Otogenic sepsis

There are three clinical forms of otogenic sepsis: septicemia, septicopyemia and bacterial shock.

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Symptoms of otogenic sepsis

A characteristic symptom of sepsis is hectic fever, accompanied by chills followed by profuse sweating. There may be several such sharp rises and falls in temperature during the day, so the temperature of the forehead is measured every 4 hours. In children, a constant increase in temperature is more often observed.

Diagnosis of otogenic sepsis

On examination, pale skin with an earthy tint is noted. Yellowing of the skin and icterus of the sclera develop as a result of DIC syndrome and hepatosplenomegaly.

The manifestation of sigmoid sinus thrombosis is swelling and pain in the soft tissues along the posterior edge of the mastoid process (Griesinger's symptom), which appears with thrombosis of the emissaries connecting this area with the sinus.

Thrombosis of the internal jugular vein is accompanied by its compaction and pain upon palpation of the vascular bundle of the neck (Whiting's symptom).

The appearance of metastatic purulent foci is more often observed in chronic purulent otitis media complicated by sinus thrombosis and significantly worsens the prognosis. Abscesses of the brain (deep and contralateral), lungs, joints, muscles and subcutaneous fat are noted. Sepsis can be complicated by bilateral focal pneumonia, pyelonephritis, endocarditis and other septicopyemic lesions of internal organs. Under the influence of antibacterial drugs, the clinical picture can be erased. Headache, nausea and vomiting with a normal composition of the cerebrospinal fluid can be a consequence of increased intracranial pressure.

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Laboratory research

Blood changes include pronounced neutrophilic leukocytosis with a shift in the leukocyte formula to the left, toxic granularity of neutrophils, increased ESR, increasing hypochromic anemia, hypoalbuminemia and hypoproteinemia.

The diagnosis of sepsis in 50% of cases is confirmed by a positive blood culture result with simultaneous determination of its sensitivity to antibiotics. In the case of sinus thrombosis and sepsis, blood is taken during the peak temperature, which is associated with the entry of microbes from the purulent focus into the bloodstream. If the results are negative, repeated studies are carried out.

Instrumental diagnostics of otogenic sepsis

To diagnose sinus thrombosis of otogenic sepsis, methods of radiation diagnostics (X-ray of the temporal bones, CT) and sinusography are used.

Radiographs and CT scans of the temporal bones show significant destructive changes in the mastoid process, cell destruction, absence of the antrum contour or its preservation in the form of a small slit-like enlightenment with clearly defined edges. In the presence of cholesteatoma, a cavity of the temporal bone with clear, smooth, outlined edges in the area of the outer wall of the attic or in the mastoid process is determined. The absence of the shadow of the superoposterior wall of the external auditory canal leads to the fusion of the enlightenment of the antrum and attic.

The most accurate evidence of sinus thrombosis can be obtained by sinusography.

Indications for consultation with other specialists

Consultations with other specialists (neurosurgeon, neurologist, ophthalmologist, infectious disease specialist, therapist, pediatrician) are necessary both to confirm the diagnosis and to comprehensively assess the effectiveness of the treatment of patients with otogenic intracranial complications.

Approximate periods of incapacity range from 1 to 3 months.