This is a presentation about complications of otitis media. It is aimed towards helping the undergraduates and postgraduates pursuing medicine and otolaryngology.
This document discusses acute suppurative otitis media (ASOM), including its definition, stages, bacteriology, treatment, and potential complications. ASOM is a pyogenic infection of the middle ear cleft lasting less than 3 weeks that is caused most commonly by streptococcus pneumoniae, haemophilus influenzae, or moraxella catarrhalis. It progresses through stages of hyperemia, exudation, suppuration, and sometimes coalescent mastoiditis. Treatment involves antibiotics, analgesics, and sometimes myringotomy to drain the ear. Complications can include subperiosteal abscess, vertigo, or mastoiditis if not properly treated.
1) Facial nerve palsy is a potential complication of both acute and chronic suppurative otitis media (CSOM). The facial nerve can become inflamed or damaged, causing weakness or paralysis of the muscles on the affected side of the face.
2) Labyrinthitis refers to inflammation of the inner ear structures and can occur when infection spreads from CSOM to the inner ear through defects in the otic capsule bone. This can cause symptoms like vertigo, hearing loss, and nystagmus.
3) Acute mastoiditis is inflammation of the air cells in the mastoid bone behind the ear. It develops when infection from the middle ear spreads to the mast
This document discusses vertigo, which refers to a hallucinatory sensation of movement caused by a mismatch of sensory information from the vestibular, visual, and proprioceptive systems. Vertigo can be caused by lesions in the peripheral, intermediate, or central nervous system. Common causes of peripheral vertigo include BPPV, Meniere's disease, and labyrinthitis. Intermediate vertigo may be caused by vestibular neuronitis or acoustic neuroma. Central causes include stroke, MS, migraines, and brain tumors. Clinical tests like nystagmus patterns and the head thrust test can help differentiate peripheral from central vertigo. Treatment depends on the underlying cause but may include medications, exercises
Keratosis obturans is a condition characterized by an accumulation of desquamated keratin in the external auditory meatus. It occurs when the normal migration of epithelium from the tympanic membrane to the posterior meatal wall is obstructed by wax or a foreign body, causing an abnormal separation of keratin. There are two main types - a silent type caused by this abnormal keratin separation, and an inflammatory type caused by acute ear canal inflammation. Clinically, it presents as a white keratin plug occluding the ear canal, sometimes with accompanying granulations or canal widening. Treatment involves removing the cause if present, using keratolytic agents, and potentially surgical removal under general anesthesia for recurrent cases
A rhinolith forms around a small foreign body introduced into the nose, causing inflammation and pus secretion high in calcium and magnesium. This allows mineral salts to precipitate over time, forming a stony mass. Rhinoliths typically cause unilateral nasal obstruction, foul discharge, pain, and ulceration. They appear on examination as an irregular, stony hard mass and can be seen on imaging tests. Rhinoliths are usually removed surgically under general anesthesia.
This document discusses acute otitis media (AOM), an inflammation of the middle ear. It notes that AOM commonly affects young children and is usually caused by bacteria spreading from the nose and throat via the Eustachian tube. The document outlines the typical stages of AOM from initial tube blockage to potential complications if left untreated. It recommends initial treatment with antibiotics, pain medication, and ear drops followed by myringotomy if symptoms persist to drain fluid and release pressure on the eardrum. Underlying conditions like chronic rhinitis or adenoiditis can predispose children to recurrent AOM.
Perichondritis refers to inflammation of the perichondrium of the external ear. It is usually caused by trauma such as piercing or burns and the most common organisms involved are Pseudomonas aeruginosa and Staphylococcus aureus. The diagnosis is clinical based on signs of inflammation and pain in the cartilaginous ear. If left untreated, it can lead to abscess, avascular necrosis of cartilage, and deformity of the pinna. Treatment involves early use of broad-spectrum antibiotics, drainage of any abscesses, and conservative surgery if resistant including irrigation and excision of necrotic cartilage to preserve the structure of the ear.
This document provides an overview of otitis externa (ear infection of the outer ear canal). It defines the condition and describes the anatomy of the external auditory canal. The stages of otitis externa are outlined from pre-inflammatory to acute and chronic. Common types are discussed including localized furuncles, diffuse acute infections, and chronic cases. Potential causes and the microbiology are summarized. Diagnosis, classification, signs and symptoms, and treatment approaches are covered for the main types of otitis externa infections. Complications are also briefly mentioned.
This document discusses acute suppurative otitis media (ASOM), including its definition, stages, bacteriology, treatment, and potential complications. ASOM is a pyogenic infection of the middle ear cleft lasting less than 3 weeks that is caused most commonly by streptococcus pneumoniae, haemophilus influenzae, or moraxella catarrhalis. It progresses through stages of hyperemia, exudation, suppuration, and sometimes coalescent mastoiditis. Treatment involves antibiotics, analgesics, and sometimes myringotomy to drain the ear. Complications can include subperiosteal abscess, vertigo, or mastoiditis if not properly treated.
1) Facial nerve palsy is a potential complication of both acute and chronic suppurative otitis media (CSOM). The facial nerve can become inflamed or damaged, causing weakness or paralysis of the muscles on the affected side of the face.
2) Labyrinthitis refers to inflammation of the inner ear structures and can occur when infection spreads from CSOM to the inner ear through defects in the otic capsule bone. This can cause symptoms like vertigo, hearing loss, and nystagmus.
