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Complications of suppurative otitis media
1. Chronic suppurative otitis media (CSOM) can lead to both cranial (intratemporal) and extra-cranial complications. Cranial complications include mastoiditis, petrositis, labyrinthitis, facial paralysis, and perilymphatic fistula. 2. Intra-cranial complications occur when infections penetrate bony barriers and spread to the dura mater, arachnoid, or pia mater, causing epidural abscesses, subdural abscesses, meningitis, or brain abscesses. Lateral sinus thrombosis is a serious complication resulting from direct extension or via the mastoid emissary vein. 3.
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Complications of suppurative otitis media
- 1. COMPLICATIONS C.S.O.M. Dr. Mohammad Aslam Chaudhry Professor E.N.T (BBH)
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- 3. “Medial wall ofmiddle ear”
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- 5. Complications of CSOM •classification 1. Cranial (Intra-temporal ) 2. Extra-cranial complications 3. Intra-cranial complications
- 7. Pre-disposing factors • Age • Virulent organisms • Cholesteatoma or Bone erosion • Presence of a congenital dehiscence • Obstruction of drainage e.g polyp • Low resistance of the patient • Poor socio-economic status
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- 9. Pathways of infections •The commonest way for extension of infection is by bone erosion due to a cholesteatoma. • Vascular extension (retrograde thrombophlebitis). • Extension along preformed pathways as – Congenital dehiscences, fracture lines, round window membrane, the labyrinth, – Dehiscences due to previous surgery.
- 10. COMPLICATIONS OF CSOM Routs of spread
- 11. Cranial complications (Intratemporal ) 1. Mastoiditis 2. Petrositis 3. Labyrinthitis 4. Facial paralysis 5. Perilymphatic fistula
- 12. Mastoiditis • Inflammation of mastoid air cells • Acute vs Chronic • Fever • 2 weeks after OM • Earache • Irritability
- 14. Labyrinthitis • • Infection of the inner ear • • SNHL • • Vertigo • • Nausea and vomiting
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- 16. Tympanosclerosis • Asymptomatic • Indicator of OM • Ear drum stiffness • Ossicular fixation
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- 18. • 56 yr • Earache • Chronic Discharge
- 19. Facial Paralysis • Slow– chronic expansion of disease • Rapid – infected cholesteatoma • With cholesteatoma requires immediate surgery • CT localizes involved portion
- 20. Facial Paralysis Management • Mastoidectomy,Remove cholesteatoma and infected debris • IV antibiotics and +/- steroids.
- 21. Petrositis • Only in pneumatised petrous pyramids • Infected petrous cells • Poor drainage • Bony coalescence → symptoms
- 22. • GRADENIGO • Retro-orbitalpain • Abducent→ Diplopia • Discharge
- 23. Extra-cranial complications • Otitis externa • Cervical lymphadenitis • Retropharyngeal & • Parapharyngeal abscesses
- 24. Impending sign @symptoms • Decreased mental status • Stiff neck • Ataxia • Visual changes • Seizures • Other Headache, lethargy, fever.
- 25. INTRACRANIAL COMLICATIONS • Barrierspenetration 1. Bone → Epidural Abscess → LST 2. Dura Mater → Subdural Abscess 3. Arachnoid →Meningitis 4. Pia Mater → Brain Abscess
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- 28. Lateral Sinus Thrombosis(sigmoid sinus) Spread of infection by direct extension or via mastoid emissary vein ↓ Pus and granulation adjacent to sigmoid sinus ↓ Reactive thrombophlebitis ↓ intraluminal thrombus ↓ CSF obstruction
- 29. Signs of LST •Picket-fence fever • Papilledema • Torticollis • Greisinger sign →
- 30. LST • LST is rare complication • CT • Angiography • MRI- MRV
- 31. LST ……Treatment • Empiricbroad coverage until C&S • antibiotic with good CSF penetration • Surgery – Mastoidectomy – Decompression – Thrombus evacuation
- 32. Intracranial Epidural Abscess •Localized between dura and bone • dural adherence to bone at suture lines • Focal osteomyelitis • Management and etiology same as subdural empyema
- 33. Subdural Abscess • Betweenthe dura and the arachnoid. • Potential space • Lack of anatomical boundaries → spread rapidly • Ear 14% • (paranasal sinusitis 75%)
- 34. Subdural Abscess -clinical • Fever • Focal neurological deficit • Headache • Seizures • Forehead or eye swelling from emissary vein thrombosis • Vomiting
- 35. Subdural Abscess -evaluation • CT of head both with and without contrast • LP - hazardous - risk of transtentorial herniation
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- 37. Meningitis: Clinical Manifestations • Headache • Nuchal rigidity • Fever and chills • Photophobia • Vomiting • Seizures • Focal neurologic symptoms • Altered sensorium (confusion, delirium, or declining level of consciousness)
- 38. Physical Examination Kernig &Brudzinski signs have low sensitivity but high specificity
- 39. Brain Abscess -Clinical Presentation • non-specific Symptoms for abscess • increased intracranial pressure • –Headache, • –Nausea/Vomiting • – Lethargy. • – Seizures.
- 40. Otic hydrocephalus Symptoms • Non-specific •Headache • Tinnitus • Nausea / vomiting • Visual disturbance • Others – lethargy, dizziness, mood change
- 41. TX • Decrease theIC pressure – Corticosteriods – Acetazolamide – Lumbar pucture • I/V Antibiotics • Mastoidectomy
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