[Simultaneous extracranial and intracranial otogenic complications].

INTRODUCTION

Chronic otitis media is the most common cause of otologic complications. A simultaneous occurrence of extracranial and intracranial otologic complications is rare in clinical practice. In this paper, we are presenting a patient with exacerbation of chronic otitis media and associated otologic complications: peripheral facial nerve palsy and subdural cerebral abscess.

CASE REPORT

A patient aged 56 who has suffered from chronic otitis media during the past 37 years, was admitted at the Clinic of Otorhinolaryngology due to worsening of the underlying disease. The clinical examination revealed chronic otitis media with granulation in the external auditory canal, pulsatile discharge and extracranial otologic complication--facial nerve paralysis. The preoperative diagnostic procedure included: cochleovestibular investigations (hearing disorder of mixed type on the left side with normal labyrinthine function), temporal bone radiography (sclerotic cell alteration of mastoid on the left), topodiagnosis of facial nerve). The laboratory finding confirmed increased number of leukocytes (21.7 x 10(9)/l), increased erythrocyte sedimentation rate (25/58 mm/h), increased fibrinogen (5.0 g/l) and presence of protein in urine. Chest and heart X-ray findings were normal. Staphylococcus aureus was isolated from ear discharge by microbiological investigation. Signs of meningitis were negative, the liquor was colorless, slightly stirred up with total number of cells 384 x 10(6)/l, sugar 2.7 mmol/l and total proteins from 0.82 g/l. Bacteriological liquor culture was negative. The ophthalmologic examination confirmed normal finding of the eye fundus and absence of increased cranial pressure. For further diagnostics CT (computerized tomography) and MRI of head (magnetic resonance imaging) were performed. The findings confirmed subdural abscess and suspected encephalitic foci of the left cerebral lobe. According to findings, surgery involving radical trepanation of the temporal bone, decompression of facial nerve, denudation of sigmoid sinus dural sinus and angle area and incision of dura mater of the cranial fossa posterior with drainage of subdural abscess (meningitis surgery) was performed.

CONCLUSION

A simultaneous occurrence of extracranial and intracranial otologic complications accompanied by subdural abscess is rare in clinical practice. The mechanism of development and spreading of subdural abscess is very interesting. In this case, subdural abscess caused the reaction of dura mater, which has prevented spreading of the disease by cerebrospinal liquid at the onset. However, there is a possibility of its further spreading by blood vessels into the brain white substance, where encephalitic foci may develop and later brain tissue abscesses as well. The clinical course of subdural abscess may be atypical, without headache and increased cranial pressure. This kind of disease demands a complex diagnostic procedure, sufficient otosurgical and neurosurgical interventions, cooperation with infectologist and administration of antibiotic therapy.