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1、写在前面的话 制作这一份耳部疾病幻灯的灵感来自于丁香园js3201上传的一组耳部疾病图片，那晚我可是手都下酸了。嘿嘿，想想肯定还有很多像我这样的朋友在一张一张地保存呢。所以呢，我就把这些图片和文字做成这份幻灯，方便大家下载。在此我感谢js3201提为我们供了如此精美的图片。linyun02 2006年11月12日,Preauricular sinus（耳前瘘管）,Preauricular sinus.The typical congenital preauricular sinus is located at the root of the helical rim just above the
2、 tragus,presumably because of failure of fusion between the hillocks of tissue that give rise to the pinna.It is a lesion commonly found in patients of all races but most frequently in people of Asian descent.It is often asymptomatic,may be bilateral and familial,and is usually nonsyndromic.Surgical
3、 excision is indicated after these lesions begin to produce a discharge or become infected.Incomplete removal almost ensures recurrence of the sinus disorder and further suppuration.,Lop or bat ear.Lop ear is frequently the term used to describe an auricle that stands out from the skull at a greater
4、 than normal angle.It is particularly stigmatizing when one ear is more prominent than the other.Surgical correction is usually done around age 6.The goal of surgery is not only to create symmetry but to make each ear esthetically pleasing.,Lop or bat ear（招风耳）,Auricular hematoma（耳廓血肿）Auricular hemat
5、oma.Auricular hematoma is an accumulation of blood under the perichondrium of the auricular cartilage.It may occur following blunt trauma,which could even be quite minor if the child has a coagulopathy.Prompt surgical drainage is required;otherwise,significant deformity will result from cartilage ne
6、crosis as resolution occurs.,Auricular perichondritis（耳软骨膜炎）Auricular perichondritis.Infection of the cartilage of the ear typically follows trauma or otitis externa.In this figure,perichondritis followed piercing of the cartilaginous area for an earring(arrow).This is a common cause,and Pseudomonas
7、 infection is usually implicated.It responds well to appropriate systemic antibiotics.An abscess requires prompt drainage to prevent deformity from cartilage necrosis,Foreign body(F in the external auditory canal.Small toy parts,beads,stones,and bits of food are common.Most of these FBs are asymptom
8、atic and are often only recognized on routine examination.An impacted small battery,such as one normally used in a hearing aid,is highly corrosive and must be dealt with urgently.It may seriously damage the canal and tympanic membrane(TM)within hours.,Most other FBs can be managed electively.Small,l
9、oose FBs may be safely and effectively removed using irrigation.Syringing of a close-fitting bean or corn kernel,if at first unsuccessful,may result in considerable swelling from water absorption and should be avoided.Oil can be used to drown live insects trapped in the canal.A firmly impacted FB,su
10、ch as a stone or bead,should be removed under controlled circumstances,using general anesthesia if necessary.In a struggling child,attempted removal may result in canal laceration,TM perforation,or even ossicular disruption.,Foreign body in the external auditory canal（外耳道异物）,Tympanic membrane（正常鼓膜）T
11、ympanic membrane(TM).The normal,healthy TM is translucent,pearly gray,and shows little vascularity.It is concave with the apex at the umbo:,(1)of the malleus,resulting in an anteroinferior light reflex(2).This reflex indicates a smooth,readily reflective surface but does not at all rule out middle e
12、ar pathology.The most obvious features of the TM are the handle of the malleus(3)and its prominent short process(4);several middle ear structures such as the chorda tympani nerve(5),incus,round window niche(7),promontory,and eustachian tube orifice(9)may also be discernible.,Atelectasis of the tympa
13、nic membrane（鼓膜不张）Atelectasis of the tympanic membrane(TM).Chronic dysfunction of the eustachian tube can cause negative middle ear pressure,which results in retraction of the TM.In this severe case,the TM is draped over the middle ear structures(see this image for structures numbered 1 through 9,wi
