Features
Features:

Product Tour >

Edraw AI >

Paid Plans:

Individuals >

Business >

Eduaction >
Resources
Blog

History

How-tos & Tips

Discovery

Biography

Business Analysis

Examples

AI concept Map

Free AI Mind Map Generator

Onenote Mind Map

Bcg Matrix Examples

Nike Marketing Strategy

Unilever SWOT Analysis

Make Mind Maps in Google Docs

Guide

FAQs

What's New

Resource Center
Templates
All Templates

Brain Storming Templates

Strategy and Planning Templates

Project Management Templates

Product Management Templates

Human Resources Templates

Agile Workflow Templates

Marketing Templates

Education Templates

Fun and Games Templates

User Gallery
Download
Pricing
Enterprise

MindMap Gallery Otolaryngology-Head and Neck Surgery--Otology 002

Otolaryngology-Head and Neck Surgery--Otology 002

This mind map of otolaryngology and head and neck surgery introduces middle ear diseases, including complications of acute otitis media, chronic suppurative otitis media, and suppurative otomastoiditis.

Edited at 2024-03-25 23:21:49

PlotWizard

Recent works View more works>>

Otolaryngology-Head and Neck Surgery--Otology 002

PlotWizard

Recent works View more works>>

Recommended to you
Outline

Otolaryngology-Head and Neck Surgery--Otology 002

Chapter 4 Middle ear diseases

Section 1 Acute otitis media (AOM)

【Classification】

1. Acute non-suppurative otitis media (acute non-suppurative otitis media): acute secretory otitis media, barotraumatic otitis media (barotraumatic otitis media)

2. Acute suppurative otitis media (acute suppurative otitis media)

1. Secretory otitis media/otitis media with effusion (OME)

[Definition] It is a non-suppurative disease of the middle ear characterized by middle ear effusion and hearing loss.

【Cause】

[Pathology] Middle ear effusion is a mixture of transudate, exudate, and mucus; it is mainly serous in the early stage, and then gradually transforms into serous-mucus, mucus

[Clinical manifestations]

symptom

Earache: obvious in children, often occurring at night, relieved the next morning, and disappearing after 1 to 2 days; not obvious in adults and chronic patients

Hearing loss: Hearing gradually declines with increased self-hearing after catching a cold; it can improve when the head position changes

Occlusion in the ear: Improved by compressing the tragus

Tinnitus: mostly intermittent; when the head moves, yawns, or blows the nose, a sound of air passing through the ears may occur.

examine

eardrum:

①Acute stage, congestion and invagination;

② When there is effusion in the tympanic cavity, it loses its normal luster, and the liquid level can even be seen through the tympanic membrane (the relationship between the liquid level and the parallel bottom surface does not change when the head moves)

Hearing Test: Conductive Hearing Loss; Acoustic Impedance Graphical Flat (Type B) Curve

Temporal bone CT: low-density shadow in the tympanum, fluid accumulation in some/all mastoid air cells, and sometimes fluid levels can be seen

Tympanocentesis

【Differential Diagnosis】

1. Nasopharyngeal carcinoma: Routinely excluded (especially unilateral secretory otitis media in adults)

2. Cerebrospinal fluid otorrhea: history of head trauma, imaging examination

3. Perilymph fistula: mostly secondary to stapes surgery or with a history of barotrauma; mostly sensorineural hearing loss

4. Cholesterol granuloma: can be a late complication of secretory otitis media

5. Adhesive otitis media: a sequelae of chronic secretory otitis media; however, the course of the disease is usually long, treatments for Eustachian tube blowout are often ineffective, and hearing loss is severe.

