Complication of suppurative otitis media :-
Whether the preceding disease has acute or chronic spread of
infection can fallow a number of routes .
1-Extension via bone that has been demineralized during
acute infection , resorption by cholesteatoma or osteitis in
chronic destructive disease .
2-Infected clot within small veins .
3-Oval or round windows.
4-Fracture temporal bone .
5-After stapedectomy .
6-Via periarteriolar spaces to the white matter of brain .
The development of the complication depend on
1-Patients factors--- age,immunity ( DM , Leukaemia).
2-bacterial factors ---- type and virulence of M.O .
3-Tretmeant efficacy of the underlying middle ear disease .
Classification of the CSOM complication
Intracranial 1-Extra Dural abscess .
2-subdural abscess .
3- Sigmoid sinus thrombophlebitis.
4-Meningitis .
5-Brain abscess .
6-Otitic hydrocephalus .
Complications within the temporal bone :
1-Mastoiditis .
2-Petrositis .
3-Facial paralysis .
4-Labyrinthine infections .
Managements of the intracranial complication of
CSOM :-e
The presentation , Diagnosis and treatment of
intracranial complication are common to all .
The symptom as headach ,malaise , fever and drowsiness’ .
any of previous symptom should alert the Otologist to the
possibility of complication and provoke initiation of
investigation and treatment without delay .
The principles of treatment common to all of the intracranial
complication :-1-Systemic antibiotic .
2-Identification of local neurological signs .
3-Treatment of ear disease .
Antibiotic therapy : general principles
1-Large dose and IV route .
2-Start treatment without waiting of culture sensitivity test ,
than change the AB according response of the patient and
result of sensitivity test .
3- When the ear infection is acute most probably due to
H.Influnsae the droug of choice is chloromphenicol
100 mg /kg/day , sometime need to combind with
gentamecin for G-ive MO , 4-5 mg /kg/day and fallow by
s.creatinin level in chronic ear disease .claforan is bactericidal
for Beta-lactamase producing cocci and for gram-negative MO ,
flagyl 400-600 mg/8hr to caver G-ive anaerobic MO .
Identification of local neurological signs by
clinical (neurological) examination and investigation
as: CT scan ,MRI ,Lumber puncture , EEG .
Treatment of the ear disease :-
Acute otitis media—1-proper antibiotic .
2-Myringotomy .
3-sometime cortical mastiodectomy .
Chronic otitis media—Treatment of the ear disease started
after control of the intracranial complication except in those
when Therese deterioration in the patient state in spite medical
treatment so need early surgical intervention as radical or
modified radical mastoidectomy
Extracranial complications :-
1-mastoiditis :-
Infection of the mastoid bone occurs in two
main form , Acute and chronic , depending on the type of otitis
media , age of the patient .
Acute mastoiditis mostly seen in children as complication of
acute otitis media , But chronic mastoiditis mostly seen in adult
age as complication of chronic suppurative otitis media(CSOM) .
Pathogenesis:
Acute mastoiditis occurred as a result of large amount of pus
formation in the middle ear cleft lead to increase pressure
inside the cleft lead to decalcification and subperiosteal abscess
formation .
Chronic mastoiditis occurred after CSOM with or without
cholesteatoma lead to invasion of the bone by granulation
tissue or cholesteatoma .
Clinical picture :-
1-recurrent or persistent pain after acute supp.otitis
media(ASOM) resolved .
2- recurrent or persistent fever (ASOM) resolved .
3-Ear discharge after ASOM resolved .
4-persistent deafness .
Signs--- 1-tenderness over mastoid bone .
2-swalling over mastoid bone .
3-sagging of posterior meatal well skin .
4-abnormal drum .
Diagnosis ---1-C.P
2-Radiologecal = X-ray mastoid .
c.T scan temporal bone .
3-blood exa. =hight WBC
Hight ESR
Treatment ----Acut mastoiditis with subperiosteal abscess
regarded as potential surgical emergency , surgical drainage or
cortical mastoidectomy .
Labyrinthitis =
The infection may extend to the labyrinth via 1-round window
2-blood vessels 3-surgical or traumatic or pathological fistula .
Pathology= classified to
1-circumscribed labyrinthitis the inflammatory
processes out side the endosteal lining of the labyrinth .
2-serous labyrinthitis only few round cells in the
perilymph without microorganisms .
3-purulant labyrinthitis pus with microorganisms
in the perilymph and endolymph of labyrinth .
4-dead labyrinth It’s the later stage , due to
obliteration of the labyrinth by granulation tissue or fibrosis
then bone formation .
C.P---Patient suffering from acute or chronic middle ear
infection , present with violent vertigo and vomiting with sever
sensaryneural hearing loss , irritetive jerk nystagmus beating
toward the infected ear .
The vestibular symptom subside but the hearing loss is
permanent .
Treatment=
1-Bed rest .
2-vestibular sedative as stimetil or stugeron or betasarke .
3-antibiotic as ampicillin with chloromphencol .
4-surgical treatment as myringotomy or cortical
mastoidectomy in acute cases , and mastoid exploration in
chronic ear infection .
Petrositis ----(gradingo syndrome)
Facial N. paralysis (Bells palsy)