AcuteSuppurative

OtitisMedia

急性化膿性中耳炎GuoMinThedepartmentofotorhynolaryngologyKeywords

Acute

急性Suppurative化膿性O(shè)titismedia

中耳炎Mucosa

粘膜Middleear

中耳Tympanicmembrane

鼓膜Externalacousticcanal

外耳道Eustachiantube

咽鼓管Malleus

錘骨Hyperemia充血Swell,swollen

腫脹

Obstruction阻塞Earfullness

耳悶Earache=earpain=otalgia耳痛

Hearingloss

耳聾Tinnitus

耳鳴Otoscopy

耳鏡檢查Perforate穿孔perforationPus

膿Retraction

內(nèi)陷Bulge

膨脹

AsickandcryingboyEaracheHighfeverCaughtacoldrecentlyTympanicmembraneisuniformlyredandbulgesoutwards

Case

ASOMWhatarethechangesWhy&HowWhatshouldwedoWhatisitDefinitionSigns&symptomsPathophysiology&pathogenyTreatmentDefinition

Acutesuppurativeotitismedia(ASOM)is

anacuteinfectionofthemucosaliningofthemiddleear

Itoccursmoreeasilyinchildrenandinfantsinwinterandspringafter

upperrespiratoryinfectionWHY?MiddleearTympaniccavity鼓室〔tympanicmembrane鼓膜〕Eustachiantube咽鼓管Tympanicantrum鼓竇Mastoidprocess乳突EustachiantubeAsmalltubeconnectingthemiddleeartothenasopharynxFunctionRegulateandequalizepressureofmiddleearPreventfluidfromaccumulatinginthemiddleearProtectfromthenasopharyngealinfectionRegulateandequalizepressureofmiddleear

AIRPreventfluidfromaccumulatinginthemiddleear

FLUIDProtectfromthenasopharyngealinfectionInchildrenandinfants,itisshorter,narrowerandmorehorizontalTympanicmembraneTympanicmembraneTheinfectiouswayBlood-bornEustachiantubeExternalacousticcanalCommonorganism:pneumococcus,heamolyticstreptococcus,heamophilusinfluenzea,staphylococcusEustachiantubewayCommonInsomecasesorganismsstayinginnasopharynxcangothroughthiswayintothemiddleearupperrespiratoryinfectionacuteinfectiousdiseases(scarlatina,measlesandpertussis)blownoseimproperlyswimordiveindirtywatersomeimpropertherapyImportantinchildrenandinfants

WhyarechildreneasiertoinfectASOM?

1.Eustachiantubeismorehorizontal,shorter,narrowerandlessstiffthanadult2.Thelargeadenoidscaninterferewiththeopeningoftheeustachiantube.3.Children’simmunesystemsarenotfullydevelopedExternalacousticmeatusway------connectedwiththetympanicmembraneperforation

(suchasthetympanicmembranetrauma,theinsertionoftympanostomytubes,tympanometry,myringotomy)rareBlood-bornPathophysiologyEustachiantubeisoccludedairfluidIntratympanicpressureTympanicmembraneretractsMucosa:hyperemiaandswollenTympanicmembraneretracts

EarfullnessTinnitus

HearinglossconductivehearinglossmaybeunnoticedEarache

notsevereHandleofmalleus:morehorizontalCornoflight:disappear/brokenTympanicmembraneishyperemia

SignsandsymptomsEarache

pulsatile,intense,preventingsleep.Inchildren:cryHearingloss

maybeovershadowedbyearacheTinnitusGeneraldisturbance

fever,lossofappetiteforfood,vomitingWBCincreases

Thisstageisessential:itisthestageatwhichthediseaseismostoftenfirstseenbyadoctor.Ifthemedicaltreatmentistimelyandproperly,itcanarrestandreversetheinflammationandcanpreventsuppuration.Tympanicmembrane:tenseandbulgesappears“full〞:convexhandleofmalleus:verticalorinvisiblePusformsandincreasesTympanicmembraneiscompressedandischemiaThrombophlebitisTympanicmembranenecrosesSignsandsymptomsEarache

moresevereastheintratympanictensionrisepounding,pulsatileGeneraldisturbance:worse

temperature:over39℃obviouslyillHearinglossandtinnitusTympanicmembraneperforationPusdischargeinsomecases,rushofpusslowsandstopswithinadayortwoEarache:relievedatonceGeneralcondition:better

TemperaturefallsWBCdecreasesOtoscopy:

perforationdisappearanceofhyperemiarestorationofnormalcolourandlandmarksInsomecases,resolutionofinflammationwithoutspontaneousperforationinthenaturalcourseofamildinfectionorundertheinfluenceofantibiotics.OcclusionoftubePre-suppurationSuppurationPusdischargeFullness+---Hearingloss++++++Earache+++++++/-Tinnitus+/-+/-+/-+/-Generaldisturbance-+++++/-TMRetractionRed&bulgesPerforation/pusHeal/PerforationstageclinicSupplementaryinvestigationsAudiometrictesting:

mild–middlelevelconductivehearinglossifthecochleaisinfected:sensorineural/mixed hearingloss

Bloodanalysis:WBCincreasesthendecreasesDIAGNOSISHistorySignsandsymptomsOtoscopySupplementaryinvestigationAtthestageofeustachiantubeocclusion:distinguishedfromocclusionduetoothercauses,suchasbyadenoids,allergicswellingoftheliningmembrane.

historyandphysicalexaminationareimportant.DifferentialdiagnosisMeatalfuruncle外耳道濕疹EarachenohearinglossTympanicmembraneisnormalAcutemyringitis急性鼓膜炎SevereearacheHearinglossisslightTympanicmembraneishyperemiaandbullaformsAfterinfluenzaorzosterAtthestageofsuppurationTreatmentControlinfectionLocaltherapyTreatrelateddiseaseControlinfection----AntibioticsArrestandreversetheinflammationPreventsuppurationandperforationRelievesymptoms,hastenresolutionoftheinfectionReducethechanceoflabyrinthineandintracranialinfectiouscomplicationsIfthepusisculturedandforsensitivitystudies:theresultcandirectthetherapyRecommendeddrug:penicillin(青霉素〕andcephalosporin〔先鋒霉素〕Recommendedusingtime:10daysLocaltherapyTherapiesbeforetheperforationandafterperforationaredifferent!Payattention!!!BeforeperforationReliefearacheandcontrollocalinflammationphenolglycerine〔酚甘油〕ephedrineandfuracillinesolution〔腎上腺素和呋喃西林溶液〕Myringotomy/tympanotomy〔鼓膜切開術(shù)〕

MyringotomyIndications:themanifestationsarenotrelievedbyantibioticstympanicmembranebulgessignificantlytympanicmembraneperforationistoosmallAfterperforationClearpusandexternalacousticcanalControlinfectionRepairthetympanicmembraneTreatrelateddisease

Treatthechronicdiseaseinnose,sinus,pha