Advertisement

Neurological Complications of Acute and Chronic Otitis Media

  • Michael J. Hutz
  • Dennis M. Moore
  • Andrew J. Hotaling
Neurology of Systemic Diseases (J Biller, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Neurology of Systemic Disease

Abstract

Purpose of Review

The aim of this study is to discuss the symptoms, diagnosis, and management of the neurologic complications of acute and chronic otitis media.

Recent Findings

Antibiotic therapy has greatly reduced the frequency of complications of otitis media. However, it is of vital importance to remain aware of the possible development of neurologic complications. There is a trend toward less severe presenting symptoms including otorrhea, headache, nausea, and fever, with altered mental status and focal neurologic deficits presenting later. In order to reduce morbidity, early deployment of a multidisciplinary approach with prompt imaging and laboratory studies is imperative to guide appropriate management.

Summary

Complications of acute and chronic otitis media may present with neurologic signs and symptoms. It is important to recognize the possible otitic origin of such complications to ensure proper management and to decrease overall morbidity and mortality

Keywords

Acute otitis media Chronic otitis media Neurologic complications 

Notes

Compliance with Ethical Standards

Conflict of Interest

Michael J. Hutz, Dennis M. Moore, and Andrew J. Hotaling declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Glasscock ME, Shambaugh GE. Surgery of the ear. 4th ed. Philadelphia PA: Saunders; 1990. p. 249–75.Google Scholar
  2. 2.
    Courville CB. Intracranial complications of otitis media and mastoiditis in the antibiotic era. I. Modification of the pathology of otitic intracranial lesions by antibiotic preparations. Laryngoscope. 1955;65(2):31–46.  https://doi.org/10.1288/00005537-195502000-00001.CrossRefPubMedGoogle Scholar
  3. 3.
    Kangsanarak J, Fooanant S, Ruckphaopunt K, Navacharoen N, Teotrakul S. Extracranial and intracranial complications of suppurative otitis media. Report of 102 cases. J Laryngol Otol. 1993;107(11):999–1004.CrossRefPubMedGoogle Scholar
  4. 4.
    Osma U, Cureoglu S, Hosoglu S. The complications of chronic otitis media: report of 93 cases. J Laryngol Otol. 2000;114(2):97–100.CrossRefPubMedGoogle Scholar
  5. 5.
    Lin YS, Lin LC, Lee FP, Lee KJ. The prevalence of chronic otitis media and its complication rates in teenagers and adult patients. Otolaryngol Head Neck Surg. 2009;140(2):165–70.  https://doi.org/10.1016/j.otohns.2008.10.020.CrossRefPubMedGoogle Scholar
  6. 6.
    Wanna GB, Dharamsi LM, Moss JR, Bennett ML, Thompson RC, Haynes DS. Contemporary management of intracranial complications of otitis media. Otol Neurotol. 2010;31(1):111–7.  https://doi.org/10.1097/MAO.0b013e3181c2a0a8.CrossRefPubMedGoogle Scholar
  7. 7.
    Goldstein NA, Casselbrant ML, Bluestone CD, Kurs-Lasky M. Intratemporal complications of acute otitis media in infants and children. Otolaryngol Head Neck Surg. 1998;119(5):444–54.  https://doi.org/10.1016/S0194-5998(98)70100-7.CrossRefPubMedGoogle Scholar
  8. 8.
    Acuin J, World Health Organization. Dept. of Child and Adolescent Health and Development, WHO Programme for the prevention of blindness and deafness. Chronic suppurative otitis media : burden of illness and management. Options. 2004.Google Scholar
  9. 9.
    American Academy of Pediatrics, ed. Clinical practice guideline. No 5 ed. ; 2004; No. 113.Google Scholar
  10. 10.
    Ngo CC, Massa HM, Thornton RB, Cripps AW. Predominant bacteria detected from the middle ear fluid of children experiencing otitis media: a systematic review. PLoS One. 2016;11(3):e0150949. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783106/.  https://doi.org/10.1371/journal.pone.0150949.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mittal R, Lisi CV, Gerring R, et al. Current concepts in the pathogenesis and treatment of chronic suppurative otitis media. J Med Microbiol. 2015;64(10):1103–16. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835974/.  https://doi.org/10.1099/jmm.0.000155.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Cummings CW, Flint PW, editors. Cummings otolaryngology—head and neck surgery. 6th ed. Philadelphia, PA: Saunders Elsevier; 2015. No. 2Google Scholar