3) Acute mastoiditis is inflammation of the air cells in the mastoid bone behind the ear. It develops when infection from the middle ear spreads to the mast
This document discusses vertigo, which refers to a hallucinatory sensation of movement caused by a mismatch of sensory information from the vestibular, visual, and proprioceptive systems. Vertigo can be caused by lesions in the peripheral, intermediate, or central nervous system. Common causes of peripheral vertigo include BPPV, Meniere's disease, and labyrinthitis. Intermediate vertigo may be caused by vestibular neuronitis or acoustic neuroma. Central causes include stroke, MS, migraines, and brain tumors. Clinical tests like nystagmus patterns and the head thrust test can help differentiate peripheral from central vertigo. Treatment depends on the underlying cause but may include medications, exercises
Keratosis obturans is a condition characterized by an accumulation of desquamated keratin in the external auditory meatus. It occurs when the normal migration of epithelium from the tympanic membrane to the posterior meatal wall is obstructed by wax or a foreign body, causing an abnormal separation of keratin. There are two main types - a silent type caused by this abnormal keratin separation, and an inflammatory type caused by acute ear canal inflammation. Clinically, it presents as a white keratin plug occluding the ear canal, sometimes with accompanying granulations or canal widening. Treatment involves removing the cause if present, using keratolytic agents, and potentially surgical removal under general anesthesia for recurrent cases
A rhinolith forms around a small foreign body introduced into the nose, causing inflammation and pus secretion high in calcium and magnesium. This allows mineral salts to precipitate over time, forming a stony mass. Rhinoliths typically cause unilateral nasal obstruction, foul discharge, pain, and ulceration. They appear on examination as an irregular, stony hard mass and can be seen on imaging tests. Rhinoliths are usually removed surgically under general anesthesia.
This document discusses acute otitis media (AOM), an inflammation of the middle ear. It notes that AOM commonly affects young children and is usually caused by bacteria spreading from the nose and throat via the Eustachian tube. The document outlines the typical stages of AOM from initial tube blockage to potential complications if left untreated. It recommends initial treatment with antibiotics, pain medication, and ear drops followed by myringotomy if symptoms persist to drain fluid and release pressure on the eardrum. Underlying conditions like chronic rhinitis or adenoiditis can predispose children to recurrent AOM.
Perichondritis refers to inflammation of the perichondrium of the external ear. It is usually caused by trauma such as piercing or burns and the most common organisms involved are Pseudomonas aeruginosa and Staphylococcus aureus. The diagnosis is clinical based on signs of inflammation and pain in the cartilaginous ear. If left untreated, it can lead to abscess, avascular necrosis of cartilage, and deformity of the pinna. Treatment involves early use of broad-spectrum antibiotics, drainage of any abscesses, and conservative surgery if resistant including irrigation and excision of necrotic cartilage to preserve the structure of the ear.
This document provides an overview of otitis externa (ear infection of the outer ear canal). It defines the condition and describes the anatomy of the external auditory canal. The stages of otitis externa are outlined from pre-inflammatory to acute and chronic. Common types are discussed including localized furuncles, diffuse acute infections, and chronic cases. Potential causes and the microbiology are summarized. Diagnosis, classification, signs and symptoms, and treatment approaches are covered for the main types of otitis externa infections. Complications are also briefly mentioned.
Chronic tonsillitis has several causes including complications from acute sinusitis or subclinical infections of the tonsils or sinuses. It most commonly affects children and young adults. There are three main types: chronic follicular tonsillitis where the tonsillar crypts are full of infected material; chronic parenchymatous tonsillitis with enlarged lymphoid tissue; and chronic fibroid tonsillitis where the tonsils are small but infected. Clinical features include recurrent sore throats, throat irritation, bad breath, and difficulty swallowing. Examination may show enlarged or small tonsils with pus or debris. Complications can include peritonsillar abscess, tonsilloliths, or intratonsillar
Otoendoscopy - Types, Uses, Procedures performed, Advantages and DisadvantagesReshma Ann Mathew
Otoendoscopy involves using a rigid endoscope inserted into the ear canal to examine the outer and middle ear.
An otoendoscope is a short, rigid telescope that is available in varying diameters and angles between 0-70 degrees. It is connected to a light source and camera for illumination and recording findings. Commonly used otoendoscopes have diameters of 1.7mm and angles of 0 or 30 degrees.
Otoendoscopy allows visualization of the entire tympanic membrane and structures like the sinus tympani, facial recess, and eustachian tube that are usually hidden. It has advantages over microscopy like extending the surgical field and providing multiple angles. Common procedures performed with o
1. The document provides information on the anatomy and physiology of the external ear canal and discusses various types of otitis externa including acute otitis externa, chronic otitis externa, necrotizing external otitis, fungal otitis externa, and herpes zoster oticus.
2. It describes the symptoms, signs, causative agents, diagnosis, and treatment for each type of otitis externa. For acute otitis externa, examples of treatment mentioned include ear toilet, medicated wicks, antibiotic-steroid preparations, and analgesics.
3. Necrotizing external otitis is described
Acute otitis media (AOM) secretory otitis media (OME)Ausaf Khan
Secretory otitis media (SOM) is characterized by the collection of non-purulent fluid in the middle ear, causing hearing impairment. It is often caused by eustachian tube obstruction from conditions like adenoid hypertrophy or nasal pharyngeal carcinoma. Patients present with bilateral deafness and mouth breathing. Examination finds a dull, retracted, immobile tympanic membrane with fluid visible behind it on pneumatic otoscopy. Treatment involves adenoidectomy and sometimes grommet insertion, though complications can include atelactasis, tympanosclerosis, or adhesive otitis media if left untreated.
Vasomotor rhinitis is a chronic non-allergic rhinitis caused by an imbalance of the autonomic nervous system leading to hyperactivity of the nasal mucosa. Symptoms include recurrent sneezing, rhinorrhea, and nasal obstruction. The exact cause is unknown but it involves overactivity of the parasympathetic nervous system causing vasodilation and secretion from the nasal glands. Treatment focuses on avoiding triggers, using oral or topical decongestants and steroids, and in severe cases, short term systemic steroids or surgical procedures like turbinate reduction.
This document discusses different types of abscesses related to the pharynx, including peritonsillar abscesses (quinsy), retropharyngeal abscesses, and parapharyngeal abscesses. It provides information on the etiology, pathogenesis, clinical features, examination findings, treatment, and potential complications of each type of abscess.
This document outlines the various symptoms associated with nasal diseases, including nasal obstruction, nasal discharge, epistaxis, disturbance of smell, sneezing, post-nasal drip, cough, headache, swelling or deformity, change in voice, and snoring. It describes the potential causes of each symptom and provides examples of diseases that can cause intermittent, progressive, or persistent nasal obstruction and watery, purulent, or bloody nasal discharge.
Nasal polyps are non-cancerous growths that can develop in the nose or sinuses. They are most common in people over 50 years of age and affect males more than females. Histologically, nasal polyps contain edema fluid and high numbers of eosinophil inflammatory cells. The most common sites for nasal polyps are the ethmoid and maxillary sinuses. Nasal polyps can cause symptoms like nasal obstruction, loss of smell, sneezing and headaches. Treatment involves steroid nasal sprays, oral steroids or surgery to remove the polyps.
