Right-sided acute otitis media

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Acute otitis media: treatment of acute otitis media

Acute otitis media is a fairly common disease that can affect both adults and children. Its symptoms manifest themselves intensely, causing discomfort to the sick person.

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To get rid of the problem, treatment should be started urgently, since the acute phase can cause complications and become chronic.

Features of the disease and causes

First you need to understand the features of this disease and the mechanism of its occurrence. Acute otitis media is a lesion of the mucous epithelium in the middle ear cavity. The main causative agent is pathogenic microflora. Bacteria enter the ear through the nasopharynx or transtimpal route, begin to actively multiply and directly cause inflammation itself.

Acute left-sided or right-sided otitis usually occurs. If bacteria affect both ears at the same time, they speak of a bilateral type of disease. Its symptoms may appear unevenly, depending on the extent of organ damage on each side.

In adults, otitis media occurs less frequently than in children, as the number of risk factors is reduced. Adults have stronger immunity, and the anatomical component of the ear-nose-throat system is normalized, and it becomes more difficult for infections to enter the ear.

The main causes of acute otitis are considered to be:

  • infectious diseases;
  • viral diseases;
  • pathologies of the nasopharynx;
  • tumors and neoplasms;
  • injuries;
  • hypothermia;
  • allergy;
  • chronic problems with the upper respiratory tract;
  • weak immunity;
  • changes in atmospheric pressure;
  • sulfur plug;
  • foreign body in the ear;
  • water ingress.

Acute otitis media occurs rapidly and intensely. The main pathogens are microorganisms of coccal groups, as well as fungi, Proteus and diphtheria bacillus.

They can penetrate into the middle ear through the bloodstream, the nasopharynx and Eustachian tube, a damaged eardrum, and even from the cranial cavity and inner ear.

Poor treatment of colds, infectious and viral diseases often results in complications in the form of acute otitis media. This disease especially often worries people with chronic sinusitis, sinusitis, tonsillitis or allergic rhinitis. Irritation of the mucous membrane of the auditory tube during medical procedures can also provoke inflammation. And if there is a deviated nasal septum or frequent problems with the tonsils, which is especially important for children, the number of episodes of otitis media increases significantly.

Symptoms and stages

It is impossible not to notice this disease. It starts suddenly and quickly gains momentum. The symptoms of acute otitis media are bright and intense. The main difference between this form of the disease is sharp pain inside the ear and fever. Mostly, the symptoms of otitis media overlap with the symptoms of a cold. Swelling and nasal congestion are observed, and when the infection spreads, concomitant diseases of the upper respiratory tract occur.

The main symptoms of acute otitis in adults:

  • sharp pain;
  • temperature;
  • malaise;
  • hearing impairment;
  • nasal and ear congestion;
  • runny nose;
  • hyperemia of soft tissues;
  • accumulation of fluid behind the eardrum;
  • the appearance of discharge;
  • noise and feeling of fluid transfusion.

Symptoms initially increase as the disease progresses. After the eardrum is perforated and the discharge is discharged, the discomfort decreases.

The disease occurs in several stages:

  • Catarrhal stage. The onset of the disease is when the mucous membrane lining the Eustachian tube is damaged. When bacteria enter, inflammation intensifies. The swollen auditory tube does not allow internal exudate to drain.
  • Exudative stage. Due to the blockage of the middle ear, exudate accumulates in it. Body temperature rises to fight infection and microorganisms, which thrive in the resulting environment and actively multiply in the absence of appropriate treatment measures.
  • Purulent stage. Pus begins to form and accumulate in the ear cavity. It fills the empty space and puts pressure on the eardrum. This causes a feeling of congestion and increases pain. Symptoms of intoxication may occur due to an increase in the concentration of waste products of pathogenic microflora. Before and inclusive of this stage, acute otitis media occurs in the preperforative stage.
  • Perforated stage. The next stage, when pus accumulated inside the ear leads to the destruction of the most vulnerable area of ​​the eardrum and its breakthrough occurs - perforation. Sharp pain is accompanied by temporary hearing loss and the onset of intense suppuration from the external auditory canal. At the same time, body temperature normalizes, and pain becomes less pronounced. It is important that the pus drains completely. In adults, perforation often occurs independently, but in children, forced paracentesis may be necessary, due to the greater thickness of the eardrum. During this period, you cannot use the usual ear drops.
  • Reparative stage. It is marked by the restoration of the integrity of the eardrum. Healing occurs independently and quite quickly. Scars may form on the membrane, but in most cases they do not affect the quality of hearing. With proper treatment, there are no bacteria or secretions left in the middle ear, and therefore, after the rupture heals, the patient recovers completely.

Often, treatment of uncomplicated acute otitis takes from 5-7 days to 2-3 weeks. It is advisable to prevent the disease from passing into the purulent stage, since with the accumulation of secretions of this kind, the risks of developing complications and chronic inflammation increase.

