Acute otitis media in adults

Posted on by admin

Types of acute otitis media and their treatment

Ear diseases occur in children and adults. Most types of acute otitis media can lead to serious consequences if not properly treated.

Table of contents:

Prescribes diagnosis, course of treatment and prevention of ENT.

Acute otitis media

This is a fast-acting infectious disease. The source of inflammation is located in the middle ear. The disease is one of the most common in pediatric and adult otolaryngology.

Inflammation affects the tympanic cavity, directly the middle ear. The latter is located in the thickness of the temporal bone. From the outside, the cavity is limited by the eardrum.

It is equally common in women and men. Doctors note that in adults the symptoms may be “blurred”, and in children there is a tendency to relapse. Children have a special ear structure, so when the disease develops, the mastoid cavity becomes infected almost immediately.

There are three types of inflammation based on the nature of inflammation:

Purulent

It implies acute purulent inflammation, affecting other parts of the auditory organ. The causative agent of this disease is bacteria that enter the auditory area through the tube. Purulent otitis media differs in stages. Local and general symptoms vary depending on the stage and severity of the process. There are three stages:

At the first stage, local and general symptoms appear. The pain is very strong, radiating to the temple. Over time, it increases. The cause is the formation of infiltrate.

Perforated

This form is distinguished by the fact that the eardrum is perforated and suppuration occurs. At this stage, the pain subsides and the temperature drops. Discharge during purulent otitis media in children in the first days is abundant and may be mixed with blood. Sometimes a pulsating reflex is observed during otoscopy.

The photo shows purulent otitis with perforation

After this stage comes the reparative stage. The discharge of pus stops, the eardrum is restored, and hearing returns to normal. This course is typical, but at any stage the disease can become chronic.

If the second stage does not occur, then severe headaches, vomiting may develop, and the general condition becomes very serious.

Exudative

The disease is characterized by the formation and long-term persistence of transudate in the tympanic cavity. It occurs much more often in children than in adults. During illness, the ventilation function is impaired. This leads to the formation of a vacuum and sweating of the serous contents. Sometimes blood is added to the latter. There are several forms of the disease.

Post-traumatic

It is formed more often in children due to minor injuries, including burns, frostbite, chemical or mechanical exposure. Through a damaged eardrum, the infection easily reaches the middle ear.

Serous

At the first stage, it resembles a purulent form of purulent otitis. Most of the patients are children under one year of age. A vacuum builds up in the area of ​​the eardrum. Afterwards a slight autophony is formed. Hearing loss is sometimes so slight that it may go unnoticed. After 30 days, mucus appears, which leads to noise and a feeling of fullness.

Bullous

If for all other forms the prerequisites are a decrease in immunity and the appearance of microcracks, then the bullous form is formed due to the presence of a virus in the blood. First, flu symptoms appear, after the virus circulates throughout the body, a focus of inflammation forms in the middle ear.

The disease is mainly found in adults who have a weak immune system. Bubbles appear on the membrane and on the walls of the passage, leading to moderate pain. The bullae can be very small or the size of a pea.

If the disease is preceded by an acute respiratory viral infection, then in addition to discharge from the ear, itching, body temperature rises, and a feeling of weakness develops.

Catarrhal

One of the most dangerous forms, since if left untreated it leads to a sharp decrease in hearing. The cause of development is upper respiratory tract infections or inflammation of the adenoids. The causative agent is coccal bacteria.

The main factor for the formation of catarrhal otitis is a persistent violation of the ventilation and drainage functions of the auditory canal. Therefore, the form is characterized by increased secretion and has a protracted course of the disease.

Symptoms

Otitis media usually lasts up to 3 weeks. At the first stage, intense pain in the ear appears. It can be unbearable, causing lack of sleep and loss of appetite. Gives to the temporal region. The temperature rises to high levels, chills and signs of intoxication appear.

In the second stage, the pain subsides, if the membrane ruptures, this leads to a decrease in temperature. Suppuration lasts no more than 7 days.

At the last stage there are practically no unusual sensations. Active healing occurs, but if the perforation is larger than 1 mm, the fibrous layer of the membrane is not restored.

When the hole becomes overgrown, an atrophic and thin film is formed, lined only with epithelial and mucous layers.

Causes

Among the main reasons are:

  • Hypothermia. During a decrease in temperature, vasoconstriction occurs, which leads to a decrease in local temperature. Bacteria begin to actively multiply.
  • Infections of the nose, nasopharynx. Even if they were in a “sleeping” state, they are activated at any moment under the influence of unfavorable factors.

In 70% of patients, examination of the contents reveals:

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

How to treat?

Based on the complaints received from the patient, the doctor suggests the presence of an inflammatory process in the middle ear. A caemartinal study is being carried out. It allows you to determine the quality of your hearing. The doctor may order you to undergo general tests and bacterioscopic examination of the exudate. Afterwards treatment is prescribed.

Medication standards

At the first signs, drops are prescribed. If purulent contents appear, local antibiotics are prescribed. When a high temperature appears and there is a risk of developing the disease, injections with antibacterial agents are prescribed.

Most drops contain an anesthetic. It helps relieve pain and restores appetite. Otipax drops and Tsitovich compress (gauze soaked in a solution of boric acid and glycerin) have a good analgesic effect.

The drug Otirelax, which has similar effects, has received good reviews. By the way, you need to drip into both ears, regardless of whether you have bilateral, left- or right-sided otitis media.

To reduce swelling of the auditory corpse, vasoconstrictor nasal drops and antihistamines are prescribed. They also allow to improve the outflow of pus from the middle ear.

Antibiotics are prescribed exclusively by a doctor, since not all are suitable for ear treatment. If there is no effect, after three days the drug is replaced with another one.

How long to treat in adults?

Treatment in adults is at least 8-11 days. Even after the condition improves, treatment continues. Early discontinuation of drugs often causes relapses or hearing loss.

How long does it take for otitis media to go away in children?

If the disease has not yet become chronic, recovery occurs in 3 to 5 days.

Chronic types require more thorough treatment for up to 10 days.

