外语渗出性中耳炎ppt课件

OTITISMEDIAWITHEFFUSION-(OME),1,一、overview,Otitismediawitheffusion(OME)ischaracterizedbyaccumulationoffluidinthemiddleear,conductivehearingloss,andisakindofnon-purulentdiseasesofmiddleear.,2,OMEoccursasaresultofdecreasedventilationofthemiddleearormastoidair-cellsystemthroughtheeustachiantube.,3,SerousOtitisMediaGlueEarNon-purulentOtitisMedia,OMEiscalledothernames:,4,OMEisoneofthemostcommonlyresultingindeafnessamongchildren.OMEoccursinadulttoo.,5,6,7,Functionoftheeustachiantube,Theeustachiantubeisessentialinmaintainingahealthy,well-aeratedthemiddleear.,8,9,Theeustachiantubeventilatesthemiddleear,protectsitfrompathogenicorganismsinthenasopharynx,equilibratespressureacrossthetympanicmembrane,andallowsdrainageofsecretionsfromthemiddleearintonasopharynx.,10,Atrest,theeustachiantubeisclosed.Duringswallowing,yawning,orsneezing,thenasopharyngealorificeofeustachiantubeisopenedtransiently.,11,Theanatomyoftheeustachiantubeofinfantsisdifferentfromadults.Theinfantileeustachiantubeismorehorizontalorientation,shorterlength,andmorepatulousconfigurationthanadult.,12,二、Pathogenesis,Anyprocessthatinterfereswithnormalopeningofproximal(nasopharyngeal)endoftheeustachiantubeormucociliaryclearancemechanismcausesOME,13,(1)、mechanicalobstruction:,largeorinfectedadenoidsturbinatehypertrophyneoplasmofnasopharynxnasopharyngealedemaorinflammation,14,(2).Allergy,Allergyreactionaffectsbothmucociliaryclearancemechanismandnormaleustachiantubeopening.,15,(3).Abnormaleustachiantubeanatomy,Suchas:cleftpalatedeformitiescanimpaireustachiantubefunction.,16,Functionaldisordersofeustachiantubenegativepressureintympaniccavityveinsinmucousbedilatedandbecongestedvesselspermeancebeincreasedseruminvesselsbeexudedintotympaniccavitymiddleeareffusion,17,三.ClinicalPresentation,SymptomsConductiveHearingLoss,Earache,Earfullness,Tinnitus.,18,PhysicalExamination,TympanicMembranetoberetracted,dull,opaque.colorcanrangefrom:lightpinktoamberandevendarkblue.,19,20,21,22,AudiometricTesting,reveals:Mildmiddlelevelsofconductivehearingloss,23,Audiogram,24,AcousticImmittance,25,Normalacousticimmittanceis“type_A”curve.Thecurvehaspeakat“O”Pascalpressurepoint.OMEsAcousticimmittanceis“type_B”curve.Itisflattympanometriccurve,26,四、Diagnosis,(一)、History:Somepatientssufferedupperrespiratorytractinfectionbefore12weeks,orsufferedrhinitis,adenoidshypertrophyet.Perennial.,27,（二）、Clinicalpresentation:,hearingimpairmenttinnitusearobstructionEarache(earpain),28,(三)、Physicalexamination,tympanicmembraneberetractedtympaniccavityeffusion,29,（四）、AudiometricTesting,Mildmiddlelevelconductivehearingloss（五）、AcousticImmittance“type_B”curve,30,1、tympanosclerosis2、glomusjugularetumor3、cerebrospinalotorrhea、nasopharyngealcarcinoma,五、DifferentialDiagnosis,31,六、Management,PrinciplesofManagement：（一）、Eliminatemiddleeareffusion,improvemiddleearventilationanddrainage.,32,(1)、Keepexpeditenasalcavityandeustachaintube,Child:0.5%ephedrineandfuracillinesolutionAdult:1%ephedrineandfuracillinesolution,33,(2)、Eustachiantubeinsufflation,ValsalvamethodPolitzermethodCatheterization,34,(3)、PunctureofTympanum,35,(4)、Tympanotomy,36,(5)、TympanostomyTube,37,（二）、Managementofetiology,TreatmentnasalandnasopharyngealdiseasesExample:adenoidhypertrophy_adenoidectomyradiationofnasopharyngealcarcinoma,38,（三）、Antibiotictreatment,PenicillinCephradineTreatmentmaintains35daysbyoral(mild)orbyinjection,IV(severe),39,（四）、Steroidtreatment,Dexamethasone:Adult:510mg/day,35days,byinjection,IV.,40,七、Prevention,ExercisePreventfluTreatmentnasalandnasopharyngealdiseases,41,5.Questions,1.Whatistheotitismediawitheffusion(OME)?2.Whataretheessen