Otorhinolaryngology · MU Plovdiv

6. Otogenic complications – extracranial and intracranial. Diagnosis and treatment.

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Topic 6 of 18 in the MU Plovdiv syllabus for Otorhinolaryngology (Medicine, Year 4). The free AceMed note covers it in 30 sections, about 2,859 words (21 min of reading), with 30 flashcards.

In this note

  1. 6) Otogenic complications of otitis
  2. Otogenic complications of otitis (Essay 6)
  3. Mastoiditis
  4. Otogenic complications – extracranial and intracranial. Diagnosis and treatment.
  5. Definition:
  6. Predisposing Factors:
  7. EXTRACRANIAL COMPLICATIONS:
  8. Pathogenesis:
  9. Diagnosis: classic clinical triad of:
  10. Diagnosis:
  11. Treatment:
  12. Labyrinthitis
  13. Symptoms:
  14. Treatment: usually goes away on its own within a few weeks or it may last for months.
  15. INTRACRANIAL COMPLICATIONS:
  16. Otogenic Meningitis 1/3 meningitis is Otogenic (Most common Intra cranial complication)
  17. Signs:
  18. Sigmoid / Lateral sinus thrombosis
  19. Otogenic Brain Abscess
  20. Clinical pictures:
  21. Extradural Abscess
  22. Subdural Abscess (empyema)
  23. Intracranial complications of otogenic origin – labyrinthitis, otogenic meningitis, epidural, subdural and intracerebral abscess. Thrombosis of the sigmoid sinus.
  24. Etiopathogenesis
  25. Classification
  26. Clinical Picture
  27. Paraclinical and Radiological Examinations
  28. Treatment Options
  29. Possible Complications
  30. Differential Diagnosis

6) Otogenic complications of otitis

  • Includes infratemporal complications (mastoiditis, labyrinthitis, facial paralysis, cholesterol granuloma, chronic otitis)
  • intracranial complications (meningitis, brain abscess, subdural empyema, otitic hydrocephalus

Otogenic complications of otitis (Essay 6)

  • Complication are caused by expansion and infection and can include
  1. Extracranial complications
  • Extratemporal - Different type of abscess
  • Intratemporal (mastoiditis, labyrinthitis, facial paralysis, cholesterol granuloma, chronic otitis)
  1. Intracranial complications (meningitis, brain abscess, subdural empyema, otitic hydrocephalus)

5 severe complications of chronic media with cholesteoma

  1. Facial palsy
  2. Labyrinthine Fistula
  3. Sepsis
  4. Meningitis
  5. Obliteration of sigmoid sinus/ Sigmod Sinus Thrombosis
  6. Abscess of brain

Mastoiditis

  • Inflammation of the air cells in the mastoid process
  • Involvement of the mucous membranes of these air cells consistently occurs in acute otitis media and is referred to as associated mastoiditis

Pathogenesis:

  • Usually originates from infection of the middle ear (most frequent complication of otitis media but overall incidence is low)
  • Important pathogenic factors = mastoid pneumatisation, virulence of infecting organism, host immune status and the treatment given for the otitis media (inadequate Ab treatment can predispose to mastoiditis)

Symptoms: fever, local pain, infants = malaise, abdominal pain and anorexia

Diagnosis: classic clinical triad of

  1. a. Prominent auricle with retro-auricular swelling
  2. b. Tenderness over mastoid
  3. c. Otorrhea
  • Mastoiditis should be suspected in cases where AOM fails to improve or worsens over a 2-3 week period

Diagnosis:

  • Otoscopy – reveal features of acute or subacute otitis media with or without tympanic perforation.
  • Posterior wall of EAC may be erythematous and swollen (“sagging of posterior canal wall)
  • CT is best way to establish diagnosis – shows clouding of mastoid air cells and middle ear spaces and demonstrates erosion of mastoid bone structure
  • CBC – elevated WBC, CRP and ESR

↑ Inflammation markers

Treatment:

  1. Mastoidectomy – always combined with I.V antibiotics
  2. Myringotomy + paracentesis/ tube insertion – necessary to decompress middle ear
  3. Antibiotics – sufficient only in early stage of mastoiditis

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