CSOM - Treatment and Complications MCQs

PETROSITIS- GRADINEGO SYNDROME It is an infection of Petrous apex air cells. It's a complication of ASOM or CSOM. Petrous apex has relation with 5th and 6th cranial nerves. It has 3 features- PNEMONIC GERD. G-Gradinego syndrome E-Ear discharge R-Retro Orbital pain due to 5 th nerve D-Diplopia-due to 6 th nerve. CT scan of temporal bone will show abscess at Petrous apex. Treatment :– Surgical exploration. Reference : Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8th Edition, Chapter name: Complications of Suppurative Otitis Media, Page number: 95

Retro orbital pain and diplopia are suggestive of petrositis. Along with otorrhoea, it forms the triad of Gradinego syndrome. Diagnosis of petrous apicitis requires HRCT tempral bone which shows abscess at Petrous apex. Treatment - Cortical, modified radical or radical mastoidectomy + IV antibiotics Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 95.

Scanty, foul smelling ear discharge is seen in atticoantral CSOM. The patient recently developed fever with chills, headache and oedema over the mastoid(Griesinger sign). All these point to a diagnosis of Sigmoid sinus thrombosis(Lateral sinus thrombosis). TREATMENT Modified radical mastoidectomy with opening the sinus wall and removal of thrombus + i/v antibiotics. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 101.

Acute coalescent mastoiditis is defined by the acute form of destruction of the thin bony septae between mastoid air cells. It may be followed by the formation of abscess cavities and the dissipation of pus into adjacent areas. Reference: Diseases of Ear, Nose, AND Throat by PL Dhingra

Anterior superior alveolar nerve supplies the upper jaw and is not injured in mandibular fracture. In fracture of mandible, C ondyle is the most commonly fractured followed by A ngle, B ody and S ymphysis ( CABS ). Malocclusion of teeth and deviation of jaw to the opposite site occur in displaced fractures of condyle. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8th Edition, pg. no - 216 Gray's Anatomy- The Anatomical Basis of Clinical Practice - 41 st edition - Page - 526

Explanation: The patient with otitis media , has developed labyrinthine fistula as a complication, which caused sensorineural hearing loss (SNHL) , tinnitus, and vertigo. This will result in a: Positive Rinne's test Positive fistula test: Due to perilymph leak or fistula Since treatment was refused, the condition progressed, resulting in complete labyrinthine destruction or the dead ear. This caused a negative fistula sign. However, the ear now has profound unilateral SNHL, where Rinne's test remains positive (a true positive result). Rinne's Test: The Rinne test compares bone conduction (BC) to air conduction (AC) of sound. In conductive hearing loss , BC > AC (i.e., the sound is heard better through bone conduction). In sensorineural hearing loss , AC > BC (i.e., the sound is heard better through air conduction).

The patient was earlier having labyrinthine fistula. Because of no treatment, he developed dead labyrinth. A negative fistula sign in this case indicates a dead labyrinth which implies severe sensorineural hearing loss. In such cases a false negative Rinne's test is most likely. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 26, 48.

Crowe Beck sign is seen in Sigmoid sinus thrombosis(Lateral sinus thrombosis). It is the engorgement of retinal veins due to pressure on the jugular vein of healthy side seen on fundoscopy. This is absent on the affected side. This is due to blockage of venous drainage of brain. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 100, 101.