耳鼻喉科学-13 颞骨骨折、中耳炎及并发症-Complications of chronic otitis media.ppt

Complications of OM Huawei Li 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 Causes Strong bacteria Damaged structures Unreasonable interventions 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 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 abscess Treatment Antibiotic Abscess cavity should be evacuated An external drainage should be placed Mastoidectomy Antrum drainage required, via epitympanum to the middle ear 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 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 Labyrinthitis Classifications Cirvumscribed labyrinthitis (fistula of labyrinth) Serous labyrinthitis Suppurative labyrinthitis 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 Osteolys