Acute otitis media of the middle ear. Acute otitis

Otitis media ranks second in the list of severe diseases of the ENT organs after sinusitis. If treated incorrectly or untimely, the disease can lead to serious complications and even complete hearing loss, so treatment must begin when the first symptoms appear. It is difficult not to notice the signs of otitis media, since the main symptom of the pathology is acute pain of high intensity, which intensifies when turning the head and trying to lie down on the painful side.

Treatment of the disease in adults and children is somewhat different. This is due to the anatomical features of the structure of the hearing organs. The Eustachian tubes in children are shorter and almost horizontal, while in adults they are slightly elevated. To prescribe effective treatment, it is important to correctly diagnose the form and stage of otitis media. To do this, you need to go to the clinic to see an otolaryngologist.

According to the duration and nature of the lesion, acute and chronic otitis media are distinguished. The chronic form is often the result of improper treatment or ignoring medical prescriptions when treating the acute form. The acute course of the disease is accompanied by severe pain, fever and other signs of general intoxication, especially if the inflammation is caused by fungal or bacterial microorganisms.

Doctors distinguish three stages of acute otitis media.

Stage	What is it characterized by?
Catarrhal	The first clinical signs of pathology appear, and exudate begins to accumulate in the middle ear. The patient experiences an increase in temperature to 38-39.5 degrees, headache and ear pain.
Purulent	There is an active proliferation of bacterial flora and the formation of pus containing dangerous toxins - waste products of bacteria. After perforation of the eardrum, pus begins to flow out
Attenuation (recovery) stage	Pus stops coming out. The hole through which the contents leaked out gradually closes

The catarrhal stage is characterized by a severe course and severe pain, which can radiate to the teeth, head, temporal part and back of the head. The patient is deprived of the opportunity to sleep and eat normally; any movement of the head causes acute pain. In addition to these symptoms, patients often complain of tinnitus, a feeling of fullness and decreased hearing acuity.

For complete recovery at this stage, 6-7 days are enough (provided that treatment is started in the first 48 hours after the first signs appear). If therapy is carried out incorrectly, the disease becomes purulent, resulting from the proliferation of bacteria or fungus.

The purulent stage lasts no more than three days and ends with a rupture of the eardrum, through which pus flows out. To prevent re-infection, the patient must be prescribed antibiotics and other antibacterial drugs.

Important! Lack of timely medical care can lead to complications, including deadly diseases: meningitis, sepsis, or fluid accumulation in the brain space (abscess). For this reason, self-medication is unacceptable - if pain in the ears occurs or any changes in the functioning of the hearing organs, you should contact a specialist.

How to treat otitis media in adults?

Therapy for the disease is always comprehensive and selected individually, taking into account the severity of the disease, concomitant diagnoses, possible complications and the patient’s age.

Treatment of the inflammatory process of the middle ear includes the following points:

antibacterial therapy;
use of local drugs in the form of drops;
compliance with strict bed rest;
physiotherapeutic methods;
vitamin therapy;
antimicrobial treatment;
the use of analgesics and NSAIDs to relieve pain.

The patient must follow all the doctor’s recommendations and observe bed rest - the speed of recovery depends on this, as well as the presence or absence of complications and consequences. In order to prevent the accumulation of purulent contents, patients are advised to drink plenty of fluids. It is better if these are decoctions of medicinal plants, berry fruit drinks or dried fruit compotes. The fact is that when taking antibiotics, you should avoid drinks containing large amounts of caffeine due to the high likelihood of side effects.

Great importance is paid to ear hygiene. If the disease proceeds with the formation of pus, it is important that all the contents are removed from the ear and not stagnate, as this can lead to new inflammatory processes and secondary infection, which is much more difficult to treat.

Video - Otitis media: causes, symptoms, treatment

Treatment regimen

The treatment regimen for acute otitis is determined individually, but the doctor takes general directions and recommendations as a basis. These include:

the use of vasoconstrictor drugs for instillation into the nose to eliminate swelling of the nasopharyngeal mucosa (“ Naphthyzin», « Galazolin», « Nazivin»);
the use of antipyretic drugs to reduce fever and eliminate febrile syndrome (“ Paracetamol»);
instillation of medical alcohol 70% to eliminate pain (can be replaced with turunda soaked in hydrocortisone);
strengthening the body's defenses and increasing local immunity with the help of immunomodulatory agents (“ Immunal», « Interferon»);
restoration of strength (any multivitamin complexes).

If a patient is diagnosed with purulent otitis, it is important to periodically rinse with hydrogen peroxide and remove all purulent discharge from the ear.

Antibiotics

For otitis media in adults, combination antibacterial therapy is often used, including oral administration of drugs in the form of tablets and local treatment - instillation of antibiotic drops into the ears. Any medications of this pharmacological group should be selected by a doctor. Treatment at all stages should be under the supervision of a specialist, since there are cases of resistance of some strains of bacteria to certain types of antibiotics.

In this case, there will be no therapeutic effect from therapy. In such a situation, the doctor will select an antibiotic of a different group (taking into account the clinical picture of the disease).

The drug of choice in most cases becomes “ Amoxicillin" It is active against a number of pathogenic bacteria and copes well with many strains of gram-positive and gram-negative bacterial microorganisms. A significant disadvantage of drugs in this group is the high risk of allergic reactions, so the doctor may prescribe other types of antibiotics. Analogues of Amoxicillin are:

"Amoxiclav";
"Augmentin";
"Amosin";
"Flemoxin".

Ampicillin trihydrate (and drugs based on it) is no less popular in the treatment of otitis of varying severity. It belongs to the semi-synthetic analogues of penicillin antibiotics and is prescribed for severe purulent forms of inflammatory processes in the middle ear. Like amoxicillin-based medications, ampicillin can cause allergic reactions: rash, itching, hives, eczema. Often, during treatment with ampicillin, patients develop dysbiosis, and cases of anaphylactic reactions have been recorded.

