Exudative otitis media. Acute suppurative otitis media. II stage of purulent inflammation

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Otitis externa, unspecified (H60.9)

general information

Short description

Otitis externa includes all inflammatory conditions of the ear, external auditory canal, or outer surface of the tympanic membrane. Otitis externa can be localized or diffuse, acute or chronic.

Localized otitis externa (furuncle)- inflammation of the hair follicle of the external auditory canal, the causative agent is most often Staphylococcus aureus. The cause of diffuse external otitis in most cases is Pseudomonas aeruginosa or Staphylococcus aureus, as well as a fungal infection, contact dermatitis, allergic contact dermatitis.

Protocol code: P-S-016 "Otitis externa"

Profile: surgical

Stage: PHC

Code (codes) according to ICD-10: H60.9 Otitis externa, unspecified

Factors and risk groups

Water ingress into the ear canal, hot and humid climate, atopic and other allergic conditions, seborrheic eczema and other skin diseases, certain systemic diseases (diabetes mellitus), some psychosocial problems, chronic otitis media, erysipelas, herpes zoster.

Diagnostics

Diagnostic criteria

Complaints and anamnesis: swelling and redness of the skin of the ear canal, peeling, weeping, mucous or purulent discharge. A sharp pain at first is replaced then by severe itching and a feeling of congestion in the ear.

Physical examination: diagnosis based on complaints, examination, hearing audiogram.

Laboratory studies: not specific.

Instrumental research: sometimes a bacteriological culture of pus and a study for fungi is necessary.

List of main diagnostic measures:

1. Complete blood count (6 parameters).

2. Microreaction.

List of additional diagnostic measures:

1. General analysis of urine.

2. Determination of glucose.

3. Examination of feces for worm eggs.

Treatment abroad

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Treatment

Treatment tactics

Treatment goals:

Non-pharmacological treatment: no.

Medical treatment

With diffuse external otitis, the ear is washed with a warm solution of rivanol (1:5000), lubricated with a 3-5% solution of silver nitrate, 1-2% alcohol solution of brilliant green, gauze swabs moistened with 2% solution of aluminum subacetate or 3% alcohol solution of boric acid.

Also used are ear drops with gentamicin and ear drops with antibiotics in combination with corticosteroids (Framecitine sulfate 5 mg + Gramicidin, 50 mcg + Dexamethasone metasulfobenzoate, 500 mcg / ml, ear drops prednisolone / neomycin, betamethasone / neomycin, gentamicin / hydrocortisone).

With external otitis media of fungal etiology, hydrocortisone, oxycort and prednisolone ointments give a good anti-inflammatory effect. NSAIDs (paracetamol 0.5-1.0 4 times a day, ibuprofen 400 mg 3 times a day) are used for fungal otitis externa.

Antibacterial therapy (amoxicillin 250/5 ml, erythromycin 250-500 mg 3 times a day) is prescribed for external otitis media of bacterial etiology.

Indications for hospitalization: with severe pain in the ear, the presence of a boil, they are transferred to a hospital for surgical intervention.

List of essential medicines:

1. Rivanol solution (1:5000)

2. Silver nitrate 3-5% solution

3. *Brilliant green alcohol solution 1%, 2% in a 10 ml, 20 ml bottle

4. Aluminum subacetate 2% solution

5. * Boric acid solution alcohol 3% 10-50 ml powder

6. *Gentamicin solution (eye drops) 0.3% 5 ml

7. * Betamethasone solution for injection in 1 ml ampoule

8. *Hydrocortisone ointment, gel 1%

9. *Methylprednisolone ointment

10. *Ibuprofen 200 mg, 400 mg tab.

11. **Amoxicillin oral suspension 250 mg/5 ml

12. **Amoxicillin + clavulanic acid powder for suspension for oral administration 156.25/5 ml; 312.5 mg/5 ml

13. **Framecitine sulfate 5mg + Gramicidin 50mcg + Dexamethasone metasulfobenzoate 500mcg/ml ear drops

List of additional medicines:

1. **Paracetamol syrup 2.4% in vial; suspension; suppositories 80 mg

2. *Diphenhydramine injection 1% 1 ml

3. *Fluconazole capsule 50 mg, 150 mg; solution in a vial for intravenous injection 100 ml

Treatment effectiveness indicators: elimination of symptoms, elimination of infection, reduction of the risk of recurrence, prevention of complications.

* - drugs included in the list of essential (vital) drugs.

** - is included in the list of types of diseases, in the outpatient treatment of which drugs are dispensed by prescription free of charge and on preferential terms.

Information

Sources and literature

1. Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007)
   1. 1. Hirsch B.E. Infection of the external ear. Am J Otolaryngol 1992;17:207 2. Hirsch BE. Infection of the external ear. Am J Otolaryngol 1992;13:145-155 3. Otitis externa. Daniel Hajoff. Search date March 2005 BMJ 4. Prodigy Guidance – Otitis externa, 2004.

Information

List of developers: Sagatova G.S., City Clinical Hospital No. 5, Almaty

Attached files

Attention!

• By self-medicating, you can cause irreparable harm to your health.
• The information posted on the MedElement website and in the mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: a therapist's guide" cannot and should not replace an in-person consultation with a doctor. Be sure to contact medical facilities if you have any diseases or symptoms that bother you.
• The choice of drugs and their dosage should be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and the condition of the patient's body.
• The MedElement website and mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Handbook" are exclusively information and reference resources. The information posted on this site should not be used to arbitrarily change the doctor's prescriptions.
• The editors of MedElement are not responsible for any damage to health or material damage resulting from the use of this site.

