Analysis And Summary Of Literature Cases Of Silent Otitis Media

Objective:The tympanic membrane of silent otitis media is complete,and there is no history of otorrhea.The clinical manifestations are lack of specificity.It is easy to misdiagnose and miss the diagnosis.This article summarizes the common clinical manifestations of silent otitis media and the characteristics of the examination results through the case review and literature review.Recognize the disease and analyze the causes of misdiagnosis and missed diagnosis,thus guiding the practice.Methods:Analysis of 17 cases of silent otitis media admitted to the First Affiliated Hospital of Kunming Medical University from January 2010 to September 2019,collect domestic literature reports of silent otitis media,conduct comparative studies,and summarize the common clinical manifestations,specialist examinations,and imaging examination results of silent otitis media.And report the data of 3 typical cases of patients with special significance,and explore the significance of their clinical manifestations for diagnosis.Results:From January 2010 to September 2019,our department diagnosed 17 patients(17 ears)with silent otitis media.The main symptoms were 17 ears(100%)with hearing loss,10 ears(58.8%)with stuffiness,and 7 ears(41.1%)with tinnitus,3 ears(17.6%)with earache,1 ear(5.8%)with headache,and 1 case(5.8%)with otogenic facial paralysis.Among them,4 ears(23.5%)had normal tympanic membrane morphology,and 13 ears(76.5%)had abnormal tympanic membrane morphology.Pure tone audiometry showed conductive deafness in 7 ears(41.1%)and mixed deafness in 10 ears(58.9%).Acoustic impedance results were obtained in 1 ears(5.8%)of type A,11 ears(64.5%)of type B,4 ears(23.6%)of type C,and 1 ear(5.8%)of type As.HRCT scan showed that all patients had soft tissue shadow filling in the middle ear cavity.During the operation,huge cholesteatoma was seen in the mastoid cavity of the 6 ears,and the ossicles were completely destroyed;granulation tissue was seen in the supratympanic cavity and sinus of the 4 ears.5 ears have different degrees of ossicular chain damage,1 ear have partial cone and vertical bone destruction of the facial nerve;6 ears have different degrees of granulation and encapsulated effusion in the tympanic cavity,tympanic sinus and mastoid process,all patients All were treated with surgery.A total of 265 patients(294 ears)with silent otitis media were included in the Chinese literature.There are 244 cases(273 ears)with detailed description of symptoms,including 177 ears(64.8%)with hearing loss,124 ears(45.4%)with ear tightness,105 ears(38.4%)with tinnitus,78 ears(28.55%)with headache,and 38 ear(13.9%)with pains Ears.265 patients(294 ears)had complications,including 15 patients with otogenic facial paralysis(5.1%),12 patients with labyrinthitis(4.0%),8 patients with meningitis(2.7%),and 7 patients with sigmoid sinus thrombophlebitis(2.3%),4 cases of subperiosteal abscess behind the ear(1.3%),1 case of brain abscess(0.3%).A total of 261 cases(286 ears)with detailed description of periosteal morphology,including 68 ears(23.8%)with normal tympanic membrane morphology and 218 ears(76.2%)with abnormal tympanic membrane morphology.A total of 215 cases(243 ears)of pure tone audiometry were recorded in detail,including 17 ears(7.0%)in normal subjects,191 ears(78.6%)in conductive deafness,30 ears(12.3%)in mixed deafness,and sensorineural deafness 5 ears(2.1%).A total of 145 patients(169 ears)were recorded in detail,including 18 ears(10.6%)in type A,89 ears(52.7%)in type B,59 ears(35.0%)in type C,and 3 ears(1.7%)in type As.Ear CT scan of the middle ear cavity can show different degrees of soft tissue shadow and different degrees of signs of destruction.Conclusion(s):Silent otitis media is characterized by a complete tympanic membrane and no history of otorrhea.However,there are irreversible pathological changes in the tympanum,tympanic sinus or mastoid process.The lack of specific manifestations of typical otitis media can silent lead to missed diagnosis and misdiagnosis.The common symptoms of silent otitis media are hearing loss,ear tightness,tinnitus,etc.;there are many abnormal changes in the shape of the drum;pure tone audiometry and acoustic impedance examination can find abnormalities.Clinically,for patients with tympanic membrane integrity and long-term ear discomfort,it is necessary to seriously ask the medical history and carefully examine the tympanic membrane;especially high-resolution temporal bone CT examination is very important for the diagnosis.Surgery is an effective treatment for the disease after a clear diagnosis.