Complications of suppurative otitis media characterized

Jan 14 2013

By Piriya Mahendra, medwireNews Reporter

Researchers emphasize the importance of an early and accurate diagnosis of chronic suppurative otitis media (CSOM) followed by surgical therapy to prevent complications.

They stress that clinicians must remain alert for clinical signs and symptoms of CSOM that may indicate the onset of potentially serious extracranial or intracranial complications.

E Yorgancilar (Dicle University, Diyarbakir, Turkey) and co-authors retrospectively analyzed the complications of 4630 patients with CSOM who were admitted to hospital over a period of 10 years, 906 of whom underwent surgery. Of the total cohort, 121 (2.6%) patients experienced complications. None of the patients died.

Of the 906 CSOM patients who underwent surgery, 511 had cholesteatoma and 395 had granulation and/or polyp tissue. Of the patients with cholesteatoma, 94 (18.4%) experienced a complication, along with 27 (6.8%) patients with granulation and/or polyp tissue.

Of the 121 patients with complications, 57 (47.1%) had extracranial complications and 37 (30.6%) intracranial. Multiple combined complications occurred in 27 (22.3%) patients.

Mastoid abscess was the most common extracranial complication, experienced by 28.3% of patients with extracranial complications, while 9.0% had labyrinthitis, 8.4% had facial nerve paralysis, and 1.3% had Bezold's abscess.

The most common intracranial complication was lateral sinus thromboplebitis, which occurred in 19.5% of patients with intracranial complications, followed by perisigmoid sinus abscess in 13.5% of patients, and meningitis in 9% of patients. Brain abscesses occurred in 6.5% of patients, while extradural abscesses occurred in 4.5% of patients.

The authors say that the most frequent intraoperative finding of complicated CSOM patients was cholesteatoma, with the exception of patients with facial nerve paralysis.

"Although the incidence of complications of CSOM has decreased in recent decades, it remains too high," write Yorgancilar et al in the European Archives of Oto-Rhino-Laryngology.

"Excessive use and misuse of antibiotic treatments may cause masked presentations, thereby reducing the diagnosis. It is critical that clinicians remain alert for clinical signs and symptoms that may indicate the onset of these potentially serious complications and be prepared to examine patients for the presence of more than one complication."

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