  13. 13.
    Thorne MC, Chewaproug L, Elden LM. Suppurative complications of acute otitis media: changes in frequency over time. Arch Otolaryngol Head Neck Surg. 2009;135(7):638–41.  https://doi.org/10.1001/archoto.2009.75.CrossRefPubMedGoogle Scholar
  14. 14.
    Mattos JL, Colman KL, Casselbrant ML, Chi DH. Intratemporal and intracranial complications of acute otitis media in a pediatric population. Int J Pediatr Otorhinolaryngol. 2014;78(12):2161–4.  https://doi.org/10.1016/j.ijporl.2014.09.032.CrossRefPubMedGoogle Scholar
  15. 15.
    Nadal D, Herrmann P, Baumann A, Fanconi A. Acute mastoiditis: clinical, microbiological, and therapeutic aspects. Eur J Pediatr. 1990;149(8):560–4.  https://doi.org/10.1007/BF01957692.CrossRefPubMedGoogle Scholar
  16. 16.
    Stockard-Pope JE. Auditory development and hearing evaluation in children. Adv Pediatr Infect Dis. 2001;48:273–99.Google Scholar
  17. 17.
    Tos M. Epidemiology and natural history of secretory otitis. Am J Otol. 1984;5(6):459–62.PubMedGoogle Scholar
  18. 18.
    Monasta L, Ronfani L, Marchetti F, et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One. 2012;7(4):e36226.  https://doi.org/10.1371/journal.pone.0036226.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Coplan J, Gleason JR. Quantifying language development from birth to 3 years using the early language milestone scale. Pediatrics. 1990;86(6):963–71.PubMedGoogle Scholar
  20. 20.
    Josephson GD, Wohl DL. Complications in pediatric otolaryngology. Boca Raton, FL: Taylor & Francis/CRC Press; 2005. p. 457–75.  https://doi.org/10.1201/b14110.CrossRefGoogle Scholar
  21. 21.
    Enoksson F, Groth A, Hultcrantz M, Stalfors J, Stenfeldt K, Hermansson A. Subperiostea abscesses in acute mastoiditis in 115 swedish children. Int J Pediatr Otorhinolaryngol. 2015;79(7):1115–20.  https://doi.org/10.1016/j.ijporl.2015.05.002.CrossRefPubMedGoogle Scholar
  22. 22.
    Psarommatis I, Giannakopoulos P, Theodorou E, Voudouris C, Carabinos C, Tsakanikos M. Mastoid subperiosteal abscess in children: drainage or mastoidectomy? J Laryngol Otol. 2012;126(12):1204–8.  https://doi.org/10.1017/S0022215112002332.CrossRefPubMedGoogle Scholar
  23. 23.
    Daniero JJ, Clary MS, O’Reilly RC. Complications of otitis media. Infect Disord Drug Targets. 2012;12(4):267–70.  https://doi.org/10.2174/187152612801319294.CrossRefPubMedGoogle Scholar
  24. 24.
    • Ghadersohi S, Young NM, Smith-Bronstein V, Hoff S, Billings KR. Management of acute complicated mastoiditis at an urban, tertiary care pediatric hospital. Laryngoscope. 2017;127(10):2321–7.  https://doi.org/10.1002/lary.26365. Recent publication with updates on the management of acute mastoiditis and its complications CrossRefPubMedGoogle Scholar
  25. 25.
    Psarommatis IM, Voudouris C, Douros K, Giannakopoulos P, Bairamis T, Carabinos C. Algorithmic management of pediatric acute mastoiditis. Int J Pediatr Otorhinolaryngol. 2012;76(6):791–6.  https://doi.org/10.1016/j.ijporl.2012.02.042. CrossRefPubMedGoogle Scholar
  26. 26.
    Alper CM, Myers EN, Eibling DE. Decision making in ear, nose, and throat disorders. Philadelphia PA: Saunders; 2001. p. 40–55.Google Scholar
  27. 27.
    Ellefsen B, Bonding P. Facial palsy in acute otitis media. Clin Otolaryngol Allied Sci. 1996;21(5):393–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Kettel K. Facial palsy of otitis origin, with special regard to its prognosis under conservative treatment and the possibilities of improving results by active surgical intervention. Arch Otolaryngol Head Neck Surg. 1943;37(3):303–48.  https://doi.org/10.1001/archotol.1943.00670030313001.CrossRefGoogle Scholar
