Otogenic complications

Contents & Reguirements

• Master the types complications, the clinical
manifestations of otogenic of Bezold abscess,
peripheral facial paralysis, meningitis, sigmoid
sinus thrombophlebitis and brain labyrinthitis,
abscess
• Be familiar with the risk signals and diagnostic
basis of otogenic intracranial complications, all
kinds of otogenic intracranial and extracranial
complications and their development
 Case
A 55 year old male presented with otorrhea in
his left ear for more than 40 years. Half a month
ago, the discharge aggravated in his left ear. The
left side had severe headache and high fever at
39.5 °C. Temporal bone CT and head MRI
showed that the left side had chronic
suppurative otitis media and mastoiditis with
sigmoid sinus thrombophlebitis.
 Case
• Questions:
• 1. Is chronic suppurative otitis media
associated with sigmoid sinus
thrombophlebitis?
• 2. How does the otogenic infection spread into
sigmoid sinus?
• 3. How to treat this disease in time?
• Brief Introduction
• 1.Definition
• The extracranial and intracranial complications caused
by suppurative otitis media and mastoiditis,
cholesteatoma and other ear diseases are collectively
referred to as otogenic complications.
• If the above diseases are not treated properly or in
time, the infection is more likely to cause
complications
• Because of its special anatomical position, it is often
life- threatening, and is one of the critical severe cases
in ENT department
• Brief Introduction
• . 2.classifications
• Intracranial complications
• Epidural abscess, subdural abscess, meningitis,
sigmold sinus thrombophlebitis, brain abscess,
cerebral hernia, hydrocephalus, etc
• Extracranial complications
• > intratemporal complications
• Labyrinthitis FP Petrositis, labyrinthine Fistula
• > extratemporal complications
• Anatomical Considerations
• Intratemporal
Mastoiditis
Labyrinthitis
Facial paralysis
Labyrinthine
fistula
Petrositis
• Intracranial
Extradural abscess
-Subdural abscess
Brain abscess
Meninigitis
Sinus thrombophilbitis
• extratemporal
Retropharyngeal abscess
Parapharyngeal abscess
• lymphadentitis
• Diagnosis
• 1. Clinical Manifestations : Intratemporal
• 1.1 Labyrinthitis
• Fistiula
The most common complications of cholesteatoma,
paroxysmal vertigo, conductive deafness and fistula test+
• Serous labyrinthitis
Diffuse non-suppurative inflammation, vertigo, severe
sensorineural hearing loss, and vestibular dysfunction
• Purulent labyrinthitis
Diffuse suppurative inflammation, severe vertigo, total
deafness, unilateral vestibular dysfunction
• Diagnosis
• 1. Clinical Manifestations : Intratemporal
• 1.2 otogenic facial paralysis
• Facial nerve edema: acute and chronic
inflammatory stimulation
• Compression of facial nerve: erosion of
cholesteatoma and compression of bone canal
• Facial nerve injury: granulation or cholesteatoma
long-term compression injury, surgical injury
• Diagnosis
• 1. Clinical Manifestations : Intratemporal
• 1.3 Petrositis
• > Headache: ophthalmic branch of trigeminal nerve
• > Ear abscess: erosion of cholesteatoma and
compression of bone canal
• > Fever: <39 °C
• > Petrous apex syndrome: abduction paralysis,
trigeminal neuralgia, localized meningitis
• > Labyrinth irritation symptoms: dizziness, nausea,
vomiting, nystagmus
• Diagnosis
• 1. Clinical Manifestations : Extratemporal
• 1.4 Postauricular subperiosteal abscess
• The mastoid cortex was broken and accumulated
under the periosteum
• More common seen in infant patients
• Fluctuating abscess behind the ear, ski redness
and pain on the surface in acute stage
• Form a fistula, which can not be cured and
sequela of cholesteatoma
• Diagnosis
• 1. Clinical Manifestations : Extratemporal
• 1.5 Otogenic cervical abscess
• > Bezold Abscess : Deep neck
• abscess
• From the thin bone wall inside the mastoid tip,
the pus accumulated to the deep surface of
sternocleidomastoid muscle, located in the deep
part of the neck under the ear
• > Mouret Abscess : Digastric abscess
• Diagnosis
• 2. Clinical Manifestations Intracranial
• 2.1 Thrombophlebitis sigmoid sinus
• > The bone plate of sigmoid sinus was eroded and
destroyed, perivenous inflammation of sigmoid sinus,
secondary thrombosis, growth, shedding and infection
• Symptoms: high fever up to 40 °C, chills, headache
• Signs: swelling and tenderness can be seen in the
mastnid reoinn and nerk
• Diagnosis
• 2. Clinical Manifestations : Intracranial
• 2.2 Extradural abscess
• > Definition: abscess is located between dura and
temporal bone
• > Headache, fever
• > Elevated intracranial pressure, meningeal
irritation, signs of nerve localization
• > Imaging features: dural shadow, middle ear
mastoid bone destruction
• Diagnosis
• 2. Clinical Manifestations : Intracranial
• 2.3 Subdural abscess
• - Definition: between dura and arachnoid or between
arachnoid and pia mater, It often occurs in the old and weak
patients.
