Chronic purulent otitis media of the middle ear

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Acute purulent otitis media

Acute purulent otitis media (otitis media purulenta acuta) is an acute purulent inflammation of the mucous membrane of the tympanic cavity, in which all parts of the middle ear are involved to one degree or another in catarrhal inflammation.

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This disease has some symptoms similar to the common cold. So, otitis media is also characterized by fever and headache.

In addition, otitis often occurs simultaneously with colds. But there are other symptoms characteristic of otitis media that indicate the development of an inflammatory process in the ear.

You can “survive a cold” without resorting to the help of doctors, but if signs of otitis media appear, you should seek help from an otolaryngologist. Because if you do not start timely treatment of purulent otitis media in adults, this disease can lead to a noticeable decrease in hearing and even cause the development of meningitis.

Causes

The cause of the disease is a combination of factors such as a decrease in local and general resistance and infection in the tympanic cavity. Purulent otitis media occurs as a result of inflammation of the auricle, affecting the middle ear cavity, mucous membrane and eardrum.

Causes of purulent otitis media:

  • entry of bacteria, viruses, fungi into the auricle;
  • complications of diseases of the nose, sinuses, nasopharynx;
  • severe ear bruise;
  • sepsis;
  • consequences of meningitis, measles, tuberculosis;
  • hypothermia.

The most common route of infection is tubogenic - through the auditory tube. Less commonly, the infection enters the middle ear through a damaged eardrum due to injury or through a wound to the mastoid process. In this case, they talk about traumatic otitis media.

Symptoms of purulent otitis media

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

Traditional symptoms of otitis media:

  • throbbing pain in the ear area;
  • pain behind the ear;
  • heat;
  • chills;
  • extraneous noise in the ear;
  • decreased audibility.

These signs are characteristic of the initial stage of the disease, when inflammation causes extensive suppuration. Typically this process lasts 2-3 days. Next, acute purulent otitis of the middle ear passes into the phase of perforated damage to the eardrum, as a result of which pus flows out of the ear cavity through the formed hole in the eardrum, and the patient experiences significant relief and pain is reduced.

The third stage is the final stage, the body fights the infection, inflammation gradually decreases, pus ceases to be released, and the eardrum restores its integrity.

Signs of otitis media in a child

Each stage of the disease is characterized by certain symptoms.

Symptoms of purulent otitis in a child of the 1st stage:

Stage 2 symptoms:

  • the temperature drops;
  • the pain subsides;
  • hearing loss continues;
  • Purulent discharge begins to come out of the ear.

Stage 3 symptoms:

  • the temperature drops;
  • the pain disappears;
  • hearing is restored;
  • the discharge stops;
  • the perforation of the eardrum heals.

This disease requires early diagnosis and antibiotic therapy.

Chronic purulent otitis media

This is an inflammation of the middle ear, which is characterized by recurrent flow of pus from the ear cavity, persistent perforation of the eardrum and progressive hearing loss (hearing loss can reach 10-50%).

This otitis is manifested by the following clinical picture:

  1. Constant purulent discharge from the ear with a putrid odor;
  2. Noise in the affected ear;
  3. Hearing impairment.

It develops when acute otitis is treated untimely or inadequately. It can be a complication of chronic rhinitis, sinusitis, etc., or a consequence of a traumatic rupture of the eardrum. Chronic otitis affects 0.8-1% of the population. In more than 50% of cases, the disease begins to develop in childhood.

Chronic purulent otitis media without bone destruction and complications can be treated with medications under the outpatient supervision of an otolaryngologist.

Complications

Lack of suitable treatment leads to irreparable damage to health. The consequences of otitis media in adults are the result of a structural transition of further inflammation into the temporal bone or inside the skull.

Complications may include:

  • violation of the integrity of the eardrum;
  • mastoiditis – inflammation of cells in the bone;
  • facial nerve paralysis.
  • meningitis - inflammation of the lining of the brain;
  • encephalitis - inflammation of the brain;
  • hydrocephalus - accumulation of fluid in the cerebral cortex.

To avoid these unpleasant diseases, you need to know how to treat purulent otitis media in adults.

Treatment regimen for acute purulent otitis media

In adults, treatment of purulent otitis media includes the following procedures and medications:

  • antibiotics;
  • painkillers, antipyretics;
  • vasoconstrictor ear drops;
  • heat compresses (until pus appears);
  • physiotherapy (UHF, electrophoresis);
  • antihistamines;
  • surgical cleaning of the ear canal from pus.

