In chronic suppurative otitis media (CSOM), new symptoms and signs can indicate local or intracranial complications requiring urgent attention.
Pain and vestibular symptoms
•
Pain is uncommon in uncomplicated CSOM. It may indicate an extradural, perisinus or brain abscess, although associated otitis externa can also cause pain in a discharging ear.
•
Vertigo indicates erosion of the lateral semicircular canal, which may progress to labyrinthitis or meningitis. A fistula test should be performed in all such cases.
•
Ataxia may indicate labyrinthitis or a cerebellar abscess.
Neurological and systemic warning features
•
Persistent headache suggests an intracranial complication.
•
Facial weakness indicates erosion of the facial canal.
•
A listless child who refuses feeds and easily goes to sleep may have an extradural abscess.
•
Fever, nausea and vomiting indicate intracranial infection.
•
Irritability with neck rigidity indicates meningitis.
•
Diplopia is associated with petrositis and Gradenigo syndrome.
Local abscess and urgency
•
An abscess around the ear indicates mastoiditis.
•
Patients may first present with complications when access to medical facilities is poor. Such presentations demand urgent attention and emergency medical or surgical treatment.