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Non-Purulent Ear Diseases PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Non-purulent ear diseases".

This medical PowerPoint presentation is about non-purulent ear diseases, conditions that affect the ear without the presence of pus or discharge. Some common non-purulent ear diseases include:

Otitis media with effusion (OME): This is a condition where fluid builds up in the middle ear without any signs of infection. It can cause hearing loss, ear pain, and balance problems.
Tinnitus: This is a condition where you hear ringing, buzzing, or other sounds in your ears. It can be caused by exposure to loud noise, age-related hearing loss, or other underlying conditions.
Menieres disease: This is a disorder of the inner ear that can cause vertigo, ringing in the ears, and hearing loss. It is believed to be caused by a buildup of fluid in the inner ear.
Otosclerosis: This is a condition where the bones in the middle ear become fixed and cannot vibrate properly, leading to hearing loss.
Eustachian tube dysfunction: This is a condition where the tube that connects the middle ear to the back of the throat becomes blocked, causing pain, pressure, and hearing loss.
Acoustic neuroma: This is a rare type of tumor that can grow on the nerve that connects the ear to the brain. It can cause hearing loss, tinnitus, and balance problems.

It is important to consult a healthcare professional if you experience any symptoms related to non-purulent ear diseases.

Tags : Non-purulent ear diseases, Otitis media with effusion , Tinnitus, Menieres disease, Otosclerosis, Eustachian tube dysfunction, Acoustic neuroma

Published on : Jun 23, 2023 | Views : 646 | Downloads : 1

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1.Non-purulent ear diseases Department of ear, nose and throat deseases Sechenov University Moscow, Russia
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1.1. part 1 of the lecture: non-purulent ear diseases Lecturer: associate Professor, Ph. D. Eremeeva K. V. Department of ear, nose and throat deseases Sechenov University Moscow, Russia
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Sensorineural hearing loss (SHL) a form of hearing loss in which one of the sections of the sound-receiving Department of the auditory analyzer is affected, starting from the sensory cells of the inner ear and ending with the cortical representation in the temporal lobe of the cerebral cortex.
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Social and medical significance of the problem of sensorineural hearing loss Prevalence: 13 million people worldwide have significant hearing changes. By 2020, the population with socially significant hearing loss will increase by 30%: who forecast A significant percentage of patients are in the age groups of high social and professional activity The problem of childhood. Congenital hearing loss is, on average, 1-2: 1000 newborns The problem of older age groups Early manifestation of presbyacoussis in residents of industrialized areas due to chronic noise injury (sound pressure level in the metro-90-100 dB)
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The national program for universal hearing screening audiological screening in the hospital-in 1-3 months examination in the hearing centerunified database: maternity hospital-diagnostic center-deaf center in the absence of screening, the diagnosis is made only by the age of three - "the child does not speak because he does not hear» Таварткиладзе Г.А., Загорянская М.Е., Румянцева М.Г., 2009 г. objective methods of hearing research: registration of auditory evoked potentials, otoacoustic emission
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The main etiological factors of sensorineural hearing loss vascular (ischemia and metabolic disorders: atherosclerosis, DM) infectious (viral infection: SARS, flu, herpes, measles, rubella) - 30% acute SHL psychoemotionaltraumatic (acoustic trauma ("noise pollution" of cities), barotrauma, traumatic brain injury), membrane rupturesototoxic (drugs) immunological (Wegener's granulomatosis, primary autoimmune diseases) stress response (activation of cellular stress factors, Kappa factor B (NF-kB) idiopathic acute SHL https://www.youtube.com/watch?v=MT1ckEeDN5w
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Оtotoxicity Drug: aminoglycoside antibiotics diuretics (acetazolamide, ethacrynic acid) non-steroidal anti-inflammatory drugs anti-cancer drugs -platinum derivatives ACE inhibitors (enalapril, monopril) anesthetics (lidocaine) antidepressants (xanax, amitriptyline, nortriptyline) antimalarial drugs (chloroquine) calcium channel blockers (nifedipine, nicardipine) Industrial factors: heavy metals (mercury, lead, arsenic) solvents (nitrobenzene) others (carbon monoxide, fluorocarbons, organic sulfur compounds) Household intoxication: drug addiction, Smoking, alcoholism
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Classification of sensorineural hearing loss Congenital Acquired For the duration of the course: sudden (develops within a few hours) acute (up to 1 month) subacute (1-3 months) chronic (over 3 months) At the time of the occurrence: prelingual (before speech development) postlingual (after the appearance of speech) According to the degree of hearing loss, there are four degrees of hearing loss(speech frequency zones) and deafness: I degree (light) - 26-40 dB; II degree (moderate) - 41-60 dB; III degree (moderately severe) - 61-80 dB; Grade IV (severe) – more than 80 dB;deafness-more than 91 dB.
