OTITIS MEDIA
Guangzhou medical college
Second Affiliated Hospital
Otolaryngology
Ouyang shunlin
? The most important disease of the middle ear
and mastoid are inflammations of various
kinds and hearing loses,Tumors of the
middle ear are rare, In this chapter we'll
mainly discussed acute suppurative otitis
media (ASOM) and chronic suppurative
otitis media (CSOM)
ASOM
? Acute suppurative otitis media is one of
the most common infections of childhood,It
may accompany any upper respiratory tract
infection such as the common cold,measles,
scarlet fever,or influenza,When virulent
bacteria invade the middle ear,an acute
suppuration occurs.
Bacteriology
? The haemolytic streptococcus,
staphylococcus or the pneumococcus are
most commonly responsible for the infection.
Infection route
? ① Bacteria or virus via the
pharyngotympanic tube into middle ear is
the maximum incidence in childhood.
? ② Infection via the external meatus is liable
to occur when a tympanic membrance
perforation is present.
? ③ otitis media arising as a blood-borne
infection is rare.
Pathology
? 1.tubal occlusion;
? 2.presuppuration;
? 3.suppuration;
? 4.resolution.
? severe,deep throbbing pain in the ear is the
cardinal symptoms;
? temperature elevation (more in infants or
children)
? hearing loss,dizziness,nausea,tinnitus
? Purulence (a mixture of blood and pus)
symptoms
Signs
? examination shows the
tympanic membrance is
thick,red,and dull,If
rupture has occurred,pus
and the perforation may be
seen.
? conductive hearing loss.
? there is usually pain during
pressure over the mastoid
antrum.
Differential Diagnosis
? external otitis or
furunculosis of external
auditory meatus,
postauricular tenderness.
? bullous myringitis,the
earache may be intense but
deafness only slight,the
membrane may be
obscured by a large
haemorrhagic bleb or blebs.
Treatment
? 1.Antibiotics should be given in full
dosage,Penicillin is the drug of choice for
empirical selection,except when the patient
is sensitive to this drug,In any case,
antibiotic sensitivity studies are important,
When sensitivity to penicillin is known to exist,
erythromycin,or broad-spectrum antibiotics
may be used.
? 2.ear drops:
? ① pre-rupture,2%phenol glycerine;
? ② after rupture,antibiotics solution such
as,
? 0.25%chloromycetin solution,
? 0.3%ofloxacin solution.
? 3.myringotomy is indicated
when there is bulging of the
drumhead and pain not
quickly relived by antibiotics,
Myringotomy is usually
performed to drain pus from
the ear in patients with
ASOM or to release serum
from the middle ear in
patients with secretory
media.
CSOM OR COM
? Neglected or recurrent infection of the middle ear may
eventually produce a chronic change in the mucosa of
the ear or destruction of the periosteum covering the
ossicles,The infection then tends to become chronic,
Chronic infection of the middle ear is much more
common in persons who had ear disease in early
children,Disease of the ear in infancy and early
children may arrest the normal pneumatization of the
mastoid,It is possible that the same process alters the
mucosa of the middle ear,so that it is more
susceptible to recurrent infection than is the normal
ear,
Aetiology and pathology
? 1.Bacteriology,characteristic of the
bacteriology of chronic otitis media is a
shift towards a predominance of gram-
negative bacilli,most frequently isolated
bacteria include Pseudomonas
aeruginosa,staphylococcus,proteus and
corynebacterium.
? 2.It is also known that chronic infection
occurs predominantly in nonpneumatizd
clefts,Here it must be said that there is a
difference opinion,some authorities
holding that failed pneumatization is a
result of infection and not a precondition.
? 3.The prevalence of CSOM is related to
social conditions.
? 4.Although a cholesteatoma may form and
gradually enlarge without contamination,it is
more common for infection early to
supervene upon a pre-existent
cholesteatoma,or for a cholesteatoma to
form as a result of infectin.
