EAR - Complications of Chronic Suppurative Otitis Media

What are the different modes of spread of infection that can lead to complications in otitis media?

Complications are usually seen in chronic unsafe type of otitis media accompanied with cholesteatoma. The different modes of spread of infection are as under:

1. Direct extension through the de-mineralized bone seen in cholesteatoma
2. Blood borne spread via the veins, through bone and dura to the venous sinuses. More common in acute infection. Lateral sinus thrombophlebitis causes spread of infection to the cerebellum
3. Through round or oval window into the auditory meatus on the vestibular aqueducts
4. Dehiscence of bony covering over the jugular bulb or the tegmen tympani
5. Neoplastic or accidental bony erosion
6. Through surgical defects in post stapedectomy surgery.

What are the different complications of chronic suppuration otitis media?

The different complications of chronic suppuration otitis media are divided into:

I. Intracranial complications
II. Extracranial complications

Describe the types, clinical features and treatment of intracranial complications of chronic suppuration otitis media.

Types of intracranial complications of chronic suppuration otitis media:

1. Extradural abscess
2. Subdural abscess
3. Meningitis
4. Brain abscess
5. Lateral sinus thrombophlebitis.
6. Otitic hydrocephalus

General symptoms of intracranial infection occur due to the following:

1. Due to the infection itself
2. Due to compression of the brain tissue

Clinical features of intracranial complications of chronic suppuration otitis media:

1. Headache
2. Malaise
3. Fever, drowsiness
4. Neck rigidity with Kernig's sign positive.
5. Hemiplegia with cranial nerve involvement

Treatment of intracranial complications of chronic suppuration otitis media:

1. Systemic antibiotics to control infection
2. Mastoidectomy to control ear infection
3. Neurosurgical opinion to manage the intracranial abscesses

Describe the types of extracranial complications of chronic suppuration otitis media along with their investigations and treatment.

Types of extracranial complications of chronic suppuration otitis media:

Mastoid infections:
1. Mastoiditis
2. Petrositis
3. Labyrinthitis
4. Facial paralysis
5. Mastoid abscesses:

  • Post auricular abscess (along zygomatic process in front of deep to sternomastoid muscle)
  • Zygomatic abscess
  • Bezold's abscess (along the medial aspect of mastoid tip upto sheath of sternomastoid)
  • Citelli's abscess (along posterior belly of diagnostic)
  • Luc's abscess(along the posterior wall of the external auditory canal)

Investigations:

1. Blood investigation
2. X-ray mastoid Schuller's view
3. High resolution CT Scan to know the extent of disease
4. Fundoscopy to rule out papilloedema
5. Lumbar puncture for CSF examination

Treatment of extracranial complications of chronic suppuration otitis media:

1. Systemic antibiotics to control the infection
2. Drainage of the abscess
3. Mastoidectomy to clear the primary infection



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