1. COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA

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

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

5. EXTRACRANIAL COMPLICATIONS
Otitis externa
Retropharyngeal abscess
Septicemia

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

7. ACUTE MASTOIDITIS

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

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

13. 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

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

17. 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.

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

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

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

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

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

31. 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

32. 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”

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

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

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

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

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

38. 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

39. 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

40. LATERAL SINUS THROMBOPHLEBITIS
Pathology
Perisinusitis
Mural thrombus
Occluding thrombus
Suppuration
Embolization

41. 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

42. Subtraction Angiogram
MRI Angiogram CT

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

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

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

47. 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

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

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

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

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

53. OTOGENIC BRAIN ABSCESS
25% of children's and 50% of adult’s brain abscesses are otogenic
Mostly in temporal lobe or cerebellum (2:1)

54. OTOGENIC BRAIN ABSCESS
Clinical manifestations
General manifestations:fever, lethargy, headache.
Manifestation of raised IC pressure
Focal manifestations
Temporal: Aphasia, hemianopia, paralysis
Cerebellar: ataxia, vertigo, nystagmus, muscle incoordination

55. OTOGENIC BRAIN ABSCESS
Diagnosis CT
MRI LP
Burr hole needling

56. CT

57. MRI

58. OTOGENIC BRAIN ABSCESS
Treatment
Repeated aspiration
Excision

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

60. 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

61. 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

62. THANK YOU