Otogenic intracranial complications can become severe and life-threatening, although the incidence of these complications has decreased because of the wide use of antibacterial drugs and advances in imaging techniques. We encountered three cases of brain abscess caused by middle ear cholesteatoma.
Case 1: A 74-year-old male who presented with otorrhea, headache, neck pain, and fever. Physical examination revealed impaired consciousness and nuchal rigidity. We diagnosed the patient as having brain abscess due to middle ear cholesteatoma. First, we only performed drainage of the brain abscess, but the abscess re-grew. Therefore, we performed abscess drainage and radical mastoidectomy simultaneously with the department of neurosurgery. Case 2: A 52-year-old male who presented with fever and headache. We diagnosed the patient as having a brain abscess of unknown cause, and the abscess improved with drainage. Subsequently, We found that the abscess was caused by a middle ear cholesteatoma and performed tympanomastoidectomy. Case 3: A 55-year-old male who presented with earache and headache. We diagnosed the patient as having a brain abscess due to a middle ear cholesteatoma. From the beginning, the treatment was planned as a joint operation with the department of neurosurgery, and abscess drainage and tympanomastoidectomy were performed simultaneously.
Although in all cases, abscess drainage and ear surgery were performed, cure was achieved in all cases, with no residual neurological sequelae. The timing of abscess drainage and ear surgery varies from case to case. Treatment of otogenic brain abscess requires intervention for both the brain abscess and middle ear lesion. However, the order in which the two should be treated has not been established yet. The treatment strategy should be decided based on the presence/absence and severity of neurological symptoms in each case and the medical care system of the facility. Close collaboration with the department of neurosurgery may be particularly important.
