Symptoms, complications and treatment of acute and chronic suppurative otitis. Chronic suppurative otitis media Ear hurts with pus

Otitis media is a common ear disease. Children are more often affected than adults. The disease is very serious. If it is not treated, the consequences can be irreversible, deaths are not uncommon.

Causes and symptoms of the disease

Purulent otitis media is an otolaryngological disease of an infectious nature, in which the epithelium of the inner and middle ear becomes inflamed. Then purulent unpleasant discharge from the auricle appears. The causes are pathogens that have entered the ear and reduced immunity.

The main ways of infection in the ear cavity with purulent otitis media.

1. Tubogenic - through the auditory tube.
2. Traumatic - through a damaged eardrum.
3. Retrograde - from the cranial cavity: with sinusitis and rhinitis.
4. Hematogenous - with blood flow: due to such serious diseases as scarlet fever, tuberculosis, measles.

Symptoms of the disease are severe ear pain, which can be throbbing or aching, congestion and tinnitus, and pus comes out of the ear, while the discharge smells unpleasant. There may also be hearing loss, fever, dizziness, nausea, vomiting, headache.

With purulent otitis, the mucous membranes of all parts of the middle ear are affected: the auditory tube, tympanic membrane, mastoid process.

Forms and stages of the disease

There are two- and one-sided variants of the disease - with the defeat of both ears or one, respectively.

Stages of the disease

The disease of purulent otitis has two forms - acute and chronic. Acute lasts 2-3 weeks, after which the disease becomes protracted. The chronic stage is characterized by persistent perforation of the tympanic membrane, constantly renewed flow of pus and hearing loss.

The disease develops due to improper and late treatment of acute otitis media. The reasons for the transition to the chronic stage are also reduced immunity, incorrectly selected antibacterial treatment of acute otitis media, upper respiratory tract diseases (chronic rhinitis, deviated septum), as well as serious concomitant ailments, such as diabetes mellitus.

There are two forms of the chronic stage according to ICD 10 codes. First: tubotympanic chronic otitis media. At the same time, the mucous region of the auditory tube and the tympanic cavity are affected. It is characterized by a small number of complications.

There is epitympano-antral otitis media. The inflammatory process affects the bone tissue, the mastoid process begins to fester, which leads to necrosis. With this form, serious consequences are possible: meningitis, sepsis.

Diagnosis and treatment of purulent otitis media

Defining the disease is not difficult. The doctor is based on the patient's complaints. An otoscopy is performed: the ear cavity is examined using a special tool. Assign bakposev discharged from the ear. If an etympanic form is suspected, an x-ray of the temporal bone is taken. The diagnosis is confirmed by a blood test, there is a sharp increase in the level of leukocytes.

Treatment of an uncomplicated form of purulent otitis media is carried out at home. At elevated temperatures, bed rest is indicated. In severe cases, the patient is admitted to the hospital.

Therapy depends on the complexity of the disease. So, at the preperforative stage, first of all, pain is eliminated in order to alleviate the condition. For these purposes, drops with an analgesic effect are used, for example, Otipax, which contains lidocaine and phenazone, Anauran, which contains lidocaine, polymyxin, neomycin. The drugs must be dripped several times a day. Nasal vasoconstrictors are prescribed, for example, Galazolin, Otrivin, Sanorin, they improve drainage function. Parcetamol, Diclofenac are prescribed as painkillers. It is strictly forbidden to blow your nose or draw liquid into the nasopharynx.

At the perforative stage, antibiotics and antihistamines are added to the vasoconstrictors. If pus drips from the ear, mucolytic agents are prescribed (ACC, Fluimucil, Erespal). In addition, physiotherapy is prescribed: UHF, UVI. The patient at home must treat the ear cavity himself: remove pus with a cotton swab. With thick secretions, first warm hydrogen peroxide is dripped into the ear, then the cavity is blotted with a dry cloth. After cleansing the auditory canal, slightly warm drops are instilled into the ear, which are prescribed by the doctor.

Antibiotics prescribed at this stage of purulent otitis: "Amoxicillin" is a broad-spectrum drug, it cannot be used during pregnancy, lactation, liver diseases; "Cefuroxime" - used intramuscularly, the same contraindications; "Azithromycin", its advantage: the appointment of one tablet per day, but it has more contraindications; "Cefazolin" - used in the form of injections, the drug can not be used during pregnancy and intestinal diseases. At the same time, drops with antibiotics are prescribed: Levomecitin, Norfloxacin. "Netelmicin".

All medicines are prescribed by a doctor according to a certain scheme. It is forbidden to start taking antibiotics on your own. With poor performance or side effects of the drug, the doctor can adjust the treatment. The duration of antibiotic therapy is at least 7-10 days. Early discontinuation is prohibited in order to avoid relapse and the transition of the disease into a chronic form.

At the perforative stage of purulent otitis, the drainage of fluid in the ear is sometimes disturbed. Then, on the fourth day, the tympanic membrane is dissected. This procedure is performed in a hospital setting to prevent complications. If the focus of inflammation has moved to the bone, it is surgically removed.

During the reparative stage, a scar is already formed on the membrane, pus from the ear stops flowing, so antibiotics and physiotherapy are stopped. With adhesions, pneumomassage of the tympanic membrane is performed. Vitamin therapy is shown. The main task: to restore hearing, strengthen immunity.

Folk remedies

It is impossible to treat the disease on your own, there is a risk of serious complications. Old grandmother's recipes can only improve well-being and reduce pain, but they cannot cure the disease. Therefore, with purulent otitis media, they are used exclusively in combination with medications. Before using home methods, you should consult with your doctor, only he can prescribe the right therapy.

The most common traditional medicine: essential oils, honey, herbs. For example, tea tree oil has pathogenic properties. A couple of drops of tea tree oil, a spoonful of apple cider vinegar are added to a spoonful of vegetable oil. The mixture is slightly warmed up, a cotton turunda is moistened in it and laid in the ear canal. Honey is diluted with water 1:1 and instilled into the ear 2-3 drops. Enhances the effect of gauze swabs moistened with propolis. Anti-inflammatory herbal preparations are taken orally in the form of tea. For example, a mixture of 4 tbsp. l. series and calendula and 2 tbsp. l. licorice root and yarrow, 3 tbsp. l. eucalyptus leaves brew 250 ml of boiling water and insist, drink a third of a glass during the day.

When treating with folk methods, it is forbidden: to warm the ear with something at the perforative stage (when there is purulent discharge), to drip alcohol, vinegar, undiluted garlic or onion juice, to open abscesses on your own.

Treatment of the disease in children

The structure of the child's ear has a number of features. The ear canal is short and wide, and the lumen of the auditory tube is narrow. According to doctors, more than 60% of children under one year old suffer from otitis media, and in 38% it becomes chronic. This is very dangerous for young patients, as the process of speech formation is disrupted, which affects learning.

The symptoms are similar to those in adults. In infants, the initial signs of purulent otitis media may be anxiety; loss of appetite; screaming when pressed on the ear area; the child lies only on one side - where it hurts. At the slightest sign of illness, it is urgent to seek help from a doctor, the disease in children develops rapidly. Literally in a day, the inflammation reaches the stage when pus flows from the ear. The risk of complications in children is much higher than in adults.

Helping children with purulent otitis has its own characteristics. At home, only the initial stage is treated, in other cases hospitalization is indicated.

Widely used in the treatment of children:

• drops "Otipaks", "Levomitsitin", "Polydex", "Tsipromed";
• infants are not prescribed vasoconstrictor drugs in the nose;
• paracetamol is used as an antipyretic, for example, Efferalgan;
• not all antibiotics can be used for children, they mainly give "Amoxicillin";
• for physiotherapy, ultrasound, pneumomassage, ionogalvanization are prescribed.

With timely treatment of purulent otitis media, the prognosis is favorable. However, if incorrect therapy is carried out, complications can be very serious, up to deafness and death.

How to deal with illness during pregnancy

During the period of gestation, the woman's body is very vulnerable. Therefore, the disease of purulent otitis in pregnant women is not so rare. Therapy is selected so as not to harm the unborn baby.

Symptoms are not always pronounced - these are the reactions of the pregnant body to the infection. The difficulty is that there remains a limited range of drugs allowed during pregnancy. Usually, doctors prescribe medicines with natural ingredients. For example, Otipax drops are allowed during this period. If antibiotics cannot be avoided, Amoxiclav is prescribed.

In a hospital, washing is carried out to remove pus from the ear. Vasoconstrictor nasal drops are not prescribed due to the risk of fetal hypoxia. The entire treatment process must be carried out strictly under the supervision of a doctor.

Possible Complications

With belated and incorrect treatment, there is a high risk of deterioration of the condition, in the first place - the transition to a chronic form. The next is partial or complete hearing loss. Sometimes purulent inflammation develops outside the eardrum. This disease is called mastoiditis. This is an acute purulent disease of the mastoid process, in which the pathological process passes to the bone tissue. At the initial stage, the symptoms are the same, only accompanied by nausea. In the future, pus accumulates inside the tympanic cavity and presses on the tissues. If drainage is not done, pus can break into the brain or neck area and cause serious pathologies.

Signs of running mastodia are:

• unbearable headache and earache;
• hearing loss;
• significant redness behind the ears.
• if the temperature has dropped sharply and pus is flowing from the ear, this is a sign that the eardrum has ruptured.

Serious complications are also purulent meningitis, epidural abscess, brain abscess. In these cases, there is pressure on the brain tissue. As a result, paresis, paralysis, disruption of the heart may occur. With any breakthrough of pus inside, there is a risk to life. Requires urgent hospitalization and surgery.

Independent and incorrect treatment is fraught with a number of complications, even fatal. If you consult a doctor at the first signs and receive qualified treatment, the disease can be dealt with easily. The more time is lost, the longer and more difficult the treatment will be and the greater the risk of complications after purulent otitis media.

Preventive measures will help prevent the occurrence of such a serious illness. This is strengthening the immune system, treating colds, avoiding ear injuries, vaccination against meningitis and pneumonia.

Many are familiar with the situation in which pus flows out of it. This is purulent otitis media. The main cause of the disease is the development of an inflammatory process of an infectious nature. To treat the disease, you can contact a specialist, or you can try to get rid of it at home.

Otitis is the development of an inflammatory process in different parts of the auditory apparatus.

When classifying this disease, they are guided by its localization. Allocate such:

• Outer. Inflammation is localized in the tissues of the ear canal. At the same time, the quality of hearing does not deteriorate. As a rule, otitis externa is accompanied by the development of a furuncle, which is accompanied by moderate pain, tissue hyperemia and swelling of the ear canal. If you do not start timely treatment, it is possible that the inflammation will go to the eardrum.
• Average. The inflammatory process develops in the middle ear or on the eardrum. The disease is accompanied by shooting pains, which are worse at night. Otitis media can cause hearing loss. With untimely treatment, the possibility of leakage of pus is not ruled out.

• Interior. Inflammation is localized in the ear labyrinth. This type of disease develops against the background of advanced otitis media. A person has a deterioration in hearing, a violation of the vestibular apparatus, vomiting and nausea.

There are many treatments for otitis media. The choice of one or another method fully depends on the type of disease and the degree of its development.

Effective Treatments

A positive result can be achieved through the use of effective methods of treatment. The most popular tools are listed below.

Drops

For the treatment of otitis externa, experts recommend using the ear. The active components of the drug are antibiotics and a steroid drug that has an immunomodulatory property. As a result of using Sofradex, you can get rid of pain, eliminate burning sensation, get rid of congestion in the ear.

Normaks drops are used for treatment. This drug may cause an allergic reaction. Therefore, you can start taking them only after the appointment of a specialist. After a positive result is achieved, it is recommended to use the drops for another 2-3 days for the purpose of prevention.

Turundy

Often, turundas are also used to treat otitis media. These are small tampons, for the manufacture of which cotton wool or a bandage can be used. The main purpose of turundas is to cleanse the ear in hard-to-reach places.

Despite the fact that turundas are sold in pharmacies, they can be made independently. To do this, you need to take cotton wool or a bandage, twist a roller 10-12 cm long out of it. Its diameter should not exceed 1-2 mm.

To increase the effectiveness of treatment, turundas can be lubricated with Levomekol or Hydrogen Peroxide. Products are introduced into the ear gradually starting from the center. As they become dirty, the turundas must be changed.

Compresses

Good help in the treatment of various types of otitis media and compresses. When used, it is possible to reduce pain and get rid of the inflammatory process. Compresses are of several types.

Warm compress

For its manufacture, a thick layer of cotton wool is used, which is applied to the ear and fixed with a warm scarf or scarf. The warm compress can be worn both at night and during the day. There will be no harm from him.

Vodka compress

The main component of this type of compress is vodka, which wets a piece of gauze (its size should be the same as the size of an ear). In the center of the gauze, it is necessary to make a hole in such a way that the patient's ear enters it. A layer of gauze is covered on top with a piece of polyethylene, in which, just like in gauze, a small hole is made. It is important that the compress covers the skin around the ear, and not just the ear itself. After that, the compress is covered with a layer of cotton wool, which is fixed with a handkerchief or scarf.

Vodka compress can be used for no more than 3-4 hours. After that, it cools down and can cause harm. It is not recommended to do compresses at night.

Alcohol and oil compresses

Good help. To do this, alcohol is preliminarily diluted with water 1: 1.

If a person is allergic to alcohol or vodka, oil can be used as an impregnation of the compress. It can be slightly warmed camphor or vegetable oil. You can also achieve a positive result when using lavender oil or lemon wormwood.

The main rule for applying a compress is that each subsequent layer must be larger in size than the previous one, completely covering it.

Washing

Since the main cause of otitis is an infection in the ear, the use of a treatment method such as washing is of great importance. As a result of its use, it is possible to wash out the accumulated pus from the ear canal. This will help get rid of the bacteria that cause the disease.

The washing procedure can be carried out using different means. Among them are:

• Furacilin solution. This method is used in cases where the integrity of the eardrum is damaged in a person. The solution can be bought ready-made at the pharmacy. To perform the flush, draw the solution into a 20 mg syringe, after removing the needle from it. Gently pulling the earlobe, inject the solution into the ear canal under high pressure. This procedure is not recommended to be carried out at home. It is better to take the help of a specialist. This will help to avoid complications in the form of hearing loss.

• Boric acid. Its use will help get rid of inflammation and reduce pain. Before washing with boric acid, the ear canal must be cleaned. To do this, you can use turundas. Take an alcohol solution of boric acid into the pipette and drip 2-4 drops into the ear, tilting your head slightly. After that, the ear must be closed with a small cotton swab.
• Hydrogen peroxide. The solution can be bought at a pharmacy. The procedure must be carried out in exactly the same sequence as when using boric acid. The peroxide solution helps to rinse and disinfect the ear canal from pus and sulfur accumulated there.

Anti-inflammatory drugs

According to experts, it is possible to achieve a positive result in the treatment of otitis media only with the use of drug treatment. For this, drugs of the penicillin group are used.

Antibiotics

These medications will help to quickly destroy the bacteria that provoked the development of otitis media. It is recommended to use the following tools:

• Amoxicillin.
• Cefuroxime.

Before taking them, be sure to consult a specialist.

warming up

When the ear is heated, blood flow is accelerated. Due to this, puffiness disappears, the process of tissue regeneration is accelerated.

Heating can be done in several ways.

heating pad

The temperature of the heating pad should be low, but comfortable for the person. It is applied to the ear of the person lying. The procedure lasts for 30-60 minutes.

Minin lamp

The duration of the procedure is no more than 15-20 minutes. The distance from the ear to the lamp should be such that the person does not feel discomfort. After 3-4 hours, warming up must be repeated.

Bag of salt

For this, ordinary kitchen salt, preheated in a dry frying pan, is suitable. It is placed in a cloth bag and applied to the ear. The duration of heating with salt should not exceed 15-20 minutes. Upon completion, the ear must be covered with a warm bandage.

Heating with wool (goat, sheep, fox, bear)

For heating, you can also use products made from the wool of a goat, sheep, fox, bear. First, they must be folded in the form of a bandage and wrapped around the ear. This method of heating can be used both during the day and at night.

Warming up with dog hair

However, the most popular heating is using dog hair. This is due to the fact that it can keep warm for a long time, and in its composition contains substances that help to quickly get rid of pain. Also, due to the irritating effect of wool on the skin in the problem area, blood flow increases, as a result of which regeneration is accelerated.

Folk remedies

It is also possible to achieve positive results in the treatment of otitis by using alternative methods of treatment at home. Among those that are used most often, the following options are especially distinguished.

drinking herbs

For the preparation of decoctions, you can use herbs such as chamomile, wild rose, wild garlic. To prepare the medicine, you need to take 1-2 tablespoons of dry chopped herbs and pour boiling water over it. Infuse the broth for 40-45 minutes, and it is ready for use.

Ointment and tincture from Propolis

To prepare it, take 100 g of butter and 15 g of black propolis. Place the mixture in a water bath until the propolis is completely dissolved. To use such an ointment, you need to moisten a small piece of cotton wool with it and put it in the ear canal. The duration of the procedure is no more than 20 minutes.

Celandine juice

Celandine has excellent anti-inflammatory properties. To use it in the treatment of otitis media, it is necessary to prepare a gruel from the green parts of the plant and lubricate a cotton swab with it. After that, put it in the ear passage for about 15-20 minutes.