Diagnosis and treatment

To effectively treat the acute form of otitis media, it is necessary to correctly diagnose and find out at what stage the disease is. Since the symptoms are quite characteristic, there are usually no problems with this. To clarify the situation in adults, a number of studies are carried out:

  • Examination with an otoscope. Hyperemic areas of the mucous epithelium, clouding of the eardrum, and its perforation are revealed. An accumulation of fluid in the middle ear may also be visible.
  • Audiometry and tympanometry. The degree of hearing loss is determined and the functioning of the eardrum is checked.
  • CT, MRI and radiography. These are auxiliary examination methods to determine the condition of soft and bone tissues; they are mainly used when complications are suspected.

Treatment of otitis media in adults is based on a combination of drug therapy and supportive measures. It is important to eliminate the cause of ear inflammation. That is why it is necessary to treat the primary disease, that is, colds, sinusitis, allergies, etc.

To relieve inflammation, eliminate swelling and destroy pathogenic bacteria, you need to break the treatment into several steps:

  • Taking anti-inflammatory drugs. These are medications that have antipyretic and anti-inflammatory effects. They also relieve pain and eliminate the consequences of infection.
  • Antibacterial agents and antibiotics. In case of serious illness, systemic administration is prescribed. For local effects, ear drops are used.
  • Antihistamines. Indispensable for allergic forms of the disease, they help relieve tissue swelling.
  • Vasoconstrictor drops. Used to relieve swelling and eliminate runny nose.

At the initial stage, treatment is supplemented with warming compresses. Physiotherapeutic procedures prescribed by an ENT specialist can be used to improve the acceptance of medications and speed up the healing process.

If pus accumulates, surgery should be performed to clear the ear cavity of the discharge. Paracentesis is a puncture of the membrane. Pus flows out through the hole, and after a few days it closes. In acute otitis in adults, rupture usually occurs independently and does not require additional medical intervention.

Prognosis and prevention

Gradually, with proper treatment, the symptoms begin to subside, and after a few weeks, complete restoration of hearing occurs. Even the presence of perforation in purulent otitis does not worsen the prognosis if treatment is not delayed.

In the absence of adequate therapy, acute inflammation can become chronic. In this case, purulent discharge constantly accumulates in the middle ear cavity and causes great discomfort. Treatment of chronic diseases not only takes a lot of time, but is also associated with the risks of side pathologies.

To protect yourself from problems, it is important to follow the rules of prevention. Otitis is associated with diseases of the nasopharynx, and therefore, first of all, it is necessary to take care of the timely treatment of these diseases. We must not allow a runny nose to progress to the chronic stage, nor should the infection spread throughout the body through the bloodstream.

For adults, an important recommendation would be to stop smoking, as tobacco smoke irritates the Eustachian tube. Take care of strengthening your health, namely:

  • lead a healthy lifestyle;
  • make it a habit to exercise and exercise;
  • eat right;
  • maintain ear hygiene;
  • Don't get too cold.

If there are frequent episodes of acute otitis media, you should consult a doctor to find out the causes of this phenomenon. This may be due to deviations in the structure of the nasopharynx, Eustachian tube and the ear itself. The disease may also be associated with neoplasms in this area or previous surgical procedures. Chronic diseases of a systemic nature also have a negative impact in adults.

To increase the body's protective function, you should take vitamins, especially during the season when the incidence of colds and ear diseases increases. With a hereditary tendency to otitis, this is very important, since each episode of the disease weakens the body and the immune system is not able to prevent repeated outbreaks of acute inflammation.

If you keep your ears clean, strengthen your immune system and treat infectious diseases in a timely manner, acute otitis media will no longer bother you.

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Acute otitis media

Acute otitis media occupies one of the first places among ENT pathologies. The disease is diagnosed in childhood and adulthood, regardless of the person’s gender. Symptoms manifest themselves brightly and intensely. Discomfort is aimed not only at the physical state of a person, but also at the psychological one. Frequent shooting pains, increased body temperature, and general ailments prevent a person from fully engaging in daily activities. Often, during illness, patients even give up their favorite activity.

Etiology

According to the international classification ICD 10, acute otitis media is coded H65, H66. Pathogenic microflora is the main provocateur of the disease. Microorganisms activate the effect on the ear canals, mucous membranes of the middle ear, penetrating through the nose and pharynx, creating an inflammatory process.

Most often, right-sided and left-sided acute otitis media are diagnosed. If bacteria manage to penetrate both organs of hearing at the same time, a bilateral disease develops. Symptoms manifest themselves unevenly; they depend on the severity of organ damage on each side.

How long otitis lasts depends on the patient’s age, the functioning of his protective immune system, the severity and form of the disease. Otolaryngologists believe the reasons for the development are:

  • past infectious diseases;
  • penetration of viruses into the body;
  • nasopharynx with pathologies;
  • the presence of tumors and neoplasms in the hearing organs;
  • allergic reactions;
  • injuries to the auditory organs;
  • frequent hypothermia of the body;
  • chronic diseases of the upper respiratory tract;
  • sulfur plug;
  • unstable atmospheric pressure;
  • location of a foreign body in the ear;
  • frequent penetration of water into the ear canals.

