《耳鼻喉学教学课件：03 OTITIS MEDIA, OM》由会员分享，可在线阅读，更多相关《耳鼻喉学教学课件：03 OTITIS MEDIA, OM（104页珍藏版）》请在金锄头文库上搜索。
1、上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOTITISMEDIA 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityAnatomyThe ear can be divided into three parts: outer ear, middle ear and inner ear. 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityAnatomy鼓室的内容上海交通大学医学院附属
2、仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityAnatomy右耳鼓膜后上后上前上前上后下后下前下前下上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong University紧张部穿孔紧张部大穿孔perforations上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong Universityperforations 边缘性穿孔 松弛部穿孔上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong Univers
3、ity上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong University上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOtitisMedia-DefinitionInflammation of the middle earMay also involve inflammation of mastoid, petrous apex, and perilabyrinthine air cells上海交通大学医学院附属仁济医院Ren Ji Hospital, Shangha
4、i JiaoTong UniversityOTITISMEDIADefinition: Presence of a middle ear infectionAcute Otitis Media: occurrence of bacterial infection within the middle ear cavity.Otitis Media with Effusion: presence of nonpurulent fluid within the middle ear cavityOM is the second most common clinical problem in chil
5、dhood after upper respiratory infection.上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityconceptionNon-suppurative inflammatory /infection in middle earNon-suppurative otitis mediaOtitis media with effusion ,omeCatarrhal otitis media Serous otitis medaMucoid otitis media上海交通大学医学院附属仁济医院Ren
6、 Ji Hospital, Shanghai JiaoTong UniversityEtiologyandpachogenesisImpaired eustachian tube function ,eustachian tube dysfunctionInfection (bacterial /viral)Immune response or allergyOther risk factors: passive tobacco exposure,or exposure to cigarette smoke ,containing lower socioeconomic status,lack
7、 of breastfeeding heredity ,reflux;上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityCSOMChronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity that is characterised by discharge from the middle ear through a perforated tympanic membrane for
8、at least 6 weeks.上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityCSOMoccursfollowinganupperrespiratorytractinfectionthathasledtoacuteotitismedia.Thisprogressestoaprolongedinflammatoryresponsecausingmucosal(middleear)oedema,ulcerationandperforation.Themiddleearattemptstoresolvethisulcerat
9、ionbyproductionofgranulationtissueandpolypformation.Thiscanleadtoincreaseddischargeandfailuretoarresttheinflammation,andtodevelopmentofCSOM,whichisalsooftenassociatedwithcholesteatoma.Theremaybeenoughpusthatitdrainstotheoutsideoftheear(otorrhea),orthepusmaybeminimalenoughtobeseenonlyonexaminationwit
10、hanotoscopeorbinocularmicroscope.Hearingimpairmentoftenaccompaniesthisdisease.上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityCOMPLICATIONSHearing loss: conductive, sensoneural, mixed)Acute mastoiditis: before the advent of antibioticsChronic perforation of the TMTympanosclerosisCholeste
11、atomaChronic suppurative OMCholesterol granuloma: Blue drum syndromeFacial nerve paralysis上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityPathogenicbacteriaCommon pathogenic bacteria for proteus, pseudomonas aeruginosa, escherichia coli, staphylococcus aureus, bacillus more. Often of mix
12、ed infection 。上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityClinicalmanifestationsHearing impairment /hearing lossBlockageTinnitusearache上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversitySignsandsymptomsAn integral symptom of acute otitis media is ear pain; other possible sym
13、ptoms include fever, and irritability (in infants). Since an episode of otitis media is usually precipitated by an upper respiratory tract infection (URTI), there are often accompanying symptoms like a cough and nasal discharge.Discharge Discharge from the ear canal can be seen in acute otitis media
14、 with perforation of the ear drum, chronic suppurative otitis media, tympanostomy tube otorrhea, or acute otitis externa. Trauma, such as a basilar skull fracture, can also lead to discharge from the ear due to cerebral spinal drainage from the brain and its covering (meninges).上海交通大学医学院附属仁济医院Ren Ji
15、 Hospital, Shanghai JiaoTong UniversityEPIDEMIOLOGYPeak incidence in the first two years of life (esp. 6-12 months)Boys more affected girls50% of children 1 yr of age will have at least 1 episode.1/3 of children will have 3 or more infections by age 390% of children will have at least one infection
16、by age 6.Occurs more frequently in the winter months上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityMICROBESATFAULT!Streptococcus pneumoniaeHaemophilus influenzae(non-typeable)Moraxella catarrhalisGroup A StreptococcusStaph aureusPseudomonas aeruginosaRSV assoc. with Acute Otitis Media上海
17、交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityClassificationofOtitisMediaAcute Acute OtitisOtitis Media Media: presents with fever, otalgia, and hearing lossOtitisOtitis Media with Effusion Media with Effusion: evidence of middle ear effusion on pneumatic otoscopyRecurrent Recurrent Otit
