Otogenic brain abscess and its management with review of literature

Abstract

INTRODUCTIONOtogenic brain abscess is a relatively common problem in developing countries, where the prevalence of chronic suppurative otitis media (CSOM) is reported to be in the range of 30-40% and 0.5%-1% of developing brain abscess. The most commonly encountered intracranial complication is meningitis followed by brain abscess. The mortality of the brain abscess is in the range of 30-40%. 1 The eradication of infection in the brain and the ear is a major challenge which was realized as early as 1893 by Sir Williams Macewan, who described mastoid approach to both the abscesses. However with the development of otology and neurosurgery as separate entities, otologists started relying on neurosurgeons for the intracranial abscess removal followed by mastoidectomy. 2Hence the standard treatment for otogenic brain abscess evolved in two separate procedures addressing primary focus in mastoid its secondary complications in the brain, each with its own surgical mortality and morbidity. 3,4 Chronic otitis media with cholesteatoma and/or granulation tissue are usually the cause. In developing countries with high incidence of cholesteatoma, brain abscess is not a rare complication. The first line of treatment is antibiotic, followed immediately by surgical evacuation of the abscess and cleansing the sources of infection.6 CT-scanning is the best available diagnostic tool. 1Due to improvement in the surgical and anesthesia techniques, recently the advantages of eradicating the ABSTRACT Background: Proper management of chronic otitis media may reduce the incidence of otogenic brain abscess. The objective of this study is to present our experience in the management of otogenic brain abscess by neurosurgical and otolaryngological surgery simultaneously. Methods: It is a retrospective study conducted between 2006-2015. 20 patients with otogenic brain abscess were admitted to neurosurgery and ENT wards for management were included in the study. On admissions patients had ENT, neurosurgery and neurological examinations. All the patients underwent neurosurgery followed by mastoidectomy. Repeat CT scanning/ MRI scanning done after 1 week to check for the success of the surgery and discharged on the 10th day after suture removal. Patients were followed up for 1-2 years. Results: The study included sixteen males and four females. Their age ranged between 4-32 years with mean of 18 years. Their chief complaints were severe headache, vomiting and fever with unilateral and or bilateral foul smelling discharge. Brain and HRCT temporal bone CT scanning showed equal incidence of abscess on the sides with 8 cerebellar, 6 temporal, 5 tempero parietal and 1 fronto parietal abscess. After completion of surgery, eighteen patients improved and two patents expired due to septic shock. Conclusions: This is technically more feasible technique with an added advantage of single anaesthesia, short stay of patient in the hospital and early disease clearance in the same procedure.

Brain Abscess in the Current Decade (2010–2019) in India—A Review

“…[43][44][45][46] Multidisciplinary treatment strategies to address the primary source have helped to improve outcomes in otogenic brain abscesses. 19 Congenital cyanotic heart disease (CCHD) in the majority of children in Asia remains either uncorrected or only partially palliated. Uncured CCHD is a high-risk factor for the occurrence, persistence, and recurrence of a brain abscess.…”

“…41 In CSOM cases, patients underwent craniotomy for abscess removal followed by radical mastoidectomy under single anesthesia in the same session or mastoidectomy was done after the patient's general and neurological conditions were stabilized. 17,19 High-dose corticosteroid treatment was administered to patients with life-threatening cerebral edema or cerebral herniation and tapered over a period of 4 weeks. 8 Anticonvulsants were administered as prophylactics, and the duration of therapy was individualized and guided by electroencephalographic (EEG) reports.…”

Cerebellar Abscess Secondary to Cholesteatomatous Otomastoiditis—An Old Enemy in New Times

“…Regarding the historical treatment of otogenic cerebellar abscesses, the Scottish surgeon William Macewan (1848Macewan ( -1924 [21] attempted the eradication of infection in the brain and ear [22]. He published the resolved cases in Pyogenic Disease of the Brain and Spinal Cord: Meningitis, Abscesses of the Brain, Infective Sinus Thrombosis in 1893.…”