14、th the addition of 10,stapedius tendon,and 11,stapes in oval window).,When severe and prolonged,these retractions can cause erosion of the long process of the incus,producing a conductive hearing loss.Retraction pockets may trap desquamated keratin,which forms an acquired cholesteatoma(see later dis
15、cussion).This is most common with retractions of the thinner part of the TM,known as the pars flaccida.Mild retractions often resolve as eustachian function improves,but a careful watch must be maintained for complications.,Acute otitis media（急性中耳炎）Acute otitis media(AOM).AOM may be suspected in the
16、 presence of otalgia,irritability,and fever in association with an upper respiratory tract infection,but the diagnosis can only be confirmed by visualization of the tympanic membrane(TM).The acutely inflamed TM is dull,opaque,and bulging with obscured landmarks and increased vascularity.The usual li
17、ght reflex may be absent,and mucopurulent secretions may be seen coming from a perforation.,Otitis media with effusion(OME).Serous or mucoid fluid in the middle ear in the absence of signs and symptoms of acute inflammation or recent acute otitis media characteristic of otitis media with effusion.He
18、aring is often reduced or fluctuating.The tympanic membrane(TM)may be bulging but is usually retracted to some degree,causing the short process of the malleus to look unusually prominent.The TM is usually yellowish and not particularly vascular.,It may on occasion be near normal in appearance,and th
19、e presence of middle ear fluid can be appreciated only by pneumatic otoscopy or tympanometry,both of which will detect impaired mobility.The presence of fluid levels or bubbles behind the TM is a good indicator that the effusion is starting to clear.,Otitis media with effusion（渗出性中耳炎）,Tympanoscleros
20、is.Tympanosclerosis,or more correctly myringosclerosis,is a hard white area of calcium deposit within the tympanic membrane(TM).It may be found in up to 50%of TMs after tube extrusion but is rarely of any functional significance.The appearance may be mistaken for a middle ear cholesteatoma,but unlik
21、e cholesteatoma,it is entirely limited to the TM.,Tympanosclerosis（鼓室硬化）,Tympanic membrane perforation（鼓膜穿孔）Tympanic membrane(TM)perforation.Perforation of the TM resulting from acute otitis media is common and can usually be expected to heal spontaneously within days.With repeated or particularly v
22、irulent infections,such perforation may fail to heal and may result in some degree of hearing loss,depending on its size and location.The perforation may permit water contamination,resulting in a middle ear infection.,It also provides a route for possible ingrowth of canal skin epithelium and the de
23、velopment of a secondary acquired cholesteatoma.Most perforations can be readily repaired using autogenous tissue such as temporalis fascia.,Congenital cholesteatoma 先天性胆脂瘤Congenital cholesteatoma.A congenital cholesteatoma may present in the middle ear or elsewhere in the temporal bone and is belie
24、ved to develop from an embryonic epithelial cell rest.It is composed of keratinizing stratified squamous epithelium.A,An early lesion typically presents anterosuperiorly in the middle ear as an asymptomatic pearl deep to an otherwise healthy tympanic membrane(TM)(arrow).Less frequently,it may presen
25、t posterosuperiorly or as filling the middle ear.,If recognized early enough,that is,before the patient is aged 3 or 4 years,it is usually possible to completely remove the lesion without compromising the patients hearing.As desquamated keratin accumulates,it forms a discrete mass or sheet of tissue
26、 that can erode into adjacent bone and result in secondary infection(.It may cause hearing loss,mastoiditis,labyrinthine damage,facial palsy,or suppurative intracranial complications.After the cholesteatoma fills the middle ear space or extends beyond into the attic or the mastoid antrum(arrow),it m
27、ay be indistinguishable from an acquired cholesteatoma.,Congenital cholesteatoma CT,Acquired cholesteatoma 获得性胆脂瘤Acquired cholesteatoma.An acquired cholesteatoma usually develops as a sequelae to long-standing or recurrent middle ear suppuration.Keratinizing stratified squamous epithelium from exter
