Emergency Management of Otogenic Intracranial Abscesses in Ent Setup

Objective: To evaluate the demographic features, clinical presentation, site of abscess and bacterial isolates in patients with otogenic intracranial abscess and to assess the outcome of emergency treatment of these cases. Material and Methods: This study was conducted in the department of ENT and Head & Neck Surgery, Khyber Teaching Hospital, Peshawar from January 2005 to December 2010. A total of 42 diagnosed cases of otogenic intracranial abscess admitted to the ENT department were included in the study. Results: Out of 42 patients 29 (69%) were male and 13 (31%) female, the age range was from 04 to 50 years. More of the patients belonged to rural areas. Majority of the patients had purulent, foul smelling and scanty discharge, associated with earache, headache and vomiting. Attic or posterior marginal perforation, cholesteatoma or granulation or cholesteatoma and granulation both were the commonest otological examination findings. General physical and neurological examination revealed that more than half of the cases had bradycardia and subnormal body temperature, a few had neck rigidity, staggering gate, unconsciousness and almost 40% of them had developed papilloedema. Lab investigation showed low haemoglobin concentration in blood in many cases and raised ESR in 10 (23%) cases. Only 24 (57%) cultures gave pathogenic growths. The commonest pathogen was Proteus, E. coli and Pseudomonas. Regarding the site of abscess, extradural was the commonest followed by cerebellar and temporal. Subdural was the least common. Conclusion: The complications of Chronic Suppurative Otitis media may occur in either sex and at any age. Any patient presenting with scanty, purulent and foul smelling discharging ear associated with earache, headache, vomiting and nystagmus should be suspected of intracranial abscess of otogenic origin. These cases should be considered serious emergency and immediate emergency measures should be taken.