Complications of csom
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Transcript of Complications of csom
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COMPLICATIONS OF CSOM
By Dr Saeed Ullah FCPSClassified ENT, Head and Neck SurgeonCMH Quetta
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Cholesteatoma
A three dimensional epithelial and connective tissue mass usually in the form of a sac with a lining of stratified squamous epithelium, filled with desquamating debris frequently containing cholesterol
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Types of cholesteatoma
Cholesteatoma Congenital Acquired
Primary Secondary
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Other pathologies
Osteitis Cholesterol granuloma
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Routes of spread
Direct erosion of bone Normal communication
Oval and round windows Vascular channels
Thrombophlebitis Periarteriolar spaces of Virchow-Robin
Abnormal preformed pathways Congenital dehiscence Acquired dehiscence
Fractures Surgical defects
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Intratemporal complications Mastoiditis Facial nerve paralysis Labyrinthitis Petrositis
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Mastoid air cell system
Mastoiditis Mastoid abscess Mastoid fistula
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Mastoid abscess
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Mastoid abscess
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Mastoid fistula
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Mastoiditis
Pus under pressure Decalcification & ostoclastic
resorption
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Clinical features
Symptoms Post aural pain Fever Discharge
Signs Tenderness Discharge Sagging of post sup meatal wall Hearing loss Swelling
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Treatment
Hosp admission Antibiotics Myringotomy Cortical mastoidectomy
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Facial nerve paralysis
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Treatment
Urgent exploration From geniculate ganglion to
stylomastoid foramen The sun never sit on facial paralysis
due to CSOM
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Labyrinthitis
Thinning or erosion of bone Two types
Circumscribed Diffuse
Serous suppurative
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Clinical features
Dizziness Detection
Fistula test Seigel’s speculum
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Treatment
Mastoid exploration Antibiotics Analgesics Anti vertiginous drugs
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Petrositis
Osteitis of the petrous bone Headache Signs and symptoms of CSOM C T scan Exploration Antibiotics
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Intracranial complications
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Intracranial complications Extra dural abscess Subdural abscess Meningitis Brain abscess Sigmoid sinus thrombosis Otitic hydrocephalus
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Extradural abscess
Persistent headache Severe pain Low grade fever Purulent discharge
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Treatment
Antibiotics Mastoid exploration
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Subdural abscess
Meningeal irritation Headache Fever Neck rigidity
Cortical venous thrombophlebitis Aphasia Hemiplegia
Raised intracranial pressure Ptosis Papilloedema
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Meningitis
High grade fever Headache Neck rigiditiy Photophobia Nausea/ projectile vomiting Drowsiness Cranial nerve palsies
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Otogenic brain abscess
Stage of invasion Headache Low grade fever
Stage of localization No symptoms
Stage of enlargement Raised intracranial pressure Disturbances of cerebrum-focal neurologic
signs Stage of termination
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Investigations
C T scan MRI Lumbar puncture
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Treatment
Medical Neurosurgical Otologic
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Lateral sinus thrombosis
Formation of perisinus abscess Thrombus formation Obliteration of sinus lumen Extension of thrombus
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Clinical features
Fever Headache Progressive anemia Griesinger’s sign Papilloedema Tobey-Ayer’s test Tenderness along jugular vein
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Investigations
Imaging studies Contrast enhance CT studies MR angiography
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Treatment
Antibiotics Mastoidectomy and exploration Ligation of internal jugular vein Anticoagulant therapy
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Otitic hydrocephalus
Lateral sinus thrombosis Extended to superior sagittal sinus Impede the function of arachnoid villi Decrease CSF absorption Increased intracranial pressure
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Clinical features
Severe headache Diplopia
6th cranial nerve palsy Papilloedema
Blurring of vision Optic atrophy blindness
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Questions
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Thank you