E.N.T 5th year, 4th & 5th lectures (Dr. Muaid)

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The lecture has been given on Nov. 1st, 2010 by Dr. Muaid.

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E.N.T 5th year, 4th & 5th lectures (Dr. Muaid)

  1. 1. By Dr. Muaid I. Aziz FICMS
  2. 2. AOM CATARRHAL EFFUSION SUPPURATIVE COM EFFUSION SUPPOARATIVE TUBOTYMPANIC ATTICOANTRAL
  3. 3. AOM  Its a viral or bacterial infection of mucosal lining of the ME+ MAC  More commoner in children than adult ? 1. adenoid 2. URTI 3. ET
  4. 4. ET disorders  ET dysfunction  Patulous ET
  5. 5. AOM Types  Catarrhal  Effusion  Suppurative
  6. 6. Acute catarrhal otitis media  URTI  Deafness ? No pain  Examination Nose Pharynx Ear Audiometry
  7. 7. Treatment  Treating underlying cause  Nasal decongestant  Inflation of the Eustachian tube
  8. 8. Acute middle ear effusion More sever variety of catarrhal OM Cause :  URTI , Allergy , Barotrauma More marked sx ( deafness, tinnitus ,vertigo) Examination  Congested , dark orange hue to it , may be retracted , little or no movement of the TM, splitted cone of light, fluid level  Medical or surgical
  9. 9. ACUTE SUPPURATIVE OTITIS MEDIA more commoner in children than in adults.  it can follow URTI which is often viral initially or it can be secondary to the introduction of water through a perforation .  Viral or bacterial adenovirus , rhinovirus streptococcus pneumonia , haemophilus influenza, branhamella catarrhalis.
  10. 10.  sudden onset dull ache in the ear which may become more sever  hearing loss  fever ( common in children )  examination will show the drum very red & marked bulging outwards of the TM with loss of surface anatomy  if the TM perforated or if there is preexisting perforation a copious mucopurulent & occasionally blood stained discharge coming from the ear  once the drum rupture the pain will decrease to a dull ache
  11. 11. Treatment  URTI should be treated .  a 5 day course AB given as amoxillin _ clavelinic acid  analgesia for pain if present  nasal decongestant  antihistamine drugs  myringotomy needed for reliving the sever pain which is due to accumulated pus in the middle ear which is not resolved by AB  if there is long standing perforation with recurrent attacks of AOM so myringoplasty is prepared for.
  12. 12. CHRONIC OTITIS MEDIA  Deafness main sx  Discharge ?  Otalgia ? Other pathology ? CX ? malignacy ?
  13. 13. CHRONIC MIDDLE EAR EFFUSION :  serous or secretory otitis media  In children & adults ?  aetiology  chronic Eustachian tube dysfunction or obstruction due to blockage of the tube in the middle Ear or nasopharynx  URTI as sinusitis , nasopharyngitis , allergic rhinitis unexplained chronic middle ear effusion specially in older person? suspicion of nasopharyngeal carcinoma.
  14. 14. Clinical features  blocked feeling in the ear  occasionally tinnitus or mild vertigo  the patient is unable to clear the ear by autoinflation .  On examination  retraction of the TM in whole or part , retraction of pars tensa is seen & the handle of malleus appears shortened & to lie in more horizontal position. The lateral process of the malleus may thus appear more prominent . the drum often have a dark or orange hue to it & occasionally a fluid level may be seen .  Examination of the nose may reveal signs of the sinusitis or allergic rhinitis , occasionally a nasopharyngeal tumor detected on examination of the nasopharynx .  Investigation : audiometry will reveal a CHL diminished or absent TM mobility on tympanogram will show flat curve which indicate –ve middle ear pressure
  15. 15. Treatment  Treating of underlying cause  myringotomy +/- grommet  Hearing aids
  16. 16. Chronic suppurative otitis media  Tubo - tympainc CSOM  Attico - antral CSOM ( tympanomastoid )
  17. 17. Tubo-tympanic CSOM  AETIOLOGY  PATHOLOGY  C/F  Mucopurulent discharge  Deafness ( mild to moderate sever ?)  Examination  Central perforation ( ant. ,posterior , kidney shaped or subtotal)  Otitis externa  Nose , nasopharynx , pharynx should examined (tonsil ,adenoid, sinus infection)  Hearing test  X-R ( PNS , postnasal space , mastoid )  Mastoid X-R ( cellular, sclerotic),erosion?  Swab for c/s
  18. 18.  CX is rare & are not serious Polyp OE More sever HL
  19. 19. TREATMENT  Treating URTI  Local treatment Thorough cleaning of ear canal (mopping , or suction clearance) AB + steroid ( 5 days) local +/- systemic Preventive measures Surgery ( myringoplasty)( recurrent , deafness with disabilities)
  20. 20. Atticoantral CSOM  TYMPANOMASTOID ?  Serious cx ?  Granulation tissue or polyp ?meaning?
  21. 21. pathology  Cholesteatoma  Granulation tissue with osteitis  Cholesterol granuloma
  22. 22. Cholesteatoma DEFINITION ( fat or keratin) TYPES
  23. 23. Congenital cholesteatoma
  24. 24. THEORIES Congenital cholesteatoma . Metaplasia Ingrowth of squamous epithelium Retraction pocket
  25. 25. Granulation tissue
  26. 26. Cholesterol granuloma  Dark brown gelatinous material with bone destruction  In combination of previous pathology  Dark blue TM  Cholesterol crystals
  27. 27. Clinical features  Discharge  Deafness  Bleeding  Otoscopy Foul smell dicharge Perforation Polyp , GT , cholesteatoma
  28. 28. Investigations  Hearing assessment  Radiology
  29. 29. Treatment  EUM + suction clearance  Polyp or GT ?  Medical or surgical ? Mastoidectomy
  30. 30. COMPLICATIONS OF OM  Extracranial  Intracranial
  31. 31. EC COMPLICATIONS  Mastoiditis ( acute, masked, chronic)  Petrositis  Labyrinthitis  Facial nerve pulsy
  32. 32. mastoiditis
  33. 33. presentation  Increasing Pain , tenderness behind the ear  Ear discharge ,no discharge(masked)  Fever (child)  Increasing pulse  Deafness
  34. 34. Examination  Downwards ,outwards protruded auricle  Fluctuant swelling  Sagging of posterior meatal wall  Perforated TM with pulsating discharge  Intact TM
  35. 35.  Investigation ( XR) , hearing assessment  Treatment  AB SURGERY
  36. 36. INTRACRANIAL COMPLICATIONS  meningitis  Extradural abscess  Subdural abscess  Brain abscess  Lateral sinus thrombosis
  37. 37. thanks

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