RADICAL MASTOIDECTOMY - ITS PLACE IN OTITIC INTRACRANIAL COMPLICATIONS

Standard recommended treatment for patients with intracranial complica tions from otitis media, has been radical mastoidectomy, whether chole steatoma is present or not. This was established in the pre-antibiotic era to improve survival. Over a six-year period, from January 1985 to December 1990, 268 patients were admitted with intracranial and extra cranial complications of otitis media. The prospective treatment consi sted of antibiotics and surgery. Surgery entailed mastoidectomy and dr ainage of intracranial collections of pus in all patients. However, pr ospectively in these patients the ear pathology and not the complicati on dictated the type of mastoidectomy performed. Cortical mastoidectom y was performed in non-cholesteatomatous ears and radical mastoidectom y in cholesteatomatous ears. Recurrence of intracranial complications occurred in only four patients (two per cent), a temporal lobe cerebri tis in the non-cholesteatomatous ear group, and, a temporal lobe absce ss, posterior fossa abscess and subdural empyema in the cholesteatomat ous ear group. The temporal lobe cerebritis settled on intravenous ant ibiotics whilst the temporal lobe abscess, posterior fossa abscess and subdural empyema required redrainage. In none of these was the ear su rgery revised. There were 15 deaths (eight per cent), all occurring in patients with intracranial complications, 12 associated with brain ab scess, two with subdural empyema and one with meningitis. Eight were f rom the non-cholesteatomatous group and seven from the cholesteatomato us group. The mortality was directly related to the patients conscious ness level on admission and not to the type of ear pathology. It can t herefore be concluded that radical mastoidectomy is unwarranted in the non-cholesteatomatous ear, even with an otogenic intracranial complic ation.