complications

Last reviewed 01/2018

• the incidence of complications from otitis media is extremely low (1)
  • extracranial and intracranial complications include:
    • incomplete resolution may lead to a persistent middle ear effusion i.e. secretory otitis media with associated hearing impairment.
      • there may be a persistent or fluctuating conductive hearing loss (loss of about 25 dB)
      • mild to moderate conductive hearing loss occurs in one half of children with chronic suppurative otitis media
    • acute otitis media may be complicated by tympanic membrane perforation (2):
      • a study was undertaken to define the characteristics of spontaneous eardrum perforation in acute otitis media (2)
        • in this study 29.5 per cent children with acute otitis media had eardrums which perforated. An increased incidence of perforation was associated with a previous history of otitis media. All perforations were small and limited exclusively to the pars tensa
        • the perforation spontaneously closed in 94 per cent of the patients within one month. The healing process was gradual and following perforation closure, there was evidence of middle ear effusion for some time before normal aeration was regained
      • central perforation of the eardrum may cause chronic infection in the middle ear and mastoid cavity (1)
        • acute mastoiditis may erode through the bone
        • this may form a subcutaneous collection of pus (Bezold's abscess)
    • contiguous spread or hematogenous spread may infect the following structures (1)
      • mastoid cavity
      • inner ear
      • petrous portion of the temporal bone
      • meninges
      • brain
    • spread of the infection, may lead to:
      • facial palsy
      • brain and dural abscesses
      • endocarditis
    • meningitis is the most serious intracranial complication (1)
    • disorders of speech, language, and cognitive abilities may also occur (1)

Reference:

• (1) Kalyanakrishnan R et al. Diagnosis and treatment of otitis media.Am Fam Physician  2007; 76:1650-8, 1659-60
• (2) Berger G. Nature of spontaneous tympanic membrane perforation in acute otitis media in children. J Laryngol Otol. 1989 Dec;103(12):1150-3.