It should be noted that after the appearance of purulent discharge, warming procedures should under no circumstances be performed. If the disease is chronic, puncture or dissection of the eardrum may be required.

How to treat purulent otitis media in adults

Diagnosis is usually not difficult. The diagnosis is made based on complaints and the results of otoscopy (visual examination of the ear cavity using a special instrument). If a destructive process in bone tissue is suspected, an x-ray of the temporal bone is performed.

Purulent otitis in adults requires outpatient treatment; at high temperatures in combination with fever, it is recommended to remain in bed. Hospitalization is required if a mastoid lesion is suspected.

To reduce pain in the initial stages of the disease, use:

  • paracetamol (one tablet 4 times a day);
  • Otipax ear drops (twice a day, 4 drops);
  • tampon according to Tsitovich (a gauze swab soaked in a solution of boric acid and glycerin is inserted into the ear canal for three hours).
To relieve swelling in the tissues of the auditory tube, the following is prescribed:

Antibiotics used for purulent otitis media:

If after several days of treatment there is no improvement or the symptoms worsen, surgical treatment is performed; it 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.

Good to know:

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Otitis media: symptoms and treatment

3 comments

We somehow ended up using aerosols to wash the baby’s otitis media when they were trying to cure his runny nose. Now we only spray Morenazal, since it is dosed, a certain amount of medicine gets into the nose immediately and the bottle lasts for a very long time!

I am 70 years old, since childhood I was diagnosed with purulent otitis with perforation of the eardrum, at first they simply diagnosed otitis, they did not offer treatment, now it is purulent otitis, they do not offer surgery. Medicines: Peroxide, sometimes antibiotics, Normax. It is not possible to visit a doctor frequently due to the distance. What medications can I suggest? After a mini-stroke I take vinpocetine and betahistine

I am 70 years old. As a child, I suffered an injury to the eardrum, followed by otitis media, then with purulent otitis media. The inflammation is constant, there is no hearing, surgery is not offered. Medicines: peroxide, antibiotics, normax. Visits to the doctor are not frequent due to the remote location. I suffered a mini-stroke - the medication vinpocetine betahistine. What else can you do to help?

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Chronic suppurative otitis media

  • What is Chronic suppurative otitis media
  • What causes chronic suppurative otitis media
  • Symptoms of Chronic suppurative otitis media
  • Diagnosis of Chronic purulent otitis media
  • Treatment of chronic suppurative otitis media
  • Which doctors should you contact if you have Chronic suppurative otitis media?

What is Chronic suppurative otitis media

Chronic suppurative otitis media is a form of inflammation of the middle ear that has 3 signs: persistent perforation, constant or periodic suppuration and progressive hearing loss.

Prevalence. A very common disease, especially in children. It occurs in approximately 1% of schoolchildren. More accurate data were obtained during examination of pre-conscription conscripts at age, among them this figure reaches 3-4%. More than half of adults suffered from otitis media in childhood.

In the structure of causes of persistent hearing loss in children associated with damage to the sound-conducting apparatus, chronic purulent otitis media occupies about 60-70%; In approximately 80% of children, the onset of the disease is associated with ARVI, in 5-7% - with other childhood infections.

What causes chronic suppurative otitis media

In most cases, chronic purulent otitis media is a consequence of acute inflammation of the middle ear. There are general and local reasons that contribute to this development of the process.

  • high virulence of microflora represented by hemolytic streptococcus, Proteus, Pseudomonas aeruginosa, anaerobes (severe general infections), staphylococcal or atypical bacteria (chlamydia, mycoplasma);
  • malnutrition, severe vitamin deficiencies;
  • genetic predisposition (heredity factor);
  • allergies, decreased immunoreactivity of the body;
  • chronic diseases of the respiratory tract and gastrointestinal tract;
  • irrational treatment of acute otitis media;
  • frequent acute inflammation of the middle ear.
  • dysfunction of the auditory tube;
  • adenoid vegetations in the nasopharynx;
  • chronic inflammatory diseases of the nose and paranasal sinuses, nasal polyposis;
  • hypertrophy of the posterior and anterior ends of the inferior turbinates, leading to tubo-otitis and deterioration of the function of the auditory tube;
  • anatomical features of the structure of the middle ear in children: poor communication between the attic (epitympanum) and the cells of the mastoid process due to a block of the mastoid cave, easily occurring swelling of the mucous membrane, many folds, pockets of the mucous membrane, worsening drainage I outflow of pus from the middle ear in acute otitis;
  • poor pneumatization of the mastoid process, its spongy or sclerotic type;
  • a close vascular connection in the child’s ear between the mucous membrane and the bone marrow cavities, which leads to the development of osteomyelitis.

