Causes and symptoms of adhesive otitis media - effective treatment. Signs and treatment of adhesive otitis media Chronic left-sided cicatricial adhesive otitis media

Adhesive otitis media is called the formation of cicatricial adhesions in the tympanic cavity of the ear as a result of a chronic inflammatory process. As a result, the patency of the auditory tube, the mobility of the auditory ossicles are disturbed, and hearing loss occurs.
Treatment of pathology can sometimes be carried out conservatively, but often it is necessary to resort to surgical intervention.

Cicatricial changes, as a rule, are irreversible, so it is not possible to completely restore ear function in severe forms of the disease. The prognosis is determined by the degree and extent of the lesion, as well as the timeliness and adequacy of the therapy.

Symptoms of the disease

The main cause of adhesive otitis (the term comes from the word "adhesion" - sticking, which is the reason for the other name: "adhesive otitis media") - serves as an inflammatory process in the tympanic cavity against the background of a weakening of its ventilation and drainage.

At the same time, a liquid is released into the cavity, which, in the absence of outflow, thickens over time and forms massive films or threads that braid the auditory ossicles and interfere with the movement of the latter, as well as gluing the walls of the cavity, the tympanic membrane.

The mucous membrane undergoes changes with a replacement for scar tissue and the formation of adhesions (hence another name - "adhesive otitis media"). As a result, the mechanism of sound conduction and, accordingly, hearing is disturbed.

Pathology is manifested by a sensation of low-frequency noise in the ear and progressive persistent hearing loss. The diagnosis is established on the basis of:

The problem is often preceded by acute inflammation of the middle ear, exudative otitis media. Also, an ear injury can lead to the development of the disease in some cases.

Treatment Methods

The effectiveness of treatment is determined by the timeliness of its initiation, as well as the degree of progression of the pathological process. At the same time, scar formation is irreversible.

Medical therapy

First of all, the causes that contribute to the development of adhesive otitis media are identified.

Children undergo, if necessary, removal of the adenoids and / or other procedures to restore nasal breathing (for example, correction of deviated nasal septum).

Medicines, price

Some funds for the conservative treatment of adhesive otitis media can be bought at a pharmacy:

Lidaza - 119 - 238 rubles;
Chymotrypsin - 429 - 790 rubles;
oxymetazoline-containing drugs - 50 - 380 rubles;
Zyrtec - 190 - 240 rubles.

Adhesive (or otherwise adhesive, adhesive) otitis media is a complication of acute inflammatory diseases of the middle ear. Unfortunately, there are currently no sufficiently effective conservative methods of treating pathology. In addition, surgical treatment is very laborious and in some cases does not allow to avoid recurrence of the disease. In connection with the foregoing, an important role is given to the prevention of the problem: timely and adequate treatment of acute otitis media or exudative otitis media.

How to treat otitis media is described in the program "Live healthy!"

Adhesive otitis media is an inflammatory process of a chronic type, which leads to the appearance of adhesions and scars in the tympanic cavity. Adhesive otitis media occurs in the middle ear, which leads to violations of the auditory ossicles and conduction of the auditory tube.

The main manifestation of this inflammatory process is noise in the ear, which can increase with the further course of the disease. If adhesive otitis media is suspected, the doctor conducts an examination and other studies of the auditory cavity, after which the patient is prescribed a medical course of treatment. In case of ineffectiveness of the course, surgical intervention is prescribed.

The main cause of the development of adhesive otitis media is the otitis media preceding it of the following types:

exudative;
catarrhal nonperforative;
chronic tubo-otitis.

The disease after these otitis could be provoked by the irrational use of antibiotic therapy. After the inflammation has been successfully resolved and the accumulated exudate has been resorbed, fibrin filaments remain in the tympanic cavity, resulting in scarring and connective tissue adhesions. Cicatricial strands begin to adhere to the auditory ossicles, which leads to impaired sound conduction and patency of the auditory tube.

It happens that adhesive otitis media can develop without previous otitis media. In this case, the causes are the following pathological processes:

diseases of the upper respiratory tract - SARS, tracheitis;
adenoids;
inflammatory diseases of the nose and paranasal sinuses - sinusitis, sinusitis;
tumors of the nose and pharynx;
injury.