Acute otitis media, the treatment of which is supervised by a doctor, is an intense and rapid disease. The main provocateurs of the pathological process were identified as diphtheria bacillus, coccal microorganisms, the presence of fungi, and Proteus. They enter the ear through the bloodstream, through the Eustachian tube, and into the cranial cavity.

Perforated otitis media makes itself felt with painful attacks and high fever. Already these symptoms signal a disruption in the functioning of the hearing organs in the first days of the disease. Often the disease develops in advanced forms of sinusitis, sinusitis, and allergic rhinitis.

Medical procedures provoke inflammation due to irritation of the mucous membranes of the passages. When the nasal septum is deviated, problems with the tonsils begin, which lead to the return of otitis media after successful therapy.

Doctors can determine the stage of the disease by how the ear looks, whether there are swollen areas, what color the skin is near the hearing aid and inside the auricle.

Symptoms of otitis media

Otitis media in adults and children has different clinical pictures. The disease is excluded by complex therapy methods throughout the day. There are three successive stages of the disease:

  • initial stage – pre-perforation;
  • perforated stage;
  • the final stage is reparative.

Each stage has its own differences. How long it takes for otitis media to go away completely depends on correct therapy at each stage of the pathology.

The first stage can last from several hours to a week. Signs of the beginning of the process are painful intense pain attacks in the ear canals. They irritate the nerve endings of the glossopharyngeal and trigeminal nerves.

The patient's sleep is disturbed and there may be no appetite. Painful attacks are accompanied by noise effects and sensations of congestion in the auditory organs. Symptoms appear due to changes in the functioning of the auditory ossicles, which are responsible for sound transmission.

General signs of acute otitis media:

The disease against the background of influenza, scarlet fever, measles involves the development of labyrinthitis in the inflammatory process. Acute bilateral otitis media can reduce the level of hearing due to disorders of sound perception.

The perforated type of the disease develops when pus accumulates in the eardrum. Holes are formed through which mucous formations containing impurities of pus and blood emerge. Pain syndromes subside, body temperature is normal, health is better, a sign of the disease moving to the next stage. At the time of the reparative stage, discharge from the ear canal is minimized, and hearing is restored.

Right-sided otitis is diagnosed more often than left-sided otitis, and does not always occur in this sequence. There are cases that symptoms do not appear in the first days of the disease; the eardrum is not able to rupture spontaneously, requiring surgical help.

Purulent otitis in the initial stage is characterized by pain radiating to the temple, crown and teeth. Noises and congestion of the hearing aid appear. At the initial stage, the disease lasts no longer than 3 days, then the next stage occurs, in which the membrane breaks through and exudate is released.

After injuries to the auditory organ, post-traumatic otitis media can develop in the labyrinth of the auricle. The symptoms are similar to otitis media; swelling and pain develop in the damaged area.

Otolaryngologists often observe vesicles containing bloody formations on the skin of the walls of the external meatus in patients. There are complaints of general malaise, increased body temperature, pain in the ear canals, decreased hearing acuity, and the appearance of unpleasant noise. In such cases, hemorrhagic otitis media is diagnosed. Experts recommend treating the pathology in medical institutions. The clinic is responsible for its patients, so there is no need to worry about the unwanted consequences of therapy. How much otitis media is treated depends on many factors that are taken into account when drawing up a therapeutic plan.

How long does it take to treat otitis media?

Acute otitis media of the middle ear is best eliminated with the help of complex therapy. With proper treatment, patients get rid of the pathology within a day. It is impossible to determine exactly how long a person will be absent from work or a child from an educational institution; each body in its own way fights an infection that has penetrated the hearing organs.

By eliminating the symptoms of acute otitis at the first manifestations, there is a chance to prevent the spread of pathogenic organisms inside the tube, which contributes to a speedy recovery.

The duration of the disease is determined by common factors:

  • how much does the ear hurt with otitis;
  • the presence of purulent formations and their quantity;
  • methods of therapy and their correct use;
  • diagnosing concomitant ailments;
  • chronic diseases;
  • level of immunity at the time of illness;
  • congenital pathologies;
  • anatomical structure of the ear;
  • patient's lifestyle.

In childhood, treatment of acute otitis takes longer; the protective functions of the child’s body are not fully formed. Adult patients with a busy lifestyle, stressful situations, and ignoring their daily routine cannot say goodbye to the pathological process for a long time, which leads to psychological disorders.

Treatment methods

Treatment of acute otitis media is prescribed after examination by a doctor, who finds out at what stage the pathology is. Diagnosis of the disease is carried out in several ways:

  • the doctor collects anamnesis from the patient;
  • an otoscope examination is performed;
  • audiometry and tympanometry are prescribed;
  • radiography is widely practiced;
  • if necessary, the patient is sent for CT or MRI.

Therapy includes medication, physiotherapy, and traditional medicine.

Drug treatment

Antibacterial therapy for acute otitis is prescribed on the 2-3rd day of the pathology. Broad-spectrum medications are used that have a detrimental effect on common pathogens (Amoxicillin). It is important to take medications on time. The course and dosage is determined by the otolaryngologist individually for each patient. There are cases when medications are prescribed in the form of injections. Injections of colitis for acute otitis media by a medical worker.