Golden mustache

A decoction is prepared from the plant, with which a piece of gauze is moistened. Thus, a compress is applied to the ear for approximately 10-15 minutes.

If the pain is very severe, you can drip 2-3 drops of golden mustache juice.

Onion

Ordinary onions can also be used to treat otitis media. A piece of vegetable is placed in the ear canal for 10-15 minutes.

You can also use drops made from freshly squeezed onion juice. They lubricate the turunda and put it in the ear for 10 minutes.

Lemon

Squeeze 3-4 drops of juice from a slice of lemon and drip them into the ear canal. This procedure can be repeated (2-3 times during the day).

Bay leaf

A decoction is prepared from 5 medium sheets, which is infused for 5-6 hours. After that, 4-5 drops of bay leaf decoction can be dripped into the ear. Repeat the procedure 3-4 times throughout the day.

live steam

To use this method, you need to take 1 kg of barley or wheat grain and heat it well in a pan or in an oven. After that, place the grain in a cloth bag and tie. Then wrap it in several layers of towel so that its temperature is comfortable for the person. With a sick ear, the patient lies on the bag. The duration of the procedure depends on the rate of cooling of the grain.

Hops and Aloe

Pour hop cones into a cloth bag and lie on it with a sore ear for 1-2 hours. After that, 2-3 drops of freshly prepared aloe juice should be dripped into the ear. Repeat these procedures for 3-4 days 3 times.

Wax and yolk ointment

To prepare it, you need to take 15 g of beeswax and melt it in a water bath. After that, add half the yolk of a hard-boiled egg to it. The finished ointment should be stored in the refrigerator for no more than 10 months.

For the treatment of otitis media, lubricate the turunda with ointment and gently place it in the ear canal.

Solanine treatment

To use this method, you need to put the potatoes in the sun for at least 2-3 weeks. Then grate it on a fine grater, squeezing the juice. Add 1 part vodka to the mixture. For readiness, let the mixture stand in a dark place for 1 week.

In the treatment of otitis media, 2-3 drops of tincture should be instilled into the sore ear and the ear canal should be buried with a cotton swab.

Tansy

A decoction is prepared from the flowers of the plant (1 tablespoon of tansy flowers per 250 ml of boiling water). The finished medicinal composition must be drunk three times a day, a third of a glass at a time.

Shevchenko method

The essence of the method is to use a mixture prepared from 40 ml of vodka and 40 ml of sunflower oil. Close the container with the mixture with a lid and shake for 5 minutes. Ready tincture must be drunk quickly.

Avicenna recipe

The essence of this recipe is that you need to take 4 pcs. almonds and grind it in a blender. After that, add 1 pinch of cinnamon and soda to the mixture, mixing everything with 1 drop of rose oil. To bind the mixture, you can add 1 tablespoon of honey. Before using it, you need to drop a little table vinegar on a piece of the mixture, which leads to its hiss. In this form, place the mixture in the ear canal and close with a piece of cotton.

Homeopathic Treatment

In some cases, it is not necessary to use antibiotics and medications. You can get by with homeopathic medicines. Among the most common are the following:

• Belladonna.
• Hamomilla.
• Ferrum Phosphoricum.
• Gepar sulfur.

Before you start taking any of the drugs, you must always consult with a specialist.

Disease prevention

In order to avoid the development of purulent otitis, it is enough to adhere to such preventive measures:

• carry out regular hardening;
• spend as much time outdoors as possible;
• try to move a lot;
• do not overcool;
• treat colds in a timely manner.

Subject to such simple rules, it will be possible to avoid the occurrence of purulent otitis media and strengthen the body.

The underlying cause of purulent otitis media is the spread of the infectious process from the nasopharyngeal cavity to the middle ear. Where the infectious agent enters through the so-called rhino-tube route. Much less often, pathogenic pathogens affect the middle ear cavity, by penetrating through the external auditory canal, due to a violation of the integrity of the tympanic membrane.

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

Reducing the body's resistance in diabetes mellitus, infectious diseases, kidney failure increases the risk of inflammatory processes in the middle ear cavity.

Symptoms

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

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

The disease proceeds in three stages:

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

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

During the examination, there is hyperemia and pronounced swelling of the eardrum. On palpation of the mastoid process, acute pain is noted.

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

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

Diagnostics

Purulent otitis is diagnosed by resorting to the following diagnostic measures:

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

Treatment of purulent otitis media should be carried out exclusively by a specialist doctor. Given the symptoms and manifestations of the overall picture of the disease, the doctor can prescribe the appropriate treatment. The main therapeutic measures are:

1. warm-up procedures. A fairly common treatment for purulent otitis media is carried out by heating. To resort to such a method of therapy should be with extreme caution and only with the consent of the attending physician. Self-performing procedures is advisable, in the absence of suppuration for the first time hours of the disease.
2. If perforation of the tympanic membrane does not occur on its own, surgery may be indicated. Representing an incision (puncture) of the tissues of the eardrum. It is important to note that surgery should be carried out as soon as possible in order to avoid unwanted complications. However, otitis media is quite rare, treated in this way.
3. Purulent otitis should be treated with the use of nasal vasodilator drops, which help relieve inflammation from the nasal and nasopharyngeal mucosa.
4. Treatment of an acute form of otitis media is carried out with the use of antibiotic therapy.
5. Purulent otitis media, accompanied by purulent discharge, is not recommended to be treated with thermal procedures. It is also forbidden to use alcohol-based ear drops, as they can damage the mucous membrane of the ear cavity.
6. The main aspect in therapeutic measures is the elimination of purulent discharge and the cleansing of the ear canal. Whether the treatment will be effective depends largely on the implementation of this procedure. You can do it yourself with care. It is highly not recommended to use cotton swabs, matches, etc. for this purpose, as they can damage the mucous membrane and violate the integrity of the eardrum.
7. Treatment aimed at relieving pain involves the use of antispasmodic and analgesic drugs. To reduce the temperature, the patient is prescribed antipyretic drugs.

Surgically, acute otitis media has to be treated quite rarely. In the case of the appointment of surgical intervention, resort to the following operations:

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

Complications and consequences of the disease

If it is not timely to treat acute otitis media or try to start treatment on your own, serious complications may develop. These include:

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

Prevention

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

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

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

Acute otitis media, detected at an early stage, is much faster to treat, so at the first manifestations of the disease, you should visit a doctor without delay.

We sprayed the baby with otitis media, we blamed ourselves very much. Now we only use dosed sprays, Morenazal is very suitable for us, dosed and not expensive, it does not cause otitis media.

Purulent otitis: symptoms and treatment

Purulent otitis media - the main symptoms:

• Noise in ears
• Elevated temperature
• Ear congestion
• Intoxication
• Earache
• Hearing loss
• Purulent discharge from the ear
• Ear redness

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

If the treatment of purulent otitis media is not carried out in time, then dangerous complications will begin to develop:

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

It is important when the first symptoms appear that indicate the progression of the disease, immediately consult a doctor for diagnosis and treatment. It should be noted that purulent otitis equally affects both adults and children. It also has no gender restrictions.

Causes of the progression of purulent otitis media:

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

An infection can enter the ear in several ways:

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

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

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

acute form

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

1. catarrhal. The beginning of the progression of the inflammatory process. At this stage, exudate begins to accumulate in the ear. The first symptoms of the disease appear - ear pain, decreased hearing function. It is important to immediately contact a specialist and begin to treat the disease with antibiotics and physiotherapy;
2. purulent form. If antibiotics and other drugs have not been previously treated, the perforation of the eardrum occurs and purulent exudate begins to flow out of the cavity. Symptoms subside;
3. the inflammatory process gradually subsides. The bleeding stops. The main symptom is hearing loss.

Chronic form

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

Chronic suppurative otitis media usually begins to progress in childhood. It is provoked by pneumococci, pseudomonads and staphylococci. Chronic suppurative otitis media has two subforms:

• mesotympanitis. The inflammatory process affects the mucous membrane of the eardrum and auditory tube. Perforation is located in the central part of the membrane;
• epitympanitis. In the pathological process, in addition to the mucosa, the bone structures of the mastoid process and the attic-antral region are involved. Perforation is localized in the upper part of the membrane. This form is dangerous because dangerous complications often progress against its background - osteitis, sepsis, meningitis, brain abscess.

Symptoms

Symptoms of the initial stage of acute suppurative otitis media:

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

The duration of the initial stage of purulent otitis media ranges from several hours to 3 days. This is followed by a transition to the perforative stage. The patient has the following symptoms:

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

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

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

It is necessary to treat the disease in stationary conditions. And especially if there is purulent otitis media in a child. The treatment plan is drawn up by the attending physician, taking into account the stage of the disease, the severity of the clinical picture, as well as the patient's condition.

Treatment of the preperforative stage:

• relief of pain syndrome. Use both systemic and local drugs;
• vasoconstrictor nasal drops;
• antihistamines;
• it is shown to apply half-alcohol compresses to the ear;
• antibiotics. Necessary for the destruction of infectious agents. Doctors usually prescribe antibiotics such as cefuroxime, amoxicillin, augmentin, etc.;
• paracentesis.

With the progression of the perforative stage, it is necessary to continue taking antibiotics, as well as antihistamines. Also, the course of treatment is supplemented with such drugs:

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

The treatment regimen at the reparative stage is supplemented by:

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

It is simply necessary to treat the disease with antibiotics, since it is these drugs that help eliminate the cause of its progression - infectious agents. It should be noted that this group of drugs should be prescribed only by the attending physician. It is unacceptable to take antibiotics on your own, as you can only aggravate the situation. Antibiotics are prescribed to be taken according to a certain scheme. During the treatment of pathology, the doctor can change the drug if the selected remedy does not have the desired effect. Also, the doctor can change the antibiotic after receiving the results of bakposev purulent exudate.

If you think that you have Purulent otitis media and symptoms characteristic of this disease, then doctors can help you: an otorhinolaryngologist, a pediatrician.

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

Acute suppurative otitis media

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

This disease is similar in some symptoms to the common cold. So with otitis, fever and headache are also characteristic.

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

A cold can be “survived” without resorting to the help of doctors, but when signs of otitis appear, it is necessary to seek help from an otolaryngologist. Because if you do not start timely treatment of purulent otitis media in adults, this disease can lead to a noticeable hearing loss and even cause the development of meningitis.

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

Causes of otitis media:

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

The most common route of infection is tubogenic - through the auditory tube. Less often, the infection enters the middle ear through a damaged tympanic membrane when it is injured or through a mastoid wound. In this case, we speak of traumatic otitis media.

Symptoms of purulent otitis media

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

Traditional symptoms of otitis media:

• throbbing pain in the ear;
• ear pain;
• heat;
• chills;
• extraneous noises in the ear;
• hearing loss.

These signs are characteristic of the initial stage of the disease, when inflammation causes extensive suppuration. This process usually takes 2-3 days. Further, acute purulent otitis media passes into the phase of perforative damage to the tympanic membrane, as a result of which pus flows out of the ear cavity through the hole in the eardrum, and the patient experiences significant relief, pain sensations decrease.

The third stage is the final one, the body fights the infection, inflammation gradually decreases, pus stops secreting, the eardrum restores its integrity.

Signs of otitis in a child

Each stage of the development of the disease is characterized by certain symptoms.

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

Symptoms of the 2nd stage:

• the temperature drops;
• the pain subsides;
• hearing loss continues;
• purulent discharge begins to flow from the ear.

Symptoms of the 3rd stage:

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

This disease requires early diagnosis and antibiotic therapy.

Chronic suppurative otitis media

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

This otitis is manifested by the following clinical picture:

1. Persistent purulent discharge from the ear, with a putrid odor;
2. Noise in the affected ear;
3. Hearing loss.

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

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

Complications

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

Complications may include:

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

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

The scheme of treatment of acute purulent otitis media

In adults, the treatment of purulent otitis media includes the appointment of such procedures and drugs:

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

It should be noted that after the appearance of purulent discharge, in no case should warming procedures be done. In the chronic course of the disease, a puncture or dissection of the eardrum may be required.

How to treat purulent otitis media in adults

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

Purulent otitis media in adults requires outpatient treatment, at high temperature in combination with fever, bed rest is recommended. Hospitalization is required if mastoid involvement is suspected.

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

• paracetamol (4 times a day, one tablet);
• Otipax ear drops (twice a day, 4 drops);
• a tampon according to Tsitovich (a gauze tampon soaked in a solution of boric acid and glycerin is inserted into the ear canal for three hours).

To relieve swelling in the tissues of the auditory tube is prescribed:

Antibiotics used for purulent otitis media:

If after several days of treatment there is no improvement or the phenomena increase, surgical treatment is performed, it is urgently indicated when signs of irritation of the inner ear or meninges appear. After paracentesis or self-perforation, it is necessary to ensure the outflow of pus from the middle ear: drain the ear canal with sterile gauze swabs 2-3 times a day or wash the ear with a warm solution of boric acid.

What and how to treat acute suppurative otitis media?

A common inflammatory ear disease is purulent otitis media. The disease is most often diagnosed in children. In view of this, in 80% of patients under three years old, inflammation of the middle ear occurs at least once a year.

There are two forms of the course of the disease. The acute form makes up 25-30% of all ear diseases and, in the absence of proper treatment, progresses to the second form - chronic, characterized by a protracted course and longer treatment. Therefore, it is recommended to consult a doctor in a timely manner in case of any suspicion of an ailment.

Acute purulent otitis: features

Purulent otitis media in adults and children is inflammation of the mucous membrane of the tympanic cavity.

During the course of the disease, any parts of the middle ear are involved in the pathogenic process.

There are two leading factors in the development of the disease:

• penetration into the ear of infectious agents;
• deterioration of the general immunity of the body.

Attention! Most often, viral otitis is diagnosed during the period of the greatest spread of acute respiratory viral infections.

Pathogenic microflora from the pharynx can penetrate into the tympanic cavity, but if a person has good immunity, then the inflammatory process in the ear will not occur.

However, with massive damage by bacteria and fungi, or in the case of their high virulence, acute purulent otitis media develops.

IN 80% of cases The following types of pathogens contribute to the emergence of the disease:

• Staphylococcus aureus (S. aureus);
• hemophilic bacillus (N. influenzae);
• pyogenic streptococcus (S. Pyogenes);
• pneumococcus (S. Pneumoniae);
• moraxella (M. catarrhalis).

Often, the infection enters the ear through the auditory tube.. Less commonly, microbes find themselves in the cavity of the hearing aid, bypassing the injured eardrum. In rare cases, pathogens are introduced into the middle ear in a hepatogenic way, when infections lead to the formation of otitis media.

In exceptional cases, acute inflammation appears during the transmission of infectious agents from the labyrinth, or the cranial cavity.

Development of the disease

Purulent otitis media begins with inflammation occurring in the auditory tube.

The process is accompanied by infiltration and edema.

With a severe malfunction in the functioning of the auditory tube, viscous pus accumulates in the middle ear.

Also, the mucous membrane thickens, and ulcers and erosions form on its surface. As a result, poor hemodynamics and the accumulation of purulent matter leads to the melting of certain areas and perforation of the eardrum, which can result in otorrhea.

Reference. Often, infectious otitis media does not end with deafness, but with a purulent lesion, destruction of morphofunctional structures is noted, which often leads to hearing loss.

The course of acute purulent otitis is divided into 3 stages:

At the initial stage there is pain in the ear, and it can go to the forehead or temple. As the inflammation spreads, the intensity of unpleasant sensations intensifies and congestion and tinnitus join the discomfort.

The patient may have a very high body temperature, which will require immediate medical attention. The duration of the pre-perforative stage varies - from 2-3 hours to 4 days.

Perforated phase occurs when the tympanic membrane ruptures and a purulent exudate appears. At this stage, the symptoms subside, and the temperature returns to normal.

On the first day after the rupture, pus is released profusely, sometimes with blood clots. After a couple of days, the volume of the exudate decreases, and it becomes more viscous. The average duration of the perforative stage - one week.

At the reparative stage the discharge of pus stops and the process of rapid regeneration begins. At the same time, the person feels good, and his auditory functions resume.

However, in most cases, the course of the acute stage of purulent otitis is sluggish and it is not accompanied by a rupture of the membrane. Therefore, during the course of all stages of the disease, the patient has constant discomfort in the ear, hearing impairment and temperature.

Important! If the patient's well-being does not improve after three days, then the inflammatory process can spread to the cranium, which will cause a number of irreversible consequences.

In order not to lose your hearing, it is important to know how and how to treat purulent otitis media. Therapy of this disease can be traditional and operational. To eliminate pain, local remedies are indicated - solution based on levomiticin, or boric acid with glycerin, as well as Otipax drops.

The ENT prescribes a number of drugs that eliminate certain symptoms:

• from swelling and dilation of blood vessels - Xylo-Mefa, Nazivin;
• from problems with the drainage of the auditory tube - Otrivin.

Attention! To improve the outflow of pus, the tympanic membrane is punctured.

Treatment of acute suppurative otitis media involves taking antimicrobial agents. So, at the preperforative stage, the doctor prescribes antiseptic drops, for example, Anauran or Polydex.

