Erdevicki Ljiljana, Belić Branislav, Arsenijević Snezana, Milojević Ivan, Stojanović Jasmina
Clinic of Otorhinolaryngology, Clinical Center Kragujevac, Kragujevac, Serbia.
Vojnosanit Pregl. 2012 May;69(5):449-52.
Otitic complications arise from expansion of the middle ear infection. Subdural empyema is a rare otitic complication, and both retropharyngeal and parapharyngeal abscesses have been described in just a few cases.
A 30-year-old male was, admitted as an emergency case because of breathing difficulties, secretion from the ear, and fever. Clinical examination had shown a purulent, fetid secretion from the ear, swelling on the roof of epipharynx, left tonsil pushed medialy, immobile epiglottis, reduced breathing space. Computed tomography revealed thick hypodense content filling cavity, mastoid entering the posterior cranial fossa, descending down throw the parapharyngeal space to the mesopharynx. On the roof and posterior wall of the epipharynx hypodense collection was also present. Tracheotomy was conducted, and incision of the parapharyngeal and retropharyngeal abscess and radical tympanomastoidectomy were performed. The patient's state deteriorated on the tenth postoperative day with hemiparesis and consciousness disorder. Magnetic resonance imaging was done. It showed subdural empyema of the left frontoparietal region and next to the falx, so craniotomy and abscess drainage were conducted.
Parapharyngeal, retropharyngeal abscess and subdural empyema are rare otitic complications. Adequate antibiotic therapy and radical surgical treatment make possible an outcome with survival.
耳部并发症源于中耳感染的扩散。硬脑膜下积脓是一种罕见的耳部并发症，仅有少数病例报道过咽后和咽旁脓肿。
一名30岁男性因呼吸困难、耳部流脓和发热作为急诊入院。临床检查显示耳部有脓性、恶臭分泌物，会厌顶部肿胀，左侧扁桃体被推向内侧，会厌活动受限，呼吸空间减小。计算机断层扫描显示有低密度内容物填充腔隙，乳突侵入后颅窝，经咽旁间隙向下延伸至中咽。会厌顶部和后壁也有低密度积液。进行了气管切开术，并切开了咽旁和咽后脓肿，同时进行了根治性鼓室乳突切除术。术后第10天，患者病情恶化，出现偏瘫和意识障碍。进行了磁共振成像检查。结果显示左额顶叶区域及镰旁有硬脑膜下积脓，于是进行了开颅手术和脓肿引流。
咽旁、咽后脓肿和硬脑膜下积脓是罕见的耳部并发症。充分的抗生素治疗和根治性手术治疗有可能使患者存活。