Symptoms of Chronic suppurative otitis media

Chronic purulent otitis media can occur in two forms: in a relatively favorable form - mesotympanitis (about half of the cases) and in a more severe form - epitympanitis (about 20% of diseases), the remaining 30% are in a mixed form - epimesotympanitis.

With mesotympantomy, the pathological process affects only the mucous membrane of the middle ear; with epitympantomy, bone tissue is involved. In this regard, it is very important to differentiate these two forms of chronic inflammation of the middle ear.

The disease occurs in two variants. In the first, the only symptoms of a chronic process are constant dry perforation of the eardrum and persistent hearing loss.

Periodically, usually after an infectious disease or infection of the tympanic cavity through a perforation (mainly when water gets in), an exacerbation occurs with fever, pain in the ear, symptoms of general intoxication, the appearance of discharge, hyperemia of the remnants of the tympanic membrane, sometimes with neurological symptoms.

In the second option, children with good general condition constantly have purulent or mucous discharge from the ear. Exacerbations in these children are accompanied by general symptoms (fever, headache, signs of intoxication) and increased discharge from the ear, accompanied by pain.

Complications. With chronic purulent otitis media, intracranial complications are possible. Such complications can also develop with acute otitis media. In case of intracranial complications, urgent surgical treatment of the ear is necessary to sanitize the lesion. Without surgery, a child can die, and often does, despite active antibacterial and other therapy.

Diagnosis of Chronic purulent otitis media

Anamnesis. At the first meeting with a sick child, it is not always possible to establish the chronicity of the process. For differential diagnosis with recurrent or protracted acute otitis media, the history must be collected especially carefully. Find out information about previous diseases. Egagaspanti most often stings in cases of scarlet fever, diphtheria or measles, as well as after the flu. To some extent, the severity of the disease is also indicated by the frequency of relapses of otitis, the duration and persistence of suppuration. It is important to find out how often exacerbations occur, whether they are accompanied by fever, signs of intoxication, severe pain in the ear, neurological symptoms (headache, dizziness, static disturbances, etc.).

They find out how the child was treated during periods of exacerbation and remission, in a clinic or in a hospital, and whether surgical intervention was previously offered. The results of previous hearing studies (audiograms), x-rays of the temporal bones and data on the composition of the microflora are of great importance.

Otoscopy. The perforation hole in chronic purulent otitis media can be of various shapes (round, kidney-shaped, etc.) and size. The main thing for the differential diagnosis of meso- and epitympanitis is the preservation of the edges of the eardrum. If there is an edge, the perforation is called central and is characteristic of mesotympanitis. If this edge is absent and the perforation reaches the tympanic ring, it is called marginal and is typical for epitympanitis.

The nature of the discharge. Mesotympanitis causes mucous discharge, often quite abundant, but odorless. If bone tissue is involved in the process, the discharge becomes more scanty, thick, and has an ichorous odor due to the onset of osteomyelitis. The amount of discharge from the ear is not of great importance for diagnosis, although with mesotympanitis with perforation located in the lower sections near the mouth of the auditory tube, they become very abundant. This form of mesotympanitis is even classified as chronic tubootitis.

Pathological changes in tissue. The osteomyelitic process in epitympanitis is often accompanied by the development of granulations. In this case, they are sometimes even visible through the perforation, and blood appears in the discharge from the ear. Granulations can protrude through this opening into the external auditory canal and take on the appearance of a polyp.

Ear polyps, although less common, can also form during mesotympanitis due to constant irritation of the mucous membrane of the tympanic cavity with pus.

Particular attention should be paid to the formation of a peculiar tumor-like formation during epitympanitis, which is called cholesteatoma. Among all children treated for chronic otitis, it occurs in 20-30% of cases, and in boys it is 2 times more likely. The pathogenesis is not fully understood.

Numerous theories (tumor, epiblastic, devascular, migration, inflammatory, etc.) do not fully explain the mechanism of its development. Some authors attach the main importance to heredity and believe that cholesteatoma occurs as a result of metaplasia of the epithelium of the middle ear with certain anatomical features. Others believe that cholesteatoma is the result of growth of the epithelium of the external auditory canal into the tympanic cavity with marginal perforation and the absence of a mechanical barrier in the form of remnants of the tympanic membrane.

