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 a torrential sweat. Such sharp ups and downs of temperature during the day can be several, so the temperature of the chela is measured every 4 hours. Children often have a constant temperature increase.

Diagnosis of otogenic sepsis

On examination, the paleness of the skin with an earthy tinge is noted. Yellowness of the skin and icteric sclera develop as a result of DIC-syndrome and hepatosplenomegaly.

The manifestation of thrombosis of the sigmoid sinus is the swelling and tenderness of the soft tissues along the posterior margin of the mastoid process (Grisinger's symptom), which appear in thrombosis of emissaries connecting this zone with the sinus.

The thrombosis of the internal jugular vein is accompanied by a tightening and painfulness 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 sinustrombosis, and significantly worsens the prognosis. There are abscesses of the brain (deep and contralateral), lungs, joints, muscles and subcutaneous fat. Complication of sepsis is 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 in the normal composition of cerebrospinal fluid may be a consequence of increased intracranial pressure.

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Laboratory research

Changes in blood consist in pronounced neutrophilic leukocytosis with a shift of the leukocyte formula to the left, toxic granulosis of neutrophils, an increase in ESR, increasing hypochromic anemia, hypoalbuminemia, and hypoproteinemia.

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

Instrumental diagnosis of otogenic sepsis

To diagnose sinustrombosis otogennogo sepsis used methods of radiation diagnosis (radiography of temporal bones, CT) and sinusography.

On the radiographs and CT of the temporal bones, significant destructive changes of the mastoid process are observed, cell destruction, absence of an antrum contour or preservation of it in the form of a small slit-like enlightenment with clearly defined edges. In the presence of a cholesteatoma, the cavity and the temporal bone are defined with clear, even, outlined edges in the outer wall of the attic or in the mastoid process. The absence of a shadow of the upper-posterior wall of the external auditory canal leads to the fusion of antrum and attic clearing.

The most accurate evidence of sinustrombosis can be obtained with sinusography.

Indications for consultation of other specialists

Consultations of other specialists (neurosurgeon, neurologist, ophthalmologist, infectious diseases specialist, therapist, pediatrician) are necessary both for confirmation of the diagnosis and for a comprehensive assessment of the effectiveness of the treatment performed in patients with otogenic intracranial complications.

Approximate terms of incapacity for work are from 1 to 3 months.