This document discusses complications that can arise from chronic suppurative otitis media (CSOM). It notes that complications occur when infection spreads beyond the middle ear into surrounding structures. Multiple complications occur in about 1/3 of patients, and children are more commonly affected than adults. Potential complications include mastoiditis, facial nerve paralysis, labyrinthine fistula, meningitis, brain abscess, and lateral sinus thrombosis. The document provides detailed descriptions and classifications of these various complications as well as their symptoms, diagnostic approach, and treatment options.
Nasal polyps can be either antrochoanal polyps, typically seen in children, or ethmoid polyps, more common in adults. Antrochoanal polyps originate in the maxillary sinus and extend backwards towards the nasopharynx, while ethmoid polyps originate in the ethmoid sinuses and grow forwards, often bilaterally. Treatment involves surgical removal of antrochoanal polyps and may require postoperative antibiotics to prevent recurrence, whereas ethmoid polyps are usually first treated medically with steroids and antihistamines and only require surgery if medical treatment fails or for large polyps.
Cholesteatoma and chronic suppurative otitis mediaainakadir
This document discusses cholesteatoma and chronic suppurative otitis media (CSOM). Cholesteatoma is defined as the presence of keratinizing squamous epithelium in the middle ear or mastoid. There are various theories for its origin, including invagination of the tympanic membrane or basal cell hyperplasia. CSOM is a long-standing middle ear infection characterized by ear discharge and permanent perforation. It is classified as tubotympanic or atticoantral, with atticoantral being more dangerous due to higher risk of bone-eroding complications like cholesteatoma. Treatment involves surgical resection for atticoantral CSOM and conservative
Chronic tonsillitis refers to chronic inflammation of the palatine tonsils. It is characterized by (1) complaints reported by the patient such as recurring sore throats, (2) disruption of the tonsils' drainage function, and (3) morphological changes seen on histological examination. Compensated chronic tonsillitis presents with no complaints but local signs of inflammation, while decompensated chronic tonsillitis results in frequent sore throats, abscesses, and possible complications affecting other organs. Adenoid hypertrophy involves enlargement of the lymphoid tissue in the nasopharynx and can partially or fully block the nasal cavity, leading to various respiratory, ear, facial, dental, sleep
1) Sinusitis complications arise when infection spreads beyond the sinus mucosa into surrounding areas like the orbit or skull. Common local complications include mucoceles/pyocles, osteomyelitis of the frontal bone or maxilla, and orbital issues like preseptal cellulitis, subperiosteal abscesses, or orbital cellulitis.
2) Intracranial complications from sinusitis spreading can cause meningitis, extradural or subdural abscesses, brain abscesses, or cavernous sinus thrombosis. Descending infections from sinus discharge can also lead to otitis media, pharyngitis, or laryngitis.
3) Orbital cell
This document discusses different types of non-suppurative otitis media, including otitis media with effusion (OME), adhesive otitis media, tympanosclerosis, and barotraumatic otitis media. It describes the symptoms, signs, and treatments for OME, which is the presence of fluid in the middle ear without infection. Causes of OME include Eustachian tube dysfunction due to obstruction, infection, or functional issues. Treatments discussed include antibiotics, nasal decongestants, myringotomy with grommet insertion, and devices to aid Eustachian tube drainage. Complications of chronic OME include tympanosclerosis, adhesive otit
Malignant otitis externa is an aggressive infection of the external ear and skull base that predominantly affects older diabetics. It is caused most commonly by Pseudomonas aeruginosa bacteria. Clinical features include severe ear pain, discharge, hearing loss, and facial nerve palsy. Diagnosis involves culture of ear discharge, blood tests, imaging, and biopsy. Treatment requires long-term antibiotics, often fluoroquinolones, along with glucose control, ear cleaning, hyperbaric oxygen, and sometimes surgery. Cranial nerve palsies and intracranial complications can occur if the infection spreads.
This document describes the indications, techniques, and postoperative care for septoplasty surgery. It indicates that septoplasty is performed to correct a deviated nasal septum causing obstruction or other issues. The key steps described are making an incision, raising mucoperichondrial flaps, removing deviated cartilage and bone, and re-approximating the flaps. Potential complications are also outlined.
Nasal myiasis is a condition where fly larvae (maggots) infest and feed on the nasal tissues of humans, causing excessive foul-smelling and bloody nasal discharge. Symptoms include nasal discharge, facial swelling, presence of maggots in the nose causing destruction of nasal tissues, and potential formation of nasal fistulas. Treatment involves carefully removing the maggots using chloroform, oil, or water along with cleaning and treating any infected or damaged nasal tissues.
This document discusses various disorders of voice including dysphonia, aphonia, diplophonia, puberphonia, phonasthenia, disorders of resonance like rhinolalia aperta and rhinolalia clausa, hoarseness, muscle tension dysphonia, spasmodic dysphonia, and sulcus vocalis. It describes the definition, etiology, symptoms, signs, investigations, and treatment of each disorder. Evaluation of hoarseness includes detailed history taking and examination of the larynx, neck, and other systems to determine the underlying cause. Botulinum toxin injections are the mainstay of treatment for spasmodic dysphonia while voice therapy is recommended for
Rhinosinusitis is inflammation of the nose and paranasal sinuses that is classified as acute or chronic based on duration of symptoms. Acute rhinosinusitis lasts less than 12 weeks and is usually viral in origin, while chronic rhinosinusitis lasts over 12 weeks with ongoing symptoms. Chronic rhinosinusitis can be further classified based on the presence of nasal polyps and type of inflammation present. Type 2 inflammation involving cytokines IL-4, IL-5 and IL-13 is associated with treatment failure, asthma, and higher rates of polyp formation. The sinus mucosa acts as an immune barrier, and type 2 inflammation can cause barrier weakness and failure, predisposing to recurrence of rhinosinusitis
This document discusses various intracranial complications that can arise from chronic otitis media, including:
1. Meningitis, which is the most common complication and occurs when infection spreads from the middle ear to the membranes covering the brain.