Excluded:

• otitis media due to barotrauma (T70.0)
• otitis media (acute) NOS (H66.9)

Chronic tubotympanic catarrh

Chronic otitis media:

• slimy
• secretory
• transudative

Excludes: adhesive disease of middle ear (H74.1)

Chronic otitis media:

• allergic
• exudative
• non-purulent NOS
• seromucinous
• with effusion (nonpurulent)

Otitis media:

• allergic
• catarrhal
• exudative
• mucoid
• secretory
• seromucosal
• serous
• transudative
• with effusion (nonpurulent)

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to contact medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

All types of otitis media in ICD-10

The main special document that is used as the statistical basis of the health system is the International Classification of Diseases (ICD). Currently, medical specialists work on the basis of the Tenth Revision Regulation, which entered into force in 1994.

The ICD uses an alphanumeric coding system. The classification of diseases is based on grouping data according to the following principles:

• Diseases of epidemic genesis;
• General diseases, including constitutional ones;
• Local pathologies classified according to the principle of anatomical location;
• Developmental diseases;
• Injury.

A separate place in the ICD-10 is occupied by diseases of the auditory analyzer, which have individual codes for each clinical unit.

Diseases of the ear and mastoid process (H60-H95)

This is a large block of pathologies, including the following groups of ear diseases, according to the division according to the anatomical principle:

• Pathology of the internal department;
• middle ear;
• Diseases with external localization;
• The rest of the states.

The distribution into blocks is based on the anatomical location, the etiological factor that caused the development of the disease, the symptoms and severity of the manifestations. Below we will take a closer look at each of the classes of auditory analyzer disorders accompanied by inflammatory processes.

Diseases of the outer ear (H60-H62)

Otitis externa (H60) is a combination of inflammatory processes of the auditory canal, auricle and tympanic membrane. The most common factor provoking its development is the action of bacterial microflora. Inflammation of external localization is typical for all age groups of the population, however, it appears more often in children and schoolchildren.

Factors provocateurs of external inflammation include minor injuries in the form of scratches, the presence of sulfur plugs, narrow auditory canals, chronic foci of infection in the body and systemic diseases, such as diabetes mellitus.

Code H60 has the following division according to ICD-10:

• Abscess of the external ear (H60.0), accompanied by an abscess, the appearance of a boil or carbuncle. It is manifested by acute purulent inflammation, hyperemia and swelling in the auditory canal, severe shooting pain. On examination, an infiltrate with a purulent core is determined;
• Cellulitis of outer ear (H60.1);
• Malignant otitis externa (H60.2) is a sluggish chronic pathology accompanied by inflammation of the bone tissue of the auditory canal or the base of the skull. Often occurs against the background of diabetes mellitus, HIV infection or chemotherapy;
• Other otitis externa of infectious origin (H60.3), including diffuse and hemorrhagic manifestations of the disease. It also includes a condition called "swimmer's ear" - an inflammatory reaction of the auditory canal to the ingress of water into it;
• Choleastomy or keratosis of the auditory canal (H60.4);
• Acute external otitis media of a non-infectious nature (H60.5), divided depending on the manifestations and etiological factor:
  • chemical - caused by exposure to acids or alkalis;
  • reactive - accompanied by severe swelling of the mucosa;
  • actinic;
  • eczematous - manifested by eczematous rashes;
  • contact - the body's response to the action of the allergen;
• Other types of otitis externa (H60.8). This also includes the chronic form of the disease;
• Otitis externa of unspecified etiology (H60.9).

Other diseases of the outer ear (H61) - pathological conditions of this group are not associated with the development of inflammatory reactions.

Diseases of the middle ear and mastoid process (H65-H75)

Let us consider in more detail each of the blocks based on the ICD-10.

Nonsuppurative otitis media (H65)

It is accompanied by an inflammatory process of the tympanic membrane and mucous membrane of the middle section of the auditory analyzer. The causative agents of the disease are streptococci, pneumococci, staphylococci. This type of disease is also called catarrhal, as it is characterized by the absence of purulent contents.

Inflammation of the Eustachian tube, the presence of choanal polyps, adenoids, diseases of the nose and maxillary sinuses, septal defects - all these factors increase the risk of developing the disease several times. Patients complain of a feeling of congestion, increased perception of their voice, hearing loss and a feeling of fluid transfusion.

The block has the following division:

• Acute serous otitis media (H65.0);
• Other acute non-suppurative otitis media (H65.1);
• Chronic serous otitis media (H65.2);
• Chronic mucous otitis media (H65.3);
• Other chronic non-suppurative otitis media (H65.4);
• Nonsuppurative otitis media of unspecified etiology (H65.9).

Suppurative and unspecified otitis media (H66)

Inflammatory process of the whole organism, local manifestations of which extend to the tympanic cavity, auditory tube and mastoid process. It occupies a third of all diseases of the auditory analyzer. The causative agents are streptococci, Haemophilus influenzae, influenza virus, respiratory syncytial virus, less often - Escherichia coli.

