Otogenic brain abscesses: A systematic review

Abstract

ObjectiveOtogenic brain abscesses are one of the most significant life‐threatening complications of otologic infections. Given their low prevalence, otogenic brain abscesses require a high index of suspicion for diagnosis. In this systematic review, we aim to provide an analysis of otogenic brain abscesses and describe common clinical signs and symptoms, bacteriology, location, treatment options, morbidity, and mortality.Data SourcesPubMed, Cochrane CENTRAL database, Google Scholar, and Scopus.MethodsA systematic review of literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses recommendations. Variables assessed included clinical signs and symptoms, bacteriology, location, treatment, morbidity, and mortality.ResultsTwenty‐nine studies met inclusion and exclusion criteria, corresponding to a total of 1307 otogenic abscess cases for review. Fifty‐five percent of abscesses were found in the temporal lobe and 28% in the cerebellum. Most patients (88.3%) had a history of suppurative chronic otitis media. The most common symptoms were headache, altered mental status, papilledema, and meningeal irritation. Fever, nausea, and vomiting affected about 40% of patients. The most commonly cultured bacterial species was Proteus mirabilis. In addition to antibiotics, most otogenic brain abscesses were treated by burr hole aspiration. Average mortality following advent of computed tomography was 8.11%.ConclusionAlthough rare, otogenic brain abscesses may occur as a complication of suppurative otitis media and require a high index of suspicion. Appropriate imaging studies and multidisciplinary expertise are crucial in the diagnosis and management.Level of Evidence4.

Complicaciones intracraneales de la otomastoiditis, presentación de caso clínico

“…es de origen otogénico, mientras que en los adultos se cree que más del 50% de los abscesos cerebrales son de este origen 9 . Comienza con la colonización de microorganismos en el parénquima cerebral, que se visualizan en estudios de TC y RM como colecciones con cápsula vascularizada que presentan refuerzo de anillo bien definido 10 .…”

Intracranial infections: lessons learned from 52 surgically treated cases

“…Otogenic brain abscess and meningitis are the most widely recognized focal complications of otitis media. 8 Curiously, an otogenic brain abscess identified with otitis media is usually found nearby the temporal bone, mostly within the temporal lobe and cerebellum (Fig. 3).…”

Risk Factors Associated With Mortality in Patients With Otogenic Brain Abscess

“…In a systematic review of otogenic brain abscess, Duarte et al (29) show the pediatric population to be overrepresented in most studies meeting inclusion criteria, and therefore it is likely that either otogenic brain abscess and associated complications more frequently occur in the pediatric population or children more commonly present with overt signs and symptoms of intracranial complications. In a case series of 47 patients with otogenic intracranial complications, Van der Pol et al (15) show 95% of pediatric patients underwent mastoidectomy, however only 57% of adults received mastoidectomy.…”