OTOLOGY- COURSE

4
ACUTE AND CHRONIC
INFLAMMATIONS OF THE MIDDLE
EAR
1. TUBO-TYMPANIC CATHARS
ETHIOLOGY:
Occurs in children under 4 years
Altered Eustachian tube function causes chronic inflammation of the
mucosa average house
Causes:
- nasopharyngitis,
- acute and chronic adenoid hypertrophy,
- hypertrophy of turbinates
- polyps,
- benign and malignant tumors, sinus disease,
- anatomic aspect of tube-horizontal,
- ogival palate ,
- choanale malformations,
- posttraumatic scar-post adenoidectomy-bride,
- allergies,
2. TUBO-TYMPANIC CATHARS
Symptomatology:
3 stages:
- simple tube obstruction
- tube obstruction with transudate in middle ear
cavity functional sequelae
Clinical symptomatology :
1. ear obstruction
2. autphonia - dimmable, and it is improved
by swallowing, blowing nose
3. low tone ear noise


3. TUBO-TYMPANIC CATHARS

Clinical examination:
1. Discrete hammers and Schrapnell
Membrane
2. Tympanic aspiration, and its mulat on
osicular chain
3. Leveling hammer
4. Whitish-gray color
5. Mobile liquid bubbles in the tympanic
cavity
6. Thickened secretions that determine the
level of the liquid-glue ear

Nasopharynx and rhinoscopy or
endoscopy examination!!!
4. TUBO-TYMPANIC CATHARS
Diagnosis :
Permeability of Eustachian Tube its doing
with Valsalva and Toynbee Maneuver
To performed a Tube catheterization is used
ITARD PROBE
Radiological examination
Tympanogram: flattened in shape curve or
negative curves
Audiometry: transmission hearing loss
5. TUBO-TYMPANIC CATHARS
TREATMENT:
Removing rhinophariyngeal causes
1. Fluid accumulation: - transtympanal
drainage -diabolo
2. Antinflammatory drugs
3. Nasal decongestans
4. Aerosols
5. Mucolytics
6. Cortisone

TUBE SYNDROME
Definition: is the impossibility to close the tube
Symptomatology: to inspiration is produce an ear
noise , acuphaena, and hearing loss
Clinical examination: the membranic tympan aspect
of flag waving at each respiratory movement
Treatment:
- insuflations of boric acid or salicylic acid acid that
produce reflex contraction of Eustachian Tube -
- Electrical Cauterization of Eustachian Tube in the
rhinopharyngeal opening hole
- injection with teflon

ACUTE MIDDLE EAR
INFLAMMATIONS


EUSTACHIAN TUBE
ACUTE OTITTIS MEDIA
CLASIFICATION :
1. MICROBIAL ACUTE OTITIS MEDIA
- Acute congestive otitis media
- Supurate Otitis media( Otitis media with
effusion)
2. NON MICROBIAL ACUTE OTITTIS MEDIA
Serous Otitis media
MICROBIAL ACUTE OTITIS MEDIA
Ethiology: is produce by Pneumococ, Haemophilus,
Stafilococ
Pathological anatomy:
1. The congestive phase : catarrhal
inflammation suppurated stage with
pururlente collections spontaneous
perforation or surgical drainage
paracentesis
2. Persistent chronic suppuration
3. Osteitis with mastoiditis
MICROBIAL ACUTE OTITIS MEDIA
Cauze favorizante:
1. Eustachian Tube disffunction
2. Rhinopharyngeal inflammations
3. Systemic viral infections: measles(rujeola),
influenza(gripa), chickenpo(varicella)
4. External Traumatisms on the TM with TM
Perforation
MICROBIAL ACUTE OTITIS MEDIA
Symptomatology:
- fever ,pain, autophonia, hearing loss, tinnitus with
low frequencies
Othoscopical examination :
- Congestive stage : intense vascular drawing of
hammer handle, or TMin the posterior and
superior region
-Catarrhals stage -retracted TM absence of the
light reflex( POLIZER BRIGHT TRIANGLE), reduction of
the mobility of TM
Functional Examination: BEZOLD TRIADE, moderate
transmission hearing loss, whispering voice(voce
soptita) under 5 m
Bezold Triade: Rinne negative on the same site with
the inflammation , Weber lateralized on the affected
site, prolonged Schwabach test, for low frequency
ACUTE SUPPURATED OTITIS MEDIA(acute otitis media
with effusion)


