The complications of acute and chronic otitis media

Dr Abdulrahman AlsanosiAssociate professor

Otolaryngology consultant Otologist Neurotologist ampSkull Base

Surgeon Director of cochlear implant program

King Abdulaziz University Hospitalamp KFMChttpfacultyksuedusaalsanosidefaultaspx

What are the predisposing factors for developing complications

Predisposing factors

bull Virulent organisms

bull Cholesteatoma and bone erosion

bull Obstruction of drainage eg by a polyp

bull Low resistance of the patient

What are the pathways for spreading of infections beyond the ear

Pathways of infection

bull The commonest way for extension ofinfection is by bone erosion due to a cholesteatoma

bull Vascular extension (retrograde thrombophlebitis)

bull Extension along preformed pathways asndash Congenital dehiscences fracture lines roundwindow membrane the labyrinthndash Dehiscences due to previous surgery

How do you classify the complicationsof otitis media

Classification

bull Intra-cranial complicationsbull Intratemporal complicationsbull Extra-cranial complications

Complications of otitis media

ExtracranialbullRetropharyngeal

abscessbullParapharyngeal

abscess bullLymphadentitis

IntratemporalbullMastoiditis bullPetrositis bullLabyrinthitis bullFacial paralysisbullLabyrinthine

fistula

IntracranialbullExtradural abscessbullSubdural abscessbullBrain abscessbullMeninigitis bullSinus

thrombophilbitis

Intra-cranial complications

What are the intracranial complications What is the commonest

How does patient with possible intracranial complications present with

What investigations to do to diagnose such complications

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

What are the predisposing factors for developing complications

Predisposing factors

bull Virulent organisms

bull Cholesteatoma and bone erosion

bull Obstruction of drainage eg by a polyp

bull Low resistance of the patient

What are the pathways for spreading of infections beyond the ear

Pathways of infection

bull The commonest way for extension ofinfection is by bone erosion due to a cholesteatoma

bull Vascular extension (retrograde thrombophlebitis)

bull Extension along preformed pathways asndash Congenital dehiscences fracture lines roundwindow membrane the labyrinthndash Dehiscences due to previous surgery

How do you classify the complicationsof otitis media

Classification

bull Intra-cranial complicationsbull Intratemporal complicationsbull Extra-cranial complications

Complications of otitis media

ExtracranialbullRetropharyngeal

abscessbullParapharyngeal

abscess bullLymphadentitis

IntratemporalbullMastoiditis bullPetrositis bullLabyrinthitis bullFacial paralysisbullLabyrinthine

fistula

IntracranialbullExtradural abscessbullSubdural abscessbullBrain abscessbullMeninigitis bullSinus

thrombophilbitis

Intra-cranial complications

What are the intracranial complications What is the commonest

How does patient with possible intracranial complications present with

What investigations to do to diagnose such complications

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Predisposing factors

bull Virulent organisms

bull Cholesteatoma and bone erosion

bull Obstruction of drainage eg by a polyp

bull Low resistance of the patient

What are the pathways for spreading of infections beyond the ear

Pathways of infection

bull The commonest way for extension ofinfection is by bone erosion due to a cholesteatoma

bull Vascular extension (retrograde thrombophlebitis)

bull Extension along preformed pathways asndash Congenital dehiscences fracture lines roundwindow membrane the labyrinthndash Dehiscences due to previous surgery

How do you classify the complicationsof otitis media

Classification

bull Intra-cranial complicationsbull Intratemporal complicationsbull Extra-cranial complications

Complications of otitis media

ExtracranialbullRetropharyngeal

abscessbullParapharyngeal

abscess bullLymphadentitis

IntratemporalbullMastoiditis bullPetrositis bullLabyrinthitis bullFacial paralysisbullLabyrinthine

fistula

IntracranialbullExtradural abscessbullSubdural abscessbullBrain abscessbullMeninigitis bullSinus

thrombophilbitis

Intra-cranial complications

What are the intracranial complications What is the commonest

How does patient with possible intracranial complications present with

What investigations to do to diagnose such complications

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

What are the pathways for spreading of infections beyond the ear

Pathways of infection

bull The commonest way for extension ofinfection is by bone erosion due to a cholesteatoma

bull Vascular extension (retrograde thrombophlebitis)

bull Extension along preformed pathways asndash Congenital dehiscences fracture lines roundwindow membrane the labyrinthndash Dehiscences due to previous surgery

