Diseases Of The Nose Throat And Ear

CHAPTER 66
INTRACRANIAL COMPLICATIONS

The incidence of intracranial complications secondary to either an acute
or chronic suppurative otitis media has become much less in the past 30
years. Two factors have probably been responsible for this, the first and
most important being the use of antibiotics and the second, the more skilful
and enlightened treatment of the suppurative conditions of the middle ear
which must reflect to a large extent the modern teaching of the undergraduate.

EXTRADURAL ABSCESS

An extradural abscess consists in a collection of pus between the bone and
the dura mater. Unless it is opened and drained it is frequently followed
by other intracranial complications. It is more common in the posterior
than in the middle cranial fossa. Extradural abscess occurs more commonly
in acute than in chronic middle ear suppuration. In chronic purulent otitis
media it is met with chiefly in cases of cholesteatoma and in acute exacerba-
tions of chronic suppuration. The extent of the abscess varies greatly; it
may be quite small, or in chronic cases it may attain a considerable
size.

SYMPTOMS. The symptoms are rarely characteristic; the majority of extra-
dural abscesses are only discovered at the time of operation. The condition
is associated with deep-seated boring pain, tenderness on tapping over the
temporal lobe or posterior fossa and rise of temperature. If the abscess is
large, there may be evidence of compression of the brain. There are rarely
any localizing symptoms although occasionally paresis of the sixth nerve
may be met with.

DIAGNOSIS. This is not easy as a rule. The relief of pain by the spontaneous
evacuation of a large quantity of pus, or the aspiration of much pus by
mopping or aspiration through the external meatus, may suggest the diag-
nosis. The continuance of pain, pyrexia and a raised pulse rate after opera-
tion for a mastoid complication should suggest the probability of the
presence of a deeper-seated collection of pus.

TREATMENT. This consists in opening the abscess and evacuating its con-
tents by free removal of the bony wall. When the abscess is opened the
pus flows out in a pulsating manner. The affected dura mater may be covered
with red 'healthy* granulations, or it may be greyish-green and slough-like.
Removal of the underlying bony wall should be continued until the whole
abscess cavity has been freely exposed. The cortical or the radical opera-
tion—according to circumstances—is performed at the same time. The
patient should be carefully watched in order to detect the first signs of