ent 3rd yr
- 1. Glin Luckose Fernandez Complications of Otitis Media
- 2. Classification : A. Intratemporal: • Mastoiditis • Petrositis • Facial Paralysis • Labyrinthitis B. Intracranial: • Extraduaral abscess • Subdural abscess • Meningitis • Brain abscess • Lateral Sinus Thromboplebitis • Otitic hydrocephalus
- 3. Petrostitis
- 4. • Spread of infection from the middle ear and mastoid to the petrous part of temporal bone is called petrositis • Associated with acute coalescent mastoiditis , latent mastoiditis , chronic middle ear infection
- 5. Pathology : Petrous bone is of 3 types : Pneumatized – with air cell extending up to petrous apex :Diploic – containing marow space :Sclerotic
- 6. 2 cell tracts are recognized : • Posterosuperior tract : Starts in mastoid and runs behind or above the bony labyrinth to the petrous apex . Some cells even passes through the arch of superior semicircular canal to reach the apex. • Anteroinferior tract : starts at the hypotympanum near the Eustachian tube runs around the cochlea to reach the petrous apex. Infection runs through these cell tracts and reaches the petrous apex .
- 7. Clinical features : Grandengio syndrome : triad of disease i. External rectus palsy ( VI nerve palsy ) ii. Deep seated ear or retro-orbital pain (V th nerve involvement ) iii. Persistent ear discharge Fever , headache , vomiting and sometimes neck rigidity may also be associated. Some may have facial paralysis , recurrent vertigo (VII nerve and statoacoustic nerve involvement )
- 8. Diagnosis : CT scan – of temporal bone will show details of the petrous apex MRI – helps to differentiate diploid marrow containing apex from fluid or pus Treatment : Cortical , modified radical or radical mastoidectomy is required . Intravenous antibacterial therapy should preceed and follow surgery
- 9. Facial Paralysis (A complication of both acute and chronic otitis media )
- 10. Acute Otitis Media : Facial nerve is well protected in its bony canal , sometimes the bony dehiscent and the nerve lies just under the middle ear mucosa . Therefore the inflammation of the middle ear can spread to epi- and perinerium causing facial paralysis . • Facial nerve function fully recovers if acute otitis media is controlled with systemic antibiotics • Myringotomy or cortical mastoidectomy may be required sometimes
- 11. Chronic Otitis Media : Facial paralysis is due to cholesteatoma or from penetrating granulation tissue . Insidious in onset slowly progressive . Cholesteatoma destroys the bony canal pressure on the nerve + edema of associated inflammatory process Treatment is urgent exploration of middle ear and mastoid .granulation tissue surrounding the nerve is removed , if the nerve is destroyed , resection of nerve and grafting .
- 12. Labyrinthitis
- 13. 3 Types of Labyrinthitis : • Circumscribed labyrinthitis • Diffuse serous labyrinthitis • Diffuse suppurative labyrinthitis
- 14. Circumscribed Labyrinthitis : Thinning or erosion of the bony capsule of labyrinth, usually of the horizontal semicircular canal . Aetiology : * CSOM with cholesteatoma * Neoplasm of middle ear eg glomus tumor * Surgical or accidental trauma to labyrinth Clinical features : sensitiveness to pressure changes , vertigo induced by presuure on tragus , cleaning ear or valsalva manoeuvre Treatment : Mastoid exploration to eliminate the cause , systemic antibiotic therapy before and after the surgery .
- 15. Diffuse Serous Labyrinthitis : Diffuse labyrinthine inflammation without pus and reversible condition if treated early . Atiology : a) Arises from pre existing circumscribed labyrinthitis associated with chronic middle ear suppuration b) Acute infection of middle ear cleft – spreads through annular ligament or round window c) Can follow stapedectomy or fenestration operation
- 16. Clinical features : Mild cases – vertigo , nausea Severe cases – vertigo worse with marked nausea, vomiting and even spontaneous nystagmus ( towards affected ear ) Since the infection is diffused cochlea is also infected with some degree of hearing loss If not diagnosed can lead to total loss of vestibular and cochlear function
- 17. Treatment : Medical : i. Patient is put to bed and head is immobilized with the affected ear above ii. Antibacterial therapy is given full dose to control infection . iii. Labyrinthine sedatives – procloperazine or dimenhydrinate iv. Myringotomy – if labyrinthitis has followed by acute ottitis media and the drum bulging Surgical : Cortical mastoidectomy or modified radical mastoidectomy
- 18. Diffuse suppurative Labyrinthitis: Diffuse pyogenic infection of the labyrinth with permanent loss of vestibular and cochlear function. Atiology : follows serous labyrinthitis Clinical Features : severe vertigo with nausea and vomiting , spontaneous nystagmus (quick component towards healthy side), patient is markedly toxic , loss of hearing . Relieves from vertigo after 3 – 6 week due to adaptation.4 Treatment : same as serous labyrinthitis , rarely drainage of labyrinth ( in meningitis or brain abscess) .