Otogenic complications with an intact tympanic membrane.

A review of 21 cases of complications of acute otitis media with a hyperemic, dull, bulging but intact tympanic membrane is presented. All cases had a retroauricular swelling. In 10 cases, a subperiosteal abscess was found, 1 of them complicated with a posterior fossa abscess, 2 had meningitis, 3 had Bezhold's abscess, 2 had thrombosis of the lateral sinus, 1 had a cerebellar abscess, 1 had cerebellitis, and 2 presented with facial nerve palsy. Ninety percent of the patients were below the age of 13. An incomplete course of antibiotic treatment was found to have been given in seven cases (30%) prior to admission. Surgical therapy consisted of a cortical mastoidectomy and a wide myringotomy. Ventilating tubes were inserted in three patients. The mastoid radiography demonstrated cloudiness, and CT scan was performed in six patients with suspected intracranial complications. The present study stresses that an intact tympanic membrane with minimal changes may be regarded by the medical profession with a low index of suspicion and can lead to severe otogenic complications. The disease can be masked by an improper antibiotic therapy.