Complications of Otits Media

• Mastoiditis
• Mastoid Abscess:Subperiosteal,Zygomatic,Bezold’s,Citelli’s,Luc’s Abscess.
• Petrositis
• Facial paralysis:Most common nerve to be damaged in CSOM is Facial Nerve.
• Labyrinthitis

• Extradural abscess
• Subdural abscess
• Meningitis
• Brain abscess
• Lateral sinus thrombophlebitis

ACUTE MASTOIDITIS

• Commonest complication of CSOM
• Patients usually presents with fever ,deafness and Pain and tenderness over mastoid tip.
• Retro auricular swelling.
• Outward and downward deviation of the pinna.
• Otorrhea-Pulsatile ear discharge – light house effect.
• Sagging of posterosuperior meatal wall
• It is best diagnosed using CT scan. It shows clouding of the mastoid air cells and middle ear spaces. It can also demonstrate erosion of the mastoid bone structure.
• Treatment – Antibiotics, Cortical mastoidectomy 

MASTOID ABSCESS

• Bezold abscess – pus breaks through the thin medial side of the tip of the mastoid and presents as a swelling in the upper part of neck
• Luc abscess – meatal abscess
• Citelli’s abscess – abscess behind the mastoid towards the occipital bone

PETROSITIS

• The syndrome is produced by disease of the apex of the petrous bone and most often occurs as a rare complication of otitis media with mastoiditis or petrous bone tumors.
• Gradenigo’s syndrome is the classical presentation and consists of a triad of : –
  • External rectus palsy (VIth nerve/abducent nerve palsy) causing diplopia.
  • Deep seated orbital or retroorbital pain (Vth nerve involvement).
  • Persistent ear discharge due to ipsilateral acute or chronic otitis media.
• Associated symptoms of otitis media are also present e.g., conductive deafness

LABYRINTHITIS

Circumscribed labyrinthitis:

• Thinning or erosion of bony capsule of labyrinth, usually of the horizontal semicircular canal
  • In a patient with CSOM, labrynthine fistula most commnonly involves Lateral SCC.
• CSOM is the most common cause
• Transient vertigo induced by pressure on tragus, cleaning the ear or Valsalva manoeuvre

Diffuse serous labyrinthitis:

• Diffuse intralabyrinthine inflammation without pus formation
• Reversible if treated early
• Circumscribed labyrinthitis is the most common cause
• Spontaneous nystagmus with quick component towards affected ear

Diffuse suppurative labyrinthitis

• Diffuse pyogenic inflammation with permanent loss of vestibular and cochlear function
• Usually follows serous labyrinthitis
• Spontaneous nystagmus with quick component towards healthy side

LATERAL/SIGMOID SINUS THROMBOPHLEBITIS

• Hectic Picket-fence type of fever with rigors
• Griesinger’s sign- due to thrombosis of mastoid emissary vein, edema over posterior part of mastoid
• Papilledema
• Tobey-Ayer test :
• Compression of jugular vein on thrombosed side – no effect on CSF pressure
• Compression of jugular vein on the normal side – rapid rise in CSF pressure
• Crowe-Beck test: pressure on the jug. vein on healthy side – engorgement of retinal & supra orbital veins
• Tenderness along Jugular vein
• Contrast CT/MRI: delta sign