Presentation on theme: "The complications of acute and chronic otitis media"— Presentation transcript:
1 The complications of acute and chronic otitis media Dr. Abdulrahman Alsanosi Associate professor Otolaryngology consultant Otologist , Neurotologist &Skull Base SurgeonDirector of cochlear implant programKing Abdulaziz University Hospital& KFMC
2 What are the predisposing factors for developing complications ?
3 Predisposing factors • Virulent organisms. • Cholesteatoma and bone erosion.• Obstruction of drainage e.g. by a polyp.• Low resistance of the patient
4 What are the pathways for spreading of infections beyond the ear?
5 Pathways of infection • The commonest way for extension of infection is by bone erosion due to a cholesteatoma.• Vascular extension (retrograde thrombophlebitis).• Extension along preformed pathways as– Congenital dehiscences, fracture lines, roundwindow membrane, the labyrinth,– Dehiscences due to previous surgery
11 What are the intracranial complications. What is the commonest 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 ?
12 Intra-cranial complications Extradural Abscess:Definition:Collection of pus against the dura of themiddle or posterior cranial fossa.When pus collects against the walls of theExtradural abscess is the commonestintracranial complication of otitis media
13 Intra-cranial complications Extradural abscess:Clinical Picture– Persistent headache on the side of otitis media.– Pulsating discharge.– Fever– Asymptomatic (discovered during surgery)Diagnosis:– CT scans reveal the abscess as well as the middleear pathology.Treatment:– Mastoidectomy and drainage of the abscess.
14 Intra-cranial complications Extradural abscess:Diagnosis– CT scans reveal the abscess as well as the middleear pathology.Treatment:– Mastoidectomy and drainage of the abscess
15 Intra-cranial complications Subdural Abscess:Definition– Collection of pus between the dura and thearachnoid.– It’s a rare pathologyClinical picture:– Headache without signs of meningeal irritation– Convulsions– Focal neurological deficit (paralysis, loss ofsensation, visual field defects)
17 Intra-cranial complications MeningitisDefinition– Inflammation of meninges (pia & arachinoid)Pathology:– Occurs during acute exacerbation of chronicunsafe middle ear infection.– Two forms:• Circumscribed meningitis: no bacteria in CSF.• Generalized meningitis: bacteria are present in CSF
18 Intra-cranial complications Meningitis Clinical picture: – General symptoms and signs: • high fever, restlessness, irritability, • photophobia, and delirium. – Signs of meningeal irritation?
19 Intra-cranial complications Meningitis– Signs of meningeal irritation:• Neck rigidity.• Positive Kernig’s sign: difficulty to straighten theknee while the hip is flexedPositive Brudzinski’s sign:– passive flexion of one leg results in a similarmovement on the opposite side or– if the neck is passively flexed, flexion occurs in thehips and knees
20 Intra-cranial complications MeningitisDiagnosis– Lumbar puncture is diagnostic:Treatment:– Treatment of the complication itself and control of earinfection:• Specific antibiotics.• Antipyretics and supportive measures• Mastoidectomy to control the ear infection.
21 Intra-cranial complications Venous Sinus Thrombosis: DefinitionThrombophlebitis of the venous sinus.Etiology:It usually develops secondary to direct extensionfrom a perisinus abscess due to unsafe otitismedia with cholesteatoma.
23 Intra-cranial complications Venous Sinus ThrombosisClinical picture:– Signs of blood invasion:• (spiking) fever with rigors and chills• persistent fever (septicemia).– Positive Greissinger’s sign which is edema andtenderness over the area of the mastoid emissaryvein.– Signs of increased intracranial pressure:headache, vomiting, and papilledema.– When the clot extends to the jugular vein, thevein will be felt in the neck as a tender cord.
24 Intra-cranial complications Venous Sinus Thrombosis: Diagnosis– CT scan with contrast– MRI, MRA, MRV– Angiography, venography– Blood cultures is positive during the febrilephase.
25 Intra-cranial complications Venous Sinus Thrombosis: Treatment – Medical: • Antibiotics and supportive treatment. • Anticoagulants – Surgical: • Mastoidectomy with exposure of the affected sinus and the intra-sinus abscess is drained.
26 Intra-cranial complications Brain Abscess:Definition– Localized suppuration in the brain substance.– It is most lethal complication of suppurative otitis mediaIncidence:– 50% is Otogenic brain abscess– It is more common in males especiallybetween 10 – 30 years of age.
27 Intra-cranial complications Brain Abscess Pathology– Site: Temporal lobe or • Less frequently, in the cerebellum. (more dangerous)
29 Intra-cranial complications Brain AbscessTreatmentMedical:• Systemic antibiotics.• Measure to decrease intracranial pressure.– Surgical:• Neurosurgical drainage of the abscess .• Appropriate mastoidectomy operation aftersubsidence of the acute stage.
30 What intratemporal bone complications do you know What intratemporal bone complications do you know ? How does each present with? How do you manage each ?
31 Intratemporal complications Labyrinthine fistulacommunication between middle and inner earIt is caused by erosion of boney labyrinth due cholesteatomaLateral canal erosion is the most common location
32 Interatemporal complications Clinical picture :Hearing lossAttack of vertigo mostly during straining ,sneezing and lifting heavy objectPositive fistula test
33 Interatemporal complications Labyrinthine fistula :DiagnosisHigh index of suspicionlongstanding diseasefistula testCt scan of temporal boneTreatment :Mastoidectomy
34 Intratemporal complications Facial nerve paralysis:Congenital or acquired dehiscence of nerve canalIt is possibly a result of the inflammatory response within the fallopian canal to the infectionTympanic segment is the most commom site to be involved
35 Itratemporal complications Facial nerve paralysisDiagnosisClinicalMay occur in acute or chronic ottis mediaCt scanTreatment
36 Intratemporal complications Facial nerve paralysisTreatment :-Acute otitis media (cortical mastoidectomy +ventilation tube)- chronic otitis media with cholestetoma ( mastoidecomy ± facial nerve decompresion )
37 MASTOIDITIS DEFINITION • It is the inflammation of mucosal lining of antrum and mastoid air cells system.Mastoiditis, per se, actually occurs with most infections of the middle ear. It is not considered a complication until bone destruction occurs
38 Intratemporal complication Mastoiditis :Pathology• Production of pus under tension• Hyperaemic decalcification• Osteoclastic resorption of bony walls
39 Clinical Features Symptoms: Earache Fever Ear discharge Signs: Mastoid tendernessSagging of posterosuperior meatal wallTM perforationSwelling over mastoidHearing loss