慢性化脓性中耳炎课件_22.pptVIP

鼓室分区 分 型 旧分型: 新分型: 体 征 鼓膜穿孔、肉芽、息肉； 听力下降：传导性或混合性。 中央型穿孔 上鼓室胆脂瘤 袋状内陷学说 胆脂瘤的分类 先天性胆脂瘤（Congenital Ch.) 为胚胎组织遗留在颅骨内形成，中耳内少见 后天性胆脂瘤(Acquired Ch.) 为外耳道或鼓膜上皮侵入中耳腔形成 　　后天原发性胆脂瘤(Primary acquired Ch.) 　　后天继发性胆脂瘤(Secondary acquired Ch.) 鼓室成型术分型表 Pathogenesis Usually multifactorial a consequence of an episode of AOM with perforation, with subsequent failure of the perforation to heal an association between OME and chronic perforation. The continued presence of a middle ear effusion leads, in some cases, to degeneration of the fibrous layer of the tympanic membrane perforations, particularly if large, may fail to heal. Two main mechanisms by which a chronic perforation can lead to continuous or repeated middle ear infections: Bacteria can contaminate the middle ear cleft directly from the external ear because the protective physical barrier of the tympanic membrane is lost. The intact tympanic membrane normally results in a middle ear gas cushion, which helps to prevent the reflux of nasopharyngeal secretions into the middle ear via the Eustachian tube. The loss of this protective mechanism results in the increased exposure of the middle ear to pathogenic bacteria from the nasopharynx Clinical Findings Symptoms： Otorrhea(Discharge): either intermittent or continuous, usually mucopurulent  Hearing loss(Deafness) Tinnitus Earache Signs: Perforation of TM, edematous mucosa, granulation tissue or polyps； Hearing loss, conductive Central perforation middle ear cancer Tuberculosis Treatment Goals： control infection eliminate ear discharge prevent further infection correct hearing loss Treatment Nonsurgical Measures (Conservative) ： Provide adequate ear protection while bathing or showering Aural Toilet: 3% hydrogen peroxide solution clearing the discharge from the external auditory canal allows the topical agent to reach the middle ear in an adequate concentration Topical antibiotics: 0.3% ofloxacin, 2.5% chloromycetin glycerine Systemic antibiotics: