Complications of suppurative otitis media


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Complications of suppurative otitis media

  2. 2. Factors influencing developmentof complications1.Age2.Poor socio-economic group3.Virulence of organisms4.Immune compromised host5.Preformed pathways6.Cholesteatoma
  3. 3. Pathways of spread ofinfection1.Direct bone erosion-hyperaemic decalcification(a/c infection),osteitis,cholesteatoma,granulation tissue (c/c)2.Venous thrombophlebitis-V of HS dural V dural venous sinuses supfl veins of brain3.Preformed pathways-congenital dehiscences,patent sutures,prevous skull fractures etc
  4. 4. Classification complications of otitis media intra temporal intracranial
  5. 5. INTRATEMPORAL COMPLICATIONS1.Mastoiditis2.Petrositis3.Facial paralysis4.labyrinthitis
  6. 6. 1)mastoiditisacute mastoiditis masked mastoiditis
  7. 7. 1a.Acute mastoiditisWhen infection spreads from the mucosa,lining the mastoid air cells &antrum,to involve bony walls of the mastoid air cell system.
  8. 8. aetiology ASOM High virulence,lowered resistance Children Β hemolytic strep,anaerobic org
  9. 9. Pathology1,production of pus under tension2,hyperaemic decalcification and osteoclastic resorption of bony walls both these processes combine cause destruction &coalescence of mastoid cells single irregular cavity filled with pus (EMPYEMA of MASTOID)
  10. 10.  Pus may break through mastoid cortex leading to subperiosteal abscess which may even burst on surface leading into a discharging fistula
  11. 11. Patient presents with1.Pain behind the ear (persistence,increase in intensity or recurrence of pain)2.fever(persistence or recurrence of fever)3.Ear discharge(becomes profuse and increase in purulence) persistence of discharge beyond 3 wks in a case of ASOM mastoiditis
  12. 12. signs1.Mastoid tenderness2.Ear discharge –mucopurulent or purulent often pulsatile(light house effect)3.Sagging of posterosuperior meatal wall4.Perforation of TM-small,wid congestion of rest of TM5.Swelling over the mastoid6.Hearing loss-CHL7.General findins-low grade fever,appear ill &toxic
  13. 13. investigations1.TC,DLC2.ESR3.X-ray mastoid4.CT temporal bone5.Ear swab
  14. 14. ddsa)Suppuration of mastoid lymph nodesb)Furunculosis of meatusc)Infected sebaceous cyst
  15. 15. treatment Hospitalisation of the patient Antibiotics Myringotomy Cortical mastoidectomy
  16. 16. complications Subperiosteal abscess Labyrinthitis Facial paralysis Petrositis Extradural abscess Subdural abscess Meningitis Brain abscess Lateral sinus thrombophlebitis Otitic hydrocephalus
  17. 17. Abscesses in relation tomastoid infection1.Post auricular abscess2.Zygomatic abscess3.Bezold abscess4.Meatal abscess(luc s abscess)5.Citelli s abscess6.Parapharyngeal or retropharyngeal abscess
  18. 18. 1b)Masked(latent)mastoiditis Slow destruction of mastoid air cells but without the acute signs &symptoms(no pain,no fever,no discharge,no mastoid swelling) Mastoidectomy show extensive destruction of the air cells with granulation tissue and dark gelatinous material filling the mastoid
  19. 19. Aetiology From inadequate antibiotic therapy
  20. 20. cfs Child Mild pain behind the ear Persistence of hearing loss TM appears thick with loss of translucency Tenderness over mastoid Audiometry-CHL X-ray mastoid-clouding of air cells
  21. 21. treatment Cortical mastoidectomy with full doses of anti biotics
  22. 22. 2)petrositis Spread of infection from the middle ear and mastoid to the petrous part of temporal bone Pneumatisation of petrous apex usually thru 2 recognised cell tracts 1.posterosuperior tract 2.anteroinferior tract
  23. 23. cfs GRADENIGO S SYNDROME a)external rectus palsy(VI N)-Diplopia b)Deep seated ear or retro orbital pain c)persistent ear Discharge Fever,headache,vomiting,neck rigidity,facial paralysis,recurrent vertigo
  24. 24. diagnosis CT scan-temporal bone(pmeumatisation of petrous apex) MRI(diploic marrow-fluid or pus)
  25. 25. treatment Cortical,radical or modified radical mastoidectomy iv antibiotics
  26. 26. 3)Facial paralysis Results either from cholesteatoma or from penetrating granulation tissue Destruction of bony canal Insidious &slowly progressive
  27. 27. treatment Urgent exploration of middle ear &mastoid Inspect facial canal from the geniculate ganglion to the stylomastoid foramen Cholesteatoma in the bony canal is uncapped in the area of involvement Granulation tissue surrounding the nerve is removed If it is actually invades the N sheath ,it is left in place If a segment of nerve is destroyed by the granulation tissue resection of nerve and grafting after control of infections
  28. 28. labyrinthitisCircumscribed diffuse serous diffuse suppurative
  29. 29. Circumscribed labyrinthitis(fistula of labyrinth) Thinning or erosion of bony capsule of labyrinth(usually HSCC)
  30. 30. cfs c/o transient vertigo Diagnosed by fistula test
  31. 31. treatment Mastoid exploration Systemic antibiotic therapy
  32. 32. Diffuse serous labyrinthitis Diffuse intralabyrinthine inflammation without pus formation Reversible condition if treated early
  33. 33. aetiology Pre –existing circumscribed labyrinthitis In acute infections of middle ear inflamn spreads thru annular ligament or the round window Following stapedectomy or fenestration operation
  34. 34. cfs Vertigo Nausea Vomiting Spontaneous nystagmus SNHL
  35. 35. TREATMENT Medical a)pt is put to bed,head immobilised with affected ear aboveb)Antibioticsc)Labyrinthine sedatives-prochloperazine or dimenhydrinated)Myringotomy SurgicalCortical or modified radical mastoidectomy
  36. 36. Diffuse suppurative labyrinthitis Diffuse pyogenic infection of labyrinth with permanent loss of vestibular and cochlear infections
  37. 37. aetiology Following serous labyrinthitis Pyogenic organisms entering through a pathological or surgical fistula
  38. 38. cfs Severe vertigo with nausea and vomiting Spontaneous nystagmus Total loss of hearing
  39. 39. treatment Same as for for serous labyrinthitis Drainage of labyrinth is required if intralabyrinthine suppuration is acting as a source of intracranial complications