Complications of operations on the tympanic cavity. Eardrum repair or tympanoplasty

In some cases, otitis media may require surgery. This procedure varies in complexity, depending on the diagnosis. In addition, long-term rehabilitation after the intervention is required, which complicates the treatment process. But sometimes this is the only way to get rid of the disease and its consequences.

Indications for surgery

Surgical intervention may require an ear affected by inflammation, which has passed into a complicated stage and is not amenable to conservative treatment. In some cases, this is the most effective way to get rid of pain and stop the destructive processes in the body.

With damage to the bone tissues of the ear and further spread of the infection, radical surgical intervention is a necessity.

Mostly in this way, a chronic type of disease is treated. This also includes the most common diagnosis in this category - chronic otitis media. In this case, the operation allows you to solve the problem and remove the purulent secret.

Surgery is necessary in cases where otitis media is accompanied by the following symptoms:

• elevated temperature;
• copious purulent exudate;
• severe pain;
• carious processes in bone tissue;
• perforation of the eardrum;
• violation of the position and functioning of individual elements of the ear.

Previously, the ear is examined with an otoscope, computed tomography and other necessary studies are performed.

Operation

The operation, which requires chronic purulent otitis, is aimed at removing the focus of inflammation and preventing further accumulation of secretions. Leathery pockets inside the middle ear cavity often cause a purulent secret to accumulate in it. Due to the violation of the outflow of fluid, a favorable environment is created for the development of pathogenic microorganisms.

An operation performed for otitis in a child is not much different from an operation in an adult, but at the same time, one can single out such a nuance as the underdevelopment of the hearing organs, which is associated with the ongoing growth processes of the body.

Chronic suppurative otitis media is promptly treated as follows. The tympanic membrane is incised to drain the pus, and then a drainage tube is inserted. After sanitation of the ear cavity, damaged areas of the epithelium are removed.

If the disease has affected the inner ear, more complex manipulations are performed in relation to those parts of the organ that have undergone changes.

Rehabilitation

Rehabilitation after surgery is a more complex process than the operation itself. Chronic suppurative otitis media can worsen if hygiene rules are violated in the postoperative period. In this case, a purulent secret is formed at the site of the damaged epithelium and fills the middle ear cavity.

Recovery can happen in different ways:

• Tamponade. After the primary healing of the epithelium, regular bandaging of the ear is performed. Additionally, antiseptics and antibiotics are used.
• dry method. In this case, the ear is cleaned daily and dried. To do this, boron powder is blown into the ear.

If the ear does not heal properly, in addition to the risk of recurrence of chronic suppurative otitis media, granulation and scarring may occur in the middle ear cavity.

A qualified surgeon and proper care after surgery increase the chances of the most effective elimination of the problem.

Tympanoplasty is an operation during which exudate is sucked out of the middle ear cavity and the anatomical position of the auditory ossicles is restored. The procedure ends with myringoplasty, i.e. reconstruction of the ear membrane, due to which the auditory function is normalized.

The volume of operational measures and the time of the operation are determined by the degree of damage to the main sections of the sound-conducting system. In the presence of relatively minor damage to the ossicular chain, complete restoration of hearing occurs. If persistent perforations provoked by purulent inflammation are observed in the ear membrane, partial or complete elimination of hearing loss is possible in 60-75% of cases.

Indications and contraindications

Can the eardrum be repaired after it has been perforated? The ear membrane is prone to self-healing, but only in the presence of a so-called dry perforation. If holes occur as a result of suppuration from the middle ear, the regenerative capacity of the tissues is reduced. This leads to persistent perforations and conductive hearing loss.

According to otosurgeons, ear surgery (tympanoplasty) can eliminate most of the pathologies that occur when the hearing aid is damaged. Direct indications for surgical intervention are:

• purulent otitis;
• conductive hearing loss;
• tympanosclerosis;
• membrane perforation;
• mesotypemanite;
• polyps in the ear cavity;
• fibrosis of the middle ear.

Like most types of surgery, tympanoplasty has a list of contraindications:

• purulent complications;
• acute inflammation in the ear;
• brain abscess;
• anomalies of the auditory tube;
• allergy at the stage of exacerbation;
• septicopyemic complications;
• infection of the upper respiratory tract.

Untimely operation can cause a brain abscess, thrombosis of large veins and the development of labyrinthitis.

Forms of operated pathologies

Inflammatory processes in the organ of hearing lead to damage not only to soft tissues, but also to bone structures, which include the auditory ossicles and cells of the mastoid process. Their destruction entails the development of severe complications, in particular mastoiditis and sepsis. In medical practice, all types of ear pathologies that can be surgically treated are usually divided into 4 groups:

1. dry perforation of the eardrum - a relatively mild form of pathology, characterized by perforation of the ear membrane without the release of serous or purulent exudate from the auditory canal;
2. meso- and epitympanitis - diseases accompanied by catarrhal inflammation in the mucous membrane of the middle ear. With the development of the disease, there are practically no failures in the conduction of sound signals by the auditory ossicles;
3. purulent otitis media - chronic inflammation, which is characterized by suppuration from the ear. As a result of tissue melting, there is a violation in the efficiency of the transformation mechanism system, which leads to the development of hearing loss;
4. adhesive otitis media is a fibrous process in the ear, in which adhesions form on the eardrum and auditory ossicles, limiting their mobility.

Treatment of purulent and adhesive otitis media is accompanied by ossiculoplasty, i.e. restoration of the normal position of the auditory ossicles. After that, the otosurgeon selects a suitable type of neotympanic membrane, with the help of which the perforations in the eardrum are closed.

How to restore the eardrum? The method of reconstruction of the ear membrane is determined by the type of perforation (central, marginal) and the degree of damage to the auditory analyzer. At the suggestion of H. Wulstein, all types of hearing-improving operations can be divided into 5 types:

• transmeatal plasty - an operation during which perforations in the membrane are eliminated through the external auditory canal;
• atticoanthrotomy - sanitation of the epitympanic space and cells of the mastoid process, followed by replacement of the damaged membrane with a multilayer elastic graft;
• radical operation - a method of creating a simplified tympanic system, characterized by sewing in a skin flap in place of the missing eardrum with an intact stirrup;
• fenestration on the semicircular canal - an operation to create new holes in the ear labyrinth, which is carried out when the stapes is immobilized;
• operation on analogue defects - engraftment of a free flap of the ear membrane to the promontorium, located at the edge of the open oval window.

In 80% of cases, conductive hearing loss that occurs against the background of purulent otitis media affects both ears. Therefore, surgery often involves the implementation of appropriate measures on both ears.

Types of transplants

To eliminate extensive perforations in the ear membrane, grafts from biologically inert materials are used. Surgical repair of the tympanic membrane prevents the appearance of retraction pockets resulting from the flap of material falling into the ear cavity.

When choosing a suitable graft, the otosurgeon takes into account the stability of the neotympanic membrane, its sound-conducting properties and degree of elasticity. During the operation to replace the destroyed eardrum, the following types of materials can be used:

• allografts;
• amnion;
• vein walls.

Important! During the rehabilitation period, it is necessary to avoid pressure drops, which can adversely affect the healing process of implants.

Restoration of the eardrum after otitis begins with conservative treatment of inflammation in the ear cavity. To accelerate the regression of pathological processes, vasoconstrictor, antibacterial, anti-inflammatory and anti-allergic drugs are used. Pharmacotherapy contributes to the elimination of foci of infection in the soft and bone tissues of the hearing organ, which increases the chances of a quick rehabilitation after surgery.

Before tympanoplasty, the patient must undergo a thorough examination, which involves the following laboratory tests:

In the presence of chronic diseases before tympanoplasty, the patient should consult with a specialized specialist.
7-10 days before the start of the operation, the patient should refuse to take blood-thinning medications. Do not eat or drink water 5 hours before entering the operating room.

Operation progress

Before the start of the operation, the otosurgeon makes local anesthesia, which allows you to stop pain during surgical procedures in the inflamed ear. If there are small holes in the ear membrane, the material for its restoration is removed from the behind-the-ear region, where a small incision is made.

In case of damage to the auditory ossicles, prostheses are installed through the incision in the middle ear cavity, which are fixed with a special gelatin sponge. After the ossiculoplasty, the incision is sutured, leaving a small hole for the gauze pad. In the absence of complications, the duration of the procedure will be approximately 1-2 hours.

The best material for myringoplasty will be your own tissue, taken behind the ear. Unlike foreign materials, it is extremely rarely rejected by the body, which increases the effectiveness of surgical treatment of ear pathologies.

Upon completion of tympanoplasty in the postoperative period, the patient is in the hospital for another 1-4 days. To prevent the development of complications, he is prescribed a seven-day course of antibiotic therapy. To eliminate tissue swelling, anemization is performed daily, i.e. the introduction of vasoconstrictor solutions at the mouth of the Eustachian tube. This helps to prevent the accumulation of transudate in the ear cavity.

The duration of the postoperative period averages 4-5 weeks. To speed up the healing process, you should avoid:

During the rehabilitation period, displacement of the prostheses of sound-conducting bones, rejection of an artificial implant, recurrence of a purulent process, etc. can occur. Signs of postoperative complications will be:

• dizziness;
• nausea;
• hearing loss.

