Topic of the lecture: chronic purulent inflammation of the ...€¦ · Theories of cholesteatoma...

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Topic of the lecture:

chronic purulent

inflammation of the middle

ear. Sanating ear surgeries.

Tympanoplasty.

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Significance

Causes hearing loss. In 18% of patients

with hearing impairment, the pathology

is a consequence of chronic purulent

otitis media.

Possible intracranial complications,

labyrinthitis, facial nerve paresis.

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Specific features of otomycosis

Fungi are usually conditional pathogenic .

Otomycosis – paradiabetic disease.

Repress bacterial flora in superinfections. Only antifungal therapy must be provided.

Have tendency to relapse. Treatment course must be repeated.

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Essential symptoms:

Purulent effusion from the ear.

Permanent perforation of the ear

drum.

Hearing loss, noise in the affected

ear.

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Forms of the disease

Mesotympanitis.

Epitympanitis.

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Mesotympanitis

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Mesotympanitis

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Audiogram conductive type of hearing loss

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Epitympanitis

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Epitympanitis

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Theories of cholesteatoma

formation

Metaplastic.

Ingrowth of epidermis.

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Mechanism of bone destruction

by cholesteatoma

Pressure.

Excretion of bone destructing

fements (causing bone lysis).

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X-ray of mastoid process

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X-ray of mastoid process

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Audiogram

Mixed type of hearing loss

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Audiogram

Perceptive type of hearing loss

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Treatment plan:

І. Examination : x-ray of the mastoid bone , audiometry, consulting neurologist and ophthalmologist .

ІІ. Common treatment.

ІІІ. Sanation of the nose and nasopharynx.

ІV. Local sanating treatment:

1st stage – mechanical evacuation of pus from

the ear;

2nd stage – infusion of medications into tympanic cavity.

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Washing epitympanic recess

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Indications for radical

operation

1. Caries of middle ear cavity walls.

2. Cholesteatoma.

3. Chronic mastoiditis.

4. Paresis of facial nerve.

6. Otogenic intracranial complications –

absolute indication.

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Radical surgery

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5 types of tympanoplasty by Wulstein

Myringoplasty.

Large tympanic cavity.

Small tympanic cavity - columella.

Reduced tympanic cavity

Fenestration of horizontal semicircular canal.

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І type of tympanoplasty

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ІІ type of tympanoplasty

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ІІІ type of tympanoplasty

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ІV type of tympanoplasty

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V type of tympanoplasty

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Transplants

Dura mater.

Buccal mucous membrane.

Skin.

Cornea .

Fascia.

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Contraindications for

tympanoplasty

Obturation of auditory tube.

Significant disfunction of

soundperceptive apparatus.

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