Acute and chronic inflammatory diseases of the outer and middle ear. The role of occupational factors in the occurrence of diseases of external ear. The etiology, pathogenesis, clinical features, diagnosis, treatment and ENT diseases prophylaxis. Department of ENT diseases of Tashkent Medical Akademy

The purpose of the lecture  explore the etiopathogenesis of diseases of the ear  clinical forms of diseases of the ear  diagnosis  prophylactic measures to prevent diseases of the ear and their complications  methods of conservative and surgical intervention

Disorders of external ear A - Perihondrit ear B - Rozsa B - Eczema of external ear T - otgematoma

Otits Classification: depending on the location of infection otitis media is divided into outer and middle. Classification: depending on the location of infection otitis media is divided into outer and middle.

Middle ear cavity A - antrum cavity B - epitimpanum C - mezotimpanum D - Eustachian tube

Paths of infection :  Tubarny  Transtimpanalny  Hematogenous

Tubarny Transtimpanalny Hematogenous Pathogens causing acute otitis Tubarny Transtimpanalny Hematogenous Pathogens causing acute otitis 1.S. Pneumoniae 2.H.influenzae atypical strains 3. M.catarrhalis 4. group A streptococci 5.S.aureus

Predisposing factors of acute otitis media  Inflammation of the upper respiratory tract.  Surgical interventions in the nasal cavity, paranasal sinuses, nasopharynx, oropharynx.  Changes in the middle ear after an illness.  Lowering the reactivity of the organism.  Hypothermia.  Adverse domestic and industrial factors.

Features of acute otitis media in young children:  Response to pain in the ear in the form of shouting, a pendulum swinging the head;  Refusal to eat;  High body temperature C;  Severe intoxication, which is often expressed excitement;  May develop symptoms of meningism

The first stage of acute otitis media Sudden onset of pain in the ear, hearing loss, ringing in the ear. At otoscopy: eardrum is bright red, no light reflex, handle, and then the lateral process of the malleus is not defined

The second stage of acute middle otitaaThe second stage of acute otitis media Profuse otorrhoea, pain in the ear are reduced, the temperature drops, improving overall health.

The second stage of acute otitis media At otoscopy: perforated ear drum, pulsating reflex - discharge flows through the perforation jerks synchronous pulse

The third stage of acute otitis media Suitable for: otorei termination, closing perforations, better hearing. Unfavorable course: the formation of adhesive otitis media, formation of chronic suppurative otitis media.

General treatment of otitis media  Antibiotics (except ototoxic);  Antihistamines;  Preparations containing calcium.

Local treatment of otitis media  Stage I:  In the vasoconstrictor nose drops  Drops in the ear  Solux lamp, dry heat, UHF  Paracentesis in lowback quadrant, followed by injection disinfectants  Stage II:  Toilet ear canal  Disinfectants drops in the ear

Mastoidit Acute purulent otitis with destruction of bony elements of the mastoid. Mastoiditis differs from acute otitis media destruction of bone mastoid.

Symptoms of mastoiditis  Increased body temperature to degrees  Pain in the ear, BTE region  Hearing loss, ringing in the ears, abundant, creamy suppuration

Otoscopy with mastoiditis The overhang of the upper posterolateral wall of the external auditory canal bone in his department. The tympanic membrane is hyperemic, thickened, pus enters through the perforations. When viewed from the outside - "ottopyrivanie" auricle pripuh Lost and redness in the area of BTE, painful life at palpation of the breasts, a prominent ridge, fluctuation (subperiosteal abscess).

Signs of chronic otitis media  The presence of persistent perforation of the eardrum  Constant or recurring suppuration from the ear  Hearing impairment in varying degrees

Forms of chronic otitis media  Mezotimpanit - chronic inflammation limited mucosa of the middle ear  Attic disease - in addition to changes in the mucosa, the process extended to the bony wall of the middle ear and the auditory ossicles

Otoscopy at mezotimpanite The eardrum is perforated in the stretched part of various sizes, but does not reach the bone frame - a central perforation. Mucosa, as seen through the perforations - hyperemic, swollen, covered with a layer of muco-purulent discharge.

