--- title: "Extracranial Complications of CSOM" description: "ENT notes on Extracranial Complications of CSOM - Intraoperative and Postoperative." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/extracranial-complications-csom" categories: ["Otology"] video: "https://www.youtube.com/watch?v=vvXwKyS8Nog" image: "https://media.theentresident.com/og-images/extracranial-complications-csom.png" --- # Extracranial Complications of CSOM ENT notes on Extracranial Complications of CSOM - Intraoperative and Postoperative. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=vvXwKyS8Nog ## 🦻 Extracranial Complications of CSOM **Extracranial complications**, which are further divided into: - Intratemporal complications - Extratemporal complications --- ### 🔬 Intratemporal Complications ### 1️⃣ Mastoiditis Mastoiditis refers to the inflammation and infection of the **mastoid air cell system**, which can extend from mucosal involvement to the **bony walls** of the mastoid. 🔸 **Types of Mastoiditis** - Acute Mastoiditis - Masked (Latent) Mastoiditis #### 🦠 **Acute Mastoiditis** **Definition:** Extension of infection from the **mucosa lining** the mastoid air cells to the **bony septa** and walls of the mastoid system. >What are the causes of Acute Mastoiditis? **⚕️ Clinical Features** - Mastoid tenderness - Fever and ear discharge - Sagging of posterior superior meatal wall - **Ironed-out mastoid** - Obliterated post-auricular sulcus - Tympanic membrane perforation >What is Ironed-out mastoid? Why does it happen? 💊 **Treatment** - Immediate **hospitalization** - **IV antibiotics** and **analgesics** - **Myringotomy** if TM is bulging (AOM cases) - **Cortical Mastoidectomy** in chronic or refractory cases #### 😷 **Masked (Latent) Mastoiditis** **Definition:** A **slowly destructive** form of mastoiditis without the overt acute symptoms seen in the acute type. >What are the causes of Masked Mastoiditis? ⚕️ **Clinical Features** - Minimal or no **pain** behind ear - No **discharge**, **fever**, or **mastoid swelling** - **Thickened, non-translucent tympanic membrane** (no perforation) 💊 **Treatment** - Full course of **IV antibiotics** - **Cortical Mastoidectomy** --- ### 2️⃣ Petrositis **Definition:** Spread of infection from the middle ear or mastoid to the **petrous part of the temporal bone**. **Association:** - Commonly occurs with **acute mastoiditis** or **cholesteatoma** - Seen in **pneumatized petrous apex** (present in ~30% individuals) >What is the pathophysiology of Petrositis? ⚠️ Classical Presentation — **Gradenigo’s Syndrome** >What is the triad seen in Gradenigo’s Syndrom? 💊 **Treatment** - **IV antibiotics** - **Cortical, Radical, or Modified Radical Mastoidectomy** (based on extent) --- ### 3️⃣ Facial Nerve Paralysis Facial nerve palsy can occur in both **AOM** and **COM**. **🧩 In Acute Otitis Media** **Pathogenesis:** - Dehiscence of facial canal → facial nerve exposed beneath middle ear mucosa - Inflammation spreads to **epineurium and perineurium** **Timeline:** - Palsy within **10 days** → due to inflammation - Palsy **after 2 weeks** → due to **bony erosion** **Treatment** - **Systemic antibiotics** and **myringotomy** - Occasionally **corticosteroids** - **Cortical mastoidectomy** if unresponsive 🧩 **In Chronic Otitis Media** **Cause:** - **Cholesteatoma** or **granulation tissue** eroding the bony facial canal **Clinical Course:** - Slow, insidious onset - Progressive facial weakness **Investigation:** - **HRCT temporal bone** to assess disease and facial canal erosion **Treatment:** - Urgent Radical or Modified Radical Mastoidectomy - Explore facial canal - Remove granulations gently; preserve uninvolved nerve sheath - Resect damaged segment and perform nerve grafting --- ### 4️⃣ Labyrinthitis Inflammation of the **inner ear (labyrinth)**, commonly secondary to middle ear infection. 🔸 **Types of Labyrinthitis** 1. Circumscribed (Localized) 2. Diffuse Serous 3. Diffuse Suppurative (Purulent) #### 🔹 **Circumscribed Labyrinthitis (Labyrinthine Fistula)** **Definition:** Abnormal communication between **inner ear and middle ear** due to **erosion of bony labyrinth**. >What are the causes of Circumscribed Labyrinthitis? **Clinical Features:** - Intermittent vertigo with normal equilibrium between attacks - Positive fistula test >What is Fistula test? >How do you perform fistula test? >What are some causes of False positive Fistula test? >What are some causes of False negative Fistula test? **Treatment:** - Systemic antibiotics - Surgical management to remove source of erosion #### 🔹 **Diffuse Serous Labyrinthitis** **Definition:** Diffuse **inflammatory reaction** of the labyrinth without pus formation — **reversible** stage. >What are the causes of Diffuse Serous Labyrinthitis? **Clinical Features:** - Spontaneous vertigo - Irritative nystagmus - Positive fistula test (if fistula present) - Mild SNHL **Treatment:** - Head immobilization (affected ear up) - IV antibiotics - Labyrinthine sedatives - **Myringotomy** if due to AOM - **Cortical mastoidectomy** if indicated #### 🔹 **Diffuse Purulent Labyrinthitis** **Definition:** Diffuse **pyogenic infection** of the labyrinth with **irreversible** cochlear and vestibular damage. **Causes:** - Usually follows **serous labyrinthitis** **Treatment:** - Same as serous form + occasionally **labyrinth drainage** --- ### 🌐 Extratemporal Complications There are **six main abscesses** associated with the mastoid that form the **extratemporal complications**. ### 1️⃣ Post Auricular Abscess **Definition:** Collection of pus in the **post-auricular region**, typically following **acute mastoiditis**. **Clinical Features:** - Swelling behind ear - Tenderness and warmth - Obliterated post auricular groove - Sagging posterior superior canal wall **Treatment:** - IV antibiotics - Cortical Mastoidectomy --- ### 2️⃣ Zygomatic Abscess **Definition:** Pus collection **above and in front of the pinna** (temporal fossa over zygomatic arch). **Features:** - Swelling in temporal region - Upper eyelid edema **Treatment:** - IV antibiotics - Surgical drainage / Mastoidectomy --- ### 3️⃣ Bezold’s Abscess **Definition:** Deep neck abscess due to **erosion of the mastoid tip**, with pus tracking along **SCM sheath**. **Clinical Features:** - Painful upper neck swelling - Torticollis **Treatment:** - IV antibiotics - Neck abscess drainage - Mastoidectomy --- ### 4️⃣ Luc’s Abscess **Definition:** **Subperiosteal abscess** within the **external auditory canal**, without bony mastoid destruction. **Features:** - Localized swelling in **posterior superior canal wall** **Treatment:** - IV antibiotics - Drainage as needed --- ### 5️⃣ Citelli’s Abscess **Definition:** Posteriorly tracking pus collection from **acute mastoiditis** into the **occipital region**. **Features:** - Swelling in occipital region - Tracks via Citelli’s tract and posterior digastric groove **Treatment:** - IV antibiotics - Surgical drainage / Mastoidectomy --- ### 6️⃣ Parapharyngeal / Retropharyngeal Abscess **Cause:** Spread from **peritubal cell infection** or **acute coalescent mastoiditis**. **Treatment:** - IV antibiotics - Drainage procedure - Address underlying mastoiditis --- ## About This Note This free ENT note on Extracranial Complications of CSOM was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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