EAR-unsafe CSOM and Some Complications

Question 1

Acute mastoiditis symptoms

Answer 1

Fever
Pain
Ironing
Tenderness
Ear discharge

Question 2

What is the first sign of mastoiditis

Answer 2

Ironing of mastoid surface(Smooth, red and shiny)

Question 3

What is Reservoir sign

Answer 3

It is seen in acute mastoiditis
It is due to pus continuously flowing from mastoid a middle ear and even on cleaning the discharge fills immediately again

Question 4

What is light House sign

Answer 4

It is seen in acute mastoiditis

The bus Kollam is continuously moving

Question 5

What view of x-ray is needed to examined for acute mastoiditis And what does it show

Answer 5

Schulers view
Clouding of air cells
Coalescence of air cells

Question 6

What is the medical management of acute mastoiditis

Answer 6

IV antibiotic for 48 hours

Question 7

What do you do if there is no improvement with medical management in acute mastoiditis

Answer 7

Surgery – cortical mastoidectomy also known as Schwartz operation

Question 8

How do you find the antrum in cortical mastoidectomy

Answer 8

Mac ewens triangle or suprameatal triangle

Question 9

Boundaries of McEwan’s triangle

Answer 9

1. temporal line
2. postero superior segment of Bony EAC
3. line drawn tangent to EC

Question 10

Cortical mastoidectomy also known as (two)

Answer 10

Shwartz operation

Canal wall up surgery (CWU)

Question 11

What is korner septum

Answer 11

It is an anatomical variations seen in some people
Makes finding the antrum difficult
It is the remnant of Petrosquamous suture

Question 12

If mastoiditis is not treated it causes abscess at four areas what are they

Answer 12

Mastoid abscess – post auricular (MC site)
Lucs abscess – in EAC
Bezold abscess – along sternocleidomastoid
Citelli’s abscess – along digastric

Question 13

Gradinego syndrome aka

Answer 13

Petrositis

Question 14

Three main features of Gradinego syndrome

Answer 14

1. ear discharge
2. retro orbital pain due to 5th nerve involvement
3. diplopia (due to 6th nerve involvement)

Question 15

Unsafe CSOM also known as (2)

Answer 15

Atticoantral CSOM

Squamousal

Question 16

Name some theories of cholesteatoma

Answer 16

1. Wittmack’s theory - retraction pockets ( 1° acquired ) MC origin
2. marginal perforations (2° acquired)
3. implantation of skin during surgery (3°acquired)
4. congenital

Question 17

Levensons criteria

Answer 17

Pearly white mouse behind intact TM

Question 18

What is prussak’s space

Answer 18

Present in epitympanum
Boundaries – lateral (bars flaccida), (neck of malleus), superior (fibres of malleolar fold)
Most common Site of cholesteatoma

Question 19

Why is unsafe CSOM called unsafe

Answer 19

It causes inflammatory osteitis
It secretes bone destroying enzyme which leads to erosion and complications

Basically it causes bone (temporal bone)

Question 20

Clinical features of unsafe CSOM

Answer 20

Ear discharge
Foul-smelling due to bone erosion
Blood stain due to granulation formation

Hearing loss (CHL/mixed)

Question 21

Treatment for unsafe CSOM

Answer 21

Surgery – modified radical mastoidectomy (MRM)

Question 22

MRM also known as

Answer 22

Canal wall down surgery (CWD)

Surgery for unsafe CSOM

Question 23

Most common sight of residual cholesteatoma after surgery

Answer 23

Sinus tympani

Question 24

Description of radical mastoidectomy

Answer 24

RM – all middle ear structures, TM are removed
Middle ear is not reconstructed
ET is plugged with a piece of cartilage
Indication – malignancy of middle ear

Question 25

Modified radical mastoidectomy description

Answer 25

Only those media structures are removed which are invaded by cholesteatoma
Middle ear is reconstructed
ET is kept patent
Indication – unsafe CSOM?

Question 26

Extracranial complications of unsafe CSOM

Answer 26

Mastoiditis (MC)
Abscess formation
Facial nerve palsy
Labyrinthitis
Labyrinthinefistula
Petrositis

Question 27

Intracranial complications of unsafe CSOM

Answer 27

Meningitis(Most common intracranial)
Extradural abscess
Subdural empyema
Brain abscess
Sigmoidsinusthrombosis
Hydrocephalus

Question 28

Sigmoid sinus thrombosis/lateral sinus thrombosis clinical features

Answer 28

Headache
Pallor
Spiky fever
Pitting oedema on mastoid
No change in CSF pressure on pressing IJV

Question 29

What kind of fever and sigmoid sinus thrombosis

Answer 29

Picket fence fever

Question 30

Griessenger sign

Answer 30

Pitting oedema On mastoid (due to blockage of mastoid emissary veins)
Seen in sigmoid sinus thrombosis

Question 31

How to check the CSF pressure

Answer 31

Tobey- Ayer test- lumbar puncture

Crowe beck test- fundus

Question 32

What does CT brain in sigmoid sinus thrombosis show

Answer 32

Delta sign

Question 33

Treatment of sigmoid sinus thrombosis

Answer 33

MRM + open the sinus plate and then clear the thrombus

Question 34

Most common site for abscess due to CSOM in brain

Answer 34

Temporal lobe abscess

Question 35

Clinical features in brain abscess

Answer 35

Fever
Vomiting
Convulsions

Question 36

Most common site and second most common site of otogenic abscess

Answer 36

Temporal lobe

Cerebellum

Question 37

Labyrinthine fistula

Answer 37

Erosion of bony cover of lateral semicircular canal

Question 38

what is positive fistula sign

Answer 38

Nystagmus on seigelisation or tragal pressure

Question 39

False positive fistula sign aka and seen in

Answer 39

Heinnebert sign 
Congenital syphilis (hypomobile ossicle)
Menieres disease(fibrous bands)

Question 40

False negative fistula sign

Answer 40

Fistula in dead labyrinth

Fistula covered by cholesteatoma