Untreated diseases, against the background of which otitis media develops, lead to the fact that the treatment period increases.

Traditional methods of ear treatment

These methods are used more often as an addition to drug therapy. Geranium, aloe, and Kalanchoe will help relieve pain. The leaf is torn off, rolled into a tube and placed in the sore ear. Aloe and Kalanchoe can be kept in the refrigerator for a day, then the juice is squeezed out of them. They soak gauze and place it in the ear.

You should eat honey and lemons. The first component is diluted with warm water. Instilled in each ear.

Herbs are also used. The heel, sweet clover, will come in handy. An excellent solution would be a ready-made calendula tincture. It is bought at the pharmacy.

Complications

If treatment is not started immediately, a purulent form of otitis media quickly develops and the eardrum ruptures. Among the most dangerous consequences is mastoiditis, which requires surgical intervention. Sometimes purulent meningoencephalitis leads to death.

To prevent the development of hearing loss and to protect your life, you need to consult a doctor at the first symptoms.

Consequences

The main consequence is hearing loss. In adults, the eardrum does not recover completely. Sometimes it takes years for your hearing to improve. This is especially dangerous for children in the first years of life, since problems with the ears often cause delayed speech development.

Prevention and consequences of otitis media, ENT recommendations in our video:

Prevention

Doctors say that it is necessary to treat colds in a timely manner and ensure that the adenoids do not become inflamed. Teach children to blow their nose correctly by closing their nostrils one at a time. Otitis is often preceded by a decrease in immunity. So don't forget to strengthen it.

Source: http://gidmed.com/otorinolarintologija/zabolevanija-lor/bolezni-uha/otit/vidy-ostrogo-srednego-i-ih-lechenie.html

Treatment of otitis in adults. Effective treatment of otitis media

Otitis is an inflammatory disease of the ear. To understand why the disease occurs and what processes occur, let us consider the anatomical structure of the hearing organ and the process of its perception of information.

Ear structure

The human ear has a very complex structure, which can be divided into three sections - the outer, middle and inner ear. The outer ear is the pinna, which receives sound waves, directing them into the external auditory canal. The outer and middle ears are separated by the eardrum, which is conventionally a hymen or membrane.

The middle ear is a cavity, a space in the temporal bone with three hearing bones located in it - the hammer, incus and stapes. It should be noted that the middle ear is closely connected to the nasopharynx. Functionally, the bones amplify the received sound vibrations and transmit them to the inner ear. The inner ear is a labyrinth of membranes in the stony part of the temporal bone with many bends filled with fluid. Vibrations coming from the middle ear are transmitted to the fluid, which already affects the receptors. This is how information is transmitted to the brain in the form of nerve impulses.

Concept, types of otitis. Causes

Otitis media is a disease that can develop in any of the three parts of the ear; accordingly, depending on the place where the inflammatory process occurs, they are distinguished:

  1. Otitis externa.
  2. Otitis media.
  3. Inflammation of the inner ear (or labyrinthitis).

There are many reasons that contribute to the onset of the disease or aggravate its course, but the main ones include:

  • diseases of the nasopharynx, leading to swelling and inflammation of the mucous membranes of the middle ear;
  • diseases that suppress and weaken the immune system (flu, measles);
  • hypothermia;
  • cold water getting into the ear;
  • injuries and various damage to the eardrum, which can lead to infection in the middle ear cavity;
  • genetic predisposition.

Based on the nature of the pathogen that causes the disease, otitis media is divided into:

Let's take a closer look at the inflammatory processes that occur in each of the three parts of the human ear, the symptoms and possible complications of otitis media.

Otitis externa. Classification. Symptoms

Otitis externa is an inflammation of the skin of the auricle along with the external auditory canal, which is caused by a bacterial or fungal infection. There are two types of external otitis: limited and diffuse.

In most cases, limited inflammation is represented by furunculosis - the formation of boils. A furuncle is an acute purulent process of a sebaceous gland or hair follicle caused by pyogenic bacteria. In the presence of favorable factors in the human body, including chronic infection, diabetes mellitus, local injuries and skin contamination, insect bites, staphylococcal microflora begins to actively provoke the inflammatory process.

Sometimes the disease is a complication of a previous flu or can be caused by an allergic reaction to medications. Signs of external otitis include itching; pain that occurs when touching the inflamed area of ​​the ear; redness and swelling of the skin of the external auditory canal, or pinna; Sometimes your body temperature may rise. Hearing, as a rule, is not affected.

Generalized otitis externa is an inflammation of the outer ear, which can often spread to the eardrum.

Based on the duration of the disease, otitis externa is classified into acute and chronic. The latter is a consequence of the lack of treatment or incorrect treatment of the acute form of the disease.

Otitis of the external ear is considered the mildest type of the disease in comparison with otitis media and otitis internal and often does not lead to serious complications, although it can sometimes cause enlargement of the nodes of the lymphatic system. Inflammation of the mucous membrane develops into a malignant form (tissue necrosis) if a person has concomitant severe functional diseases (diabetes) or the immunodeficiency virus. But such cases, fortunately, are rare.

Otitis media Classification and symptoms

Of all forms of otitis media, inflammation of the middle ear is the most common in both children and adults. As noted earlier, the nature of the disease can be bacterial or viral. Among bacteria, the main pathogens are streptococci or Haemophilus influenzae. Viruses that cause inflammation include rhinovirus, influenza virus, or respiratory syncytial virus.

The first signs of inflammation of the middle ear are throbbing, shooting or aching pain in the organ, which intensifies when swallowing, sneezing or coughing. This disease is also characterized by noise in the ear, weakness, sleep disturbance, lack of appetite, and a sharp deterioration in hearing.

Basically, inflammation of the middle ear is the result of a previous runny nose or flu, which causes a decrease in immunity and an increase in the number of bacteria in the nasal cavity. The nasal cavity is connected to the middle ear by the auditory tube, in which fluid and various microorganisms accumulate, provoking the onset of the inflammatory process. At the same time, the eardrum experiences pressure and expands outward, which is why pain appears.