Important! Ampicillin is contraindicated in women during lactation and pregnancy, as well as in patients with severe liver dysfunction.

To treat chronic otitis media, the patient will need stronger broad-spectrum medications, such as aminoglycosides. The most popular drug in this series is “ Netilmicin" This drug is available in the form of an injection solution that is placed directly into the affected area. The product quickly destroys pathogenic flora and helps relieve inflammatory processes. Medicines in this group should not be used by elderly patients, as well as women carrying a child and breastfeeding.

Attention! In case of allergies or other medical indications, the doctor may prescribe a fluoroquinolone antibiotic for the patient (for example, “ Ciprofloxacin"). They are less likely to cause allergies and are better tolerated by all categories of patients.

The dosage regimen, as well as the regimen and duration of therapy should be determined by the attending physician. Ignoring medical prescriptions can lead to a decrease in the effectiveness of treatment, chronicity of the pathological process and the development of superinfection.

Physiotherapy

Treatment using physiotherapeutic methods allows you to stop the inflammatory process, destroy pathogenic microorganisms and relieve pain. Most often, for otitis media, patients are prescribed the following types of procedures:

Ural irradiation (strengthens local immunity, destroys bacteria, relieves inflammation);
UFO pharynx and “tube-quartz”;
phototherapy (“blue lamp”) – eliminates pain and inflammation;
electrophoresis.

Light therapy should not be used if there is pus in the ear. In all other cases, this method shows high results and is one of the safest ways to quickly cope with otitis media.

Important! If there is a significant decrease in hearing, the patient may require additional treatment methods: pneumomassage of the eardrum or blowing of the ear canal. The question of the appropriateness and necessity of their use should be decided by the attending physician.

Folk recipes

Aloe juice

Moisten a cotton swab generously with aloe juice and insert it into the sore ear for 20-30 minutes. Perform the procedure 3-4 times a day.

Onions

Grind a fresh peeled onion through a meat grinder. Squeeze the juice through cheesecloth and mix with a teaspoon of vegetable oil. Use the resulting composition for instillation into the sore ear (1-2 drops 3 times a day) or for applying compresses.

Propolis tincture

A tincture of 20% propolis can be instilled into the ears. It has a pronounced analgesic, antibacterial, antiseptic and anti-inflammatory effect. Greater effectiveness can be achieved by mixing the tincture (100 ml) with a spoon of honey. You need to instill the product 4-5 times a day, 1-2 drops.

Garlic

The garlic needs to be peeled and a clove placed in the sore ear. It is important not to push the garlic too far as it may get stuck. An alternative solution could be a compress of garlic juice, which should be placed on the sore ear 2-4 times a day for purulent otitis media.

All of these recipes must be used until complete recovery. Before using alternative medicine methods, you should consult a doctor.

Video - How to treat otitis media at home

Treatment of otitis media is not a very difficult task if you consult a specialist in time and do not self-medicate. It is important to remember that incorrectly selected therapy can cause deadly illnesses, so it is better to entrust your health to specialists and strictly follow all prescriptions and recommendations.

Ear pain of varying intensity, which:
- may be constant or pulsating;
- may be pulling or shooting;
- can radiate to the teeth, temple, and back of the head.
Ear congestion.
Hearing loss.
Noise in the ear.
Discharge from the ear.
Enlarged and painful lymph nodes.
Pain in the area behind the ear.

Symptoms may occur in one ear (unilateral otitis media) or both ears (bilateral otitis media).

Acute otitis media is often accompanied by symptoms of intoxication - general weakness, increased body temperature and others.

In acute otitis media, symptoms from other ENT organs are often observed:

nasal congestion;
nasal discharge;
pain or sore throat.

Forms

Catarrhal stage(catarrhal otitis media) – the initial stage of the disease.
- Manifests:
  - ear pain;
  - ear congestion;
  - deterioration in general health.
- When examining the ear:
  - the auricle is painless;
  - the external auditory canal is wide;
  - the eardrum is reddened, with no signs of fluid behind it.
- Discharge from the ear is not characteristic of catarrhal otitis media.
- Without treatment, acute catarrhal otitis media can turn into a purulent form.

Stage of purulent inflammation(suppurative otitis media) is in turn divided into two stages.
- Pre-perforative stage – in this case, pus accumulates in the middle ear cavity due to progressive inflammation, but the eardrum remains intact.
  - This stage is characterized by increased pain in the ear, increased congestion in the ear, and decreased hearing in the affected ear.
  - On examination, the eardrum is red, bulging, and sometimes purulent discharge can be seen behind it; there is no discharge from the ear.
- Perforated stage – due to the growing pressure of pus in the middle ear cavity, the eardrum ruptures, and pus begins to flow out of the ear canal. In this case, the ear pain often becomes less intense.
  - On examination, there is purulent discharge in the ear canal and a violation of the integrity (perforation) of the eardrum.
  - When blowing through the ears (exhale through a tightly closed mouth, while pinching the nose with your fingers), pus leaks out through a perforation in the eardrum.

Reparative stage(process resolution stage) – with adequate treatment:
- inflammation in the ear is stopped;
- the pain goes away;
- discharge stops;
- Perforation of the eardrum in most cases heals on its own.

In this case, periodic ear congestion may still persist for some time.

Upon examination, the appearance of the eardrum is normal.

Reasons

Contrary to popular belief, acute otitis media is not directly related to hypothermia, walking in cold weather without a hat, exposure to drafts, or water getting into the ear.

Acute otitis media is caused by various pathogenic microorganisms - bacteria and viruses.
- Most often they enter the tympanic cavity (middle ear cavity) through the auditory tube in inflammatory diseases of the nose, paranasal sinuses, nasopharynx, and throat.
- When you blow your nose incorrectly (with both nostrils at the same time, with your mouth closed), the contents of the nose under pressure enter the middle ear, causing inflammation.

