Acute otitis media. Types of acute otitis media and their treatment. Can deafness occur after otitis media

Not everyone knows what it is - otitis media. This is a disease that affects the human ear. It consists in acute inflammation of the tissues that make up this important sense organ. Otitis media affects thousands of people of all ages every year. And it is well known that otitis media cannot be called a harmless disease.

What is otitis

To understand the principle of otitis media, it is necessary to remember what it is - the ear, what it is for and how it works. In fact, the ear is far from being only the auricle, as some might think. The ear has a complex system hidden inside that converts sound waves into a form that is convenient for perception by the human brain. However, picking up sounds is not the only function of the ears. They also perform a vestibular function and serve as an organ that allows a person to maintain balance.

The three main sections of the ear are the middle, outer and inner. The outer ear is the auricle itself, as well as the auditory canal leading to the eardrum. Behind the tympanic membrane is an air-filled tympanic cavity containing three auditory ossicles, the purpose of which is to transmit and amplify sound vibrations. This area makes up the middle ear. From the middle ear, vibrations enter a special area, which is located in the temporal bone and is called the labyrinth. It contains the organ of Corti - a cluster of nerve receptors that convert vibrations into nerve impulses. This area is called the inner ear. Also of note is the Eustachian tube, which enters behind the palatine tonsils and leads into the tympanic cavity. Its purpose is to ventilate the tympanic cavity, as well as to bring the pressure in the tympanic cavity into line with atmospheric pressure. The Eustachian tube is usually referred to as the middle ear.

It should be noted that otitis media can affect all three ear regions. Accordingly, if the disease affects the outer ear, then they talk about otitis externa, if the middle one, then about otitis media, if the inner one, about the internal one. As a rule, we are talking about only one-sided lesion, however, with otitis media caused by infections of the upper respiratory sections, the disease can develop on both sides of the head.

Also, otitis media are divided into three varieties depending on the cause - viral, bacterial or traumatic. External otitis can also be fungal. The most common form of the disease is bacterial.

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Otitis externa - symptoms, treatment

External otitis occurs as a result of infection of the surface of the skin of the auricle with bacteria or fungi. According to statistics, approximately 10% of the world's population has suffered from otitis externa at least once in their lives.

Factors contributing to otitis media in adults are:

• hypothermia of the auricle, for example, while walking in the cold;
• mechanical damage to the auricle;
• removal of sulfur from the ear canal;
• ingress of water, especially dirty, into the ear canal.

Bacteria and fungi "love" the ear canal for the reason that it is damp, dark and quite humid. It is the perfect breeding ground for them. And, probably, everyone would have otitis externa, if not such a protective feature of the body as the formation of earwax. Yes, earwax is not at all a useless and clogging ear canal substance, as many people think. It performs important bactericidal functions, and therefore its removal from the ear canal can lead to otitis media. The only exceptions are cases when too much sulfur is released, and it affects the perception of sounds.

Inflammation of the external auditory canal usually refers to a variety of skin diseases - dermatitis, candidiasis, furunculosis. Accordingly, the disease is caused by bacteria, streptococci and staphylococci, fungi of the genus Candida. In the case of furunculosis, inflammation of the sebaceous glands occurs. The main symptom of otitis externa is, as a rule, pain, which is especially aggravated by pressure. Elevated temperature with external otitis usually does not happen. Hearing loss rarely occurs with otitis externa, except when the process affects the eardrum or the ear canal is completely closed by pus. However, after the treatment of otitis media, hearing is fully restored.

Diagnosis of external otitis in adults is quite simple. As a rule, a visual examination by a doctor is sufficient. A more detailed method for diagnosing otitis involves the use of an otoscope, a device that allows you to see the far end of the ear canal and the eardrum. The treatment for otitis media is to eliminate the cause of the inflammation of the ear. Otitis externa in adults is treated with antibiotics or antifungal drugs. The type of antibiotic therapy should be determined by the doctor. As a rule, in the case of external otitis, ear drops are used, not tablets. In case of damage to external tissues of the auricle that are not located in the area of ​​\u200b\u200bthe auditory canal, ointments are used. A frequent complication of otitis externa is the transition of the inflammatory process to the middle ear through the tympanic membrane.

Otitis media

Otitis media is inflammation of the middle part of the ear. Such inflammation of the ear is one of the most common diseases on Earth. Hundreds of millions of people fall ill with ear infections every year. According to various data, from 25% to 60% of people have had otitis media at least once in their lives.

The reasons

In most cases, the inflammatory process of the middle ear is not a primary disease. As a rule, it is a complication of otitis externa or infectious diseases of the upper respiratory sections - tonsillitis, rhinitis, sinusitis, as well as acute viral diseases - influenza, scarlet fever.

How does an infection get from the respiratory departments into the ear? The fact is that she has a direct path there - this is the Eustachian tube. With respiratory symptoms such as sneezing or coughing, particles of mucus or sputum may be thrown through the tube into the ear. In this case, both inflammation of the Eustachian tube itself (eustachitis) and inflammation of the middle ear can occur. When the Eustachian tube is blocked in the tympanic cavity, devoid of ventilation, stagnant processes can occur and fluid can accumulate, which leads to the multiplication of bacteria and the onset of the disease.

The cause of otitis media can also be mastoiditis, allergic reactions that cause swelling of the mucous membranes.

Otitis media has several types. First of all, chronic and acute otitis media are distinguished. According to the degree of development, otitis media are divided into exudative, purulent and catarrhal. Exudative otitis media is characterized by the accumulation of fluid in the tympanic cavity. With purulent otitis media, the appearance of pus and its accumulation are noted.

Otitis media, symptoms in adults

Symptoms in adults include primarily painful sensations in the ear. Pain in otitis media can be sharp or shooting. Sometimes pain can be felt in the temple or crown, it can pulsate, subside or intensify. With exudative otitis media, there may be a sensation of splashing water in the ear. Sometimes there is ear congestion, as well as a feeling of hearing one's own voice (autophony) or just an indefinite noise in the ear. Tissue swelling, hearing impairment, fever, headaches are often noted. However, an increase in temperature is often not a symptom of otitis media, but only a symptom of the infectious disease that caused it - acute respiratory infections, acute respiratory viral infections or influenza.

The most difficult course is observed in the purulent form of otitis media. In this case, the main symptom of otitis media is the discharge of pus. The tympanic cavity is filled with pus, and the body temperature rises to + 38-39ºС. Pus can thin the surface of the eardrum and form a hole in it through which it seeps out. However, this process is generally favorable, since the pressure in the cavity drops, and as a result, the pains become less acute. The process of outflow of pus takes about a week. From this point on, the temperature drops to subfebrile values ​​and wound healing begins. The total duration of the disease is 2-3 weeks with proper and timely treatment.

The chronic form of the disease is characterized by a sluggish infectious process, in which there are seasonal bursts, during which the disease becomes acute.

