How to cure chronic suppurative otitis media: advice from an otolaryngologist. Chronic suppurative otitis media Chronic suppurative otitis media

• Periodic or constant discharge of pus from the ear, sometimes with an admixture of blood. Discharge from the ear may be foul-smelling.
• Persistent hearing loss.
• Ear congestion.
• Sensation of fluid in the ear.
• Periodic pain in the ear.
• Noise in the ear.
• Dizziness.
• Violation of the mobility of the muscles of the face (paresis of the facial nerve) - with a far advanced process.
• Headache - usually appears only with the development of complications (inflammation of the meninges, etc.).

Forms

• Chronic suppurative otitis media- caused by various bacteria, most often, several at the same time. Conventionally, two types of chronic suppurative otitis media are distinguished, although in reality it is often difficult to draw a line between them:
  • mesotympanitis - only the mucous membrane of the tympanic cavity is involved in inflammation, the bone remains intact. Perforation (defect) of a tympanic membrane of various sizes in its central department is usually noted;
  • epitympanitis - bone is often involved in inflammation. In most cases, with epitympanitis, cholesteatoma develops - a formation consisting of cells of the upper layer of the skin of the external auditory canal, which grow into the tympanic cavity through a perforation located in the upper part of the tympanic membrane. Purulent inflammation accelerates the growth of cholesteatoma, which presses on the surrounding tissues and destroys them.

• Chronic exudative otitis media- accumulation of viscous fluid in the tympanic cavity for more than 2 months, the integrity of the tympanic membrane is usually preserved. It develops as a result of a long-term dysfunction of the auditory tube (connects the middle ear cavity with the nasopharynx).

• Chronic adhesive otitis media- the formation of scar tissue in the tympanic cavity, scarring of the eardrum. All structures of the middle ear (auditory ossicles) are soldered together and with the tympanic membrane, which leads to persistent hearing loss. Chronic adhesive otitis media is usually the result of recurrent acute otitis media or long-term untreated exudative otitis media.

Causes

Causes of chronic otitis media:

• untreated or undertreated acute otitis media;
• scars in the tympanic cavity due to recurring acute otitis media;
• dysfunction of the auditory tube (connects the middle ear cavity with the nasopharynx);
• some infectious diseases, for example, scarlet fever (a disease usually caused by group A beta-hemolytic streptococcus, manifested by a small punctate rash, fever, weakness, headache, inflammation of the palatine tonsils).

Contribute to the transition of acute otitis media to chronic:

• various chronic inflammatory diseases (for example, foci of infection in the paranasal sinuses - chronic sinusitis);
• violation of nasal breathing (curvature of the nasal septum, adenoids - pathologically enlarged pharyngeal tonsil);
• diabetes mellitus is a chronic disease accompanied by an increase in the level of glucose (sugar) in the blood;
• Immunodeficiencies are disorders of the immune system that lead to increased susceptibility of the body to infections. May be congenital or acquired (eg, AIDS);
• long-term chemotherapy treatment;
• smoking, alcohol abuse;
• malnutrition, life in unfavorable climatic or social conditions.

A provoking factor in the exacerbation of chronic otitis media can be:

• hypothermia;
• water in the ear
• colds.

Diagnostics

• Analysis of complaints and anamnesis of the disease:
  • whether the patient notes the discharge of pus from the ear, hearing loss, ear congestion, for how long these complaints are disturbing;
  • whether there were single or repeated acute otitis media (acute inflammation of the middle ear), what treatment was carried out;
  • whether there are chronic diseases, impaired nasal breathing.
• Examination of the ear (otoscopy), including using a microscope or endoscope. If there is pus in the ear canal, the ear should be carefully cleaned to carefully examine the eardrum.
  • In chronic purulent otitis media without exacerbation, perforation (defect) of the tympanic membrane is usually determined.
  • There may be areas of retraction of the eardrum (so-called retraction pockets).
  • With exacerbation of chronic suppurative otitis media, pus is released from the perforation.
  • In chronic exudative otitis media, the membrane is usually intact, with fluid visible behind it.
  • In chronic adhesive otitis media, scars are visible on the membrane, it is deformed, retracted.
• Hearing test:
  • tuning fork tests (special tests with tuning forks make it possible to find out whether hearing loss is associated only with chronic inflammation in the middle ear or if damage to the auditory nerve has joined);
  • audiometry - the study of hearing using a special device. Allows you to more accurately determine the degree of hearing loss, as well as the involvement of the auditory nerve in the process.
• While maintaining the integrity of the tympanic membrane, tympanometry is performed. The method allows you to assess the mobility of the tympanic membrane, the pressure in the tympanic cavity. If there is fluid or scarring in the middle ear, there is a reduction or complete absence mobility of the tympanic membrane, which is reflected in the shape of the tympanogram curve.
• In chronic suppurative otitis media, a swab is taken from the ear to determine the bacteria that cause the disease and their sensitivity to antibiotics.
• Computed tomography (CT) of the temporal bones.
• Vestibular tests (assessment of dizziness, balance) - to detect lesions of the inner ear.
• If necessary, consultation.

Treatment of chronic otitis media

Treatment depends on the form and stage of the disease.

• In the presence of perforation (defect) of the tympanic membrane, it is strictly contraindicated for water to enter the ear. When showering or bathing, cover your ear with cotton wool soaked in oil.
• With exacerbation of chronic purulent otitis media, conservative treatment is carried out. Most effective method is regular ear washing by an otolaryngologist and the use of ear drops with antibiotics. It is important to avoid the use of drops containing substances that are toxic to the ear, as well as alcohol, as this can lead to permanent hearing loss due to toxic effects on the auditory nerve. Self-medication in such a situation is extremely dangerous.
• Conservative treatment of chronic suppurative otitis media should be considered as preoperative preparation. The main method of treatment is surgery, the purpose of which is to restore the integrity of the eardrum in order to prevent infection in the middle ear and improve hearing.
• The operation is often performed under anesthesia, behind the ear (an incision behind the auricle, a more radical option) or through an external ear canal(a cut inside the ear, a more gentle option). The choice of surgical technique depends on the prevalence of the inflammatory process, the presence and size of cholesteatoma (a complication of chronic otitis media in the form of a tumor-like formation consisting of cells of the upper layer of the skin growing into the middle ear cavity and temporal bone), and the skills of the surgeon.
• The tympanic membrane defect is closed with various materials. It is convenient to use the patient's own cartilage for this, which is usually taken from the tragus (a cartilaginous process that closes the entrance to the external auditory canal), because. there is no further rejection. They take a very small piece of cartilage, after which the tragus practically does not change shape.
• After the operation, the patient should be under the supervision of the attending physician, the ear is washed.
• In chronic exudative otitis, shunting of the tympanic cavity is indicated: under local anesthesia, a small hole is made in the tympanic membrane, into which a shunt is placed for several months - a microscopic tube. Through the shunt, the contents are removed from the middle ear cavity, and drugs are administered. The hole in the membrane after removal of the shunt usually overgrows on its own.
• In chronic adhesive otitis media, it is also indicated to restore hearing. surgery- excision of scars from the middle ear cavity, replacement of the scarred tympanic membrane with a graft (artificial tympanic membrane), for example, from the patient's own cartilage.
• For the effective treatment of chronic otitis media, it is extremely important to eliminate the foci chronic inflammation in the nose, nasopharynx, paranasal sinuses, restore nasal breathing.

Complications and consequences

• Mastoiditis (inflammation of the mastoid process of the temporal bone) is characterized by swelling, swelling of the behind-the-ear region.
• Intracranial complications (meningitis - inflammation of the dura mater, encephalitis - inflammation of the substance of the brain, brain abscess - a limited abscess in the brain) are characterized by a severe general condition, severe headache, the appearance of brain symptoms (neck muscle tension, vomiting, confusion, etc.).
• Thrombosis of the sinuses (cavities in the dura mater in which deoxygenated blood). At the same time, there is a strong headache, exophthalmos (bulging eyes), convulsions, coma (lack of consciousness) and other severe disorders of the nervous system.
• Neuritis of the facial nerve (inflammation of the facial nerve) - manifested by asymmetry of the face, impaired mobility of half of the face.
• Otogenic sepsis is a generalized infection spreading in various bodies and tissues with blood flow.
• Cholesteatoma is a formation consisting of cells of the upper layer of the skin of the external auditory canal that grow into the tympanic cavity through a perforation (defect) of the tympanic membrane. May destroy surrounding tissue, including bone.
• Irreversible hearing loss.
• The risk of death.

Prevention of otitis media chronic

• Timely and adequate treatment of acute otitis media.
• Treatment of chronic diseases of the nose, nasopharynx; nasal breathing correction.
• Correction of immunodeficiency states and diabetes mellitus - a chronic disease accompanied by an increase in the level of glucose (sugar) in the blood.
• Timely visit to the doctor at the first signs of ear disease. Self-medication, independent use of ear drops (they may be ineffective or even dangerous), warming up the ear without a doctor's prescription is unacceptable.

Additionally

The tympanic cavity of an adult has a volume of about 1 cm 3, it contains the auditory ossicles responsible for the transmission of the sound signal - the hammer, anvil and stirrup.
The tympanic cavity is connected with the nasopharynx by the auditory (Eustachian) tube, with the help of which pressure is equalized outside and inside of the tympanic membrane: during swallowing movements, the auditory tube opens, the middle ear is connected to external environment.
Normally, the tympanic cavity is filled with air.

Inflammatory diseases of the middle ear are widespread among the population of all age groups. According to WHO, from 1 to 5% of the world's population suffer from inflammatory diseases of the middle ear with varying degrees of hearing loss.

Despite modern possibilities of diagnostics and treatment of acute inflammatory diseases of the middle ear, the proportion of chronic diseases resulting from acute ones remains significantly high. In particular, in Russian Federation chronic suppurative otitis media occurs in up to 39.2 cases per thousand population.

Chronic suppurative otitis media (CHSO)- a disease of the middle ear, characterized by three main indicators: persistent perforation of the eardrum, persistent or intermittent suppuration from the ear and hearing loss.

According to the clinical course and severity of the disease, two forms of chronic suppurative otitis media are distinguished: mesotympanitis(tubotympanic suppurative otitis media) and epitympanitis(chronic epitympano-antral purulent otitis media). The fundamental difference between the two forms of the disease is the damage to the bone structures of the middle ear and the predominant localization of the pathological process in the tympanic space in the epitympanic form. Downstream mesotympanitis is a more favorable form of CHSO.

Causes of chronic suppurative otitis media (CHSO)

Chronic purulent otitis media is the result of an advanced form of acute otitis media or its insufficient treatment, in which the post-inflammatory changes in the mucous membrane and structures of the middle ear contribute to the chronicity of the process. A persistent violation of the integrity of the tympanic membrane can also be caused by a number of other external factors, among which there is a chemical effect or mechanical damage due to trauma.

The development of CHSO is due to various factors, including a decrease in the overall immune status of the body, the presence of concomitant diseases of the body, virulent strains of pathogens resistant to antibacterial drugs, violation of reparative processes, dysfunction of the auditory tube, etc. The development and maintenance of CHSO can also be facilitated by the curvature of the nasal septum, the presence of adenoid vegetations.

Signs and symptoms of chronic suppurative otitis media

Usually sick x chronic suppurative otitis media or HGSO make the following complaints:

• intermittent or persistent suppuration from the ear,
• hearing loss,
• intermittent ear pain
• to the sensation of noise in the ear,
• dizziness.

However, in some cases, these symptoms may be absent or mild. The reasons for the exacerbation of the process there may be a cold, water in the ear, a common cold, diseases of the nose and nasopharynx. With an exacerbation of the disease, suppuration increases, body temperature may increase, noise increases or appears, mild pain in the ear.

