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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
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)
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
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
2)petrositis
Spread of infection from the middle
cfs
GRADENIGO S SYNDROME
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
treatm ent
Urgent exploration of middle ear &mastoid
Inspect facial canal from the geniculate ganglion
labyrinthitis
Circumscribed
diffuse
diffuse serous
suppurative
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
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
D iff
use suppurative
labyrinthitis
aetiology
Following serous labyrinthitis
Pyogenic organisms entering
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