The course of the disease can vary in speed of development, as well as in duration, according to which they distinguish:

  1. Acute otitis media (fluid accumulates in the ear). This is the reason why you hear your own voice in your head.
  2. Chronic otitis media (ear filled with pus).

Acute otitis. Forms

If we classify the inflammatory process according to the nature of the course (clinical picture), then otitis media can be catarrhal or purulent, thus the development of the disease undergoes three stages - acute catarrhal otitis media, acute purulent otitis media and the recovery stage.

Acute catarrhal otitis is an inflammatory process associated with the localization of fluid in the middle ear cavity. In addition to pain and elevated body temperature (38-39 °C), this form of the disease is characterized by redness and swelling of the eardrum, and ear congestion. Patients note that they hear their own voice in their heads when talking.

The appearance of foci of pus and its accumulation in the middle ear cavity is acute purulent otitis. Treatment is not carried out for the first 2-3 days, because usually during this period the eardrum ruptures and pus comes out. At the same time, the patient feels better, the body temperature returns to normal, and the pain stops. In addition to pus, bloody and serous discharge may be observed. If the course of the disease passes without complications, then the third stage begins - recovery.

With the beginning of the recovery stage, the inflammatory process decreases, suppuration stops and the damaged membrane gradually tightens. If treatment of otitis in adults is carried out in accordance with prescriptions and under the supervision of a specialist, then recovery occurs in 2-3 weeks. By this time, hearing is usually completely restored.

Chronic otitis media. Stages

If treatment is untimely or insufficient, acute otitis media progresses to its chronic stage. Chronic otitis media is an inflammatory process characterized by constant or periodically recurring suppuration from the ear. This type of otitis, in addition to the already known symptoms, such as increased body temperature, itching, deterioration of general condition, is characterized by complications in the form of hearing loss and persistent perforation of the eardrum. Typically, the chronic course of the disease is a consequence of previous sinusitis or acute purulent otitis. In some cases, this form of otitis occurs as a result of a rupture (or perforation) of the eardrum or a deviated nasal septum after an injury. Depending on the location of the perforation, as well as its size, three stages of chronic otitis are distinguished:

  1. Tubotympanic otitis (mesotympanitis).
  2. Epimesotympanitis.
  3. Epitympanitis.

In the tubotympanic form of otitis, a violation of the tympanic membrane occurs, as a rule, in the central part, and the pathology is manifested by inflammation of the mucous membranes of the tympanic cavity. Inflammation does not affect bone tissue.

Epimesotympanitis is a stage of chronic otitis, during which extensive perforation of the eardrum occurs, damage affecting its upper and middle sections.

The epitympanoantral form of otitis is characterized by rupture of the upper, most pliable and fragile areas of the membrane. This stage of the disease, as well as epimesotympanitis, is dangerous due to the occurrence of pathological processes associated with the formation of granulomas, polyps and cholesteatoma - a capsule filled and surrounded by purulent particles of the epidermis, which, constantly growing, puts pressure on the eardrum, destroys the bone component of the middle ear and opens the " way" to the purulent process in the inner ear.

In addition, there is another form of the inflammatory process - bilateral otitis - a disease that simultaneously affects the hearing organ on both sides.

If we consider the existing complications of the disease, then perforation of the eardrum is the most common. With prolonged accumulation of pus, pressure in the middle ear increases, causing the membrane to become thinner. There is a risk of its rupture (perforation). To prevent the transition of the inflammatory process to the stage of internal otitis and to avoid the subsequent development of serious pathologies, you should resort to puncturing the eardrum surgically, rather than waiting for the moment when this happens spontaneously.

Inflammation of the inner ear. Symptoms

Internal otitis has another name - labyrinthitis - this is a disease that is less common in comparison with otitis of the external and middle ear, but is the most dangerous in terms of threat to human health and life. Purulent processes that affect bone tissue can cause serious complications, for example, meningitis (an inflammatory process in the membranes of the brain) or sepsis (blood poisoning due to pus entering it). As a rule, internal otitis is the result of complications of previous otitis media or the consequences of a severe infectious disease. High body temperature, severe headache and vomiting, loss of balance - all these are symptoms of internal otitis, for which it is necessary to seek help from a specialist as soon as possible. In addition, with such forms of the disease there is a sharp deterioration in hearing, up to its complete loss.

In order to make an accurate diagnosis and, as a result, prescribe the correct treatment regimen for the patient, doctors resort to otorhinolaryngological examination and laboratory tests.

Diagnosis of otitis. Surveys and research

Laboratory diagnostics are carried out mainly to establish the nature of the origin of otitis media - bacteriological or virological. Using a serological reaction of blood serum and a polymerase chain reaction, antibodies to pathogens are detected. Also, the results of a general blood test will show the presence or absence of an inflammatory process in the body.

Basic instrumental methods for diagnosing otitis:
  • Tympanocentesis is the examination of fluid obtained by surgically puncturing the membrane. The procedure allows you to determine the antibiotic necessary to fight a particular type of infection, but in practice it is not often used.
  • Tympanometry - checking the mobility of the eardrum.
  • Otoscopy is an examination of the eardrum and ear canal using an otoscope.
  • Audiometry - determination of hearing acuity in cases of suspected hearing loss.
  • Computed tomography of the brain and skull structure (CT), magnetic resonance imaging (MRI) - are used for suspected purulent inflammatory processes and intracranial complications, help diagnose the formation of various pathologies - polyps, cholesteanoma, etc.

Conservative treatment of otitis in adults

To avoid the development of complications and achieve recovery with minimal waste of time and effort, otitis media must be treated in a timely manner, in fact, like any other disease. For each form of the inflammatory process, a special treatment method is provided, with its inherent procedures and medications.

Otitis of the external ear is treated on an outpatient basis, using drops that contain an antibiotic. Sometimes antibiotics may be prescribed along with corticosteroids or antihistamines if the illness is caused by an allergic reaction. There are also procedures for washing the ear canal with an antiseptic solution. If this therapy does not lead to recovery or is impossible due to severe swelling of the ear canal and facial cellulite, oral medications are prescribed. At elevated body temperatures, antipyretics are used, as well as analgesics if pain is present. In rare cases, when purulent inflammation of the tissues of the outer ear occurs, surgical intervention may be indicated.

