What are the complications of otitis media in adults and children? Let’s find out the answer!
Table of Contents
Complications of Otitis Media
Cholesteatoma definition: What is a cholesteatoma? Cholesteatoma is a type of chronic otitis media that is a little different.
What causes cholesteatoma? The most common cause is a long-term problem with the eustachian tube, which causes the upper, loose part of the tympanic membrane to move inward. This makes a sac lined with squamous epithelium, which, if its neck gets blocked, can fill with desquamated keratin and stay infected for a long time.
Cholesteatomas usually break down bone, with the mastoid breaking in early and the ossicular chain breaking down. Over time, they can wear away and reach the inner ear, the facial nerve, and sometimes even the brain.
An otoscopic exam may show an epitympanic retraction pocket or a perforation on the edge of the tympanic membrane that leaks keratin debris or granulation tissue.
Cholesteatoma is treated by putting the sac back together with surgery or taking it out completely. This may require making a “mastoid bowl,” in which the ear canal and mastoid are joined together to make a large cavity that needs to be cleaned regularly.
Acute suppurative mastoiditis usually happens after a few weeks of acute otitis media that has not been treated well enough. It is marked by pain behind the ear, redness, and rising fever.
A CT scan shows that the mastoid air cells have joined together because their bony septa have been broken.
The first treatment step is to give intravenous antibiotics (like 0.5–1.5 g of cefazolin every 6–8 hours) to kill the most common germs (S pneumoniae, H influenzae, and S pyogenes), do a myringotomy to drain and culture the ear. If medical treatment doesn’t work, surgery is needed to drain the fluid (mastoidectomy).
When the drainage of its pneumatic cell tracts gets blocked, an infection can stay in the middle part of the petrous bone, which is between the inner ear and the clivus. This could lead to a foul discharge, deep ear and retroorbital pain, sixth nerve palsy (Gradenigo syndrome), and meningitis.
Based on the results of the culture, treatment involves a long course of antibiotics and surgical drainage through a petrous apicectomy.
Either acute or chronic otitis media can cause facial palsy. In an acute case, it is caused by inflammation of the seventh nerve in its middle ear segment.
The treatment is a myringotomy to drain and culture the ear, followed by intravenous antibiotics (based on culture results). The use of corticosteroids is controversial. However, the prognosis is good, and most people get better completely.
Chronic otitis media usually causes facial palsy to develop slowly because cholesteatoma puts constant pressure on the seventh nerve in the middle ear or mastoid.
For treatment, the underlying disease must be fixed through surgery. Unfortunately, the outlook is not as good as it is for facial paralysis caused by an acute middle ear infection.
Sigmoid Sinus Thrombosis
Septic thrombophlebitis occurs when an infection gets stuck in the mastoid air cells next to the sigmoid sinus. This is signaled by signs of systemic sepsis, like rising fevers and chills, and sometimes by high pressure inside the head (headache, lethargy, nausea and vomiting, papilledema).
Magnetic resonance venography is a non-invasive way to make a diagnosis (MRV). Intravenous antibiotics are the main treatment (based on culture results). Surgery to drain the blood and tie off the internal jugular vein may be necessary when embolization is suspected.
Central Nervous System Infection
By far, otogenic meningitis is the most common brain infection caused by an ear infection. The spread of bacteria causes acute suppurative otitis media through the blood, most often H influenzae and S pneumoniae.
Chronic otitis media happens when an infection moves along a pre-made path, like the petrosquamous suture line, or when the disease spreads directly through the dural plates of the petrous pyramid.
Epidural abscesses happen when a disease spreads directly into an area that has been infected for a long time. Most of the time, they don’t cause any symptoms, but they can cause deep pain in the area, headaches, and low-grade fever. Most of the time, they are found by accident during surgery. When a person has septic thrombophlebitis next to an epidural abscess, an abscess can form in the temporal lobe or cerebellum.
Most of the time, S aureus, S pyogene, and S pneumoniae are to blame. However, meningitis and often death happens when the subarachnoid space is broken.
I hope you understand the most common complications of otitis media in adults and children.