Concurrent Intracranial Complications of Acute Suppurative Otitis Media: Subdural Empyema, Epidural Abscess and Sigmoid Sinus Thrombosis

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Aksoy A., Doğan Karataş T., Salık K. T., Topal H., Çakır Kıymaz Y., Karademir M.

Master of Head and Neck Surgery IFHNOS 2025, İstanbul, Türkiye, 13 - 15 Kasım 2025, (Özet Bildiri)

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: İstanbul
  • Basıldığı Ülke: Türkiye
  • Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
  • Sivas Cumhuriyet Üniversitesi Adresli: Evet

Özet

Aim

Intracranial complications of otitis media, although rare in the post-antibiotic era, continue to pose a significant risk of morbidity and mortality. Prompt diagnosis supported by advanced neuroimaging and multidisciplinary management is crucial to achieve favorable clinical outcomes.

Case Description

A 19-year-old male with no prior systemic illness or trauma presented with a two-month history of left-sided otalgia, purulent otorrhea, and progressive hearing loss unresponsive to oral amoxicillin–clavulanate therapy. His condition was further complicated by persistent headache localized to the left retro-orbital region. Otoscopic examination revealed purulent discharge through a marginal tympanic membrane perforation with postauricular tenderness. Laboratory analysis demonstrated leukocytosis (14,950/µL), neutrophilia (12,520/µL), and elevated C reactive protein (129.8 mg/L). Contrast-enhanced temporal bone CT revealed coalescent mastoiditis with bony erosion and a sigmoid plate defect, while MRI and MR venography confirmed subdural empyema, epidural abscess, and partial thrombosis of the left transverse and sigmoid sinuses. Empirical intravenous antibiotic therapy with vancomycin, meropenem, and metronidazole was initiated under infectious disease supervision and later modified to ceftriaxone following meropenem-induced neutropenia. Anticoagulation with enoxaparin and warfarin was discontinued due to postoperative hematoma formation. On hospital day two, due to clinical deterioration, emergency left tympanomastoidectomy was performed, yielding 8–10 cc of purulent drainage from a bony defect overlying the sigmoid sinus. Postoperatively at the fifth day, the patient developed two generalized status seizures, controlled with diazepam and levetiracetam. Progressive enlargement of the subdural empyema on follow-up imaging necessitated neurosurgical drainage through a left occipitoparietal approach. Following a 46 day period of observation, the patient was discharged without any reported sequelae.

Conclusion

The concurrent development of subdural empyema, epidural abscess, and sigmoid sinus thrombosis represents an exceptionally rare but severe complication of otitis media. Early imaging, timely surgical intervention, and coordinated multidisciplinary care remain essential for preventing adverse outcomes and ensuring complete recovery.

Keywords: Otitis media; subdural empyema; epidural abscess; sigmoid sinus thrombosis; intracranial complications