How do you classify the complicationsof otitis media

Classification

bull Intra-cranial complicationsbull Intratemporal complicationsbull Extra-cranial complications

Complications of otitis media

ExtracranialbullRetropharyngeal

abscessbullParapharyngeal

abscess bullLymphadentitis

IntratemporalbullMastoiditis bullPetrositis bullLabyrinthitis bullFacial paralysisbullLabyrinthine

fistula

IntracranialbullExtradural abscessbullSubdural abscessbullBrain abscessbullMeninigitis bullSinus

thrombophilbitis

Intra-cranial complications

What are the intracranial complications What is the commonest

How does patient with possible intracranial complications present with

What investigations to do to diagnose such complications

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Pathways of infection

bull The commonest way for extension ofinfection is by bone erosion due to a cholesteatoma

bull Vascular extension (retrograde thrombophlebitis)

bull Extension along preformed pathways asndash Congenital dehiscences fracture lines roundwindow membrane the labyrinthndash Dehiscences due to previous surgery

How do you classify the complicationsof otitis media

Classification

bull Intra-cranial complicationsbull Intratemporal complicationsbull Extra-cranial complications

Complications of otitis media

ExtracranialbullRetropharyngeal

abscessbullParapharyngeal

abscess bullLymphadentitis

IntratemporalbullMastoiditis bullPetrositis bullLabyrinthitis bullFacial paralysisbullLabyrinthine

fistula

IntracranialbullExtradural abscessbullSubdural abscessbullBrain abscessbullMeninigitis bullSinus

thrombophilbitis

Intra-cranial complications

What are the intracranial complications What is the commonest

How does patient with possible intracranial complications present with

What investigations to do to diagnose such complications

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

How do you classify the complicationsof otitis media

Classification

bull Intra-cranial complicationsbull Intratemporal complicationsbull Extra-cranial complications

Complications of otitis media

ExtracranialbullRetropharyngeal

abscessbullParapharyngeal

abscess bullLymphadentitis

IntratemporalbullMastoiditis bullPetrositis bullLabyrinthitis bullFacial paralysisbullLabyrinthine

fistula

IntracranialbullExtradural abscessbullSubdural abscessbullBrain abscessbullMeninigitis bullSinus

thrombophilbitis

Intra-cranial complications

What are the intracranial complications What is the commonest

How does patient with possible intracranial complications present with

What investigations to do to diagnose such complications

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Classification

bull Intra-cranial complicationsbull Intratemporal complicationsbull Extra-cranial complications

Complications of otitis media

ExtracranialbullRetropharyngeal

abscessbullParapharyngeal

abscess bullLymphadentitis

IntratemporalbullMastoiditis bullPetrositis bullLabyrinthitis bullFacial paralysisbullLabyrinthine

fistula

IntracranialbullExtradural abscessbullSubdural abscessbullBrain abscessbullMeninigitis bullSinus

thrombophilbitis

Intra-cranial complications

What are the intracranial complications What is the commonest

How does patient with possible intracranial complications present with

What investigations to do to diagnose such complications

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Complications of otitis media

