Introduction: Intracranial complications are the most serious among the complications of otogenic diseases, especially brain abscess caused by cholesteatoma, which has a very high lethality rate. We summarized the clinical data of patients with otogenic intracranial complications admitted to the Department of Otorhinolaryngology of Peking Union Medical College Hospital in recent years. Of the 14 patients, 10 were male and 4 were female, aged 12-62 years at the time of onset, with a mean age of 32.1 years; the intracranial and ear lesions were ipsilateral. Of the ear lesions, 12 cases (85.7%) were cholesteatoma of the middle ear and 2 cases (14.3%) were non-cholesteatoma chronic suppurative otitis media. Of the intracranial complications, the most common were cerebral temporal lobe abscess (42.9%), cerebellar abscess (28.6%), perisylvian sinus abscess (21.4%), sigmoid sinus thrombophlebitis (14.3%), and meningitis (14.3%). The most common complaints on admission were headache (92.9%), high fever (78.6%) and nausea and vomiting (71.4%), etc., and all patients had pus overflow from the ear canal (100%). Pus culture results showed that Proteus mirabilis (35.7%), Staphylococcus epidermidis (21.4%) and Pseudomonas aeruginosa (14.3%) were the most common. Combined surgical+pharmacological regimen was used in all cases. All patients underwent emergency single mastoidectomy/radical mastoidectomy. All 14 patients admitted by us were discharged successfully after clinical cure with 100% cure rate. The following is a typical case profile of one of them. The patient came to our hospital with high fever and coma, and entered the clinical stage of critical illness, with the possibility of death at any time. The patient was discharged from the hospital after active resuscitation. Case introduction: The patient was a 57-year-old female farmer from a remote mountain village, who was admitted to our hospital on October 23, 2006, with headache, fever, lack of mental clarity, and foul-smelling pus coming out of her left ear for 20 days. Before admission, the patient had been treated with anti-inflammatory therapy for common otitis media in a local hospital, and she gradually developed apathy and named aphasia. She was referred to several hospitals for treatment of infectious diseases in internal medicine, but the cause of the disease was not clarified. After admission to our hospital, it was clear that the patient had a history of intermittent pus flow in the left ear for more than 40 years, and the possibility of otogenic intracranial complications was considered. Emergency CT and MRI examinations were performed, which revealed a localized occupation in the left temporal lobe of the brain, cystic wall formation, edema of the surrounding brain tissues, soft tissue density shadow of the mastoid process of the middle ear, and bone defects of the skull, and the diagnosis of otogenic temporal lobe abscess was clearly established (see Figures 1a, 1b, and 1c). On the night of admission, an emergency single mastoidectomy was performed. Intraoperative findings included a large amount of pus in the mastoid cavity, a large amount of cholesteatomatous leukoderm in the middle ear cavity and external auditory canal, and bony defects at the mastoid and tympanic chamber channels at the canopy, with a large amount of pus flowing down. The pus culture of the mastoid cavity was found to be Lactococcus lactis subspecies Hodgkiniae. Two options existed at the time for the treatment of the temporal lobe abscess, i.e., surgical treatment based on puncture aspiration/surgical removal of the abscess and medical treatment based on anti-infection. After a collaborative consultation with neurosurgery and infection medicine, it was decided to give a combination of desmethylvancomycin + ceftriaxone sodium + gentamicin + mannitol, with localized open dressing changes in the mastoid process. After this comprehensive treatment, the patient’s symptoms were significantly relieved. MRI at 15 days after mastoid single chiseling showed a reduction of the left temporal lobe abscess and thickening of the abscess capsule wall (see Figures 2a and 2b). MRI at 45 days after mastoidectomy showed significant reduction of the left temporal lobe abscess, disappearance of the cystic cavity, and significant thickening of the cystic wall (see Fig. 3a), and radical mastoidectomy was performed, during which granulation of the mastoid and middle ear cavities was detected without pus. Postoperative anti-infective treatment was continued for 3 weeks, the vital signs were stable, the main biochemical tests were normal, the middle ear mastoid cavity was dry, and the patient was discharged from the hospital on December 28, 2006, and has been well since the follow-up.