Complications of Acute Otitis Media

👂 Complications of Acute Otitis Media

In this post, we explore the complications of Acute Otitis Media (AOM), classified into extracranial and intracranial categories.

Each complication is discussed in terms of types, clinical features, diagnostic approach, and treatment.

🔍 Classification of Complications of Acute Otitis Media

1. Extracranial Complications of Acute Otitis Media

• Tympanic membrane perforation
• Acute mastoiditis
• Petrositis
• Facial nerve palsy
• Labyrinthitis

2. Intracranial Complications of Acute Otitis Media

• Meningitis
• Extradural abscess
• Subdural empyema
• Sigmoid sinus thrombosis
• Focal otitic encephalitis (cerebritis)
• Brain abscess
• Otitic hydrocephalus

What is the most common complication of Acute Otitis Media?

What is the most common extracranial complication of Acute Otitis Media?

What is the most common intracranial complication of Acute Otitis Media?

🦻 Extracranial Complications of Acute Otitis Media

✅ 1. Tympanic Membrane Perforation

• Seen in 1–10% of AOM cases.

• Presents with purulent or bloody otorrhea and sudden pain relief.

• Usually involves posterior half of pars tensa.

What are the 3 most common organisms causing Tympanic membrane perforation in Acute Otitis Media?

• Possible Outcomes:

  • Spontaneous healing
  • Persistent perforation
  • Chronic otitis media (if >3 months)
  • Further complications

✅ 2. Acute Mastoiditis

• Types:

1. Radiological extension (not a true complication)
2. Periosteitis (via emissary veins) – no abscess, pinna pushed forward
3. Subperiosteal abscess – abscess in postauricular region; may extend to:
   • Zygomatic abscess
   • Basal abscess
   • Retropharyngeal/parapharyngeal abscess
4. Masked mastoiditis – after incomplete treatment

• Clinical Features:
  • Seen mostly in < 2-year-old children
  • History of 10–14 days of ear symptoms
  • Postauricular swelling, pinna protrusion, McEwen's triangle tenderness
  • Bulging or normal tympanic membrane
  • Sagging posterior canal wall (with abscess)

What are the organisms causing Mastoiditis in Acute Otitis Media?

• Investigations:
  • CBC, CRP, Blood culture
  • CT Mastoid with contrast

What are the indications of CT Scan in Acute mastoiditis?

• Treatment:

  • IV antibiotics
  • Cortical mastoidectomy - if no response after 24–72 hrs
  • Immediate surgery for subperiosteal abscess or deteriorating child

What antibiotics are used in treatment of Mastoiditis?

✅ 3. Petrositis

• Involves petrous apex of temporal bone

• Presents with Gradenigo’s Triad

What are the features seen in Gradenigo's Triad?

Treatment:

• Mastoidectomy with petrous apex decompression

✅ 4. Facial Nerve Palsy

• Rare: 0.005% of AOM

• Caused by:

  • Staphylococcus aureus
  • Neuropraxia from edema or toxins

• Common in congenital dehiscence of fallopian canal

Treatment:

Ventilation tube + IV antibiotics Corticosteroids Cortical mastoidectomy - if poor response

✅ 5. Labyrinthitis

Types:

1. Serous labyrinthitis

   • Non-purulent, mild vertigo, SNHL, good recovery

2. Suppurative labyrinthitis

   • From mastoid/middle ear
   • Severe vertigo, permanent SNHL, systemic features

Treatment:

• Antibiotics, ventilation tube
• In some cases: Tympanomastoidectomy, cochleotomy, steroids

🧠 Intracranial Complications of Acute Otitis Media

✅ 1. Meningitis

• 50–90% of intracranial AOM complications
• Caused by: Streptococcus pneumoniae

Features:

• Headache, fever, vomiting, photophobia
• In infants: bulging fontanelle

Diagnosis:

• Lumbar puncture: ↑WBC, ↓glucose in CSF

Treatment:

• 3rd gen cephalosporins, vancomycin for resistant cases
• Mastoidectomy, only if needed after stabilization

✅ 2. Extradural Abscess

• Pus collects between bone and dura
• Can also cause perisinus abscess if near sigmoid sinus

Treatment: Surgical drainage

✅ 3. Subdural Empyema

• Rare but serious
• Pus collects between dura and arachnoid
• Associated with direct spread or thrombophlebitis

Treatment:

• Burr hole/craniectomy
• Mastoidectomy

✅ 4. Sigmoid Sinus Thrombosis

• Seen in 0–2.7%
• Erosion of sinus wall → infected thrombus → septicemia

Features:

• Headache, picket fence fever, Griesinger’s sign

What is Picket Fence fever?

What is Griesinger’s sign?

Diagnosis: MRI with venography

Treatment:

• Antibiotics: Ceftriaxone, metronidazole, clindamycin
• Surgery: Mastoidectomy, sinus thrombectomy, IJV ligation
• Anticoagulation (if no hemorrhage)

✅ 5. Focal Otitic Encephalitis (Cerebritis)

• Localized inflammation/edema of brain tissue
• May co-exist with other complications

Treatment: Aggressive IV antibiotics

✅ 6. Brain Abscess

• Common sites: Temporal lobe, Cerebellum

• Caused by: Streptococcus pneumoniae

Features: Headache, signs of raised ICP, focal deficits

Diagnosis: CT scan followed by lumbar puncture

Treatment:

• Broad-spectrum antibiotics
• Mastoidectomy + Neurosurgical drainage

✅ 7. Otitic Hydrocephalus

• Raised ICP without obstructive lesion or mass
• Also called Benign Intracranial Hypertension

Features:

• Headache, diplopia, visual disturbances, papilledema
• Often associated with sigmoid/transverse sinus thrombosis

Diagnosis:

• MRI/MRV
• Lumbar Puncture: Raised pressure, normal CSF

Treatment:

• Steroids, mannitol, acetazolamide, diuretics

📌 Summary Table