Mastoiditis is an inflammation of the mastoid process behind the ear and air spaces connecting it to the middle ear that can develop as a complication of acute otitis media or chronic otitis media with symptoms of otalgia, swelling over the mastoid bone, and purulent discharge from the ear. It is typically treated with antibiotics, ear irrigation to remove discharge, analgesics, and may require surgical treatments like mastoidectomy or myringotomy if medical management is insufficient.
Acute epiglottitis is an acute inflammatory condition of the epiglottis and nearby structures like the arytenoids, aryepiglottic folds, and vallecula.It is a life-threatening infection that causes profound swelling of the upper airways which can lead to asphyxia and respiratory arrest.Bacterial etiology is the most common cause of epiglottitis. Soft tissue lateral xray of neck shows thumb sign. Airway management is the main concern of epiglottitis.
This is a seminar presentation conducted by 4th year medical students under supervision of a lecturer. Reference were not attached here, but all information are from google, few textbooks and also from previous ENT posting's seminar.
Acute epiglottitis is an acute inflammatory condition of the epiglottis and nearby structures like the arytenoids, aryepiglottic folds, and vallecula.It is a life-threatening infection that causes profound swelling of the upper airways which can lead to asphyxia and respiratory arrest.Bacterial etiology is the most common cause of epiglottitis. Soft tissue lateral xray of neck shows thumb sign. Airway management is the main concern of epiglottitis.
This is a seminar presentation conducted by 4th year medical students under supervision of a lecturer. Reference were not attached here, but all information are from google, few textbooks and also from previous ENT posting's seminar.
Swallowing of any foregion body like coins, pins,seeds,buttton batteries and platic pieces is common in children.In older persons pieces of bone (fish or chicken) or part of loose denture is common. It becomes an emergency situation and needs urgent treatment.In this ppp I have discussed this problem in a brief and clear way
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Swallowing of any foregion body like coins, pins,seeds,buttton batteries and platic pieces is common in children.In older persons pieces of bone (fish or chicken) or part of loose denture is common. It becomes an emergency situation and needs urgent treatment.In this ppp I have discussed this problem in a brief and clear way
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
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Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
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The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
4. Anatomy and Physiology
• Consists of the auricle and EAM
• Skin-lined
• Approximately 2.5 cm in length
• Ends at tympanic membrane
• Auricle is mostly skin-lined cartilage
• External auditory meatus
– Cartilage: ~40%, Bony: ~60%
– S-shaped, Narrowest portion at bony-cartilage junction
5. Anatomy and Physiology
• EAC is related to
various contiguous
structures
– Tympanic membrane
– Mastoid
– Glenoid fossa
– Cranial fossa
– Infra-temporal fossa
6. • Innervation: cranial nerves V
,VII, IX, X, and greater auricular nerve
• Arterial supply: superficial temporal, posterior and deep auricular
branches
• Venous drainage: superficial temporal and posterior auricular veins
• Lymphatics
7. OTITIS EXTERNA
• An acute or chronic infection of the whole
or a part of the skin of the external ear
canal
• Otitis externa is often referred to as
"swimmer’s ear" because repeated
exposure to water can make the ear canal
more vulnerable to inflammation
9. Speculum findings:
• the canal may be so swollen that a view
into the ear is impossible
• In swimmers, divers and surfers, chronic
water exposure can lead to the growth of
bony swellings in the canal known as
exostoses. These can interfere with the
drainage of wax and predispose to
infection.
12. Factors contributing to AOE
• High humidity
• Water exposure
• Maceration of canal skin
• High environmental temperature
• Local trauma
• Perspiration
• Allergy
• Stress
• Removal of normal skin lipids
• Absence of cerumen
• Alkaline pH of canal
13. AOE: Pre-inflammatory Stage
• Oedema of stratum corneum and plugging
of apopilosebaceous unit
• Symptoms: pruritus and sense of fullness
• Signs: mild edema
• Starts the itch/scratch cycle
15. AOE: Severe Stage
• Severe pain, worse
with ear movement
• Signs
• Lumen obliteration
• Purulent otorrhoea
• Involvement of peri-
auricular soft tissue
16. AOE: Treatment
• Most common pathogens: P. aeruginosa and S. aureus,
E.coli and proteus.
• Four principles
• Frequent canal cleaning; swab or suction
• With sever EO, placement of a wick made of
sponge or gauze provides a pathway for drops to
be delivered to the EAC wall skin for 48-72 hours!