Cholesteatoma masses are saturated with cholesterol, waste products of microorganisms, desquamated epithelium and due to the constant growth of the cholesteatoma matrix shell), atrophy and destruction (lysis) of individual sections of the temporal bone occur (it was even called “bone-eater”). This is the main danger of cholesteatoma. With mesotympanitis, cholesteatomas are rare (in approximately 3-5% of cases). Diagnosing cholesteatoma is not always easy. In older children, you can try to probe the attic through the perforation, and you will feel soft and rough bone (due to caries). Sometimes, using a special cannula, you can rinse the attic through the perforation hole and detect cholesteatoma scales in the fluid. In young children, this is, as a rule, impossible to do, and therefore an indication of cholesteatoma can only be given by an X-ray examination of the temporal bone, in which a defect in the bone tissue in the form of a clearing is clearly identified in the images.

Cholesteatoma in children has the following features:

  • low symptoms;
  • education in a short time;
  • the fastest growth in a child under 5 years of age;
  • damage to the roof of the tympanic cavity, cave, semicircular canals and the wall of the facial nerve canal is more rare than in adults.
  • increased tendency to relapse due to a retraction pocket in the upper parts of the tympanic cavity.

Hearing examination. The study of auditory function is important, and the issue is not the degree of its decline. With meso-tympanitis, hearing loss can also be significant due to, for example, conduction disturbances in the chain of auditory ossicles. On the contrary, with epitympanitis, hearing can remain relatively good, since sound transmission to some extent can be carried out through granulations or cholesteatoma masses.

For diagnosis, it is important that with epitympanitis, the inner ear is much more often involved in the process, which is expressed on the audiogram by a decrease in bone conduction.

Radiography. Diagnosis of small cholesteatoma of the middle ear is quite difficult. The choice of optimal projections is of great importance for a correct understanding of the prevalence of the process. Currently, the Sueller (cave) and Mayer (attic) projections are more often used.

When the process worsens, the clear contour of the sclerotic bone is lost, as it is involved in the inflammatory process. In these cases, transorbital projections (according to Sossa) are used, in which the superposition (overlay) of dense formations on each other is reduced and it is possible to identify even a small cholesteatoma located in the attic and in the opening leading to the cave.

Differential diagnosis. Chronic purulent otitis media sometimes has to be differentiated from a tumor and histiocytosis. With histiocytosis X, almost 70% of children have ear pathology. Signs of histiocytosis:

  • isolated or systemic damage to bone tissue with multiple defects, sequestration and areas of purulent melting;
  • proliferation of specific granulation tissue (eosinophilic granuloma);
  • total lymphadenopathy with hepatosplenomegaly;
  • skin damage; exophthalmos as a result of the formation of xanthoma nodes in the anterior cranial fossa along the optic nerve; damage to the flat bones of the skull (primarily the temporal bone).

Quite rare, but still found in childhood, middle ear sarcoma: round cell, spindle-shaped sarcoma and lymphangiosarcoma. It often occurs as a primary tumor in early childhood. Pale pink bleeding granulations are detected in the external auditory canal; a biopsy allows for an accurate diagnosis. CT data indicate the spread of the process. Treatment is radiation and surgery, but its effectiveness is low due to rapid metastasis.

Treatment of chronic suppurative otitis media

Treatment depends on the period of the disease; the choice of treatment method is related to the duration of the disease, the frequency and severity of exacerbations, otoscopic picture, radiological data, hearing status, etc.

In principle, it can be noted that in most cases, with chronic purulent mesotympanitis, conservative treatment is carried out, and with epitympanitis, surgical treatment is carried out.

In case of exacerbation of the process with pain in the ear, the appearance or intensification of suppuration, active general anti-inflammatory therapy with antibiotics, as well as local therapy, is carried out. During the period of remission, without exacerbation of the process, when general symptoms disappear and suppuration continues, local therapy is used mainly (antiseptic, often alcohol, drops, injecting sulfonamide powder).

