Disease of the middle ear

1. Disease of the middle ear

2. Cause Congenital ? Healed otitis media - Abnormal ossicles - Perforation of TM - Crouzon�s syndrome -Thining of area of TM - Treachercollins syndrome - Tympanosclerosis - Dehiscense of FN - Chronic adhesive otitis media Trauma - Loss of portion of the ossicular chain - Traumatic rupture of TM ? Tumor - Fracture of temporal bone ? Disease of otic capsule Infection - Otitis media - Tuberculous otitis media

3. Acute Otitis media ??????????????????????????????????????????? ???????????????????????????????????????????????????????? ????? 3 ???????

4. Pathogen ??????????? Bacteria Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Streptococcus, Gr A Staphylococcus aureus Miscellaneous Nonpathogens culture

5. Symptoms ???????????????? 1-2 ?????? ?????????????????????? ????? ?????? ????????????? ?????? ?????????????????? ??????????????????? ????????? ???????? ??????????? ??????????

7. Acute Otitis Media

8. Acute otitis media

9. Stage of acute otitis media Stage 1 Hyperemia swelling and redness of tympanic membrane , mucosa in middle ear , eustachian tube , mastoid ??????????????????? ?????????????????????????????????????? ??????????????????? ????? ???????????????????? Stage 2 Exudation tympanic membrane ????????????????????????? ?????? ?????????????????????????????? ??????????????????????????????????????????????

10. 

11. Stage 3 Suppuration Ruptured tympanic membrane , Otorrhea ???????????????? ??????? ????????????????????????? Stage 4 Coalescense ???????????????????????? ???? mastoid Decalcification , osteoclastic reaction ??? mastoid ???????????????????????????????? ???????????????1 ???????????? 2 ??????? ?????????? ?????? ????? ???????????????? ???????????????????? 2 Coalescense mastoiditis

13. Stage 5 Resolution ????????????? ???????????????????????? tympanic membrane ???????????????????? ????????????????????? Stage 6 Complication ?????????????????? ???? coalescence Extracranial , Intracranial

14. Stage 5

15. Complication Extracranial Mastoiditis , subperiosteal abscess Petrositis Labyrinthitis Facial nerve palsy

16. Complication Intracranial Meningitis Epidural abscess Lateral sinus thrombosis Brain abscess Subdural abscess Focal otitis encephalitis Otitic hydrocephalus

17. Treatment Antibiotic : amoxicillin 40 mg/kg/day 10-14 days ???????????????????????????????????????? 24-48 hr ( ??? penicillin ??? erythromycin ???? bactrim ) Supportive treatment ???? ?????? ??????

18. Treatment Decongestant ( oral ) ???????? eustachian tube ?????????????? ???????? Antihistamine ??????????????????????? ???? ????????????????????

19. Treatment Tympanocentesis ?????????????????????? , ???????????????????????????? ???? infant, immunocompromised host Myringotomy drain pus ????????????????????? 48 ????????????????????????? ?????? complication ???? facial nerve palsy

20. Chronic (superative) otitis media ?? perforation ?????????????? Recurrent infection Common organism P aeruginosa (48-98%) S aureus (15-30%) Klebsiella (10-21%)

21. Safe ear : ????? drainage ????? ??????????????????????? ????????????????????????? ?? central perforation ?????? infection ?????? eustachian tube ??? middle ear cavity

23. Chronic Otitis Media

24. Chronic Otitis Media

25. �

26. Unsafe ear COM ???????? drainage ????? ????? complication ??????????????? ???????????? Perforation ???????????????????????? (marginal) ???? attic(epitympanic recess perforation ??????? cholesteatoma

27. Marginal Perforation

29. Cholesteatoma ?? epithelium ??????????????grow ??????????????????????? perforation ???????????????????????????? epithelium ??????????

30. Cholesteatoma

31. ????????????????? Safe ear ??????????????????????????? ???? ???????? ????????????? ????????????????? Unsafe ear ????????????????? ???????????????????????????????????? ???????????? ????????????????? ?????????????????? ????????????????????????? ???? ???????? ?????????? ??????????????????? ????????

32. ????????????????? History: present with a draining ear of some duration and a premorbid history of recurrent AOM Typically, they deny pain or discomfort hearing loss in the affected ear. Reports of fever, vertigo, and pain should raise concern about intratemporal or intracranial complications. A history of persistent CSOM after appropriate medical treatment should alert the physician to consider cholesteatoma.

33. ????????????????? Physical: The external auditory canal may or may not be edematous and is typically not tender. The discharge varies from fetid, purulent, and cheeselike to clear and serous. Granulation tissue is often seen in the medial canal or middle ear space. The middle ear mucosa visualized through the perforation may be edematous or even polypoid, pale, or erythematous.

