Learning Objectives: Intracranial complications from middle ear disease Patterns of presentation Management of intracranial complications

Middle ear disease remains relatively common in the UK population with a previous study revealing the prevalence of inactive chronic otitis media to be 2.6% and active chronic otitis media to be 1.5% in the adult population. The incidence of intracranial complications from middle ear disease has fallen, however these life threatening complications are often diagnosed late and need to be treated aggressively.

We performed a retrospective analysis of patients referred to a tertiary neurosurgical centre with intracranial complications from both mucosal and squamous middle ear disease. The case notes and imaging were reviewed for comparison. Patient age, symptom duration, type of middle disease, management, complications and outcomes were determined. The results were then compared with a similar analysis performed at the same institution 20 years previously.

The majority of patients had active squamous otitis media. Previous surgical treatment of cholesteatoma did not prevent development of intracranial complications when there was recurrent disease. Meningitis was the predominant intracranial complication with venous sinus thrombosis and abscess rates lower. One patient developed a false aneurysm of the internal carotid artery from active mucosal otitis media.

There has been little change in the range of complications encountered over the past 20 years. For conditions such as false aneurysms, advances in interventional radiology have led to improved outcomes.

We present these cases to highlight the issues regarding diagnosis and management of patients with intracranial complications from chronic middle ear disease. High index of suspicion and aggressive surgical treatment remain essential as delay in diagnosis or treatment can be catastrophic.