A good effect is also observed when using low-energy radiation from a helium-neon laser. Contraindications to laser therapy: chronic otitis with ear polyps, cholesteatoma, symptoms of mastoiditis, suspected intracranial complications. Laser irradiation leads to a reduction in otorrhea, swelling and tissue hyperemia. However, performing laser therapy on children requires staff to pay increased attention to safety rules. There are a lot of methods of local treatment, but an indispensable precondition for the action of the medicinal substance on the mucous membrane of the middle ear is the removal of pus - the so-called toilet of the ear. With persistent and persistent treatment of mesotympanitis, it is possible to achieve cessation of suppuration in 80-90% of cases.

If a child comes in without an exacerbation, without suppuration, then preventive measures are taken:

  • sanitation of the nasopharynx;
  • treatment of chronic inflammatory processes in the nasal cavity and paranasal sinuses;
  • general and local hardening to prevent respiratory diseases;
  • preventing water from getting into the ear, since water can cause suppuration (when bathing a child or washing his hair, close the external auditory canal with cotton wool moistened with sterile petroleum jelly).

To close the perforation, the same semi-surgical (refreshing the edges of the perforation, cauterizing them) and surgical methods (high-energy laser exposure and myringoplasty) are used.

It is more difficult to carry out effective conservative treatment for chronic purulent epitympanitis, especially if it is accompanied by the development of granulations, polyps or the formation of cholesteatoma.

Treatment methods (local and general) that are used for epitympanitis can, at best, eliminate the exacerbation of the process, but do not eliminate osteomyelitis. It would seem that the easiest way to carry out treatment is surgically, but the main obstacle to its widespread use remains satisfactory hearing, which, as a rule, decreases as a result of surgery.

In this regard, in recent years, limited operations have been widely used, in which, under the control of an operating microscope, only carious bone is removed and, if possible, the sound conduction system of the middle ear is preserved (so-called hearing-preserving operations). In 75% of cases, such microsurgical interventions make it possible to sanitize the ear and at the same time preserve auditory function.

Such operations are technically complex and require good preparation: sanitation of the upper respiratory tract, preliminary washing of the tympanic cavity, restoration of patency of the auditory tube, etc.

If the child’s hearing has already been lost as a result of a chronic purulent process, then a radical general cavity operation is performed on the ear, in which all pathological contents are removed: cholesteatoma, polyps, granulations, carious bone, auditory ossicles affected by the process, etc.

Such a surgical intervention is quite complex and requires a good knowledge of the anatomy of the temporal bone, since it is necessary to operate in a small space next to the facial nerve canal, labyrinth, sigmoid sinus, middle cranial fossa, etc.

In a typical case, an incision is made along the postauricular transitional fold, after separating the soft tissues with a chisel or burs, the cave is opened, then the posterior bone wall of the external auditory canal and the lateral wall of the attic are removed. As a result, a common space is formed from the tympanic and antral cavities (therefore, the operation is called general cavity).

After the operation, the ampulla of the horizontal semicircular canal is clearly visible, since the posterior bone wall is removed to its level, the horizontal section of the canal of the facial nerve, the mouth of the auditory tube, the roof of the tympanic cavity and antrum, the bone wall separating the cells of the mastoid process from the sigmoid sinus. The preserved posterior skin wall of the external auditory canal is cut in such a way that pedicle flaps are formed (T- or L-shaped plastic). These flaps subsequently become the source of the epidermis. The post-auricular incision is usually sutured at the end of the operation, and the postoperative cavity is treated by dressings (through the external auditory canal).

At the first stage, the trepanation bone cavity is covered with a thin layer of granulation, along which gradual epidermization occurs from plastic flaps of the posterior wall of the external auditory canal. This process is quite lengthy, lasting several months.

The postoperative period in children is more difficult than in adults, due to the tendency to excessive growth of granulations, frequent reinfection of the cavity through the auditory tube, difficulties in dressings, and exacerbations of the process after infectious diseases.

In approximately 5-10% of cases, the purulent process in the postoperative cavity continues, although intracranial complications are practically not observed due to good outflow.

A negative aspect of radical ear surgery is the inevitable decrease in hearing by about 30 dB due to the removal of carious auditory ossicles and remnants of the eardrum. However, in case of severe carious processes that are not amenable to conservative treatment, the operation is performed, since the likelihood of developing otogenic intracranial complications poses a great danger, in relation to which the operation has a preventive value.

Tympanoplasty. Around the 50s, it was proposed not only to sanitize the middle ear in case of chronic inflammation with the help of radical general cavity surgery, but also to perform reconstructive intervention, restoring the sound-conducting apparatus to one degree or another.

