急性中耳乳突炎(英文版).pptVIP

Acute otitis media and mastoiditis Definition AOM: is an infectious process of the middle ear cleft and to a variable extent, of the mastoid air cell system. Bacteriology Streptococcus pneumoniae (48%)Haemophilus influenzae (31%)Moraxella catarrhalis (20%)P-hemolytic streptococcus (decreased following widespread immunization program)Pseudomonas aeruginosa (uncommon cause of AOM) Routine of infectionVia eustachian tubeupper respiratory infection (acute rhinonitis and nasal pharyngitis)Upper respiratory communicative disease Swimming and dive in unclear waterAnatomic contribution (Eustachian tube in infant is wide and short and the two orifice in the same level) Routine of infectionVia external acoustic canal and TMPerforation Myringotomy or myrigotosisVia blood supply Pathology Mucosal inflammationSerous, hemorrhagic, or purulent exudate in middle cavityRupture of tympanic membrane Symptoms Otalgia 60% patients can spontaneous remissionFullnessHearing lossFever It may be masked by analgesics or antibiotic Physical findingIncreased vascularization of the TM, frequently spreading beyond the annulus to the skin of the external canal.Bony landmarks are visible. Physical findingsRapid middle ear exudation occurs, Blurring of the malleus short process, followed by edema and bulging of the pars flaccida. Physical findingsThe progression of this disease may result in rupture of TM, releasing the middle ear contents leads to retraction of the pars flaccida and visualization of some landmarks. Lab testsBlood counts usually shows leukocytosis with polymorphonuclear elevation.CT MRI is necessary only for the rare patients with a serious complication (meningitis or brain abscess) Hearing testsConductive hearing lossDegree of hearing loss will depend on the amount and viscosity of the middle ear exudate, TM edemaIt vary from 10-50 dB with predominant involvement of the low frequenciesHearing loss may mixed when there is labyrinthine extension. Managements Antibiotic therapyExperi