Various conditions that make it difficult for the auditory tube to open and allow air to enter the middle ear, for example:
- the presence of adenoids - overgrown tissue of the pharyngeal tonsil;
- enlarged posterior ends of the nasal turbinates;
- sharp curvature of the nasal septum;
- pathology in the area of the nasopharyngeal openings of the auditory tubes.
  Promotes disruption of ventilation of the middle ear and the development of inflammation in it, especially with concomitant viral infection.

Acute otitis media can also develop when the pathogen enters the middle ear through the blood during various infectious diseases (for example, influenza).

Inflammation of the middle ear can occur as a result of injury to the eardrum and infection entering the middle ear from the external environment.

Diagnostics

Analysis of complaints and medical history:
- pain, ear congestion;
- hearing loss;
- discharge from the ear;
- increased body temperature;
- deterioration in general health;
- the presence of concomitant infections - influenza, ARVI, diseases of the nose, paranasal sinuses, adenoids (pathologically enlarged pharyngeal tonsil), - against the background of which ear complaints appeared.

Ear examination:
- changes in the eardrum are noted - its redness, bulging, change in mobility, defect in the form of a rupture;
- the presence of pus in the ear canal.

For a more thorough examination of the ear, magnifying equipment is used - otoscope, otomicroscope, endoscope.

If nasal breathing is difficult, the nasopharynx and the area at the mouth of the auditory tube (connecting the middle ear to the nasopharynx) should be examined using endoscopic techniques.

In case of ear congestion and hearing loss - tuning fork examination (special tests with tuning forks, which make it possible to find out whether hearing loss is associated with the development of inflammation in the middle ear or with damage to the auditory nerve).

Tympanometry. The method allows you to evaluate the mobility of the eardrum and the pressure in the tympanic cavity.
- It is carried out only in the absence of defects of the eardrum.
- If there is fluid (pus) in the middle ear, there is a decrease or complete absence of mobility of the eardrum, which is reflected in the shape of the tympanogram curve.

Audiometry is a hearing test.
Consultation is also possible.

Treatment of acute otitis media

Treatment depends on the stage of the disease.

At the initial stage of the disease, a warm compress is prescribed to the parotid area and physiotherapy. When a purulent process develops, any heating of the ear (compresses, blue lamp) is strictly prohibited.
If there is no defect in the eardrum, anesthetic drops are prescribed in the ear. In such a situation, instilling antibacterial drops is not advisable, since they do not penetrate the eardrum.
If there is a perforation (rupture) of the eardrum, antibiotic drops are prescribed in the ear.
- It is important to avoid using drops that contain substances that are toxic to the ear, as well as alcohol, as this can lead to permanent hearing loss.
- Self-medication in such a situation is extremely dangerous.
Prescription of vasoconstrictor nasal sprays is mandatory.
Painkillers, antipyretics if necessary.
Treatment of diseases of the nose and nasopharynx.
Immediate administration of systemic antibiotics is recommended for severe otitis or the presence of severe concomitant pathology or immunodeficiency (immune disorder). In other cases, local treatment is recommended, observation for 2-3 days and only then deciding whether to prescribe an antibiotic.
In the pre-perforative stage of acute purulent otitis media (there is an accumulation of pus in the tympanic cavity, but the eardrum is intact, accompanied by severe ear pain and increased body temperature), paracentesis is recommended (a small puncture of the eardrum under local anesthesia). This allows you to relieve pain, speed up recovery, and facilitate the delivery of medications to the ear.
In the resolution stage, it is possible to prescribe physiotherapy, exercises for the auditory tube, and blowing out the ears.
In acute otitis media, it is recommended to protect the ear from water, especially if there is a perforation of the eardrum.

Complications and consequences

In severe cases or in the absence of adequate treatment, the following complications may develop:

mastoiditis (inflammation of the mastoid process of the temporal bone) – characterized by swelling, swelling of the postauricular area;
intracranial complications (meningitis, encephalitis) - characterized by a severe general condition, severe headache, the appearance of brain symptoms (neck tension, vomiting, confusion, etc.);
neuritis of the facial nerve (inflammation of the facial nerve) – manifested by facial asymmetry, impaired mobility of half the face;
otogenic sepsis - a generalized infection spread to various organs and tissues through the bloodstream.

All of the above complications require immediate hospitalization.

Chronicization of the process and the development of persistent hearing loss (hearing loss) are also possible.

Prevention of acute otitis media

Prevention of respiratory diseases:
- avoiding hypothermia;
- hardening of the body;
- healthy lifestyle (giving up bad habits, playing sports, walking in the fresh air, etc.);
- compliance with personal hygiene rules.
Treatment of chronic diseases:
- nose;
- paranasal sinuses (sinusitis, sinusitis);
- nasopharynx (adenoids);
- throat (tonsillitis);
- oral cavity (caries).

Restoring normal nasal breathing if it is difficult.

When developing an acute respiratory infection with a runny nose, use the correct technique of blowing your nose (each nostril in turn, mouth open) and rinsing your nose (with a smooth stream, followed by gentle blowing of your nose).
Timely consultation with a doctor at the first signs of otitis media. Self-medication, independent use of ear drops (they may be ineffective or even dangerous), or warming the ear without a doctor’s prescription is unacceptable.

Additionally

The tympanic cavity of an adult has a volume of about 1 cm 3, it contains the auditory ossicles responsible for transmitting the sound signal:

hammer;
anvil;
stapes.

The tympanic cavity is connected to the nasopharynx by the auditory (Eustachian) tube, with the help of which pressure is equalized outside and inside the eardrum: during swallowing movements, the auditory tube opens, the middle ear is connected with the external environment.

Normally, the tympanic cavity is filled with air.

Otitis media is an acute infectious disease manifested by specific symptoms. The disease must be treated, as it is dangerous for the development of complications. No person is immune from the disease, so it is necessary to be able to recognize otitis media in time, the symptoms and treatment of which depend on the form of inflammation.

The disease is an infectious disease and occurs in the form of acute or chronic inflammation. Pathology develops due to the entry of pathogenic microorganisms into the Eustachian tubes, and from there into the middle ear.

