Otitic hydrocephalus

• Otitic hydrocephalus is a condition in which there is increased intracranial tension secondary to acute or chronic middle ear infection.
• The CSF shows shows normal levels of protein, glucose and is sterile

Pathogenesis

• Middle ear infection can predispose to lateral sinus (transverse sinus) thrombosis
• The thrombus can extend into the superior sagittal sinus and impede the drainage of CSF
• This results in increased intracranial tension

Clinical features

Features of increased intracranial tension are present:

• Headache, nausea, vomiting
• Diploplia due to lateral rectus palsy (abducent nerve is usually the first nerve to be affected in increased intracranial tension)
• Blurred vision – due to papilloedema / optic atrophy

Signs:

• Papilloedema
• Nystagmus
• Lumbar puncture – shows increased CSF pressure, but normal levels of cells, protein and glucose. It is sterile

Treatment:

• Measures to decrease the intracranial tension
  • Medical
    • high dose steroids
    • acetazolamide
    • mannitol
  • Surgical
    • repeated lumbar puncture
    • lumbar drain
    • lumboperitoneal shunt
• Treating the ear infection
  • antibiotics – topical and intravenous
  • mastoid surgery