Important! If after a month the discharge from the ear after tympanoplasty does not decrease in volume, seek the help of a specialist.

With otitis media, the external or external part of the ear apparatus is affected. The disease can occur regardless of the age category. At the same time, if the ears are affected by a neglected form of the disease, it often passes into a chronic form. Timely and competent treatment of the disease is important.

This will avoid dangerous complications, among which the main ones are: problems with the development of the speech apparatus, disorders in psychomotor development. If the disease is not properly treated at an older age, progressive hearing loss can become a consequence. Ear surgery for otitis media may be needed if the disease is too advanced, dangerous complications have appeared.

Features of the therapeutic effect

If there are problems with the ear, the main therapy of the pathological process is due to the appointment of anti-inflammatory, analgesic, antibacterial drugs.

In parallel, compresses are also carried out using ointments, drops, boric alcohol. Given the complexity of the disease and its variety, sometimes surgical treatment may be required.

This procedure can have varying degrees of complexity, this is dictated by the severity of the disease being diagnosed. In addition, after such treatment, a long period of time is required for rehabilitation. And this significantly complicates the process of therapy. But in rare cases, such treatment is the only way to cure the disease, to prevent the development of possible complications.

The main indications for surgical treatment of pathology

If a disease such as otitis media develops, then surgery may be required for the inflamed organ, the disease of which has passed into an advanced stage, while conservative methods of therapy are ineffective.

In certain cases, this method is the most effective for eliminating intensely expressed painful sensations, for inhibiting destructive reactions in the body.

If the ear bones are affected, further spread of the infectious process occurs, a radical treatment option is a necessity.

Usually, this method of therapy is suitable for getting rid of a chronic type of disease. When it helps to eliminate the accumulation of purulent contents that cannot come out on their own.

Surgical treatment of otitis is necessary when the following clinical manifestations appear during the development of the disease:

• Hyperthermia, which does not subside even after the start of treatment with antibacterial drugs;
• The presence of abundant contents of a purulent nature;
• Intensely expressed painful syndrome;
• The presence of carious processes in bone tissues;
• Rupture of the eardrum;
• The presence of a chronic inflammatory process in the cavity of the organ with an intense process of suppuration;
• Significant deterioration in the quality of sound perception;
• Dysfunctions in the location and functioning of some departments of the hearing aid.

Before carrying out any intervention, diagnostic measures are necessarily prescribed, which include: otoscopy, computed tomography, and other important examinations.

The simplest intervention is to incise the tympanic membrane so that the contents can be freely brought out. With timely surgical therapy, the disease proceeds more easily, and the cure comes quickly. In addition to the fact that this procedure helps to bring out the exudate, it helps to restore the quality of sound perception and prevent the risk of infection.

The main contraindications for the intervention

Performing any surgical procedures for the treatment of otitis media of various forms is contraindicated in the following situations:

• If the condition is very severe;
• When chronic diseases go into the stage of active exacerbation;
• In the presence of sepsis;
• If there is complete deafness;
• In the presence of violations in the patency of the ear canal.

Features of surgical treatment

Surgical treatment, which needs chronic otitis media, involves getting rid of the focus of the inflammatory process, preventing further accumulation of purulent exudate. Since the outflow of fluid is impaired, there are positive conditions for further activation of pathogens.

Surgical treatment in a child and an adult is carried out according to almost the same algorithm. But at the same time, the child takes into account the underdevelopment of the structure of the ear apparatus.

The procedure for intervention in the presence of purulent otitis media of a chronic form is carried out as follows. To pump out the contents inside the organ, a resection of the eardrum is performed, a tube is inserted into its cavity for further drainage. After further sanitation, the damaged areas of the epithelial layer are excised.

In the event that there is a lesion of the internal part of the hearing aid, more complex manipulations will be required. The parts of the ear that have been damaged are removed.

Surgical treatment is usually performed under local anesthesia. The features of the procedure are the prevention of the inflammatory process, the removal of exudate from the cavity of the middle part of the ear apparatus. This medical procedure is called a myringotomy.

Preparation for the intervention begins with the use of antibacterial agents. The duration of the course of therapy is four days. Then you can carry out medical manipulations. In the event that there is a serious form, an incision is made along the entire perimeter of the membrane. In this case, one should be very careful not to penetrate deep into the tympanic cavity, not to damage the surface of its walls.

The final stage of therapy is the removal of purulent exudate, as well as the subsequent antiseptic treatment of the cavity with anti-inflammatory, antiseptic substances. At the end of all the performed manipulations, the incision itself is plugged.

In the event that an intensely pronounced inflammatory process is observed, and purulent exudate continues to accumulate, it will be necessary to install a special tube that will prevent the incision from overgrowing and will help ventilate the cavity.

This shunt is removed after the inflammatory process stops and the production of purulent exudate is inhibited. After the shunt is removed, the incision heals quickly.

Features of the recovery period

The recovery period after a medical procedure is much more difficult than the intervention itself. If the rules of personal hygiene are violated during the rehabilitation period, a relapse of a chronic disease may occur.

Exudate will begin to accumulate again in the place where the epithelial layer was previously damaged. Soon the contents again fill the cavity of the ear canal.

An important step in the recovery period is the regular change of sterile swabs. It is important to keep the ear canal clean at all times. After a while, tampons will no longer be needed, as the incision heals.

The total duration of the rehabilitation period with the constant wearing of tampons can last from several weeks to two to three months. It is important to visit a specialist regularly during this time to examine and check the quality of hearing.

During this period of time, it is important to ensure that water does not get into the ear, to avoid sudden blowing or sneezing, flights. According to experts, in almost all cases, after this treatment, there is an improvement in the quality of hearing.

In some cases, otitis media may require surgery. This procedure varies in complexity, depending on the diagnosis. In addition, long-term rehabilitation after the intervention is required, which complicates the treatment process. But sometimes this is the only way to get rid of the disease and its consequences.

Indications for surgery

Surgical intervention may require an ear affected by inflammation, which has passed into a complicated stage and is not amenable to conservative treatment. In some cases, this is the most effective way to get rid of pain and stop the destructive processes in the body.

With damage to the bone tissues of the ear and further spread of the infection, radical surgical intervention is a necessity.

Mostly in this way, a chronic type of disease is treated. This also includes the most common diagnosis in this category - chronic otitis media. In this case, the operation allows you to solve the problem and remove the purulent secret.

Surgery is necessary in cases where otitis media is accompanied by the following symptoms:

• elevated temperature;
• copious purulent exudate;
• severe pain;
• carious processes in bone tissue;
• perforation of the eardrum;
• violation of the position and functioning of individual elements of the ear.

Previously, the ear is examined with an otoscope, computed tomography and other necessary studies are performed.

Operation

The operation, which requires chronic purulent otitis, is aimed at removing the focus of inflammation and preventing further accumulation of secretions. Leathery pockets inside the middle ear cavity often cause a purulent secret to accumulate in it. Due to the violation of the outflow of fluid, a favorable environment is created for the development of pathogenic microorganisms.

An operation performed for otitis in a child is not much different from an operation in an adult, but at the same time, one can single out such a nuance as the underdevelopment of the hearing organs, which is associated with the ongoing growth processes of the body.

Chronic suppurative otitis media is promptly treated as follows. The tympanic membrane is incised to drain the pus, and then a drainage tube is inserted. After sanitation of the ear cavity, damaged areas of the epithelium are removed.

If the disease has affected the inner ear, more complex manipulations are performed in relation to those parts of the organ that have undergone changes.

Rehabilitation

Rehabilitation after surgery is a more complex process than the operation itself. Chronic suppurative otitis media can worsen if hygiene rules are violated in the postoperative period. In this case, a purulent secret is formed at the site of the damaged epithelium and fills the middle ear cavity.

Recovery can happen in different ways:

• Tamponade. After the primary healing of the epithelium, regular bandaging of the ear is performed. Additionally, antiseptics and antibiotics are used.
• dry method. In this case, the ear is cleaned daily and dried. To do this, boron powder is blown into the ear.

If the ear does not heal properly, in addition to the risk of recurrence of chronic suppurative otitis media, granulation and scarring may occur in the middle ear cavity.

A qualified surgeon and proper care after surgery increase the chances of the most effective elimination of the problem.

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.

Purulent otitis media

Modern drug therapy using drugs such as antibiotics, painkillers and anti-inflammatory ear drops, as well as various folk remedies used at home, can relieve inflammation, restore hearing and avoid the development of serious complications.

Types of otitis media

Otitis is usually classified depending on the localization into:

• interior, the development of which provokes chronic suppurative otitis media (if not treated);
• average, which acts as a complication of ENT diseases;
• outer, which occurs mainly after water enters the ear canal.

Causes of purulent otitis media

The main factors that can provoke the onset and development of the disease in adults include:

• the presence of adenoids;
• inflammation of the nasopharynx (rhinitis, sinusitis);
• viral infections (parainfluenza, SARS, influenza);
• decreased immunity;
• improper oral hygiene.

