This is a Chronic infection of the middle ear, In which a cholesteatoma errodes the bone and produces complication

2. Dr.Asmatullah Achakzai
MBBS, DLO, MCPS, FCPS
Senior registrar ENT department Sandeman
(PROV) Hospital Quetta.

3. Complications of
Suppurative
Otitis Media

4. CLASSIFICATION
INTRATEMPORAL INTRACRANIAL
1. Mastoiditis 1) Extradural Abscess
2. Petrtositis 2) Subdural Abscess
3. Facial paralysis 3) Otogenic Meningitis
4. Labrynthitis 4) Brain abscess
5. Subperiosteal Abscess 5) Lateral sinus thrombophlebitis
6. Postauricular fistula 6) Otitc hydrocrphalus
7. Labrynthine fistula 7) Pnemocoele
8) Cerebrospinal Fluid otorrhea

7. Factors Influencing Development
of Complications
1. Age
2. Poor socio-economic Group
3. Virulence of Organisms
4. Immune-compromised host
5. Preformed pathways
6. Cholesteatoma

8. Pathways of Spread of Infection
1. Direct bone erosion
2. Venous Thrombophlebitis
3. Performed Pathways
i. Congenital
ii. Patent sutures
iii. Previous skull fracture
iv. Surgical defects
v. Oval and round windows
vi. Infection from Labyrinth

9. CLASSIFICATION
Complications of Otitis Media are classified into two main
Groups
A. Intratemporal (within the Confines of Temporal Bone)
1. Mastoiditis
2. Petrositis
3. Facial paralysis
4. Labryinthitis
B. Intracranial
1. Extradural abscess 5. Lateral sinus Thrombophlebitis
2. Subdural abscess 6. Otitic hydrocephalus
3. Meningitis
4. Brain Abscess

10. Middle Ear
Roof
Floor
Medical
Posterior
Thrombosis of jugular bulb
• Acute Mastoiditis
• Facial nerve palsy
• Lateral sinus
thrombosis etc
• Extradural abscess
• Subdural abscess
• Temporal & Cerebellar abscess
• Meningitis
• Brain abscess
• Otitis hydrocephalus

11. Sequelae of Otitis Media
 Preforation of tympanic Membrane.
 Ossicular erosion.
 Atelectasis and adhesive otitis media.
 Tympanosclerosis.
 Cholesteatoma formation.
 Conductive hearing loss due to Ossicular erosion or
fixation.
 Sensorineural hearing loss.
 Speech impairment.
 Learning disabilities.
The last two are secondary loss of hearing in the development phase of
the infant or child.

12. INTRATEMPORAL COMPLICATIONS OF
OTITIS MEDIA
(a) Acute Mastoiditis
Mucosal lining of antrum and mastoid air cell
system
Aetiology
a) Exanthematous fevers
b) Poor nutrition
c) Diabetes

14. Pathology
1. Production of pus under tension
2. Hyperaemic decalcification and osteoclastic resorption
of bony walls

15. Clinical Features
Symptoms
1. Pain behind the ear.
2. Fever
3. Ear discharge
Signs
1. Mastoid tenderness
2. Ear discharge
3. Sagging of poterosuperior meatel wall
4. Perforation of tympanic membrane
5. Swelling over mastoid
6. Hearing loss
7. General Findings

16. Investigations
a) Blood Counts
b) ESR
c) X-ray Mastoid
d) Ear swab

17. Differential Diagnosis
C) Infected sebaceous Cyst
a) Suppuration of mastoid lymph nodes.
b) Furunculosis of meatus
1. Absence of preceding acute otitis media.
2. Painful movements of pinna
3. Swelling of meatus is confined to the cartilaginous part only.
4. Discharge is never mucoid or mucopurulent.
5. Enlargement of pre or Postauricular lymph nodes.
6. Conductive hearing loss is usually mild and is due to the occlusion of
meatus.
7. An absolutely normal looking tympanic membrane excludes possibility of
acute mastoiditis.
8. X-ray mastoid with clear air-cell system excludes acute mastoiditis.