Ear inflammation is one of the most common diseases.

Reasons:

infection of the ear by bacteria or viruses;
complication after influenza or acute respiratory viral infection;
inflammation of the nasopharynx;
sinusitis;
mechanical damage to the ear.

Otitis is considered more of a childhood disease, as it is rare among adults. In children, this disease most often results from a too narrow Eustachian tube. Any inflammation in the nasopharynx or nasopharyngitis leads to the spread of infection through the Eustachian tube into the ear.

In adults, otitis media in the vast majority of cases develops against the background of a general decrease in immunity. The disease is often a complication of inadequate treatment of infectious and viral diseases, including sinusitis.

The risk group includes adults with chronic sinusitis, patients with immunodeficiency and patients with diabetes.

Middle ear disease is accompanied by severe symptoms and requires timely treatment.

Symptoms and signs of the disease

Otitis media is an inflammatory disease with an acute onset and rapid progression of symptoms.

If your ear hurts, you should immediately consult a doctor.

Classic clinical picture:

high temperature and fever;
acute “shooting” pain in the ear;
hearing loss, feeling of congestion;
discharge from the external auditory canal.

Usually, with otitis media, nasal congestion and inflammation of the nasopharynx are observed. This is due to the structural features of the ENT organs, the work of which is closely interconnected. Otitis may be a consequence of inflammation of the maxillary sinuses or nasopharyngitis, but if it acts as an independent disease, it necessarily entails a general deterioration in well-being and the spread of the pathological process to nearby organs.

Types and stages of otitis media

There are two forms of otitis media – acute and chronic. Against the background of the inflammatory process, exudate accumulates. Based on the type of fluid, otitis media is divided into purulent and catarrhal.

If treated incorrectly or untimely, the disease can lead to serious complications.

In the vast majority of cases, the cause of ear inflammation is cocci (staphylococcus, pneumococcus) and other opportunistic microorganisms. Their activation is due to a decrease in immune defense, or occurs against the background of severe inflammatory processes in the nasopharynx. The causes of the development of acute and chronic diseases are the same, only the severity of the symptoms differs.

Acute otitis media

Acute inflammation of the middle ear is characterized by a rapid increase in body temperature and pain. The main signs of the disease are severe pain and high body temperature. The pathological process may involve surrounding tissues, which leads to the spread of pain throughout the affected part of the head.

A characteristic feature of acute inflammation is sharp, excruciating pain, the so-called “lumbago”. After some time, the inflammatory process resolves, the pain subsides, and purulent fluid begins to ooze from the ear canal.

Noise, pain and pulsation in the ears are characteristic signs of inflammation.

Acute otitis media occurs in 3 stages:

Stage 1: acute eustachitis;
Stage 2: acute catarrhal inflammation;
Stage 3: acute purulent inflammation.

Acute eustachitis is accompanied by tinnitus, a feeling of pulsation and congestion, and a slight increase in temperature (up to 37-37.4). This stage lasts up to several days, and then turns into acute catarrhal inflammation, which is accompanied by severe pain and an increase in temperature to subfebrile levels. In this case, there is aseptic inflammation of the middle ear, strong noise and pulsation in the ears, severe congestion, accompanied by hearing impairment.

Acute purulent inflammation is the next stage of the disease. This is accompanied by severe pain that radiates to the teeth, lower jaw, eyes and temporal region. The pain intensifies when swallowing and when trying to blow your nose to clear the nose. Body temperature rises to 39-400 C. After some time, the eardrum is perforated, a wound is formed, through which pus flows out. At this stage, symptoms begin to subside.

Acute purulent inflammation will be accompanied by pain until the discharge finds a way out. If this does not happen for a long time, the otolaryngologist makes a puncture through which the purulent masses are removed.

After complete cleansing of the inflamed cavity and removal of the purulent contents, the perforation gradually heals and the disease completely resolves.

Chronic otitis media

Chronic otitis media is a consequence of inadequate treatment of acute inflammation. It develops in two cases: with frequent relapses of acute inflammation with the formation of perforation and discharge of discharge, or as a result of lack of treatment for acute inflammation.

The disease can lead to temporary or permanent hearing loss.

Each time the eardrum ruptures to drain purulent contents from the middle ear to the outside, a small perforation is formed. Over time, it heals, but a scar appears in its place. In the case of chronic otitis, these scars become inflamed or do not heal completely due to the small amount of residual purulent masses in the perforation.

As a rule, the acute form of the disease does not cause pathological hearing impairment. Ear congestion and hearing loss are temporary symptoms that disappear after the integrity of the eardrum is restored. Chronic otitis media can lead to irreversible hearing impairment, but we are talking specifically about weakening, but not complete loss of the ability to hear.

Diagnostic measures

An experienced ENT doctor can easily determine the cause of the ailment.

There are no problems with making a diagnosis. An experienced doctor only needs to interview the patient and examine the ears using an endoscope and otoscope to suspect the cause of the ailment. To confirm the presence of purulent inflammation, an X-ray of the temporal bone or a computed tomography scan is prescribed.

Treatment of otitis media in adults at home

Otitis media should be treated on an outpatient basis. The treatment regimen depends on the form and stage of inflammation. In the absence of purulent discharge, therapy is carried out with local remedies using ear drops. If an abscess is present, antibiotic therapy is prescribed. Traditional methods of treatment also exist, but they are recommended to be used as an auxiliary rather than the main therapeutic agent.

Incorrect treatment can lead to deafness!

Chronic otitis media of the middle ear requires complex therapy; self-medication in this case is unacceptable. Inadequate therapy is dangerous for the development of hearing loss.

The most effective drops for otitis media

Antiseptics and antibacterial drugs in the form of drops are used for treatment.

Popular medicines:

Sofradex;
Tsipromed;
Otipax;
Normax.

The medicine is prescribed by a doctor; you should not self-medicate.

