Intracranial Abscess due to Cholesteatoma of the Middle Ear; A Case Report.

A 46-year-old man, with a history of right otitis media since childhood, complained of right otalgia and aural discharge for a month. The patient was admitted immediately because of severe headache and mastoid destruction seen on X-ray films. On admission, he showed signs of meningeal irritation and an intracranial complication was suspected. Intensive chemotherapy was begun. CT scan was done on the next day and revealed massive destruction of the right mastoid. Emergency mastoidectomy was performed, and a cholesteatoma was found in the antrum and the mastoid. Headache was improved postoperatively, but a relatively well encapsulated abscess of the right temporal lobe was found by postoperative MRI. Following chemotherapy, sudden arrest of respiration occurred on the 14th postoperative day, and emergency craniotomy was done, but the patient died 3 days postoperatively.It has been reported by many authors that with the advance of diagnosis by imaging and therapeutic methods, the mortality of otogenic intracranial complications has been greatly reduced. Yet the mortality due to otogenic intracranial abscess has not been lowered enough. There are two therapeutic approaches: one is otologic surgery first, followed by neurosurgical treatment ; and the other is intracranial surgery first, followed by otologic treatment, waiting for the improvement of the general condition. In the present case, we treated the patient by the first method unsuccessfully. We discuss, with a review of the literature, the degree to which conservative treatment is possible after otologic surgery.