CASE SERIES

1. Case series:

2. INTRODUCTION
Otogenic intracranial abscesses are an
uncommon but life-threatening complication
of otitis media
 This study is to recognizing this
complication as well as provide some
information about the disease
process and management.

3. • Here it is a case series at our hospital of 3
patients with diagnosis of otogenic brain
abscess.

4. CASE-1
• Pt
• Female- 27y
• Left Ear Discharge – childhood, Insidious onset, progressive
in nature, whitish, foul smell& intermittent.
• Left Ear Pain- One month, more during discharge, progressive,
piercing in nature , continuous through the day, fever
• Head ache since 1 month

5. History cont…
• No significant Personal/Family History.
• General Examination:-
• Pulse-87/mint.
• RS-clear.
• CVS-S1,S2+.
• CNS-GCS-15/15.
• Abd-Soft

6. Local Examination:-
Ear
Left Ear
• Pinna/Pre&Post auricular:-
• Normal
• Tenderness:-
• No
• E.A.C:-
• Granulation +
• TM:-
• Granulations +,
Whitish
Debry + at Attic Area
• FISTULA TEST:-
• -VE
Right Ear
• Normal
• No
• Normal
• Normal
• -VE

7. Tuning Fork Test:-
• Rinne’s Test:-
BC>AC
• Weber Test:-
Lateralised to Left
• ABC Test:-
Not reduced
• PTA:-
26.6db
Mild conductive hearing loss
AC>BC
Not reduced
18.3db

8. • Nose/Throat :- Normal
• Investigations:-
• Surgical Profile-within Normal limitis

9. MRI Scan Brain & Temporal Bones:-
Thick Walled Hypo dense Ring Enhancing lesion in Left
Temporal Region with Left mastoiditis and No Significant mass
effect or Midline shift

10. Diagnosis:-Lt CSOM – SQUAMOSAL TYPE
with OTOGENIC BRAIN ABSCESS

11. CASE-2
Age/Sex:- 10y/M,
• Discharge from Right Ear –Childhood,
• Pain in Right Ear-One Month,
• Swelling over Right Temporal Region-One Month,
• Vertigo – One Month,
• Fever – One Month.

12. • Pt had history of altered
sesorium,drowseness,vomitings
• No significant Personal/Family History.
• General Examination:-
• Pt conscious/coherent/well oriented.
• Pulse-92.
• RS-clear.
• CVS-S1,S2.
• CNS-GCS-15/15.
• Abd-Soft

13. Local Examination:-
Ear
Right Ear
• Pinna/Pre&Post auricular:-
• Normal
• Tenderness:-
• Over Mastoid process
&Conchae
• E.A.C:-
• Oedematous,Granulations +
• TM:-
• Granulations +, Remnant of
T.M with Annulus
• FISTULA TEST:-
• -VE
Left Ear
• Normal
• No
• Normal
• Normal
• -VE

14. Tuning Fork Test:-
• Rinne’s Test:-
BC>AC
• Weber Test:-
Lateralised to Right
• ABC Test:-
Not reduced
• PTA:-
35db
Mild conductive
hearing loss

15. CT Scan Brain & Temporal Bones:-
Thick Walled Hypo dense Ring Enhancing lesion in Right
Parietal Region with Significant mass effect and Midline shift
with Right mastoiditis

16. Diagnosis:-Rt CSOM –SQUAMOSAL
with OTOGENIC BRAIN ABSCESS

17. CASE 3
Male-46y
Presented with:
Right ear discharge 5yrs
Head ache -2months
Nausea -2months
Generalised body weakness-1month

18. Local Examination:-
Ear
Right Ear
• Pinna/Pre&Post auricular:-
• Normal
• Tenderness:-
• no
• E.A.C:-
• normal
• TM:-
• STP+ATTIC
RETRACTION
GRANULATION+
• FISTULA TEST:-
• -VE
Left Ear
• Normal
• No
• Normal
• Normal
• -VE

19. Tuning Fork Test:-
• Rinne’s Test:-
BC>AC
• Weber Test:-
Lateralised to Right
• ABC Test:-
Not reduced
• PTA:-
44.6db
moderate conductive
hearing loss

20. Ct scan showing ring enhanced lesion in Rt
temporal region with midline shift

21. Diagnosis : Rt CSOM SQUAMOSAL
type with Rt temporal abscess.

22. MANAGEMENT
all the 3 patients were
managed with
 3wks IV antibiotics
 Followed by excision &
drainage of brain
abscess. by
craniotomies/burr hole
drainage.

23. • MODIFIED RADICAL
MASTOIDECTOMY.
• 3 pts were tolerated the
procedure well, no
mortality were recorded
• . No pt reported with
recurrence of intra
cranial complications

24. OTOGENIC BRAIN ABSCESS
DEFINITION : Brain abscess is a focal
suppurative process within the brain
parenchyma surrounded by a region of
Inflammation

25. OTOGENIC BRAIN
ABSCESS
50-75 % adult brain abscess & 25% in child is otogenic.
Temporal abscess is twice as common as cerebellar abscess
Mortality associated with otogenic brain is around 25%.in preantibiotic
era
ROUTES OF INFECTION:
1.Direct spread:
• via Tegmen plate: Temporal abscess
• via Trautmann’s triangle: Cerebellar abscess
2. Retrograde spread: via thrombophlebitis
•

26.  sometimes the infection
could extend via the
Virchow -Robin spaces
in to the cerebral white
matter.
 Trautmann's triangle. It
is Pathway to posterior
cranial fossa from
mastoid cavity

27. STAGES OF BRAIN
ABSCESSs
1-10DAYS
10-14
>14Days

28. Bacteriology
• Anaerobic streptococci
• Streptococcus pneumoniae
• Staphylococci
• Proteus
• E. coli
• Pseudomonas
• Bacteroidis fragilis

29. CLINICAL FEATURES
• Patient looks very toxic & drowsy.
• Deep boring headache with projectile vomiting
• Foul-smelling creamy otorrhea indicates a
fulminant destructive process.
TRIAD OF BRAIN ABSCESS:
Headache.
High grade fever
Symptoms due to focal neurological deficits

30. CONCLUSION
 Diagnosis should be considered in all such patients
presenting with a ear discharge, headache, fever, seizures
and confusion, especially after failing conservative
treatment
 OBA remains a life-threatening condition requires
prolonged systemic antimicrobial therapy surgical
intervention.
 It is recommended to evaluate such cases by imaging to rule
out brain abscess ,to reduce mortality & morbidity.