Complications of CSOM
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CSOM complications extracranial intracranial otitis media authoritative
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Complications of CSOM are classically divided into extracranial (intratemporal) and intracranial complications. They occur more often in unsafe CSOM with cholesteatoma.
1. Extracranial / intratemporal complications
- Mastoiditis with coalescence and bone destruction
- Subperiosteal (mastoid) abscess
- Postauricular abscess
- Bezold abscess
- Zygomatic abscess
- Citelli abscess
- Facial nerve palsy
- Labyrinthitis
- Serous labyrinthitis
- Suppurative labyrinthitis
- Labyrinthine fistula, usually lateral semicircular canal erosion from cholesteatoma
- Petrositis (Gradenigo syndrome: otorrhea, deep facial pain due to trigeminal involvement, and abducens palsy)
- Ossicular erosion causing conductive hearing loss
2. Intracranial complications
- Meningitis
- Extradural (epidural) abscess
- Subdural empyema
- Brain abscess
- Temporal-lobe abscess
- Cerebellar abscess
- Lateral/sigmoid sinus thrombosis or thrombophlebitis
- Otitic hydrocephalus (raised intracranial pressure related to venous sinus thrombosis)
A standard text also lists bone destruction, subperiosteal abscess, facial paralysis, labyrinthitis, petrositis, brain abscess, subdural abscess, epidural abscess, and septic venous-sinus thrombosis as recognized CSOM complications. Textbook of Family Medicine 9e, p. 268. A clinical review similarly reports mastoid abscess as a frequent extracranial complication and lateral sinus thrombophlebitis among frequent intracranial complications, as summarized in this PubMed review.
Danger signs needing urgent ENT assessment: fever, severe headache, vomiting, neck stiffness, drowsiness, postauricular swelling, vertigo, facial weakness, diplopia, or new neurological deficits.
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