Surgical Outcome of Otogenic Brain Abscess in Chronic Suppurative Otitis Media

Objective: To determine the surgical out come of otogenic brain abscess in chronic suppurative otitis media.Material and Methods: This descriptive study was conducted at the departments of ENT, Head, Neck Surgery and Neurosurgery Postgraduate Medical Institute (PGMI) Lady Reading Hospital Peshawar from June 2004 to May 2009 with a total duration of five years. The diagnostic criteria were detailed history, thorough Neuro-otological examination and radiological investigations. These patients were admitted into ENT Department and they were put on quadruple therapy. CT scans were performed on emergency basis and as the patients were diagnosed as having otogenic brain abscess urgent evacuation of abscess was done by neurosurgeon. All the patients with established brain abscess were included in this study while those patients having small multiple abscesses, early cereberitis and non otogenic brain abscesses were excluded from study. A well informed consent was taken from patient explaining the procedure, its risks, benefits and associated complications. The abscesses were primarily treated by neurosurgeons and the ears were later on treated by ENT surgeons. There was neither intra operative nor postoperative complication.Results: This study included 22 patients in the age range of 12-51 years with mean age 25 years. Sixteen were male and six were female, with female to male ratio 1 : 2.6. These patients presented with history of discharging ear, headache, vomiting and disorientation. The signs of disease in these patients were granulation tissues/ cholesteatoma in ear and papilloedema. CT scans were performed in all 22 cases (100%) while MRI in 10 cases (45.45%). There were single brain abscess in 14 cases (63.63%) while 8 cases (44.45%) having multiple brain abscesses. Mainly abscess were found in temporal region followed by cerebellar. The patients with chronic ear disease were treated by radical mastoidectomy and modified radical mastoidectomy after treating the brain abscess by Neurosurgeon. The Neurosurgical procedures performed were capsulotmies in 13 cases (59.09%), Bur hole aspiration in 7 cases (31.81%) and Trans mastoid excision in 2 cases (9.09%). These patients were followed for 3 monthly having CT scan with contrast with bone window.Conclusion: We concluded from our study that otogenic brain abscess is a life threatening complication, so early identification with help of CT scan and prompt surgical intervention with appropriate treatment of middle ear (primary disease) is essential for better outcom