Acute purulent otitis media treatment

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Acute purulent otitis media

Pathogenesis of the disease

The fundamental cause of purulent otitis is the spread of the infectious process from the nasopharyngeal cavity to the middle ear. Where the infectious pathogen enters through the so-called rhino-tubar route.

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Much less often, pathogenic pathogens affect the middle ear cavity by penetrating through the external auditory canal, due to a violation of the integrity of the eardrum.

Also, acute otitis media can occur against the background of various diseases of the upper respiratory system, in the presence of adenoids in children and through the blood.

A decrease in the body's resistance in diabetes mellitus, infectious diseases, and renal failure increases the risk of inflammatory processes in the middle ear cavity.

Symptoms

Clinical manifestations of acute otitis depend on the degree of the disease. General symptoms indicating the occurrence of otitis media:

  • purulent ear discharge;
  • elevated temperature;
  • pain in the ear area;
  • aching headaches;
  • frequent dizziness;
  • hearing impairment;
  • the specific smell of their ear.

The disease occurs in three stages:

At the first stage, the symptoms of the disease are characterized by acute pain. The pain in this case can be very varied, both burning, squeezing, shooting, and pulsating, stabbing, aching.

Over time, constant pain, intensifying at night, interferes with proper sleep and significantly reduces the patient’s quality of life. Against the background of these pathological processes, a decrease in auditory perception develops and the general condition is disrupted. There is a significant increase in body temperature (38-39̊ C), which is difficult to reduce with the help of medications.

During the examination, hyperemia and pronounced swelling of the eardrum are observed. When palpating the mastoid process, acute pain is noted.

Purulent otitis media in the second stage is manifested by a rupture of the eardrum with purulent discharge. Symptoms become sluggish, pain subsides, the patient’s condition becomes better, and the temperature decreases.

In the absence of complications during the course of the disease, purulent otitis media of the middle ear flows into the third stage - restorative. At this stage, inflammation subsides, the process of suppuration ceases, and the symptoms completely disappear. Otitis media usually subsides after 2-3 weeks.

Diagnostics

Purulent otitis media is diagnosed using the following diagnostic measures:

  • general medical history;
  • examination of the ear cavity;
  • endoscopic, tuning fork examination of the ear.
  • acumetry to study auditory function;
  • impedance measurement to determine the condition of the eardrum.

Treatment

Treatment of purulent otitis media should be carried out exclusively by a medical specialist. Taking into account the symptoms and manifestations of the general picture of the disease, the doctor can prescribe suitable treatment. The main therapeutic measures are:

  1. Warm-up procedures. A fairly common treatment for purulent otitis media is carried out by heating. You should resort to this method of therapy with extreme caution and only with the consent of your doctor. It is advisable to carry out the procedures independently, in the absence of suppuration for the first time during the illness.
  2. If perforation of the eardrum does not occur on its own, surgery may be prescribed. Representing a cut (puncture) in the tissue of the eardrum. It is important to note that surgical intervention must be carried out as soon as possible in order to avoid unwanted complications. However, otitis media is quite rarely treated in this way.
  3. Purulent otitis media must be treated with the use of nasal vasodilating drops, which help relieve inflammation from the nasal and nasopharyngeal mucosa.
  4. Treatment of the acute form of otitis media is carried out using antibacterial therapy.
  5. Purulent otitis media, accompanied by purulent discharge, is not recommended to be treated with thermal procedures. The use of alcohol-based ear drops is also prohibited, as they can damage the mucous membrane of the ear cavity.
  6. The main aspect of therapeutic measures is the elimination of purulent discharge and cleansing of the ear canal. Whether treatment will be effective largely depends on the procedure. You can do it yourself, being careful. It is highly not recommended to use cotton swabs, matches, etc. for this purpose, as they can damage the mucous membrane and disrupt the integrity of the eardrum.
  7. Treatment aimed at relieving pain involves the use of antispasmodics and analgesics. To reduce the temperature, the patient is prescribed antipyretic drugs.

Surgical treatment of acute otitis media is quite rare. If surgical intervention is prescribed, the following operations are resorted to:

  1. Tympanostomy is prescribed if otitis media does not respond to drug treatment. This procedure is carried out by installing a special tube that helps facilitate the process of outflow of purulent discharge.
  2. Myringotomy - treatment is aimed at opening the eardrum. They resort to this method if there is acute pain and pronounced symptoms.

Complications and consequences of the disease

If acute otitis media is not treated in a timely manner or if you try to start treatment on your own, serious complications may develop. These include:

  • spread of the infectious-inflammatory process to the bone located behind the auricle;
  • the occurrence of otogenic sepsis;
  • hearing impairment;
  • rupture of the eardrum;
  • progression into a chronic form of the disease;
  • destruction of the auditory ossicles;
  • tumor-like neoplasm – choleoasteatoma;
  • infectious lesion of the lining of the brain.

Prevention

Preventive measures should primarily be aimed at timely treatment of viral respiratory diseases. To prevent them and reduce the risk of occurrence, the following preventive measures should be observed:

  • If possible, try not to overcool the body;
  • dress according to weather conditions;
  • observe the rules of personal hygiene;
  • eliminate bad habits;
  • do light exercise.

Treatment of acute respiratory diseases accompanied by rhinitis includes the correct technique of blowing the nose and rinsing the nasal cavity.

Acute otitis media, detected at an early stage, can be treated much more quickly, so at the first manifestations of the disease you should immediately visit a doctor.

We washed the baby’s ear infections with aerosols and blamed ourselves very much. Now we only use dosed sprays. Morenasal suits us very well, it’s dosed and not expensive, it doesn’t cause otitis media.

Source: http://nasmorklechit.ru/otity/gnojnyj-otit.html

Acute purulent otitis: stages, symptoms and treatment of the disease

Otitis is one of the most common diseases, which can manifest itself independently, or may arise as a complication after an infection. The treatment of otitis media requires special attention. Because there are a number of serious complications.

Acute purulent otitis: description

Causes of the disease

Acute purulent otitis is an inflammation of the mucous membrane of the tympanic cavity, in which in most cases other parts of the middle ear are also involved.

There are many reasons for the appearance of otitis media. The main ones include:

  1. Low immunity. As a rule, due to weak immunity, many diseases begin to develop, and otitis media is no exception.
  2. Anomalies in the development of the craniofacial bone, which lead to the abnormal structure of certain organs.
  3. Viral diseases. Very often, otitis media is a complication after a viral illness. This happens due to improper treatment or neglect of doctors' recommendations. Typically, otitis media develops after influenza or ARVI.
  4. Bacterial diseases caused by the penetration of harmful bacteria into the body. A weakened immune system is not able to resist them, and if the disease begins, it must be treated with antibiotics. But many patients hope either for treatment with folk remedies or simple medications. And in the end everything develops into acute purulent otitis media.
  5. Allergy. Often, allergies cause inflammation of the mucous membranes not only in the nose and throat, but also in the ears. This happens due to the penetration of particles that irritate it. During an exacerbation (for example, in people suffering from an allergy to ragweed, this is the end of August), otitis media can develop, because the body thus reacts to the inflammatory process.
  6. Inflammatory processes in the nasopharynx. It is generally accepted that if a runny nose is not properly treated, then everything can spread to the ears. This is actually true. All ENT organs are interconnected, and if not treated correctly, the infection and inflammatory process easily spread further.
  7. Infection through the blood. This happens very rarely.
  8. Hypothermia. Surprisingly, most cases of purulent otitis occur in the summer, when parents allow their children to swim in ponds, and the water there is not very warm and is not sterile.
  9. An injury during which either the eardrum or the mucous membrane may be damaged. As a result of severe damage, infection can occur and inflammation may occur.
  10. Diseases of the nervous system that can provoke illness due to improper conduction of nerve impulses.