【treat】

in principle

Clear middle ear fluid, improve middle ear ventilation/drainage, and treat the cause

non-surgical treatment

Control infection; corticosteroids can be used in the acute phase

Improve Eustachian tube ventilation and drainage: Eustachian tube insufflation, oral myrtle oil capsules (thinning mucus), nasal decongestants (when there is nasal congestion)

Surgical treatment

Tympanocentesis

Myringotomy: suitable when myringocentesis is ineffective

Myringotomy and tube placement: suitable for cases where the condition is delayed and relapses

Tympanoplasty, simple mastoidectomy, tympanoplasty: used when the above treatments are ineffective

Related diseases

Aggressive treatment of nasopharyngeal or rhinosinus disease

2. Acute suppurative otitis media

【Cause】

Pathogenic bacteria

Streptococcus pneumoniae, Haemophilus influenzae, hemolytic Streptococcus, Staphylococcus aureus, Pseudomonas aeruginosa, etc.

route of infection

Eustachian tube route (the most common): ① Acute upper respiratory tract infection; ② Swimming/diving in unclean water; ③ Acute upper respiratory tract infectious diseases; ④ Improper breastfeeding position of infants and young children; ⑤ Short, wide and flat Eustachian tube in children

Others: external auditory canal-tympanic membrane pathway, hematogenous infection

[Clinical manifestations] More common in children

symptom

Systemic symptoms: chills, fever, vomiting, diarrhea

Local symptoms: severe earache (pulsating/tingling, aggravated by swallowing/coughing, may radiate), hearing loss, tinnitus; systemic symptoms were significantly relieved/disappeared after perforation, earache, hearing loss, and tinnitus were relieved, but otorrhea occurred. (Initially bloody, later becomes mucopurulent)

physical signs

Around the ears: There may be slight tenderness at the tip of the mastoid process and the sinus tympanum area; mild redness and swelling may be seen in the skin of the mastoid area in children.

Otoscopy: Early tympanic membrane congestion; perforation sites are more common in the pars tensa

Hearing test: conductive hearing loss (loss more than 35dB, VS secretory otitis media)

Blood routine: WBC↑, N%↑; tends to normal after perforation

【treat】

in principle

Control infection and smooth drainage

General treatment

Use antibiotics, nasal decongestants (conducive to restoring Eustachian tube function), and supportive care as early as possible

topical treatment

Before tympanic membrane perforation

2% phenol glycerin ear drops: anti-inflammatory and analgesic; but contraindicated after perforation

① Myringotomy: ① The systemic and local symptoms are severe, the tympanic membrane is obviously bulging, and the above treatment effect is not good; ② Although the tympanic membrane has been perforated, it is too small and the drainage of secretions is not smooth; ③ There are suspected complications, but no need yet Immediate mastoidectomy

After the tympanic membrane is perforated: first clean the external auditory canal thoroughly with 3% hydrogen peroxide, wipe it dry, and then instill antibiotic ear drops; most perforations can heal on their own after the inflammation completely subsides, otherwise tympanoplasty is possible

3. Acute mastoiditis

[Pathology] Acute purulent inflammation of the muco-periosteum of the mastoid air cells, especially the mastoid bone (pneumatization type is common), is a complication of acute suppurative otitis media; in children aged 2 to 3 years, it is called sinusitis ( Because the mastoid has not yet developed); pathology is divided into acute coalescent mastoiditis, hemorrhagic mastoiditis, mastoid osteomyelitis (poor pneumatization), masked mastoiditis )

[Clinical manifestations]

symptom

During the recovery period of acute suppurative otitis media (disease 3 to 4 weeks), various symptoms do not continue to decrease but worsen.

Symptoms in children are more severe: ① high fever, pulse rate, drowsiness, and convulsions; ② gastrointestinal symptoms; ③ pseudomeningitis (with signs of meningeal irritation but no typical cerebrospinal fluid changes); ④ intracranial complications (including purulent meningitis )

examine

Periauricular: The mastoid skin is swollen and flushed, the posterior auricular groove disappears, and there is obvious tenderness in the sinus tympanum area/mastoid tip area.