Treatment of chronic suppurative otitis media and consequences of NOT treatment

Conservative treatment of chronic suppurative otitis media allows to achieve only a temporary improvement, and in some cases is completely ineffective. The main reason for inefficiency conservative treatment is the presence of persistent perforation of the tympanic membrane. A defect in the tympanic membrane is an open route for the spread of infection. environment in the region of the middle ear, which normally has the structure of a closed cavity, the only communication of which with the external environment is through the auditory tube. The presence of persistent perforation of the tympanic membrane, constant or periodic suppuration supports the inflammatory process in the middle ear, which often leads to destruction (destruction) of the chain of the auditory ossicles of the middle ear. The long course of CHSO leads to a more pronounced hearing loss and a greater spread of the inflammatory process.
Timely diagnosis and treatment of CHSO are the key to preventing the spread of the pathological process in the middle ear and the progression of hearing loss.

Surgical treatment of chronic suppurative otitis media

Tympanoplasty

For many decades, surgical methods of treatment, which are the most effective, have been used with great success in the treatment of patients with CHSO. One of these methods is . Tympanoplasty is a method of surgical restoration of the sound-conducting apparatus of the middle ear - the tympanic membrane and the ossicular chain, aimed at stopping suppuration and improving hearing. Tympanoplasty with a intact, functioning ossicular chain may be limited to the restoration of the tympanic membrane only - myringoplasty. A frequent consequence of CHSO is the complete or partial destruction of the ossicular chain. If there is a defect or non-functionality of individual elements of the ossicular chain, ossiculoplasty is performed to restore the integrity and mobility of the ossicular chain. Tympanoplasty can be performed as an independent operation, or as a necessary, final stage of reconstructive operations after previously undergone sanitizing (radical) operations on the middle ear.

To date, the "gold standard" in the materials used in tympanoplasty all over the world are recognized as the patient's autotissue (cartilage, perichondrium, fascia of the temporal muscle). This is due not only to the complete immunological compatibility of tissues, which eliminates the risk of transplant rejection, but also high rates functional qualities of these materials.
Tympanoplasty is currently a widely used method of surgical treatment of CHSO. The use of modern surgical equipment and instruments, together with the accumulated experience of surgical treatment, makes it possible to effectively treat patients - to achieve improved hearing and complete cessation of suppuration.

In the Scientific and Clinical Department of Ear Diseases of the Federal State Budgetary Institution NKCO, the most modern surgical techniques are used using modern microscopic equipment, microsurgical equipment performed by highly qualified otosurgeons trained in the best foreign clinics in Europe. Our specialists are constantly improving their skills, following the latest trends in the world of otosurgery.

Purulent inflammatory process in the middle ear cavity, which has a chronic course. Chronic suppurative otitis media is characterized by conductive or mixed hearing loss, suppuration from the ear canal, pain and noise in the ear, sometimes dizziness and headache. Chronic purulent otitis media is diagnosed according to otoscopy, hearing tests, bacteriological culture of ear secretions, X-ray and tomographic examinations of the temporal bone, analysis of vestibular function and the patient's neurological status. Patients with chronic purulent otitis media are treated with both conservative and surgical methods (sanitizing surgery, mastoidectomy, anthrotomy, labyrinth fistula closure, etc.).

General information

Chronic suppurative otitis media is an otitis media that is accompanied by persistent suppuration from the ear for more than 14 days. However, many specialists in the field of otolaryngology point out that otitis media with suppuration lasting more than 4 weeks should be considered chronic. According to WHO, chronic suppurative otitis media occurs in 1-2% of the population and in 60% of cases leads to persistent hearing loss. In more than 50% of cases, chronic suppurative otitis media begins its development before the age of 18 years. Chronic purulent otitis media can cause purulent intracranial complications, which in turn can lead to the death of the patient.

Causes

Pathogens in chronic suppurative otitis media, as a rule, are several pathogenic microorganisms. Most often it is staphylococci, proteus, klebsiella, pseudomonia; in rare cases- streptococci. In patients with a long course of chronic purulent otitis media, along with the bacterial flora, pathogens of otomycosis are often sown - yeasts and molds. Immediate causes:

• Acute otitis media. In the vast majority of cases, chronic suppurative otitis media is the result of a transition to the chronic form of acute otitis media or the development of adhesive otitis media.
• Ear injury. The development of the disease is also possible when the tympanic cavity is infected as a result of an ear injury, accompanied by damage to the tympanic membrane.
• Other diseases of the ENT organs. The occurrence of chronic suppurative otitis media is due to dysfunction of the auditory tube in eustachitis, aerootitis, adenoids, chronic sinusitis;

Contribute to the development of chronic purulent otitis media from acute various immunodeficiency states (HIV infection, side effect treatment with cytostatics or X-ray therapy), endocrinopathy (hypothyroidism, obesity, diabetes mellitus), irrational antibiotic therapy or unjustified reduction in the treatment of acute purulent otitis media.

Classification

Chronic suppurative otitis media has 2 clinical forms:

• Mesotympanitis(tubotympanic otitis). It makes up about 55% and is characterized by the development of an inflammatory process within the mucous membrane of the tympanic cavity without involving its bone formations.
• epitympanitis(epithympanic-antral otitis media) Epitympanitis accounts for the remaining 45% of cases of chronic suppurative otitis media. It is accompanied by destructive processes in the bone tissue and in many cases leads to the formation of ear cholesteatoma.

Symptoms

Main clinical signs chronic suppurative otitis media are suppuration from the ear, hearing loss (hearing loss), tinnitus, pain in the ear and dizziness. Suppuration may be permanent or intermittent. During the period of exacerbation of the disease, the amount of discharge, as a rule, increases. If granulation tissue grows in the tympanic cavity or there are polyps, then the discharge from the ear may be bloody.

Chronic suppurative otitis media is characterized by a conductive type of hearing loss caused by impaired mobility of the auditory ossicles. However, long-term chronic suppurative otitis media is accompanied by mixed hearing loss. The resulting disturbances in the operation of the sound-perceiving part auditory analyzer are caused by reduced blood circulation in the cochlea as a result of prolonged inflammation and damage to the hair cells of the labyrinth by inflammatory mediators and toxic substances formed during the inflammatory reaction. Damaging substances penetrate from the tympanic cavity into the inner ear through the windows of the labyrinth, the permeability of which increases.

Pain syndrome usually moderately expressed and occurs only during periods when chronic suppurative otitis media enters an exacerbation phase. An exacerbation can be triggered by SARS, pharyngitis, rhinitis, laryngitis, tonsillitis, fluid in the ear. During the period of exacerbation, there is also an increase in body temperature and the appearance of a feeling of pulsation in the ear.

Complications

Epitympanitis has a more severe course than mesotympanitis. This chronic purulent otitis media is accompanied by bone destruction, which results in the formation of skatole, indole, and other chemicals that give the ear discharge a fetid odor. When the destructive process spreads to the lateral semicircular tubule inner ear, the patient has systemic dizziness. With the destruction of the wall of the bony facial canal, paresis of the facial nerve is noted. Epitympanitis often leads to the development of purulent complications: mastoiditis, labyrinthitis, meningitis, brain abscess, arachnoiditis, etc.

Diagnostics

Chronic suppurative otitis media can be diagnosed with endoscopy data, auditory analyzer studies, bacteriological culture of discharge from the ear, skull radiography, CT and MSCT of the skull with a targeted study of the temporal bone.

• Ear examination. Otoscopy and microotoscopy are performed after the toilet of the outer ear with a thorough cleaning of the external auditory canal. They reveal the presence of perforation in the eardrum. Moreover, chronic purulent otitis media, proceeding according to the type of mesotympanitis, is distinguished by the presence of perforation in the tense region of the tympanic membrane, while epitympanitis is typically characterized by the location of the perforation in the loose area.
• The study of auditory function. Chronic purulent otitis media is characterized by hearing loss according to audiometry, conductive or mixed hearing loss according to threshold audiometry, impaired mobility of the auditory ossicles according to acoustic impedancemetry. Eustachian tube patency, electrocochleography, otoacoustic emission are also assessed.
• Studies of the vestibular analyzer. Chronic purulent otitis media, accompanied by vestibular disorders, is an indication for electronystagmography, stabilography, video oculography, pressor test, indirect otolithometry.

If there is a neurological disorder in the clinic, consultations with a neurologist and MRI of the brain are necessary.

Treatment of chronic suppurative otitis media

Purulent otitis without bone destruction and complications can be treated with medication under the outpatient supervision of an otolaryngologist. Such drug therapy aimed at removing the inflammatory process. In cases where chronic suppurative otitis media occurs with bone destruction, it is essentially a preoperative preparation of the patient. If chronic purulent otitis media is accompanied by paresis of the facial nerve, headache, neurological disorders and / or vestibular disorders, then this indicates the presence of a destructive process in the bone and the development of complications. In such a situation, it is necessary to hospitalize the patient as soon as possible in a hospital and consider the issue of his surgical treatment.

Conservative therapy

Chronic suppurative otitis media is usually treated conservatively or preoperatively for 7-10 days. During this period, the ear toilet is performed daily, followed by washing the tympanic cavity with antibiotic solutions and instillation of antibacterial drops into the ear. Given that chronic suppurative otitis media is accompanied by perforation in the eardrum, ototoxic aminoglycoside antibiotics cannot be used as ear drops. You can use ciprofloxacin, norfloxacin, rifampicin, as well as their combination with glucocorticosteroids.

Surgery

For the purpose of complete rehabilitation and functional recovery, chronic suppurative otitis media with bone destruction needs surgical treatment. Depending on the prevalence of the purulent process, chronic purulent otitis media is an indication for a sanitizing operation with mastoidoplasty or tympanoplasty, aticoanthrotomy, mastoidotomy, labyrinthotomy and plastic labyrinth fistula, removal of cholesteatoma. If chronic purulent otitis media is accompanied by diffuse inflammation with the threat of complications, then a general ear surgery is performed.

Forecast

Timely sanitation of a chronic purulent focus in the ear provides a favorable outcome of the disease. The earlier the treatment is carried out, the greater the chances of recovery and preservation of hearing. In advanced cases, when chronic suppurative otitis media leads to significant bone destruction and / or the development of complications, reconstructive surgery is necessary to restore hearing. In some cases, with the most unfavorable outcome, patients require

Chronic purulent inflammation of the middle ear causes persistent pathological changes in the mucous membrane and bone tissue, leading to a violation of its transformational mechanism. Severe hearing loss in early childhood entails a violation of speech, complicates the upbringing and education of the child. This disease may limit the suitability for military service and the choice of certain professions. Chronic suppurative otitis media can cause severe intracranial complications. To eliminate the inflammatory process and restore hearing, it is necessary to undertake complex operations using microsurgical techniques.

Chronic purulent otitis media is characterized by three main features: the presence of persistent perforation of the tympanic membrane, periodic or constant suppuration from the ear, and hearing loss.

Etiology . In chronic suppurative otitis media, in 50-65% of cases, staphylococci (mainly pathogenic) are sown, in 20-30% - Pseudomonas aeruginosa and in 15-20% - Escherichia coli. Often, with the irrational use of antibiotics, fungi are found, among which Aspergillus niger is more common.

Pathogenesis . It is generally accepted that chronic suppurative otitis media most often develops on the basis of prolonged acute otitis media. Among the factors contributing to this include chronic infections, pathology of the upper respiratory tract with impaired nasal breathing, ventilation and drainage function of the auditory tube, incorrect and insufficient treatment of acute otitis media.

Sometimes the inflammatory process in the middle ear can be so sluggish and unexpressed that it is not necessary to talk about the transition of acute inflammation to chronic, but it should be considered that it had chronic features from the very beginning. Such a course of otitis can occur in patients suffering from diseases of the blood system, diabetes, tuberculosis, tumors, hypovitaminosis, immunodeficiency.

Sometimes acute otitis media transferred in childhood with measles and scarlet fever, diphtheria, typhoid fever leads to necrosis of the bone structures of the middle ear and the formation of a subtotal defect of the tympanic membrane.