Symptoms

The leading symptoms of adhesive otitis media are tinnitus and gradual hearing loss. Otoscopy performed shows the presence of cicatricial bands and retraction of the tympanic membrane. Hearing loss occurs as a result of impaired sound conduction.

Symptoms of adhesive otitis media are quite similar to the clinical symptoms of other diseases. Therefore, a lot of diagnostic measures and studies are carried out to make a final diagnosis. Also, diagnostic studies are carried out in order to exclude other pathological processes - tubo-otitis, sulfur plug, atherosclerosis, etc.

Hearing loss is the main symptom in adhesive otitis media.

Diagnosis of this disease includes the following examinations:

visual examination by an ENT doctor;
audiometry;
otoscopy;
determination of the degree of patency of the auditory tube;
impedancemetry;
audiometry;
endoscopic catheterization.

Audiometry is performed to determine the degree of hearing loss. To determine the degree of patency of the auditory tube, blowing through the Politzer is carried out. In the presence of adhesive otitis media, this procedure does not give almost any improvement in hearing. But to make a final diagnosis, catheterization of the tube is performed, followed by otoscopic control.

Otoscopic examinations are one of the most important points in the diagnosis of the disease. With the help of otoscopy, the degree of retraction of the tympanic membrane, the presence of scars and darkening are established. In the process of otoscopy, adhesions and strands are also detected.

Acoustic impedancemetry is performed to study the mobility of the auditory ossicles and the tympanic membrane. This study is carried out with the help of air, which thickens and liquefies. As a result, the eardrum retracts or straightens. if a person has adhesive otitis media, then the eardrum remains practically motionless.

Treatment

At the initial stage of the treatment of adhesive otitis media, the factors that lead to problems with the conduction of the auditory tube are eliminated. At this stage, the following is carried out:

sanitation of the nasopharynx, nasal sinuses;
adenotomy (in childhood);
restoration of breathing through the nose - measures are taken to eliminate the curvature of the nasal septum.

A positive effect in the treatment is also provided by blowing through the Politzer. Pneumomassage of the tympanic membrane complements the efficiency of blowing. The following drugs are administered through a specially installed catheter:

fluimucil;
hydrocortisone;
chymotrypsin.

To maintain the protective reactions of the body, the patient is recommended vitamin therapy, ATP and more. Antihistamines are also recommended.

In addition to drug therapy, physiotherapy is usually prescribed. There are the following procedures:

ultrasonic massage;
microwave therapy;
mud treatment.

In some cases, conservative treatment does not have a positive effect. Surgical treatment is prescribed. With tympanometry, the mobility of the auditory ossicles is restored and the adhesive bands are dissected. Unfortunately, this method shows a temporary result, because the percentage of re-formation of adhesions is high. In such situations, a more effective result is shown by the replacement of damaged auditory ossicles with artificial specimens.

With bilateral adhesive otitis, which is accompanied by an intense hearing loss, hearing aids are recommended in the elderly and younger.

Remember, a timely appeal to a specialist will help to avoid serious complications and health problems.

Inadequate treatment of inflammatory processes of the nasopharynx causes complications and often leads to negative consequences. One of the ailments resulting from untreated infectious ENT diseases is adhesive otitis media.

The disease is characterized by an acute inflammatory process of the mucous membrane and a sharp deterioration in hearing, due to a violation of the motor functions of the auditory ossicles. In addition, due to the development of this disease, adhesions form on the tympanic membrane, which disrupt the patency of the auditory opening.

Causes of the disease

Adhesive otitis media begins to develop against the background of inflammatory processes in the middle ear area - acute otitis media and its forms. The provocateur of pathology can also be the incorrect use of antibiotics in the course of treatment. Some drugs successfully fight pathological processes in the ear cavity, help to liquefy the exudate accumulated in it, but leave fibrin threads after treatment.

It is they who cause the appearance of adhesive and cicatricial cysts that impede the movement of the auditory ossicles.

Sometimes the following pathologies become the causes of adhesive otitis in a person:

sinusitis or sinusitis;
Neoplasms of the nasopharynx;
Infectious and inflammatory processes of the upper respiratory tract - SARS, tracheitis, bronchitis;
Mechanical damage to the nasal cavity, ear injuries, deformation or rupture of the eardrum.

