Complications of AOM include acute mastoiditis, suppurative labyrinthitis with vertigo and sensorineural hearing loss, meningitis and brain abscess. Acute mastoiditis is an osteomyelitis of the mastoid system and may spread to cause a fluctuant subperiosteal abscess over the mastoid cortex, sigmoid thrombophlebitis, meningitis, brain abscess, and facial paralysis. The perforation may have resulted from recurrent POM with rupture of the drum or from trauma. The hearing loss from the perforation alone will typically range form 0 to 35 dB. The opening into the middle ear predisposes to recurrent infections probably by contamination from the external canal. An episode of purulent otorrhea often follows getting the ear wet while swimming or showering.
Proper treatment requires suctioning and antibiotics.
The sequelae of these recurrent infections include scarring and destruction of ossicles as well as sensorineural hearing loss which is probably secondary to the effects of bacterial toxins crossing the round window membrane. Tympanoplasty is the general term to describe a variety of techniques to graft the defect in the drum and repair or replace the damaged ossicles with banked or artificial bones. Cholesteatoma Cholesteatoma is a cyst of squamous epithelium which causes damage in the middle ear and mastoid. Rarely the cyst is congenital and may arise anywhere in the temporal bone. The cyst usually becomes infected with anaerobic organisms which produce a putrid otorrhea.