Vasoconstrictors must be prescribed. Widely used are Naphazoline, Oxymetazoline, Naphthyzine. The drug is injected into the nasal passages in a position lying on one's side. Thus, the medicine penetrates the Eustachian tube.

For severe pain and purulent accumulations, it is recommended to instill ear drops in the ear, which contain Lidocaine and Phenazol. If perforation of the eardrum occurs, combination medications containing an antibiotic and an analgesic are prescribed. Local agents Miristamine, Sofradex, Cipropharm are actively fighting the infection.

ethnoscience

Non-traditional methods of therapy have come into modern medicine since the time of our ancestors. It is important to understand that it is prohibited to treat a patient with medicinal decoctions and tinctures, mixtures and drops without consulting an otolaryngologist, especially if the patient is an infant. Plants that seem harmless at first glance can cause allergic reactions and complicate the course of the disease.

According to “grandmother’s” recipes, decoctions are prepared, which are used to moisten the turundas, placing them in the ear canals. There are many cooking options:

  • Relieves itching with otitis externa using chamomile mixed with 100 ml of hot water. The potion infuses for about minutes. The auricle is wiped with a swab dipped in the broth, and the turunda can be placed for 2-3 hours.
  • A decoction of bay leaf, the preparation of which is identical to a chamomile potion, will help relieve inflammation.

Heated salt is used for therapy, which eliminates painful attacks. An alcoholic infusion of propolis is instilled into the ear and garlic drops are prepared. Beetroot juice with honey, onion juice diluted with water, and walnut oil will help eliminate inflammation and eliminate discomfort.

Physiotherapy

To increase the effectiveness of treatment, physiotherapy is used. Most of the techniques actively combat swelling and inflammation, expel bacteria, infections, and dilate blood vessels. Stimulating procedures normalize blood flow. Experts recommend doing pneumomassage, amplipulse therapy, magnetic therapy, and diadynometry with currents. Each manipulation improves bleeding, eliminates stagnant purulent formations, and relieves swelling.

They practice cleansing therapy methods, which include blowing and washing the ear canals. It is best to carry out the procedures in a medical facility with the help of a qualified specialist or under his strict supervision.

Warming manipulations have an effective effect on the hearing aid. Sollux is carried out by exposing the affected ear to a special incandescent lamp or ultraviolet radiation. Using electrophoresis, the required medicine is administered through the skin and mucous membranes, reducing the dosage and minimizing the side effects of its effect on the body. Often, specialists prescribe UHF during an exacerbation of the disease or in the chronic form of the disease.

Surgery

Over many years of healing, it is important to treat otitis media surgically in case of complications, to relieve serious complications. Modern medicine offers many surgical techniques that restore hearing lost due to pathology.

Several operations are performed if:

  • the ear is filled with adhesions;
  • scar tissue forms;
  • The auditory ossicles are destroyed.

The first surgical intervention eliminates the inflammatory focus, returning the eardrums to the required functioning. The second stage of the operation is to completely restore hearing. During the postoperative period, the patient is observed by health workers. Tampons are placed in the patient's ear canals and left in the sink for 7 to 30 days. Change turundas once a day, instilling prescribed ear drops into the ear.

The operation is aimed at eliminating inflammation, closing the perforation of the tympanic cavity, and restoring the functioning of the auditory ossicles. In medicine, it is called tympanoplasty. A surgical procedure helps to cure ENT disease in a short time.

Forecast

According to statistical data, the prognosis of acute otitis media in most cases is favorable. Proper treatment relieves the patient of painful attacks in a short time, improving blood flow in the affected area. It takes several weeks for 100% hearing to be restored.

It is important to contact an otolaryngologist in a timely manner so that the acute form of the disease does not turn into chronic. Purulent accumulations provoke the spread of infection to neighboring organs, which leads to severe and protracted pathological processes.

Prevention of otitis

In modern medicine, there are many measures for timely relief of otitis media. It is easier to take preventive measures and prevent the disease than to wage an active and long fight, eliminating its foci of development. You cannot hope that the signs of otitis media will disappear on their own without treatment methods.

The first step in prevention is strengthening the protective immune system on an ongoing basis. Experts recommend:

  • Pay maximum attention to nutrition. The diet every day should be rich in vitamins, minerals, and substances necessary for the body.
  • Temper the body from infancy.
  • Sunbathing is beneficial.
  • You need to spend more time outdoors.
  • Sports activities and activities should be alternated with proper rest.
  • You should not abuse medications. It is important to use antibacterial agents minimally and only when necessary.

In order not to provoke inflammation of the hearing organ, it is advised to protect it from injury as much as possible. It is important to properly perform personal hygiene procedures; you should not pick at the ear canals to remove all accumulated wax.

Frequent provocateurs of the disease are drafts and severe hypothermia. You need to dress according to the season, avoid walking in the rain and cold wind.