Regardless of what exactly caused the appearance of the disease, having noticed the first signs and symptoms, you need to contact a specialist. Timely prescribed drug treatment will prevent the acute and purulent stage and exclude surgical intervention.

Main symptoms

Adhesive otitis media, compared to other pathologies of the middle ear, has several obvious features, one of which is persistent tinnitus. This is due to the fact that adhesions and scars formed on the mucous membrane of the tympanic cavity, as it were, “pull in” the eardrum, disrupting the passage of sound through the auditory tubes. Therefore, the main symptoms of the disease are a rapid decrease in hearing acuity and constant tinnitus.

The remaining symptoms of the disease resemble the clinical picture of otitis media, in its various manifestations and forms, and therefore the final diagnosis and treatment should be determined and prescribed only by a specialist. Diagnosis is also important because it allows you to exclude a number of dangerous pathologies of the middle ear - tubo-otitis, excessive accumulation of serous matter, atherosclerosis, and others.

Diagnostics

Before prescribing adequate treatment, a specialist will definitely conduct a diagnosis. As a rule, to identify adhesive otitis media, doctors carry out a number of activities:

Otoscopy and audiometry are two mandatory procedures. The first involves a visual inspection of the inside of the ear using a strong light source and a reflector in the form of a small mirror or lens. The second method is a hearing test, in which the doctor uses a different tone and volume of his voice.
Impedancemetry is a procedure aimed at detecting pathological changes in the auditory tube, tympanic membrane, as well as determining the mobility of the tympanic ossicles.
Catheterization - a method for examining the auditory tube connecting the ear to the nasopharynx;
Visual inspection of the ear canals.

In the presence of a disease, audiometry and subsequent catheterization, as the main sources of otoscopic control, are important, fundamental manipulations in diagnosis. The same can be said about checking the mobility of the auditory ossicles and the presence of adhesions and scars in the tympanic cavity. The tympanic membrane in connection with these loses the ability to move, which provokes a sharp loss of hearing in the patient.

After conducting an examination and identifying the main symptoms, the otolaryngologist prescribes treatment. Adhesive otitis media, diagnosed in the early stages, is amenable to drug therapeutic treatment, without the use of surgical intervention.

Treatment

The first thing the specialist who prescribes the treatment pays attention to is whether there are symptoms and indicators that hearing problems have appeared against the background of poor patency of the Eustachian tube. If this is indeed revealed, the treatment will be based on the elimination of factors - provocateurs.

Procedures

To do this, the doctor will carry out the following activities:

Adenotomy (in children);
Sanitation of the nasal sinuses and passages;
Repair of a damaged nasal septum.

The Politzer blowing procedure also becomes effective in treatment. Manipulation is carried out in the clinic and combines the procedure with pneumomassage of the tympanic membrane. In addition, treatment may be accompanied by the introduction to the site of the lesion of drugs - Chymotrypsin, Hydrocortisone, Fluimucil. The drugs are delivered through a catheter, the dosage and frequency of drug administration is determined only by the doctor!

Physiotherapy

Against the background of drug therapy, a specialist may recommend the following auxiliary treatment with physiotherapy:

Microwave;
Ultrasound;
Mud treatment and pneumomassage.

If the symptoms and diagnosis confirmed the impossibility of restoring the mobility of the auditory ossicles by therapeutic methods, the otolaryngologist prescribes an operation. Surgical intervention allows you to restore mobility and temporarily free the patient from scars and adhesions.

Danger of relapse

Doctors state at the same time that 80% of patients return to them with the same problem, therefore, in order to fully restore hearing and recover, before the operation, you will be offered to replace the auditory ossicles with artificial grafts. Symptoms of a sharp hearing loss and the diagnosis of "adhesive otitis media" most often provide that sooner or later each patient will face a choice - complete deafness or hearing aids.

That is why there are a number of preventive measures that must be taken if you or your child has a tendency to colds, otitis, sinusitis.