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hearing loss unilateral or bilateral Tinnitus The violation of intelligibility Possible vestibular symptoms (cochleovestibular syndrome) Clinical manifestations of sensorineural hearing loss
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С128 С128 С128 normal Normal С128 С128 С128 С128 С128 С128 Violation of sound transmissionon the right. The lateralization to the side WORSE than the hearing ear Violation of sound perceptionon the right. Lateralization in the side of the BETTER hearing ear Violation of sound transmissionon the right Violation of sound perceptionon the right A 30” B 15” В 0” К 15” В 10” К 5” Positive (+) Positive (+) Negative (-) C 128-tuning fork with a frequency of 128 Hz; A-air conductivity B-bone and tissue conductivity Weber test Rinne test Tuning fork tests: differential diagnosis of sensorineural and conductive hearing loss https://www.mediccity.ru/directions/451
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Diagnosis of sensorineural hearing loss study of auditory function otoneurological examination study of hemodynamic parameters of brachiocephalic vessels, indicators of blood clotting system radiodiagnostics
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normal Violation sound guides Violation sound perception Age-related changes in hearing norm Bone sound transmission Air sound transmission Pure tone threshold audiometry Mixed hearing loss
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П. усл.ед. А 6 4 2 0 -400 -200 0 +200 Р, мм вод. ст. А – normal Tympanometry
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Over-threshold audiometry identifying the phenomenon of accelerated growth of the volume indicates a lesion of the hair cells of the Corti organ it is most often detected in inflammatory or drug intoxication of the snail, the hydropse of the labyrinth
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Speech audiometry
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X-ray of temporal bones by Stenvers Neurinoma of the left auditory nerve. The inner ear canal on the left is expanded (arrow). https://www.medbor.ru/metodika_i_tehnika_polucheniya.../golova/149.html
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Acoustic neurinoma Contrast-enhanced MRI of the cerebellopontine angle (the arrow indicates the formation of) Characteristic audiological picture: right-sided sensorineural hearing loss https://radiosurgery.ldc.ru/nevrinomy-sluhovogo-nerva
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Therapeutic tactics for sensorineural hearing loss Drug therapy Drugs that improve cerebral blood circulation and metabolism, improve the rheological properties of blood (piracetam, vinpocetin, pentoxififillin) Drugs that affect IBD (betagistin) Glucocorticoids (methylprednisolone, dexamethasone) Vegetotropic therapy (tofizopam) Vitamins-neurotropic agents Dehydration therapy (diacarb) Non-drug treatment measures Reflexotherapy HBOT Hirudotherapy Manual therapy Hearing aid Cochlear implantation timely delivery, individual approach
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Cochlear implantation A cochlear implant is a medical device that allows partial or complete restoration of hearing in some patients with severe or severe SHL www.myshared.ru/slide/1360262/
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Cochlear implant: how it works The function of the cochlear implant –stimulation by electrical impulses of the auditory nerve fibers in the cochlea The cochlear implant consists ofexternal (wearable) and internal (implantable) parts. The wearable part contains: Microphone Microprocessor to convert the sound into electrical impulses Transmitter The implantable part contains: Receiver Signal decoder A system of electrodes that are implanted in the cochlea and located on the basilar membrane, directly in contact with the auditory nerves
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Tinnitus: classification objective (vibratory) - audible to an outside observer and can be registered using auscultation and other instrumental methods of examination of the patient (5%) Reasons: Pathology of temporomandibular joints Myoclonus of the middle ear muscles, soft palate Dehiscence of the auditory tube
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Tinnitus: classification Subjective (non-vibratory) - occurs in the absence of a real sound source and does not lend itself to evaluation from the outside (95%) Reasons: Metabolic (cerebral atherosclerosis, hepatitis, diabetes mellitus, hypoglycemia, Hypo - and hyperthyroidism) Diseases of the external, middle, inner ear (sulfur plug, exostosis of the external auditory canal, external otitis, otitis media, otosclerosis, nst, acoustic and barotrauma, Meniere's disease, hunt syndrome) "perception of silence" - a manifestation of endogenous somatic sounds, usually masked by environmental sounds, in a healthy person who is in a soundproof room
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Damage factor Powerful short-term sound or pulse noise exceeding the pain threshold (over 130 dB): military operations, terrorist attack, industrial emergency, use of pyrotechnics, acoustic equipment Clinical manifestations: SNT, vestibular disorders Acoustic, barometric trauma On the audiogram-local neuritis at 4000Hz
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Noise scale Измеров Н.Ф., Каспаров А.А., 2010г.
