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100% found this document useful (1 vote)
246 views147 pagesKiến Thức Cơ Bản Tai Mũi Họng (Sách Dịch)
Uploaded by
thảo nguyễnCopyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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/ 147
Original tile: ABC of ar, Nose and Throat
By Harold Ludman and Patrick J. Bradley
Copyright © 2013 by Blackwell Publishing Ltd
All Rights Reserved. Authorised translation from the English language edition published by Blackwell Publishing L1d. Responsiblity
for the accuracy of the translation rests solely with Sao Dieu Medi JSC and is not the responsibility of Blackwell Publishing Ltd. No
partof this book may be reproduced in any form without the writen permission ofthe original copyright holder, Blackwell Publishing,
Ld.
‘Copyright © 2014 by Blackwell Publishing Ltd, and Sao Dieu Media JSC.
Tic phim: Kign Thi Ca Bin TAL MU! HONG
‘Tic gi: Harold Ludman va Patrick J. Bradley
Cang ty C5 phn Trayén tng Séo Digw(SDmecia) git bin quyén xust bin va phat hinh An bin ig Viet ren ton thé go theo
hop déng chuyén giao bin quyén vi Blackwell Publishing Ltd
‘Bit etsy sao chép mdo Khéng dice sy dng j cia cng ty SDmedia déu la bat hap php va vi pham Luat Xuat ban Vigt Nam, Ludt Ban
‘quyn Quéc tf va Cing ude Bao ho Bin quyén $& hau Tei tué Berne,
ISBN: 978-6-046-60811-0
(Cong ty C6 phn Truyén théng Sie Diéw
203 Nam Kj Khoi Nghia, Phuéng 7, Quan 3, TP.HCM.
‘Tek: (08) 3932 1568
ax: (08) 3932 1575
Email: infoasdmedia.n
‘Website: wwwsdmedia.vy Muc luc
Ban bignp.vi
Ls nd di, vi
Ban bign dich, ix
Lai nd du (An int
f8t).x
Lai cim on (An ban tigng Viet), xi
(ich Khim Tai, Mai, Hong,
Daw Tai,
Chay Dich Tal 15
Nghe Kém Nguoi Lén, 21
Nghe Kém &Tré Em, 27
LU Diy Thin Kinh Thinh Giic v8 Cac Log U Gée Cau - Tia Nao Khe, 33,
Uta 39
(Cheng Mat vi. MAt Thing Bing, 44
9 Ligt Mot, 49
10 Dau Ving Mat, 83
11h Ly Noang Can Mai, $8
12 ich Tit Mo, 65
13 Chiy Miu Mas,
14 Nehgt Mal vd ROI Loan Ng, 76
15 Phiw Thast Tao Hin Mat, 81
16 Dau Hong, 89
17 Khin Ting va Cie R6i Logn Phit Am, 94
16 Tie Nghén Dating Thaw Thi Rt 100
19 Neiy vi Ngung Tha Khi Ngo, 108
20 Cae Vin DE VE Nust, 113
21 Chin Thusng Diu Mat C6,
22 Di Vat, 125
23 Khoi U Vin
26 Ung Thu Bu C8139
ing!