In the definition of the disease, which is characterized by the formation of adhesions, scars, dry perforation in the tympanic cavity, retraction of the tympanic membrane, impaired patency of the auditory tube, and sometimes the destruction of the chain of the auditory ossicles or their ankylosing, there is still no consensus. A large number of terms that have been used and are currently used in the literature shows that along with the general features inherent in this disease, there are a lot of details that diversify its clinical picture. Some authors took only morphological changes in the middle ear as the basis of terminology, others associated the name with the nature of the previously transferred inflammatory process, others considered it necessary to emphasize the dynamics of pathological changes occurring in the middle ear.

It should be emphasized that the first term for destructive changes in the mucous membrane of the middle ear under the influence of a purulent process was the definition proposed back in 1869 by F. Troltsch - tympanosclerosis. However, after the work of A. Politzer, the term "adhesive" (adhesive) otitis, process, catarrh began to be widely used along with such definitions as non-purulent otitis media, dry perforated otitis, tympanosclerosis.

Basic research on the study of morphological changes in acute, chronic and adhesive otitis was carried out in 1929 by the classic of otorhinolaryngology Witmaak. He proved that for the residual manifestations of acute otitis media, the formation of adhesions in the niche of the window of the vestibule, the incus-stapedial joint, elements typical of adhesive otitis media, is typical. He emphasized that with adhesive otitis media, changes are observed not only in the mucous membrane and submucosal layer, but also in the underlying bone. In such cases, lime deposits are noted in the thickness of the mucous membrane of the middle ear. Sometimes typical changes in the mucous membrane of the middle ear (foci of keratinization, degeneration) are observed even without previous inflammation in it. This process of metaplasia of the epithelium can capture the annular ligament and lead to its ossification, immobility or stiffness of the base of the stapes, in other words, to hearing loss. When analyzing adhesions, scar membranes removed from the middle ear with adhesive otitis media, a maturing connective tissue with neoplasm of vessels, or hyalinized scar tissue, was revealed; development of bone tissue against the background of severe sclerosis, foci of round cell infiltration. Sclerotic tissue is usually covered with stratified squamous epithelium with areas of keratinization, the integumentary epithelium is preserved in some areas, a typical wound surface is determined over a large area. Thus, we can talk about different stages of development of fibrous tissue due to a purulent process in the middle ear, which is determined by the duration of the disease, as well as the reactivity of the body. It should be emphasized that adhesive otitis media is by no means identical to tympanosclerosis in its modern interpretation. Adhesive otitis media is a collective term that combines the numerous manifestations of the consequences of inflammation in various parts of the middle ear.

Epidemiology. Of the total number of patients suffering from hearing loss, in 26-30% it can be associated with manifestations of adhesive otitis media. The method of preventing the occurrence of adhesive otitis media is the prevention and rational treatment of patients, both children and adults, with inflammatory processes in the middle ear; sanitation of the nasal cavity, paranasal sinuses and nasopharynx by medical and surgical methods.

Clinical picture. Clinical manifestations of adhesive otitis media are pronounced, with typical manifestations on the eardrum and characteristic complaints. However, in some cases, when these typical signs are absent on the tympanic membrane, the condition can be regarded as otosclerosis. Complaints - hearing loss more often in one ear, a feeling of noise in it; in the anamnesis, as a rule, indications of acute, subacute or recurrent otitis media.

Diagnostics. The diagnosis is established by analyzing all manifestations characteristic of adhesive otitis media - a typical anamnesis, otoscopic picture, including microotoscopy (cloudy eardrum, absence or displacement of the light cone, retraction of the eardrum, dry perforation, calcareous deposits in the thickness of the stretched part of the eardrum) .

Hearing test:
❖ acumetry - determination of the level of perception of whispered or spoken speech, tests with tuning forks - Rinne test: comparison of the time of perception of the sound of a tuning fork through the ear canal and from the surface of the mastoid process (study of air and bone conduction). The Rinne test is negative - air conduction is worse than bone conduction. Weber's test - latelarization of the sound of a tuning fork, installed on the crown of the patient, towards the diseased ear. The Jelly test is positive in the norm and in adhesive otitis - with periodic pressure on the tragus region of the auricle, the air pressure in the ear canal increases and decreases, which leads to displacement of the tympanic membrane and the ossicular chain, in particular, the stirrup in the oval window; with otosclerosis, this test is negative. Tonal audiometry: with normal bone conduction, an increase in the thresholds for the perception of sounds through the air is noted, an interval of varying degrees between the curve of bone and air conduction. Speech audiometry allows you to explore the susceptibility of words at different frequencies, which determines the social degree of hearing in a patient. In young children, play audiometry is used. Tympanometry - determination of the acoustic resistance of the sound transmitting apparatus: the tympanic membrane, the ossicular chain, the membrane of the labyrinth windows. During the adhesive process, the tympanogram is flattened without a pronounced peak (type B). Sometimes a differential diagnosis is made between adhesive otitis media, otosclerosis, and sensorineural hearing loss. For this purpose, they resort to recording an acoustic reflex, auditory evoked potentials, and recording otoacoustic emissions.