Sofradex is a combination drug based on a corticosteroid and an antimicrobial agent. Ear drops are effective at the initial stage of the disease, before pus begins to accumulate in the middle ear. The product is used 2-3 drops up to four times a day. The course of treatment takes on average 4-5 days.

Quite a popular drug in the practice of ENT doctors.

Tsipromed drops contain the fluoroquinolone ciprofloxacin. This is a broad-spectrum antimicrobial agent that quickly relieves inflammation caused by opportunistic microorganisms. The drug is used in ophthalmological and otolaryngological practice. Drops are used up to 3 times a day, 1 drop in each ear.

Before use, you should consult a specialist.

Otipax is a drug with analgesic and anti-inflammatory effects. The drug contains phenazone and lidocaine. Drops are used for acute otitis media to reduce pain. In case of severe suppuration, the drug is combined with antibiotics. The product can be used 4 drops 4 times a day.

Use with caution!

Normax is an effective antimicrobial agent based on the fluoroquinolone norfloxacin. This drug is characterized by broad antimicrobial activity and rapid action. It is used 5 drops three times a day for 4-5 days.

Antibiotics for otitis media in adults

For otitis media, broad-spectrum antibacterial drugs are used. The combination of ear drops with antibiotic tablets helps to minimize the risks of complications and the disease becoming chronic.

The doctor will prescribe a course of treatment and dosage.

The following groups of drugs are most often prescribed:

penicillins (Amoxicillin, Amoxiclav, Augmentin);
fluoroquinolones (Tsipromed, Norfloxacin)
cephalosporins (Ceftriaxone)
macrolides (Sumamed, Azithromycin).

The first-line drugs of choice are penicillins. Amoxicillin, Amoxiclav or Augmentin are prescribed. Fluoroquinolones are broad-spectrum antimicrobial agents used in cases of intolerance or ineffectiveness of penicillins. Cephalosporins or macrolides are also prescribed as substitutes for penicillin intolerance.

The dosage and duration of antibiotic treatment is selected individually for each patient.

Treatment with folk remedies

Traditional treatment of otitis media is an extremely dubious measure that cannot replace conservative drug therapy. Such methods can be used as additional ones, but only after consultation with a doctor. It is important to remember that improper treatment of otitis media can lead to hearing loss.

Incorrect treatment can lead to hearing loss.

Mix Dimexide and boric acid solution in equal proportions, apply to cotton wool and place it in the ears for an hour. Repeat this manipulation three times a day.
Place 5 large bay leaves in a bowl, add a glass of hot water and boil for 20 minutes. Then cover with a lid, wrap in a towel and leave to steep for another two hours. The product is taken one tablespoon three times a day, while 2-3 drops are instilled into the inflamed ear.
When the eardrum ruptures and pus is released, hydrogen peroxide is used, which is instilled with a pipette, or used in the form of an ear turunda. This helps to quickly clear the ear canal of purulent contents and avoid the transition of acute otitis into a chronic disease.

The only folk method used in modern medicine is hydrogen peroxide. The product has a number of limitations, and in rare cases can provoke the development of complications, but it really effectively clears pus and prevents its re-accumulation. However, it is recommended to consult a doctor before using peroxide.

Possible complications of the disease

Despite the frightening symptoms, acute otitis media practically does not lead to hearing loss if it is treated correctly and in a timely manner.

Timely and correct treatment will help you quickly cope with the disease.

Complications are characteristic of an advanced chronic form of the disease and manifest themselves:

inflammation of the meninges (meningoencephalitis);
damage to the facial nerve;
sepsis, when purulent masses enter the general bloodstream;
hearing loss.

Timely detected otitis media can be treated quite successfully. Typically, treatment for otitis media takes about one week. Pain and discomfort disappear on the second day after starting drug therapy.

Prevention of otitis media

Otitis in adults is often a consequence of problems with nasal breathing. This may be due to chronic inflammation of the maxillary sinuses or a deviated nasal septum. Otitis media can be prevented only through timely treatment of these disorders.

It is also important to prevent weakening of the immune system and promptly treat any viral and infectious diseases.

Acute otitis media (AOM) is an acute inflammatory process localized in the tissues of the middle ear, namely in the tympanic cavity, the area of the auditory tube and the mastoid process. This disease is more often diagnosed in children, but in adults it also accounts for about 30% of all ENT pathologies.

Etiology, classification and mechanisms of disease development

Acute otitis media is an infectious disease that can be caused by viruses, bacteria or viral-bacterial associations.

Viruses that cause acute respiratory infections play a major role in the development of AOM, namely:

parainfluenza,
adenoviruses,
enteroviruses,
respiratory syncytial viruses,
coronaviruses,
rhinoviruses,
metapneumoviruses.

In 70% of patients, when examining exudate obtained from the middle ear, bacteria are detected. Most often this is:

Streptococcus pneumoniae,
Haemophilus influenzae,
Moraxella catarrhalis.

Contribute to the development of the disease:

reduced immune status of the body (congenital immunodeficiencies, recent acute infectious diseases, concomitant severe somatic pathology (bronchial asthma, diabetes mellitus, kidney disease);
the presence of a cleft palate in a child;
active and passive smoking;
low socioeconomic status of the patient.

Based on the nature of inflammation, there are 3 stages of AOM:

catarrhal,
exudative (serous),
purulent.

The mechanisms of their development also differ.

Catarrhal otitis media(other names - tubootitis) often develops with acute respiratory viral infections - swelling caused by inflammation in the upper respiratory tract spreads to the mucous membrane of the auditory tube, which impairs its patency. As a result, all 3 functions of the pipe are disrupted:

ventilation (the air contained in the pipe is sucked in, and the entry of new air is difficult),
protective (due to insufficient ventilation, the partial pressure of oxygen decreases - the bactericidal activity of the pipe cells weakens),
drainage (impaired free flow of fluid from the pipe - leads to the proliferation of bacteria in the middle ear).

The consequence of these processes is a decrease in pressure in the tympanic cavity, leading to the suction of secretions from the nasopharynx and the release of non-inflammatory fluid - transudate.