28、nal canal skin or the outer epithelial layer of the tympanic membrane(TM)may enter the middle ear space by ingrowth through an existing perforation,by accumulation in a retraction pocket,by traumatic implantation,or may possibly develop by metaplasia of middle ear mucosa.The,subsequent infective com
29、plications and bony erosion can be indistinguishable from those of a congenital cholesteatoma.A so-called primary acquired cholesteatoma presents with an attic crust overlying a keratin-filled pocket(large arrow).The mesotympanum may appear to be entirely normal.With progression of the disease,chole
30、steatoma can be seen extending deep to the TM in the upper mesotympanum(small arrow).,Acute mastoiditis 急性乳突炎Acute mastoiditis.Acute mastoiditis implies not only a suppurative mucositis of the middle ear and mastoid mucosa but also some degree of periostitis or even bone loss in the mastoid cells or
31、 cortex.Postauricular redness,pain,tenderness,and swelling usually occur about 2 weeks after what may have been an unremarkable or even unnoticed acute suppurative otitis media.A subperiosteal abscess is frequently present but may go unrecognized because of the surrounding induration.If uncontrolled
32、,acute mastoiditis can give rise to sigmoid sinus thrombosis with septic embolization,meningitis,and brain abscess.,Facial nerve palsy 面神经麻痹Facial nerve palsy.Facial nerve palsy both acute(AOM)and chronic(eg,cholesteatoma)can occasionally complicate middle ear infection.This 18-month-old girl had su
33、dden onset of this right complete facial nerve palsy early in the course of her acute otitis media.Facial nerve palsy complicating otitis media dictates immediate surgical drainage of the middle ear usually with ventilating tube insertion.Eye care is critical because corneal injury can occur during
34、the time that it takes the nerve to recover.Recovery occurs within the next few weeks to months and is almost always nearly complete,Branchialotorenal sequence Branchialotorenal sequence.Congenital hearing loss commonly occurs as part of a syndrome or sequence.A,A child with branchiootorenal sequenc
35、e shows first(1)and second(2)branchial clefts with a lower branchial pit(3)on the neck.This child also had a dermoid cyst on the scalp(D).B,CT of the temporal bone shows incomplete partitioning of the turns of the cochlea(black arrow),and the vestibule is bulbous(white arrow).These findings are part
36、 of what is termed Mondinis dysplasia of the inner ear.Children with any syndrome affecting the head and neck should be carefully evaluated for evidence of hearing loss.,Treacher Collins syndrome and bone-anchored hearing aid 下颌-颜面成骨不全综合征和骨导助听器Treacher Collins syndrome and bone-anchored hearing aid(
37、BAHA).Syndromic hearing loss can also be conductive in nature.In the case of Treacher Collins syndrome(mandibulofacial dysostosis),the first and second branchial arch derivatives,including the middle ears,ossicles,tympanic membrane(TM),external auditory canals,and pinnae,are involved.The resulting m
38、aximal conductive hearing loss(50 to 60 d can be rehabilitated with BAHAs,which allow percutaneous attachment of a hearing aid to the skull using,osseointegrated titanium fixtures.These hearing aids directly stimulate the skull and the cochlea,improving hearing and allowing normal speech and languag
39、e development.,Cochlear implant in a child with the CHARGE association（CHARGE联合征患儿耳蜗植入）Cochlear implant in a child with the CHARGE(colobomata of the eyes,heart defects,choanal atresia,mental retardation,and genitourinary and ear anomalies)association.CHARGE-related hearing loss may be both conductiv
40、e and sensorineural(mixed hearing loss)but is not uncommonly entirely sensorineural and of sufficient severity to warrant cochlear implantation,as illustrated.Children with CHARGE do reasonably well,with their implants,although usually not as well as other profoundly deaf children.In the absence of other abnormalities,children with cochlear implants have a greatly enhanced quality of life in that they can communicate verbally and do not need special schools.,Thank you!,2006-11-12,
