黄江菊《耳鼻咽喉科学》6.4CSOM.pptVIP

Treatment Surgery Mastoidectomy Mastoidectomy+Tympanoplasty Treatment Surgery Diagram of the exposure obtained during a canal-wall-up mastoidectomy of the right ear Tympanic membrane after myringoplasty * Chronic Suppurative Otitis Media Zhong Shixun Ph.D. Department of Otolaryngology The First Affiliated Hospital Chongqing Medical University Definition Long period of time infection of mucous membrane of middle ear, characterized by otorrhea (8 wk) through a perforated tympanic membrane(TM) and hearing loss classification traditional now: CSOM Mucosal (Simple) bony cholesteatoma CSOM cholesteatoma Pathogenesis Usually mutifactorial a consequence of an episode of AOM with perforation, with subsequent failure of the perforation to heal Other diseases in nose, sinus, or pharynx Lowered resistance：e.g. malnutrition, anaemia, immunological impairment, baby Patology begins at Eustachean tube Affects mainly middle ear cavity causing persistent perforation Pathology Edematous mucosa with submucosal fibrosis and infiltration by chronic inflammatory cells. Polyps Bone erosion: The inflammatory process is thought to lead to infiltration and activation of osteoclasts and mononuclear cells containing various proteolytic enzymes Granulation tissue: In over 95% of the temporal bones studied from individuals with a history of CSOM Clinical Findings Symptoms： otorrhea: Either intermittent or continuous, usually mucopurulent Blood-stained drainage is often noted with granulation tissue or polyps Clinical Findings Symptoms： hearing loss Degree depends on the size and location of the TM perforation and the status of the middle ear Size Ossicular chain involvement fibrosis or inflammatory granulation tissue tinnitus Signs Signs: Perforation of TM, edematous mucosa, granulation tissue or polyp； Hearing loss, conductive subtotal Central Total Marginal conductive mixed sensorineural normal Radiographic studies CT Diagnosis： History +Signs+ Examination Differential Diag