2. Extradural and subdural abscesses, which develop when infection spreads through the bone and collects between the skull and brain or between the brain's membranes.
3. Brain abscesses, which usually form when infection extends from the middle ear into the brain tissue, commonly through areas of bone dehiscence. Lateral sinus thrombophlebitis involves infection and clot formation within the venous sinus near the ear.
This document discusses various complications that can arise from chronic otitis media (COM). It begins by defining COM complications as infections spreading beyond the middle ear to nearby structures. It then lists various extracranial and intracranial complications, including meningitis, extradural abscesses, subdural empyema, lateral sinus thrombophlebitis, brain abscesses, otitic hydrocephalus, and CSF otorrhea. It further discusses several of these complications in more detail, outlining their pathogenesis, clinical features, investigations, differential diagnoses, and management approaches.
Chronic tonsillitis has several causes including complications from acute sinusitis or subclinical infections of the tonsils or sinuses. It most commonly affects children and young adults. There are three main types: chronic follicular tonsillitis where the tonsillar crypts are full of infected material; chronic parenchymatous tonsillitis with enlarged lymphoid tissue; and chronic fibroid tonsillitis where the tonsils are small but infected. Clinical features include recurrent sore throats, throat irritation, bad breath, and difficulty swallowing. Examination may show enlarged or small tonsils with pus or debris. Complications can include peritonsillar abscess, tonsilloliths, or intratonsillar
Otoendoscopy - Types, Uses, Procedures performed, Advantages and DisadvantagesReshma Ann Mathew
Otoendoscopy involves using a rigid endoscope inserted into the ear canal to examine the outer and middle ear.
An otoendoscope is a short, rigid telescope that is available in varying diameters and angles between 0-70 degrees. It is connected to a light source and camera for illumination and recording findings. Commonly used otoendoscopes have diameters of 1.7mm and angles of 0 or 30 degrees.
Otoendoscopy allows visualization of the entire tympanic membrane and structures like the sinus tympani, facial recess, and eustachian tube that are usually hidden. It has advantages over microscopy like extending the surgical field and providing multiple angles. Common procedures performed with o
1. The document provides information on the anatomy and physiology of the external ear canal and discusses various types of otitis externa including acute otitis externa, chronic otitis externa, necrotizing external otitis, fungal otitis externa, and herpes zoster oticus.
2. It describes the symptoms, signs, causative agents, diagnosis, and treatment for each type of otitis externa. For acute otitis externa, examples of treatment mentioned include ear toilet, medicated wicks, antibiotic-steroid preparations, and analgesics.
3. Necrotizing external otitis is described
Acute otitis media (AOM) secretory otitis media (OME)Ausaf Khan
Secretory otitis media (SOM) is characterized by the collection of non-purulent fluid in the middle ear, causing hearing impairment. It is often caused by eustachian tube obstruction from conditions like adenoid hypertrophy or nasal pharyngeal carcinoma. Patients present with bilateral deafness and mouth breathing. Examination finds a dull, retracted, immobile tympanic membrane with fluid visible behind it on pneumatic otoscopy. Treatment involves adenoidectomy and sometimes grommet insertion, though complications can include atelactasis, tympanosclerosis, or adhesive otitis media if left untreated.
Vasomotor rhinitis is a chronic non-allergic rhinitis caused by an imbalance of the autonomic nervous system leading to hyperactivity of the nasal mucosa. Symptoms include recurrent sneezing, rhinorrhea, and nasal obstruction. The exact cause is unknown but it involves overactivity of the parasympathetic nervous system causing vasodilation and secretion from the nasal glands. Treatment focuses on avoiding triggers, using oral or topical decongestants and steroids, and in severe cases, short term systemic steroids or surgical procedures like turbinate reduction.
This document discusses different types of abscesses related to the pharynx, including peritonsillar abscesses (quinsy), retropharyngeal abscesses, and parapharyngeal abscesses. It provides information on the etiology, pathogenesis, clinical features, examination findings, treatment, and potential complications of each type of abscess.
This document outlines the various symptoms associated with nasal diseases, including nasal obstruction, nasal discharge, epistaxis, disturbance of smell, sneezing, post-nasal drip, cough, headache, swelling or deformity, change in voice, and snoring. It describes the potential causes of each symptom and provides examples of diseases that can cause intermittent, progressive, or persistent nasal obstruction and watery, purulent, or bloody nasal discharge.
Nasal polyps are non-cancerous growths that can develop in the nose or sinuses. They are most common in people over 50 years of age and affect males more than females. Histologically, nasal polyps contain edema fluid and high numbers of eosinophil inflammatory cells. The most common sites for nasal polyps are the ethmoid and maxillary sinuses. Nasal polyps can cause symptoms like nasal obstruction, loss of smell, sneezing and headaches. Treatment involves steroid nasal sprays, oral steroids or surgery to remove the polyps.
This document discusses complications that can arise from chronic suppurative otitis media (CSOM). It notes that complications occur when infection spreads beyond the middle ear into surrounding structures. Multiple complications occur in about 1/3 of patients, and children are more commonly affected than adults. Potential complications include mastoiditis, facial nerve paralysis, labyrinthine fistula, meningitis, brain abscess, and lateral sinus thrombosis. The document provides detailed descriptions and classifications of these various complications as well as their symptoms, diagnostic approach, and treatment options.
Nasal polyps can be either antrochoanal polyps, typically seen in children, or ethmoid polyps, more common in adults. Antrochoanal polyps originate in the maxillary sinus and extend backwards towards the nasopharynx, while ethmoid polyps originate in the ethmoid sinuses and grow forwards, often bilaterally. Treatment involves surgical removal of antrochoanal polyps and may require postoperative antibiotics to prevent recurrence, whereas ethmoid polyps are usually first treated medically with steroids and antihistamines and only require surgery if medical treatment fails or for large polyps.