ExtracranialbullRetropharyngeal

abscessbullParapharyngeal

abscess bullLymphadentitis

IntratemporalbullMastoiditis bullPetrositis bullLabyrinthitis bullFacial paralysisbullLabyrinthine

fistula

IntracranialbullExtradural abscessbullSubdural abscessbullBrain abscessbullMeninigitis bullSinus

thrombophilbitis

Intra-cranial complications

What are the intracranial complications What is the commonest

How does patient with possible intracranial complications present with

What investigations to do to diagnose such complications

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complications

What are the intracranial complications What is the commonest

How does patient with possible intracranial complications present with

What investigations to do to diagnose such complications

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

What are the intracranial complications What is the commonest

How does patient with possible intracranial complications present with

What investigations to do to diagnose such complications

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complications

Extradural Abscess Definitionbull Collection of pus against the dura of thebull middle or posterior cranial fossabull When pus collects against the walls of thebull Extradural abscess is the commonestbull intracranial complication of otitis media

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complicationsExtradural abscess

Clinical Picturendash Persistent headache on the side of otitis mediandash Pulsating dischargendash Feverndash Asymptomatic (discovered during surgery)1048721Diagnosisndash CT scans reveal the abscess as well as the middleear pathology1048721Treatmentndash Mastoidectomy and drainage of the abscess

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complications

Extradural abscess Diagnosisndash CT scans reveal the abscess

as well as the middleear pathology1048721Treatmentndash Mastoidectomy and

drainage of the abscess

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complicationsSubdural Abscess Definitionndash Collection of pus between the dura and thearachnoidndash Itrsquos a rare pathology Clinical picturendash Headache without signs of meningeal irritationndash Convulsionsndash Focal neurological deficit (paralysis loss ofsensation visual field defects)

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complications

Subdural AbscessInvestigationsndash CT scan MRITreatmentndash Drainage (neurosurgeons)ndash Systemic antibioticsndash Mastoidectomy

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complications

MeningitisDefinitionndash Inflammation of meninges (pia amp arachinoid)Pathologyndash Occurs during acute exacerbation of chronicunsafe middle ear infection

ndash Two forms

bull Circumscribed meningitis no bacteria in CSFbull Generalized meningitis bacteria are present in CSF

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complicationsMeningitis

Clinical picturendash General symptoms and signsbull high fever restlessness irritabilitybull photophobia and deliriumndash Signs of meningeal irritation

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complicationsMeningitis ndash Signs of meningeal irritation

bull Neck rigiditybull Positive Kernigrsquos sign difficulty to straighten theknee while the hip is flexed Positive Brudzinskirsquos signndash passive flexion of one leg results in a similarmovement on the opposite side orndash if the neck is passively flexed flexion occurs in thehips and knees

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complicationsMeningitis

Diagnosisbull ndash Lumbar puncture is diagnostic

Treatmentndash Treatment of the complication itself and control of earinfectionbull Specific antibioticsbull Antipyretics and supportive measuresbull Mastoidectomy to control the ear infection

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complicationsVenous Sinus Thrombosis

Definitionbull Thrombophlebitis of the venous sinusbull Etiologybull It usually develops secondary to direct

extensionbull from a perisinus abscess due to unsafe otitismedia with cholesteatoma

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complications

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complications

Venous Sinus ThrombosisClinical picturendash Signs of blood invasionbull (spiking) fever with rigors and chills bull persistent fever (septicemia)ndash Positive Greissingerrsquos sign which is edema andtenderness over the area of the mastoid emissaryveinndash Signs of increased intracranial pressureheadache vomiting and papilledemandash When the clot extends to the jugular vein thevein will be felt in the neck as a tender cord

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complicationsVenous Sinus Thrombosis

Diagnosisbull ndash CT scan with contrastbull ndash MRI MRA MRVbull ndash Angiography venographybull ndash Blood cultures is positive during the febrile phase

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complications

Venous Sinus Thrombosis Treatmentndash Medicalbull Antibiotics and supportive treatmentbull Anticoagulantsndash Surgicalbull Mastoidectomy with exposure of the affectedsinus and the intra-sinus abscess is drained

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complicationsBrain Abscess Definitionbull ndash Localized suppuration in the brain substancebull ndash It is most lethal complication of suppurative otitis media bull Incidencebull ndash 50 is Otogenic brain abscessbull ndash It is more common in males especiallybull between 10 ndash 30 years of age

