course 4 - otitele medii
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OTOLOGY- COURSE4
ACUTE AND CHRONICINFLAMMATIONS OF THE MIDDLE
EAR
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1. TUBO-TYMPANIC CATHARSETHIOLOGY: Occurs in children under 4 years Altered Eustachian tube function causes chronic inflammation of the
mucosa average house Causes:
- nasopharyngitis,
- acute and chronic adenoid hypertrophy,- hypertrophy of turbinates- polyps,- benign and malignant tumors, sinus disease,- anatomic aspect of tube-horizontal,- ogival palate ,- choanale malformations,- posttraumatic scar-post adenoidectomy-bride,- allergies,
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2. TUBO-TYMPANIC CATHARS
Symptomatology : 3 stages:
- simple tube obstruction
- tube obstruction with transudate in middle earcavity functional sequelae Clinical symptomatology :
1. ear obstruction2. autphonia - dimmable, and it is improved
by swallowing, blowing nose3. low tone ear noise
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3. TUBO-TYMPANIC CATHARS
Clinical examination :1. Discrete hammers and SchrapnellMembrane2. Tympanic aspiration, and its mulat onosicular chain
3. Leveling hammer4. Whitish-gray color5. Mobile liquid bubbles in the tympaniccavity6. Thickened secretions that determine thelevel of the liquid-glue ear
Nasopharynx and rhinoscopy orendoscopy examination!!!
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4. TUBO-TYMPANIC CATHARS
Diagnosis : Permeability of Eustachian Tube its doing
with Valsalva and Toynbee Maneuver
To performed a Tube catheterization is usedITARD PROBE
Radiological examination
Tympanogram: flattened in shape curve ornegative curves
Audiometry: transmission hearing loss
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5. TUBO-TYMPANIC CATHARS
TREATMENT: Removing rhinophariyngeal causes
1. Fluid accumulation: - transtympanaldrainage -diabolo
2. Antinflammatory drugs3. Nasal decongestans
4. Aerosols5. Mucolytics6. Cortisone
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TUBE SYNDROME
Definition: is the impossibility to close the tube Symptomatology : to inspiration is produce an ear
noise , acuphaena, and hearing loss Clinical examination : the membranic tympan aspect
of flag waving at each respiratory movement Treatment :
- insuflations of boric acid or salicylic acid acid thatproduce reflex contraction of Eustachian Tube -
- Electrical Cauterization of Eustachian Tube in therhinopharyngeal opening hole
- injection with teflon
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ACUTE MIDDLE EARINFLAMMATIONS
EUSTACHIAN TUBE
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ACUTE OTITTIS MEDIA
CLASIFICATION:1. MICROBIAL ACUTEOTITIS MEDIA
- Acute congestive otitis media- Supurate Otitis media( Otitis media with
effusion)
2. NON MICROBIAL ACUTEOTITTIS MEDIASerous Otitis media
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MICROBIAL ACUTE OTITIS MEDIA
Ethiology: is produce by Pneumococ, Haemophilus,Stafilococ
Pathological anatomy:
1. The congestive phase : catarrhalinflammation suppurated stage withpururlente collections spontaneousperforation or surgical drainage paracentes is
2. Persistent chronic suppuration 3. Osteitis with mastoiditis
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MICROBIAL ACUTE OTITIS MEDIA
Cauze favorizante:1. Eustachian Tube disffunction
2. Rhinopharyngeal inflammations
3. Systemic viral infections: measles(rujeola),influenza(gripa), chickenpo(varicella)
4. External Traumatisms on the TM with TMPerforation
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MICROBIAL ACUTE OTITIS MEDIA
Symptomatology:- fever ,pain, autophonia, hearing loss, tinnitus withlow frequencies
