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外耳、中耳、颞骨解剖Anatomy of external ear,middle ear,temporal bone颞骨 temporal bone 颞骨：左右成对，位于颅骨两侧中下1/3部 temporal bone:Around in pairs,located in the skull on both sides of the middle and lower third department鳞部 Squamous portion乳突部：Mastoid portion 正常乳突部骨质有许多含气小腔，称乳突气房。There are many small gas cavity normal mastoid bone,said the mastoid cells。按其气化程度，分为四型：According to the degree of gasification,divided into four type 气化型：pneumatic type 板障型：diploetic type 硬化型:sclerotic type 以及混合型:mixed type 位于上部的最大气房，称为鼓窦。the maximum mastoid cells,Located in the upper part,called the tympanic antrum.与中耳鼓室相通，是手术的重要标志。tympanic antrum and the tympanic cavity are interlinked,is an important symbol of the operation.鼓部 Tympanic portion 岩部 Petrous portion茎突 Styloid process 内听道：面神经,听神经及迷路动静脉 internal auditory meatus：Facial nerve，acoustic nerve，labyrinthine artery and labyrinthine veins外耳 External ear 外耳包括耳廓及外耳道 external ear include auricle and external auditory canal耳廓 auricle the auricular cartilage supports auricle outline耳屏与耳轮脚之间的凹陷：耳前切迹，此处无软骨。Between the tragus and crus of helix:anterior notch of ear,Here is no cartilage 耳廓前面的皮肤与软骨粘连较后面紧，皮下组织少.Skin and cartilage in front of auricle are strong compacting，and there is less subcutaneous tissue 炎症时，感觉神经易受压迫产生剧痛。When inflammation,Sensory nerve vulnerable to oppression Have a sharp pain.耳廓软骨膜炎，可发生软骨坏死，导致耳廓挛缩，变形。When auricular perichondritis,Cartilage necrosis can occur，Lead to deformation of auricle 耳廓血管位置表浅，皮肤菲薄，容易受冻。The location of auricle blood vessels is shallow，and Skin is thin Easy to cold外耳道 external acoustic meatus 向内直至鼓膜，长度约为2.5-3.5cm，由软骨部（外1/3）和骨部（内2/3）组成。Inward until the tympanic membrane,Length is about 2.5 3.5 cm,cartilaginous part(Outside1/3)and bony part(inside2/3)外耳道软骨切迹：外耳道软骨在前下方常有2-3个垂直的，由结缔组织充填的裂隙 notches in cartilage of external：in the below and front of cartilage of external acoustic meatus ，2-3 vertical cracks，filled by the connective tissue.意义：外耳道与腮腺之间感染互相传播的途径。significance:The spread of the external auditory canal and parotid gland infection between each other 外耳道皮下组织甚少，皮肤与软骨膜或与骨膜紧密相贴，炎症时神经末梢受压可引起剧痛。There is seldom subcutaneous tissue in external auditory canal.Skin and cartilage are strong compacting.When inflammation,Sensory nerve vulnerable to oppression Have a sharp pain.软骨部皮肤含有耵聍腺，能分泌耵聍，并富有毛囊和皮脂腺。Cartilage department skin contains cerumen gland,Secretion of cerumen,And full of hair follicle and sebaceous glands.中耳 middle ear 包括鼓室，咽鼓管，鼓窦及乳突4部分 tympanic cavity pharyngotympanic tube the tympanic antrum mastoid process含气空腔，位于鼓膜和内耳外侧壁之间。容积：1-2ml.cavity containing air，between the tympanic membrane and the inner wall.鼓室 tympanic cavity鼓膜 tympanic membrane锤骨柄 短突 鼓膜脐部 光锥manubrium of malleus short process of malleus umbo cone of light 鼓膜大部分借纤维软骨环嵌附于鼓沟内，称为紧张部。Most of tympanic membrane embedded within the tympanic sulcus by fibrous cartilage ring,Known as the pars tensa.上方直接附丽于颞骨鳞部，较松驰，称为松弛部。The upper tympanic membrane is directly attached to temporal bone scales,more relaxation,Known as the pars flaccida.以鼓膜紧张部上下边缘为界：上鼓室 中鼓室下鼓室。By the upper and lower edgea of the pars tensa epitympanummesotympanumhypotympanum 鼓膜结构分为3层：外 复层鳞状上皮中 纤维组织层内 粘膜层 Tympanic membrane structure is divided into three layers:outer stratified squamous epithelium middle Fibrous tissue layer inner mucous layer4个象限 4 quadrant后上象限：内有听小骨及鼓索神经。Back and superior quadrant:otosteon and chorda tympani nerve鼓膜的有效振动面积/蹬骨足板面积=17倍，即声压提高17倍。Effective vibration area of tympanic membrane/The stirrup bone plate area=17 times.Sound pressure increase 17 times鼓室边界 Boundary of tympanic cavity 外壁：鼓膜 Outer wall:tympanic membrane内壁：鼓岬，是耳蜗底周所在处 inner wall：promontory，the first ring of Cochlear 上壁：鼓室盖，与颅中窝的颞叶分隔Superior wall：tegmen tympani,Separated with the temporal lobe brain in the middle cranial fossa下壁：颈静脉壁Inferior wall:jugular wall前壁：颈动脉壁Anterior wall：carotid artery wall后壁：乳突壁Posterior wall；mastoid wall 鼓室内容物：听小骨，肌肉和韧带等 Ossicles muscle ligament听小骨：锤骨 砧骨 蹬骨ossicular chain：malleus incus ,stapes韧带：固定听骨Ligament：fixation of Ossicles肌肉：Two muscle：tensor tympani muscle stapedius muscle 听骨链功能：作为一个杠杆系统，将声波由鼓膜传至内耳。