If a newborn has acute otitis media due to an anomaly in the structure of the auditory tube and the inability to ventilate the tympanic cavity, then the inflammatory process immediately becomes chronic. Sometimes a persistent dry perforation of the tympanic membrane is formed, which plays the role of an unnatural way of ventilation of the tympanic cavity and antrum, and suppuration does not recur. Other patients experience discomfort because the tympanic cavity communicates directly with the external environment. They are worried about constant pain and noise in the ear, which increases significantly during exacerbations.

Clinic . According to the nature of the pathological process in the middle ear and the associated clinical course, two forms of chronic suppurative otitis media are distinguished: mesotympanitis and epitympanitis.

Chronic purulent mesotympanitis characterized by damage to the mucous membrane of the middle ear.

Mesotympanitis is different favorable flow. Its exacerbations are most often caused by exposure to the mucous membrane of the tympanic cavity of external adverse factors (water, cold air) and colds. During exacerbation, inflammation can occur in all floors of the tympanic cavity, antrum and auditory tube, but due to the mild swelling of the mucous membrane and the preservation of ventilation of the pockets of the attic and antrum, as well as a sufficient outflow of discharge from them, conditions are not created for the transition of inflammation to the bone.

Perforation of the tympanic membrane is localized in its stretched part. It can be of various sizes and often occupies most of its area, acquiring a bean-shaped shape (Fig. 1.7.1). A distinctive feature of perforation in mesotympanitis is the presence of a rim of the remnants of the tympanic membrane around the entire perimeter, which is why it is called rim.

This type of perforation is decisive in the diagnosis. The main criterion for distinguishing mesotypanitis from epitympanitis is limitation of the pathological process by the mucous membrane of the middle ear.

There are periods of remission and exacerbation of the disease. With exacerbation of the complaints of patients are reduced to a decrease in hearing and suppuration from the ear. Detachable abundant mucous or mucopurulent, light, odorless. The mucous membrane of the medial wall of the tympanic cavity is thickened. The complicated course of mesotympanitis is characterized by the appearance granulations and polyps of the mucous membrane, which contributes to an increase in the amount of discharge. Hearing is reduced according to the type of sound conduction disorder, and then - according to the mixed type. During the period of remission, suppuration from the ear stops. Hearing remains low and persistent perforation of the tympanic membrane is preserved, since its edges are scarred and do not have regeneration.

As a result of chronic recurrent inflammation of the mucous membrane of the tympanic cavity, adhesions can occur that limit the mobility of the auditory ossicles and aggravate hearing loss.

Chronic purulent epitympanitis is different unfavorable course. It's connected with the transition of inflammation to bone tissue with the onset of sluggish limited osteomyelitis. This course of the pathological process is due to an increased tendency to swelling, infiltration and exudation of the mucous membrane of the middle ear, as well as an unfavorable variant of the anatomical structure of the attic and the entrance to the cave. The severity of the folds and pockets in the attic and the narrow aditus ad antrum contribute to the violation of the ventilation of the middle ear cavities and the delay of the pathological discharge during inflammation. The bone walls of the attic and antrum, the malleus and incus are affected. The stirrup is less commonly involved.

There may be a delimitation of the attic from the middle floor of the tympanic cavity. Then the impression of a normal otoscopic picture is created, since the stretched part of the tympanic membrane is not changed. The mesothimanum is normally ventilated through the auditory tube and all identification points of the tympanic membrane are well expressed. But if you look more closely, you can see a perforation or crust covering it above the short process of the malleus. After removing this crust, the doctor's eyes often open a defect in the loose part of the eardrum. This is characteristic of epitympanitis marginal perforation(Fig. 1.7.2).

In this section, the perforation cannot be rimmed, since there is no cartilaginous ring here that delimits the membrane from the bone in the stretched part. The tympanic membrane is attached directly to the bony edge of the rivinium notch. Together with the defeat of the bone structures of the attic, the bone edge of this notch is damaged and marginal perforation occurs.

The discharge is thick, purulent, not abundant, and may be extremely scarce in general, drying into a crust covering the perforation. The absence of a discharge does not indicate a favorable course of the disease. On the contrary, the destruction of bone structures in the depths of the ear is pronounced. The hallmark of osteomyelitis of the bone is strong unpleasant odor, due to the release of indole and skatole and the activity of anaerobic infection. In the area of ​​bone caries, granulations, polyps, and often destruction of the ossicular chain are noted.

In addition to suppuration, patients often suffer from headaches. When the wall of the lateral semicircular canal is destroyed, dizziness occurs. The presence of a fistula is confirmed by a positive tragus symptom (appearance of pressor nystagmus towards the diseased ear when the tragus obstructs the external auditory canal).

Hearing is lowered sometimes to a greater extent than with mesotympanitis, although with pinpoint perforation and the preservation of the chain of auditory ossicles, he suffers little. More often than with mesotympanitis, low-frequency noise is noted in the ear. Hearing loss is first conductive, then mixed and finally sensorineural in nature as a result of the toxic effect of inflammation products on the receptor formations of the cochlea.

In patients with epitympanitis, secondary cholesteatoma - accumulation of layers of epidermal masses and their decay products rich in cholesterol. The main theory of the formation of cholesteatoma is the ingrowth of the keratinized stratified squamous epithelium of the external auditory canal into the middle ear through the marginal perforation of the tympanic membrane. The epidermal masses are enclosed in a connective tissue membrane - a matrix, covered with epithelium, tightly adjacent to the bone and growing into it. Constantly produced epidermal masses increase the volume of cholesteatoma, which exerts a destructive effect on the bone with its pressure. In addition, the destruction of the bone is facilitated by the chemical components released by the cholesteatoma (the enzyme collagenase) and the decay products of bone tissue. Cholesteatoma is most often localized in the attic and antrum.

Occurring with epitympanitis complications are mainly associated with bone destruction, although granulations and polyps are also observed as with mesotympanitis. In the presence of cholesteatoma, bone tissue decay occurs more actively, so complications are much more common. In addition to the fistula of the horizontal semicircular canal, facial nerve paresis, labyrinthitis, and various intracranial complications may occur.

Diagnosis of epitympanitis is helped by X-ray of the temporal bones according to Schüller and Mayer. In patients suffering from this disease since childhood, there is a sclerotic type of structure of the mastoid process. Against this background, with epitympanitis, bone destruction can be determined.

Treatment . Tactics of treatment of chronic suppurative otitis media depends on its form. The task is to eliminate the inflammatory process in the middle ear and restore hearing, so the full treatment of chronic otitis media with hearing loss should end with a hearing-restoring operation.

With mesotympanitis, predominantly conservative local anti-inflammatory therapy is carried out. Termination of osteomyelitis of the bone with epitympanitis and removal of cholesteatoma can only be carried out surgically. In this case, conservative treatment is used in the process of differential diagnosis of epitympanitis and mesotympanitis and preparation of the patient for surgery. The occurrence of labyrinthitis, paresis of the facial nerve and intracranial complications requires urgent surgical intervention, usually in an expanded volume.

Servicemen with chronic purulent otitis media are subject to dynamic observation by a unit doctor and a garrison otolaryngologist.

Conservative treatment begin with the removal of granulations and polyps of the mucous membrane that support inflammation. Small granulations or a strongly swollen mucous membrane are cauterized with a 10-20% solution of silver nitrate. Larger granulations and polyps are removed surgically.

As in acute suppurative otitis media great importance has a thorough and regular holding of the ear toilet.

After the toilet of the ear, various medicinal substances are used in the form of drops, ointments and powder. The method of application depends on the phase of inflammation and corresponds to the dermatological principle (wet - wet, dry - dry), therefore, solutions are used first, and in the final phase of treatment they switch to ointment forms or powder insufflations.

Water-based liquid medicinal substances are used (20-30% solution of sodium sulfacyl, 30-50% solution of dimexide, 0.1-0.2% solution of mefenamin sodium salt, 1% solution of dioxidine, etc.). At an earlier date than in acute otitis, they can be replaced with alcohol solutions (3% alcohol solution of boric acid, 1-5% alcohol solution of salicylic acid and sodium sulfacyl, 1-3% alcohol solution of resorcinol, 1% formalin solution and silver nitrate ). In case of intolerance to alcohol solutions by the patient (severe pain, burning in the ear), the use of aqueous solutions is limited.

Antibiotics are topically applied taking into account the sensitivity of the microflora. With prolonged use, they can grow granulation tissue and cause dysbacteriosis. The use of ototoxic antibiotics should be avoided.

Glucocorticoids (hydrocortisone emulsion, prednisolone, flucinar, sinalar, etc.) have a powerful anti-inflammatory and hyposensitizing effect. Hydrocortisone emulsion is best used at the very beginning of treatment to relieve severe swelling of the mucous membrane. Corticosteroid ointments are used in the final phase of treatment.

Enzymatic preparations (trypsin, chymotrypsin) are used to thin the viscous secretion and improve the absorption of medicinal substances.

Positive results were noted with the use of biogenic preparations (Solcoseryl in the form of ointment and jelly, 10-30% alcohol solution of propolis), antibacterial preparations of natural origin (novoimanin, chlorophyllipt, sanguirythrin, ectericide, lysozyme)

In order to restore the patency of the auditory tube, vasoconstrictor drugs are prescribed in the nose on an ointment basis. By the method of tragus injection through the tympanic cavity, drugs are applied to the mucous membrane of the auditory tube. After instillation into the ear of the medicinal substance in the horizontal position of the patient on his side, press several times on the tragus. medicinal substances can be introduced into the auditory tube through the nasopharyngeal mouth using an ear metal catheter.

Diagnostic and therapeutic technique for epitympanitis is washing through the marginal perforation of the attic using a Hartmann cannula. This is how cholesteatoma scales and pus are washed, which helps to relieve tension in the attic and reduce pain. For washing the attic, only alcohol solutions are used, since cholesteatoma masses have increased hydrophilicity and swelling of cholesteatoma can increase pain in the ear, and sometimes provoke the development of complications.

A good addition to the treatment are physiotherapeutic methods of exposure: endaural ultraviolet irradiation (tube quartz), electrophoresis of medicinal substances, UHF, etc.

Local treatment should be combined with the appointment of drugs that increase the reactivity of the body. A prerequisite is a balanced diet with a sufficient content of vitamins and restriction of carbohydrates.

A patient with chronic purulent otitis media is warned about the need to protect the ear from exposure to cold wind and water ingress. During water procedures, bathing close the external auditory canal with cotton wool soaked in vaseline or vegetable oil. Cosmetic creams and corticosteroid ointments are also used for this purpose. The rest of the time, the ear is kept open, since the oxygen contained in the air has a bactericidal effect, and clogging of the external auditory canal creates thermostatic conditions that promote the growth of microorganisms.

Surgery in chronic purulent otitis media, it is aimed at removing the pathological focus of osteomyelitis and cholesteatoma from the temporal bone and improving hearing by restoring the sound-conducting apparatus of the middle ear.

The tasks of surgical interventions in various situations are:

emergency elimination of the otogenic cause of intracranial complications, labyrinthitis and paralysis of the facial nerve;

elimination of the focus of infection in the temporal bone in a planned manner in order to prevent complications;

plastic defects of the sound-conducting apparatus in the long term after the sanitizing operation;

Simultaneous removal of pathology in the middle ear with plastic defects of the sound-conducting apparatus;

Elimination of adhesions in the tympanic cavity with plastic surgery of perforation of the tympanic membrane;

plastic perforation of the tympanic membrane.

In 1899 Küster and Bergmann proposed radical (general cavity) ear surgery, which consists in creating a single postoperative cavity connecting the attic, antrum and cells of the mastoid process with the external auditory canal (Fig. 1.7.3). The operation was performed behind the ear approach with the removal of all auditory ossicles, the lateral wall of the attic, part of the posterior wall of the auditory canal and the pathological contents of the middle ear with curettage of the entire mucous membrane.