Othoscopical examination : - Congestive stage : intense vascular drawing of
hammer handle, or TMin the posterior andsuperior region
-Catarrhals stage -retracted TM absence of thelight reflex( POLIZER BRIGHT TRIANGLE), reduction ofthe mobility of TM
Functional Examination : BEZOLD TRIADE, moderatetransmission hearing loss, whispering voice(vocesoptita) under 5 m
Bezold Triade : Rinne negative on the same site withthe inflammation , Weber lateralized on the affectedsite, prolonged Schwabach test, for low frequency
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ACUTE SUPPURATED OTITIS MEDIA(acute otitis mediawith effusion)
Definition : It is a suppurative process to the all middle earscompartments
Anatomo-pathologically aspects: hyperplasia of the middleear mucous
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ACUTE SUPPURATED OTITIS MEDIA(acute otitis mediawith effusion)
SYMPTOMATOLOGY:- It is an evolution stage of one catharallis otitis media
, when the secretion is transformed from serous andmucous in purulent(suppurative)
- clinical symptoms: ear pain,pulsation in the ear withirradiation on the dental arch fever 39-40
2 Phase: before perforation and after perforation
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ACUTE SUPPURATED OTITIS MEDIA(acute otitis mediawith effusion) BEFOR PERFORATION
Clinical examination :- diffused hyperemia of TM intensive red TM- intensive vascularisation of hammer handle- the congestion is extended to the EAC trough theTympanic Ring- light reflex is ersed(wiped)- the surface of TM is matt- sometimes pain to pressing the mastoid =mastoidean reaction
- transmission hearing loss, with acouphena anddizziness (vertigo) , that is produce by labyrinthirritation
- fever, Febr, fatigue (tiredness), leukocytosis andtachycardia
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ACUTE SUPPURATED OTITIS MEDIA(acute otitis mediawith effusion)
after perforation
IS A ACUTE SUPPRATED OTITS MEDIA PERFORATION CAN BE SPONTANEOUS OR PROVOCATED-
PARACENTESISClinical examination :
Pus in EAC, that can be purulent(supurative) and bloody oryelow-greenish, it does not smell
Congestive TM, middle perforation with irregular margins
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ACUTE SUPPURATED OTITIS MEDIA(acute otitis mediawith effusion)
Evolution: - after 10-14 days with correct treatment we see that the
suppuration beganes to yield
- After more than 7-10 days it will produce the healing Complications :
- meningitis
. Labyrinthitis
- mastoiditis
- become chronic
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ACUTE SUPPURATED OTITIS MEDIA
Classification :
1. after evolution (development): supracute and subacuteforme
2. after perforation aspects- middle perforation( mezotympanic perforation)- perforation to Shrapnell Membran anterior-superior
Prussak and posterior-superior Troeltsh
3. after according to the nature of pathogen- pneumococ- staphylococ
- enterococ
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ACUTE SUPPURATED OTITIS MEDIA
Diferentialle diagnosis:
1. External otitis media2. Inflammation of TM- MIRINGITIS3. zona zoster auricullaris4. Chronic otitis media in acute forme
Treatment:- to relieve the pain antialgic drugs- antiinflammatory drugs- antibiotics after microbiological examination of secretion- nasal dezobstruction
Evolution: 10 -14 days with treatment is produce the healingIn case of perforation persistence is a high risk of chronicity and
recurrence
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ACUTE SUPPURATED OTITIS MEDIA to children
Is very frequently Sometimes it can be unobserved
othologycal examination is very important Every fever stage needs to have anothological examination!!!