Diagnostics

In case of suspicious symptoms, you should consult a doctor. Diagnosis is carried out by an otolaryngologist. For this, the following diagnostic feature can be used. If the patient of the otolaryngologist inflates his cheeks, then the immobility of the membrane indicates that air does not enter the tympanic cavity from the nasopharynx and, therefore, the Eustachian tube is blocked. Examination of the eardrum is carried out using an optical device - an otoscope also helps to identify some characteristic signs, for example, protrusion of the eardrum and its redness. For diagnosis, a blood test, computed tomography, and radiography can also be used.

Treatment

How to treat treat the disease? Treatment of otitis media is quite difficult compared to the treatment of external. However, in most cases, conservative treatment is used. First of all, in acute otitis media, it makes no sense to instill ear drops with antibacterial drugs, since they will not enter the inflammation site. However, with inflammation of the middle ear, the focus of which is adjacent directly to the eardrum, anti-inflammatory and analgesic drops can be instilled into the ear. They can be absorbed by the eardrum, and the substance will enter the region of the middle part of the hearing organ, into the tympanic cavity.

Antibiotics are the main treatment for otitis media in adults and children. As a rule, medicines are taken in the form of tablets. However, if the eardrum ruptures, antibiotic ear drops can also be used. A course of antibiotics should be prescribed by a doctor. He also chooses the type of antibiotics, since many of them have an ototoxic effect. Their use can cause permanent hearing loss.

The treatment with penicillin antibiotics, amoxicillins, as well as cephalosporins or macrolides demonstrated the greatest effectiveness in otitis media of the middle ear. However, cephalosporin has an ototoxic effect, so it is not recommended to inject it directly into the ear through a catheter or instill it into the ear canal in case of damage to the eardrum. Antiseptic agents, such as miramistin, can also be used for therapy.

In the treatment of otitis media, it is often necessary to use painkillers. To relieve pain in case of a disease of the middle part of the hearing organ, drops with painkillers, for example, lidocaine, are used.

In the case of perforation of the membrane, scarring stimulants are used to accelerate its healing. These include the usual solution of iodine and silver nitrate 40%.

Glucocorticoids (prednisolone, dexomethasone), as well as non-steroidal anti-inflammatory drugs, can be used as anti-inflammatory drugs and agents that can relieve swelling. In the presence of allergic processes or exudative otitis media, antihistamines are used, for example, suparastin or tavegil.

Also, with exudative otitis media, drugs are taken to thin the exudate, for example, carbocysteine. There are also complex drugs that have several types of action, for example, Otipax, Otinum, Otofa, Sofradex. With purulent discharge, the ear canal should be regularly cleaned of pus and washed with a weak stream of water.

Is it possible to warm the ear? It depends on the type of disease. In some cases, heat can speed up healing, while in others, it can aggravate the disease. In the purulent form of the disease of the middle ear, heat is contraindicated, and in the catarrhal stage, heat promotes blood flow to the affected area and accelerates the patient's recovery. Also, heat is one of the effective ways to reduce the pain of otitis media. However, only a doctor can give permission to use heat, self-medication is unacceptable. In the event that heat is contraindicated, it can be replaced by physiotherapy procedures (UHF, electrophoresis).

Often they resort to a surgical method for the treatment of the middle ear, especially in the case of a purulent variant of the disease and its rapid development, threatening severe complications. This operation is called paracentesis and is aimed at removing pus from the tympanic cavity. With mastoiditis, an operation can also be performed to drain the internal areas of the mastoid process.

Also, special catheters are used to blow and clear the Eustachian tube. Drugs can also be administered through them.

Folk remedies in the treatment of inflammation of the middle ear in adults can only be used for relatively mild forms of the disease and with the permission of the attending physician. Here are some recipes suitable for the treatment of otitis media.

Cotton wool is moistened with propolis infusion and injected into the area of ​​​​the external auditory canal. This composition has wound healing and antimicrobial properties. The tampon must be changed several times a day. Plantain juice, instilled into the ear in the amount of 2-3 drops per day, has a similar effect. To get rid of infections of the nasopharynx and larynx, which provoke infections of the middle ear, you can use rinses based on chamomile, sage, St. John's wort.

Complications

Otitis ear with proper therapy can go away without leaving any long-term consequences. However, inflammation of the middle ear can cause several types of complications. First of all, the infection can spread to the inner ear and cause otitis media - labyrinthitis. In addition, it can cause permanent or transient hearing loss or total deafness in one ear.

Perforation of the eardrum also leads to hearing loss. Although, contrary to popular belief, the eardrum can become overgrown, but even after its overgrowth, hearing sensitivity will be permanently reduced.

Mastoiditis is accompanied by acute pain in the parotid space. It is also dangerous for its complications - a breakthrough of pus on the membranes of the brain with the appearance of meningitis or in the neck.

labyrinthitis

Labyrinthitis is an inflammation of the inner ear. Of all the varieties of otitis media, labyrinthitis is the most dangerous. With inflammation of the inner ear, typical symptoms include hearing loss, vestibular disturbances, and pain. Treatment of internal otitis is carried out only with the help of antibiotics, no folk remedies in this case will help.

Labyrinthitis is dangerous with hearing loss as a result of the death of the auditory nerve. Also, with internal otitis, complications such as a brain abscess are possible, which can be fatal.

Otitis media in children

Otitis media in adults is much less common than it is in children. This is due, firstly, to the weaker immunity of the child's body. Therefore, infectious diseases of the upper respiratory tract are more common in children. In addition, structural features of the auditory tube in children contribute to stagnant processes in it. It has a straight profile, and the enlarged lumen at its entrance facilitates the entry of mucus and even pieces of food or vomit (in infants).

Careful treatment of otitis in childhood is very important. If the wrong treatment is carried out, then the disease can become chronic and make itself felt already in adulthood with chronic outbreaks. In addition, if otitis media is not cured in infancy, it can threaten partial hearing loss, and this, in turn, leads to mental retardation of the child.

Prevention of otitis media

Prevention includes the prevention of such situations as hypothermia of the body, primarily in the ear area, the ingress of dirty water into the ear canal. It is necessary to promptly treat inflammatory diseases of the upper respiratory tract, such as sinusitis, sinusitis, and pharyngitis. While swimming, it is recommended to use a cap, and after being in the water, the ear canal should be completely cleaned of water. In the cold and damp period of the year, it is recommended to wear a hat when going outside.

Acute otitis media (AOM) is an acute inflammatory process localized in the tissues of the middle ear, namely in the tympanic cavity, the area of ​​the auditory tube and the mastoid process. This disease is more often diagnosed in children, however, in adults it also accounts for about 30% of all ENT pathology.

Etiology, classification and mechanisms of the development of the disease

Acute otitis media is an infectious disease that can be caused by viruses, bacteria, or viral-bacterial associations.

An important role in the development of CCA is played by viruses that cause acute respiratory infections, namely:

• parainfluenza,
• adenoviruses,
• enteroviruses,
• respiratory syncytial viruses,
• coronaviruses,
• rhinoviruses,
• metapneumoviruses.

