chronic suppurative otitis media
Introduction
Introduction to chronic suppurative otitis media Chronic suppurative otitis media is a chronic suppurative inflammation of the middle ear mucosa, periosteum or deep bone, often associated with chronic mastoiditis. Mostly due to delayed treatment or treatment of acute suppurative otitis media, prolonged to chronic; or a direct continuation of acute necrotic otitis media. The presence of chronic lesions in the nose and throat is also an important cause. Generally, 6 to 8 weeks after the onset of acute inflammation, middle ear inflammation still exists, collectively referred to as chronic. The disease is extremely common. Clinically, it is characterized by repeated pus in the ear, perforation of the tympanic membrane and hearing loss. Can cause serious intracranial and extracranial complications and endanger life. The disease needs to be differentiated from chronic suppurative otitis media with chronic tympanic hemitis, chronic tympanitis, middle ear cancer, tuberculous otitis media, and the like. Middle ear cancer is a rare malignant cancer that occurs in the middle ear, mostly primary. The cause of middle ear cancer is likely to be a long-term infection of the middle ear. According to statistics, most patients with middle ear cancer have a history of chronic suppurative otitis media. The age of onset is mostly 40 to 60 years old. The pathology of this disease is the most common squamous cell carcinoma, and basal cell carcinoma and adenocarcinoma are rare in the middle ear. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: vertigo meningitis
Cause
Causes of chronic suppurative otitis media
Acute infectious diseases (25%):
Secondary to acute infectious diseases such as scarlet fever, measles and pneumonia, acute necrosis of the middle ear mucosa, inflammation invading the sinusoidal mastoid, especially secondary to the more resistant Proteus and Pseudomonas aeruginosa infection, treatment is very difficult .
Nasal, pharyngeal chronic disease (20%):
Nasal, pharyngeal chronic diseases and sinusitis, tonsillitis and hypertrophy of hypertrophy, inflammatory secretions easily enter the eustachian tube, and the lesions hinder the drainage of the pharynx.
Improper medication (15%):
Delayed treatment and improper medication in the acute phase.
Mastoid dysplasia (10%):
Mastoid dysplasia, difficult to dissipate after the lesion occurs.
Chronic general illness (10%):
Chronic body diseases such as anemia, diabetes, tuberculosis and nephritis, the body's resistance is weakened.
Allergic disease (5%):
Suffering from allergic diseases, such as respiratory mucosal allergic edema, exudation, involving the eustachian tube and middle ear.
Cholesteatoma occurs in the upper tympanic cavity, and the bones are necrotic or the outer wall of the drum is destroyed.
Prevention
Chronic suppurative otitis media prevention
1. If you get water in your ear when you take a bath or swim, you may easily breed bacteria. If you have already entered the water, you can use a cotton swab to clean it, but the depth should not be too deep.
2. People who have had otitis media are prone to relapse. They should avoid colds. Once they have a cold or otitis media, they should be treated by a qualified doctor.
3. If someone smokes at home, paint or scent, keep the air flowing, which will prevent the upper respiratory tract mucosa from being stimulated and cause swelling.
Complication
Chronic suppurative otitis media complications Complications vertigo meningitis
Common complications of mastoidectomy are:
1 Injury facial paralysis, due to anatomical unfamiliarity, improper operation technique and congenital facial nerve anomaly, can cause partial or complete injury, 80% in the tympanic segment.
2 damage level semi-regular tube or scrape the humerus, causing symptoms such as dizziness, nausea, vomiting, such as secondary infection can cause permanent sputum,
3 surgical exposure of meningeal or sigmoid sinus plate causes intracranial infection such as meningitis,
4 damage to the internal jugular vein and internal carotid artery, causing massive bleeding, occasionally in patients with gallbladder destruction and severe osteomyelitis,
5 The bone bridge is not completely open and the bone wall of the external auditory canal is not sufficiently cut, resulting in granulation of the external auditory canal. In the future, scars are formed and even locked.
6 The most common is cholesteatoma. If the diseased tissues such as granulation and osteitis are not completely removed, the postoperative pus will continue.
