Download Labyrinthitis

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
www.tma.uz
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.
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
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 39-40 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 3839 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 relativelywoven layer or hull
of. Inside the cavity is
lined with
cholesteatoma
epithelium.
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
www.tma.uz