耳鼻咽喉科学课件：6_Otitis Media with Effusion
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《耳鼻咽喉解剖生理》课件
吞咽和呼吸的产生过程
吞咽过程
食物进入口腔后，通过舌头的搅拌和唾液的消化作用，经过咽部通道进入食道 ，再进入胃。在吞咽过程中，软腭、咽后壁、食道上括约肌等结构协同作用， 确保食物顺利进入食道。
呼吸过程
呼吸是人体获取氧气和排出二氧化碳的重要生理过程。呼吸时，空气通过鼻腔 或口腔进入气管，再进入肺。在呼吸过程中，声带、气管、支气管等结构协同 作用，确保气体顺利进出肺部。
耳鼻咽喉疾病的治疗方法
药物治疗
手术治疗
对于耳鼻咽喉疾病，药物治疗是最常见的 治疗方法。如慢性鼻炎可以使用鼻炎药水 、抗过敏药物等进行治疗。
对于某些严重的耳鼻咽喉疾病，如扁桃体 炎、声带息肉等，手术治疗是必要的。
物理治疗
生活方式调整
物理治疗如激光、微波等可用于治疗慢性 咽炎等疾病。
除了药物治疗和手术治疗外，患者还需要 注意调整生活方式，如戒烟、避免刺激性 气体的吸入等。
03
嗅觉感受器
鼻腔内有嗅觉感受器，能够接收气味分子并传递到大脑，产生嗅觉。
嗅觉的产生过程
气味分子与嗅觉感受器结合
当气味分子通过鼻腔进入鼻腔内部，与嗅觉感受器结合，引发一 系列生物化学反应。
神经信号传递
嗅觉感受器将生物化学反应转化为神经信号，通过嗅神经传递到大 脑皮层，产生嗅觉。
大脑解析气味
大脑对接收到的神经信号进行解析，识别出不同的气味，并产生相 应的感知和记忆。
鼻子的生理功能与特点
呼吸功能
鼻子是呼吸系统的入口，能够 吸入氧气并排出二氧化碳，维
持人体正常代谢。
嗅觉功能
鼻子能够识别各种气味，帮助 人们辨别环境中的气味变化， 如食物的新鲜程度、危险的气 体等。
Hale Waihona Puke 清洁过滤功能鼻子能够过滤吸入的空气中的 尘埃、细菌等有害物质，保护 下呼吸道和肺部不受外界污染 物的侵害。
分泌性中耳炎
03 治疗及预防
2个月至12岁患儿OME的治疗 （2）外科手术治疗
• 观察期间较好耳的听力水平为40dB或更差； • 病程持续在3～4月或以上伴有听力减退； • 已经引起鼓膜或中耳的结构损伤； • 合并急性中耳炎反复发作等的患儿，可考虑外科手术干预。
03 治疗及预防
2个月至12岁患儿OME的治疗 （2）外科手术治疗
03 治疗及预防
手术治疗 ② 鼓膜切开术：
③ 鼓膜切开置管术：
病情迁延不愈，或反复发作的慢性分泌性中耳炎、胶耳等。一般放置6-8周，最长 可达1-2年。
03 治疗及预防
成人OME的治疗 病因治疗
• 胃一食管一咽喉反流； • 鼻部、鼻咽部、口咽部疾病等； • 对慢性分泌性中耳炎未査出明显相关疾病时，可作颞骨CT扫描，
间歇性低调耳鸣，呈轰鸣声，轻度耳痛。未诉发热、面瘫、眩晕、 恶心及呕吐等症状。 • 既往史：既往体健，无手术外伤史。 • 过敏史：无食物、药物过敏史。
04
04 病例分析
耳内镜检查
纯音听阈检查
声导抗检查
骨气导差 ---传导性聋
谢谢
如发现鼓室或乳突内有肉芽时作鼓膜切开加置管术；如鼓室粘连时， 应作鼓室探査术或单纯乳突开放术，彻底清除病变组织后，根据不 同情况进行相应的手术。
03 治疗及预防
2个月至12岁患儿OME的治疗
（1）保守治疗 观察等待：国外较新的流行病学发现，75％—90％的患儿在3个月内可痊 愈，且婴儿和幼小儿的自愈率更高。而过早的药物和手术干预无益处，反 而增加相应的副作用，即使鼓膜充血也不可作为临床使用抗生素的指征。 故在诊断之日起应对患儿进行为期3个月的观察随访。观察期间每2～4周 定期复查鼓气耳镜和声导抗。
01 临床表现
制分泌性中耳炎讲课文档
— 伴有高危因素的患儿
腭裂 永久性听力下降 言语发育迟缓或障碍 自闭症
与遗传有关的疾病、颅面发育异常等引起的认识和言语表达障碍等
第十八页，共26页。
鼓膜置管术的并发症
耳漏
鼓室萎缩
鼓膜穿孔
置管术后并 发症
鼓室硬化
脱管或堵管
中耳胆脂瘤
第十九页，共26页。
讨论问题Ⅳ
是否同期或择期行腺样体切除术？
▲ 初发病例伴有腺样体肥大？ ▲ 复发病例伴有腺样体肥大或慢性腺样体炎？ ▲ 扁桃体切除术?
Ⅳ级 回顾性病例对照研究或无对照的病例系统分析 Ⅴ级 未经科学验证的专家经验，综述，个案报道等
第十五页，共26页。
分泌性中耳炎的规范化诊疗
• 美国：《分泌性中耳炎临床指南，2004 》
AAP AAFP AAO-HNS
• 中国：《儿童中耳炎诊断和治疗指南，2008》
中华耳鼻咽喉头颈外科杂志编辑委员会
讨论问题Ⅰ
分泌性中耳炎如何诊断及鉴别诊断？
第五页，共26页。
病史 体征
诊断依据
辅助检查
鼓室压图及声反射 鼓气耳镜 颞骨HRCT 诊断性穿刺?
第六页，共26页。
第七页，共26页。
鉴 别 诊断
鼻咽癌
脑脊液耳鼻漏
粘连性中耳炎
胆固醇肉芽肿
第八页，共26页。
讨论问题Ⅱ
分泌性中耳炎非手术治疗方法及合理性？
耳声发射：敏感性较高，但对于诊断中耳疾病特异性不高 颞骨CT：相对可靠的的方法，但存在放射损伤的问题
第二十四页，共26页。
讨论问题Ⅶ
分泌性中耳炎诊疗与预防新措施的探讨？