hing thst ng Anh - Wit, 151
5,131
Bing thuat ng Viet ~ Anh, 155 Cich day 30 nim, Stephen Lock - sau It Téng Bidn tip cia tap chi
British Medical Journal -€3 yéu ef ts (HL) viet m9t oat bai cho
tap chi niy. Sau dd, cic bai vit dy da dige tip hop lai dé phat hinh
An Ban Diu Tién cia quyéa sich nay (nam 1981). Khi not vé tim
{quan trong cia chuyén nginh Tai-MGi-Hong, 8. Lock divi
‘chuyén nginh nay ehiém phin Kin trong tit cd cic vin dé cia
bénh nhan khi ho dé kim ben", déing thei Ong nhén man tim
‘quan trong cia né trong Inh vue Kinh t- Ong noi cud sich may “la
{ap hop cic bai viet ghip cic bes lim sang ban rn c6 thém mét
tai Iu thye én, ding tin cdy Ki d6i mat voi ede vin dé thudng
{ip trong chuyén gin’
Ké tr thoi digm d6, chuyén nganh Tal-Mai-Hong (ENT) da phat
i vit mo rong them, nbiing phuong tin chin dodn da duge:
thign,cich digu tr abu ri loan va bénh i da thay déi, nhung di
vi hia hét bénh nhan khi én Khim lin dé (gap ba si da khoat
‘bic gia din), du e6 thé duge trdn an néu ching ta chin don
chin cw ula ra ai Khuyén thich hop w6 ede bign pha di tr
“Tuy nhien, vai bénh nhan chi e6 nhang tru chung "ab hod vun
vt" ning la fa bigu ign ea mot ben If rma trong nie Sn ben
|
inh 2.9 909199 than nghe da hala th kh d6 chung ta 6 thé yin oa rr vigm
i gta. CSc hach in cin Khong bao gi nd kin rong tang hop viém
i ida do gin
igu tri viém tai gia cap tinh tao mat
ign ngu ta vin con tanh cA vé win dé lig mo! gn niin ASOM,
‘cf cin phi di te i khsing sinh hay khdng, do trong ce series phn
lich thi kj ning va kin nghiém cia cic bic si trong chin doin Bénin
ny e6 Kc big kh niu (hic stl). Néu Khdng e6 inh nghim, th
if trdng hop nia ed ming nbi dd hoge sung hye cing ta d6u
1 ai gia cp tinh, trong ki du chiing ny etng 3
{the gip tong cic bénh I kh. Trong cic th ghigm lim sing, cing
nim ta thém ee
tuvang hop béah nha sé phuc hot ma khong cin ding thude v0 1b
‘ay nbign, ching a née ding khang sinh di vi tite
evdng hop cd nghi ng ASOM ~ do nds teng hap no eting in bie
sichuyén kha sic nh lath s® khéng e6 tinh kha thi,
chin doa I vi
ts eng of th
p ign twomg chin dosn gu ay,
aghién eda 1
(Cac Khing sinh duge Rhwyén cio thy thuge vio aguyén nhin gly
bbénh, High nay cle loai vi tring thuGng gip hit bao gm
Streptococcus pneumoniae, Haemophilus nfl Moraselle
‘catarrhalis (eal vi Khun abe Wye cao Streptococcus aim A hién
_khdng cin phd bin teong bg ny). Khang sinh duge chon Ia du
1ién Bl amoxil wi Hu 125 mg (3 liningdy) dot v9 enh nin <2
tdi, 250 mg G liningly) dit vii nba 2-10 tus, vd 500 mg (3
1Ginfngiy) da va tng benh nh lin hon, hoac ching a e6 thé ding,
‘erythromycin khibnh nha cd ding ws pencilin (mcd thude ny
km higu qua hom di vit Haemophilus inftucnzae, vi diy Bc mba
sui bea trong 25% euding hop). Néu nghi mgd bi nhiém cic ching vi
Khun ¢6 men lactamase thi ering ta thuting ding amoxicillin két
hop vai clavulanic acid (vd, Augmentin), hoe wimethoprim Ket hap
vi sulphamethosazole (co-trimoxazole). Ngubi ta Khuyén ding
ung ung th chi ws ci dw ie (tude day iu du ching ta
thusing st dung dng chich). Ching ta cin diate trong vg taht
5 ngiy. gu thd trg bao gdm thudcgidm dau va kim Sm a, Dw ove
Tamim tiv 6 thé pip gdm dav, Néu mang nb di thing, thi ching
ta lun lu nn ly dich ta dem cy. hung di Khsng sinh nén da
inn kim sang chat khong ph dy ten et qua vtring hoc: ty nhign,
ket qui cy gp ching ta d&i King sin trong mét strung hop
