• Gulshan Hussain
  • Mohibullah Khan
  • Saeed ullah
  • Hidayat ullah


Background: The relationship between otitis media and intracranial disease has long been established. Intracranialcomplications from Otitis Media can be quite devastating to the patient if an early diagnosis is not made. Brain abscessis one of the most dreadful complications of middle ear disease. The epidemiological presentation, clinical featuresand results of treatment are discussed in this study. Methods: This is a two years’ prospective study of 20 cases ofotogenic brain abscess carried out at PGM I, LRH Peshawar. The data on history and management of these patientswere collected and are reported. Results: There were 12 (60%) males and 6 (40%) females with a ratio of 3:2. Majorityof the patients were teenagers; however, the age range was from 5 to 40 years. Chronic suppurative otitis media wasthe main cause of otogenic brain abscesses. The commonest site was cerebellum. The commonest organism isolatedwas proteus (20%) followed by anaerobes (15%) and pseudomonas (10%). The commonest organism reported fromear discharge was also proteus. CT scan of the brain with contrast was the investigation on which further managementwas based. Burr-hole aspiration was the main neurological procedure adapted in this study. There was no neurologicaldeficit and epilepsy post operatively. Repeated aspiration was sometimes needed and recurrence was a problem (15%).Radical mastoidectomy was performed to eradicate focus of infection and make the ear safe (95%). The mortality was10% in this study.


Weiner G.M. Benard Williams. Prevention of intracranial

problems in our ear and sinus surgery: a possible role of

Cefotaxime. J. Laryng Otology. 1993; 107(11): 1005-7.

Mumtaz M. Former, J.P. Auger. L. O'Gorman-Schloss. Otitis

media and CNS complications. J. Larry Otology. 1992; June

(3): 24-6

Rafiq, KM., Iflikhar A. Abdullah. J., Shaeeb K... Shahdin.

Otogenic brain abscess in Peshawar. Pak. J. Otolaryngology.

; (2): 140-3.

Sharm H., Dayal, D. Otogenic intracranial complications:

review of 10 years’ experience. Pak. J. otolaryngology. 1990;

: 146-9.

JAMC, Vol. 12, No. 3, 2000

Singh B., Muhaaraaaj TJ. Radical mastoidectomy: its place in

otogenic intracranial complications. J. Laryngol Otology.

; 103(12): 1113-18.

Mathew TJ. Marus G. Otogenic intradural complications, (a

review of 37 patients) J. layng Otol. 1985; 102(2): 181.

Zia Mr. Butt MI. Butt Zi Result of mastoidectomies for otitis

media. Pak. J. Otolaryngology. 1994; 10: 220-23.

Sadler JW. The ear. in Longman's and Wilkins. 1989: 328-36.

Kangsanarak J, Foodnanat S, Ruckphaopunt K. Navacharoln

N, Teotrakul. S. Extracranial and intracranial complications of

suppurative otitis media: report of 102 cases. J Laryngol

Otology. 1993; 107(11)994-1004.

Anthony Wright. Anatomy and ultra-structure of human ear in

Scott Brown s Otolaryngology: Basic Sciences 5th edn.

London: Butterworth. 1987: 1-14.

Zia MR. Muzaffar K. Khaliq-uz-Zaman. Intracranial

complications of ear disease. Pak. J. Otolaryngology. 1993; 9:


Bradley PJ, Manning Kp, Shaw MDM . Brain abscess

secondary to otitis media. J-Laryngol-Otology. 1988; 88 (12):


Chotmonkel V, Sangsaard S. Intracranial complications of

chronic suppurative otitis media. Southeast-Asean. J. Trop.

Med. Public Health. 1992; 23: 510-13.

Julian S., Fernandes C.M.C., Johannes, S. Intracranial

otogenic complications: a presenting problem. Laryngoscope.

; 96(3): 272-77.

Gower D. McGuirt WF, Salem W. Intracranial Complications

of Acute and chronic infectious ear disease: a problem still

with us. Laryngoscope. 1983; 93 (August):

Williams B Cerebral abscess (editorial). Br J. Neurosurgery.

