Subdural empyema of otorhinological origin.

The UCLA experience with subdural empyema (SDE) of otorhinological origin was reviewed. All cases of SDE with additional intracranial complications were excluded. Thirteen cases of SDE were identified with the predisposing factors being sinusitis (ten), mastoiditis (two), and otitis media (one). Based on data obtained from this review and from studies previously published in the literature, the keys to optimal outcome are rapid diagnosis, craniotomy with complete evacuation of the purulent collection followed by immediate surgical management of the otorhinological source of the SDE, and appropriate antibiotic therapy. Computed tomography is nearly always diagnostic but can be equivocal and magnetic resonance imaging may become the diagnostic study of choice. Of the five patients initially treated with burr holes. None of the patients initially managed with craniotomy were worse or died, whereas of the four patients initially managed with burr holes, two were worse (25 per cent) and two died (25 per cent). Antibiotic therapy is guided by the organisms found in the empyema and the site of origin of the infection. The otolaryngologist must remain aware of the clinical features and management of SDE and work closely with his neurosurgical colleagues to provide early, decisive surgical treatment.