Despite a decrease in intracranial complications from otogenic infections since the introduction of antibiotics, there is still morbidity and mortality associated with this. This group from the Netherlands conducted a retrospective review of all the patients treated for intracranial complications at their tertiary referral institution. Forty-seven patients were included, 21 children and 26 adults. All patients had a high resolution CT scan of the temporal bone as part of their work-up. Of the children, 95% presented with complications of acute otitis media, whereas in the adult patients AOM only accounted for 81%. In both groups, the remaining patients had underlying chronic otitis media with cholesteatoma. Other than otologic symptoms, in the paediatric group symptoms mimicking meningitis were most common: nausea / vomiting, headache and diplopia in order of frequency. In the adult group decreased consciousness, headache and hemiparesis were the most common. These symptoms were described as closer to ‘mimicking stroke’. In 76% of children cerebral venous thrombosis (CVT) was the main complication, which was significantly higher than that of the adult population (23%). In adults, the main complication was meningitis (50%), followed by intracranial abscess (38%). All patients were treated with antibiotics. Of the paediatric patients, 95% underwent surgical intervention by way of cortical mastoidectomy and attico-antrostomy, however this was considerably less in the adult group, with only 58% having surgical intervention. Three patients died in the adult group and there were no deaths in the paediatric group. This study not only highlights the differences in presentation between adults and children, but also the continued small, but significant mortality rate that can still be associated with complications of otitis media.