Bacteria are found in 70% of patients in the study of exudate obtained from the middle ear. Most often it is:

• Streptococcus pneumoniae,
• haemophilus influenzae,
• Moraxella catarrhalis.

Contribute to the development of the disease:

• reduced immune status of the body (congenital immunodeficiencies, recent acute infectious diseases, concomitant severe somatic pathology (bronchial asthma, diabetes mellitus, kidney disease);
• the presence of a cleft palate in a child;
• active and passive smoking;
• low socioeconomic status of the patient.

According to the nature of inflammation, 3 stages of AOM are distinguished:

• catarrhal
• exudative (serous),
• purulent.

The mechanisms of their development also differ.

Catarrhal otitis media(other names -, tubo-otitis) often develops in acute respiratory viral infections - edema caused by inflammation in the upper respiratory tract extends to the mucous membrane of the auditory tube, which impairs its patency. As a result, all 3 functions of the pipe are violated:

• ventilation (the air contained in the pipe is sucked in, and the flow of a new one is difficult),
• protective (due to insufficient ventilation, the partial pressure of oxygen decreases - the bactericidal activity of the pipe cells weakens),
• drainage (violation of the free outflow of fluid from the pipe - leads to the multiplication of bacteria in the middle ear).

The consequence of these processes is a decrease in pressure in the tympanic cavity, leading to suction of the secret from the nasopharynx and the release of a non-inflammatory fluid - transudate.

Also, the cause of eustachitis can be sudden changes in atmospheric pressure - when diving and surfacing divers (mareotitis), ascent and descent of the aircraft (aerootitis).

exudative otitis media(secretory, serous, mucosal otitis media) is a consequence of catarrhal: against the background of dysfunction of the auditory tube, a decrease in general and local immunity, the inflammatory process progresses - inflammatory fluid, or exudate, is intensely secreted into the tympanic cavity. Restoring the ventilation function of the middle ear at this stage will lead to recovery, and if the patient is not helped, the process can take a chronic course, transforming into fibrosing otitis media (a scarring process in the tympanic cavity), leading to a pronounced one.

Acute suppurative otitis media- this is an acute purulent inflammation of the mucous membrane of the tympanic cavity with involvement in the process of other parts of the middle ear. The causative agent of this form of the disease are bacteria. They enter the tympanic cavity more often through the auditory tube - tubogenic way. Through a mastoid wound or injury to the tympanic membrane, the infection can also enter the tympanic cavity - in this case, otitis media is called traumatic. There is a third possible way for infection to enter the middle ear - with blood flow (hematogenous). It is observed relatively rarely and is possible in some infectious diseases (measles, scarlet fever, tuberculosis, typhus).

In acute purulent otitis media, inflammatory changes occur not only in the mucous membrane, but also in. An inflammatory fluid is released, first of a serous, and then of a purulent nature. The mucosa thickens sharply, ulcerations and erosions appear on its surface. At the height of the disease, the tympanic cavity is filled with inflammatory fluid and thickened mucous membrane, and since the drainage function of the tube is impaired, this leads to the bulging of the tympanic membrane outward. If the patient is not assisted at this stage, the tympanic membrane area melts (its perforation), and the contents of the tympanic cavity flow out (this is called otorrhea).

Against the background of treatment, the inflammation subsides, the amount of exudate decreases, suppuration from the ear stops. The hole in the eardrum is scarred, but the patient still feels stuffiness in the affected ear for a long time. The criteria for recovery are the normalization of the picture when examining the ear - otoscopy, plus a complete restoration of hearing.

Why is acute otitis media more common in children?

There are age-related features of the structure of the middle ear, which contribute to a more rapid spread of infection from the nasopharynx to the middle ear. The auditory tube in children is short, wide and located almost horizontally (devoid of the physiological curves characteristic of adults). The tympanic cavity of young children is filled with a special, so-called myxoid, tissue - this is a gelatinous, loose embryonic connective tissue, which is a fertile ground for the development of an infectious process.

In addition to anatomical and physiological features, children are characterized by some pathological conditions that contribute to the development of CCA. First of all, these are (hypertrophic changes in the lymphoid tissue of the nasopharynx) - streptococci and Haemophilus influenzae are often found in them.

Children visiting children's groups are constantly in contact with each other's infectious agents. For one child, a particular pathogen may be conditionally pathogenic and not cause disease, while for another it may be virulent, aggressive and cause inflammation of the upper respiratory tract, from where the process may pass to the middle ear.

Children often suffer from respiratory viral infections, a complication of which may be CCA. In addition, these infections not only weaken the immune system, but also lead to morphological changes in the mucous membrane of the respiratory tract, reducing its immunity (resistance) to potentially dangerous (pathogenic) microflora.

There are so-called transient (physiological) immunodeficiency states that are characteristic of young children - they are also a favorable background for the occurrence of infectious diseases.

Clinical picture of acute otitis media

Often acute otitis media occurs with pronounced symptoms, however, there are also latent otitis media - when the clinical manifestations of the disease are mild.

For CCA, as for any other infectious disease, common symptoms are characteristic:

• general weakness;
• feeling unwell;
• loss of appetite;
• increase in body temperature to febrile figures.

With catarrhal otitis media, patients complain of:

• slight hearing loss - a violation of sound conduction mainly at low frequencies; after swallowing saliva or yawning, hearing temporarily improves;
• resonation of one's voice in a diseased ear - autophony.

Ear pain is usually of low intensity or absent at all.

The course of exudative otitis is usually asymptomatic. The patient notes:

• feeling of pressure, sometimes noise in the ear;
• light autophony;
• some hearing loss.

Pain sensations, as a rule, are absent, and after a while the patient adapts to hearing loss and ceases to notice it.

Acute purulent otitis media can proceed easily and quickly resolve, sluggishly and last for a long time, acutely and violently. Usually it ends with a complete recovery, but sometimes the inflammatory process becomes chronic. In the absence of timely treatment, purulent otitis media can be complicated by mastoiditis, intracranial infectious processes, and even sepsis.

Clinically, during acute purulent otitis media, it is customary to distinguish 3 stages:

• preperforative;
• perforative;
• reparative.

Not necessarily a specific otitis media will go through all 3 stages - already at the initial (pre-perforative) stage, it can be resolved.

1. preperforative stage. The leading complaint of the patient is pain in the ear, especially when lying on the side of the lesion. The pain is pronounced, sharp, shooting, radiating to the temple. Gradually growing, it becomes unbearable, painful, deprives the patient of rest and sleep. There may be pain when touching the mastoid process. Simultaneously with pain sensations, there is a feeling of congestion in the ear, noise in it, and hearing is reduced. The general condition of the patient is disturbed: there are signs of intoxication, the body temperature is elevated to febrile numbers. Duration of the initial stage: 2-3 hours - 2-3 days.
2. The perforative stage is determined by the onset of suppuration from the ear, which arose as a result of perforation of the eardrum. The discharge from the ear is at first abundant, their character is mucopurulent or purulent, often with an admixture of blood. Over time, the amount of secretions decreases, they thicken and become purulent. The patient's condition at this stage improves dramatically: the pain in the ear subsides, the body temperature decreases, sometimes even normalizes. The duration of suppuration is 5-7 days.
3. At the reparative stage, the suppuration of their ear stops, the perforation is scarred, and hearing is gradually restored.