‘cin thit Hign nay chung ta him kh gp tring hop mang nbi cing
‘hing ra do dp suit nung claw, trong tinh hudng nay chung ta nea
{ign hin rach mang ahi dudi giy me nim gi thodt mi trong tai gia
‘a ngoii- ch diy khosing 50 nm, dy la mek thi thu thug gp tai
‘Vuong que An, v3 ign nay’ th thu:
ny vn ft dg the hig
hud auyén fai mt 6 Khu vc ttn Th iin ip cy Bd ae
chi rit iu so vi Vuong que Anh,
Vigm tai gia clip ti phi, duge djnh nghia Ti e6 ba dt gm cp
trong ving, 6 thing, 6 thé od nguyen nh do: mbt s5 yu 18 mba ty
dich trong tal git kéo di, ve Kh nang ahigm tring cc dich ny
trom gia, Ching ta 66 thst dung thi thudt rach ahi Ket hop v6
«di Sng thdng nb VA lon kém theo nguy co nhiém tring cling 6 thé
ls mot gay nin tuy sign ign nay vin dang tank i vat cia
hngo VA tren ning di erg nay. Kh khdngc6 ce ya 6 mguy eth
trong mi dt vigm ai gia ep ching ta ngn dé tr) theo tng dat
Ching tac thé cin ne mde bide php digu tr thay thé he Bs
lungamiiilin hs eo trnnoavole ti thing dn 2 nie, Sas mdi dt ip,
puta | on
+t
tale trv ink thing, vi cing ta hdl ion tr a trem
lin sing trong ving 3 tin sau khi Khoi pit
Viém tai xuong cham cép tinh (hiry xuong)
itm ti xuomg chim ep inh thin do su hay cic bé wong vich
:xong) nim gta ce théng bio chim, sau dé chang s® hop mht a
‘i nba (inh 2.10) Bay i mst tia tinh chim, cn Khosing 2-3
twin dé hinh think, Trong suit Hhosing thi glan dd chung ta sé
ip bigu hign chiy dich tai Iuong nhigu vi ln tue gua 6 thing
mang nh, km theo met mdi va s6t, ti Khi qua tinh my dee
bai thud King sinh. NEu ching ta dxac nhin mang nk Binh
thi bgob hie dé Khong thé bj viém suing chim duge. Tinh
hung khé kin A khi méx bénl abn duge nght kid phye hoi sau
tinh, hung thu su ben nin chu Khoi ben,
tink tang, 9" ti’ chi le ché bi te ing
toan thin cia khing sinh. Ching ta nr nghi mgd beni If niy
(wim suong chim ep) & bst ky bénh han no c6 chay dich ta
Hn tye tren 10 nga, dc bigt nu ting trang khong khde,
‘X-quang (hode 16t hon fa CT-scan) ving khi bio chim e6 thé whip
_chn sin tnk trang ny nung khong pha ln lon xc dink do
(Chi khithiy hg thing ki bo chim binh thuting (Hin 2.118 vb) th
‘ching mi c6 thé loi tet vim song cham, Hin nb hy bé
"og khdng phi ie no ctng d phat ign. Viem tai noi co thé gly
ving be thing bio chim do phi
chm, Diu eng kin digo thug duge ma tI hin tong ph ne
sau tiv gy yh vb tal sung du (in 212) cho tly mot
ai dean muon ham cia vgm xuang chim, lic my hing 0 spe
{46 mang chu song, Diy Is ma ign cing ea viém song chim
clu khdig phil me edd ef n6, Ap-xe dust ming chu
song cing & thé gy phi né wing ten cba phan si Sng ta no
(oii teung xim hn vio than sung bén nga thuong nh). dy
nh ti thn chi gpa phan ngodl ng ai. NEw
su kh Kho st sng chim bing hin inh hoc ma vin cén nghi ng
igs ta khupéa cio nén phi thus tham sit bing phuong php ‘sio
bio thing nb
‘aim im ttn mom
Hinh 2.10.50 Ws bo n | Kin Thue Cor Ban Tai Mii Hong
inh 2.11 ion sen
btndy cb ky bao
inh 2.12 vier suong cham cp dn cO yuan va a
Cac bign chting khéc cia viém tai gidta cp tinh
tao mi
sau diy litt cd nhing bign ching o6 thé xiy ra cia nhitg dang
wiém ta gta man tinh tg0 mu 6 gay hy xuomg (Hin 2.13) (xem
Chung 3). Bign ching sé xuathign néu tink trang nhiém tring Lan
Ua, Cit tai bin xy ra trong phn vam tha dang
é¢ mit, vig mé dao tao ma va huytkhsi tinh mach be
rai bin xy ra trong np so bao gm viem mang ndo, 4p-xe
ng cing v8 4p-xe no (6 thy this
ngoai mang cing,
dug hose ti6u no).
