Otites infectieuses de l'adulte et de l'enfant Flashcards
Les lésions de l’oreille externe :
- au niveau du pavillon
- au niveau du CAE
> Pavilion:
- Otohematoma: blood between the perichondrium and the cartilage, evacuation and drainage
- Perichondritis: after an open trauma, an infected hematoma, an open otitis externa, the flag is red, oedematous. Germe ++ Ps Aeruginosa, ATB general, watch out for cartilaginous necrosis
- Painful nodule: dyskeratosis centered by a neuroma on the edge of the helix (Darwin), resection ++
> CAE:
- otitis externa ++ frequent, summer, trauma
=> intense otalgia, palpation tragus painful, no fever, over-normal eardrum
= bacterial or mycotic external otitis (Aspergillus, filament and black spots), a furuncle of the hairy area of the CAE or an infected eczema (Streptococcus, Aeruginosa)
TT: local ATB or local antimycotic + symptomatic
- Zona VIIbis: intense otalgia, burns + vesicles at the conch and CAE (Ramsay-Hunt)
- Earwax plug: pain with water ++
- Foreign bodies
- Tumors of CAE
Les lésions de l’oreille moyenne
- OMA ++
- Tubal catarrh: dysfunction of the auditory tube related to a tubal obstruction, pressure variations or tumor obstruction.
Otalgia + hypoacusia + congestion of the eardrum + shift of the tympanogram towards the negative pressures - Phlyctenular myingitis: phlyctenes on the tympanic membrane, puncture under ATB
- Chronic otitis
- Mastoiditis: mastoid tip pain during otitis, retroauricular swelling
Otalgies réflexes
- Trigeminal: dental origin, oral cavity, rhino-pharynx, temporomandibular joint
- Facial: zona (rash, earache, peripheral facial palsy, dizziness and perceptual deafness), tumor
- Glossopharyngeal: oral cavity, oropharynx, rhino pharynx
- Pneumogastric: larynx, pharynx and esophagus
- Sympathetic cervical: lymphadenopathy, parotid, cervical spine
OMA : généralités
acute otitis media = infectious inflammation of the mucosa of the middle ear, contamination by the nasopharynx and nasal cavities ++
90% viral - 10% bacterial (H.Influenzae, Pneumococcus)
Contributing factors:
- community life
- passive smoking
- history of recurrent ear infections
- season winter and autumn
- no breastfeeding
OMA : diagnostic
=> during a rhino-pharyngitis + otalgia +/- otorrhea
Otoscopy: says the diagnosis
> congestive stage: bright red tympanum
> collected stage: purple tympanum, bulging with disappearance of the reliefs
> perforated stage: tympanic perforation with mucopurulent fluid
OMA : traitement
> Congestive stage: simple treatment and monitoring
- nasal clearing, ear instillation, analgesics
> Suppurative stage:
Probable ATB = Amoxicillin ++ or Augmentin
- duration of 8-10J in children, 5J in adults
° Paracentesis: incision in the antero-inferior quadrant of the eardrum = drainage and bacteriological samples
OMA : complications
> Mastoiditis: pus through the cortical bone of the mastoid bone during purulent otitis with flag detachment and retroauricular swelling.
CT: mastoid opacity (++ search for meningoencephalic complications)
TT: ATB + paracentesis +/- surgery
> Facial paralysis
Meningitis
Chronic tympanic perforation
Sero-mucosal otitis (10-20%) in the long term
OMC : généralités
Chronic otitis media = inflammatory processes of the middle ear evolving for more than 3 months.
> Benign or non-cholesteatomatous (OSM, OMTO)
Dangerous or cholesteatomatous
OMC : Otite séromuqueuse (OSM) ou OMC à tympan fermé
Sero-mucosal otitis = effusion without symptoms of acute infection
> Frequent ++ 50% of children and bilateral (85%)
Favoring factors: velar division, cavum tumor (unilateral ++), adenoid hypertrophy, trisomy 21
Hypoacousie ++
Otoscope: matt, amber, retracted, fluid level
Audiometry: transmission deafness (27 dB)
Tympanogram: straight
OSM : TTT
Often favorable evolution ++
We will treat the OSM which will give complications or with a prolonged evolution
- nasopharyngeal infection: washing ++ ablation of the vegetations
- Tubal permeability and aeration: transtympanic aerators (ATT) if complications:
° deafness: transmission deafness greater than 30 dB, language delay
° fluid effusion: repeated infections
OMC : Otite muqueuse à tympan ouvert
Otitis mucosa with open tympanum = perforated eardrum with otorrhea +++ due to muciparous metaplasia of the middle ear
> Otoscopy: non-marginal perforation, does not reach the walls of the duct
TTT: nasopharyngeal lavage, removal of vegetations, aspiration of secretions, eardrum (tympanoplasty)
Séquelles des otites : Tympanosclérose
Sequels:
> Tympanosclerosis: hyaline transformation of the mucosa of the middle ear, infiltration of pseudocartilages or pseudocalcary immobilizing the ossicles => progressive hypoacusis + white tympanus of hard plates (otoscopy) + transmission deafness
Séquelles des otites : Otite atélectasique
Atelectatic otitis:
> Tympanic retraction pocket: collapse of the tympanic cavity which results in the retraction of the membrane.
Otoscopy: topography (atrial or attic), marginal or not, self-cleaning or not (otorhea), reversible or fixed.
TT:
- clean, stable = monitoring, TT infections
- desquamating, uncontrollable, otorrheic or disabling transmission loss = tympanoplasty
> Fibroadhesive otitis: filling of the tympanic cavity with fibrous tissue, blocking the ossicles.
Otoscopy: white tympanum, gray, thickened, with verticalization of the hammer handle
Mixed deafness ++ impairment of the inner ear (evolution)
TT: Amplifying hearing aid (surgery failure)
Cholestéatome
Cholesterectoma = presence of a keratinized epithelium with potential for desquamation, migration and erosion.
Progressive hypoacusis, purulent otorrhoea, foul.
Imaging ++ visualization
TT: lesion eradication + tympanoplasty + clinical and radiological monitoring (min 10 years cause recurrences)