At the beginning of the development of the disease, on the inflamed ear, you can apply alcohol compress. Since this procedure may increase discomfort in some patients, it should be carried out with caution.

Preperforative stage

At the preperforative stage, which is accompanied by signs of intoxication, systemic antibiotics. These drugs are taken orally, or injected into muscles or veins.

Often in acute purulent otitis media, the following antibiotics are used:

1. Amoxicillin- taken orally three times a day, 0.5 g for a week.
2. Cefuroxime- administered intramuscularly in the form of injections.
3. Augmentin- the dosage is prescribed by the doctor.
4. Phenoxymethylpenicillin- take orally 250 mg 3 times a day.
5. Ampicillin- administered intramuscularly in the form of injections.

To stop the histamine action that occurs against the background of pathological processes, antiallergic drugs are prescribed ( Erius, Loratadine).

And pills are used to eliminate pain and inflammation. Diclofenac, Nise or Nurofen.

For a speedy recovery, it is recommended to supplement the intake of medicines with physiotherapy, including pneumomassage, UHF, iontophoresis with lidase, UV radiation and laser therapy.

Attention! With purulent otitis, it is important to ensure that water does not get into the affected ear. Because it can aggravate the healing process.

Conclusion

In order not to develop acute purulent otitis media, the treatment of which requires the use of antibiotics that have a toxic effect on the body, it is important not to forget about prevention. First of all, you should prevent the development of respiratory diseases.

Therefore, it is important to avoid hypothermia, eat well and regularly carry out hardening procedures. Also, the full treatment of chronic diseases of the respiratory organs will help prevent the occurrence of acute inflammation of the ear.

Acute suppurative otitis media

ACUTE PURULENT OTITIS MEDIA. MASTOIDIT.

Acute purulent otitis media is an acute purulent inflammation of the mucous membrane of the air cavities of the middle ear. All parts of the middle ear are involved in the inflammatory process - the auditory tube, the tympanic cavity, the mammillary process, and not just the tympanic cavity.

Among ear diseases, acute purulent inflammation of the middle ear occupies the first place in terms of frequency. Acute purulent otitis media accounts for 25-30% of all ear diseases.

Acute suppurative otitis media can lead to persistent hearing loss, both conductive and perceptual. This is the social significance of the disease.

One of the consequences of acute purulent otitis media may be its transition to a chronic form, which also leads to the development of deafness.

The danger of acute purulent otitis media is due to the fact that it can lead to the development of otogenic intracranial complications (meningitis, thrombosis of the cerebral sinuses, abscess of the cerebral hemispheres and cerebellum) and otogenic sepsis.

Etiology of acute suppurative otitis media.

Most often, in acute inflammation of the middle ear, Streptococcus p n eumoniae, Haemophilus influenzae and Moraxella catarrhalis are found. Rare in older patients, Gram-negative Escherichia coli are found in infants with otitis media. Viruses can be isolated in about 4% of cases in the discharge from the middle ear, with respiratory syncytial virus and influenza virus being the most common.

The disease develops against the background of reduced body resistance, since the infectious process is determined by the interaction of micro- and macro-organisms.

Most often, the infection enters the middle ear through the auditory tube. This is the main route of infection into the middle ear. In diseases of the nose and nasopharynx, pathological changes occur in the auditory tube (swelling of the mucous membrane, paralysis of the ciliated epithelium), which allow microbes to freely enter the middle ear. Adenoids, adenoiditis, hypertrophic rhinitis, deviated nasal septum, purulent sinusitis lead to a violation of the ventilation and drainage functions of the auditory tube, and as a result, the protective function. In this case, the possibility of infection of the middle ear increases significantly.

Also, acute purulent otitis media can occur when an infection enters through the blood, especially with influenza.

In case of violation of the integrity of the eardrum as a result of a domestic or combat injury, the infection enters the middle ear through the external auditory canal.

A certain role in the course of acute otitis media has the structure of the mammillary process (pneumatic, diploetic, sclerotic). Normal and most favorable for the functioning of the middle ear is the pneumatic structure of the mammillary process. Mastoiditis often occurs with a diploetic structure, intracranial complications - with a sclerotic one.

Depending on the age, acute otitis has features of the course. Children suffer from acute otitis media very often.

In a newborn, the auditory tube, located in a horizontal plane, has a relatively small lumen. In adults, this structure is located at an angle of 45° with respect to the ear. In adults, the auditory tube is located above the nose and its lumen is relatively large. Children are predisposed to inflammation of the middle ear because the products of the secretion of the nasopharynx can freely pass through the horizontally located, open auditory tube, introducing pathogenic microbes into the middle ear. In addition, a small inflammation can close the already small lumen of the auditory tube in a child, complicating the course of the inflammatory process. Remnants of myxoid tissue in the middle ear of infants provide fertile ground for the growth of pathogens.

Pathological anatomy. When an infection enters the mucous membrane of the middle ear, the phenomena of mucoid swelling, small cell infiltration, arterial hyperemia develop, and exudate accumulates. At first, the exudate may be serous or hemorrhagic, but quickly becomes purulent. The amount of exudate increases, the pressure in the tympanic cavity increases. The mucous membrane thickens sharply, becomes covered with ulcers, sometimes granulation tissue grows. The pressure of the exudate on the eardrum leads to a local disturbance of the trophism in it, as a result of which it breaks and suppuration from the ear appears - otorrhea.

Thanks to local and general immune reactions, the inflammatory processes of the body subside and after that reparative processes begin. Granulation of the edges of the perforation of the tympanic membrane can lead to its closure. The mucous membrane is renewed.

Acute purulent inflammation of the middle ear, as a rule, goes through three stages.

Stage 1 - the development of the inflammatory process and the increase in clinical symptoms or the preperforative stage.

Stage 2 - perforative.

Stage 3 - reparative or reverse development of the disease.

Stage I - preperforative (lasts 1-3 days) - is characterized by a diffuse inflammatory process in the ear without delimitation. The onset of the disease is acute, severe shooting, throbbing pain in the ear, which closes other ear manifestations: hearing loss, noise, sensation of fluid transfusion in the ear. There are pronounced symptoms of general intoxication: high body temperature, chills and general malaise.

The mastoid process is slightly painful. There may be vestibular manifestations: dizziness, nausea, nystagmus, significant hearing loss. Tympanic membrane red, infiltrated, prominent, especially in posterior quadrants; the outline of the handle of the malleus often disappears. In the pre-perforative stage, in the absence of delimitation, the infection can spread to the labyrinth and into the cranial cavity, causing early complications with a particularly severe course.

Otoscopy - at the beginning of the disease, an injection of the vessels of the tympanic membrane is observed along the handle of the malleus and along the radius from it. This is a limited hyperemia, which eventually becomes diffuse. Later, an inflammatory infiltration of the tympanic membrane appears. The relief of the tympanic membrane is smoothed out, the identification marks disappear. The light reflex disappears first, the lateral process of the malleus disappears last.

Inflammatory changes in the blood: neutrophilic leukocytosis, shift of the leukoformula to the left, SOE is significantly accelerated.

Stage II - perforative (lasts 4-7 days) - is characterized by the occurrence of spontaneous perforation of the tympanic membrane, which most often occurs 24-48 hours after the onset of the disease. After the occurrence of perforation and outflow of exudate from the middle ear, the pain quickly subsides, the body temperature decreases. Through the perforation, first hemorrhagic, and subsequently purulent, exudate is released, usually odorless. The contours of the perforation of the tympanic membrane, as a rule, are not visible, because it is slit-like. The place of perforation can be judged when there is a pulsating reflex - pus is released in small drops through the perforation synchronously with the pulse - “pulsates”.

The appearance of secretions with an unpleasant odor gives reason to suspect bone necrosis (necrotic inflammation of the ear), which may be due to scarlet fever, measles, agranulocytosis, and the like.

Stage III - recovery (reverse development or reparative, continues until the end of the 3rd week). The amount of secretions decreases, they become mucous, flow out without periodic shocks. The eardrum turns pale, small perforations close.

In the general analysis of blood at all stages of otitis media, moderate leukocytosis and accelerated NCO are noted.

What happens with a perforated eardrum?

1. A small perforation heals by regenerating all three layers without leaving any marks.

2. With a large perforation, the middle fibrous layer does not regenerate and then atrophic areas remain, which can lead to hearing loss.

3. Sometimes, at the site of perforation, scar tissue is formed with the deposition of salts in it. The perforation heals by secondary intention. During otoscopy, the doctor sees a white scar, which indicates that the patient had a history of acute purulent otitis media.

4. If the perforation does not close, then the mucous membrane of the tympanic membrane fuses along the edge with the outer (epidermal) layer and a persistent perforation is formed.

Features of the course of acute suppurative otitis media in early childhood

1. In children, the eardrum is much thicker than in adults. This prevents the unauthorized breakthrough of pus and the transition of the disease from stage 1 to stage two.

2. Difficulties in diagnosis are also increased due to the fact that the auditory canal in infants is much narrower than in an adult. The tympanic membrane is located closer to the horizontal plane. The smaller the child, the more difficult it is to hold the otoscope.

3. In newborns and infants, the bone part of the external auditory canal is not expressed and the tympanic membrane is adjacent to its membranous-cartilaginous section. In this regard, pressing on the tragus in acute purulent otitis media causes or intensifies ear pain in such children. In older children and adults, this symptom is characteristic of otitis externa.

If the baby has an intoxication syndrome, which is not associated with damage to other organs, then it is necessary to exclude acute otitis media, that is, seek advice from an otorhinolaryngologist. Pay attention to the behavior of children. In the event of acute otitis media, children of the first months of life are restless, turn their heads, and older children grab their sore ear with their hands.

The disease in children, as a rule, begins suddenly, at night. Body temperature is very high - 39-40°C. In severe cases, meningism and parenteral dyspepsia may occur.

Meningism is a meningeal syndrome without pathological changes in the cerebrospinal fluid. Meningism is caused by increased pressure in the cranial cavity due to local irritation of the dura mater. Meningism in infants is manifested by convulsions, protrusion of the crown of the head, a fixed gaze, and vomiting.

Parenteral dyspepsia - gastrointestinal disorders, the cause of which lies outside the gastrointestinal tract. In acute otitis, this pathology is explained by the absorption of toxins from the middle ear, as well as the reflex effect of the inflammatory focus on the gastrointestinal tract.

Consequences of acute purulent otitis media

1. Most often, the disease ends with the complete healing of the eardrum and the resumption of hearing (recovery).

2. Persistent hearing loss as a result of the formation of adhesions in the tympanic cavity (without perforation).

3. The occurrence of persistent perforation of the tympanic membrane (transition to chronic otitis media).

4. The development of a number of complications: mastoiditis, labyrinthitis, severe sensorineural hearing loss, paresis of the facial nerve, otogenic sepsis, intracranial complications, and the like.

If recovery does not occur before the end of the 3rd week, then there is a risk of complications. The signs of which are: worsening of the general condition, a repeated increase in body temperature, increased pain in the ear (which was already beginning to subside), an increase in the amount of discharge, no improvement in hearing or its subsequent decrease, the appearance of pain in the area of ​​the mammillary process, an increase in leukocytosis and SOE.

The first stage of the disease.

1. The regimen should be at home, at high body temperature - in bed. Severe general condition is an indication for hospitalization.

2. The diet should be such that it is easily digestible, fortified.

At the initial stage of acute otitis media - the stage of catarrh, one should, first of all, try to restore the patency of the auditory tube. For this purpose, the patient, who lies without a pillow with his head turned to the affected side, drips vasoconstrictor drops into the nose: naphthyzine solution 0.1%, adrenaline solution 0.05%, sanorin solution, galazolin. It is advisable to use oral decongestants, for example, pseudoephedrine or isofedrine at 0.06 three times a day, children under 6 years old - 0.03 three times a day, infants - 0.015 per day.

It is highly advisable to use mixtures intended for nasal administration, which contain decongestants, antihistamines, vitamin C: adrianol and betadrine (only for adults).

Otipax (contains phenazone and lidocaine) is injected into the external auditory canal. A good result is the use of drops of this composition:

Rp.: Sol. Prednisoloni hemisuccinatis 5.0(25mg)

Sol. Benzylpenicillini 250 000 Od - 5.0*

M.D.S 3. 4 drops in the external auditory canal

or on the turunda before contact with the eardrum.

Locally in the ear with non-perforative otitis media are prescribed: 3% boric alcohol, 5% carbolic-glycerin drops or camphor oil (in the form of heat), otinum, otipax. Wet turundas soaked in boric alcohol or an alcohol solution of furacilin, their introduction into the external auditory canal can cause pain, so it is better to combine these solutions with glycerin.

Ultimately, alcohol-glycerin drops act at this stage mainly as an “intra-ear semi-alcohol compress”, which is advisable to supplement with a compress on the ear area. For this purpose, several (4.5) layers of gauze, with a cut for the auricle, are impregnated with 40% ethyl alcohol or vodka. Then apply compress paper (film) - also with a cut and cotton wool. The latter are covered in the ear area, them and the sink, and fixed with several rounds of bandage.

Symptomatic therapy. This is, first of all, the appointment of painkillers and drugs that reduce body temperature: analgin, aspirin, paracetamol, ketorolac (ketanov), ibuprofen with paracetamol (brustan).

At the same time, nonspecific desensitization therapy is prescribed - antihistamines, calcium preparations, vitamins, in particular, ascorbic acid.

Physiotherapy procedures. A UHF, LUCH-2, Solux lamp is prescribed for a sore ear. At home, use a warming compress, dry warm dressings, blue light.

The appearance of exudate in the cavity of the middle ear, as indicated by the protrusion of the tympanic membrane, is an indication for paracentesis (tympanotomy).

Tympanopuncture is performed using a thin needle with a blunt cut, which is dressed on a syringe. The tympanic membrane is pierced in the region of the posterior quadrants or in the place of the greatest protrusion. The content of the tympanic cavity is aspirated with a syringe and then washed with a solution of antibiotics and corticosteroids. The entry of the solution into the nasopharynx indicates that the auditory tube is passable.

Paracentesis is carried out with a special spear-shaped needle, which is called paracentesis. During paracentesis, the tympanic membrane is punctured on the verge of the upper and lower posterior quadrants, because it is there that the tympanic membrane is more distant from the medial wall, which makes it possible to avoid injury. Pus and blood, which immediately appear after paracentesis in the external auditory canal, are removed with cotton wool and an ear probe, or the ear is toileted with a cannula connected to an electric suction device. After paracentesis, it is advisable to put a turunda with a solution of adrenaline (1: 1000) or another vasoconstrictor solution into the external auditory canal for several minutes. This will help expand the paracentesis opening and improve the outflow of pus from the tympanic cavity.

Regarding the choice of antibiotic, it is due to the spectrum of bacterial flora, causative in relation to acute otitis media.

Of the antibiotics in otorhinolaryngology, the advantage is given to macrolides, aminopenicillins and cephalosporins. These antibiotics tend to override the bacterial flora that causes inflammatory diseases of the ear and upper respiratory tract. In the treatment of acute purulent otitis media from macrolides, clarithromycin (Klacid) has proven itself well, with aminopenicillins - amoxil (Amoxil-KMP); semi-synthetic penicillins protected by clavulanic acid - amoxicillin with clavulanic acid (enhancin, augmentin, amoxic-lav); from cephalosporins of the 1st generation - cefazolin (reflin, cefazolin-KMP); from the 2nd generation - cefaclor (vercef), cefuroxime, lora-carbef, cefprozil; from the 3rd generation - ceftriaxone (oframax, cef-triaxone-KMP), cefixime, cefotaxime, ceftazidime.

With a protracted course of otitis media, Olfen is prescribed to enhance anti-inflammatory therapy. Olfen is a non-steroidal anti-inflammatory drug with a pronounced anti-inflammatory, analgesic and antipyretic effect. Olfenu's active ingredient is diclofenac. The drug is used in a course of 7 days, in tablets of 50 mg, three times a day.

In the first days of the disease, it is advisable, especially in children, to use the natural factor of nonspecific resistance interferon:

In the second stage of acute purulent otitis media (perforative), it is necessary to wash the ear 2-3 times a day, with dry cotton on the ear probe or with 3% hydrogen peroxide. After the toilet, various disinfectants are injected into the ear: 3% boric alcohol, 5% sulfacyl alcohol, 0.1% furacilin alcohol, bivacin, garazon, normax.

All other treatment that was carried out in the 1st period of the disease (with the exception of oil drops in the ear) remains in the second period.

As a rule, in acute otitis media, perforation of the tympanic membrane appears on the 2-3rd day of illness.

Treatment in the 3rd stage of the disease is reduced to the rehabilitation of the hearing function: the ears are blown behind the Politzer, catheterization of the auditory tubes, pneumomassage of the eardrums. These manipulations contribute to the resumption of the patency of the auditory tubes and the mobility of the ossicular chain and the tympanic membrane.

One of the consequences of acute suppurative otitis media can be complications.

Mastoiditis is an inflammatory disease of the mastoid bone. As a rule, mastoiditis is secondary - as a complication of acute purulent otitis media, or develops as a result of an exacerbation of chronic purulent otitis media. Extremely rare is primary mastoiditis, that is, an independent disease that has arisen without previous acute or chronic otitis media. Primary mastoiditis occurs as a result of trauma to the mammillary process or hematogenous drift of purulent metastasis with sepsis of a non-otogenic nature, as well as with syphilis and tuberculosis.

