Signs in Complications of Otitis Media

Signs in Complications of Otitis Media

Several classical signs are seen in the complications of otitis media. In this post, we will discuss:

• Delta Sign
• Griesinger Sign
• Ring Sign
• Kernig Sign
• Brudzinski Sign
• Ironed Out Appearance of Mastoid
• Lighthouse Sign
• Reservoir Sign

Delta Sign

📌 Type of Sign

👉 Radiological Sign seen on:

• Contrast enhanced CT (CECT)
• MRI

What is the other name of Empty Triangle Sign?

🔍 What is the Sign?

Delta Sign refers to a triangular filling defect within the dural venous sinus, surrounded by contrast enhancement.

Described radiologically as:

👉 Central low density with rim enhancement

Seen in Lateral (Sigmoid) Sinus Thrombosis, a complication of otitis media.

Which section of CT Scan shows the Delta sign?

What does Central low density with rim enhancement indicate?

🔺 Why is it Called Delta Sign?

The appearance resembles a triangle (delta), hence the name Delta Sign.

What is the most common ENT cause of lateral sinus thrombosis?

Griesinger Sign

📌 Type of Sign

👉 Clinical Sign elicited during Mastoid examination.

🔍 What is the Sign?

Griesinger Sign refers to edema of the post auricular soft tissues overlying the mastoid process, due to thrombosis of the mastoid emissary vein.

Seen in Lateral Sinus Thrombosis.

What is the pathogenesis behind Griesinger Sign?

👨‍⚕️ Eponym

Named after Griesinger, who described mastoid region edema due to mastoid emissary vein thrombosis in lateral sinus thrombosis.

Which is the vein involved in Griesinger Sign?

Ring Sign

📌 Type of Sign

👉 Radiological Sign

Seen on Contrast enhanced CT or MRI Brain.

🔍 What is the Sign?

Ring Sign refers to a ring enhancing lesion, with a central necrotic or hypodense area surrounded by an enhancing capsule.

Seen in Brain Abscess, a complication of otitis media.

What is the pathogenesis behind Ring sign?

What are the stages of Brain abscess?

What is the most common ENT cause of brain abscess?

What is the most common site of otogenic brain abscess?

What is the most common intracranial complication of CSOM?

What are the intracranial complications of CSOM?

What is the Differential Diagnosis of Ring Enhancing Lesion seen on CT?

Kernig Sign

📌 Type of Sign

👉 Clinical Sign

A sign of Meningeal irritation.

🔍 What is the Sign?

Kernig Sign refers to pain or resistance on extending the knee when the hip is flexed.

Seen in Meningitis, the most common intracranial complication of CSOM.

🩺 How is it Elicited?

1- The hip is flexed

2- With the hip flexed, the knee is extended

A positive sign is:

✅ Pain in the lower back

✅ Resistance to extension of the knee

✅ Complete inability to extend the knee

⭐ In a normal patient, the knee can be fully extended.

🧠 Why Does it Occur?

Knee extension stretches the sciatic nerve and the inflamed meninges, resulting in pain and spasm, preventing full knee extension.

👨‍⚕️ Eponym

Named after Vladimir Kernig, who described this sign in patients with meningitis.

💡 Mnemonic

KE from KErnig

👉 Knee Extension is painful

What are the CSF findings in bacterial meningitis?

Brudzinski Sign

📌 Type of Sign

👉 Clinical Sign

A sign of Meningeal irritation.

🔍 What is the Sign?

Brudzinski Sign refers to involuntary flexion of the hip and knee on flexing the neck.

Seen in Meningitis.

🩺 How is it Elicited?

1- The patient lies in the supine position

2- The examiner gently flexes the neck forward

A positive sign is:

✅ Involuntary hip and knee flexion

🧠 Why Does it Occur?

Flexion of the neck stretches the inflamed meninges.

To reduce the stretch and the pain, the patient reflexly flexes the hip and knee.

👨‍⚕️ Eponym

Named after Josef Brudzinski, a Polish paediatrician, who first described this sign.

💡 Mnemonic

B from Brudzinski

👉 On Bending the neck, hip and knee are flexed

Ironed Out Appearance of Mastoid

📌 Type of Sign

👉 Clinical Sign seen during Examination of the mastoid region.

🔍 What is the Sign?

Ironed Out Appearance refers to a smooth, shiny, flattened appearance of the skin over the mastoid region, with loss of the normal bony contour.

Seen in Acute Mastoiditis.

⭐ A normal mastoid feels irregular, not smooth, on palpation.

🧠 Why Does it Occur?

Infection spreads from the middle ear to the mastoid air cells

→ Breaks through the mastoid cortex

→ Periostitis with subperiosteal pus collection

→ Thickened periosteum

→ Skin over the mastoid becomes stretched, shiny and swollen

👔 Why is it Called Ironed Out Appearance?

The post-auricular swelling destroys the normal mastoid appearance, leaving it flat and smooth like ironed cloth, hence the name Ironed Out Appearance.

What are all the other Signs in seen Acute Mastoiditis?

Lighthouse Sign

📌 Type of Sign

👉 Clinical Sign seen during Otoscopy.

📌 Also Known As

👉 Pulsatile Otorrhea

🔍 What is the Sign?

Lighthouse Sign refers to pus coming out under pressure through a small pinhole perforation of the tympanic membrane, synchronizing with each arterial pulse.

Which stage of ASOM do you see Lighthouse sign in?

What are the stages of ASOM?

What is the sign seen in the stage of presuppuration of ASOM?

🧠 Why Does it Occur?

• Pus collects in the middle ear and mastoid
• Pus escapes under pressure through the pinhole perforation
• Transmitted vascular pulsations from the middle ear make the discharge appear pulsatile
• The pulsatile discharge reflects the light intermittently during otoscopy

🚨 Why is it Called Lighthouse Sign?

The intermittently reflecting pulsatile discharge resembles a lighthouse beam flashing intermittently, hence the name Lighthouse Sign.

Reservoir Sign

📌 Type of Sign

👉 Clinical Sign seen during Otoscopy.

🔍 What is the Sign?

Reservoir Sign refers to rapid refilling of the external auditory canal with pus or discharge within minutes of suctioning it clear.

Seen in Acute Mastoiditis.

🧠 Why Does it Occur?

• Continuous pus production in the mastoid air cells and middle ear cleft
• Pus keeps draining into the external auditory canal as soon as it is cleared

🪣 Why is it Called Reservoir Sign?

The mastoid and middle ear act as a reservoir of pus, refilling the external auditory canal rapidly each time it is cleaned, hence the name Reservoir Sign.

⭐ High Yield Rapid Revision Table

🧠 Viva Pearls

• Griesinger Sign is due to thrombosis of the mastoid emissary vein.
• Ring Sign is seen in brain abscess.
• Kernig Sign and Brudzinski Sign are signs of meningeal irritation.
• Kernig Sign is pain or resistance on knee extension with the hip flexed.
• Brudzinski Sign is involuntary hip and knee flexion on flexing the neck.
• Ironed Out Appearance of the mastoid is due to periostitis and subperiosteal pus collection.
• Lighthouse Sign is also known as pulsatile otorrhea.
• Reservoir Sign is due to continuous pus production in the mastoid and middle ear.

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