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.

1. Intracranial Complications of Otitis Media
Department of ENT
Presenter-Surendra Poudel
(2010/58)

2. Intracranial Complications of Otitis
Media
 Meningitis
 Otogenic brain abscess
 Lateral sinus thrombophlebitis
 Epidural abscess
 Subdural abscess
 Otitic hydrocephalus

3. 1. Meningitis
 Inflammation of leptomeninges(piamater and
arachnoid mater) .
 Most common and serious intracranial complication.
 Follows Acute otitis media (AOM) in children and
infants (blood borne spread);
 And Chronic suppurative otitis media(CSOM) in
adults. (bone erosion or retrograde thrombophlebitis).

4. Clinical features
 Rise in temperature(102-104∙F)often with chills and
rigor
 Headache
 Neck rigidity
 Photophobia and mental irritability
 Nausea and vomiting(sometimes projectile)
 Drowsiness which may progress to delirium or coma
 Cranial nerve palsies and hemiplegia

5. On examination
 Neck rigidity
 Kernig’s sign positive
 Brudzinski’s sign positive
 Tendon reflexes exaggerated initially but later become
sluggish or absent

6. Diagnosis
 History and clinical presentation
 Investigation;
lumbar puncture: cell count , protein, sugar
CT scan , MRI
Treatment
 Antimicrobials with Dexamethasone
 Surgical controversial) only in cases of antimicrobials
failing to respond in 48 hrs

7. 2. Otogenic Brain Abscess
 Develops in the temporal lobe or the cerebellum of the
affected side .
 Temporal lobe abscess is twice as common as
cerebellar abscess.
 In children, 25% of brain abscesses are otogenic;
50% in case of adults

8. Brain abscess develops through 4 stages
 1. Stage of invasion (initial encephalitis)
-usually asymptomatic
 2. Stage of localisation(latent abscess)
 3. Stage of enlargement(manifest abscess)
-aggravation of symptoms
 4. Stage of termination(rupture of abscess)
- fatal meningitis

9. Pathology
Diagram showing evolution of brain
abscess

10. Clinical features
Due to raised ICP;
Headache
Nausea and vomiting
Level of consciousness
Papilloedema
Slow pulse and subnormal temperature

11. Localising features
Temporal lobe abscess Cerebellar abscess
Nominal aphasia Headache
Homonymous hemianopia Spontaneous nystagmus
Contralateral motor paralysis Ipsilateral hypotonia and
weakness
Epileptic fits Ipsilateral ataxia
Pupillary changes and
oculomotor palsy
Past pointing and intentio
tremor
Dysdiadochokinesia

12. Investigations
Skull X ray, CT scan , X ray mastoids or CT scan, lumbarpubcture
Treatment
Medical -
 high dose intravenous broad spectrum antibiotics
ceftriaxone +metronidazole+gentamicin
 Dexamethasone
 Anti epileptics: phenytoin
 Antibiotics ear drop andayral toilet
Surgical-
 Multidisciplinary(Neurosurgeon +ENT surgeon)
- surgical drainage of the abscess, followed by mastoidectomy to clear the
ear disorder.

13. 3. Lateral sinus thrombophlebitis
 Inflammation of inner wall of lateral venous sinus with
formation of an intrasinus thrombus

14. Pathophysiology
Erosion of sigmoid sinus plate  peri-sinus abscess  inflammation of
outer wall  endophlebitis  mural thrombus infect, Propagate
or  size  occlusion of sinus lumen  intra-sinus abscess 
propagating infected thrombus

15. Clinical features
 Hectic Picket-fence type of fever with rigors
 Headache
 Progressive anaemia and emaciation
 Griesinger’s sign(pathognomic)
 Papilloedema
 Tobey-Ayer test
 Crowe-Beck test
 Tenderness along jugular vein

16. Investigations
Blood smear, culture
 CSF examination
 X ray mastoids
 Imaging
 Culture and sensitivity of ear swab
Treatment
IV antibiotics
Mastoidectomy: Cortical (AOM), R/MRM (COM)
 Expose the sinus  Confirm by look, feel &
 aspiration  Evacuation

17. 4. Epidural abscess
 Collection of pus between the bone and duramater

18. Pathophysiology
 The affected dura is covered with granulation and
appear unhealthy and discolored
 In AOM, bone over dura- destroyed by hyperemic
decalcification.
 In COM, destroyed by cholesteatoma.

19. Clinical features
 Usu. Asymptomatic, and discovered accidentally
during surgery(cortical or modified radial
mastoidectomy)
 However , presence is suspected when there is,
1. Persistent headache on the side of OM
2. Severe pain in the ear
3. General malaise with low grade fever
4. Pulsatile purulent ear discharge
5. Disappearance of headache with free flow of pus
from the ear(spontaneous abscess drainage)

20.  Diagnosis :
contrast enhanced CT or MRI
Treatment:
Antimicrobial therapy
surgical exploration

21. 5. Subdural abscess
 Collection of pus between dura and arachnoid mater

22. Pathology

23. Clinical features
Meningeal irritation •Fever(102*F or more)
•Headache
•Malaise, drowsiness
•Neck rigidity
•Kernig’s sign positive
Thrombophlebitis
(cortical veins of cerebrum)
•aphasia
•Hemianopia
•Hemiplegia
•Jacksonian type of epileptic
fits
Raised ICP 3rd nerve
involvement;papilloedema,
ptosis,dilated pupil

24.  Diagnosis by CT or MRI
 Treatment
 surgical emergency: managed by neurosurgeon
Treatment of choice:
High dose iv antibiotics
Once stabilised neurologically, then underlying ear
disease managed
Surgery of ear
Antiepileptic medication

25. Otitic hydrocephalus
 Characterised by raised intracranial pressure with
normal CSF findings.
 It is seen in children and adolescents with acute or
chronic middle ear infections
 Mechanism:
lateral sinus thrombosis -> obstruction of venous
return. If thrombosis extends to superior sagittal
sinus,it will also impede the function of arachnoid
villi->Raised ICP

26. Cliniacal features
 Headache
 Drowsiness
 Nausea & Vomiting
 Blurring of vision
 Diplopia
 Papilloedema
 6th CN nerve palsy
 Eventually optic atrophy

27. Investigations
 Lumbar Puncture
 Elevated CSF pressures with normal biochemistry
 Done with caution (herniation)
 CT scan
 MRI:
 Imaging modality of choice
 Allows for superior evaluation of venous sinuses

28. Management
Goal
 Eradication of ear disease and
 Lowering elevated intracranial pressure
Recommendations
 Decompression of sigmoid sinus
 CSF fluid drainage – shunts
 Optic Sheath decompression: To prevent optic
atrophy
Medical:
 Mannitol
 Diuretics
 Corticosteroids
 Acetazolamide

29. Thank you