COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA

Factors influencing development of complications

1.Age2.Poor socio-economic group3.Virulence of organisms4.Immune compromised host5.Preformed pathways6.Cholesteatoma

Pathways of spread of infection1.Direct bone erosion-hyperaemic

decalcification(a/c infection),osteitis,cholesteatoma,granulation 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

Classification

complications of otitis media

intra temporal intracranial

INTRATEMPORAL COMPLICATIONS1.Mastoiditis2.Petrositis3.Facial paralysis4.labyrinthitis

1)mastoiditis

acute mastoiditis masked mastoiditis

1a.Acute mastoiditis

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 Β hemolytic strep,anaerobic org

Pathology

1,production of pus under tension2,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 with

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 tenderness2.Ear discharge –mucopurulent or purulent

often pulsatile(light house effect)3.Sagging of posterosuperior meatal wall4.Perforation of TM-small,wid congestion of

rest of TM5.Swelling over the mastoid6.Hearing loss-CHL7.General findins-low grade fever,appear ill

&toxic

investigations

1.TC,DLC2.ESR3.X-ray mastoid4.CT temporal bone5.Ear swab

dds

a)Suppuration of mastoid lymph nodesb)Furunculosis of meatusc)Infected sebaceous cyst

treatment

Hospitalisation of the patient Antibiotics Myringotomy Cortical mastoidectomy

complications

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

Abscesses in relation to mastoid infection1.Post auricular abscess2.Zygomatic abscess3.Bezold abscess4.Meatal abscess(luc s abscess)5.Citelli s abscess6.Parapharyngeal or retropharyngeal

abscess

1b)Masked (latent)mastoiditis 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

treatment

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)

treatment

Cortical,radical or modified radical mastoidectomy

iv antibiotics

3)Facial paralysis

Results either from cholesteatoma or from penetrating granulation tissue

Destruction of bony canal Insidious &slowly progressive

treatment

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 serous diffuse

suppurative

Circumscribed labyrinthitis(fistula of labyrinth) Thinning or erosion of bony capsule

of labyrinth(usually HSCC)

cfs

c/o transient vertigo Diagnosed by fistula test

treatment

Mastoid exploration Systemic antibiotic therapy

Diffuse 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

TREATMENT

Medical a)pt is put to bed,head immobilised with

affected ear aboveb)Antibioticsc)Labyrinthine sedatives-prochloperazine

or dimenhydrinated)Myringotomy SurgicalCortical or modified radical mastoidectomy

Diffuse 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

treatment

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

intralabyrinthine suppuration is acting as a source of intracranial complications

Thank you……