; 4: 248-51

Brydon HI. Hardwidge C. l ire management of cerebellar

abscess since the introduction of C.T. Scanning Br. J.

Neurosurgery. 1994; 8: 447-55

Munz M. Farmer JP. Auger L. O'Gorman AM. Sehloss MI).

Imaging case of the month otitis media and CNS

complications. J. Otolaryngology. 1992; 21 224-26.

Rashid A. Rafiq M. Khan. Iflikhar Alam. Otogenic intracranial

abscess. J-P-M-A. 1992 (September):220-21.

Schwaber MK, Pensak MC. Bartels IJ The early signs and

symptoms of neurologic complications of chronic suppurative

otitis media Laryngoscope. 1989; 99 (April):

Ibrahim AWM, AIRajeh SM. Chowdhury IJM. Ammar A.

Brain abscess in Saudi Arabia. Neurosurgery Rev 1990; 13


Schmidt KG. Rasmussen JW. Frederickson PB11q KochJensen C. Pederson NT. Indium-III-Granulocyte scintigraphy

in brain abscess diagnosis: limitations and pitfalls. J. Nuclear

Medicine. 1990; 31: 1121-27

Shah AA. G.T. vs non-CT evaluation and management. J.

Postgraduate Medical Institute. 1993; 6: 37-45.

Warwick R. William PL. Development of nervous system in

Gray's anatomy. 35th edn. Longman: 1973: 126-44.

Heinman HS. Braudo AI. Anserobic infection of brain:

observation on eighteen consecutive cases of brain abscess.

Am. J. Med. 1983; 35: 682-97.

Leys D. Christisens JL. Dermabura PH. et al. Management of

focal intracranial infections: is medical treatment better than

surgery? J. Neurol. Neurosurgery Psychiatry. 1990; 53: 472-

Sabiha PIT. Farida J, Cheah FK, Microbiology of cerebral

abscess: a four - year study in Malaysia. .1. Tropical Medicine

and Hygiene. 1993, 96: 191-96.

Donald FE, Firth JL, Holland IM. Hope DT. Isfahani P. Punt

JAG. Bri. J. Neurosurgery. 1990; 4: 265-72.

Puthuchesry DS and Purasskthi N. The bacteriology of brain

abscess: a local experience is Malaysia. Transactions Royal

Society Tropical Medicine & Hygiene. 1990; 84: 589-92.

Singh B, Maharaj TJ. Radical mastoidectomy: its place in

otogenic intracranial complications. J. Laryngol Otology.

3; 107: 1113-18.

Brith RH. Brain abscess. In Neurosurgery by Wilkins RH and

Rengachary SS. London: McGraw Hill. 1985: 1928-56. .32.

Mathew TJ. Marus J. Otogenic intradural complications J.

Layng Otol. 1988; 102: 211-24.

Aebi C, Kaufmann F, Schaad UB. Brain abscess in childhood

- long term experience. European J. Pediatrics. 1991; 150:


Kulah A, O Zatik N, Topell 1. Otogenic intracranial abscess.

Acta. Neurochir (Wion). 1990; 107: 140-46.

Murthv PSN, Sukumar R, Hazarika P, Ralo AD. Mukulchand

and Raja A, Otogenic Brain abscess in childhood. Intern. J.

Pediatric Otorhinolaryngol. 1991; 22: 9-17.

Bolz EA. Chronologic outline of development of otology. In

Sounders WH, Paperalla MM ed's . Atlas of ear surgery. St.

Louse: C.V. Mosby. 1971: 1-14.

Bidzinsk J. Koszewski W. The value of different methods of

treatment of brain abscess in C.T. era. Acta. Neurochir. 1990;


Richards J, Sisson PR. Hichman JE, Ingham HR, Selkon JB.

Microbiology, chemotherapy and mortality of brain abscess in

Neweastle-Upon-Tyne between 1979 and 1988. Scandinavian

J. Infectious Diseases. 1990; 22: 511-18