Dural herniations, encephaloceles: an index of neglected chronic otitis media and further complications.

A retrospective review of 110 consecutive cases of chronic otitis media surgery was carried out in a large metropolitan public teaching hospital in the United States that serves the inner-city population. The purpose was to identify dural herniations and encephaloceles (DHE) as well as complications associated with these entities. Twenty-nine such patients (26.4%) were identified, 7 of which (6.4%) were encephaloceles. In patients with DHE, cholesteatoma was found in 83%, a labyrinthine fistula in 48%, preoperative facial paralysis in 14% (4 patients), facial nerve involvement by cholesteatoma in 24%, and suppurative intracranial complications in 21%. DHEs were repaired through the mastoid, via a mini-craniotomy or a formal middle cranial fossa approach. The incidence of DHEs in this patient population is very high, which reflects neglected chronic ear disease. The associated complications require extensive surgery for eradication, and the potential for morbidity and mortality is significant.