Such a surgical intervention saved the life of a patient with intracranial complications, but was accompanied by large destruction in the middle ear, severe hearing loss, and often vestibular disorders. Therefore, V.I. Voyachek proposed the so-called conservative radical ear surgery. It provided for the removal of only pathologically altered bone tissue and mucous membranes with the preservation of intact parts of the auditory ossicles and the tympanic membrane. Since this operation was limited to the connection of the attic and antrum into a single cavity with the auditory meatus, it was called attic-anthrotomy.

With urgent interventions for otogenic intracranial complications, a radical operation is still performed with a wide exposure of the sigmoid sinus and dura mater, but, if possible, they try to preserve the elements of the sound-conducting apparatus. The operation is completed with plastic surgery of the postoperative cavity with a meatotympanic flap. This operation combines the principle of radicalism in relation to the opening of the cellular system of the mastoid process and a sparing attitude to the sound-transmitting structures of the tympanic cavity.

Subsequently, attic-anthrotomy began to be carried out with a separate approach to the antrum and attic, while maintaining the inner part of the posterior wall of the external auditory canal. The antrum is opened through the mastoid process, and the attic through the ear canal. This operation is called separate attic-anthrotomy. A drain is inserted into the antrum cavity, through which it is washed with various medicinal solutions. At present, efforts are being made to preserve or plastically restore the lateral wall of the attic. Sparing the posterior wall of the ear canal and the lateral wall of the attic allows you to save a larger volume of the tympanic cavity and the normal position of the tympanic membrane, which significantly improves the functional result of the operation.

Plastic surgery of the postoperative cavity was already undertaken during the first extensive variant of radical ear surgery. It was planned to lay a non-free meatal flap in the posterior sections of the postoperative cavity (Fig. 1.7.3). It was the source of epithelialization of the cavity. During attic-anthrotomy according to Woyachek, a meato-tympanic flap was created, which served simultaneously as a source of epithelialization and closure of perforation of the tympanic membrane.

Currently tympanoplasty provides for the use of the remaining elements of the sound-conducting apparatus of the middle ear, and in case of their partial or complete loss, the reconstruction of the transformation mechanism using various materials (bones, cartilage, fascia, veins, fat, cornea, sclera, ceramics, plastics, etc.) ossicular chain and tympanic membrane.

Tympanoplasty is indicated for chronic purulent otitis media, less often for adhesive otitis media, injuries and anomalies in the development of the ear. Before surgery, the ear must be dry for six months. Before tympanoplasty, an audiological examination is performed, the type of hearing loss, the cochlear reserve, and the ventilation function of the auditory tube are determined. With a pronounced violation of sound perception and the function of the auditory tube, tympanoplasty is not very effective. With the help of a prognostic test - tests with a cotton swab according to Kobrak, a possible increase in hearing acuity after surgery is established (hearing is examined for whispered speech before and after applying a cotton swab moistened with vaseline oil to perforation of the eardrum or into the ear canal opposite it).

Tympanoplasty is sometimes performed simultaneously with a sanitizing separate atticoanthrotomy, when the surgeon is confident in the sufficient elimination of the focus of infection. If the bone lesion is extensive, then the hearing-restoring operation is done as the second stage a few months after atticoanthrotomy.

There are 5 types of free plasty according to Wullstein H.L., 1955 (Fig. 1.7.4).

Type I - endaural myringoplasty in case of perforation of the tympanic membrane or reconstruction of the membrane in case of its defect.

Type II - a mobilized tympanic membrane or neotympanic membrane is placed on a preserved incus with a defect in the head, neck, or handle of the malleus.

Type III - miringostapedopexy. In the absence of the malleus and anvil, the graft is placed on the head of the stirrup. A "columella - effect" is created by the type of sound conduction in birds that have one auditory bone - the columella. It turns out a small tympanal cavity, consisting of the hypotympanum, the tympanic opening of the auditory tube and both labyrinth windows.

IV type - screening of the window of the cochlea. In the absence of all auditory ossicles, except for the base of the stirrup, the graft is placed on the promontorium with the formation of a reduced tympanic cavity, consisting of the hypotympanum, the cochlear fenestra, and the tympanic opening of the auditory tube. Hearing is improved by increasing the pressure difference across the labyrinth windows.

Type V - fenestration of the horizontal semicircular canal according to Lempert (Lempert D., 1938). Sound conduction is carried out through a transplant that covers the operating window of the semicircular canal. This variant of tympanoplasty is used in the absence of all elements of the sound-conducting apparatus of the middle ear and a fixed stirrup.

Tympanoplasty also involves the restoration of the integrity of the eardrum - myringoplasty. It may be limited to closing the perforation of the membrane with various plastic materials or the creation of a neotympanic membrane.

Small persistent rim perforations of the tympanic membrane are often eliminated after refreshing the edges and gluing egg amnion, thin nylon, sterile paper to the membrane with fibrin glue, through which the regenerating epithelium and epidermis spread. For this purpose, you can also use BF-6 glue and Kolokoltsev glue.

Marginal perforations are closed with meatal or meatotympanic non-free flaps during radical ear surgery (Krylov B.S., 1959; Khilov K.L., 1960).

Concluding the coverage of the principles of treatment of chronic purulent otitis media, one should once again pay attention to the fact that the need for surgery both to sanitize the focus of infection and restore hearing requires expanding the indications for surgical intervention. A planned operation with indications should be performed simultaneously and consist of three stages: revision, sanitation and plastic surgery.

Conservative treatment of patients with mesotympanitis, uncomplicated by granulations and polyps, is carried out in the military unit by appointment of an otolaryngologist, and in the event of an exacerbation of the process, in a hospital. Sanitizing operations are performed in the otolaryngological department of garrison hospitals. Complex hearing-restoring surgical interventions are performed in the district, central military hospitals and the ENT clinic of the Military Medical Academy.

All patients with chronic purulent otitis media, including those after ear surgery, are under the dynamic supervision of a unit doctor and a garrison otolaryngologist. Examination of military personnel is carried out according to Art. 38 of the order of the Ministry of Defense of the Russian Federation N 315 of 1995

Purulent otitis media is considered one of the rather serious diseases, the treatment of which requires a large investment of time and money. You can’t just give up on him, because the disease is accompanied by unpleasant, and sometimes unbearable pain.

The consequences of purulent otitis are very serious. It could be meningitis, a lesion of the lining of the brain that will lead to bad symptoms and a significant reduction in life expectancy. Finally, the most obvious is hearing loss. Once you save on treatment, you will be forced to wear expensive hearing aids for the rest of your life.

How does purulent otitis media manifest itself?

Otitis media is an inflammation of the ear that is caused by thousands of different causes. Otitis is divided into three types. The first is otitis externa. This disease is easily curable with the help of folk remedies alone. Owners of otitis media will have to make a little more effort, while there is a risk of serious complications. Internal otitis, which is also called labyrinthitis, is the most dangerous and intractable. In addition to hearing impairment, it leads to malfunctions vestibular apparatus and loss of coordination.

Purulent otitis media is one of the most common diseases. It is not easy to cure, so at the first suspicions it is better to seek medical care based on the following symptoms found in you or your child:

1. High temperature - more than 38°C.
2. Headaches. Most often they are manifested by a pulsation in the temples.
3. Pain in the ears. Sometimes they are indistinguishable from a headache and merge with it.
4. Noise in ears. You have a feeling that something is constantly rustling and buzzing above your ear.
5. Pain in the eyes and jaw. It has a shooting and sharp character.
6. Hearing loss. You may not be able to hear a person speaking incoherently in your ear.
7. Blocked ear canal. The whole day does not leave the feeling as if a piece of cotton wool is stuck in the ear.
8. Purulent discharge. A cloudy liquid with an unpleasant odor can sometimes flow from the ear.

Most often, otitis media begins due to infections that are caused by bacteria, viruses, or fungi. They enter the middle ear through the nasopharynx, so all its diseases increase the risk of the disease at times. In addition, you can get sick with purulent otitis media if you constantly supercool, injure your ear, or allow water to enter it.

How to cope with the disease?

In terms of treatment, adults have more options than the younger generation, since their body is less prone to allergies and sensitivity to various medications. One of the main postulates of treatment is the need to maintain the normal functioning of the auditory tubes. Therefore, if the patient has records of rhinitis, adenoids and other diseases in the card, they must be treated first.

They are also purged and washed. To do this, a special catheter is inserted into the ear, which reaches the eardrum. Through it, special medicines enter the ear, which reduce inflammation and dry the surface of the organ, since the medicine that gets on the mucus immediately loses its effectiveness.

Treatment of purulent otitis involves the use of drugs such as:

1. Glucocorticoids. They will significantly reduce swelling and begin to fight inflammation in the ear.
2. Antibiotics. They are used as needed and administered intramuscularly. Sometimes they are placed immediately in the ear, before having treated it with antiseptic agents. The most commonly used are penicillins or cephalosporins. If there are contraindications to their use, doctors recommend the use of macrolide antibiotics. At the same time, the contraindications of the antibiotic used should not include “bad effect on hearing”.
3. Antihistamines. They are used in the event that purulent otitis media was preceded by an allergy to the nasopharynx. When edema appears due to allergies, mucus is secreted and the auditory gaps are closed, this easily provokes inflammation.
4. Vasoconstrictor drops. They are mainly designed to expand the auditory tubes and are instilled into the nose several times a day. Caution: long-term use of these drugs is addictive.

How to treat children?

The body in children is more fragile and sensitive than in an adult, so their treatment is carried out differently. One of the main mistakes of parents is the use of boric alcohol. This will not bring any effect, but will only increase the pain, as a result of which the child will suffer more.

All drugs should be individually prescribed by a doctor, focusing on the weight and height of the child, the diseases he has suffered and individual reactions to certain drugs. In this case, the disease is more difficult for the child to carry and causes more serious consequences, so you need to see a doctor as soon as possible.

Antibiotic treatment is unavoidable in both adults and children. But for the latter, they are appointed more carefully and after several examinations. Typically, an antibiotic is selected from the following row: Ceftriaxone, Amoxiclav or Cefuroxime. In addition, pus can be removed by cutting the eardrum, which is usually performed on children over 3 years of age.

If the child is not even a year old, vasoconstrictor or ear drops are not prescribed to him, since they are prohibited at this age. Otherwise, many unpleasant symptoms may appear, up to convulsions and vomiting.

Simultaneously with nasal drops or instead of them, often rinse the nose with a saline solution in the amount of 3 drops. After its application, the mucus from the nose must be pumped out with a pear. In order to bring down the temperature, use products containing paracetamol, but only after the approval of the doctor.

Analgin and aspirin for children are prohibited. Sometimes a blue lamp and dry heat are used. During illness, it is better to keep the child at home and not let him go outside, bathing him is also not recommended, at least in the most acute phase of the disease. If you follow all the doctor's recommendations, you can cure otitis media without resorting to surgery.

Folk remedies in the fight against the disease

Washing your own ears is not the safest procedure, and this should be done only in extreme cases. But if you decide, use the time-tested decoction of chamomile. Pour in 1 tbsp. l. in half a liter of water and boil. After that, leave to infuse for 40 minutes. Rinse their ear, but make sure that the decoction remains warm.

To reduce pain, you can insert tampons moistened with 10% propolis into the ear. This tincture can be purchased at the pharmacy. You can use a more gentle way and dilute propolis with peach or sunflower oil in a ratio of 1: 2. Bury the medicine 7 or 10 drops 4 times a day. For children under 4 years old, the dose is reduced to 5 drops.

Also, wild garlic is an excellent anti-inflammatory agent in the treatment of otitis media. You can be treated with both its juice and alcohol or water infusion. For the latter, take 20 g of berries and pour 20 ml of boiled water. Let it brew for about an hour. For the second, pour the same amount of berries with vodka in a ratio of 1: 4. It takes two weeks to insist. Infusion, water or alcohol, moisten a cotton swab and insert it into the ear for a while.

