Complications of chronic otitis media with cholesteatoma during a 10-year period in Kosovo

We review and discuss the results of treatments for complications of cholesteatomatous chronic otitis media (CCOM) in a tertiary health care center. In a retrospective study, the medical records of patients with complications of CCOM who had undergone surgical treatment at the ENT Clinic of the University Clinical Center of Kosovo for the period 1994-2004 were reviewed. From a total of 1,803 patients suffering from CCOM, in 91 patients, 55 (60.4%) men and 36 (39.6) women, one or two complications are recorded. The mean age of the subjects was 30 years, and the age range was from 1 to 76 years. Extracranial (EC) complications were observed in 52 cases (57.1%), and intracranial (IC) complications were seen in 29 patients (31.9%). Twelve patients (11%) had multiple complications. For the EC cases, we found that subperiostal mastoidal abscess occurred in 26% of the all patients, facial nerve palsy was seen in 16.48% and labyrinthine fistula occurred in 10%. For the IC cases, meningitis (19.7%) and perisinusal abscess (15.3%) were the most common complications. The most often isolated pathogen from ear swabs was Proteus mirabilis in 33.3% of cases. The most frequent radiological diagnostic procedures were mastoid tip X-rays, which were performed in 77% of the patients, and computed tomography in 24%; magnetic resonance imaging was not performed on any of the patients during the study period. Patients with EC complications were treated in the ENT Clinic, whereas patients with IC complications, after otologic surgical procedures, were transferred to the Neurosurgery Clinic or to the Clinic for Infectious Diseases. In this series, three patients (3.3%) died as a result of complications, while the remaining 96.7% survived. Complications of COM with cholesteatoma can represent life-threatening conditions, and close cooperation between otosurgeons, neurosurgeons and infectious disease specialists is mandatory.