BACKGROUND After introduction of antibiotics endocranial complications in otitis media are less common, but there are still diagnostic and therapeutic problems. PATIENTS 124 patients (5 months-16 years) underwent mastoidectomy. The number, type and therapy of otitic complications is presented. RESULTS Nine percent of the patients showed up with endocranial complications. Besides lateral sinus thrombosis (five patients), meningitis (five patients) and epidural abscess (five patients), one cerebral and one cerebellar abscess was found. Four patients developed more than one complication. THERAPY A complete mastoidectomy was performed with exploration of the dura and punction of the lateral sinus. In several cases these procedures gave the first diagnostic hint for endocranial complications. CONCLUSION The occurrence of endocranial complications in the era of antibiotics should not be underestimated. Cholesteatoma is still a main risk factor for severe complications. If there is any doubt, further imaging studies (CT, MRI) are necessary. Diagnosis and therapy makes a close cooperation between neurosurgeon and ear surgeon and other specialties mandatory.