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COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA

COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA. ROUTES OF SPREAD. Direct extension Thrombophlebitis Normal anatomical pathways Non anatomical bony defects. COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA. Extracranial complications Cranial (intra-temporal) complications Intracranial complications.

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COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA

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  1. COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA

  2. ROUTES OF SPREAD • Direct extension • Thrombophlebitis • Normal anatomical pathways • Non anatomical bony defects

  3. COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA • Extracranial complications • Cranial (intra-temporal) complications • Intracranial complications

  4. EXTRACRANIAL COMPLICATIONS • Otitis externa • Retropharyngeal abscess • Septicemia

  5. CRANIAL (INTRATEMPORAL) COMPLICATIONS • Acute mastoiditis • Petrositis • Facial nerve paralysis • Labyrinthine fistula and labyrinthitis

  6. ACUTE MASTOIDITIS

  7. PATHOLOGY OF ACUTE MASTOIDITIS Involvement of the bone of the mastoid air cells by acute suppurative inflammation

  8. 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 Bezold’s abscess

  9. 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 Bezold’s abscess • Imaging

  10. TREATMENT OF ACUTE MASTOIDITIS • IV antibiotics • Cortical mastoidectomy if medical treatment fails or if there are signs of abscess formation • Observe for other complication

  11. CORTICAL “SIMPLE” MASTOIDECTOMY An 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.

  12. CRANIAL (INTRATEMPORAL) COMPLICATIONS • Acute mastoiditis • Petrositis (apical apicitis) • Facial nerve paralysis • Labyrinthine fistula and labyrinthitis

  13. PETROSITIS (PETROUS APICITIS) An extension of infection from the middle ear into a pneumatized petrous apex.

  14. DIAGNOSIS OF PETROSITIS • Gradenigo’s syndrome • Otitis media (otorrhea) • Retro-orbital pain • Squint (VI cranial nerve palsy) • Imaging

  15. TREATMENT OF PETROSITIS • Antibiotics and myringotomy • Surgical drainage if medical treatment fails

  16. CRANIAL (INTRATEMPORAL) COMPLICATIONS • Acute mastoiditis • Petrositis • Facial nerve paralysis • Labyrinthine fistula and labyrinthitis

  17. 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

  18. 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”

  19. CRANIAL (INTRATEMPORAL) COMPLICATIONS • Acute mastoiditis • Petrositis (apical apicitis) • Facial nerve paralysis • Labyrinthine fistula and labyrinthitis

  20. PATHOLOGY OF LABYRINTHITIS • Labyrinthine fistula • Circumscribed labyrinthitis • Acute diffuse serous labyrinthitis • Acute diffuse suppurative labyrinthitis • Chronic labyrinthitis

  21. DEFINITION OF LABYRINTHINE FISTULA Loss of the bony labyrinthine wall exposing the endosteum

  22. DIAGNOSIS OF LABYRITHINE FISTULA • No symptoms • Vertigo • SNHL • Fistula test • CT scan

  23. INTRACRANIAL COMPLICATIONS • Extradural abscess • Lateral sinus thrombophlebitis • Subdural empyema • Meningitis • Brain abscess • Otitic hydrocephalus

  24. EXTRADURAL ABSCESS • Accumulation of pus between dura and bone • In the middle or posterior fossa (perisinus) • Causes headache but may be silent • Diagnosis is confirmed by CT or MRI • Treatment is by drainage

  25. 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

  26. LATERAL SINUS THROMBOPHLEBITIS Pathology • Perisinusitis • Mural thrombus • Occluding thrombus • Suppuration • Embolization

  27. LATERAL SINUS THROMBOPHLEBITIS Diagnosis • 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

  28. Subtraction Angiogram MRI Angiogram CT

  29. TREATMENT OF SINUS THROMBOPHLEBITIS • IV antibiotics • Surgery should follow within 48 hours unless there is dramatic clinical and radiological improvement

  30. SURGICAL TREATMENT OF SINUS THROMBOPHLEBITIS • Exposure of healthy dura proximal and distal

  31. SURGICAL TREATMENT OF SINUS THROMBOPHLEBITIS • Exposure of healthy dura proximal and distal • Verify the sinus content

  32. SURGICAL TREATMENT OF SINUS THROMBOPHLEBITIS • Exposure of healthy dura proximal and distal • Verify the sinus content • Blood clot: leave alone • Pus:incise to drain • Ligate only if there is repeated embolisms or uncontrolled extension

  33. INTRACRANIAL COMPLICATIONS • Extradural abscess • Lateral sinus thrombophlebitis • Subdural empyema • Meningitis • Brain abscess • Otitic hydrocephalus

  34. OTOGENIC MENINGITIS • Infection of the subarachnoid space • The most common intracranial complication • Fever, headache, neck stiffness, phonophobia, restlessness etc • Kernig’s & Brudziniski signs

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