  29. 29.
    Persky AH. Facial palsy of otitis origin. Arch Otolaryngol Head Neck Surg. 1938;27(4):395–402.  https://doi.org/10.1001/archotol.1938.00650030406001.CrossRefGoogle Scholar
  30. 30.
    Savic DL, Djeric DR. Facial paralysis in chronic suppurative otitis media. Clin Otolaryngol Allied Sci. 1989;14(6):515–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Takahashi H, Nakamura H, Yui M, Mori H. Analysis of fifty cases of facial palsy due to otitis media. Arch Otorhinolaryngol. 1985;241(2):163–8.  https://doi.org/10.1007/BF00454350.CrossRefPubMedGoogle Scholar
  32. 32.
    Joseph EM, Sperling NM. Facial nerve paralysis in acute otitis media: cause and management revisited. Otolaryngol Head Neck Surg. 1998;118(5):694–6.PubMedGoogle Scholar
  33. 33.
    Gaio E, Marioni G, de Filippis C, Tregnaghi A, Caltran S, Staffieri A. Facial nerve paralysis secondary to acute otitis media in infants and children. J Paediatr Child Health. 2004;40(8):483–6.  https://doi.org/10.1111/j.1440-1754.2004.00436.x.CrossRefPubMedGoogle Scholar
  34. 34.
    Yetiser S, Tosun F, Kazkayasi M. Facial nerve paralysis due to chronic otitis media. Otol Neurotol. 2002;23(4):580–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Chole RA, Donald PJ. Petrous apicitis. clinical considerations. Ann Otol Rhinol Laryngol. 1983;92(6 Pt 1):544–51.  https://doi.org/10.1177/000348948309200603.CrossRefPubMedGoogle Scholar
  36. 36.
    Agrawal S, Husein M, MacRae D. Complications of otitis media: an evolving state. J Otolaryngol. 2005;34(Suppl 1):33.Google Scholar
  37. 37.
    Prasad SC, Shin SH, Russo A, Di Trapani G, Sanna M. Current trends in the management of the complications of chronic otitis media with cholesteatoma. Curr Opin Otolaryngol Head Neck Surg. 2013;21(5):446–54.  https://doi.org/10.1097/MOO.0b013e3283646467.CrossRefPubMedGoogle Scholar
  38. 38.
    Hakuba N, Hato N, Shinomori Y, Sato H, Gyo K. Labyrinthine fistula as a late complication of middle ear surgery using the canal wall down technique. Otol Neurotol. 2002;23(6):832–5.  https://doi.org/10.1097/00129492-200211000-00003.CrossRefPubMedGoogle Scholar
  39. 39.
    Penido Nde O, Borin A, Iha LC, et al. Intracranial complications of otitis media: 15 years of experience in 33 patients. Otolaryngol Head Neck Surg. 2005;132(1):37–42.  https://doi.org/10.1016/j.otohns.2004.08.007.CrossRefPubMedGoogle Scholar
  40. 40.
    Leskinen K, Jero J. Acute complications of otitis media in adults. Clin Otolaryngol. 2005;30(6):511–6.  https://doi.org/10.1111/j.1749-4486.2005.01085.x.CrossRefPubMedGoogle Scholar
  41. 41.
    Wellman MB, Sommer DD, McKenna J. Sensorineural hearing loss in postmeningitic children. Otol Neurotol. 2003;24(6):907–12.  https://doi.org/10.1097/00129492-200311000-00015.CrossRefPubMedGoogle Scholar
  42. 42.
    • Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015;(9):CD004405. doi:  https://doi.org/10.1002/14651858.CD004405.pub5. Systematic review of the literature regarding the efficacy of corticosteroids in acute bacterial meningitis.
  43. 43.
    Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267–84.  https://doi.org/10.1086/425368.CrossRefPubMedGoogle Scholar
  44. 44.
    PB MI, Berkey CS, King SM, et al. Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomized clinical trials since 1988. JAMA. 1997;278(11):925–31.  https://doi.org/10.1001/jama.1997.03550110063038.CrossRefGoogle Scholar
  45. 45.
    de Gans J, van de Beek D. European dexamethasone in adulthood bacterial meningitis study investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347(20):1549–56.  https://doi.org/10.1056/NEJMoa021334.CrossRefPubMedGoogle Scholar
  46. 46.
    Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82(9):806–13.  https://doi.org/10.1212/WNL.0000000000000172.CrossRefPubMedGoogle Scholar
  47. 47.
