Adhesive otitis media
Introduction
Introduction to adhesive otitis media Adhesive otitis media (adhesiveotitismedia) is also known as chronic catarrhal or fibrous otitis media. The adhesion is mostly located in the posterior part of the middle tympanic cavity. The tympanic membrane becomes thicker and adheres to the tympanic membrane. The ossicular bone can be adhered to the vestibular window alone or completely. The fibrous tissue embeds the tibia and the anvil bone together on the vestibular window, and the vestibular window. Can be partially or completely closed. Histological examination of the mucosal epithelium is a solid fibrous tissue, which may have calcification or new bone formation, but much less than tympanic hardening, the pathology of the two is difficult to distinguish. The ossicle can also be partially absorbed, and the ossicular chain is interrupted. Adhesive otitis media is a fibrous tissue hyperplasia or scar formation in the middle ear, which is the result of inflammation of the middle ear. Often sick in childhood. basic knowledge Sickness ratio: 0.01%-0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: subperiosteal abscess in the ear, labyrinth, sigmoid sinus thrombophlebitis, subperiosteal abscess
Cause
Causes of adhesive otitis media
Bacterial infection (40%)
Suppurative otitis media or secretory otitis media caused by bacterial infection, when the above two types of otitis media are not prolonged enough to damage the middle ear mucosa, it can cause fibroblasts in the granulation tissue to produce new fibrous tissue, or effusion. The process can cause the mucosa inside the drum to adhere to the tympanic membrane, and even the ossicular chain is fixed. It is generally believed that acute otitis media is treated with antibiotics alone, neglecting tympanic drainage and restoring eustachian tube function, which is the main cause of tympanic adhesion.
Tympanic fibrosis (20%)
The adhesion is mostly located in the posterior part of the middle tympanic cavity. The tympanic membrane becomes thicker and adheres to the tympanic membrane. The ossicular bone can be singly or completely adhered around the oval window. The fibrous tissue embeds the tibia and the long bone of the anvil bone together on the oval window. The oval window can be partially or completely closed. Adhesive otitis media is divided into three phases: 1 acute eustachian tube inflammation, obstruction of the eustachian tube, negative pressure in the tympanic cavity, and exudation of fluid. 2 The exudate is mechanized, adhesion occurs, and the mucous membrane of the middle ear mastoid mucosa is edematous. The exudate contains cholesterol crystals, and the mastoid small chamber is filled with connective tissue. 3 mastoid small chamber with gas absorption, small bone absorption, early edema obstruction of the eustachian tube, can be re-swelled and smooth in the later stage.
Genetic factors (3%)
Clinical case statistics revealed a family history of induction of the disease.
Prevention
Adhesive otitis media prevention
Pay attention to the indoor air circulation, keep the nasal cavity open, actively treat nasal diseases, blow nose can not force and simultaneously close the two nostrils, should cross the unilateral snot, after the swimming to let the water out of the ear, chronic otitis media should not swim, Actively prevent colds.
Complication
Adhesive otitis media complications Complications , subperiosteal abscess, labyrinthitis, sigmoid sinus thrombophlebitis, subperiosteal abscess
The suppurative inflammation of the middle ear can cause various complications. The main route of infection is direct erosion and destruction of bone. Most of them are caused by acute exacerbation of chronic cholesteatoma otitis media. It is more common in male young adults and pathogenic bacteria. Proteus, Pseudomonas aeruginosa and hemolytic streptococcus, staphylococcus, pneumococcal mixed infection is common, according to the site of complications can be divided into extracranial, intra-temporal and intracranial 3, extracranial and tibia internal complications are common There are post-periosteal abscesses, labyrinthitis and facial paralysis; intracranial complications are common meningitis, sigmoid sinus thrombophlebitis, brain abscess, etc. Among the 3 types of complications, intracranial complications are the most critical, diagnosis and Improper handling and high mortality are one of the most serious diseases of otolaryngology.
Symptom
Adhesive middle ear inflammation symptoms Common symptoms Hearing loss Tinnitus hearing loss
Clinical manifestations of adhesive otitis media:
(1) The patient has a history of otitis media in the past. The main symptoms are hearing loss and tinnitus.
(2) Tympanic membrane examination showed that the tympanic membrane was invaginated or atrophied, thickened, turbid, the surface was uneven, the light cone disappeared, and the mobility was limited. Sometimes the tympanic membrane shrinks and thins, invaginates adhesions, scar formation, and sees calcified plaques, sometimes with the drumsticks sticking together like a large perforation of the tympanic membrane. The original tympanic membrane perforator, the new tympanic membrane is thin and translucent. An otoscope examination showed that the tympanic membrane activity was weakened or disappeared.
(3) Hearing tests are conductive, and in severe cases, mixed hemorrhoids may occur. The tympanogram of the acoustic impedance test showed a low peak type (As type) or a tympanic negative pressure type (c type), and the sacral muscle reflex disappeared, suggesting that the tympanic membrane was above.
Examine
Examination of adhesive otitis media
Otoscopy: Most patients have intact tympanic membrane, but have different degrees of atrophy, thickening, scarring, turbidity or calcification. Sometimes there is a pronounced pocket-shaped invagination of the tympanic membrane or the tension, and the short break of the hammer stem and the hammer bone is prominent. The activity of the entire tympanic membrane is weakened or inactive, and the surface of the tympanic membrane may have a local blistering outward bulging, and individual patients may have effusion in the tympanic cavity.
Audiological examination: pure tone test is mostly conductive hearing loss, and the hearing curve is generally flat type, not more than 60dB. If the lesion involves two windows or the inner ear, there is a mixed hearing loss. The tympanogram of the acoustic impedance test is B type, and the sacral muscle reflex disappears.
Eustachian tube function test: The eustachian tube showed different degrees of obstruction, and the symptoms of the patient were usually not improved after the eustachian tube was blown.
Imaging of the humerus: X-ray film or CT scan of the mastoid can show poor gasification of the mastoid, and the air cavity of the middle ear and mastoid disappears, showing low-density shadows, generally without bone destruction.
Nasopharyngeal and nasal examination: Nasal endoscopy or fiberoptic nasopharyngoscopy can be used to understand the pathological changes of nasopharyngeal and nasal diseases.
Diagnosis
Diagnosis and identification of adhesive otitis media
Diagnosis of adhesive otitis media:
1. Hearing loss, conductive convulsions, and more with tinnitus.
2. The tympanic membrane is intact, turbid, invaginated, calcium spot, thickened or atrophied; the tympanic membrane and the drumstick are irregularly adhered, and the activity is poor. If the tympanic membrane shrinks and becomes thin, and the bag is invaginated, the structure inside the drum can be clearly seen, which is easily misdiagnosed as tympanic membrane perforation.
3. Eustachian tube function has many obstacles. The acoustic impedance test shows that the tympanic pressure curve is type B. The staped muscle reflex disappeared.
To identify otitis externa and edema, acute tympanitis:
(1) External auditory canal inflammation and edema, diffuse swelling in the external auditory canal and ear canal, exudation of pulpy secretions, late limitation of edema and pus, secretion without mucus, deafness is not characteristic. Pressing the tragus is painful, and the lymph nodes are often swollen after the ear.
(B) acute tympanitis, often complicated by influenza and herpes zoster, tympanic membrane congestion forming a cannon, severe ear pain, but no perforation and pus, hearing loss is not heavy, blood leukocytes do not increase.
