. Author manuscript; available in PMC: 2015 Oct 1.

Published in final edited form as: Otolaryngol Clin North Am. 2014 Aug 1;47(5):651–672. doi: 10.1016/j.otc.2014.06.006

Table 3.

Complications of acute otitis media (AOM)

Complication	Presentation	Diagnostic Tests	Treatment Options
Intracranial, extratemporal
Meningitis	Headache, altered mental status, nausea, vomiting, lethargy, poor oral intake, seizures, meningismus, focal neurologic deficits	LP after CT or MRI to exclude other intracranial complications	Antibiotics
Intracranial abscess		CT first-line and for follow-up	Myringotomy ± tympanostomy tube
Subdural or epidural abscess		MRI more sensitive	Antibiotics
		CT first-line and for follow-up	Myringotomy ± tympanostomy tube
		MRI more sensitive	Neurosurgical consultation

Otitic hydrocephalus (nonobstructing mural thrombus of transverse sinus)	Headache, vomiting, blurred vision, seizures, abducens palsy	LP to measure ICP, after CT to exclude mass effect: high ICP and normal cytology	Antibiotics
			Measures to decrease ICP

Thrombosis of dural venous sinuses (lateral or sigmoid sinus thrombophlebitis)	Headache, neck stiffness, fever, otalgia, postauricular pain & erythema	CT-contrast enhanced, MRI/MRA/MRV	Antibiotics ± anticoagulation
			Myringotomy ± tympanostomy tube ± Mastoidectomy
			Consider clot removal

Extracranial, intratemporal
Acute mastoiditis (see Fig. 1)	Postauricular erythema, tenderness, edema, protrusion of pinna	CT: bony erosion, destruction of mastoid air cells	Antibiotics
			Myringotomy ± tympanostomy tube
			Mastoidectomy or aspiration of subperiosteal abscess

Subperiosteal abscess	Postauricular erythema, tenderness, fluctuance	CT: fluid collection adjacent to eroded mastoid cortex	Antibiotics
			Myringotomy ± tympanostomy tube
			Mastoidectomy or needle aspiration of abscess

Petrositis (Gradenigo’s syndrome)	Abducens palsy and retrobulbar pain	CT first-line	Antibiotics
		MRI for nerve involvement, apical petrositis	Myringotomy ± tympanostomy tube
			Mastoidectomy

Facial nerve palsy	Often incomplete acute onset facial weakness on affected side	CT to assess extent of disease and rule out cholesteatoma or other lesion	Antibiotics
Facial nerve palsy			Myringotomy ± tympanostomy tube

Labyrinthitis	Acute onset SNHL and vertigo	Physical examination	Antibiotics
			Myringotomy ± tympanostomy tube
			Consider steroids if SNHL persists

TM perforation	Otorrhea	Physical examination	Antibiotics
TM perforation	Otorrhea	Physical examination	Close follow-up to determine for surgical repair

Extracranial, extratemporal
Sepsis	Fever, lethargy, tachycardia, hypotension	Physical examination	Antibiotics
Sepsis	Fever, lethargy, tachycardia, hypotension	Physical examination	Myringotomy ± tympanostomy tube

Abbreviations: CT, computed tomography scan; ICP, intracranial pressure; LP, lumbar puncture; MRA, magnetic resonance angiography; MRI, magnetic resonance imaging; MRV, magnetic resonance venography; SNHL, sensorineural hearing loss; TM, tympanic membrane.

Adapted from Refs.^3,49,50