The following points contribute to the transition of the process to the bone of the mastoid process and the development of mastoiditis:

1) high virulence of the infection;

2) general weakness of the body;

3) difficulty in the outflow of exudate from the middle ear cavity, late spontaneous perforation of the tympanic membrane;

4) irrational treatment of acute otitis media, namely, untimely performed tympanopuncture and paracentesis.

The pathoanatomical process with mastoiditis goes through such stages.

1. Inflammation of the mucoperioste of the cells of the mammillary process, mucoid swelling.

2. Osteitis - bone partitions between cells are involved in the process, which are then destroyed, melted.

3. A cavity filled with pus is formed - empyema of the mammillary process. The process can go outside, the cortical layer of the bone is destroyed and pus penetrates under the periosteum, a subperiosteal abscess develops. If the process extends deep into the cranial cavity, then intracranial complications develop.

Clinic for mastoiditis. There are general and local symptoms of mastoiditis. General symptoms do not differ significantly from the manifestations of acute purulent otitis media: fever, feeling unwell, reaction from the blood. The absence of a decrease in body temperature or even an increase in it, throbbing pain in the ear with the appearance of perforation and suppuration without retention of pus raises the suspicion of mastoiditis, if it does not have other reasons for this. Mastoiditis, as a rule, develops before the end of the second - the beginning of the third week of the course of acute otitis media. However, in some cases, especially in severe forms of influenza, scarlet fever, mastoiditis can occur almost simultaneously with acute otitis media.

Local symptoms of mastoiditis include the following.

1. Independent pain or pain on palpation of the area of ​​the mammillary process. Later - a characteristic headache, especially at night. Pain when pressing on the mammillary process may not be experienced by elderly people with a thick cortical layer of the mammillary process, especially with destruction mainly in the deep cells of the process.

2. Swelling and pastosity of the soft tissues of the mammillary process, hyperemia of the skin above it, smoothness of the behind-the-ear fold, auricle discharge (easily recognized when compared with the healthy side).

3. Otoscopy: suppuration intensifies, pulsation of pus resumes, pus becomes thick, the eardrum becomes hyperemic. A characteristic otoscopic symptom is the overhang of the soft tissues of the posterior-upper wall of the bony part of the external auditory canal, which corresponds to the anterior wall of the antrum or the concentric narrowing of the bony part of the auditory canal. This symptom is due to inflammation of the periosteum in the presence of pus in the cave and cells of the mammillary process.

4. Sometimes pus can break through from the mammillary process through its outer cortical layer. In this case, a subperiosteal abscess develops.

Atypical (special) forms of mastoiditis may occur.

1. Zygomaticitis is the result of the spread of a purulent inflammatory process in mastoiditis to the zygomatic process.

2. Apical-cervical mastoiditis, the most common form of which is Bezoldivsky mastoiditis. With this form of mastoiditis, pus breaks through the inner surface of the apex of the mastoid process. Pus is localized deep under the sternocleidomastoid muscle.

3. Squamite - the process extends to the cells of the scales of the temporal bone.

4. Petrositis - cells of the pyramidal part of the temporal bone are involved in the process.

Treatment for mastoiditis. There are conservative and surgical treatment of mastoiditis.

Conservative treatment of mastoiditis is carried out in the same way as acute purulent otitis media in the second stage: ear toilet, the introduction of disinfectant solutions into the ear, active anti-inflammatory therapy, anti-temperature and hyposensitizing drugs.

With the ineffectiveness of conservative treatment, an operation is indicated - trepanation of the mammillary process. This operation is called anthrotomy, antromastoidectomy or antromastoidectomy. The purpose of the operation is to open the antrum.

Absolute indications for surgery are the presence of a subperiosteal abscess or the development of intracranial complications.

Anthromastoidotomy technique. In the behind-the-ear area, an arcuate opening is performed along the line of attachment of the auricle. After stopping the bleeding with a raspator, the soft tissues are separated from the bone back enough to find the cognitive points of the Shipo triangle:

In the area of ​​​​the anterior-upper corner of the Shipo triangle, trepanation of the bone begins with a chisel or cutters and a drill. The bone is removed until an antrum is found. It is usually located at a depth of 1.5-2 cm from the surface. The antrum should be widened so that the entrance to the antrum is clearly visible. After removal of the pathologically altered bone within healthy and granulations, the behind-the-ear wound is tamponed and conducted openly. After its cleaning and granulation (after 1.5-2 weeks), mastoidoplasty is performed.

Anthropuncture is sometimes performed for infants with suspected latent otoantritis. Anthropuncture is a puncture of the cavern of the mammillary process for diagnostic and therapeutic purposes. The needle injection site is located directly under the temporal line, retreating 2-3 mm back from the place of attachment of the auricle, slightly below the level of the upper wall of the external auditory canal. A thick needle, which has a clearance of at least 1 mm, is placed perpendicular to the surface of the mammillary process, then slowly inserted through soft tissues and bone to a depth of 0.5-1 cm until its end falls into the cavity. The correct insertion of the needle can be checked by purging it and the cavities of the middle ear with air from a syringe. Blood flowing from the needle indicates that the needle is in the sigmoid sinus.

For therapeutic purposes, the middle ear cavity is washed through a needle with an isotonic solution of sodium chloride, disinfectants, and antibiotics.

Symptoms and treatment of acute suppurative otitis media

Acute purulent otitis media is an otolaryngological pathology characterized by purulent inflammation in the middle ear: tympanic cavity, Eustachian tube, mastoid process. The cause of the development of ENT diseases are bacteria and fungal pathogens that actively multiply in the ear cavity when the immune defense is weakened. Untimely treatment of the disease leads to the development of stenosis, hearing loss, autophony, labyrinthitis, sepsis, etc.

Provocateurs of catarrhal processes in the mucous membranes of the middle ear are mainly streptococci, staphylococci, aspergillus, diphtheria bacillus and actinomycetes. The active development of pathogenic flora occurs in case of a decrease in local immunity. The reason for this may be insufficient production of sulfur in the ear canal, which has a pronounced antimicrobial effect.

Etiology of the disease

According to statistics, purulent otitis media accounts for approximately 10% of all ear diseases. Most often, pathological processes in the tissues of the organ of hearing are observed in children under 3 years of age, which is due to the anatomical features of the structure of some parts of the ear and reduced immune reactivity. There are no specific causative agents of acute suppurative otitis media. ENT pathology appears as a post-infectious or post-traumatic complication.

A decrease in the immune forces of the body, provoking purulent inflammation in the ear, in 80% of cases is caused by an infectious lesion of the nasopharynx:

Much less often, pathogenic agents enter the ear through injuries of the mastoid process. Even less often, the disease occurs in the case of hematogenous transfer of infectious agents during the development of measles, scarlet fever, tuberculosis, etc.

According to otolaryngologists, there are a number of factors that contribute to a decrease in the reactivity of immunity. These include:

Important! The constant flow of water into the ear canal leads to a change in the pH level in the auditory canal, which is fraught with a decrease in local immunity.

Causes of otitis media in children

Infants are susceptible to the disease, which is associated with structural features of the Eustachian tube. Up to three years, the process of formation of some parts of the auditory apparatus continues, and until the indicated time, the Eustachian tube remains rather short, but wide. It is located almost perpendicular to the nasopharynx, so pathogens and fluid enter the ear canal almost unhindered.

In pediatrics, there are several main reasons for the development of ENT pathology in children:

• leakage of the milk mixture into the tympanic cavity;
• deficiency of trace elements and vitamin C;
• frequent rhinitis, sore throat, adenoids;
• insufficiently debugged mechanism of thermoregulation;
• reduced reactivity of the immune system;
• ear injuries caused by improper ear canal toileting.

Infectious diseases in children are very common, causing swelling of the mucous membranes of the nasopharynx. Subsequently, the bacterial or viral flora penetrates the middle ear through the tubular route when sneezing or coughing.

Purulent inflammation of the organ of hearing in 90% of cases is secondary and is the result of untimely treatment of the catarrhal form of ENT disease.

Symptoms

The main sign of the development of purulent inflammation in the ear is the release of mucopurulent exudate from the ear canal. As a result of the course of acute catarrhal processes in the mucous membranes of the organ of hearing, the Eustachian tube thickens, as a result of which the acuity of hearing decreases. The classic signs of the development of the disease are:

It is possible to recognize the development of the disease in an infant by other clinical manifestations. Purulent inflammation causes severe pain, so the child may become restless or whiny. Due to increased pain during breastfeeding, the child refuses to eat. From the ear opening, yellowish masses stand out, which have an unpleasant odor.

Important! Against the background of the development of autophony in children under 1.5 years of age, problems often arise during the formation of speech.

Stages of development

Depending on where the inflammation occurs, ENT disease can be right-sided (left-sided), intermittent, or bilateral. Acute left-sided purulent otitis media is no different from right-sided, except for the location of the focus of inflammation. However, in medical practice, otolaryngologists are more likely to encounter bilateral ear pathology.

During the development of an ENT disease, there are several main stages, namely:

In young children, the tympanic membrane is denser, therefore, at the stage of perforation, it does not always break through, which leads to the flow of purulent masses into the ear labyrinth.

Features of therapy

With an accurate diagnosis and determination of the optimal treatment regimen, the symptoms of the disease can be stopped within 10-12 days. The presence of purulent contents in the discharge indicates the development of fungal or bacterial flora in the foci of inflammation. To eliminate them, the following types of medicines are used:

• glucocorticosteroid drops ("Garazon", "Dexona") - eliminate inflammatory processes, which helps to restore the drainage function of the auditory tube;
• non-steroidal anti-inflammatory drops ("Otinum", "Otipax") - stop inflammation and pain, but unlike hormonal drugs, they do not contribute to the appearance of adverse reactions;
• antibacterial ear drops ("Fugentin", "Normaks") - kill pathogenic bacteria that provoke the occurrence of purulent exudate and inflammation in the mucous membranes of the middle ear;
• systemic antibiotics ("Amoxicillin", "Ciprofloxacin") - inhibit the activity of the microbial flora in the foci of inflammation, due to their ability to inhibit the synthesis of cell walls of pathogens;
• antipyretics ("Nuforen", "Paracetamol") - normalize body temperature, which leads to an improvement in well-being.

Important! "Ciprofloxacin" can not be used by children under 18 years of age and women during pregnancy or lactation.

Antibacterial therapy, coupled with the use of symptomatic drugs, promotes rapid recovery. In the case of a timely appeal to a specialist, it will be possible to eliminate the manifestations of ear pathology within 7-10 days.

Features of the treatment of purulent otitis media in adults: differential diagnosis, complex therapy, prognosis

Purulent otitis is a common infectious disease. The acute form accounts for 25-30% of all ear diseases. The infection enters through a special tube. With ailments of the nose and nasopharynx, pathological changes are formed in this part, which allow microbes to enter the middle ear without any problems.

Purulent otitis media ICD-10: etiology

The disease according to the ICD-10 classification has codes from H66.0 to H 66.9. Two main factors leading to the development of the problem have been established: dysfunction of the auditory tube and the presence of an infection in the middle ear. The Eustachian tube helps equalize the pressure in the tympanic cavity.

Thanks to special cilia, mucus moves from the middle ear to the nasopharynx. If there is swelling of the mucous membrane, a foreign body, a tumor, then the pipe may become blocked. Additional reasons for the development of the disease include:

Provoking factors and causes of the disease

Purulent processes occur as a result of increased activity of streptococci, staphylococci, diphtheria and tubercle bacilli. For the development of an acute form of purulent otitis, certain conditions are necessary, for example, sensitization of the body to microbes. Most often, purulent otitis media appears against the background of viral ailments, is their complication.

Predisposing factors include:

• hypothermia,
• hypovitaminosis,
• overwork,
• inflammatory processes in the nasopharynx,
• entry of microflora into the ear in an appropriate virulent amount.

The first call about the beginning of the development of a purulent form of otitis is an increase in body temperature, the appearance of chills. A headache begins to appear, which is accompanied by:

What happens in the ear with otitis

Purulent otitis is divided into two types:

This form occurs due to bacteria entering the middle ear. Inflammation leads to swelling of the auditory tube.

The mucous membrane of the departments is thin, and the lower layer performs the function of the periosteum. As the pathology develops, the mucosa thickens, erosions appear on the surface. The middle ear itself fills with exudate. At first it wears a serous form, but over time it becomes purulent.

At the peak of the development of the disease, the tympanic cavity is completely filled with pus, and the tympanic film itself is covered with a white coating. Under the pressure that has arisen, the latter bursts, the outflow of pus begins, which lasts 6-7 days.

Symptoms and causes of acute suppurative otitis media:

Chronic

Inflammation, which is characterized by a constant flow of pus from the ear cavity, a persistent violation of the integrity of the membrane and a progressive hearing loss. This type usually develops in the absence of proper treatment at the acute stage or is a consequence of a traumatic rupture of the eardrum.

According to statistics, 0.8-1% of the population suffers from this form. In 50% of cases, the disease develops in childhood, starting as catarrhal otitis media. Due to serious intracranial complications, the disease is one of the most serious not only for health, but also for life. More often the chronic form of otitis is bilateral and very rarely right-sided or left-sided.

The transition from an acute form to a chronic one is associated with several factors:

• low immune resistance
• improper selection of antibacterial drugs,
• pathologies of the upper respiratory tract,
• the presence of comorbidities.

For the purulent form of otitis media, the stages are characteristic:

Not always the disease goes through all three stages. With the right treatment regimen, already at the first stage, the disease can acquire an abortive course.

At the initial (pre-perforative) stage, patients complain of a sharp pain that radiates to the temporal region. As it grows, it becomes unbearable. Pain occurs due to inflammatory infiltration of the mucous membranes. Sometimes pains appear when probing and studying the mastoid process. This is due to inflammation of its mucous membrane. There is noise and congestion. There are signs of intoxication of the body, the body temperature reaches 38-39 degrees.

The perforative stage is characterized by perforation of the eardrum and the appearance of suppuration. At the same time, the pain quickly subsides, well-being improves. The discharge is very copious at first, sometimes mixed with blood. Then they begin to gradually decrease, but on average it lasts 5-7 days. If the disease is acute, then the perforation is small and round.

reparative stage. It is characterized by the cessation of suppuration. In most cases, spontaneous scarring of the perforation and hearing recovery occur. Minor damage to the eardrum recovers quickly enough.

Diagnostics

For the medical history, an analysis of the medical history is collected. ENT makes a preliminary diagnosis with the appearance of throbbing pain, which intensifies during chewing, with hearing impairment and the appearance of a feeling of pressure. An increase in body temperature and the appearance of discharge from the ear are also symptoms of a purulent form.

The patient is then sent for a complete blood count. It will show the presence of inflammation of a bacterial nature in the body. Usually there are leukocytes, increased ESR and a shift of the leukocyte formula to the left.

Taken for research and exudate directly from the focus of inflammation. It is being studied for bacteria and sensitivity to antibiotics.

Survey

1. Otoscopy. Inspection of the external auditory canal with an ear funnel or otoscope.
2. Capertone examination. It reveals whether hearing loss is due to inflammation or disease of the auditory nerve.
3. Radiography, MRI. They allow you to accurately determine the presence of inflammation in the cavities of the middle ear and mastoid process.
4. Paracentesis. It is carried out sometimes. The tympanic membrane is punctured to determine the contents.

Since the diagnosis does not cause difficulties, the patient can be assigned a complex of therapeutic effects.

Medically

To eliminate a bacterial infection, various drops, antibiotics, and medications are prescribed to eliminate the accompanying symptoms.

Most drops for rupture of the eardrum and purulent otitis media are prohibited. Because they can only aggravate the course of the disease. Despite good reviews in the treatment of otitis in adults and children with perforation of the eardrum, Otipax drops cannot be used. The exception is drops of Otof. They are indicated in the treatment of purulent discharge. This is an antimicrobial drug.

Another drop that has not only anti-inflammatory, but also analgesic effect is Anauran. This remedy is indicated in acute and chronic forms.

Antibiotics

In addition to exposure to ear drops, antibiotics are prescribed. A popular remedy is amoxicillin, which has antimicrobial and antiseptic effects. Aminoglycoside is also a drug for local injection use, but is allowed to be taken for no more than 14 days. Drugs can be prescribed in the form of tablets or capsules, in severe cases injections are used.

Other drugs

When the temperature rises above 39 degrees, antipyretics are prescribed. They can be based on paracetamol or ibuprofen. If purulent otitis media is a consequence of SARS, then for a faster recovery, the doctor prescribes antiviral and immunostimulating drugs.

Folk remedies

Purulent otitis with the help of traditional medicine methods is not recommended to be treated. This is due to the fact that it is impossible to guess how one or another method will work in a particular case.

How to treat purulent otitis without complications in our video:

Physiotherapy

Physiotherapy is prescribed to reduce the symptoms of the disease and restore hearing. Among the methods of influence:

If it is necessary to deliver an antibiotic quickly to the affected area, then electrophoresis with antibiotics is prescribed.

Surgery

If conservative treatment does not lead to the desired effect, then surgical intervention is used. In the inflammatory process, a good outflow of contents is important.

