Otogenic brain abscess always develop in the temporal lobe or the cerebellum of the same side of the infected ear. The purpose of the paper is to examine the current state of the art about epidemiology, diagnosis, and treatment of this infection. In a quarter of cases, the origin of the brain abscess is not known 7, 12. Foral and venkata sunil bendi and vivekan and ruosu an, year2017. Otogenic cerebral abscesses have carried a high mortality in the past, partly because of the ineffectiveness of penicillin in eliminating bacteroides fragilis. Early diagnosis of oba is crucial for successful treatment. Otogenic brain abscess presenting with gait ataxia europe. Otogenic brain abscess oba is a rare complication to otitis media, but one with a potentially devastating outcome. Eight cases of cerebellar abscess and 2 cases of temporal lobe abscess in the paediatric age group were reported including 4 cases of latent brain abscesses which manifested themselves after mastoidectomy for middle ear infection.
To present our experience with the management of otogenic brain abscess and compare it with the current concept of treatment. Roughly 50% of brain abscesses in adults and 25% in children are believed to stem from otogenic infections 8, 18, though the incidence has decreased due. Herein, we present a rare case of rapidly progressing facial paralysis with concomitant severe headache and ipsilateral hearing loss secondary to an otogenic brain abscess, treated with the transmastoid approach, drainage, and facial nerve decompression. Brain abscess is by far the most serious of otogenic complications.
Otogenic brain abscesses with intracranial complications are often located adjacent to the temporal lobe and cerebellum, with the middle segment of the temporal lobe and lateral lobe of the. Otogenic and cardiogenic sources are among the most common. These microorganisms can cause intracranial complications by direct extension of infection beyond the temporal bone to the intracranial cavity. The most common cause of brain abscess is direct extension of infection through a bony defect, in the tegment antri in case of cerebral abscess or in trautmans triangle in case of cerebellar abscess 1,9. Clostridium glycolicum isolated from a patient with otogenic.
In children nearly 25% of brain abscesses are otogenic in nature, whereas in adults who are more prone to chronic ear infections the percentage rises to 50%. Jun 29, 2007 otogenic brain abscess volume 82 issue 11 y. While streptococcus pneumoniae is the most common cause of bacterial meningitis in adults, cases of pneumococcal brain abscess have rarely been reported. The basic concepts in treating otogenic brain abscesses include immediate decompression of the abscess, prompt eradication of the primary otogenic nidus, and the active prevention of abscess recurrence. Radical mastoidectomy and tympanoplasty were performed.
Surgical excision of middle ear and mastoid disease can effectively arrest the infections and the progression of the disease to a more severe stage of. The occurrence of brain abscess secondary to ear disease while becoming infrequent in this antibiotic era can and does present itself. Fundamental to the successful management of bacterial brain abscesses is a multidisciplinary approach. A focal intracranial infection that is initiated as an area of cerebritis and evolves into a collection of pus surrounded by a vascularized capsule. Although the occurrence of otogenic brain abscess has been considerably reduced through improvements to antibiotics, brain abscesses remains one of the most significant life threatening complications of chronic otitis media. Brain abscess are commonly considered the second most common intracranial complication of om after meningitis fig. Herein, the authors report a rare case of otogenic brain abscess with facial paralysis. Our experience with these and other unreported otogenic complications is at great variance with the opinions of some clinicians who repeatedly emphasized their extreme rarity occasioned by the advent of antibiotic therapy. Shifting paradigm in brain abscess management at tertiary. Here, we are reporting, a case of right temporal otogenic brain abscess caused by enterococcus faecalis in a 12 year old male child. Risks of developing an otogenic intracranial abscess the.
Otogenic infective complications meningitis cerebrospinal. Csom have been considered as risk factors for otogenic brain complications. Mar 12, 2014 oscarwilde irish writer and poet died of otogenic brain abscess 6. Our experience with these and other unreported otogenic complications is at great variance with the opinions of some clinicians who repeatedly emphasized their extreme rarity occasioned by the advent of. Otogenic brain abscesses are one of the most significant life. Myers, md international editor otogenic brain abscess. Sixtyfive percent of the patients were between 5 and 15 years of age. By performing craniotomy and mastoidectomy concurrently, it is possible to treat iccs and to remove the source of infection with a single anesthetic procedure during 1 hospital visit. We report the case of a 67yearold male patient who presented with gait ataxia and dizziness. Fortyone patients in whom otogenic brain abscess was diagnosed and has been treated since 1968 are presented. The risk of repeated collection of pus is almost completely eliminated, and hence the expense involved in repeated imaging is saved. Review of 41 cases levent sennaroglu, md, and bulent. Otogenic brain abscess is accompanied by headache, aural symptoms including aural discharge in the left ear, nausea, emesis, fever, and others. After meningitis, brain abscesses represent the second most common intracranial complication of chronic otitis media com 14, with an associated mortality rate ranging between 7% and 61% in most large series 11, 14.
Introduction the prevalence of middle ear infections and its. Pdf objective otogenic brain abscesses are one of the most significant life. Introduction the natural history of middle ear infections has been radically changed since the advent of antibiotics 4. Otogenic intracranial abscesses are usually caused by streptococcus pneumoniae, group a streptococcus, staphlococcus aureus and proteus species 2, 11, 12. Abstract introduction an otogenic brain abscess is a common ent problem but an otogenic trapezius abscess can also be experienced in otolaryngological practice, particularly in patients with chronic suppurative otitis media. We describe a case of otogenic brain abscess caused by s. Imaging of cerebritis, encephalitis, and brain abscess. Bacteriological study of otogenic cerebral abscesses. Ct scan revealed a right temporal lobe abscess with 3mm midline shift. The temporal lobe abscess usually occurs in the middle and basal portions of the temporal lobe, adherent to the dura over the roof of the petrous bone. Imaging studies revealed a left cerebellar abscess and extensive. Surgical excision of middle ear and mastoid disease can effectively arrest the infections and the progression of the disease to a more severe stage of complications. Infection produces a transient, unnoticed period of encephalitis, characterized by fever, chills and rigors, headache and neck stiffness.
