COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA

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COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA
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ROUTES OF SPREAD

• Direct extension
• Thrombophlebitis
• Normal anatomical pathways
• Non anatomical bony defects

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COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA

• Extracranial complications
• Cranial (intra-temporal) complications
• Intracranial complications

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EXTRACRANIAL COMPLICATIONS

• Otitis externa
• Retropharyngeal abscess
• Septicemia

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CRANIAL (INTRATEMPORAL) COMPLICATIONS

• Acute mastoiditis
• Petrositis
• Facial nerve paralysis
• Labyrinthine fistula and labyrinthitis

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ACUTE MASTOIDITIS
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PATHOLOGY OF ACUTE MASTOIDITIS

• Involvement of the bone of the mastoid air cells
  by acute suppurative inflammation

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DIAGNOSIS OF ACUTE MASTOIDITIS

• General constitutional manifestations
• Tympanic membrane changes
• Sagging of posterosuperior meatal wall
• Otorrhea and reservoir sign
• Retroauricular tender red swelling
• Subperiosteal and Bezolds abscess

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DIAGNOSIS OF ACUTE MASTOIDITIS

• General constitutional manifestations
• Tympanic membrane changes
• Sagging of posterosuperior meatal wall
• Otorrhea and reservoir sign
• Retroauricular tender red swelling
• Subperiosteal and Bezolds abscess
• Imaging

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TREATMENT OF ACUTE MASTOIDITIS

• IV antibiotics
• Cortical mastoidectomy if medical treatment fails
  or if there are signs of abscess formation
• Observe for other complication

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CORTICAL SIMPLE MASTOIDECTOMY

• An operation in which the mastoid antrum and air
  cells are converted into one cavity without
  disturbing the middle or external ears. It may be
  combined with myringotomy.

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CRANIAL (INTRATEMPORAL) COMPLICATIONS

• Acute mastoiditis
• Petrositis (apical apicitis)
• Facial nerve paralysis
• Labyrinthine fistula and labyrinthitis

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PETROSITIS (PETROUS APICITIS)

• An extension of infection from the middle ear
  into a pneumatized petrous apex.

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DIAGNOSIS OF PETROSITIS

• Gradenigos syndrome
• Otitis media (otorrhea)
• Retro-orbital pain
• Squint (VI cranial nerve palsy)
• Imaging

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TREATMENT OF PETROSITIS

• Antibiotics and myringotomy
• Surgical drainage if medical treatment fails

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CRANIAL (INTRATEMPORAL) COMPLICATIONS

• Acute mastoiditis
• Petrositis
• Facial nerve paralysis
• Labyrinthine fistula and labyrinthitis

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FACIAL PARALYSIS IN AOM

• Mostly due to pressure on a dehiscent nerve by
  inflammatory products
• Usually is partial and sudden in onset
• Treatment is by antibiotics and myringotomy

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FACIAL PARALYSIS IN CSOM

• Usually is due to pressure by cholesteatoma or
  granulation tissue
• Insidious in onset
• May be partial or complete
• Treatment is by immediate surgical exploration
  and proceed

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CRANIAL (INTRATEMPORAL) COMPLICATIONS

• Acute mastoiditis
• Petrositis (apical apicitis)
• Facial nerve paralysis
• Labyrinthine fistula and labyrinthitis

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PATHOLOGY OF LABYRINTHITIS

• Labyrinthine fistula
• Circumscribed labyrinthitis
• Acute diffuse serous labyrinthitis
• Acute diffuse suppurative labyrinthitis
• Chronic labyrinthitis

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DEFINITION OF LABYRINTHINE FISTULA

• Loss of the bony labyrinthine wall exposing the
  endosteum

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DIAGNOSIS OF LABYRITHINE FISTULA

• No symptoms
• Vertigo
• SNHL
• Fistula test
• CT scan

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INTRACRANIAL COMPLICATIONS

• Extradural abscess
• Lateral sinus thrombophlebitis
• Subdural empyema
• Meningitis
• Brain abscess
• Otitic hydrocephalus

