Cholesteatoma otitis media
Introduction
Introduction to cholesteatoma otitis media Chronic suppurative otitis media is divided into three types, including simple type, bone type and cholesteat type. Cholesteatoma otitis media is the third type, and it is also the most serious type of otitis media, and is a type of complication. The so-called cholesteatoma is the accumulation of the epithelium that falls off in the middle ear. As it gets bigger, it expands to the surrounding area, causing adjacent bone destruction. Upward, inward and backward are important blood vessels and nerves. Once destroyed, The nerve causes paralysis of the facial nerve, and expansion into the brain will form life-threatening complications such as brain abscess. Therefore, once the diagnosis is cholesteatous otitis media, surgery must be performed. The main purpose of this otitis media surgery is not to present high hearing, not to prevent pus, mainly to prevent complications. Of course, during the operation, the doctor will do his utmost to help raise the hearing and dry ear rate after high surgery. However, due to the relationship between the lesions, the dry ear rate after cholesteatoma otitis media surgery is not too high, about 80%. In general, if the patient's condition has tympanoplasty conditions, and the tympanoplasty is added during the operation, the postoperative hearing will be improved. If there is no condition for tympanoplasty and only cholesteatoma radical surgery, the hearing after surgery will not decline. As for the current pus, this is the infection is not controlled, that is, the surgery did not reach the purpose of dry ears. Regular dressing change, clean the operation cavity, perform bacterial culture and drug sensitivity test on pus, and use extremely sensitive antibiotics for treatment according to the results of drug sensitivity test. basic knowledge The proportion of illness: 0.02% Susceptible people: no special people Mode of infection: non-infectious Complications: hearing impairment, deafness, meningitis
Cause
The cause of cholesteatoma otitis media
The exact mechanism of cholesteatoma formation is unclear. Due to the direct compression of cholesteatoma or the release of chemicals, it can destroy the surrounding bone and spread inflammation, leading to a series of intracranial and extracranial complications. Therefore, the middle ear of cholesteatoma must be treated as soon as possible.
Prevention
Cholesteatoma otitis media prevention
1. If you get water in your ear when you take a bath or swim, you may easily breed bacteria. If you have already entered the water, you can use a cotton swab to clean it, but the depth should not be too deep.
2. People who have had otitis media are prone to relapse. They should avoid colds. Once they have a cold or otitis media, they should be treated by a qualified doctor.
3. If someone smokes, paints or scented at home, they should keep the air flowing, which will prevent the upper respiratory tract mucosa from being stimulated and cause swelling.
Complication
Complications of cholesteatoma otitis media Complications, hearing impairment, deafness, meningitis
Otitis media infections are slow, but highly destructive and can cause permanent damage. Gray or yellow pus may flow out from time to time in the ear. You can lose a part of your hearing. The longer you get infected, the more your hearing loss will be. Therefore, early detection of early treatment is very important. If the infection is advanced, it may spread to the posterior mastoid bone. If the mastoid is infected, it may require treatment with a mastoidectomy. In rare cases where treatment is ineffective, the ear bones may be damaged, causing permanent deafness.
Repeated episodes of chronic otitis media will increase the perforation of the tympanic membrane and harden the adhesion of the middle ear, which will further reduce the hearing. If the drug is not used properly, it can also cause the nerve function of the inner ear to decline, which is more difficult to treat. More serious is that repeated inflammation of the middle ear can lead to osteoarthritis or cholesteatoma otitis media. When the bone is eroded, it may cause intracranial and extracranial complications such as facial nerve spasm, meningitis, brain abscess, and even life-threatening.
Symptom
Cholesteatoma type of middle ear inflammation symptoms common symptoms ear pus tympanic membrane perforation conductive deafness
The ear continues to pus for a long period of time, with a special malodor, and there is marginal perforation in the tympanic membrane or in the upper part of the tension. From the perforation, there is a gray-white scaly or bean-like substance in the drum, which is strangely smelly.
Generally, there are heavier conductive sputum, such as lesions and cochlea, and deafness is mixed. A CT scan can determine the extent of the lesion and guide the procedure.
Examine
Examination of cholesteatoma otitis media
Otoscopy
Before congenital cholesteatoma invades the tympanic membrane, the tympanic membrane is intact but often grayish white and full. Acquired cholesteatoma is mostly perforated of the tympanic membrane or the posterior marginal perforation of the tympanic membrane, sometimes accompanied by the destruction of the bone wall at the outer wall of the outer wall of the drum or the outer wall of the external auditory canal. The perforated edge may have granulation or polyps. The keratin is piled up and the secretions are stinky. If the tympanic membrane is intact, it should be examined with a otoscope. If the tympanic membrane is active and the appearance is normal, it is estimated that the middle and lower tympanic membranes have been closed by the tympanic compartment without being invaded by cholesteatoma.
Hearing test
If the tympanic membrane is perforated and the tension is basically normal, such as pure tone hearing test gas, the bone conduction difference is less than 20 dB, indicating that the ossicular chain is still intact. Gas and bone conduction difference is about 30dB, which often indicates that the tympanic membrane is in contact with the tibia or vestibular window, which naturally forms the bird's auditory bone or tympanic cavity. Gas and bone conduction difference is greater than 50dB, suggesting that the ossicular chain is interrupted.
Film degree exam
Papillary X-ray examination has a certain diagnostic value for larger cholesteatoma. High-resolution CT scans can show the destruction of the middle ear bone wall, and the edges of the bone destruction are dense and sharp. The extent of cholesteatoma and the invasion of surrounding tissues can be clearly shown. In particular, the small upper tympanic cholesteatoma has a coronal scan of the lateral wall of the upper drum, which can be detected early.
Diagnosis
Diagnosis and diagnosis of cholesteatoma otitis media
Diagnostic criteria
1. Medical history: The above medical history is an important basis for doctors' diagnosis.
2. Ear specialist examination: including otoscopy and hearing function examination, it can be seen that there is marginal perforation in the tympanic membrane or in the upper part of the tension. Sometimes, there are gray-white scaly or bean-like substances in the tympanic membrane at the perforation of the tympanic membrane. It has a strange smell. Generally, there are heavier conductive sputum, such as lesions and cochlea, and deafness is mixed.
3. Imaging examination: CT scan of the mastoid is necessary to determine the extent of middle ear lesions, whether there is bone destruction, not only an essential basis for the diagnosis of this disease, but also to develop surgical plans and improve surgical safety. Provide important information.
Differential diagnosis
It is differentiated from chronic otitis media and secretory otitis media.