For this, the removal of granulations and polyps is prescribed. Shunting of the tympanic cavity is also prescribed. A small hole is made in the membrane, into which a small tube is inserted. Medicines are administered through it. It is possible to perform surgery on the labyrinth and the middle ear.

The photo graphically shows paracentesis with shunt placement

Complications

The main complication is hearing loss. In advanced stages, the bone tissue in the temple area is also affected. This leads to the development of meningitis and brain abscess. Sometimes happens:

The prognosis with proper treatment is favorable. The disease ends with recovery and restoration of hearing. If a person has started the disease, then it can become chronic with the formation of persistent perforation of the eardrum.

Prevention

Preventive measures include:

1. Treatment of chronic diseases of the nose, throat.
2. Prevention of viral infections.
3. Timely treatment of inflammatory diseases.
4. Avoid contact with dirty water.
5. Correction of immunodeficiency states.

At the first sign of any otitis media, you should immediately consult a doctor. Self-medication, as well as the use of ear drops without the testimony of a specialist, is not allowed.

Otitis media. Causes, symptoms, modern diagnosis and effective treatment

FAQ

The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious physician.

Anatomy and physiological features of the middle ear

The outer ear is separated from the middle ear by the tympanic membrane. The inner ear is located in one of the bones that forms the skull and is called the temporal bone.

Further in the middle ear there is a system of three small bones connected together and following one after another (hammer, anvil, stirrup). Through these bones, mechanical waves are transmitted from the eardrum to the inner ear.

Causes of otitis media

• General cooling. When the body temperature decreases, peripheral blood vessels constrict, which further leads to a decrease in local temperature. Bacteria in such conditions begin to feel very comfortable and multiply intensively, giving rise to an increasing infectious and inflammatory process.
• Poor nutrition and low consumption of fruits and vegetables as food also serves as an unfavorable background for maintaining the body's defenses at the proper high level.
• Dormant infections of the nose, sinuses, or nasopharynx, at any time can be activated and serve as a source of spread of the disease to the middle ear.

The main diseases leading to the development of acute otitis.

Symptoms of otitis media

Eustachitis (tubo-otitis)

exudative otitis media

Acute suppurative otitis media

The infection enters the middle ear most often through the auditory tube.

Clinical symptoms are somewhat different from the previous two forms of middle ear disease. Here the staging of the course of the pathological process is already present.

1. Preperforative- means the initial pathological process in which there is no destruction of the eardrum.

The main complaint of patients is severe pain, which moves to the temple and crown.

General symptoms of intoxication are manifested by an increase in body temperature, which usually does not exceed 38 degrees Celsius. Other common symptoms are headache, diffuse character, deterioration in general well-being, weakness, dizziness and even vomiting.

1. Perforated. The inflammatory process at the local level is characterized by the formation of mucus, and later pus, which has pronounced proteolytic properties, that is, it can dissolve the tissues surrounding it. What happens in the perforative stage of purulent otitis media. The walls of the tympanic membrane gradually become thinner and, if the active inflammatory process is not reduced, in the end, a small hole forms in it, through which purulent masses begin to flow out.

When the tympanic membrane is perforated (ruptured), the pressure in the tympanic cavity decreases sharply, and the sharp unbearable pain subsides sharply. The symptoms of intoxication also decrease, the temperature drops to more physiologically normal numbers (subfebrile temperature 37-37.5 degrees).

The size of the hole in the eardrum with otitis media depends on the type of pathological agents, that is, simply put, pathogens. The duration of suppuration usually lasts for a week, after which the inflammatory process subsides and the disease enters its final stage.

1. Reparative. This stage means that the disease is at the recovery stage, in which the inflammatory processes gradually subside, and the healing of the affected tissues begins. Purulent discharge disappears, the general condition becomes much better, body temperature returns to normal.

With a long protracted inflammatory process, auditory functions are significantly impaired. The disease can be complicated by the spread of infection to neighboring areas, which will significantly worsen the situation and create a risk to the life of the patient. After treatment, depending on the degree of destruction, scars of different sizes form in the eardrum, and the function of conducting sound waves by the auditory ossicles is also impaired. Timely diagnosis and rational treatment started in time will greatly alleviate the suffering of the patient, as well as speed up the recovery process. Under normal general conditions, the disease lasts about 15-20 days.

Otitis media in children

1. A shortened auditory tube, with a wide internal lumen, does not provide reliable protection against the spread of infection from the nasopharynx. In some cases, even food masses can get into it when the baby burps.
2. In the last trimester of pregnancy and, especially during delivery, through the wide opening of the auditory tube, amniotic fluid can penetrate into the middle ear cavity.
3. Approximately within one year, the mucous membrane of the middle ear is covered with residual embryonic tissue, which serves as a good nutritional basis for the reproduction and development of pathogenic bacteria. Normally, the remnants of such tissue dissolve over time, but with prematurity and frequent colds that weaken the immune system, its transformation into normal tissue is delayed.
4. Babies, most of their lives are in a horizontal position of the body. This fact is predisposing to the development of congestion in the nasopharynx and tympanic cavity.
5. Adenoids. Frequent pathological growth of the pharyngeal tonsil, in which the lumen of the auditory tubes is partially closed, and pathogenic microbes that penetrate the tympanic cavity develop in them.
6. Until the age of three, the immune defense is just beginning to form in the child's body. Therefore, the slightest contact with the infection provokes the disease.

In young children, local symptoms are mild, or may be completely absent. Tearfulness, irritability, sleep disturbances and refusal of the breast are the main signs that appear with inflammation of the middle ear in infants. Like any infectious process, acute otitis media is accompanied by fever, gastrointestinal upset, headache, and other signs of intoxication. However, acute otitis media is not the only disease leading to the appearance of such symptoms. Based on this, it is necessary to be very careful when examining, identifying characteristic symptoms. At first glance, they may seem insignificant, but they help to find out what kind of violation the child has.

Infectious diseases and acute otitis media

• With influenza, an acute inflammatory process extends to the inner ear and inflammation of the meninges can develop - meningitis.
• Acute otitis media in scarlet fever or measles is characterized by a severe general condition and the predominance of the underlying disease. The most pronounced symptoms of acute otitis media appear a few days after the onset of scarlet fever. A characteristic sign is that the affected tissues begin to be rejected and an unpleasant putrefactive odor spreads from the patient. The internal structure of the middle ear is significantly disturbed and very often the disease becomes chronic, or serious complications remain in the form of hearing loss.

Complications of acute purulent otitis media

In the initial stages, when only the mucous membrane of the mastoid cells becomes inflamed, the symptoms practically do not differ from those in acute purulent otitis media. General symptoms of intoxication are present, with fever, headache, dizziness, and nausea.

• Feeling of pressure in the ear.
• Unbearable pain in the head and parotid space.
• On examination, one can clearly see the ear anteriorly, and protrusion and severe redness with a cyanotic tint behind the auricles. If you press on this area, then there will be a sharp pain.
• A sharp drop in body temperature and improvement in the general condition of the patient, combined with suppuration from the ear, will indicate that there is a rupture in the eardrum.
• Hearing is significantly impaired.

Chronic suppurative otitis media

1. First, periodic acute purulent processes melt the eardrum. It collapses and ceases to function normally.
2. Secondly, pus is constantly present in the tympanic cavity, which flows out through extensive holes in the tympanic membrane.
3. Thirdly, in a chronic inflammatory process, not only the eardrum is destroyed, but also the auditory ossicles. The function of sound conduction is disturbed and the patient's hearing loss is constantly progressing.

The disease is common in the general population. Usually, the initial signs of the disease appear from childhood. A frivolous attitude to the treatment, a late visit to the doctor, or constant colds that reduce the overall resistance of the body - all this is a predisposing factor in the development of a chronic purulent-inflammatory process in the middle ear.

Diagnosis of otitis media

The presence of general symptoms of inflammation in combination with local signs of the presence of an infectious process indicate a pathology in the middle ear. Of the instrumental diagnostic methods, simple otoscopy has become widespread.

• With tubootitis, the tympanic membrane is retracted inward, since the rarefaction of air creates vacuum conditions in the tympanic cavity.
• With exudative or purulent otitis media, the tympanic membrane, on the contrary, swells outward, due to pus or mucus accumulated in the tympanic cavity. Its color changes from pale gray to bright red.
• If suppuration is present, then otoscopy will most likely reveal defects in the wall of the tympanic membrane.

With mastoiditis, to confirm the diagnosis, as well as to identify intracranial complications, x-rays of the head are prescribed in special lateral projections. In this case, various defects are found in the bones around the mastoid process.

In order to find out the cause of acute otitis media, it is mandatory to check the nasal cavity, nasopharynx for the presence of infectious diseases and other pathological changes.

Treatment of otitis media

In cases where conservative methods of treatment do not help, they resort to surgery. There are cases of lightning-fast development of acute purulent otitis media, in which the general condition of the patient is significantly impaired, there is a high risk of complications in the form of infection under the membranes of the brain, the development of an abscess of the brain, or generalization of the infection. If the tympanic cavity is not opened in time and its purulent contents are not removed, the consequences can be disastrous.

• Paracentesis- one of the types of surgical intervention in which the eardrum is opened and purulent masses are pumped out of the tympanic cavity. After that, drugs are administered through a catheter.

• Anthrotomy- also a surgical method of treatment, which consists in opening the entrance (cave, antrum) of the cells of the mastoid process and draining with antiseptic solutions. Anthrotomy is indicated for the development of acute mastoiditis in adults, or anthritis in young children, according to urgent indications.

The method of surgical intervention, and the volume of the operation performed, is determined by the doctor strictly according to indications. After operations on the middle ear, as a rule, a special drainage tube is left in the cavity to be cleaned, for subsequent rinsing with antibiotics or other antiseptic solutions. Drainage is carried out until signs of intoxication disappear and purulent masses cease to form.

The choice of treatment methods depends entirely on the current clinical situation, the attending physician, anatomical and physiological features, as well as the patient's condition.

Prevention of otitis media

• The body is constantly exposed to medium physical activity, that is, it is necessary to actively engage in sports or do gymnastics in the morning.
• Body-swallowing actions also include wiping the body with a cool, damp towel, and for those who have strong immunity, you can also douse with cold water after taking a shower.
• Staying in the fresh air, sunbathing, of course, are an important factor that increases the body's immune forces.

Compliance with a diet rich in all nutritious ingredients, vitamins and minerals protects the body from the harmful effects of pathological environmental factors.

For children with a history of acute otitis media, periodic examinations by a family doctor will prevent the occurrence of complications associated with hearing loss.

How to treat otitis media with folk remedies?

• Propolis infusion. In a pharmacy, you can buy a ready-made propolis infusion in 96-degree ethyl alcohol. Ordinary cotton swabs are moistened with 20% infusion and gently inserted into the ear canal by 1-2 cm. Swabs are changed every day or twice a day. The tool helps to destroy microbes, reduce inflammation, and heal tissues. It can also be used after purulent otitis ( if middle ear pus has been surgically removed).
• Garlic. A few small cloves of garlic are baked with lard until the cloves soften. After that, the garlic clove is cooled to a moderately hot temperature ( bearable) and inserted into the external auditory meatus. The procedure is repeated 1-2 times a day for 10-15 minutes. This destroys pathogenic microbes. This method is not recommended for the accumulation of pus in the tympanic cavity ( purulent otitis media).
• elderberry flowers. Dry elderberry flowers are scalded with boiling water and, not allowing to cool, are applied to the ear, wrapped in bags. Warming up is done 2-3 times a day with the permission of the attending physician.
• plantain juice. Juice should be squeezed from young carefully washed plantain leaves. 2-3 drops of juice are instilled into the sore ear ( can be diluted with water in equal proportions). This reduces pain.
• Melilot officinalis. Dry leaves of sweet clover are mixed in equal proportions with dry chamomile flowers. For 2 tablespoons of a mixture of these herbs, 200 - 250 mg of boiling water is needed. Insist them in a large glass or mug ( maybe in a thermos), covered with a saucer on top. After 40 - 60 minutes, a clean cotton swab is dipped in the infusion and inserted into the ear canal. The procedure is repeated 2-3 times a day for a week.
• walnut leaves. Juice is squeezed out of young washed walnut leaves. It is diluted in equal proportions with boiled water and instilled into the sore ear 2-3 drops 1-2 times a day. The remedy is recommended for the accumulation of pus in the tympanic cavity.
• Pomegranate juice with honey. Pomegranate juice ( better squeezed at home) is heated with a little honey. When the honey is melted, the juice is well mixed and cooled to room temperature. Dip a swab into the resulting mixture and smear the walls of the ear canal with it. This helps relieve pain and inflammation.

It is also recommended to use gargles based on medicinal herbs ( chamomile, St. John's wort, etc.). Special charges for such rinsing can be found in pharmacies. The point is that the infection especially in children) enters the middle ear mainly from the nasopharynx. If otitis media has developed, this suggests a parallel ongoing infectious process on the tonsils. It is against him that these rinses are directed. Such an integrated approach to treatment will avoid chronic infection.

What ear drops are best for otitis media?

• Fast action. Taking medicines by mouth in the form of tablets and capsules) or injections is associated with a certain delay in the therapeutic effect. This is due to the fact that the active substances are first absorbed at the injection site, then enter the bloodstream and only with the blood are delivered to the affected area. Ear drops immediately deliver the active substance to the focus.
• Good local effect. Ear drops fall through the ear canal to the eardrum. In most cases, with otitis media, there are no holes in it. However, the drug is quickly absorbed by the walls and the membrane itself and has a good effect on the tissues of the tympanic cavity, where the pathological process usually occurs.
• Ease of drug administration. Often, to achieve a good effect from the treatment, it is necessary to administer the drug regularly. This is especially important in the treatment of antibiotics. Microbes do not die from a single contact with the drug. It is necessary to maintain its high concentration for several days. Drops are convenient in that the patient can use them independently at work, at home or on the road. When prescribing, for example, injections, hospitalization may be required if no one can regularly administer the medicine to the patient at home.
• Low chance of adverse reactions. Almost all drugs used for otitis media are also available in the form of tablets or solutions for intramuscular injection. However, this administration of the drug assumes that the drug is absorbed by the body and enters the ear with the bloodstream. At the same time, it will also enter other organs and tissues, which increases the likelihood of various complications and side effects. When using drops, the medicine is absorbed through the mucous membrane in small quantities, and only a small part of it enters the bloodstream.

With a serious course of the disease, ear drops may not give the desired effect. Then the introduction of the necessary drugs through a special catheter in the Eustachian tube is recommended. This is an unpleasant procedure performed by an ENT doctor. As a result, medicinal solutions enter directly into the tympanic cavity. A similar effect is possible with perforation of the tympanic membrane, when ear drops enter the tympanic cavity through a hole in the membrane. This usually happens during a purulent process.

• Antibiotics. Antibiotics are the basis of treatment for any infectious process. With otitis media, the correct choice of antibiotic can only be made by an ENT doctor after examining the patient. Some antibiotics ( cephalosporin, augmentin) can be toxic to the auditory nerve. Their use will only aggravate the course of the disease. The most common are norfloxacin, rifampicin, chloramphenicol, clotrimazole ( antifungal drug), ciprofloxacin, miramistin ( antiseptic). For the exact choice of antibiotic, it is necessary to establish to which drug the infection is most sensitive.
• Painkillers. Most often, ear drops contain a small amount of lidocaine. It has a strong local anesthetic effect and is safe to use. In rare cases, some people may have hypersensitivity ( allergy) to this drug.
• Anti-inflammatory. To quickly relieve inflammation, glucocorticoid drugs are used. Drops based on dexamethasone, beclomethasone are used.
• Scar stimulants. Sometimes, after perforation of the tympanic membrane, scarring of the opening is delayed. Then a solution of iodine or silver nitrate 40% is prescribed in the form of drops. They cauterize the edges of the hole and granulations begin to form there. The process of scarring of the membrane is accelerated.

In practice, there are many factors that influence the choice of drops for the treatment of a particular patient. The most important of them are the stage of the process, the type of infection, the presence of allergies in the patient, the presence of perforation of the eardrum. To achieve the maximum effect, doctors often prescribe so-called combination drugs. Such drops contain substances from various pharmacological groups, and therefore the effect of them will be complex. The most common drugs are Otipax, Otinum, Otofa, Sofradex and others. However, without examination by an ENT doctor, the use of any of them can only aggravate the situation.

Do I need to warm the ear with otitis media?

• Expansion of blood vessels in the ear. Under the action of heat, small vessels dilate and fill with blood. Due to this, tissue nutrition is improved and their regeneration is faster. It is easier for the body to fight infectious processes, since there are more blood cells ( neutrophils, eosinophils and others) migrate to the area of ​​inflammation.
• The release of fluid from the vessels. The expansion of blood vessels increases the permeability of their walls. Because of this, the liquid part of the blood ( plasma) without cells can leave the vascular bed. This leads to swelling of the mucous membrane or the accumulation of a small amount of fluid in the tympanic cavity. This effect in some cases can increase pain.
• Impact on microorganisms. In the early stages of the disease, when there are few microbes, dry heat can inhibit their growth and prevent the development of infectious tissue damage. However, this depends on the type of microorganism. The so-called pyogenic microflora, which leads to the formation of pus, can, on the contrary, accelerate its growth at elevated temperatures. Therefore, dry heat should never be used for purulent otitis media.
• Neutralization of pain receptors. Recent studies show that heat modifies the structure of pain receptors in tissues, which reduces pain. This effect is especially noticeable in young children. This is usually effective in the initial stages of the disease. In the later stages, with severe structural disorders, thermal exposure is not enough to relieve pain.

