Mode of spread of infection

• Direct extension through the de-mineralized bone seen in cholesteatoma.
• Blood borne spread via the veins, through bone and dura to venous sinuses, more common in acute infections. Lateral sinus thrombophlebitis causes spread of infection to the cerebellum.
• Through round or oval window into the auditory meatus on the vestibular aqueducts.
• Dehiscence of bony covering over the jugular bulb or the tegmen tympani.
• Neoplastic or accidental bone erosion.
• Through surgical defect in post Stapedotomy surgery.

Complications of CSOM

General symptoms of Intracranial complications are due to

• 1. Symptoms due to the infection.
• 2. Compression of brain tissue.

Clinical features

• Headache.
• Malaise.
• Fever, drowsiness.
• Neck rigidity with Kernig’s sign positive.
• Hemiplegia with cranial nerve symptoms.

Treatment:

• Systemic antibiotics to control infection.
• Mastoidectomy to remove ear infection and cholesteatoma.
• Neurological opinion to manage the intracranial abscess.

Treatment of Intratemporal infection includes

• Systemic antibiotics to control infection.
• Drainage of abscess.
• Mastoidectomy to remove ear infection and cholesteatoma.