Otoscopy: The posterior upper wall of the bony external auditory canal is red, swollen and collapsed; the tympanic membrane is congested and the perforation is generally small/pus is pulsing at the perforation. Temporal bone CT: the air content of the mastoid is reduced, the atrial septum is destroyed (VS secretory otitis media), and fluid levels appear

Blood routine: WBC↑, N%↑

【Differential Diagnosis】

[Treatment] Early, systemic and local treatment are the same as for acute suppurative otitis media; if necessary, simple mastoidectomy

Section 2 Chronic suppurative otitis media (chronic suppurative otitis media)

1. Chronic suppurative otitis media

[Cause] Most of the pathogenic bacteria are Gram-negative bacilli; found in: ① acute suppurative otitis media without appropriate and thorough treatment, and the course of the disease is prolonged > 8 weeks; ② adenoid hypertrophy, chronic tonsillitis, chronic suppurative sinusitis → otitis media Recurrent attacks and long-lasting relapse; ③ systemic/local resistance↓

[Clinical manifestations]

symptom

Otorrhea (the most prominent): intermittent or long-term, aggravated by reinfection of the upper ear/external auditory canal; the secretion is mucopurulent, and may contain granulations, polyps, and blood

Hearing loss: varying degrees

tinnitus

examine

Tympanic membrane perforation: divided into central type and edge type; intratympanic wall mucosal congestion, edema, polyps/granulations, and purulent secretions around

Hearing test: Conductive or mixed hearing loss

Temporal bone CT: The mastoid can be pneumatic type or barrier/sclerotic type

【Differential Diagnosis】

1. Chronic myringitis: long-term/intermittent pus discharge in the ear, granular granulation on the tympanic membrane, but no perforation; temporal bone CT is normal

2. Middle ear cancer: long-term pus discharge in the ear, recent bleeding, earache, and difficulty opening the mouth; examination shows new organisms in the tympanic cavity; facial paralysis can occur in the early stage; temporal bone CT shows bone destruction; biopsy of the new organisms can confirm the diagnosis

3. Tuberculous otitis media: other tuberculosis lesions throughout the body; early facial paralysis; large perforation of the tympanic membrane with pale granulations

【treat】

in principle

Smooth drainage, control infection, clean lesions, restore hearing, and eliminate causes

medical treatement

Topical medication: suitable for those with smooth drainage; Note: ① Thoroughly wash and dry with 3% hydrogen peroxide before use; ② Ototoxic antibiotics are strictly prohibited; ③ Avoid powders and corrosives

Antibiotic solution: suitable for congestion, edema, and excessive secretions in the tympanic mucosa

Ethanol/glycerin preparation: suitable for cases with little pus and moist tympanic cavity

Systemic medication: suitable for acute attacks of inflammation

Surgical treatment

Mastoid opening tympanoplasty: suitable for patients with granulations/polyps in the middle ear, or obvious hypertrophy of the tympanic mucosa that has failed to respond to regular drug treatment. CT shows soft tissue shadows in the mastoid and lesions that have involved bone.

Tympanoplasty: The middle ear inflammation has been completely absorbed, leaving a central perforation of the tympanic membrane tension.

2. Middle ear cholesteatoma/middle ear epidermoid tumor

【Classification】

1. Congenital cholesteatoma (congenital cholesteatoma): developed from embryonic ectoderm leftover/vagus in the skull

2. Acquired cholesteatoma: primary (no history of suppurative otitis media, but cholesteatoma may develop secondary purulent inflammation after bacterial infection), secondary (secondary to chronic suppurative otitis media, secretory otitis media)

[Pathogenesis] Acquired cholesteatoma: ① bag-shaped invagination theory (primary cholesteatoma): poor eustachian tube ventilation → long-term negative pressure in the middle ear → invagination of the pars flaccida of the tympanic membrane; ② epithelial transition theory (followed by Secondary cholesteatoma); ③ squamous metaplasia theory (secondary cholesteatoma); ④ basal cell proliferation theory (primary cholesteatoma)

[Pathology] It is actually a cystic structure (not a tumor); but it can destroy the surrounding bone and cause severe intracranial and extracranial complications (most common in various acute and chronic otomastoiditis media)

[Clinical manifestations]

symptom

Otorrhea: Secondary cases may have long-term pus discharge and often have a foul odor; in primary cases, there is no pus in the ear in the early stage, and it only occurs when there is infection.

