Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2611_Библиотеки_им_академика_М_И_Перельмана.pdf
206
CMDT 2025
CHAPTER 8
» General Considerations
P aeruginosa, Proteus species, Staphylococcus aureus, and
» Clinical Findings
The clinical hallmark of chronic otitis media is purulent
aural discharge. Drainage may be continuous or intermit-
» Treatment
▲
Figure 8–3. Cholesteatoma. (Used, with permission,
from Vladimir Zlinsky, MD, in Roy F. Sullivan, PhD:
Audiology Forum: Video Otoscopy, www.RCSullivan.com;
from Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley H. The
Color Atlas of Family Medicine, 2nd ed. McGraw-Hill, 2013.)
monas, 500 mg twice a day for 1–6 weeks, may help dry a
» Complications of Otitis Media
A. Cholesteatoma
B. Mastoiditis
H influenzae, and S pyogenes), and myringotomy for
C. Petrous Apicitis
D. Facial Paralysis
OTOLARYNGOLOGY DISORDERS
S pneumoniae. Rupture into the subarachnoid space results
3. Otosclerosis
207
E. Sigmoid Sinus Thrombosis
F. Central Nervous System Infection
moniae. In chronic otitis media, it results either from pas-
4. Trauma to the Middle Ear
▲
Figure 8–4. Traumatic perforation of the left
tympanic membrane. (Used, with permission, from
William Clark, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr,
Chumley H. The Color Atlas of Family Medicine, 2nd ed.
McGraw-Hill, 2013.)
208
CMDT 2025
5. Middle Ear Neoplasia
CHAPTER 8
DISEASES OF THE INNER EAR
1. Sensorineural Hearing Loss
A. Presbycusis
Pulsatile tinnitus thus warrants magnetic resonance angiography (MRA) and MRV to rule out a vascular mass.
EARACHE
of people between the ages of 65 and 75 years and almost
50% of those over 75 experience hearing difficulties. There is
B. Noise Trauma
C. Physical Trauma
D. Ototoxicity
OTOLARYNGOLOGY DISORDERS
in all patients who present with sudden hearing loss without
obvious middle ear pathology. Prognosis is mixed, with
209
may cause irreversible hearing loss even when administered
in therapeutic doses. When using these medications, it is
E. Idiopathic Sudden Sensory Hearing Loss
F. Autoimmune Hearing Loss
210
2. Tinnitus
CMDT 2025
CHAPTER 8
ESSENTIALS OF DIAGNOSIS
»
Phantom noise or sounds.
»
Persistent tinnitus often, although not always,
indicates the presence of hearing loss.
»
Intermittent periods of mild, high-pitched tinnitus
lasting seconds to minutes are common in normal-hearing persons.
» General Considerations
» Clinical Findings
A. Symptoms and Signs
» Treatment
The most important treatment of tinnitus is avoidance of exposure to excessive noise, ototoxic agents, and other factors that
may cause cochlear damage. Masking the tinnitus with music
3. Hyperacusis
Pulsatile tinnitus—often described by the patient as
B. Diagnostic Testing
4. Vertigo
ESSENTIALS OF DIAGNOSIS
»
Either a sensation of motion when there is no
motion or an exaggerated sense of motion in
response to movement.
»
Duration of vertigo episodes with associated hearing loss or other neurologic issues are the keys to
diagnosis.
»
Evaluation includes audiogram, electronystagmography (ENG) or videonystagmography (VNG),
and head MRI.
OTOLARYNGOLOGY DISORDERS
211
» General Considerations
» Clinical Findings
A. Symptoms and Signs
Vertigo is the cardinal symptom of vestibular disease. Ve r-
Table 8–2. Causes of vertigo (listed in alphabetical
order, within categories).
Peripheral causes
Benign paroxysmal positioning vertigo
Ethanol intoxication
Inner ear barotraumas
Ménière disease
Semicircular canal dehiscence
Vestibular neuritis/labyrinthitis
Central causes
Cerebellar ataxia syndromes
Chiari malformation
Multiple sclerosis
Seizure
Wernicke encephalopathy
Mixed central and peripheral causes
Cerebellopontine angle tumors
Vestibular schwannoma
Meningioma
Endocrinopathies
Hypothyroidism
Pendred syndrome
Hyperviscosity syndromes
Waldenström macroglobulinemia
Infections
Lyme disease
Syphilis
Migraine
Stroke and vascular insufficiency
Anterior inferior cerebellar artery stroke
Posterior inferior cerebellar artery stroke
Vasculitides
Behçet disease
Cogan syndrome
Granulomatosis with polyangiitis
Susac syndrome
Vertebral artery insufficiency
Vascular compression
Table 8–3. Common vestibular disorders: differential
diagnosis based on classic presentations.
Duration of
Typical
Vertiginous
Episodes
Seconds Perilymphatic
Hours Ménière disease,
Days Labyrinthitis,
Auditory
Symptoms
Present
fistula
syphilis
autoimmune inner
ear disease,
cerebellopontine
angle tumor,
ototoxicity
Auditory Symptoms
Absent
Benign paroxysmal
positioning vertigo
(cupulolithiasis),
vertebrobasilar
insufficiency,
migraine-associated
vertigo
Migraine-associated
vertigo
Vestibular neuronitis,
migraine-associated
vertigo, multiple
sclerosis, cerebellar
degeneration
1. Peripheral vestibular disease—Peripheral vestibulopa-
testing (quickly lowering the patient to the supine position
212
2. Central disease—Vertigo arising from CNS disease
CMDT 2025
CHAPTER 8
B. Labyrinthitis
B. Vestibular Testing
» Vertigo Syndromes Due to
Peripheral Lesions
A. Ménière Disease
C. Benign Paroxysmal Positioning Vertigo
D. Vestibular Neuronitis
OTOLARYNGOLOGY DISORDERS
F. Perilymphatic Fistula
G. Cervicogenic Vertigo
213
E. Traumatic Vertigo
Labyrinthine concussion is the most common cause of
H. Migrainous Vertigo
214
I. Superior Semicircular Canal Dehiscence
CMDT 2025
CHAPTER 8
1. Vestibular Schwannoma (Acoustic Neuroma)
» Vertigo Syndromes Due to Central Lesions
sensorineural hearing loss should be evaluated for an intracranial mass lesion. Vestibular dysfunction more often
2. Vascular Compromise
DISEASES OF THE CENTRAL AUDITORY &
VESTIBULAR SYSTEMS
3. Multiple Sclerosis
OTOLARYNGOLOGY DISORDERS
OTOLOGIC MANIFESTATIONS OF AIDS
Proteus, Staphylococcus, and Pseudomonas, and rarely, by
Pneumocystis jirovecii. Sensorineural hearing loss is com-
215
» Clinical Findings
» Treatment
º
DISEASES OF THE NOSE &
PARANASAL SINUSES
INFECTIONS OF THE NOSE &
PARANASAL SINUSES
1. Viral Rhinosinusitis (Common Cold)
ESSENTIALS OF DIAGNOSIS
»
Associated malaise, headache, and cough.
»
Nasal congestion, facial pressure, rhinorrhea, and
hyposmia.
»
Erythematous, engorged nasal mucosa without
intranasal purulence.
»
Symptoms are self-limited, lasting typically less
than 10 days.
mentosa, an almost addictive need for continuous usage.
» Complications