The Ways of Improvement Diagnosis and Treatment of Otogenic Intracranial Complications (OIC)

Introduction: Despite decreased frequency of OIC development in number of World Countries, these diseases still threaten patient’s life and remain one of lethality reasons in otorhinolaryngological hospitals.

Purpose: Improvement of diagnostic and treatment methods of otogenic venous sinuses lesions (VSL) of dura mater, meningitis and brain abscesses (BA).

Materials and methods: Over 50 years of working in ENT clinics of various regions, we observed more than 300 patients with OIC. These complications were extra- and subdural abscesses, VSL, sepsis, leptomeningitis, meningoencephalitis, BA. The last 15 years a sharp decreasing number of patients applying with VSL, sepsis and prevalence of meningoencephalitis, BA is noted. General clinical, otoneurological, psychoneurological bacteriological, immunological, serological tests, CT, MRI were applied.

Results: Researches allowed developing differential-diagnostic criteria (DDC) between otogenic and non-otogenic purulent bacterial meningitis, viral serous, tuberculosis’ meningitis, meningeal symptom complex with VSL, cranial cerebral trauma and brain tumors combined with purulent otitis media. We elaborated methods detecting and surgical sanitation BA through trepanation cavity of ear. Who should treat patient with otogenic BA – otosurgeon or neurosurgeon? The answer is still unknown. Otogenic BA is often located near diseased ear, doesn’t have capsule, combined with other intracranial complications, spontaneously opened and communicated with diseased ear, requires intervention of otosurgeon. Contralateral, distant localization of abscesses requiring neurosurgical approach is possible. Consequently, there can not be unambiguous answer to this question, an agreement of both specialists is required. Extensive mastoidectomy with opening of cranial fosses was applied on patients. In BA, mainly used dissection, drainage of abscesses; last 30 years – method of balanced substitution of abscess contents with medicinal solutions. Conclusions. Elaborated DDC, detection and treatment methods of BA made possible to differentiate otogenic meningitis from other types of meningitis, choose correct treatment tactics, apply sparing method of BA diagnosis and treatment, improve prognosis.