上海交通大学耳鼻咽喉科学英文版课件 acute suppurative otitis media.ppt

1、Acute suppurative otitis mediaOverviewMiddle ear mucosa in acute suppurative inflammation.Common for ENT.PathogensStreptococcus pneumoniae肺炎链球菌 Haemophilus influenzae流感嗜血杆菌 Hemolytic Streptococcus溶血性链球菌 Staphylococcus葡萄球菌 EtiologyAcute upper respiratory tract infectionAcute rhinitisAcute nasopharyng

2、itisAcute tonsillitisAcute infectious diseasesScarlet feverMeaslesWhooping coughEtiology Infection by Eustachian tube Infants due to eustachian tube short and flat Infection by the external auditory canal Infection by bloodSymptomsSystemic symptoms:Chills,feverLoss of appetiteRelieve after tympanic

3、membrane perforationEaracheHearing loss and tinnitusOtorrheaconductive deafnessTreatment Systemic treatment Antibiotics to control infection Decongestants Supportive therapyTreatmentTopical treatmentPhenol glycerol Ear DropsMyringotomy Before perforation of tympanic membraneCleaning pus with 3%hydro

4、gen peroxideAntibiotic eardropsRemove nasal,pharyngeal diseasesadenoidal hypertrophychronic sinusitistonsillitisAfter perforation of tympanic membraneTreatmentAcute mastoiditisEtiology Complication of acute suppurative otitis media Pathogens:drug resistant or Insensitive to commonly used antibiotics

5、 Simultaneously with other diseases:scarlet fever,measles,etc Poor drainage anatomical structure of mastoid air cellSymptom Earache continuously exists after the perforation of tympanic membrane,or with serious headache Ear discharging increase instead No hearing improve after the perforation of tym

6、panic membrane or more serious hearing loss Systemic symptom become more serious Differential diagnosis:Furuncle external auditory canalChronic suppurative otitis mediaPathogenesis After acute suppurative otitis media Acute necrotizing otitis media Simultaneously with other diseases:scarlet fever;me

7、asles,etc Eustachian tube dysfunction Chronic nasal and pharyngeal diseases Pathogens Staphylococcus aureus 金黄色葡萄球菌 Pseudomonas aeruginosa 肺炎链球菌 Categories chronic simple otitis media chronic otitis media with osteitis chronic otitis media with cholesteatomachronic simple otitis mediachronic otitis

8、media with osteitisCholesteatomaSymptomsEar discharging IntermittentlyMucus secretionsMild conductive deafness Perforation of tympanic membrane,Middle ear mucosa smooth or mild congestive,Ossicular mostly intactX-ray or CT No bone destruction pneumatic type or diploetic type mastoid process Large pe

9、rforation in tense part of tympanic membrane or Marginal perforation,there are granulation or polyps in tympanumX-ray or CT Mostly diploetic type mastoid process Soft tissue shadow in tympanum,tympanic antrum entrance and mastoid process SymptomsSymptomsEar discharging continuously Produce foul-smel

10、ling pus which is characteristic of anaerobic streptococciMild or serious conductive deafness,Mixed hearing loss Occasionally in advanced stageTreatmentRemove upper respiratory diseases chronic sinusitistonsillitisTopical treatmentmedicine/surgery according to different typesClear pus in external au

11、ditory canal and tympanum completely before ear dropsAminoglycoside otic solution forbiddenAvoid powder Avoid colored ear drops Corrodent forbiddenAntibiotics ear drops Treatment Pus unobstructed drainage same as the simple but regular follow-up Poor drainage/suspected complications mastoid operatio

12、nTreatmentSurgery as soon as possible1873 Simple mastoidectomy1878 Myringoplasty1891 Radical mastoidectomy 1910 Modified radical MastoidectomyTreatment Now tympanoplasty with or without mastoidectomy Classification Extra-cranial complications Intra-cranial complicationsComplications Chronic otitis m

13、edia with cholesteatomaAcute mastoiditis and mastoid abscesses (most common complication).Petrositis.Labyrinthitis.Facial paralysis.Osteomyelitis of the temporal boneExtra-cranial complicationsExtra-cranial complications External otitis Cervical lymphadenitis Retropharyngeal abscesses Parapharyngeal

14、 abscesses Intracranial complicationsExtradural abscess(commonest intracranial complication)Subdural abscessMeningitisBrain abscessTemporal lobe abscessCerebellar abscessLateral sinus thrombosisOtitic hydrocephalusExtra-cranial complicationsMastoid abscessExtra-cranial complicationsLabyrinthitisExtra-cranial complicationsFacial palsyExtra-cranial complications Intracranial complicationsBrain Abscess Intracranial complicationshydrocephalus Intracranial complicationsThanks！