Function of ossicular chain:As a lever system,Will transmit the sound waves from the tympanic membrane to the inner ear.锤骨柄长度/砧骨长脚长度=1.3倍，即声压提高1.3倍。Length of Hammer shank/Length of long limb of incus=1.3times.Sound pressure increase 1.3 times 171.3=22.1倍，相当于27dB。加上弧形鼓膜的杠杆作用，整个中耳增压效率约为30dB。171.3=22.1，amount to 27dB,Combined with the leverage of arc tympanic membrane.The whole pressure boost of middle ear is about 30 db鼓膜成形术 myringoplasty 当鼓膜穿孔，造成听力下降或者反复中耳炎时，可 考虑行鼓膜修补术 When the tympanic membrane perforation,cause hearing loss or recurrent otitis media,myringoplasty should be taken into account.常用的修补材料：颞肌筋膜，耳屏软骨软骨膜 Common materials for repair :fascia of temporalis；perichondrium of The tragus cartilage咽鼓管 pharyngotympanic tube 沟通鼓室和鼻咽部，两个开口 Communication middle ear and nasopharynx Two openings 功能：调节鼓室气压，保持鼓膜内外压力平衡。Function：adjust gas pressure of tympanic cavity，maintain a balance of pressure inside and outside of tympanic membrane The middle ear cavity pressure is equal to atmospheric pressure 当咽鼓管功能障碍时，中耳腔内压出现负压，鼓室内积水，形成分泌性中耳炎。When the pharyngotympanic tube dysfunction middle ear cavity pressure appear negative pressure hydrops in tympanic cavity formation of secretory otitis media.鼓膜穿刺术 tympanotomy鼓膜置管术 myringotomy with grommet insertion鼓窦 tympanic antrum 鼓室与乳突气房相互交通的枢纽 Hub of tympanic cavity and mastoid cells乳突及乳突气房 mastoid cells 按其气化程度，分为四型：气化型，板障型，硬化型，以及混合型。According to the degree of gasification,divided into four type气化型：pneumatic type板障型：diploetic type硬化型，sclerotic type以及混合型。mixed type耳廓化脓性软骨膜炎suppurative perichondritis of auricle 多因外伤感染所致，耳廓软骨的急性化脓性炎症，caused by infection after trauma Acute suppurative inflammation of auricle cartilage 由于炎症渗出液压迫可致软骨缺血，坏死。该病可致耳廓疤痕挛缩畸形。Due to inflammatory exudate oppression can cause cartilage ischemia or even necrosis，the disease can cause deformity of auricle.常见细菌：绿脓杆菌，金黄色葡萄球菌，链球菌，大肠杆菌等。Common pathogenic bacteria：Pseudomonas aeruginosa，staphylococcus aureus，streptococcus，escherichia coli 临床表现：局部红肿热痛，继之耳廓弥漫性肿大，疼痛加剧，软骨坏死，耳廓畸形。clinical manifestation：local heat swelling pain，and then diffuse enlargement of the auricle,the pain intensified,chondronecrosis,and aural deformity 治疗：大量广谱，抗绿脓杆菌的抗生素。脓肿形成后及时切开引流。Treatment:A large number of broad spectrum antibiotics,resistance to pseudomonas aeruginosa after the formation of an abscess,timely incision drainage should be done 外耳道疖furuncle of external acoustic 外耳道皮肤的局限性化脓性炎症 Localized suppurative inflammation of external ear canal skin 发生于外耳道软骨部，In cartilage of external auditory canal 致病菌绝大多数为金黄色葡萄球菌。pathogenic bacteria：staphylococcus aureus 临床表现 clinical manifestation：1 疼痛剧烈 intense pain 2 疖破溃，脓液流出 Furuncle burst,pus out 3 耳前耳后淋巴结肿大 lymphadenectasis in front/post of the ear 4 全身反应：体温升高，全身不适。general reaction：fervescence，general malaise 检查 physical examination 1 明显耳屏压痛及耳廓牵引痛 Obvious tragus tenderness and Auricle traction pain 2 外耳道软骨部局限性红肿隆起 Localized red and swollen in cartilage of external auditory canal 3 触之有波动感 fluctuation 治疗 Treatment:1 局部治疗 局部抗生素软膏应用，脓肿形成后切开排脓。Local treatment:Antibiotic Ointment,abscess incision drainage 2 全身治疗 严重者需全身应用抗生素。general treatment:General use of antibiotics in serious patient 中耳炎并发症Complications of otitis media 主要由胆脂瘤型中耳炎引起，均为炎症性并发症。Mainly caused by cholesteatoma of middle ear,All are inflammatory complications颅内并发症 intracranial complications 硬膜外脓肿 硬膜下脓肿 脑膜炎 脑脓肿 Epidural Abscess subdural abscess brain abscess meningitis颅外并发症：extracranial complications 迷路炎（内耳炎）Labyrinthitis(inner ear)耳后骨膜下脓肿 subperiosteal abscess oF post of the ear 颈部脓肿 Abscess of neck 周围性面瘫（炎症侵犯面神经）peripheral facial paralysis（Inflammation affect the facial nerve）
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