(耳鼻咽喉头颈外科学)4.3（参考翻译）CSOM

1、( (耳鼻咽喉头颈外科学耳鼻咽喉头颈外科学)4.3)4.3（参考翻（参考翻译）译）CSOMCSOMPathology 病理学病理学 Edematous mucosa with submucosal fibrosis and infiltration by chronic inflammatory cells. 粘膜水肿并发粘粘膜水肿并发粘膜下纤维化及慢性炎症细胞浸润膜下纤维化及慢性炎症细胞浸润 Polyps 息肉息肉 Bone erosion 骨侵蚀骨侵蚀: The inflammatory process is thought to lead to infiltration and acti

2、vation of osteoclasts and mononuclear cells containing various proteolytic enzymes 炎症过程被认为是导致破骨细胞和含有各种炎症过程被认为是导致破骨细胞和含有各种蛋白水解酶的单核细胞浸润和激活的原因蛋白水解酶的单核细胞浸润和激活的原因 Granulation tissue 肉芽组织肉芽组织: In over 95% of the temporal bones studied from individuals with a history of CSOM 在对有在对有CSOM病史的人的颞骨研究中超过病史的人的颞骨研究

3、中超过95%存存在在Clinical Findings 临床表现临床表现 Symptoms 症状：症状： Otorrhea 耳漏耳漏: Either intermittent or continuous, usually mucopurulent 间歇的或连续的，通常为脓性间歇的或连续的，通常为脓性 Blood-stained drainage is often noted with granulation tissue or polyps 血性分泌物通常提示肉血性分泌物通常提示肉芽组织或息肉芽组织或息肉Clinical Findings 临床表现临床表现 Symptoms 症状：症状： he

4、aring loss 听力损害听力损害 Degree depends on the size and location of the TM perforation and the status of the middle ear 程度取程度取决于决于TM穿孔的大小和位置穿孔的大小和位置Size 尺寸尺寸Ossicular chain involvement 听骨链牵涉听骨链牵涉fibrosis or inflammatory granulation tissue 纤维纤维化或炎性肉芽组织化或炎性肉芽组织 Tinnitus 耳鸣耳鸣Signs 体征体征Signs 体征体征: Perforatio

5、n of TM, edematous mucosa, granulation tissue or polyp； TM穿孔、粘膜水肿、肉芽组织及息肉穿孔、粘膜水肿、肉芽组织及息肉 Hearing loss, conductive 听力损害，传导听力损害，传导subtotalCentral Total Marginal conductivemixedsensorineuralnormalRadiographic studies 影像学研究影像学研究 CT Diagnosis 诊断：诊断： History +Signs+ Examination 病史病史+体征体征+查体查体 Differential

6、 Diagnosis 鉴别诊断鉴别诊断 : Carcinoma of middle ear 中耳癌中耳癌 Tuberculosis 结核结核Treatment 治疗治疗 Goals 目标：目标： Eliminate lesions 消除病变消除病变 Free draining to obtain a dry ear 自由排液以获得干耳自由排液以获得干耳（？）（？） Prevent further infection 防止进一步感染防止进一步感染 Restore normal functioning to the middle ear 恢复正常恢复正常中耳功能中耳功能 Relieve patho

7、geny 缓解病因缓解病因Treatment 治疗治疗 Nonsurgical Measures 非手术性措施：非手术性措施： Provide adequate ear protection while bathing or showering 沐浴或淋浴时为耳朵提供足够的保护沐浴或淋浴时为耳朵提供足够的保护 Bacteriological analysis before medical treatment 医疗医疗前进行细菌学分析前进行细菌学分析 Aural Toilet 耳器耳器: 3% hydrogen peroxide solution 过氧过氧化氢溶液化氢溶液 clearing th

8、e discharge from the external auditory canal allows the topical agent to reach the middle ear in an adequate concentration 清理外耳道积液允许局部化学物质在中耳达到清理外耳道积液允许局部化学物质在中耳达到适当的浓度适当的浓度Treatment 治疗治疗 Nonsurgical Measures 非手术性措施：非手术性措施： Topical antibiotics 外用抗生素外用抗生素: 0.3% ofloxacin 氧氟沙氧氟沙星星, 2.5% chloromycetin

9、glycerine 氯霉素甘油氯霉素甘油, 3% boric alcohol 硼酸酒精硼酸酒精 Systemic antibiotics 全身抗生素全身抗生素: useful in acute exacerbation of chronically infected ear 用于慢性感染用于慢性感染急性加重急性加重Surgical Measures 手术措施：手术措施： Indications 适应症适应症: impending or established intratemporal or intracranial complications 即将或已建立的颞骨内或颅内并发症即将或已建立的颞

