complications

1. Complications Of CSOM
1

2. Classified as
• Intra cranial
• Extra-cranial, Intra-temporal
2

3. Routes of entry
• Bony erosion (cholesteatoma,osteitis)
• Anatomical pathway: oval window, round window,
internal auditory canal, suture line, cochlear &
vestibular aqueduct
• Retrograde Thrombophlebitis
• Congenital bony defects: facial canal, tegmen plate
• Acquired bony defects: fracture, neoplasm,
stapedectomy
3

4. Extra-Cranial
4

5. Mastoiditis
• It is the inflammation of mucosal lining of mastoid antrum
and air cells system.
• Pathology
o Production of pus under tension
o Hyperaemic decalcification
o Osteoclastic resorption of bony walls
5

6. 6

7. Mastoid reservoir sign Sagging of posterior wall
7

8. Ironed out appearance Mastoid cavity
8

9. Types of sub-periosteal
abscess
• Post-auricular
• Bezold
• Citelli
• Zygomatic
• Luc
9

10. Post-auricular Abscess
• Commonest.
• Present behind
the ear.
• Pinna pushed
forward &
downward.
10

11. • Luc: swelling in external auditory canal
• Bezold absceses-swelling over sternocleidomastoid
muscle
• Citelli absceses-swelling over posterior belly of
digastric muscle
• Parapharyngeal & Retropharyngeal: due to spread of
pus along Eustachian tube
11

12. Treatment
• Urgent hospital admission
• Broad spectrum I.V. antibiotics
No response to medical treatment in 48 hrs
• Cortical Mastoidectomy
12

13. Facial Nerve
Paralysis
13

14. • Seen in AOM,COM(both mucosal and squamosal
variety)
14

15. • AOM: sudden onset, full recovery
• COM: gradual onset, paralysis persist(erosion)
Treatment:
• Medical(Corticosteroids)
• Modified Radical Mastoidectomy(Sq CSOM)
• Facial nerve decompression if required
• Physioyheraphy
15

16. Labrynthitis
16

17. • Inflammation of bony labyrinth
Route of infection:
• Round window membrane
• Pre-formed opening (Stapedectomy)
• Retrograde spread of meningitis
types:
• Serous labyrinthitis
• Otogenic suppurative labyrinthitis
• Meningitic suppurative labyrinthitis
17

18. •
18
Cholesteatoma

19. Treatment
• Bed rest (affected ear up). Avoid head movement.
• Labyrinthine sedative: Prochlorperazine, Cinnarizine
• Broad spectrum I.V. antibiotics
• Modified Radical Mastoidectomy: removes infection
19

20. PETROSITIS
20

21. • Spread of infection from middle ear and mastoid to the
(peumatised) petrous part of temporal bone.
21

22. Gradenigo syndrome
• It is triad of,
• Persistent otorrhoea
• Retro-orbital pain: Trigeminal nerve involvement
• Diplopia: Convergent squint due to lateral rectus palsy
by injury to abducent nerve
22

23. Etiology:
• mastoiditis involving petrous apex along postero-superior
& anteroinferior tracts in relation to bony labyrinth
23

24. Sub-Periosteal
abscess & Fistula
24

25. Pathology
Production of pus under tension
hyperaemic decalcification (halisteresis)
osteoclastic resorption of bone
sub-periosteal abscess
penetration of periosteum + skin
fistula formation
25

26. Sub-periosteal fistula: dry Sub-periosteal fistula: wet
26

27. Intra Cranial
27

28. Meningitis
It defined as inflammation of leptomeninges (Pia &
Arachnoid) with bacterial invasion of CSF in
subarachnoid space.
28

29. On examination
1. Kernig’s sign– Extension of leg with thigh flexed
causes pain
2. Brudzinski’s sign– Flexion of neck causes flexion
of hip and knee.
3. Exaggerated tendon reflex
4. Papilloedema
29

30. Otogenic brain abscess
• 50-70 % adult & 25% in child abscess are otogenic
• Route of infection:
1. Direct spread:
• via Tegmen plate:
Temporal abscess
• via Trautmann’s triangle:
Cerebellar abscess
2. Retrograde
thrombophlebitis
30

31. Trautmann’s Triangle
• Superiorly: superior
petrosal sinus
• Posteriorly: sigmoid sinus
• Anteriorly: semi-circular
canals)
• Pathway to posterior
cranial fossa from
mastoid cavity
31

32. Stages of Brain Abscess
• Early cerebritis(invasion)- 1-3 days
• Late cerebritis(Localization)-4-10days
• Early capsule formation(Enlargement)-10-13 days
• Late capsule formation(termination)-14 days.
32

33. Otitic Hydrocephalus
• Defined as raised intracranial pressure with normal
CSF finding
• Seen in children
and adolescent with
acute and chronic
middle ear infection
33

34. Extradural Abscess
• It is collection of pus
between dura matter
and the bone of the IC
34

35. Subdural abscess
• Collection of pus between dura and arachnoid
• Erosion of bone and dura by thrombophlebitic
process
35

36. Lateral sinus thrombosis
• Syn – Sigmoid sinus thrombosis
• Definition – It is an inflammation of inner wall of
lateral venous sinus with thrombus formation.
36

37. • griesinger sign picket fence fever
37

38. THANK YOU
38