Garlic can be used for the same purpose. Grind half a cup of garlic, pour the same amount olive oil and leave for 3 days away from sunlight.

Purulent otitis is clearly not something that can be neglected.

Hearing loss is the lesser of evils in case of missed or untimely treatment.

The disease can lead to loss of coordination, deadly meningitis, and brain damage. To prevent this from happening, seek medical help in time, help yourself with folk remedies, after consulting with your doctor beforehand, and do not start diseases of the nasopharynx.

How to treat purulent otitis media depending on the stages of the disease

Purulent otitis, as a rule, develops as a result of infectious inflammation.

It is dangerous for its complications, as it occurs in the inner cavity of the ear, where independent access for external processing is impossible.

Therefore, only a doctor can give an exact answer to the question of how to treat purulent otitis media.

In the development of purulent otitis, three stages are usually distinguished:

• First stage: inflammation develops in the ear cavity, causing swelling of the mucous membrane with the formation of mucus, pus. At this moment, a person feels severe pain both in the ear and in the areas adjacent to it (the jaw, head may hurt, nasal congestion may be felt, pressure on the eyes). This stage is usually characterized by fever, decreased appetite, and weakness. Symptoms increase with the advent of evening and night time.
• Second stage: there is a release of purulent mass from the ear by melting the eardrum. After the tension inside the ear cavity is relieved, the pain decreases and the temperature decreases. Self-occurring suppuration can lead to significant damage to the eardrum. Therefore, a tympanic membrane puncture procedure is often used to reduce the size of the injury. This procedure is also prescribed if otitis media develops rapidly, which creates a threat of penetration of pus into the brain.
• Third stage characterized by a decrease in inflammation and recovery of the organ. At this time, you can not stop the prescribed treatment. If treatment is abandoned due to an improvement in well-being, a second exacerbation may occur, since the infection will not be completely eliminated.

Diagnosis of the disease is carried out in order to determine how to treat purulent otitis media, depending on the stage of development and the causative agent of the infection.

It includes the following indicators:

• otoscopy (presence of pus, integrity of the eardrum);
• blood test;
• sowing secretions to determine the pathogen;
• hearing research.

For the treatment of purulent otitis media, the following medical methods are used:

• antibiotics are taken orally, intramuscularly, injected into the ear cavity through the eardrum;
• hormonal drugs are used to reduce swelling;
• antihistamines to exclude the development of allergic reactions;
• painkillers;
• antipyretics, if the temperature during otitis media lasts a long time.

In some cases, when there is a risk of serious complications or they have already occurred, surgical operations are performed. In order to avoid such a situation, it is necessary to start treatment on time, especially if purulent otitis media is diagnosed in a child.

How to treat acute diffuse otitis media

Acute diffuse otitis media is expressed in inflammation of the skin and subcutaneous layers of the outer ear.

The causes of this disease can be damage to the skin of the ear canal, caused by:

• injuries;
• unsuccessful manipulations during hygiene procedures;
• ingress of foreign bodies;
• burns;
• exposure to chemicals.

External diffuse otitis occurs when bacteria or fungi infect the damaged surface of the skin.

Acute diffuse otitis media, as a rule, can manifest itself with the following symptoms:

• pronounced swelling of the outer ear;
• the presence of a boil at the site of injury;
• heat;
• pain sensations;
• swollen lymph nodes.

Depending on the nature of the infection, it is determined how to treat acute suppurative otitis media.

Various treatments are used, such as:

• medication;
• physiotherapy;
• treatment with folk remedies;
• surgical intervention.

How to treat acute otitis media with medication:

• antibiotics in the form of ear drops or ointments;
• antibacterial agents orally;
• antifungal drugs in the form of ointments;
• antiviral drugs;
• hormonal drugs.

Physiotherapy includes the use of UV and UHF.

If the boil is large and pus does not come out, then with the help of a surgical operation such a boil is opened and cleared of purulent contents.

How to treat acute otitis with folk remedies:

• cleansing the ear canal with swabs soaked in chamomile decoction or wild garlic juice;
• introduction into the ear of turundas soaked in infusions and juice of herbs, such as nightshade, plantain, mint leaves;
• the inclusion in the diet of foods in which ascorbic acid is present (oranges, lemons, hawthorn, wild rose).

How to treat acute otitis media depends on many factors. In order for the treatment to be effective, it is necessary to consult a doctor.

Purulent otitis media

We used to call any pain in the ear otitis, but this is far from the case. In fact, purulent otitis media is an inflammation of the epithelium of the mucous tissues of the airways of the middle ear. A serious illness requires a competent approach in treatment in order to prevent unpleasant complications, such as hearing loss or meningitis.

Causes of purulent otitis media

Acute purulent otitis media will not appear in a child who has dirty water in his ear. The causes of this disease are mostly internal:

• weakened immunity;
• complications from an infectious disease, or a cold;
• infection through the blood.

When the body has low resistance to infections, even improper blowing of the nose can cause otitis media, as a result of which pathogenic microbes enter the middle ear area through the auditory tube. Also, viruses that cause infections can get into the ear with injuries and injuries of the eardrum. In children, even unremoved adenoids can cause otitis media.

If the disease is not treated, it runs the risk of flowing into chronic purulent otitis media, and then any draft can cause re-suppuration in any of the sections of the middle ear - the tympanic cavity, mammillary process and auditory tube.

The main symptoms of purulent otitis media

There are several signs that help determine that you have acute suppurative otitis media, and not another disease of the hearing organs. But the main symptoms of various diseases in the field of otolaryngology usually coincide. Symptoms of otitis media:

• hearing loss;
• headaches;
• pain in the ear, ear canal, sometimes pain radiating to the jaw;
• temperature rise to 38-39 degrees.

These signs are characteristic of the initial stage of the disease, when inflammation causes extensive suppuration. This process usually takes 2-3 days. Further, acute purulent otitis media passes into the phase of perforative damage to the tympanic membrane, as a result of which pus flows out of the ear cavity through the hole formed in the eardrum, and the patient experiences significant relief, pain sensations decrease. The third stage is the final one, the body fights the infection, inflammation gradually decreases, pus stops secreting, the eardrum restores its integrity.

How to treat purulent otitis media?

Treatment of purulent otitis media primarily aims to eliminate the microorganisms that caused the inflammatory process. Most often it is one of the types of staphylococcus, streptococcus, or the causative agents of colds and flu. Usually, the body is able to cope with these types of microbes on its own, therefore, in the initial stage of the disease, it makes sense to take medicines that restore immunity, use a multivitamin complex and general strengthening agents.

To combat high fever, you can take Aspirin, Paracetamol, and other medicines that are well known to all of us.

You can also use special drops for purulent otitis media:

• Otipax;
• Otinum;
• Garazon;
• 3% boric alcohol;
• 5% carbolic-glycerin drops;
• camphor oil.

All these remedies are good in the first stage of the disease. A prerequisite is also bed rest with a light diet. In severe cases, hospitalization may be required.

If the disease progresses rapidly, there is a chance that the body will cope with it without additional use of antibiotics. Otherwise, it is advisable to use one of the following drugs:

• Amoxicillin;
• Amoxiclav;
• doxycycline;
• Sumamed;
• Rovamycin.

They can be used in the form of tablets or as intramuscular injections.

Chronic suppurative otitis media

Chronic suppurative otitis media is an inflammation of the organ of hearing, which has a chronic form. The disease in most cases occurs against the background of advanced acute otitis media or its improper treatment. The inflammatory process is characterized by its own signs, features of the course and treatment of the disease in children and adults.

This is a fairly common disease that almost every person encounters in their lives. The prevalence of the pathology is caused by its frequent latent course and the rapid penetration of the infection into the ear cavity.

It is important to carry out treatment in a timely manner, since a purulent process can quickly lead to unpleasant consequences - hearing impairment or loss, and when the disease is neglected, it is even dangerous for human life.

Causes

As a rule, chronic purulent otitis media occurs against the background of an acute inflammation of the ear cavity or as a result of a rupture of the eardrum. Often the disease occurs in childhood. This is due to physiological characteristics, as well as the rapidity of the spread of infection and the inability to make a diagnosis in time.

The causative agents of infection are usually microorganisms such as Pseudomonas, Staph, Proteus, Escherichia coli, Klebsiella pneumoniae. With a prolonged course of a purulent inflammatory process, as well as after taking antibiotics, fungal bacteria Candida, Aspergillus, Mucor are often found in the ear cavity during sowing.

Otolaryngologists also name such causes of purulent otitis media:

• eustachitis;
• aerootitis;
• adenoiditis;
• chronic sinusitis.

These ENT diseases lead to dysfunction of the auditory tube, which entails the development of chronic purulent otitis media. Particularly susceptible to the disease are people with immunodeficiency diseases and conditions - HIV infection, diabetes mellitus, hypothyroidism, obesity.

Types of disease

Purulent chronic otitis media can have two forms - mesotympanitis and epitympanitis. Mesotympanitis, or tubotympanic chronic suppurative otitis media occurs in 55% of cases. In the inflammatory process, the mucous membrane of the tympanic cavity is damaged, while the bone formations are not amenable to pathological changes. In the case of the development of epitympanitis, both the mucous membrane and bone formations suffer, such a purulent process occurs in 45% of patients. The second form of the disease is more dangerous, as it causes destructive changes in the bone tissue, which usually inevitably leads to such a complication as ear cholesteatoma.

Signs and symptoms

Purulent chronic otitis is accompanied by such a symptomatic triad:

• suppuration from the ear cavity;
• hearing loss;
• perforation of the tympanic membrane.

You can also recognize the disease by such additional symptoms as tinnitus and their congestion, pain, dizziness. Suppuration may not always be observed, it is periodic or permanent. Usually the amount of discharge increases during the period of exacerbation of the disease. If granulation tissue grows in the ear cavity or there are polyps, then the discharge may be a mixture of pus and blood.

In the pathological process, the mobility of the auditory ossicles is disturbed, therefore, hearing loss develops. The pain syndrome is rarely pronounced, the pain rather delivers just unpleasant sensations, it intensifies during the period of exacerbation of chronic otitis media. Exacerbation of inflammation can occur against the background of the flow in the body of diseases such as:

• SARS;
• pharyngitis;
• rhinitis;
• laryngitis;
• angina.

Fluid entering the ear can also cause an exacerbation phase. The course of mesotympanitis in most cases is calm, the discharge is not abundant, it can appear only during the period of exacerbation of the disease.

During the period of exacerbation, the temperature rises and there may be a sensation of pulsation in the ear. Epitympanitis is characterized by a more severe course than mesotempanitis; during the inflammatory process, chemicals are formed in the tympanic cavity - skatol, indole and others, which give the purulent contents a fetid odor.

Epitympanitis often causes purulent complications, including mastoiditis, labyrinthitis, meningitis, brain abscess, aranchoiditis.

Diagnosis of the inflammatory process

Treatment of chronic suppurative otitis media depends on accurate diagnosis. Diagnostic measures include the following actions of an otolaryngologist:

• general examination of the ear cavity;
• use of endoscopy or otomicroscopy methods;
• tympanometry;
• audiological examination;
• a thorough study of the microflora and its sensitivity to certain groups of antibiotics;
• fistula samples;
• computed tomography of the temporal bones.

To find out about the presence or absence of perforation in the tympanic cavity, specialists perform otoscopy and microotoscopy. These two diagnostic procedures are carried out after washing the outer ear and cleaning the ear canal.

Treatment of the disease

Purulent otitis media of a chronic form, if it does not affect bone formations and does not cause other complications, can be effectively cured with medications. But in any case, even if the disease is characterized by a calm course, therapy for purulent otitis should be carried out under the supervision of an otolaryngologist.

If purulent otitis occurs with bone destruction, drug therapy is the preoperative preparation of the patient. In cases where the pathological process is accompanied by headache, paresis of the facial nerve, neurological and vestibular disorders, it means that the disease has caused serious complications. They will also require treatment, so the patient is immediately hospitalized and the otolaryngologist is considering a surgical operation aimed at restoring the functionality of the hearing organ.