Cholesteatoma and chronic suppurative otitis mediaainakadir
This document discusses cholesteatoma and chronic suppurative otitis media (CSOM). Cholesteatoma is defined as the presence of keratinizing squamous epithelium in the middle ear or mastoid. There are various theories for its origin, including invagination of the tympanic membrane or basal cell hyperplasia. CSOM is a long-standing middle ear infection characterized by ear discharge and permanent perforation. It is classified as tubotympanic or atticoantral, with atticoantral being more dangerous due to higher risk of bone-eroding complications like cholesteatoma. Treatment involves surgical resection for atticoantral CSOM and conservative
Chronic tonsillitis refers to chronic inflammation of the palatine tonsils. It is characterized by (1) complaints reported by the patient such as recurring sore throats, (2) disruption of the tonsils' drainage function, and (3) morphological changes seen on histological examination. Compensated chronic tonsillitis presents with no complaints but local signs of inflammation, while decompensated chronic tonsillitis results in frequent sore throats, abscesses, and possible complications affecting other organs. Adenoid hypertrophy involves enlargement of the lymphoid tissue in the nasopharynx and can partially or fully block the nasal cavity, leading to various respiratory, ear, facial, dental, sleep
1) Sinusitis complications arise when infection spreads beyond the sinus mucosa into surrounding areas like the orbit or skull. Common local complications include mucoceles/pyocles, osteomyelitis of the frontal bone or maxilla, and orbital issues like preseptal cellulitis, subperiosteal abscesses, or orbital cellulitis.
2) Intracranial complications from sinusitis spreading can cause meningitis, extradural or subdural abscesses, brain abscesses, or cavernous sinus thrombosis. Descending infections from sinus discharge can also lead to otitis media, pharyngitis, or laryngitis.
3) Orbital cell
This document discusses different types of non-suppurative otitis media, including otitis media with effusion (OME), adhesive otitis media, tympanosclerosis, and barotraumatic otitis media. It describes the symptoms, signs, and treatments for OME, which is the presence of fluid in the middle ear without infection. Causes of OME include Eustachian tube dysfunction due to obstruction, infection, or functional issues. Treatments discussed include antibiotics, nasal decongestants, myringotomy with grommet insertion, and devices to aid Eustachian tube drainage. Complications of chronic OME include tympanosclerosis, adhesive otit
Malignant otitis externa is an aggressive infection of the external ear and skull base that predominantly affects older diabetics. It is caused most commonly by Pseudomonas aeruginosa bacteria. Clinical features include severe ear pain, discharge, hearing loss, and facial nerve palsy. Diagnosis involves culture of ear discharge, blood tests, imaging, and biopsy. Treatment requires long-term antibiotics, often fluoroquinolones, along with glucose control, ear cleaning, hyperbaric oxygen, and sometimes surgery. Cranial nerve palsies and intracranial complications can occur if the infection spreads.
This document describes the indications, techniques, and postoperative care for septoplasty surgery. It indicates that septoplasty is performed to correct a deviated nasal septum causing obstruction or other issues. The key steps described are making an incision, raising mucoperichondrial flaps, removing deviated cartilage and bone, and re-approximating the flaps. Potential complications are also outlined.
Nasal myiasis is a condition where fly larvae (maggots) infest and feed on the nasal tissues of humans, causing excessive foul-smelling and bloody nasal discharge. Symptoms include nasal discharge, facial swelling, presence of maggots in the nose causing destruction of nasal tissues, and potential formation of nasal fistulas. Treatment involves carefully removing the maggots using chloroform, oil, or water along with cleaning and treating any infected or damaged nasal tissues.
This document discusses various disorders of voice including dysphonia, aphonia, diplophonia, puberphonia, phonasthenia, disorders of resonance like rhinolalia aperta and rhinolalia clausa, hoarseness, muscle tension dysphonia, spasmodic dysphonia, and sulcus vocalis. It describes the definition, etiology, symptoms, signs, investigations, and treatment of each disorder. Evaluation of hoarseness includes detailed history taking and examination of the larynx, neck, and other systems to determine the underlying cause. Botulinum toxin injections are the mainstay of treatment for spasmodic dysphonia while voice therapy is recommended for
Rhinosinusitis is inflammation of the nose and paranasal sinuses that is classified as acute or chronic based on duration of symptoms. Acute rhinosinusitis lasts less than 12 weeks and is usually viral in origin, while chronic rhinosinusitis lasts over 12 weeks with ongoing symptoms. Chronic rhinosinusitis can be further classified based on the presence of nasal polyps and type of inflammation present. Type 2 inflammation involving cytokines IL-4, IL-5 and IL-13 is associated with treatment failure, asthma, and higher rates of polyp formation. The sinus mucosa acts as an immune barrier, and type 2 inflammation can cause barrier weakness and failure, predisposing to recurrence of rhinosinusitis
This document discusses various intracranial complications that can arise from chronic otitis media, including:
1. Meningitis, which is the most common complication and occurs when infection spreads from the middle ear to the membranes covering the brain.
2. Extradural and subdural abscesses, which develop when infection spreads through the bone and collects between the skull and brain or between the brain's membranes.
3. Brain abscesses, which usually form when infection extends from the middle ear into the brain tissue, commonly through areas of bone dehiscence. Lateral sinus thrombophlebitis involves infection and clot formation within the venous sinus near the ear.
This document discusses various complications that can arise from chronic otitis media (COM). It begins by defining COM complications as infections spreading beyond the middle ear to nearby structures. It then lists various extracranial and intracranial complications, including meningitis, extradural abscesses, subdural empyema, lateral sinus thrombophlebitis, brain abscesses, otitic hydrocephalus, and CSF otorrhea. It further discusses several of these complications in more detail, outlining their pathogenesis, clinical features, investigations, differential diagnoses, and management approaches.
This document discusses various complications that can arise from chronic suppurative otitis media (CSOM). It describes intra-cranial and extra-cranial complications, including mastoiditis, facial nerve paralysis, labyrinthitis, petrositis, subperiosteal abscesses, meningitis, brain abscesses, otitic hydrocephalus, extradural abscesses, subdural abscesses, and lateral sinus thrombosis. For each complication, it discusses the pathology, clinical features, investigations, and treatment approaches.
This document discusses various complications that can arise from chronic suppurative otitis media (CSOM). It classifies complications as either intracranial or extracranial/intratemporal. Some potential complications described include mastoiditis, facial nerve paralysis, labyrinthitis, petrositis, subperiosteal abscesses, meningitis, brain abscesses, otitic hydrocephalus, extradural abscesses, subdural abscesses, and lateral sinus thrombosis. Factors that influence the risk of these complications include pathogen virulence, patient immune status, and anatomical defects.