34. ???????????????????????? ????????????? ????????????????????????? mastoid ?????????????????? ???? fistula test ????????????????? ????????????????????????? 7 ?????????????? Malignant otitis externa Tumor granuloma

35. pure tone audiometry in chronic otitis media chronic otoitis media result in a mixed conduction and sensorineural deafness which indicate more extensive disease

37. Complication Safe ear Tympanosclerosis Cholesterol granuloma Unsafe ear Extracranial : ???????????????????? ,?????????????????????????? 7, labyrinthitis,pertrous sinusitis Intracranial : meningitis ,epidural abscess, lateral sinus thrombophebitis, brain abscess, otitic hydrocephalus

38. Treatment Medical treatment ???????????????????, ?????????????????????????A solution of 50% peroxide and 50% sterile water is generally painless and effective. Thirty to 40 mL of this solution can be irrigated through the external auditory canal ??????????, ???????? ??????????????????????????????????????? ????????????????????

39. Surgical treatment Tympanoplasty Mastoidectomy Radical mastoidectomy

40. ????????????????????????????? COM Inadequate treatment of acute otitis media Chronic dysfunction of eustachian tube Persistent perforation of ear drum Irreversible change in middle ear Persistent osteomyelitis in mastoid Factors ????? ???? nasal allergy, malnutrition,anemia Persistent disease in nose, sinuses, nasopharynx

41. OTITIS MEDIA WITH EFFUSION characterized by a nonpurulent effusion of the middle ear that may be either mucoid or serous. typically do not involve pain or fever. can occur during the resolution of AOM once the acute inflammation has resolved.

42. OTITIS MEDIA WITH EFFUSION Etiology Eustachian tube obstruction -URI / sinusitis -Adenoid hypertrophy -CA nasopharynx ??????????? AOM ??????????? otitis barotrauma Allergy

43. OTITIS MEDIA WITH EFFUSION Etiology newer models describe the primary event as inflammation of the middle ear mucosa caused by a reaction to bacteria already present in the middle ear. The inflammatory mediators released as a result of bacterial antigenic challenge induce the up-regulation of mucin genes.

44. Symptoms ???????? ??????????????? ???? delayed speech ?????? ????? ??????????????????????????????? ????? valsava maneuver ???????????????????????????????????????????? ??????????????

45. Signs TM retraction Short process malleus ??????? ?????????? TM ????????? Pneumatic otoscopy ????? TM ??????????? ??????????????????? ?? ?????????? ??? ????????????? ??????????????? serous fluid ????????????????? (glue ear )

46. Signs TM retraction Short process malleus ??????? ?????????? TM ????????? Pneumatic otoscopy ????? TM ??????????? ??????????????????? ?? ?????????? ??? ????????????? ??????????????? serous fluid ????????????????? (glue ear )

47. Otitis Media with Effusion

48. Otitis Media with Effusion

49. Otitis Media with Effusion

50. Otitis Media with effusion

51. Otitis media with effusion

52. Otitis media with effusion:

53. Life style modification Avoiding secondhand smoke Breastfeeding whenever possible Avoiding feeding, either by breast or bottle, while completely supine Avoiding exposure to a large number of children, particularly in daycare centers Avoiding exposure to children who are known to be affected Avoiding known allergens

54. Antibiotic-Amoxycillin, trimethoprim-sulfamethoxazole , Cephalosporin Steroid (nasal spray) Decongestant valsava manuver Myringotomy

55. tympanostomy and tube

56. Tympanostomy tube Indication: Fail medical Rx 3 month Bilateral significant hearing loss Permanent obstruction of Eustachian tube

57. Otosclerosis Otic capsule ?? spongy bone ???????????? ????? footplate ??? stapes ?? ankylosing ??????????????????? ?????? spongy bone ?????? cochlea ???????????? Female > male Age 20 � 30 years Many cases of otosclerosis are genetic and approximately 60% of cases run in the family.

58. Otosclerosis

59. ????? : ?????? ??????????? 2 ????(80%) ???????????????????????? conductive hearing loss > 30 dB ???????????????????????????????? ( paracusis ) ???? tympanic membrane ?????? ???????????????? active???? hyperemia ??? promontary ???????????????????????? � Schwartze�s sign �

60. Otosclerosis Associated condition - van der Hoeve�s syndrome ?????????????????? blue sclera ????? ?? osteogenesis imperfecta ?????????????????????? autosomal dominant - osteitis derformans ( Paget�s disease ) ???????????????? footplate ??? stapes ??? absorbed ???????????????? spongy osteoid bone ?????????????????????? oval window ?????????????????????? cochlea ?????????

61. Treatment Fluoride Hearing aid Surgery : stapedectomy

62. Treatment a surgical procedure called stapedectomy (or more correctly stapedotomy),

63. Question 1.Acute otitis media ??????????????? ?????????????????????????? a. Pseudomonas aeruginosa b. Streptococcus pneumoniae c. Haemophilus influenzae d. Moraxella catarrhalis

64. Question 2.Otitis media with effusion ??????????complication ?????????? a. malignant otitis externa b. primary acquired cholesteatoma c. secondary acquired cholesteatoma d. sensorineural hearing loss

65. Question 3. ????????????????? Otosclerosis a. ???????????????20-40?? b. ??????????? progressive conductive hearing loss c. ????????????????????????? chronic sinusitis d. ???????? stapedectomy