Eustachitis can also be caused by sudden changes in atmospheric pressure - during the diving and ascent of submariners (mareotitis), ascent and descent of an airplane (aerootitis).

Exudative otitis media(secretory, serous, mucosal otitis media) is a consequence of catarrhal: against the background of dysfunction of the auditory tube, a decrease in general and local immunity, the inflammatory process progresses - inflammatory fluid, or exudate, is intensely released into the tympanic cavity. Restoring the ventilation function of the middle ear at this stage will lead to recovery, and if the patient is not provided with assistance, the process can take a chronic course, transforming into fibrosing otitis media (scarring process in the tympanic cavity), leading to severe.

Acute purulent otitis media is an acute purulent inflammation of the mucous membrane of the tympanic cavity involving other parts of the middle ear. The causative agent of this form of the disease is bacteria. They enter the tympanic cavity most often through the auditory tube - tubogenically. Through a wound of the mastoid process or with an injury to the eardrum, the infection can also enter the tympanic cavity - in this case, otitis is called traumatic. There is a third possible route for infection to enter the middle ear - through the bloodstream (hematogenous). It is observed relatively rarely and is possible in some infectious diseases (measles, scarlet fever, tuberculosis, typhoid).

In acute purulent otitis media, inflammatory changes occur not only in the mucous membrane, but also in. An inflammatory fluid is released, first serous and then purulent. The mucous membrane sharply thickens, ulcerations and erosions appear on its surface. At the height of the disease, the tympanic cavity is filled with inflammatory fluid and thickened mucous membrane, and since the drainage function of the pipe is impaired, this leads to the bulging of the eardrum outward. If the patient is not given assistance at this stage, a section of the eardrum melts (its perforation), and the contents of the eardrum flow out (this is called otorrhea).

During treatment, the inflammation subsides, the amount of exudate decreases, and suppuration from the ear stops. The hole in the eardrum is scarred, but the patient continues to feel stuffiness in the affected ear for a long time. The criteria for recovery are normalization of the picture during ear examination - otoscopy, plus complete restoration of hearing.

Why acute otitis media occurs more often in children

The structure of a child’s ear is such that an infection from the nasopharynx can quickly spread to the structures of the middle ear.

There are age-related features of the structure of the middle ear that contribute to a more rapid spread of infection from the nasopharynx to the middle ear. The auditory tube in children is short, wide and located almost horizontally (devoid of physiological bends characteristic of adults). The tympanic cavity of young children is filled with a special, so-called myxoid, tissue - this is gelatinous, loose embryonic connective tissue, which is a favorable soil for the development of the infectious process.

In addition to anatomical and physiological characteristics, children are characterized by some pathological conditions that contribute to the development of AOM. First of all, this is (hypertrophic changes in the lymphoid tissue of the nasopharynx) - streptococci and Haemophilus influenzae are often found in them.

Children attending children's groups are constantly in contact with each other's infectious agents. For one child, a particular pathogen may be opportunistic and not cause disease, but for another it may be virulent, aggressive and cause inflammation of the upper respiratory tract, from where the process may spread to the middle ear.

Children often suffer from respiratory viral infections, which can be complicated by AOM. In addition, these infections not only weaken the immune system, but also lead to morphological changes in the mucous membrane of the respiratory tract, reducing its immunity (resistance) to potentially dangerous (pathogenic) microflora.

There are so-called transient (physiological) immunodeficiency states that are characteristic of young children - they are also a favorable background for the occurrence of infectious diseases.

Clinical picture of acute otitis media

Often AOM occurs with pronounced symptoms, but latent otitis also occurs - when the clinical manifestations of the disease are mild.

NDE, like any other infectious disease, is characterized by general symptoms:

general weakness;
feeling unwell;
loss of appetite;
increase in body temperature to febrile levels.

With catarrhal otitis media, patients complain of:

slight hearing loss – disturbance of sound conduction mainly at low frequencies; after swallowing saliva or yawning, hearing temporarily improves;
resonating your voice in the affected ear – autophony.

Ear pain is usually of low intensity or absent at all.

The course of exudative otitis media is usually asymptomatic. The patient notes:

a feeling of pressure, sometimes noise in the ear;
slight autophony;
some hearing loss.

Painful sensations, as a rule, are absent, and after a while the patient adapts to hearing loss and stops noticing it.

Acute purulent otitis media can occur easily and resolve quickly, sluggishly and continue for a long time, acutely and violently. Usually it ends with complete recovery, but sometimes the inflammatory process becomes chronic. In the absence of timely treatment, purulent otitis media can be complicated by mastoiditis, intracranial infectious processes and even sepsis.

Clinically, during acute purulent otitis media, it is customary to distinguish 3 stages:

pre-perforative;
perforative;
reparative.

It is not necessary for a specific otitis to go through all 3 stages - it can resolve already at the initial (pre-perforative) stage.

Pre-perforation stage. The patient's leading complaint is pain in the ear, especially when lying on the affected side. The pain is pronounced, sharp, shooting, radiating to the temple. Gradually increasing, it becomes unbearable, painful, depriving the patient of peace and sleep. There may be pain when touching the mastoid process. Simultaneously with the pain, there is a feeling of stuffiness in the ear, noise in it, and hearing loss. The general condition of the patient is disturbed: there are signs of intoxication, body temperature is elevated to febrile levels. Duration of the initial stage: 2–3 hours – 2–3 days.
The perforated stage is determined by the onset of suppuration from the ear, resulting from a perforation of the eardrum. Discharge from the ear is initially profuse, mucopurulent or purulent in nature, often mixed with blood. Over time, the amount of discharge decreases, it thickens and becomes purulent in nature. The patient’s condition at this stage improves sharply: the pain in the ear subsides, the body temperature decreases, sometimes even returns to normal. The duration of suppuration is 5–7 days.
At the reparative stage, the suppuration of their ear stops, the perforation is scarred, and hearing is gradually restored.