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Acute otitis media

Acute otitis media is a rapidly occurring infectious and inflammatory lesion of the middle ear cavity. The clinical picture of the disease includes severe pain, general manifestations, sensations of congestion and noise in the ear, decreased hearing, and the appearance of a perforation in the eardrum followed by suppuration. The diagnosis of acute otitis media is based on data from a clinical blood test, otoscopy, various hearing tests, skull radiography, rhino- and pharyngoscopy, and examination of the auditory tube. General treatment of the disease is carried out with antibiotics, antihistamines and anti-inflammatory drugs; local therapy consists of blowing out the auditory tube, instilling ear drops, washing the tympanic cavity, introducing proteolytic enzymes into it, etc.

Acute otitis media

Acute otitis media is a widespread pathology in both pediatric and adult otolaryngology. Acute otitis media is the most common form of otitis media. It is observed with equal frequency in women and men. Recently, there has been a tendency of acute otitis media to a more sluggish course in adults and frequent recurrence in children. In young children, due to the structural features of the ear in acute otitis media, the antrum - the mastoid cave - is immediately involved in the inflammatory process and the disease has the character of otoanthritis. Acute otitis media can occur as a complication of eustachitis, exudative otitis media, aerootitis, ear trauma, and inflammatory diseases of the nasopharynx.

Causes of acute otitis media

Up to 65% of acute otitis media are caused by streptococcal infection. In second place in terms of frequency of occurrence are pneumococcus and staphylococcus. In rare cases, acute otitis media is caused by diphtheria bacillus, Proteus, or fungi (otomycosis).

Most often, the penetration of infectious agents into the tympanic cavity occurs through the tubogenic route - through the auditory (Eustachian) tube. Normally, the auditory tube serves as a barrier that protects the middle ear from microorganisms in the nasopharynx entering it. However, with various general and local diseases, its function may be impaired, which leads to infection of the tympanic cavity with the development of acute otitis media. Factors that provoke dysfunction of the auditory tube are: inflammatory processes of the upper respiratory tract (rhinitis, ozena, pharyngitis, laryngitis, laryngotracheitis, tonsillitis, adenoids, chronic tonsillitis); benign tumors of the pharynx (angioma, fibroma, neuroma, etc.), tumors of the nasal cavity; surgical interventions in the nasal cavity and pharynx; diagnostic and therapeutic procedures (Politzer blowing, catheterization of the auditory tube, tamponade for nosebleeds).

The development of acute otitis media can occur when the tympanic cavity becomes infected through the transtympanic route - through a damaged eardrum, which happens with injuries and foreign bodies in the ear. The hematogenous route of infection of the middle ear cavity with the occurrence of acute otitis media can be observed in common infections (measles, influenza, scarlet fever, rubella, diphtheria, syphilis, tuberculosis). A casuistic case is the appearance of acute otitis media due to the penetration of infection from the cranial cavity or inner ear.

In the occurrence of acute otitis media, the state of general and local immunity is important. When it decreases, even saprophytic flora entering the tympanic cavity from the nasopharynx can cause inflammation. Relatively recently, it was proven that the so-called ear allergy, which is one of the manifestations of systemic allergies along with allergic rhinitis, exudative diathesis, allergic dermatitis, asthmatic bronchitis and bronchial asthma, plays an important role in the appearance of acute otitis media. An important role in the development of acute otitis media is played by unfavorable environmental factors: hypothermia, dampness, sudden changes in atmospheric pressure.

Symptoms of acute otitis media

Acute otitis media lasts on average about 2-3 weeks. During a typical acute otitis media, 3 successive stages are distinguished: pre-perforation (initial), perforation and reparative. Each of these stages has its own clinical manifestations. With timely treatment or high immunological resistance of the body, acute otitis media can take an abortive course at any of the indicated stages.

The pre-perforative stage of acute otitis media can take only a few hours or last 4-6 days. It is characterized by a sudden onset of intense ear pain and severe general symptoms. Ear pain is caused by rapidly increasing inflammatory infiltration of the mucous membrane lining the tympanic cavity, resulting in irritation of the nerve endings of the glossopharyngeal and trigeminal nerves. Ear pain in acute otitis media is sharply painful and sometimes unbearable, leading to sleep disturbances and decreased appetite. It radiates to the temporal and parietal regions. Pain syndrome in patients with acute otitis media is accompanied by noise and congestion in the ear, and hearing loss. These symptoms are due to the fact that due to inflammatory changes, the mobility of the auditory ossicles located in the tympanic cavity, which are responsible for sound conduction, decreases.

General manifestations of acute otitis media are an increase in body temperature to 39°C, general weakness, chills, fatigue and weakness. Influenza, scarlet fever and measles acute otitis media often occur with simultaneous involvement in the inflammatory process of the inner ear with the development of labyrinthitis and hearing loss due to sound perception disorders.

The perforated stage of acute otitis media occurs when, as a result of the accumulation of too much purulent content in the tympanic cavity, the eardrum ruptures. Through the resulting hole, mucopurulent, then purulent, and sometimes bloody discharge begins to emerge. At the same time, the health of the patient with acute otitis media improves noticeably, the pain in the ear subsides, and the body temperature improves. Suppuration usually lasts no more than a week, after which the disease progresses to the next stage.

