108 Suppurative Otitis Media—Complications

The complications of otitis media (OM) are associated with a high morbidity and may be life threatening with an 8% mortality risk from intracranial complications. Complications can arise from all forms of active otitis media including cholesteatoma, middle ear mucosal disease and acute otitis media. The complications occur by spread of infection:

• Directly via the oval or round window to reach the labyrinth, through osteomyelitic bone to reach the dura and lateral sinus, or to affect a congenitally dehiscent facial nerve.

• By retrograde propagation of small foci of thrombophlebitis, of emissary veins, which may extend through the temporal bone and dura to the major venous sinuses to cause a lateral sinus thrombosis and by further extension a cerebellar or temporal lobe abscess.

• Along the periarteriolar spaces to cause a temporal or cerebellar lobe abscess.

Browning, in a retrospective study, has calculated that the annual risk of a patient with chronic otitis media developing an otogenic intracerebral abscess is approximately 1 in 10,000, and 1:3,500 for developing meningitis.

The complications may be classified as extracranial or intracranial.

108.1 Extracranial Complications (~ 40%)

• Mastoiditis/post-aural abscess—75% of extra-cranial complications.

• Chronic otitis externa and meatal stenosis.

• Ossicular discontinuity from ossicular erosion.

• Middle ear adhesions.

• Tympanosclerosis which may spread from the tympanic membrane over the ossicular chain causing ossicular chain fixation.

• Lower motor neuron facial nerve palsy.

• Serous or purulent labyrinthitis.

• Labyrinthine fistula.

• Petrositis and Gradenigo’s syndrome (signs of acute suppurative otitis media [ASOM], an ipsilateral abducent nerve palsy and pain in the distribution of the ipsilateral trigeminal nerve).

• Bezold’s and Citelli’s abscess—also complications of acute otitis media.

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