Otogenic cerebellar abscess - two case histories

Objective: The otogenic brain abscess remains a serious intracranial complication of otitis media despite advantages in diagnostics and antibiotic treatment during the last decades. We discuss the clinical picture and the possible ways of treatment by the example of two case histories.

Methods: Case 1: We report about a 38-year-old man, who was suffering in cholsteatoma since 30 years. The surgical revision was restricted by the patient since this time. The acute symptoms of meningitis were caused by intracranial involvement and cerebellar abscess due to cholesteatoma. After surgical revision we observed a period of clinical improvement. A repeated surgery became necessary because of renewed brain abscess at the cerebellar region five weeks after primary operation. Case 2: A 6-year-old girl was already treated with antibiotics because of subacute mastoiditis since three weeks. She was entering the ENT department because of headache and otorrhoea. During mastoidectomy the bone destruction leads to a cerebellar abscess. The neurological symptoms were regredient immediately after the surgical revision.

Conclusions: Both case histories underline the importance of cerebellar abscess as an intracranial complication of chronic otitis media. The neurologic symptoms and the CT-scan were essential for the exact diagnosis. The following treatment includes the surgical revision of the middle ear, the abscess-drainage as well as the lavage of the cavity with antibiotics.