Infectious diseases contribute to the fact that pathogens enter the middle section of the analyzer with the flow of blood and lymph. The danger of a purulent process is the development of possible complications in the form of meningitis, brain abscess, deafness, sepsis.

According to ICD-10 it is divided into blocks:

• Acute suppurative otitis media (H66.0);
• Chronic tubotympanal purulent otitis media. Mesotympanitis (H66.1). The term "tubotympanal" means the presence of a perforation in the eardrum, from which purulent contents flow;
• Chronic epitympano-antral suppurative otitis media (H66.2). "Epitympano-antral" means a difficult process, accompanied by damage and destruction of the auditory ossicles;
• Other chronic suppurative otitis media (H66.3);
• Purulent otitis media, unspecified (H66.4);
• Otitis media, unspecified (H66.9).

Otitis media in diseases classified elsewhere (H67*)

• 0* Otitis media in bacterial diseases (scarlet fever, tuberculosis);
• 1* Otitis media in viral diseases (influenza, measles);
• 8* Otitis media in other diseases classified elsewhere.

Inflammation and blockage of the auditory tube (H68)

The development of the inflammatory process is facilitated by the influence of staphylococci and streptococci. For children, the typical causative agents of the disease are pneumococci and the influenza virus. Often accompanied by various forms of ear inflammation, diseases of the nose and throat.

Other etiological factors include:

• chronic infections;
• The presence of adenoids;
• Congenital anomalies in the structure of the nasopharynx;
• Neoplasms;
• Atmospheric pressure jumps.

Blockage of the Eustachian tube develops against the background of inflammatory processes of the tympanic cavity or nasopharynx. Recurrent processes lead to thickening of the mucous membrane and blockage.

Perforation of the tympanic membrane (H72)

Rupture of the tympanic membrane can serve as a provoking factor in the development of inflammation of the middle ear, and its consequences. The purulent contents that accumulate in the tympanic cavity during inflammation creates pressure on the membrane and breaks it.

Patients complain of a sensation of tinnitus, expiration of pus, hearing loss, and sometimes sanious discharge.

Diseases of the inner ear (H83)

Other diseases of the inner ear (H83) - the main block associated with inflammation processes in the most inaccessible parts of the ear.

Labyrinthitis (H83.0) is an inflammatory disease of the internal part of the auditory analyzer that occurs due to trauma or the action of an infectious genesis factor. Most often occurs against the background of inflammation of the middle ear.

Manifested by vestibular disorders (dizziness, impaired coordination), hearing loss, sensation of noise.

A clear coded classification of ICD-10 allows you to maintain analytical and statistical data, controlling the level of morbidity, diagnosis, reasons for seeking help in health facilities.

How to beat chronic otitis media: the basics of proper treatment

The inflammatory process in the ear, which is characterized by constant copious purulent discharge from the organ, a change in the eardrum, is called chronic otitis media. Sometimes discharge also appears from the nasal passages. This inflammation periodically resumes and is localized on the membrane of the tympanic membrane. The disease develops with improper treatment of acute otitis media or the absence of it. Chronic otitis media microbial 10 is dangerous for its complications that develop in the bone tissue and inside the skull. It causes meningitis, which is not always treatable, and the person dies. The chronic course of the disease causes paralysis of the facial nerve. And the most common complication is hearing loss and deafness.

Otitis media is an inflammatory process localized in various parts of the ear.

Development of the disease

Chronic otitis media develops against the background of the acute stage of the disease. This happens with a long course of the disease or with improper treatment. The onset of the disease is laid in childhood. This is due to the anatomical features of the structure of the ear in babies, in which an infection from the oral cavity easily enters the middle ear area and causes an inflammatory process. Otolaryngologists say that children's otitis media is a common disease that requires urgent treatment. If it is not healed, then the infection becomes sluggish and develops into chronic manifestations of the disease.

Staphylococci, streptococci, yeast fungi and other microorganisms provoke the disease.

The main reasons for the development of a chronic disease, otolaryngologists distinguish:

• improper treatment or advanced otitis media in the acute stage;
• ear injury;
• frequent sinusitis;
• acute purulent otitis, which forms scars on the eardrum;
• change in the functional characteristics of the auditory tube;
• infectious diseases (flu or scarlet fever).

External otitis media code 10 is an inflammatory disease that is localized on the outer part of the ear and shell. It causes the infection to spread to the tympanic membrane.

But why do not all acute otitis develop into chronic manifestations? Indirect causes of this stage of the disease are:

1. inflammatory diseases in chronic stages;
2. reduced immune conditions (AIDS, diabetes, obesity);
3. anomaly in the development of the nasal septum, which leads to impaired nasal breathing;
4. courses of antibiotic therapy (this leads to a weakening of the immune system and the development of conditionally pathogenic microflora);
5. poor-quality diet and lack of vitamins, minerals in the body;
6. environment.

Comparison of a healthy ear with a diseased one

This variety, like all chronic diseases, manifests itself acutely, at times. The cause of the onset of exacerbation is hypothermia, water entering the auricle, an acute respiratory disease. If provoking factors are avoided, then the number of acute manifestations of the disease can be reduced tenfold.