The reparative stage of acute otitis media is characterized by a sharp decrease and cessation of suppuration from the ear. In most patients at this stage, spontaneous scarring of the perforation in the eardrum occurs and complete restoration of hearing occurs. If the perforation size is more than 1 mm, the fibrous layer of the eardrum is not restored. If healing of the hole does occur, then the perforation site remains atrophic and thin, since it is formed only by the epithelial and mucous layers without a fibrous component. Large perforations of the eardrum do not close; along their edge, the outer epidermal layer of the membrane fuses with the internal mucous membrane, forming calloused edges of the residual perforation.

Acute otitis media does not always occur with a typical clinical picture. In some cases, there is an initially prolonged and mild nature of the symptoms, and the absence of spontaneous rupture of the eardrum. On the other hand, an extremely severe course of acute otitis media with severe symptoms, temperature up to 40°C, headache, nausea and dizziness is possible. Delayed formation of perforation of the tympanic membrane in such cases leads to the rapid spread of infection into the cranial cavity with the development of intracranial complications. In cases where, after perforation of the eardrum, there is no improvement in the condition, there is a worsening of symptoms after some improvement, or prolonged (more than a month) suppuration is observed, one should think about the development of mastoiditis.

Diagnosis of acute otitis media

The diagnosis of acute otitis media is established by an otolaryngologist based on the patient’s complaints, the characteristic sudden onset of the disease, the results of otoscopy and microotoscopy, and hearing tests. A clinical blood test in patients with a typical course of acute otitis media reveals moderate leukocytosis and a mild acceleration of ESR. Severe forms of the disease are accompanied by pronounced leukocytosis with a shift to the left and a significant acceleration of ESR. An unfavorable sign indicating the development of mastoiditis is the absence of eosinophils.

The otoscopic picture of acute otitis media depends on the stage of the disease. In the initial period, injection of the radial vessels of the tympanic membrane is detected. Then the hyperemia becomes diffuse, infiltration and protrusion of the membrane towards the ear canal are noted, and sometimes a whitish coating is present. In the perforated stage, otoscopy reveals a slit-like or round perforation of the eardrum, and a pulsating light reflex is observed - pulsation of pus synchronous with the pulse, visible through the perforation. In some cases, prolapse of the mucous membrane of the tympanic cavity, resembling granulation tissue, is observed through the perforated hole. In the reparative stage of acute otitis media, otoscopy may indicate fusion of the perforation or its organization in the form of compaction and callus of the edge.

Audiometry, threshold audiometry and tuning fork testing detect conductive hearing loss. Acoustic impedance measurements indicate reduced mobility of the auditory ossicles. If mastoiditis and petrositis are suspected, an X-ray of the skull in the area of ​​the mastoid process is performed to exclude intracranial complications MRI and CT scan of the brain. Identification of diseases of the nasopharynx, which could be the cause of acute otitis media, is carried out using rhinoscopy, pharyngoscopy, laryngoscopy, determining the patency of the Eustachian tube, and radiography of the paranasal sinuses.

Treatment of acute otitis media

Acute otitis media is treated depending on the stage and, as a rule, on an outpatient basis. If complications develop, hospitalization of the patient is indicated. To relieve pain in the preperforative stage of acute otitis media, ear drops containing anesthetics are used. It is effective to instill drops heated to °C, followed by closing the ear canal with cotton wool and Vaseline, which is removed after a few hours. Turundas moistened with an alcoholic solution of boric acid are also used. To relieve swelling and improve the drainage function of the auditory tube, antihistamines and nasal vasoconstrictor drops are prescribed: oxymetazoline, xylometazoline, naphazoline, tetrizoline, xylometazoline.

General therapy for patients with acute otitis media is carried out with anti-inflammatory drugs: diclofenac, ibufen, etc. In case of increased body temperature and intense pain, antibiotic therapy is indicated. The drugs of choice are amoxicillin, cefuroxin, spiramycin. Once you start taking an antibiotic, you need to drink it for 7-10 days, since early cessation of antibiotic therapy can lead to relapses and complications, chronic otitis media, and the formation of adhesions inside the tympanic cavity.

A good effect in the pre-perforation stage of acute otitis media is obtained by blowing the auditory tube according to Politzer and washing the middle ear with antibiotic solutions in combination with glucocorticosteroid drugs. Protrusion of the eardrum during treatment indicates that despite all therapeutic measures, a large amount of pus accumulates in the tympanic cavity. This condition is fraught with the development of complications and requires paracentesis of the eardrum.

In the perforated stage of acute otitis media, along with the use of antihistamines, vasoconstrictors and antibacterial agents, toilet of the external ear and transtympanic administration of drugs are carried out. To reduce swelling and secretion of the mucous membrane, fenspiride is used, and mucolytics (acetylcysteine, herbal preparations) are used to thin out thick secretions. Physiotherapeutic treatment is prescribed: ultraviolet irradiation, UHF and laser therapy.

