Received 10 September 2009; received in revised form 18 November 2009; accepted 19 November 2009.
Abstract
Objective
To describe the presentation and management of otogenic intracranial abscesses in a tertiary care pediatric hospital.
Study Design
Case series and chart review.
Setting
Tertiary care pediatric hospital.
Subjects and Methods
An inpatient database was queried for the following diagnostic codes from 2000 to 2008: [383.2] petrositis, [383] acute mastoiditis, [386.3] labyrinthitis, [351.0] facial paralysis (Bell's palsy), [351.9] facial nerve disorder unspecified, [351.8] other facial nerve disorders, [383.01] subperiosteal abscess, [383.02] Gradenigo's syndrome, [320] meningitis, [324.9] extradural or subdural abscess, [324.0] intracranial abscess, [325] thrombosis of intracranial venous sinus, and [348.2] otic hydrocephalus. Presenting signs and symptoms, microbiology, length of stay, surgical findings, and outcomes were recorded for each patient.
Results
Forty patients were identified with an otogenic intracranial complication. Thirty patients had evidence of an intraparenchymal, epidural, subdural, or petrous apex suppurative complication of otitis media. Twenty-four of 30 (80%) patients had a canal wall up mastoidectomy, three (10%) patients had a craniotomy without a mastoidectomy, and three (10%) patients were managed with intravenous antibiotics with or without pressure equalization tubes. There were no mortalities in this series of patients.
Conclusion
Patients with intracranial abscesses, in selected cases, can be managed with intravenous antibiotics without mastoidectomy. The use of canal wall up mastoidectomy is an acceptable alternative to radical mastoidectomy when surgical intervention is necessary.
Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
Corresponding author: Brandon Isaacson, MD, UT – Southwestern Medical Center, Department of Otolaryngology, 5323 Harry Hines Blvd, Dallas, TX 75287
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
ABSTRACT