it is bilateral
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OTITIS MEDIA INFECTIOUS AND CONTAGIOUSDISEASES
COMPLICATION OF INFECTIOUS ANDCONTAGIOUS DISEASE
1. Scarlet fever - 2 formes: earlier in first 2-3 days,necrotizing
2. Measles 3. Influenza- blestering on the tympanic membran
surface, bleeding ear tympanic membran 4. Erizipelas - blistering plaque in EAC and on TM suface 5. Whooping cough(pertusis) 6. Mumps- is associated with neurosenzorial hearing
loss, by affecting cochlea
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Acute inflammation of Tympanic membrane
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INFANTS OTHOMASTOIDITIS
Ethiology : Nasal and rhinopharyngeal infections General poor hygiena Prematurity Eustachian Tube conformation
Pathological anatomy :
Inflammation with an implication of Inflamaia cu afectarea tuturoresuturilor urechii medii Clinical Forms: latent and manifestsClinical picture :
Insomnie
Fever Restlessness(agitation) Digestive disorders Weight loss
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INFANTS OTHOMASTOIDITIS
Clinical examination : Nasal secretions Pain on the pressing tragus Diffuse hyperemia of TM Bulging of TM pressing the Ear pavillion forward and down It is necessary to performe tympanotomy- suppurative
secretion
Clouding mastoid
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INFANTS OTHOMASTOIDITIS
Latent(hidden) form It appeares to dystrophic children It appears than a toxicosis form : nervous syndrom, digestive
syndrom, dehydration
Clinical Examination:- it is possible to have less noisy signs- posterio-superior wall of EAC falling- clouding mastoid
Evolution : Endocranial complications
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INFANTS OTHOMASTOIDITIS
TREATMENT
Earlier drainage
Combating associated infections TYMPANOTOMY Antibiotics Nasal desobstruction sol ANTROMASTOIDECTOMY Dezobstruante nazale
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ACUTE SUPPURATE OTOMASTOIDITISEtiopathogeny: middle ear supurative process, that is transmited to mastoid trough
aditus ad antrum
Clinical Form : acute not exteriorities latent form, acute exteriorities, infantsototmastoiditis
Pathological anatomy :
Initially Form: diffuse TM hyperemia hiperemia, mucosa thickening, suppuratesecretions
Second Form: invading the mastoid bone, mastoid empyema, bone thickening-externalizing
Clinical examination:
Pain on palpation mastoid Intense congested,and bulging of the TM TM perforation by pulsed pus leaking Gelle-fistulla is a fistulla of EAC, ptosis the posterior superior wall of EAC Transmission hearing loss
Clouding mastoid
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ACUTE SUPPURATE OTOMASTOIDITIS
Clinical Form:
Supacute form -catching simultaneously middle ear and mastoid Subacute form- headache, purulent otoree Apparently primitive, minimal changes and major mastoid TM
Complications : Otogena meningitis Facial Nerve Paralysis
Epidural abscess Labyrinthitis
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CHRONIC OTITIS MEDIA
Definition : chronic inflammatory process of middle ear and mastoid
It is a polymicrobial pathology
Pathological anatomy :
1. Damage to the tympanic membrane: perforated TM-
mezotimpanale or epitimpanale, respectively pars pars flaccid-membrane voltage or Shrapnell, free or adherent edges 2. Mucosal lesions: cellular infiltration and formation microchiste,
polyps grains 3. Bone lesions: vascular thrombosis in the osicular chain bone
necrosis ... Osteitis.