Cholesteatoma
?Histologically,cholesteatoma are
of two types,epidermoid
cholesteatoma and cholesterol
granuloma.
epidermoid cholesteatoma
? epidermoid cholesteatoma is a
bag-like cystic structure lined
by keratinizing stratified
squamous epithelium resting
on a fibrous stroma of variable
thickness,epidermoid
cholesteatoma is a by-product
of keratinizing squamous
epithelium,
cholesterol granuloma
? cholesterol granuloma is a
granulomatous structure formed
by variable numbers of
cholesterol crystals,sometimes
with haemosiderin,surrounded
by foreign body giant cells,and
embeded in fresh granulation
tissue,cholesterol granuloma
results from deposition of
cholesterol at a site of
suppuration or haemorrhage,
and is often associated with a
blue drum,
Congenital cholesteatoma
? A congenital cholesteatoma is
aetiologically unconnected with
chronic suppurative otitis and is
generally anatomically unconnected
with the middle ear cleft,It arises in
an embryonic cell rest in any of the
cranial bones and may remain
undetected for years,If it arise in the
temporal bone,i.e,petrous pyramaid,
it may,by extension,make
anatomical connection with the
middle ear cleft and become
infected therefrom..
Primary acquired cholesteatoma
? Primary acquired
cholesteatoma
refers to those
tumors arising
without a previous
otitis media
Genesis of primary
acquired cholesteatoma
Obstruticed attic by
embryonic remnants
Negative attic pressure
membrane
Invagination
Embryonic cell
rest Normal pavement
epithelium
Subclinnical infection
added
epithelial metaplasia
Squamous
epithelium
in middle ear
cholesteatoma
Tubal
occlusion
secondary acquired
cholesteatoma
? while secondary
acquired
cholesteatoma
occurs in ears known
to been the seat of a
previous infection,or
to be currently
infected,
Genesis of secondary acquired
cholesteatoma
? if a previous acute otitis media has resulted in
necrosis of the tympanic membrane and of middle
ear mucosa there may be a tendency,especially if
the perforation is marginal,for squamous
epithelium to migrate into the middle ear from the
external meatus,Especially,if a marginal
perforation or attic perforation exists,the
alternating processes of healing and degeneration
may result in the advance of squamous
epithelium into the middle.
Signs and symptoms
? The principal symptom of com is purulent otorrhoea,
while the principal sign is the observation of pus
coming from the middle ear via a perforation,
Otorrhoea may have been proceeding for years before
the patient seeks advice.
? Conductive deafness is inevitable in com;
? Increase smell or blood-staining,polypus at the
meatus,pain,vertigo,or headache,that often brings
the patients to the doctor,and not infrequently these
symptoms are indicative of complication requiring
urgent surgical intervention.
The safe ear(benign com) and
unsafe ear(dangerous com)
? safe ear unsafe ear
? disease area tubotympanic attic-antrum
? perforation anterior or central attic or marginal
? pus mucoid,odourless,profuse thick,fetid,scanty
? granulations uncommon common
? polypus if present,usually pale,usually hyperaemic,
? oedematous fleshy
? deafness conductive,usually conductive or mixed,
? slight to moderate moderate to severe
? cholesteatoma uncommon common
Diagnosis
? Signs and symptoms
? CT or X-ray film
Treatment
? Treatment has two main objectives; first to
arrest disease,and second to secure
conditions that will permit return of tissues to
normal or that will allow recovery of function,
It is,a general ideal of treatment to secure
these objectives by medical,if possible,in
preference to surgical means.
Medical treatment
? Topical antibiotic application:
? ① 0.25%chloromycetin solution
? ② 0.3%ofloxacin solution
? ③ 4%bonic acid alcohol
? aural toilet is an essential precursor to any
topical application,ear drops should be
applied by the displacement method.