These are the main reasons why a person may develop acute purulent otitis media. The main thing is to recognize the disease in time and consult a specialist to avoid the development of even greater complications. People who suffer from otitis periodically are advised to avoid cold rooms, wear a hat, and immediately treat any viral or bacterial diseases, since their ears are a weak spot where the second and subsequent times the infection will penetrate much faster than the first time.

Disease frequency

Scientists have conducted many studies to find out who is most susceptible to developing acute suppurative otitis media. And, to our great regret, they came to the conclusion that these were children. After a child goes to kindergarten, his body is attacked by many bacteria and viruses. And it will depend on what kind of immunity he has (and most often it is weak), whether they penetrate inside the body or not.

Some parents do not attach importance to a runny nose and take their children to kindergarten, even knowing that the snot has not been treated. This is a big mistake, since at the age of three to five years the risk of developing a complication (that is, the transition from a simple runny nose to acute purulent otitis media) increases.

Statistics show that about 70% of children have had otitis media at least once in their lives, and, as a rule, this happened either after the flu or after a simple runny nose.

Boys are considered more susceptible to the disease. Very rarely, otitis media can be found in adults, because most of them, during illness (with a runny nose, cough), immediately begin to be treated with broad-spectrum antibiotics that kill all harmful bacteria.

Symptoms of acute purulent otitis media

It is very difficult to confuse acute purulent otitis media with some other disease, because its symptoms are so obvious that they force a person to consult a specialist.

The main symptoms of the disease include:

  • Painful sensations in the ear area. First of all, the patient begins to feel severe pain, and sometimes it becomes unbearable. It worsens at the moment when a person tries to touch the ear. At the same time, some patients note that the pain is sometimes sharp and appears at the moment when you need to turn your head, bend over, or any other sudden movement.
  • Hearing loss, which occurs against the background of severe inflammation. The mucous membrane is very thin, and therefore any penetration of infection is accompanied by hearing loss. In some cases, patients say that they hear practically nothing, all sounds are muffled. And you have to watch TV at almost the highest volume.
  • Increased body temperature. The inflammatory process in the ear is accompanied by an increase in body temperature, and most often it rises to 39 degrees. It is problematic to knock it down in the first two days, since suppuration continues. And only on the third day, if treatment has been started, the temperature will gradually decrease. Patients note that in the first two days the temperature seems to “jump”, then it is at 39 degrees, then drops to 37.5. Because of this, the person is in a feverish state, when he is either hot or cold.
  • Discharge of pus. Discharge from the ear does not appear immediately, since in the first days the focus of inflammation, one might say, matures, and pus accumulates in it. After the mucous membrane is no longer able to withstand it, it breaks through and the pus flows out. The discharge can be either purulent or mixed with blood due to the formation of a wound. In the first few hours after the breakthrough, the discharge will be very strong, but gradually, its amount decreases, but does not end.

The main thing is not to think that the disease will go away on its own. Such thoughts creep into people’s minds after their health improves. And it improves due to the breakthrough of suppuration. At the moment when pus flows out of the wound, the body temperature drops and the person feels comfortable. But the infection remains in place and at any moment can get even worse.

Stages of the disease

Doctors distinguish three stages of the disease, each of which is characterized by its own symptoms:

The pre-perforation stage is considered the most initial stage of the development of the disease. It is characterized by the onset of symptoms, the main one of which will be pain in the ear area. Moreover, the pain can radiate to the temple, forehead, which causes even greater discomfort. Over time, the pain intensifies as the source of inflammation grows and can become unbearable. Even painkillers may not have the desired effect. Along with the pain, tinnitus and congestion also appear, which further aggravate the person’s general condition. The patient begins to hear much worse, this is especially evident if otitis media develops during the flu. Then the inner ear is also involved, which disrupts the overall process of sound perception.

In addition to the above symptoms, a person’s condition may deteriorate sharply, the body aches, the temperature rises to 39 degrees, and sometimes higher (it all depends on the immune strength). All signs of intoxication appear, which must be dealt with immediately. Otherwise, the condition will only get worse.

The pre-perforation stage can last from several hours to several days.

The next stage of the disease is perforative. It begins when the eardrum ruptures and pus leaks out. At this stage, the pain subsides sharply. The person begins to feel much better, the body temperature drops to acceptable values ​​or disappears altogether. At this moment, pus begins to flow out of the ear. On the first day after the rupture, the discharge will be quite strong and you can even notice the admixture of blood that appears there due to the wound formed. Patients note that it is as if their ear begins to pulsate. After a few days, the amount of discharge decreases, it becomes thicker and more like pus. This phenomenon lasts about 7 days.

More information about otitis media can be found in the video.

The reparative stage is characterized by the cessation of the flow of pus, as well as a sharp healing of the wound. When this happens, the patient begins to hear normally (hearing is gradually restored), body temperature remains at a normal level, and health improves even more. But the disease does not always proceed as described above. At any moment and at any stage the process can be disrupted. In most cases, the disease is sluggish and there is no rupture or leakage of pus. Because of this, a person’s body temperature is constantly elevated (but no longer to 39 degrees, but remains at 38), hearing is not restored, and the pain does not subside.

Also, there are cases when, during the first stage, ear pain is also accompanied by headache, vomiting, and dizziness.

This happens when pus matures for a long time and perforation forms. If this happens, and the period drags on for more than three days, then this can lead to the spread of inflammation deep into the skull, which will lead to irreparable consequences. Typically, the illness lasts from two to three weeks. It all depends on what medications the patient is treated with and whether he follows all the recommendations of the attending physician.

Diagnosis of the disease

Diagnosis of acute purulent otitis

Diagnosing acute purulent otitis media is not difficult. First of all, when a patient turns to a specialist, he will listen to all his complaints. Already at this stage, a specialist can make a preliminary diagnosis, since, as mentioned above, the symptoms of the disease are so obvious that it is quite difficult to miss it.

But in some cases the following procedures may be required:

  • Examination of the ear, during which the doctor will see how inflamed the mucous membrane is.
  • A computed tomography scan will show whether the infection has spread further and whether there are other lesions.
  • A blood test to determine the degree of the inflammatory process.
  • Analysis of ear contents. It is taken to determine which bacterium is causing the inflammation in order to choose the right antibiotics for treatment.

Sometimes a doctor can refer you for an examination to a dentist, because there have been cases when the cause of otitis was caries, or rather an infection that penetrated through the tooth. And if caries is not cured, then it will constantly affect the body. After receiving all the results, the doctor will be able to make a diagnosis and determine the stage of the disease.

Treatment of acute purulent otitis

Recommendations for the treatment of ear disease

During treatment, special attention is paid to the stage of the disease, since the use of a particular drug will depend on this. In the very first days, when the patient’s well-being deteriorates sharply, it is necessary to improve it a little. Antipyretic drugs are prescribed to reduce body temperature. As a rule, adults are recommended to drink Paracetamol three times a day, and children to give Nurofen, as it not only reduces fever, but also reduces pain.

