Part 30. The Ear

Chapter 586. Clinical Manifestations

Chapter 587. Hearing Loss

Etiology

Genetic-Congenital

    ; *Pendred. Usher, Wardenburg syndrome

    ; *Pierre-Robin, Treacher Collins, Klippel-Feil, Crouzon syndrome, OI

    ; familial

           - *AR : 70-80%

Genetic-Postnatal

Nongenetic-Congenital

Nongenetic-Postnatal

★Table 587-1 Risk Factors That Identify Neontes At-Risk For Seonsorineural Hearing Impairments

Hearing Screening

Clinical Audiologic Evaluations

Audiometry

Speech Recognition Thresholds

Play Audiometry

    ; 2½ - 5yr

Visual Reinforcement Audiometry

    ; 5-6mo - 2½

Behavioral Observation Audiometry

    ; below 5mo

Acoustic Immitance Testing

Auditory Brain Stem Response

    ; neonatal newborn

    ; used for diagnosis of auditory dysfunction & disorder of auditory nervous system

    ; *not assess “hearing”

    ; reflects auditory neuronal electric responses

Otoacoustic Emissions

Chapter 589. External Otitis

Etiology

    ; *Pseudomonas aeruginosa, Enterobacter aerogenes, Proteus mirabilis, Klebsiella pneumoniae, streptococci, S. epidermidis, fungi such as candida, aspergillus

    ; *herpes virus hominis, varicella-zoster

Chapter 590. Otitis Media And Its Complication

Epidemiology

# infants & young children

    ; *▲high risk group

           - ★6-36mo & 4-6yr

# common in male

Pathogenesis

# ♥소아에서 흔한 이유 ?

    1) Eustachian tube dysfunction

           ; more horizontal

           ; torus tubarius surrounding numerous lymphoid follicles

           ; enlargement of adenoid - mechanical obstruction

           ; stiffness of cartilage support of the tube - functional obstruction

    2) susceptibility to recurrent URI

    3) immature developing immune systems

590.1 Acute Otitis Media

Clinical Manifestation

# fever

    ; 1/3 to 1/2

 

Treatment

# ★Organism

    1) infant & children

           ; Str. pneumoniae

           ; atypable H. influenze

           ; Moraxella catarrhalis

    2) neonate over 2wks

           ; Str. pneumoniae, H. influenzae

    3) *neonate less than 2wks

           ; *G(-) bacteria, Sta. aureus, GBS

# oral amoxicillin 40mg/kg/24hr tid for 10days

    ; initial AB

# *AB medication 24-48hr후에도 fever, pain이 계속되면 further evaluation & medications

    ; tympanocentesis & myringotomy

590.2 Persistent Middle-Ear Effusion

; asymptomatic이면 치료하지 않고, 6wks뒤에 재검사를 실시한다.

    --> 대부분 normalized

590.3 Recurrent Acute Otitis Media

590.4 Otitis Media With Effusion

# acute ; less than 3wks, subacute ; 3wks-3mo, chronic ; greater than 3mo

Treatment

# ♥Indication Of Treatment

    ; symptomatic

           - hearing loss

    ; young infants

    ; asso. purulent URI

    ; vertigo

    ; alteration of tympanic membrane - severe atelectasis, deep retraction pockets, pars flaccida

    ; middle ear change - adhesive otitis, ossicular involvement

    ; persist for 3mo or longer

    ; frequently recur

    -->  1) AB change

           2) topical or systemic nasal decongestants, antihistamine

           3) systemic corticosteroids

           4) eustachian tube-middle-ear inflation

590.5 Atelectasis Of The Tympanic Membrane-Middle Ear And High Negative Pressure

590.6 Complication And Sequelae

Hearing Loss

Perforation

Chronic Supprative Otitis Media With Mastoiditis

Acquired Cholesteatoma

Mastoiditis

Acute Mastoid Osteitis

Petrositis

Adhesive Otitis

Tympanosclerosis

Ossicular Discontinuity

Facial Paralysis

Supprative Labyrinthitis

Cholesterol Granuloma

Neck Abscess

Infectious Eczematoid Dermatitis

Intracranial Suppurative Complication

Meningitis

Extrdural Abscess

Subdural Empyema

Focal Otitic Encephalitis

Otogenic Brain Abscess

Lateral Siuns Thrombosis

Otitic Hydrocephalus