2. Otitis media is an inflammation of
part or all of the mucoperiosteal
lining of the tympano-mastoid
compartment comprising Eustachian
tube, the tympanic cavity, the
mastoid antrum, and all the
pneumatized spaces of the temporal
bone.
Complications of otitis media have
been defined as spread of infection
beyond the confines of the lining
mucosa of the middle-ear cleft.
4. Perforation of the Pars Tensa.
Acute Mastoiditis/Subperiosteal
Abscess.
Petrositis.
Facial Paralysis
5. preschool children
Nasopharynx is the source of the infection.
Initial inflammation of the middle-ear cleft is
followed by suppuration, complication, and
then resolution.
The perforation may heal spontaneously or
may became persistent.
Myringoplasty done in persistant
perforations.
6. Acute mastoiditis is the extension
of the middle-ear inflammation of
AOM into the antrum and mastoid
air cells.
7. Immunocompromised patients.
Poorly treated infection.
Virulence of the organism.
Preformed anatomaical pathway
• Poor pneumatisation of
mastoid bone
• Previous history of infection
• Paediatric age group
8.
9.
10. Lucs abscess: subperiosteal
abscess beneath the
temporal muscle with
concomitant mastoiditis.
11. Facial paralysis and/or vertigo with or without SNHL.
Management includes IV antibiotics, myringotomy,and
cortical mastoidectomy
12. Postulated that anaerobic organisms such as
Peptococcus spp. and Bacteriodes spp. thrive
in the anaerobic environment of the mastoid in
which the aditus is blocked by granulation
tissue.
Indolent osteitis results that causes little or no
pain.
It is important to maintain a high index of
suspicion for this insidious disease.
13. Petrositis: Inflammation of the
pneumatized spaces of the petrous portion
of the temporal bone
Systemic antibiotics.
Mastoidectomy with skeletonization of the
semicircular canals.
Petrous apex can be approached by several
routes, depending on the location of the
infection, the pneumatization of the
temporal bone, and the status of the
hearing.
14. Gradenigo Syndrome (GS) is
classically described as a clinical
triad of otitis media, facial pain,
and abducens palsy that in the
past most commonly developed
from infection in the petrous
temporal bone
15. Children are most susceptible
Routes of spread of infection to the facial
nerve are
1. via natural dehiscences
2. natural pathways that connect the
such as the canal for the stapedius muscle,
neurovascular connections
3.infection of bone around the
Fallopian canal.
Management: antibiotics,steroid
myringotomy, mastoidectomy, facial nerve
decompression
20. Mastoid cortex can be breached,
and pus accumulates under the
periosteum, Blunting of the
postauricular crease and
anterio-inferior displacement of
the pinna are early signs.
CT scan
Management is antibiotic,
tympanomastoidectomy
21. The lateral semicircular canal is
particularly susceptible.
Vertigo is often induced by straining against
a closed glottis. Hearing loss or deafness,
ipsilateral facial paresis/paralysis, and
otalgia.
The spontaneous nystagmus usually beats
towards the non diseased, contralateral ear.
22.
23. Bone erosion is the result of
coalescent mastoiditis
Protective granulations
24. Oval or round window,
Internal auditory canal,
Cochlear aqueduct,
Endolymphatic duct and sac.
Suture or a dchiscent floor of the
hypotympanum over jugular bulb.
Skull fracture or previous surgery.
A perilymph fistula, either congenital or
acquired.
25. There is a rich network of veins
within the temporal bone that is
in direct communication within
the temporal bone and that, in
turn, is in direct communication
with the extracranial,
intracranial, and cranial diploic
veins
26. Generalized bacterial meningitis is an
inflammatory response to bacterial
infection of the pia-arachnoid and the CSF
of the subarachnoid space.
Localized meningitis may be defined as a
localized inflammation of the dura and pia-
arachnoid confined to the region.
28. CT scan
MRI
CSF study and culture sensitivity
Pus culture and sensitivity
Third-generation cephalosporins
Vancomysin
Steroid
Surgery to make the ear disease free
29.
30. A brain abscess is a focal
suppurative process within the
brain parenchyma surrounded by
a region of encephalitis.
Brain abscess secondary to otitis
media displays a bimodal age
distribution.
Male-to-female ratio has been
approximately 3: 1
31. Streptococcus
Staphylococcus
Escherichia coli and Proteus,
Klebsiella, and Pseudomonas species.
Otogenic brain abscesses are often
the result of venous thrombophlebitis
rather than direct dural extension
32.
33. Brain abscess formation is indicated by the presence of the triad of
(1) headache, (2) high-grade fever, and (3) focal neurologic deficits
Cerebellar abscesses provoke dizziness, ataxia, nystagmus, and
vomiting.
Temporal lobe lesions may result in seizures.
Papilledema is frequently seen in stage 3 of abscess formation
36. High grade fever(picket fence)
Proptosis, ptosis, chemosis,
Ophthalmoplegia
Tenderness and edema over the mastoid
(Griesinger's sign)
Propagation of the thrombus into the
internal jugular vein causes it to become
hard, cord-like, and very tender to palpation,
and results in a stiff neck.
37. CT Scan-"delta sign"-an
empty triangle at the level of
the sigmoid sinus,
consisting of the clot
MRI is more sensitive than
CT scanning in detecting
Thrombosis the" delta" sign
as seen with gadolinium-
enhanced
39. Headache, drowsiness, vomiting, blurring of vision, and diplopia and
sixth cranial nerve palsy
Optic atrophy can eventually develop.
A lumbar puncture should be done with caution, herniation of the
cerebellar tonsils may occur.
MRI is the imaging modality of choice as it allows for superior
evaluation of the venous sinuses.
40. Decompression of the sigmoid sinus.
CSF drainage procedures, such as shunts.
Optic sheath decompression.
Medical therapy includes corticosteroids, mannitol, diuretics, and
acetazolamide
41. Headache of abrupt onset
Fever and vomiting
The rapidity with which the patient deteriorates points
to a subdural empyema.
MRI is the imaging of choice
42. Subdural empyema is a surgical emergency, and prognosis is related
to the promptness of diagnosis and drainage.
Lumbar puncture is contraindicated as it could precipitate herniation
of the cerebellar tonsils.
Emergency drainage with high-dose, intravenous antimicrobial
medication is the treatment of choice.
43. Epidural abscesses are rarely symptomatic.
Management
The discovery of granulation tissue penetrating bone or granulation
tissue along the sigmoid sinus should prompt further exploration.
The surrounding bone should be gently removed and the abscess
drained.