6. Otogenic complications – extracranial and intracranial. Diagnosis and treatment. Flashcards
What are Otogenic Complications?
- SPREAD of INFX, BEYOND the CONFINES of MUCOSAL Spaces of MIDDLE EAR CLEFT
- That is RARE / HAZARDOUS, that MUST BE evaluated / treated by a Specialist WITHOUT DELAYS
What are the PREDISPOSING FACTORS of Otogenic Complications?
- HIGHLY Virulent Organisms
- POOR Host Immune Response
- IMPROPER Tx
- Age
- POOR Socio-economic Status
What is the CLASSIFICATION of EXTRACRANIAL COMPLICATIONS?
- EXTRA-TEMPORAL
a) Superiosteal Abscess
b) Bezoldt’s Abscess
c) Digastric
d) Zygomatic - INTRA-TEMPORAL
a) Mastoiditis
b) Petrositis
c) Labyrinthitis
d) Facial Paralysis
Describe MASTOIDITIS (Intra-Temporal; Extracranial)
{Symptoms, Etiology, Dx, Tx}
- INFLAMMATION of AIR CELLS in MASTOID Process
- MOST COMMON Complication of OTITIS
- ## Has a LATENT COURSE
- SYMPTOMS
a. Fever / Local Pain
b. Infants = Malaise / Ab Pain / Anorexia
- DIAGNOSIS
a. Otoscopy = Features of Acute / Subacute OM with / without TM Perforation
b. CT = Bone Destruction
c. Lab Tests = INCREASED WBC, C-RP, ESR
———————————————————————
- TREATMENT
a. Surgical Tx
- Mastoidectomy
- Paracentesis = puncture of the tympanic membrane in order to evacuate the middle ear of pathological secretion
- Placement of Myringotomy Tube = DECOMPRESS Middle Ear
b. IV Antibiotics = Culture-Directed
What are the TYPES of INTRACRANIAL COMPLICATIONS?
- Meningitis
- Sigmoid Sinus Thrombosis
- Brain Abscess
- Extradural Abscess
- Subdural Abscess
What are the ROUTES OF SPREAD for INTRACRANIAL?
1) PRE-FORMED PATHWAYS
- Blood Vessels / Diploic Veins
- Labyrinth (Round / Oval Windows/ Internal Auditory Canal)
- Bony Sutures / Fractures
2) NEWLY-FORMED aka BONE DESTRUCTION
- INFECTED Osteitis
- Cholesteatoma
Describe OTOGENIC MENINGITIS (Intracranial)
{Stages, Symptoms / Signs, Diagnosis}
- The INFLAMMATION of LEPTOMENINGES + CSF of Subarachnoid Space
- MOST COMMON!
- ## Leading cause of Acute OM
- 3 Stages of Generalised Meningitis
1) Serous = Outpouring fluid + INCREASED CSF pa
2) Cellular = INCREASED N.O of Cells (Lymph)
3) Bacterial = Bacteria + Polymorph Nuclear Leu in LARGE N.Os
——————————————————————– - SYMPTOMS
a. Fever with Chills
b. Headache
c. Neck Rigidity
d. Photophobia
e. Mental Irritability
f. Nausea + Vomiting - SIGNS
a. +ve Kernig’s Sign
b. +ve Brudzinksi’s SIgn
——————————————————————– - DIAGNOSIS
a. CT Scan of Temporal Bone
b. MRI
c. Funduscopic
d. Lumbar Puncture of CSF
- Cloudy
- INCREASED pa
- INCREASED Protein Conc
- DECREASED Glu / Chlorine
Describe LATERAL / SIGMOID SINUS THROMBOSIS
{Pathogenesis, Clinical Features, Diagnosis, Treatment}
- The THROMBOPHLEBITIS of LATERAL VENOUS SINUS
- ## Developed AFTER the EXTENSION of PERISINUS ABSCESS, due to ADVANCED OM
- PATHOGENESIS
1) Acute / Chronic OM occur
2) Bone Destruction
3) Perisinus Abscess
4) Inflammation of Dura (Sinus Outer Wall)
5) Mural Thrombosis
———————————————— - CLINICAL FEATURES
1) Signs of BLOOD INVASION - Fever w/ Rigors / Chills
- +ve GREISINGER’S SIGN (Oedema / Tenderness) over Mastoid Emissary Vein
2) Signs of INCREASED INTRACRANIAL pa
- Headache / Vomiting
- Papilledema
————————————————
- DIAGNOSIS
0 CT Scan w/ Contrast = DELTA Sign
0 MRI, Angiography, Venography
0 +ve Blood Culture in FEBRILE PHASE
————————————————
- TREATMENT
0 Medical
a. High Dosage IV Antibiotics
b. Supportive Tx
c. Anticoagulants
0 Surgical
a. Mastoidectomy = EXPOSING Affected Sinus; Draining Intra-Sinus Abscesses
What is OTOGENIC BRAIN ABSCESS?