Elimination of inflammation in the middle ear during the normal course of the disease takes place on an outpatient basis. Treatment of otitis in adults is carried out with the prescription of antibiotics, antiseptics and bed rest. To reduce pain, warm 96% alcohol is used as drops (in case of suppuration, this procedure is contraindicated). For local use, physiotherapy is prescribed, and it is also possible to use a blue lamp. A warming compress for otitis media (alcohol, vodka or camphor oil based) would also be useful, and should be kept for no more than 3-4 hours. It is also necessary to remember that you cannot apply a compress at elevated body temperature.

If, nevertheless, the disease does not proceed without complications, then the patient will show signs of acute otitis - purulent otitis will develop. Treatment can be continued with antibiotics or surgery.

Surgical intervention

Sometimes it happens that conservative treatment of otitis media in adults does not lead to an improvement in the patient’s condition. In such situations, surgical dissection of the eardrum is performed - tympanostomy. This manipulation allows you to avoid complications, since the puncture is made at a favorable and correct point, the pus comes out through a specially installed tube, and the pain syndrome is reduced, and recovery occurs faster. In addition, the biomaterial (purulent discharge) is subject to laboratory bacteriological testing for sensitivity to antibiotics. If hearing acuity is not restored after the procedures, blowing and pneumatic massage may be prescribed.

There are cases when a natural rupture of the eardrum occurs. This is observed mainly with inflammation of the middle ear and requires immediate surgical intervention.

In the tubotympanic form of otitis, the task of surgical treatment is to restore the integrity of the eardrum - tympanoplasty using one's own cartilage.

The epitympanoantral form of otitis is associated with the destruction of bone tissue. With this course of the disease, the goal of surgical intervention is to remove the bone pathology and restore the eardrum using prostheses made of inert materials (titanium).

Internal otitis is the result of ineffective treatment of otitis media and is dangerous due to the occurrence of purulent complications with damage to the meninges. Therefore, with such forms of the disease, hospitalization of the patient with further provision of surgical care is necessary.

It should be remembered that prevention is always better than cure. Prevention of otitis media can include the timely elimination of foci of infection inside the body (caries, sinusitis), as well as the elimination of hypothermia. When the first signs of illness appear, it is important to immediately seek medical help from specialists.

Source: http://www.syl.ru/article/182118/new_lechenie-otita-u-vzroslyih-effektivnoe-lechenie-otita

Acute otitis media in adults: modern choice of rational therapy

About the article

For citation: Nikolaev M.P. Acute otitis media in adults: modern choice of rational therapy // Breast Cancer. 2005. No. 21. S. 1442

The problem of treating acute otitis media in adults still remains one of the most pressing in modern otorhinolaryngology. This is due to the high prevalence (20–30%) and frequency of cases of microflora resistance to basic antibiotics, an increase in viral infections of the middle ear, unsatisfactory treatment results, and often the transition of acute inflammation to a chronic form [2,3,5].

There are several ways of infection entering the middle ear: tubogenic, traumatic, hematogenous. The most common of them is tubogenic. Acute and chronic diseases of the nasal cavity, sinuses, nasopharynx, tumors, as a rule, lead to the development of acute otitis media. The process begins with dysfunction of the auditory tube and disruption of its patency or functional impairment caused by the ineffectiveness of the mechanism of its active opening. Both mechanisms lead to the creation of negative pressure in the tympanic cavity and transudation of fluid, which is initially sterile, but after the entry of bacterial or other flora takes on an inflammatory nature, aimed at eliminating the pathogen, regenerating damaged tissues and restoring functional structures. At the first stage, blood flow increases at the site of inflammation, the permeability of capillary walls increases, and the migration of white blood cells directly into the tissue increases. Then protective mechanisms are launched - inflammatory mediators and oxygen free radicals are released, which in the acute period has a positive effect on the inflammatory process. However, the prolonged presence of highly active cells and free radicals in the lesion leads to serious tissue changes due to the transformation of collagen and peroxidation of cell membranes. In this case, the inflammatory reaction, initially aimed at stimulating the immune system and repair processes, can become uncontrolled, forming a so-called “vicious circle” (infection and inflammation reinforce each other), which contributes to the chronicization of the pathological process with the development of complications and the addition of superinfection [12].

Etiological factors of acute otitis media can also include immunodeficiency (in particular, low levels of IgA, IgG2), HIV infection, and genetic predisposition [9].

Acute otitis media is an acutely developed inflammation of the middle ear cavities, manifested by one or more symptoms (ear pain, fever, discharge from the ear, hearing loss). Usually the disease lasts no more than 3 weeks and can even spontaneously end in recovery with complete restoration of the anatomical integrity of the structures of the middle ear and their functions, but it can take on a protracted or recurrent course.

In acute otitis media, the inflammatory process involves not only the tympanic cavity, but also the cellular system of the mastoid process, antrum, aditus and auditory tube.

The main causative agents of acute otitis media are pneumococcus (Streptococcus pneumoniae) and Haemophilus influenzae, which constitute an average of 60% of bacterial pathogens, less commonly Moraxel (Moraxella cataralis) - 3-10%, streptococcus (Streptococcus pyogenus) - 2-10%, staphylococcus (Staphylococcus aureus) – 1–5%. About 20% of cultures from the tympanic cavity turn out to be sterile. It is believed that about 10% of acute inflammations of the middle ear are caused by viruses; mycoplasma (Micoplasma pneumoniae), which can cause bullous hemorrhagic myringitis, may play a certain role [1,7].

Diagnosis of acute otitis media is based on typical complaints and instrumental examination data.

Otoscopy usually determines hyperemia and thickening of the eardrum, its bulging and impaired mobility. If there is discharge in the external auditory canal, examination using optics (otoscope, microscope) allows you to see the perforation, which in some cases is slit-like, often covered with edematous mucous membrane.

During acute otitis media, there are usually 3 stages or phases: pre-perforative, perforative and reparative.