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EXTRADURAL ABSCESS

• Accumulation of pus between dura and bone
• In the middle or posterior fossa (perisinus)
• Causes headache but may be silent
• Diagnosis is confirmed by CT or MRI
• Treatment is by drainage

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SUBDURAL ABSCESS (EMPYEMA)

• Suppuration of the subdural space
• May be localized, multiple or diffuse
• Sever headache, fever, irritative and paralytic
  focal neurological symptoms
• CT and MRI
• Treatment is by neurosurgical drainage

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LATERAL SINUS THROMBOPHLEBITIS

• Pathology
• Perisinusitis
• Mural thrombus
• Occluding thrombus
• Suppuration
• Embolization

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LATERAL SINUS THROMBOPHLEBITIS

• Diagnosis
• Fever, rigor, and sweating
• Headache and neck pain
• Tenderness and edema in the neck
• Manifestation of increased IC pressure
• Propagation and embolic manifestations
• Blood culture, CSF manometry
• CT, MRI

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Subtraction Angiogram
MRI Angiogram
CT
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TREATMENT OF SINUS THROMBOPHLEBITIS

• IV antibiotics
• Surgery should follow within 48 hours unless
  there is dramatic clinical and radiological
  improvement

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SURGICAL TREATMENT OF SINUS THROMBOPHLEBITIS

• Exposure of healthy dura proximal and distal

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SURGICAL TREATMENT OF SINUS THROMBOPHLEBITIS

• Exposure of healthy dura proximal and distal
• Verify the sinus content

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SURGICAL TREATMENT OF SINUS THROMBOPHLEBITIS

• Exposure of healthy dura proximal and distal
• Verify the sinus content
• Blood clot leave alone
• Pusincise to drain
• Ligate only if there is repeated embolisms or
  uncontrolled extension

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INTRACRANIAL COMPLICATIONS

• Extradural abscess
• Lateral sinus thrombophlebitis
• Subdural empyema
• Meningitis
• Brain abscess
• Otitic hydrocephalus

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OTOGENIC MENINGITIS

• Infection of the subarachnoid space
• The most common intracranial complication
• Fever, headache, neck stiffness, phonophobia,
  restlessness etc
• Kernigs Brudziniski signs

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OTOGENIC MENINGITIS

• Infection of the subarachnoid space
• The most common intracranial complication
• Fever, headache, neck stiffness, phonophobia,
  restlessness etc
• Kernigs Brudziniski signs
• Lumber puncture

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INTRACRANIAL COMPLICATIONS

• Extradural abscess
• Lateral sinus thrombophlebitis
• Subdural empyema
• Meningitis
• Brain abscess
• Otitic hydrocephalus

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OTOGENIC BRAIN ABSCESS

• 25 of children's and 50 of adults brain
  abscesses are otogenic
• Mostly in temporal lobe or cerebellum (21)

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OTOGENIC BRAIN ABSCESS

• Clinical manifestations
• General manifestationsfever, lethargy, headache.
• Manifestation of raised IC pressure
• Focal manifestations
• Temporal Aphasia, hemianopia, paralysis
• Cerebellar ataxia, vertigo, nystagmus, muscle
  incoordination

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OTOGENIC BRAIN ABSCESS

• Diagnosis
• CT
• MRI
• LP
• Burr hole needling

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CT
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MRI
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OTOGENIC BRAIN ABSCESS

• Treatment
• Repeated aspiration
• Excision

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INTRACRANIAL COMPLICATIONS

• Extradural abscess
• Lateral sinus thrombophlebitis
• Subdural empyema
• Meningitis
• Brain abscess
• Otitic hydrocephalus

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OTITIC HYDROCEPHALUS

• Very rare
• An idiopathic benign intracranial hypertension
  associated with ear disease. It most often
  follows lateral sinus thrombophlebitis
• Clinically Manifestations of increased IC
  pressure
• Treatmentsteroids, diuretics, hyperosmolar
  dehydrating agents, repeated LP

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GENERAL PRINCIPLES OF TREATMENT OF THE
COMPLICATIONS

• Parental antibiotics
• Surgery for the complication if applicable
• Treatment of the ear lesion
• Myringotomy in AOM
• Mastoidectomy in CSOM

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