Thus, the effect of heat in inflammation of the middle ear is dual. On the one hand, it improves blood circulation and relieves pain, on the other hand, it increases the risk of developing a purulent process. Only an ENT doctor can give an unambiguous answer whether it is necessary to apply heat after examining the patient. It is necessary to find out the type of inflammation and its stage. In the early stages, this method is usually justified. With the intensive development of microbes, it is contraindicated due to the risk of severe complications.

Can otitis media cause inflammation of the brain?

Otitis media in severe cases can give the following complications:

• Purulent meningitis. This complication occurs due to purulent inflammation of the meninges. At the same time, the brain tissue itself is not involved in the pathological process. However, irritation of the dura mater leads to the appearance of severe headaches. Without treatment, the pressure in the cranium greatly increases and the brain is squeezed, which can lead to death.
• epidural abscess. Having broken into the cranial cavity, pus can be localized on top of the dura mater. Its local accumulation will lead to the so-called epidural abscess. This complication is dangerous by the further spread of pus or the growth of the abscess cavity, which causes compression of the brain.
• brain abscess. Unlike an epidural abscess, in this case we are talking about a cavity with pus located directly in the brain. Such abscesses are very difficult to treat, since surgical access to the cavity is associated with the risk of brain damage. At the same time, there is a high risk of squeezing the brain tissue.
• Thrombosis of the venous sinus. In the brain, the outflow of venous blood is carried out through wide cavities - venous sinuses. If pus gets into these sinuses, their thrombosis can occur. Then the blood circulation in the entire area will be disturbed. The veins of the brain begin to overflow with blood, squeezing the sensitive nerve tissue. There is also a problem with the flow of arterial blood, and the brain does not receive enough oxygen. With the spread of pus from the temporal bone ( it is in it that otitis media develops) there is a risk of thrombosis of the lateral and sigmoid sinuses.

Thus, in none of these cases is there inflammation of the nervous tissue of the brain. However, squeezing this tissue is no less dangerous. The transmission of impulses between neurons is disrupted. Because of this, the patient may experience a variety of disorders - paresis, paralysis, sensory disturbances, respiratory and palpitations. With any options for a breakthrough of pus into the brain, there is a danger to life. Even urgent hospitalization and intervention of specialists cannot always save the patient. Therefore, it is important to pay attention to the first manifestations of inflammation in the cranium.

• rapid rise in temperature 38 - 39 degrees or more);
• severe headache ( aggravated by head movement);
• nausea and vomiting that does not depend on food intake ( vomiting of central origin);
• inability to tilt head forward until the chin touches the sternum), as this causes severe pain in the patient;
• convulsions;
• mental disorders ( drowsiness, confusion, lethargy, coma)
• specific meningeal symptoms of Kernig and Brudzinsky ( determined by the doctor during the examination).

All these symptoms are not characteristic of otitis media. They are associated with irritation of the meninges and speak of the spread of a purulent process. In these cases, doctors transfer the patient to the intensive care unit or intensive care unit ( as of) and change the tactics of treatment. Neurosurgeons are involved for consultation.

• timely start of treatment of otitis media;
• examination by an ENT doctor without self-treatment);
• following the instructions of a specialist bed rest if necessary, regular medication);
• preventive examinations during the recovery period;
• notifying the doctor of new symptoms or a change in general condition.

Thus, directly encephalitis ( inflammation of brain neurons) cannot develop with otitis media. But all purulent complications associated with infection in the cranial cavity inevitably affect the functioning of the brain. In a broad sense, they can be grouped under the term "inflammation of the brain." Timely intensive treatment can save the patient's life. But residual effects in the form of chronic headaches, motor and sensory disorders are not excluded. Therefore, patients need to do everything to stop the disease at the stage of otitis media, when there is still no direct threat to life.

Can deafness occur after otitis media?

• Pressure disorders in the tympanic cavity. Otitis media is often caused by an infection spreading from the nose or mouth. Microbes enter the tympanic cavity through the Eustachian tube, which opens in the nasopharynx. In this case, swelling of the mucous membrane of the Eustachian tube occurs. The tympanic cavity is, as it were, isolated from the outer space, and pressure is not regulated in it. Because of this, the eardrum is constantly retracted or, conversely, bulges. This prevents its vibrations and reduces the acuity of hearing. This deafness is temporary. After the edema is removed and the inflammation is eliminated, the pressure in the tympanic cavity equalizes, and the membrane again begins to transmit vibrations normally.
• Filling the tympanic cavity with fluid. With an infectious process in the tympanic cavity, cells in the mucous membrane begin to secrete more fluid. As microbes multiply certain types) pus also begins to form in the cavity. As a result, it is filled with liquid. This makes it difficult for the eardrum to vibrate and impairs the movement of the auditory ossicles. Because of this, hearing acuity is greatly reduced. After removal of fluid from the tympanic cavity ( self-absorbable or surgically) hearing is usually fully restored.
• Perforation of the tympanic membrane. Perforation is a perforation or rupture of the membrane. With otitis media, it may appear due to intense purulent inflammation. Pus tends to melt tissue. If a hole forms in the eardrum, then it ceases to perceive sound waves normally. Because of this, hearing deteriorates. Usually small holes scar on their own or are surgically sutured after recovery. However, hearing acuity is usually permanently reduced after this.
• Sclerosis of the joints of the tympanic ossicles. Normally, sound waves are converted on the eardrum into mechanical vibrations. From here they are transmitted to the inner ear through a system of three auditory ossicles - the hammer, anvil and stirrup. These bones are located in the tympanic cavity of the middle ear. They are interconnected by small joints, which gives them the necessary limited mobility. As a result of inflammation in the middle ear ( especially with purulent processes) these joints may be affected. Their mobility increases, decreases or completely disappears. In all cases, vibrations begin to be transmitted worse to the inner ear, and hearing acuity decreases.
• Scarring of the eardrum. After inflammation or perforation of the eardrum, a layer of connective tissue may form on it over time. This makes it thicker and less sensitive to vibrations, which can make hearing worse for a patient after otitis media. The introduction of special drugs ( breaking down and softening connective tissue) or physiotherapy can help restore hearing acuity.
• Complications in the inner ear. Purulent processes in the middle ear can spread to the inner ear. It contains sensitive receptors, damage to which is fraught with complete and irreversible hearing loss. Usually, such complications occur with delayed or incorrect treatment of otitis media.
• Auditory nerve injury. It occurs quite rarely and is associated with irreversible hearing loss. Directly purulent process from the middle ear reaches the auditory nerve very rarely. However, in some cases, antibiotics that treat inflammation have an ototoxic effect, killing neurons in the auditory nerve. As a result, the inflammation subsides, all sound transmission mechanisms in the ear work, but the signals from them are not transmitted to the brain.

In the above cases, it is mainly a temporary hearing loss. However, in severe cases, pathological changes may be irreversible. Thus, deafness is one of the most severe complications of otitis media. It can occur as in children ( for whom this disease is, in principle, more characteristic) as well as in adults.

• Timely visit to the doctor. If you experience pain in the ear, discharge from the ear, or a decrease in hearing acuity, you should immediately contact an ENT doctor. At each stage of the development of the disease, there are effective methods of treatment. The sooner they are applied, the less significant the damage will be.
• Refusal of self-medication. Sometimes patients during the first days of the disease try to cope with it on their own. At the same time, they begin to use folk remedies or pharmacological preparations, not knowing the features of the pathological process. In some cases, this leads to a worsening of the situation. For example, warming or putting alcohol in the ear can sometimes cause pus to develop faster. This will increase the risk of hearing loss in the future.
• Treatment of respiratory diseases. As mentioned above, otitis media is often the result of the spread of infection from the pharyngeal cavity. Especially often this reason occurs in childhood, when the Eustachian tube is wider and shorter. Prevention of otitis is the treatment of tonsillitis, tonsillitis and rhinitis. The chronicity of infectious processes increases the risk of infection and hearing loss.
• Compliance with doctor's orders. After examining the patient, the specialist prescribes certain procedures and drugs. They are necessary for the speedy suppression of the inflammatory process and the destruction of microbes. It is important to follow the doctor's instructions regularly. This is especially true when taking antibiotics ( delaying intake even by a few hours can weaken the antimicrobial effect). After recovery, there is no more pus or inflammation in the middle ear. However, hearing can be restored gradually. To speed up this process, certain procedures are also assigned ( physiotherapy, preventive examinations, etc.). Conscientiously following the doctor's instructions for several weeks ( How long does the average treatment last?) is the key to success.

If these simple rules are followed, the risk of complete hearing loss from otitis media is minimal. Ignoring the prescriptions of a doctor and attempting self-treatment can lead to irreversible deafness.

When to see a doctor for otitis media?

• Earache. The pain can be of a different nature - from acute, unbearable to dull, constant. This symptom occurs due to inflammation of the mucous membrane in the tympanic cavity. With purulent processes, pain can radiate ( give away) in the lower jaw on the side of the lesion.
• Ear congestion. The symptom is characteristic of tubo-otitis, when the lumen of the Eustachian tube closes due to edema. The pressure in the tympanic cavity decreases, the tympanic membrane retracts, and there is a feeling of congestion.
• Hearing loss. Often the disease begins with a subjective feeling of hearing loss, which the patient himself complains about. After a few days, pain or congestion may appear.
• General anxiety. The symptom is noted in young children who cannot complain of pain. They do not sleep well, are capricious, often cry. This may be the first manifestation of the inflammatory process.
• autophony. This symptom consists in duplicating the patient's own voice when he speaks. The symptom occurs due to isolation of the tympanic cavity ( closure of the Eustachian tube).
• Noise in the ear. Usually caused by a pathological process in the Eustachian tube.
• Temperature. In the early stages, the temperature may not be at all. With otitis media, it is rarely the first manifestation of the disease. Most often, this course is noted if otitis media has developed against the background of an upper respiratory tract infection ( angina, rhinitis, tonsillitis, etc.)

If these symptoms appear, it is recommended to consult an ENT doctor for a more thorough examination. Usually, the doctor may notice other signs of a developing disease. Then otitis media can be stopped even in the first stages of the disease, and the risk to health is minimal. If you go to the doctor because of a feeling of fullness in the ear ( it gives severe paroxysmal pain) or about discharge from the ear, which means that the disease is already in full swing. Fluid accumulates in the tympanic cavity inflammatory exudate) or pus forms, which cause these symptoms. At this stage, the treatment is already more complex, and it is more difficult to predict the course of the disease.

• further deterioration of the general condition;
• the development of purulent inflammation, which will require more complex medical procedures ( administration of drugs through a catheter in the Eustachian tube);
• perforation ( gap) eardrum, which will increase the recovery time;
• irreversible hearing loss and with the development of complications, deafness is also possible);
• need for surgical intervention incision of the tympanic membrane and removal of pus);
• the transition of the purulent process to the region of the inner ear, into the cranial cavity ( with severe brain complications);
• generalization of infection entry of microbes into the blood);
• mental retardation of a child prolonged hearing loss and slow recovery inhibit the development of speech skills and the learning process in general).

Thus, a doctor should be consulted at the first symptoms of the disease. The more time passes from the beginning of the inflammatory process, the longer the treatment will be and the higher the risk of dangerous complications. In most cases, contacting a specialist at the first stage of the disease allows you to achieve complete recovery after 5 to 7 days. Otherwise, the treatment and full recovery of hearing can take many weeks.

Acute suppurative otitis media

What is Acute Purulent Otitis Media?

What provokes / Causes Acute suppurative otitis media:

Pathogenesis (what happens?) during Acute suppurative otitis media:

Symptoms of acute suppurative otitis media:

Sometimes the thickened mucosa of the tympanic cavity prolapses through the perforation of the tympanic membrane in the form of a formation resembling granulation. After a few days, the amount of discharge decreases, they become thick and acquire a purulent character. Suppuration usually lasts 5-7 days. Perforation in acute otitis media is usually small, round with a defect in the membrane. Slit-like perforations without tissue defect are less common. More extensive perforations occur with scarlatinal, measles, tuberculous lesions.

Diagnosis Acute suppurative otitis media:

Treatment of acute suppurative otitis media:

A warming half-alcohol compress on the ear is also applied locally, accelerating the resolution of the inflammatory process. However, if after applying the compress the patient notes an increase in pain in the ear, the compress should be removed immediately so as not to provoke the development of complications.

- The transition of the disease to a chronic form (chronic suppurative otitis media), with the formation of persistent perforation of the tympanic membrane, with recurrent suppuration and progressive hearing loss.

- The development of one of the complications of acute purulent otitis media: mastoiditis (anthritis in children), petrositis, labyrinthitis, paresis of the facial nerve, one of the intracranial complications (meningitis, abscess of the brain or cerebellum, thrombosis of the sigmoid sinus, sepsis, etc.).

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

Prevention of acute suppurative otitis media:

- High prevalence of respiratory viral infections that reduce the mucociliary activity of the respiratory epithelium, including the epithelium of the auditory tube, suppress local immune defenses Widespread, often unsystematic and unreasonable use of antibiotics, which leads to the emergence of resistant strains of pathogens and at the same time disrupts the body's natural defenses.

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

- Decrease in general non-specific resistance due to physical inactivity, limited exposure to the open air and the sun, insufficient consumption of foods rich in vitamins.

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

Which doctors should be consulted if you have Acute suppurative otitis media:

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Acute suppurative otitis media

Purulent otitis media accounts for about 30% of all types of ENT diseases. This is a common disease, especially among children. According to statistics, 80% of babies from birth to 3 years of age suffer from this disease at least once.

What is purulent otitis

Purulent otitis refers to inflammatory diseases of the ear. An ailment can occur in any of the calves of this organ: external, middle or internal.

The most common form of otitis media is:

• eardrum;
• tympanic cavity;
• auditory ossicles;
• the auditory (or Eustachian) tube, which connects the middle ear to the nasal cavity and serves as a drainage system. It is on it, in most cases, that the infection gets here.

Children suffer from this disease more often, since the structure of the ear in childhood differs from its structure in adults. Their auditory tube is shorter and wider, and in the middle ear cavity in newborns there is a liquid in which bacteria that have entered grow faster.

An infection in the ear causes an inflammatory process, as a result of which the mucous membrane and eardrum swell, erosions and ulcers form on its walls, blood vessels expand, the permeability of their walls decreases, exudate is gradually released and accumulates. As the disease progresses, the inflammatory process covers all parts of the middle ear, and otitis media becomes acute. It can also spread to adjacent tissues, the inner ear, and the cranial cavity, leading to meningitis. There is unilateral and bilateral purulent otitis media, when both ears become inflamed.

If the disease is not treated, it can become chronic. In patients with chronic suppurative otitis media, periods of remission alternate with exacerbations of the disease. His treatment is longer and more difficult. It is divided into mesotympanitis (when only the mucous membrane is affected) and epitympanitis (inflammation covers the bones). The first type is relatively calm, it can be cured by conservative methods. It is much more difficult with epitympanitis, since there is a high risk of its spread to the brain tissue.

Causes of otitis media

What causes acute suppurative otitis media?

1. Infection from the nasopharynx and upper respiratory tract (streptococci, cocci, pneumococci, staphylococci) through the auditory canal into the eardrum. This happens during a strong cough, sneezing or blowing your nose. With a sharp pressure on the barrier of the auditory tube, as a result of which it breaks through and the infection, along with mucus, enters the middle ear.
2. Other routes of infection are hematogenous, that is, through the bloodstream, and through a damaged eardrum (for example, due to various injuries).
3. Acute suppurative otitis media can be a complication of viral diseases (for example, influenza or scarlet fever).
4. Water in the ears and subsequent hypothermia.
5. Allergic reactions.
6. Reduced immunity. Weak body defense is another factor due to which purulent otitis media can develop.

Among the ailments that predispose to the occurrence of purulent otitis media are: sinusitis, rhinitis, adenoids. Chronic processes in the nasopharynx disrupt the drainage system of the auditory canals, so microbes can easily enter the ear.

Purulent otitis: symptoms

Symptoms of purulent otitis media in adults:

• Sharp pain in the ear. Pain is a consequence of irritation of the nerve endings, which occurs due to swelling of the tissues and the release of pus. Appearing in the depths of the ear, the pain gives the temples, neck or teeth. With the accumulation of exudate, the tympanic membrane protrudes and eventually breaks through, perforation occurs. After the release of pus, the pain subsides;
• Fever, which is a consequence of inflammation and the entry of toxins and microbes into the blood. Body temperature may rise to 38-39ᵒС;
• Ear discharge. At the beginning they are serous-bloody, then - purulent.
• Hearing loss (as a result of accumulation of exudate), tinnitus, feeling of congestion. These symptoms may bother you for some time after recovery, then they go away on their own. If the inner ear was involved in the inflammatory process, then there is a significant hearing loss.

