Complications of Otits Media

  • Complications of otitis media are classified into two main groups:
  • Mastoiditis
  • Mastoid Abscess:Subperiosteal,Zygomatic,Bezold's,Citelli's,Luc's Abscess.
  • Petrositis
  • Facial paralysis:Most common nerve to be damaged in CSOM is Facial Nerve.
  • Labyrinthitis
  • Extradural abscess
  • Subdural abscess
  • Meningitis
  • Brain abscess
  • Lateral sinus thrombophlebitis
  • Commonest complication of CSOM
  • Patients usually presents with fever ,deafness and Pain and tenderness over mastoid tip.
  • Retro auricular swelling.
  • Outward and downward deviation of the pinna.
  • Otorrhea-Pulsatile ear discharge – light house effect.
  • Sagging of posterosuperior meatal wall
  • It is best diagnosed using CT scan. It shows clouding of the mastoid air cells and middle ear spaces. It can also demonstrate erosion of the mastoid bone structure. Treatment – Antibiotics, Cortical mastoidectomy
  • Bezold abscess – pus breaks through the thin medial side of the tip of the mastoid and presents as a swelling in the upper part of neck
  • Luc abscess – meatal abscess
  • Citelli's abscess – abscess behind the mastoid towards the occipital bone
  • The syndrome is produced by disease of the apex of the petrous bone and most often occurs as a rare complication of otitis media with mastoiditis or petrous bone tumors.
  • Gradenigo's syndrome is the classical presentation and consists of a triad of : -
  • External rectus palsy (VIth nerve/abducent nerve palsy) causing diplopia.
  • Deep seated orbital or retroorbital pain (Vth nerve involvement).
  • Persistent ear discharge due to ipsilateral acute or chronic otitis media.
  • Associated symptoms of otitis media are also present e.g., conductive deafness
  • Circumscribed labyrinthitis:
  • Thinning or erosion of bony capsule of labyrinth, usually of the horizontal semicircular canal
  • In a patient with CSOM, labrynthine fistula most commnonly involves Lateral SCC.
  • CSOM is the most common cause
  • Transient vertigo induced by pressure on tragus, cleaning the ear or Valsalva manoeuvre
Diffuse serous labyrinthitis:
  • Diffuse intralabyrinthine inflammation without pus formation
  • Reversible if treated early
  • Circumscribed labyrinthitis is the most common cause
  • Spontaneous nystagmus with quick component towards affected ear
Diffuse suppurative labyrinthitis
  • Diffuse pyogenic inflammation with permanent loss of vestibular and cochlear function
  • Usually follows serous labyrinthitis
  • Spontaneous nystagmus with quick component towards healthy side
  • Hectic Picket-fence type of fever with rigors
  • Griesinger's sign- due to thrombosis of mastoid emissary vein, edema over posterior part of mastoid
  • Papilledema
  • Tobey-Ayer test :
  • Compression of jugular vein on thrombosed side – no effect on CSF pressure
  • Compression of jugular vein on the normal side – rapid rise in CSF pressure
  • Crowe-Beck test: pressure on the jug. vein on healthy side – engorgement of retinal & supra orbital veins
  • Tenderness along Jugular vein
  • Contrast CT/MRI: delta sign
Exam Question
  • Commonest complication of CSOM is Mastoiditis.
  • Gradenigo's syndrome involves V, VI cranial nerves.
  • Features of Gradenigo Syndrome include Diplopia,retro-orbital pain (due to involvement of the Cranial nerves VI and V),persistent ear discharge.
  • Extracranial complications of CSOM:Mastoiditis, Mastoid Abscess(Subperiosteal,Zygomatic,Bezold's,Citelli's,Luc's Abscess), Petrositis, Facial paralysis ,Labyrinthitis
  • Acute mastoiditis is characterized by Clouding of air cells ,Deafness and Outward and downward deviation of the pinna.
  • Essential radiological feature of acute mastoiditis is Clouding of air cells of Mastoid.
  • In Mastoiditis ,tenderness present at tip.
  • Gradenigo's Syndrome is caused by abscess over the apex of Petrous bone.
  • Most common nerve to be damaged in CSOM is Facial Nerve.
  • In a patient with CSOM, labrynthine fistula most commnonly involves Lateral SCC.
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