This document discusses chronic suppurative otitis media, including factors that contribute to it, classifications, potential complications, and treatments. It covers both intratemporal complications like mastoiditis, petrositis, and facial paralysis, as well as intracranial complications such as extradural abscess, subdural abscess, meningitis, and brain abscess. For each complication, it discusses the pathology, clinical features, investigations, differential diagnosis, and treatment approaches.
3. Factors
Age
Poor socioeconomic group
Virulence of organism
Immune-compromised host
Preformed pathways
Cholesteatoma
4. Pathways spread of infection
Direct bone erosion
Venous thrombophlebitis
Preformed pathways
Congenital dehiscences
Patent sutures
Previous skull fractures
Surgical defects
Oval and round windows
Infection from labyrinth
5. Sequelae of otitis media
Perforation of
tympanic
membrane
Ossicular erosion
Atelectasis and
adhesive otitis
media
Tympanosclerosis
Cholesteatoma
formation
Conductive
hearing loss
Sensorineural
hearing loss
*Speech
impairment
*Learning
disabilities
9. A. [i] ACUTE MASTOIDITIS
Inflammation of
mucosal lining
of antrum and
mastoid air cell
system
mucosa bony
walls
10. Accompanies / follow
ASOM
1. Virulence of organism
2. Lowered resistance
3. Children
1. Production of pus
under tension
Production > drainage
2. Hyperaemic
decalcification and
osteoclastic resorption
of bony wall
Destruction,
coalescence of
mastoid air cell
[empyema of mastoid]
subperiosteal
Aetiology PATHOLOGY
11. Clinical Features
Pain behind the ear
Fever
Ear discharge
Mastoid tenderness
Light house effect (
pulsatile purulent
discharge)
Sagging of
posterosuperior meatal
wall
Perforation of tympanic
membrane
Swelling over the
mastoid
Hearing loss
SYMPTOMS SIGNS
16. Abscesses in relation to mastoid
infection
Postauricular abscess
Zygomatic abscess
Bezold abscess
Meatal abscess (Luc
abscess)
Behind the mastoid (Citelli’s
abscess)
Para/retropharyngeal
abscess
17. A. (ii) MASKED (LATENT)
MASTOIDITIS
Slow destruction of mastoid air cells with no sign
and symptoms
Destruction of air cells + dark gelatinous material +
Eroded tegmen tympani and sinus plate +
extradural or perisinus abscess
Aetiology :
Inadequate dose/ duration/ frequency of antibiotic
18. Mild pain behind ear +
Persistent hearing loss
Thick , opaque
tympanic membrane
Tenderness over
mastoid
Audiometry- conductive
hearing loss
X-ray mastoid- clouding
of air cells with loss of
cell outline
Cortical
mastoidectomy
Antibiotics
CLINICAL
FEATURES
TREATMENT
19. B.PETROSITIS
Spread from middle ear
and mastoid to petrous
part of temporal bone
Associated with acute
coalescent /latent
mastoiditis or chronic
middle ear infection
22. Treatment
Cortical, modified radical /radical
mastoidectomy
Find fistulous tract, curette and enlarge
free drainage
IV antibiotic + surgical intervention
Only antibiotics: Initial 4-5 days of high
dose systemic antibiotics
23. C. FACIAL PARALYSIS
Result from cholesteatoma /penetrating
granulation tissue
Cholesteatoma destroys bony canal + edema
pressure on nerve
Insidious but slowly progressive
Treatment:
Exploration of middle ear and mastoid
Uncapped cholesteatoma
Remove granulation tissue if not involving nerve
sheath
Resection of nerve and grafting after infection
controlled and fibrosis matured
28. A. EXTRADURAL ABSCESS
Collection of pus
between the bone and
dura
Pathology:
Destroyed by
cholesteatomapus
contact directly with dura
Venous thrombophlebitis
dura is intact
Dura covered by
granulations / appear
unhealthy and
29. Asymptomatic
Persistent headache
on the side of otitis
media
Severe pain in ear
General malaise with
low grade fever
Pulsatile purulent ear
discharge
Disappearance of
headache with free
flow of pus from the
ear
Cortical / modified
radical /radical
mastoidectomy
Antibiotic X 5 days
Diagnosis: contrast
enhanced CT or MRI
CLINICAL FEATURE TREATMENT
30. B. SUBDURAL ABSCESS
Pus between dura and
archnoid
Pathology
Spreads by erosion of
bone and dura
/thrombophlebitic
process subdural
space and comes to lie
against the convex
surface of cerebral
hemisphere
Clinical features
Meningeal irritation [
headache, fever, neck
rigidity, Kernig’s sign]
Cortical venous
thrombophlebitis [
aphasia, hemiplegia]
Raised ICP [
papilledema, ptosis,
dilated pupil ]
Treatment:
burr holes /craniotomy
for drainage +IV
antibiotics
31. C. MENINGITIS
Inflammation of pia
and arachnoid
Most common
intracranial
complication
Mode of infection
Blood-borne
Chronic ear disease
Fever with chills and
rigors
Headache
Neck rigidity
Photophobia and mental
irritability
Nausea and vomiting
Drowsiness, delirium or
coma
Cranial nerve palsies and
hemiplegia
CLINICAL
FEATURES
33. D. OTOGENIC BRAIN ABSCESS
Adult ( 50%) : CSOM with
cholesteatoma
Child ( 25%) : acute otitis media
Route of infection:
Cerebral : direct extension through
tegmen /retrograde thrombophlebitis
Cerebellar : direct extension through
Trautmann’s triangle / retrograde
thrombophlebitis
Bacteriology:
aerobic [ SP, PM, EC,]
Anaerobic [ BF, HI]
34. Pathology
Stage of invasion (initial
encephalitis)
Headache, low grade fever,
malaise, drowsiness
Stage of localization (latent
abscess)
Stage of enlargement
(manifest abscess)
Edema raised ICP
Stage of termination
(rupture of abscess)
35. Clinical features
1.Symptoms and
signs of raised ICP
Headache
Nausea and vomiting
Level of
consciousness
Papilloedema
Slow pulse and
subnormal
temperature
37. Skull x-ray
CT scan
X-ray mastoids or CT
scan
Lumbar puncture
Antibiotics IV
Dexamethasone or
mannitol
Suction clearance and
topical drops
Repeated aspiration
through a burr hole
Excision of abscess
Open incision of the
abscess and evacuation
of pus
Radical mastoidectomy
INVESTIGATION TREATMENT
38. E.LATERAL SINUS
THROMBOPHLEBITIS
Inflammation of inner wall of lateral venous sinus with
formation of intrasinus thrombus
Occur due to acute coalescent mastoiditis, masked
mastoiditis, chronic suppuration of middle ear and
cholesteatoma
Pathology:
Formation of
perisinus
abscess
Endophlebitis
and mural
thrombus
formation
Obliteration of
sinus lumen
and intrasinus
abscess
Extension of
thrombus
39. Acute- haemolytic
streptococcus,
pneumococcus or
staphylococcus
Chronic- +
cholesteatoma,
Bacillus proteus,
Pseudomonas
pyocyaneus, E. coli
and staphylococci
Hectic Picket-fence
type of fever with
rigors
Headache
Progressive anaemia
and emaciation
Griesinger’s sign
Papilloedema
Tobey-Ayer test,
Crowe-Beck test
Tenderness along
jugular vein
BACTERIOLOGY
CLINICAL
FEATURES:
40. Blood smear
Blood culture
CSF examination
X-ray mastoid
Imaging studies
Culture and sensitivity
Septicaemia and
pyaemic abscess in
lungs, bones, joints or
subcuteaneous tissue
Meningitis and subdural
abscess
Cerebellar abscess
Thrombosis of jugular
bulb and jugular vein
Cavernous sinus
thormbosis
Otitic hydrocephalus
INVESTIGATION COMPLICATION
41. Treatment
Intravenous antibacterial drugs
C/ MR mastoidectomy and exposure of sinus
Ligation of internal jugular vein
Failed antibiotic and surgical treatment
Spreading tenderness along jugular vein
Anticoagulant therapy
Supportive treatment
42. F.OTITIC HYDROCEPHALUS
Raised ICP with normal CSF findings
In children with acute/ chronic middle ear infection
Lateral sinus thrombosis obstruction +
extension to superior sagittal sinus decreased
absorption
Clinical features
Symptoms:
• Severe
headache
• Diplopia
• Blurring of vision
Signs:
• Papilloedem
a
• Nystagmus
43. Treatment:
Reduce CSF pressure to
prevent optic atrophy and
blindness
Acetazolamide and
corticosteroids
Repeated lumbar
puncture / placement of
lumbar drain,
lumboperitoneal shunt
Antibiotic therapy and
mastoid exploration
Notas do Editor
2. mastoiditis: clouding of air cell, unclear bony partitions, cavity
Scalp infc LN enlarged n supp , no ho OM, ear disc, superficial
No ho OM,painful pinna movement, enlarge pre/post aur LN, normal TM, boil/furuncle
Except for subperiosteal abscess, all are also compl of CSOM
Runs along these cells tracts and reaches the petrous apex
Forming epidural abscess involving cranial nerve VI and trigeminal gangion
Can also be compl of ACOM, dehiscent bony canaln nerve under middle ear mucosa,
3rd nerve
Inc cell and protein, dec sugar
Worse in morning, projectile,leth, drowsy, conf, stup, coma,
Face first, uncinate gyrus, transtentorial herniation
To lesion side, finger nose,
Lower icp, ear discharge
Abscess on outer dural wall of sinus, infl cause thrombus,
IRREGULAR FEVER WITH SEV PEAKS PER DAY, CR,mild due to perisinus abscess, eryth n edema over posterior part o mastoid
Blur disc margin, retinal hemo, cbt healthy side caus eretinal engorged retinal vein