上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 cholesteatoma_第1頁(yè)
上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 cholesteatoma_第2頁(yè)
上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 cholesteatoma_第3頁(yè)
上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 cholesteatoma_第4頁(yè)
上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 cholesteatoma_第5頁(yè)
已閱讀5頁(yè)，還剩71頁(yè)未讀， 繼續(xù)免費(fèi)閱讀

下載本文檔

版權(quán)說(shuō)明：本文檔由用戶(hù)提供并上傳，收益歸屬內(nèi)容提供方，若內(nèi)容存在侵權(quán)，請(qǐng)進(jìn)行舉報(bào)或認(rèn)領(lǐng)

文檔簡(jiǎn)介

CholesteatomaShankaiYinProfDeptofOtolaryngology,thesixthhospitalaffiliatedtoShanghaijiaotonguniversityOtolaryngologyinstituteatShanghaijiaotonguniversityCholesteatomaShankaiYinProEpidemiologyExactprevalenceisunknownIncidenceestimatedbetween3and12.6per100,000EpidemiologyExactprevalenceiClassificationCongenitalAcquiredPrimaryacquired(retractionpocket)SecondaryacquiredClassificationCongenitalPathogenesisCongenitalArisefromembryonalrestsofepithelialcellsLocation(petrouspyramid,mastoidandmiddleearcleft)LevensoncriteriaWhitemassmedialtonormalTMNormalparsflaccidaandtensaNohistoryofotorrheaorperforationsNopriorotologicproceduresPriorboutsofotitismedianotgroundsforexclusionPathogenesisCongenitalTheories

“Acquired”inclusiontheory -TosEpidermalresttheory-TeedMichaelTheories“Acquired”inclusiCongenitalcholesteatomaCongenitalcholesteatomaPrimaryacquiredEustachiantubedysfunctionPooraerationoftheepitympanicspaceRetractionoftheparsflaccidaNormalmigratorypatternalteredAccumulationofkeratin,enlargementofsacPrimaryacquiredPrimaryacquiredcholesteatomaPrimaryacquiredcholesteatomaSecondaryacquiredImplantation–surgery,foreignbody,blastinjuryMetaplasia–transformationofcuboidalepitheliumtosquamousepitheliumfromchronicinfectionInvasion/Migration–medialmigrationalongpermanentperforationofTMPapillaryingrowth–intactparsflaccida,inflammationinPrussack’sspace,breakinthebasalmembrane,cordsofepitheliummigrateinwardSecondaryacquired上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件cholesteatomaClinicalmanifestationsCommonPainlessotorrheaRefractory/recurrentearinfectionsConductivehearinglossUncommonVertigo/SensorineuralFacialnerveparalysisCNSinfectionsBrainherniation/CSFleakPneumocephalusClinicalmanifestationsCommonhistoryPhysicalExaminationOtomicroscopyPosterosuperiorretractionpocketwithsquamGranulationfromdiseasedboneAuralpolypsPneumaticotoscopy–positivefistularesponsesuggestserosionintolabyrinthCulturesshouldbeobtainedininfectedearsDiagnosishistoryDiagnosisAudiologyusuallyconductiveloss,mayvarygreatly;confirmwithtuningforksImaging

CTtemporalbone–definitelyobtainforrevisioncases,complicationsofchronicsuppurativeotitismedia,sensorineuralhearingloss,vestibularsymptoms,othercomplicationsofcholesteatomaAudiologyImagingPurposeDiagnosisDeterminingextentRiskassessmentModalitiesPlainfilmComputedtomographyscansMagneticResonanceimagingImagingPurpose

GoalsofCTImagingMiddleearventilationOssiculardestructionEpitympanumaccessMastoidcortexTegmenintegrityLabyrinthinvolvementFacialnerveinvolvementSurgicalchangesGoalsofCTImagingMiddleear上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件cholesteatoma上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件cholesteatoma上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件cholesteatomaCTdisadvantagesGranulationtissuevs.cholesteatomaSpecificsofttissueproblemsDuralinvolvementAbscessBrainherniationLabyrinthinvolvementSigmoidsinusthrombosisMRIneededCTdisadvantagesGranulationtiMRImagingHypointenseonT1IsointensetobrainIntermediateonT2NonenhancingGranulationtissuedoesenhanceRecurrencedetectionLesions>2mm90%sensitive,100%specificityMRImagingHypointenseonT1T2DelayedcontrastT1T2DelayedcontrastT1DifferentialDiagnosisChronicserousotitismediaJugulotympanicparagangliomasCholesterolgranulomasNeurofibromasHemangiomasArachnoidcystJugularbulbanomaliesTympanosclerosisencephaloceleDifferentialDiagnosisChronicTreatmentCreatea“dryandsafe”ear