In the first three days, it is recommended to adhere to bed rest, since a large load is placed on the body, and the general condition does not allow one to lead a normal lifestyle. If signs of mastoiditis (spread of infection inside the skull) appear, the patient should be hospitalized immediately.

To improve ear ventilation, the patient is prescribed vasoconstrictor drops, such as Otrivin, Nazivin. Moreover, they need to be instilled a little differently than for a runny nose. It is best to lie on your back and turn your head to the side. Place 5 drops into each nostril. After some time, you need to blow your nose, but under no circumstances should you do it forcefully. And besides, with otitis media, you should not draw mucus from your nose into your mouth (as many people like to do). This can worsen the condition and spread the infection. In the pre-perforation stage, the patient suffers from severe pain in the ear. To reduce them a little, it is better to instill special drops. So, doctors advise resorting to a solution of boric acid. And also Otipax drops, which have an analgesic effect.

It should be noted that cold drops should not be used. They must first be warmed in the palms to room temperature so that they do not irritate the mucous membranes.

Also, during acute purulent otitis, doctors prescribe antibiotics for oral administration, especially when the body temperature does not decrease for three days and remains at 39 degrees. This is very dangerous, especially if a small child is sick. Amoxicillin is most often prescribed, since it contains substances that can affect the suspected pathogens of the disease. They can also prescribe Augmentin, Spiramycin.

Typically, antibiotic therapy lasts from 7 to 10 days. You cannot suddenly stop taking antibiotics after taking a few days of the course. Although many people do this after they notice an improvement in their condition. This cannot be done because the bacteria become resistant to the drug, and next time you will have to take a stronger and more harmful drug.

During the removal of pus, the doctor may prescribe taking antihistamines and microlytic agents to improve the process of excretion of pus.

If otitis media is not treated correctly, serious complications may develop, which include:

  • Transition of the disease to the chronic stage
  • Development of facial nerve paresis
  • Development of mastoiditis (infection entering the skull)
  • Meningitis
  • Brain abscess
  • Adhesions and fusion of the eardrum

Acute purulent otitis is a very dangerous disease that requires timely treatment and a serious approach. You cannot be skeptical and think that the disease will go away on its own. If you ignore the symptoms, you can wait for a brain abscess or meningitis.

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Comments (1)

Daniel

01/02/2018 at 23:13 | #

A really tough pain, this happened many years ago, I still haven’t forgotten it. Fever, headache, ear pain and temporary deafness in one ear, just really bad. A whole package of medicines was bought to treat just one ear.

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Purulent otitis: symptoms and treatment

Purulent otitis - main symptoms:

  • Noise in ears
  • Fever
  • Earache
  • Ear congestion
  • Intoxication
  • Hearing loss
  • Purulent discharge from the ear
  • Redness of the ear

Purulent otitis is a common otorhinolaryngological pathology, which is characterized by inflammation of the epithelium lining the surface of the inner and middle ear. As a result, purulent exudate appears in the ear cavity.

If purulent otitis media is not treated in time, dangerous complications will begin to develop:

  • membrane rupture;
  • chronic hearing loss;
  • decreased hearing function;
  • cholesteatoma;
  • facial nerve paresis;
  • brain abscess;
  • intracranial pathologies.

It is important that when the first symptoms appear that indicate the progression of the disease, immediately consult a doctor for diagnosis and treatment. It is worth noting that purulent otitis media affects both adults and children equally. There are also no restrictions regarding gender.

Etiology

Reasons for the progression of purulent otitis media:

  • penetration of infectious agents into the middle and inner ear;
  • decreased body reactivity.

An infection can enter the ear in several ways:

  • through the auditory tube. This route of penetration is called tubogenic;
  • traumatic. Infectious agents enter the ear through a damaged eardrum;
  • retrograde. The infection spreads from the cranial cavity;
  • hematogenous. In this case, infectious agents enter the ear through the bloodstream. This is often observed against the background of influenza, typhus, scarlet fever, and tuberculosis.

The main reason for the progression of chronic suppurative otitis media is inadequate treatment of acute purulent inflammation of the ear.

Forms

  • acute purulent otitis media;
  • chronic purulent otitis media.

Acute form

Acute purulent otitis media begins to progress after pathogenic microorganisms penetrate the middle ear (through the auditory tube). It is observed in pathologies of the upper respiratory tract, nasopharynx, etc.

  1. catarrhal The beginning of the progression of the inflammatory process. At this stage, exudate begins to accumulate in the ear. The first symptoms of the disease appear - pain in the ear, decreased hearing function. It is important to immediately contact a specialist and begin treating the disease with antibiotics and physiotherapeutic procedures;
  2. purulent form. If treatment with antibiotics and other medications has not been previously carried out, the eardrum is perforated and purulent exudate begins to leak from the cavity. Symptoms subside;
  3. the inflammatory process gradually subsides. The suppuration stops. The main symptom is decreased hearing function.

Chronic form

Chronic purulent otitis media is a disease characterized by inflammation of the middle ear. A characteristic feature of the pathology is the recurrent flow of purulent exudate from the ear cavity. Other signs include persistent perforation of the eardrum, as well as a progressive decrease in hearing function. Chronic purulent otitis media progresses due to inadequate treatment of the acute form of the disease. But it is also worth noting that the disease can manifest itself as a complication of chronic rhinitis, sinusitis or rupture of the eardrum.

Chronic suppurative otitis media usually begins to progress in childhood. It is provoked by pneumococci, pseudomonas and staphylococci. Chronic suppurative otitis media has two subforms:
  • mesotympanitis. The inflammatory process affects the mucous membrane of the eardrum and auditory tube. The perforation is located in the central part of the membrane;
  • epitympanitis. In addition to the mucous membrane, the pathological process involves the bone structures of the mastoid process and the attic-antral region. The perforation is localized in the upper part of the membrane. This form is dangerous because dangerous complications often progress against its background - osteitis, sepsis, meningitis, brain abscess.

Symptoms

Symptoms of the initial stage of acute purulent otitis media:

  • hearing loss;
  • increasing pain in the ear, which can radiate to the temple, crown and dentition;
  • intoxication syndrome;
  • the patient notes the appearance of noise and congestion in the affected ear;
  • hyperthermia;
  • hyperemia.

The duration of the initial stage of purulent otitis ranges from several hours to 3 days. After this, the transition to the perforative stage occurs. The patient exhibits the following symptoms:

  • membrane rupture. As a result, active release of purulent exudate occurs. This process can last one week;
  • pain in the ear subsides;
  • stabilization of the patient's condition;
  • body temperature returns to normal levels.

Symptoms of the reparative stage of purulent otitis in children and adults:

  • restoration of auditory function;
  • purulent exudate stops separating;
  • hyperemia of the membrane disappears;
  • scarring of the formed perforation is observed.

Treatment

The disease must be treated in a hospital setting. And especially if there is purulent otitis media in a child. The treatment plan is drawn up by the attending physician, taking into account the stage of the disease, the severity of the clinical picture, as well as the patient’s condition.

