Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10220
Peer-review started: April 23, 2022
First decision: June 8, 2022
Revised: June 21, 2022
Accepted: August 15, 2022
Article in press: August 15, 2022
Published online: October 6, 2022
Processing time: 156 Days and 20.2 Hours
Otogenic brain abscess caused by middle ear cholesteatoma is a potentially serious and life-threatening complication in the ear, nose, and throat clinic. The mortality rate associated with otogenic brain abscesses is 8%–26.3%. Recently, in China, the incidence of brain abscess secondary to middle ear cholesteatoma has started to increase due to antibiotic resistance.
A 55-year-old male presented hearing loss in the right ear and headache for 1 mo in 2018. Computed tomography (CT) showed an area of low density in the right middle ear and mastoid and auditory ossicle defects and a small amount of soft tissue density in the left middle ear. The parietal wall of the right tympanic cavity and the posterior wall of the mastoid sinus were thin and less continuous. Cranial magnetic resonance imaging revealed an area of low intensity encapsulated by an area of high intensity in the right temporal lobe. We diagnosed him with a brain abscess secondary to middle ear cholesteatoma. He received surgery to drain the abscess followed by a modified radical mastoidectomy. The patient visited our department 3 years later because of intermittent otorrhea in the left ear. CT revealed that the area of the soft tissue density in the left middle ear and mastoid was significantly increased. The posterior wall of the mastoid sinus was destroyed, leaving the left middle ear connecting with the brain. The patient underwent a modified radical mastoidectomy in the left ear
Regular follow-up and timely treatment of contralateral ear disease are vital for the prevention of otogenic complications in patients with otogenic abscesses secondary to middle ear cholesteatoma in the unilateral ear.
Core Tip: There are few studies about the occurrence of a cholesteatoma in the contralateral ear in patients with otogenic brain abscess secondary to cholesteatoma in the unilateral ear. Here, we report a case of cholesteatoma in the contralateral ear with the destruction of the posterior wall of the mastoid sinus three years after curing middle ear cholesteatoma complicated with an otogenic intracranial abscess in the unilateral ear, reminding us of the importance of the detailed examination in regular follow-up and timely treatment.