Otogenic brain abscess (OBA) is a rare complication to otitis media, but one with a potentially devastating outcome. Early diagnosis of OBA is crucial for successful treatment. The objective of this study was to determine the incidence of OBA in a Danish population and to describe its clinical manifestation, management and outcome.
Material and methods
A total of 93 patients were retrospectively enrolled by diagnosis codes for brain abscess from 1999 to 2010. Records were reviewed to register age, symptoms, clinical findings, co-morbidity, imaging, microbiology and treatment.
Seven were found to have had an otogenic focus of infection. The incidence of OBA was 1/million, and the mean age was 43 years, ranging from ten to 81 years. Five patients had acute otitis media and two had infectious cholesteatoma. Four had previously suffered a head trauma. The young patients presented with symptoms indicative of meningitis and the elderly patients with symptoms resembling a stroke. None of the patients were treated with antibiotics before admission to hospital.
No mortalities occurred, but three had sequelae in the form of hearing loss and/or neurological impairment.
The OBAs manifested with symptoms mimicking meningitis in young patients and stroke in elderly patients. Absence of fever does not rule out OBA; and regardless of any present ear symptoms, an ear nose and throat examination should be performed without delay to locate the focus of infection and to facilitate targeted treatment.
Correspondence: Tina Kissow Lildal. E-mail: firstname.lastname@example.org
Conflicts of interest: none. Disclosure forms provided by the authors are available with the full text of this article at www.danmedj.dk
REFERENCE: Dan Med J 2014;61(6):A4849