Otitis Media et al：中耳炎详细信息等.ppt

* * * * The sphenoid sinus sits just anterior to the sella turcica. Sphenoid sinusitis usually does not occur alone but with a pan sinusitis and can be life threatening. Early diagnosis is important to decrease the chance of neurologic complications caused by extension of infection into the brain. Emergency surgery may be necessary * * * * McAlister WH, et al. Imaging of sinusitis in children. Pediatr Infect Dis J. 1999;18: * Gwaltney JM Jr. Acute community acquired sinusitis. Clin Infect Dis. 1996;23 1209-1223 * Very little data exists to recommend any of the above on scientific basis but can be helpful. Oral/nasal decongestants aid in airflow and patient comfort. Oral Antihistamines would aid the patient with allergic rhinitis predisposing to ABS. Astelazine, an antihistamine nasal spray has a non allergic indication and can be helpful. Saline irrigation removes allergic and non allergic triggers for rhinitis and gives symptomatic relief. It also decreased crust formation and helps liquefy secretions No data on mucolytic agents in ABS.. * * * * * * Pathophysiology Vestibular labyrinth - detects linear and angular head movements Semicircular canals - angular Hair cells organized under cupula Otolithic organs (utricle, sacule) - linear Hair cells attached to a layer of otoconia Vestibular nerve - superior, inferior branch Afferent nerve fibers are bipolar - cell bodies lie within Scarpa’s ganglion * Pathophysiology Balance requires – Normal functioning vestibular system Input from visual system (vestibulo-ocular) Input from proprioceptive system (vestibulo-spinal) Central causes compromise central circuits that mediate vestibular influences on posture, gaze control, autonomic fx Disruption of balance between inputs results in vertigo Goal of treatment: restore balance between different inputs * Pathophysiology Vestibular system influences autonomic system Intimate linkage in brainstem pathways between vestibular and visceral inputs Alteration of vestibula