• Topical antibiotics, and if severe>> Systemic or
PO-ABT
• Pain control
• Instructions for prevention
17. AT A GLANCE. . .
• Otalgia
• Tenderness on palpation or manipulation
(Tragus sign)
• Ear fullness
• Conductive hearing loss.
• Erythema of meatus and canal
• Swelling and obstruction of canal
• Crusting and discharge
• Odor!
18. Necrotizing (malignant) External Otitis(NEO)
• Potentially lethal infection of EAC and
surrounding structures
• Pseudomonas aeruginosa is the usual
culprit
• Risk Factors:
- Diabetes Mellitus
- Elderly
- Immunocompromised state
- Human Immunodeficiency Virus (HIV)
• Typically seen in diabetics and
immunocompromised patients
19. NEO: Signs & Symptoms
• Similar to Otitis Externa except
• Severe, unrelenting Ear Pain and Headache
• Persistent discharge
• Does not respond to topical medications
• Commonly associated with Diabetes Mellitus
• Granulation tissue in posterior and inferior canal
• Pathognomonic for necrotizing otitis
• Occurs at bone-cartilage junction
• Extra-auricular findings
• Cervical Lymphadenopathy
• Trismus (TMJ involvement)
• Facial Nerve Palsy or paralysis
• (Bell's Palsy)
• Associated with poor prognosis
20. NEO: Diagnosis, Prevention and
Treatment:
• Prognosis; Reportedly mortality 20-53%
• Diagnosis : History, Physical Examn, Labs and
Imaging:
- Labs; CBC, Culture of discharge, ESR, Serum glucose,
Serum creatinine.
- Radiology; CT, or MRI (ear)
• Prevention:
- Avoid use of cotton swabs in ear and other canal trauma.
- Use caution when irrigating ear of high risk patients.
- Treat eczema of ear canal and other pruritic dermatitis
21. NEO: Treatment
• Intravenous antibiotics for at least 4 weeks
– with serial gallium scans monthly
• Local canal debridement until healed
• Pain control
• Use of topical agents controversial
• Hyperbaric oxygen experimental
• Surgical debridement for refractory cases
22. NEO: Mortality
• Death rate essentially unchanged despite
newer antibiotics (37% to 23%)
• Higher with multiple cranial neuropathies
(60%)
• Recurrence not uncommon (9% to 27%)
• May recur up to 12 months after treatment
23. Chronic Otitis Externa
• Acute otitis externa occurs in 4 of every 1000 people
per year
• Otitis externa is defined as chronic when the duration
of the infection exceeds 4 weeks or when more than
4 episodes occur in 1 year
• Bacterial, fungal, dermatological aetiologies
COE: Symptoms
• Unrelenting pruritus
• Mild discomfort
• Dryness, Crusting, and flaking of canal skin
25. COE: Treatment
• Similar to that of AOE
• Topical antibiotics, frequent cleanings
• Topical Steroids
• Surgical intervention
• Failure of medical treatment
• Goal is to enlarge and resurface the EAC
26. Radiation-Induced Otitis Externa
• OE occurring after
radiotherapy
• Often difficult to treat
• Limited infection treated
like COE
• Involvement of bone
requires surgical
debridement and skin
coverage
27. Furunculosis
• Acute localized infection
• Lateral 1/3 of posterosuperior canal
• Obstructed apopilosebaceous unit
• Pathogen: S. aureus
32. Acute inflammation in middle ear
< 3 weeks (1 month)
Often associated with a viral upper
respiratory infection
Most common reason for medical therapy
for children younger than 5 years
Recurrent otitis media:
At least 4 episodes/ year
At least 3 episodes/ 6 months
(with adequate therapy)
Acute otitis media
33. Most children have at least one episode of
AOM (by age 3, 50-85%)
Peak incidence age 6-15 months
Increased incidence in the fall and winter
Only 20% are adults
>700 milion cases/year
Epidemiology
34. Eustachian tube is lined with respiratory
mucosa
Responds together with nasopharynx
mucosa
Edema > narrowed
lumen
negative middle
ear pressure
Influx of pathogens from nasopharynx is
possible
Causes
>
35. Causes
Inflammatory response in middle ear worsens
the obstruction
Trigger:
Allergies
Upper respiratory tract infections
GER (especially children)
Adenoid hypertrophy
Other
40. Risk factors
Underlying pathology
Unrepaired cleft palate
Parental smoking
Large familys/attending daycare
Immunocompromised states
41. Otalgia (not always)
Fever
Hearing loss
(speech delay for children)
Headache
Nausea
Cough
Rhinitis
Conjunctivitis
Signs and symptoms
42. Pneumatic otoscopy/otoscopy:
Red or opaque eardrum
Retracted eardrum
Immobile or hypo-mobile eardrum
Presence of fluid behind eardrum
(purulent, serous, mucoid)
Retraction pockets
Bullous myringitis
Physical
Examination
43.
