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Subdural empyema of otorhinological origin

Published online by Cambridge University Press:  29 June 2007

P. A. Wackym ,
R. F. Canalis  and
T. Feuerman
P. A. Wackym*
Affiliation:
Divisions of Head and Neck Surgery (Drs Wackym and Canalis) and Neurosurgery (Dr Feuerman), UCLA School of Medicine, Los Angeles, California, USA and Harbor/UCLA Medical Center, Torrance, California, USA.
R. F. Canalis
Affiliation:
Divisions of Head and Neck Surgery (Drs Wackym and Canalis) and Neurosurgery (Dr Feuerman), UCLA School of Medicine, Los Angeles, California, USA and Harbor/UCLA Medical Center, Torrance, California, USA.
T. Feuerman
Affiliation:
Divisions of Head and Neck Surgery (Drs Wackym and Canalis) and Neurosurgery (Dr Feuerman), UCLA School of Medicine, Los Angeles, California, USA and Harbor/UCLA Medical Center, Torrance, California, USA.
*
Dr P. A. Wackym, MD 62-132 CHSDivision of Head and Neck SurgerySchool of Medicine, UCLA10833 LeConte AvenueLos Angeles, California 90024-1624USA.
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Abstract

The UCLA experience with subdural empyema (SDE) of otorhinological origin was reviewed. All cases of SDE with additional intracranial complications were excluded. Thirteen cases of SDE were identified with the prediposing factors being sinusitis (ten), mastoiditis (two), and otitis media (one). Based on data obtained from this review and from studies previously published in the literature, the keys to optimal outcome are rapid diagnosis, craniotomy with complete evacuation of the purulent collection followed by immediate surgical management of the otorhinological source of the SDE, and appropriate antibiotic therapy. Computed tomography is nearly always diagnostic but can be equivocal and magnetic resonance imaging may become the diagnostic study of choice. Of the five patients initially treated with craniotomy, 100 per cent improved as compared to 50 per cent of the eight patients initially treated with burr holes. None of the patients initially managed with craniotomy were worse or died, whereas of the four patients initially managed with burr holes, two were worse (25 per cent) and two died (25 per cent). Antibiotic therapy is guided by the organisms found in the empyema and the site of origin of the infection. The otolaryngologist must remain aware of the clinical features and management of SDE and work closely with his neurosurgical colleagues to provide early, decisive surgical treatment.

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 104 , Issue 2 , February 1990 , pp. 118 - 122
Copyright
Copyright © JLO (1984) Limited 1990

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