1、.1.2一、一、overviewnOtitis media with effusion(OME)is characterized by accumulation of fluid in the middle ear,conductive hearing loss,and is a kind of non-purulent diseases of middle ear.3nOME occurs as a result of decreased ventilation of the middle ear or mastoid air-cell system through the eustachi
2、an tube.4 Serous Otitis Media Glue Ear Non-purulent Otitis Media OME is called other names:.5nOME is one of the most commonly resulting in deafness among children.OME occurs in adult too.6.7.8Function of the eustachian tubenThe eustachian tube is essential in maintaining a healthy,well-aerated the m
3、iddle ear.9.10 The eustachian tube ventilates the middle ear,protects it from pathogenic organisms in the nasopharynx,equilibrates pressure across the tympanic membrane,and allows drainage of secretions from the middle ear into nasopharynx.11 At rest,the eustachian tube is closed.During swallowing,y
4、awning,or sneezing,the nasopharyngeal orifice of eustachian tube is opened transiently.12nThe anatomy of the eustachian tube of infants is different from adults.nThe infantile eustachian tube is more horizontal orientation,shorter length,and more patulous configuration than adult.13二、二、Pathogenesisn
5、Any process that interferes with normal opening of proximal(nasopharyngeal)end of the eustachian tube or mucociliary clearance mechanism causes OME.14(1)、mechanical obstruction:nlarge or infected adenoids nturbinate hypertrophy n neoplasm of nasopharynx nnasopharyngeal edema or inflammation.15(2).Al
6、lergynAllergy reaction affects both mucociliary clearance mechanism and normal eustachian tube opening.16(3).Abnormal eustachian tube anatomynSuch as:cleft palate deformities can impair eustachian tube function.17 Functional disorders of eustachian tubenegative pressure in tympanic cavity veins in m
7、ucous be dilated and be congested vessels permeance be increased serum in vessels be exuded into tympanic cavity middle ear effusion.18三三.Clinical Presentationn Symptoms Conductive Hearing Loss,Earache,Ear fullness,Tinnitus.19Physical ExaminationTympanic Membrane to be retracted ,dull,opaque .color
8、can range from:light pink to amber and even dark blue.20.21.22.23 Audiometric Testing nreveals:Mildmiddle levels of conductive hearing loss .24Audiogram.25 Acoustic Immittance.26 Normal acoustic immittance is“type_A”curve.The curve has peak at“O”Pascal pressure point.nOMEs Acoustic immittance is“typ
9、e_B”curve.It is flat tympanometric curve.27四、四、Diagnosisn(一一)、History:Some patients suffered upper respiratory tract infection before 1 2 weeks,or suffered rhinitis,adenoids hypertrophy et.Perennial.28（二）、（二）、Clinical presentation:nhearing impairment n tinnitus near obstruction nEarache(ear pain).29
10、(三三)、Physical examinationntympanic membrane be retractedntympanic cavity effusion.30（四）、（四）、Audiometric TestingnMild middle level conductive hearing loss（五）、（五）、Acoustic Immittance“type_B”curve.311、tympanosclerosis2、glomus jugulare tumor 3、cerebrospinal otorrhea 、nasopharyngeal carcinoma五、五、Differen
11、tial Diagnosis.32六、ManagementnPrinciples of Management：n（一）、（一）、Eliminate middle ear effusion,improve middle ear ventilation and drainage.33(1)、Keep expedite nasal cavity and eustachain tubenChild:0.5%ephedrine and furacilline solution Adult:1%ephedrine and furacilline solution.34(2)、Eustachian tube
12、 insufflation Valsalva methodPolitzer methodCatheterization.35(3)、Puncture of Tympanum.36(4)、Tympanotomy.37(5)、Tympanostomy Tube.38（二）、（二）、Management of etiology Treatment nasal and nasopharyngeal diseasesExample:adenoid hypertrophy_ adenoidectomyradiation of nasopharyngeal carcinoma.39（三）、（三）、Antib
13、iotic treatmentnPenicillinnCephradinenTreatment maintains 35 days by oral(mild)or by injection,IV(severe).40（四）、四）、Steroid treatmentnDexamethasone:Adult:510mg/day,35days,by injection,IV.41七、七、PreventionnExercisenPrevent flunTreatment nasal and nasopharyngeal diseases.425.Questions1.What is the otitis media with effusion(OME)?2.What are the essential causes of OME?3.Please represents main clinical presentations of OME.43Reference BooknOtolaryngology Head&Neck Surgery Third Edition Charles W.Cummings,M.D.1998 Mosby-Year Book,Inc.44