The typical course of acute otitis media is described above, but in some cases its clinical manifestations are sharply different from the classic ones.

Sometimes the disease is extremely severe: with a sharp deterioration in general condition, high fever, up to 40 C, nausea and vomiting, headache and dizziness.
In some cases, the eardrum does not perforate, and purulent masses spread from the middle ear into the cranial cavity, causing complications that threaten the patient’s life.
Otitis may already at the initial stage become asymptomatic, sluggish, and protracted. In this case, the general symptoms are mild, the pain is not intense, the eardrum is not perforated, and thick, viscous pus accumulates in the middle ear cavity.

If the patient’s condition does not improve and the temperature does not decrease after perforation of the eardrum, this means that the inflammatory process has moved to the mastoid process - it has developed.

If it does not stop within 5-7 days, but lasts up to a month, it indicates an accumulation of pus inside the mastoid process, or empyema.

In children of early and preschool age, the diagnosis of acute otitis media can present some difficulties, since the child does not always correctly voice his complaints, and parents and the pediatrician may mistake the child’s fever and whims for symptoms of ARVI (acute respiratory viral infection).

The child should be referred for consultation to an ENT specialist if:

If acute otitis media is suspected, the child must be examined by an ENT doctor.

Severe disturbances in the general condition of the child;
2 sleepless nights;
severe pain and prolonged fever;
protruding auricle;
smoothness of the postauricular fold;
leakage of fluid from the ear - otorrhea;
pain when suddenly pressing on the tragus of the affected ear;
pain when palpating or tapping the mastoid process.

Diagnosis of acute otitis media

Based on the patient’s complaints and medical history, the doctor will only assume the presence of an inflammatory process in the middle ear. Otoscopy – a visual examination of the eardrum using a special device – an otoscope – will help confirm or refute this diagnosis. The eardrum has an appearance specific to each stage of the disease:

at the stage of acute tubootitis, the membrane is only slightly retracted;
the exudative stage is characterized by hyperemia (redness) and thickening of the eardrum, and the hyperemia first covers the loose part of it, then spreading to the entire surface of the eardrum;
the pre-perforative stage of acute purulent otitis is otoscopically manifested by bright hyperemia and swelling of the eardrum and its bulging into the cavity of the external ear of varying degrees of severity;
at the perforated stage, the presence of a hole in the eardrum is determined, from which serous-purulent, purulent or bloody exudate is released;
at the reparative stage, the perforation hole is closed with scar tissue, the eardrum is gray and cloudy.

In order to determine the quality of hearing, a tuning fork study is carried out, the results of which also vary at different stages.

Changes in the general blood test are nonspecific - signs of an inflammatory process are determined (leukocytosis, neutrophilia (if there is a bacterial infection), increased ESR).

A bacterioscopic examination of exudate taken from the source of inflammation will determine the type of pathogen and its sensitivity to antibacterial drugs.

Treatment of acute otitis media

Since the course of acute otitis media is characterized by a clear stage, the treatment of this disease is also specific at each stage.

In general, treatment for NDE may include:

osmotically active painkillers and anti-inflammatory drugs of local action (in the form of ear drops);
systemic and topical decongestants ();
systemic antibiotic therapy;
antihistamines;
toilet and anemia of the nasal cavity;
anemization and catheterization of the auditory tube;
myringotomy and shunting of the tympanic cavity.

In this case, the following are considered ineffective means:

decongestant therapy in the form of tablets and syrups (taken by mouth) - there is no evidence of their effectiveness, and side effects are common;
mucolytics (drugs that thin mucus) orally - the reasons are the same;
local antibacterial drugs (in the form of ear drops) - the antimicrobial component of these drugs does not have the desired effect on microorganisms located in the tympanic cavity; the use of drugs in this group is justified only at the perforated stage of acute purulent otitis, since there is a hole in the membrane through which the active substance enters the tympanic cavity. In this case, the prescribed drug should not have an ototoxic effect (antibiotics such as Polymyxin B, Neomycin, Gentamicin have this effect).

Ear drops

Ear drops are often used in the treatment of acute otitis media. Many patients prescribe them to themselves, which risks causing irreparable harm to their health. Drops containing anti-inflammatory and analgesic components are used only when the eardrum is intact, since their entry through the perforation into the tympanic cavity can negatively affect the patient’s hearing.

To administer the drops more accurately, use the hand opposite the inflamed ear to slightly pull the auricle up and back - this technique will align the ear canal and the drops will fall exactly to their destination. After instillation, it is necessary to close the ear canal with cotton wool soaked in Vaseline for 2-3 hours - in this case, the active agent will not evaporate and will have maximum therapeutic effects.

As mentioned above, antibacterial drops are prescribed only in the case of perforated otitis media.

Drops with an antihistamine component in their composition are prescribed to reduce swelling and eliminate a possible allergic factor.

Topical decongestants (xylometazoline, oxymetazoline) are a necessary part of the treatment of AOM, since dysfunction of the auditory tube develops precisely against the background of swelling of the mucous membrane of the upper respiratory tract. Drugs in this group can be addictive, so they are prescribed only in short courses - no more than 4-5 days.

Antibacterial therapy

Timely initiation of adequate treatment will help a child suffering from otitis media to cope with the disease as quickly as possible.

Not all forms of acute otitis media require antibiotic treatment, but treatment with drugs in this group reduces the risk of developing complications of this disease. In the absence of serious symptoms of intoxication, such as vomiting, intense growing headache, prescribing an antibiotic can be delayed for 48–72 hours, since AOM often resolves on its own, without their use. Antibiotics are required for any form of acute otitis media in children under 2 years of age and in patients with immunodeficiencies. First, an antibiotic is prescribed empirically, taking into account the range of typical pathogens of the disease. In the case when the pathogen is laboratory determined and the medicinal substances to which it is most sensitive are known, the drug should be replaced.

At the first stage of AOM, catheterization of the auditory tube is recommended, which should be done daily. A mixture of naphthyzine solution and a water-soluble corticosteroid, which have a vasoconstrictor and anti-inflammatory effect, is injected through the catheter. Among medications, the patient may be prescribed topical decongestants.