The typical course of acute otitis media is described above, however, in some cases, its clinical manifestations are sharply different from the classical ones.

• Sometimes the disease is extremely difficult: with a sharp deterioration in the general condition, high, up to 40 C, temperature, nausea and vomiting, headache and dizziness.
• In some cases, perforation of the eardrum does not occur, and purulent masses spread from the middle ear into the cranial cavity, causing complications that threaten the life of the patient.
• Otitis can already at the initial stage take an asymptomatic, sluggish, protracted character. In this case, the general symptoms are slightly pronounced, the pain is not intense, the eardrum is not perforated, and thick, viscous pus accumulates in the middle ear cavity.

If the patient's condition does not improve and the temperature does not decrease after perforation of the tympanic membrane, this means that the inflammatory process has moved to the mastoid process - it has developed.

Not stopping in 5-7 days, but lasting up to a month, indicates the accumulation of pus inside the mastoid process, or empyema.

In children of early and preschool age, the diagnosis of acute otitis media can present some difficulties, since the child does not always correctly voice his complaints, and parents and the pediatrician may mistake the child's fever and whims for symptoms of SARS (acute respiratory viral infection).

The child should be referred for a consultation with an ENT in the presence of:

• Severe violations of the general condition of the child;
• 2 sleepless nights;
• severe pain and prolonged fever;
• protrusion of the auricle;
• smoothness of the behind-the-ear fold;
• leakage of fluid from the ear - otorrhea;
• soreness with sudden pressure on the tragus of the diseased ear;
• pain when probing or tapping on the mastoid process.

Diagnosis of acute otitis media

Based on the patient's complaints and the history of the disease, the doctor will only assume the presence of an inflammatory process in the middle ear. Otoscopy will help to confirm or refute this diagnosis - a visual examination of the eardrum using a special device - an otoscope. The tympanic membrane has a form specific to each of the stages of the disease:

• at the stage of acute tubootitis, the membrane is only slightly retracted;
• the exudative stage is characterized by hyperemia (redness) and thickening of the tympanic membrane, and the hyperemia first covers its loose part, then spreading to the entire surface of the membrane;
• the preperforative stage of acute purulent otitis is otoscopically manifested by bright hyperemia and swelling of the tympanic membrane and its bulging into the cavity of the external ear of varying severity;
• at the perforative stage, the presence of a hole in the eardrum is determined, from which serous-purulent, purulent or blood-tinged exudate is released;
• at the reparative stage, the perforation is closed with scar tissue, the tympanic membrane is gray, cloudy.

In order to determine the quality of hearing, a tuning fork study is carried out, the results of which also vary at different stages.

Changes in the general blood test are nonspecific - signs of an inflammatory process are determined (leukocytosis, neutrophilia (if a bacterial infection occurs), an increase in ESR).

A bacterioscopic study of exudate taken from the focus of inflammation will determine the type of pathogen and its sensitivity to antibacterial drugs.

Treatment of acute otitis media

Since a clear staging is determined during acute otitis media, the treatment of this disease is also specific at each stage.

In general, treatment for AOM may include:

• osmotically active analgesics and anti-inflammatory drugs of local action (in the form of ear drops);
• systemic and topical decongestants ();
• systemic antibiotic therapy;
• antihistamines;
• toilet and anemization of the nasal cavity;
• anemization and catheterization of the auditory tube;
• myringotomy and shunting of the tympanic cavity.

In this case, the following are considered ineffective means:

• decongestant therapy in the form of tablets and syrups (taken by mouth) - there is no evidence of their effectiveness, and side effects are common;
• mucolytics (drugs that thin mucus) orally - the same reasons;
• topical antibacterial drugs (in the form of ear drops) - the antimicrobial component of these drugs does not have the desired effect on microorganisms in the tympanic cavity; the use of drugs in this group is justified only at the perforative stage of acute purulent otitis media, since there is a hole in the membrane through which the active substance enters the tympanic cavity. In this case, the prescribed drug should not have an ototoxic effect (antibiotics such as Polymyxin B, Neomycin, Gentamicin have it).

Ear drops

Ear drops in the treatment of acute otitis media are often used. Many patients prescribe them to themselves, which risks causing irreparable harm to their health. Drops containing anti-inflammatory and analgesic components are used only with a whole tympanic membrane, since getting them through a perforated hole into the tympanic cavity can adversely affect the patient's hearing.

For a more accurate introduction of drops, one should use the hand opposite the inflamed ear to slightly pull the auricle up and back - this technique will align the ear canal and the drops will fall exactly to their destination. After instillation, it is necessary to close the ear canal with cotton wool moistened with petroleum jelly for 2-3 hours - in this case, the active agent will not evaporate and will have maximum therapeutic effects.

As mentioned above, antibacterial drops are prescribed only in case of perforated otitis media.

Drops with an antihistamine component in their composition are prescribed to reduce swelling and eliminate a possible allergic factor.

Topical decongestants (xylometazoline, oxymetazoline) are a necessary part of the treatment of AOM, since the dysfunction of the auditory tube develops against the background of edema of the mucous membrane of the upper respiratory tract. It is possible to get used to the drugs of this group, therefore they are prescribed only in short courses - no more than 4-5 days.

Antibacterial therapy

Not all forms of acute otitis media require antibiotic treatment, but treatment with this group of drugs reduces the risk of developing complications of this disease. In the absence of serious symptoms of intoxication, such as vomiting, intense increasing headache, the appointment of an antibiotic can be delayed for 48-72 hours, since AOM often resolves on its own, without their use. Antibiotics are mandatory for all forms of acute otitis media in children under 2 years of age and in patients with immunodeficiencies. First, the antibiotic is prescribed empirically, taking into account the spectrum of typical pathogens of this disease. In the case when the pathogen is laboratory determined and the medicinal substances to which it is most sensitive are known, the drug should be replaced.

At the first stage of CCA, catheterization of the auditory tube is recommended, which should be performed daily. A mixture of naphthyzine solution and a water-soluble corticosteroid, which have a vasoconstrictive and anti-inflammatory effect, is injected through the catheter. Of the medications, the patient may be prescribed topical decongestants.

At the second stage of OSA, some experts recommend the introduction of a thin cotton turunda moistened with osmotol (a mixture of ethyl alcohol 90% and glycerin in a ratio of 1: 1) into the external auditory canal. Turunda must be closed from the outside with a cotton swab with petroleum jelly. This technique prevents the turunda with osmotol from drying out and the effects of this remedy are fully manifested - warming, analgesic, dehydrating. The compress remains in the ear for a day. In parallel with the compress, it is necessary to use vasoconstrictor nasal drops.

