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Case No. 317
2013-10-01~2013-10-31
출제자 : 김대윤
Hit : 357
| Period | 2013-10-01~2013-10-31 |
|---|---|
| Diagnosis | eosinophilic otitis media |
| Clinical information | F/17 C.C : Both thick otorrhea from 3 years ago Total IgE : 1116 KU/L (Normal : <100) 진단은? |
| Discussion | F/17 C.C : Both thick otorrhea from 3 years ago Total IgE : 1116 KU/L (Normal : <100) Past history: S/P pressure equilibrium tube, right, 1 year ago Known allergic asthma Answer : eosinophilic otitis media 설명 및 리뷰 Middle ear cavity에 soft tissue 또는 fluid가 있고 동반되어 rhinosinusitis 가 같이 있다. 또한 양측 E-tube가 patent하다. Temporal bone CT상 middle ear cavity 에 soft tissue lesion and fluid가 있어 일반적인 acute or chronic otomastoiditis생각할 수 있다. 그러나, IgE가 올라가는 등의 천식환자에서 otorrhea 가 thick discharge를 보일 때, 임상적으로 eosinophilic otomastoiditis를 의심해 볼 수 있다. 이 때 Patent E-tube, Smooth and soft-tissue bulging from the inflamed middle ear cavity with bilateral involvement, Bilateral paranasal sinusitis 가 보이면, CT에서도 eosinophilic otomastoiditis를 생각할수 있는데, 특히 일반적인 COM의 기전과 달리 E-tube가 patent한 경우, 이 exudate가 drainage 장애에 의한 것이 아니고, inflamed muscosa에서 흘러나온 것을 시사하는 것으로 eosinophic otomastoiditis 를 시사하는 중요 소견으로 알려져 있다. Review Eosinophilic otitis media Relatively rare, intractable disease characterized by the presence of a highly viscous yellow effusion with extensive accumulation of eosinophils in the middle ear On physical examination, most EOM patients show a patulous Eustachian tube rather than tubal stenosis, which is different from OME or COM. T helper type 2-dominant predisposition, such as bronchial asthma, an antigenic material may easily invade via a patulous Eustachian tube and stimulate inflammatory cells. occurs mainly in patients with bronchial asthma and is resistant to conventional treatments for otitis media Treatment: systemic or topical glucocorticoid is believed to be the most effective treatment for EOM CT finding might be similar to COM, with heterogeneous soft tissue within the middle ear and mastoid, with or without minimal erosion of the ossicles DDx point : 1. Smooth, soft-tissue bulging from the inflamed middle ear cavity 2. Bilateral paranasal sinusitis 3. Clearly visible tubal Eustachian tubal lumina Reference Won Jung Chung MD et al. Eosinophilic Otitis Media: CT and MRI Findings and Literature Review. Korean J Radiol. 2012 May-Jun; 13(3): 363–367. Iino Y, Tomioka, et al. Diagnostic criteria of eosinophilic otitis media, a newly recognized middle ear disease. Auris Nasus Larynx. 2011;38:456–461. |
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