Otitis media (OM) is a heterogeneous disease with a wide spectrum of presentations and natural histories. The etiology, presentation, natural history, and management of acute and chronic otitis media (AOM and COM) are discussed in detail in other chapters. In this chapter, we discuss the complications, both intratemporal and intracranial, of AOM and COM and cholesteatoma, and their management. These complications are summarized in Table 149.1
AOM is a common infection, estimated to represent up to 5.8% of all patient visits to physicians (1
). In the vast majority of cases, the pathologic process is self-limited, or resolves with antibiotic therapy. Indeed, although not universally agreed upon, some have recently considered observation alone for straightforward cases of AOM, with antibiotics reserved for refractory cases, or for prevention of complications in higher risk patients (3
). AOM may resolve completely, resolve and recur, or evolve into one of many manifestations of COM. Complications of OM can occur directly from AOM or arise from COM. Although these complications are rare today, they occur in developed countries at approximately the same frequency as in underdeveloped countries, and are associated with high rates of serious morbidity and mortality (4
). Prompt diagnosis and rapid, effective therapy are critical to minimizing these sequelae.