慢性中耳炎的并發(fā)癥(英文版)課件

1、Complications of OMComplications of OMThree categories on an anatomic basisExtratemporal extracranialBezold abscessMouret abscessSubperiosteal abscessIntratemporal Mastoiditis, labyrinthitis, sensorineural hearing loss, petrositisFacial paralysis, labyrinthine fistulaIntracranial Epidural abscess, S

2、igmoid sinus thrombosis, otitic hydrocephalus, meningitis, brain abscess, subdural abscessThree categories on an anatoCauses Strong bacteriaDamaged structuresUnreasonable interventionsCauses Transmission course Pathways of spreadDirect extension of infection to structure (bone erosion)Hemogenous rou

3、tine (microbiologic an host factors)Bacteria gain access to intracranial through unsealed gap, inner earTransmission course Pathways oBezold abscessDefinition: Erosion the tip of the mastoid bone Infects the soft tissue of the neck, Deep to the sternocleidomastoid muscleDiagnosisEar infectionMass in

4、 the neck Fever, neck stiff, otorrheaCT scanBezold abscessDefinition: Bezold abscessTreatment AntibioticAbscess cavity should be evacuatedAn external drainage should be placedMastoidectomyAntrum drainage required, via epitympanum to the middle earBezold abscessTreatment Subperiosteal abscessDefiniti

5、on: Bone erosion, via osteitis or necrosis, leads to a dehiscence into the postauricular soft tissue.DiagnosisFever, pain and otorrhea Followed by appearance of the postauricular mass, displacing the auricle anteriorlyCT scan Subperiosteal abscessDefinitiSubperiosteal abscessManagements AntibioticDr

6、ainage, using postauriclar incision After achieving effective drainage of the mastoid infection, the site of suppuration can be addressedNecrotic tissues require debridementSubperiosteal abscessManagemeLabyrinthitis Classifications Cirvumscribed labyrinthitis (fistula of labyrinth)Serous labyrinthit

7、isSuppurative labyrinthitisLabyrinthitis Classifications Fistula of labyrinthIncluding bone erosion, exposure of the endosteal membrane and a true fistula into the fluid compartment of the inner ear.It occurs in 5-10% of cases with cholesteatoma Lateral semicircular canal is the most common location

8、 (90%)Mechanism of bone erosion Osteolysis resorptive osteitisFistula of labyrinthIncluding Fistula of labyrinthDiagnosisVertigo (intermittent or constant)Hearing lossFistula test (only 50% of patients are positive)CT scan may demonstrate evidence of fistula, however, small fistula can be overlooked

9、Fistula of labyrinthDiagnosisFistula of labyrinthManagementsSurgical inverventionmastoidectomyRemoval cholesteatoma matrix at the primary operation, fistula closed with temporal fasciaLeaving cholesteatoma matrix undisturbed. 9-12 months later, second operation is performed.antibioticFistula of laby

10、rinthManagementSerous labyrinthitisOccurs from inflammation, rather than infectionCaused by bacterial toxins, inflammtory mediatorsInflammatory cells rather than bacteria are found in the labyrintine fluidsVertigo, sensorineural hearing lossSerous labyrinthitisOccurs froSuppurative labyrinthitisBact

11、eria infiltrates the fluid space of inner earVestibular symptomsAcute phase of inflammation: Vertigo, nauseaThe phase of central compensation: imbalance or unsteadinessRecovery phase: severe perturbation, patients experiences a brief sensation of vertigo.Suppurative labyrinthitisBacteSuppurative lab

12、yrinthitisSymptoms associated with cochleaPermanent sensorineural hearing lossTinnitusInterventions AntibioticAddress the problem of the underlying COM and cholesteatomaElectrolyte (due to vomiting)PreventionEarly and effective treatment of the COM and cholesteatomaSuppurative labyrinthitisSymptPetr

13、ous apicitisThe most medial and anterior portion of the temporal bone30% of temporal bones with pneumatization of the petrous apexProximity to the posterior and middle cranial fossaePetrous apicitisThe most mediaPetrous apicitisGradenigos syndromeDeep ear and retroorbital pain (irritation of the tri

14、geminal nerve)Ipsilateral abducents nerve palsyPetrous apicitisGradenigos syPetrous apicitisManagementsAntimicrobials directed against the most likely pathogens.If hearing present in the affected ear, otic capsule should be preserved while effective drainage achieved retrolabyrinthine, infralabyrint

15、hine, infracochlear approachs can gain access to the petrous apexPetrous apicitisManagementsPetrous apicitisManagementsThe affected ear is dead ear, translabyrinthine or transcochlear approaches afford greater access to the petrous apexPetrous apicitisManagementsIntracranial complicationsOverview It

16、 is less frequently, due to Improved access to medical care and medicationBroad spectrum antibioticPathways of spreadDirect extension of infection to intracranial structure (bone erosion)Hemogenous routine (microbiologic an host factors)Bacteria gain access to intracranial through unsealed gap, inne

17、r earIntracranial complicationsOverSigmoid sinus thrombosisPathway Direct extension of mastoid infectionRetrograde thrombosisAntergrade thrombosisDiagnosisClinical presentation: high, spiking fevers, Headache, Intracraninal high pressure active ear diseaseAcute phase of thrombosis, absence of flow s

18、ignal in MR venography images.Sigmoid sinus thrombosisPathwaSigmoid sinus thrombosisManagementsSurgical explorationMastoidectomy to expose the sigmoid sinusA needle may be used to aspirate the sinus, if free-flowing blood returns, then no additional surgery is needed. If no blood returns, then open

19、and draining the sinus are indicated.In the face of ongoing septic pulmonary emboli, internal jugular vein ligation can be performed.Sigmoid sinus thrombosisManageSigmoid sinus thrombosisManagementsMedical treatmentAntibioticsAnticoagulation (in individual cases, in the face of propagating thrombosi

20、s)Sigmoid sinus thrombosisManageMeningitis Among intracranial complications of COM, meningitis is one of the most common, it account for 50% of the intracranial complications.In COM, bacterial contamination may occur via bone erosion with epidural abscess/granulation formation or retrograde thrombop

21、hlebitis of emissary veins.Meningitis Among intracranial MeningitisDiagnosisSymptoms of COMHigh fever, headache, vomiting Neck stiffness and altered mental statusCT or MRI will document meningeal enhancementLumbar puncture and examination of the CSF is mandatory (CFS leukocytosis and low glucose, el

22、evated level of protein and lactate, bacteria culture present positive)MeningitisDiagnosisMeningitisManagementsUrgent antibiotic (culture and sensitivity reports from the CSF samples can further direct antibiotic therapyAdjunctive therapy (dexamethasone can reduce the neurologic and auditory squelae

23、 of bacterial meningitisReduce the high intracranial pressure Mastoidectomy (removal lesion and achievement of drainage)MeningitisManagementsBrain abscess62% of abscesses were located in the tempora lobe and 34% in the cerebellumDirect extension along preformed pathways or perivascular channels is m

24、ore likely route of infection.The thin bone of tegmen may be more easily violated than the bone overlying the posterior fossa dura, given the increased frequency of temporal lobe versus cerebellar abscess.Brain abscess62% of abscesses Brain abscessphasesInitial phase: localized microfoci and cerebritis or encephalitisSecond phase: expansion and secondary delineation of the abscessFinal phase: a