These surgical interventions are performed using operating microscopes with special, thinnest instruments using local or alloplastic tissue. This complex of hearing-improving surgery is called tympanoplasty.

Depending on the degree of destruction as a result of the inflammatory process or operation of the sound-conducting apparatus, the founder of tympanoplasty A. Vulshtein identified 5 types of tympanoplasty: the simplest is the elimination of a defect in the eardrum (myringoplasty or type I tympanoplasty), the most complex is type V, when the entire sound-conducting system is destroyed. Type V tympanoplasty is used quite rarely.

Naturally, a prerequisite for tympanoplasty is sufficient preservation of the function of the receptor apparatus of the inner ear.

Tympanoplasty in adults is used quite often and is effective in approximately 70% of cases.

The attitude towards this operation is ambiguous. On the one hand, its widespread implementation is limited by:

  • significant difficulties in hearing testing at an early age;
  • inability to determine hearing during surgery (due to anesthesia);
  • more frequent allergization and immune instability, frequent childhood infections;
  • anatomical and physiological features of the auditory tube, the difficulty of determining its functional state and examining the nasopharynx;
  • characteristics of the microflora (predominance of staphylococcus, Pseudomonas aeruginosa and Proteus);
  • aggressiveness of cholesteatoma;
  • difficulties in managing the postoperative period.

On the other hand, bilateral hearing loss leads to impaired speech development, changes in the child’s psyche, decreased intelligence, mental retardation, difficulties in learning, communication with peers, etc. As a result, it is believed that tympanoplasty in children is possible starting from 8-10 years of age, but it is better to perform it in two stages, after a sanitizing operation. At an earlier age, tympanoplasty is indicated only for bilateral process and hearing loss.

Which doctors should you contact if you have Chronic suppurative otitis media?

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How to cure chronic purulent otitis media: advice from an otolaryngologist

Chronic purulent otitis media is a complex ENT disorder that, if treated incorrectly or not, leads to significant hearing loss and complications. Statistics say that this disease among adults reaches 1% of all ailments. This high rate is associated with the problems of self-medication of the acute form of the disease, which, with improper therapy, becomes sluggish and acquires the characteristics of chronic manifestations. Chronic purulent otitis is treated by an otolaryngologist.

Chronic purulent otitis media of the middle ear is an inflammation of the hearing organ that has a chronic form.

Causes and types of disease

Chronic manifestations of the disease begin after the patient suffers from acute purulent otitis media, which drags on for many reasons for more than a month. This transition is associated with pathological changes in the organ, the intensity of which depends on the nature of the infection, the person’s immunity, and concomitant diseases.

The chronic inflammatory process is provoked by pathological conditions in other systems of the nasopharynx, which affect the functioning of the auditory tube. Such ailments include:

  • adenoids;
  • injuries to the nose that led to a deviated septum of the organ;
  • abnormalities in the development of the nasal septum;
  • purulent sinusitis with frequent exacerbations;
  • rhinitis.

Otolaryngologists are faced with cases where infectious otitis media immediately acquires the characteristics of a chronic course of the disease. This happens with necrotizing otitis, tuberculosis, inflammation of the weakened part of the membrane.

The sluggish form of chronic otitis is also associated with decreased immune conditions, which are accompanied by inflammatory processes in other organs.

Based on the clinical picture of the disease and the severity of the process, otolaryngologists distinguish two types of the disease.

  1. Mesotympanitis (tubotympanic chronic purulent otitis media) is a benign chronic form of the disease. In this case, there are signs of perforation of the eardrum, and the inflammatory process itself does not spread to other areas. Mesotympanitis goes away easily, and its treatment takes less time.
  2. Epitympanitis (chronic epitympanic antral purulent otitis media) is a severe inflammation of the middle ear, characterized by the manifestation of caries of adjacent bones. This disease is considered to have a malignant course.

Purulent chronic otitis of the middle ear can have two forms - mesotympanitis and epitympanitis

This division of the disease is of fundamental importance, since the tactics of further therapy depend on it. Treatment of the first type of disease is conservative and produces positive results, while epitympanitis requires surgical intervention in the affected area.

Signs and symptoms

Purulent otitis media in the chronic stage has mild symptoms. The patient complains of periodic purulent discharge from the auricle and decreased hearing function of the ear. Sometimes noises appear - symptoms of perforation of the eardrum. The patient may also experience headaches or dizziness, but do not associate them with inflammation in the ear.