At the second stage of AOM, some experts recommend inserting a thin cotton wool moistened with osmotol (a mixture of ethyl alcohol 90% and glycerin in a 1:1 ratio) into the external auditory canal. The turunda must be closed from the outside with a cotton swab and Vaseline. This technique prevents the turunda with osmotol from drying out and the effects of this remedy are fully realized - warming, analgesic, dehydrating. The compress remains in the ear for 24 hours. In parallel with the compress, it is necessary to use vasoconstrictor drops in the nose.

At stage 3 of the process, the patient is recommended to catheterize the auditory tube and microcompresses with osmotol. Systemic antibiotic therapy is also indicated. If after 24–48 hours there is no effect from the treatment, the patient needs a paracentesis or tympanopuncture procedure. Medications include taking strong analgesics (paracetamol and ibuprofen).

At the perforative stage, local antibacterial drugs in the form of ear drops are added to the preliminary treatment; in addition, the patient continues to receive vasoconstrictor nasal drops and analgesic drugs. Catheterization of the auditory tube and frequent toileting of the external auditory canal are also indicated.

At the reparative stage of acute otitis, observation by an ENT specialist is not always necessary. However, if the perforation was large enough, it is important to control the scarring process in order to prevent the inflammatory process from becoming chronic.

Most often, ENT doctors in their practice have to deal with acute otitis media. This disease occurs in both adults and children. Most often, acute otitis media is unilateral. Bilateral otitis is possible in rare cases.

Otitis- a disease whose characteristic feature is an inflammatory process in any part of the ear. According to its localization, acute otitis media can be external, middle and internal.

Depending on the nature of the inflammatory process, otitis media is acute or chronic. Acute otitis is, as a rule, the result of exposure to various infections and colds, and less often – injuries. Chronic otitis often develops after untreated acute otitis, but in some cases it can develop independently: for example, against the background of previous injuries to the ear area, or due to the presence of chronic foci of infection in the body (for example, adenoids in children).

Acute external otitis

This is an inflammatory process inside the external auditory canal. It can be limited (in the form of one or several boils) or diffuse (along the entire ear canal). It is usually caused by an infection that can be introduced into it through microtrauma (for example, with cotton swabs, matches) or through frequent contact with water (for example, with frequent swimming in the pool). There is sharp pain with passive movements of the ear and ear cartilage. Possible suppuration and swelling of the external auditory canal, along with hearing loss and a feeling of fullness in the ear.

Acute otitis media

This is an acute inflammation of the middle ear. This form of otitis is very common, especially in children. Its cause is most often also an infection: it occurs against the background of acute respiratory viral infections, colds, rhinitis, sinusitis, adenoids. In more rare cases, the disease may have a traumatic origin.

Acute internal otitis (or labyrinthitis)

It is an acute inflammation of the structures of the inner ear, which is not only part of the auditory organ, but also an organ of balance. More often it is a complication of otitis media, tuberculosis, meningitis or other bacterial or viral infections; develops less frequently after trauma. This is a serious but quite rare disease that has the following symptoms: dizziness, tinnitus, balance disorders, nausea, vomiting, temporary or permanent hearing loss.

Clinical symptoms of acute otitis

This is a severe “shooting” pain in the ear, a rise in temperature, decreased hearing, noise in the ear, accompanied by a feeling of “stuffiness”. When the eardrum ruptures, which usually occurs on the 2nd or 3rd day of the disease, pus appears from the ear, and the symptoms begin to subside. If the eardrum does not rupture on its own, then a small puncture is necessary to allow the pus to pour out (the eardrum then heals safely).

Treatment of otitis media

As a rule, acute otitis requires contacting an ENT doctor. True, some cases of uncomplicated otitis may go away on their own, but it is very difficult to predict the severity of this disease without examination by a specialist. Self-medication is not recommended; this is only permissible in cases where, for one reason or another, contacting a specialist is difficult. In this case, the patient should be provided with rest and dry heat on the area of the sore ear (you can use a heating pad wrapped in a towel). Blue light therapy (“Blue Lamp”) can also be used. Among the medications, you can use ear drops (Sofradex, Tobradex, Otipax, etc.), painkillers (ibuprofen, paracetamol), antihistamines with a sedative effect (tavegil, diphenhydramine, suprastin).

However, the basis of treatment in most cases is antibiotic therapy: amoxicillin, cefixime, ciprofloxacin, azithromycin and a number of other antibiotics can be used. In any case, it is highly desirable that the antibiotic for treatment is also prescribed by an otolaryngologist.

Physiotherapy is used successfully in the treatment of otitis media. Along with the blue lamp light therapy mentioned above, there may be other procedures: UV irradiation, UHF, etc. However, physiotherapy is contraindicated in the midst of an acute period in the presence of an active purulent process in the ear.

Sometimes surgery may be required (for example, puncture of the eardrum, which was also mentioned above). The choice of a specific type of treatment or procedure should be made by an ENT doctor.

As a rule, if treatment was timely and adequate, acute otitis, regardless of its form, responds well to treatment, and any adverse consequences can be avoided. However, in advanced cases, complications or the disease may become chronic. In chronic otitis media, approximately the same symptoms are observed as in acute forms of this disease: pain, noise and congestion in the ear, hearing loss, suppuration, and in rare cases, disturbances in balance and coordination - however, these symptoms are less pronounced, sluggish in nature. At the same time, the disease proceeds much more persistently, periodically either subsiding or exacerbating.

Among the serious and dangerous complications of both acute and chronic otitis, the following can be noted: meningitis, encephalitis, brain abscesses, persistent auditory or vestibular disorders, mastoiditis, etc. All these complications, as already mentioned, can occur only in the absence of timely treatment, or as a result of neglecting the advice of a doctor. Paying attention to your health is therefore an important factor in avoiding complications and adverse effects of otitis media.