上海交通大学耳鼻咽喉科学英文版课件 cholesteatoma.ppt

Classification Cranial complications Extra-cranial complications Intra-cranial complications Cranial complications Acute mastoiditis and mastoid abscesses (most common complication). Petrositis. Labyrinthitis. Facial paralysis. Osteomyelitis of the temporal bone Extra-cranial complications External otitis Cervical lymphadenitis Retropharyngeal Parapharyngeal abscesses Intracranial complications Extradural abscess (commonest intracranial complication). Subdural abscess. Meningitis. Brain abscess: Temporal lobe abscess. Cerebellar abscess. Lateral sinus thrombosis. Otitic hydrocephalus. Potentially life threatening Suppurative otorrhea, chronic headache, pain, fever – impending intracranial complication Mental status changes, nuchal rigidity, cranial neuropathies require neurosurgical consult Brain Abscess Questions? * Cause is multifactorial. Facial cleft/ cardiac defect anophthalmia/ microphthalmia limb reduction defects/ severe renal malformation holoprosencephaly Congenital – squamous epithelium trapped in the temporal bone during embryogenesis – 6mo to 5 yrs obstruct Eustachian tube - middle ear fluid and CHL encase ossicular chain behind TM Primary acquired – result of tympanic membrane retraction – retraction of the pars flaccida into the epitympanum OR posterior quadrant of the tympanic membrane retracted into the posterior middle ear Secondary acquired – result of injury to the TM – perf, PE tubes * Hearing loss, otorrhea, otalgia, tinnitus, vertigo and nasal obstruction; Previous history of chronic otitis media, tympanic membrane perforation or otologic surgery; Progressive unilateral hearing loss with chronic fetid otorrhea suspicious * Figure 1. An ideal coronal CT scan with the external and internal auditory canal simultaneously displayed. The scutum is intact (arrow). The stapes suprastructure and incus body (arrowhead) are preserved but the long process of incus has been eroded. The tympanic membrane is retracted onto the stapes head b