Treatment in the reparative stage of acute otitis media is aimed at preventing the formation of adhesions, restoring the functions of the auditory tube, and increasing the body's defenses. They use blowing of the auditory tube, introducing proteolytic enzymes into the tympanic cavity through it, pneumomassage of the eardrum, ultraphonophoresis with hyaluronidase, vitamin therapy, taking biostimulants (royal jelly, calf blood hemoderivat).

Prognosis of acute otitis media

With timely and competent treatment, and sufficient activity of immune mechanisms, acute otitis media ends with complete recovery and 100% restoration of hearing. However, a late visit to the doctor, poor immunity, adverse external influences and underlying diseases can cause a completely different outcome of the disease.

Acute otitis media can transform into chronic suppurative otitis media, which is accompanied by progressive hearing loss and relapses of suppuration. In some cases, the inflammatory process leads to pronounced cicatricial and adhesive changes in the tympanic cavity, disrupting the mobility of the tympanic ossicles and causing the development of adhesive otitis media with persistent hearing loss.

In severe cases, acute otitis media is accompanied by the development of a number of complications: purulent labyrinthitis, mastoiditis, neuritis of the facial nerve, petrositis, meningitis, sigmoid sinus thrombosis, brain abscess, sepsis, some of which can be fatal.

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Acute otitis media

Acute otitis media is an acute inflammatory process that can develop in all parts of the ear, but in most cases this term refers to acute inflammation of the middle ear, i.e. acute otitis media.

The ear is a complex organ that not only perceives sound vibrations, but is also responsible for the position of the body in space and the ability to maintain balance. The ear consists of three sections - outer, middle and inner. The outer ear is formed by the pinna and the auditory canal, which ends at the eardrum. The function of the outer ear is to capture sound signals and transmit them further to the structures of the middle ear. The middle ear consists of the tympanic cavity located between the eardrum and the opening of the temporal bone. The tympanic cavity contains the ossicles (hammer, incus and stapes). The function of this part of the ear is to conduct sound. The middle ear cavity is connected to the nasopharynx by the Eustachian tube, through which the pressure in the tympanic cavity and external atmospheric pressure are equalized.

The inner ear is formed by a system of canals (cochlea) located in the temporal bone. The cochlea is filled with fluid and lined with hair cells, which convert mechanical vibrations of the fluid into nerve impulses that enter the corresponding parts of the brain along the auditory nerve. The function of the inner ear is to provide balance. Inflammation of the inner ear (otitis media) is usually called labyrinthitis.

A differential diagnosis of acute internal otitis with brain pathologies that can cause dizziness, including neoplasms, is required.

Acute otitis media can occur at any age, but children are more susceptible to it - in them it is the most common otorhinolaryngological disease. In the first years of life, about 80% of children experience acute otitis media, and by the age of 7 – up to 95%. In approximately 30% of cases, otitis media suffered in childhood is the cause of hearing loss in adults.

Causes and risk factors

The causative agents of acute otitis are most often staphylococci, pneumococci, Haemophilus influenzae, Klebsiella, Pseudomonas aeruginosa, Moraxella, microscopic yeast-like fungi of the genus Candida, and influenza virus.

Risk factors include:

  • infectious and inflammatory diseases of the ENT organs;
  • mechanical or chemical injuries to the ear;
  • presence of a foreign body in the ear;
  • water getting into the ear;
  • improper ear hygiene;
  • hypothermia;
  • operations on the nasal cavity and/or nasopharynx;
  • allergies;
  • immunodeficiency states;
  • diabetes;
  • childhood and old age.

Forms of the disease

Depending on the nature of the inflammation of the middle ear, acute catarrhal otitis and acute purulent otitis are distinguished.

By origin, acute otitis occurs in the following forms:

Acute external otitis may be limited and diffuse.

Limited external otitis manifests itself in the form of inflammation of the hair follicle or the development of a boil in the external auditory canal.

Stages of the disease

The clinical picture of acute otitis includes the following stages:

  1. Catarrh.
  2. Purulent inflammation, which, in turn, is divided into pre-perforation and perforation stages.
  3. Recovery or transition to a chronic form.

Symptoms of acute otitis media

Symptoms of acute otitis depend on the form of the disease.

In acute otitis media, intense shooting pain in the ear, a feeling of ear fullness, and hearing loss first appear.

Local symptoms are accompanied by general malaise: weakness, lethargy, increased body temperature - usually to subfebrile, but sometimes to febrile levels. In some cases, acute inflammation of the middle ear is accompanied by a sore throat, nasal congestion, and nasal discharge.

Children in the first years of life with acute otitis media refuse to eat, as pain in the ear intensifies when sucking and swallowing. In addition, in children, acute otitis media is often accompanied by regurgitation, vomiting, and diarrhea.

A few days after the onset of the disease, the eardrum perforates and the serous (catarrhal otitis) and then purulent (in some cases bloody) contents leak out. At the same time, the patient's general condition improves. Body temperature returns to normal, ear pain subsides. Suppuration usually lasts no more than a week. After scarring of the perforation, hearing is usually restored. In the case of an unfavorable course of the disease, purulent exudate may not pour out, but spread into the cranial cavity with the subsequent development of meningitis or brain abscess. Acute otitis media lasts on average 2-3 weeks.

