急性化脓性中耳炎.ppt

1、Acute Suppurative Otitis Media急性化脓性中耳炎,Guo Min The department of otorhynolaryngology,Key words,Acute 急性 Suppurative 化脓性 Otitis media 中耳炎,Mucosa 粘膜 Middle ear 中耳 Tympanic membrane 鼓膜 External acoustic canal 外耳道 Eustachian tube 咽鼓管 Malleus 锤骨,Hyperemia 充血 Swell , swollen 肿胀 Obstruction 阻塞 Ear fullness

2、 耳闷 Earache = ear pain = otalgia 耳痛 Hearing loss 耳聋 Tinnitus 耳鸣,Otoscopy 耳镜检查 Perforate 穿孔 perforation Pus 脓 Retraction 内陷 Bulge 膨胀,A sick and crying boy Earache High fever Caught a cold recently Tympanic membrane is uniformly red and bulges outwards,Case,Definition,Acute suppurative otitis media (

3、ASOM) is an acute infection of the mucosa lining of the middle ear,It occurs more easily in children and infants in winter and spring after upper respiratory infection,WHY ?,Middle ear,Tympanic cavity 鼓室 （ tympanic membrane 鼓膜） Eustachiantube 咽鼓管 Tympanicantrum鼓窦 Mastoidprocess 乳突,Eustachian tube,A

4、small tube connecting the middle ear to the nasopharynx,Function,Regulate and equalize pressure of middle ear Prevent fluid from accumulating in the middle ear Protect from the nasopharyngeal infection,Regulate and equalize pressure of middle ear,AIR,Prevent fluid from accumulating in the middle ear

5、,FLUID,Protect from the nasopharyngeal infection,In children and infants, it is shorter, narrower and more horizontal,Tympanic membrane,Tympanic membrane,The infectious way,Blood-born,Eustachian tube,External acoustic canal,Common organism: pneumococcus, heamolytic streptococcus, heamophilus influen

6、zea, staphylococcus,Eustachian tube way,Common In some cases organisms staying in nasopharynx can go through this way into the middle ear upper respiratory infection acute infectious diseases ( scarlatina, measles and pertussis) blow nose improperly swim or dive in dirty water some improper therapy

7、Important in children and infants,Why are children easier to infect ASOM?,1. Eustachian tube is more horizontal , shorter, narrower and less stiff than adult 2. The large adenoids can interfere with the opening of the eustachian tube. 3. Childrens immune systems are not fully developed,External acou

8、stic meatus way,- connected with the tympanic membrane perforation ( such as the tympanic membrane trauma, the insertion of tympanostomy tubes, tympanometry, myringotomy),rare,Blood-born,Pathophysiology,Eustachian tube is occluded,air fluid,Intratympanic pressure,Tympanic membrane retracts,Mucosa: h

9、yperemia and swollen,Tympanic membrane retracts,Ear fullness Tinnitus Hearing loss conductive hearing loss may be unnoticed Earache not severe,Handle of malleus: more horizontal Corn of light: disappear / broken,Tympanic membrane is hyperemia,Signs and symptoms,Earache pulsatile, intense, preventing

10、 sleep. In children: cry Hearing loss may be overshadowed by earache Tinnitus General disturbance fever, loss of appetite for food, vomiting WBC increases,This stage is essential: it is the stage at which the disease is most often first seen by a doctor. If the medical treatment is timely and proper

11、ly, it can arrest and reverse the inflammation and can prevent suppuration.,Tympanic membrane: tense and bulges appears “full”: convex handle of malleus: vertical or invisible,Pus forms and increases,Tympanic membrane is compressed and ischemia,Thrombophlebitis,Tympanic membrane necroses,Signs and s

12、ymptoms,Earache more severe as the intratympanic tension rise pounding, pulsatile General disturbance: worse temperature: over 39 obviously ill Hearing loss and tinnitus,Tympanic membrane perforation,Pus discharge in some cases, rush of pus slows and stops within a day or two Earache: relieved at on

13、ce General condition: better Temperature falls WBC decreases Otoscopy: perforation disappearance of hyperemia restoration of normal colour and landmarks,In some cases, resolution of inflammation without spontaneous perforation in the natural course of a mild infection or under the influence of antib

14、iotics.,stage,clinic,Supplementary investigations,Audiometric testing: mild middle level conductive hearing loss if the cochlea is infected: sensorineural / mixed hearing loss Blood analysis: WBC increases then decreases,DIAGNOSIS,History,Signs and symptoms,Otoscopy,Supplementary investigation,At th

15、e stage of eustachian tube occlusion: distinguished from occlusion due to other causes, such as by adenoids, allergic swelling of the lining membrane. history and physical examination are important.,Differential diagnosis,Meatal furuncle 外耳道湿疹 Earache no hearing loss Tympanic membrane is normal,Acut

16、e myringitis 急性鼓膜炎 Severe earache Hearing loss is slight Tympanic membrane is hyperemia and bulla forms After influenza or zoster,At the stage of suppuration,Treatment,Control infection Local therapy Treat related disease,Control infection - Antibiotics,Arrest and reverse the inflammation Prevent su

17、ppuration and perforation Relieve symptoms, hasten resolution of the infection Reduce the chance of labyrinthine and intracranial infectious complications,If the pus is cultured and for sensitivity studies: the result can direct the therapy Recommended drug: penicillin ( 青霉素） and cephalosporin（先锋霉素）

18、 Recommended using time: 10days,Local therapy,Therapies before the perforation and after perforation are different!,Pay attention !,Before perforation,Relief earache and control local inflammation phenol glycerine（酚甘油） ephedrine and furacilline solution （肾上腺素和呋喃西林溶液） Myringotomy / tympanotomy（鼓膜切开术）

19、,Myringotomy,Indications: the manifestations are not relieved by antibiotics tympanic membrane bulges significantly tympanic membrane perforation is too small,After perforation,Clear pus and external acoustic canal Control infection Repair the tympanic membrane,Treat related disease,Treat the chronic disease in nose, sinus, pharynx, and nasopharynx: chronic rhinitis, chronic sinusitis, chronic tonsillitis and adeno