ear anatomyotitis externa acute otitis media短耳的解剖外耳道炎急性中耳炎课件

Ear anatomys Second branchial arch(reichert;s cartilage)cartilage) manubrium of malleus manubrium of malleus ,long and lenticular process of ,long and lenticular process of incus ,stapesincus ,stapes Anatomy of the earAnatomy of the ear External ear:External ear: 1.1.Auricle :Auricle : l l Arise from the first and second Arise from the first and second branchial cleft.branchial cleft. l l Cartilage +perichondrium +skin Cartilage +perichondrium +skin (close adherent together) except (close adherent together) except the lobule. the lobule. 2-External auditory canal:2-External auditory canal: First pharyngeal cleft First pharyngeal cleft Length:2.5 cmLength:2.5 cm Cartilaginous EAC:Cartilaginous EAC: lateral 1/3 fibrocartilage contains lateral 1/3 fibrocartilage contains apopilosebaceous unitsapopilosebaceous units Osseous EAC:Osseous EAC: medial 2/3periosteummedial 2/3periosteum Post sup squamaPost sup squama The remainder tympanic The remainder tympanic plateplate Squmotympanic Squmotympanic Bony cochlea; in front the vestibule ,snail in front the vestibule ,snail shell in shape ,2 1/2 turns, shell in shape ,2 1/2 turns, central axis (central axis (mediolusmediolus )inner )inner wall of the canalwall of the canal l l Contain perilymph Contain perilymph =extracellular fluids =extracellular fluids Membranous labyrinthMembranous labyrinth l l communicating sacs and communicating sacs and ducts within the bony cavities ducts within the bony cavities Saccule Organ of corti; Scala vestibuliScala vestibuli -oval window -oval window Scala tympaniScala tympani -round window -round window l l Both contain perilymph Both contain perilymph Scala mediaScala media -endolymph -endolymph Physiology of hearing Physiology of hearing Sound energy air Sound energy air external canal TM external canal TM Ossicles cochlear fluid Ossicles cochlear fluid wave stimulation of wave stimulation of basal membrane basal membrane shearing of hair cell with shearing of hair cell with tectorial membrane tectorial membrane rapid depolarization rapid depolarization impulse carried along the impulse carried along the auditory nerve .auditory nerve . l l Area advantage :TM 55 Area advantage :TM 55 mm the stapes 3.2mm mm the stapes 3.2mm =17:1=17:1 l l Lever effect : 1.3:1Lever effect : 1.3:1 l l Transformer ratio 22:1 25Transformer ratio 22:1 25 -30 dB gain-30 dB gain Central connection of cochlear Central connection of cochlear nerve nerve The vestibular labyrinth The vestibular labyrinth Semicircular canalsSemicircular canals =hair cell gelatinous =hair cell gelatinous cupula sheared (angular movements ) cupula sheared (angular movements ) vestibular nerve .vestibular nerve . Utricle and sacculeUtricle and saccule= hair cell otoconial = hair cell otoconial membrane (linear acceleration ; l l pseudomonas aeruginosa, staphlococcus (furuncle)pseudomonas aeruginosa, staphlococcus (furuncle) SSxSSx: : l l pain ,tragal tendreness otalgia ,pruritus, edematous pain ,tragal tendreness otalgia ,pruritus, edematous erythematous EAC, conductive hearing loss.erythematous EAC, conductive hearing loss. RX:RX: l l suction cleaning suction cleaning l l Ear drop Ear drop l l Analgesia Analgesia l l Antibiotic Antibiotic Eczematous otitis externa:Eczematous otitis externa: l l Allergic dermatitis Allergic dermatitis SSx;SSx; l l pruritis ,redness oedema , pruritis ,redness oedema , mild pain,dry scaly skinmild pain,dry scaly skin RX:RX: l l recognize the allergen recognize the allergen l l Hydrocortisone cream Hydrocortisone cream l l Antihistamin Antihistamin l l Coal tar ointment ,silver nitrate Coal tar ointment ,silver nitrate ,canalplasty (,canalplasty (chronic stagechronic stage) ) Seborrhoeic otitis Seborrhoeic otitis externa :externa : l l Greasy, scaling and Greasy, scaling and crusting condition crusting condition Cause:Cause: l l abn sebum and waxabn sebum and wax SSx:SSx: l l Greasy yellow scales Greasy yellow scales l l itching itching RX:RX: l l Shampoo selenium Shampoo selenium sulphide and ketoconazole sulphide and ketoconazole l l Ointment; salicylic acid and Ointment; salicylic acid and sulpher 2%sulpher 2% Herpetic lesionsHerpetic lesions: : l l Herpes simplex (acyclovir in severe casesHerpes simplex (acyclovir in severe cases ) ) l l herpes zoster oticus herpes zoster oticus Sever pain Sever pain Vesication Vesication Cranial nerve lesion deafness SNHLCranial nerve lesion deafness SNHL VertigoVertigo Facial nerve palsies Facial nerve palsies l l Ramsay hunt syndrom Ramsay hunt syndrom l l RX:RX: oral and topical acyclovir earlyoral and topical acyclovir early Otomycosis :Otomycosis : l l Aspergillus ,candidaAspergillus ,candida SSX:SSX: l l moist tissue paper dotted moist tissue paper dotted gray membran, prurtic gray membran, prurtic RXRX l l : suction cleaning: suction cleaning l l Fungicides :Fungicides : nystatin ,econazolnystatin ,econazol Otitis externa malignans (osteomyelitis Otitis externa malignans (osteomyelitis of skull base):of skull base): l l Pseudomonas infection occurring in elderly Pseudomonas infection occurring in elderly diabetic patients .diabetic patients . SSX:SSX: l l Granulation tissue in EAC at the bony Granulation tissue in EAC at the bony cartilagenous junction cartilagenous junction l l Persist otalgia, otorrhea Persist otalgia, otorrhea l l Crainal nerve involvement Crainal nerve involvement l l VII, IX ,X XI ,XII,V,VIVII, IX ,X XI ,XII,V,VI DX ;DX ; l l CT scan, bone scan ,culture CT scan, bone scan ,culture RXRX: : l l diabetic controldiabetic control l l Prolonged parentral anti- pseudomonus abxProlonged parentral anti- pseudomonus abx l l Ear drop Ear drop l l Debridement Debridement l l Hyperbaric oxygen Hyperbaric oxygen Acute Acute otitisotitis media media Inflammation of the middle ear cavity (3 Inflammation of the middle ear cavity (3 weeks)weeks) Pathophysiology :Pathophysiology : l l ET dysfunction ,spread of the infection ET dysfunction ,spread of the infection via submucosal lymphatic or direct via submucosal lymphatic or direct spreadspread Pathogens;Pathogens; l l S,pneumonia, H, influnza.Moraxella S,pneumonia, H, influnza.Moraxella Risks:Risks: l l Craniofacial abnCraniofacial abn l l Rec URTIRec URTI l l Day care Day care l l Bottle feeding Bottle feeding l l smoking smoking l l immunological disorders IgA ,IgG immunological disorders IgA ,IgG deficienciesdeficiencies l l Ciliary dysfunction Ciliary dysfunction l l Adenoid hypertrophy Adenoid hypertrophy l l GERDGERD l l NGT NGT SSX:SSX: l l Otalgia,aural fullness, hearing loss, tinnitus Otalgia,aural fullness, hearing loss, tinnitus ,fever,fever l l Hyperemic TM ,non mobile bulgingTM ,air Hyperemic TM ,non mobile bulgingTM ,air fluid level fluid level RXRX; ; l l oral ABX for 10 days oral ABX for 10 days l l Antipyretics , analgsia oral and nasal Antipyretics , analgsia oral and nasal decongestantsdecongestants l l Myringotomy sever otalgia Myringotomy sev