At the 3rd stage of the process, catheterization of the auditory tube and microcompresses with osmotol are recommended to the patient. Systemic antibiotic therapy is also indicated. If after 24-48 hours the effect of the treatment is absent, the patient needs a paracentesis or tympanopuncture procedure. Of the medications, the use of strong analgesics (based on paracetamol and ibuprofen) is indicated.

At the perforative stage, local antibacterial drugs in the form of ear drops are added to the preliminary treatment, in addition, the patient continues to receive vasoconstrictor nasal drops and analgesics. Also shown is the catheterization of the auditory tube, a frequent toilet of the external auditory canal.

At the reparative stage of acute otitis, the observation of an ENT is not always necessary. However, if the perforation was large enough, it is important to control the scarring process in order to prevent chronic inflammation.

Otitis media is inflammation and swelling of the ear. It can be chronic or acute, purulent or catarrhal. Most often, this disease occurs in children. According to statistics, approximately 80% of children under 3 years of age have had otitis media at least once.

Manifested by pain in the ear (throbbing, shooting, aching), elevated body temperature, hearing loss, tinnitus, mucopurulent discharge from the external auditory canal.

Otitis media is the most common cause of hearing loss (hearing loss). This disease affects people of all ages, but children are most susceptible to the disease, due to the peculiarities of the anatomical structure of the Eustachian tube.

Causes of otitis media

The inflammatory process at the level of the middle ear is most often secondary. This means that, initially, the infection enters the tympanic cavity from other departments that communicate with it. Secretory otitis media occurs when fluid from a cold or an allergic reaction enters the middle ear through the Eustachian tube.

Depending on the location of the pathological process there are three types of otitis media:

• interior;
• outer;
• otitis media.

The two main causes of otitis media are infection and spread of inflammation from the nasopharynx to the middle ear, as well as ear trauma. Also, the disease can occur due to:

• skin injuries of the external auditory canal;
• after exposure to contaminated water;
• performing surgical operations in the area of ​​the nasopharynx or nasal cavity;
• as a consequence of , ;
• with infectious diseases, kidney disease, hypothermia.

Otitis media can be caused by various pathogenic microorganisms: bacteria, viruses, fungi (otomycosis) and various microbial associations.

Symptoms of otitis media

First of all, otitis media and its symptoms will depend on the form and location of the inflammatory process. The general picture of acute otitis media and its symptoms can be characterized by the following features:

• ear pain is sharp, strong and sometimes unbearable, radiating to the temporal and parietal region;
• hearing loss,
• hyperthermia;
• elevated temperature;

After 1-3 days from the onset of the disease, a rupture forms in the eardrum, suppuration begins. During this period, the temperature drops, the pain decreases, the general condition improves.

With an unfavorable development of the disease, pus can break through not outside, but inside, the cranial cavity, provoking the development of a brain abscess, meningitis and other dangerous diseases.

The symptoms of chronic otitis media are similar, but less pronounced. As a rule, pain is present, hearing loss is more significant than in the acute stage.

Children get sick more often, due to the structural features of the middle ear, and often a purulent process can develop in a day or two. The child often cries, cries out, holds his ear, cannot sleep. In such cases, you should immediately consult a doctor.

Treatment of otitis media

First of all, local treatment of the disease depends on its form. Treatment of otitis should be immediate, in view of the danger of developing serious consequences: the spread of the disease into the space of the skull or the inner ear, which can threaten complete hearing loss.

Subject to timely access to a doctor, the treatment of otitis media is successfully carried out with medications and physiotherapy procedures. For treatment, anti-inflammatory drugs and antibiotics are widely used, as well as antipyretic drugs if the patient has a high temperature. To relieve swelling of the nasal mucosa, vasoconstrictor drops are necessarily instilled.

If the tympanic cavity does not drain on its own within the first three days, a dissection of the tympanic membrane is indicated.

In general, the home treatment regimen for otitis media consists of the following components:

• bed rest;
• nasal vasoconstrictors;
• antimicrobials;
• antibacterial agents;
• physiotherapy treatment;
• warm compresses;
• vitamins.

Acute purulent otitis requires the use of antibiotic therapy, as well as the evacuation of pus from the middle ear cavity. After completing the main course, the patient is prescribed restorative and resolving therapy. Treatment of chronic otitis media also consists of anti-inflammatory and antibacterial therapy, with enhanced immunocorrection.

It should be noted that the treatment of otitis at home should be carried out only with the permission of an otolaryngologist. Do not self-medicate. In cases where conservative methods do not help, they resort to a surgical operation.

Ear drops for otitis media

The use of any of these drugs is allowed only after receiving appropriate advice from a doctor.

1. Garazon, Sofradex, Dexon, Anauran - glucocorticosteroid drops;
2. Otinum, Otipaks - anti-inflammatory drops;
3. Otofa, Tsipromed, Normax, Fugentin - antibacterial drops.

To achieve the maximum therapeutic effect, it is recommended to combine the use of drops with antibiotics, they should be prescribed by a specialist after the diagnosis is established.

The main preventive measures of otitis in children and adults are the prevention and timely treatment of inflammatory diseases of the nose and nasopharynx, chronic diseases of the nose, paranasal sinuses. Properly carry out the toilet of the nose.

Otitis is an infectious and inflammatory process that can affect absolutely all parts of the ear. It is one of the most well-known pathologies in the practice of ENT doctors, accompanied by discomfort and can even cause hearing loss. Therefore, the question of how to treat acute otitis media in adults is relevant for many patients.

The nature of the disease

This is an ailment that affects the ears. At the time of malaise, an active inflammatory process develops, which causes discomfort. The human ear does not end only at the auricle, through which you can pick up sounds. This organ is considered quite complex, because all its main elements are located deep in the head. It is divided into outer, inner and middle. Each of these lobes can undergo an inflammatory process.

Otitis is a rather serious disease. All dangerous complications develop when timely treatment is not carried out. Activities should be performed only under the supervision of an otolaryngologist. If self-medication is present, then the disease can become chronic or even fatal.

Classification

Otitis in adults manifests itself in different ways and includes a large group of ear diseases. Depending on the speed and duration of the course of the disease, the following stages are observed:

• acute;
• chronic.

According to localization, diseases can be divided into three forms:

• external - this is an inflammatory process of the skin in the auricle or auditory external passage, manifested in the form of eczema, dermatitis, erysipelas, furunculosis and sulfur plug;
• medium - is considered the most common form and occurs after infectious colds as a complication;
• internal is an inflammatory process that forms in the inner ear.

By the nature of the manifestation, the disease is divided into:

• purulent - in the course of its course, many putrefactive deposits are formed;
• catarrhal - characterized by hyperemia and edema, during which the vessels overflow with blood;
• exudative - proceeds with the formation of effusions.

Depending on the occurrence, they are distinguished:

• bacterial;
• traumatic;
• viral.

The reasons

Contrary to popular belief, acute otitis in adults is most often not associated with exposure to drafts, hypothermia, water in the ear and walking in the cold season without a hat.

