Acute otitis media and mastoiditis Chunfu dai m,d ph. d Otolaryngology Department Fudan Univeristy
Acute otitis media and mastoiditis Chunfu Dai M.D & Ph.D Otolaryngology Department Fudan Univeristy
Definition AOM: is an infectious process of the middle ear cleft and to a variable extent, of the mastoid air cell system t Eardrum 5 Semortulnr cants B Vestibular nerve Facial Nerve 4 StaDes
Definition ◼ AOM: is an infectious process of the middle ear cleft and to a variable extent, of the mastoid air cell system
Bacteriology Streptococcus pneumoniae(48%0) Haemophilus influenzae (31%) Moraxella catarrhalis(20%) P-hemolytic streptococcus (decreased following widespread immunization program 烫应科 Pseudomonas aeruginosa (uncommon cause of AOM)
Bacteriology ◼ Streptococcus pneumoniae (48%) ◼ Haemophilus influenzae (31%) ◼ Moraxella catarrhalis (20%) ◼ P-hemolytic streptococcus (decreased following widespread immunization program) ◼ Pseudomonas aeruginosa (uncommon cause of AOM)
阻断细菌耐药性的“恶性循环” 合理 临床■细菌 治疗 不合 治愈 消除 传 细 选择 药菌
阻断细菌耐药性的“恶性循环” 感染 耐药性 增加 传播 选择 耐药菌 细菌 未消除 不合理 治疗 合 理 治 疗 临 床 治 愈 细 菌 消 除
青霉素耐药的肺炎链球菌 9—98年在美国流行情况 50 40 30 s20 18% 10 0 R85S8高怒8S8 8s8 8艮§ (Doen. Am J Med. 1995: 99(6B): 3S-7S; Jacobs et al., AAC 1999: 43: 1901; Jacobs et al abstract C-61, ICAAC 1999)
(Doern. Am J Med. 1995;99(6B): 3S-7S; Jacobs et al., AAC 1999:43:1901; Jacobs et al abstract C-61, ICAAC 1999) 0 10 20 30 40 50 % Penicillin Resistance 中度敏感 (0.12 - 1.0 µg/ml) 耐药 ( 2.0 µg/ml) 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988-89 1990-91 1992-93 1994-95 1997 1998 16% 18% 29% 33% 青霉素耐药的肺炎链球菌 79－98年在美国流行情况
Routine of infection Via eustachian tube upper respiratory infection acute rhinonitis and nasal pharyngitis, Upper respiratory communicative disease (diaphea, meals, et al Swimming and dive in unclear water Anatomic contribution (Eustachian tube in infant is wide and short and the two orifice in the same level) 1. Eardrum rcutar canals B Vestibular nerve Note Eustachian tube
Routine of infection ◼ Via eustachian tube ◼ upper respiratory infection (acute rhinonitis and nasal pharyngitis) ◼ Upper respiratory communicative disease (diaphea, mealse, et al) ◼ Swimming and dive in unclear water ◼ Anatomic contribution (Eustachian tube in infant is wide and short and the two orifice in the same level)
Routine of infection Via external acoustic canal and Tm Perforation Myringotomy or myrigotosis Via blood supply 1. Eardrum rcutar canals B Vestibular nerve Note Eustachian tube
Routine of infection ◼ Via external acoustic canal and TM ◼ Perforation ◼ Myringotomy or myrigotosis ◼ Via blood supply
Pathology Mucosal inflammation Serous, hemorrhagic or purulent exudate in middle cavity Rupture of tympanic membrane
Pathology ◼ Mucosal inflammation ◼ Serous, hemorrhagic, or purulent exudate in middle cavity ◼ Rupture of tympanic membrane
Symptoms Fever It may be masked by analgesics or antibiotic otalgia u% patients can spontaneous remission Fullness Hearing loss a ncus
Symptoms ◼ Fever ◼ It may be masked by analgesics or antibiotic ◼ Otalgia ◼ 60% patients can spontaneous remission ◼ Fullness ◼ Hearing loss
Physical findings Increased vascularization of the TM, initially located in pars of flaccida, frequently spreading beyond the annulus to the skin of the external canal Bony landmarks are visible
Physical findings ◼ Increased vascularization of the TM, initially located in pars of flaccida, frequently spreading beyond the annulus to the skin of the external canal. ◼ Bony landmarks are visible