In the absence of timely and adequate treatment, acute otitis media can become chronic, which is associated with a high risk of hearing loss.

Acute internal otitis (labyrinthitis) is characterized by severe attacks of dizziness, which are accompanied by nausea, vomiting, tinnitus, and hearing impairment. Labyrinthitis in most cases is a complication of acute otitis media, so the appearance of vestibular disorders in acute otitis media should alert us to the deepening of the inflammatory process.

The manifestation of acute limited external otitis is first itching, and then pain in the ear canal, which can radiate to the upper and lower jaw, temple, and back of the head. The pain intensifies when chewing, as well as at night. Limited external otitis manifests itself in the form of inflammation of the hair follicle or the development of a boil in the external auditory canal. A boil can completely block the lumen of the ear canal, which causes hearing loss. When the boil is opened and its contents drain, the pain subsides and the patient's condition improves.

In acute diffuse external otitis, patients complain of a feeling of fullness, itching, and then severe pain in the ear, which intensifies during conversation, when chewing food, and palpation of the ear. There is hyperemia of the ear canal, its swelling and slit-like narrowing, and enlargement of regional lymph nodes. Discharge from the ear in acute diffuse external otitis is usually scanty, initially serous, and then purulent. The inflammatory process may spread to the soft tissues of the parotid region and the auricle.

Diagnosis of acute otitis media

To determine acute otitis, a history and complaints are collected, an objective examination is carried out, and, if necessary, instrumental and laboratory diagnostic methods are used.

If acute otitis is suspected, otoscopy is usually performed, which makes it possible to examine the eardrum, detect its thickening, hyperemia, injection, protrusion or perforation. X-ray examination of the temporal bones reveals a decrease in pneumatization of the middle ear cavities. Tympanometry is used to determine the ability of the eardrum and auditory ossicles to conduct auditory pressure waves. Audiometry is indicated to identify hearing impairment.

In order to identify the pathogen and determine its sensitivity to anti-infective drugs, a bacteriological study is carried out.

Children in the first years of life with acute otitis media refuse to eat, as pain in the ear intensifies when sucking and swallowing.

A differential diagnosis of acute internal otitis with brain pathologies that can cause dizziness, including neoplasms, is required. Acute otitis media is differentiated from histiocytosis, a tumor of the tympanic cavity. Acute external otitis should be differentiated from mumps, other types of otitis, eczema of the external auditory canal, mastoiditis, and furuncle of the auditory canal. For the purpose of differential diagnosis of acute otitis media with other diseases, computer or magnetic resonance imaging of the brain may be prescribed.

Treatment of acute otitis media

Treatment of acute external otitis is local, in most cases it consists of washing the external auditory canal with antiseptic solutions.

In cases of severe pain and fever, painkillers from the group of non-steroidal anti-inflammatory drugs are prescribed. If necessary, mature boils are opened, after which the ear canal is washed with antiseptic solutions.

Treatment of acute otitis media is carried out with anti-infective (in most cases antibacterial) drugs, non-steroidal anti-inflammatory drugs. Vasoconstrictor drugs are used locally to eliminate swelling of the nasal cavity and nasopharynx in order to drain the tympanic cavity. If the tympanic cavity does not drain on its own within several days from the onset of the disease, the tympanic membrane is dissected (paracentesis). If, after scarring of the eardrum, the patient’s hearing is not restored, blowing and pneumatic massage are indicated.

Conservative treatment of acute internal otitis is mainly symptomatic. To eliminate nausea and vomiting, antiemetic drugs and antihistamines are used. If conservative therapy is ineffective, surgical intervention is indicated. According to indications, a labyrinthotomy is performed, opening the pyramid of the temporal bone.

Possible complications and consequences

In the absence of timely and adequate treatment, acute otitis media can become chronic, which is associated with a high risk of hearing loss.

In approximately 30% of cases, otitis media suffered in childhood is the cause of hearing loss in adults.

In addition, the disease can be complicated by the development of sepsis, inflammation of the mastoid process of the temporal bone, encephalitis, meningitis, brain abscess, thrombosis of the cerebral sinuses, and facial nerve paralysis. The occurrence of intracranial complications can lead to death.

Forecast

With timely and adequate treatment of acute otitis, the prognosis is favorable. In the presence of underlying diseases, immunodeficiency conditions, late seeking medical help, self-medication and the occurrence of complications, the prognosis worsens.

Prevention

To prevent the development of acute otitis media, it is recommended:

  • timely treatment of infectious diseases, especially diseases of the ENT organs;
  • strengthening the body's defenses;
  • avoiding hypothermia;
  • avoiding injury to the ear (including refusal to attempt to independently remove foreign bodies from the ear and use objects not intended for this purpose to clean the ears);
  • compliance with personal hygiene rules.

Video from YouTube on the topic of the article:

Education: “First Kiev Medical College”, specialty “Laboratory Diagnostics”.

The information is generalized and is provided for informational purposes. At the first signs of illness, consult a doctor. Self-medication is dangerous to health!

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