THE OTOGENIC BRAIN-ABSCESS

Background: Otogenic complications are rare but typical following acut e or chronic ear infections like mastoiditis and cholesteatoma. A life -threatening sequela is the otogenic brain abscess located in the temp oral lobe or cerebellum. Patients: At the ENT Department of the Medica l University of Hannover/Germany we treated 8 patients suffering from otogenic brain abscesses in the temporal lobe during the last three ye ars. The average age of the 6 male and 2 female patients was 48 years. In 5 patients the abscess developed due to a cholesteatoma with super infection. Three cases showed acute mastoiditis. All patients were ope rated using an otosurgical retroauricular approach, in five cases a cl assical radical mastoidectomy was performed. In two cases the abscess was reached via mastoidal approach and was subsequently drained. In tw o other cases the abscess was drained some days later by neurosurgical approach due to increased neurological symptoms. The other patients w ere treated with high-dosed antibiotics under regular clinical and rad iological control. Results: In 7 cases complete regression of the absc ess was achieved. Five patients were discharged without further otolog ical or central-nervous problems. One female patient developed severe meningitis with generalized thrombosis of the central blood sinus syst em and died in central circulatory failure. Two other patients develop ed a moderate psychopathologic syndrome and were admitted to rehabilit ation institutions. Conclusions: The analysis of our patients shows th at otogenic brain abscesses should be regarded especially as a severe complication of the untreated cholesteatoma. It is important to use mo dern imaging modalities like computer tomography or MRI for early dete ction of the intracerebral lesion and to perform an early otosurgical intervention. Under antibiotics and CT control, healing of this severe complication can be achieved in most cases. However, the danger of ac ute and chronic ear diseases has to be kept in mind in all medical dis ciplines.