Definition: It is a suppurative process to the all middle ears
compartments
Anatomo-pathologically aspects: hyperplasia of the middle
ear mucous
ACUTE SUPPURATED OTITIS MEDIA(acute otitis media
with effusion)
SYMPTOMATOLOGY:
- It is an evolution stage of one catharallis otitis media
, when the secretion is transformed from serous and
mucous in purulent(suppurative)
- clinical symptoms: ear pain,pulsation in the ear with
irradiation on the dental arch fever 39-40
2 Phase: before perforation and after perforation
ACUTE SUPPURATED OTITIS MEDIA(acute otitis media
with effusion) BEFOR PERFORATION
Clinical examination:
- diffused hyperemia of TM intensive red TM
- intensive vascularisation of hammer handle
- the congestion is extended to the EAC trough the
Tympanic Ring
- light reflex is ersed(wiped)
- the surface of TM is matt
- sometimes pain to pressing the mastoid =
mastoidean reaction
- transmission hearing loss, with acouphena and
dizziness (vertigo) , that is produce by labyrinth
irritation
- fever, Febr, fatigue (tiredness), leukocytosis and
tachycardia
ACUTE SUPPURATED OTITIS MEDIA(acute otitis media
with effusion)
after perforation

IS A ACUTE SUPPRATED OTITS MEDIA
PERFORATION CAN BE SPONTANEOUS OR PROVOCATED-
PARACENTESIS
Clinical examination:
Pus in EAC, that can be purulent(supurative) and bloody or
yelow-greenish, it does not smell
Congestive TM, middle perforation with irregular margins

ACUTE SUPPURATED OTITIS MEDIA(acute otitis media
with effusion)
Evolution:
- after 10-14 days with correct treatment we see that the
suppuration beganes to yield
- After more than 7-10 days it will produce the healing
Complications:
- meningitis
. Labyrinthitis
- mastoiditis
- become chronic
ACUTE SUPPURATED OTITIS MEDIA
Classification :
1. after evolution (development): supracute and subacute
forme

2. after perforation aspects
- middle perforation( mezotympanic perforation)
- perforation to Shrapnell Membran anterior-superior
Prussak and posterior-superior Troeltsh

3. after according to the nature of pathogen
- pneumococ
- staphylococ
- enterococ
ACUTE SUPPURATED OTITIS MEDIA
Diferentialle diagnosis:
1. External otitis media
2. Inflammation of TM- MIRINGITIS
3. zona zoster auricullaris
4. Chronic otitis media in acute forme
Treatment:
- to relieve the pain antialgic drugs
- antiinflammatory drugs
- antibiotics after microbiological examination of secretion
- nasal dezobstruction
Evolution: 10 -14 days with treatment is produce the healing
In case of perforation persistence is a high risk of chronicity and
recurrence
ACUTE SUPPURATED OTITIS MEDIA to children
Is very frequently
Sometimes it can be unobserved
othologycal examination is very important
Every fever stage needs to have an
othological examination!!!
it is bilateral
OTITIS MEDIA INFECTIOUS AND CONTAGIOUS
DISEASES

COMPLICATION OF INFECTIOUS AND
CONTAGIOUS DISEASE

1. Scarlet fever - 2 formes: earlier in first 2-3 days,
necrotizing
2. Measles
3. Influenza- blestering on the tympanic membran
surface, bleeding ear tympanic membran
4. Erizipelas - blistering plaque in EAC and on TM suface
5. Whooping cough(pertusis)
6. Mumps- is associated with neurosenzorial hearing
loss, by affecting cochlea
Acute inflammation of Tympanic membrane
INFANTS OTHOMASTOIDITIS
Ethiology :
Nasal and rhinopharyngeal infections
General poor hygiena
Prematurity
Eustachian Tube conformation
Pathological anatomy:
Inflammation with an implication of Inflamaia cu afectarea tuturor
esuturilor urechii medii
Clinical Forms: latent and manifests
Clinical picture :
Insomnie
Fever
Restlessness(agitation)
Digestive disorders
Weight loss