The stage of catarrhal-purulent inflammation (pre-perforative) is characterized by moderate or severe pain in the ear, absence of discharge from the ear, hearing loss, tinnitus, autophony, increased body temperature to sub- or febrile levels, hyperemia of the eardrum, its bulging, smoothness or absence identification marks.

At the perforated stage, pain in the ear is moderate or absent, but pus appears in the ear canal, hearing loss intensifies and is conductive in nature, body temperature decreases and becomes subfebrile or normalizes, perforation of the eardrum is determined, from which pus comes.

In the reparative stage, there is no pain or discharge, body temperature normalizes, but moderate conductive hearing loss persists in some cases, the eardrum becomes gray, and the perforation is covered with a scar.

Each stage of the inflammatory process requires its own individual treatment approach. An important component of symptomatic and etiopathogenetic therapy is local anti-inflammatory therapy that meets certain fundamental criteria, namely, to ensure the concentration of the optimal dose of the active substance directly at the site of inflammation; not have systemic exposure to the prescribed drug in order to reduce unwanted side effects; be accessible to the general population.

The decline in the level of well-being of the population, the quality of life, and the increase in infectious diseases significantly complicate the provision of appropriate care to patients with inflammation of the middle ear.

In the non-perforative stage of inflammation of the middle ear, actions aimed at restoring the function of the auditory tube are necessary. This requires the use of vasoconstrictor drops in the nose (xylometazoline, etc., 5 drops in each nostril 3-4 times a day), as well as drops in the ear (choline salicylate, gentamicin + betamethasone, 5 drops 3 times a day). These drops are prescribed on the first day of the disease to relieve pain, which is caused by swelling of the eardrum and its tension. Ear drops containing the non-opioid analgesic-antipyretic phenazone and lidocaine should be instilled into the ear, then sealing the ear canal with cotton wool and petroleum jelly for several hours. In this case, the drug will not evaporate and will have maximum anti-edematous and analgesic effect. If a positive effect does not occur after a day, you should resort to paracentesis or tympanocentesis.

At the perforated stage, when pus appears in the ear canal, the ear canal should be toileted using disinfectant solutions (rivanol, furatsilin, ectericide, etc. or 3% hydrogen peroxide followed by the introduction of ear drops (ciprofloxacin, rifamycin) [4,5,6 ] containing antibiotics. The advantage of this method of administration is a local effect at the site of inflammation and the absence of a systemic effect. When instilled into the ear and into the tympanic cavity, the drug has a pronounced antimicrobial effect. These drops do not have an ototoxic effect, so they can be used for perforation of the eardrum , but drops such as cholinasalicylate, gentamicin + betamethasone have an ototoxic effect, and their use at this stage is undesirable.

Ciprofloxacin is an antibiotic from the fluoroquinolone group, has a wide spectrum of antibacterial action, has a bactericidal effect on gram-positive and gram-negative flora, including Pseudomonas aeruginosa. The drug inhibits bacterial DNA, as a result of which microbial synthesis of cellular proteins and DNA is disrupted. Ciprofloxacin acts both on the proliferation of bacteria and on bacteria in the dormant stage [13]. The clinical effectiveness of ciprofloxacin in Cipromed ear drops is enhanced by the viscous base – propylene glycol. In addition to these drops, you can use a solution of amoxicillin/clavulanate and dexamethasone in a 3:1 dilution with the addition of 1–2 drops of a 0.1% adrenaline solution, followed by injection by pressing on the tragus [8].

There is a combination drug containing chloramphenicol, a broad-spectrum bacteriostatic antibiotic that disrupts the process of protein synthesis in the microbial cell. The drug is active against gram-positive and gram-negative bacteria. Beclomethasone dipropionate is a glucocorticoid that has anti-inflammatory and antihistamine effects. Lidocaine hydrochloride is a local anesthetic that causes a reversible blockade of impulse transmission along nerve fibers by blocking the passage of sodium ions through the membrane. The presence of clotrimazole in the drug provides, among other things, an antifungal effect due to disruption of the synthesis of ergosterol, which is part of the cell membrane of fungi, which changes the permeability of the membrane and causes subsequent lysis. Thus, the drug allows you to achieve antibacterial, anti-inflammatory, antifungal and analgesic effects in inflammatory processes in the middle ear.

At the reparative stage of the inflammatory process, attempts should be made to restore hearing, since there is a high risk of chronicity of the process. Catheterization of the auditory tube, pneumomassage, and laser therapy (5–7 procedures) for 5 minutes each have a good effect.

In the initial stage of acute otitis media, analgesics and non-steroidal anti-inflammatory drugs (acetylsalicylic acid, metamizole, tramadol, ketoprofen, ibuprofen, ketorolac, etc.) are usually prescribed to relieve pain and reduce the inflammatory response.

Antihistamines are usually used to relieve the allergic component and accompanying effects of rhinitis, to reduce swelling of the mucous membrane of the auditory tube.

Antibiotic therapy for acute otitis media deserves special discussion. With this disease, in a significant percentage of cases, systemic antibacterial drugs are not required. Almost 75% of antibiotics currently used are of questionable therapeutic value [12]. In addition, in proportion to the consumption of systemic antibiotics, microflora develops resistance to them. The phenomenon of bacterial resistance represents a big problem in the treatment of infectious diseases of the entire population.

The most common mechanisms for protecting bacteria from antibiotics are: rearrangement of targets (the target is a certain function of the microorganism that is specifically suppressed by a given drug) in such a way that the drug is no longer able to interact with them; impaired penetration of the antibiotic into the microbial cell; its inactivation by bacterial enzymes; displacement of the antibiotic by the enzyme systems of the pathogen.

It is generally accepted that it is possible to prevent the further development of bacterial resistance by introducing strict rules for the use of antibiotics into medical practice - they should be prescribed only when absolutely necessary, their antimicrobial spectrum should be adequate, and the dosages and duration of treatment used should be optimal.

In this regard, topical antibacterial and anti-inflammatory treatment is of great importance, which helps to avoid systemic metabolism of the drug, and also facilitates the delivery of the optimal dose of the active drug directly to the site of inflammation.