Treatment. Therapeutic measures are aimed at restoring or improving hearing. Conservative methods of treatment (blowing of the auditory tubes, pneumomassage of the eardrums), physiotherapy are practically ineffective. Surgical intervention is carried out in different volumes - from the dissection of adhesions, the use of chymotrypsin to the mobilization of the auditory ossicle chain, stapedoplasty and tympanoplasty, or a combination of them, which brings success in no more than 50%. Dynamic observation is necessary for hearing control. Terms of disability - 2-4 weeks after surgery. In the postoperative period, depending on the volume of the operation, the patient is recommended self-blowing of the ears, light pneumomassage of the tympanic membrane.

Very often, inflammatory processes of varying severity develop in the body. Adhesive which begin to manifest itself with impaired auditory activity, is not uncommon. This disease is accompanied by inflammation in the middle ear. As a result, adhesions with strands are formed, and mobility is impaired. Why does this disease occur? What treatments do doctors offer?

Features of adhesive otitis media

It is represented by two components: a cavity with auditory ossicles and the Eustachian tube. They are separated by the eardrum, which is also responsible for the transmission of sound vibrations. They pass through the bones to the structures of the inner ear. This is where the subsequent transmission and perception of signals along the auditory nerves takes place. After that, the sound is received by the corresponding part of the brain. Adhesive otitis media appears due to a decrease in the mobility of the eardrum and bones. The disease is accompanied by partial or complete impairment of sound perception.

Causes

Most often, the cause of the pathology is inflammatory processes in the middle ear - acute otitis media and its various forms. The illiterate use of antibiotics during treatment can also provoke the disease. The drugs successfully fight inflammation in the ear cavity, but at the same time liquefy the exudate accumulated in it. As a result, scar bands and adhesions from the connective tissue are formed. They braid the bones, blocking the mobility of structures and disrupting the patency of the auditory tube.

In otolaryngology, there are cases when adhesive otitis media develops as an independent disease. It is preceded by a variety of pathological processes that significantly impede the patency of the auditory tube and prevent full ventilation of the tympanic cavity. Such violations include:

prolonged tonsillitis;
adenoids;
damage to the nasal septum;
neoplasms in the pharynx;
diseases affecting the upper respiratory tract (laryngitis, SARS);
chronic inflammation in the nasal cavity (sinusitis, sinusitis).

Regardless of the cause of the disease, having noticed its first signs, it is necessary to consult a doctor. Timely prescribed treatment can prevent the development of serious complications, avoid surgical intervention.

Clinical manifestations of the disease

The development of the pathological process begins gradually. The first symptom that patients pay attention to is tinnitus. Adhesive otitis media is characterized by a conductive type of hearing impairment, when there is a persistent deterioration in the mechanical conduction of sound vibrations. The clinical symptoms of the disease are in many ways similar to the picture of other ailments. Therefore, many diagnostic measures are used to determine the cause of the hearing change. They allow to exclude other pathological processes that can lead to conductive hearing loss (accumulation of sulfuric secretion, tubo-otitis, otosclerosis, etc.).

Establishing diagnosis

What principles guides the doctor when choosing treatment tactics? "Adhesive otitis media" is a serious diagnosis, for confirmation of which a complete examination of the patient is required. It usually includes:

visual inspection;
otoscopy (examination of the ear cavity using a light source and a reflector);
catheterization (examination of the auditory tube, which connects the ear to the nasopharynx);
audiometry (hearing acuity test);
impedancemetry (detection of changes in the structure of the Eustachian tube, eardrum).

