Complications of C.S.O.M.

• Complications arise when infection spreads from

the middle ear cleft to structures from which it is
normally separated from bone

• More common with Acute than chronic before

antibiotics era

• Now more common with CSOM

 Routs of infection
• Through bone demineralization(AOM)/resorption
(COM)
• Thrombophlebitis
• Round window/oval window/ Bony dehiscence
• Accidental or traumatic defects Non Anatomical
defects
• Surgical defects
• Periarteriolar space of Virchow-Robin
 Aggravating factors
• Patient Attributes,age, immune state, DM,
Leukemia

• Bacterial Attributes, Virulence, susceptibility,

H.influenzae type B, strpt. Pneumoniae

• Efficacy of Treatment of Otitis media

 Intracranial
• Extradural abscess
• Subdural abscess
• Meningitis
• Brain abscess(Temporal lobe/Cerebellar)
• Otitic hydrocephalus
• Lateral sinus(sigmoid/Transverse)Thrombosis
 Extra cranial(Intratemporal)
• Facial Nerve Paralysis • Squamous cell
carcinoma of middle
• Labyrinthitis & ear

• Labyrinthine fistula

• Petrositis and Gradenigo’s

syndrome(Signs of som+6th
N. Palsy and pain in the
distribution of 5th nerve)
 Warning signs
• Chronic ear discharge despite treatment
• Recurrent infection within 2wks of
treatment
• Otalgia
• Foul smelling discharge
• Sudden in discharge with pain………..
 ………..Warning signs
• Vertigo • Altered mentation/
• Headache drowsiness
occipital/unilateral • Clumsiness/
• Fever forgetfulness
• lethargy/malaise • Visual disturbance
• nausea • Signs of meningeal
• vomiting irritation
Sagging of post.superior meatal wall
 Management
General Principles
• Admit the patient
• Systemic antibiotic therapy
• Neurosurgical attention
• Treatment of ear lesion
 Admit the patient
• History

• General examination

• otological examination

• Neurological examination
 Systemic antibiotic therapy
• Cefuroxime
• Cefotaxime
• Gentamycin
• Metronidazole
• Chloramphenicol
 Investigations
• CBC/ ESR/ Biochem/ Urinalysis

• CT (HRCT)

• MRI

• CSF
 Neurosurgical attention
• Burr holes for abscesses

• Lumber puncture in controlled conditions

 Treatment of ear lesion…….

• Cortical Mastoidectomy for venous

thrombosis
• Modified radical or radical mastoidectomy
for CSOM
• Facial nerve decompression via
mastoidectomy in CSOM/Antibiotics ,rarely
Myrigotomy in AOM
………...Treatment of ear lesion
• For labyrinthine fistula mastoidectomy
covering of fistula with fascia or

leaving the matrix of cholesteatoma over

fistula