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complicationsBrain Abscess

Pathologybull ndash Site Temporal lobe or bull Less frequently in

the cerebellum (more dangerous)

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complications

Brain AbscessDiagnosisbull ndash CT scansbull ndash MRI

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intra-cranial complications

Brain AbscessTreatmentMedicalbull Systemic antibioticsbull Measure to decrease intracranial pressurendash Surgicalbull Neurosurgical drainage of the abscess bull Appropriate mastoidectomy operation aftersubsidence of the acute stage

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

What intratemporal bone complications do you know

How does each present with

How do you manage each

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intratemporal complications

Labyrinthine fistula bull communication between middle and inner ear bull It is caused by erosion of boney labyrinth due

cholesteatoma bull Lateral canal erosion is the most common

location

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Interatemporal complications

Clinical picture bull Hearing lossbull Attack of vertigo mostly during

straining sneezing and lifting heavy object bull Positive fistula test

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Interatemporal complications

Labyrinthine fistula Diagnosis bull High index of suspicionbull longstanding diseasebull fistula test bull Ct scan of temporal bone Treatment Mastoidectomy

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intratemporal complications

Facial nerve paralysisbull Congenital or acquired dehiscence of nerve

canal bull It is possibly a result of the inflammatory

response within the fallopian canal to the infection

bull Tympanic segment is the most commom site to be involved

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Itratemporal complications

Facial nerve paralysis Diagnosis bull Clinical bull May occur in acute or chronic ottis mediabull Ct scan Treatment

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intratemporal complications

Facial nerve paralysis Treatment -Acute otitis media (cortical mastoidectomy

+ventilation tube)- chronic otitis media with cholestetoma

( mastoidecomy plusmn facial nerve decompresion )

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

MASTOIDITIS

bull DEFINITIONbull bull It is the inflammation of mucosal lining ofbull antrum and mastoid air cells systembull Mastoiditis per se actually occurs with most

infections of the middle ear It is not considered a complication until bone destruction occurs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Intratemporal complication

Mastoiditis Pathology

bull Production of pus under tensionbull Hyperaemic decalcificationbull Osteoclastic resorption of bony walls

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Clinical Features

Symptomsbull Earachebull Feverbull Ear dischargeSignsbull Mastoid tendernessbull Sagging of posterosuperior meatal wallbull TM perforationbull Swelling over mastoidbull Hearing loss

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Investigations

bull bull Blood CPbull bull CT scan temporal bonesbull bull Ear swab for cs

Differential Diagnosis

bull bull Suppuration of mastoid lymph nodesbull bull Furunculosis of meatusbull bull Infected Sebaceous cyst

TREATMENT

Medical treatmentminus Hospitalizeminus Antibioticsminus AnalgesicsSurgical treatmentminusMyringotomyminus Cortical mastoidectomy

Extracranial complications

bull Extension of infection to the neckbull Bezold abscess ( extension of infection from

mastoid to SCM)

Thanks

• The complications of acute and chronic otitis media
• What are the predisposing factors for developing complications
• Predisposing factors
• What are the pathways for spreading of infections beyond the ear
• Pathways of infection
• Slide 6
• How do you classify the complications of otitis media
• Classification
• Complications of otitis media
• Intra-cranial complications
• What are the intracranial complications What is the commonest How does patient with possible intracranial complications present with What investigations to do to diagnose such complications
• Slide 12
• Slide 13
• Slide 14
• Intra-cranial complications
• Intra-cranial complications
• Slide 17
• Slide 18
• Slide 19
• Slide 20
• Slide 21
• Slide 22
• Intra-cranial complications
• Slide 24
• Slide 25
• Slide 26
• Slide 27
• Intra-cranial complications
• Slide 29
• What intratemporal bone complications do you know How does each present with How do you manage each
• Intratemporal complications
• Interatemporal complications
• Slide 33
• Slide 34
• Itratemporal complications
• Slide 36
• MASTOIDITIS
• Intratemporal complication
• Clinical Features
• Investigations
• Differential Diagnosis
• TREATMENT
• Extracranial complications
• Slide 44