Systemic antibiotic therapy is necessary in cases where it is necessary to eliminate the risk of possible intracranial complications. It is mandatory in cases of complicated otitis, when there is severe intoxication, signs of labyrinthitis or mastoiditis, or the presence of concomitant pathology (diabetes mellitus, kidney disease, blood disease).

When prescribing antibacterial therapy, it is necessary to study the discharge with determination of flora and sensitivity to antibiotics. However, such a study is not always possible; in addition, immediate antibiotic therapy is sometimes necessary. In these cases, empirical antibiotic therapy is required. The leading drugs for empirical therapy should be considered amoxicillin and amoxicillin/clavulanate. They are most active against penicillin-resistant pneumococci. In case of allergy to b-lactams, it is advisable to use macrolide antibiotics. If pathogens are resistant to amoxicillin, and for recurrent otitis media, amoxicillin/clavulanate (Panklav) is prescribed at 625 mg x 3 times a day. Panclave is a broad-spectrum antibiotic; contains semisynthetic penicillin amoxicillin and b-lactamase inhibitor clavulanic acid. Clavulanic acid inhibits most clinically significant b-lactamases and protects amoxicillin from the loss of antibacterial activity caused by the production of b-lactamases, both by major pathogens and co-pathogens, and by opportunistic microorganisms. This combination provides high bactericidal activity of Panclave. Panclave has a wide spectrum of antibacterial action. Active against both strains sensitive to amoxicillin and against strains producing b-lactamases. Other antibiotics are ceftriaxone, cefuroxime ascetil. The use of other antibiotics due to the resistance of the microflora to them or due to toxicity and low bioavailability is undesirable (co-trimoxazole, ampicillin, gentamicin, etc.) Therefore, when acute otitis media occurs for the first time in patients who have not previously received antibiotics during the previous month, Amoxicillin can be recommended (as an alternative - macrolides). In patients who have previously received antibiotics, if amoxicillin is ineffective after 1-2 days, the use of Panclave is most effective; alternatives to it include ceftriaxone, cefuroxime-axetil, and for allergies to lactams, modern macrolides. In case of complicated otitis media and the ineffectiveness of these drugs, fluoroquinolones of the III–IV generation are recommended. But they should be treated with caution. They are considered reserve drugs; their use is advisable in case of a high risk of developing complications of otitis media, as well as in cases of ineffectiveness of antibacterial therapy with other drugs. In these cases, the following regimen of antibacterial therapy for complicated forms of acute otitis media can be proposed: amoxicillin/clavulanate (Panklav) 650 mg 3 times a day for 48 hours, if the effect is positive, continue this treatment, otherwise, levofloxacin 0.5–1 .0 g 1 time per day.

Prescribing adequate systemic antibacterial therapy, as a rule, leads to a rapid improvement within 1–2 days of the patient’s well-being, normalization of body temperature, disappearance of cerebral symptoms, etc.

1. Kosyakov S.Ya. Acute, prolonged and recurrent otitis media: choice of treatment at a crossroads / S.Ya.Kosyakov, A.S.Lopatin // Consilium Medicum.–2004.–T.6.–N.4.–P.270–274.

2. Kravchenko D.V. Results of examination and treatment of patients with acute purulent otitis media / D.V. Kravchenko // Otorinology News. and logopathol. – 2002. – No. 1. – P. 77–78.

3. Nikolaev V.V. Experience of general and local use of antihomotoxic drugs in otorhinolaryngology / V.V. Nikolaev // Biolog.med. – 1997. – No. 1. – P. 34–35.

4. Nikolaev M.P. Modern approaches to local therapy for otitis / M.P. Nikolaev, N.E. Baykova, V.M. Zaitsev, etc. // Ros. otorhinol.–2005.–No. 3 (16).–P.82–84.

5. Ovchinnikov A.Yu. Experience of using the drug candibiotic in otorhinolaryngological practice / A.Yu. Ovchinnikov // Ros. Otol.–2004.–No. 4 (11).–P.101–103.

6. Romanova E.V. The use of ear drops “tsipromed” in the treatment of otitis media / E.V. Romanova, F.V. Semenov // Ros. Otol.–2004.–No. 3 (10).–P.143–144.

7. Turovsky A.B. Acute inflammation of the external and middle ear./ A.B. Turovsky, A.I. Kryukov // Consilium Medicum–2000– Vol.8.– P.323–325.

8. Turovsky A.B. Antibacterial therapy of acute otitis media in modern conditions / A.B. Turovsky, A.V. Balandin // Vestn. otorhinolar. – 2004. – No. 1. – P. 35–38.

9. De Castro Junior T. Sih Acute Otitis Media |T.De Castro Junios || JuxFed of ORL (JFOS) –1998.–S.–17–23.

10. Froom J.Diagnosis and antibiotic treatment ofacute otitis media, report from international primary care networa | I.Froom,bL.Culpepper P/Grob et al. || Br.Med J.–1990.–Vol.300.–P 582–588.

11. Kligman EW Twenty common problems in primary care | EWKligman Earache. In B. D. Weiss et al. || Ist edition – New York: Mc Grow Yill. – 1999. – P. 123–144/

12. Uhari M. Meta –analytical review of the risk factors for acute otitis media | M. Uhari, K. Mantyssari, M. Niemela||Clin Infect Dis.–1996.–Vol.22.–P. 1079–1083.

13. Vidal–2001 | Havas Medi Media. Directory.2001.– P.13–455.

Introduction The most common diseases of the bronchopulmonary system, in the pathogenesis of cats.

Treatment of patients with diseases of the vocal apparatus (voice-forming system) is one of a.

© "RMZh (Russian Medical Journal)"

Register now and get access to useful services

  • Medical calculators
  • List of selected articles in your specialty
  • Video conferencing and much more

Register

Source: http://www.rmj.ru/articles/obshchie-stati/Ostryy_sredniy_otit_u_vzroslyh_sovremennyy_vybor_racionalynoy_terapii/

Otitis - what is it, types, symptoms in adults, treatment of otitis ear

Otitis is an ENT disease, which is an inflammatory process in the ear. It manifests itself as pain in the ear (pulsating, shooting, aching), elevated body temperature, hearing loss, tinnitus, mucopurulent discharge from the external auditory canal. The severity of the pathological process depends entirely on the virulence of microorganisms, and the state of the human immune defense also plays an important role.