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1.1. part 2 of the lecture: non-purulent ear diseases Lecturer: associate Professor, Ph. D. Eremeeva K. V. Department of ear, nose and throat deseases Sechenov University Moscow, Russia
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Meniere's Disease t is characterized by variability of hypotheses and clinical manifestations of peripheral cochleovestibular disorders attacks of dizziness, accompanied by nausea, vomiting, balance disorderprogressive unilateral hearing loss (80-90%) noise in the affected ear As an independent nosological form identified by Prosper Menier (1861)
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Meniere's disease: clinical classification In shape: typical (classical) - a triad of signs described by Meniere: noise in the ear and hearing loss, balance disorders, vegetative disordersatypical -manifestations of individual signs of the triadcochlear vestibular Lermuaye syndrome (hearing loss and painful ear noise, dizziness attacks, during which the cochlear symptoms regress) Adrift: attack (angioedema) acute period Remission status meniericus
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Meniere's disease: etiology proximate cause – endolymphatic hydropspredominance of the tone of the parasympathetic part of the autonomic nervous system, which occurs as a result of vegetative-vascular dystoniapredisposing factor: poor circulation in the system of vascularization of the labyrinth metabolic disorders, in particular water-salt dysfunction of the endocrine system development of perivascular fibrosis
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The mechanism of development of hydrops of the labyrinth hyperproduction of endolymph reduction of endolymph resorption violation of membrane permeability
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Theories of Meniere's disease development Anatomical (hypoplasia or obliteration of the vestibular water supply, sclerotic changes of the temporal bone pyramid in the immediate vicinity of the endolymphatic SAC and the vestibular water supply on the affected side, reduction in the size of the endolymphatic SAC) Genetic (autosomal dominant type of inheritance of this pathology) Immunological (detection of immune complexes in the endolymphatic SAC in patients with MD) Vascular (MD connection with migraine) Allergic (the frequency of allergic reactions in patients with MD is higher than in the General population) Metabolic (potassium retention in the endolymphatic space causes potassium intoxication of hair cells and vestibular neuroepithelium, resulting in hearing loss and dizziness)
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“Obvious” Meniere's disease: definition AAO–HNS (American Academy of Otolaryngology and head and neck Surgery, 1995) ≥2 spontaneous vertigo attacks lasting ≥20 min. hearing loss confirmed by audiological studies in at least one case ear noise and / or feeling of congestion in the causal ear other reasons are excluded
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Stages of Meniere's disease reversible-attacks of cochleo-vestibular-vegetative disorders, hydrops is detected only in the period immediately preceding the attack, on the tonal audiogram-the presence of a conductive componentpronounced clinical manifestations - the presence of symptoms of Meniere's disease, intra-Labirint pressure is constantly increased, hearing fluctuation, on the tonal audiogram-the predominance of the sensorineural componentthe final one is the presence of a symptom complex of Meniere's disease, progressive hearing loss, the bone-air gap disappears on the tonal audiogram, the curves acquire a descending configuration
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Diagnosis of Meniere's disease Computer stabilometry Video oculography Audiometry Vestibular myogenic evoked potentials (MEP) (no peaks P13, N23-graph as a straight line) Electrocochleography. Transtimpanal electrocochleography (violation of the ratio of values of amplitudes SP (summation potential) /PD (action potential): p>0.3) Dehydration tests Duplex scanning of brachiocephalic vessels Variational heart rate monitoring Magnetic resonance imaging of the brain and cervical spine
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Electrocochleography otoacustica.com.br/eletrococleografia.html If there is a hydropse in the inner ear, the following signs are detected The increase in the amplitude of the negative wave summation potential (SP), a preceding action potential (AP), with a corresponding increase in the amplitude of the summation potential and action potential more 0,42.2. Shift of the latent period of the action potential during alternate stimulation with clicks with the initial phase of thickening and dilution by more than 0.2 MS.3. The change in the amplitude of the summation potential in the study of tonal parcels at a frequency of 1000-2000 Hz.Clinical recommendations
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Treatment of Meniere's disease Conservative Betahistine hydrochloride Dehydration therapy Vitamin therapy Sedative therapy Physiotherapy Reflexotherapy Surgical cutting the drum string drainage, endolymphatic SAC incision of the cochleovestibular nerve laser destruction of the labyrinth Intratympanal injection of a solution of gentamicin The relief of an attack Bed rest Exclusion of bright light, loud sounds1 ml of 0.1% solution of atropine sulfate p/K, 2 ml of 2.5% solution of pipolfen b / m, betagistine 48 mg
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Methods of rehabilitation measures in patients with Meniere's disease Exercises on stabilographic complexes: training of vestibular function, vision, development of muscle and joint feeling Physical therapy aimed at improving statokinetic stability Correction of the patient's anxiety, uncertainty and fear Natural factors: climate therapy, mud therapy http://www.mbn.ru/ru/mbn-product-type/stabilometry