Signs of the disease

Acute otitis media, ICD code 10, is characterized by acute pain in the ears. Sometimes it becomes unbearable. Patients also note dizziness with otitis media, a feeling of congestion in the ears, hearing loss. The chronic stage of this disease is not characterized by vivid symptoms and does not appear immediately. A sign of the presence of the disease is purulent discharge from the ear, which is permanent or temporary, intensifies or will be sluggish. Pulsation in the ear and headache with otitis at this stage are common and indicate an advanced disease. But not always the patient associates it with problems in the middle ear.

The patient also complains to the otolaryngologist about hearing loss in chronic otitis media. At the same time, their circulation is noted already with significant violations of the auditory function.

Stages and varieties of the disease

Acute otitis media code for microbial 10 is distinguished by several varieties. Each of them has characteristic differences and requires a competent approach to treatment.

Otolaryngologists distinguish between two main types of chronic otitis media.

• Benign is characterized by the localization of the inflammatory process on the eardrums. Other nearby organs and mucous membranes are not involved. Therefore, this type of ailment differs in local localization. Such benign otitis is called mesotympanitis. Perforation of the tympanic membrane varies in size, but it is localized in its central part.
• Malignant external otitis (epitympanid) is a type of disease that has spread to bone tissue and mucous membranes. This is a dangerous stage of the disease, which leads to the destruction of bone tissue. Purulent masses can reach the cerebral cortex and develop inflammation. Such otitis requires complex treatment.

Modern otolaryngology has various diagnostic methods, one of them is tympanometry

Chronic otitis media code for microbial 10 has an exudative and adhesive variety. The first is characterized by the accumulation of viscous mucus in the paratympanic cavity. Such purulent otitis does not violate the integrity of the membrane, it occurs as a result of changes in the integrity of the auditory tube. If exudative otitis media is not treated, then a chronic stage of adhesive disease occurs. It occurs due to scars on the eardrum. This affects the quality of a person's hearing.

Treatment

An experienced otolaryngologist can diagnose chronic otitis media by MBC 10 after conducting an examination. Purulent discharge still does not give a reason to make this diagnosis. If perforation of the tympanic membrane is added to them, then we are talking about a chronic manifestation of otitis media. X-ray or tomography (MRI or CT) helps to find out the spread of the inflammatory process. The images show the affected areas and the extent of the infection. In addition, the doctor will prescribe a complete blood count, which will help determine the body's ability to fight inflammation. For the correct prescription of therapy, bacterial cultures of purulent contents of the ear are also taken. This laboratory research method will help identify the infection and select a drug that will be more effective in combating it.

Even the most experienced doctor will not be able to identify the microorganism by eye. Therefore, it is important at the first symptoms to come to a consultation with a doctor and conduct a complete examination. Otitis is an infectious disease that can be treated, and the sooner it is diagnosed, the sooner a full recovery will occur, and the auditory organ will not lose its functional abilities.

The sooner you get in touch, the better.

Based on the results of the above studies, taking into account the examination and complaints of the patient, the otolaryngologist prescribes a comprehensive treatment. It removes the external manifestations of the disease and has a detrimental effect on the causative agent of inflammation.

If the disease is diagnosed at the stage of benign otitis, then after research, the doctor prescribes the following groups of drugs:

1. anti-inflammatory;
2. drugs that relieve pain;
3. antibacterial (antibiotics).

The patient daily cleans the ear passages and undergoes physiotherapy, if such are prescribed by the doctor. The otolaryngologist drains fluid and secretions from the ear. If the inflammation is caused by overgrown polyps, then they are removed.

If, after the examination, the otolaryngologist notes changes in the bone tissue, then taking these drugs will be the first step towards surgical treatment.

Dozens of people prefer non-traditional therapies. To do this, they are ready to try grandmother's recipes, just to get rid of the discomfort in chronic otitis media. Otolaryngologists do not advise wasting time on dubious advice from traditional medicine. Advanced stages of chronic otitis media are more difficult to treat and are accompanied by complete hearing loss. Therefore, the treatment of perforation of the tympanic membrane must be effective and fast. Whether otitis media is contagious or not does not really matter, but the roots of this inflammation lie in an infection that cannot be cured by any herbs from traditional medicine.

Chronic otitis media is a disease that can be treated. But an experienced otolaryngologist should prescribe it, after conducting a comprehensive examination of the patient and finding out the degree of the inflammatory process. At the first signs of the disease, consult a doctor and start treatment. This will help preserve the main function of the ear. If you suffer from frequent inflammatory diseases of the ears, then avoid hypothermia, eat well, monitor the state of immunity.

Classification of otitis according to ICD 10

ICD 10 is the 10th revision of the International Classification of Diseases, adopted in 1999. Each disease is assigned a code or cipher for the convenience of storing and processing statistical data. Periodically (every ten years) there is a revision of the ICD 10, during which the system is adjusted and supplemented with new information.

Otitis is an inflammatory type of disease that is based in the ear. Depending on which part of the organ of hearing inflammation is localized, in ICD 10 otitis is divided into three main groups: external, middle, internal. The disease may have an additional label in each group, indicating the cause of development or the form of the course of the pathology.

Otitis externa H60

External inflammation of the ear, also called "swimmer's ear", is an inflammatory disease of the external auditory canal. The disease got its name due to the fact that the risk of catching an infection is greatest among swimmers. This is explained by the fact that exposure to moisture for a long time provokes infection.

Also, external ear inflammation often develops in people who work in a humid and hot atmosphere, use hearing aids or earplugs. A minor scratch on the external auditory canal can also cause the development of the disease.

