1. Complications of suppurative otitis media can occur when infection spreads from the middle ear through direct bone erosion, venous thrombophlebitis, or preformed pathways. 2. Intratemporal complications include mastoiditis, petrositis, facial paralysis, and labyrinthitis. Acute mastoiditis occurs when infection spreads from the middle ear mucosa to the mastoid air cells. 3. Labyrinthitis can be circumscribed, diffuse and serous, or diffuse and suppurative with permanent hearing and vestibular loss if not treated promptly.

1. COMPLICATIONS OF
SUPPURATIVE OTITIS
MEDIA

2. Factors influencing development
of complications
1.Age
2.Poor socio-economic group
3.Virulence of organisms
4.Immune compromised host
5.Preformed pathways
6.Cholesteatoma

3. Pathways of spread of
infection
1.Direct bone erosion-hyperaemic
decalcification(a/c
infection),osteitis,cholesteatoma,granulation
tissue (c/c)
2.Venous thrombophlebitis-V of HS dural V
dural venous sinuses supfl veins of brain
3.Preformed pathways-congenital
dehiscences,patent sutures,prevous skull
fractures etc

5. Classification
complications of otitis media
intra temporal intracranial

6. INTRATEMPORAL COMPLICATIONS
1.Mastoiditis
2.Petrositis
3.Facial paralysis
4.labyrinthitis

7. 1)mastoiditis
acute mastoiditis masked mastoiditis

8. 1a.Acute mastoiditis
When infection spreads from the mucosa,lining
the mastoid air cells &antrum,to involve
bony walls of the mastoid air cell system.

9. aetiology
 ASOM
 High virulence,lowered resistance
 Children
 Β hemolytic strep,anaerobic org

10. Pathology
1,production of pus under tension
2,hyperaemic decalcification and osteoclastic
resorption of bony walls
both these processes combine
cause destruction &coalescence of
mastoid cells
single irregular cavity filled with pus
(EMPYEMA of MASTOID)

11.  Pus may break through mastoid cortex
leading to subperiosteal abscess which may
even burst on surface leading into a
discharging fistula

13. Patient presents with
1.Pain behind the ear (persistence,increase in
intensity or recurrence of pain)
2.fever(persistence or recurrence of fever)
3.Ear discharge(becomes profuse and increase
in purulence)
persistence of discharge beyond 3 wks in
a case of ASOM mastoiditis

14. signs
1.Mastoid tenderness
2.Ear discharge –mucopurulent or purulent often
pulsatile(light house effect)
3.Sagging of posterosuperior meatal wall
4.Perforation of TM-small,wid congestion of rest of
TM
5.Swelling over the mastoid
6.Hearing loss-CHL
7.General findins-low grade fever,appear ill &toxic

15. investigations
1.TC,DLC
2.ESR
3.X-ray mastoid
4.CT temporal bone
5.Ear swab

18. dds
a)Suppuration of mastoid lymph nodes
b)Furunculosis of meatus
c)Infected sebaceous cyst

19. treatment
 Hospitalisation of the patient
 Antibiotics
 Myringotomy
 Cortical mastoidectomy

20. complications
 Subperiosteal abscess
 Labyrinthitis
 Facial paralysis
 Petrositis
 Extradural abscess
 Subdural abscess
 Meningitis
 Brain abscess
 Lateral sinus thrombophlebitis
 Otitic hydrocephalus

21. Abscesses in relation to
mastoid infection
1.Post auricular abscess
2.Zygomatic abscess
3.Bezold abscess
4.Meatal abscess(luc s abscess)
5.Citelli s abscess
6.Parapharyngeal or retropharyngeal abscess

23. 1b)Masked
(latent)mastoiditis
 Slow destruction of mastoid air cells but
without the acute signs &symptoms
(no pain,no fever,no discharge,no mastoid
swelling)
 Mastoidectomy show extensive destruction
of the air cells with granulation tissue and
dark gelatinous material filling the mastoid

24. Aetiology
 From inadequate antibiotic therapy

25. cfs
 Child
 Mild pain behind the ear
 Persistence of hearing loss
 TM appears thick with loss of translucency
 Tenderness over mastoid
 Audiometry-CHL
 X-ray mastoid-clouding of air cells

26. treatment
 Cortical mastoidectomy with full doses of
anti biotics

27. 2)petrositis
 Spread of infection from the middle ear and
mastoid to the petrous part of temporal bone
 Pneumatisation of petrous apex usually thru
2 recognised cell tracts
1.posterosuperior tract
2.anteroinferior tract

28. cfs
 GRADENIGO S SYNDROME
a)external rectus palsy(VI N)-Diplopia
b)Deep seated ear or retro orbital pain
c)persistent ear Discharge
 Fever,headache,vomiting,neck rigidity,facial
paralysis,recurrent vertigo

29. diagnosis
 CT scan-temporal bone(pmeumatisation of
petrous apex)
 MRI(diploic marrow-fluid or pus)

30. treatment
 Cortical,radical or modified radical
mastoidectomy
 iv antibiotics

31. 3)Facial paralysis
 Results either from cholesteatoma or from
penetrating granulation tissue
 Destruction of bony canal
 Insidious &slowly progressive

32. treatment
 Urgent exploration of middle ear &mastoid
 Inspect facial canal from the geniculate ganglion to
the stylomastoid foramen
 Cholesteatoma in the bony canal is uncapped in the
area of involvement
 Granulation tissue surrounding the nerve is removed
 If it is actually invades the N sheath ,it is left in place
 If a segment of nerve is destroyed by the granulation
tissue resection of nerve and grafting after control of
infections

33. labyrinthitis
Circumscribed diffuse serous diffuse
suppurative

34. Circumscribed labyrinthitis
(fistula of labyrinth)
 Thinning or erosion of bony capsule of
labyrinth(usually HSCC)

35. cfs
 c/o transient vertigo
 Diagnosed by fistula test

36. treatment
 Mastoid exploration
 Systemic antibiotic therapy

37. Diffuse serous labyrinthitis
 Diffuse intralabyrinthine inflammation
without pus formation
 Reversible condition if treated early

38. aetiology
 Pre –existing circumscribed labyrinthitis
 In acute infections of middle ear inflamn
spreads thru annular ligament or the round
window
 Following stapedectomy or fenestration
operation

39. cfs
 Vertigo
 Nausea
 Vomiting
 Spontaneous nystagmus
 SNHL

40. TREATMENT
 Medical
a)pt is put to bed,head immobilised with
affected ear above
b)Antibiotics
c)Labyrinthine sedatives-prochloperazine or
dimenhydrinate
d)Myringotomy
 Surgical
Cortical or modified radical mastoidectomy

41. Diffuse suppurative
labyrinthitis
 Diffuse pyogenic infection of labyrinth with
permanent loss of vestibular and cochlear
infections

42. aetiology
 Following serous labyrinthitis
 Pyogenic organisms entering through a
pathological or surgical fistula

43. cfs
 Severe vertigo with nausea and vomiting
 Spontaneous nystagmus
 Total loss of hearing

44. treatment
 Same as for for serous labyrinthitis
 Drainage of labyrinth is required if
intralabyrinthine suppuration is acting as a
source of intracranial complications