复旦大学：《耳鼻咽喉科学》课程教学资源（PPT课件讲稿，英文版）Complications of Chronic Otitis Media

Complications of Chronic otitis media Chunfu dai

Complications of Chronic Otitis Media Chunfu Dai

Three categories on an anatomic basis Extratemporal extracranial a Bezold abscess Subperiosteal abscess Intratemporal Mastoiditis, labyrinthitis, sensorineural hearing loss, petrositis Facial paralysis, Cholesteatoma, labyrinthine fistula Intracranial Epidural abscess, lateral sinus thrombosis, otitic /drocephalus meningitis brain abscess subdural abscess

Three categories on an anatomic basis ◼ Extratemporal extracranial ◼ Bezold abscess ◼ Subperiosteal abscess ◼ Intratemporal ◼ Mastoiditis, labyrinthitis, sensorineural hearing loss, petrositis ◼ Facial paralysis, cholesteatoma, labyrinthine fistula ◼ Intracranial ◼ Epidural abscess, lateral sinus thrombosis, otitic hydrocephalus, ◼ meningitis, brain abscess, subdural abscess

Causes Hyper-function of immune system Infant older Strong bacteria Damaged structures cholesteatoma Unreasonable interventions Drug resistant Poor drainage

Causes ◼ Hyper-function of immune system ◼ Infant, older ◼ Strong bacteria ◼ Damaged structures ◼ cholesteatoma ◼ Unreasonable interventions ◼ Drug resistant, ◼ Poor drainage

Transmission course Pathways of spread Direct extension of infection to structure (bone erosion) Hemogenous routine (microbiologic an host factors Bacteria gain access to intracranial through unsealed gap, inner ear

Transmission course ◼ Pathways of spread ◼ Direct extension of infection to structure (bone erosion) ◼ Hemogenous routine (microbiologic an host factors) ◼ Bacteria gain access to intracranial through unsealed gap, inner ear

1. Eardrum 5 Semicrcular canais B Vestibular nerve 3 Incus Facial Nerve f0 Eustachian tube MF

Bezold abscess Definition Erosion the tip of the mastoid bone Infects the soft tissue of the neck, Deep to the sternocleidomastoid muscle Diagnosis Ear infection Mass in the neck Fever neck stiff, otorrhea CT scan

Bezold abscess ◼ Definition: ◼ Erosion the tip of the mastoid bone ◼ Infects the soft tissue of the neck, ◼ Deep to the sternocleidomastoid muscle ◼ Diagnosis ◼ Ear infection ◼ Mass in the neck ◼ Fever, neck stiff, otorrhea ◼ CT scan

Bezold abscess Treatment Antibiotic Abscess cavity should be evacuated 口 An external drainage should be placed Mastoidectomy Antrum drainage required LSC via epitympanum to the middle ear MF

Bezold abscess ◼ Treatment ◼ Antibiotic ◼ Abscess cavity should be evacuated ◼ An external drainage should be placed ◼ Mastoidectomy ◼ Antrum drainage required, via epitympanum to the middle ear

Supperiosteal abscess Definition Bone erosion, via osteitis or necrosis leads to a dehiscence into the postauricular soft tissue DiagnoSIs Fever, pain and otorrhea Followed by appearance of the postauricular mass, displacing the auricle anteriorly CT scan

Supperiosteal abscess ◼ Definition: Bone erosion, via osteitis or necrosis, leads to a dehiscence into the postauricular soft tissue. ◼ Diagnosis ◼ Fever, pain and otorrhea ◼ Followed by appearance of the postauricular mass, displacing the auricle anteriorly ◼ CT scan

Supperiosteal abscess Managements Antibiotic a Drainage, using postauriclar incision After achieving effective drainage of the mastoid infection, the site of suppuration can be addressed Necrotic tissues require debridement

Supperiosteal abscess ◼ Managements ◼ Antibiotic ◼ Drainage, using postauriclar incision ◼ After achieving effective drainage of the mastoid infection, the site of suppuration can be addressed ◼ Necrotic tissues require debridement

Labyrinthitis Classifications Circumscribed labyrinthitis (fistula of labyrinth) Communication of middle ear with perilymphatic space Serous labyrinthitis Toxin, inflammatory media Suppurative labyrinthitis Bacteria

Labyrinthitis ◼ Classifications ◼ Cirvumscribed labyrinthitis (fistula of labyrinth) ◼ Communication of middle ear with perilymphatic space ◼ Serous labyrinthitis ◼ Toxin, inflammatory media ◼ Suppurative labyrinthitis ◼ Bacteria