Treatment of the pre-perforation stage:

  • relief of pain syndrome. Both systemic and local medications are used;
  • vasoconstrictor nasal drops;
  • antihistamines;
  • It is recommended to apply semi-alcohol compresses to the ear;
  • antibiotics. Necessary for the destruction of infectious agents. Doctors usually prescribe the following antibiotics: cefuroxime, amoxicillin, augmentin, etc.;
  • paracentesis.

As the perforated stage progresses, it is necessary to continue taking antibiotics and antihistamines. The course of treatment is also supplemented with the following drugs:

  • mucolytics;
  • anti-inflammatory drugs;
  • physiotherapeutic treatment: UHF, laser therapy, UV;
  • removal of purulent exudate from the ear canal.

The treatment regimen at the reparative stage is supplemented by:

  • vitamin therapy;
  • blowing the auditory tube;
  • taking biostimulants;
  • by introducing drugs into the tympanic cavity that prevent adhesions from forming.

It is simply necessary to treat the disease with antibiotics, since these drugs help eliminate the cause of its progression - infectious agents. It is worth noting that this group of drugs should only be prescribed by the attending physician. It is unacceptable to take antibiotics without permission, as you can only make the situation worse. Antibiotics are prescribed to be taken according to a specific regimen. During treatment of a pathology, the doctor may change the drug if the chosen remedy does not have the desired effect. Also, the doctor can change the antibiotic after receiving the results of bacterial culture of the purulent exudate.

If you think that you have purulent otitis and the symptoms characteristic of this disease, then doctors can help you: an otolaryngologist, a pediatrician.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Otomycosis is a fungal disease that affects the middle and outer ear. According to the location of the lesion, the disease is in most cases one-sided, and only in one out of ten cases the problem occurs simultaneously in two ears. The disease is caused by Candida, Penicillium and Aspergillus fungi.

Rupture or perforation of the eardrum is damage to the membrane due to exposure to a large number of unfavorable factors. Under the influence of mechanical, physical, chemical or thermal reasons, a gap is formed, which disrupts a person’s ability to fully hear sounds. Sometimes self-recovery of the membrane is observed, but only with minor damage. With more severe trauma, a scar may remain, and in particularly severe situations, any violation of integrity can lead to hearing loss.

Chronic otitis is an inflammatory disease of the middle ear, which is characterized by the formation of a hole in the eardrum with constant or recurrent discharge of pus from the auricle.

Mesotympanitis is a chronic inflammatory disease of the mucous membrane of the tympanic cavity, most pronounced in its middle and lower sections, in which there is abundant purulent discharge from the ear cavity, swelling and necrotic changes in the mucous membrane of the inner ear. In most cases, chronic purulent mesotympanitis is unilateral, but in some cases a bilateral development of the pathological process is possible. Self-medication is unacceptable, as it can lead to complete hearing loss.

Otitis in a child is considered the most common pathology among this age category, affecting all structures of the auditory canal. Experts in the field of pediatric otolaryngology claim that by the age of 7, approximately 95% of children suffer from this disease.

With the help of exercise and abstinence, most people can do without medicine.

Symptoms and treatment of human diseases

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Source: http://simptomer.ru/bolezni/otolaringologiya/1328-gnoynyy-otit-simptomy

Doctor Kochetkov P.A.

Surgical treatment of ENT diseases

Acute purulent otitis media

This disease is a disease based on the inflammatory process of the mucous membrane of the middle ear. Suppurative otitis media is caused by a viral bacterial and fungal infection. As a rule, the infectious process spreads to the middle ear from the nasal cavity and nasopharynx, and as a complication of colds, acute respiratory infections, sinusitis, sore throat and other diseases of the upper respiratory tract.

The main manifestations of acute purulent otitis media are as follows.

1. Before suppuration occurs from the ear, acute pain in the ear occurs, usually constant, which gradually increases and is especially intensified in the evening. This is the so-called catarrhal stage of purulent otitis media. Pain occurs because swelling of the mucous membrane and mucus or pus accumulating in the middle ear during inflammation put pressure on the nerve endings, which are especially numerous on the eardrum. The patient is worried about weakness, loss of appetite, and usually a high temperature. Infants refuse to eat because sucking movements increase pain. If no therapeutic effect is provided at this moment, otitis media progresses to the next stage.

2. Any purulent process tends to break through, since the production of pus occurs during inflammation for quite a long time. As a rule, the purulent process melts the eardrum and the patient begins to “run” from the ear. Depending on the severity of the inflammatory process, mucus, pus, ichor, or mixed discharge may be released from the ear canal. At this stage, the diagnosis of acute purulent otitis media is appropriate. However, pus does not always break out. In a number of situations, the inflammatory process spreads to the bone tissue of the temporal region and the mastoid process of the temporal bone. A disease develops - mastoiditis, which requires more serious medical intervention. Therefore, during the catarrhal stage described above, and if the feeling of pain in the ear persists and increases, the otolaryngologist correctly performs a puncture of the eardrum - paracentesis. This allows the pus to be released from the middle ear to the outside, thereby preventing the development of complications from the pus breaking into other areas of the head. After this procedure, the patient's condition quickly improves. Paracentesis is a painful procedure and is performed under local anesthesia. In children, it is advisable to puncture the eardrum under anesthesia, since children are afraid, cry and cannot sit still, and for paracentesis it is necessary for the patient to remain motionless. Paracentesis, performed according to indications and performed by a qualified ENT doctor, has absolutely no consequences and does not affect hearing.

3. After a rupture of the eardrum, either voluntary or performed by a doctor, the inflammatory process begins to subside and the patient recovers. However, this does not mean that otitis media cannot be treated. For the entire period of the disease, the patient should be prescribed conservative treatment, including antibacterial, local, physical therapy and other treatment methods. The entire period of acute purulent otitis media, with proper treatment, lasts from 5 to 10 days. After recovery, restorative and resorption therapy must be carried out, which is usually prescribed by a clinic doctor.

What contributes to the occurrence of acute suppurative otitis media

1. Diseases of the nose, paranasal sinuses, nasopharynx. This includes acute and chronic rhinitis, deviated nasal septum, and adenoids in children. This happens because for the structures of the middle ear to function properly, the nose must breathe freely. When nasal breathing is difficult, normal outflow from the middle ear does not occur and favorable conditions are created for the development of infectious inflammation (this mechanism is described in more detail in the section - adenoids). Therefore, patients who have had purulent otitis media should be carefully examined for nasal diseases. Children should have their adenoids removed.

2. In children of the first year of life, the cause of purulent otitis may be the penetration of formula or breast milk through the auditory tube into the middle ear, which is a favorable environment for infection. This is because the baby is usually fed in a lying position, so it is very important that the baby is fed properly, using breast milk. which by its nature does not contain an infectious agent or special mixtures. Dishes used for feeding must be thermally treated. An important point here is the child’s ability to breathe freely through his nose, so it is mandatory to perform a toilet in the nasal cavity to remove mucus and crusts, which very often form in the nasal cavity in young children.

3. The factor that provokes the occurrence of acute purulent otitis is hypothermia. Practice shows that in the summer the number of patients seeking help from an ENT doctor for otitis media increases. This is due to the fact that people begin to swim in rivers, seas and other bodies of water, where when diving, dirty water containing bacteria enters the ear canals and causes an inflammatory process. Therefore, I categorically do not recommend diving in open waters, which especially applies to children.