▲中耳炎疫苗？ ▲咽鼓管逆行插管？ ▲激光造孔？
应有利于咽鼓管功能的 保护与恢复，而不是损伤！
外耳疾病 (英文版) PPT-
Otitis media with effusion
children
About 90% of children (80% of individual ears) have OME at some time before school age
most often between ages 6 months and 4 years. In the first year of life, more than 50% of children will experience OME, increarnal ear
Cerumen
Cerumen=sebaceous + apocrine secretions + desquamated epithelial debris
An acidic coat preventing of EAC infection A scanty amount, obstructive masses Hearing loss ,discomfort, a source of infection The irrigation method ,use of a cerumen
Otitis media with effusion
Etiology
1. Eustachian tube dysfunction (primary)
Mechanical intrinsic: edema of the tubal mucosa extrinsic: adenoid tissue,NPC
Otitis media with effusion
several reasons: Small children get more OME than older children or adults for
耳鼻咽喉科学PPT课件
相互联系
解剖上相互沟通 生理上相互联系 病理上相互影响 诊断上相互参考 治疗上相互辅助 常见病多发病:四炎一聋（中耳炎、鼻炎鼻窦炎、咽炎 扁桃体炎、喉炎和耳聋）为研究和教学基点。
2020/3/8
耳鼻喉科既独立又与整个机体广泛 密切关联
本科疾病
全身疾病
鼻窦炎、中耳炎
眶内、颅内各种并发症
鼻咽喉阻塞性变
筛窦
位于筛骨内，发育较早 气房呈蜂窝状。 前组筛窦：体表投影，内
眦与鼻根间。开口于中鼻 道中份。 后组筛窦：开口于上鼻道
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额窦
位于额骨内、外板之间 额窦开口于中鼻道的前部。
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蝶窦
蝶窦
位于鼻腔后上方蝶骨体 内，由蝶窦中
细菌栓子
• 海绵窦血栓性静脉炎
2020/3/8
外鼻静脉与眼静脉及海绵窦的关系
二、鼻腔
• 为一狭长的腔隙，被鼻中隔分成大致相等的左右 两腔。
• 前部由皮肤覆盖称鼻前庭
•
鼻域
• 后部由粘膜覆盖称固有鼻腔
2020/3/8
1、鼻前庭：起于前鼻孔，止于鼻阀 特征 皮下富含皮脂腺、汗腺，并长有鼻毛 外伤后易感染发生疖肿。 又因皮肤与骨膜直接相连，一旦发生 疖肿， 疼痛剧烈。
呼吸区
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嗅部
鼻窦
鼻窦 是鼻腔周围颅骨
内的含气空腔。 左右成对,共四对
按其所在颅骨命 名为： * 额窦 * 筛窦 * 上颌窦 * 蝶窦
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鼻窦开口部位
前组鼻窦包括 额窦、前组筛窦和上颌窦—— 均开口于中
《中医耳鼻咽喉科学》PPT课件
治疗关系:
补中益气
鼻病治脾 健脾祛湿
益气摄血
泻脾胃伏火
3.鼻与胆 所属关系：①胆脉起于目锐眦，布脑后，通过经络与 鼻联系；
②胆之经气通脑，脑下通頞(è，鼻梁)， 頞 下为鼻，胆～髓海～鼻。 生理关系：胆之经气上通于脑。 胆气和平，则脑、頞、鼻安康。 病理关系：①胆热循经直犯鼻窍。 ②胆移热于脑，下犯頞与鼻窍。 ③肝胆火热上迫致鼻衄。 治疗关系： 鼻病治肝胆 清泻肝胆湿热
生理关系：①心主神明，耳司听觉，受心之主宰。
②心主血脉，宗脉聚耳，心血上奉， 濡养耳窍。
③心脉络耳,肾精通耳,心肾相交，听觉 聪敏。
病理关系:①心虚血耗，心肾不交 则耳鸣、耳聋、 眩晕；
②邪热上犯耳窍，壅闭心包→ 黄耳伤寒
耳与心治疗关系
耳病治心或心肾同治
滋补心血 滋肾宁心 清心开窍 宁心安神
3.耳与肝(胆)： 所属关系：①胆脉循耳后，入耳中，走耳前。 肝络脉络于耳。 ②肝血与肾精同源，肝为肾之子，肾主耳， 故肝与耳亦相关。 生理关系：肝胆之气通达于耳，肝血上奉于耳，耳的 生理功能正常。 病理关系 ：①肝胆经气失调 耳胀、肿、痛、鸣、 肝胆火热上犯 聋、流脓、 眩晕
少阳胆经，支脉从目外眦，下行至大迎， 折行于出页。（出页：眼眶下沿至鼻旁 及上牙床的骨，相当于上颌窦的部位。） 少阴心经支脉挟咽，经面部，沿鼻旁上 联目系。 督脉，由巅顶沿前额下行鼻柱，至鼻尖 到上唇。 任脉，环绕口唇，上至龈交，分左右循 鼻旁到二目下。 阳跷脉，从颈外侧、上挟口角，循鼻外 侧到达目内眦。
