Common site is external mastoid cortex which shows osteolysis and subperiosteal abscess, usually extends towardsa EAM, along zygomatic bone
Bezold Abscess:
Osteolysis at mastoid tip with debris in the soft tissues of the neck
Perisinus Abscess:
Osteolysis in internal mastoid cortex leads to perisinus and epidural abscess
CT shows erosion of cortical plate overlying the sigmoid sinus
Apical petrositis:
Rare complication
Occurs in individuals with pneumatized petrous apex (30% of population)
Classic clinical triad: 6th nerve palsy, deep facial pain, ipsilateral otorrhea (Gradenigo syndrome) CT shows erosions of petrous apex with abnormal enhancement of adjacent meninges
Epidural abscess:
Most common intracranial complication
Common in posterior fossa due to destruction in Trautmann triangle over sigmoid sinus plate or in posterior cortex of petrous pyramid
Next common site is middle cranial fossa
Dural venous thrombophlebitis:
Due to extradural abscess
Common sinus involved is sigmoid sinus leading to thrombosis
May propogate to jugular vein, other dural sinuses
Subdural empyema:
More common with sinusitis than with otitis media
Carotid artery involvement:
Rare complication
ICA is commonly involved
Clinically present with recurrent hemorrhage from throat, nose, ear; Horner syndrome
MR and MRA show carotid spasm or arteritis
Brain (cerebral or cerebellar) abscess
Meningitis
Hydrocephalus
Encephalitis
Labyrinthitis
Facial nerve paralysis
Hearing loss
References:
Vazquez E et al. Imaging of Complications of Acute Mastoiditis in Children. Radiographics. 2003;23:359-372
