外语 渗出性中耳炎课件

OTITISMEDIAWITH

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

3OMEisoneofthemostcommonlyresultingindeafnessamongchildren.

OMEoccursinadulttoo.

567Function

oftheeustachiantubeTheeustachiantubeisessentialinmaintainingahealthy,well-aeratedthemiddleear.8Theeustachiantubeventilatesthemiddleear,protectsitfrompathogenicorganismsinthenasopharynx,equilibratespressureacrossthetympanicmembrane,andallowsdrainageofsecretionsfromthemiddleearintonasopharynx.

10Theanatomyoftheeustachiantubeofinfantsisdifferentfromadult’s.Theinfantileeustachiantubeismorehorizontalorientation,shorterlength,andmorepatulousconfigurationthanadult.12(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

.182021

AudiometricTesting

reveals:Mild~middlelevelsofconductivehearingloss

23Audiogram24

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（四）、AudiometricTestingMild~middlelevel

conductivehearingloss（五）、AcousticImmittance

“type_B”curve

30

1、tympanosclerosis

2、glomusjugularetumor3、cerebrospinalotorrhea４、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

Treatmentnasalandnasopharyngealdiseases415.Questions1.Whatistheotitismediawitheffusion(OME)?2.WhataretheessentialcausesofOME?3.Pleaserepresentsmainc