This document discusses potential complications that can arise from chronic suppurative otitis media (CSOM). It classifies complications as either intra-cranial or extra-cranial, and describes various routes of infection spread. Extra-cranial complications include mastoiditis, facial nerve paralysis, labyrinthitis, cholesteatoma, subperiosteal abscesses, and fistula formation. Intra-cranial complications discussed are meningitis, brain abscesses, hydrocephalus, and lateral sinus thrombosis. Treatment options involve antibiotics, corticosteroids, surgery such as mastoidectomy, and physiotherapy.

1. Complications Of CSOM
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2. Classified as
• Intra cranial
• Extra-cranial, Intra-temporal
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3. Routes of entry
• Bony erosion (cholesteatoma,osteitis)
• Anatomical pathway: oval window, round window,
internal auditory canal, suture line, cochlear &
vestibular aqueduct
• Retrograde Thrombophlebitis
• Congenital bony defects: facial canal, tegmen plate
• Acquired bony defects: fracture, neoplasm,
stapedectomy
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4. Extra-Cranial
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5. Mastoiditis
• It is the inflammation of mucosal lining of mastoid antrum
and air cells system.
• Pathology
o Production of pus under tension
o Hyperaemic decalcification
o Osteoclastic resorption of bony walls
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6. 6

7. Mastoid reservoir sign Sagging of posterior wall
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8. Ironed out appearance Mastoid cavity
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9. Types of sub-periosteal
abscess
• Post-auricular
• Bezold
• Citelli
• Zygomatic
• Luc
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10. Post-auricular Abscess
• Commonest.
• Present behind
the ear.
• Pinna pushed
forward &
downward.
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11. • Luc: swelling in external auditory canal
• Bezold absceses-swelling over sternocleidomastoid
muscle
• Citelli absceses-swelling over posterior belly of
digastric muscle
• Parapharyngeal & Retropharyngeal: due to spread of
pus along Eustachian tube
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12. Treatment
• Urgent hospital admission
• Broad spectrum I.V. antibiotics
No response to medical treatment in 48 hrs
• Cortical Mastoidectomy
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13. Facial Nerve
Paralysis
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14. • Seen in AOM,COM(both mucosal and squamosal
variety)
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15. • AOM: sudden onset, full recovery
• COM: gradual onset, paralysis persist(erosion)
Treatment:
• Medical(Corticosteroids)
• Modified Radical Mastoidectomy(Sq CSOM)
• Facial nerve decompression if required
• Physioyheraphy
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16. Labrynthitis
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17. • Inflammation of bony labyrinth
Route of infection:
• Round window membrane
• Pre-formed opening (Stapedectomy)
• Retrograde spread of meningitis
types:
• Serous labyrinthitis
• Otogenic suppurative labyrinthitis
• Meningitic suppurative labyrinthitis
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18. •
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Cholesteatoma

19. Treatment
• Bed rest (affected ear up). Avoid head movement.
• Labyrinthine sedative: Prochlorperazine, Cinnarizine
• Broad spectrum I.V. antibiotics
• Modified Radical Mastoidectomy: removes infection
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20. PETROSITIS
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21. • Spread of infection from middle ear and mastoid to the
(peumatised) petrous part of temporal bone.
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22. Gradenigo syndrome
• It is triad of,
• Persistent otorrhoea
• Retro-orbital pain: Trigeminal nerve involvement
• Diplopia: Convergent squint due to lateral rectus palsy
by injury to abducent nerve
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23. Etiology:
• mastoiditis involving petrous apex along postero-superior
& anteroinferior tracts in relation to bony labyrinth
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24. Sub-Periosteal
abscess & Fistula
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25. Pathology
Production of pus under tension
hyperaemic decalcification (halisteresis)
osteoclastic resorption of bone
sub-periosteal abscess
penetration of periosteum + skin
fistula formation
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26. Sub-periosteal fistula: dry Sub-periosteal fistula: wet
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27. Intra Cranial
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28. Meningitis
It defined as inflammation of leptomeninges (Pia &
Arachnoid) with bacterial invasion of CSF in
subarachnoid space.
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29. On examination
1. Kernig’s sign– Extension of leg with thigh flexed
causes pain
2. Brudzinski’s sign– Flexion of neck causes flexion
of hip and knee.
3. Exaggerated tendon reflex
4. Papilloedema
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30. Otogenic brain abscess
• 50-70 % adult & 25% in child abscess are otogenic
• Route of infection:
1. Direct spread:
• via Tegmen plate:
Temporal abscess
• via Trautmann’s triangle:
Cerebellar abscess
2. Retrograde
thrombophlebitis
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31. Trautmann’s Triangle
• Superiorly: superior
petrosal sinus
• Posteriorly: sigmoid sinus
• Anteriorly: semi-circular
canals)
• Pathway to posterior
cranial fossa from
mastoid cavity
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32. Stages of Brain Abscess
• Early cerebritis(invasion)- 1-3 days
• Late cerebritis(Localization)-4-10days
• Early capsule formation(Enlargement)-10-13 days
• Late capsule formation(termination)-14 days.
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33. Otitic Hydrocephalus
• Defined as raised intracranial pressure with normal
CSF finding
• Seen in children
and adolescent with
acute and chronic
middle ear infection
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34. Extradural Abscess
• It is collection of pus
between dura matter
and the bone of the IC
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35. Subdural abscess
• Collection of pus between dura and arachnoid
• Erosion of bone and dura by thrombophlebitic
process
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36. Lateral sinus thrombosis
• Syn – Sigmoid sinus thrombosis
• Definition – It is an inflammation of inner wall of
lateral venous sinus with thrombus formation.
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37. • griesinger sign picket fence fever
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38. THANK YOU
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