外語課件 滲出性中耳炎

1、12一、一、overviewnOtitis media with effusion (OME) is characterized by accumulation of fluid in the middle ear, conductive hearing loss , and is a kind of non-purulent diseases of middle ear.3nOME occurs as a result of decreased ventilation of the middle ear or mastoid air-cell system through the eusta

2、chian tube .4 Serous Otitis Media Glue Ear Non-purulent Otitis Media OME is called other names:5nOME is one of the most commonly resulting in deafness among children. OME occurs in adult too .678Function of the eustachian tubenThe eustachian tube is essential in maintaining a healthy, well-aerated t

3、he middle ear.910 The eustachian tube ventilates the middle ear, protects it from pathogenic organisms in the nasopharynx, equilibrates pressure across the tympanic membrane, and allows drainage of secretions from the middle ear into nasopharynx.11 At rest , the eustachian tube is closed. During swa

4、llowing, yawning, or sneezing, the nasopharyngeal orifice of eustachian tube is opened transiently. 12nThe anatomy of the eustachian tube of infants is different from adults .nThe infantile eustachian tube is more horizontal orientation, shorter length, and more patulous configuration than adult.13二

5、、二、PathogenesisnAny process that interferes with normal opening of proximal ( nasopharyngeal ) end of the eustachian tube or mucociliary clearance mechanism causes OME14(1)、mechanical obstruction:nlarge or infected adenoids nturbinate hypertrophy n neoplasm of nasopharynx nnasopharyngeal edema or in

6、flammation15(2).AllergynAllergy reaction affects both mucociliary clearance mechanism and normal eustachian tube opening.16(3).Abnormal eustachian tube anatomynSuch as: cleft palate deformities can impair eustachian tube function.17 Functional disorders of eustachian tubenegative pressure in tympani

7、c cavity veins in mucous be dilated and be congested vessels permeance be increased serum in vessels be exuded into tympanic cavity middle ear effusion 18三三.Clinical Presentationn Symptoms Conductive Hearing Loss , Earache, Ear fullness , Tinnitus .19Physical ExaminationTympanic Membrane to be retra

8、cted , dull , opaque . color can range from : light pink to amber and even dark blue. 20212223 Audiometric Testing nreveals: Mildmiddle levels of conductive hearing loss 24Audiogram25 Acoustic Immittance26 Normal acoustic immittance is “type_A” curve. The curve has peak at “O” Pascal pressure point.

9、 nOMEs Acoustic immittance is “type_B” curve. It is flat tympanometric curve27四、四、 Diagnosisn(一一)、History: Some patients suffered upper respiratory tract infection before 1 2 weeks, or suffered rhinitis, adenoids hypertrophy et. Perennial.28（二）、（二）、Clinical presentation :nhearing impairment n tinnit

10、us near obstruction nEarache(ear pain)29(三三)、Physical examinationntympanic membrane be retractedntympanic cavity effusion30（四）、（四）、Audiometric TestingnMild middle level conductive hearing loss（五）、（五）、Acoustic Immittance “type_B” curve 311、tympanosclerosis2、glomus jugulare tumor 3、cerebrospinal otorr

11、hea 、nasopharyngeal carcinoma五、五、Differential Diagnosis32六、 ManagementnPrinciples of Management：n（一）、（一）、Eliminate middle ear effusion , improve middle ear ventilation and drainage.33 (1)、Keep expedite nasal cavity and eustachain tubenChild : 0.5%ephedrine and furacilline solution Adult : 1% ephedri

12、ne and furacilline solution 34(2)、Eustachian tube insufflation Valsalva methodPolitzer methodCatheterization35( 3) 、 Puncture of Tympanum36( 4)、 Tympanotomy37 (5)、 Tympanostomy Tube38 （二）、（二）、Management of etiology Treatment nasal and nasopharyngeal diseasesExample: adenoid hypertrophy_ adenoidectom

13、yradiation of nasopharyngeal carcinoma39（三）、（三）、Antibiotic treatmentnPenicillinnCephradinenTreatment maintains 35 days by oral(mild) or by injection,IV(severe)40（四）、四）、Steroid treatmentnDexamethasone : Adult: 510mg/day, 35days,by injection,IV. 41七、七、PreventionnExercisenPrevent flunTreatment nasal and nasopharyngeal diseases425.Questions1.What is the otitis media with effusion (OME)?2. What