This document summarizes various complications that can arise from chronic suppurative otitis media (CSOM). It discusses intratemporal complications like mastoiditis, facial nerve paralysis, and labyrinthitis. It also covers intracranial complications such as extradural and subdural abscesses, meningitis, brain abscesses, sigmoid sinus thrombosis, and otitic hydrocephalus. For each complication, it provides details on symptoms, investigations, and treatment approaches.

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