Symptom
Chronic suppurative middle ear symptoms Symptoms Common ear lobes, earache, secondary infection, vertigo, dizziness, conduction, deafness, ear discharge, meningitis, granuloma
According to the pathology and clinical manifestations are divided into three types:
(1) simple type: the most common, mostly due to recurrent upper respiratory tract infection, the pathogenic bacteria invade the tympanic cavity through the eustachian tube. The clinical features are; ear pus, mostly intermittent, mucinous or mucous pus Sexuality, generally not stinky, the amount varies, when the upper respiratory tract infection, the amount of pus increases, the perforation of the tympanic membrane is mostly central to the tension, the size is different, but there are residual tympanic membrane around the perforation, the tympanic mucosa is pink or pale, light Degree is thickened, deafness is conductive, generally not heavy;
(B) type of bone ulcer: also known as necrotic or granulation type, mostly from acute necrotic otitis media, this type of characteristics: ear pus is mostly persistent, purulent bloodshot, often smelly, tympanic membrane tension Large perforations may involve drum rings or marginal perforations, granulation or polyps in the tympanic cavity, and may protrude through the external auditory canal through the perforation, and the conductive sputum is heavier;
(C) cholesteatoma type: cholesteatoma non-true tumor, but a cystic structure located in the middle ear, mastoid cavity, because the capsule contains cholesterol crystals, it is called cholesteatoma;
The ear continues to pus for a long time, and has a special malodor. The tympanic membrane is loose or has a marginal perforation on the upper part of the tension. From the perforation, there is a gray-white scaly or bean-like substance in the drum, which is strangely odorous and generally has a relatively heavy conductive . The lesion spreads to the cochlea and the deafness is mixed.
According to the severity of the lesion and the degree of risk, it is divided into three types.
(1) Simple type, also known as eustachian tube tympanic type, most commonly seen, the lesion is mainly confined to the tympanic cavity, the normal eustachian tube and the anterior tympanic cavity are covered by ciliated columnar epithelium, containing gland, posterior tympanic cavity, sinus sinus and mastoid Cuboidal epithelium, tympanic bone, muscles, ligaments and nerves are surrounded by mucous membranes, forming many wrinkles and shallow pockets. Generally, mucosal infections are inflamed. If the treatment is timely, the tympanic membrane is perforated and the circulation is smooth, and the inflammation can be cured quickly. Otherwise, The lesions in the shallow bag are enlarged, and the mucosal lesions become irreversible. Although there are not many pus in the pus, the long-term pus is not enough, or the pus is repeated shortly after the healing, and the mastoids are well vaporized and innocent.
(2) Necrotic type, also known as bone ulcer type, extensive destruction of mucosal tissue, hemorrhage and necrosis can occur in the ossicle, drum ring, sinus sinus and mastoid small room, especially the perforation occurs above the slack and the posterior tympanic cavity. More and more odor, perforation often see granulation and polyps obstruction drainage, severe hearing loss, sometimes headaches and dizziness, mastoids are mostly interstitial or sclerotic.
(3) The cholesteatoma type is also called dangerous type. The hyperplasia epithelial mass is formed in the tympanic or sinus sinus. It is surrounded by fibrous tissue, containing necrotic upper mass, keratin and cholesterol crystal, which can destroy bone by pressure. It has the nature of malignant tumors, so it was mistakenly called cholesteatoma in the past. It is not a tumor in nature. Although there are not many ear sputums, it is very strange. There are white fragments in the perforation, and the cholesteatoma epithelial group. Cause headache, dizziness, extensive destruction of bone, easy to complicated with intracranial and extracranial complications, it is called dangerous otitis media, mastoids are mostly hardened.
Simple type necrotic cholesteatoma type purulent mucus or purulent, not thick, white or yellowish, odor is not completely purulent, not thick, yellow, sometimes bloody, odorous and completely purulent, A small amount, very thick, with suede, yellow color, great odor, like a stinky egg recurrent time, intermittent persistent or intermittent, pus rarely edema tympanic membrane perforation mostly central small perforation central large perforation , or marginal perforation slack or marginal perforation ossicular chain is normal, tympanic mucosal edema is damaged, tympanic granules and polyps are damaged, tympanic granules and cholesteatoma deafness mildly conductive deafness moderate Conductive deafness, severe conductive deafness, or mixed deafness, cholesteatoma, few common mastoid X-rays, increased small chamber density, no bone destruction, interstitial mastoid osteomyelitis, intergranular destruction, sclerosing mastoid, There are many edges with neat round bone destruction.
