Clinical outcomes of different treatments and risk factors in patients with otogenic brain abscess, a real-world evidence-based retrospective study

Acta Otolaryngol. 2020 Nov;140(11):919-924. doi: 10.1080/00016489.2020.1800088. Epub 2020 Aug 17.

Abstract

Background: Otogenic Brain Abscess (OBA) is a life-threatening complication secondary to otitis media, but its appropriate management remains controversial.

Objectives: To understand the demographic characteristics, management, and variables that affect the outcomes of patients with OBA based on our experiences over 11 years.

Material and methods: Clinical data were collected for 41 patients. Prognostic factors associated with mortality were assessed, and clinical outcomes compared among groups receiving different treatments.

Results: Among the 41 patients, 19.6% did not undergo surgery, 39.0% were treated with two-stage surgery (otological surgery and neurosurgery) and 41.4% were treated with single-stage surgery (otological surgery or neurosurgery). Overall mortality rate was 32.5%, and mortality was significantly higher in patients with invasion of the petrous apex (odds ratio [OR]: 7.81, 95% confidence interval [95% CI]: 1.26-48.36), and lower in those with appropriate surgical management (single otological surgery, OR: 0.07, 95% CI: 0-0.97; single neurosurgery, OR: 0.13, 95% CI: 0.02-1.0; two-stage surgery, OR: 0.08, 95% CI: 0.01-0.64) or a higher Glasgow Coma Scale (GCS) score at admission (OR: 0.64, 95% CI: 0.44-0.93).

Conclusions and significance: Data on invasiveness and pre-surgery GCS greatly aid in predicting the prognosis of OBA patients. Early evaluation will facilitate decision-making by physicians treating OBA patients.

Keywords: Otogenic brain abscess; clinical outcome; different treatment; risk factor.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Brain Abscess / drug therapy
  • Brain Abscess / etiology
  • Brain Abscess / mortality
  • Brain Abscess / surgery*
  • Child
  • Cholesteatoma / complications
  • Cholesteatoma / surgery
  • Combined Modality Therapy
  • Evidence-Based Practice
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures* / adverse effects
  • Neurosurgical Procedures* / methods
  • Otitis Media / complications*
  • Otologic Surgical Procedures* / adverse effects
  • Otologic Surgical Procedures* / methods
  • Retrospective Studies
  • Risk Factors
  • Young Adult

Substances

  • Anti-Bacterial Agents