A Case of Cerebellar Abscess Associated with Middle Ear Cholesteatoma.

The mortality from otogenic intracranial complications has decreased markedly from the preantibiotic era to the present. However the mortality of cellebellar abscess cases remains high. This paper reports a case of cerebellar abscess associated with middle ear cholesteatoma, who was saved by a combination of intensive medical and surgical care with the cooperation of the Otology and Neurosurgery units.The patient was a 53-year-old man who had right aural discharge, headache and vertigo. He visited a private hospital, where he underwent radical surgery for the middle ear cholesteatoma. After 2 months, he again suffered from severe headache and vertigo. He presented at our hospital, and Computed Tomography (CT) scanning and Magnetic Resonance Imaging (MRI) of the brain revealed two abscesses in the right cerebellar hemisphere and obstructive hydrocephalus. Emergency stereotactic drainage of the abscess, and endoscopic 3rd ventriculostomy was performed with local anesthesia by a neurosurgeon. After waiting until the patient's condition improved and the cerebellar abscesses were capsulated, we performed an operation for total removal of the cholesteatoma. The cochlea, vestibule and semicircular canals were all filled with a large quantity of purulent discharge, exuberant cholesteatoma and granulation.After surgery, the patient lost right hearing acuity, but showed no neurologic sequelae and returned to previous levels of mental and physical health. Reduction of mortality from otogenic intracranial complications could be achieved with early diagnosis and interventions, including appropriate conservative therapy with antibiotics and appropriate neurosurgical and otological procedures.