What it is, what are the first signs and symptoms of otitis media, as well as how to treat it in adults without consequences for the ear, we will consider further in the article.

What is otitis media?

Otitis is an inflammatory lesion of the inner, middle or outer part of the human ear, occurring in a chronic or acute form. The disease is characterized by damage to the structures of the outer, middle or inner ear, and patients present specific complaints. Symptoms in adults depend on the area of ​​inflammation, the addition of local or systemic complications.

The pathology can develop at any time of the year, but the peak of visits to the hospital occurs in autumn and winter, when people have not yet had time to switch from heat to cold.

Causes

The causes and symptoms of otitis depend on the type of disease, the state of the immune system and environmental factors. The fundamental elements in the formation of the disease are the influence of air temperature, the purity of the water used for hygiene, and the time of year.

The causes of otitis are considered:

  • Penetration of infection from other ENT organs - as a complication of a concomitant infectious viral disease;
  • Various diseases of the nose, sinuses and nasopharynx. This includes all types of rhinitis, deviated nasal septum, adenoids (adenoid vegetations);
  • Injuries to the ear;
  • Hypothermia and weakened immunity.

Conditions that significantly increase the risk of developing the disease include:

  • allergies;
  • inflammation of the ENT organs;
  • immunodeficiency states;
  • performing surgical operations in the area of ​​the nasopharynx or nasal cavity;
  • infancy, childhood.

Otitis media in adults is a disease that needs to be taken seriously and you need to know its symptoms, consequences and treatment.

Types of otitis

The structure of the human ear is divided into three interconnected parts, which have the following names:

Depending on which specific part of the organ the inflammatory process occurs, in medicine it is customary to distinguish three types of otitis:

Otitis externa

Otitis externa can be limited or diffuse, in some cases it spreads to the eardrum, and is more common in elderly patients. Occurs as a result of mechanical or chemical trauma to the ear. A patient with otitis externa complains of throbbing pain in the ear, which radiates to the neck, teeth and eyes, and intensifies when talking and chewing.

Development is promoted by two factors:

  • Infection caused by a sharp object (hairpin, toothpick);
  • Entry and accumulation of moisture in the external auditory canal.

It often occurs when the ear is constantly in contact with water, such as when swimming, which is why it is called “swimmer’s ear.”

Otitis media ear

With otitis media, the inflammatory process occurs in the tympanic cavity. There are many forms and variants of the course of this disease. It can be catarrhal and purulent, perforated and non-perforated, acute and chronic. With otitis media, complications can develop.

Internal otitis

This type is also called labyrinthitis; its symptoms can vary in severity (from mild to pronounced).

Symptoms of otitis media are similar in all forms of the disease, but their intensity and some features depend on the type.

According to the nature of the disease, the following forms are distinguished:

  • Spicy. It occurs suddenly and has severe symptoms.
  • Chronic. The inflammatory process continues for a long time and has periods of exacerbation.

According to the ways in which otitis manifests itself, the following forms are distinguished:

  • Purulent. There is an accumulation of pus behind the eardrum.
  • Catarrhal. There is swelling and redness of the tissues, there is no liquid or purulent discharge.
  • Exudative. Fluid (blood or lymph) accumulates in the middle ear, which is an excellent breeding ground for microorganisms.

The otolaryngologist determines how and how to treat otitis media by establishing the type and degree of the disease.

Symptoms of otitis media in adults

The clinical picture of otitis directly depends on the location of the pathological process.

  • earache . This symptom is constantly disturbing and is the main one that brings the greatest discomfort. Sometimes the pain shoots into the teeth, temple, lower jaw. The reason for the development of this condition in otitis media is considered to be increased pressure in the ear cavity;
  • redness of the ear canal, change in the color of the auricle;
  • gradual deterioration of hearing caused by the opening of ulcers and filling of the ear canal with purulent masses;
  • fever - most often there is an increase in body temperature, however, this is also an optional sign;
  • Discharge from the ear with external otitis almost always occurs. After all, nothing prevents the inflammatory fluid from being released.

Symptoms of otitis media are often accompanied by a runny nose, which leads to swelling of the nasal mucosa and congestion of the auditory tube.

  • In the case of the development of acute purulent local external otitis (furuncle in the ear canal), the patient complains of pain in the ear, which intensifies with pressure or pulling on it.
  • There is also pain when opening the mouth and pain when inserting an ear specula to examine the external auditory canal.
  • Externally, the auricle is swollen and red.
  • Acute infectious purulent diffuse otitis develops as a result of inflammation of the middle ear and suppuration from it.
  • heat;
  • ear pain (throbbing or aching);
  • decreased hearing function, which usually recovers a few days after the first onset of symptoms;
  • nausea, general malaise, vomiting;
  • purulent discharge from the ears.
  • The main symptom of the acute form is severe pain in the ear, which patients describe as jerking or shooting.
  • The pain can be quite intense, worsening in the evening.
  • One of the signs of otitis is the so-called autophony - the presence of constant noise in the ear, not associated with sounds from the outside, ear congestion appears.

Acute otitis media should always be treated completely, as the pus will begin to spread into the skull.

  • Hearing loss.
  • Periodic purulent discharge from the ear.
  • Dizziness or tinnitus.
  • Pain appears only during periods of exacerbation.
  • Possible increase in temperature.

If you have symptoms of otitis, you need to urgently consult a doctor, who will correctly diagnose and tell you how to treat the inflammation.

Complications

Do not think that otitis media is a harmless cold. In addition to the fact that it unsettles a person for a long time, reducing his ability to work for at least 10 days, it is possible to develop irreversible changes with persistent deterioration or complete loss of hearing.