心肺同居上焦
心主血，肺主气
气血运
化
气为血帅，血为气母
生理关系：①心主神明、主嗅；鼻主嗅觉；
②心气充沛，鼻功正常。
病理关系：心肺病致鼻病—鼻衄、鼻不利。
复旦大学耳鼻喉资料 (26)
Clearance and defense
Immotile cilia syndrome
Pathogenesis
Infection
PCR detects the middle ear fluid, positive findings was 70% S pneumonia, haemophalus influenzae, haemolytic streptocuccus Middle ear is a isolated immune system Inflammatory mediators Specific antibody, immunologic complex Antigen may from adenoid or nasopharygeal lymph
Obstruction of Eustachian tube
Mechanic obstruction
enlarged adenoid, tumor, enlarged inferior turbinate Weakness of related muscle,
Non mechanic obstruction
检查
Diagnosis
Hearing test
Rinne test: negative Audiogram: conductive hearing loss, no more than 40 dB Tympanogram: B type or C type
Lateral nasopharyngeal radiograph: hypertroph of adenoid Nasopharyngeal exam: to exclude spaceoccupation lesion
Chronic otitis media 耳鼻咽喉科学课件
Classification
Congenital cholesteatoma Acquired cholesteatoma
Pathology
Mechanics of mucosal transformation and epithelial ingrowth have been the focal point of cholesteatoma
Ectodermal epithelial in proximity of the geniculate ganglion, medial to the neck of the malleus
Pathology
Diagnosis criteria:
Patients without previous history of ear disease, with normal and intact TM
The temporal bone pneumatization should be normal
Clinical presentations
Otorrhea
Malodorous associated with cholesteatoma
Hearing loss
Air conduction threshold is within 40 dB means TM proferation with intact ossicular chain
Etiology
Unresolved middle ear infection.
1. Uncomplicated inflammatory process of the middle ear may evolve over time to produce persistent effusion and irreversible mucosal change
Congenital cholesteatoma Acquired cholesteatoma
Pathology
Mechanics of mucosal transformation and epithelial ingrowth have been the focal point of cholesteatoma
Ectodermal epithelial in proximity of the geniculate ganglion, medial to the neck of the malleus
Pathology
Diagnosis criteria:
Patients without previous history of ear disease, with normal and intact TM
The temporal bone pneumatization should be normal
Clinical presentations
Otorrhea
Malodorous associated with cholesteatoma