There are several ways for infection to enter the eardrum cavity. Most often, it penetrates there through the auditory tube in the presence of various inflammatory diseases. The development of traumatic otitis occurs due to infection of the cavity of the tympanic membrane of the middle ear through the mastoid process or injured tympanic membrane. Another, most rare, variant of infection penetration is hematogenous: during the course of diseases such as typhus, tuberculosis, scarlet fever, measles, influenza, pathogenic bacteria enter the middle part of the hearing organ through the blood.

Very often, infants suffer from various forms of otitis media, which is explained by the peculiarities of the anatomy of the child's ear. In infants, the auditory tube is much wider and shorter than in an adult, and is located almost horizontally. In this regard, the secret of the nasopharynx can freely pass through the open auditory tube, delivering pathogenic microorganisms to the middle ear. A slight inflammation can close the already small lumen of the auditory tube in the baby, reducing hearing and complicating the course of the disease. The result of this anatomical feature is often bilateral purulent otitis media. As the baby grows, their number decreases due to the development of the hearing aid.

Signs of the disease

Purulent otitis in adults has the following main symptoms:

• shooting or aching ear and headache;
• purulent discharge from the ears;
• congestion and noise in the ear;
• heat;
• reduced hearing.

Course of the disease

The course of purulent otitis occurs, as a rule, in several stages:

preperforative stage. The symptoms that appear at this stage are pronounced:

• sharp growing pain;
• reduced hearing;
• painful palpation of the mastoid process;
• temperature increase.

perforative stage, during which, after the rupture of the tympanic membrane, the release of pus begins, sometimes with an admixture of ichor. The temperature gradually drops, the ear pain subsides.

reparative stage. After the cessation of the outflow of pus and the gradual scarring of the openings of the eardrum, the patient's hearing is restored.

Acute purulent otitis media in adults lasts no more than 20 days on average. Weakened immunity or inadequate treatment can cause the development of any complication. At any stage, acute otitis media can transform into chronic suppurative otitis media, which is characterized by mild symptoms.

Acute form of the disease

Acute purulent otitis media in adults develops after a pathogenic environment enters the middle ear through the auditory tube, which occurs during acute or exacerbation of chronic diseases of the upper respiratory tract or upper respiratory tract.

The first, or catarrhal, form of otitis media, which lasts from several days to 2 weeks, is characterized by the onset of an inflammatory process with the formation of exudate.

The next stage - purulent otitis media - begins with the perforation of the eardrum, after which the outflow of pus occurs, lasting about 6-7 days, and the subsequent subsidence of pain.

The third stage is characterized by the attenuation of inflammation, the decrease and cessation of suppuration, during which hearing may decrease. You can restore it gradually as the scarring of the perforation of the eardrum.

Chronic form of the disease

Chronic suppurative otitis media, which is an inflammatory process of the middle ear, is characterized by:

• perforated eardrum;
• recurrent course of pus from the cavity of the organ of hearing;
• reduced hearing, the loss of which can reach up to 50%.

Chronic purulent otitis media develops in cases where the patient did not treat or treated incorrectly acute purulent otitis media. It can appear as a complication of chronic sinusitis or rhinitis, as well as due to rupture of the eardrum after an ear injury. Chronic otitis media affects one in 100 people worldwide. In almost half of all cases, the disease makes itself felt in childhood, manifesting itself even in infants. Possible intracranial complications are a real danger not only to health, but also to the life of the baby.

Acute otitis in adults can turn into a chronic form due to the presence of such adverse factors as: low resistance of the human body to infections, the presence of concomitant diseases of the respiratory tract, blood and ENT organs.

Chronic purulent otitis media, depending on the location of the perforated opening of the tympanic membrane and the severity of the disease, is divided into 2 forms:

• mesotympanitis, in which the mucous membrane of the tympanic cavity and the auditory tube is affected;
• epitympanitis, in which bone tissue is already involved in the inflammatory process, which can lead to its necrosis.

Complications

Improper treatment for purulent otitis media, after which purulent-inflammatory pathology begins to cover bone tissue, is fraught with severe irreversible consequences.

In this case, the following complications are possible:

• violation of the eardrum, after which you can completely lose your hearing;
• mastoiditis (inflammatory process of the temporal bone);
• osteitis (bone caries);
• labyrinthitis (inflammation of the inner ear);
• meningitis (inflammatory disease of the lining of the brain)
• encephalitis (inflammatory pathology of the brain).

Treatment of purulent otitis media

Diagnosis of the disease in adults, as a rule, is not difficult. The diagnosis of "acute purulent otitis" is made on the basis of the patient's complaints and the results of otoscopy. If bone destruction is suspected, an x-ray of the temporal bone is taken.

Treatment of the disease in adults is carried out on an outpatient basis, in the presence of fever and high temperature, the patient is prescribed bed rest. It is necessary to treat acute otitis in a hospital if there is a suspicion of damage to the mastoid process.

Medical treatment includes:

• antibiotics;
• astringent or vasoconstrictor drops;
• painkillers.

It is necessary to treat acute suppurative otitis media based on the severity of symptoms and the stage of the disease.

At the preperforative stage of the disease, to stop a severe pain syndrome, such agents are used as: alcohol solutions (boric acid or chloramphenicol with glycerin), warmed ear drops (otipax, anauran), oral preparations (diclofenac, paracetamol);

Means for simulating drainage function: vasoconstrictor drops (galazolin, otrivin), warming alcohol compresses on the ear area to accelerate the resolution of the inflammatory process at home.

If necessary, paracentesis is used. During this operation, the tympanic membrane is punctured for unhindered outflow of pus.

At the second, perforative, stage, experts recommend treating the disease using drug therapy:

• vasoconstrictor nasal drops;
• antibiotics;
• antihistamines;
• mucolytics (fluimucil, ACC);
• ear drops in a heated form after cleansing the ear with a solution of hydrogen peroxide.

In addition, effective physiotherapy treatment includes:

• warm compresses at home on the ear area.

Treatment at the reparative stage, the main purpose of which is to strengthen the immune system and restore hearing, is stopped: antibiotics, mechanical cleansing of the ear canal, and thermal procedures are cancelled. To prevent adhesions in the tympanic cavity, endaural iontophoresis using lidase, pneumatic massage of the tympanic membrane, enzyme agents can be prescribed. To restore hearing, surgery may be needed to remove adhesions and straighten the eardrum.

1. Bury a sore ear with a non-perforated eardrum twice a day with a mixture prepared from mummy and rose oil mixed in a ratio of 1 to 10.
2. As an anesthetic, inject a cotton flagellum soaked in a solution prepared from 100 g of water and 2 g of mummy into the ear.

1. Bury in the ear three times a day drops made from freshly squeezed lemon juice.
2. Treat the ear canal of the affected ear with a mixture prepared from honey and pomegranate juice taken in equal amounts.
3. For 3 weeks, insert a flagellum soaked in a 20% alcohol solution of propolis into the ear.

These and other folk remedies can be successfully used at home for both adults and children who have previously consulted with their doctor.

Choice of antibiotics

Antibiotics in the treatment of acute purulent otitis are selected based on the spectrum of the causative bacterial flora. To date, cephalosporins (ceftriaxone, cefaclor, cefazolin), aminopenicillins (amoxil) and macrolides (clacid) have found wide application in otolaryngology. These antibiotics effectively cover with their activity those pathogenic microorganisms that cause inflammatory diseases of the ear.

Antibiotics for children are prescribed with extreme caution, depending on the severity of the disease and the age of the baby. The most popular antibacterial agents in children: supraks, flemoxin, amoxiclav, amoxicillin. Antibiotics are available in a convenient form for use in the form of soluble tablets, suspensions and syrups.

The duration of the course with these drugs should be at least 7-10 days. If antibiotics are canceled earlier, this can provoke a relapse of the disease, its transition to a chronic form and the development of complications.

Otipax ear drops are well known to both patients and doctors. Being a combination of drugs such as phenazone and lidocaine hydrochloride, Otipax is a non-steroidal agent that has an anti-inflammatory effect and gives a local anesthetic effect.

Otipax is effective as a symptomatic treatment for some forms of chronic suppurative otitis, as well as after an operation has been performed.

In addition, otipax has found its application in:

• otitis media in the acute period;
• viral otitis;
• barotraumatic otitis.

In adults, otipax is used 4 drops 3-4 times a day, in children under one year old - 1-2 drops, 1-2 years old - 3 drops, older people - 4 drops three times a day. Treatment with Otipax should be carried out for 3 to 10 days. When using the drug in the recommended dosage, an overdose is unlikely.

Timely use of Otipax prevents the development of purulent complications and perforation of the eardrum.

Disease prevention

Everyone knows the common truth that the disease is easier to prevent than to treat later. To prevent such a disease as acute purulent otitis, it is necessary to eliminate the main factors that can lead to its occurrence. For this it is important:

• engage in hardening of the body;
• keep the ear canals clean at home;
• timely treat infectious and chronic diseases and visit the dentist.

The best preventive measure for a baby is breastfeeding.