• Symptoms: diffuse headache, chills and high fever, jet
vomiting, mental and neurological symptoms
• Signs: intracranial hypertension, meningeal stimulation,
nerve Do localization
• Imaging features: dural shadow, middle ear mastoid bone
destruction
• Diagnosis
• 2. Clinical Manifestations : Intracranial
• 2.4 Otogenic meningitis
• > Definition: suppurative inflammation of the
meningitis
• Diagnosis
• 2. Clinical Manifestations: Intracranial
• 2.4 Otogenic meningitis
• > Ear symptoms and signs
• > General symptoms: high fever, chills, headache, vomiting
• - Meningeal irritation: cervical resistance/neck rigidity,
cervical ankylosis, and arcuate reflex Kernig sign(+)
Brudzinskin sign(+);
• > Intracranial hypertension: headache, vomiting,
papilledema
• - Mental, neurological symptoms: irritabili
• Diagnosis
• 2. Clinical Manifestations Intracranial
• 2.5 Otogenic brain abscess
• > Definition: ear disease causes pus to spread into
brain parenchyma, mainly in temporal lobe and
cerebellum
• > The most dangerous and common brain
• > The diagnosis was confirmed by imagine
examination
• Diagnosis
• 2. Clinical Manifestations Intracranial
• 2.5 Otogenic brain abscess
• > Stages of progression
• Onset (localized encephalitis or meningitis, about days):
chills, fever, headache, vomiting, mild meningeal
stimulation;
• Dormant period (suppurative period, lasting for 10 days to
weeks): the symptoms were not obvious or light;
• The obvious stage (abscess formation period, time is
different):
• Diagnosis
• 3.Assistant Examinations
• 3.1 Lab test
• - Blood routine test: WBC count and polymorphonuclear
leukocyte count increased
• - Lumbar puncture + CSF pressure, routine, culture: helpful
for the diagnosis of intracranial complications
• - Hearing : identify whether cochlea and auditory are
abnormal
• - Vestibular function examination: whether the semicircular
canal and otolith function are abnormal
• Ophthlmoscope: papilledema
• Diagnosis
• 3.Assistant Examinations
• 3.2 Imaging examination
• - CT scan of temporal bone: most of otogenic
intracranial and extracranial complications can
be identified, thin-layer, magnification
• > MRI of inner ear and internal auditory canal:
differentiation of abscess, effusion,
hemorrhage, tumor and inflammation
• Diagnosis
• 4.Maps to diagnosis
• 4.1 history of otogenic diseases: otitis media,
cholesteatoma of middle ear, etc
• 4.2 in case of any of the following situations, it shall
be regarded as a dangerous signal:
• - Sudden reduction or cessation of ear pus
(obstruction of drainage)
• * Severe ear pain, headache
• * Cold, fever, chills
• - Vertigo, nausea, vomiting, change of mind, etc
• Diagnosis
• 4.Maps to diagnosis
• 4.3 Susceptibility factors
• > Virulence of pathogenic bacteria:
Pseudomonas aeruginosa, Staphylococcus
aureus, Streptococcus
• > Patient resistance: weak, old man, infant
• - Poor drainage
 • Diagnosis
• 4.Maps to diagnosis
• 4.4 Anatomic pathways
• Complications
Pathways
Bone Vessels, bone erosion, Preformed Pathway
,Labyrinth IAC/CA
• Etiology & Pathogenesis
• 1. Etiology
• Inflammation destroys bone wall
• Poor health: severe chronic disease, weak
resistance, malnutrition
• Virulence: Gram negative bacilli,
Staphylococcus aureus
• Etiology & Pathogenesis
• 2 Infectious and spreading approaches
• > Peripheral bone destruction
• > According to anatomic pathway: vestibular
window, cochlear window or bone suture
• > Blood Route
• Treatment
• Therapeutic principles
• > Elimination of primary ear diseases
• Treatment of intracranial and extracranial
complications
• > Symptomatic support
• - Different treatments for patients with
different complications
• Treatment
• Surgical Options
• - mastoidectomy
• - facial nerve
• - inner ear
• - intracranial
• Sufficient broad-spectrum antibiotics
• Reducing intracranial pressure; mannitol,
corticosteroids
• Supportive treatment
• Summary
• The main way of otogenic intracranial
complications?
• Which middle ear diseases are more likely to
cause otogenic complications?
• What are the common intracranial complications?
• What are the common complications in temporal
bone?
• Common extratemporal complications in infants?