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Background: Otogenic intracranial complications are rare diseases. If misdiagnosed and untreated they can lead to serious condition of patient and life-threatening. This group of complications ought to be kept in mind in patients with chronic otitis media., Aim of the Study: We discuss types of otogenic complications and performed treatment., Material and Methods: Retrospective analysis of patients treated in our department between 1998-2006 was made. About 700 ear operations were performed in that period of time., Results: Intracranial otogenic complications were noticed in 9 cases. Despite performed treatment one patient with cerebellum abscess died. The rest patients were operated with good result., Conclusions: Precise otolaryngological examination with additional investigations like CT and MRI are very important to establish the final diagnosis and save patient's health or life.

In our study we made attempt to assess which clinical criteria are essential for choosing optimal treatment for children suffering from cerebral abscesses. We observed the clinical results obtained at our Department from treatment of infections of the central nervous system (CNS) in children and analysed them with respect to applied therapy and clinical conditions. Between 1990 to 2000, 45 children aged 3 days to 15 years (mean 1.34 years, standard deviation 3.23 years) with infections of the CNS were treated at our Department. Within this group, 26 patients were diagnosed with cerebral abscesses, 1 with epidural empyema, 3 with subdural empyema and 15 with pyocephalus. 42 patients were operated. In 3 patients a conservative treatment was introduced at the moment when the abscesses were in the initial stage of organisation; in each case after a complete cycle of antibiotic therapy a regression of lesion was noted. The most frequently performed--in 19 patients--surgical procedure was the radical excision of the abscess by craniotomy. In 2 cases a re-operation was necessary. The highest rate of re-operations was noted in the group of children treated by external drainage; within this group of 18 patients only one 3-month-old girl did not require an additional surgical intervention. Neuroendoscopic techniques were used in 7 patients with compound hydrocephalus. Out of 45 treated children, 3 died from encephalitis, the primary reason being the infection of the ventriculo-peritoneal shunt. All children were assessed according to the Glasgow Outcome Scale and the results were significantly worse in those under 3 years in age. We suggest that in children above 3 years of age with mature abscesses of the central nervous system an operative evacuation of the abscesses by craniotomy should be performed.

In the years 1953-1989 in the Department of Otolaryngology, Medical Academy in Poznań 75 patients were treated for otogenic brain abscesses, among them 19 were children. In the last ten years the number of cases of this complication was not increased significantly in children and adults. In 3 cases abscess was diagnosed in acute otitis media, in the remaining cases it was a complication of chronic otitis media with cholesteatoma. Brain abscesses were situated more frequently in the temporal lobe. In children they developed more frequently on the right side. The survival in temporal lobe abscesses in children was 90%, and in cerebellar abscesses 75%. In adults the survival rate was about 80% for both localizations. In the treatment of these otogenic complications wide radical operation on the middle ear or ++antro-mastoidectomy with exposure of the dura and simultaneous approach to the abscess from the postoperative ear cavity, with puncture of the abscess and replacement of its contents with normal saline with antibiotic is the routine method in the Department.

Between 1953-1984 we treated 64 otogenic brain abscesses (44 of the temporal lobe and 20 of the cerebellum). This material included 2 cerebral abscesses and 1 cerebellum abscess in children. In 3 cases the abscess was a complication of acute otitis media. 84% of patients with a temporal lobe abscess and 85% with a cerebellar abscess recovered. Treatment consisted of removal of the inflammatory process in the middle or inner ear with subsequent puncture of the abscess and replacement of the pus by antibiotic solution. Otologic, neurologic, ophthalmolgic, EEG and CT examinations were performed on 50 patients. Residual signs of epilepsy were found in 6 patients. Forty one patients resumed work or study. The merit of computer tomography (CT) in diagnosing brain abscesses is emphasized. Since CT has been used a successful outcome has been obtained in 8 cases and a fatal result in 1.