topic of lecture : acute purulent inflammatory diseases of...
TRANSCRIPT
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Topic of lecture:
Acute purulent
inflammatory diseases of
middle ear (otitis media
purulenta acuta).
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Definition
Purulent otitis media – inflammatory
infectious disease of middle ear
cavities.
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The typical features of it are:
It happens often (more than 30% of all
patients in ENT- department);
can result in the hearing loss;
passes to chronic otitis;
can lead to development of intracranial
complications.
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Etiology
Viruses and bacteria cause acute purulent
otitis media.
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What are the most
important ways of infection
penetration into the middle
ear ?
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An infection gets into the middle
ear by next ways:
From the cavity of nose through an
auditory tube. Often it happens at acute
rhinitis.
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An infection gets into the middle
ear by next ways:
Through external auditory canal - when
ear-drum is damaged. It is at the break of
ear-drum as a result of trauma.
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The next way
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What is the ear trauma
mechanism?
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Ear – drum trauma
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What help can be given to patients
with trauma?
At the fresh breaks of eardrum such help
is given: under an operating microscope
the edges of the torn eardrum are adjusted
to each other. They accrete whereupon.
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An infection gets into the middle
ear by next ways:
Penetration of infection through a blood is
hematogenic way. This way is basic at the
infectious diseases.
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Necrotic otitis
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Necrotic otitis. Necrosis of mastoid
process
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What patients have more
predispositions to acute
otitis?
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The important role plays
the state of nose, paranasal sinuses,
nasopharynx;
such diseases as chronic rhinitis, deviation
of nasal septum, purulent sinusitis;
patients with chronic diseases;
babies
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Clinics
It has three stages:
1) nonperforated;
2) perforated;
3) reparative.
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1 stage
Basic complaint of patient is pulsating,
shooting, prickly pain in the ear.
A general weakness appears.
Body temperature increases to 38-39° C.
The inflammatory changes in the blood
test.
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Acute purulent otitis media
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Acute purulent otitis media
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2 stage
There is the perforation of ear-drum
Purulent discharge appears from an ear.
Pain calms down in the ear, the general condition gets better, the temperature of body falls.
At otoscopy the pulsating reflex is observed – a pus comes through the perforation by drops synchronously with of a pulse.
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Perforation of tympanic membrane
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3 stages
An inflammatory process calms down,
purulent discharge is stopped.
An eardrum gets an ordinary color.
Hearing loss remains. Hearing is restored
slowly.
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Anatomical structure of baby’s ear
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Acute otitis at children
Begins suddenly, at night.
Temperature of body is ever-higher – 39-40°C.
A child becomes uneasy, twists by a head, seizes ill ear by hand.
The general condition gets worse considerably.
Babies can have vomit, gastroenteric disorders.
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Diagnostics
Otoscopy
X-ray
Audiometry
Impedansmetry (in first stage)
CT
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An otoscopy
at first hyperemia of ear-drum appears;
it becomes thick
when much pus accumulates in a
tympanic cavity, an eardrum knobs
outside.
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Mastoid process x-ray by
Schüller
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Treatment
І. 1. Antibiotics
2.Nasal decongestants
3.Ear drops
4.Symptomatic therapy
5.Physiotherapy
6.Myringotomy or paracentesis
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Paracentesis of tympanic
membrane
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incision (puncture) after
paracentesis
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Peripheral paresis of facial nerve
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Thanks for your attention
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Suitable factors for development
of mastioditis:
High virulence of infection.
Decrease of body’s common resistance.
Poor pus drainage.
Non rational therapy.
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Mastioditis.
Swelling of upper posterior wall of external
acoustic meatus
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Stages of antromastoidotomy
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Stages of antromastoidotomy
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Stages of antromastoidotomy
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Trepanation of mastoid process