Having imputed to yourself the fulfillment of these simple measures as a rule of life, you can forever forget about such a disease as purulent otitis media, and keep your ears healthy and your hearing sensitive.

Purulent otitis: causes, symptoms, treatment

Inflammation of the middle ear is accompanied by the development of acute otitis, and under adverse conditions the process becomes chronic. Acute suppurative otitis media is often observed in children. Proper treatment of this disease is necessary so that signs of chronic inflammation do not appear. Purulent otitis is accompanied by the release of pus, increasing deafness and the formation of a hole (perforation) in the eardrum.

Causes of the disease

In childhood, otitis media suffered almost every second. Today, its prevalence among schoolchildren is 1%, and among young recruits it increases to 4%. In 6 out of 10 children with persistent deafness, the cause of this condition was complications from inflammation of the ear.

Bilateral suppurative otitis usually occurs after a respiratory illness or any childhood infection. The disease can also be unilateral. The disease appears when, against the background of weakened local immunity of the mucous membrane, bacterial microorganisms enter through the hole connecting the nasopharynx and middle ear. There they multiply and cause symptoms of purulent otitis media.

Bacteria that cause purulent otitis:

• hemolytic streptococcus;
• Proteus;
• staphylococcus;
• Pseudomonas aeruginosa;
• mycoplasma;
• chlamydia;
• anaerobic infection.

Acute purulent otitis media transforms into chronic under the influence of general and local unfavorable factors.

Common causes of process chronization:

• entry of highly active microbes into the middle ear cavity;
• starvation, exhaustion, beriberi;
• hereditary predisposition to pathology of ENT organs;
• chronic allergic diseases (hay fever, asthma);
• diseases of the respiratory and digestive organs (bronchitis, peptic ulcer, and others), which serve as a source of constant infection;
• improper treatment of purulent otitis media in adults and children;
• frequent acute inflammation in the middle ear.

Local factors favorable for the transition of an acute form to a chronic one include:

• violation of the structure and patency of the auditory tube;
• adenoids;
• chronic rhinitis and sinusitis;
• nasal polyps;
• an increase in the inferior nasal concha, which disrupts the function of the auditory tube;
• anatomical features in children that cause rapid swelling and stagnation of the contents in the middle ear during its inflammation;
• small airiness of the mastoid process.

Clinical signs

Acute inflammation of the middle ear is accompanied by such signs of purulent otitis media:

• fever;
• acute pain in the ear;
• weakness, headache, nausea;
• purulent ear discharge;
• on examination - redness of the eardrum.

If purulent otitis in adults or children becomes chronic, it can occur in two main forms:

• mesotympanitis (only the mucous membrane becomes inflamed);
• epitympanitis (involved bone tissue).

There are two variants of the course of the disease. In the first case, there is a hole in the eardrum without discharge, which is accompanied by hearing loss. The exacerbation is provoked by the ingress of water into the ear and is accompanied by the signs of acute otitis media listed above. Neurological complications of otitis media may occur. They may be accompanied by unsteadiness when walking and dizziness.

The second option is accompanied by a constant discharge of pus or clear fluid from the ear. With exacerbations, the temperature rises and the discharge intensifies. The constant release of purulent contents irritates the skin and causes external (that is, inflammation of the auricle) purulent otitis media. It is manifested by itching and soreness of the skin.

With epitympanitis, a complication is often formed - cholesteatoma.

What is cholesteatoma

With purulent epitympanitis in children, more often in boys, a peculiar formation appears in the form of a tumor - cholesteatoma. It is not clear by what processes it arises. Some scientists believe that cholesteatoma occurs when the epithelial cells of the middle ear change under the influence of hereditary disorders. Others believe that this formation appears as a result of the penetration of the epithelial layer of the external auditory canal into the tympanic cavity with defects in the tympanic membrane.

Cholesteatoma is impregnated with dead epithelial cells, decay products of microbes, fatty substances and cholesterol. Its shell grows and destroys the temporal bone (earlier such a disease was called a carnivore). With mesotympanitis, such formation is observed only in 3% of patients.

The destruction of the temporal bone is diagnosed by enlightenment, visible on the radiograph. Features of cholesteatoma in children:

• the practical absence of symptoms;
• short formation time;
• growth in the first 5 years of life;
• tendency to relapse.

Diagnostics

The patient is asked about the course of the disease, the frequency of exacerbations, symptoms and previous treatment. Additional diagnostic methods are used.

The consequences of purulent otitis media are the formation of a hole in the eardrum and permanent hearing loss. The hole during examination may have a different shape and edges. If the edge is even, such a perforation is called central and accompanies a milder form - mesotympanitis. If there is no edge, and the membrane is completely absent, this picture is typical for epitympanitis.

With mesotympanitis, abundant, odorless mucous discharge is visible. If the osteomyelitic process begins with the decay of the bone, the contents of the middle ear become thicker and become putrid (ichorous).

If, with mesotympanitis affecting the mouth of the auditory tube, the hole in the membrane is low, this causes very abundant mucous discharge from the ear.

With epitympanitis, bone tissue is destroyed, and granulations (growths) form in its place. They are often seen on otoscopy through a hole in the eardrum. At the same time, blood appears in the secretions. Growing granulations through the defect of the membrane penetrate into the outer ear in the form of a polyp. With mesotympanitis, an ear polyp is formed in rare cases.

Hearing study

The cause of hearing loss in epi- and mesotympanitis can be various pathological processes. Usually they are associated with a defect in the tympanic membrane and fusion between the bones of the middle ear. With epitympanitis, the inner ear often becomes inflamed, which also leads to deafness.

The growth of polyps or cholesteatoma tissue with epitympanitis, on the contrary, can improve hearing, since a dense medium conducts sound waves better.

Radiography

X-rays in different projections can in some cases reveal cholesteatoma. However, this method is not decisive in the diagnosis of otitis media.

Differential Diagnosis

To properly treat the disease, it is necessary to distinguish it from similar processes:

With histiocytosis, in addition to symptoms from the ENT organs, there is an increase in the liver and spleen, damage to bones, skin and lymph nodes, proliferation of granulomas, "protrusion" of the eyeballs (exophthalmos).

Sarcoma of the middle ear is a rare tumor that develops in children and quickly metastasizes. It is diagnosed with a biopsy of malignant tissue.

The duration of treatment for otitis media depends on the stage of the disease, the condition of hearing, the eardrum and other characteristics. An individual treatment plan is drawn up for each patient. Therapy for most forms of otitis media is medical, and only in chronic epitympanitis with bone destruction is surgery prescribed.

Acute suppurative otitis media

Shows bed rest and rest. Antibiotics and antipyretics are prescribed. Treatment with a sollux lamp (“blue lamp”) or UHF, as well as a helium-neon laser, is indicated. Vasoconstrictor nasal drops are prescribed to facilitate the outflow of contents through the auditory tube into the nasopharynx.

Warm anesthetic drops are used for otitis media:

• 96% medical alcohol;
• 5% solution of phenol in glycerin (with the appearance of pus they are canceled);
• Otipax (with a whole eardrum);
• Otofa (antibiotic drops) and others.

Any treatment for otitis should be prescribed only by an ENT doctor! Many medications are contraindicated for perforated eardrums and can lead to complications and deafness.

If, despite the treatment, pus remains in the middle ear, the membrane is punctured and this content is removed. Then the hole gradually heals.

Exacerbation of chronic otitis media

Any treatment will be effective only after the removal of pus. To do this, use a thorough cleansing of the ear canal with cotton wool wrapped around a thin probe. Solutions of boric acid, albucid, furacilin, dioxidine and other antiseptics are instilled into the ear. Systemic antibiotic therapy is prescribed.

With persistent treatment, it is possible to stop the outflow of pus from the ear even in the chronic course of the disease in 85% of patients.

Chronic otitis media in remission

If the patient applied without exacerbation and he does not have suppuration from the ear, the following are used:

• removal of adenoids, treatment of tonsillitis, caries, sinusitis;
• hardening;
• When bathing, cover your ears with cotton wool soaked in Vaseline.

To close the perforation of the membrane, its edges are cauterized, treated with a laser, or plastic (recovery) is performed.

With epitympanitis, when the bone is affected by a purulent process, treatment is much more difficult. If the hearing is not yet lost, very complex microsurgical interventions are used to remove the purulent focus and preserve the auditory function.

With complete hearing loss as a result of chronic otitis media, all affected tissues are removed and the hearing aid is restored using tympanoplasty. If such an operation is not performed, in the future the patient is invited to use an auditory prosthesis.

Is ear surgery for otitis media scary?

Otitis media is a common inflammatory disease of the middle ear. The disease occurs in both children and adults. When the acute form is started, the pathology passes into the chronic stage. In childhood, otitis media leads to problems in the development of speech, delayed psychomotor development. In chronic form in adulthood contributes to the development of deafness.

The main principles of the treatment of the disease are anti-inflammatory, analgesic and antibacterial therapy. Along with antibiotics, patients are prescribed compresses from boric alcohol and Vishnevsky ointment, various drops, warming up. Depending on the complexity of the disease and its form, surgery may be required.

When is surgery required?