This document discusses intracranial complications that can arise from otitis media, including various types of abscesses, meningitis, sinus thrombosis, and hydrocephalus. Key complications mentioned are mastoiditis, labyrinthitis, extradural and subdural abscesses, otogenic brain abscess, lateral sinus thrombosis, and otitic hydrocephalus. Causes, clinical features, investigations, bacteriology, treatment, and pathology are described for several of these complications.
This document discusses fracture complications from Dr. Utkarsh Shahi of King Faisal University. It begins by outlining immediate, early, and late complications of fractures both locally and systemically. Immediate complications include hemorrhage, vascular injury, and nerve injury. Early complications include infection, compartment syndrome, fat embolism syndrome, and delayed union. Late complications consist of non-union, malunion, avascular necrosis, and arthritis. The document then provides details on diagnosing and treating specific complications like hemorrhage, nerve injury, and compartment syndrome. It emphasizes the importance of early diagnosis and management to prevent long-term issues.
This document discusses various diseases and abnormalities of the external nose and nasal cavity. It covers topics such as nasal furunculosis, nasal vestibulitis, saddle nose, hump nose, crooked nose, congenital tumors like dermoid cyst and encephalocele, nasolabial cyst, rhinophyma, papilloma, basal cell carcinoma, squamous cell carcinoma, melanoma, hemangioma, foreign bodies, and rhinolithiasis. Treatment approaches including antibiotics, anti-inflammatory drugs, rhinoplasty, reconstruction, and surgery are described for many of these conditions.
This document discusses complications that can arise from chronic otitis media (COM), including both extracranial and intracranial complications. Extracranial complications include postauricular abscess, facial palsy, and sensorineural hearing loss. Intracranial complications include meningitis, brain abscess, lateral sinus thrombosis, and otitic hydrocephalus. Management of complications involves intravenous antibiotics, drainage or excision of abscesses, and surgical treatment of the ear infection. Early and effective treatment of both the complication and the underlying ear disease is important.
Sinusitis can lead to several intracranial and extracranial complications. Intracranial complications include meningitis, encephalitis, extradural abscess, subdural abscess, brain abscess, and cavernous sinus thrombosis which occur due to the spread of infection from paranasal sinuses to the brain. Extracranial complications include descending infections that can cause otitis media, pharyngitis, tonsillitis, laryngitis, and tracheobronchitis. Sinusitis may also act as a focus of infection leading to conditions like polyarthritis, tenosynovitis, and fibrositis.
Mastoiditis is an infection of the mastoid air cells that can develop as a complication of acute otitis media. It can present as acute or chronic and have various classifications. While now rare due to antibiotics, potential complications include intratemporal extensions into nearby structures or intracranial extensions through direct bone erosion. Management involves antibiotics, with mastoidectomy sometimes needed for severe or unimproving cases to prevent serious complications. Complications range from local abscesses to epidural abscesses, venous sinus thrombosis, and even more serious intracranial infections if not properly treated.
This document discusses the intracranial complications that can arise from otitis media, including meningitis, brain abscesses, lateral sinus thrombophlebitis, epidural abscesses, subdural abscesses, and otitic hydrocephalus. For each complication, the document outlines the pathology, clinical features, diagnostic process, and treatment options. The most common and serious complication is meningitis, which can develop from both acute and chronic otitis media. Brain abscesses occur in stages and present with symptoms of increased intracranial pressure. Lateral sinus thrombophlebitis involves inflammation and clotting within the venous sinus.
This document outlines various potential complications of chronic rhinosinusitis that can affect the orbit, intracranial cavity, and bones. It describes orbital complications such as preseptal cellulitis, orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. Intracranial complications discussed include meningitis, epidural abscess, subdural abscess, intracerebral abscess, cavernous sinus thrombosis, and sagittal sinus thrombosis. Bone complications include osteomyelitis (Pott's puffy tumor). Chronic complications include mucocoeles.
- Cestodes (tapeworms) that can infect humans include Taenia saginata, Taenia solium, Diphyllobothriurn latum, Hymenolepis nana, Echinococcus granulosus, and Echinococcus multilocularis.
- Taeniasis results from intestinal infection by the adult tapeworm, while cysticercosis results from larval lodging in various sites like the brain, muscles, eyes.
- Neurocysticercosis, caused by Taenia solium larvae in the brain, is the most common parasitic infection of the brain worldwide.
- Symptoms depend on the location of the cysts. Cysts in
The document discusses various conditions that can cause acute scrotal pain, including testicular torsion, epididymitis, Fournier's gangrene, hernias, and referred pain from other sources. Testicular torsion is a medical emergency requiring immediate surgical intervention to prevent testicular infarction, while epididymitis is usually treated with antibiotics as an outpatient. Physical examination, ultrasound, and urine testing can help differentiate between potential causes of acute scrotal pain.
Rhinosinusitis can lead to serious orbital, intracranial, and bony complications if not properly treated. The document describes the various classifications of orbital complications including preseptal cellulitis, orbital cellulitis, subperiosteal abscess, and orbital abscess. It also details intracranial complications such as meningitis, epidural/subdural empyema, brain abscess, and cavernous sinus thrombosis. Treatment involves antibiotics, surgical drainage if needed, and management of the underlying sinusitis. Failure to improve or clinical deterioration despite treatment indicates the need for more aggressive management.
The document discusses otogenic brain abscesses, which occur when a middle ear infection spreads beyond the ear to nearby structures like the brain. Key points:
- CT scans are crucial for accurately diagnosing brain abscesses and associated complications like meningitis or thrombosis. They also guide treatment and allow monitoring of resolution.
- Common pathogens are anaerobic bacteria. Treatment involves IV antibiotics, steroids, and surgery like burr hole drainage or mastoidectomy depending on abscess location.
- Residual abscesses may require repeat drainage. CT scans after treatment confirm full resolution before discharge to prevent recurrence of infection.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
2. HISTORICAL NOTES
● Hippocrates (460 B.C)
“Acute pain of the ear with
continued high fever is to be
dreaded for the patient may
become delirious & die”
3. ● Roman physicist celcus (25 AD)
“Inflammation & pains of the ear lead sometimes to insanity &
death”.