INFANTS OTHOMASTOIDITIS
Clinical examination:
Nasal secretions
Pain on the pressing tragus
Diffuse hyperemia of TM
Bulging of TM
pressing the Ear pavillion forward and down
It is necessary to performe tympanotomy- suppurative
secretion
Clouding mastoid
INFANTS OTHOMASTOIDITIS
Latent(hidden) form
It appeares to dystrophic children
It appears than a toxicosis form : nervous syndrom, digestive
syndrom, dehydration

Clinical Examination:
- it is possible to have less noisy signs
- posterio-superior wall of EAC falling
- clouding mastoid

Evolution :
Endocranial complications
INFANTS OTHOMASTOIDITIS

TREATMENT

Earlier drainage
Combating associated infections
TYMPANOTOMY
Antibiotics
Nasal desobstruction sol
ANTROMASTOIDECTOMY
Dezobstruante nazale
ACUTE SUPPURATE OTOMASTOIDITIS
Etiopathogeny: middle ear supurative process, that is transmited to mastoid trough
aditus ad antrum

Clinical Form : acute not exteriorities latent form, acute exteriorities, infants
ototmastoiditis

Pathological anatomy:
Initially Form: diffuse TM hyperemia hiperemia, mucosa thickening, suppurate
secretions
Second Form: invading the mastoid bone, mastoid empyema, bone thickening-
externalizing
Clinical examination:
Pain on palpation mastoid
Intense congested,and bulging of the TM
TM perforation by pulsed pus leaking
Gelle-fistulla is a fistulla of EAC, ptosis the posterior superior wall of EAC
Transmission hearing loss
Clouding mastoid
ACUTE SUPPURATE OTOMASTOIDITIS
Clinical Form:
Supacute form -catching simultaneously middle ear and mastoid
Subacute form- headache, purulent otoree
Apparently primitive, minimal changes and major mastoid TM

Complications :
Otogena meningitis
Facial Nerve Paralysis
Epidural abscess
Labyrinthitis
CHRONIC OTITIS MEDIA
Definition: chronic inflammatory process of middle ear and mastoid

It is a polymicrobial pathology

Pathological anatomy :
1. Damage to the tympanic membrane: perforated TM-
mezotimpanale or epitimpanale, respectively pars pars flaccid-
membrane voltage or Shrapnell, free or adherent edges
2. Mucosal lesions: cellular infiltration and formation microchiste,
polyps grains
3. Bone lesions: vascular thrombosis in the osicular chain bone
necrosis ... Osteitis.
CHOLESTEATOMATOUS OTITIS MEDIA WITH EFFUSION
Perforaie marginal a MT, cu henierea epiteliului CAE
SKIN IN THE WRONG PLACE
Clasificare: colesteatom n sac herniar, colesteatom extensiv
Atica- punct de plecare, invadarea membranei Shrapnell
Antrul mastoidian- posibilitate de extindere spre mastoid
Lezarea lanului osicular de procesele osteitice
Casa medie- leziuni extinse ale canalului facial
Extindere spre canalul facialului sau canal semicircular

Acute exteriorized Mastoiditis
topirea septurilor mastoidiene i formarea
flegmonului endomastoidian
Abces subperiostal superior
Abces retroauricular postero-superior
subperiostal
Otomastoidita temporal
Abces substernocleidomastoidian BEZOLD
Otomastoidita occipital
Otomastoidita jugodigastric
Petrozita sau petroaticita
SINDROMUL GRADENIGO- OMS, cefalee
intens, paralizia oculomotorului extern


