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
¡ÚTable
587-1 Risk Factors That Identify Neontes At-Risk For Seonsorineural Hearing
Impairments
Hearing Screening
Clinical Audiologic Evaluations
Audiometry
Speech Recognition Thresholds
Play Audiometry
; 2¨ö - 5yr
Visual Reinforcement Audiometry
; 5-6mo - 2¨ö
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
;
*¡ãhigh risk group
-
¡Ú6-36mo & 4-6yr
# common in male
Pathogenesis
# ¢¾¼Ò¾Æ¿¡¼ ÈçÇÑ
ÀÌÀ¯ ?
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
# ¡ÚOrganism
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 24-48hrÈÄ¿¡µµ fever, painÀÌ °è¼ÓµÇ¸é further evaluation & medications
; tympanocentesis &
myringotomy
590.2 Persistent Middle-Ear Effusion
; asymptomaticÀ̸é Ä¡·áÇÏÁö ¾Ê°í, 6wksµÚ¿¡ Àç°Ë»ç¸¦ ½Ç½ÃÇÑ´Ù.
--> ´ëºÎºÐ 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
# ¢¾Indication
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