Necrotizing otitis externa
Introduction
Introduction to necrotizing otitis externa Necrotizing otitis externa is a progressive, dangerous otitis externa with invasive bone destruction. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: meningitis brain abscess
Cause
Causes of necrotizing otitis externa
It is initially believed that immune-mediated diseases can also explain the high incidence of diabetes. Because of the poor dysfunction of leukocyte migration in diabetic patients, phagocytosis is delayed or defective, lymphocyte reactivity is reduced, and opsonic antibodies are impaired. All these factors are easy to cause diabetes patients to be infected with the disease, malnutrition and anemia as the causative factors of the pathogen is Pseudomonas aeruginosa.
Prevention
Necrotizing otitis externa prevention
Prevention of necrotizing otitis externa:
First of all, you should quit bad habits. Digging the ear not only damages the skin and causes infection, but also often stimulates the skin to grow "external ear canal papilloma", causing frequent bleeding in the ear canal and even affecting hearing. Second, it is necessary to prevent sewage from entering the ear. Before washing your hair and swimming, you can use a special rubber stopper or a clean cotton ball to apply oil to block the external auditory canal. It is necessary to remove the external auditory canal or foreign body in time. Finally, care should be taken to keep your ears dry and avoid damage. Prevention and treatment of necrotizing otitis externa:
The principles of treatment for otitis externa are: control infection, cleanse the area, remove the molting, and promote dryness. In the acute phase, antibiotics such as methotrexate 0 5g can be applied systemically, orally, 3 times a day to control infection. Those with severe ear pain can take analgesics such as painkillers, 1 to 2 tablets each time. Local treatment can be applied to the external auditory canal with 5% to 8% aluminum acetate small gauze, and the patient can drip the above-mentioned liquid every 3 to 4 hours. The gauze is changed every day, which has astringent anti-inflammatory effect and can promote drying. Or coated with 2% to 5% silver nitrate solution; or coated with tetracycline cortisone ointment, erythromycin ointment, dermatitis ointment. Chinese medicine can be used in the otitis (see the external auditory canal edema) small gauze wet application, promote healing. In the chronic phase, the topical dermatitis flat ointment coating or the traditional Chinese medicine ear inflammatory soft gauze wet compressing effect is better; if the external auditory canal is thickened and rough, the traditional Chinese medicine purple returning oil ( comfrey, angelica, sesame oil, sesame oil, medicine Fry in oil, when the medicine is black and yellow, under the fire, wait for the cool and spare. Use the blood to moisten the muscles, reduce swelling and itching, apply to external ear canal inflammation, external skin eczema, rough skin, thickening) coating.
Complication
Necrotic otitis externa complications Complications meningitis brain abscess
Inflammatory bone destruction of this disease can be developed, often involving the posterior fossa of the parotid gland, skull base, cranial nerves and brain tissue, eventually endangering the patient's life due to bleeding, meningitis, and brain abscess. The pathogen is often Pseudomonas aeruginosa. Clinical manifestations of ear pain and resistance to analgesics. There are serous and purulent ear leaks, which may also be accompanied by bleeding, odor, hearing loss, mandibular joint dyskinesia, and the general condition deteriorates with the severity of the disease; granulation can be seen on the bottom wall of the external auditory canal, which can be complicated by mumps and infection of the posterior fossa. Inner ear infection, V, VI, IX, X, XI, XII and other cranial nerve palsy and meningitis, brain abscess, CT showed bone destruction.
Symptom
Necrotizing symptoms of external auditory canal Symptoms Common symptoms of ear discharge, ear pain, hearing loss, leukocytosis
Onset of illness, earache and ear pus are the main symptoms, earache is persistent, gradually intensified, often radiated to the forehead, the skin of the outer ear canal at the junction of the bone and cartilage begins to have erosion, followed by granulation, external auditory canal, The auricle and the screen can be swollen, there is obvious impact on the auricle traction pain, the mastoid can also be related to swelling and toothache, tympanic membrane perforation or necrosis, but the patient can also objectively not involve the tympanic membrane and inner ear, treated by general gingivitis , often no clear effect. The condition can continue to develop, down the skull base frequently. Or through the external auditory canal cartilage fissure involving the cartilage, bone tissue, parotid gland and adjacent blood vessels and nerves, leading to osteophyte or skull base osteomyelitis, multiple neural crest, wherein the facial nerve involvement is most false, lesion flow and jugular vein hole, then glossopharyngeal nerve The vagus nerve and accessory nerve are damaged. The infection spreads forward and can invade the infraorbital fossa. It eventually causes massive hemorrhage, meningitis, brain tumor, brain softening and death.
Examine
Examination of necrotizing otitis externa
For the development of external auditory canal inflammation, especially in elderly patients or patients with active sputum inflammation, should be vigilant, ask for medical history, send pus culture, learn blood sugar, Tang urine sugar and related blood and nutritional status. Examination, the presence of granulation tissue on the parietal wall of the external auditory canal is helpful for diagnosis, and the erythrocyte sedimentation rate can be used as a non-diagnostic reference. The sacral tomography or CT scan can estimate the extent of the lesion or the presence or absence of dead bone formation.
Diagnosis
Diagnosis and diagnosis of necrotizing otitis externa
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Should be identified with malignant tumors.
