complications of csom
DESCRIPTION
complications of chronic suppurative otitis mediaTRANSCRIPT
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 !