inh 2.13
Viém tai gia man tinh xudt tiét (viém tai gidta
thanh dich)
au nhe, mo hi va can dau thuting ngin li dc tinh thug gap cha
dich nhdy, die trong khoang tai gia. Quan sit mang ni thay bit
thudng do e6 dich (Hink 2.14 va 2.15). Theo kinh din, chiing ta co
thé phat hin céc mach mau dng tin) tai mang nhi, va c6 thé gay
him lin vai mt chin dod khéc. Mang nht c6 thé mau ving hodc
sank (duong) sim, Tuy nin, t@ em sé biéu bign kde mank, khong
6 6t, va inh tang nghe km di kém thug dae ghi nh trong mst
khoding that gian nao dé,
Mot die diéin co bin glip chin don li sy thay d6i dp di dong cia
‘ming ni, duge phat hign khi bie s¥chuyén khoa tai dng dén ds du
Vitloa tai eé bom hai. Mang nltied thé khéng di ding khi ching ta thay
«4p suit ng tai ngoti, hole mang nh phink ra chim, sau d6 bi it
n Khong duge phéng thich. Su thay
‘duge ghi nhin bang eich do
‘io nfanh do mot phn p le cha
461 9 di dong ming nb cting e6 th
hi-lugng-d6, tong dé ngués ta diing mot thit bj do tré khang (ea
_miing nh) khi thay 46 in tue p sus ea Sing tal, vt mute cao how Sp
suit Kh quyéin cho ti ue thi hon dp sutkhi quyén. Cie may do nh
Iaang 6 don gin (tu dng) sé cho ra két qua nhanh chang giip ching
ta bit dig ip su kh trong tai gia vis thay di Sp suit (nu cd) ki
‘ang va giim ap suat ng tai ngods. Tuy nhiga,c6 thé gap pha nhuing sai
sot ve kj thudtkhi cg cic log may ny.
Hin 2.14 vir ti gta than ch (OME Ay hin om enang o p Bau Tai | 13,
Hin 2.15) Hi Sah ming nt phi ong OME) uce dS km ch oi
\Viém tai ngoai ‘ac tinh’ (ho:
otitis externa
Dy ka mot bénh ly higm nhving 1 mot dang nim tring ning (in
Iau ¥ diy khong phal béoh ly u), nguyen hin do Pseudomonas
it) - ‘Malignant’
‘aeruginosa. Thting gap trén bénh nbn Ion tus bi di th
io ding,
‘Ching ta nén nghi nga beni iy tén teen nhdm beh nin nay, dc
bigt ng ngues bénb bj dau tai dt di, Khong twang xing wi ccd
hhigu eda viem tai ngodl, Nhigm tring s@ xim Kin sin so vi cic mo
smém sung quan. Néuc6 ligt mat hoe tn thuong cic diy thin kinh
so hie thi da a du hu go y én chin dosin ny. Trude di tile
wong thuding cao, Mét dé ching glip nghi ngi Ia thiy €& m6 hat,
trong Ging tal, vi ching ta cn pha khdo sit bang phuong pha sean
ong voi Te-99, Ching ta diga tri vi gentamicin (inh mach) v8
thea dat cdc théing s6 huyét hoe hang ngiy, hokc vi erproflosacin
(ong). Cn digo tin tue trong nbigu tain co 164 khi nt daw,
chy két hop vi thus gin dau
Cac nguyén nhan khac gay dau tai
Vid mang nb tao bing nude ~ Bay mot nguyén nhin kc iy
dau tai di doi, Nhidm virus (c6 thé I vis elim) sé gly nga tinh
‘ang néi bong nude v4 xt huyét tai mang nt (Fin 2.16) v2 én
tai nga. Thutng kém dich tai git (6 thé in miu) vi Kho phn bgt
ta eb thé chi din
‘i mol inh rong vim tl gia, Vif dod, ch
hang sinh, hung thude duy nbat
mot thuse gidm dau man,
in ding trong tes
wp ny
Hi ching Ramsay Hunt ~ Pay li mot bén I higm gip, nguyen
rohan do varicella-zoster virus, trigu ching c6 thé gm yéu mat ko
hat d@t ngot, km theo ndi ban (do herpes) tén win ta (Hinh 8.1)
inh 2.16 vem ming nb tso bona f
Bau quy chiéu
'Néa 6ng tai ngodi va ming nh bin thudng, visu di dong cia mang nh
‘ng binh thiéing khi him bang dén soi tic bum hs, thi eigu ching
fu tai Khng thé do bgnb ft tai, Dau tac thé do cic co quan Khe
sit dung chung dug thin kinh cim gh véi tai ngodi hege tai gia
(Hinh2.
