[Clinical emergency-complicated infections of the middle ear and paranasal sinuses]

Complicated infections of the middle ear and paranasal sinuses remain a relevant clinical challenge. Although acute otitis media and acute sinusitis are generally self-limiting, a small but clinically significant proportion of cases progress to severe local, orbital, or intracranial complications. These include acute mastoiditis, labyrinthitis, facial nerve palsy, orbital complications, frontal bone osteomyelitis, intracranial abscess, meningitis, and cerebral venous sinus thrombosis, all of which are associated with considerable morbidity and potential mortality. The current review provides an overview of the classification, clinical presentation, red flags, diagnostic workup, and microbiological spectrum of complicated disease courses as well as therapeutic strategies. The literature review is based on a selective search of the PubMed database, with particular consideration given to the current Association of the Scientific Medical Societies in Germany (AWMF) guidelines (as of 2025). Early recognition of warning signs and prompt interdisciplinary diagnostic and therapeutic management are crucial to prevent irreversible sequelae such as hearing loss, visual impairment, and permanent neurological deficits.