Surgical treatment
? Primary objects of operative treatment:
? ① to render the patient safe
? ② to prevent further deterioration of function
operation methods
? cortical mastoidectomy(simple
mastoidectomy,Schwartze opration)
? classical radical mastoidectomy
? modified radical mastoidectomy,attic-
antrostomy
? anterior tympanotomy
? combined-approach mastoidectomy
? posterior tympanotomy
reconstructive surgery
? myringoplasty
? ossiculoplasty
? tympanoplasty
tympanoplasty
? tympanoplasty without
mastoidectomy (Closed technique)
? tympanoplasty with mastoidectomy
(Opened technique)
思考题
? 慢性化脓性中耳炎的临床分型及特点
Reference book
? Textbook of otolaryngology David d,
decease,MD sixth edith
? Disease of the ear Stuart R,mawson
fourth edith
?The end
? Thank
you
分泌性中耳炎
（ secretory otitis media SOM）
? 分泌性中耳炎是以鼓室积液及传导性
聋为主要特征的中耳非化脓性疾病。
又名卡他性中耳炎等。可分为急、慢
性两种，为小儿常见病。
病因
? 总之是尚未完全明确。可能病因有：
? 1、咽鼓管功能障碍
? 2、感染
? 3、免疫反应
临床表现
? 1、症状：听力减退，耳痛，耳鸣
? 2、检查：鼓膜改变。电测听为传导性聋，声阻抗
示 B或 C型鼓室导抗图
鉴别诊断
? 1、胆固醇肉芽肿，颈静脉球体瘤
? 2、脑脊液耳漏
? 3、鼻咽肿瘤
治疗
? 1、清除积液，改善通气引流：
? ①鼓膜穿刺抽液 ②鼓膜切开冲洗 (Myringotomy)
③ 鼓室置管术 (Gromnet insertion)
? 2、积极治疗原发疾病：鼻及鼻咽疾病等
? 3、药物治疗,
? ①抗生素 ②激素 ③沐舒坦等
思考题
? 分泌性中耳炎的临床表现及诊断
参考书
? 耳鼻咽喉科学 第五版 田勇泉主编
Guangzhou medical college
Second Affiliated Hospital
Otolaryngology
Ouyang shunlin
? The most important disease of the middle ear
and mastoid are inflammations of various
kinds and hearing loses,Tumors of the
middle ear are rare, In this chapter we'll
mainly discussed acute suppurative otitis
media (ASOM) and chronic suppurative
otitis media (CSOM)
ASOM
? Acute suppurative otitis media is one of
the most common infections of childhood,It
may accompany any upper respiratory tract
infection such as the common cold,measles,
scarlet fever,or influenza,When virulent
bacteria invade the middle ear,an acute
suppuration occurs.
Bacteriology
? The haemolytic streptococcus,
staphylococcus or the pneumococcus are
most commonly responsible for the infection.
Infection route
? ① Bacteria or virus via the
pharyngotympanic tube into middle ear is
the maximum incidence in childhood.
? ② Infection via the external meatus is liable
to occur when a tympanic membrance
perforation is present.
? ③ otitis media arising as a blood-borne
infection is rare.
Pathology
? 1.tubal occlusion;
? 2.presuppuration;
? 3.suppuration;
? 4.resolution.
? severe,deep throbbing pain in the ear is the
cardinal symptoms;
? temperature elevation (more in infants or
children)
? hearing loss,dizziness,nausea,tinnitus
? Purulence (a mixture of blood and pus)
symptoms
Signs
? examination shows the
tympanic membrance is
thick,red,and dull,If
rupture has occurred,pus
and the perforation may be
seen.
? conductive hearing loss.
? there is usually pain during
pressure over the mastoid
antrum.
Differential Diagnosis
? external otitis or
furunculosis of external
auditory meatus,
postauricular tenderness.
? bullous myringitis,the
earache may be intense but
deafness only slight,the
membrane may be
obscured by a large
haemorrhagic bleb or blebs.
