Double Vision and Ear Discharge in a 14-Year-Old Girl

Olugbemiga Jegede, MD; Walid Abuhammour, MD


December 09, 2015


Acute suppurative otitis media is defined as a suppurative infection involving the mucosa of the middle ear cleft. By convention, it is termed acute if the infection is less than 3 weeks in duration. Obstruction of the eustachian tube seems to be the most important antecedent event in the pathophysiology of acute suppurative otitis media.[1,2] Most cases of acute suppurative otitis media are triggered by upper respiratory infections, which seed the middle ear cavity through the eustachian tube orifice. Infections involving the nasopharynx can infect the middle ear through the pharyngeal end of the eustachian tube. Most commonly, the infection is viral in origin; however, allergic symptoms may also play an important role in the pathogenesis.

Pathogenic bacteria can secondarily infect the middle ear mucosa. The bacteria that commonly cause this disorder are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.[3] To become pathogenic, the bacteria must become adherent to the mucosal lining of the middle ear cavity. This is possible with prior viral infection of the middle ear mucosa. If the infection persists beyond a period of 2 weeks, an associated thickening of the mucoperiosteum is noted, especially in the air cells around the periantral area that lead to a blockage of the drainage from the antral cells.

The trapped secretions in the mastoid air cell system cause intense pressure, venous stasis, and local acidosis. This acidosis causes dissolution of calcium from the bone, causing decalcification and coalescence of the mastoid air cell system. This condition is known as coalescent mastoiditis.[1] This stage is characterized by the emergence of otalgia and low-grade fever. Erosion of the outer mastoid cortex can lead to the formation of an abscess under the periosteum of the mastoid cortex.[1,2,3] Known complications include the following:

  • Mastoiditis

  • Petrositis or petrous apicitis (Gradenigo syndrome)

  • Facial nerve palsy

  • Meningitis

  • Venous sinus thrombosis


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