Sometimes the disease proceeds easily and quickly if the body's defenses are able to fight the infection, or if the treatment started on time helps them in this. When the reactivity of the body is reduced, inflammation can become widespread. Severe pain in the ear, high fever and a large amount of discharge - these symptoms are observed when purulent otitis media occurs against the background of SARS.

Stages of purulent otitis media

During otitis media, 3 stages are distinguished:

1. Preperforative(duration from several hours to several days). After infection in the middle ear, an inflammatory process begins, which causes pain in the ear and an increase in body temperature. Exudate accumulates in the tympanic cavity and begins to put pressure on the membrane. The pain is sharp, unbearable. Hearing problems are observed at this stage.
2. perforative stage(5-7 days). The eardrum ruptures and the stage of suppuration begins. Immediately appear abundant, mucous discharge mixed with blood. Then they become smaller, they are thick. Inflammation gradually disappears, the person's condition improves, pain and fever decrease.
3. Reparative stage. This is the final stage, during which inflammation and suppuration stops, perforation is delayed. If the gap was small, then scarring occurs quickly.

If full recovery does not occur and the eardrum does not heal, then chronic suppurative otitis media develops. It is characterized by the periodic occurrence of pain and purulent discharge from the ear, as well as a gradual decrease in hearing and the presence of a persistent defect in the eardrum.

Consequences of purulent otitis media

As a rule, the disease lasts 2-3 weeks, although in different cases it proceeds differently. For example, the first stage takes on a protracted character, its signs are mild. If perforation does not occur for a long time and pus does not come out of the ear, then an adhesive process develops (viscous pus accumulates). As a result, adhesions and scars are formed that interfere with the work of the auditory ossicles and disrupt the patency of the auditory tube. This can lead to hearing loss and even deafness.

An acute course of the disease is also possible, with the rapid spread of the inflammatory process deep into the skull (extradural abscess). Such complications in purulent otitis media can even lead to the death of the patient, so urgent surgical treatment is important.

The long period of the perforative stage should be alert, when the discharge and temperature do not go away after 2-3 weeks. This may indicate inflammation and accumulation of pus in the mastoid process. This disease is called mastoiditis. It is dangerous because it can cause hearing loss, meningitis, facial paralysis, brain abscess.

The development of mastoiditis can also be indicated by the resumption of the disease after the patient's condition improves. Pain and fever return again. The reason for this is the stagnation of exudate.

One of the unpleasant consequences of purulent otitis media in adults - cholesteatoma, is characterized by the accumulation of dead epithelial cells in the middle and even the inner ear. Such a formation is removed surgically, but hearing loss still remains.

Complications can develop due to a weakened immune defense of the body, a high degree of pathogenicity of microbes that have entered the ear, and also due to untimely or incorrectly performed therapy.

Diagnostics

If you suspect purulent otitis media, you should contact an otolaryngologist or ENT specialist, who will examine the diseased ear. Otoscopy is performed under bright light, with a special otoscope. Purulent otitis is indicated by hyperemia and protrusion of the eardrum. After perforation, there is a pulsation and pus exit through a perforation in the membrane.

Additionally, you need to pass a general blood test. If the indicators of leukocytes and ESR are not greatly increased, then the disease proceeds calmly. When a blood test shows severe leukocytosis, the disappearance of eosinophils, or a sharp increase in ESR, this may indicate the spread of inflammation and infection.

Another possible test is a bacterial culture, during which a swab is taken to determine the type of bacteria. This information is needed in order to choose the right medicine. With a mild form (or during the pre-perforative stage) of the disease, bakposev is not needed, since its results will be ready in 5-7 days, and during this time the otitis media disappears. But, if the symptoms are pronounced or do not go away for a long time, then this analysis is necessary.

According to indications, audiometry is performed to test hearing. If meningitis, mastoiditis and other complications are suspected, studies such as CT and MRI are prescribed. Tomography will help to identify inflammation in the bones of the skull, meninges, the presence of formations in cholesteatoma and the accumulation of fluid in hard-to-reach places.

Purulent otitis: treatment in adults

Based on the results of the examination and analysis, the ENT prescribes a treatment that is aimed at relieving symptoms, relieving inflammation and restoring normal hearing.

To do this, use a set of measures:

• blowing the auditory tube to restore drainage and ventilation. It is produced using a special ear catheter, into which a solution of Dexamethasone, Amoxicillin and a couple of drops of a 0.1% solution of adrenaline is injected. This procedure is very effective, it allows you to significantly speed up the process of recovery and restoration of hearing;
• physiotherapy procedures (heating, UVI, microwave). They take a course of 1-2 weeks. Physical procedures have a beneficial effect on biological processes in a sore spot, activate protective reactions in the body and accelerate the healing process;
• spray or nose drops. Such drugs constrict blood vessels, stop mucus secretion, clear the Eustachian tube and improve breathing. You can use Naphthyzin or Sanorin, which are instilled 3 times a day for 3-5 days. Before instillation, clear the nose. Drip both nostrils;
• regular self-cleansing of the ear canal so that pus does not accumulate in the ear (this should be done carefully);
• antipyretic. A drug such as Paracetamol is necessary in case of persistent high fever, which torments patients in the first stage;
• analgesics for pain relief. There are ear drops for purulent otitis media, with an analgesic effect, which act purposefully. For example, Otizol, which contains benzocaine, antipyrine and phenylephrine hydrochloride, has an antiseptic, anti-edematous, anti-inflammatory and analgesic effect. There are also other drops based on lidocaine (Otipax). They are prescribed in the pre-perforative stage, after the appearance of perforation they cannot be used. You can also put anesthetic tampons in your ears. A 1:1 solution of boric acid and glycerin is suitable for this. A tampon soaked in the solution is inserted up to the eardrum and covered with a cotton swab. You need to keep it for 4 hours;
• antifungal agents, if the causative agent is a fungus;
• washing the ears in the hospital with saline or water. To relieve swelling, decongestants are used, for example, Dexamethasone;
• antibiotics for infection and inflammation.

In the treatment of chronic otitis, the principle remains the same. The primary task is to clear the ear of pus and relieve inflammation. This helps an enhanced course of blowing and washing. For the latter, a solution of Adrenaline or Ephedrine is used (to relieve swelling), as well as a solution of Formalin, Silver nitrate, alcohol, Gordeev's liquid (they have an antiseptic, astringent effect, help to cauterize the granulations that form in chronic purulent otitis). The constant use of antiseptics will help destroy harmful microorganisms. In addition to the above drugs, boric acid is widely used, but it is better not to use hydrogen peroxide. In addition to antiseptics, exposure to antibacterial drugs, that is, antibiotics, is necessary.

Let us consider in more detail what antibiotics are prescribed for purulent otitis media. With a mild degree of the disease, at the preperforative stage, preparations in the form of tablets of the penicillin group, mainly with amoxicillin (active against cocci), are suitable. It is found in Amoxicillin, Flemoxin. It is taken orally in a course of 7-10 days, 3 times a day every 6 hours. Improvements should be noticeable after 1-2 days of taking the tablets.

If the prescribed antibiotic does not help after 3 days, then it is replaced with another, more powerful one, for example, Augmentin or Amoxil, in which amoxicillin with clavulanic acid is present. They act on a large number of different microorganisms.

When penicillins do not have the desired result (in severe form of the disease) or the person is allergic to penicillin, antibiotics of the cephalosporin group, for example, Ceftriaxone, Cefuroxime or Cefazolin, which has a wide spectrum of action, can be prescribed. They are usually administered intramuscularly.

There are also ear drops for purulent otitis with an antibiotic that have an antimicrobial effect. They do not have as many side effects as they act locally. They are also not difficult to use on their own, unlike intravenous or intramuscular injections.

• Ciprofarm (active ingredient - ciprofloxacin);
• Normax. (active substance - norfloxacin);
• Otofa (contain rifampicin sodium).

There are combined ear drops. They are more powerful and are often used in the treatment of chronic suppurative otitis media.

• Candibiotic, which contains clotrimazole (antifungal), lidocaine (pain reliever), chloramphenicol (antibacterial), beclomethasone dipropeonate (anti-inflammatory and antiallergic).
• Fugentin (contains a combination of antibiotics: fusidic acid and gentamicin).
• Anauran. It also contains lidocaine, and as an antibiotic - polymyxin sulfate and neomycin sulfate.
• Sofradex. It contains two types of antibiotics - framycetin sulfate and gramicidin, as well as a glucocorticoid - dexamethasone.

Ear drops are not effective at the pre-perforative stage of acute otitis media.

Since antibiotics have a number of side effects, they are not recommended for mild illness. Such treatment is advisable at the stage of pus release, with severe pain and fever.

The chronic form of purulent otitis media is difficult to cure with conservative methods, so you have to resort to surgical ones. Sometimes only in this way it is possible to remove accumulated granulations and adhesions, and restore hearing.

How to wash the ear with purulent otitis media at home? You can use a small amount of hydrogen peroxide or warm water. It is necessary to collect 1 ml of liquid in a syringe or pear and pour into the middle ear. Then close the ear with a cotton swab and leave for 3 minutes. This procedure is repeated several times.

Before instillation, the drops must be warmed up in the hand, then tilt your head to one side and drip as many drops as written in the instructions.

Along the way, in the treatment of purulent otitis media, it is necessary to treat other diseases, if any. Without it, you won't be able to recover. To boost immunity, you can also drink a course of vitamins.

With severe pain, copious discharge and significant hearing loss, the patient is sent to the hospital. You should also go to the hospital if the condition does not improve after a few days of treatment. Dizziness, vomiting, severe headache - indicate inflammation of the brain. This condition requires surgical intervention, when a person's eardrum is cut. This contributes to the release of pus and alleviates the patient's condition.

Remember that with otitis media, the patient needs bed rest. Blow your nose carefully, clearing one nostril at a time.

Prevention of otitis media

For the prevention of purulent otitis media, you need:

• strengthen immunity (vitamins, special immunomodulating agents, hardening, etc.);
• timely treat viral diseases, apply means for the prevention of influenza and colds;
• avoid injury to the eardrum (do not pick foreign objects in the ears);
• avoid getting water in the ears, wipe the water after bathing;
• there is also a vaccination against otitis media, meningitis and pneumonia.

To avoid complications, it is necessary to drink the entire course of the antibiotic to the end, even if relief has already come. To eliminate hearing problems that may occur after purulent otitis media, a number of hearing-improving procedures are performed.

Hello dear readers of Andryukhin's blog. Purulent otitis media is a fairly common inflammatory disease of the middle ear. Most often they affect children and adolescents under 18 years of age. If the disease is started, it easily becomes chronic. According to WHO, in every fourth case this leads to a decrease or loss of hearing.

Before you learn how to cure purulent otitis media at home, let's find out the symptoms, causes, forms and stages of purulent otitis media. In this article, you will learn whether and how to cure purulent otitis media at home, as well as an effective remedy for boosting immunity.

By its nature, otitis can be:

1. Otitis externa. With external otitis media, reddening of the auricle occurs, a furuncle appears. This is mainly due to severe hypothermia, as well as weak or depressed immunity. This is a fairly common disease among inflammation of the auricle, which manifests itself in the form of various rashes and pustules. This form is easily treated and has little to no serious consequences. Most often, they suffer from those who are engaged in swimming.
2. Otitis media. This is an inflammation of the middle ear, usually in chronic otitis externa. With the transition of otitis media into a chronic form, the development of choleastomy is possible, which has a destructive effect on the hearing aid and can lead to hearing loss or hearing loss. It is a fairly common disease that occurs with varying degrees of severity.
3. Nonpurulent otitis. Against the background of an inflammatory disease of the upper respiratory tract (influenza, SARS or measles), swelling of the mucous membrane of the Eustachian tube begins, which turns into non-purulent otitis media. Usually this is due to hypothermia (feet are frozen), against which there is swelling of the nasopharynx (sore throat, runny nose and stuffy ears begin). With weak immunity, inflammation in the nasopharynx increases and fluid effusion begins to accumulate in the tympanic cavity. This process can take several months. Otitis in this stage can last about 2 years and without proper treatment does not go away on its own and usually becomes chronic.
4. Purulent otitis. Purulent otitis media is the discharge of pus in acute otitis media or an exacerbation of the chronic form of otitis media. If pus cannot be discharged normally, then complications may develop in the form of damage to the eardrum. Sometimes there is allergic otitis, in which there is swelling and partial hearing loss, but this is caused by allergic edema, which is accompanied by other signs and symptoms of allergies. Usually the purulent form of otitis develops quickly and abruptly. The accumulation of pus in the tympanic cavity occurs within 1-2 weeks, there are severe pains in the ear area, the body temperature rises. In such cases, forced perforation of the tympanic membrane (rupture of a thin membrane by the middle and outer ear) is shown to release pus. This leads to a temporary decrease in hearing acuity. Pus usually comes out within 7-10 days, occasionally this process can stretch for a whole month. If you do not provide proper treatment, otitis media becomes chronic with periodic discharge of pus and negative changes in the auditory system. Treatment is usually within 30 days. In children, otitis media is usually bilateral with signs of inflammation, the treatment of which requires inpatient treatment for 10-14 days.
5. Chronic otitis. Although it does not manifest itself as sharply as acute otitis media, it can easily pass inside the ear and provoke inflammation and swelling of other organs. If not properly treated, it can lead to hearing loss.

Symptoms of purulent otitis media

The main symptoms of purulent otitis are:

1. Shooting, throbbing, or aching pain in the ear. Pain can be given to the temple and teeth, also when coughing, sneezing and swallowing.
2. Headache.
3. Discharge from the ear of a purulent consistency.
4. Noise, itching and stuffiness in the ear.
5. Hearing loss. The decrease may be temporary, there may be sensations of water in the auricle.
6. Elevated temperature. The temperature rises up to febrile states.
7. General weakness and malaise. The person gets tired very quickly.

Causes of purulent otitis media

The main causes of purulent otitis are:

1. Water ingress.
2. mechanical injury.
3. Burns.
4. Diabetes.
5. Age. In children, the hearing aid does not form immediately, and until it is fully formed, the child is quite susceptible to otitis media.
6. Hypothermia.
7. Weak or depressed immunity.
8. Penetration of pathogenic microorganisms. Bacteria and viruses can enter the ear through
9. damaged eardrum, Eustachian tube or through infected blood.
10. Inflammatory and catarrhal processes of the nasopharynx. This is the main cause of the onset and development of purulent otitis media. Inflammation in the upper respiratory tract and infectious diseases (tuberculosis, typhoid, measles, scarlet fever and others) can provoke the development of purulent otitis media.

Risk factors

The main risk factors are:

1. Injuries to the tympanic membrane, mastoid process and deviated nasal septum. Injury to the eardrum often occurs in a fight upon impact, and sometimes also happens in welders when scale gets into the ear.
2. allergic conditions.
3. Swimming lessons. During swimming, water enters the ear.
4. Elderly people.
5. Features of the anatomy of the middle ear.
6. Weak immune defense of the body, immunodeficiency states and diseases.
7. Severe form of beriberi.
8. Non-compliance with the rules of hygiene of the auricle.

Stages of development of purulent otitis media

In total, 3 stages of the development of purulent otitis media are distinguished:

1. Preperforative. At this stage, a person's temperature rises, up to 39 degrees, hearing loss occurs, a sharp and growing pain in the auricle appears, often the pain radiates to the temple area, and when the mastoid process is probed, pain appears.
2. Perforated. At this stage, the body temperature decreases, the pain disappears, and after the rupture of the eardrum, pus is released, sometimes even with an admixture of ichor.
3. Reparative. The membrane is restored, hearing begins to improve, pus stops flowing out.

At any of these stages, otitis media can easily become chronic. If this happens at the initial stage, then the integrity of the eardrum is preserved, and mucus accumulates in the cavity, which is difficult to remove. If the integrity of the membrane is maintained long enough, thick mucus accumulates and severe headaches, dizziness appear, the temperature begins to rise, vomiting and general weakness appear, and vestibular apparatus disorders develop. In some cases, the infection can go deeper and lead to life-threatening consequences.

After perforation of the eardrum, pus and mucus come out, the general condition improves, pain in the ear may appear and the temperature rises. This suggests that there is stagnation of pus in the tympanic cavity or an inflammatory process has begun on the mastoid process of the temporal bone. If this happens, then the discharge of pus may still be within a month.

Purulent discharge is usually scarce, but during the period of exacerbation, its amount increases sharply.

The acute stage can last from 10 to 20 days. In the presence of weakened or depressed immunity, as well as improper treatment, complications may develop. After the end of purulent discharge, the general condition improves, the pain disappears and usually this leads to recovery.

If not all of the pus came out, then the spread of infection and even the development of meningitis and brain abscess may begin.

The duration and course of treatment of purulent otitis media depends on the following factors:

1. Type and form of otitis.
2. The state of the body's immune defenses.
3. The age of the person.
4. Inflammatory and infectious diseases of the nasopharynx.
5. Features of the anatomy of the ear system.

Medical treatment of purulent otitis media

Otitis always begins with an acute stage. Treatment of the acute stage of otitis should be carried out under the supervision of the attending physician, since with a sharp development of inflammation, inflammatory processes can move to other organs of the head and cause hearing loss.