18、isOtitis Media Media: inability to clear middle ear effusionsChronic Serous Chronic Serous OtitisOtitis Media Media: presents as fullness in the ear, tinnitus, or another acute disease.上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityRISKFACTORSUpper Respiratory InfectionsAllergiesCraniof
19、acial abnormalities (cleft palate)Downs SyndromePassive smoking上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityPATHOGENESISThis problem mainly deals with eustacian tube dysfunction. Otitis Media usually follows an URI in which there is edema of the eustacian tube, leading to blockage. St
20、asis of these middle ear secretions lead to infection and irritationOther factors: allergic rhinitis, nasal polyps, adenoidal hypertrophy上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversitySIGNS&SYMPTOMSNeonates/Infants: change in behavior, irritability, tugging at ears, decreased appetite,
21、vomiting.Children(2-4): otalgia, fever, noises in ears, cannot hear properly, changes in personalityChildren (4): complain of ear pain, changes I personality上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOnPhysicalexamThe classic description for Otitis Media is an erythematic, opaque, b
22、ulging tympanic membrane with loss of anatomic landmarks including a dull/absent light reflex.Pneumatic Otoscopy: decreased tympanic membrane mobility上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityDIAGNOSISPneumatic Otoscopy: standard tool for diagnosisImpedance Tympanometry: useful for
23、 MEE. Measures the resonance of the ear canal for a fixed sound as the air pressure is varied.Spectral Gradient Acoustic Reflectometry: measures the condition of the middle ear by assessing the response of the TM to a sound stimulus. Equivalent to tympanometry for dx of middle ear effusions 上海交通大学医学
24、院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityDiagnosiscont.Diagnostic tympanocentesis & myringotomy: involves puncturing the tympanic membrane and aspirating middle ear fluid to relieve pressure. Only used if the primary and secondary line treatment fail.With the increasing incidence of drug
25、resistant strains of S. pneumoniae, CDC recommends the capacity of clinicians to be efficient in using tympanocentesis. 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityINDICATIONSFORTYMPANOCENTESISToxic appearing childFailed treatment regimen with antibioticsSuppurative complicationsImmu
26、nosuppressed pt.Newborn infant in which the usual pathogens may not be the case.上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityDIFFERENTIALDIAGNOSISOtitis externaBullous myringitisCerumen impactionDental abscessForeign body in ear canalReferred pain (parotid/tooth/lymphadenitis)Tonsilit
27、is上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityTREATMENTAmoxicillin: 20-40 mg/kg/day tid for 10-14 days or,Augmentin: 45 mg/kg/day po bid for 10-14 daysAuralgan: analgesic/adjunct for ear pain 2-4 drops tid上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong University2ndLineTreatmentReg
28、imenCefzilPediazole ( erythromycin/sulfisoxazole)Bactrim (trimethoprim/sulfamethoxazoleThese medications are used as secondary agents if the primary antibiotic has failed after 10 days and the symptoms persists.上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityComplicationscontIntracranial
29、 complicationsBacterial meningitisEpidural abscessSubdural empyemaBrain abscessOtitic hydrocephalusLateral sinus thrombosis上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOtitisMedia$3.5 billion in expendituresMost common reason for visit to pediatricianTympanostomy tube placement is 2nd
30、 most common surgical procedure in childrenDevelopment of multidrug-resistant bacteria 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOtitisMedia-HistoryEgyptian mummies have perforations of TM and mastoid destructionPrehistoric Iranian population has evidence of middle ear diseaseOM ac
31、counted for 27% of admissions to Bellevue Hospital in 1932 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOtitisMedia-ClassificationAcute OM - rapid onset of signs & sx, 3 episodes by three yearsmost common in 6 - 11 mos 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOM-per
32、sistentmiddleeareffusion(MEE)High incidence of MEE, avg of 40 daysChildren less that 2 years much more likely to have persistent MEEWhite children with higher incidence of MEE上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOtitisMedia-RaceHigher incidence in:EskimosNative AmericansAustra
33、lian and African aborigines上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOM-DayCareGreater risk of AOM in children 3 mos or assoc hearing loss, vertigo, frequency, ME pathology, discomfortAntibioticsshown to be of benefit, 75% PCR + bacterial DNAAntibiotics + steroid21% improvement com
34、pared to abx aloneprednisone 1 mg/kg day x 7 daysvaricella?Myringotomy & tympanostomy +/- adenoidectomy上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityTympanostomytubeinsertionUnresponsive OME 3 mos bil, or 6 mos uni, sooner if assoc hearing problemsRecurrent MEE with excessive cumulativ