Most often, such an ailment develops due to the ingress of various pathogenic viruses and bacteria into the ear area during:

• inflammatory diseases of the ENT organs, directly through the auditory tube;
• improper blowing of the nose, which is performed immediately with two nostrils and during this period the contents of the nose enter the area of ​​​​inflammation;
• infectious diseases (ARVI, influenza, measles, scarlet fever) with blood flow.

In addition, acute otitis media in adults can develop if air is obstructed due to:

• the presence of adenoids, which are enlarged tissue of the pharyngeal tonsil;
• sharp curvature of the partitions;
• expansion of the posterior ends of the nasal conchas;
• at the time of trauma to the eardrum, under the influence of which an infection enters the middle ear from the external environment, it is also called post-traumatic otitis media.

Acute appears during the period of inflammatory processes, which significantly cover the subcutaneous layers of the outer ear and skin. The main cause of the disease may be infection of the nasopharynx with bacteria or fungi, which are obtained as a result of:

• improper manipulations in hygiene, which are carried out at home;
• injuries;
• ingress of chemicals and foreign objects;
• burns.

Symptoms of acute otitis media in adults

The disease is characterized by the following symptoms:

• the appearance of several or one boils at the site of injury;
• swelling of the outer ear;
• a significant increase in temperature, not lower than 38;
• pain sensations;
• enlargement of the lymph nodes.

The symptoms of such a disease can be quite diverse and manifest in a different form. One of the main signs of pathology is the appearance of noise, congestion and pain in the affected organ. The ailment may not be strong, but it may manifest itself painfully, and even be felt deep in the ear, spread in the temporal or occipital region, sometimes reflected in the teeth. It should be noted that in this case, the toothache can manifest itself so sharply and significantly that the patient does not think about other symptoms and goes directly to the dentist. Such sensations disturb the patient's sleep, can be stabbing, throbbing and aching in nature, and become more significant at the time of blowing your nose, sneezing, swallowing and coughing.

There are additional symptoms in which it is necessary to begin treatment of acute otitis media in adults:

• hearing loss;
• an increase in lymph nodes, which provoke soreness;

All of the above signs can exist both on the side of both ears (bilateral) and one of them (unilateral).

Such an ailment is often accompanied by the main signs of intoxication, namely a sharp increase in temperature and general malaise. And also reactions from the nasopharynx can be observed:

• nasal congestion and discharge from it;
• pain and sore throat.

stages

This disease can proceed in different ways, so it is classified into several stages.

Catarrhal otitis is considered the initial stage of the disease and is expressed by the following symptoms:

• stuffy ear;
• significant deterioration in general well-being;
• severe pain in the affected organ.

On examination, the doctor observes:

• the auricle is painless;
• a wide external auditory meatus is visible;
• fluid in the eardrum does not collect.

If it is not correct to treat acute otitis media in adults at this stage, then it can be ensured that it turns into a purulent form, and this is a serious indication for hospitalization.

Such inflammation, in turn, can be divided into two types.

1. The preperforative stage corresponds to a condition in which, in terms of the integrity of the tympanic membrane, a significant amount of pus accumulates in the middle ear cavity as a result of an increasing inflammatory process. It is characterized by the following symptoms:

• increased ear and headache;
• hearing worsens in the affected area;
• there is a significant congestion of the ear and noise in it.

To diagnose the stage at the time of the examination, the doctor does not observe the outgoing discharge, and a purulent discharge is visible behind the red eardrum.

2. The perforative stage is a lesion of the middle part of the organ of hearing, in which, if you do not know how to treat acute otitis media for an adult and start it, the following signs will appear:

• significant suppuration is formed;
• due to the fact that strong pressure is formed, a complete rupture of the eardrum occurs inside the ear cavity
• after all the contents flow out, the intensity of the pain gradually decreases.

When examined by a specialist, there is a lack of integrity of the tympanic membrane and there are purulent masses in the ear canal, which perfectly flow through the perforation at the time of blowing out the ears.

Diagnostics

Often, other ailments are hidden under the symptoms of otitis media, so it is not recommended to self-treat. Only an otolaryngologist can accurately establish the diagnosis. In order to set a verdict, the specialist performs a survey of the patient and examines the ear of his patient. Most often, the information and history obtained during the physiological examination is sufficient to identify the presence of acute otitis media in adults. Treatment of pathology is prescribed only after the formation of an accurate diagnosis.

If the signs are not expressed, then the doctor will definitely send for additional studies.

1. To diagnose otitis externa, otoscopy, pneumonic otoscopy and otomicroscopy are used - these are the main ways to examine the external auditory canal and tympanic membrane using special medical instruments.
2. To confirm otitis media, tympanometry is used - this is a special test for the mobility of the eardrum and the patency of the auditory ossicles. Acoustic reflectometry is also performed - to register the intra-ear muscles for sound stimulation. Computed and magnetic resonance imaging is done only if there is a suspicion of the formation of intracranial or purulent complications.
3. To detect otitis media, various hearing tests are used to check the functioning of the nerve that is directed to the brain directly from the inner ear. Electronystamography is done to register rhythmic or arrhythmic movements of the eyeballs. Computed or magnetic resonance imaging to detect various pathologies of the brain.

Treatment

Acute otitis in adults is a common problem. Therefore, for its treatment, you need to use the right methods.

Often used vasoconstrictor drops in the nose, as they can reduce swelling of the mucous membrane of the Eustachian tube. Such drugs include Galazolin, Naphthyzin, Nazol and many others, they simply become mandatory if a pathology is suspected.

Antiseptic solutions are injected locally into the ear canal. Not so long ago, boric acid was used for this purpose, and now our doctors often use it. Although in other countries, more modern and effective drugs are used to treat acute otitis media in adults. It happens that with significant pain, special drops are used that cause anesthesia, and anti-inflammatory hormones are also used. Today, there are a lot of drugs that are instilled into the ear. The most popular of them are Otinum, Otipax, Sofradex, Garazon and dozens of other drugs.

Antibacterial components play a special role in therapy, therefore sulfonamides and antibiotics are often used in the treatment of acute otitis media in adults. These include - "Amoxicillin", "Cefuroxime", "Ceftriaxone" and "Azithromycin". The use of such funds has a number of features. The drug should not only act on bacteria, but also seep well into the tympanic cavity.

The above methods of treatment can in no case be taken into account as a regimen for therapy. This must be done by a doctor who has a good qualification. It must be remembered that with timely and proper treatment of acute otitis media in adults, the disease ends quickly enough and most often does not form hearing loss. If you delay therapy or self-medicate, then this can result in serious problems. The most innocuous if such otitis becomes chronic, and a bad option is complete hearing loss and purulent meningitis.

There is no need to be very worried if suppuration begins to appear from the ear, since with proper therapy a small scar forms at the site of the rupture of the tympanic membrane, which almost never leads to hearing loss in the future.

