外語滲出性中耳炎課件

OTITISMEDIAWITH

EFFUSION----(OME)1.一、overviewOtitismediawitheffusion(OME)ischaracterizedbyaccumulationoffluidinthemiddleear,conductivehearingloss,andisakindofnon-purulentdiseasesofmiddleear.2.OMEoccursasaresultofdecreasedventilationofthemiddleearormastoidair-cellsystemthroughtheeustachiantube.

3.

SerousOtitisMedia

GlueEarNon-purulentOtitisMedia

OMEiscalledothernames:4.OMEisoneofthemostcommonlyresultingindeafnessamongchildren.

OMEoccursinadulttoo.

5.6.7.Function

oftheeustachiantubeTheeustachiantubeisessentialinmaintainingahealthy,well-aeratedthemiddleear.8.9.Theeustachiantubeventilatesthemiddleear,protectsitfrompathogenicorganismsinthenasopharynx,equilibratespressureacrossthetympanicmembrane,andallowsdrainageofsecretionsfromthemiddleearintonasopharynx.

10.

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

11.Theanatomyoftheeustachiantubeofinfantsisdifferentfromadult’s.Theinfantileeustachiantubeismorehorizontalorientation,shorterlength,andmorepatulousconfigurationthanadult.12.二、PathogenesisAnyprocessthatinterfereswithnormalopeningofproximal(nasopharyngeal)endoftheeustachiantubeormucociliaryclearancemechanismcausesOME13.(1)、mechanicalobstruction:largeorinfectedadenoidsturbinatehypertrophyneoplasmofnasopharynxnasopharyngealedemaorinflammation

14.(2).AllergyAllergyreactionaffectsbothmucociliaryclearancemechanismandnormaleustachiantubeopening.15.(3).Abnormaleustachiantube

anatomySuchas:cleftpalatedeformitiescanimpaireustachiantubefunction.

16.

Functionaldisordersofeustachiantube→negativepressureintympaniccavity

→veinsinmucousbedilatedandbecongested→vesselspermeancebeincreased→seruminvesselsbeexuded

intotympaniccavity→

middleeareffusion

17.三.ClinicalPresentation

SymptomsConductiveHearingLoss,

Earache,

Earfullness,Tinnitus

.18.PhysicalExaminationTympanicMembranetoberetracted,dull,opaque.colorcanrangefrom:lightpinktoamberandevendarkblue.

19.20.21.22.

AudiometricTesting

reveals:Mild~middlelevelsofconductivehearingloss

23.Audiogram24.

AcousticImmittance25.

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

OME’sAcousticimmittanceis“type_B”curve.Itisflattympanometriccurve26.四、Diagnosis(一)、History:

Somepatientssufferedupperrespiratorytractinfectionbefore1~2weeks,orsufferedrhinitis,adenoidshypertrophyet.

Perennial.

27.

（二）、Clinicalpresentation:

hearingimpairment

tinnitus

earobstruction

Earache(earpain)

28.(三)、Physicalexamination

tympanicmembraneberetracted

tympaniccavityeffusion

29.（四）、AudiometricTestingMild~middlelevel

conductivehearingloss（五）、AcousticImmittance

“type_B”curve

30.

1、tympanosclerosis

2、glomusjugularetumor3、cerebrospinalotorrhea

４、nasopharyngealcarcinoma

五、DifferentialDiagnosis31.

六、Management

PrinciplesofManagement：

（一）、Eliminatemiddleeareffusion,improvemiddleearventilationanddrainage.

32.

(1)、Keepexpeditenasalcavity

andeustachaintubeChild:0.5%ephedrineandfuracillinesolution

Adult:1%ephedrineandfuracilline

solution

33.(2)、Eustachiantubeinsufflation

Valsalvamethod

Politzermethod

Catheterization

34.(3)、PunctureofTympanum35.(4)、Tympanotomy36.

(5)、TympanostomyTube37.

（二）、Managementofetiology

Treatmentnasalandnasopharyngealdiseases

Example:adenoidhypertrophy__

adenoidectomy

radiationofnasopharyngealcarcinoma

38.（三）、AntibiotictreatmentPenicillin

Cephradine

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

39.（四）、SteroidtreatmentDexamethasone:

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

injection,IV.

40.

七、PreventionExercise

Preventflu

Treatmentnasalandnasopharyngealdiseases41.5.Questions1.Whatistheotitismediawitheffusion(OME)?2.WhataretheessentialcausesofO