Learning Objectives:

Introduction: Cholesteatoma can erode and destroy important structures within the temporal bone, thus it can cause the spreading of intracranial infections. We will describe three otogenic infectious cases by their routes of infection.

Case:

case 1: A 69-year-old man was treated for meningitis at another hospital. He was introduced to our hospital for further survey. We found meningitis caused by cholesteatoma, then we performed a tympanoplasty. Cholesteatoma eroded some parts of the temporal bone, and the otitis interna seemed to be a cause.

case 2: A 28-year-old man was introduced to our hospital because of temporal abscess. A CT revealed an area of low density in the middle ear associated with a bony defect at a part of the sigmoid sinus, and we found sinus-thrombosis around that area. Then we performed a tympanoplasty, and need to treat it with antibiotics for 2 months.

case 3: A 60-year-old man was treated for a brain abscess at another hospital. He was introduced to our hospital because cholesteatoma was pointed out. We performed a tympanoplasty and an abscess drainage, then continued to treat it with antibiotics for 4 months.

Discussion: Concerning the routes of otogenic intracranial infection, there are three routes: otitis interna, a direct invasion through the eroded temporal bone and a hematogenous infection such as phlebitis of meningeal veins. In all cases, it is important to remove the primary disease and continue treatment with the effective antibiotics. But in certain cases, performing an abscess drainage was also required. We decide the indication for surgery depending on the patients' condition and a proposal from the neuro-surgeon. For our patients, a tympanoplasty was performed first because their conditions were stable due to the antecedent treatment.

Conclusions: It is controversial when to operate for cholesteatoma with intracranial complications. The appropriate treatment should be required in accordance with the condition.