Queenie's 微笑的黃金

從來沒有這樣的感冒過  前幾天是抱著面紙一包的用  鼻塞應該是有嚴重吧  就是......那種吃東西時會覺得呼吸不到的感覺
但是  怪的是   耳朵就是有像一直處於剛搭飛機完的那種壓力不平衡感覺

而且  居然只有一隻耳朵有這種感覺 又有點聽力悶悶的(一度覺得只想用左耳去聽東西了) 

不過  也意外發現當我彎腰 頭的姿勢改變時  耳朵的壓力就relief很多???

昨天ER晚班時   真的是有困擾到我   於是麻煩ENT幫我看一下……沒想到驚呼……

“……….阿!!!積水了啦………”

多謝各位關心  包括鄭醫師還有打電話來  謝謝及時幫我解決中耳積水的顏醫師  (雖然有擦了一些local 還是覺得這麼一抽……還是有痛到阿!!) 

Otitis Media with Effusion中耳積水

Otitis media with effusion (OME) refers to fluid in the middle ear space without symptoms of an acute ear infection. OME occurs when the Eustachian tube, which connects the inside of the ear to the back of the throat, becomes blocked. This tube helps drain fluids to prevent them from building up in the ear. The secretions drain from the tube and are swallowed.

When the Eustachian tube is partially blocked, fluid accumulates in the middle ear. The process may be acute (0 to 3 weeks in duration), subacute (3 to 12 weeks in duration), or chronic (greater than 12 weeks in duration).

The following can cause swelling of the lining of the Eustachian tube, leading to increased secretions:  

• Allergies
• Irritants (especially cigarette smoke)
• Respiratory infections

The following can cause the Eustachian tube to close or become blocked:

• Sudden increases in air pressure (such as descending in an airplane or on a mountain road)
• Drinking while lying on your back

OME is most common in winter or early spring, but can occur at any time of year. It can affect people of any age, although it occurs most often in children under age 2. (It is rare in neonates.)  Younger children get OME more often than older children or adults for several reasons:

• The tube is shorter, more horizontal, and straighter, making it easier for bacteria to enter
• The tube is floppier, with a tinier opening that's easy to block
• Young children get more colds because it takes time for the immune system to be able to recognize and ward off cold viruses

成人少見  可能之病因如下:

1、鼻咽部腫瘤。

Diagnosis：

A general ear examination may show dullness, air bubbles, fluid behind the eardrum, or reduced movement of the eardrum.

A test called tympanometry(鼓室聽力) can is a more accurate tool for diagnosing OME. The results of the test can help tell the amount and thickness of the fluid present.  

Aspiration of the middle ear is the most definitive method of verifying the presence and type of middle ear effusion and infecting organism; however,  its use for this purpose in the ED setting is rarely practical. Diagnostic  tympanocentesis(鼓膜穿刺抽水) may be performed by inserting an 2.5- to 3-in. 18-gauge spinal needle or catheter over a needle attached to a syringe through the anterior inferior or posterior inferior quadrant of the TM. The aspirate should be cultured in blood culture broth, on blood and chocolate agar plates, and sent for Gram stain.

Treatment：

The standard initial treatment for AOM is amoxicillin, 40 mg/kg/24 h in three divided doses, or ampicillin, 50 to 100 mg/kg/24 h in four divided doses, for 10 days.