Surgery is performed when the disease is in the chronic or acute stage. The procedure involves an incision in the eardrum. It is necessary for the outflow of purulent contents from the ear. Timely surgical care leads to an easier course of the disease and contributes to the complete cure of the patient.

The main indications for intervention:

• increased body temperature;
• the formation of abundant purulent exudate;
• pain in the ear;
• development of carious processes in bone tissues;
• membrane perforation;
• hearing loss;
• chronic inflammatory processes in the middle ear with severe suppuration.

Reference. In addition to the withdrawal of purulent contents, the procedure is also prescribed to restore ear function and exclude infection.

Ear surgery for otitis is contraindicated:

• in case of serious condition of the patient;
• with chronic diseases in the active phase;
• during sepsis;
• with complete deafness;
• with violations of the patency of the auditory tube.

Intervention stages

The operation is performed under local anesthesia. For young children and excitable patients, the use of round anesthesia is allowed. Features of the operation - to prevent inflammation and remove purulent contents from the middle ear.

The procedure is called myringotomy. If the tympanic membrane is perforated, it may need to be reconstructed. Such a procedure is called myringoplasty.

The main event in preparation for surgery is course of antibiotics. It is prescribed in a complicated situation. The course lasts no more than 4 days. After that, the procedure itself is carried out.

The operation consists in piercing the membrane with a spear-shaped needle. Modification of the membrane requires its incision. Usually it is localized in the lower segment of the ear. Serious modifications require an incision in the central segment of the membrane.

If chronic otitis is diagnosed, the operation involves a puncture around the entire perimeter evenly. It is important that the needle does not penetrate deep into the tympanic cavity and does not damage the surface of the walls.

The final stage is to remove the purulent contents and treat the cavity with an anti-inflammatory and antiseptic composition. Finally, the incision is sealed.

If the inflammatory process is strong and purulent contents are constantly formed, a shunt may be required - tympanostomy tube. It prevents overgrowth of the incision and provides ventilation of the cavity.

The shunt is removed after the inflammatory process is completely blocked, and purulent contents are not released. After the tube is removed, the incision heals quickly.

Features of rehabilitation

The operation is a quick procedure that takes place without major complications. It is important to take proper care of the ears during the rehabilitation phase. In most cases, after surgery, the patient remains in the hospital. At this time, the doctor observes the incision and the formation of purulent contents.

The patient is prescribed course of antibiotics. It lasts from 7 to 10 days. Antibiotics help to avoid possible complications and the development of infection. Taking antihistamines is necessary to relieve swelling and reduce pressure in the ear canal.

Another stage of rehabilitation is the constant replacement of tampons. The ear canal must be kept clean. Gradually, the tampons are removed. When setting tympanostomy tubes, a constant visit to a specialist will be required.

They are set for a period from 2-3 weeks to several months. At each appointment, the specialist conducts a hearing test and examines the tubes.

Important! At the rehabilitation stage, it is necessary to avoid getting water into the ears, you should not blow your nose sharply or sneeze. Air travel, swimming pool, diving and other pressure swing activities are not recommended.

Surgery for otitis is performed at various stages of the disease and is not serious. The main task of the patient is to properly prepare for the procedure and fulfill all the requirements of the doctor at the stage of rehabilitation.

Experts note that after the operation, the quality of hearing improved in most patients. Inflammatory processes in the ear began to take place less acutely. Otitis does not become chronic and does not lead to perforation of the eardrum.

Purulent otitis media operation

Symptoms and course:

Discharge from the ear may be mucous, mucopurulent, and rarely purely purulent, usually odorless. Sharp, sometimes fetid, occurs when pus is retained in the ear canal (with poor ear care). Hearing loss is usually the type of violation of the sound-conducting system. The degree of depression depends on the preservation of the ossicular chain of the middle ear and the loss of mobility due to scarring.

Under unfavorable conditions, suppuration can continue for many years, in the absence of complications, disturbing patients a little, since it is not accompanied by pain or fever. With a one-sided lesion, some do not even notice a decrease in hearing. With the complete cessation of suppuration, a small perforation may close with the formation of a scar on the membrane. Hearing usually does not fully recover.

Based on anamnesis, ear examination. Additionally, x-rays of the temporal bones and sowing from the ear for flora and sensitivity to antibiotics are performed.

Complete nutrition, hardening, biostimulants, homeopathy, etc., treatment of common diseases, sanitation of the upper respiratory tract, sometimes surgical. Local therapy is reduced to a thorough and systematic removal of pus and the use of disinfectants and astringents to act on the mucous membrane. With abundant secretions, the ear is washed with a solution of hydrogen peroxide 3%, ethacridine lactate (1: 1000), antibiotics (according to the results of sowing) and then blown into the ear in the form of a powder.

The use of drugs should be alternated after 12-15 days, because. microbes become resistant to drugs. Antibiotics are administered intramuscularly only with exacerbation and ineffectiveness of local treatment. As physiotherapy - UVI through a tube, UHF, laser radiation, mud therapy. In the presence of granulations and polyps, minor surgical operations are resorted to.

Chronic purulent otitis media without bone destruction and complications can be treated with medication under the outpatient supervision of an otolaryngologist. Such drug therapy is aimed at removing the inflammatory process. In cases where chronic suppurative otitis media occurs with bone destruction, it is essentially a preoperative preparation of the patient. If chronic purulent otitis media is accompanied by paresis of the facial nerve, headache, neurological disorders and / or vestibular disorders, then this indicates the presence of a destructive process in the bone and the development of complications. In such a situation, it is necessary to hospitalize the patient as soon as possible in a hospital and consider the issue of his surgical treatment.

Chronic suppurative otitis media is usually treated conservatively or preoperatively for 7-10 days. During this period, the ear toilet is performed daily, followed by washing the tympanic cavity with antibiotic solutions and instillation of antibacterial drops into the ear. Given that chronic suppurative otitis media is accompanied by perforation in the eardrum, ototoxic aminoglycoside antibiotics cannot be used as ear drops. You can use ciprofloxacin, norfloxacin, rifampicin, as well as their combination with glucocorticosteroids.

For the purpose of complete rehabilitation and functional recovery, chronic suppurative otitis media with bone destruction needs surgical treatment. Depending on the prevalence of the purulent process, chronic purulent otitis media is an indication for a sanitizing operation with mastoidoplasty or tympanoplasty, aticoanthrotomy, mastoidotomy, labyrinthotomy and plastic labyrinth fistula, removal of cholesteatoma. If chronic purulent otitis media is accompanied by diffuse inflammation with the threat of complications, then a general ear surgery is performed.

Intracranial - meningitis, local - mastoiditis, hearing loss, granulation, polyps.

The information in this section is intended for medical and pharmaceutical professionals and should not be used for self-medication. The information is provided for informational purposes and cannot be considered official.

What help is needed for the ear with purulent otitis

Purulent otitis media (in accordance with the generally accepted international system ICD 10, the disease was assigned the code H66) is a complicated inflammation in the middle ear after pathogenic bacteria enter this section. The disease is usually accompanied by severe pain, fever. After perforation of the eardrum, discharge appears. Under the condition of an early start, the treatment of purulent otitis is usually not difficult.

The classic treatment regimen includes antibiotics and the fight against infection in the nasopharynx. Additionally, physiotherapy may be prescribed. But if the course of taking the drugs is not completed, or the disease is left to chance, the inflammation turns into a chronic sluggish process or spreads further. More often with prolonged purulent otitis media, there is such a complication on the ears as hearing loss.

Pathogenesis and main causative agents of purulent otitis

The auditory or Eustachian tube is a kind of bridge connecting the nasal cavity and ears. It is clear that any microflora from the nasopharynx can easily penetrate into the space behind the eardrum. However, the appearance of signs of purulent otitis is prevented by the properties of the epithelium covering the inner wall of the Eustachian tube. The mucus secreted by these cells contains various components, local immunity factors with antimicrobial activity.

Therefore, normally, these substances prevent the spread of bacterial flora and the occurrence of a disease such as purulent otitis media. However, under the influence of a number of factors, which, among other things, cause the appearance of non-purulent inflammation in the ear, the rheology of the mucus and the functioning of the structures that secrete the secret are disturbed. As a result, pathogenic bacteria can freely enter the cavity of the organ of hearing. The buildup of pressure usually results in perforation of the eardrum.

Identification of the causative agent in each case of purulent otitis media is difficult, since for this it is necessary to inoculate the secret obtained from the middle ear cavity. This procedure is invasive and can be performed using a special puncture microneedle. Usually, such a manipulation is done in the case of recurrent ear purulent otitis media. According to statistics, usually inflammation in the ear is caused by strains of bacteria that are constantly present in the nasopharynx in almost every person.

These are pneumococcus and Haemophilus influenzae. Moreover, half of them secrete β-lactamase, which makes these microorganisms resistant to most antibiotics from the penicillin group. More rarely, purulent otitis is a disease caused by strains of bacteria Moraxella, Staphylococcus aureus, β-hemolytic streptococcus. According to doctors, it is possible to assume the role of mycoplasma and chlamydia in the occurrence of symptoms of inflammation in the ear.

