Effectiveness of simultaneous source- control surgery in chronic purulent otitis media with intracranial complications

Objective: to study and optimize the tactics of surgical treatment of chronic purulent otitis media with intracranial complications.

Material and methods: during the study period from 2010 to 2024, 62,707 patients were hospitalized at the SI NMC “Shifobakhsh,” of whom 11,570 had acute or chronic suppurative middle ear inflammation, accounting for 18.5% of all admissions. Intracranial complications were observed in 95 patients, representing 0.15% of all hospitalized patients and 0.82% of those with inflammatory middle ear disease.

After comprehensive evaluation and confirmation of the final diagnosis, patients underwent source-control surgery on the affected ear. More than 50% of patients with intracranial complications underwent simultaneous procedures, consisting of concurrent source-control surgery of the ear and surgery for the intracranial lesion (brain abscess excision, evacuation of an extradural abscess, etc.). In 42 patients whose intracranial complications presented as meningitis or meningoencephalitis, only ear source-control surgery combined with conservative treatment was performed

Results: the data indicate that chronic suppurative otitis media plays the principal role in the development of intracranial complications; however, acute otitis media, especially post-influenza otitis media, may also contribute substantially to the development of meningitis and sigmoid sinus thrombosis. Among the 95 patients with otogenic intracranial complications, 16 (16.8%) were diagnosed with brain or cerebellar abscess, while 35 (36.8%) had an extradural abscess. Aſter diagnosis, these patients were admitted to the neurosurgical department, where combined simultaneous source-control procedures were performed. These procedures were associated with faster recovery, primary wound healing, a shorter hospital stay, and sustained remission.

Conclusion: computed tomography and magnetic resonance imaging of the mastoid processes and brain play a key role in the diagnosis of otogenic intracranial complications and make it possible to select timely and appropriate treatment strategies. Single-stage combined neurosurgical and otorhinolaryngological procedures for otogenic intracranial abscesses yield favorable outcomes in these life-threatening conditions while minimizing mortality.

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