causes, presentation and treatment of CSOM

1. COMPLICATIONS OF CSOM
By
Dr Saeed Ullah FCPS
Classified ENT, Head and Neck Surgeon
CMH Quetta

2. Cholesteatoma
 A three dimensional epithelial and connective
tissue mass usually in the form of a sac
with a lining of stratified squamous epitheliu
m, filled with desquamating debris frequently
containing cholesterol

4. Types of cholesteatoma
 Cholesteatoma
 Congenital
 Acquired
 Primary
 Secondary

5. Other pathologies
 Osteitis
 Cholesterol granuloma

7. Routes of spread
 Direct erosion of bone
 Normal communication
 Oval and round windows
 Vascular channels
 Thrombophlebitis
 Periarteriolar spaces ofVirchow-Robin
 Abnormal preformed pathways
 Congenital dehiscence
 Acquired dehiscence
 Fractures
 Surgical defects

9. Intratemporal complications
 Mastoiditis
 Facial nerve paralysis
 Labyrinthitis
 Petrositis

10. Mastoid air cell system
 Mastoiditis
 Mastoid abscess
 Mastoid fistula

12. Mastoid abscess

13. Mastoid abscess

14. Mastoid fistula

15. Mastoiditis
 Pus under pressure
 Decalcification & ostoclastic resorption

16. Clinical features
 Symptoms
 Post aural pain
 Fever
 Discharge
 Signs
 Tenderness
 Discharge
 Sagging of post sup meatal wall
 Hearing loss
 Swelling

17. Treatment
 Hosp admission
 Antibiotics
 Myringotomy
 Cortical mastoidectomy

18. Facial nerve paralysis

19. Treatment
 Urgent exploration
 From geniculate ganglion to stylomastoid
foramen
 The sun never sit on facial paralysis due to
CSOM

20. Labyrinthitis
 Thinning or erosion of bone
 Two types
 Circumscribed
 Diffuse
 Serous
 suppurative

21. Clinical features
 Dizziness
 Detection
 Fistula test
 Seigel’s speculum

22. Treatment
 Mastoid exploration
 Antibiotics
 Analgesics
 Anti vertiginous drugs

23. Petrositis
 Osteitis of the petrous bone
 Headache
 Signs and symptoms of CSOM
 CT scan
 Exploration
 Antibiotics

24. Intracranial complications

25. Intracranial complications
 Extra dural abscess
 Subdural abscess
 Meningitis
 Brain abscess
 Sigmoid sinus thrombosis
 Otitic hydrocephalus

26. Extradural abscess
 Persistent headache
 Severe pain
 Low grade fever
 Purulent discharge

27. Treatment
 Antibiotics
 Mastoid exploration

28. Subdural abscess
 Meningeal irritation
 Headache
 Fever
 Neck rigidity
 Cortical venous thrombophlebitis
 Aphasia
 Hemiplegia
 Raised intracranial pressure
 Ptosis
 Papilloedema

30. Meningitis
 High grade fever
 Headache
 Neck rigiditiy
 Photophobia
 Nausea/ projectile vomiting
 Drowsiness
 Cranial nerve palsies

31. Otogenic brain abscess
 Stage of invasion
 Headache
 Low grade fever
 Stage of localization
 No symptoms
 Stage of enlargement
 Raised intracranial pressure
 Disturbances of cerebrum-focal neurologic signs
 Stage of termination

32. Investigations
 CT scan
 MRI
 Lumbar puncture

33. Treatment
 Medical
 Neurosurgical
 Otologic

34. Lateral sinus thrombosis
 Formation of perisinus abscess
 Thrombus formation
 Obliteration of sinus lumen
 Extension of thrombus

35. Clinical features
 Fever
 Headache
 Progressive anemia
 Griesinger’s sign
 Papilloedema
 Tobey-Ayer’s test
 Tenderness along jugular vein

36. Investigations
 Imaging studies
 Contrast enhance CT studies
 MR angiography

37. Treatment
 Antibiotics
 Mastoidectomy and exploration
 Ligation of internal jugular vein
 Anticoagulant therapy

38. Otitic hydrocephalus
 Lateral sinus thrombosis
 Extended to superior sagittal sinus
 Impede the function of arachnoid villi
 Decrease CSF absorption
 Increased intracranial pressure

39. Clinical features
 Severe headache
 Diplopia
 6th cranial nerve palsy
 Papilloedema
 Blurring of vision
 Optic atrophy
 blindness

40. Questions

41. Thank you