DOI: https://doi.org/10.53350/pjmhs22169135 ORIGINAL ARTICLE P J M H S Vol. 16, No. 09, September, 2022 135 Intracranial Otogenic Complications in Adults: New Factors That Influence its Onset MOHAMMAD QAMAR NASIR 1 , RUQQIYA SAADAT 2 , SYED UMAIR IFTIKHAR 3 , ABDUL SHAKOOR 4 , AMEER HUMZA 5 , HASSAN MAJID BHATTI 6 1 Senior Registrar, ENT Unit-II, Services Hospital Lahore 2 Senior Registrar, ENT Department, Islam Teaching Hospital Sialkot 3 Senior Registrar, ENT Department, University of Lahore 4 Senior Registrar, ENT Unit-I, Sir Ganga Ram Hospital, Lahore 5 Senior Registrar, ENT Department, Fatima Memorial Hospital Lahore 6 Senior Registrar, Department of ENT, Shalamar Medical and Dental College/Shalamar Hospital Lahore Correspondence to Dr. Mohammad Qamar Nasir, E-mail: mohammadqamarnasir@gmail.com, Cell: +92 334 4357377 ABSTRACT Aim: To investigate new factors which influence intracranial otogenic complications in adults. Study Design: Retrospective study Place and duration of study: Department of ENT, Services Hospital Lahore from 1 st October 2021 to 31 st March 2022. Methodology: Fifty patients were analyzed in COVID times (2020-2021) with intracranial otogenic complications for determination of new factors for the onset of this disease complication. Hundred patients were assessed from the time period of 2014-2018. The diagnosis was confirmed on the basis of MRI or MRV imaging with intracranial complications. Reverse Transcriptase PCR was also performed on each patient through naso-pharyngeal swab test. The patients age, gender, clinical and comorbidity history, neurological state, immobility, prophylaxis and coagulopathy risks were documented. Result: The mean age of the patients was 62.3±5.5 years during COVID times and 50.2±6.1 years before COVID-19. The Pre- COVID-19 period had all males reported with intracranial otogenic complications. While in COVID times 12% females were reported with intracranial otogenic complications such as meningitis, brain abscess as well as Lateral/venous sinus thrombosis. Lateral/venous sinus thrombosis among IOC was more commonly observed in the COVID time. Conclusion: Cerebral lateral/venous-sinus thrombosis is appeared to be the rare factor that can be linked with COVID-19. Keywords: Complications, Otitis media, COVID-19, Adult, Intracranial otitis INTRODUCTION COVID-19 has been presented as a wide manifesting disease with multi spectrum of symptoms. Otitis media has been one of the highlighted complications of a viral infection such as COVID-19 or is associated with rare presentations with conjunction and other symptoms. 1 COVID-19 had been observed for its damaging effects on middle and inner ear. 2-4 Cochlea has been mostly involved without presentation of general clinical symptoms. 3 Radiological proven labyrinthitis has also been presented sporadically 5 . Acute and chronic otitis media are considered to occur at random rates in any set of given population. There are some factors which have been reported to instigate the intracranial otogenic complications (IOC). These include limited medical resources, raised morbidity in a population as well as thromboembolic activity of COVID-19 which includes venous thromboembolism through the endothelial rupturing 6-8 . Sigmoid- sinuses and the transverse sinuses have been identified as the main sites of the cerebral venous-sinus thrombosis (CVST) which is related with the COVID-19. In some cases, multiple sinus spanning was also observed 9-13 . Most of the CVST cases have been reported in adults having comorbidities but research elaborated the presentation of this even in youngsters with complication and significant clinical history 14 . The present study was designed to detail the new associated factors in Pakistani population which results in the formation of the IOC specifically in the adults. This study will assist in finding the new causative agents who are left un-assessed and therefore not addressed timely. MATERIALS AND METHODS This cohort study designed as retrospectively was carried out at ENT Department Services Hospital Lahore. The study enrolled all the patients who were diagnosed with IOC after their complete clinical assessment and conformation. The study was approved by the ethical board and informed consent was taken from each ----------------------------------------------------------------------------------------- Received on 24-04-2022 Accepted on 17-08-2022 participant or their attendants. Analysis of IOC cases reported within last five years was also made. Fifty patients were analyzed in COVID times (2020-2021) with IOC for determination of new factors for the onset of this disease complication while 100 patients were assessed before such as from (2014-2018). The IOC was termed as subacute/chronic otitis media having chronic ear discharge, exacerbation of acute symptoms such as otalgia, fever or headache. The diagnosis was confirmed on the basis of MRI or MRV imaging with intracranial complications. Intracranial complications involved meningitis, sigmoid sinus vein thrombosis, epidural or sub-epidural or brain abscess, internal jugular vein thrombosis. Reverse transcriptase PCR was also performed on each patient through naso-pharyngeal swab test. The patients age, gender, clinical and comorbidity history, neurological state, immobility, prophylaxis and coagulopathy risks were documented. No changes in population size or type were ensured for minimizing bias in the study. Routine laboratory details including antibody IgG test for COVID-19, complete blood count as well as D dimer, serum ferritin results were also analyzed. Data was analyzed using SPSS version 25.0 by using odds ratio and probability with a p value <0.05 as significant. RESULTS The mean age of the patients was 62.3±5.5 years during COVID and 50.2±6.1 years of pre-COVID. The pre COVID 19 period had all males reported with IOC whereas in COID times 12% females were also reported with IOC (Table 1). The time cohort also presented that cardiovascular and pulmonary complications were significantly higher in the COVID times as compared with the pre- Covid period where as venous sinus thrombosis and coagulopathy risk was higher in pre-COVID time significantly from COVID duration. There was insignificant variance within chronic otitis history between both time cohorts with a probability as 1.1 (Table 2). Meningitis, brain abscess as well as venous sinus thrombosis related with IOC was more commonly observed in the COVID time especially in a combination presentation in COVID patients which were confirmed through RT PCR and the probability was 0.009 (Fig. 1). The MRV imaging of IOC patients with COVID