35、e durationRecurrent AOM - 3/6 mos or 4/12 mosEustachian tube dysfunctionSuppurative complication上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityComplicationsIntratemporalhearing lossTM perforationCSOMretraction pocketscholesteatomamastoiditispetrositislabyrinthitisadhesive OMtympanoscler
36、osisossicular dyscontinuity and fixation facial paralysischolesterol granulomanecrotizing OEIntracranialmeningitisextradural abscesssubdural empyemafocal encephalitisbrain abscesslateral sinus thrombosisotitic hydrocephalus上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityCasehistory1 1/2
37、year old wm presents to ENT clinic with 2nd episode of “ear infections” in last monthNormal history with no medical problems and no prior surgical proceduresMother describes a “cold” for the last few days and then started running a fever and pulling at ears. Describes the child as very irritable 上海交
38、通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityPhysicalExamTemp 100 F, VS wnlIrritable childEars - eac clear, tms erythematous, bulging with yellowish MEE AUNose - clear rhinorrheaotherwise wnl上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityCasehistoryReturns to clinic one mont
39、h later with same complaints againDx as AOM3rd episode in last 2 mos and 5th in last year上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityCasehistoryPlaced on sulfisoxizol prophylaxis3 wks later presents with recurrent AOM 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityCasehi
40、storyBM&T performed, doing well at 3 wksMother calls at 3 mos and says has had to be tx with po abx and ear gtts 3 times by pcp for bilateral otorrhea 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityNewFrontiersPrevention more cost effective than treatmentEven slight decrease would have
41、profound economic impactVaccinesXylitol上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityVaccinesPneumococcal vaccinepoorly immunogenic in childrendid exhibit antibody response H. influenzaeno polysaccharide capsuleserum bactericidal antibody M. catarrhalishuman pathogen 上海交通大学医学院附属仁济医院Ren
42、 Ji Hospital, Shanghai JiaoTong UniversityVaccines150 viral immunotypes100 rhinoviruses with poor prognosis for vaccine developmentRSV most common - developing intranasal delivery system上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityXylitolSweetening substituteInhibits growth of pneumoc
43、occus and inhibits adhesion of pneumococcus and H. flu in nasopharynxGum and syrup reduced incidence of AOM 40% and 30% 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversitySummarizeAcute otitis media course more than 6 8 weeks, lesion protruded into middle ear mucosa, periosteum or deep bone
44、, causes irreversible damage of chronic suppuratie inflammation. Often and chronic dash forward phlogistic merger exists. The disease common, can cause severe intracranial complications and endanger the life and presented with the ear long-term intermittent or continuous flow pus, eardrums could hea
45、ring loss and for characteristics上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityCauseAcute suppurative otitis media not seasonable treatment or improper use. Germs toxicity is excessive. The whole body or local resistance is low. The tube and ventilation drainage channel in the middle e
46、ar long-standing obstruction. The nose and throat of chronic disease.上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong University上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong University上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityClassificationAccording to the pathological changes
47、 and clinical expression can be divided into the following three type Simply typeSimply type: the most common, due to repeated attacks of the upper respiratory tract infection, pathogenic bacteria infection caused by the eustachian tube.Bone abscess type:Bone abscess type: also called granulation ty
48、pe, often caused by a severe necrosis type otitis media. cholesteatomacholesteatoma type: type: the so-called cholesteatoma is not the true tumor,chronic otitis media with cholesteatoma, but a located in the middle ear cystic structure, internal capsule for complex layer squamous epithelium extracap
49、sular to a thickness of the fibre is and the nearby wall or bone tissue closely linked, sac except full of fall off epithelial and Angle of the material, passable cholesterol crystallization, so call it as bravery fat tumors上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityClassificationof
50、chlolesteatomaCongenitalAcquired:primary acquired (retraction pocket) secondary acquired上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityPathogenesisofchlolesteatomaCongenital: arise from embryonal rests of epithelial cells locationPrimary acquired: eustachian tube dysfunction poor aerati
51、on retraction of the pars flaccida上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityPathogenesisofchlolesteatomaSecondary acquired : implantionsurgery ,foreign body ,blast njury metaplasia invasion /migration 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOtogeniccomplications
52、上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityComplicationsoftotismediaHearing lossHole in the eardrumCholesteatomaMastoiditisParalysis of the faceInner ear infection Mastoid abscessMeningitisBrain abscessFluid on the brain上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityOto
53、genicextrcranialcomplicationsPostauricular subperiosteal abscessBezolds abscessLabyrinthitis: fistula of labyrinth serous labyrinthitis suppurative labyrinthitisPeripheral facial paralysis上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityIntracranialcomplicationsBacterial meningitisEpidura
54、l abscessSubdural empyemaBrain abscessOtitic hydrocephalusLateral sinus thrombosis上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong University上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversitycholesteatomatypeformationtheoryPouch retraction doctrine Tile primary Transitional epithelium the
55、ory Tile secondary上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityThecomplicationsofCSOMEach year 21,000 people worldwide die due to complications of CSOM.上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityChronicsuppurativeotitismedia(simpletype)Lesions limited middle drum-type
56、 mucosa ；Pathological: drum-type congestion, add thick, rounded cells infiltration, goblet cells secrete, from increased ；Clinical features: intermittent flow pus, stick pus, not smelly, the central sex perforation, mild conduction deafness. 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong Universi
57、tyChronicsuppurativeotitismedia(simpletype)上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityChronicsuppurativeotitismedia(boneabscesstype)Beyond the mucosal lesions, tissue destruction, deep bone, TingGu, bone ring, granulation or polyps ；Clinical characteristics: the ear for discharging,
58、 thick, smelly, bleeding or capillaries, edge perforation, heavier conduction deaf; ；CT middle ear soft tissue shadow ；Can produce all sorts of complications .上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityRightchronicsuppurativeotitismedia(boneabscesstype)Male, 33 years. The right ear
59、festering for years, external canal deep see and granulation tissue. Cross-sectional CT shows: a. the right gasification papilloma gas room bright poor, avoid looking frumpy interval; Main see papilloma large bone destruction involves external canal. B. higher level and drum sinus and gas room after
60、 the mass destruction bone involvement B sinus wall. 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityChronicsuppurativeotitismedia(cholesteatomatype)The true tumor, cystic multilayer squamous epithelium, fall off epithelium, Angle iodide cholesterol clefts ；Clinical characteristics: the
61、ear long-term continuous flow pus, odd smelly, relaxation department or nervous after the top marginal perforation, silvery white scaly skin, or bean dregs kind thing;CT bone destruction 。上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityChronicsuppurativeotitismedia(cholesteatomatype）上海交通
62、大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityRightearcholesteatomaCross-sectional CT: showing right sclerosis type papilloma, bone destruction area, more sclerosis, regular and thick edge.上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityDifferentialdiagnosis1More middle ear can
63、cer for squamous cell carcinoma, good hair at age patients. Ear is hemorrhagic secretion and granulation, with ear pain, can appear with side peripheral facial paralysis and mouth difficulties, have the first , late , X, , cranial nerve symptoms. Patients have long ear discharging history. Check see
64、 external canal or there were new biological ratio, touch is bleeding. Imaging examination, often can find local bony destruction. New biological biopsy help diagnose. 2 N/med tuberculosis sex middle ear more dash forward phlogistic secondary to tuberculosis or other parts of tuberculosis. Insidious
65、 onset, the ear purulent fluid thin, for the central nervous TMS or marginal perforation, sometimes visible pale granulation. The hearing loss is obvious. Papilloma X-ray scan bone destruction or death hints bone formation. For granulation tissue for pathology examination, or take the secretion smea
66、r, training, animal vaccination, most can diagnose; Diagnose have difficulty, can consider line vesssed papilloma 。上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityTreatmentEliminate the etiology, control of infection, remove the focus, unobstructed drainage, and restore listen to functio
67、n Pathogeny cure: timely cure acute suppurative otitis media, and prompted an healing. Positive for the upper respiratory tract disease, such as chronic tonsillitis, slow gonad sample body inflammation, chronic sinusitis, etc。Local treatment: including drug therapy and surgery。上海交通大学医学院附属仁济医院Ren Ji
68、Hospital, Shanghai JiaoTong UniversityTreatment(1) Simply type: the local drug to give priority to. Usually use 3% peroxide wash our ears, a swab the drying or with the attractor is sucked clean, again drip into the antibiotics potions. According to different choice the disease local drug: (1) mucos