+ Hi ming (dy thn kink IX ~thigt hu) trong viém amidan ip tts
hoc carcinoma ving 1/3 sau ea luo.
+ Hu thanh quin (day thin kin X ~ lang thang
wang soang Ie
+ Ring o6i him tren, khap thai dug-him hoe tuyén mang ti (a
Usin kinh V ~ sink ba, ahinh ham dud). Cie nguyen nhin do cay"
‘mang ta thud sé phat hign dé ding: tuy nhién néu nguyen nh
ing Khén (bi ket) thaging kha phat hign ha, Benh IY kop tht
dhcng-him thang say 14 sau khi thay Ai thot quen nba do me
). Bau c6 thé do:
trong carcinoma
ting. ns ring hode coo ring,
han wt Kt the
wy ke
+ Cot sing 6 (C2 va C3), Ba thug td nd
is khong duce tho ai, Chung taco thé har bang, el
thm gi ben can to
hi og 14_|_kign Thue Coan Tai Mai Hong
Cac nguyén nhan do than kinh
Nu khong. e6 ben iy wiém 6 tai vi khong e6 benh I 6 shang ving
6 thé gly dau quy chigu len tai, cde nguyén nhan con Ii bao gor:
dau thn kinh ving ludi-hau,trigu ching gdm dau nut et 6 tai kha
pt khi chang ta cham dén mot ving ‘trigger’ (cd sting) nim trong,
‘ing chi phat cm gidc cia day thin kinh so IX nim 6 phia sau hau;
‘et dau thin kin dang migraine, dhudng gip hom bg nin iam é
Tamly
“Thuting chung ta khong thé phat hign duge nguyén nhan mio va eo
thé tai bi dau lin quan dn trim cm, ching tao thé digu tr thi wi
ce thu6e chéing tem cim,
Tailigu doc thém
Gleeson M (ed) (2008) Scott Brown's Otorhinolaryngology, Head and
‘edn, Vol. 3 (part 19): The ear, hearing and balance
Hodder, London,
Hinh 2.17 Navn cay ns guy bie
Jerome O, Klein MD Is Acute Oui
editorial. Engl J Med 2011;368:2.
1s Media 4 Treatable Disease?
Ludman H, Wright T (eds) (1998) Diseases of the Ear, 6th edn.
Amold-Hodder Headline, Londo,
Williams RL, Chalmers TC, Stange KC, Chalmers FT, Bowin SI.
Use of antibiotics in preventing recurrent acute otitis media and in
treating otitis media with effusion: a meta-analytic
resolve the brouhaha. JAMA 1993:270:1344-51
tempt to
ww.nhs.uk/conditions/ottis-media
‘www:nhs.uk/Conditions/Otitis-ext
‘wwrcutodatecom/contents/malignant-necrotizing-external-otits
‘wvew gpnotebook co.uk/medwebpage clin CHUONG 3
Chay Dich Tai
Robin Youngs
Gloucestershire Royal Hospital, Gloucester, UK.
‘TONG QUAN
= Dich Ut chy) sta mt widu ching ay niu kh chi vb
tuang mot 56 cong déng benh ninco thé Dicichly hod x8
lan
‘Trude ki ching 1 @ thé chin don chioh xd, nén hat a cho
Sach bang 6g it hodc au Kh
Trude nh tal (fchd) chia thing sink steroid thu qu
wong did W vid dng ange
= CIuly ech ado ver ada man nh xy 2 thing nib thing,
= Colesteatoma 6 thé him voi cc tal bin nguy hig
CChiy dich tat By mt tru ehving gay niu Kho chiv, c6 thé c6
‘nguyén nhan do nhigm tring, vigm, chin thing hoje d6iKhi lbw
‘tia tal ngoi hod tal ila (Ghi ch 3.1). Chi (dich) tat kéo di kom
‘thao c® mii c6 thé khign banh nh bi thi wh ch ly (¥E mats
Ini) mot s6 nn van héa ten te git (Hin 3.1).
