Pediatric otogenic intracranial abscesses.

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.