--- title: "Complications of Acute Otitis Media" description: "A detailed overview of extracranial and intracranial complications of Acute Otitis Media - types, pathophysiology, clinical features, investigations, and treatment." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/complications-of-acute-otitis-media" categories: ["Otology"] video: "https://www.youtube.com/watch?v=iq1_rwLCNms" image: "https://media.theentresident.com/og-images/complications-of-acute-otitis-media.png" --- # Complications of Acute Otitis Media A detailed overview of extracranial and intracranial complications of Acute Otitis Media - types, pathophysiology, clinical features, investigations, and treatment. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=iq1_rwLCNms ## 👂 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 | Complication | Type | Common Feature | Diagnosis | Treatment | | --- | --- | --- | --- | --- | | Tympanic Membrane Perforation | Extracranial | Otorrhea, pain relief | Otoscopy | Usually heals, monitor | | Mastoiditis | Extracranial | Postaural swelling, fever | CT Mastoid | IV antibiotics, mastoidectomy | | Petrositis | Extracranial | Gradenigo's Triad | CT/MRI | Drainage surgery | | Facial Nerve Palsy | Extracranial | Facial weakness | Clinical + EMG | Ventilation tube, steroids | | Labyrinthitis | Extracranial | Vertigo, SNHL | Audiometry, MRI | Antibiotics, surgery if needed | | Meningitis | Intracranial | Fever, irritability, fontanelle | LP | 3rd gen cephalosporins ± surgery | | Extradural Abscess | Intracranial | Fever, headache | CT/MRI | Drainage | | Subdural Empyema | Intracranial | Raised ICP signs | CT/MRI | Burr hole + mastoidectomy | | Sigmoid Sinus Thrombosis | Intracranial | Picket fence fever, Griesinger sign, headache | MRI | Surgery, anticoagulation | | Cerebritis (Encephalitis) | Intracranial | Focal signs, edema | MRI | Intensive antibiotics | | Brain Abscess | Intracranial | Headache, focal deficit | CT + LP | Drainage + antibiotics | | Otitic Hydrocephalus | Intracranial | Raised ICP without lesion | MRI, LP | ICP control meds | --- ## About This Note This free ENT note on Complications of Acute Otitis Media was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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