急性化膿性中耳炎ASOM

1、急性化膿性中耳炎ASOM Etiology#The common infective organisms are beta hemolytic streptococcus, pneumo-coccus, Hemophilus influenzae, and staphylococcus. #Eustachian tubes: viral upper respiratory infection, enlarged adenoids, sinus infections, allergy-causing edema in the eustachian tube region, and cleft p

2、alate. 第1頁/共17頁#Other cause: traumatic rupture , perforation of the tympanic membrane , from infection following ear surgery. #ASOM is a self-limiting disease, and when treated adequately it rarely leaves any residual change. 第2頁/共17頁Clinical Features Symptoms. Fever, malaiseOtalgiaDecrease in heari

3、ngDischarge from the ear canal: muco-purulent or purulent . ( perforation of the tympanic membrane).第3頁/共17頁On ExaminationIn the early stage, the tympanic membrane will show retraction and lack of mobility. Next with the onset of edema and exudation the drum will lose its landmarks, appear thick and

4、 dull, and may have a fluid level. The fluid is thick and not clear, as in the case of serous otitis media. 第4頁/共17頁Tympanic membrane outward and cause bulging of the drum. If untreated the tympanic membrane will rupture, giving rise to a serosanguinous and then mucopurulent or purulent discharge fr

5、om the ear. Perforation occurs in tympanic membrane central.第5頁/共17頁Tympanic membrane before perforationwith ASOM第6頁/共17頁Tympanic membrane after perforation with ASOM第7頁/共17頁After perforation, pain and fever may not be as marked as in the earlier stages, but there is persistence of purulent discharg

6、e and recurrence of pain. Pressure on the mastoid tip will produce pain-mastoid tenderness. Infection may spread to mastoid cause mastoiditis.第8頁/共17頁Tuning fork tests : a conductive hearing loss. X-ray film or CT scan examinations in the early stages may show haziness or cloudiness. 第9頁/共17頁Treatme

7、nt Symptomatic Treatment. Analgesics : painantipyretics : fever. fluid replacement : prevent of dehydration 第10頁/共17頁The culture and the sensitivity of discharge Antibiotic treatment : Penicillin given systemically will manage most of these infections. In children the possibility of Hemophilus influ

8、enzae should be kept in mind, and this may require ampicillin if there is no response to penicillin or if the culture and the sensitivity test so indicate. Antibiotics should be given for 5 to 7 days, certainly not less.第11頁/共17頁Systemic decongestants help reduce swelling and thereby facilitate drai

9、nage of the middle ear. These are given for a period of two weeks or more, depending on how quickly the middle ear becomes free of fluid.If the drum appears full and bulging, a myringotomy should be carried out for drainage. 第12頁/共17頁Ear drops also can be value for infection in ASOM. 0.25%-1% Chlora

10、mphenicol and 0.3% Ofloxacin ear drops are recommended. Before using ear drops, cleaning purulent discharge in ear by 2% hydrogehperoxidesolution. Cold cream can be used to protect skin macerated from ear discharge. Local treatment第13頁/共17頁Clinical Features Symptoms. Fever, malaiseOtalgiaDecrease in

11、 hearingDischarge from the ear canal: muco-purulent or purulent . ( perforation of the tympanic membrane).第14頁/共17頁Treatment Symptomatic Treatment. Analgesics : painantipyretics : fever. fluid replacement : prevent of dehydration 第15頁/共17頁Systemic decongestants help reduce swelling and thereby facilitate drainage of the middle ear. These are given for a period of t