TreatmentCreatea“dryandsaf

Non-surgicalTreattheInfection–FloxinOticDropsDecreasetheinflammation–TopicalsteroidsDebridementoftheexternalcanalNon-surgicalTreattheInfectiSurgicalAtticotomyRadicalMastoidectomyBondyModifiedRadical(Canalwalldown)mastoidectomyTympanoplastyandcanalwallupmastoidectomySurgicalAtticotomyPrognosisResidualorrecurrentcholesteatomaover5years–15to40%Reportedtobeupto67%inthepediatricpopulationClosefollow-up

Regularexaminationsneeded-6monthsPrognosisResidualorrecurrentComplicationsDuraltear-CSFleakFistulaofthehorizontalsemicircularcanal(vertigo)–Upto10%FacialnerveinjuryInjurytothesigmoidsinus/jugularbulbOtiticHydrocephalusHearingloss30%haveconductivelosspre-operativelyPostoperatively,anadditional30%haveworseningoronsetofhearinglossduetoextentofdiseaseInfection–Meningitis,Abscess,lateralsinusthrombosis–Upto1%ComplicationsDuraltear-CSFPredisposingfactorsVirulentorganismsCholesteatomaandboneerosionPresenceofacongenitaldehiscence(e.g.dehiscentfacialcanal)orapreformedpathway(e.g.skullbasefracture)Obstructionofdrainagee.g.byapolyp.LowresistanceofthepatientPredisposingfactorsVirulentoPathwaysofinfectionThecommonestwayforextensionofinfectionisbyboneerosionduetoacholesteatoma.Vascularextension(retrogradethrombophlebitis).Extensionalongpreformedpathwaysas–Congenitaldehiscences,fracturelines,roundwindowmembrane,thelabyrinth,–Dehiscencesduetoprevioussurgery.PathwaysofinfectionThecommoClassificationCranialcomplicationsExtra-cranialcomplicationsIntra-cranialcomplicationsClassificationCranialcomplicaCranialcomplicationsAcutemastoiditisandmastoidabscesses(mostcommoncomplication).Petrositis.Labyrinthitis.Facialparalysis.OsteomyelitisofthetemporalboneCranialcomplicationsAcutemasExtra-cranialcomplicationsExternalotitisCervicallymphadenitisRetropharyngealParapharyngealabscessesExtra-cranialcomplicationsExtIntracranialcomplicationsExtraduralabscess(commonestintracranialcomplication).Subduralabscess.Meningitis.Brainabscess:Temporallobeabscess.Cerebellarabscess.Lateralsinusthrombosis.Otitichydrocephalus.IntracranialcomplicationsExtPotentiallylifethreateningSuppurativeotorrhea,chronicheadache,pain,fever–impendingintracranialcomplicationMentalstatuschanges,nuchalrigidity,cranialneuropathiesrequireneurosurgicalconsultPotentiallylifethreatening上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件cholesteatoma上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件cholesteatomaBrainAbscessBrainAbscessQuestions?Questions?CholesteatomaShankaiYinProfDeptofOtolaryngology,thesixthhospitalaffiliatedtoShanghaijiaotonguniversityOtolaryngologyinstituteatShanghaijiaotonguniversityCholesteatomaShankaiYinProEpidemiologyExactprevalenceisunknownIncidenceestimatedbetween3and12.6per100,000EpidemiologyExactprevalenceiClassificationCongenitalAcquiredPrimaryacquired(retractionpocket)SecondaryacquiredClassificationCongenitalPathogenesisCongenitalArisefromembryonalrestsofepithelialcellsLocation(petrouspyramid,mastoidandmiddleearcleft)LevensoncriteriaWhitemassmedialtonormalTMNormalparsflaccidaandtensaNohistoryofotorrheaorperforationsNopriorotologicproceduresPriorboutsofotitismedianotgroundsforexclusionPathogenesisCongenitalTheories

“Acquired”inclusiontheory -TosEpidermalresttheory-TeedMichaelTheories“Acquired”inclusiCongenitalcholesteatomaCongenitalcholesteatomaPrimaryacquiredEustachiantubedysfunctionPooraerationoftheepitympanicspaceRetractionoftheparsflaccidaNormalmigratorypatternalteredAccumulationofkeratin,enlargementofsacPrimaryacquiredPrimaryacquiredcholesteatomaPrimaryacquiredcholesteatomaSecondaryacquiredImplantation–surgery,foreignbody,blastinjuryMetaplasia–transformationofcuboidalepitheliumtosquamousepitheliumfromchronicinfectionInvasion/Migration–medialmigrationalongpermanentperforationofTMPapillaryingrowth–intactparsflaccida,inflammationinPrussack’sspace,breakinthebasalmembrane,cordsofepitheliummigrateinwardSecondaryacquired上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件cholesteatomaClinicalmanifestationsCommonPainlessotorrheaRefractory/recurrentearinfectionsConductivehearinglossUncommonVertigo/SensorineuralFacialnerveparalysisCNSinfectionsBrainherniation/CSFleakPneumocephalusClinicalmanifestationsCommonhistoryPhysicalExaminationOtomicroscopyPosterosuperiorretractionpocketwithsquamGranulationfromdiseasedboneAuralpolypsPneumaticotoscopy–positivefistularesponsesuggestserosionintolabyrinthCulturesshouldbeobtainedininfectedearsDiagnosishistoryDiagnosisAudiologyusuallyconductiveloss,mayvarygreatly;confirmwithtuningforksImaging