The procedure for the treatment of acute otitis media in adults:

• immediately seek advice from an otolaryngologist;
• when this is not possible, it is allowed to independently use vasoconstrictors in the nose, which perfectly relieve swelling, and to drip the above drops into the ear, which, in addition to the anti-inflammatory effect, can perfectly dissolve earwax;
• it is important that the ear is in dry heat, for this cotton wool is put into it, and then a scarf or cap is put on;
• you need to know that it is not allowed to apply hot heating pads.

ethnoscience

In addition to the use of drugs in the treatment of acute otitis media in adults, recipes are also used that can be prepared independently at home.

1. Onion with oil - these components are used in the purulent course of the disease. To do this, you need to prepare a gruel or squeeze the juice from the onion and add a small amount of butter or linseed oil there. Freshly prepared mass is introduced along with a swab into the ear.
2. Chamomile is used to treat acute middle in adults. To do this, the nose is washed with a warm solution from it. For cooking, you need 1 tsp. dry ingredient per cup of boiling water. Let it brew well and strain. If the pain is very strong, it is undoubtedly necessary to go to the doctor, since the inflammatory process quickly passes to the periosteum and causes damage to the meninges.
3. For the treatment of acute purulent otitis in adults, a collection of wild angelica, peppermint, coconut lavender, 3 tbsp is also used. l., medicinal sweet clover - 2 tbsp. l., ivy-shaped burda - 1 tbsp. l. (it is important to know that the last ingredient is a poison, so you should not overdo it). The prepared mixture is poured into 0.5 liters of boiling water or infused with vodka. After preparation, a swab is wetted in a liquid and inserted into a sore ear. It also helps a lot if there is a hearing loss.
4. Juice from walnut leaves is instilled 3 drops into each ear with purulent otitis media.
5. Chamomile flowers and sweet clover help in the treatment of acute middle in adults. To do this, you need to take in the same parts 2 tbsp. l. collection and steam with 1 glass of hot water, after insist 30 minutes and filter. In the infusion, moisten the cloth and squeeze a little, apply as a compress.
6. Mix oak bark, calamus rhizome, cinquefoil erect root and thyme. For infusion, you need 2 tbsp. l. wrap the collection in a cloth and put in a glass of boiling water for 4 minutes, then squeeze. Such poultices are required to be performed 3-4 times a day.
7. The juice of fresh basil leaves is instilled 7-10 drops a couple of times a day.
8. You need to prepare 2 tbsp. l. rhizomes of the burnet officinalis and pour it with 2 cups of boiling water, warm it in a water bath for 30 minutes, and then insist for 15 minutes. Use 3-4 times a day for 1 tbsp. l. with purulent flow.

Complications

If the symptoms of acute otitis in adults are not properly treated, then this form can become chronic. The neglected stage leads to a partial or complete defect of the tympanic membrane and periodically renewed or continuous discharge of pus from the ear. In the end, the patient's hearing is reduced.

Complications are not so common, many quickly and promptly turn to the doctor for help, as they understand how important such treatment is. If the disease is allowed to take its course, the following problems may arise:

• choleostomy, tissue growth behind the eardrum, resulting in hearing impairment;
• destruction of the middle ear, namely the hammer, anvil and stirrup;
• mastoiditis is an inflammatory lesion in the temporal bone of the mastoid process;
• it usually takes about two weeks for such a wound to heal.

The above complications are not as dangerous as intracranial ones can become. If you do not know how to treat acute otitis media in adults, then this can even lead to a brain abscess, meningitis, focal encephalitis and hydrocephalus. Such problems are very rare, but they do happen and are considered extremely dangerous. Complications that affect the brain can be fatal.

In order for the treatment to be successful, it is necessary to observe bed rest. Adults and busy people need at least a couple of days to be at home on sick leave and not go to sports training. Both physical and mental peace are very important, as this contributes to recovery.

All doctor's advice must be followed and strictly followed. You can’t personally prescribe pharmaceutical preparations for yourself, the only thing that is allowed is to use drops for acute otitis media in adults like Otipax, as they will significantly improve the condition and help you get to the doctor with less pain. It is not allowed to stop taking the drugs after the disappearance of the symptoms of the disease without a doctor's prescription. It is also recommended to drink a Paracetamol tablet before going to him, as it will not harm your health. This drug is effective and has few contraindications.

Prevention

The best defense is always an attack. Therefore, the use of preventive measures, after the disease has been cured, is necessary.

According to experts, if you follow the recommendations, you can reduce the risk of otitis media again to a minimum:

• it is required to avoid getting water into the ears, if this cannot be done, then they need to be dried well;
• when cleaning the ears, it is forbidden to remove all the sulfur, you need to leave at least a little, as it is a protector from infection;
• be sure to observe personal hygiene and at the slightest discomfort in the ears, you need to contact an otolaryngologist, because even a small problem can develop into a global one.

It should be noted that with timely treatment, otitis media is not a big deal. You should not self-medicate, because without special equipment and knowledge it is impossible to assess the level of the problem. It is, of course, recommended to use folk remedies, but only as an addition to the main drug therapy.

Some patients feel a "transfusion of water in the ear" when changing the position of the head. There is also a change in hearing. Pain in the ear is minor, often absent. Otoscopy shows retraction of the tympanic membrane, its unsharp hyperemia. If present in the tympanic cavity, it is yellowish, rarely greenish. Sometimes otoscopy shows the level of fluid in the tympanic cavity. Treatment: vasoconstrictor drugs (2-3% solution, 0.1% adrenaline solution, 1-3% cocaine solution, sanorin) in, (see), UVR through a tube,. With prolonged processes, paracentesis is performed (see).

Acute suppurative otitis media. It develops as a result of infection penetration mainly through the auditory (Eustachian) tube or hematogenous route. Symptoms: in the first stage, severe pain in the ear, radiating to the teeth, head; ear congestion, hearing loss. Often the temperature rises (up to 38-38.5 °, in children up to 40 °). In debilitated patients, it can proceed with a normal temperature. At an otoscopy (see) the tympanic membrane is hyperemic, contours are smoothed. At the end of this stage, a protrusion of the eardrum appears. After the appearance of suppuration (spontaneous rupture of the eardrum or paracentesis), the second stage begins. Pain in the ear subsides, the general condition improves, the temperature returns to normal. Pus is visible in the external auditory canal (odorless, often with an admixture of mucus). The protrusion of the tympanic membrane decreases, but hyperemia, smoothness of the contours remain. The third stage is characterized by the cessation of suppuration. The leading complaint is hearing loss. The tympanic membrane gradually assumes a normal appearance. Treatment: at all stages, the measures recommended for acute catarrh are carried out. In the first stage, in addition, you can use 5% carbolic-glycerin drops in the ear (stop as soon as suppuration from the ear appears), swabs with alcohol. Inside appoint acetylsalicylic acid, analgin. In the second stage - a thorough systematic toilet of the external auditory canal (dry cleaning or washing with weak disinfectant solutions - boric acid 2% solution, - 0.02% solution). In the third stage, it is necessary to blow out the tympanic membrane, UHF on the ear area until hearing is normalized. In the presence of pronounced general phenomena, antibiotics are used.