Hearing loss
Air conduction threshold is within 40 dB means TM proferation with intact ossicular chain
Etiology
Unresolved middle ear infection.
1. Uncomplicated inflammatory process of the middle ear may evolve over time to produce persistent effusion and irreversible mucosal change
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The most common cause of hearing loss in children in the developed world, and has peaks in incidence from 2 to 5 years of age.
More than 50% of children experience OME in the first year of life.
Allergy
Middle effusion contain immunoglobulins (IgA、 IgG、 IgM、IgD)，immune complexes, and chemical mediators involved in the inflammatory response.
Possible humoral immune deficiencies
Otitis Media with Effusion
Definition
OME refers to a non-purulent inflammation in the middle ear cleft, characterized by conductive hearing loss and effusion in the tympanic cavity. Acute: less than 8 weeks Chronic: more than 8 weeks
Etiology
Eustachian tube (ET) dysfunction Inflammatory theory Others
Etiology
Eustachian tube (ET) dysfunction
Mechanical
Intrinsic mechanical obstruction:
Advanced otitis media with effusion with markedly retracted right tympanic membrane, with an apparent foreshortened handle of the malleus and thick, mucoid effusion
air-fluid meniscus, bullae
Physical examination
Bubbles confirming the presence of fluid
Air-fluid meniscus
Physical examination
Otitis media with effusion. The tympanic membrane is opaque, has lost its transparency, is vascularized, and retracted. The light reflex is shorter and moved upward due to retraction of the tympanic membrane
nasal and/or sinus disease
Clinical Findings
History
OME nearly always follows AOM as it resolves. However, MEE can be present without preceding AOM May be completely asymptomatic Most common symptom: hearing loss Aural fullness and/or pressure, “blocked” felling Acute: mild earache tinitus
Inflammatory theory
41% incidence of positive bacterial cultures
Streptococcus pneumoniae Haemophilus influenzae
Viruses：
influenza V. adenovirus
Others:
Etiology
Eቤተ መጻሕፍቲ ባይዱstachian tube (ET) dysfunction
Functional
Result of either decreased tubal stiffness or an inefficient active opening mechanism.
Proponents believe that either form of obstruction results in inadequate ventilation of the middle ear with resulting negative middle ear pressure.
Inflammation of the mucous membrane of the ET.
Allergic diathesis causing edema of the tubal mucosa.
Extrinsic mechanical obstruction:
obstructing masses: Adenoid hyperplasia Chronic rhinitis and sinusitis Chronic tonsilitis Nasopharyngeal tumor
Symptoms usually involve hearing loss or aural fullness, but typically do not involve pain or fever.
In children, hearing loss is generally mild and is often detected only with an audiogram.
Physical examination
Otoscopy:
loss of the light reflex, translucent membrane
decreased mobility of the tympanic membrane
yellowness and/or redness with hypervascularity, purulent MEE.
More than 50% of children experience OME in the first year of life.
Allergy
Middle effusion contain immunoglobulins (IgA、 IgG、 IgM、IgD)，immune complexes, and chemical mediators involved in the inflammatory response.
Possible humoral immune deficiencies
Otitis Media with Effusion
Definition
OME refers to a non-purulent inflammation in the middle ear cleft, characterized by conductive hearing loss and effusion in the tympanic cavity. Acute: less than 8 weeks Chronic: more than 8 weeks
Etiology
Eustachian tube (ET) dysfunction Inflammatory theory Others
Etiology
Eustachian tube (ET) dysfunction
Mechanical
Intrinsic mechanical obstruction:
Advanced otitis media with effusion with markedly retracted right tympanic membrane, with an apparent foreshortened handle of the malleus and thick, mucoid effusion
air-fluid meniscus, bullae
Physical examination
Bubbles confirming the presence of fluid
Air-fluid meniscus
Physical examination
Otitis media with effusion. The tympanic membrane is opaque, has lost its transparency, is vascularized, and retracted. The light reflex is shorter and moved upward due to retraction of the tympanic membrane
nasal and/or sinus disease
Clinical Findings
History
OME nearly always follows AOM as it resolves. However, MEE can be present without preceding AOM May be completely asymptomatic Most common symptom: hearing loss Aural fullness and/or pressure, “blocked” felling Acute: mild earache tinitus
Inflammatory theory
41% incidence of positive bacterial cultures
Streptococcus pneumoniae Haemophilus influenzae
Viruses：
influenza V. adenovirus
Others:
Etiology
Eቤተ መጻሕፍቲ ባይዱstachian tube (ET) dysfunction
Functional
Result of either decreased tubal stiffness or an inefficient active opening mechanism.
Proponents believe that either form of obstruction results in inadequate ventilation of the middle ear with resulting negative middle ear pressure.
Inflammation of the mucous membrane of the ET.
Allergic diathesis causing edema of the tubal mucosa.
Extrinsic mechanical obstruction:
obstructing masses: Adenoid hyperplasia Chronic rhinitis and sinusitis Chronic tonsilitis Nasopharyngeal tumor
Symptoms usually involve hearing loss or aural fullness, but typically do not involve pain or fever.
In children, hearing loss is generally mild and is often detected only with an audiogram.
Physical examination
Otoscopy:
loss of the light reflex, translucent membrane
decreased mobility of the tympanic membrane
yellowness and/or redness with hypervascularity, purulent MEE.