Classification of purulent otitis media

Depending on the rate of development of clinical signs, several stages of the course of purulent otitis are distinguished. But there is another classification of the disease. It is based on physiological changes that are noticeable only after the ears are examined by an ENT doctor. According to the nature of the perforation of the tympanic membrane and the degree of involvement in the inflammatory process of the departments of the organ of hearing, purulent otitis media of the following forms are distinguished:

• tubotympanic (mesotympanitis), when the disease captures only the Eustachian tube and the space behind the eardrum;
• epitympano - antral (epitympanitis) with damage to the auditory ossicles and tissues of the mastoid process.

The first form of the disease can be considered favorable. It is successfully treated and does not lead to severe hearing impairment. Changes after epitympano - antral type of inflammation are usually irreversible and require a complex surgical operation. Depending on the frequency of occurrence of symptoms of purulent otitis media, the disease can be acute or chronic.

Etiological factors in the development of acute and chronic suppurative otitis

All causes of purulent otitis can be divided into several groups. These are tubogenic (or rhinotubercular), that is, the penetration of infection through the auditory tube, external, affecting the ears during perforation of the eardrum and hematogenous. In the latter case, the microbial flora enters the internal cavity of the organ of hearing with blood from other foci of inflammation. Needless to say, this situation is extremely rare. The following factors can cause pain and other symptoms of acute purulent otitis media:

• angina, it must be emphasized that this disease is contagious, but leads to the development of inflammation in the ear only if there are predisposing causes;
• tonsillitis;
• pharyngitis;
• bacterial rhinitis, sinusitis;
• trauma with damage to the tympanic membrane and mastoid process;

In addition, purulent otitis media can be the result of measles, scarlet fever, diphtheria, and tuberculosis. Often a similar disease occurs after the transferred influenza virus. A retrograde path of transmission of pathogenic microflora is also possible with labyrinthitis, meningitis, or an abscess in the cranial cavity. An exacerbation of a chronic inflammatory process appears against the background of respiratory infections, water entering through an unextended eardrum when swimming or diving, and hypothermia.

Provoking factors

As practice shows, the presence of one or even several of the listed reasons does not always cause purulent otitis media in adults and children. Predisposing factors to the occurrence of an acute or chronic form of the disease are insufficient nutrients in the diet, beriberi. Persistent swelling of the nasal cavity causes an allergic reaction, adenoid vegetations, disorders of the nervous regulation of the vessels of the mucosa (vasomotor rhinitis). They interfere with the normal functioning of the nasopharyngeal system - Eustachian tube polyps, neoplasms. The risk of developing purulent otitis media increases with weakened immunity as a result of HIV infection or AIDS, under the influence of taking certain medications (cytostatics, corticosteroids, chemotherapy drugs).

Stages of purulent otitis media

Unlike other forms of inflammation of the middle ear, purulent is characterized by pronounced clinical signs. Their intensity and development is closely related to the disorders occurring in the tympanic cavity. The disease proceeds in several stages. They are called the stage of purulent otitis media:

• preperforative. An inflammatory process begins in the mucous membrane of the Eustachian tube, which gradually covers the space behind the tympanic membrane;
• direct perforation of the membrane. By all the laws of physics, pressure in the middle ear cannot increase indefinitely. As a result, a large volume of serous fluid mixed with mucus and pus breaks through the thin membrane. In addition, the transudate contains proteolytic enzymes that contribute to the destruction of the tissues of the membrane;
• postperforative. With a favorable course at this stage, scarring of the eardrum begins. This process can be compared to the healing of a small scratch. But if the size of the perforation exceeds 1 mm, the hole is covered with mucous tissue, which is more susceptible to the influence of environmental factors.

However, this classification is not applicable to chronic suppurative otitis media. The exacerbation usually begins bypassing the first stage. It is also worth noting that the presence of mixed microflora is characteristic of long-term inflammation. Therefore, this form of the disease is more difficult to treat.

Clinical manifestations and diagnosis of purulent otitis

Symptoms of purulent otitis in adults and children increase gradually. But in some cases, a person does not pay due attention to the first clinical signs of inflammation. Usually an acute infection is preceded by a feeling as if water had entered the ears. Then there are such signs of purulent otitis media:

• severe pain, since in the cavity of the organ of hearing there are sensitive endings of nerves that transmit impulses to other tissues of the face, soreness is felt in the jaw, temple, cheek;
• discharge from the ear canal. Their nature depends on the form of the disease. So, mesotympanitis causes an odorless mucous discharge, and epitympanitis causes scanty, thick, fetid discharge;
• hearing impairment, the symptom is subjective, since a slight deterioration in this function does not mean that the bone tissue is not affected by the infectious process;
• the temperature with purulent otitis rises to 38 ° and above, but usually decreases after perforation and exudate.

The disease can be determined by examining the eardrum by an ENT doctor. Further diagnostics by radiography and tomography is necessary when deciding whether to perform a surgical intervention. If the results of the examination are in doubt, blood and urine tests may give directions to find out the exact cause of the temperature increase.

Ear drops for the treatment of purulent otitis media

It must be said that drops with purulent otitis media should be prescribed with caution. The fact is that most drugs cause irreversible hearing loss. Therefore, the list of drugs that can treat the disease at the stage of perforation of the tympanic membrane is limited to a few medicines. At the first stage in the treatment of purulent otitis media (if there is no discharge), you can drip the following drugs:

These drops are not used for long-term treatment of purulent otitis in adults and children, since they do not have antibacterial activity. Due to the ototoxic effect, their use is limited during pregnancy and lactation. The same can be said about antimicrobial ear drops. Antibiotics contain such drugs prescribed for the treatment of otitis media:

The advantages of Anauran and Candibiotic drops are the presence in their composition, in addition to the antibiotic, of an anesthetic and an anti-inflammatory component. Therefore, they are recommended to be used in the initial stages of purulent otitis to relieve pain instead of Otipax and its analogues. Separately, it must be said about such a drug as Otofa. This remedy contains the antibacterial substance rifampicin and is the only medicine that can be dripped for a perforated eardrum.

Other medications for the treatment of purulent otitis media

Unlike non-purulent forms of inflammation of the ear, it is contraindicated to warm up and make compresses in acute and chronic purulent otitis media. Heat provokes further reproduction of pathogenic microflora and greatly increases the risk of meningitis and other dangerous complications. Therefore, it is better to use gauze or cotton swabs soaked in antimicrobial solutions. Doctors advise using Miramistin or Dioxidin.

These drugs are not available in the form of ear drops. Miramistin is sold in vials, and Dioxidin is sold in ampoules. They can also be instilled into the ear in the same dosage as other means - 3-4 drops 2-3 times a day. It must be emphasized that, regardless of whether right-sided or left-sided otitis media, both ears should be treated simultaneously.

Antibiotics for systemic use - the main therapy for purulent otitis media

Treatment of purulent otitis in most cases is not complete without antibacterial drugs. The complications that this disease can cause are much more dangerous than the possible side effects from the use of drugs in this group. Therefore, antibiotics are prescribed when severe symptoms of purulent otitis appear, when the temperature is kept at 37.5 ° and above for two days or more. Usually drugs with a wide spectrum of effectiveness are used.

For example, during pregnancy, the use of a protected form of amoxicillin Amoxiclav is allowed. Relatively safe for a newborn is a medicine from the cephalosporin group Ceftriaxone. Its counterpart is Zinnat. However, this antibiotic is prescribed for purulent otitis for children older than 2 years and adults.

How long the treatment lasts depends on at what stage of the disease the antibacterial drug was started. If the medicine was prescribed at the first symptoms of the pathology, this period is 7-10 days. With the spread of a purulent process, it is possible to prescribe a combination of antibiotics. In this case, the course of admission lasts up to two weeks.

Complications of purulent otitis media

Complications of purulent otitis occur with improper treatment of the disease at home or even in its absence. In addition, ear compresses and heating can worsen the patient's condition. Therefore, timely diagnosis and compliance with the doctor's recommendations are of great importance in the prevention of complications of purulent otitis media. Otherwise, mastoiditis, labyrinthitis and otogenic intracranial pathologies may occur.

This is a lesion of all tissues of the mastoid process with bone destruction. Usually occurs at a late stage of ear inflammation (at the end of the second - beginning of the third week of the disease). Symptoms of mastoiditis are fever, hearing loss, pain when pressing on the tragus, swelling behind the auricle, as a result of which it bulges noticeably. Sometimes it is possible to release pus not only due to perforation of the eardrum, but also through the back wall of the ear canal.

At the initial stages of mastoiditis, its therapy does not differ from the treatment of purulent otitis media in adults. But if the use of Amoxiclav or Ceftriaxone remains ineffective, Levofloxacin is indicated. In the treatment of the disease, surgical intervention is widely used. However, the indication for surgery is the deterioration of the patient's condition while taking antibiotics.

Labyrinthitis and meningitis

Labyrinthitis is an acute purulent inflammation of the inner ear, which is limited or diffuse. It is dangerous by damage to the vestibular apparatus and the sound analysis system. Even with timely treatment, several outcomes of the pathology are possible. This recovery, the cessation of inflammation with a persistent impairment of hearing and a sense of balance, purulent labyrinthitis and the death of all cell receptors.

Rzayev R.M. Chronic otomastoiditis (with cholesteatoma). At the patient (50 old-years) with chron

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Prof. Polunin M.M., Ph.D. Ivanenko A.M., Kulmakov S.A., B.

Meningitis is dangerous due to the rapid development of symptoms, disability and death of a person. Typical clinical signs of the disease are a sharp increase in temperature, vomiting not associated with food intake, photophobia, bursting headache. From the first day of the development of pathology, characteristic meningeal symptoms appear. These are neck stiffness and Kernig's syndrome.

Surgical treatment of purulent otitis

The most common and relatively minimally invasive method for surgical treatment of purulent otitis media in adults and children is the puncture of the eardrum. It is done with a special scalpel under local or general anesthesia. Through the holes, the ear cavity is washed and a mixture of hydrocortisone glucocorticoid and antibiotic in saline is poured. After the procedure, a sterile swab is inserted into the ear canal and free discharge of pus from the tympanic cavity is ensured. Recurrent otitis requires other operations to restore hearing:

• mastoidoplasty for the reconstruction of the mastoid process;
• tympanoplasty, its purpose is the sanitation of the ear cavity and the regeneration of the eardrum;
• atticoanthromy is designed to remove necrotic tissue;
• mastoidectomy, this operation for purulent otitis media is performed to cure mastoiditis if there is no effect from drug therapy.

With damage to the inner ear in childhood and adulthood, a labyrinthotomy is indicated. In most cases, doctors try to perform hearing-preserving surgery. However, with the further development of the inflammatory process and the risk of meningitis and intracranial abscesses, a radical operation is indicated. Remove the remnants of the auditory ossicles and eardrum. The main complication of this procedure is a hearing loss of approximately 30 dB. This intervention is carried out only in a hospital after the patient has been hospitalized. The doctor will show a detailed video of the operation during the consultation.

Traditional medicine and physiotherapy

Of the methods of physiotherapy for the treatment of purulent otitis, a helium-neon laser, washing the ear cavity with hydrogen peroxide and other antiseptic solutions, and ultraviolet radiation are widely used. It is contraindicated to warm the ear with compresses, to act on active points with acupressure with symptoms of purulent otitis media. Chronic inflammation of the ear can be treated with homeopathic remedies. Folk methods of treating the disease are also widespread:

• take in equal proportions the grass of celandine, St. John's wort, calendula and succession (photos of these plants can be found in the reference book). Pour 100 ml of boiling water and leave for 8 hours. Bury in a sore ear, before that it should be washed with drops of hydrogen peroxide;
• pour a glass of vegetable oil into an enamel pan, add a tablespoon of beeswax and bring to a boil. Then gradually mix in the pounded yolk of a boiled chicken egg and filter through a sieve or gauze. Use the ointment to lubricate the skin behind the ear or apply to a cotton swab and insert into the ear canal;
• chop the garlic, squeeze out its juice, dilute with warm boiled water in a ratio of 1:1. Moisten gauze turundas in this solution and insert them into the ear for 20-30 minutes.

The consequences of purulent otitis media are very severe, therefore, treatment with folk remedies at home is contraindicated in infants and children under 2 years of age. A child should also not be vaccinated if there are the slightest signs of an inflammatory process. Recurrent purulent otitis media requires mandatory monitoring by an ENT doctor. Surgery done before irreversible changes develop will help preserve hearing.

Ear surgery for chronic suppurative otitis media

With otitis media, the external or external part of the ear apparatus is affected. The disease can occur regardless of the age category. At the same time, if the ears are affected by a neglected form of the disease, it often passes into a chronic form. Timely and competent treatment of the disease is important.

This will avoid dangerous complications, among which the main ones are: problems with the development of the speech apparatus, disorders in psychomotor development. If the disease is not properly treated at an older age, progressive hearing loss can become a consequence. Ear surgery for otitis media may be needed if the disease is too advanced, dangerous complications have appeared.

Features of the therapeutic effect

If there are problems with the ear, the main therapy of the pathological process is due to the appointment of anti-inflammatory, analgesic, antibacterial drugs.

In parallel, compresses are also carried out using ointments, drops, boric alcohol. Given the complexity of the disease and its variety, sometimes surgical treatment may be required.

This procedure can have varying degrees of complexity, this is dictated by the severity of the disease being diagnosed. In addition, after such treatment, a long period of time is required for rehabilitation. And this significantly complicates the process of therapy. But in rare cases, such treatment is the only way to cure the disease, to prevent the development of possible complications.

The main indications for surgical treatment of pathology

If a disease such as otitis media develops, then surgery may be required for the inflamed organ, the disease of which has passed into an advanced stage, while conservative methods of therapy are ineffective.

In certain cases, this method is the most effective for eliminating intensely expressed painful sensations, for inhibiting destructive reactions in the body.

If the ear bones are affected, further spread of the infectious process occurs, a radical treatment option is a necessity.

Usually, this method of therapy is suitable for getting rid of a chronic type of disease. In chronic otitis media, surgical treatment helps to eliminate the accumulation of purulent contents that cannot come out on their own.

Surgical treatment of otitis is necessary when the following clinical manifestations appear during the development of the disease:

• Hyperthermia, which does not subside even after the start of treatment with antibacterial drugs;
• The presence of abundant contents of a purulent nature;
• Intensely expressed painful syndrome;
• The presence of carious processes in bone tissues;
• Rupture of the eardrum;
• The presence of a chronic inflammatory process in the cavity of the organ with an intense process of suppuration;
• Significant deterioration in the quality of sound perception;
• Dysfunctions in the location and functioning of some departments of the hearing aid.

Before carrying out any intervention, diagnostic measures are necessarily prescribed, which include: otoscopy, computed tomography, and other important examinations.

The simplest intervention is to incise the tympanic membrane so that the contents can be freely brought out. With timely surgical therapy, the disease proceeds more easily, and the cure comes quickly. In addition to the fact that this procedure helps to bring out the exudate, it helps to restore the quality of sound perception and prevent the risk of infection.

The main contraindications for the intervention

Performing any surgical procedures for the treatment of otitis media of various forms is contraindicated in the following situations:

• If the condition is very severe;
• When chronic diseases go into the stage of active exacerbation;
• In the presence of sepsis;
• If there is complete deafness;
• In the presence of violations in the patency of the ear canal.

Features of surgical treatment

Surgical treatment, which needs chronic otitis media, involves getting rid of the focus of the inflammatory process, preventing further accumulation of purulent exudate. Since the outflow of fluid is impaired, there are positive conditions for further activation of pathogens.

Surgical treatment in a child and an adult is carried out according to almost the same algorithm. But at the same time, the child takes into account the underdevelopment of the structure of the ear apparatus.

The procedure for intervention in the presence of purulent otitis media of a chronic form is carried out as follows. To pump out the contents inside the organ, a resection of the eardrum is performed, a tube is inserted into its cavity for further drainage. After further sanitation, the damaged areas of the epithelial layer are excised.

In the event that there is a lesion of the internal part of the hearing aid, more complex manipulations will be required. The parts of the ear that have been damaged are removed.

Surgical treatment is usually performed under local anesthesia. The features of the procedure are the prevention of the inflammatory process, the removal of exudate from the cavity of the middle part of the ear apparatus. This medical procedure is called a myringotomy.

Preparation for the intervention begins with the use of antibacterial agents. The duration of the course of therapy is four days. Then you can carry out medical manipulations. In the event that there is a serious form of chronic otitis media, an incision is made along the entire perimeter of the membrane. In this case, one should be very careful not to penetrate deep into the tympanic cavity, not to damage the surface of its walls.

The final stage of therapy is the removal of purulent exudate, as well as the subsequent antiseptic treatment of the cavity with anti-inflammatory, antiseptic substances. At the end of all the performed manipulations, the incision itself is plugged.

In the event that an intensely pronounced inflammatory process is observed, and purulent exudate continues to accumulate, it will be necessary to install a special tube that will prevent the incision from overgrowing and will help ventilate the cavity.

This shunt is removed after the inflammatory process stops and the production of purulent exudate is inhibited. After the shunt is removed, the incision heals quickly.

Features of the recovery period

The recovery period after a medical procedure is much more difficult than the intervention itself. If the rules of personal hygiene are violated during the rehabilitation period, a relapse of a chronic disease may occur.

Exudate will begin to accumulate again in the place where the epithelial layer was previously damaged. Soon the contents again fill the cavity of the ear canal.

An important step in the recovery period is the regular change of sterile swabs. It is important to keep the ear canal clean at all times. After a while, tampons will no longer be needed, as the incision heals.

The total duration of the rehabilitation period with the constant wearing of tampons can last from several weeks to two to three months. It is important to visit a specialist regularly during this time to examine and check the quality of hearing.

During this period of time, it is important to ensure that water does not get into the ear, to avoid sudden blowing or sneezing, flights. According to experts, in almost all cases, after this treatment, there is an improvement in the quality of hearing.