After examination, the otolaryngologist determines the nature of the discharge. They are:

The latter are characteristic of chronic otitis media of the middle ear, which is caused by polyp tumors. Discharge without a characteristic odor, its volume varies.

Symptoms of a perforated eardrum are decreased hearing in the patient. It is associated with the activity of inflammation, the degree of damage to the labyrinthine windows and auditory ossicles. Minor perforation of the eardrum reduces audibility by no more than 30 dB. With a significant defect in this part of the organ, hearing decreases below these values.

Chronic otitis media does not bother the patient with the severe pain that he experienced during the acute course of the disease. Therefore, some manifestations of the disease are perceived by the patient complacently and remain unnoticed until they worsen. Hypothermia and nasopharyngeal diseases lead to another outbreak of the disease. At these moments, chronic purulent otitis media of the middle ear acquires pronounced symptoms:

  1. increase in the number of discharges;
  2. temperature increase;
  3. feeling of pulsation in the ears, noises;
  4. dull pain in the inflamed area.

The disease can be recognized by such a symptom as congestion in the ears.

If the treatment is prescribed correctly, then mesotympanitis quickly passes, suppuration stops, and the eardrum scars. But there are cases when concomitant factors interfere with the normal course of the disease, the inflammation spreads further and damages the bone walls.

Diagnosis of the inflammatory process

After the patient contacts the otolaryngologist, he conducts a set of examinations that help him identify the disease and determine at what stage of development chronic acute purulent otitis media of the middle ear. The doctor takes into account the patient’s complaints and conducts an examination to determine the characteristics of the otoscopic picture. It helps to find out the amount and characteristics of the secreted fluid, the degree of change in the mucous membrane, and the condition of the labyrinth windows.

Endoscopy is used to differentiate inflammation at the mouth of the auditory tube. The same method is used to assess provoking factors and examine the nasopharynx.

The degree and nature of auditory perception is checked using the Rinne and Weber tests, as well as tone threshold audiometry.

If the patient complains of dizziness, a comprehensive neurological examination is prescribed. This helps differentiate possible complications.

Symptoms of otitis media in the chronic stage give the otolaryngologist the right to prescribe the patient an X-ray or tomography of the temporal bone. This is necessary to clarify the localization of the inflammatory process, the condition and possible changes in the bone tissue.

Treatment of chronic purulent otitis is impossible without bacteriological analysis of secretions from the ear for flora. It helps to identify the pathogen and select an effective drug to which it is sensitive.

The otolaryngologist also prescribes clinical tests (blood and urine tests). Their results help to clarify the immune load on the body and the influence of the source of infection on it.

Trust your ENT specialist and coordinate all treatment steps with him

Treatment and prevention

After making the correct diagnosis, the doctor decides on treatment tactics. To begin with, the patient undergoes sanitation of the respiratory tract:

  • removal of adenoids (if there is an inflammatory process in them);
  • restoration of the functioning of nasal breathing (if it is impaired).

The doctor checks the patency of the auditory tubes, ensures normalization of the outflow of purulent contents from the ear (removal of polyps) and cleanses the cavity and eardrum from the discharged substance. This allows medications to penetrate and work better. Treatment of purulent chronic otitis media of the middle ear is carried out by instillation of vasoconstrictor drugs, as well as drugs that relieve swelling and reduce inflammation. To suppress the vital activity of microflora, a variety of antibacterial and antiseptic drugs are used.

This treatment tactic will be effective for mesotympanitis. If the inflammation has more severe manifestations, then the above measures will prepare for surgical intervention. Treatment of purulent otitis in the stage of epitympanitis requires surgery. It cannot be cured with therapeutic methods.

Complete restoration of hearing after purulent otitis occurs faster if, along with medications, the otolaryngologist prescribes certain types of physiotherapy.

This helps the membrane to scar quickly. Treatment for purulent otitis is prescribed by the doctor after an examination and the results of diagnostic tests.

Chronic otitis will not occur if the acute period of this disease is treated in a timely manner and treated to the end. At the same time, it is very important to consult a doctor in time for advice and prescriptions. This will protect against possible complications.