69、al hyperemia ratio, edema, has purulent or mucus pus with antibiotics when aqueous or antibiotics and sugar cortical hormone drugs mixed droplet ears. If 0.3% of ear drops 0.25%, levofloxacin chloramphenicol liquid and so on, or according to the bacteria cultivation and middle ear purulent fluid dru
70、g sensitivity test results, the choice of appropriate has no ears toxicity of antibiotic drugs. (2) to mucosal inflammation wanes, the purulent fluid reduce, the middle ear humid usable alcohol glycerin agents, such as 3% boric acid alcohol 。Aminoglycoside antibiotics used in middle ear local can ca
71、use ear poisoning, avoid being used. Generally dont advocate using powder, powder can be blocked by eardrums could, interfere with drainage, further cause severe complications. Try to avoid the drop in non-ferrous drugs in order to prevent the local observation. In the middle ear cavity with contain
72、 avoid phenols, arsenic from class.上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityTreatmentEar drops law: patients take seat or a lie, the ear disease. Gently pull auricle above will be back, to the plane drops into the solution in 3 5 drops. And then to finger gently directe anatomical
73、 had several times, prompted by an liquids perforation into the middle ear 5 10 min rear can change positions. Make the ear drops solution temperature and the temperature close as far as possible, lest cause dizziness 。上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityTreatment (2) Bone ab
74、scess type 1) The drainage unblocked, with local drug is given priority to, pay attention to check regularly 。2) Patent epi-mesotympanic route granulation available 10% 20% nitric acid silver burning; Bigger, burning the granulation is invalid, should with scraping giant-cell spoon. The middle ears
75、polyps can be used for a trap excise, conditions in best surgical microscope operation 。3) Poor drainage or is suspected of complications, must do papilloma radical surgery. According to the disease extent, can be improved and obstruction.the dash forward, as far as possible the reconstruction middl
76、e ear sound structure, in order to retain or improve listening 。上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityTreatment(3) cholesteatoma type: an operation is preformed as soon as possible, remove the focus, to prevent complications。 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong Un
77、iversityTreatmentPapilloma radical surgery aims to: (1) completely clear tympanometry, drum sinus and papilloma cavity bravery fat tumor, granulation, polyps and pathological changes of bone and mucous membrane, etc. (2) the reconstruction of the hearing. Intraoperative as far as possible with the s
78、ound function reserves are closely connected with middle ear structure, such as listening to small bone, residual eardrums and eustachian tube mucosa, and even complete plane and drum groove, etc, and based on this, a period or reconstruction phase 2 hearing. (3) tries to dry the ear. 上海交通大学医学院附属仁济医
79、院Ren Ji Hospital, Shanghai JiaoTong UniversityThreeofthedifferentialdiagnosisofchronicsuppurativeotitismediaBone destruction, thick edge, sharp complications complications General no complications General no complications Can cause intracranial complications, Can cause intracranial complications, an
80、d outside and outside Often cause intracranial Often cause intracranial complications, and complications, and outside outside Treatment principle Nonoperative treatment Surgical treatment as Surgical treatment Papilloma X piece or temporal bone CT No bone destruction Drum sinus area can be a fuzzy e
81、dge of pervious to light area; The middle ear of a soft tissue Bone destruction, thick edge, sharp Eardrums and tympanotomy The tension of the central sex perforation, tympanometry mucosa is smooth, can be mild edema Nervous department big hole or relaxation of marginal perforation, there were indic
82、ated granulation or polyps Relaxation department or nervous after the top marginal perforation, visible gray scaly skin of substance, odd smell. After the plane on the bone, wall can be broken down 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong UniversityCasediscussionsSome 36 male, repeatedly le
83、ft ear discharging 6 years, companion is giddy, inspect content rotating 1 day doctor, the patient has been repeatedly for six years left ear discharging, listening declined obviously, and anti-inflammatory can get better, but to catch cold catch cold, fatigue, ear after water is easy to relapse, ca
84、nt cure, a day after the catch cold catch cold before, once again left ear discharging, the quick turn around when appear giddy, inspect content rotation, with nausea and vomiting 2 times. Inspection: the left ear see within the tao light yellow purulent, an nervous department big perforation, tempo
85、ral bone CT: left tympanometry, drum filling of soft tissue in the sinus. Hearing: left ear severe mixed deaf. Fistula test: weak positive. 。excuse me: (1) also need to ask what symptom? (2) the medical examination for added? (3) the diagnosis is? (4) the treatment measures? What? 上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong University上海交通大学医学院附属仁济医院Ren Ji Hospital, Shanghai JiaoTong University
