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Clasificarea otitelor

Clasificarea otitelor

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Published by Septimus Silviu

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Published by: Septimus Silviu on Jun 23, 2012
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12/03/2012

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CLASIFICAREA OTITELOR I.Otite cu timpan deschis ac=otita supurata ac.II. Otite cu timpan inchis ac.=ot.seroasa ac cr.=otita supurata simpla;otita supurata propriu-zisa cr.=ot.seromucoasaOTITA SUPURATA AC.Definitie:proces inflamator ac al mucoasei U. mediiEtiologie: bacteriana=Haemophiluss influenzae;Branhamella catarrhalis AP:I hiperemie+edem al mucoasei II exudat inflamatorClinic:Icongestiva=otalgie,hipoacuzieIIcolectata=otalgie pulsatila,hipoacuzieIIIsupurata=otoreeIVcicatrizare=hipoacuzie-3 sapt Evolutie,complicatii=vindecare-7 zile;otomastoidita ac.;otite sup. crTratament: gen=antibiotice :Ampi 2g/zi;Augmentin 2g/zi;klacid=2g/zi;penicilina=2mil/ziotologic I=decongestionante=boramid II=paracenteza III pansamente cu alc.boricat /paracenteza(otoree pulsat)rinologic =decongestinante rinofaringiene=aerosoli,instilatii (bixtonim,rinofug) OTITA SEROMUCOASADefinitie=epansament lichidian prin proces inflamator subac.sau cr.al U.medii in spatele unui timpan fara solutie de continuitateHistologie normala si patologica-epiteliu ciliatant.predomina cel. ciliatepostcele mucipare -cel. ciliate furnizeaza date despre spatiul aerian(antene) la cel. bazale si orienteaza diferentierea= metaplazie spre cel.mucipare-proliferare capilara=infiltrat limfocitar,monocite,fibrocite fibre de colagen--epansament bogat in PN,macrofage,proteine 28-45% bacterian [H.influenzae,Branhamella cat. Streptococus pneumoniae]-tulburari de ventilatie timpanica O2=41mmHg CO2=47mmHg- singe venosaerO2=159,CO2=0,3I-inflamatieClinicSUB=afectiune multiforma cu tablouri clinice diferite pina la re-II-disfunctie tubara tractie timpanica,atelectazie,otita fibroadezivacolaps prin m.ciocanului -hipoacuzie30db pe frecventele conversationale Co=bilateralaOB:retractia timpanului cu absenta mobilitatii Ad=unilat.nivellichid retractie retractie post retractie postpost orizontalizarea proeminentaminerului ciocanului apof. ScurteEvolutie: 1) vindecare spontana 2) stare cicatriciala adeziva: otita fibroadeziva,atelectazie 3) colesteatomTratament: Co:inflamatia=adenoidectomie,antib+antiinfl.nesteroidiene-3 cure- aerator transtimpanicAd:antib+antiinfl;vasoconstrictoare nazale(pseudoefedrine cu act.centrala) aerator transtimpanicOTITA SUPURATA SIMPLADefinitie=inflamatie cr a mucoasei U.mediiAP:1) 2)timpan=perforatie mezotimpanala 3)lant osicular indemn –apof.descendenta a nicovalei lizata prin lipsa de vascularizatie 4)corticalaosoasa=proces de condensarePatogenie:disfunctie tubara=incapacitate de a egaliza pres.neg.intratimpanica in timpul deglutitieiClinic: otoree seromucoasa in puseele de infectii rinofaringieneEvolutie: acutizari si remisiuni fara complicatii infectioaseTratament:in puseuacutDNF+anemizari cu vasoconstrictoare ale tr.E(antib.conf.antibiogramei,antiinflamatorii nesteroidiene)in perioada calma=timpanoplastieOTITA SUPURATA PROPRIU-ZISADefinitie:prezenta in U.med a unui epiteliu malpighian,migrant,keratinizat,descuamant`Etiologie:bacteriana;germeni gr-,proteus,piocianicAP:-metaplazie epiteliala=tes. de granulatie polip auricular[sediu unui proces enzimatic continuu]-infiltrat inflamator cr.-osteita-colesteatom(migrare epiteliala,invaginare)Clinic:otoree fetida,perforatie marginala, masa alb sidefie,moale,nesensibila,nevascularizata,polip,hipoacuzie de transmisie sau mixtaEvolutie: spre o complicatie endocranianaTratament:excluzivitate chirurgical PARALIZIA DE FACIAL PERIFERICAmotor-m.scaritei senzitiv-zona Ramsay-Hunt senzorial-gust2/3ant.limba-m.fetei vegetativ -gld.submax.subling.lacrimale-burta post.digastric -secretie mucoasa nasosinusala,rinofaringianaEtiologie: centrala:ramolisment,scleroza in placi,siringomielieintrapietroasa:virala,infectioasa,tumorala,traumatica extrapietroasa: tumori parotidaDg+asimetrie facialaDg.dif :centrala predomina pe facial inf.fara Ch.Bell Tratament: viral=vitamine complex B,antivirale(aciclovir)infectioase=antibiotice+antiinflamatorii chirurgical=decompresiunetumorala=chir.made by traiang

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