Suppurative otitis media without any complications can usually be cured within 7-10 days. During this period, the affected ear is washed daily with antibacterial solutions, the pathogenic secret is removed and drops based on antibiotics are instilled. The following drops are used in the treatment:

• ciprofloxacin;
• norfloxacin;
• rifampicin;
• their combination with glucocorticosteroids.

When bone destruction has disrupted the functioning of the organ of hearing, a surgical operation becomes inevitable. An otolaryngologist, depending on the degree of damage to the bone tissue, performs such types of operations - mastoidoplasty, tympanoplasty, aticoanthrotomy, mastoidotomy, labyrinthotomy, labyrinth fistula plastic surgery.

Treatment of otitis media with traditional medicine will not bring positive results, but can only cause a number of serious complications, so it is important to abandon self-medication.

Preventive actions

To prevent the development of a purulent inflammatory process of the middle ear, it is important to exclude the factors that cause it. In infants, the disease often develops from the wrong way of feeding: the child should be kept near the chest not in a horizontal, but in a vertical or semi-vertical position. In addition, according to otolaryngol, children who often suffer from infectious diseases are susceptible to the development of otitis media in childhood. To prevent the development of otitis, all diseases should be treated in a timely manner.

When the first signs of otitis media are detected in children or adults, it is important to visit a specialist's office as soon as possible.

Otitis media in a child: symptoms, causes and treatment

Otitis media in a child occurs much more often than in adults. The reasons for this imbalance are obvious - they are associated with the immune system of babies that is not yet strong enough, which is not yet able to actively resist the development of inflammation. External manifestations of the disease, depending on the type of otitis media, differ, and therapeutic approaches should also be different.

What are otitis media in children and why do they occur

Otitis is an inflammation of the ear. What are otitis media in children and what are their differences? There are external otitis media and otitis media - depending on which part of the organ of hearing is inflamed. The course of the disease, which is very common at a young age, can be acute or chronic. The inflammatory process may or may not be accompanied by suppuration. With this inflammation, there is a hearing impairment (mild or medium degree). The danger of all types of otitis in children is in their complications. Complications of purulent otitis media are especially dangerous. With this in mind, the mother should be attentive to the complaints of the child. If the baby complained about the ear, the mother should immediately call pediatrician. He, having examined the child, will give the necessary recommendations and, if he deems it necessary, appoint a consultation with a pediatric ENT doctor.

Otitis externa can be a furuncle of the external auditory canal, but it can be otitis externa and diffuse. A boil develops as a result of infection in the hair follicle or in sebaceous gland that is located near this bag. Why does otitis externa occur in young children? The reason for the infection is usually a minor injury to the skin (the mother is not careful when cleaning the baby's ear, or the child puts some hard object with sharp edges into his ear).

Acute otitis media often develops as a complication of acute rhinitis. Staphylococci, streptococci, pneumococci, etc. can act as pathogens. The cause of otitis media in children is adenoid growths that cover the mouths of the Eustachian tubes and thereby create conditions for stagnation of air in the “tympanic cavity - Eustachian tube” system. In turn, a complication of acute otitis media, as well as a complication of tubo-otitis is

The causative agents of acute suppurative otitis media are the same as in acute otitis media. If, for some reason, timely and sufficient treatment of acute purulent otitis media is not carried out, if the sick child is malnourished, if the resistance of his body is reduced due to some prolonged illness, then the acute purulent process in the ear can turn into a chronic one, and then we can already say about the presence of chronic suppurative otitis media in a child. Among the causes of this otitis media in children, pathogens such as streptococci, staphylococci and E. coli should be mentioned. If a Pseudomonas aeruginosa appears in the ear, otitis media is very difficult.

What are the symptoms of otitis externa and otitis media in a child

What are the symptoms of otitis in a child depending on the type of inflammation?

With otitis externa, the child complains of pain in the ear. The pain is growing, and when you press the tragus auricle- is getting stronger. Body temperature rises, parotid and cervical The lymph nodes, tissues in the external auditory canal swell strongly - sometimes this passage is completely closed. After opening the boil, pus pours out of the ear. Recovery follows soon after.

Acute otitis media begins some time after the onset of a runny nose. Yet again hallmark otitis media in a child is ear pain. Sometimes a child complains of pain in both ears. If you press on the tragus of the auricle, the pain becomes stronger. Body temperature rises, appetite and sleep suffer. There is noise in the ear, hearing is impaired. JIOP doctor, when examining a diseased ear, sees redness of the eardrum. Also, with otitis media of the ear in a child, the symptoms are changes in the blood test: leukocytosis, increased ESR.

Signs of purulent and chronic otitis in a child

Acute purulent otitis occurs with the same symptoms, but signs of intoxication of the body are added to them: increased fatigue, general weakness, pallor of the skin and mucous membranes. Elevated body temperature - up to 40 ° C - lasts for several days. The pain in the ear becomes stronger and seems to pulsate. At some point, there is a breakthrough of pus that has accumulated in the tympanic cavity through the tympanic membrane outward; and the amount of pus can be significant. With a breakthrough of pus, an admixture of blood is usually found in it. After the pus is poured out, the pain quickly subsides. There is a hearing loss.

Chronic purulent otitis is characterized by suppuration that lasts a long time. The suppuration can be constant or periodically opening. The substance discharged from the ear may be mucous or mucopurulent in nature; rarely - purulent discharge. If a Pseudomonas aeruginosa appears in the ear, or if pus stagnates in the tympanic cavity, a putrid odor may appear from the ear. A symptom of this otitis media in a child is constant noise in the affected ear. When examining (using special instruments) the tympanic membrane, the doctor sees a hole in it. Chronic suppurative otitis can be complicated by mastoiditis, meningitis; local complications - proliferation of granulations, the appearance of polyps; cholesteatoma is a rare complication.

How to treat otitis media in a child

Before treating otitis in a child, the baby must be shown to a specialist. The patient is examined by an ENT doctor and prescribes the necessary therapy. In the treatment of otitis media in a child, good nutrition is very important. In the child's diet, there should be more foods that are sources of vitamins A, C, group B, etc. for the body.

With external otitis, the diseased ear is warmed up several times a day, warming compresses are made (around the ear). Every day, turundas are placed in the external auditory canal with a remedy prescribed by a doctor. Effective physiotherapy.

In acute otitis media, treatment is also local and general. How to treat otitis media in a child if it occurs in the middle ear? In this case, heating is prescribed several times a day; warming compresses with vegetable or camphor oil, vodka, semi-alcohol compresses are made around the ear.

With severe pain in the ear, analgesic drops are prescribed. The effectiveness of treatment increases with the connection of physiotherapy. At the same time, the nose is treated - with the aim of speedy recovery functions of the Eustachian tube.

And how to treat otitis media in a child if the disease is an acute purulent inflammation? In this case, the doctor makes a paracentesis - a small incision in the eardrum. Through this incision, pus is poured out, and the baby's condition improves. The doctor observes the child every day, performs an ear toilet, puts turundas with medicines in the external auditory meatus. They warm the sick ear, put warm compresses, and do physiotherapy. With symptoms of purulent otitis in children, treatment is also prescribed for the nose with the nasopharynx.

In chronic suppurative otitis, the doctor also makes a daily ear toilet; locally used anti-inflammatory drugs; antibiotics are administered parenterally; physiotherapy is given. In cases where conservative therapy is ineffective, when there may be complications of otitis media, surgical treatment is indicated. If it is possible to achieve a long period without suppuration, an operation is performed to restore the integrity of the eardrum. This operation is called "myringoplasty".

Treatment of otitis media in children at home: first aid for a child

The kid suddenly complained that his ear hurts. Timely competent actions of the mother will help in this case to alleviate the condition of the child and prevent the development of dangerous complications. Before starting the treatment of otitis in children at home, first, of course, you need to call the local pediatrician at home.

After that, the mother should:

• measure the child's body temperature; if the body temperature is increased significantly, the child is recommended to give something from antipyretics: paracetamol in the form of syrup, acetylsalicylic acid(aspirin) in an age dose, for a small child - put a cefecon candle; if a mother gives a sick child acetylsalicylic acid, then it is certainly in milk;
• if the pain is severe, and the child cannot endure it, providing first aid for otitis media in a child, you need to give some pain medication for oral administration - for example, analgin in an age dose; an analgesic is also injected into the ear - you can drip novocaine, otinum into the ear if they are in the home first aid kit; if there is no novocaine or otinum at hand, you can drip a few drops of warm vodka into the external auditory meatus; rather quickly, the pain in the ear weakens after the introduction of a few drops of warm vegetable oil into it; for this purpose, you can use any vegetable oil - olive, corn, sunflower, soybean, etc. (upon recovery of the child, the ear must be washed to remove oil residues from the external auditory canal); after the mother has dripped one of these remedies into the baby's ear, he should take about 15 minutes. lie down - while the sore ear should be turned to the ceiling; after instillation, the external auditory canal is always plugged with a cotton swab;
• when treating otitis in a child at home, you need to warm up the sore ear; the warming procedure, despite its simplicity, is very effective; its effectiveness is due to the fact that heat always has a mild analgesic effect; in addition, heat causes local expansion of blood vessels and, consequently, a rush of blood to the inflamed ear, and in conditions of abundant blood supply, the focus of inflammation resolves much faster; sometimes it is enough to warm up the ear once at the very beginning of the disease - and the process of inflammation begins to "lose ground"; the child needs to warm up the ear 3-4 times a day; each time the warm-up procedure should take 12-15 minutes; it is recommended to use a regular heating pad (the child should lie on the heating pad with a sore ear); it is important to remember that when the body temperature rises, warming up cannot be done;
• also very effective is such help with otitis media in a child at home, like warm compresses; with inflammation, a compress is made around the ear; most often for compresses use such means as sunflower oil, camphor oil, vodka, alcohol, half diluted with water; do warming compresses 2 times a day: 1 time during the day for 1.5-2 hours and all night; if the child has an elevated body temperature, compresses should never be done, otherwise the body temperature will still rise;
• cover the child's sore ear with dry cotton; until the doctor says that recovery has come, the baby's ear should be constantly closed; cotton wool is fixed on the ear with a handkerchief or cap.

Folk remedies for the treatment of otitis media in children

Be sure to warn that the methods and means recommended folk medicine, are used as an adjunct to the main treatment that the JIOP doctor will prescribe to the child.

The following are the best folk remedies for treating otitis media in children at home:

• alternating with other means, instill a warm infusion of chamomile flowers into the sore ear; preparation of infusion: place 1 teaspoon of dried flowers in a preheated bowl, pour a glass of boiling water and insist under the lid for about 15 minutes, strain;
• at folk treatment otitis media in children, gauze turundas (wicks) soaked in warm oil should be placed twice a day in the external auditory canal walnut, for 2-3 hours;
• propolis oil can be used as an effective anti-inflammatory and analgesic; put with him 2 times a day for 2-3 hours in a sore ear gauze turundas;
• eat more grapes; preferably - sweet varieties; grapes for the body are an excellent source of energy, which is very necessary to fight the disease;
• cleansing the external auditory canal from pus, moisten a cotton swab with fresh wild garlic juice (bear onion);
• an effective folk remedy for otitis media in children is fresh onion juice mixed in equal amounts and linseed oil; having moistened gauze turunda with this mixture, it is necessary to put the latter in the external auditory meatus for 1.5-2 hours; alternate with other means.

Otitis - medium, acute, purulent, in children, symptoms and treatment

Otitis is an inflammation of the middle ear, which is the most common disease of the ENT organs. At the heart of otitis media is inflammatory processes in the mucous membrane that occur in the middle ear. In general, the outer ear consists of such parts as the auricle, the external auditory meatus and the tympanic membrane, which separates the outer ear from the middle ear. The middle ear is a tiny cavity that houses the bony mechanism that transmits sound waves to the inner ear canal.