10、骨内或颅内并发症 Polyps or fibrotic granulation tissue 息肉或肉芽组织纤维化息肉或肉芽组织纤维化 otorrhea failing to respond to medical treatment 药物治疗耳漏药物治疗耳漏无效无效 a correctable conductive hearing loss or a TM defect 矫正传导矫正传导性听力损失或性听力损失或TM缺陷缺陷 Surgical Measures 手术措施：手术措施： Techniques 方法方法: Myringoplasty 鼓膜成形术鼓膜成形术an operation lim

11、ited to superficial repair of TM defects, without exploration of the middle ear cleft操作仅限于操作仅限于TM的表面修复缺的表面修复缺陷陷,没有深入中耳裂没有深入中耳裂 Tympanoplasty 鼓室成形术鼓室成形术an operation involving exploration of the middle ear cleft 深入中耳裂的手深入中耳裂的手术术 Mastoidectomy 乳突切开术乳突切开术removal of varying portions of the bony EAC to ob

12、tain improved access to the epitympanic and mesotympanic spaces 移除不移除不同部位的骨性同部位的骨性EAC以扩大上鼓室和中鼓室的空间以扩大上鼓室和中鼓室的空间Cholesteatoma 胆脂瘤胆脂瘤 Definition 定义定义: A bag like cystic structure lined by keratinizing stratified squamous epithelium in which crystals of cholesterol, desquamated tissue debris, keratin a

13、nd bacteria are embedded 袋状囊性结构，由角化袋状囊性结构，由角化的复层鳞状上皮细胞填充，胆固的复层鳞状上皮细胞填充，胆固醇结晶，脱落的组织碎片，角蛋醇结晶，脱落的组织碎片，角蛋白和细菌嵌入其中白和细菌嵌入其中 Not a real tumor 并非真正的肿瘤并非真正的肿瘤Pathogenesis 发病机理发病机理 Not completely understood 尚不明确尚不明确 The invagination theory 内陷理论内陷理论Eustachian tube dysfunction 咽鼓管机能障碍Poor aeration of the epitym

14、panic space 鼓室上隙通气不良Retraction of the pars flaccida 松弛部收缩Accumulation of keratin, enlargement of sac角蛋白的积累，囊腔扩大Pathogenesis 发病机理发病机理 The invagination theory 内陷理论内陷理论Pathogenesis 发病机制发病机制 The invagination theory 内陷理论内陷理论Clinical Findings 临床表现临床表现 Symptoms 症状：症状： recurrent or persistent purulent otorr

15、hea, generally fetid；反复或持续化脓性耳漏，一般散发着臭味；反复或持续化脓性耳漏，一般散发着臭味 Hearing loss 听觉损害：听觉损害：conductive or mixed； 传导性传导性或混合性或混合性 Tinnitus, otalgia 耳鸣，耳痛耳鸣，耳痛 Vertigo, facial nerve palsy 眩晕，面部神经麻痹眩晕，面部神经麻痹-rarely 少见少见 Signs 体征：体征： TM: perforation, retraction 穿孔，收缩穿孔，收缩 purulent otorrhea, polyps and granulation

16、tissue, and ossicular erosion, bone destruction 化脓性耳漏、息肉化脓性耳漏、息肉和肉芽组织、听骨链侵蚀、骨破坏和肉芽组织、听骨链侵蚀、骨破坏 Audiometry 听力测定听力测定: conductive or mixed hearing loss, may vary greatly 传导性或混合性听力损害，不同传导性或混合性听力损害，不同个体间可能差异较大个体间可能差异较大 CholesteatomaAttic Cholesteatoma上鼓室胆脂瘤Attic Cholesteatoma Attic CholesteatomaMastoid C

17、holesteatomaTreatment 治疗治疗 Advice to patient 建议病人建议病人: surgical management as soon as possible 尽快手术治疗尽快手术治疗 Nonsurgical measures 非手术性措施非手术性措施 remove infected debris from the ear canal 去除耳道内去除耳道内感染的杂物感染的杂物 keep all water out of the ears to prevent further contamination 排尽耳内水以防深层感染排尽耳内水以防深层感染 apply ototopical agents that cover the usual bacterial organisms 应用耳部局部药剂以覆盖常见的细菌生物应用耳部局部药剂以覆盖常见的细菌生物Treatment 治疗治疗 Surgical goals 手术目标手术目标 Remove diseased tissues 切除病变组织切除病变组织 Prevent and treat complications 预防和治疗并发症预防和治疗并发症 Obtain a dry ear 得到干耳得到干耳 Improve hearing 提高听力提高听力Tre