Treatment
? 1.Antibiotics should be given in full
dosage,Penicillin is the drug of choice for
empirical selection,except when the patient
is sensitive to this drug,In any case,
antibiotic sensitivity studies are important,
When sensitivity to penicillin is known to exist,
erythromycin,or broad-spectrum antibiotics
may be used.
? 2.ear drops:
? ① pre-rupture,2%phenol glycerine;
? ② after rupture,antibiotics solution such
as,
? 0.25%chloromycetin solution,
? 0.3%ofloxacin solution.
? 3.myringotomy is indicated
when there is bulging of the
drumhead and pain not
quickly relived by antibiotics,
Myringotomy is usually
performed to drain pus from
the ear in patients with
ASOM or to release serum
from the middle ear in
patients with secretory
media.
CSOM OR COM
? Neglected or recurrent infection of the middle ear may
eventually produce a chronic change in the mucosa of
the ear or destruction of the periosteum covering the
ossicles,The infection then tends to become chronic,
Chronic infection of the middle ear is much more
common in persons who had ear disease in early
children,Disease of the ear in infancy and early
children may arrest the normal pneumatization of the
mastoid,It is possible that the same process alters the
mucosa of the middle ear,so that it is more
susceptible to recurrent infection than is the normal
ear,
Aetiology and pathology
? 1.Bacteriology,characteristic of the
bacteriology of chronic otitis media is a
shift towards a predominance of gram-
negative bacilli,most frequently isolated
bacteria include Pseudomonas
aeruginosa,staphylococcus,proteus and
corynebacterium.
? 2.It is also known that chronic infection
occurs predominantly in nonpneumatizd
clefts,Here it must be said that there is a
difference opinion,some authorities
holding that failed pneumatization is a
result of infection and not a precondition.
? 3.The prevalence of CSOM is related to
social conditions.
? 4.Although a cholesteatoma may form and
gradually enlarge without contamination,it is
more common for infection early to
supervene upon a pre-existent
cholesteatoma,or for a cholesteatoma to
form as a result of infectin.
Cholesteatoma
?Histologically,cholesteatoma are
of two types,epidermoid
cholesteatoma and cholesterol
granuloma.
epidermoid cholesteatoma
? epidermoid cholesteatoma is a
bag-like cystic structure lined
by keratinizing stratified
squamous epithelium resting
on a fibrous stroma of variable
thickness,epidermoid
cholesteatoma is a by-product
of keratinizing squamous
epithelium,
cholesterol granuloma
? cholesterol granuloma is a
granulomatous structure formed
by variable numbers of
cholesterol crystals,sometimes
with haemosiderin,surrounded
by foreign body giant cells,and
embeded in fresh granulation
tissue,cholesterol granuloma
results from deposition of
cholesterol at a site of
suppuration or haemorrhage,
and is often associated with a
blue drum,
Congenital cholesteatoma
? A congenital cholesteatoma is
aetiologically unconnected with
chronic suppurative otitis and is
generally anatomically unconnected
with the middle ear cleft,It arises in
an embryonic cell rest in any of the
cranial bones and may remain
undetected for years,If it arise in the
temporal bone,i.e,petrous pyramaid,
it may,by extension,make
anatomical connection with the
middle ear cleft and become
infected therefrom..
Primary acquired cholesteatoma
? Primary acquired
cholesteatoma
refers to those
tumors arising
without a previous
otitis media
Genesis of primary
acquired cholesteatoma
Obstruticed attic by
embryonic remnants
Negative attic pressure
membrane
Invagination
Embryonic cell
rest Normal pavement
epithelium
Subclinnical infection
added
epithelial metaplasia
Squamous
epithelium
in middle ear
cholesteatoma
Tubal
occlusion
secondary acquired
cholesteatoma
? while secondary
acquired
cholesteatoma
occurs in ears known
to been the seat of a
previous infection,or
to be currently
infected,
Genesis of secondary acquired
cholesteatoma
? if a previous acute otitis media has resulted in
necrosis of the tympanic membrane and of middle
ear mucosa there may be a tendency,especially if
the perforation is marginal,for squamous
epithelium to migrate into the middle ear from the
external meatus,Especially,if a marginal
perforation or attic perforation exists,the
alternating processes of healing and degeneration
may result in the advance of squamous
epithelium into the middle.