4. The cause of otitis media can be trauma, either accidental at home or caused by the patient to himself. In children, it happens that parents try too hard to clean the child’s ear and accidentally injure the eardrum. at the same time, it is very easy to get an infection, which becomes the cause of further inflammation.

Otitis may also develop for other reasons that are less common. In any case, even if the patient is well aware of what acute purulent otitis is and knows how to treat it, this is not a reason for refusing to be examined by a doctor. A patient with otitis must be examined by an otolaryngologist, since complications may develop in the absence or inadequate treatment. It is also relevant that it is necessary to establish the cause of otitis media. As noted above, the main reason is problems with nasal breathing. That is why it is important to undergo treatment from a qualified otolaryngologist who can prevent complications and recurrences of otitis media.

Treatment for acute purulent otitis media is prescribed by a doctor who examines and subsequently works with the patient. I will dwell only on some of the features of the treatment of this disease.

Features of the course and treatment of acute purulent otitis media

1. A very common treatment method for ear pain is warming up. Patients usually use dry heat, alcohol drops, compresses and other physical methods. This method must be used with caution. It can be used only in the first hours of the disease, before the onset of suppuration from the ear. This leads to the following feature.

2. I categorically do not recommend performing thermal procedures if there is suppuration from the ear. Especially. Under no circumstances should alcohol-based drops be placed in the ear. since they can burn the mucous membrane. Treatment must be prescribed by a doctor.

3. In children, acute purulent otitis media develops very quickly. sometimes even lightning fast. Therefore, suppuration may occur in them already on the first day after the onset of the disease. Very often, especially in children in the first months of life, the pediatrician makes a diagnosis of otitis media by pressing on the tragus of the ear with a finger. The child reacts by crying. I would like to note that children may experience pain during this manipulation as normal.

4. If the doctor has established indications for puncturing the eardrum, it should be performed as soon as possible to avoid complications.

5. One of the conditions for effective treatment is the removal of pus or mucus from the ear canal, i.e. carrying out his toilet. You can do this yourself, but I categorically do not recommend using improvised means, such as matches, iron pins, or ready-made cotton swabs that are currently on sale. The skin of the ear canal can be damaged and purulent discharge may enter the wound, which can lead to external otitis media or additional injury to the eardrum. This is of particular importance in children who have very delicate skin of the ear canal. To clean the ear canal, it is better to use cotton swabs moistened with a 3% hydrogen peroxide solution or a 0.9% sodium chloride solution. But it is best when this procedure is performed by a qualified nurse or doctor under vision control.

6. If a doctor has prescribed thermal procedures for the ear area, you can use warming with a blue lamp (reflector), and also use semi-alcohol (alcohol with water 1 to 2 or 1 to 3) or vodka compresses. To carry out the latter, you should take a gauze napkin, square or oval, the size of which should extend beyond the auricle by 1.5-2 cm. A cut is made in the middle of the napkin through which the auricle is “threaded”. The napkin is moistened with the solution, then “put on” the ear, polyethylene is placed on top of it, then a layer of cotton wool or a knitted cap is put on. The compress should be kept as long as it has a thermal effect. Usually it lasts at least 2 hours.

7. When treating otitis, a mandatory component is the use of vasoconstrictor drops (naphthyzine or its analogs) in the nose to relieve swelling of the mucous membrane of the nasal cavity and nasopharynx.

Here, perhaps, are a few tips that may help you correctly treat acute purulent otitis media in you or your child. If you have any questions, the author will be happy to answer them. Write

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Diseases

A deviated nasal septum is a violation of the anatomy of the nasal cavity. Treatment of this disease is only possible through surgery. The operation of the nasal septum is called septoplasty of the nasal septum. The purpose of this operation is to straighten and reimplant back the part of the nasal septum that was deviated, while preserving the mucous membrane.

New material on foreign bodies in the maxillary sinus has been added to the PATIENTS section.

Sinusitis should be understood as inflammation of the maxillary paranasal sinus.

Source: http://www.lor.ru/patient/ostryy-gnoynyy-sredniy-otit.html

Acute purulent otitis media

  • What is Acute suppurative otitis media
  • What causes Acute purulent otitis media
  • Pathogenesis (what happens?) During Acute purulent otitis media
  • Symptoms Acute purulent otitis media
  • Diagnosis Acute purulent otitis media
  • Treatment of Acute purulent otitis media
  • Prevention Acute purulent otitis media
  • Which doctors should you contact if you have Acute suppurative otitis media?

What is Acute suppurative otitis media

This is a fairly widespread disease of the middle ear, which can occur either in a mild form or, developing rapidly, causing a severe general inflammatory reaction of the body. However, in both cases, it often leaves behind an adhesive process, accompanied by difficult-to-treat hearing loss, or becomes chronic, often progressive, also leading to hearing loss and often severe complications. Acute purulent otitis media is especially common in children under 3 years of age. A distinctive feature of this disease at present is a less acute onset and sluggish course, and in childhood - a tendency to relapse.

What causes Acute purulent otitis media

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. Through the auditory tube, microflora often enters the tympanic cavity, saprophytizing in the pharynx, but this does not cause inflammation if local and general reactivity is normal. If the influx of microflora was massive or it was highly virulent even in small quantities, acute otitis media occurs, as well as in the case of a small influx of saprophytic microflora with reduced reactivity. The main causative agents of acute otitis media (up to 80%) in adults and children are S. pneumoniae and H. influenzae, somewhat less commonly M. catarrhalis, S. pyogenes, S. aureus or associations of microorganisms. Viral otitis is more often observed during epidemics of viral diseases.

The most common route of infection is tubogenic - through the auditory tube. Usually there is no microbial flora in the cavities of the middle ear, which is explained by the barrier function of the mucous membrane of the auditory tube. Mucus is produced here, which has an antimicrobial effect, and the villi of the ciliated epithelium constantly move the mucous secretion towards the nasopharynx. With various general infectious diseases, local acute exacerbations and chronic, inflammatory diseases of the upper respiratory tract, the protective function of the epithelium of the auditory tube is disrupted, and the microflora penetrates into the tympanic cavity. 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. The third route of infection into the middle ear, hematogenous, is relatively rare. It is possible with infectious diseases such as influenza, scarlet fever, measles, typhoid, tuberculosis, etc. In extremely rare cases, acute otitis media develops as a result of retrograde spread of infection from the cranial cavity or labyrinth.

Pathogenesis (what happens?) During Acute purulent otitis media

Acute otitis media begins with inflammation of the mucous membrane of the auditory tube and the tympanic cavity. In this case, swelling of the mucous membrane and its leukocyte (neutrophil and lymphocytic) infiltration are observed. The mucous membrane of the tympanic cavity is very thin (0.1 mm) and is a mucoperiosteum (i.e., integral with the periosteum), so the inflammatory reaction is in the nature of mucoperiostitis. As a result of a sharp disruption of the function of the auditory tube, the middle ear is filled with exudate, which may initially be serous and then acquires a purulent character (liquid, thick, viscous). The mucous membrane becomes significantly thickened (tens of times), erosion and ulceration appear on its surface. At the height of inflammation, the tympanic cavity is filled with exudate, granulations and thickened mucous membrane. When the drainage function of the auditory tube is impaired, this leads to the outward bulging of the eardrum. As a result of strong pressure from purulent exudate and circulatory disorders, melting of some area and perforation of the eardrum, followed by otorrhea, often occur.

