Post on 15-Apr-2017
transcript
COMPLICATIONS OF CSOM
By Dr Saeed Ullah FCPSClassified ENT, Head and Neck SurgeonCMH Quetta
Cholesteatoma
A three dimensional epithelial and connective tissue mass usually in the form of a sac with a lining of stratified squamous epithelium, filled with desquamating debris frequently containing cholesterol
Types of cholesteatoma
Cholesteatoma Congenital Acquired
Primary Secondary
Other pathologies
Osteitis Cholesterol granuloma
Routes of spread
Direct erosion of bone Normal communication
Oval and round windows Vascular channels
Thrombophlebitis Periarteriolar spaces of Virchow-Robin
Abnormal preformed pathways Congenital dehiscence Acquired dehiscence
Fractures Surgical defects
Intratemporal complications Mastoiditis Facial nerve paralysis Labyrinthitis Petrositis
Mastoid air cell system
Mastoiditis Mastoid abscess Mastoid fistula
Mastoid abscess
Mastoid abscess
Mastoid fistula
Mastoiditis
Pus under pressure Decalcification & ostoclastic
resorption
Clinical features
Symptoms Post aural pain Fever Discharge
Signs Tenderness Discharge Sagging of post sup meatal wall Hearing loss Swelling
Treatment
Hosp admission Antibiotics Myringotomy Cortical mastoidectomy
Facial nerve paralysis
Treatment
Urgent exploration From geniculate ganglion to
stylomastoid foramen The sun never sit on facial paralysis
due to CSOM
Labyrinthitis
Thinning or erosion of bone Two types
Circumscribed Diffuse
Serous suppurative
Clinical features
Dizziness Detection
Fistula test Seigel’s speculum
Treatment
Mastoid exploration Antibiotics Analgesics Anti vertiginous drugs
Petrositis
Osteitis of the petrous bone Headache Signs and symptoms of CSOM C T scan Exploration Antibiotics
Intracranial complications
Intracranial complications Extra dural abscess Subdural abscess Meningitis Brain abscess Sigmoid sinus thrombosis Otitic hydrocephalus
Extradural abscess
Persistent headache Severe pain Low grade fever Purulent discharge
Treatment
Antibiotics Mastoid exploration
Subdural abscess
Meningeal irritation Headache Fever Neck rigidity
Cortical venous thrombophlebitis Aphasia Hemiplegia
Raised intracranial pressure Ptosis Papilloedema
Meningitis
High grade fever Headache Neck rigiditiy Photophobia Nausea/ projectile vomiting Drowsiness Cranial nerve palsies
Otogenic brain abscess
Stage of invasion Headache Low grade fever
Stage of localization No symptoms
Stage of enlargement Raised intracranial pressure Disturbances of cerebrum-focal neurologic
signs Stage of termination
Investigations
C T scan MRI Lumbar puncture
Treatment
Medical Neurosurgical Otologic
Lateral sinus thrombosis
Formation of perisinus abscess Thrombus formation Obliteration of sinus lumen Extension of thrombus
Clinical features
Fever Headache Progressive anemia Griesinger’s sign Papilloedema Tobey-Ayer’s test Tenderness along jugular vein
Investigations
Imaging studies Contrast enhance CT studies MR angiography
Treatment
Antibiotics Mastoidectomy and exploration Ligation of internal jugular vein Anticoagulant therapy
Otitic hydrocephalus
Lateral sinus thrombosis Extended to superior sagittal sinus Impede the function of arachnoid villi Decrease CSF absorption Increased intracranial pressure
Clinical features
Severe headache Diplopia
6th cranial nerve palsy Papilloedema
Blurring of vision Optic atrophy blindness
Questions
Thank you