Vol.95 No.3 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 95 No. 3 March 2002
Otogenic Intracranial Complications in an Infant
Tomoe Yoshida, Masahiko Yamamoto, Toshiyuki Nomura,
Hiromi Orihara and Sayuri Yano
(Toho University School of Medicine, Sakura Hospital)
Although otogenic intracranial infectious complication is now rare, it can still have a serious outcome. We report here a young child with intracranial infections secondary to extension of acute otitis media. A 5-year-old boy developed thin epidural empyema in both the middle fossa and posterior fossa ipsilateral to the otitis media. Mastoidectomy was urgently performed and the posterior fossa abscess was drained to the external canal through the opened mastoid. The patient recovered uneventfully.
We considered that this potentially serious condition developed in this case because of poor understanding by the patient's mother about the necessity of antibiotics, which resulted in the purulent otitis media being only partially treated.
A literature survey of otogenic intracranial complication in Japan for the period 1992～2000 showed on 26 cases of which males were predominantly affected with the ratio of 4：1. The peak incidence occurred in patients in their forties and fifties. Cholesteatoma was the most common underlying problem (65.4％) in the period, which was similar to 1982～1991. However, acute otitis media as a cause of intracranial complication became three times more frequent in the 1992～2000 period. Brain abscess was most common, exceeding 50％ of reported cases, and epidural abscess also increased in incidence. Causative pathogens included streptococcus species, pseudomonas, staphylococci, and some other microbes, and these were similar in both period. Cases following middle ear surgery were less common in the latter period.
Key words : otogenic intracranial complications, otitis media, cholesteatoma, brain abscess, epidural abscess