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COMPLICATIONS OF

SUPPURATIVE OTITIS
MEDIA

Factors infl
uencing developm ent ofcom plications

1.Age
2.Poor socio-economic group
3.Virulence of organisms
4.Immune compromised host
5.Preformed pathways
6.Cholesteatoma

Pathw ays ofspread of


infection
1.Direct bone erosion-hyperaemic
decalcification(a/c
infection),osteitis,cholesteatoma,gra
nulation tissue (c/c)
2.Venous thrombophlebitis-V of HS
dural V dural venous sinuses
supfl veins of brain
3.Preformed pathways-congenital
dehiscences,patent sutures,prevous
skull fractures etc

Classifi
cation
complications of otitis
media

intra temporal
intracranial

IN TRATEM PO RAL
CO M PLICATIO N S
1.Mastoiditis
2.Petrositis
3.Facial paralysis
4.labyrinthitis

1)m astoiditis
acute mastoiditis
mastoiditis

masked

1a.Acute m astoiditis
When infection spreads from the
mucosa,lining the mastoid air cells
&antrum,to involve bony walls of the
mastoid air cell system.

aetiology
ASOM
High virulence,lowered resistance
Children
hemolytic strep,anaerobic org

Pathology
1,production of pus under tension
2,hyperaemic decalcification and
osteoclastic resorption of bony walls
both these processes combine
cause destruction
&coalescence of mastoid cells
single irregular cavity filled
with pus
(EMPYEMA of
MASTOID)

Pus may break through mastoid

cortex leading to subperiosteal


abscess which may even burst on
surface leading into a discharging
fistula

Patient presents w ith


1.Pain behind the ear
(persistence,increase in intensity or
recurrence of pain)
2.fever(persistence or recurrence of
fever)
3.Ear discharge(becomes profuse and
increase in purulence)
persistence of discharge
beyond 3 wks in a case of ASOM
mastoiditis

signs
1.Mastoid tenderness
2.Ear discharge mucopurulent or purulent
often pulsatile(light house effect)
3.Sagging of posterosuperior meatal wall
4.Perforation of TM-small,wid congestion of
rest of TM
5.Swelling over the mastoid
6.Hearing loss-CHL
7.General findins-low grade fever,appear ill
&toxic

investigations
1.TC,DLC
2.ESR
3.X-ray mastoid
4.CT temporal bone
5.Ear swab

dds
a)Suppuration of mastoid lymph nodes
b)Furunculosis of meatus
c)Infected sebaceous cyst

treatm ent
Hospitalisation of the patient
Antibiotics
Myringotomy
Cortical mastoidectomy

com plications
Subperiosteal abscess
Labyrinthitis
Facial paralysis
Petrositis
Extradural abscess
Subdural abscess
Meningitis
Brain abscess
Lateral sinus thrombophlebitis
Otitic hydrocephalus

Abscesses in relation to
m astoid infection
1.Post auricular abscess
2.Zygomatic abscess
3.Bezold abscess
4.Meatal abscess(luc s abscess)
5.Citelli s abscess
6.Parapharyngeal or retropharyngeal
abscess

1b)M asked (latent)m astoiditis


Slow destruction of mastoid air cells

but without the acute signs


&symptoms
(no pain,no fever,no discharge,no
mastoid swelling)
Mastoidectomy show extensive
destruction of the air cells with
granulation tissue and dark
gelatinous material filling the
mastoid

Aetiology
From inadequate antibiotic therapy

cfs
Child
Mild pain behind the ear
Persistence of hearing loss
TM appears thick with loss of

translucency
Tenderness over mastoid
Audiometry-CHL
X-ray mastoid-clouding of air cells

treatm ent
Cortical mastoidectomy with full

doses of anti biotics

2)petrositis
Spread of infection from the middle

ear and mastoid to the petrous part


of temporal bone
Pneumatisation of petrous apex
usually thru 2 recognised cell tracts
1.posterosuperior tract
2.anteroinferior tract

cfs
GRADENIGO S SYNDROME

a)external rectus palsy(VI N)Diplopia


b)Deep seated ear or retro
orbital pain
c)persistent ear Discharge
Fever,headache,vomiting,neck
rigidity,facial paralysis,recurrent
vertigo

diagnosis
CT scan-temporal

bone(pmeumatisation of petrous
apex)
MRI(diploic marrow-fluid or pus)

treatm ent
Cortical,radical or modified radical

mastoidectomy
iv antibiotics

3)Facialparalysis
Results either from cholesteatoma or

from penetrating granulation tissue


Destruction of bony canal
Insidious &slowly progressive

treatm ent
Urgent exploration of middle ear &mastoid
Inspect facial canal from the geniculate ganglion

to the stylomastoid foramen


Cholesteatoma in the bony canal is uncapped in
the area of involvement
Granulation tissue surrounding the nerve is
removed
If it is actually invades the N sheath ,it is left in
place
If a segment of nerve is destroyed by the
granulation tissue resection of nerve and grafting
after control of infections

labyrinthitis
Circumscribed
diffuse

diffuse serous

suppurative

Circum scribed labyrinthitis


(fi
stula oflabyrinth)
Thinning or erosion of bony capsule

of labyrinth(usually HSCC)

cfs
c/o transient vertigo
Diagnosed by fistula test

treatm ent
Mastoid exploration
Systemic antibiotic therapy

D iff
use serous labyrinthitis
Diffuse intralabyrinthine

inflammation without pus formation


Reversible condition if treated early

aetiology
Pre existing circumscribed

labyrinthitis
In acute infections of middle ear
inflamn spreads thru annular
ligament or the round window
Following stapedectomy or
fenestration operation

cfs
Vertigo
Nausea
Vomiting
Spontaneous nystagmus
SNHL

TREATM EN T
Medical

a)pt is put to bed,head immobilised with


affected ear above
b)Antibiotics
c)Labyrinthine sedatives-prochloperazine
or dimenhydrinate
d)Myringotomy
Surgical
Cortical or modified radical mastoidectomy

D iff
use suppurative
labyrinthitis

Diffuse pyogenic infection of

labyrinth with permanent loss of


vestibular and cochlear infections

aetiology
Following serous labyrinthitis
Pyogenic organisms entering

through a pathological or surgical


fistula

cfs
Severe vertigo with nausea and

vomiting
Spontaneous nystagmus
Total loss of hearing

treatm ent
Same as for for serous labyrinthitis
Drainage of labyrinth is required if

intralabyrinthine suppuration is
acting as a source of intracranial
complications

Thank you

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