Potential otogenic complications caused by cholesteatoma of the contralateral ear in patients with otogenic abscess secondary to middle ear cholesteatoma of one ear:A case report

BACKGROUND Otogenic brain abscess caused by middle ear cholesteatoma is a potentially serious and life-threatening complication in the ear,nose,and throat clinic.The mortality rate associated with otogenic brain abscesses is 8%–26.3%.Recently,in China,the incidence of brain abscess secondary to middle ear cholesteatoma has started to increase due to antibiotic resistance.CASE SUMMARY A 55-year-old male presented hearing loss in the right ear and headache for 1 mo in 2018.Computed tomography(CT) showed an area of low density in the right middle ear and mastoid and auditory ossicle defects and a small amount of soft tissue density in the left middle ear.The parietal wall of the right tympanic cavity and the posterior wall of the mastoid sinus were thin and less continuous.Cranial magnetic resonance imaging revealed an area of low intensity encapsulated by an area of high intensity in the right temporal lobe.We diagnosed him with a brain abscess secondary to middle ear cholesteatoma.He received surgery to drain the abscess followed by a modified radical mastoidectomy.The patient visited our department 3 years later because of intermittent otorrhea in the left ear.CT revealed that the area of the soft tissue density in the left middle ear and mastoid was significantly increased.The posterior wall of the mastoid sinus was destroyed,leaving the left middle ear connecting with the brain.The patient underwent a modified radical mastoidectomy in the left ear CONCLUSION Regular follow-up and timely treatment of contralateral ear disease are vital for the prevention of otogenic complications in patients with otogenic abscesses secondary to middle ear cholesteatoma in the unilateral ear.

Shifting paradigm in brain abscess management at tertiary care centre in Nepal

Aim: 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.Otogenic and cardiogenic sources are among the most common.Classic clinical presentation is seen in very few cases only.Burr hole with aspiration works well with good clinical outcomes.Control of primary source in cases of ear infection in the single setting results in good outcomes,reduces for additional surgery,and decreases the duration of hospital stay.Methods: This is prospective observational study conducted at Institute of Medicine,Tribhuvan University Teaching Hospital,Kathmandu,Nepal over the period of two and a half years(from September 2014 to March 2017).We analyzed the demographic profile,management strategies and outcome of these cases diagnosed with brain abscess using Microsoft Excel 2007.Results: A total of 51 cases were undertaken for surgical management.There were 35 males and 16 females with the male to female ratio of 2.18:1.The mean age of the study population was 16.76 years with age range from 4 months to 60 years.Otogenic source was the most common.Temporal lobe was the most common abscess location.Headache was the most common clinical presentation and was seen in 86.27%of the study population.All cases were initially managed with burrhole and aspiration of the abscess.Only 3.92%(n = 2)of cases subsequently required surgical excision of the abscess wall.Only 11.76%(n = 6)of the cases required multiple aspiration.Only 19.61%(n = 10)showed positive culture.Pseudomonas aeruginosa and E.coli were the most common organisms grown.Mortality rate among the study group was 3.92%.Conclusion: With the advent of modern technology in neuroimaging,mortality due to brain abscess has significantly decreased.Joint involvement of the otorhinolaryngology team and efforts in addressing the primary source have further helped in improving outcomes in cases of otogenic brain abscess.Hence,source control is of paramount importance in managing the brain abscess.