• itching, pain in the ear canal of the infected ear;
• discharge of purulent masses from the affected ear.

Attention! If the ear is clogged with purulent masses, do not clean the infected ear at home, this can be fraught with a complication of the disease. If discharge from the ear is detected, it is recommended to immediately consult a doctor.

According to ICD 10, the code for otitis externa has an additional marking:

• H60.0 - formation of an abscess, abscess, accumulation of purulent secretions;
• H60.1 - cellulitis of the external ear - damage to the auricle;
• H60.2 - malignant form;
• H60.3 - diffuse or hemorrhagic otitis externa;
• H60.4 - formation of a tumor with a capsule in the outer part of the ear;
• H60.5 - uninfected acute inflammation of the outer ear;
• H60.6 - other forms of pathology, including chronic form;
• H60.7 Otitis externa, unspecified.

Otitis media H65-H66

Doctors try to penetrate as deeply as possible into the secrets of diseases for their more effective treatment. At the moment, there are many types of pathology, among which there are non-purulent types with the absence of inflammatory processes in the middle ear.

Non-purulent inflammation of the middle ear is characterized by the accumulation of fluid, which the patient does not feel immediately, but already at a later stage of the disease. Pain during the course of the disease may be completely absent. Lack of damage to the eardrum can also make diagnosis difficult.

Reference. Most often, non-purulent inflammation in the middle ear is observed in boys under 7 years of age.

This disease can be divided into many factors, among which are especially distinguished:

• the time of the course of the disease;
• clinical stages of the disease.

Depending on the time of the course of the disease, the following forms are distinguished:

1. Acute, in which inflammation of the ear lasts up to 21 days. Untimely treatment or its absence can lead to irreversible consequences.
2. Subacute - a more complex form of pathology, which is treated on average up to 56 days and often leads to complications.
3. Chronic - the most complex form of the disease, which can fade and return throughout life.

The following clinical stages of the disease are distinguished:

• catarrhal - lasts up to 30 days;
• secretory - the disease lasts up to a year;
• mucosal - prolonged treatment or complication of the disease up to two years;
• fibrous - the most severe stage of the disease, which can be treated for more than two years.

The main symptoms of the disease:

• discomfort in the ear area, its congestion;
• Feeling like your own voice is too loud
• feeling of overflowing liquid in the ear;
• permanent hearing loss.

Important! At the first suspicious symptoms of ear inflammation, consult a doctor immediately. Timely diagnosis and the necessary therapy will help to avoid many complications.

Non-purulent otitis media (ICD code 10 - H65) is additionally labeled as:

• H65.0 Acute serous otitis media
• H65.1 - Other acute nonpurulent otitis media;
• H65.2 - Chronic serous otitis media
• H65.3 - Chronic mucous otitis media;
• H65.4 - Other chronic otitis media of non-purulent type;
• H65.9 Otitis media, nonsuppurative, unspecified

Purulent otitis media (H66) has a division into blocks:

• H66.0 - acute purulent otitis media;
• H66.1 - chronic tubotympanal purulent otitis media or mesotympanitis, accompanied by a rupture of the eardrum;
• H66.2 - chronic epitympanic-antral purulent otitis media, in which the destruction of the auditory ossicles occurs;
• H66.3 - other chronic suppurative otitis media;
• H66.4 Purulent otitis media, unspecified;
• H66.9 Otitis media, unspecified.

Otitis media H83

Doctors consider labyrinthitis or internal otitis media to be one of the most dangerous types of inflammation of the organ of hearing (ICD code 10 - H83.0). In the acute form, the pathology has pronounced symptoms and develops rapidly, in the chronic form, the disease proceeds slowly with the periodic manifestation of symptoms.

Attention! Untimely treatment of labyrinthitis can lead to very serious consequences.

The disease is localized inside the auditory analyzer. Due to inflammation, which is located near the brain, the signs of such a disease are very difficult to recognize, as they can indicate various diseases.

1. Vertigo, which may last for a long time and disappear instantly. This condition is very difficult to stop, so the patient may suffer from weakness and disorders of the vestibular apparatus for a very long time.
2. Impaired coordination of movements, which appears due to pressure on the brain.
3. Constant noise and hearing loss are sure signs of the disease.

This type of disease cannot be treated on its own, since labyrinthitis can be deadly and lead to complete deafness. It is very important to start the right treatment as early as possible, only in this way there is a high probability of doing without consequences.

Due to the presence of an understandable classification (ICD-10), it is possible to conduct analytical studies and accumulate statistics. All data is taken from citizens' appeals and subsequent diagnoses.

Directory of major ENT diseases and their treatment

All information on the site is for informational purposes only and does not claim to be absolutely accurate from a medical point of view. Treatment must be carried out by a qualified doctor. By self-medicating, you can harm yourself!

Otitis media 10

In search of the necessary information regarding the disease of interest, a person is faced with such an abbreviation as "ICD 10". What does she mean? The ICD stands for International Classification of Diseases, which describes the coding for each disease. The number 10 indicates that this handbook was approved in accordance with the normative act of the tenth revision in the late nineties of the last century. Every 5-10 years the handbook is reviewed and corrected.

Among ear pathologies, otitis media is the most common. According to the ICD 10 reference book, it refers to diseases of the ear and mastoid process.

