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1、OTITISMEDIAWITHEFFUSION OME 1 一 overview Otitismediawitheffusion OME ischaracterizedbyaccumulationoffluidinthemiddleear conductivehearingloss andisakindofnon purulentdiseasesofmiddleear 2 OMEoccursasaresultofdecreasedventilationofthemiddleearormastoidair cellsystemthroughtheeustachiantube 3 SerousOt
2、itisMediaGlueEarNon purulentOtitisMedia OMEiscalledothernames 4 OMEisoneofthemostcommonlyresultingindeafnessamongchildren OMEoccursinadulttoo 5 6 7 Functionoftheeustachiantube Theeustachiantubeisessentialinmaintainingahealthy well aeratedthemiddleear 8 9 Theeustachiantubeventilatesthemiddleear prote
3、ctsitfrompathogenicorganismsinthenasopharynx equilibratespressureacrossthetympanicmembrane andallowsdrainageofsecretionsfromthemiddleearintonasopharynx 10 Atrest theeustachiantubeisclosed Duringswallowing yawning orsneezing thenasopharyngealorificeofeustachiantubeisopenedtransiently 11 Theanatomyoft
4、heeustachiantubeofinfantsisdifferentfromadult s Theinfantileeustachiantubeismorehorizontalorientation shorterlength andmorepatulousconfigurationthanadult 12 二 Pathogenesis Anyprocessthatinterfereswithnormalopeningofproximal nasopharyngeal endoftheeustachiantubeormucociliaryclearancemechanismcausesOM
5、E 13 1 mechanicalobstruction largeorinfectedadenoidsturbinatehypertrophyneoplasmofnasopharynxnasopharyngealedemaorinflammation 14 2 Allergy Allergyreactionaffectsbothmucociliaryclearancemechanismandnormaleustachiantubeopening 15 3 Abnormaleustachiantubeanatomy Suchas cleftpalatedeformitiescanimpaire
6、ustachiantubefunction 16 Functionaldisordersofeustachiantube negativepressureintympaniccavity veinsinmucousbedilatedandbecongested vesselspermeancebeincreased seruminvesselsbeexudedintotympaniccavity middleeareffusion 17 三 ClinicalPresentation SymptomsConductiveHearingLoss Earache Earfullness Tinnit
7、us 18 PhysicalExamination TympanicMembranetoberetracted dull opaque colorcanrangefrom lightpinktoamberandevendarkblue 19 20 21 22 AudiometricTesting reveals Mild middlelevelsofconductivehearingloss 23 Audiogram 24 AcousticImmittance 25 Normalacousticimmittanceis type A curve Thecurvehaspeakat O Pasc
8、alpressurepoint OME sAcousticimmittanceis type B curve Itisflattympanometriccurve 26 四 Diagnosis 一 History Somepatientssufferedupperrespiratorytractinfectionbefore1 2weeks orsufferedrhinitis adenoidshypertrophyet Perennial 27 二 Clinicalpresentation hearingimpairmenttinnitusearobstructionEarache earp
9、ain 28 三 Physicalexamination tympanicmembraneberetractedtympaniccavityeffusion 29 四 AudiometricTesting Mild middlelevelconductivehearingloss 五 AcousticImmittance type B curve 30 1 tympanosclerosis2 glomusjugularetumor3 cerebrospinalotorrhea nasopharyngealcarcinoma 五 DifferentialDiagnosis 31 六 Manage
10、ment PrinciplesofManagement 一 Eliminatemiddleeareffusion improvemiddleearventilationanddrainage 32 1 Keepexpeditenasalcavityandeustachaintube Child 0 5 ephedrineandfuracillinesolutionAdult 1 ephedrineandfuracillinesolution 33 2 Eustachiantubeinsufflation ValsalvamethodPolitzermethodCatheterization 3
11、4 3 PunctureofTympanum 35 4 Tympanotomy 36 5 TympanostomyTube 37 二 Managementofetiology TreatmentnasalandnasopharyngealdiseasesExample adenoidhypertrophy adenoidectomyradiationofnasopharyngealcarcinoma 38 三 Antibiotictreatment PenicillinCephradineTreatmentmaintains3 5daysbyoral mild orbyinjection IV
12、 severe 39 四 Steroidtreatment Dexamethasone Adult 5 10mg day 3 5days byinjection IV 40 七 Prevention ExercisePreventfluTreatmentnasalandnasopharyngealdiseases 41 5 Questions 1 Whatistheotitismediawitheffusion OME 2 WhataretheessentialcausesofOME 3 PleaserepresentsmainclinicalpresentationsofOME 42 ReferenceBook OtolaryngologyHead NeckSurgery ThirdEditionCharlesW Cummings M D 1998Mosby YearBook Inc 43 ThankYou 44