The initially abundant mucopurulent discharge gradually becomes thick and purulent, and as the inflammation subsides, their quantity decreases and the suppuration stops completely. After this, the perforation of the eardrum may heal, but ear congestion persists for some time. The criterion for recovery is normalization of the otoscopic picture and complete restoration of hearing.

Symptoms Acute purulent otitis media

In typical cases, acute purulent otitis media is characterized by a staged course. Local and general symptoms of the disease are expressed differently depending on the stage and severity of the process. There are three stages of acute suppurative otitis media:

It should be noted that not in all cases the process necessarily goes through all three stages. As a result of the mobilization of sufficient natural defenses of the body and with timely intensive therapy, the disease can already acquire an abortive course at the first stage.

The initial, pre-perforative stage of the disease is characterized by pronounced local and general symptoms. The leading complaint is pain in the ear, often very sharp, radiating to the temple and crown. Steadily growing, it sometimes becomes painful and unbearable. Pain occurs as a result of inflammatory infiltration of the mucous membrane of the tympanic cavity and the accumulation of exudate in it; in this case, irritation of the receptor endings of the branches of the trigeminal and glossopharyngeal nerves occurs. Sometimes there is pain on palpation and percussion of the mastoid process, which is caused by inflammation of its mucous membrane. At the same time, congestion and noise in the ear occur as a result of inflammation and limited mobility of the eardrum and the chain of auditory ossicles. Objectively, conductive hearing loss is detected with a slight deterioration in bone conduction of sound. With influenza otitis, as well as measles and scarlet fever, the inner ear is sometimes involved in the process, which is manifested by a more significant impairment of sound perception.

During this period, the general condition of the patient is often disturbed - signs of intoxication appear, body temperature rises to °C, changes characteristic of the inflammatory process are detected in the peripheral blood.

During otoscopy, the injection of blood vessels along the handle of the malleus and the radial vessels of the membrane is first visible, accompanied by shortening of the light cone. Then the hyperemia of the eardrum increases, becomes diffuse, its identifying points disappear, the membrane protrudes, becomes infiltrated, and sometimes becomes covered with a whitish coating. The duration of the initial stage of acute otitis media is from several hours to 2-3 days. The signs of this stage can be expressed differently - from obvious to imperceptible, but the main symptom - hyperemia of the eardrum (all or part of it) - is always present.

The perforated stage is characterized by perforation of the eardrum and the appearance of suppuration. At the same time, the pain in the ear quickly subsides, the patient’s well-being improves, and the body temperature decreases. Discharge from the ear is initially profuse, mucopurulent, sometimes mixed with blood. During otoscopy, a so-called pulsating reflex can be observed, when pus is visible through the perforation and pulsates synchronously with the pulse. A pulsating light reflex appears when a beam of light is reflected, which falls on a drop of discharge located in the perforation. This pulsation is associated with the pulsation of the blood-filled mucous membrane, in contrast to the same light reflex in chronic purulent destructive otitis media, where the dura mater is the cause of the pulsation.

Sometimes the thickened mucous membrane of the tympanic cavity prolapses through the perforation of the tympanic membrane in the form of a formation resembling granulation. After a few days, the amount of discharge decreases, it becomes thick and becomes purulent. Suppuration usually lasts 5-7 days. Perforation in acute otitis media is usually small, round with a membrane defect. Slit-like perforations without a tissue defect are less common. More extensive perforations occur with scarlet fever, measles, and tuberculosis.

The reparative stage is characterized not only by the cessation of suppuration and, in most cases, spontaneous scarring of the perforation, but also by the restoration of hearing. Along with a gradual decrease and then cessation of discharge, hyperemia and infiltration of the eardrum disappear, its shine appears, and identifying contours become distinguishable. Small perforations (up to 1 mm) close quite quickly, leaving no traces. With a large perforation, the middle fibrous layer at the site of the defect usually does not regenerate, and then, if the perforation does close, the epidermal layer on the outside and the mucous layer on the inside are restored. This area looks atrophic, has the appearance of tissue paper, and sometimes there are deposits of lime salts. Round-shaped perforations with a pronounced tissue defect often do not close; in this case, the mucous membrane of the membrane along the edge fuses with the epidermis and a persistent perforation with calloused edges is formed. Fibrous adhesive changes after otitis media often remain in the tympanic cavity itself, limiting the mobility of the auditory ossicles, which indicates an adhesive process, which in some cases can progress.

The typical course of acute purulent otitis media can be disrupted at any stage of the process. In some cases, the disease immediately takes on a sluggish, protracted nature with mild general symptoms. Perforation of the eardrum does not occur, but a viscous, thick secretion accumulates in the tympanic cavity, which is difficult to evacuate. Following this, an adhesive (adhesive) process often develops in the tympanic cavity.

Sometimes, on the contrary, in the first period the course of the disease can be extremely severe, with high fever, severe headache, vomiting, dizziness and a sharp deterioration in general condition. The reason for such a violent reaction is often long-term persistent perforation of the eardrum in the presence of exudate in the middle ear. In some cases, even before perforation, the infection can quickly spread from the middle ear into the cranial cavity and lead to severe intracranial complications and even death.

In some patients, despite perforation of the eardrum, the temperature does not decrease and the patient's condition does not improve. This course of the process is usually associated with the active development of inflammation in the mastoid process, i.e. the appearance of mastoiditis.

Sometimes, during the normal course of the disease after perforation of the eardrum, when the patient’s condition has already improved and the temperature has returned to normal, a rise in temperature is noted again, and pain in the ear appears. This clinical picture indicates a violation of the outflow and retention of pus in the cavities of the middle ear and may be a consequence of the formation of granulations in the mucous membrane, which create conditions for stagnation of exudate in the tympanic cavity, or it is associated with the onset of mastoiditis.

Suppuration that does not stop for a long time (3-4 weeks), when after cleaning the ear pus fills the ear canal again, indicates empyema of the mastoid process (mastoiditis), which usually causes melting of its bone bridges. Sometimes profuse suppuration, especially with pulsation of pus, is a sign of an extradural abscess.

In the normal course of acute otitis, changes in the peripheral blood are manifested by moderate leukocytosis without a pronounced shift to the left, and a mild increase in ESR. With a severe disease, pronounced leukocytosis is observed with a noticeable shift to the left. These changes, sometimes combined with the disappearance of eosinophils, are an unfavorable sign, especially in the late stage of the disease, when they may indicate the development of a complication (mastoiditis) or possible spread of infection into the cranial cavity.

The duration of the disease usually does not exceed 2-3 weeks. The complicated course and unfavorable outcomes of acute purulent otitis media may be due to a decrease in the local and general immune defense of the body, the high virulence of the pathogen and its resistance to the antibiotics used, and irrational treatment of the disease.

Diagnosis Acute purulent otitis media

Diagnosis of the typical course of acute purulent otitis media is not difficult. The diagnosis is made on the basis of complaints, anamnesis and features of the otoscopic picture. Sometimes otitis media has to be differentiated from otitis externa.

Treatment of Acute purulent otitis media

Treatment of a patient with acute purulent otitis media should be differentiated depending on the stage of the disease, the severity of clinical symptoms and take into account the characteristics of the patient’s somatic status.

In the acute stage of the disease, an outpatient regimen is recommended, and in case of a pronounced increase in temperature or general malaise, bed rest is recommended. If there is a suspicion of an incipient complication - mastoiditis, especially intracranial, the patient should be urgently hospitalized.