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CHOLESTEATOMATOUS OTITIS MEDIA WITH EFFUSION
Perforaie marginal a MT, cu henierea epiteliului CAE SKIN IN THE WRONG PLACE
Clasificare: colesteatom n sac herniar, colesteatom extensivAtica- punct de plecare, invadarea membranei ShrapnellAntrul mastoidian- posibilitate de extindere spre mastoid Lezarea lanului osicular de procesele osteitice Casa medie- leziuni extinse ale canalului facialExtindere spre canalul facialului sau canal semicircular
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Acute exteriorized Mastoiditis
topirea septurilor mastoidiene i formareaflegmonului endomastoidian
Abces subperiostal superiorAbces retroauricular postero-superiorsubperiostal
Otomastoidita temporal Abces substernocleidomastoidian BEZOLDOtomastoidita occipital Otomastoidita jugodigastric Petrozita sau petroaticitaSINDROMUL GRADENIGO- OMS, cefaleeintens, paralizia oculomotorului extern
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COLESTEATOM ATICAL
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COLESTEATOM CAE I CASA MEDIE
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Semne clinice ale colesteatomului
Otoree purulent fetid Evoluia continu a otoreei Otoree insensibil la tratament local i general Otoragie
Polipi n casa medie sau granulaii, lamele decolesteatom dispuse concentric Hipoacuzie de transmisie HP sau HM. Acufene- ureche nfundat
Paralizia facial Perioade de renclzire Complicaii endocraniene
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DIAGNOSTICUL POZITIV AL COLESTEATOMULUI
Examen otoscopic Ex audiometric RTG sau CT mastoidian
Dup tipul de leziune Natura leziunilor timpanale
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TRATAMENTUL COLESTEATOMULUI
TRATAMENT CURATIV: - suprimarea cauzeicare l-a produs TRATAMENT SIMPTOMATIC- dezinfectante
nazale i rinofaringiene, soluii localeantiseptice TRATAMENT CHIRURGICAL-
ANTROMASTOIDECTOMIA LRGIT tehnic nchis sau deschis
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OTOREEA TUBAR SIMPTOMATOLOGIE
- otoree mucoas, intermitent - surditate de transmisie moderat 10 -15 dB
EXAMEN OBIECTIV:- perforaie antero -inferioar - sediu marginal
- margini bine delimitate- prin perforaie se vede mucoasa cavit timp hiperemic,congestionat
EVOLUIE I PROGNOSTIC:- otoree rebel la tratament - nlturarea cauzelor de vecintate
Complicaii: - otita extern - iritaia CAE
Tratament: curativ i simptomatic
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ATICITELE
Caracteristici:1. Localizare atical 2. Debut i origine obscure 3. Fr antecedente auriculare semnificative 4. Evoluia lent a unui colesteatom primitiv Anatomia patologic:
perforaie marginal la nivelul membraneiShrapnell
Perforaie mic cu leziuni osoase
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ATICITELE
EX CLINIC LA DEBUT
Hipoacuzie uoar rmne mult timp nemodificat Cefalee occipital Secreii auriculare minime Evoluie silenioas, lent Secreie clar ,fetid CAE normal PERFORAIE LA NIVELUL MEMBRANEI SHRAPNEL
Extragere de lamele de colesteatom din atic Manevra Valsalva negativ- blocaj atical Palparea mastoidei negativ
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ATICITELE EX. CLINIC IN PERIOADA DE OTOREE:
Hipoacuzie net lezarea lanului osicular CAE normal Lamele de colesteatom n atic
Mucoas granulat, hiperemic CLASIFICAREA ATICITELOR:1. Anterioare cu perforaie mic 2. Posterioare cu perforaii largi, retromaleare 3. Polipoase4. Colesteatomatoase5. Perforaii asociate
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ATICITELEForme complicate:
1. dureroas 2. vertiginoas 3. complicat cu paralizie de facial
Evoluia: Supuraie continu,cu complicaii endocraniene Prognostic:
Afectarea auzului, complicaii endocraniene Tratament: chirugical- antroaticotomie,
antromastoidectomie
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ANTROATICOTIMPANITELE
Definiie: proces supurativ cu participareaaticii, antrului, otoree fetid, purulent,colesteatomatoas, leziuni osiculare,persistena i tenacitatea supuraiei, eecultratamentului conservator
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ANTROATICOTIMPANITELE
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OTOMASTOIDITA CRONIC SUPURAT
Anatomie patologic: Proces osteitic, asociat cu un proces supurat Cuprinde toate cavitile UM Simptomatologie:
I. Mastoidita cr. simpl 1. forma comun- sm clinice reduse, otoree, durere lapalparea mastoidei
2. forma fistulizant- forma Gelle- fistula atico- timpanic,prbuirea CAE perete postero -superior
II. Mastoidita cronic renclzit complicaii grave endocraniene, labirintite, petrozite,
abcese, paralizie de N. Facial.
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