18. Treatment
a) Hospitalisation of the patient.
b) Antibiotics.
c) Myringotomy.
d) Cortical mastoidectomy.
1. Subperiosteal abscess.
2. Sagging of posterosuperior meatal wall.
3. Positive reservoir sign
4. No change in condition of patient
5. Mastoids, leading to complications

19. Complications of acute mastoiditis
1. Subperiosteal abscess
2. Labyrinthitis
3. Facial paralysis
4. Petrositis
5. Extradural abscess
6. Subdural abscess
7. Meningitis
8. Brain abscess
9. Lateral sinus thrombophlebitis
10. Otitic hydrocephalous

20. Abscesses in relation to Mastoid
infection
a) Postauricular abscess
b) Zygomatic abscess
c) Bezold abscess
d) Meatal abscess
e) Behind the mastoid
f) Parapharyngeal or retropharyngeal abscess

21. Masked (Latent) Mastoiditis
 It is a condition of slow destruction of mastoid air cells but
without the acute signs and symptoms seen in acute mastoiditis.
Aetiology
In adequate antibiotic therapy.
Clinical Features
1. Mild pain behind the ear.
2. Hearing loss
3. Mastoid tenderness

22. Treatment
 Cortical mastoidoctomy
 Full dose of anti biotic treatment

23. Petrositis
Clinical Features
1. Gradenigo’s syndrome
2. Fever
3. Headache
4. Vomiting
5. Sometime neck rigidity
Diagnosis
1. CT scan
2. MRI

24. Treatment
 Cortical mastoidoctomy
 Modified and radical mastoidoctomy
 Eagleton’s approach
 Almoor’s anterior approach
 Ramadier’s-Lamerts approach
 Frenckner’s Operation

25. Facial paralysis
 It can occur as a complication of both acute and chronic otitis
media.

26. Labyrinthitis
It is the inflammation of the labyrinth as an extension of otitis media
and purulent meningitis.
Etiology
1. Trauma
2. Bacterial infection
3. Meningitis
Classification
1. Circumscribed Labyrinthitis
2. Diffuse serous Labyrinthitis
3. Diffuse suppurative Labyrinthitis
1. Acute suppurative labyrinthitis
2. Chronic or fibro-osseous labyrinthitis

27. Causes
1. Cholesteatoma
2. Congenital syphilis
3. Granulomatous disease
4. Temporal bone tumors
5. Chronic otitis media
6. Pneumococcal type

28. Symptoms
 Recurrent attacks of dizziness and nausea
aggravated by movements of the head and body
which lasts about a week.
 Temperature and hearing are within normal limits or
there may be mild conductive loss.

29. Signs
 Spontaneous nystagmus towards the diseased ear is present
during the attacks.
 Fistula sign will be positive.
Investigation
 CT scan
 Audiogram
Treatment
 Medical treatment
 Surgical treatment

30. Causes
1. Secondary to pre-existing circumscribed labyrinthitis.
2. Chronic suppurative otitis media – untreated.
3. Mastoidectomy operation in the presence of
circumscribed labyrinthitis.
4. Trauma
5. Surgery of the inner ear.

31. Symptoms
1. Vertigo
2. Sensorineural hearing loss
3. Temperature
Signs
1. Nystagmus
2. Fistula sign in positive if secondary to
circumscribed labyrinthitis

32. Differential Diagnosis
 Suppurative labyrinthitis – Sensorineural hearing loss is
present which is total and permanent. In serous labyrinthitis
hearing loss is temporary.
TREATMENT
Medical
 Absolute bed rest
 Antibiotics
 Labyrinthine sedative
Surgical
Surgery may be Required

33. Diffuse Suppurative Labyrinthitis
 It is a diffuse purulent peri - and endo - lymphatic condition.
Causes
1. Chronic suppurative otitis media.
2. Subdural abscess or meningitis.

34. Symptoms
1. Onset is acute in acute suppurative type.
2. Nausea
3. Vomiting
4. Vertigo
5. Ataxia
6. Deafness

35. Signs
 Nystagmus
 Fistula
Investigations
 Caloric test
 Audiogram
 CT scan
 CSF

36. Treatment
 Medical
Absolute bed rest, labyrinthine sedative and
antibiotics
 Surgical
Mastoidectomy with labyrinthectomy may be
necessary with patient threatening intracranial
complications

37. THANK YOU