● Arabian physician Avicenna (980-1037 AD) stated that the ear
discharge was due to the brain disease.
● Morgagni (1682-1771), noted that the ear infection comes first
before the brain abscess.
● McEwen in 1881 showed great surgical success - 18 patients
recovered out of 19 operated cases of brain abscess.
4. Factors influencing development of complications
● Infective organism
● Virulence
● Susceptibility to antibiotics
● Adequacy of medication
● Resistance of host
● Type of pneumatization
● History of previous otitis media.
5. DEFENSE MECHANISM
● Ability of mucous membrane to localise & overcome infection.
● Intact bony walls of tympanic cavity & pneumatic cells.
● Granulation tissue.
7. OSTEOTHROMBOPHLEBITIS
➢ Infection pass from lining mucosa of the middle ear & mastoid
through intact bone by progressive thrombophlebitis of small
venules.
➢ Occur in acute middle ear infection or acute exacerbations of
chronic infection.
➢ Complication occurs early.
➢ Prodromal period is lacking.
➢ Bony walls of the middle ear & mastoid is intact.
➢ Bone & mucoperiosteum lining of mastoid air cells are inflamed and
bleed easily.
8. BONE EROSION
➢ Nearly always the manner of spread in COM.
➢ Complication occurs several weeks later.
➢ A prodromal period of partial or intermittent involvement precedes
diffuse involvement.
➢ At operation, dehiscence of the bony barrier is found.
➢ A layer of granulation cover the exposed soft tissue of neighbouring
structure.
➢ Treatment should always include the removal of suppurating, bone
eroding focus.
12. MENINGITIS
❖ MC intracranial complication of otitis media.
❖ Spreads directly through necrotic bone of middle ear.
❖ As a complication of suppurative labyrinthitis, through Internal
Acoustic meatus, vestibular & cochlear aqueducts.
13. contd...
Pia-arachnoid inflamed
Outpouring of fluid in the subarachnoid space
Raised intracranial pressure
White blood cells & multiplying organisms in CSF
Irritation of upper cervical nerve roots
17. INVESTIGATIONS
❖ HRCT.
❖ MRI with gadolinium contrast.
❖ Lumbar puncture
➢ Turbid,purulent
➢ Glucose nearly to zero
➢ Protein content
➢ Polymorphs in CSF
➢ Gram staining
➢ Culture & sensitivity.
18. TREATMENT
❖ HIGH DOSE ANTIBIOTICS
➢ Empirical therapy:
3rd generation cephalosporins + vancomycin.
❖ CORTICOSTEROIDS
➢ A 4 day regime of 0.6 mg/kg/day in four divided doses
started before or with the antibiotics.
SURGERY : surgical exterenation of the diseased mastoid once
patient is stabilised.
19. OTOGENIC BRAIN ABSCESS
➢ Focal suppurative process within the brain parenchyma
surrounded by a region of encephalitis.
➢ Often the result of venous thrombophlebitis rather than direct
dural extension.
➢ Can occur in temporal lobe or cerebellum.
➢ Polymicrobial culture including anaerobes:
○ Gram +ve-> streptococcus & staphylococcus species
○ Gram -ve -> E coli, proteus, klebsiella & pseudomonas.
○ Anaerobic -> bacteroides.
23. TREATMENT
➢ MEDICAL
○ High dose IV broad spectrum antibiotics
○ Dexamethasone
○ Anti epileptic- phenytoin.
➢ SURGICAL:
○ Neurosurgical intervention of draining the abscess is quintessential
○ Once the patient is stable , mastoidectomy can be done.
24. OTOGENIC SUPPURATIVE THROMBOPHLEBITIS
➢ Simultaneous presence of venous thrombosis & suppuration in
the intracranial cavity.
➢ Often associated with perisinus extradural abscess.
➢ Can also occur by osteo thrombophlebitic extension via small
venules.
➢ The infected mural thrombus can extend cranially to sagittal
sinus or cavernous sinus via superior & inferior petrosal sinus.
➢ It can also extend caudally to Internal Jugular vein thereby to
the right atrium.
27. PATHOGENESIS
Erosion of the bone covering the sigmoid sinus
Immune status of host osteothrombophlebitic extension
Perisinus abscess/inflammation
Inflammation of outer wall (dura) of sinus
Inflammation of intima (inner wall of sinus)
Platelet, RBCs,fibrin,WBCs
Adhere to inflamed area
MURAL THROMBUS
Mural thrombus propagates, obliterating lumen
28. CLINICAL FEATURES
➢ Picket fence fever, with diurnal temp exceeding 103℉
➢ Headache
➢ Griesinger ’s sign
➢ Papilloedema
➢ Vision loss
➢ Tenderness along the anterior border of sternomastoid muscle
➢ Proptosis & chemosis - CST
➢ Otalgia
➢ Queckenstedt or Tobey-ayer test.
31. TREATMENT
➢ High dose antibiotics
➢ Anticoagulation if CST
present.
➢ Surgical exploration &
removal of clot.
➢ Internal jugular vein ligation.
32. OTITIC HYDROCEPHALUS
➢ Raised intracranial pressure with normal CSF findings.
➢ Benign raised intracranial tension.
➢ Commonly associated with sigmoid sinus thrombosis.
➢ Spontaneous recovery.
33. MECHANISM
➢ SYMOND: retrograde extension of thrombophlebitis from sigmoid sinus
to superior sagittal sinus
Blockage of arachnoid villi
CSF absorption & secretion
➢ Increase in CSF volume
➢ Secondary to brain edema
➢ Disruption in venous circulation.
37. EPIDURAL (EXTRADURAL) ABSCESS
➢ Occurs after bone demineralisation or bone erosion adjacent to the
middle or posterior fossa sura.
➢ Middle fossa extradural abscess:
○ Lateral: erosion of tegmen tympani, strip a large area of dura
from the inner surface of squamous temporal bone.
○ Medial: infection of petrous apex causes middle fossa
extradural abscess medial to arcuate eminence, irritates
trigeminal nerve & 6th cranial nerve. ( gradenigo syn).
➢ Posterior fossa extradural abscess:
○ In close association with lateral sinus.
○ Spread is laterally limited by internal acoustic meatus.
