Intracranial spread of organism may occur via the middle ear by thrombophlebitis or by penetration of the dura of the middle or posterior cranial fossae.
Meningitis
Clinical features:
Presents as headache, neck stiffness and photophobia. Lumbar puncture confirms the diagnosis. Pneumococcus and Haemophilus influenzae are common pathogens.
Management:
Treatment is by intravenous antibiotics followed by mastoidectomy once the meningitis has revolved.
Venous sinus thrombosis
Follows spread of middle ear and mastoid infection through the bone over the sigmoid sinus.
Clinical features:
Presents as headache, pyrexia and rigors. Extension of thrombus to the superior sagittal sinus leads to CSF outflow obstruction: otitic hydrocephalus.
Management:
Treatment is by intravenous antibiotics and mastoidectomy, during which infected thrombus may need to be removed from the sinus lumen.
Intracranial abscess
Extradural, subdural and cerebral abscesses occur. Infection spreads into the middle and posterior cranial fossae leading to temporal lobe and cerebellar abscesses respectively. Diagnosis by CT scan and treatment by neurosurgical drainage.
2019年6月5日星期三
Complications of suppurative otitis media (化膿性中耳炎的并發症) - Extracranial (顱外并發症)
Facial nerve paralysis
Aetiology:
Pressure by cholesteatoma on the facial nerve in the middle ear or mastoid.
Clinical features:
Presents as partial or complete lower motor neurone facial paralysis with evidence of chronic middle ear disease on otoscopy.
Management:
Treatment is by immediate surgical decompression of the facial nerve via a mastoidectomy operation.
Suppurative labyrinthitis
Aetiology:
Follows erosion of the bony labyrinth most commonly over the lateral semicircular canal. In the early stages compression of the air in the external meatus causes vertigo from mechanism stimulation of the labyrinth (fistula test). Later purulent infection in the inner ear causes severe vertigo and sensorineural deafness.
Management:
Treatment is by intravenous antibiotics and eradication of cholesteatoma via mastoidectomy.
Gradenigo’s syndrome
Otorrhoea is associated with pain behind the eye and diplopia, caused by fifth and sixth nerve irritation resulting from air cell infection at the petrous apex.
2019年6月3日星期一
Suppurative Otitis media (化膿性中耳炎) - Chronic otitis media (慢性中耳炎)
Chronic otitis media (慢性中耳炎)
Aetiology:
Chronic inflammation of the middle ear cleft is usually associated with a perforation of the tympanic membrane. Perforation usually result from previous episodes of acute otitis media when the membrane fails to heal following rupture, but can be due to direct or indirect trauma. In children, perforations can persist following extrusion of ventilation tubes from the tympanic membrane.
Organism can reach the middle ear from the Eustachian tube or from the external meatus. Chronic middle ear infection is also associated with ossicular damage, with the incudostapedial joint being the most commonly affected linkage.
Clinical features:
A central perforation in the pars tensa part of the membrane is associated with recurrent otorrhoea and conductive deafness. This type of perforation is regarded as safe as neurological complications are rare. An attic or marginal perforation can be associated with the development of a cholesteatoma and is regarded as unsafe.
Management:
Cases of central perforation should be kept dry. If recurrent otorrhoea occurs, ear drops containing a mixture of steroid and antibiotic are used and attention should be paid to possible source of infection in the nasopharynx, nose and paranasal sinuses. A dry perforation can be repaired by myringoplasty. Traumatic central perforations usually heal spontaneously.
Aetiology:
Chronic inflammation of the middle ear cleft is usually associated with a perforation of the tympanic membrane. Perforation usually result from previous episodes of acute otitis media when the membrane fails to heal following rupture, but can be due to direct or indirect trauma. In children, perforations can persist following extrusion of ventilation tubes from the tympanic membrane.
Organism can reach the middle ear from the Eustachian tube or from the external meatus. Chronic middle ear infection is also associated with ossicular damage, with the incudostapedial joint being the most commonly affected linkage.
Clinical features:
A central perforation in the pars tensa part of the membrane is associated with recurrent otorrhoea and conductive deafness. This type of perforation is regarded as safe as neurological complications are rare. An attic or marginal perforation can be associated with the development of a cholesteatoma and is regarded as unsafe.
Management:
Cases of central perforation should be kept dry. If recurrent otorrhoea occurs, ear drops containing a mixture of steroid and antibiotic are used and attention should be paid to possible source of infection in the nasopharynx, nose and paranasal sinuses. A dry perforation can be repaired by myringoplasty. Traumatic central perforations usually heal spontaneously.
2019年6月1日星期六
Suppurative Otitis media (化膿性中耳炎) - Acute mastoiditis (急性乳突炎)
Acute mastoiditis (急性乳突炎)
Aetiology:
Acute mastoiditis may complicate acute otitis media. Infection of the mastoid air cell system occurs.
Clinical features:
Presents as worsening of otalgia with tenderness over the mastoid antrum. The external meatus may be narrowed by oedema of the posterior-superior wall. In advanced cases a subperiosteal abscess may push the ear forward. Diagnosis is confirmed by opacity of the mastoid cells on CT scan.
Management:
Initially high-dose parenteral antibiotic therapy is required, although in cases that fail to respond to antibiotics, or in which a subperiosteal abscess has formed, surgical drainage via a cortical mastoidectomy is required.
Aetiology:
Acute mastoiditis may complicate acute otitis media. Infection of the mastoid air cell system occurs.
Clinical features:
Presents as worsening of otalgia with tenderness over the mastoid antrum. The external meatus may be narrowed by oedema of the posterior-superior wall. In advanced cases a subperiosteal abscess may push the ear forward. Diagnosis is confirmed by opacity of the mastoid cells on CT scan.
Management:
Initially high-dose parenteral antibiotic therapy is required, although in cases that fail to respond to antibiotics, or in which a subperiosteal abscess has formed, surgical drainage via a cortical mastoidectomy is required.
2019年5月30日星期四
Suppurative Otitis media (化膿性中耳炎) - Acute otitis media (急性中耳炎)
Acute otitis media (急性中耳炎)
Aetiology:
Acute infection of the middle ear cleft, common in young children. This usually occurs as part of an upper respiratory tract infection, with Haemophilus influenzae and Pneumococcus being the most common pathogens.
Clinical features:
Presents as severe otalgia and deafness. The tympanic membrane is red and bulging. Rupture may occur leading to purulent otorrhoea.
Management:
Treat with oral antibiotic therapy (amoxicillin, cotrimoxazole or erythromycin) and adequate analgeria.
Aetiology:
Acute infection of the middle ear cleft, common in young children. This usually occurs as part of an upper respiratory tract infection, with Haemophilus influenzae and Pneumococcus being the most common pathogens.
Clinical features:
Presents as severe otalgia and deafness. The tympanic membrane is red and bulging. Rupture may occur leading to purulent otorrhoea.
Management:
Treat with oral antibiotic therapy (amoxicillin, cotrimoxazole or erythromycin) and adequate analgeria.
訂閱：
文章 (Atom)