COLESTEATOM ATICAL
COLESTEATOM CAE I CASA MEDIE
Semne clinice ale colesteatomului
Otoree purulent fetid
Evoluia continu a otoreei
Otoree insensibil la tratament local i general
Otoragie
Polipi n casa medie sau granulaii, lamele de
colesteatom dispuse concentric
Hipoacuzie de transmisie HP sau HM.
Acufene- ureche nfundat
Paralizia facial
Perioade de renclzire
Complicaii endocraniene
DIAGNOSTICUL POZITIV AL COLESTEATOMULUI
Examen otoscopic
Ex audiometric
RTG sau CT mastoidian
Dup tipul de leziune
Natura leziunilor timpanale
TRATAMENTUL COLESTEATOMULUI
TRATAMENT CURATIV: - suprimarea cauzei
care l-a produs
TRATAMENT SIMPTOMATIC- dezinfectante
nazale i rinofaringiene, soluii locale
antiseptice
TRATAMENT CHIRURGICAL-
ANTROMASTOIDECTOMIA LRGIT tehnic
nchis sau deschis

OTOREEA TUBAR
SIMPTOMATOLOGIE
- otoree mucoas, intermitent
- surditate de transmisie moderat 10-15 dB
EXAMEN OBIECTIV:
- perforaie antero-inferioar
- sediu marginal
- margini bine delimitate
- prin perforaie se vede mucoasa cavit timp hiperemic,
congestionat
EVOLUIE I PROGNOSTIC:
- otoree rebel la tratament
- nlturarea cauzelor de vecintate
Complicaii:
- otita extern- iritaia CAE
Tratament: curativ i simptomatic
ATICITELE
Caracteristici:
1. Localizare atical
2. Debut i origine obscure
3. Fr antecedente auriculare semnificative
4. Evoluia lent a unui colesteatom primitiv
Anatomia patologic:
perforaie marginal la nivelul membranei
Shrapnell
Perforaie mic cu leziuni osoase

ATICITELE
EX CLINIC LA DEBUT
Hipoacuzie uoar rmne mult timp nemodificat
Cefalee occipital
Secreii auriculare minime
Evoluie silenioas, lent
Secreie clar ,fetid
CAE normal
PERFORAIE LA NIVELUL MEMBRANEI SHRAPNELL
Extragere de lamele de colesteatom din atic
Manevra Valsalva negativ- blocaj atical
Palparea mastoidei negativ

ATICITELE
EX. CLINIC IN PERIOADA DE OTOREE:
Hipoacuzie net
lezarea lanului osicular
CAE normal
Lamele de colesteatom n atic
Mucoas granulat, hiperemic
CLASIFICAREA ATICITELOR:
1. Anterioare cu perforaie mic
2. Posterioare cu perforaii largi, retromaleare
3. Polipoase
4. Colesteatomatoase
5. Perforaii asociate
ATICITELE
Forme complicate:
1. dureroas
2. vertiginoas
3. complicat cu paralizie de facial
Evoluia:
Supuraie continu,cu complicaii endocraniene
Prognostic:
Afectarea auzului, complicaii endocraniene
Tratament: chirugical- antroaticotomie,
antromastoidectomie

ANTROATICOTIMPANITELE
Definiie: proces supurativ cu participarea
aticii, antrului, otoree fetid, purulent,
colesteatomatoas, leziuni osiculare,
persistena i tenacitatea supuraiei, eecul
tratamentului conservator
ANTROATICOTIMPANITELE
OTOMASTOIDITA CRONIC SUPURAT
Anatomie patologic:
Proces osteitic, asociat cu un proces supurat
Cuprinde toate cavitile UM
Simptomatologie:
I. Mastoidita cr. simpl
1. forma comun- sm clinice reduse, otoree, durere la
palparea mastoidei
2. forma fistulizant- forma Gelle- fistula atico-timpanic,
prbuirea CAE perete postero-superior
II. Mastoidita cronic renclzit
complicaii grave endocraniene, labirintite, petrozite,
abcese, paralizie de N. Facial.


V mulumesc
pentru rbdare!