38. CLINICAL FEATURES
➢ Usually asymptomatic
➢ Gradenigo syndrome:
○ Otorrhea
○ Retro orbital pain
○ Diplopia
➢ Persistent headache on the side of otitis media.
➢ General malaise with low grade fever.
➢ Disappearance of headache with free flow of pus from the ear (
spontaneous abscess drainage).
40. SUBDURAL EMPYEMA
➢ Collection of pus between dura and arachnoid mater.
➢ Spread of infection through the dura with formation of granulation
tissue in the subdural space.
41. PATHOLOGY:
OTITIS MEDIA
EROSION OF TEGMEN BRAIN ABSCESS THROMBOPHLEBITIS
EROSION OF DURA BRAIN ABSCESS RUPTURES
INFECTION IN SUBDURAL SPACE
EXPANDING MASS LESION
43. DIAGNOSIS by CT or MRI
➢ TREATMENT:
○ Surgical drainage of abscess.
○ High dose IV antibiotics.
○ Once stabilised neurologically, then underlying ear disease
managed.
○ Antiepileptic medication
46. ACUTE MASTOIDITIS
● It is the extension of middle ear inflammation into antrum &
mastoid air cells.
● Mastoid antrum & epitympanum communicate freely through
aditus ad antrum.
● Common in children.
● Causative organisms include strep. pneumoniae , strep
pyogenes, staph aureus, Haemophilus influenzae, and
pseudomonas aeruginosa.
47. Pathogenesis
● Following otitis media - tympanomastoiditis.
● Blockade of aditus - loculation of mucopurulent material within
antrum and air cells.
● Persistent blockade of aditus - retrograde thrombophlebitis -
edema and cellulitis of tissues overlying mastoid.
● If pus not drained - necrosis and demineralisation of bony
trabeculae - ‘coalescent mastoiditis’.
● Where the entire mastoid becomes a single cavity filled with pus.
48. Clinical features
Symptoms:
● Earache
● Fever
● Ear discharge - profuse and purulent
Signs:
● Mastoid tenderness.
● Sagging of postero-superior meatal wall
● TM perforation
● Swelling, redness, bulging over the mastoid (ironed out mastoid)
● Hearing loss ( conductive)
53. MASKED MASTOIDITIS
Slow destruction of mastoid air cells.
Acute sign & symptoms of acute mastoiditis are absent.
Inadequate antibiotic therapy - dose, frequency, duration.
Pain, discharge, fever, mastoid swelling - absent.
Mostly progress to complication.
Mastoidectomy - extensive destruction of air cells
Granulation tissue
Dark gelatinous material filling the mastoid.
54. PETROSITIS
Inflammation of pneumatized spaces of the petrous part of the temporal
bone.
Petrous bone - two groups of air cell tracts- communicate mastoid &
middle ear to the petrous apex.
Postero superior tract: in continuity with mastoid antrum, epitympanum
that clusters around semicircular canals at the base of pyramid.
Antero inferior tract: In continuity with the mesotympanum,
protympanum, and hypotympanum & passes around the cochlea to
petrous apex.
Petrositis may be acute or chronic.
55. ● Acute petrositis
● Middle ear inflammation- antrum and mastoid
air cells - medial progression involving petrous
pyramid.
● If inflammatory products are retained- osteitis
of petrous apex .
● Gradenigo syndrome -
● Ear discharge
● Retro Orbital pain (Trigeminal nerve)
● Diplopia ( lateral rectus palsy -
Abducens nerve)
● Chronic petrositis
● In addition to inflammatory changes - new bone
formation & resorption
56. Management :
Investigations:
● CT temporal bone.
Treatment :
● Systemic antibiotics.
● Radical mastoidectomy with skeletonization
of semicircular canals to remove disease
from middle ear and petrous apex.
● Approaches to petrous apex
● Eagleton’s approach.
● Thornwalt’s operation.
● Almoor’s approach.
● Ramadier’ s operation.
● Freckner’s operation.
58. FACIAL NERVE PARALYSIS
Complication of both acute and chronic otitis media.
ROUTES OF SPREAD:
● Natural dehiscence - dehiscence of fallopian canal.
● Natural pathways - ex, canal for stapedius, neurovascular bundle.
● Direct extension - ex, osteitis around fallopian canal.
Toxins and ischemia probably have an ancillary role.
TREATMENT:
In AOM- myringotomy & appropriate antibiotic for 10 days.
In COM - CWD mastoidectomy with decompression of the fallopian
canal, antibiotics.
59. LABYRINTHITIS
Inflammation of inner ear/ labyrinth.
Pathogenesis:
-spread through round window, fistula, preformed pathways.
-inflammatory products pass into perilymph of scala tympani by
diapedesis from adjacent labyrinthine vessels.
- fibrillary precipitate accumulates in perilymphatic and
endolymphatic spaces.
60. Symptoms & signs
● Vertigo
● Loss of balance
● nausea/ vomiting
● nystagmus
● High frequency SNHL
● Hearing distortion
● diplacusis
61. Treatment
● Complete bed rest - with restriction of head movement
● Parenteral chlorperazine / cinnarizine
● Dehydration - IV fluids.
● IV antibiotics.
● Acute infection - Myringotomy
● Chronic infection - mastoid exploration
62. Labyrinthine fistula
Complication of COM
Results from erosion of endochondral bone of bony labyrinth- movement
of perilymph and structures of endolymphatic compartments when
pressure in EAC changes.
Most commonly - dome of lateral SCC.
Cholesteatoma found in all cases.
Incidence of fistula in cholesteatoma is 7-10%
63. symptoms/signs
● Short periods of imbalance.
● Vertigo
● Tullio’s phenomenon - feeling of imbalance on sudden exposure to
loud noises.
● Fistula sign - positive.
● Investigations
● CT - erosion of lateral SCC
● cholesteatoma
64. Treatment
Canal wall down mastoidectomy
- All cholesteatoma is removed except for small area around fistula
site. After careful removal of cholesteatoma debri without
disturbing matrix. Matrix is elevated. A small piece of tissue / thin
cap of bone placed over site and secured with fibrin glue / packing
after the cholesteatoma is removed.
- Risk of removing cholesteatoma from fistula is total / partial loss of
hearing.