Signs and symptoms
? The principal symptom of com is purulent otorrhoea,
while the principal sign is the observation of pus
coming from the middle ear via a perforation,
Otorrhoea may have been proceeding for years before
the patient seeks advice.
? Conductive deafness is inevitable in com;
? Increase smell or blood-staining,polypus at the
meatus,pain,vertigo,or headache,that often brings
the patients to the doctor,and not infrequently these
symptoms are indicative of complication requiring
urgent surgical intervention.
The safe ear(benign com) and
unsafe ear(dangerous com)
? safe ear unsafe ear
? disease area tubotympanic attic-antrum
? perforation anterior or central attic or marginal
? pus mucoid,odourless,profuse thick,fetid,scanty
? granulations uncommon common
? polypus if present,usually pale,usually hyperaemic,
? oedematous fleshy
? deafness conductive,usually conductive or mixed,
? slight to moderate moderate to severe
? cholesteatoma uncommon common
Diagnosis
? Signs and symptoms
? CT or X-ray film
Treatment
? Treatment has two main objectives; first to
arrest disease,and second to secure
conditions that will permit return of tissues to
normal or that will allow recovery of function,
It is,a general ideal of treatment to secure
these objectives by medical,if possible,in
preference to surgical means.
Medical treatment
? Topical antibiotic application:
? ① 0.25%chloromycetin solution
? ② 0.3%ofloxacin solution
? ③ 4%bonic acid alcohol
? aural toilet is an essential precursor to any
topical application,ear drops should be
applied by the displacement method.
Surgical treatment
? Primary objects of operative treatment:
? ① to render the patient safe
? ② to prevent further deterioration of function
operation methods
? cortical mastoidectomy(simple
mastoidectomy,Schwartze opration)
? classical radical mastoidectomy
? modified radical mastoidectomy,attic-
antrostomy
? anterior tympanotomy
? combined-approach mastoidectomy
? posterior tympanotomy
reconstructive surgery
? myringoplasty
? ossiculoplasty
? tympanoplasty
tympanoplasty
? tympanoplasty without
mastoidectomy (Closed technique)
? tympanoplasty with mastoidectomy
(Opened technique)
思考题
? 慢性化脓性中耳炎的临床分型及特点
Reference book
? Textbook of otolaryngology David d,
decease,MD sixth edith
? Disease of the ear Stuart R,mawson
fourth edith
?The end
? Thank
you
分泌性中耳炎
（ secretory otitis media SOM）
? 分泌性中耳炎是以鼓室积液及传导性
聋为主要特征的中耳非化脓性疾病。
又名卡他性中耳炎等。可分为急、慢
性两种，为小儿常见病。
病因
? 总之是尚未完全明确。可能病因有：
? 1、咽鼓管功能障碍
? 2、感染
? 3、免疫反应
临床表现
? 1、症状：听力减退，耳痛，耳鸣
? 2、检查：鼓膜改变。电测听为传导性聋，声阻抗
示 B或 C型鼓室导抗图
鉴别诊断
? 1、胆固醇肉芽肿，颈静脉球体瘤
? 2、脑脊液耳漏
? 3、鼻咽肿瘤
治疗
? 1、清除积液，改善通气引流：
? ①鼓膜穿刺抽液 ②鼓膜切开冲洗 (Myringotomy)
③ 鼓室置管术 (Gromnet insertion)
? 2、积极治疗原发疾病：鼻及鼻咽疾病等
? 3、药物治疗,
? ①抗生素 ②激素 ③沐舒坦等
思考题
? 分泌性中耳炎的临床表现及诊断
参考书
? 耳鼻咽喉科学 第五版 田勇泉主编
