Epidemiology of Intratemporal Complications of Otitis Media

Abstract

Introduction Despite the advent of antibiotics and immunizations in the last century, complications of otitis media remain quite frequent, have high morbidity and mortality rates, and pose a challenge to the otorhinolaryngologist. Objective To establish the annual incidence of intratemporal complications of otitis media and prospectively evaluate patients via an analysis of epidemiologic and clinical aspects. Methods Prospective, observational study. Between February 2010 and January 2011, patients admitted to a tertiary care, university-based otology practice with diagnosis of otitis media and an associated intratemporal complication (ITC) were included in the study. The following data were evaluated: age, sex, type of ITC, treatment, imaging tests findings, type and degree of hearing loss, and clinical outcome. The overall incidence of all complications and of each complication individually was determined. Results A total of 1,816 patients were diagnosed with otitis media. For 592 (33%) individuals, the diagnosis was chronic otitis media; for 1,224 (67%), the diagnosis was acute otitis media. ITCs of otitis media were diagnosed in 15 patients; thus, the annual incidence of intratemporal complications was 0.8%. We identified 19 ITC diagnoses in 15 patients (3 patients had more than one diagnosis). Labyrinthine fistulae were diagnosed in 7 (36.8%) individuals, mastoiditis in 5 (26.3%), facial palsy in 4 (21.1%), and labyrinthitis in 3 (15.8%). Conclusion The incidence of intratemporal complications in Brazil remains significant when compared with developed countries. Chronic otitis media with cholesteatoma is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.

Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives

“…Bone erosion can occur in both chronic OM with or without cholesteatoma but more common in cholesteatomatous type [47,48]. A recent study reported that labyrinthine fistula was the commonest intracranial complication of OM especially with cholesteatomatous type [49] (Fig. 2).…”

Chronically Discharging Ears: Evalution with High Resolution Computed Tomography

“…There is a tendency of pars tensa cholesteatoma to preferentially spread along the medial wall of the tympanic cavity; hence, there is early involvement of otic capsule and labyrinth. However, in advanced cases with extensive involvement, distinction of the cholesteatoma into pars flaccida and tensa may not be possible [ 6 , 8 , 14 – 18 ].…”

“…Ultimate resort in such cases may be labyrinthectomy which may cause complete deafness (4). On MRI, there is labyrinthine enhancement in the presence of a fistula [ 5 , 14 , 22 – 25 ].…”

“…Breach of the outer mastoid cortex leads to post-auricular abscess formation (Macewen’s triangle), whereas erosion of the mastoid tip may lead to the spread in the cervical region (Bezold’s abscess). Occasionally, a peri-auricular abscess may develop in the absence of cortical breach due to the involvement of mastoid emissary veins (Griesinger’s sign) [ 14 , 28 , 29 ].…”

“…Due to its location, an involvement of the petrous apex is of utmost clinical concern, as it may further spread to the middle and posterior cranial fossa. On HRCT, there is opacification of the pneumatized petrous apex [ 14 , 30 ].…”