[A case of otogenic brain abscess].

A case of otogenic brain abscess, secondary to cholesteatoma, is reported. Early diagnosis is very important for the treatment of otogenic brain abscess, which is a life-threatening disease. Early diagnosis of this disease is often difficult, because of modification by antibiotics. A 62-year-old male with a longstanding history of chronic left otorrhea with severe headache and fever, was admitted to our hospital. He was diagnosed as having left cholesteatoma, but prolonged headache and high fever did not improve. Unfortunately, we could not detect otogenic brain abscess early in the diagnostic process because of the modification by antibiotics and a lack of recognition for otogenic complications. Six days after admission, brain CT demonstrated a well-encapsulated brain abscess in the left temporal lobe. Although conservative treatment was administered, the diameter of the brain abscess increased daily. There are two therapeutic approaches;one is ear surgery, followed by neurosurgical treatment;the other is intracranial surgery, followed by otogenic treatment, after the general condition of the patient has improved. We selected the latter one to treat our case. The abscess was surgically drained by a neurosurgeon because of the high possibility it would penetrate the cerebral ventricle. The shadow of the brain abscess on CT disappeared after surgical drainage, and the symptoms began to improve. After his general condition improved, removal of cholesteatoma was performed. Two months later, he continuoes to do well. We concluded that this approach was a very useful and reasonable treatment in our case.