Complications of unsafe CSOM
1) Intratemporal
2) Intracranial
1) Intracranial :
a) Abscess formation : 4 types of abscess can be formed .
i) Mastoid abscess : Post auricular MC type .
ii) Bezold's abscess : Along Sternoclavicular Mastoid muscle . Mastoid tip is involved in Bezold's abscess .
iii) Citelli's abscess : Along digastric muscle
iv) Luc's abscess : Inside External Auditory Canal
Labyrinthine fistula : It is the erosion of outer bony cover of SCC .
c/c : Vertigo
Fistula sign : Positive seen in a ) Labyrinthine fistula b) Hypermobile stapes footplate c) Following fenestration surgery
False positive seen in : a) congenital syphilis b) some cases of Meniere's disease c) Superior semicircular canal dehiscence
False negative seen in : Fistula in dead labyrinth AND fistula covered by cholesteatoma .
INTRACRANIAL complications : a) Meningitis b) Extradural abscess c) Subdural empyema d) Brain abscess e) sigmoid sinus thrombosis f) Hydrocephalus
Note : MC complication of CSOM is mastoiditis
MC site of otogenic brain abscess is temporal lobe .
Sigmoid sinus thrombosis : a) Headache b) pallor c) spiky fever (picket fence fever ) d) pitting edema over mastoid = Griesinger sign + e) NO CHANGE OF CSF PRESSURE ON PRESSING IJV ( normally there is increase in CSF pressure on pressing IJV )
Tobey Ayer Test : Do Lumbar puncture . Measure CSF pressure with manometer , if on pressing IJV there is no change in manometer pressure = abnormal finding .
Crowe Beck Test : If on pressing IJV there is no change in retinal vein pressure Crowe Beck Test is abnormal
Note : CECT shows Delta sign
Treatment of choice of unsafe CSOM with various complications remains to be Modified Radical Mastoidectomy only except in 2 situation : a) Subdural empyema } Neurosurgery is TOC for both
b) Brain abscess }
1) Intratemporal
2) Intracranial
1) Intracranial :
a) Abscess formation : 4 types of abscess can be formed .
i) Mastoid abscess : Post auricular MC type .
ii) Bezold's abscess : Along Sternoclavicular Mastoid muscle . Mastoid tip is involved in Bezold's abscess .
iii) Citelli's abscess : Along digastric muscle
iv) Luc's abscess : Inside External Auditory Canal
Labyrinthine fistula : It is the erosion of outer bony cover of SCC .
c/c : Vertigo
Fistula sign : Positive seen in a ) Labyrinthine fistula b) Hypermobile stapes footplate c) Following fenestration surgery
False positive seen in : a) congenital syphilis b) some cases of Meniere's disease c) Superior semicircular canal dehiscence
False negative seen in : Fistula in dead labyrinth AND fistula covered by cholesteatoma .
INTRACRANIAL complications : a) Meningitis b) Extradural abscess c) Subdural empyema d) Brain abscess e) sigmoid sinus thrombosis f) Hydrocephalus
Note : MC complication of CSOM is mastoiditis
MC site of otogenic brain abscess is temporal lobe .
Sigmoid sinus thrombosis : a) Headache b) pallor c) spiky fever (picket fence fever ) d) pitting edema over mastoid = Griesinger sign + e) NO CHANGE OF CSF PRESSURE ON PRESSING IJV ( normally there is increase in CSF pressure on pressing IJV )
Tobey Ayer Test : Do Lumbar puncture . Measure CSF pressure with manometer , if on pressing IJV there is no change in manometer pressure = abnormal finding .
Crowe Beck Test : If on pressing IJV there is no change in retinal vein pressure Crowe Beck Test is abnormal
Note : CECT shows Delta sign
Treatment of choice of unsafe CSOM with various complications remains to be Modified Radical Mastoidectomy only except in 2 situation : a) Subdural empyema } Neurosurgery is TOC for both
b) Brain abscess }
No comments:
Post a Comment