When the disease is allowed to take its course, the following complications may occur:

  • rupture of the eardrum (as a rule, it takes 2 weeks for the hole to heal);
  • choleostomy (tissue growth behind the eardrum, hearing impairment);
  • destruction of the auditory ossicles of the middle ear (incus, malleus, stapes);
  • mastoiditis (inflammatory lesion of the mastoid process of the temporal bone).

Diagnostics

A competent doctor diagnoses acute otitis without special devices and innovative technologies. A simple examination of the auricle and ear canal using a head reflector (a mirror with a hole in the center) or an otoscope is sufficient to diagnose otitis media.

As methods to confirm and clarify the diagnosis, a general blood test can be prescribed, which reveals signs of inflammation (increased ESR, increased number of leukocytes, etc.).

Instrumental methods include radiography and computed tomography of the temporal regions.

How to treat otitis media in adults?

Antibacterial drugs (antibiotics, sulfonamides, etc.) play a special role in the treatment of otitis media. Their use has a number of features - the medicine should not only act on the bacteria that cause otitis media, but also penetrate well into the tympanic cavity.

Treatment of inflammatory changes in the auricle begins with bed rest. Antibiotics, anti-inflammatory drugs, antipyretic drugs are prescribed simultaneously. A combination of drugs can effectively treat pathology.

Comprehensive treatment of otitis ear

It's no secret how acute otitis in adults is treated - drops in the ears. This is the most common medicine for otitis media. Depending on the type of disease, different drugs are used. Ear drops can contain only an antibacterial drug or be combined - contain an antibiotic and an anti-inflammatory substance.

The following types of drops are distinguished:

  • glucocorticosteroids (Garazon, Sofradex, Deksona, Anauran);
  • containing anti-inflammatory non-steroidal drugs (Otinum, Otipax);
  • antibacterial (Otofa, Tsipromed, Normax, Fugentin).
The course of treatment takes 5-7 days.
  1. In combination with ear drops for otitis, otolaryngologists often prescribe vasoconstrictor nasal drops (Naphthyzin, Nazol, Galazolin, Otrivin, etc.), thanks to which it is possible to relieve swelling of the mucous membrane of the Eustachian tube and thereby reduce the load on the eardrum.
  2. In addition to the drops, the complex may also include antihistamines (anti-allergic) agents that have the same goal - relieving swelling of the mucous membrane. These could be tablets of Loratadine, Suprastin, Diazolin, etc.
  3. To reduce temperature and reduce ear pain, non-steroidal anti-inflammatory drugs based on paracetamol (Panadol), ibuprofen (Nurofen), nise are prescribed.
  4. Antibiotics for otitis in adults are added to the treatment of acute moderate form with the development of purulent inflammation. The use of Augmentin has proven itself well. Rulid, Amoxiclav, Cefazolin are also effective.

In addition to the measures listed, physiotherapy procedures are used:

  • UHF for the nose area;
  • laser therapy for the area at the mouth of the auditory tube;
  • pneumomassage focused on the area of ​​the eardrum.

If all the above actions did not lead to regression of the process, or treatment was started at the stage of perforation of the eardrum, then first of all it is necessary to ensure a good outflow of pus from the middle ear cavity. To do this, regularly cleanse the external auditory canal of secretions.

During the manipulation, local anesthesia is used. A puncture is made in the eardrum using a special needle, through which the pus is removed. The incision heals on its own after the discharge of pus stops.

Recommendations

The doctor's recommendations must be followed:

  • You cannot prescribe medications yourself, choose the dosage, or stop taking medications when the symptoms of otitis media disappear.
  • Wrong actions taken at your own discretion can cause harm to your health.
  • Before contacting a doctor, you can only take a paracetamol tablet to reduce pain. This drug is effective and has few contraindications. When used correctly, paracetamol rarely causes side effects.

Prevention

The main goal of preventing otitis in adults is to prevent the Eustachian tube from becoming blocked by thick mucus. This is not such a simple task. As a rule, acute rhinitis is accompanied by liquid discharge, but during treatment the mucus often becomes much thicker, stagnating in the nasopharynx.

  1. Foci of chronic infection - tonsillitis, pharyngitis - increase the risk of otitis media.
  2. After swimming, especially in open water, you need to thoroughly dry your ears to prevent water and bacteria from getting inside. Especially for people prone to otitis media, antiseptic drops have been developed that are placed in the ears after each bath.
  3. Regularly clean your ears from dirt and wax and maintain hygiene. But it is better to leave a minimum of sulfur, since it protects the ear canal from pathogenic microbes.

In conclusion, it is worth noting that otitis media is a very unpleasant disease. Do not think that all symptoms will go away on their own. Be sure to consult a doctor when the first signs appear. People often treat otitis unduly frivolously, not realizing that complications from this infection can lead to the most tragic consequences.

Discussion: 6 comments

How to treat otitis media if there is no desire to take antibiotics? Or is it impossible without them?

If the form is purulent, then antibiotics are indispensable. I had ordinary otitis, I did not treat it and it turned into a more complex form. As a result, I spent a lot of time, health and money on medications. Therefore, be sure to consult a doctor when the initial form appears, and even if antibiotics are prescribed, do not take them. It is clear that these are not vitamins, but if there is already pus, then very serious complications are possible. And next to the ear is the brain, so be a reasonable person and listen to your doctor

Thank you very much for the article. I'll keep it on mind.

Even untreated caries can cause otitis media.

My mother (80 years old, diabetes) had purulent otitis, she had surgery twice - they removed the pus from outside the ear, and injected him with a bunch of antibiotics. They discharged me - they thought everything was fine, but the polyp was growing in the ear again. Now he goes to the doctor once every 2 weeks to have the tumors removed. Is there any possibility of recovery?

Try to go to other specialists (because it may be a banal doctor’s mistake or they do it on purpose so that they pay for the procedures), I came across this when they were treated for one disease for many years, and after a while it turned out that this disease never existed .

But, don’t forget about your mother’s age. 80 years is not 20, so any disease is very difficult.

Add a comment Cancel reply

© All information on the “Symptoms and Treatment” website is provided for informational purposes. Do not self-medicate, but consult an experienced doctor. | User agreement and contacts |

Source: http://simptomy-i-lechenie.net/otit/