    Brouwer MC, Tunkel AR, GM MK 2nd, van de Beek D. Brain abscess. N Engl J Med. 2014;371(5):447–56.  https://doi.org/10.1056/NEJMra1301635.CrossRefPubMedGoogle Scholar
  48. 48.
    Christensen N, Wayman J, Spencer J. Lateral sinus thrombosis: a review of seven cases and proposal of a management algorithm. Int J Pediatr Otorhinolaryngol. 2009;73(4):581–4.  https://doi.org/10.1016/j.ijporl.2008.12.004.CrossRefPubMedGoogle Scholar
  49. 49.
    Sitton MS, Chun R. Pediatric otogenic lateral sinus thrombosis: role of anticoagulation and surgery. Int J Pediatr Otorhinolaryngol. 2012;76(3):428–32.  https://doi.org/10.1016/j.ijporl.2011.12.025.CrossRefPubMedGoogle Scholar
  50. 50.
    Bales CB, Sobol S, Wetmore R, Elden LM. Lateral sinus thrombosis as a complication of otitis media: 10-year experience at the Children’s Hospital of Philadelphia. Pediatrics. 2009;123(2):709–13.  https://doi.org/10.1542/peds.2008-0280.CrossRefPubMedGoogle Scholar
  51. 51.
    Ghosh PS, Ghosh D, Goldfarb J, Sabella C. Lateral sinus thrombosis associated with mastoiditis and otitis media in children: a retrospective chart review and review of the literature. J Child Neurol. 2011;26(8):1000–4.  https://doi.org/10.1177/0883073811401745.CrossRefPubMedGoogle Scholar
  52. 52.
    Ulanovski D, Yacobovich J, Kornreich L, Shkalim V, Raveh E. Pediatric otogenic sigmoid sinus thrombosis: 12-year experience. Int J Pediatr Otorhinolaryngol. 2014;78(6):930–3.  https://doi.org/10.1016/j.ijporl.2014.03.016.CrossRefPubMedGoogle Scholar
  53. 53.
    Carvalho KS, Bodensteiner JB, Connolly PJ, Garg BP. Cerebral venous thrombosis in children. J Child Neurol. 2001;16(8):574–80.  https://doi.org/10.1177/088307380101600807.CrossRefPubMedGoogle Scholar
  54. 54.
    Symonds CP. Otitic hydrocephalus: a report of three cases. Br Me J. 1932;1(3705):53–4.  https://doi.org/10.1136/bmj.1.3705.53.CrossRefGoogle Scholar
  55. 55.
    Doyle KJ, Brackmann DE, House JR, 3rd. Pathogenesis of otitic hydrocephalus: clinical evidence in support of symonds’ (1937) theory. Otolaryngol Head Neck Surg. 1994;111(3 Pt 1):323–327. DOI:  https://doi.org/10.1177/01945998941113P125.
  56. 56.
    Clemis JD, Jerva MJ. Hydrocephalus following translabyrinthine surgery. J Otolaryngol. 1976;5(4):303–9.PubMedGoogle Scholar
  57. 57.
    Powers JM, Schnur JA, Baldree ME. Pseudotumor cerebri due to partial obstruction of the sigmoid sinus by a cholesteatoma. Arch Neurol. 1986;43(5):519–21.  https://doi.org/10.1001/archneur.1986.00520050089032.CrossRefPubMedGoogle Scholar
  58. 58.
    Tomkinson A, Mills RG, Cantrell PJ. The pathophysiology of otitic hydrocephalus. J Laryngol Otol. 1997;111(8):757–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Woodhall B. Variationa of the cranial venous sinuses in the region of the torcular herophili. Arch Surg. 1936;33(2):297–314.  https://doi.org/10.1001/archsurg.1936.01190020113010.CrossRefGoogle Scholar
  60. 60.
    • Wong BY, Hickman S, Richards M, Jassar P, Wilson T. Management of paediatric otogenic cerebral venous sinus thrombosis: a systematic review. Clin Otolaryngol. 2015;40(6):704–14.  https://doi.org/10.1111/coa.12504. A recent systematic review of the management of cerebral venous sinus thrombosis CrossRefPubMedGoogle Scholar
  61. 61.
    Coutinho J, de Bruijn SF, Deveber G, Stam J. Anticoagulation for cerebral venous sinus thrombosis. Cochrane Database Syst Rev. 2011;(8):CD002005. doi:  https://doi.org/10.1002/14651858.CD002005.pub2.
  62. 62.
    Saposnik G, Barinagarrementeria F, Brown RD Jr, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011;42(4):1158–92.  https://doi.org/10.1161/STR.0b013e31820a8364.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Michael J. Hutz
    • 1
  • Dennis M. Moore
    • 1
    • 2
  • Andrew J. Hotaling
    • 1
  1. 1.Department of Otolaryngology – Head and Neck SurgeryLoyola University Medical CenterMaywoodUSA
  2. 2.Division of Otolaryngology – Head and Neck SurgeryHines VA Medical CenterHinesUSA

Personalised recommendations