ICD code 10

Each disease, including otitis, in children and adults has its own encryption, consisting of capital letters of the Latin alphabet and numbers. All groups are divided into several subgroups, and those, in turn, are divided into sections. It is based on what part of the organ is affected, what was the source of the disease, in what form it proceeds.

Otitis media is an inflammatory disease that involves parts of the human auditory apparatus in the process. It occurs as a result of viruses and bacteria entering the ear, with the further development of pathology.

Contributing factors to the appearance of otitis are weakened immunity, the presence of foci of inflammation in the nasopharynx, underdevelopment of the Eustachian tube in a child. The ICD 10 code is compiled for ear pathologies according to several criteria:

• the place of localization of the process (outer, middle, inner ear);
• epidemiology (type of pathogen that provoked the pathology);
• in what form it proceeds (acute, chronic);
• the nature of the exudate (purulent, serous, catarrhal, hemorrhagic).

Diseases of the outer ear H60-H62

Otitis externa (H 60) - a disease that affects the shell, cartilage, ear canal. The main symptoms in this condition will be irritation, swelling of tissues, discharge of a purulent or serous nature from a diseased organ.

The most common cause of outer ear disease is a bacterial infection. Contributing factors to the development of pathology are:

Otitis with external localization affects all groups of the population, regardless of age. But still, more often the disease is diagnosed in children and the elderly. The reason for this is the weakening of the protective functions of the body.

H60, according to ICD 10, is divided into the following subgroups:

• H60.0 - Abscesses. It is characterized by furunculosis of the external auditory canal and concha, carbuncles, an abscess after traumatization. For this condition, swelling, redness, pain of a pulsating nature, the presence of purulent exudate in the focus of inflammation are typical.
• H60.1 - Wen (atheroma).
• H60.2 - Malignant form. For this group, acute symptomatic manifestations are not typical, it proceeds sluggishly. Bone, periosteum, cartilage may be involved in the process. The risk group includes people who have undergone a course of chemotherapy, have a history of diabetes, and are infected with HIV.
• H60.3 - Other infectious forms. According to the ICD, this includes diffuse and hemorrhagic lesions of the outer ear, a disease called "Swimmer's Ear" - a pathology that is provoked by constant exposure to moisture on the organ.
• H60.4 - Choleastomy (keratosis). This disease has no pronounced symptoms, the patient may not know about its existence for a long time. It is characterized by the fusion of the epidermis of the ear canal with the tissues of the tympanic membrane, followed by the formation of a tumor-like formation in which keratin accumulates.
• H60.5 - Acute otitis externa of non-infectious origin. In turn, the subgroup is divided into sections, depending on the origin:
  • chemical - occurs due to exposure to aggressive components such as acid, alkali;
  • reactive - accompanied by a lightning-fast development of puffiness;
  • actinic;
  • contact - occurs after contact with a potential allergen;
  • eczematous - characterized by the presence of rashes typical of eczema;
• H60.8 - Other otitis externa NOS
• H60.9 - Inflammation without specified etiology.

According to ICD 10, under the code H61, diseases of the outer part of the hearing aid that are not associated with inflammatory processes are encrypted. This includes deformity of the shell, sulfuric plug, stenosis and ekvostosis of the auditory canal, and other unspecified pathologies.

Code H62 according to ICD 10 includes otitis externa provoked by systemic pathologies of an infectious nature. Inflammation can provoke shingles, herpes, mycosis, candidiasis, impetigo.

Otitis media H65 - H66

Otitis media is a pathology, in most cases provoked by infectious pathogens. Often, inflammation in this department occurs due to viruses entering the body. Penetrating the mucous membranes of the nasopharynx, they multiply rapidly, penetrate the bloodstream, with which it spreads throughout the body, including the ear apparatus. The pathogen can also enter directly from the foci in the nasopharynx and paranasal sinuses through the Eustachian tube. Children of the first years of life, in which the tube is short and wide, are especially susceptible to this method of transmission.

According to ICD 10, otitis media of the middle section is divided into catarrhal and purulent.

Nonpurulent otitis media H65

This pathology is characterized by inflammation of the middle part of the ear apparatus, including the eardrum. The root cause is viruses, followed by the addition of a bacterial infection. This form of flow is called catarrhal, with it there are no purulent discharges.

Provoking factors for the development of otitis media in most cases are pathologies of the nasopharynx, such as sinusitis, tonsillitis, adenoiditis, deviated nasal septum, rhinitis. Patients with this pathology express the following complaints:

• Severe pain syndrome of a different nature. The pain is sharp, aching, throbbing, shooting, bursting.
• Sensation of ear congestion, extraneous noise.
• Decreased hearing acuity.
• Violation of sound perception of one's own voice.
• Sensation of water overflowing inside the body.

There are three forms of non-purulent otitis media, according to which pathologies are also divided in ICD 10:

• acute, lasts up to three weeks;
• subacute, manifests itself within two months;
• chronic, appears with untimely assistance or improperly selected therapy, it is impossible to get rid of this form.

Non-purulent otitis media according to ICD 10 is coded as H65, is divided into the following subgroups:

• H65.0 - acute otitis media with serous discharge;
• H65.1 - other non-purulent lesions of the middle section;
• H65.2 - chronic serous otitis;
• H65.3 - mucous otitis media (chronic);
• H65.4 - other non-purulent chronic otitis;
• H65.9 - otitis media of unspecified etiology.