And the middle ear also transforms the incoming sound waves into special nerve impulses that enter the brain. Otitis is external, that is, when there is inflammation of the auricle or inflammation of the ear canal. There is also otitis media, that is, inflammation of the middle ear occurs. Usually, otitis media occurs after complications of infectious diseases, such as influenza, tonsillitis, and others.

Acute otitis media

Acute otitis media is common disease organism, where the local manifestation is inflammatory and infectious processes, covering all three anatomical air-bearing components of the middle ear, this is the tympanic cavity, the auditory tube and the mastoid process. According to statistics, otitis media occurs in 25-30% of people who have ear diseases and this indicates that acute otitis media is a widespread disease. In the first place in terms of the incidence of acute otitis media are children under 5 years of age, and the second place is occupied by the elderly, and in third place are adolescents under 14 years of age. Acute otitis media does not have a specific pathogen, and also cannot be caused by pathogenic microorganisms of various types, which include viruses, microbes and fungal flora, or their associations.

The trigger mechanism for the development of acute otitis media is acute respiratory viral infections or influenza. In addition, general suggestive factors and risk factors that favor the onset and further development of acute otitis play a great role in the development of the disease.

Symptoms of otitis media

It is worth noting that the mildest form of otitis media is otitis externa, but in addition to it, there is otitis media and otitis media. Regarding the symptoms of otitis media, it is usually aching pain with periodic

character, as well as possible swelling of the auricle and the temperature of the human body rises. The causes of otitis externa can also be mechanical damage to the tissue of the outer ear, that is, microtrauma due to improper cleaning or trauma to the auricle. Inflammation of the mucous membrane in the middle ear is called otitis media. The danger of this type of otitis is that it leads to very serious consequences. For example, total or partial hearing loss may occur, and inflammation may further spread, even to the lining of the brain.

In addition, otitis media is usually accompanied by severe pain in the ear, hearing loss, a feeling of stuffiness in the ear and the noise of overflowing water, and in severe forms, otitis media is accompanied by discharge from the ear canal and an increase in body temperature, which can be more than 38 degrees. And if incorrect and untimely treatment of otitis media is not carried out, then in the future this can lead to the development of internal otitis media.

Symptoms of internal otitis are very similar to those of otitis media, however, in this case, there is a high risk of complications, so hospitalization is necessary and may even be required. surgical treatment otitis media in the hospital. In addition, otitis media, like many other diseases, can occur in chronic and acute form.

If this is an acute form of otitis media, then severe pain arises very quickly, which grows even more every hour or even minutes. If this is a chronic form of otitis, then it proceeds more slowly, and its symptoms are less pronounced, like other forms, but this does not eliminate the danger after the onset of this disease.

Acute otitis media

As for acute otitis, it proceeds in stages. For example, inflammation of the mucous membrane of the middle ear first appears, then suppuration appears and perforation of the tympanic membrane occurs. In general, acute otitis media can proceed quite easily if there is no noticeable general reaction of the body. In some cases, this form of otitis media can take a severe course, which has sharp reactive phenomena on the part of the body. The causes of acute otitis media are infections that have entered the tympanic cavity. This can happen due to a sharp weakening or hypothermia of the body.

Even acute otitis media can occur a second time, and be the result of a complication of infections and as a result of damage to the upper respiratory tract or after the flu. In childhood, the disease can occur after suffering scarlet fever, diphtheria, measles and other childhood infectious diseases. Another acute inflammation of the middle ear can occur after chronic or acute inflammation of the nose and throat. Depending on the severity of the course of the disease, there are general and local symptoms of otitis media. For example, with the usual course of acute otitis media, recovery and complete recovery often occur. auditory functions. If there are unfavorable conditions for treatment, then the course of the disease may acquire a protracted sluggish character, or it will turn into a chronic form.

In a typical course of acute purulent otitis media, three periods of development are distinguished. For example, in the first period there is the emergence and development of inflammatory processes in the middle ear. In this case, the pain in the ear is very strong and gradually increasing, and in more severe cases it becomes simply unbearable and painful, which can make you restless. Most often, the pain is felt deep in the ear, and by its nature it can be throbbing, tearing, aching or shooting. Quite often, in acute otitis media, the pain can radiate to the teeth, the back of the head, to the temple or spread throughout the head, and also intensifies when blowing your nose, sneezing, swallowing, coughing, as in this case the pressure in the tympanic cavity increases greatly.

At the next stage in the development of otitis media, perforation of the eardrum occurs and the result of inflammation is suppuration. Then, after suppuration, the temperature usually decreases, but this painful process can last 4-7 days. With inflammation, suppuration is first observed abundant, and then significantly decreases and the pus acquires a thick consistency. If acute otitis media is observed in the ear, then the pus in this case has no smell. If in this case there is no external otitis media.

As for the third period of acute otitis media, then there is a gradual cessation of inflammatory processes, then suppuration disappears, the work of the middle ear normalizes and the perforation of the tympanic membrane overgrows. And the duration of each of these periods can vary from a few days to two weeks.

Acute catarrhal otitis

This form of otitis is accompanied by inflammation of the cavities of the middle ear, which is caused by streptococci, staphylococci and other pathogens. Provoke acute catarrhal otitis media can be reduced body resistance, diabetes mellitus, hypothermia, beriberi, kidney disease, rickets, various infectious diseases, and so on. Most often, bacteria enter the middle ear from the nasal cavity, through the auditory tube, and this occurs with exacerbated inflammation of the mucous membrane during acute rhinitis, acute respiratory infections, influenza, or acute otitis media.

Factors that accelerate the spread of infection are coughing, adenoid growths, sneezing or improper blowing of the nose, because it is necessary to clear each nostril in turn. Symptoms of catarrhal otitis are noise in the ear, pain, feeling of congestion and hearing loss. And usually the pain in this case is of an increasing nature, it can also radiate to the teeth, be felt deep in the ear, or radiate to the parietal-temporal or occipital region. In addition, discomfort can be observed when coughing, sneezing and swallowing, which very often deprives the patient of appetite and sleep. And if an illness occurs against the background of a general infectious disease, the temperature can rise sharply.

When examining a patient, the doctor discovers the redness of the eardrum, and touching it is very painful. Regarding treatment, catarrhal otitis media requires bed rest, and complications require hospitalization. To eliminate pain, you will need to instill carbolic glycerin and alcohol at 70% into the hearing aid, 5-6 drops in each ear. Next, a cotton wick is inserted into each ear overnight. Additionally, physiotherapy, heating pads and vodka compresses are used. And vasoconstrictor and bactericidal drops are instilled into the nose. If the temperature is high, the doctor prescribes antipyretic drugs.

Acute exudative otitis

This form of otitis is an inflammation of the middle ear with the formation of transudate and its long-term preservation in the tympanic cavity. According to its prevalence, acute exudative otitis media in children is more common than in adults. And acute exudative otitis is diagnosed in 60% of children aged 3-7 years and in 10% of children aged 12-15 years. The causes of exudative acute otitis media are quite diverse and can be divided into local and general. For example, common causes include allergies, decreased general immune reactivity, environmental factors, specific diseases that reduce immunity, and frequent infections.

If these are local causes of exudative otitis, then this may be a violation of the ventilation function of the auditory tube, as a result of hypertrophy of the pharyngeal tonsil, as well as a sluggish inflammatory-allergic process in the pharyngeal tonsil. In children, the clinical symptoms of this disease are not very pronounced. Quite often, the main symptom of the disease is hearing loss or severe noise in the ear. But since children aged 2-5 years usually do not complain about hearing loss, exudative otitis in this case is most common and gives complications. And if a child with this form of otitis media is not treated, then after 3-4 years he may develop persistent and irreversible hearing loss, which is caused by a cicatricial adhesive process in the middle ear, the formation of pockets in the tympanic membrane, atrophy of the tympanic membrane or its perforation. In addition, the sound-perceiving apparatus may be partially damaged.

Acute suppurative otitis media

This form of otitis is a purulent acute inflammation of the mucous membrane on the eardrum. With this form of the disease, all parts of the middle ear are also involved in catal inflammation. Acute suppurative otitis is a widespread disease of the middle ear, which very often occurs in a mild form, and then can develop rapidly and cause a severe inflammatory reaction of the body. But in both cases, quite often, acute purulent otitis media leaves an adhesive process in the future, which is accompanied by hard-to-treat hearing loss, and can also turn into a chronic and often progressive form, which leads to hearing loss and other serious complications.

The most common acute purulent otitis media occurs in children under 3 years of age. And its distinctive feature is an acute onset and a rather sluggish course, but in childhood the tendency to recurrence of the disease increases. The main factors that provoke this disease are a combination of a decrease in general and local resistance, as well as infection in the tympanic cavity. Quite often, microflora enters through the auditory tube directly into the tympanic cavity, which saprophytes in the pharynx. But this cannot cause inflammation if the general and local reactivity is normal. And if the intake of microflora was massive or the microflora was highly virulent, then in this case acute otitis media occurs.

The main causative agents of acute otitis in children and adults are the main infections or associations of microorganisms. Most often, viral otitis occurs during epidemics of viral diseases.

The most common route for infection is through the auditory tube. And since there is no flora with microbes in the cavity of the middle ear, the barrier function of the mucous membrane in the auditory tube comes into play. As a result, mucus is produced here, which has an antimicrobial effect. Villi ciliated epithelium auditory tube move the mucous secret to the nasopharynx. Therefore, for different general infectious diseases, with local acute exacerbations, as well as with inflammatory, chronic diseases of the upper respiratory tract, the function of protecting the epithelium in the auditory tube is impaired. As a result, the microflora immediately penetrates into the tympanic cavity.

In some rare cases, the infection can enter the middle ear through a damaged eardrum in an injury or through a wound in the mastoid process. In this case, traumatic otitis media occurs. The rarest way for infections to enter the middle ear is the hematogenous method. And it is possible in the presence in the body of such infectious diseases as measles, influenza, scarlet fever, tuberculosis and others. In extremely rare cases, acute purulent otitis media can develop as a result of retrograde spread of infection directly from the cranial cavity or from the labyrinth.

Acute otitis in children

Usually, acute otitis in children begins with a sharp pain in the ear and high fever. And most often it starts after suffering the flu or a cold. The most important thing to do in this situation is to put a warm vodka compress behind the auricle and it is best to do it with camphor alcohol, which must be diluted half with water. Most often, the compress reduces pain and the child calms down, but you do not need to stop there. Since the child should immediately be shown to the doctor immediately. It is worth noting that otitis media is terrible for its complications that can occur if the child is not treated in time. In addition, otitis media can become chronic or may lead to partial hearing loss.

The structure of the organ of hearing predisposes to the occurrence of complications of otitis media. Indeed, in children, the hearing aid is more tortuous than in adults, and at the end of the passage is the eardrum, which is a barrier that covers the middle ear. And behind this very thin film is the tympanic cavity, which has an instrument of sound conduction - these are the auditory ossicles, nerves, muscles and blood vessels. The tympanic cavity consists of the auditory tube, which connects it to the nasopharynx, which should be the main focus. Indeed, with various respiratory or other infections that are most common in children, an inflammatory process begins, which most often affects the nasopharynx. Therefore, through the auditory tube, which in children is shorter and wider than in adults, microbes immediately enter the tympanic cavity.

Acute otitis media

This disease is a manifestation of inflammation in the tissues of the tympanic cavity, mastoid process and auditory tube. Most often, acute otitis media occurs in childhood, but it can affect people of any age. The inflammatory process in the middle ear can be caused by various microorganisms, these are streptococci, staphylococci, fungi and viruses. Most often, microorganisms enter the middle ear directly through the auditory tube, and this is usually facilitated by processes in the nose, nasopharynx, paranasal sinuses, or in the presence of adenoids in children. A more rare way for infections to enter the middle ear is through the external auditory canal during injuries to the eardrum. The occurrence of acute otitis media can also occur with infectious diseases such as scarlet fever, influenza or measles, and there is another way for infection to enter - this is through the blood.