44.
45. Otorrhea (in case of
tympanostomy tube, perforation)
Mastoid tenderness
Anteriorly rotated pinna
Tympanometry
Audiometry
Inspection or pharynx and
nasal cavity
Physical
Examination
46. Diagnosis
Acute onset of signs and syptoms
The presence of middle ear effusion
(hypomobile eardrum, air-fluid level)
Signs and symptoms of middle ear inflamation
(erythema, otalgia)
47. Acute mastoiditis
Abscess formation
Facial paralysis
Otitis media with effusion
PersistentAOM
RecurrentAOM
Hearing loss
Perforation of eardrum
Complications
49. Antibacterial therapy for:
Children of age <6months
6 months to 2 years with severe illness
Recurrent or billateral AOM
Immunocompromised patients
Patients with a perforated tympanic membrane
Pain management (Ibuprofen, Diclofenac,
paracetamol)
Decongestants and/or antihistamines,
nasal steroids
Treatment
50. Antibacterial therapy
Amoxicilin 750-1500mg/day 50-100 mg/kg/day
(has not recived amoxicilin in past 30 days and has no
allergy to penicilin)
Amoxicillin-clavulanate 875/125mg/day
90/6.4 mg/kg/day
(alternative for amoxicilin)
Ceftriaxone 1-2g/day 50mg/kg/day or
Cefuroxim 500mg/day 30mg/kg/day
Azithromycin, clarithromycin, erythromycin in
case of allergy to penicilin
5-7-10 days
52. Non-drug Treatment
Myringotomy in case of sevare pain
Tympanocentesis in case of severe pain andas a diagnostic
procedure if there is no improvement with
• 2nd line of antibiotics
(local anesthesia)
(narcosis)
53. Avoiding risk factors if possible
Vaccination: ?
S. Pneumonia (PCV-7)
Influenza
• Adenoidectomy
• Polipectomy
Preventive measures
54. Differential diagnosis
Otitis externa
Impacted cerumen or foreign body in ear
Tympanosclerosis
Otitis media with effusion
Injury of the ear
56. • INTRODUCTION
• The mastoid process is the portion of the temporal bone of the skull that
is behind the ear which contains open, air-containing spaces.
• DEFINITION
• It is an inflammation of the mastoid process behind the ear and of the
air space connecting it to the cavity of the middle ear.
57. • CLASSIFICATION
1.Acute mastoiditis: It is a rare complication of acute otitis media.
2.Chronic mastoiditis: It is most commonly associated with CSOM or
with cholesteatoma formations.
• CAUSES & RISK FACTORS
1.Infection of the middle ear.
2.Injury of the mastoid bones and cells.
3. Cholesteatoma.
4.Upper respiratory infection.
58. SIGNS AND SYMPTOMS
1.Otalgia.
2.Swelling on the mastoid bone.
3.Perforation of the ear drum.
4.Loss of hearing.
5.Severe pain at eating time.
6.Increased cranial pressure.
7.Painless discharge from the affected ear.
8.Otorrhoea(purulent discharge) may be odorless or foul smelling.
9.Nausea, vomiting.
61. Treatment
• MEDICAL MANAGEMENT
1. Antibiotic and steroid eardrop for infection and inflammation, e.g.
Ciplox-D.
2. Ear-irrigation: For removing purulentdischarge.
3. Analgesics drugs: Aspirin, Nimuslide.
• SURGICAL MANAGEMENT
1. Mastoidectomy: It is a surgical procedure that removes diseases
mastoid air cells.
2. Myringotomy: It is a surgical procedure in which a tiny incision is
created in the eardrum relieves pressure caused by excessive buildup
of fluid orpus.
3. Tympanoplasty: also called eardrum repair. It is the surgical
reconstruction of the perforated eardrum or the small bones of the
middle ear.