Purulent otitis media H66

This form of the disease is characterized by the presence of purulent masses in the ear. Pathology is often accompanied by a rupture of the eardrum. The purulent process is dangerous with complications, including meningitis, brain abscesses, sepsis, and complete hearing loss.

According to the ICD 10 classifiers, H66 is divided into the following sections:

• H66.0 - acute purulent otitis media;
• H66.1 - otitis media, accompanied by rupture of the eardrum;
• H66.2 - chronic epitympano - antral purulent otitis media, accompanied by the destruction of the auditory ossicles;
• H66.3 - other chronic suppurative otitis media;
• H66.4 - purulent otitis media of unspecified etiology;
• H66.9 - otitis media NOS.

Perforation of the tympanic membrane H72

Rupture of the eardrum, according to ICD 10, has the code H72. Depending on the location of the perforation, the group is divided into several sections.

An inflammatory process in the middle ear can serve as the root cause of this condition, as a result of which a large amount of fluid is formed. She presses on the membrane, it breaks.

Perforation can also occur due to trauma. In this case, the rupture will be followed by inflammation of the middle ear.

Conclusion

With the advent of the ICD reference book, maintaining analytics and statistics on incidence and relapse rates has become much easier. All data are taken from the reports of employees of medical institutions. One ICD 10 code encodes the type of disease, its form, which system or organ is affected.

ICD 10 is the 10th revision of the International Classification of Diseases, adopted in 1999. Each disease is assigned a code or cipher for the convenience of storing and processing statistical data. Periodically (every ten years) there is a revision of the ICD 10, during which the system is adjusted and supplemented with new information.

Otitis is an inflammatory type of disease that is based in the ear. Depending on which section the inflammation is localized, in ICD 10 otitis is divided into three main groups: external, middle, internal. The disease may have an additional label in each group, indicating the cause of development or the form of the course of the pathology.

External inflammation of the ear, also called "swimmer's ear", is inflammatory disease of the external auditory canal. The disease got its name due to the fact that the risk of catching an infection is greatest among swimmers. This is explained by the fact that exposure to moisture for a long time provokes infection.

Also, external ear inflammation often develops in people who work in a humid and hot atmosphere, use or. A minor scratch on the external auditory canal can also cause the development of the disease.

Main symptoms:

• itching, pain in the ear canal of the infected ear;
• discharge of purulent masses from the affected ear.

Otitis externa

Attention! If the ear is clogged with purulent masses, do not clean the infected ear at home, this can be fraught with a complication of the disease. If discharge from the ear is detected, it is recommended to contact immediately.

According to ICD 10, the code for otitis externa has an additional marking:

• H60.0- formation of an abscess, abscess, accumulation of purulent secretions;
• H60.1- cellulitis of the external ear - damage to the auricle;
• H60.2- malignant form;
• H60.3- diffuse or hemorrhagic otitis externa;
• H60.4- formation of a tumor with a capsule in the outer part of the ear;
• H60.5- uninfected acute inflammation of the external ear;
• H60.6- other forms of pathology, including chronic form;
• H60.7- unspecified otitis externa.

Otitis media H65-H66

Doctors try to penetrate as deeply as possible into the secrets of diseases for their more effective treatment. At the moment, there are many types of pathology, among which there are non-purulent types with the absence of inflammatory processes in.

Nonpurulent inflammation of the middle ear characterized by the accumulation of fluid, which the patient does not feel immediately, but already at a later stage of the disease. Pain during the course of the disease may be completely absent. Lack of damage to the eardrum can also make diagnosis difficult.

Reference. Most often, non-purulent inflammation in the middle ear is observed in boys under 7 years of age.

This disease can be divided into many factors, among which stand out in particular:

• the time of the course of the disease;
• clinical stages of the disease.

Depending on the time of the course of the disease, the following forms are distinguished:

1. , in which inflammation of the ear lasts up to 21 days. Untimely treatment or its absence can lead to irreversible consequences.
2. subacute- a more complex form of pathology, which is treated on average up to 56 days and often leads to complications.
3. Chronic- the most complex form of the disease, which can fade and return throughout life.

The following clinical stages of the disease are distinguished:

• catarrhal- lasts up to 30 days;
• secretory- the disease lasts up to a year;
• mucosal- protracted treatment or complication of the disease up to two years;
• fibrous- the most severe stage of the disease, which can be treated for more than two years.

The main symptoms of the disease:

• discomfort in the ear area, its congestion;
• Feeling like your own voice is too loud
• feeling of overflowing liquid in the ear;
• permanent hearing loss.

Important! At the first suspicious symptoms of ear inflammation, contact immediately. Timely diagnosis and the necessary therapy will help to avoid many complications.

Non-purulent otitis media (ICD code 10 - H65) is additionally labeled as:

• H65.0- acute average serous otitis;
• H65.1- other acute nonpurulent otitis media;
• H65.2- chronic serous otitis media;
• H65.3- chronic mucous otitis media;
• H65.4- other chronic otitis media of non-purulent type;
• H65.9- non-purulent otitis media, unspecified.

