ABSTRACT
The proximity of the middle ear to the intracranial cavity allows potential spread of infection and development of intracranial complications. Routine antibiotic use has significantly reduced the frequency of complications of otitis media; however, intracranial spread of infection still occurs and has a high mortality in case series acute otitis media (AOM) and chronic otitis media (COM) may both lead to intracranial complications. Middle ear infection can spread outside of the temporal bone by three mechanisms: bony erosion, thrombophlebitis or direct spread. Broad-spectrum antibiotics are commenced promptly and modified as bacterial sensitivities become available. Initial management of an otogenic brain abscess involves stabilisation and broad-spectrum antibiotics. Positive cultures usually reveal polymicrobial infection including anaerobes. Neurosurgical drainage of the abscess is combined with surgical management of the middle ear and mastoid disease if the patient is sufficiently stable. Otitic hydrocephalus is a rare complication of otitis media and is often associated with sigmoid sinus thrombosis.