Hearing loss: secondary cases are generally more severe; primary cases are generally less severe.

Tinnitus: Appears in middle to late stages

examine

Otoscope: perforation of the tympanic membrane, and gray-white scaly/bean dregs-like material in the tympanum can be seen from the perforation site, with a strange odor; in the early stage of congenital primary disease, there may be no ear discharge and the tympanic membrane is intact.

Hearing Test: Conductive/Mixed Hearing Loss

Temporal bone CT: There are areas of bone destruction in the tympanum, sinus tympanum, and mastoid process, but the edges are dense and neat.

【Differential Diagnosis】

Chronic suppurative otitis media simple type, bone ulcer type, cholesteatoma type

[Treatment] Early surgery

Purpose

① Completely remove the diseased tissue; ② Reconstruct the sound transmission structure; ③ Prevent complications; ④ Get a dry ear

technique

Removal of diseased tissue: radical mastoidectomy

Rebuilding sound-transmitting structures: tympanoplasty

Section 3 Complications of purulent otomastoiditis media (otogenic complications)

I. Overview

[Pathway] ① Inflammation destroys the bone wall; ② Blood circulation; ③ Normal anatomical pathways such as unclosed bone sutures

【Classification】

extracranial complications

Intratemporal complications: labyrinthitis, petrositis, peripheral facial paralysis

Extratemporal complications: subperiosteal abscess behind the ear, subperiosteal abscess at the root of the zygomatic process, subgaleal abscess, Bezold's abscess, Mouret's abscess

intracranial complications

Extradural abscess, subdural abscess, sigmoid sinus blood

Thrombophlebitis, meningitis, brain abscess (most serious), otogenic hydrocephalus, cerebral herniation

【diagnosis】

① Medical history: Especially when patients with otitis media suddenly develop headache, fever, cessation/increase of pus discharge, change of consciousness, or indifferent expression;

②Ear examination;

③Temporal bone and brain imaging examination;

④Fundus examination;

⑤ Laboratory tests of cerebrospinal fluid and blood;

⑥Bacterial culture

【treat】

① Complete surgery to remove the mastoid process and related lesions of the middle ear;

② Adequate broad-spectrum antibiotics;

③Symptomatic treatment (such as intracranial hypertension);

④Supportive therapy

2. Extracranial complications

(1) Labyrinthitis/otitis interna

(2) Petrositis

[Characteristics] It is more common in middle-aged people following acute mastoiditis; clinical manifestations include headache (trigeminal neuralgia), otorrhea, elevated body temperature (but rarely >39°C), petrosal apex syndrome (V/VI nerve involvement) →Extraocular rectus paralysis, pain in the trigeminal nerve distribution area (localized meningitis), labyrinth irritation symptoms

(3) Postauricular subperiosteal abscess

[Pathology] Inflammation penetrates the lateral bone wall of the tympanic sinus/mastoid tip bone cortex, causing the pus accumulated in the mastoid cavity to flow into the rupture area of the lateral mastoid bone plate and collect under the mastoid periosteum behind the ear, forming an abscess.

[Clinical manifestations] ① Pain in and behind the ear, which may be accompanied by headache and fever on the same side; ② Obvious redness, swelling and tenderness behind the ear, and even obvious fluctuations; fistulas may be left in patients with ruptured abscesses; ③ Empyema in the external auditory canal; perforation of the tympanic membrane, Polyps, granulations, and cholesteatoma can be seen; ④ Temporal bone CT shows blurred mastoid air cells and bone destruction.

