Complications of unsafe CSOM

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 }






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