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Radical mastoidectomy: its place in otitic intracranial complications

Published online by Cambridge University Press:  29 June 2007

Bharath Singh  and
Tejprakash Jugpershad Maharaj
Bharath Singh*
Affiliation:
(Durban, South Africa)
Tejprakash Jugpershad Maharaj
Affiliation:
(Durban, South Africa)
*
B. Singh, Department of Otorhinolaryngology, Faculty of Medicine, University of Natal, PO Box 17039, Congella4013, South Africa
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Abstract

Standard recommended treatment for patients with intracranial complications from otitis media, has been radical mastoidectomy, whether cholesteatoma is present or not. This was established in the pre-antibiotic era to improve survival. Over a six-year period, from January 1985 to December 1990, 268 patients were admitted with intracranial and extracranial complications of otitis media. The prospective treatment consisted of antibiotics and surgery. Surgery entailed mastoidectomy and drainage of intracranial collections of pus in all patients.

However, prospectively in these patients the ear pathology and not the complication dictated the type of mastoidectomy performed. Cortical mastoidectomy was performed in non-cholesteatomatous ears and radical mastoidectomy in cholesteatomatous ears.

Recurrence of intracranial complications occurred in only four patients (two per cent), a temporal lobe cerebritis in the non-cholesteatomatous ear group, and, a temporal lobe abscess, posterior fossa abscess and subdural empyema in the cholesteatomatous ear group. The temporal lobe cerebritis settled on intravenous antibiotics whilst the temporal lobe abscess, posterior fossa abscess and subdural empyema required redrainage. In none of these was the ear surgery revised.

There were 15 deaths (eight per cent), all occurring in patients with intracranial complications, 12 associated with brain abscess, two with subdural empyema and one with meningitis. Eight were from the non-cholesteatomatous group and seven from the cholesteatomatous group. The mortality was directly related to the patients consciousness level on admission and not to the type of ear pathology.

It can therefore be concluded that radical mastoidectomy is unwarranted in the non-cholesteatomatous ear, even with an otogenic intracranial complication.

Keywords

Otitis mediasuppurativecomplicationsCholesteatomaFacial paralysisMeningitisBrain abscessSurgerymastoidectomy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 107 , Issue 12 , December 1993 , pp. 1113 - 1118
Copyright
Copyright © JLO (1984) Limited 1993

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