In order to restore or improve the ventilation and drainage functions of the auditory tube, vasoconstrictor or astringent drops are prescribed (solutions of Otrivin, Naphthyzin, Sanorin or Galazolin, etc., 3% solution of Protargol), which are poured 5 drops into the nose 3 times a day , it is better to have the patient lying on his back with his head turned towards the sore ear.

The patient should be warned not to blow his nose forcefully and not simultaneously through both nostrils. He should be prohibited from drawing mucus from the nose into the mouth, as this leads to the entry of infected secretions from the nose into the nasopharynx and auditory tube.

In the pre-perforative stage of acute otitis media there may be a pronounced pain syndrome, which is caused by swelling of the tympanic membrane and its tension due to the pressure of the inflammatory exudate from the side of the tympanic cavity. To relieve pain, topical osmotically active drugs are used. These drugs include an alcoholic 3% solution of boric acid or chloramphenicol in half with glycerin. In order to achieve an analyzing effect in acute otitis media, Otipax ear drops are also used; they contain the non-opioid analgesic-antipyretic phenazone and lidocaine.

The local analgesic lidocaine is also included in Anauran ear drops; however, it also contains the antibiotics polymyxin and neomycin, which makes it impossible to use these drops in the presence of perforation of the eardrum. Anauran is effective in the combination of external and otitis media before perforation occurs.

These drops, pre-heated to °C, should be poured into the ear, then hermetically closing the external auditory canal with cotton wool and Vaseline for several hours. It is recommended to repeat such administration of drugs 2-3 times during the day.

The use of antibiotics in the pre-perforation stage is certainly indicated for severe pain and increased body temperature. The drug of choice for the treatment of complicated forms of otitis in adults is amoxicillin 0.5 g orally 3 times in CVT for 7-10 days. If there is no effect after three days of amoxicillin therapy, the antibiotic should be changed to augmentin (0.625-1.0 g orally 2-3 times a day) or cefuroxime axetil orally (0.25 or 0.5 g 2 times a day). If you are allergic to lactam antibiotics, modern macrolides are prescribed (Rulid 0.15 g orally 2 times a day; spiramycin 1.5 million IU orally 2 times a day). Even if there is a sharp improvement in the patient’s general condition and local symptoms are alleviated, the course of antibiotic therapy should not be stopped prematurely; its duration is at least 8-10 days. Premature discontinuation of drugs contributes to relapse of the disease and the formation of adhesions in the tympanic cavity, which leads to persistent hearing loss.

For pain relief in the initial stage of the disease, paracetamol 0.5 g 4 times a day or diclofenac (Voltaren) 0.05 g 3 times a day is prescribed orally.

A warming semi-alcohol compress is also applied topically to the ear, which accelerates the resolution of the inflammatory process. However, if after applying the compress the patient notices increased pain in the ear, the compress should be removed immediately so as not to provoke the development of complications.

An important place in the treatment of acute purulent otitis media is occupied by catheterization of the auditory tube. Blowing of the auditory tube in acute otitis media with the help of a catheter is performed in order to drain the middle ear, eliminate the vacuum in the tympanic cavity that always occurs with this disease, and also introduce medications into it. In addition, catheterization helps normalize the function of the auditory tube and has a beneficial effect on the course of inflammation. The fear of infection from the pharyngeal cavity into the middle ear is unfounded, since in acute otitis media the pharyngeal microflora has already penetrated into the middle ear, and the auditory tube has largely lost its protective function. Catheterization is carried out from the very beginning of the disease and this often makes it possible to achieve an abortive course of the process; in stage III of acute inflammation of the middle ear, blowing with a catheter also gives a good therapeutic effect. Most often, after blowing through a catheter, 2-3 drops of 0.1% adrenaline solution are injected into the tympanic cavity, and then a mixture of a suspension of hydrocortisone and penicillin (or another antibiotic, taking into account the nature of the flora), dissolved in an isotonic solution of sodium chloride. You should first determine the patient’s tolerance to the drug that is intended to be used; Ototoxic antibiotics should never be injected into the ear. If, despite the treatment, protrusion of the eardrum is observed during otoscopy, then paracentesis is indicated - an incision of the eardrum. Protrusion of the eardrum in one place or another occurs from the pressure of the inflammatory fluid, which can cause intralabyrinthine and intracranial complications. After inflammation subsides, the fluid locked in the tympanic cavity is organized into connective tissue, which forms adhesive otitis media with severe hearing loss.

Paracentesis should be performed as an emergency if signs of irritation of the inner ear or meninges appear (dizziness, vomiting, severe headache, etc.). In children, especially in infancy, the eardrum is thicker and more resistant to the breakthrough of purulent exudate than in adults. At the same time, the general symptoms of acute purulent otitis media (pain, fever, intoxication) in early childhood are more pronounced. Therefore, the need for paracentesis in children occurs more often.

The incision of the eardrum is made with a special paracentesis needle in compliance with the rules of asepsis, under visual control. The external auditory canal is first thoroughly cleaned and its walls are treated with alcohol. The operation is performed under local anesthesia; in very restless children, light anesthesia with nitrous oxide is sometimes used. Local topical anesthesia is achieved by injecting for 10 minutes. into the external auditory canal until it comes into contact with the eardrum of a cotton wick soaked in a special medicinal mixture (Acidi carbolici 0.5, Mentholi 2.0, Cocaini hydrochloridi 2.0, Spiritus aethylid 10.0). However, more reliable anesthesia occurs with infiltration anesthesia subcutaneously into the posterior wall of the ear canal at the border of the transition of the membranous cartilage to the bone.

The patient is in a semi-sitting or lying position, his head is placed on a pillow and fixed with the hands of an assistant. The incision is usually made in the posteroinferior quadrant of the eardrum (usually this is the place of greatest bulging) and is made from the bottom up through its entire thickness. It is better to do this under a microscope. The insertion depth of the paracentesis needle is 1-1.5 mm; with deeper insertion, the labyrinthine wall can be injured. The incision should not reach the annulus tympanicus, so that persistent perforation does not form in the future. Usually, the perforation artificially formed during paracentesis closes on its own after a few days, and all three of its layers grow together. After perforation by pus, it closes less often, since its edges do not stick together, and it gapes.

After paracentesis, a sterile gauze turunda or cotton wool is inserted into the external auditory canal. The main attention is paid to ensuring the free flow of pus. Therefore, turundas should be changed frequently, while clearing the ear canal of pus. When the pus thickens, it can be removed by infusing a 3% solution of hydrogen peroxide, which, when combined with pus, forms foam. From the depths of the ear canal, foam and pus are removed by suction and using a probe with cotton wool wound onto it.

If there is a perforated eardrum, medications can be administered into the middle ear using transtympanic injection. The above mixture of antibiotic and hydrocortisone (and subsequently enzymes that prevent the formation of scars in the tympanic cavity - trypsin, chymopsin, lidase, etc.) is poured into the external auditory canal in an amount of 1 ml. and injected by gently pressing the tragus into the external opening of the auditory canal. In this case, the medicinal substance passes through the tympanic cavity, the auditory tube and can enter the nasal cavity and mouth. Catheterization and transtympanic injection of drugs are effective methods of treatment.