Source: http://nasmorkoff.ru/ear/kak-vylechit-xronicheskij-gnojnyj-srednij-otit-sovety-otolaringologa/

Chronic suppurative otitis media

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

Chronic suppurative otitis media

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

Causes of chronic suppurative otitis media

The causative agents of chronic purulent otitis media are, as a rule, several pathogenic microorganisms. Most often these are staphylococci, Proteus, Klebsiella, Pseudomonia; in rare cases - streptococci. In patients with a long course of chronic purulent otitis media, along with the bacterial flora, the causative agents of otomycosis - yeast and mold fungi - are often sown. In the vast majority of cases, chronic suppurative otitis media is the result of a transition to the chronic form of acute otitis media. The development of the disease is also possible when the tympanic cavity becomes infected as a result of ear trauma, accompanied by damage to the eardrum.

The occurrence of chronic purulent otitis media is due to the high pathogenicity of the pathogens; dysfunction of the auditory tube due to eustachitis, aerootitis, adenoids, chronic sinusitis; development of adhesive otitis media as a result of repeated acute otitis media. Various immunodeficiency conditions (HIV infection, a side effect of treatment with cytostatics or radiotherapy), endocrinopathies (hypothyroidism, obesity, diabetes mellitus), irrational antibiotic therapy or unjustified reduction in the duration of treatment of acute purulent otitis contribute to the development of chronic purulent otitis media from acute.

Classification of chronic suppurative otitis media

Chronic purulent otitis media has 2 clinical forms: mesotympanitis and epitympanitis. Mesotympanitis (tubotympanic otitis) accounts for about 55% and is characterized by the development of an inflammatory process within the mucous membrane of the tympanic cavity without involving its bone formations. Epitympanitis (epitympanic-antral otitis) accounts for the remaining 45% of cases of chronic purulent otitis media. It is accompanied by destructive processes in bone tissue and in many cases leads to the formation of cholesteatoma of the ear.

Symptoms of chronic suppurative otitis media

The main clinical signs of chronic suppurative otitis media are suppuration from the ear, decreased hearing (hearing loss), tinnitus, pain in the ear and dizziness. Suppuration can be constant or periodic. During the period of exacerbation of the disease, the amount of discharge usually increases. If granulation tissue grows in the tympanic cavity or there are polyps, then the discharge from the ear may be bloody.

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

The pain syndrome is usually moderate and occurs only during periods when chronic purulent otitis media enters the acute phase. An exacerbation can be triggered by ARVI, pharyngitis, rhinitis, laryngitis, sore throat, or fluid getting into the ear. During an exacerbation, there is also an increase in body temperature and a feeling of pulsation in the ear.

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

Diagnosis of chronic suppurative otitis media

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

Otoscopy and microotoscopy are carried out after toileting the outer ear with thorough cleansing of the external auditory canal. They detect the presence of perforation in the eardrum. Moreover, chronic purulent otitis media, which occurs as mesotympanitis, is characterized by the presence of perforation in the tense area of ​​the tympanic membrane, while epitympanitis is characterized by the location of perforation in the loose area.

Chronic suppurative otitis media is characterized by decreased hearing according to audiometry, conductive or mixed hearing loss according to threshold audiometry, impaired mobility of the auditory ossicles according to acoustic impedance measurement. Eustachian tube patency, electrocochleography, and otoacoustic emissions are also assessed. Chronic purulent otitis media, accompanied by vestibular disorders, is an indication for examining the vestibular analyzer using electronystagmography, stabilography, videooculography, pressor test, and indirect otolitometry. If there are neurological disorders in the clinic, consultation with a neurologist and an MRI of the brain are necessary.

Treatment of chronic suppurative otitis media

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

Chronic suppurative otitis media is usually subject to conservative or preoperative treatment for 7-10 days. During this period, the ear is cleaned daily, followed by washing the tympanic cavity with antibiotic solutions and instilling antibacterial drops into the ear. Considering that chronic purulent otitis media is accompanied by perforation in the eardrum, ototoxic aminoglycoside antibiotics cannot be used as ear drops. You can use ciprofloxacin, norfloxacin, rifampicin, as well as their combination with glucocorticosteroids.

For the purpose of complete sanitation and functional restoration, chronic purulent otitis media with bone destruction requires surgical treatment. Depending on the prevalence of the purulent process, chronic purulent otitis media is an indication for sanitizing surgery with mastoidoplasty or tympanoplasty, aticoantrotomy, mastoidotomy, labyrinthotomy and labyrinthine fistula plastic surgery, and removal of cholesteatoma. If chronic purulent otitis media is accompanied by diffuse inflammation with the threat of complications, then general ear surgery is performed.

Prognosis of chronic suppurative otitis media

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

Chronic purulent otitis media - treatment in Moscow

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