TREATMENT

Medical treatmentminus Hospitalizeminus Antibioticsminus AnalgesicsSurgical treatmentminusMyringotomyminus Cortical mastoidectomy

Extracranial complications

bull Extension of infection to the neckbull Bezold abscess ( extension of infection from

mastoid to SCM)

Thanks

• The complications of acute and chronic otitis media
• What are the predisposing factors for developing complications
• Predisposing factors
• What are the pathways for spreading of infections beyond the ear
• Pathways of infection
• Slide 6
• How do you classify the complications of otitis media
• Classification
• Complications of otitis media
• Intra-cranial complications
• What are the intracranial complications What is the commonest How does patient with possible intracranial complications present with What investigations to do to diagnose such complications
• Slide 12
• Slide 13
• Slide 14
• Intra-cranial complications
• Intra-cranial complications
• Slide 17
• Slide 18
• Slide 19
• Slide 20
• Slide 21
• Slide 22
• Intra-cranial complications
• Slide 24
• Slide 25
• Slide 26
• Slide 27
• Intra-cranial complications
• Slide 29
• What intratemporal bone complications do you know How does each present with How do you manage each
• Intratemporal complications
• Interatemporal complications
• Slide 33
• Slide 34
• Itratemporal complications
• Slide 36
• MASTOIDITIS
• Intratemporal complication
• Clinical Features
• Investigations
• Differential Diagnosis
• TREATMENT
• Extracranial complications
• Slide 44

Extracranial complications

bull Extension of infection to the neckbull Bezold abscess ( extension of infection from

mastoid to SCM)

Thanks

• The complications of acute and chronic otitis media
• What are the predisposing factors for developing complications
• Predisposing factors
• What are the pathways for spreading of infections beyond the ear
• Pathways of infection
• Slide 6
• How do you classify the complications of otitis media
• Classification
• Complications of otitis media
• Intra-cranial complications
• What are the intracranial complications What is the commonest How does patient with possible intracranial complications present with What investigations to do to diagnose such complications
• Slide 12
• Slide 13
• Slide 14
• Intra-cranial complications
• Intra-cranial complications
• Slide 17
• Slide 18
• Slide 19
• Slide 20
• Slide 21
• Slide 22
• Intra-cranial complications
• Slide 24
• Slide 25
• Slide 26
• Slide 27
• Intra-cranial complications
• Slide 29
• What intratemporal bone complications do you know How does each present with How do you manage each
• Intratemporal complications
• Interatemporal complications
• Slide 33
• Slide 34
• Itratemporal complications
• Slide 36
• MASTOIDITIS
• Intratemporal complication
• Clinical Features
• Investigations
• Differential Diagnosis
• TREATMENT
• Extracranial complications
• Slide 44

Thanks

• The complications of acute and chronic otitis media
• What are the predisposing factors for developing complications
• Predisposing factors
• What are the pathways for spreading of infections beyond the ear
• Pathways of infection
• Slide 6
• How do you classify the complications of otitis media
• Classification
• Complications of otitis media
• Intra-cranial complications
• What are the intracranial complications What is the commonest How does patient with possible intracranial complications present with What investigations to do to diagnose such complications
• Slide 12
• Slide 13
• Slide 14
• Intra-cranial complications
• Intra-cranial complications
• Slide 17
• Slide 18
• Slide 19
• Slide 20
• Slide 21
• Slide 22
• Intra-cranial complications
• Slide 24
• Slide 25
• Slide 26
• Slide 27
• Intra-cranial complications
• Slide 29
• What intratemporal bone complications do you know How does each present with How do you manage each
• Intratemporal complications
• Interatemporal complications
• Slide 33
• Slide 34
• Itratemporal complications
• Slide 36
• MASTOIDITIS
• Intratemporal complication
• Clinical Features
• Investigations
• Differential Diagnosis
• TREATMENT
• Extracranial complications
• Slide 44