04- Ear IV - Complications_OM

7/30/2019 04- Ear IV - Complications_OM

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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

MASTOIDECTOMYAn 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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COMPLICATIONS

Acute mastoiditis

Petrositis (apical apicitis)




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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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COMPLICATIONS

Acute mastoiditis

Petrositis




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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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COMPLICATIONS

Acute mastoiditis

Petrositis (apical apicitis)




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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 posteriorfossa (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

THROMBOPHLEBITISPathology

Perisinusitis

Mural thrombus

Occluding thrombus

Suppuration

Embolization


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LATERAL SINUS

THROMBOPHLEBITISDiagnosis

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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CT Subtraction

AngiogramMRI

Angiogram


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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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distal

Verify the sinus content


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distal

Verify the sinus content

Blood clot: leave alone

Pus:incise to drain

Ligate only if there is repeated embolisms

or uncontrolled extension


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INTRACRANIAL



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



Subdural empyema

Meningitis

Brain abscess



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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 (2:1)


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Clinical manifestations

General manifestations:fever, lethargy,

headache. Manifestation of raised IC pressure

Focal manifestations

Temporal: Aphasia, hemianopia, paralysisCerebellar: ataxia, vertigo, nystagmus, muscle

incoordination


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Diagnosis

CT

MRI

LP

Burr hole needling


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CT


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MRI


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Treatment

Repeated aspiration

Excision


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INTRACRANIAL



Subdural empyema

Meningitis

Brain abscess



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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

Treatment:steroids, diuretics, hyperosmolar

dehydrating agents, repeated LP

GENERAL PRINCIPLES OF


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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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THANK YOU

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04- Ear IV - Complications_OM