,單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),*,單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),*,Otitis Media with Effusion,Otitis Media with Effusion,Definition,OME refers to a,non-purulent inflammation,in the middle ear cleft,characterized by,conductive hearing loss,and,effusion,in the tympanic cavity.,Acute:less than 8 weeks,Chronic:more than 8 weeks,Definition OME refers to a non,Symptoms usually involve,hearing loss,or,aural fullness,but typically do not involve pain or fever.,Symptoms usually involve heari,In children,hearing loss is generally,mild,and is often detected only with an audiogram.,The most common cause of hearing loss in children in the developed world,and has peaks in incidence from 2 to 5 years of age.,More than 50%of children experience OME in the first year of life.,In children,hearing loss is g,Etiology,Eustachian tube(ET)dysfunction,Inflammatory theory,Others,Etiology Eustachian tube(ET),Etiology,Eustachian tube(ET)dysfunction,Mechanical,Intrinsic,mechanical obstruction:,Inflammation,of the mucous membrane of the ET.,Allergic diathesis,causing edema of the tubal mucosa.,Extrinsic,mechanical obstruction:,obstructing masses:,Adenoid hyperplasia,Chronic rhinitis and sinusitis,Chronic tonsilitis,Nasopharyngeal tumor,EtiologyEustachian tube(ET)d,Etiology,Eustachian tube(ET)dysfunction,Functional,Result of either decreased tubal,stiffness,or an inefficient,active opening,mechanism.,Proponents believe that either form of obstruction results in,inadequate ventilation,of the middle ear with resulting,negative middle ear pressure.,EtiologyEustachian tube(ET)d,Inflammatory theory,41%incidence of positive bacterial cultures,Streptococcus pneumoniae,Haemophilus influenzae,Viruses,：,influenza V.,adenovirus,Inflammatory theory,Others:,Allergy,Middle effusion contain,immunoglobulins,(IgA,、,IgG,、,IgM,、,IgD),，,immune,complexes,and,chemical mediators,involved in the inflammatory response.,Possible humoral immune deficiencies,nasal and/or sinus disease,Others:,Clinical Findings,Clinical Findings,History,OME nearly always,follows AOM,as it resolves.However,MEE can be present without preceding AOM,May be completely asymptomatic,Most common symptom:hearing loss,Aural fullness and/or pressure,“,blocked,”,felling,Acute:mild earache,tinitus,HistoryOME nearly always follo,Physical examination,Otoscopy:,loss of the light reflex,translucent membrane,decreased mobility,of the tympanic membrane,yellowness and/or redness with,hypervascularity,purulent MEE.,air-fluid meniscus,bullae,Physical examinationOtoscopy:,Physical examination,Bubbles confirming the presence of fluid,Air-fluid meniscus,Physical examinationBubbles co,Physical examination,Advanced otitis media with effusion with markedly retracted right tympanic membrane,with an apparent foreshortened handle of the malleus and thick,mucoid effusion,Otitis media with effusion.The tympanic membrane is opaque,has lost its transparency,is vascularized,and retracted.The light reflex is shorter and moved upward due to retraction of the tympanic membrane,Physical examination Ad,Physical examination,Nasopharynscopy:,Adenoid hypertrophy,Nasopharyngeal carcinoma,Physical examinationNasopharyn,Physical examination,Tympanometry,Type B or Type C,Physical examinationTympanomet,Physical examination,Audiometry,usually a moderate conductive hearing loss,Physical examinationAudiometry,Physical examination,Tympanocentesis,both a therapeutic and a diagnostic procedure,A complete examination of the head and neck to exclude other disease such as,adenoid,hypertrophy,NPC et al.,Physical examinationTympanocen,Differential Diagnosis,Nasopharyngeal carcinoma,Cerebrospinal fluid otorrhea,Differential Diagnosis Nasopha,Treatment,Observation,A large number of patients with OME require no treatment,particularly if the hearing impairment is mild.,Spontaneous resolution occurs in a significant proportion of patients.,A period of,watchful waiting,of,3 months,from the onset(if known)or from the diagnosis(if onset unknown)before considering intervention is therefore advisable,spontaneous resolution in over 90%of children.,Treatment Observation,Treatment,Ideally,early treatment should be initiated in patients in whom spontaneous resolution is unlikely.,A bilateral hearing impairment of,30 dB,is factor that make spontaneous resolution less likely.,If there is a significant delay in speech and language development or if OME is present in an only hearing ear.,TreatmentIdeally,early treatm,Principles:,Relieve,pathogeny,Improve,drainage,in,middle,ear,Remove,effusion,Principles:,Nonsurgical Measures,Medical treatments include antibiotics,steroids.,Catheterization,Decongestion,Nonsurgical Measures,Surgical Measures,Tympanotomy,Myringotomy,Myringotomy with ventilation tube insertion,Mastoidectomy,Adenoidectomy,tonsillectomy,Surgical Measures,Myringotomy with grommet insertion,Myringotomy with grommet inser,耳鼻咽喉科學(xué)ppt課件：6_Otitis-Media-with-Effusion,Preoperation,Postoperation,Preoperation Postoperation,Adenoidectomy