The cost associated with the diagnosis, treatment, and management of the intracranial complications of otogenic brain abscess should be considered as a cause of serious concern. To describe the presentation and management of otogenic intracranial abscesses in a tertiary care pediatric hospital study design. Management of otogenic brain abscess using the transmastoid. The rim of a brain abscess is usually thinner than that seen with neoplastic lesions fig. The proximity of the brain compartments to the ear increases the chances of infections getting percolated to central nervous system. Clinical database records from our tertiary center were searched for patients with the diagnosis codes of otogenic brain abscess g06.
Pdf otogenic brain abscess presenting with gait ataxia. The physician must understand these complications to recognize them quickly and treat them appropriately. The objective of this study was to determine the incidence of oba in a danish population and to describe its clinical manifestation, management and outcome. Over five years 19982003 six patients with otogenic brain abscess were. Ct and mri figures 1 and 2 suggested left otitis media and mastoiditis associated with a temporal lobe calcified otogenic brain abscess. Classic clinical presentation is seen in very few cases only. Pyogenic brain abscess caused by streptococcus pneumoniae. Management of otogenic brain abscess otogenic brain abscess has been a cause for severe morbidity and mortality in the developing world. Brain abscesses are associated with otitis media in around 30% of cases.
Otogenic brain abscess management abdul aziz ashoor, fachartzt fhno objective. Brain abscesses are focal suppurative processes, usually originating from a chronic otitis media, mastoiditis, sinusitis, or dental infection, from penetrating traumas or postsurgery. Brain abscess is a potentially fatal cns infection. As for the place of living, the patients from the provinces were more frequent, while with respect to their level of education, those with elementary or high school degrees were predominant. On the basis of our results, we believe that transmastoid approach is an effective and logical option for the treatment of otogenic brain abscess, and merits further investigation in the form of a prospective study. Of papers identifying otogenic comorbidities in patients presenting with brain abscess n 21.
This article is from iranian journal of otorhinolaryngology, volume 24. Right temporal otogenic brain abscess by enterococcus. Apr 25, 2018 location and symptoms of otogenic brain abscess. Ent department, king fahd hospital of the university.
Jan 19, 2016 a 33yearold man presented with a 2year history of recurrent episodes of purulent discharge from the left ear. Otogenic brain abscess with pneumocephalus springerlink. In our group of patients, otogenic brain abscesses were significantly more frequent in male patients in their forties, with median age of 33. Appropriate clinical and laboratory diagnosis and prompt initiation of antimicrobial chemotherapy is essential to reduce the resultant morbidity and mortality. Approximately onethird of brain abscesses are associated with otitis media and mastoiditis, often with an associated cholesteatoma. Microorganisms most commonly found in otogenic brain abscesses include streptococci, staphylococci, enterobacteriaceae, and anaerobic bacteria, as well as fungi, in. Intitial stage meningismus, nausea, headache, psychological, changes, the csf shows pleocytosis and fever increase of pressure and protein 2. Symptoms table symptoms of otogenic brain abscess 1. The causative pathogens of bacterial brain abscesses vary according to geographic location, age, underlying medical andor surgical condition, and mode of infection. Review of 41 cases international original articles eugene n. Microbiological diagnosis of enterococcus faecalis was done by aspirated pus from brain abscess. Intracranial complications secondary to ear infections is an established clinical condition. A 33yearold man presented with a 2year history of recurrent episodes of purulent discharge from the left ear. The study was retrospective and included the patients treated at the institute of otorhinolaryngology and maxillofacial surgery of the clinical centre of serbia diagnosed with otogenic brain abscess during a fiveyear period 19962000.
As otogenic cerebral abscesses constitute a major proportion of all cerebral abscesses, the use of metronidazole against obligateanaerobicbacteria, whichtend. Case reports cerebral ventriculitis associated with. Otogenic brain abscess is mostly caused by staphylococcus aureus, streptococcus pneumoniae, h. The commonest cause of the intracranial abscesses collected prospectively during the last two years was chronic middle ear infection 73%. Compared to the other modalities for therapeutic intervention, the transmastoid approach has the advantage of eradicating the primary source of infection while additionally providing an easily accessible method for abscess aspiration that represents a novel, safe, and effective treatment. All otogenic brain abscesses resulted from chronic otitis media with cholesteatoma and or granulations2,4.
Temporal lobe abscess is twice as common as cerebellar abscess. Furthermore, in patients with an otogenic brain abscess, the dis. The date range was january 1, 1998, through september 30, 2008. Case series transmastoid approach to otogenic brain abscess. Imaging studies revealed a left cerebellar abscess and extensive destructive. Given their low prevalence, otogenic brain abscesses require a high index of suspicion for diagnosis. Latent stage epileptiform, attacks, neurologic signs abnormal colloid curve.
A ct scan of the brain obtained after administration of contrast material shows evidence of a ringenhancing lesion in a welldefined abscess fig. Brain abscess is a challenging clinical entity with substantial high case fatality rates despite significant advances in imaging techniques, laboratory modalities, surgical interventions, and antimicrobial treatment. In otogenic intracranial abscess, a multidisciplinary approach is essential to reduce the risk of mortality. Brain abscess remains a serious and lifethreatening disease that requires immediate diagnostic and therapeutic attention. Brain abscess is by far the most serious of otogenic complica tions. The diagnosis was based on the clinical history, otological investigations, contrast enhanced computerized tomography and surgical findings.
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