Chronic Otitis Media with Intracranial Complications: A Case Report and Literature Review

Introduction: The intracranial complications are relatively rare in chronic otitis media, occurring more frequently in cases of cholesteatoma. The most common is meningitis, epidural abscess, and lateral sinus thrombophlebitis, with high mortality. We aimed to report a case of complication of chronic otitis media in a young patient treated at the Department of Otorhinolaryngology.

Case report: An 18-year-old male patient has left purulent otorrhea for 8 years with no improvement with antibiotics. One week ago started earache, pain, and edema retroauricular and temporo-frontal and left temporo-frontal. On examination, the patient was lucid and oriented, with no neurological abnormalities such as facial palsy. With otoscopy, we observed otorrhea with granulation tissue in the external auditory canal, preventing visualization of the tympanic membrane. There were also erythema and edema with fluctuation in the left mastoid and left temporo-frontal. Computed tomography of the mastoid showed opacification of the left mastoid extensive bone erosion, besides material with soft-tissue density and permeating gas subperiosteal region. With clinical diagnosis of otomastoiditis with subperiosteal and extradural, abscess was performed with skin-draining collection of material for culture and started broad-spectrum antibiotics and tympanomastoidectomy with clinicoradiological follow-up.

Conclusion: In patients with intratemporal complications, one should always evaluate for intracranial complications associated even without neurological signs. The ear pain in these patients should be alert to the possibility of complication. In such cases, radiological evaluation is indispensable, and treatment should be made as early as possible.