CTtemporalbone–definitelyobtainforrevisioncases,complicationsofchronicsuppurativeotitismedia,sensorineuralhearingloss,vestibularsymptoms,othercomplicationsofcholesteatomaAudiologyImagingPurposeDiagnosisDeterminingextentRiskassessmentModalitiesPlainfilmComputedtomographyscansMagneticResonanceimagingImagingPurpose

GoalsofCTImagingMiddleearventilationOssiculardestructionEpitympanumaccessMastoidcortexTegmenintegrityLabyrinthinvolvementFacialnerveinvolvementSurgicalchangesGoalsofCTImagingMiddleear上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件cholesteatoma上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件cholesteatoma上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件cholesteatomaCTdisadvantagesGranulationtissuevs.cholesteatomaSpecificsofttissueproblemsDuralinvolvementAbscessBrainherniationLabyrinthinvolvementSigmoidsinusthrombosisMRIneededCTdisadvantagesGranulationtiMRImagingHypointenseonT1IsointensetobrainIntermediateonT2NonenhancingGranulationtissuedoesenhanceRecurrencedetectionLesions>2mm90%sensitive,100%specificityMRImagingHypointenseonT1T2DelayedcontrastT1T2DelayedcontrastT1DifferentialDiagnosisChronicserousotitismediaJugulotympanicparagangliomasCholesterolgranulomasNeurofibromasHemangiomasArachnoidcystJugularbulbanomaliesTympanosclerosisencephaloceleDifferentialDiagnosisChronicTreatmentCreatea“dryandsafe”ear

TreatmentCreatea“dryandsaf

Non-surgicalTreattheInfection–FloxinOticDropsDecreasetheinflammation–TopicalsteroidsDebridementoftheexternalcanalNon-surgicalTreattheInfectiSurgicalAtticotomyRadicalMastoidectomyBondyModifiedRadical(Canalwalldown)mastoidectomyTympanoplastyandcanalwallupmastoidectomySurgicalAtticotomyPrognosisResidualorrecurrentcholesteatomaover5years–15to40%Reportedtobeupto67%inthepediatricpopulationClosefollow-up

Regularexaminationsneeded-6monthsPrognosisResidualorrecurrentComplicationsDuraltear-CSFleakFistulaofthehorizontalsemicircularcanal(vertigo)–Upto10%FacialnerveinjuryInjurytothesigmoidsinus/jugularbulbOtiticHydrocephalusHearingloss30%haveconductivelosspre-operativelyPostoperatively,anadditional30%haveworseningoronsetofhearinglossduetoextentofdiseaseInfection–Meningitis,Abscess,lateralsinusthrombosis–Upto1%ComplicationsDuraltear-CSFPredisposingfactorsVirulentorganismsCholesteatomaandboneerosionPresenceofacongenitaldehiscence(e.g.dehiscentfacialcanal)orapreformedpathway(e.g.skullbasefracture)Obstructionofdrainagee.g.byapolyp.LowresistanceofthepatientPredisposingfactorsVirulentoPathwaysofinfectionThecommonestwayforextensionofinfectionisbyboneerosionduetoacholesteatoma.Vascularextension(retrograde

溫馨提示

  • 1. 本站所有資源如無(wú)特殊說(shuō)明，都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請(qǐng)下載最新的WinRAR軟件解壓。
  • 2. 本站的文檔不包含任何第三方提供的附件圖紙等，如果需要附件，請(qǐng)聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶(hù)所有。
  • 3. 本站RAR壓縮包中若帶圖紙，網(wǎng)頁(yè)內(nèi)容里面會(huì)有圖紙預(yù)覽，若沒(méi)有圖紙預(yù)覽就沒(méi)有圖紙。
  • 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
  • 5. 人人文庫(kù)網(wǎng)僅提供信息存儲(chǔ)空間，僅對(duì)用戶(hù)上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理，對(duì)用戶(hù)上傳分享的文檔內(nèi)容本身不做任何修改或編輯，并不能對(duì)任何下載內(nèi)容負(fù)責(zé)。
  • 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容，請(qǐng)與我們聯(lián)系，我們立即糾正。
  • 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶(hù)因使用這些下載資源對(duì)自己和他人造成任何形式的傷害或損失。

評(píng)論

0/150

提交評(píng)論