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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Complications of OM,Complications of OM,Three categories on an anatomic basis,Extratemporal extracranial,Bezold abscess,Mouret abscess,Subperiosteal abscess,Intratemporal,Mastoiditis,labyrinthitis,sensorineural hearing loss,petrositis,Facial paralysis,labyrinthine fistula,Intracranial,Epidural abscess,Sigmoid sinus thrombosis,otitic hydrocephalus,meningitis,brain abscess,subdural abscess,Three categories on an anato,Causes,Strong bacteria,Damaged structures,Unreasonable interventions,Causes,Transmission course,Pathways of spread,Direct extension of infection to structure(bone erosion),Hemogenous routine(microbiologic an host factors),Bacteria gain access to intracranial through unsealed gap,inner ear,Transmission course Pathways o,Bezold abscess,Definition:,Erosion the tip of the mastoid bone,Infects the soft tissue of the neck,Deep to the sternocleidomastoid muscle,Diagnosis,Ear infection,Mass in the neck,Fever,neck stiff,otorrhea,CT scan,Bezold abscessDefinition:,Bezold abscess,Treatment,Antibiotic,Abscess cavity should be evacuated,An external drainage should be placed,Mastoidectomy,Antrum drainage required,via epitympanum to the middle ear,Bezold abscessTreatment,Subperiosteal abscess,Definition:Bone erosion,via osteitis or necrosis,leads to a dehiscence into the postauricular soft tissue.,Diagnosis,Fever,pain and otorrhea,Followed by appearance of the postauricular mass,displacing the auricle anteriorly,CT scan,Subperiosteal abscessDefiniti,Subperiosteal abscess,Managements,Antibiotic,Drainage,using postauriclar incision,After achieving effective drainage of the mastoid infection,the site of suppuration can be addressed,Necrotic tissues require debridement,Subperiosteal abscessManageme,Labyrinthitis,Classifications,Cirvumscribed labyrinthitis(fistula of labyrinth),Serous labyrinthitis,Suppurative labyrinthitis,Labyrinthitis Classifications,Fistula of labyrinth,Including bone erosion,exposure of the endosteal membrane and a true fistula into the fluid compartment of the inner ear.,It occurs in 5-10%of cases with cholesteatoma,Lateral semicircular canal is the most common location(90%),Mechanism of bone erosion,Osteolysis,resorptive osteitis,Fistula of labyrinthIncluding,Fistula of labyrinth,Diagnosis,Vertigo(intermittent or constant),Hearing loss,Fistula test(only 50%of patients are positive),CT scan may demonstrate evidence of fistula,however,small fistula can be overlooked,Fistula of labyrinthDiagnosis,Fistula of labyrinth,Managements,Surgical invervention,mastoidectomy,Removal cholesteatoma matrix at the primary operation,fistula closed with temporal fascia,Leaving cholesteatoma matrix undisturbed.9-12 months later,second operation is performed.,antibiotic,Fistula of labyrinthManagement,Serous labyrinthitis,Occurs from inflammation,rather than infection,Caused by bacterial toxins,inflammtory mediators,Inflammatory cells rather than bacteria are found in the labyrintine fluids,Vertigo,sensorineural hearing loss,Serous labyrinthitisOccurs fro,Suppurative labyrinthitis,Bacteria infiltrates the fluid space of inner ear,Vestibular symptoms,Acute phase of inflammation:Vertigo,nausea,The phase of central compensation:imbalance or unsteadiness,Recovery phase:severe perturbation,patients experiences a brief sensation of vertigo.,Suppurative labyrinthitisBacte,Suppurative labyrinthitis,Symptoms associated with cochlea,Permanent sensorineural hearing loss,Tinnitus,Interventions,Antibiotic,Address the problem of the underlying COM and cholesteatoma,Electrolyte(due to vomiting),Prevention,Early and effective treatment of the COM and cholesteatoma,Suppurative labyrinthitisSympt,Petrous apicitis,The most medial and anterior portion of the temporal bone,30%of temporal bones with pneumatization of the petrous apex,Proximity to the posterior and middle cranial fossae,Petrous apicitisThe most media,Petrous apicitis,Gradenigo,s syndrome,Deep ear and retroorbital pain(irritation of the trigeminal nerve),Ipsilateral abducents nerve palsy,Petrous apicitisGradenigos sy,Petrous apicitis,Managements,Antimicrobials directed against the most likely pathogens.,If hearing present in the affected ear,otic capsule should be preserved while effective drainage achieved,retrolabyrinthine,infralabyrinthine,infracochlear approachs can gain access to the petrous apex,Petrous apicitisManagements,Petrous apicitis,Managements,The affected ear is dead ear,translabyrinthine or transcochlear approaches afford greater access to the petrous apex,Petrous apicitisManagements,Intracranial complications,Overview,It is less frequently,due to,Improved access to medical care and medication,Broad spectrum antibiotic,Pathways of spread,Direct extension of infection to intracranial structure(bone erosion),Hemogenous routine(microbiologic an host factors),Bacteria gain access to intracranial through unsealed gap,inner ear,Intracranial complicationsOver,Sigmoid sinus thrombosis,Pathway,Direct extension of mastoid
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