Chronic suppurative otitis media

Purulent otitis media (H66) has a division into blocks:

• H66.0- acute purulent otitis media;
• H66.1- chronic tubotympanal purulent otitis media or mesotympanitis, accompanied by a rupture of the eardrum;
• H66.2- chronic epitympano-antral purulent otitis media, in which the destruction of the auditory ossicles occurs;
• H66.3- other chronic purulent otitis media;
• H66.4- purulent otitis media, unspecified;
• H66.9- otitis media, unspecified.

Otitis media H83

Doctors consider one of the most dangerous types of inflammation of the organ of hearing labyrinthitis or otitis media (ICD code 10 - H83.0). In the acute form, the pathology has pronounced symptoms and develops rapidly, in the chronic form, the disease proceeds slowly with the periodic manifestation of symptoms.

Attention! Untimely treatment of labyrinthitis can lead to very serious consequences.

The disease is localized inside the auditory analyzer. Due to inflammation, which is located near the brain, the signs of such a disease are very difficult to recognize, as they can indicate various diseases.

Clinical manifestations:

1. Dizziness, which can last quite a long time and disappear instantly. This condition is very difficult to stop, so the patient may suffer from weakness and disorders of the vestibular apparatus for a very long time.
2. Impaired coordination of movements, which appears due to pressure on the brain.
3. Constant noise and hearing loss are sure signs of a disease.

This type of disease cannot be treated on its own, since labyrinthitis can be deadly and lead to complete deafness. It is very important to start the right treatment as early as possible, only in this way there is a high probability of doing without consequences.

Due to the presence of an understandable classification (ICD-10), it is possible to conduct analytical studies and accumulate statistics. All data is taken from citizens' appeals and subsequent diagnoses.

The outer ear is the peripheral part of the human auditory apparatus. It consists of the external auditory canal, which has cartilaginous and bony parts, and the auricle. The outer ear is separated from the middle ear cavity by the tympanic membrane. With local inflammation of the external auditory canal, they speak of limited external otitis media. It is a purulent-inflammatory process in the area of ​​​​the hair follicle - a furuncle. Diffuse inflammation of the ear canal, covering its cartilaginous and bone parts, in otolaryngology is called diffuse otitis externa. Diffuse otitis externa is characterized by inflammatory changes in both the skin and subcutaneous fatty tissue of the ear canal, and may be accompanied by inflammation of the eardrum.

Limited otitis externa.

Symptoms of limited external otitis.

Treatment goals:

Relief of the inflammatory process in the middle ear cavity;

Elimination of symptoms of general intoxication;

Hearing restoration;

Disappearance of pathological discharge from the ear;

Improved well-being and appetite.

Non-drug treatment: regimen - general, diet with restriction of sweets.

Medical treatment:
1. Relief of fever (> 38.5) - paracetamol ** 10- 15 mg/kg, up to 4 times a day.

2. Toilet of the ear (dry the ear with turunda), after which the transtympon introduction of local antimicrobial and antibacterial drugs (for example, ear drops withamoxicillin, ciprofloxacin). Topical antibiotics from the group of quinolones andsemi-synthetic penicillins are the safest for topical use in children practice.

3. In the presence of an allergic component - desensitizing therapy (for example, diphenhydramine hydrochloride, at an age dosage 2 times a day, for 5 days).

4. Antibacterial therapy: Antibiotics are given empirically, with predominant use of oral forms. The selection of antibacterial agents according to the sensitivity of the flora in vitro is carried out only if empirical tactics are ineffective.
The drugs of choice are semi-synthetic penicillins, macrolides, alternative - cephalosporins II-III generation.

Amoxicillin** 25 mg/kg twice daily for 5 days or protected penicillins (amoxicillin + clavulanic acid** 20-40 mg/kg, 3 times a day).

Azithromycin* 10 mg/kg 1 day, 5 mg/kg daily for 4 consecutive days orally or clarithromycin* 15 mg per kg in divided doses, 10-14 days orallyor erythromycin** - 40 mg per kg divided, 10-14 days orally.

Cefuroxime* 40 mg/kg/day, divided into 2 divided doses, 10-14 days orally. For cefuroxime, the maximum dose in children is 1.5 g.

Ceftazidime - powder for solution for injection in a vial of 500 mg, 1 g, 2 g.

For the treatment and prevention of mycosis with prolonged massive antibiotic therapy - itraconazole.

Preventive actions:

Prevention of viral diseases;

Avoid getting water in the ears (up to 1 month);

Permanent nose toilet;

Do not bottle feed your baby lying down.

Prevention of complications:

Timely paracentesis;

Prompt hospitalization.

Further management: 5 days after treatment if symptoms persist antibiotic therapy is extended for another 5 days if symptoms persist 2weeks or more, it is necessary to confirm the diagnosis of chronic otitis mediaotoscopically and prescribe appropriate therapy.

List of essential medicines:

1. **Paracetamol 200 mg, 500 mg tab.; 2.4% syrup in vial; 80 mg suppositories

2. ** Amoxicillin 500 mg, 1000 mg tab.; 250 mg, 500 mg capsule; 250 mg/5 ml oral suspension

3. **Amoxicillin + clavulanic acid, tab. 250mg/125mg, 500mg/125mg, 875 mg/125 mg, powder for suspension 125 mg/31.25 mg/5 ml, 200 mg/28.5 mg/5 ml, 400 mg/57 mg/5 ml

4. *Cefuroxime 250 mg, 500 mg tablet; 750 mg in vial, powder for preparation injection solution