Comp Supp Otitis Media2

8/9/2019 Comp Supp Otitis Media2

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COMPLICATIONS OFSUPPURATIVE OTITIS MEDIA

Presented by: VIKASH GOOMANY

Roll no: 18


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CLASSIFICATION

Intra-temporal complications

Intra-cranial complications

Extra-cranial complications


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EXTRA-CRANIALCOMPLICATIONS

External otitis.

Cervical lymphadenitis

Retropharyngeal abscess

Parapharyngeal abscess


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INTRA-TEMPORALCOMPLICATIONS

Acute mastoiditis and mastoid abscesses (most

common complication).

Petrositis.

Labyrinthitis.

Facial paralysis.Osteomyelitis of the temporal bone


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INTRA-CRANIALCOMPLICATIONS

Extradural abscess (commonest intracranialcomplication)

Subdural abscess

Meningitis

Brain abscess:

Temporal lobe abscess

Cerebellar abscess

Lateral sinus thrombophlebitis

Otitic hydrocephalus


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INTRA-TEMPORALCOMPLICATIONS


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PETROSITIS

Petrous bone of 3 types: pneumatised, diploic and

sclerotic

Only in pneumatised petrous pyramids ( 30 %

normal subjects)

2 cell tracts

Infections runs along the cell tracts

Poor drainage and bony coalescence symptoms


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SYMPTOMS

GRADenigo syndrome

Classical presentation and consists of the following

triad

Retro-orbital Pain

Abducent N palsy Diplopia

Discharge from earHowever it is uncommon to see full triad


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SYMPTOMS(CONTD)

Associated symptoms:

Fever

Headache

Vomiting

Neck rigidity

If facial and statoacoustic nerves involved:

Paralysis

Recurrent vertigo


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DIAGNOSIS

CT scan

Bony details of petrous apex and air cells

MRI

Differentiate diploic marrow containing apex

from pus or fluid


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TREATMENT

Mastoidectomy

Cortical, radial or modified radical if not done before

Fistulous tract is found out and enlarged to provide free

drainage

Intravenous antibacterial therapy

Given initially high doses and continued for 4-5 days

after disappearance of symptoms


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FACIAL PARALYSIS

1. AOM


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Other procedures done:

Myringotomy (occasionally)

Cortical mastoidectomy (rarely)

Operative decompression is unnecessary


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FACIAL PARALYSIS

2. CSOM

Paralysis by bony covering eroded by

cholesteatoma or granulation tissue

Pressure on nerve by a cholesteatoma sac

Diagnosis

Slow onset, associated ear discharge

CT Scan


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Treatment

Urgent operative exploration of middle ear and mastoid

for cholesteatoma and granulation tissue

Cholesteatoma removed from surface of nerve

Granulation tissue is left untouched

Healthy bone removed decompression

Full recovery in 70% of pts


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LABYRINTHITIS

3 types of labyrinthitis

Circumscribed

Diffused serous

Diffuse suppurative


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CIRCUMSCRIBED LABYRINTHITIS

Thinning and erosion of bony capsule oflabyrinth(horizontal scc)

Symptoms

Vertigo induced by pressure on tragus, cleaning or performing

Vasalva manoeuvre

Diagnosis by fistula test

Pressure on tragus causes vertigo and nystagmus

Siegles speculum(+ve pressure to ear canal)

Treatment

Mastoid exploration to eliminate cause of CSOM or cholesteatoma

Antibiotic to prevent infection during operation


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DIFFUSE SEROUS LABYRINTHITIS

Diffuse intralabyrinthine inflammation without pus

formation and reversible if treated properly

Follows circumscribed labyrinthitis or

cholesteastoma

Symptoms

Vertigo with marked nausea, vomiting and spontaneous

nystagmus

SN hearing loss

Loss of vestibular and cochlear function


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MANAGEMENT

Medical

Complete bed rest

Parental prochlorperazine / cinnarizine for vertigo

Parental antibiotics

Vestibular head exercises

Surgical

Exploration of mastoid

Not necessary to drain a dead labyrinth


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SUPPURATIVE LABYRINTHITIS

Due to unchecked serous labyrinthitis

Clinical features

Violent vertigo and vomiting

SN loss

Nystagmus

Loss of cochelar fn is evidence of transition to irreversible

suppurative state dead labyrinthitis

Diagnosis

CT Scan

Treatment same as serous type


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INTRA-CRANIALCOMPLICATIONS


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EXTRADURAL ABSCESS

Pus between the dura and bone Occurs in both ac and chr infections of middle ear

Pathology In acute otitis media

bone over dura destroyed by hyperemic decalcification

In chronic otitis media Bone is destroyed by cholesteastoma where pus comes

directly in contact with bone


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Inf can also occur by venous thrombophlebitis(bone

intact)

Affected dura may be covered with granulations or

appear unhealthy and discoloured


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EXTRADURAL ABSCESS

Clinical features

Incidental finding or

Chronic ear discharge, malaise

Persistent headache that disappear with drainage of pus

severe pain in ear

Diagnosis contrast enhanced CT and MRI

Management

Pus evacuated, bone removed(mastoidectomy),

granulation tissue left

Antibiotics, treat other complication


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REFERENCES

Internet

Diseases of ENT - Dhingra


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Thank you for your kind attention

Documents

Comp Supp Otitis Media2