If otitis media often recurs or was undertreated, then it may have become chronic. Treatment of chronic suppurative otitis media is usually carried out on an outpatient basis; it will not be possible to cure it quickly. In this case, it often happens that you can only get rid of the accumulated pus in the tympanic cavity only surgically.

If the mastoid process is affected, immediate hospitalization may be required.
Using antibiotic therapy, purulent otitis media can be cured quickly enough. This will remove the symptoms in 2-4 days, but for a complete cure, you need to complete a full course of antibiotic treatment, usually about 10 days (depending on the drug, its dosage and the appointment of the attending physician). If it is not cured, then with every cold, otitis media can return.

The following medicines are prescribed as antibiotics:

1. Azithromycin. It is taken once a day 250 mg. As contraindications are: arrhythmia, liver and kidney disease and hypersensitivity to macrolides. As side effects can be: dizziness, headaches, congestion in the ears, nausea, conjunctivitis, nervousness, weakness and high fatigue.
2. Amoxicillin. It is taken three times a day: morning, afternoon and evening. The course of admission is 8-10 days. In the absence of any therapeutic effect when taken within 3 days, it should be abandoned and another antibiotic prescribed. Refers to broad-spectrum antibiotics, has antimycotic and antiseptic properties and can be taken at any stage of purulent otitis media. Contraindications: during pregnancy, breastfeeding, mononucleosis and liver diseases. As side effects can be: allergic conditions and diseases of the gastrointestinal tract.
3. Ampicillin. It is used in the form of intramuscular injections. Contraindications for admission: individual intolerance to the components of the drug, pregnancy and liver disease. When taking the drug, there may be the following side effects: allergies, disorders of the gastrointestinal tract, candidiasis, dysbacteriosis and disorders in the central nervous system.
4. Augmentin. Contraindications for admission: pregnancy, breastfeeding, phenylketonuria and liver and kidney disease. As side effects can be: headaches, dizziness, urticaria, candidiasis, itching, as well as temporary thrombocytopenia and leukopenia. It is a fairly strong remedy and is prescribed for severe symptoms of purulent otitis media. The dosage is determined individually and by the attending physician.
5. Spiramycin. It is taken twice a day: in the morning and in the evening, 1.5 million IU. It is not recommended to take with: individual intolerance to the components of the drug, obstruction of biliary protocols and breastfeeding. Side effects are: esophagitis, diarrhea, nausea, colitis and skin rash. Usually prescribed for allergies to other antibiotics.
6. Cefazolin. It is used in the form of intramuscular injections. Reception is contraindicated in: individual intolerance to cephalosporinam, pregnancy, breastfeeding, diseases of the intestines and kidneys. Side effects can be: allergies, disorders of the gastrointestinal tract, dysbacteriosis, convulsions, and with prolonged use, stomatitis is possible.
7. Ceftriaxone. It is used in the form of intramuscular injections once a day. Reception is contraindicated in: individual intolerance to cephalosporinam and severe forms of diseases of the gastrointestinal tract. It is prescribed quite rarely due to many side effects, namely: dizziness, headaches, nosebleeds, thrombocytosis, convulsions, flatulence, colitis, jaundice, itching, candidiasis, feverish conditions, increased sweating and pain in the epigastric region.
8. Cefuroxime. It is used in the form of intramuscular injections. Appointed if Augmentin and Amoxicillin have shown their low effectiveness in the treatment. Reception is contraindicated in: individual intolerance to cephalosporinam, the first trimester of pregnancy and breastfeeding. Side effects when taken can be: headaches, drowsiness, hearing loss, constipation, nausea, impaired renal function, neutropenia and eosinophilia.
9. Ciprofloxacin. It is applied twice a day: in the morning and in the evening at a dosage of 250 mg. Taking an antibiotic is contraindicated in: pregnancy, breastfeeding and epilepsy. Possible side effects include nausea, skin allergies, and sleep disturbances.
10. Phenoxymethylpenicillin. It is taken three times a day: morning, afternoon and evening, 250 mg. Has individual intolerance to penicillin. After taking the drug, the following side effects may develop: allergies and disorders in the gastrointestinal tract, as well as an acute hypersensitivity reaction.

In addition, for the treatment of purulent otitis media, antibiotics are prescribed in the form of drops for instillation into the auricle:

1. Candibiotic. Contraindications for use are pregnancy and breastfeeding. As a side effect, there may be allergic conditions. These drops also have antifungal properties.
2. Levomycetin. In addition to the fact that the drops are widely used in ophthalmology, due to the fact that when instilled they do not penetrate too deep into the ear, they are good for mild forms of otitis media.
3. Netilmicin. Drops have proven themselves in the treatment of chronic otitis media.
4. Norfloxacin. Drops have a broad antibacterial action. As side effects can be: burning, itching and a small rash on the skin around the ear.

Whatever improvements have occurred in the process of therapy, the course of antibiotics should not be stopped prematurely. The course of admission is prescribed by the attending physician and is usually 7-10 days. Early discontinuation of the intake can provoke the reappearance of purulent otitis or it can become chronic with the development of various complications.

With the development of complications, surgical intervention in the form of a dissection of the eardrum is possible.

At the beginning of the development of otitis media, ear drops and compresses can be used. Ear drops work great and can easily cure otitis externa. Most ear drops should be stored in a refrigerator and warmed to room temperature before use.

Compresses can be:

1. Dry. Such a compress is designed to relieve pain and keep warm, and it also does not allow the spread of infection. You can keep it as long as you like. As a bandage, it is recommended to use a natural fabric, preferably made of wool or cotton.
2. Wet. Such a compress helps in the treatment of otitis media, since a drug is applied to a cotton swab, then this swab is placed in the auricle. The maximum time that you can keep such a compress should not exceed 2 hours.

The need for compresses should be checked with your doctor.

Features of the treatment of purulent otitis in children at home

Treatment of purulent otitis in a child at home should be completely excluded, since in children it develops rapidly and can very quickly become chronic. Even at the slightest suspicion, it is necessary to show the child to the doctor, and only after the examination, the specialist can prescribe a comprehensive treatment, and only he decides whether it is possible to treat him at home or not.

If doctors diagnose a child with an advanced form of purulent otitis media, then immediate hospitalization may be required in order to cleanse the ear cavity of pus and mucus and make a dissection of the eardrum.

In addition to drug treatment, the specialist prescribes regular procedures to cleanse the ear cavity from accumulated pus and mucus. Purulent discharge is removed very carefully, after each such procedure, it is necessary to treat the place with special solutions. It is also necessary to provide the child with a plentiful warm drink. This has a positive effect on the process of his treatment.

Treatment of purulent otitis in adults at home

At home, otitis externa without the use of antibiotics is possible, but the treatment will stretch, and the symptoms can persist for up to 10-15 days, including pain. The effectiveness of treatment at home mainly depends on the condition of the patient. If the disease has become chronic, such treatment will be ineffective without the use of a course of antibiotic therapy.

Treatment of purulent otitis at home should be carried out only after receiving the attending physician, who will make up complex therapy. At home, the patient must comply with all doctor's recommendations and bed rest.

Treatment consists of taking the following drugs:

1. Antibiotics. With purulent otitis media, they are prescribed necessarily, they kill pathogenic microorganisms.
2. Antipyretic and anti-inflammatory drugs. They are prescribed to normalize temperature, relieve inflammation, eliminate pain and improve the general condition.
3. Ear and nasal vasoconstrictor drops. They relieve inflammation, eliminate pain and swelling of the Eustachian tube.
4. Immunomodulatory complexes. To speed up recovery, they supply the body with all the necessary vitamins and minerals.
5. Antihistamines. They are prescribed to relieve swelling and inflammation, and also prevent the appearance of allergic conditions.

Also, to remove pus and mucus from the ear cavity, it is necessary to perform washing, this will help reduce the time for complete recovery.

Treatment of purulent otitis with folk remedies

To cure otitis at home, it is necessary, first of all, to cure the primary infectious focus that caused otitis media, this will help prevent relapse.

With non-purulent otitis media, warm compresses are used, such compresses can relieve pain, but it is impossible to cure otitis media using only compresses.

With purulent otitis, the use of compresses is considered ineffective. It is forbidden to use traditional medicine methods in the treatment of purulent otitis media, as you can lose time, and inflammation will spread to the brain tissue. In the treatment of this disease, traditional medicine can only be used as an additional therapy to the main treatment prescribed by the attending physician.

It is also not worth rejecting alternative medicine, since its use together with the main therapy can accelerate a complete cure.

1. Garlic and vegetable oil. Bring the vegetable oil to a boil and throw the previously peeled garlic cloves into it, fry them for 5 minutes and then remove the garlic. Store the oil in a glass container in a dark and cool place. Bury your ears with this oil.
2. Propolis. After washing and cleaning the ear cavities, put tampons soaked in propolis solution into the ears.
3. Mint and vodka. To prepare mint drops, pour 1 teaspoon of mint into 100 ml. vodka and insist in a dark place for 7 days. Peppermint drops should be instilled into a sore ear.
4. Cheremsha. Soak turunda (a narrow cotton or gauze swab that is inserted into the ear canal) soaked with wild garlic juice. Wild garlic juice has good antimicrobial and bactericidal properties.
5. Bunny fat. Rabbit fat helps well if used as ear drops. Fat should be instilled only at room temperature, if necessary, it must first be warmed up.
6. Chamomile. Pour 1 tablespoon of chamomile flowers with 2 cups of water, bring to a boil over low heat and let it brew for 45 minutes. Use a decoction in a warm form in the form of douching in a sore ear.
7. Salt. Warm the bag of salt and use as a dry warm compress.

It is also useful and you can drink drinks from currants, rose hips, raspberries, which saturate the body with essential vitamins and minerals.

Possible complications and consequences of purulent otitis media

The lack of adequate treatment of purulent otitis media can provoke the spread of the purulent-inflammatory process to the tissues and organs of the skull, including the brain.

Possible complications:

1. Violation of the integrity of the eardrum. This can lead to hearing loss and even total hearing loss.
2. Bone caries(osteitis). Ostitis leads to cholesteatoma, which in turn can lead to the destruction of bone tissue.
3. Paralysis of the facial nerve.
4. Encephalitis. This is a group of diseases that affect the brain.
5. Mastoiditis. This is an inflammation of the mastoid process of the temporal bone, in which there is an accumulation of mucus and pus, which leads to the destruction of bone tissue.
6. Hydrocephalus. This is an accumulation of cerebrospinal fluid in the ventricular system of the brain in excess of normal.
7. Meningitis. This is an inflammation of the membranes of the brain and spinal cord.
8. Libyrinth. Inflammation of the inner ear often leads to complications such as meningitis and hydrocephalus.
9. Abscess of the brain, cerebellum. This is an accumulation of purulent discharge in the brain.
10. Sepsis. This condition requires the provision of emergency resuscitation.
11. Possible death.

All patients with acute purulent otitis should undergo a medical examination every 6 months.

Prevention of purulent otitis media

To prevent the occurrence and development of purulent otitis media, the following rules must be observed:

1. Timely treat infectious and catarrhal diseases, complications of which can lead to the occurrence of purulent otitis media.
2. Use antibiotics only as directed by your doctor.
3. Increase the body's immune defense, if necessary, take vitamin complexes.
4. Sufficient physical activity.
5. Proper and healthy nutrition.
6. Timely sanitation of the oral cavity and nasopharynx.
7. Avoid hypothermia.

Purulent otitis media is one of the most serious and dangerous diseases of the ear cavity, which must be treated immediately and which cannot be cured at home without the help of a doctor. Late treatment or an attempt to start treating it at home can seriously undermine health.

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This article will focus on the type of otitis media that doctors diagnose most often. It is the middle ear that is most susceptible to inflammatory processes due to the peculiarities of its structure. The mechanism of infection in the middle ear is one, but there are many options for the development of the disease after infection. For example, in one patient, otitis media can be cured with antibacterial drops without antibiotics in two or three days, and some will have to do it to draw out the accumulated pus from the ear, which can lead to inflammation of the meninges. There are many variations in the development of otitis media, respectively, it is advisable to be familiar with all of them and determine in time how dangerous your type of inflammation is, whether you need to immediately go to the doctor, or you can try to cope with the disease at home using improvised means. In order to be able to understand why this disease occurs, one should understand how the structures are arranged in which the inflammation process actually occurs. To do this, we suggest that you familiarize yourself with the structure and functions of the middle ear.

The structure and function of the middle ear

The middle ear is located deep in the temporal bone, deeper than the first section of the ear - the outer ear (its constituent parts are the auricle and the external auditory tube; the outer ear ends in front of the tympanic membrane). After the middle ear, an even more deeply located section in the skull begins - the inner ear.

The elements that make up the middle ear are:

• tympanic cavity
• auditory tube
• mastoid
• bone cells of the mastoid process (hammer, anvil, stirrup)

Of all these components, the first two play the most important role for the consideration of our topic - the tympanic cavity and the auditory tube. We will talk about them in more detail.

tympanic cavity

The tympanic cavity is located between the tympanic membrane and the inner ear. Its surface is covered with a mucous membrane, it is also filled with air, and includes the auditory ossicles: anvil, stirrup and hammer. These three formations are interconnected with the help of joints and ligaments; they work on the principle of a lever. The function of these auditory ossicles is to transmit sound vibrations and amplify them. Due to the fact that these structures amplify sound several times, we are able to distinguish even weak sound waves in autumn.

There are also two muscles in our middle ear. The function of the first is to create tension in the tympanic membrane, and the second is to support the weight of the auditory ossicles, regulation of their movements, which helps the ear to adapt to sounds of different volumes and frequencies.

Auditory (Eustachian) tube

In order for the ear to work normally, it is necessary to create conditions under which the pressure on both sides of the eardrum is the same. Such conditions are provided by the auditory tube, which connects the tympanic cavity and the nasopharynx. This tube is also lined with a mucous membrane inside. Due to the fact that part of the walls of the auditory tube consists of cartilaginous tissue, when yawning, swallowing, these walls move away from each other. Accordingly, the passage expands, and air enters the tympanic cavity, maintaining the necessary pressure in it.

There is also a mastoid process. Its cells are designed to improve the acoustic properties of the middle ear.

So you got acquainted with the structure of the middle ear. Now let's find out what features of this structure are the reason that almost any disease of the nasopharynx can cause otitis media.

Causes of otitis media

The main cause of inflammation is one - the presence of the auditory tube, or rather the connection of the nasopharynx and the middle ear, which it creates. The fact is that when we get sick, for example, with a respiratory disease, pathogenic microorganisms appear in our nasopharynx, which cause inflammation due to which we get the picture familiar with respiratory infections: sore throat, swelling, fever and more. Such bacteria are able to penetrate through the auditory tube into our ear, respectively, provoking inflammation there as well. The risk of inflammation of the middle ear is especially high in children, because their auditory tube is shorter and wider - it is easier for microorganisms to get to the tympanic cavity.
Then these bacteria get on the mucous membrane, which covers the walls of the middle ear and provokes the creation of a focus of inflammation there. Inflammation appears due to the fact that the body sends its cells to "fight" microbes, this is a defensive reaction to an alien invasion. Also, while the cells of our body are trying to destroy foreign agents, purulent discharge often appears. Pus consists, among other things, of dead and living cells and bacteria.

Symptoms of otitis media

Often, otitis media, especially when it comes to the middle ear, appears suddenly. Few patients have inflammation that is not a complication of SARS or another disease of the nasopharynx. Therefore, the presence of a respiratory infection can be called the first factor that can reinforce your suspicion of having otitis media. You could also get otitis media if:

• in or drawing pain
• increased temperature (the level of this increase depends on how severe the inflammation is)
• you feel unwell in general (nausea, vomiting)

A sure sign of otitis media is purulent discharge. If they are already present, it means that the pus has created a hole in the eardrum through which it flows out. Such a tear of the eardrum is an unpleasant thing, but it is he who is a sign of a good course of the disease. It is much worse and more dangerous if there is no pus, and the ear constantly hurts, the body temperature is raised quite strongly (above 38 degrees). Such signs indicate the possibility of you having purulent otitis media, but at the same time, the pus could not penetrate the eardrum and is constantly inside the ear. A complication of such purulent otitis is the transition of inflammation to the deeper structures of the skull and the possibility of developing meningitis (inflammation of the meninges).

Prognosis for purulent otitis media

If you turned to the ENT in time and he prescribed you treatment, having determined the type of inflammation and its localization, then the following will indicate that you are on the mend:

• ear pain relief
• normalization of temperature or its decrease
• lack of congestion
• absence of headaches or decrease in their intensity

If you had purulent otitis media, then the doctor may notice, after examining the ear with the help of special tools, that the damaged eardrum is tightening. This is also very good and indicates that your hearing was not seriously damaged during the inflammation.

If you use all the necessary drugs and perform the procedures prescribed by the doctor for a week, and the pain does not decrease, then this means that you need to start treatment with local antibiotics (only in the ear) or general action.

If the ear hurts, and the pus does not flow out, then the ENT doctor may prescribe a procedure during which a hole is created in the membrane and the pus is removed from the ear with an instrument or gauze turundas.

To prevent serious complications when the first symptoms appear, pay a visit to the doctor - you will save both time and money, which otherwise can be spent on the treatment of otitis media in an advanced stage.