Complications of csom

COMPLICATIONS OF CSOM

- ASHWIN GOBBUR BLDEU’s SBMP MEDICAL COLLEGE

CLASSIFICATION

INTRATEMPORAL COMPLICATIONS : LABYRINTHITIS

INRACRANIAL COMPLICATIONS : EXTRADURAL ABSCESS SUBDURAL ABSCESS MENINGITIS

LABYRINTHITIS

TYPES :

1) CIRCUMSCRIBED2) DIFFUSE SEROUS3) DIFFUSE SUPPURAIVE

1. CIRCUMSCRIBED LABYRINTHITIS (FISTULA OF LABYRINTH )

• Erosion of bony capsule of SCC (HORIZONTAL)

AETIOLOGY : CSOM + Cholesteatoma Neoplasms of middle ear Trauma

CLINICAL FEATURES Due to EXPOSURE OF MEMBRANOS

LABYRINTH, it becomes sensitive to pressure changes – On clenching teeth– Pressure on tragus…

DIAGNOSISFISTULA TESTI. PRESSURE ON TRAGUS - pressure on tragus

induces pain, vertigo and nystagmus (quick component towards ear under test)II. SIEGEL’S SPECULUM - positive pressure

applied to ear canal, nystagmus induced (quick component towards affected ear)

TREATMENT

Mastoid exploration to eliminate the cause Systemic antibiotic therapy to be instituted

before and after surgery to prevent spread of infection into the labyrinth

2. DIFFUSE SEROUS LABYRINTHITIS• It is diffuuse inralabyrinthine inflammation

without pus formation and is a reversible condition if treated early

• AETIOLOGY : Pre-existing circumscribed labyrinthitis +

chronic middle ear suppuration or cholesteatoma

Acute infections of middle ear cleft Following stapedectomy or perforation

CLINICAL FEATURES• Mild cases – Vertigo Nausea• Severe cases – Severe vertigo Mared nausea Spontaneous nystagmus (quick componenet towards afected ear) Sensorineural hearing loss

TREATMENTMEDICAL : i. Bed rest + immobilization with affected ear aboveii. Antibacterial theraphy iii. Labyrinthine sedatives – Prochlorperazineiv. Myringotomy

SURGICAL : i. Cortical mastoidectomy (in acute masoiditis)ii. Radical mastoidectomy (middle ear

cholesteatoma)

3. DIFFUSE SUPPURATIVE LABYRINTHITIS

• Diffuse pyogenic infection of the labyrinth with permanent loss of vestibular and cochlear functions

AETIOLOGY : Follows serous labyrinthitis Pyogenic organisms entering through a

pathological or surgical fistula

CLINICAL FEATURES• Severe vertigo • Nausea acute vestibular failure• Vomiting• Spontaneous nystagmus (quick component

towards healthy side)• Patient is markedly toxic• Total loss of hearing • Vertigo relieved due to central compensation

after 3-6 weeks

TREATMENT

• Same as for serous labyrinthitis• Drainage of labyrinth is required, if

suppuration acts as source of intracranial complication

COVERINGS OF BRAIN

EXTRADURAL ABSCESS

• Collection of pus between bone and dura.• Occurs both in acute and chronic otitis media

PATHOLOGY• Acute otitis media-Bone over dura destroyed

by hyperaemic decalcification• Chronic otitis media-destroyed by

cholesteatoma• Pus comes directly in contact with the dura

CLINICAL FEATURES

TREATMENT

CORTICAL or MOIFIED or RADICAL MASTOIDECTOMY

- Extradural abcess is evacuated

ANIBIOTIC COVER - Given for 5 days and observed for further

complications

SUBDURAL ABSCESSCollecion of pus between dura and arachnoid mater

Spread of ear infection by - Erosion of bone and dura - Thrombophlebitis

CLINICAL FEATURESMENINGEAL IRRITATION fever, malaise, neck rigidity, Kernig’s signCORTICAL VENOUS THROMBOPHLEBITIS hemiplagia, jacksonian epilepsy, aphasia …RAISED INRACRANIAL TENSION ptosis, dialated pupil, CT MRI required for

diagnosis TREATMENT :

MENINGITIS Inflammation of PIA and ARACHNOID• MOST COMMON COMPLICATION OF OTITIS

MEDIA MODE OF INFECTION :Blood borne – childrenBone erosion – adults

CLINICAL FEATURES

DIAGNOSIS : CT and MRI LUMBAR PUNCTURE (turbid, PMN, sugar )

TREATMENT

• CEFIROXIME (G+ve)• GENTAMYCIN (G-ve)• METRONIDAZOLE (Anaerobes) initially IV later oral for 3 months

Thank you !