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