- It is the LOCALISED SUPPURATION in the BRAIN SUBSTANCE
- The MOST LETHAL Complication of Chronic SUPPURATIVE OM
What is the PATHOGENESIS of OTOGENIC BRAIN ABSCESS?
1) Acute / Chronic OM
2) Osteitis = Bone Destruction
3) Retrograde Thrombophlebitis of Dural V.
4) Encephalitis
a| Stage 1 = Initial Encephalitis (Fever / Headache / Vomiting / Rigidity)
b| Stage 2 = Latent {Localisation / Encapsulation}; Symptoms are minimal / absent e.g. Headache
c| Stage 3 = Expanding Abscess (General INCREASE in Intracranial pa; Localised Pa on Brain Centres)
5) Necrosis / Liquefaction of Brain Tissue w/ Surrounding Oedema
6) Abscess w/ Capsule + Surrounding Granulation Tissue
What are the SYMPTOMS of OTOGENIC BRAIN ABSCESS?
1) General INCREASE in INTRACRANIAL pa
- Severe / Continuous Headache
- Projectile Vomiting
- Slowed Pulse
- INCREASED BP
- Disorientation
2) Local pa on BRAIN CENTRES
- CHEYEN-STOKES Respiration
- JACKSONIAN Convulsions
- Ocular Paralysis w/ Pupillary Changes
- Aphasia
What are 2 TYPES of OTOGENIC BRAIN ABSCESSES?
1) TEMPORAL LOBE Abscess
- Leads to Aphasia
- Leads to Paresis of Contralateral Face / Mouth
- Leads to Paresis of Contralateral Extremities
2) CEREBELLAR ABSCESS, which leads to:
- Ataxia = Fall to Affected Side
- Ipsilateral Hypotonia / Weakness
- Spontaneous Vertical Nystagmus
- Intentional Tremor w/ Past-Pointing
What is the TREATMENT for OTOGENIC BRAIN ABSCESS?
1) Medical
- Broad-Spectrum Antibiotics
- MEASURES for Decreasing Intracranial pa
2) Surgical
- NEUROSURGICAL DRAINAGE / EXCISION of Abscess
- MASTOIDECTOMY after subsiding Acute Stage
Describe EXTRADURAL ABSCESS
{Clinical Picture, Diagnosis}
- ## It’s COLLECTION of PUS AGAINST the Dura of MIDDLE / POSTERIOR Cranial Fossa
- CLINICAL PICTURE
0 Persistent Headache on Side of OM
0 Pulsating Discharge
0 Fever
0 Potentially Asymptomatic = Discovered in Surgery
—————————————————————— - DIAGNOSIS
0 CT = Shows Abscess / Middle Ear Pathology
0 MRI = CHOICE!
Describe SUBDURAL ABSCESS / EMPYEMA
{Clinical Picture, Diagnosis}
- ## It’s COLLECTION of PUS BTW Dura Mater AND Arachnoid Mater
- CLINICAL PICTURE
0 Headache, Vomiting
0 Fever
0 Confusion, Drowsiness, Coma
0 Hemiparesis
0 Seizures = Focal / Generalised
—————————————————————— - DIAGNOSIS
0 CT = Shows Abscess / Middle Ear Pathology
0 MRI = CHOICE!