| Ghichu 3:1 Céenguyén nhan gy chy dich tai
+"Viém ng tai ngadi (Sp tinh van tinh)
+i ta gid (ep tinh vb man tn)
| «chan thuang ving xuong th dong
+ Uviing tai aig)
[Bin thin clich tao thé bit mgusin da vig ing tango
tit bé mat cia ming ni, hode ti iém mac 6t trong tai gia (Hin
3.2), Djeh tt tr tal gla thucing niga vi nh, do bin chit dil
luge Ht trp idm mac ta git, Trong Kim sing, a xe t6t mot
trudmg hop chay dich tai, ching ta cn chin dosn bgnh chinh xée,do
«ching ta nén khaithac ky bg sit vi khim lim sing cin thio,
1 bie si chuyén khoa Tai-Mai-tong c6 thé sit dung kinh hign wi
X48 so ta ngay tai phong kh (Hinh 3.3) Ki két hop kinh hign vi
‘acc dung ca ht ela, ching ta c thé ht sgch dich tai vi quan sit
[ky Ging tai va mang nh. DSi v6t cic bac s gia inh, co thé Ky sach
dich 14 bang cich ding bang gb
Hind 3.4 Chiy ch a
eng ri
Sng nga
Hin 3.2 ch 0 chy nt
Quo
Sep ausis ong
raha
6 16 _| ign Thiic CoBan Tai Mal Hong
7
a
Hinh 3.3 Dung kin ign v va dung ey hit 6 va mot ben nn
Cac thudc nhé tai ché déi véi trading hop chay
dich tai
(Cac loa thud hia ich nhit trong di tri chy (dich) ta a thude
dling ti ché, thuémg & dang nd tai, nbung cing e6 thé 6 dang
‘iu hode cream. Cie loa thude nay e6 thé két hop thuée khang
thude khdng nim, thuse sit Khuda, cc lal dung moi va
Steroids, Khi muén digu ti tai nio thi ching ta cho bénh ohin
‘nim nghing qua dé thay ta bén dé, sau dé nh thu ttn got
‘ao ti n6i ding nghiém phap dn tai dé dy thuée vio tai. Ching
ta sn ving sun binh ta dé diy thud chay xubing doc theo dn
tal, va néu mang nbt bi thing thi thuse 58 vio tat gta (Hin
3), Hign ngu ta vin tranh ci ring kh thing nh thi nea
ding thue nh tat hay khOng, vi vin dé con nhigu tanh e& Khe
la cd ding thuGe chia aminoglycoside khéng, vd. neomycin,
gentamicin va framycetin, Nhang khing sin niy rit 6 higu qui
6i vi tai chiy dich vi chiing ¢6 phé téc dong len vi khudin
thong gip 6 vd nhang trudng hop bi chiy deh tat Cac loai thude
cha aminoglycosides khi ding dung toin thin s¢ giy dc cho ed
phn think gide v8 phin ei
Ak, mot 26 “di ligu théng ke" cho théy aminoglycoside (dong tai
ch) bi chong chi dinh sit dung khi mang nhi bi thing. Tuy niga,
cle bie st Tei-MGi-Hong toi Anh vin ding rong rai thude nha tai
hop chiy (dich)
dink cia tai rong. Tai Vuong quéc
chia aminoglycosides trong digu tr nbiing tru
tai, The sy thi nguy ex cho ta-trong cia ede thusc neta (chika
aminoglycosides) la rit nh, Nhiing guidelines hign ti ita Vuong
{que Anb (Philips va cs, 2007) cho phep si dung nling loai thude
ny d6ivdinhitng raging hop tai dang chay dich, vi mot det st dung
6 thé kéo dti dén 2 tin, Céc khing sinh Khée, vd. quinolones
(ciprofloxacin vi ofloxacin) thi khéng giy doc cho tai, va thug e6
higu qua trong diéy ti. Tuy nhign, néu chung ta sit dung quad niga
quinolones thi vé mat Ij thuyétc6 thé tgo ra nhiing ching vi khusa
ng vi ning Khang sinh ny.
Viém éng tai ngoai man tinh (chronic otitis
externa)
(Cé nbigu tc nh ti tang nguy cab vigm tal ngod man tinh (Ghi
2), Théng thuimg dng tango dus Kim sach bat hign twyng
