 328-36.
Kangsanarak J, Foodnanat S, Ruckphaopunt K. Navacharoln
N, Teotrakul. S. Extracranial and intracranial complications of
suppurative otitis media: report of 102 cases. J Laryngol
Otology. 1993; 107(11)994-1004.
Anthony Wright. Anatomy and ultra-structure of human ear in
Scott Brown s Otolaryngology: Basic Sciences 5th edn.
London: Butterworth. 1987: 1-14.
Zia MR. Muzaffar K. Khaliq-uz-Zaman. Intracranial
complications of ear disease. Pak. J. Otolaryngology. 1993; 9:
-7.
Bradley PJ, Manning Kp, Shaw MDM . Brain abscess
secondary to otitis media. J-Laryngol-Otology. 1988; 88 (12):
-91.
Chotmonkel V, Sangsaard S. Intracranial complications of
chronic suppurative otitis media. Southeast-Asean. J. Trop.
Med. Public Health. 1992; 23: 510-13.
Julian S., Fernandes C.M.C., Johannes, S. Intracranial
otogenic complications: a presenting problem. Laryngoscope.
; 96(3): 272-77.
Gower D. McGuirt WF, Salem W. Intracranial Complications
of Acute and chronic infectious ear disease: a problem still
with us. Laryngoscope. 1983; 93 (August):
Williams B Cerebral abscess (editorial). Br J. Neurosurgery.
; 4: 248-51
Brydon HI. Hardwidge C. l ire management of cerebellar
abscess since the introduction of C.T. Scanning Br. J.
Neurosurgery. 1994; 8: 447-55
Munz M. Farmer JP. Auger L. O'Gorman AM. Sehloss MI).
Imaging case of the month otitis media and CNS
complications. J. Otolaryngology. 1992; 21 224-26.
Rashid A. Rafiq M. Khan. Iflikhar Alam. Otogenic intracranial
abscess. J-P-M-A. 1992 (September):220-21.
Schwaber MK, Pensak MC. Bartels IJ The early signs and
symptoms of neurologic complications of chronic suppurative
otitis media Laryngoscope. 1989; 99 (April):
Ibrahim AWM, AIRajeh SM. Chowdhury IJM. Ammar A.
Brain abscess in Saudi Arabia. Neurosurgery Rev 1990; 13
-7.
Schmidt KG. Rasmussen JW. Frederickson PB11q KochJensen C. Pederson NT. Indium-III-Granulocyte scintigraphy
in brain abscess diagnosis: limitations and pitfalls. J. Nuclear
Medicine. 1990; 31: 1121-27
Shah AA. G.T. vs non-CT evaluation and management. J.
Postgraduate Medical Institute. 1993; 6: 37-45.
Warwick R. William PL. Development of nervous system in
Gray's anatomy. 35th edn. Longman: 1973: 126-44.
Heinman HS. Braudo AI. Anserobic infection of brain:
observation on eighteen consecutive cases of brain abscess.
Am. J. Med. 1983; 35: 682-97.
Leys D. Christisens JL. Dermabura PH. et al. Management of
focal intracranial infections: is medical treatment better than
surgery? J. Neurol. Neurosurgery Psychiatry. 1990; 53: 472-
Sabiha PIT. Farida J, Cheah FK, Microbiology of cerebral
abscess: a four - year study in Malaysia. .1. Tropical Medicine
and Hygiene. 1993, 96: 191-96.
Donald FE, Firth JL, Holland IM. Hope DT. Isfahani P. Punt
JAG. Bri. J. Neurosurgery. 1990; 4: 265-72.
Puthuchesry DS and Purasskthi N. The bacteriology of brain
abscess: a local experience is Malaysia. Transactions Royal
Society Tropical Medicine & Hygiene. 1990; 84: 589-92.
Singh B, Maharaj TJ. Radical mastoidectomy: its place in
otogenic intracranial complications. J. Laryngol Otology.
3; 107: 1113-18.
Brith RH. Brain abscess. In Neurosurgery by Wilkins RH and
Rengachary SS. London: McGraw Hill. 1985: 1928-56. .32.
Mathew TJ. Marus J. Otogenic intradural complications J.
Layng Otol. 1988; 102: 211-24.
Aebi C, Kaufmann F, Schaad UB. Brain abscess in childhood
- long term experience. European J. Pediatrics. 1991; 150:
-86.
Kulah A, O Zatik N, Topell 1. Otogenic intracranial abscess.
Acta. Neurochir (Wion). 1990; 107: 140-46.
Murthv PSN, Sukumar R, Hazarika P, Ralo AD. Mukulchand
and Raja A, Otogenic Brain abscess in childhood. Intern. J.
Pediatric Otorhinolaryngol. 1991; 22: 9-17.
Bolz EA. Chronologic outline of development of otology. In
Sounders WH, Paperalla MM ed's . Atlas of ear surgery. St.
Louse: C.V. Mosby. 1971: 1-14.
Bidzinsk J. Koszewski W. The value of different methods of
treatment of brain abscess in C.T. era. Acta. Neurochir. 1990;
-20.
Richards J, Sisson PR. Hichman JE, Ingham HR, Selkon JB.
Microbiology, chemotherapy and mortality of brain abscess in
Neweastle-Upon-Tyne between 1979 and 1988. Scandinavian
J. Infectious Diseases. 1990; 22: 511-18
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