The fundamental manipulations in the diagnosis of the disease are audiometry and subsequent catheterization. Impedancemetry allows you to check the mobility of the bones and identify adhesions. Due to the latter, it gradually loses its functions, which provokes a sharp decrease in hearing in the patient.

Based on the results of the examination, the doctor prescribes the appropriate treatment. Adhesive otitis media, detected in the early stages, responds well to drug therapy and does not require surgical intervention. With the advanced form of the disease, an operation is prescribed. In especially serious cases, the patient is shown the use of a hearing aid. What other ways of treating pathology exist?

Drug therapy

At the very initial stage of the pathological process, the patient is prescribed injections of B vitamins, aloe, and the vitreous body. To improve the elasticity of adhesions and prevent their further spread to the Eustachian tube, Lidaza, Fluimucil, and Chymotrypsin are prescribed.

Physiotherapy

Conservative drug treatment is usually supplemented with physiotherapy. The most effective are the following procedures:

ultrasonic massage;
mud treatment.

To prevent recurrence of the disease, it is recommended to repeat the course of treatment 2-3 times a year.

Politzer method and adhesive otitis media

Treatment with the blowing of the Eustachian tube according to the Politzer method gives a positive effect. The procedure involves constant monitoring with an otoscope. One olive is inserted into the ear of the patient, the other - by the doctor. A catheter is also attached to the patient's nostril, from which the balloon departs. The second nostril is clamped with a finger, after which the patient is asked to slowly pronounce the word "steamer". With each pronunciation of the stressed syllable, the pear is squeezed. If there are no adhesions in the Eustachian tube, air passes unhindered.

This procedure is often combined with pneumomassage of the tympanic membrane. With the help of a special apparatus, the membrane is exposed to a jet of air, the strength of which is controlled. Such a procedure has a positive effect on the mobility of the tympanic membrane, prevents the formation of adhesions.

Surgery

Not always with the help of drugs and physiotherapy it is possible to defeat the adhesive. Treatment with conservative methods does not bring results? In such situations, when the disease is characterized by a bilateral nature, the patient is prescribed an operation - tympanotomy. During surgery, the doctor opens the eardrum, thereby providing access to the auditory ossicles. Tympanotomy allows you to get rid of the accumulated exudate, eliminate adhesions.

Even the operation does not give a 100% guarantee of a positive result. Often, against the background of a large area of \u200b\u200bdamage by adhesions, adhesive otitis media recurs. Symptoms of the disease after surgery do not differ from those before the start of treatment. Patients are diagnosed with scars that gradually deform the eardrum, which affects the quality of hearing. It may be impossible to stop the pathological process and improve the patency of the Eustachian tube. In such situations, they resort to replacing the bones with artificial polymer prostheses, and ventilation is carried out through the auditory canal.

Danger of relapse

Patients who have undergone adhesive otitis media should be under the supervision of an otorhinolaryngologist for six months after treatment. After this period, it is recommended to undergo a second examination to make sure that there are no pathological changes in the ear cavity. If abnormalities are detected, the course of treatment is repeated. In the future, the disease can provoke fibrinous-cicatricial changes in the structure of the middle ear. Unfortunately, such violations are irreversible. In the absence of adequate treatment, pathology can cause auditory ossicles, which leads to total deafness.

Prevention measures

An acute inflammatory process in the middle ear often ends with a diagnosis of adhesive otitis media. Treatment with folk remedies or drugs does not always bring a positive result. Surgical intervention is very time consuming and does not prevent recurrence of the disease. Therefore, it is necessary to engage in the prevention of the disease. It is recommended to start from the first days of a child's life. Breastfeeding ensures the full formation of the muscles of the ear, resulting in a reduced susceptibility to the effects of pathological agents. Moreover, it strengthens the body's immune system and reduces the risk of developing respiratory diseases.

Modern pharmacology offers a number of drugs to increase resistance to viral pathologies and quick recovery from colds. They are also excellent prevention of adhesive otitis media. Among such medicines, Influvac, Imudon, Bronchomunal should be singled out. Before using the drugs, it is recommended to consult with a specialist on the dosage and duration of the prophylaxis course. If inflammation could not be avoided, it is necessary to follow the treatment regimen suggested by the doctor. Any deviation from the recommendations of a specialist is dangerous for a relapse of the disease.