In the second, perforated, stage of acute purulent otitis media, the patient continues to receive antibiotics, antihistamines, and vasoconstrictor drops are still injected into his nose in order to restore the function of the auditory tube. In case of profuse thick purulent discharge, mucolytics are prescribed (fluimucil, ACC, fluifort, sinudret), erespal is an anti-inflammatory drug that reduces hypersecretion and swelling of the mucous membrane and stimulates the function of the ciliated epithelium of the auditory tube. Physiotherapeutic procedures (UV irradiation, UHF or microwave therapy, laser therapy) and warm compresses on the ear at home also contribute to a faster recovery.

Local treatment is aimed at providing favorable conditions for the outflow of purulent discharge from the tympanic cavity. The patient should be instructed so that he can independently remove purulent secretions from the depths of the external auditory canal 2-3 times a day. A piece of sterile cotton wool is wound onto a threaded probe or onto the free end of a match. For adults, the auricle is pulled back and up (for a child - back and down) and a probe or match with cotton is carefully inserted deep into the ear canal to the eardrum. The manipulation is repeated until the cotton wool remains dry. In case of thick pus, a warm solution of 3% hydrogen peroxide is first poured into the ear canal, after which the ear should be thoroughly dried.

After removing the purulent secretion, a medicinal solution prescribed by a doctor, heated to 37 °C, is poured into the ear. This can be 0.5-1% dioxidine solution, 20% sodium sulfacyl solution, Otofa drops containing the active substance rifamycin, Normax, tsipromed, etc.

It is not recommended to prescribe alcohol drops in the second stage of otitis, since alcohol often causes irritation of the mucous membrane of the tympanic cavity and severe pain.

Suppuration usually stops after a few days and this marks the transition of the disease to the final reparative stage. Perforation of the eardrum is most often closed with a gentle, inconspicuous scar. Adhesions may develop in the tympanic cavity, which, as a rule, do not limit the movement of the auditory ossicles and eardrum. During this period, it is important to achieve as complete a hearing restoration as possible. Antibiotic therapy is canceled, ear toilet is stopped, thermal procedures are also completed. After the disappearance of perforation, the main attention is paid to restoring the ventilation function of the auditory tube and increasing the body's resistance. The auditory tube is blown through the Politzer method or through a catheter, and it is possible to introduce enzyme preparations into the tympanic cavity that prevent the formation of adhesions. For the same purpose, pneumomassage of the eardrum is performed using a Siegle pneumatic funnel, and endaural iontophoresis with lidase.

It is recommended to continue vitamin therapy, biostimulants are prescribed - apilak, actovegin. To ensure the restoration of hearing function, control audiometry is performed. In a typical favorable course, recovery occurs with the elimination of the inflammatory process and complete restoration of hearing. The perforation of the eardrum closes, leaving almost no traces; sometimes, when a scar is formed, lime salts are deposited in it - petrificates that look like white spots.

Forecast. Along with the noted favorable course of acute purulent otitis media, ending with recovery and restoration of hearing, other outcomes are possible.

— Transition of the disease into a chronic form (chronic suppurative otitis media), with the formation of persistent perforation of the eardrum, with recurrent suppuration and progressive hearing loss.

— Development of one of the complications of acute purulent otitis media: mastoiditis (antritis in children), petrositis, labyrinthitis, facial nerve paresis, one of the intracranial complications (meningitis, brain or cerebellar abscess, thrombosis of the sigmoid sinus, sepsis, etc.).

- The formation of adhesions and adhesions in the tympanic cavity, between the auditory ossicles causes their stiffness and progressive hearing loss - adhesive otitis media develops.

Prevention Acute purulent otitis media

Prevention of inflammatory diseases of the middle ear involves eliminating or weakening the influence of those factors that contribute to the occurrence of acute otitis media and its transition to chronic.

In infants, the level of natural resistance is directly dependent on the method of feeding. With breast milk, the child receives substances that provide nonspecific humoral protection, for example, lysozyme, immunoglobulins, which is very important for the child’s adaptation to environmental conditions. Therefore, an important measure for the prevention of colds and otitis media is feeding the child with breast milk.

Until recently, the incidence of acute otitis media in children was caused by childhood infectious diseases. Thanks to mass specific prevention, it has now been possible to reduce the incidence of infections in children such as measles and scarlet fever.

A number of other factors also influence the incidence of otitis media in children and adults.

— High prevalence of respiratory viral infections that reduce the mucociliary activity of the respiratory epithelium, including the epithelium of the auditory tube, suppressing local immune defense. Widespread, often unsystematic and unjustified use of antibiotics, which leads to the emergence of resistant strains of pathogens and at the same time disrupts the body’s natural defense reactions.

- Sensitization of the body and distortion of the mechanisms of local and general immune defense when eating foods containing preservatives, various synthetic additives, and in children - during artificial feeding.

— Decrease in general nonspecific resistance due to physical inactivity, limited exposure to the open air and sun, and insufficient consumption of vitamin-rich foods.

— Adenoids always contribute to the occurrence and chronicity of acute otitis media, so timely adenotomy is advisable.

Elimination of the adverse effects of these factors makes it possible to reduce the incidence of inflammatory diseases of the middle ear. In particular, methods for specific prevention of influenza and acute respiratory diseases (Influvac, IRS-19, Imudon, etc.) have appeared, active sanitation of the upper respiratory tract is being carried out, and methods of adequate treatment of acute respiratory diseases without systemic antibiotics are becoming widespread.

In the development of acute otitis media and in its transition to chronic, chronic foci of infection in the nose and pharynx are of great importance. Timely sanitation of such foci of infection and restoration of normal nasal breathing are important components in the complex of measures to prevent otitis media. Prevention of chronic suppurative otitis media is the correct treatment of a patient with acute otitis media. An important component of this treatment is timely paracentesis (according to indications), as well as adequate antibiotic therapy, taking into account the characteristics of the pathogen and its sensitivity to antibiotics. The transition of acute otitis to chronic is often facilitated by early discontinuation of the antibiotic, its use in small doses and lengthening the intervals between antibiotic administrations.

Patients who have suffered acute otitis media, even with a favorable course of the convalescence period and with normalization of the otoscopic picture and hearing, should be under medical supervision for 6 months. By the end of this period, they must be re-examined, and if signs of trouble in the ear are detected (slight hearing loss, changes in the otoscopic picture, impaired tubular function), the course of treatment should be repeated - blowing the auditory tube, pneumomassage of the eardrum, biostimulators, etc., until operations (tympanotomy, tympanic cavity bypass).

Each patient with chronic suppurative otitis media at the first visit must undergo a course of intensive therapy and then decide on further tactics: either the patient is immediately sent for surgical sanitation, or after at least 6 months he undergoes hearing-improving surgery. If there are contraindications to one or another operation, the patient must be registered at a dispensary with periodic monitoring (at least 1-2 times a year) and, if necessary, repeated courses of treatment are carried out. It should be borne in mind that even long-term remissions that last for many years during chronic otitis often create the appearance of well-being for both the patient and the doctor. With a calm clinical picture of chronic purulent otitis media, the patient may develop cholesteatoma or an extensive carious process in the cavities of the middle ear, which, in addition to increasing hearing loss, can lead to the development of severe, often life-threatening complications. At the same time, the earlier the ear is sanitized, the greater the chances of preserving and improving hearing.

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

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