A complication of acute purulent otitis media is (see). In young children, during the transition of the process to the tympanic cave, anthrite develops (otoanthritis, otitis-anthritis). In weakened children, anthrite proceeds latently. Local symptoms are mild. The general symptoms are pronounced sharply: the child is drowsy or, conversely, restless, often cries, sleeps poorly, lacks appetite, weight falls quickly, the skin is pale gray or cyanotic, muffled, quickened, the stool is liquid, the temperature is increased to 38-39 °, but often subfebrile or even normal. Treatment: hospitalization of the patient, in the absence of the effect of conservative treatment, anthrotomy is performed (see Mastoidectomy).

Rice. 4 - 8. Acute otitis media: fig. 4 - transudate in the tympanic cavity; rice. 5 - the initial period of the disease, the injection of blood vessels along the handle of the malleus; rice. 6 - radial injection of vessels of the tympanic membrane; rice. 7 - diffuse hyperemia of the tympanic membrane, a sharp protrusion of the upper posterior quadrant; rice. 8 - papillary protrusion of the upper posterior quadrant of the tympanic membrane. Rice. 9. Residual changes in the tympanic membrane after acute otitis media: scars, petrifications.

Acute catarrhal otitis media, or catarrh of the auditory (Eustachian) tube (otitis media catarrhalis, catarrhus tubae auditivae), usually develops when inflammation of the nasal mucosa and nasopharynx spreads to the auditory tube. The lumen of the tube decreases or closes and the flow of air into the middle ear becomes difficult or completely stops. Part of the air (oxygen) present in the middle ear is absorbed, the pressure in it drops, there is a rush of blood to the vessels of the mucous membrane (hyperemia ex vacuo) with the formation of an effusion - transudate (printing. Fig. 4) and retraction of the eardrum.

Symptoms. Congestion, noise in the ear, hearing loss, heaviness in the head and an unpleasant sensation due to the strong sound of one's own voice (autophony). Sometimes it seems to patients that water has got into the ear, because when the position of the head changes, the transudate moves and they feel, as it were, a “transfusion of water” in the ear. Pain is minor, only tingling is observed. The temperature is normal or slightly elevated. Otoscopy - the eardrum is retracted, its color depends on the color of the translucent transudate - greenish, reddish, etc.

Treatment. Vasoconstrictor nasal drops and ear blowing. If the transudate or exudate in the middle ear does not disappear and hearing does not improve, an incision in the eardrum (paracentesis) should be made, which opens the exit to the exudate.

Acute suppurative otitis media(otitis media purulenta acuta) usually develops as a result of infection entering the middle ear through the auditory tube. The hematogenous route of infection occurs only occasionally in some severe infectious diseases. The most common pathogens are hemolytic streptococcus, pneumococcus. Morphological changes in the tympanic cavity affect the hyperemia of the mucous membrane, infiltration and exudation. The eardrum becomes red, thickened; in its own and mucous layers, destructive changes occur, leading to its softening.

Symptoms. Ear pain, fever, hearing loss, tympanic membrane hyperemia. The pain in the ear is usually severe, stitching, shooting, throbbing; radiates to the crown, teeth; at the height of the disease, when the cavity is filled with exudate, it becomes unbearable. The results of otoscopy (printing. Fig. 5-8): at the beginning of the disease, hyperemia in the upper-posterior quadrant of the tympanic membrane, injected vessels on the handle of the malleus; in the future, hyperemia becomes diffuse; details of the membrane are not distinguishable. The membrane protrudes outward due to its infiltration and exudate pressure. The tympanic membrane, changed under the influence of the inflammatory process, breaks due to the pressure of the exudate and discharge from the ear (otorrhoea) appears. At first they are liquid, serous-bloody, then they become mucopurulent and thicker. With the growth of granulation in the middle ear, as well as with influenza otitis media, there is an admixture of blood. Significant suppuration usually lasts 6-7 days, then it decreases and stops. The eardrum returns to normal and hearing is restored.

Diagnosis. In typical cases, diagnosis is fairly easy. Often, the symptoms of acute otitis media are blurred or even absent; the disease does not have an acute onset, proceeds without obvious changes in the tympanic membrane, without pain, perforation and suppuration. Such an atypical course of the disease may be due to the properties of the infection, a decrease in general and local reactivity, and irrational antibiotic therapy. The diagnosis in such cases is made on the basis of clinical observation and radiography of the temporal bones. A slight increase in temperature and chilling, cloudiness of the eardrum and blurring of its contours should be considered as a possible manifestation of atypical otitis media.

Differential diagnosis between otitis externa and otitis media is carried out according to the following criteria: with otitis externa, the discharge is purely purulent, there is no mucus impurities; hearing loss is typical for otitis media; for external - pain when touching the walls of the ear canal, when pulling on the auricle, especially when pressing on the tragus, when chewing; pulsation of pus in the ear is characteristic of otitis media.

Forecast. Recovery with full restoration of hearing is the most common outcome of acute otitis media. However, there are other outcomes: in the tympanic cavity, adhesions and adhesions are formed between the tympanic membrane and the wall of the cavity, between the bones; scars are visible on the eardrum, white spots, which are deposits of lime salts - petrificates (printing table, Fig. 9). Sometimes perforation remains persistent, suppuration periodically resumes and otitis media takes a chronic course. Acute otitis can be complicated by mastoiditis (see). Threatening complications of acute otitis include labyrinthitis, meningitis, sepsis.

Treatment. To alleviate pain (until pus appears), drops are poured into the external auditory canal (Ac. carbolici crystallisati 0.5; Cocaini 0.3; Glycerini 10.0) or cotton swabs soaked in 5% boric alcohol are inserted deep into the auditory canal (3 -4 times a day). Heat is successfully used in various forms. Sulfa drugs and antibiotics are of primary importance. The condition for their successful action is the sensitivity of the otitis flora to them. With rational antibiotic therapy, in some cases, acute otitis media takes an abortive course - ends in a few days without the formation of perforation and suppuration.

If after several days of treatment there is no improvement or the phenomena increase, paracentesis is performed (see), which is urgently indicated when signs of irritation of the inner ear or meninges appear. After paracentesis or self-perforation, it is necessary to ensure the outflow of pus from the middle ear: drain the ear canal with sterile gauze swabs 2-3 times a day or wash the ear with a warm solution of boric acid. With a thick consistency of mucopurulent discharge, a 3% solution of hydrogen peroxide is poured into the ear (8-10 drops each) and left there for 10-15 minutes, the resulting foam helps to remove thick or dried pus. Boric alcohol is advisable to prescribe when otitis media passes into the subacute stage. If, after the cessation of suppuration, hearing is not restored, the ear is blown (see) and pneumomassage (see) of the tympanic membrane.

Prevention: restoration of normal nasal breathing, sanitation of the nose and nasopharynx, treatment of purulent sinusitis. The removal of adenoid growths plays an important role, since they often cover the pharyngeal mouths of the auditory tubes and are a source of infection of the middle ear.