外語滲出性中耳炎課件

OTITISMEDIAWITH

EFFUSION----(OME).1OTITISMEDIAWITH

EFF一、overviewOtitismediawitheffusion(OME)ischaracterizedbyaccumulationoffluidinthemiddleear,conductivehearingloss,andisakindofnon-purulentdiseasesofmiddleear..2一、overviewOtitismediawithefOMEoccursasaresultofdecreasedventilationofthemiddleearormastoidair-cellsystemthroughtheeustachiantube.

.3OMEoccursasaresultof

SerousOtitisMedia

GlueEarNon-purulentOtitisMedia

OMEiscalledothernames:.4OMEiscalledothernames:.4OMEisoneofthemostcommonlyresultingindeafnessamongchildren.

OMEoccursinadulttoo.

..7.7Function

oftheeustachiantubeTheeustachiantubeisessentialinmaintainingahealthy,well-aeratedthemiddleear..8Function

oftheeustachiantu.9.9Theeustachiantubeventilatesthemiddleear,protectsitfrompathogenicorganismsinthenasopharynx,equilibratespressureacrossthetympanicmembrane,andallowsdrainageofsecretionsfromthemiddleearintonasopharynx.

.10Theeustachiantubevent

Atrest,theeustachiantubeisclosed.Duringswallowing,yawning,orsneezing,thenasopharyngealorificeofeustachiantubeisopenedtransiently.

.11Atrest,theeustachiaTheanatomyoftheeustachiantubeofinfantsisdifferentfromadult’s.Theinfantileeustachiantubeismorehorizontalorientation,shorterlength,andmorepatulousconfigurationthanadult..12Theanatomyoftheeustachian二、PathogenesisAnyprocessthatinterfereswithnormalopeningofproximal(nasopharyngeal)endoftheeustachiantubeormucociliaryclearancemechanismcausesOME.13二、PathogenesisAnyprocessthat(1)、mechanicalobstruction:largeorinfectedadenoidsturbinatehypertrophyneoplasmofnasopharynxnasopharyngealedemaorinflammation

.14(1)、mechanicalobstruction:lar(2).AllergyAllergyreactionaffectsbothmucociliaryclearancemechanismandnormaleustachiantubeopening..15(2).AllergyAllergyreactionaf(3).Abnormaleustachiantube

anatomySuchas:cleftpalatedeformitiescanimpaireustachiantubefunction.

.16(3).Abnormaleustachiantube

Functionaldisordersofeustachiantube→negativepressureintympaniccavity

→veinsinmucousbedilatedandbecongested→vesselspermeancebeincreased→seruminvesselsbeexuded

intotympaniccavity→

middleeareffusion

.17Functionaldisordersofeu三.ClinicalPresentation

SymptomsConductiveHearingLoss,

Earache,

Earfullness,Tinnitus

..18三.ClinicalPresentationSymptoPhysicalExaminationTympanicMembranetoberetracted,dull,opaque.colorcanrangefrom:lightpinktoamberandevendarkblue.

.19PhysicalExaminationTympanic.1.22.22

AudiometricTesting

reveals:Mild~middlelevelsofconductivehearingloss

.23

AudiometricTesting

Audiogram.24Audiogram.24

AcousticImmittance.25AcousticImmittance.25

Normalacousticimmittanceis“type_A”curve.Thecurvehaspeakat“O”Pascalpressurepoint.

OME’sAcousticimmittanceis“type_B”curve.Itisflattympanometriccurve.26Normalacousticimmittancei四、Diagnosis(一)、History:

Somepatientssufferedupperrespiratorytractinfectionbefore1~2weeks,orsufferedrhinitis,adenoidshypertrophyet.

Perennial.

.27四、Diagnosis(一)、History:

（二）、Clinicalpresentation:

hearingimpairment

tinnitus

earobstruction

Earache(earpain)

.28

（二）、Clinicalpresentation:

(三)、Physicalexamination

tympanicmembraneberetracted

tympaniccavityeffusion

.29(三)、Physicalexamination

tym（四）、AudiometricTestingMild~middlelevel

conductivehearingloss（五）、AcousticImmittance

“type_B”curve

.30（四）、AudiometricTestingMild~

1、tympanosclerosis

2、glomusjugularetumor3、cerebrospinalotorrhea

４、nasopharyngealcarcinoma

五、DifferentialDiagnosis.31

1、tympanosclerosis

2、glomus

六、Management

PrinciplesofManagement：

（一）、Eliminatemiddleeareffusion,improvemiddleearventilationanddrainage.

.32

六、ManagementPrinciplesof

(1)、Keepexpeditenasalcavity

andeustachaintubeChild:0.5%ephedrineandfuracillinesolution

Adult:1%ephedrineandfuracilline

solution

.33

(1)、Keepexpeditenasalc(2)、Eustachiantubeinsufflation

Valsalvamethod

Politzermethod

Catheterization

.34(2)、Eustachiantubeinsufflati(3)、PunctureofTympanum.35(3)、PunctureofTympanum.35(4)、Tympanotomy.36(4)、Tympanotomy.36

(5)、TympanostomyTube.37

(5)、TympanostomyTube.37

（二）、Managementofetiology

Treatmentnasalandnasopharyngealdiseases

Example:adenoidhypertrophy__

adenoidectomy

radiationofnasopharyngealcarcinoma

.38

（二）、Managementofetiology（三）、AntibiotictreatmentPenicillin

Cephradine

Treatmentmaintains3~5daysbyoral(mild)orbyinjection,IV(severe)

.39（三）、AntibiotictreatmentPenici（四）、SteroidtreatmentDexamethasone:

Adult:5~10mg/day,3~5days,by

injec