Otoscopy at epitimpanit In the ear canal pus greenish-yellow, thick, with a putrid odor, sometimes mixed with holesteatomnyh masses. Perforation is located in the slack of the membrane, and it reaches the edge of the bone edge of the frame - regional perforation. It may be destruction of the bone wall of the upper division of the tympanum - epitympanum

Cholesteatoma Tumour formation arises and develops in the middle ear cavity on the background of chronic-cal, destructive-tion process. Presented outside the connecting relatively- woven layer or hull of. Inside the cavity is lined with cholesteatoma epithelium.

Types of tympanoplasty Types of tympanoplasty

Labyrinthitis  Labyrinthitis - an inflammatory disease of the ear labyrinth which arises as a complication of acute or chronic suppurative middle ear disease, meningitis, general-specific (syphilis, tuberculosis) and non-specific infectious diseases.  Classification:  Acute  Chronic

Labyrinthitis  Labyrinthitis can include: limited, diffuse,  serous and purulent.  Typical symptoms of labyrinthitis lesions are:  dizziness, experienced by the patient at rest or in motion  gait disorder  nausea, vomiting  nystagmus  fistula symptom (for a limited form of labyrinthitis)

Acut labyrinthitis  The clinical picture  Acute onset and rapid development of symptoms  Peripheral kohleovestibulyar syndrome of irritation or destruction of  Sensorineural hearing loss  In the propagation process in the wall of the fallopian canal may result in VII and XIII of the cranial nerves:  - Paresis of all branches of the facial nerve;  - Dry eyes;  - Disturbance of taste on the affected side;  - Inhibition of salivation.

Chronic labyrinthitis  Etiology  Chronic purulent otitis media complicated by caries, cholesteatoma  Sometimes - a consequence of acute labyrinthitis  The development of adhesions after acute labyrinthitis (scar labyrinthitis / labirintoz)

Clinic chronic labyrinthitis  The gradual development and sluggish during the  Mild dizziness that occurs mainly when turning the head, change of body position  Slight nausea  Headaches and pain mastoidal  Uncertainty in walking, especially in the dark  In the period of acute symptoms of purulent process may take on the nature of the classical acute labyrinthitis

The etiology of vestibular disorders  Defeat of the neck, including degenerative-dystrophic changes of the cervical spine  Exo-and endotoxic lesions of the vestibular apparatus  CNS disease  Metabolic and hematologic diseases  Congenital and hereditary abnormalities

Central positional vertigo  Central positional vertigo is associated  in violation of the vestibular nuclei and vestibular  connections in the brain stem.  Etiology  Neoplasms ZCHYA  Poor circulation in the brain stem  Atherosclerosis

The etiology of vestibular disorders  Diseases of middle and inner ear inflammatory and noninflammatory nature  Vascular diseases of the inner ear and CNS, and their consequences  Trauma and injuries and ENT head injury, including noise, vibration, barometric  Tumours ENT and CNS

The clinical picture of central positional vertigo  Dizziness is expressed slightly  There is often a focal neurological symptoms  Hearing no symptoms  The presence of position-changing Ny (nystagmus changes direction when the position of the head or body)

The central position SNy  In conducting tests of Dix-Hollpayka appears as if turning the head to the right and left, and is directed towards the upper-ear, that is, if the head is turned to the right, nystagmus directed to the left, and vice versa.  Does not decay, but remains at all times maintain the posture.  When repeated samples Ny extinction is not observed

Vestibular maneuver Epley (for rear left semicircular canal) In the sitting position turn your head at 45 0 in the direction of a "healthy" ear

Vestibular maneuver Epley (for rear left semicircular canal) The patient is quickly placed on the left side (head, face up). There is a dizzy spell with rolling nystagmus to the left. Retain this position for 3 minutes. During this time, the otoliths are omitted in the lowest part of the semicircular canal.

Vestibular maneuver Epley (for rear left semicircular canal) Quickly flip the patient's right side (head, face down). There is also the left-sided rolling nystagmus. Retain this position for 3 minutes. The otoliths are displaced to the output of the semicircular canal.

Vestibular maneuver Epley (for rear left semicircular canal) Patient slowly return to starting position. Otoliths go into the cavity of elliptical pouch.

Department of ENT diseases of Tashkent Medical Academy