耳性小脳膿瘍の1症例と最近の耳性頭蓋内合併症について

DOI 被引用文献16件 参考文献65件

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  • Otogenic Cerebellar Abscess; A Case Report and Review of the Literature

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A 43-year-old male with a long-standing history of chronic left otorrhea, suddenly developed left otalgia, severe occipital headache and gait disturbance. Five days later, this patient was hospitalized because of deterioration of the level of consciousness, high fever, urinary incontinence, etc.<BR>Examination revealed granulation tissue with thick pus filling the left external auditory canal, suggesting aural cholesteatoma. Computed tomography showed cerebellar abscess of 30 mm in diameter and secondary hydrocephalus in the left hemisphere, possibly of otogenic origin. The patient underwent craniosurgical drainage of the abscess twice by a neurosurgeon together with intensive antibiotic therapy. After his general condition improved, left radical mastoidectomy was carried out and a large mass of cholesteatoma filling the mastoid cavity was removed. There was erosion of the posterior bony wall of the mastoid exposing the posterior fossa dura, where fistulization of the mastoid into the posterior cranial fossa presumably occurred.<BR>Our literature review of otogenic intracranial complications during the past 10 years in Japan indicated that there were 78 reported cases including 42 cases of brain abscess (60%). Almost all patients with otogenic brain abscess had a history of chronic purulent otorrhea, more than half (64.5%)had cholesteatoma and there was a marked male predominance in this disease. Although recent reports in the literature indicate a tendency toward greater reliance on intensive antibiotic therapy, it should be constantly remembered that chronic suppurative otitis media can be a serious disease, particulary when associated with cholesteatoma, and that intracranial complications can be prevented by timely surgical intervention.

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