Chronic otitis meia 耳鼻咽喉科学课件.pptVIP

Chronic otitis media Chunfu Dai M.D Ph. D Otolaryngology Department Eye Ear Nose and Throat Hospital Fudan University Definition COM: unresolved inflammatory process of the middle ear and mastoid associated with TM perforation, otorrhea and hearing loss. Etiology Unresolved middle ear infection. Uncomplicated inflammatory process of the middle ear may evolve over time to produce persistent effusion and irreversible mucosal change Fluid contains enzymes to alter the mucosal lining of the middle ear, it results in collapse or chronic perforation Obstruction of narrow communication between the antrum and the attic, the aditus. Etiology Dysfunction of Eustachian tube Chronic inflammation in nose and pharynx Dysfunction of immune system Bacteriology Pseudomonas aeruginosa (40-60%) Straphylococus aureus (10-20%) Anaerobic bacteria Pathology Middle ear mucosa is lined by secretory epithelium forming glandlike structure. Hyalinization or tympanosclerosis A healing response It occurs during quiescent periods It is formed by fused collagenous fibers It is hardened by the deposition of calcium and phosphate crystals Conductive hearing loss is associated with masses restricting ossicular mobility Pathology Ossicular erosion is frequent in COM Infection process per se Necrosis following vascular thrombosis It most commonly affect the lenticular process of the incus and head of the stapes Pathology Cholesterol granulomas Presence of yellowish masses surrounded by granulation tissue, edematous mucosa and fibrous tissue It contains many cholesterol crystals and foreign body giant cells. Pathology Cholesteatoma: cystlike, expanding lesions of the temporal bone, lined by stratified epithelium and containing desquamated keratin and purulent material. Classification Congenital cholesteatoma Acquired cholesteatoma Pathology Mechanics of mucosal transformation and epithelial ingrowth have been the focal point of cholesteatoma Pocket retraction: dysfunction of Eustachian tu