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

Chronic otitis media Chunfu dai md ph d Otolaryngology Department Eye Ear Nose and Throat hospital Fudan University

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

Definition ◼ COM: unresolved inflammatory process of the middle ear and mastoid associated with TM perforation, otorrhea and hearing loss

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 2. Fluid contains enzymes to alter the mucosal lining of the middle ear, it results in collapse or chronic perforation 3. obstruction of narrow communication between the antrum and the attic the aditus

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 2. Fluid contains enzymes to alter the mucosal lining of the middle ear, it results in collapse or chronic perforation 3. Obstruction of narrow communication between the antrum and the attic, the aditus

Etiology Dysfunction of Eustachian tube Chronic inflammation in nose and pharynx a Dysfunction of immune system

Etiology ◼ Dysfunction of Eustachian tube ◼ Chronic inflammation in nose and pharynx ◼ Dysfunction of immune system

Bacteriology Pseudomonas aeruginosa(40-60%) Staphylococus aureus(10-20%) Anaerobic bacteria

Bacteriology ◼ Pseudomonas aeruginosa (40-60%) ◼ Straphylococus aureus (10-20%) ◼ Anaerobic bacteria

Pathology Middle ear mucosa is lined by secretory epithelium forming glandlike structure u 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 ◼ 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 a Infection process per se u Necrosis following vascular thrombosis a It most commonly affect the lenticular process of the incus and head of the stapes

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 ◼ 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 ◼ 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 tube

Pathology ◼ Mechanics of mucosal transformation and epithelial ingrowth have been the focal point of cholesteatoma ◼ Pocket retraction: dysfunction of Eustachian tube