Extradural Granulation Complicated by Chronic Suppurative Otitis Media with Cholesteatoma

Background: Extrdural granulation or abscess is a possible complication of chronic suppurative otitis media (CSOM) with cholesteatoma. However, due to development of newer antibiotics and advances in bacteriology and imaging techniques, the incidence of extradural granulation or abscess has significantly decreased. The present study analyzed the clinical presentation, imaging findings, and surgical treatment of eight patients with CSOM with cholesteatoma extending to the cranial fossa. Patients and Methods: From 2000 to 2012, 1,010 patients were surgically treated for CSOM with cholesteatoma. Patients with extension to the cranial fossa were studied. Clinical presentation, imaging studies, operative findings, surgical treatment, and postoperative results were evaluated. Results: Twenty cases (1.9%) in a series of 1,010 patients with CSOM with cholesteatoma had bony destruction of the cranial fossa in the temporal bone computed tomography (cr). Of the 20 cases, eight (0.79%) were identified as extradural granulation by magnetic resonance imaging. One patient exhibited nodular enhancement, but it disappeared on preoperative antibiotic treatment. Surgical access for removal of cholesteatoma with extradural granulation was accomplished through canal wall-down tympanomastoidectomy. Conclusion: CSOM with cholesteatoma can extend to either the middle or posterior cranial fossa. While CT is sufficient to reveal bony destruction of the cranial fossa, magnetic resonance imaging is required to differentiate and define intracranial extension of CSOM with cholesteatoma.