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1.1. part 3 of the lecture: non-purulent ear diseases Lecturer: associate Professor, Ph. D. Eremeeva K. V. Department of ear, nose and throat deseases Sechenov University Moscow, Russia
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OtosclerosisOtosclerosis (greek) otos – ear, sclerosis - solidification is Described for the first time in the 18th century Politzer coined the term 1894 a disease of the hearing organ caused by a focal pathological process of the enchondral layer of the bone capsule of the labyrinth, which leads to the fixation of the base of the stirrup in the window of the vestibule Shea JJ., Jr Fenestration of the oval window. Ann Otol Rhinol Laryngol. 1958;67(4):932–951
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Epidemiology Clinically pronounced otosclerosis affects 1-2% of the world's population (histological otosclerosis is detected in 10%) The disease affects the most socially active part of the population aged 15 to 45 years, women predominate
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Ethiology The etiology of the disease is not established Among the many hypotheses of the occurrence of the disease prevail Autoimmune Hereditary (autosomal dominant heredity of a specific type of reaction to various Exo - and endogenous effects) Alimentary Exo-and endogenous factors: puberty, pregnancy, menopausehypofunction of the thyroid glandimpact of noise and vibration
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Otosclerosis: clinical manifestations Symptoms: Progressive double-sided conductive bradyacuasia Ear noise (67-98% of patients)"paracusis Willisii" (50% of patients) Toynbee symptom (lack of sulfur) Lempert's symptom (thinning of the eardrum) symptom Schwarze (focus of otosclerosis) symptom Verhovskogo-Tillo (a wide external auditory canal) Blue sclera
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Classification by the nature of the audiometric picture The tympanic form is characterized by normal values of auditory sensitivity in bone conduction and the presence of a sufficient bone-air interval (BAI)
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Mixed form. The gentle nature of the curves, increased thresholds of auditory sensitivity in bone conduction and a sufficiently large BAI Classification by the nature of the audiometric picture
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Cochlear form Descending curves of auditory sensitivity in bone and air conduction with a small BAI and-reserve of the cochlea Classification by the nature of the audiometric picture
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Reflex on the stapedial muscle when fixing the stirrup is missing (4) , in contrast to the acoustic reflex in the norm (1) Audiological diagnosis of otosclerosis:reflex on stapedial muscle
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Computer diagnostics of otosclerosis Mobility of the malleolus-incus joint In fMSCT patients with otosclerosis, there was a thickening of the membrane of the vestibule window and a decrease in the volume of movements, as well as a decrease in the movements of the malleolus-incus joint. А.С.Лопатин, Е.Н.Латышева, И.В.Бодрова, 2012 Axial projection. The foot plate of the stapes is thickened.
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Surgical treatment of otosclerosis Indirect mobilization of the stapes base Direct mobilization of the stapes base Fenestration of the labyrinth Stapedoplasty
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The result of the operation is evaluated by reducing the BAI
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inflammation of the middle ear, characterized by the accumulation of non-purulent fluid in it Exudative otitis media
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Causes of exudative otitis media Acute and chronic diseases of the nose, paranasal sinuses and pharynx with the spread of inflammation to the pharyngeal mouth of the auditory tube Adenoids Neoplasms of the nasopharynx Inadequate treatment of acute otitis media Barotrauma
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Theories of development of exudative otitis media Hydrops ex vacuo – violation of the patency of the auditory tube leads to resorption of air in the cavities of the middle ear and transudation of fluid in them Violation of the function of the atrial epithelium of the auditory tube The inflammatory theory Secretory theory-violation of the secretory function of the middle ear mucosa
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Clinical manifestation of exudative otitis media Uni-or bi-lateral hearing loss fluctuating character (when changing the position of the head) Autophony Sensation of congestion and / or fluid transfusion in the ear Tinnitus
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Diagnosis of exudative otitis media Type “B” tympanogramm Otoscopy – air bubbles on the background of exudate in the tympanic cavity (arrows)
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Elimination of the cause of the disease Rehabilitation of inflammatory processes in the nasopharynx, Adenotomy, removal of neoplasms of the nasopharynx Correction of nasal cavity architectonics nasal cavity and paranasal sinuses Restoration of drainage and ventilation function of the auditory tube Topical decongestants Blowing the auditory tube by Politzer Catheterization of the auditory tube Exercise therapy for auditory tubes Pneumatic massage of the eardrum Treatment of exudative otitis media
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Surgical treatment of exudative otitis media- shunting of the tympanic cavity Otoscopic picture myringotomy with aspiration of the contents of the tympanic cavity Otoscopic picture of the shunting of the tympanic cavity www.entusa.com/eardrum_and_middle_ear.htm
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References Пальчун В.Т., Крюков А.И. 2010 Учебные пособия кафедры болезней уха, горла и носа Сеченовского Университета