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ENT Secrets > Chapter 38 - Complications of Otitis Media > Flashcards

Chapter 38 - Complications of Otitis Media Flashcards

1
Q

3 main routes of spread of OM

A

hematog
direct extension
thrombus propagation (thrombophlebitis of local perforating veins)

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2
Q

Bacteria involved with complicated AOM

A

Most common are still S Pneumo/H Flu/Morax, but may involve bacteria with increased resistance
MRSA, Pseudomonas, Klebsiella, P acnes, bacteroides species. Often polymicrobial

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3
Q

Which involved bony destruction and granulation tissue - AOM or CSOM?

A

CSOM

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4
Q

Which structural deformities increase risk of direct extension of infection in middle ear and mastoid

A

T bone trauma
Mondini
enlarged vestibular aqueduct
prior surgery

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5
Q

How ear infections lead to meningitis

A

Usually AOM
Hematogenous spread
HA, nausea, nuchal rigidity, photophobia, AMS, fever

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6
Q

Two critical steps to workup meningitis as AOM complication

A

CSF analysis

CT to r/o other complications

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7
Q

Examples of direct extension of ear infection

A

postauricular abscess, Bezold abscess, sigmoid sinus thrombosis, epidural abscess, subdural empyema

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8
Q

Bezold’s abscess

A

Infection erodes the mastoid cortex medial to SCM attachment, where digastric attaches
Extends to infratemporal fossa

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9
Q

What makes a Bezold’s abscess difficult to palpate?

A

Deep to cervical fascia enveloping SCM and trapezius

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10
Q

Name all extracranial/intratemporal OM complications

A

Acute mastoiditis, coalescent mastoiditis, chronic mastoiditis, postauricular abscess, bezold ascess, temporal abscess, petrous apicitis, labyrinthine fistula, facial paralysis, acute suppurative labyrinthitis, encephalocele, CSF leak, hearing loss (CHL/SNHL)

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11
Q

Name all intracranial complications of OM

A

Meningitis, brain abscess, subdural empyema, epidural abscess, lateral sinus thrombosis, otic hydrocephalus

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12
Q

Age at which OM is more likely to be complicated

A

60-80% episodes of complicated OM occur in 0-20 yo

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13
Q

Most common AOM complication

A

OME

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14
Q

Which nerve palsy can petrous apicitis present with?

A

VI

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15
Q

Where does the EAC tend to sag with cholesteatoma canal erosion?

A

posterior superior EAC

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16
Q

Kernig and Brudzinski signs

A

K: when hip/thigh at 90, can’t extend knee
B: neck flex –> hips flex

17
Q

Queckenstedt’s sign

A

Apply bilateral IJ pressure during LP –> if no rise in pressure, there is obstruction of CSF flow in the subarachnoid space (as in meningitis, lateral sinus thrombophlebitis)

18
Q

Gradenigo syndrome triad

A

petrous apicitis: retro-orbital pain, VI palsy, otorrhea

19
Q

Citelli abscess

A

cervical infection extending along posterior dig

20
Q

General Tx for AOM complications

A

Since previously normal ear and not much mucosal edema blocking access to mastoid –> ABx only, mastoidectomy usually not needed
May need PE tube

21
Q

General Tx for complicated CSOM

A

bony erosion, granulation tissue, infection may propagate along vascular foramina, so ABX plus surgery

22
Q

ABx for complicated OM

A

IV, aerobes and anaerobes until cx directed possible

Combos of Vanc, Ampicillin-Sulbactam, cephs, flagyl

23
Q

Should you use anticoagulants for sigmoid sinus thrombosis?

A

literature is inconclusive

may prevent clot extension and embolization

24
Q

Treatment of: Acute mastoiditis

A

ABx +/- tympanocentesis, mastoidectomy

25
Q

Treatment of: coalescent mastoiditis

A

ABX + mastoidectomy

26
Q

Treatment of: postauricular abscess, Bezold abscess, temporal abscess

A

ABX, I/D, mastoidectomy

27
Q

Treatment of: petrous apicitis

A

ABx, +/- steroids/mastoidectomy/drainage

28
Q

Treatment of: Labyrinthine fistula

A

remove cholesteatoma +/- ABx/fistula repair

29
Q

Treatment of: CN VII paresis

A

+/- Abx/steroids/tympanocentesis/decompression

30
Q

Treatment of: Acute suppurative labyrinthitis

A

ABx +/- steroids/mastoidectomy

31
Q

Treatment of: Meningitis

A

ABx, steroids, tympanocentesis, +/- mastoidectomy

32
Q

Treatment of: intraparenchymal brain abscess

A

ABx +/- I/D, mastoidectomy

33
Q

Treatment of: subdural empyema, epidural abscess

A

ABx, I/D, mastoidectomy

34
Q

Treatment of: Sigmoid sinus thrombosis

A

ABX, mastoidectomy +/-steroids/anticoag/clot removal/ligation IJ

35
Q

Treatment of: otic hydrocephalus

A

ABx, mastoidectomy +/- diuretics/steroids/antocoag/clot removal/serial LPs

ENT Secrets (79 decks)

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