Chapter 38 - Complications of Otitis Media Flashcards
3 main routes of spread of OM
hematog
direct extension
thrombus propagation (thrombophlebitis of local perforating veins)
Bacteria involved with complicated AOM
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
Which involved bony destruction and granulation tissue - AOM or CSOM?
CSOM
Which structural deformities increase risk of direct extension of infection in middle ear and mastoid
T bone trauma
Mondini
enlarged vestibular aqueduct
prior surgery
How ear infections lead to meningitis
Usually AOM
Hematogenous spread
HA, nausea, nuchal rigidity, photophobia, AMS, fever
Two critical steps to workup meningitis as AOM complication
CSF analysis
CT to r/o other complications
Examples of direct extension of ear infection
postauricular abscess, Bezold abscess, sigmoid sinus thrombosis, epidural abscess, subdural empyema
Bezold’s abscess
Infection erodes the mastoid cortex medial to SCM attachment, where digastric attaches
Extends to infratemporal fossa
What makes a Bezold’s abscess difficult to palpate?
Deep to cervical fascia enveloping SCM and trapezius
Name all extracranial/intratemporal OM complications
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)
Name all intracranial complications of OM
Meningitis, brain abscess, subdural empyema, epidural abscess, lateral sinus thrombosis, otic hydrocephalus
Age at which OM is more likely to be complicated
60-80% episodes of complicated OM occur in 0-20 yo
Most common AOM complication
OME
Which nerve palsy can petrous apicitis present with?
VI
Where does the EAC tend to sag with cholesteatoma canal erosion?
posterior superior EAC
Kernig and Brudzinski signs
K: when hip/thigh at 90, can’t extend knee
B: neck flex –> hips flex
Queckenstedt’s sign
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)
Gradenigo syndrome triad
petrous apicitis: retro-orbital pain, VI palsy, otorrhea
Citelli abscess
cervical infection extending along posterior dig
General Tx for AOM complications
Since previously normal ear and not much mucosal edema blocking access to mastoid –> ABx only, mastoidectomy usually not needed
May need PE tube
General Tx for complicated CSOM
bony erosion, granulation tissue, infection may propagate along vascular foramina, so ABX plus surgery
ABx for complicated OM
IV, aerobes and anaerobes until cx directed possible
Combos of Vanc, Ampicillin-Sulbactam, cephs, flagyl
Should you use anticoagulants for sigmoid sinus thrombosis?
literature is inconclusive
may prevent clot extension and embolization
Treatment of: Acute mastoiditis
ABx +/- tympanocentesis, mastoidectomy
Treatment of: coalescent mastoiditis
ABX + mastoidectomy
Treatment of: postauricular abscess, Bezold abscess, temporal abscess
ABX, I/D, mastoidectomy
Treatment of: petrous apicitis
ABx, +/- steroids/mastoidectomy/drainage
Treatment of: Labyrinthine fistula
remove cholesteatoma +/- ABx/fistula repair
Treatment of: CN VII paresis
+/- Abx/steroids/tympanocentesis/decompression
Treatment of: Acute suppurative labyrinthitis
ABx +/- steroids/mastoidectomy
Treatment of: Meningitis
ABx, steroids, tympanocentesis, +/- mastoidectomy
Treatment of: intraparenchymal brain abscess
ABx +/- I/D, mastoidectomy
Treatment of: subdural empyema, epidural abscess
ABx, I/D, mastoidectomy
Treatment of: Sigmoid sinus thrombosis
ABX, mastoidectomy +/-steroids/anticoag/clot removal/ligation IJ
Treatment of: otic hydrocephalus
ABx, mastoidectomy +/- diuretics/steroids/antocoag/clot removal/serial LPs
