Intracranial Complications due to Chronic Suppurative Otitis Media-Atticoantral Disease with a Reference to its Microbiological Profile: A Retrospective Study

Introduction: Intracranial Complications (ICC) in patients with Chronic Suppurative Otitis Media-Atticoantral Disease (CSOMAAD) is a life threatening disease. Knowing the microbiological profile of the causative organisms will help in selecting empiric antibiotic.

Aim: To determine the demographic pattern and clinical presentation of patients with CSOM-AAD presenting with ICC, and to assess the microbiological profile of causative organisms.

Materials and Methods: This was a retrospective study, where medical records of all patients diagnosed with CSOM-AAD and ICC, in a tertiary teaching hospital, Manipal, Karnataka, India, between July 2012 and June 2018 were reviewed. The data regarding demographics, clinical and audiological evaluation, microbiological reports were analysed. Data was entered into Microsoft Excel sheet 2010 and was calculated as mean, median and percentages.

Results: Out of total 244 patients with CSOM-AAD, 15 presented with ICC. The age range was between 17-41 years (median age21years). The most common complaint was headache, n=11 (73%) and the most common complication was intracranial abscess, n=10 (67%). In three cases, sampling from different sites isolated different organisms and hence a total of 20 samples (11 from ear swab, six from abscess drained pus, two from cerebrospinal fluid and one from blood culture) were analysed. Gram Negative Bacilli (GNB) were isolated most of the times, n=10 (50%) followed by Gram Positive Cocci (GPC), n=6 (30%) and anaerobes, n=2 (10%). Most of the isolated GNB and GPC were susceptible to carbapenem and vancomycin, respectively.

Conclusion: Intracranial complications are usually seen in young adults, and they present with headache, fever and ear discharge. Majority of the complications are caused by GNB. Vancomycin and carbapenem provide empiric cover for GPC and GNB, respectively.