In addition, a decrease in the body's resistance to various infectious diseases, kidney diseases, diabetes and hypothermia can contribute to the development of inflammatory processes in the middle ear. In the course of the disease, acute otitis media is purulent and catarrhal. And during acute otitis media there are three stages. The first stage is acute catarrhal otitis, that is, the onset and development of inflammatory processes in the middle ear and a further increase in the symptoms of the disease, which are associated with the accumulation of exudate, are fluids in the middle ear.

The second stage is purulent otitis media, that is, the formation and accumulation of pus in the middle ear cavity, which leads to rupture of the eardrum and suppuration. The third stage in the development of acute otitis media is the subsidence of the inflammatory process, which significantly decreases and suppuration gradually stops, and then the edges of the tympanic membrane fuse.

Acute otitis externa

This form of otitis media is an inflammation of the skin of the cartilaginous part of the auditory canal. Symptoms of acute otitis externa are pain in the ear, pain when chewing, when pressing on the tragus, pain when pulling the auricle. Naturally, with this disease, there may be swelling near the auricle on both sides or on one of them. Still possible pain when pressing the mastoid process, and the pain itself intensifies towards the ear folds. It is also observed in acute otitis externa narrowing of the external auditory canal with varying degrees of severity. In addition, lymphadenitis of the anterior lymph nodes is possible.

When the eardrum is not inflamed, hearing may not be affected. And when differential diagnosis detachment of cholesteatoma skin on the back wall of the external auditory canal may occur. For the treatment of acute otitis externa, turundas with Burov's liquid or boric alcohol are introduced into the external auditory canal, and UHF therapy is also prescribed for the treatment of the ear area. And with severe pain and high temperature the body is prescribed antibiotics - this is oletethrin, doxycycline, vibramycin or erythromycin for 6-7 days. Similar treatment is carried out with purulent discharge.

If the disease is prolonged. Then the doctor prescribes intramuscular injections of antibiotics, prescribes autohemotherapy and locally prescribes staphylococcal toxoid. If recurrent furunculosis has developed, then in this case autohemotherapy will be required, a blood test for sugar is performed to rule out diabetes, and vitamin therapy is necessary.

Acute bilateral otitis media

Acute bilateral otitis media is inflammation in the tissues of the eardrum or auditory tube. In addition, the inflammatory process can affect the surrounding tissues. Most often, acute otitis media does not lead to hearing loss, but there are exceptions if it is purulent otitis media, in which the tissues of the middle ear are destroyed. Acute bilateral otitis media develops in five stages. The very first stage is characterized by stuffy ears, tinnitus, and fever may be absent. In the second stage, acute catarrh in the middle ear is possible, which is characterized by symptoms of the first stage. There may be shooting pain in the ear, fever and inflammation of the mucous membranes. The next stage of the disease is the preperforative stage, which is characterized by unbearable pain, passing into the neck, eyes, teeth and throat. Body temperature at this stage can rise to a risky level.

At the next post-perforative stage of acute bilateral otitis media, the pain subsides, but suppuration from the ears begins. The last stage is the reparative stage, that is, the relief of inflammation and the beginning of recovery. The most important danger during suppuration is the threat that pus will enter the cranial cavity and cause the development of a brain abscess or meningitis. In addition, you need to remember about the obligatory visit to the doctor at the very first manifestations of ear pain or if the ears are blocked. And if these symptoms do not go away in two to three weeks, then there is a danger of the disease.

If treatment is carried out only with non-traditional means, then this can cause complications, since such methods are used only under the supervision of a doctor. Moreover, therapy must be carried out, taking into account all aspects of the disease, for example, taking into account how pronounced the inflammatory reaction is, taking into account all complications and other concomitant diseases. In addition, it is very important to take into account the general condition of the patient, as well as his individual characteristics. And depending on the nature and form of the middle ear lesion, a treatment method is chosen, which can be surgical or conservative. According to statistics, acute bilateral otitis media can have manifestations in 80% of children under 3 years of age. Quite often, otitis media develops after hypothermia or after a cold. And in order to prevent it, it is necessary to treat the mucous membrane of the throat and nose in a timely manner.

Regarding the treatment of otitis media, it is worth noting that this is very serious illness which must be treated. Therefore, at the first symptoms, you should immediately contact an otolaryngologist. After all, only a doctor can correctly establish the form of otitis media and, on the basis of this, prescribe the right treatment. And even if a person is an adherent of treatment folk methods, then without medicines treatment of otitis media is impossible. Otitis is usually treated for about 10 days, but in more severe forms, treatment may be delayed. In any case, a timely visit to the doctor is necessary.

It is worth noting that the treatment of otitis media is complex, and for a start, the patient must be provided with complete rest so as not to provoke the occurrence of complications. Then it is necessary to prescribe specialized antibiotics in order to carry out an operational fight against the causative agent of otitis media. Antibiotics can be in tablets, these are Solutab, Flemoklav, Tsifran or antibiotics in drops, these are Otipax and Sofradex, but they must be at room temperature before instillation. However, only a doctor should prescribe antibiotics.

It happens, it happens that otitis media takes a person by surprise, for example, on a day off. And in this case it is necessary not to start the situation. That is why, with the appearance of pain in the ear, with lumbago or twitching, it is necessary to buy Sofradex drops for adults, and Otipax drops will help for children. In this case, be sure to follow the dosage indicated in the instructions, and then instill in each ear. If it came very severe pain In this case, you can take a pain reliever. However, if the ear has already stopped hurting, then you still need to see a doctor. Since there is a high probability of complications.

For otitis externa, treatment should consist of warming, washing the ear canal and using warm compresses. If an abscess has already formed, then it becomes necessary to open it. With otitis media, antibiotics and antipyretics are prescribed. When suppuration has already begun, the doctor in the hospital makes an incision in the eardrum so that the pus flows out of the ear as quickly as possible. You will also need to mix 70% alcohol and glycerin in equal parts, and in this solution you should soak the turunda from cotton wool, and then insert it into your ear. Then you need to put a cotton ball moistened with ordinary baby cream, and after 2 hours remove it. After a few procedures, the swelling will disappear.

To eliminate ear pain, you need to take painkillers. For example, Coldrex is prescribed for adults, and Nurofen is prescribed for children, as a result, relief will come literally immediately. But it is very important to know that any warming compresses should not be used at high temperatures. And also take the treatment of otitis very seriously.

Prevention of otitis media

To prevent any inflammation, those means are needed that help strengthen the body, for example, the correct mode of work, nutrition and rest, systematic sports and physical education, and hardening. In addition, those people who suffer from chronic otitis should be well treated and take all necessary precautions. For example, while bathing or washing your hair, you need to protect your ears from dirty water, usually ear plugs or cotton swabs are used for this, which should be moistened with vegetable oil. When pus comes out of the ear, then, as directed by the doctor, you need to clean the ears from the accumulation of pus, as well as apply the procedures and medicines prescribed by the doctor.

Those people who are predisposed to diseases of the throat or nose should definitely consult a doctor regarding their treatment and prevention of the disease. In addition, it is necessary to systematically treat the tonsils, and in advanced cases they must be removed. In addition, it is imperative to treat a runny nose, and especially if it is a chronic form. In addition, each person should carefully blow their nose, because with increased blowing of the nose through the Eustachian tube, mucus with microbes can enter the tympanic cavity, which will cause inflammation in it, that is, otitis media.

You should know that during exacerbations of otitis media it is undesirable to perform any strenuous physical work, and also you can not leave the house with wind and extreme cold, and it is advisable to avoid talking. Even with exacerbations, the ear is covered with a warm bandage. If the patient has severe pain in the ear area, then painkillers can be used, which are prescribed only by a doctor. In general, in most cases, preventive measures do not allow inflammation in the ear to those people who are at risk.

Chronic otitis - medium, purulent, treatment of chronic otitis media

Chronic otitis media

Chronic otitis media is characterized by profuse discharge from the nose and ear canal, which periodically resume. In most patients, chronic otitis media begins in childhood. The main reason for the transition of acute otitis into a chronic form is a violation in the tympanic cavity due to increased pathogenicity of pathogens, as well as due to the lack of resistance. immune system. The most important reason why chronic otitis media develops is the lack of timely treatment and unreasonable therapy.

With a variety of clinical course and symptoms of this disease, chronic otitis is divided into benign and malignant. For example, in a benign form, the inflammatory process develops in the mucous membrane of the tympanic cavity, therefore it does not penetrate beyond its limits, that is, beyond the bone walls. Such otitis can develop over the years and does not give serious complications, since it is relatively local and limited. If it is malignant otitis, then the inflammatory process covers the bone walls, as a result, caries develops on them, bone destruction, and granulation growth occurs. Such inflammatory processes can reach the meninges and lead to fatal intracranial complications. In most cases, otitis has a benign course, so they capture only the mucous membrane of the tympanic cavity.

Purulent chronic otitis is characterized by periodic or constant suppuration, hearing loss and swelling of the eardrum. There are two main forms of purulent otitis media, these are mesotympanitis and epitympanitis. For example, mesotympanitis is characterized by damage to the mucous membrane of the middle section in the tympanic cavity with the release of odorless pus from the ear. Sometimes with this form, polyps and granulations are present. And epitympanitis is characterized by damage to the mucous membrane and bone with the spread of inflammation to the mastoid process. Quite often, with this disease, cholesteatoma develops, which is formed as a result of ingrowth of the epidermis of the auditory tract or tympanic membrane directly into the middle ear. The cells of the epidermis are desquamated and a tumor-like formation is formed, which gradually destroys the surrounding tissues, and this contributes to the development of various complications. That is why epitympanitis is characterized by the release of pus with a pungent odor.

Treatment of purulent chronic otitis media is aimed at eliminating all pathological changes in the nasopharynx, in the nose and in its paranasal sinuses. With mesotympanitis, conservative treatment is carried out, that is, systematic cleaning of the ear, instillation with a 3% solution of boric alcohol, as well as injection of sulfonamides and a very fine powder of boric acid. The main conservative method for the treatment of epitympanitis is washing with an alcohol solution, which is done only by a doctor. If there is no effect after conservative treatment or complications occur, then radical ear surgery is performed.

Treatment of chronic otitis media

At the very first suspicion of an ear disease, you should immediately consult a doctor or call him at home, if this Small child to inspect and consult on complaints. After all, with a timely start and with proper treatment you can save the child from suffering and prevent unpleasant consequences. For example, in acute otitis media, only conservative treatment is usually sufficient. Necessarily, therapy should include a course of taking antibiotics in the form of injections or in tablet form, which is at least 5-7 days, and careful treatment is especially important for children under 2 years of age. This treatment is necessary to prevent possible complications. In addition, it is necessary to regularly apply those medications, which constrict blood vessels and maintain the patency of the auditory tube.

It is worth noting that local treatment is used to treat chronic otitis media. For example, with otitis media, thermal procedures are most effective, since heat can activate lymph circulation and blood circulation in the very focus of inflammation and contributes to the additional production of protective blood cells. For example, for treatment, heating with a blue lamp is carried out, half-alcohol or vodka compresses are used, and turundas with ear drops are also inserted.

In the treatment of acute otitis media in a chronic form, it is necessary to constantly remove pus with cotton swabs, rinse the ear canal with disinfectant solutions, these are chlorhexidine, miramistin, and special antiseptics are also instilled into the ear, these are tsipromed, otofa and normax. In addition, in addition, the doctor may prescribe thermal physiotherapy, these are UV, UHF therapy, laser radiation or mud therapy. If catarrhal otitis media is treated, then it takes about a week, and the treatment of purulent otitis media will take more than two weeks. Therefore, before starting treatment, the doctor identifies a type of otitis media and only then prescribes the correct and necessary treatment.