[Treatment] ① Systemic antibiotic treatment; ② Mastoid surgery: complicated by acute mastoiditis → simple mastoidectomy; complicated by chronic suppurative middle ear mastoiditis → radical mastoidectomy or modified radical mastoidectomy; young children → sinus tympanotomy

(4) Otogenic neck abscess

1. Bezold abscess (subdigastric abscess): pus ruptures from the tip of the mastoid process (well pneumatized) to the inner surface of the sternocleidomastoid muscle; manifests as high fever, chills, pain on the side of the neck, and limited neck movement

2. Mouret abscess (deep neck abscess): pus ruptures from the tip of the mastoid process to the digastric groove and spreads to the pharyngeal space; it manifests as high fever, limited head rotation, pain in swallowing, and difficulty in opening the mouth; a few can cause laryngeal edema/ Asphyxia, cavernous sinusitis, subphrenic abscess

3. Intracranial complications

(1) Thrombophlebitis of sigmoid sinus (thrombophlebitis of sigmoid sinus)

[Clinical manifestations]

symptom

Early stage: symptoms are atypical, including earache and severe headache.

Sepsis: chills, high fever (body temperature can be >39°C), pulse rate, and shortness of breath; the heat type is usually flaccid fever

Symptoms of thrombosis expansion: increased intracranial pressure, jugular foramen syndrome

examine

Blood routine: WBC obvious ↑, N% ↑; RBC/Hb ↓

Fundus examination: papilledema, retinal vein dilation; when the internal jugular vein is compressed but there is no change in the fundus vein, it indicates occlusive thrombosis of the internal jugular vein (Growe's test is positive)

Tobey-Ayer test (neck compression test): to determine whether there is an embolism in the sigmoid sinus

①Method: When measuring cerebrospinal fluid pressure through lumbar puncture, compress the internal jugular vein on the contralateral side. At this time, the cerebrospinal fluid pressure rises rapidly and exceeds the original pressure.

[Treatment] ① Surgery to completely remove the lesions and smooth drainage; ② Antibiotics

(2) Otogenic meningitis (otitis meningitis/otogenic meningitis)

[Clinical manifestations]

Performance

Chills, high fever, headache (especially in the back of the head), projectile vomiting, rapid pulse, and children may have diarrhea and cramps

Meningeal irritation signs: cervical rigidity, positive Kernig sign/Brudzinski sign

Psychological and neurological symptoms: irritability, twitching of limbs, drowsiness, coma, brain herniation. Pyramidal tract signs: weakened superficial reflexes, hyperactive deep reflexes, positive pathological reflexes

examine

Blood routine: WBC↑, N%↑

Lumbar puncture: cerebrospinal fluid pressure ↑, cell number ↑ (mainly polymorphonuclear cells), protein ↑, sugar ↓, chloride ↓; bacterial culture may be positive

1~2 times; then compress the internal jugular vein on the affected side. When there is occlusive thrombosis in the sigmoid sinus, the cerebrospinal fluid pressure does not increase or slightly increases.

[Treatment] ① Note that when intracranial pressure is very high, surgery should be performed while lowering intracranial pressure; ② Treat with sufficient antibiotics and use glucocorticoids as appropriate; ③ Supportive therapy

(3) Otogenic brain abscess

[Pathology] Mostly located in the temporal lobe, followed by the cerebellum

[Clinical manifestations]

installment

Onset period: elevated body temperature, chills, headache, vomiting, mild meningeal irritation; indicative of localized meningitis. Incubation period: mostly no obvious symptoms; indicative of suppurative stage

Significant stage: Symptoms of poisoning, intracranial hypertension, and focal localization signs; indicating the stage of abscess formation.

Terminal stage: Most people can be cured with timely treatment; but there are also cases of sudden death due to cerebral herniation.

examine

Fundus examination: papilledema may be present

Lumbar puncture: It is helpful to judge the prognosis of the disease during diagnosis and treatment.

cranial imaging examination

[Treatment] Surgical treatment is the main treatment (lower intracranial pressure first), supplemented by anti-infection and supportive therapy