Potential otogenic complications caused by cholesteatoma of the contralateral ear in patients with otogenic abscess secondary to middle ear cholesteatoma of one ear: A case report

BACKGROUND: Otogenic brain abscess caused by middle ear cholesteatoma is a potentially serious and life-threatening complication in the ear, nose, and throat clinic. The mortality rate associated with otogenic brain abscesses is 8%–26.3%. Recently, in China, the incidence of brain abscess secondary to middle ear cholesteatoma has started to increase due to antibiotic resistance. CASE SUMMARY: A 55-year-old male presented hearing loss in the right ear and headache for 1 mo in 2018. Computed tomography (CT) showed an area of low density in the right middle ear and mastoid and auditory ossicle defects and a small amount of soft tissue density in the left middle ear. The parietal wall of the right tympanic cavity and the posterior wall of the mastoid sinus were thin and less continuous. Cranial magnetic resonance imaging revealed an area of low intensity encapsulated by an area of high intensity in the right temporal lobe. We diagnosed him with a brain abscess secondary to middle ear cholesteatoma. He received surgery to drain the abscess followed by a modified radical mastoidectomy. The patient visited our department 3 years later because of intermittent otorrhea in the left ear. CT revealed that the area of the soft tissue density in the left middle ear and mastoid was significantly increased. The posterior wall of the mastoid sinus was destroyed, leaving the left middle ear connecting with the brain. The patient underwent a modified radical mastoidectomy in the left ear CONCLUSION: Regular follow-up and timely treatment of contralateral ear disease are vital for the prevention of otogenic complications in patients with otogenic abscesses secondary to middle ear cholesteatoma in the unilateral ear.