Middle ear mucosal inflammation can induce cholesteatoma and cholesterol granuloma containing cholesterol crystals. Although the latter is Choleatosis, it is only a granuloma, which is quite different from the epithelial accumulation of cholesteatoma. The main differences between the etiology and pathology are:
1. Cholesterol granuloma due to obstruction of the eustachian tube, negative pressure in the tympanic cavity, exudation or formation of rubber ear, capillary bleeding, cholesterol crystals and hemoglobin precipitation formed on the epithelial surface, tympanic membrane blue, small mastoid Room mucosal edema, typical manifestations of cholesterol granuloma under the microscope, cholesterol crystals surrounded by foreign body giant cells, outer layer of fibrous granulation tissue, more common in tympanic hemorrhagic necrotizing lesions, not the predecessor of cholesteatoma, not related to cholesteatoma formation .
2. There are two mechanisms of cholesteatoma
(1) Congenital cholesteatoma is rare. The remaining epithelial tissue of the inner ear is stimulated by a certain factor to proliferate too long, and the epithelial mass formed is mostly located in the upper tympanic cavity. There is no history of otitis media, and the tympanic membrane is completely normal. After dilating through the tympanic membrane, it begins to pus due to secondary infection.
(2) Acquired cholesteatoma is a localized stimulation of epithelial hyperplasia, which accounts for 30% of chronic otitis media. The causes are different. Nowadays, most people accept the theory, one is the epithelial migration theory, that is, the external auditory canal. The basal cells of the skin germinal layer have special proliferative growth potential. Under the stimulation of otitis media, the basal cells proliferate and invade the submucosal connective tissue or form granuloma, while submucosal sclerosis forms new bone, the mass increases, and the tympanic membrane is secondary. Perforation, the formation of epithelial mass epithelial stratum corneum shedding necrosis, secondary infection, can precipitate cholesterol and a variety of chemical spoilage substances, this physicochemical factors can cause erosion of surrounding bones, expose the surrounding meninges, nerves and Blood vessels, and many intracranial and extracranial complications, which destroy tissue performance like tumors, so Wendt (1873) was first named cholesteatoma, which is not a tumor, but it has been used for a long time and needs to be corrected later. Another view is that It is caused by upper respiratory tract infection, obstruction of eustachian tube, negative pressure in tympanic cavity, invagination of tympanic membrane, or epithelium behind external auditory canal Into the sinus sinus to form a capsular bag, which is the pre- cholesteatoma, this period can be maintained for several years, such a timely removal of accumulated keratin, can eliminate the formation of cholesteatoma, or the accumulated epithelial mass can be broken into the tympanic cavity once infected Forming a slack or marginal perforation and cholesteatoma.
[clinical manifestations]
1. The nature and time of pus are different due to the severity of the lesion. The light is mucopurulent, intermittent, good and bad; the severe is persistent, yellow thick pus and smelly.
2. Acute attacks may include headache, earache, dizziness and fever. In severe cases, facial paralysis and meningitis may occur.
3. The early tympanic membrane is a central round or kidney-shaped perforation. Even the small perforation of the slack and the margin is visible. This area is often covered by purulent sputum, and there is little pus. If the purulent sputum is not carefully removed, it is easy to miss the diagnosis.
Examine
Examination of chronic suppurative otitis media
(A) simple type: mastoid X-ray film is often hardened, and no bone defects are destroyed.
(B) type of bone ulcer: mastoid X-ray film is a type of sclerosis or stenosis, accompanied by bone defect damage.
(C) cholesteatoma type: mastoid X-ray film shows the upper tympanic cavity, sinus or mastoid bone destruction area, the edge is thick and tidy.
Diagnosis
Diagnosis and differentiation of chronic suppurative otitis media
The disease needs to be differentiated from chronic suppurative otitis media with chronic tympanic hemitis, chronic tympanitis, middle ear cancer, tuberculous otitis media, and the like.
Middle ear cancer is a rare malignant cancer that occurs in the middle ear, mostly primary. The cause of middle ear cancer is likely to be a long-term infection of the middle ear. According to statistics, most patients with middle ear cancer have a history of chronic suppurative otitis media. The age of onset is mostly 40 to 60 years old. The pathology of this disease is the most common squamous cell carcinoma, and basal cell carcinoma and adenocarcinoma are rare in the middle ear.
Tuberculous otitis media is a tuberculosis infection. Mainly secondary to tuberculosis, can also be spread from adenoid tuberculosis or bone, joint tuberculosis and cervical lymph node tuberculosis, the bacteria can invade the middle ear through the eustachian tube, and the middle ear and milk through the blood circulation or lymphatic system. Sudden. Tuberculosis in the outer ear is rare, and tuberculous middle ear mastoiditis is occasionally reported.