ENT surgery

Chronic otitis media

As a result of acute inflammation of the middle ear (suppuration of the ear), the eardrum can rupture and perforation is formed. Such a perforation usually heals. If this does not happen, there is hearing loss, which is often accompanied by noise in the ear or in the head and intermittent or constant discharge from the ear. This is a chronic inflammation of the middle ear.

The manifestations of this disease depend on what stage - exacerbation or remission - it is, whether or not the disease has spread to the mastoid process, or there is a perforation of the tympanic membrane.

These symptoms may be in the form of discharge from the ear, hearing loss, tinnitus (noise in the head), dizziness, pain, or, in rare cases, facial expression problems.

Normal tympanic membrane

Chronic otitis. Type of tympanic membrane with various inflammations

Ear care for chronic otitis media

If there is a perforation, you should not allow water to enter the ear canal. To do this, when you shower or wash your hair, put a cotton swab soaked in petroleum jelly in your ear canal. Swimming and swimming are allowed only if you can prevent water from entering the ear canal.

If there is discharge from the ear, in addition to taking the prescribed drugs, the ear canal should be cleaned of pus.

Medical treatment of chronic otitis media

Often, drug treatment helps to stop the discharge from the ear. Treatment consists of a thorough cleaning of the ear and regular use of ear drops or instillation of powdered medicines. In some cases, oral antibiotics are prescribed.

Surgical treatment of chronic otitis

For many years, surgical treatment for chronic otitis media has been used primarily to sanitize the pathological focus and prevent serious complications. The use of new modern surgical techniques today in most cases also allows you to restore the destroyed mechanism of sound conduction (tympanic membrane and auditory ossicles).

Various tissue grafts can be used to replace or repair the eardrum. The most commonly used shell (fascia) of the temporal muscle and the shell of the cartilage of the tragus of the auricle (perichondria). Destroyed auditory ossicles can be replaced with artificial grafts or by transferring viable remnants of the patient's own ossicles.

In cases where the ear is filled with adhesions and scar tissue, or when all the auditory ossicles have been destroyed, there is a need for several operations. At the first operation, the rehabilitation of the inflammatory focus and the creation of a functional tympanic cavity are achieved. During the second operation, the final stage of hearing restoration is performed - ossiculoplasty (prosthesis of the auditory ossicles). The decision on the phased restoration of the sound-conducting apparatus is made during the first operation.

After the operation, the ear canal remains plugged for 1 week to 1 month. All this time, the patient should instill ear drops into the ear canal once a day.

Chronic otitis media: main types of operations

Most cases of acute inflammation of the middle ear (acute otitis media) result in complete recovery. However, in some cases, the eardrum may not heal and develop a persistent (permanent) perforation.

Myringoplasty is an operation aimed at closing the perforation of the eardrum. The operation is performed when there is no more inflammation in the ear and the auditory ossicles are not destroyed. This operation closes the middle ear and improves hearing.

The operation is usually performed under local anesthesia, often through the external auditory canal. For extensive perforations, a behind-the-ear approach is used.

Types of cuts

Behind the ear tissue is used to close a defect in the tympanic membrane.

The patient is hospitalized for several days and can start working 1-2 weeks after discharge. Complete healing and improvement of hearing in most cases occurs in 2-3 months.

Tympanoplasty

The inflammatory process in the middle ear can lead to perforation of the tympanic membrane, damage to the mucous membrane, auditory ossicles and auditory nerve.

Tympanoplasty is an operation aimed at eliminating the inflammatory (purulent) process in the ear, closing the perforation of the eardrum and restoring the transmission mechanism of the auditory ossicles. With the help of this operation, the ear is healed and hearing is improved. In the case when there is no need to restore the eardrum, the operation is usually performed under local anesthesia through the ear canal.

Most tympanoplasty operations are performed behind the ear under local or general anesthesia. Perforation of the tympanic membrane is closed by fascia from behind the ear. The transmission of sound to the inner ear is achieved by moving or replacing the auditory ossicles.

Tympanic membrane perforation repair

In some cases, it is impossible to restore both the tympanic membrane and the transmission mechanism of the auditory ossicles at the same time. In such cases, the tympanic membrane is first restored, and then, after 6 months or more, the transmission mechanism is restored.

The patient is usually hospitalized for a few days, and after 2-3 weeks he can start working. Complete healing occurs in 2-3 months. For several months, the patient may not notice an improvement in hearing.

Tympanoplasty with mastoidectomy

An active inflammatory process in some cases can stimulate the ingrowth of the skin of the ear canal through the perforation of the tympanic membrane into the middle ear and into the mastoid process. Such a "cyst" with walls made of skin is called cholesteatoma. Over time, cholesteatoma can enlarge and destroy adjacent bone. In cholesteatoma, the discharge from the ear is more persistent and often foul-smelling. In most cases, persistent discharge is associated with the spread of inflammation to the nearby bone.

When cholesteatoma or inflammation of the bone is detected, treatment should be started as soon as possible. Antibiotic ear drops and oral antibiotics in most cases have a temporary effect. As soon as the treatment is stopped, the discharge from the ear resumes.

Cholesteatoma and chronic inflammation of the ear can go on for many years without any complications other than constant discharge and hearing loss. However, sometimes as a result of the spread of the process, the surrounding structures can also be damaged. In this case, the patient feels pressure in the ear and headache. Dizziness and asymmetry of the face may appear, meningitis and other intracranial complications may develop. If any of these symptoms appear, you should immediately consult a doctor. An urgent operation may also be needed to remove the focus of inflammation and prevent serious complications.

When destruction due to cholesteatoma or inflammation reaches the mastoid process, surgical treatment can be difficult. The operation is performed behind the ear approach.

middle ear cholesteatoma

In most patients with cholesteatoma, it is impossible to simultaneously remove the pathological focus and restore hearing. During the first operation, sanitation is performed and the eardrum is restored. For sanitation, it is necessary to perform an operation on the mastoid process - a mastoidectomy.

There are two types of operations on the mastoid (mastoid) process: with preservation and removal of the posterior wall of the auditory canal. The decision to use one or another type of operation, as a rule, is made during the operation.

Operations with preservation of the posterior wall of the ear canal are more preferable, since the ear after such operations (after 3-4 months) is more protected and requires less care.

However, in some cases, it is necessary to resort to operations with the removal of the posterior wall of the auditory canal, which is associated with the characteristics of the disease or the structure of the mastoid process. Healing after such operations is longer. As a result, the patient has a wider opening (inlet) of the auditory canal, but externally the ear practically does not change its appearance. In the future, it is necessary to constantly monitor and clean the mastoid (operational) cavity, and often avoid getting water into the ear.

This operation is usually performed under general anesthesia and requires hospitalization for 7-10 days. 1-3 weeks after discharge, the patient can start working.

If it is necessary to perform a second operation, it is performed after 6-12 months in order to restore hearing and re-examine the middle ear cavities to identify non-removed (remaining) areas of the pathological focus.

Tympanoplasty: planned second stage - ossiculoplasty

The purpose of this operation is to revise the middle ear cavities and improve hearing. The operation can be performed through the ear canal or behind the ear. The operation is usually performed under local anesthesia. The cavities of the middle ear are checked for the presence of the remaining focus of pathology. Sound transmission to the inner ear is achieved by replacing damaged auditory ossicles with a prosthesis.

The patient is hospitalized for several days and after another 7-10 days can start working. Hearing usually improves after 10 days, and often over time, hearing can continue to improve for up to three months.

Tympanoplasty with revision of the burr cavity

The purpose of this operation is to try to stop suppuration from the burr cavity and to improve hearing in patients who have undergone general ear surgery in the past.

The operation is performed under local or general anesthesia behind the ear. The mastoid cavity after removal of pathological formations can be sealed with muscle and adipose tissue from the behind-the-ear region or bone. Over time, the ear canal can be repaired with cartilage or bone. The tympanic membrane is restored and, if possible, the transmission mechanism is also restored. However, in most cases, a second hearing repair is necessary (see: Tympanoplasty: Planned Second Stage).

The patient is usually hospitalized for a few days and can return to work 1-3 weeks after discharge. Complete healing of the cavity inside the ear occurs after 4 months.

Operation forecast

Ear discharge: The closure of a perforated tympanic membrane is effective in more than 90% of cases, resulting in a closed and dry ear.

Hearing: Hearing improvement after surgery depends on many factors, primarily on the degree of destruction of the structures of the middle ear and the presence of conditions conducive to normal ear healing.

It happens that two operations are necessary to improve or preserve hearing, and the hearing between the first and second operations may be slightly worse than it was before the operation.

What are the consequences of the operation

Any ear surgery can lead to the following symptoms.

Loss of taste and dry mouth. Taste disturbance and dry mouth are quite common after ear surgery and resolve within a few weeks after surgery. However, in some patients, these disorders remain for a longer time.

Noise in the ear. Noise in the ear (noise in the head) is often present in the patient before the operation and, as a rule, there is a short-term noise after the operation. It can last for 1-2 months and will gradually decrease as hearing improves. At the same time, if hearing does not improve or worsens, the noise may also persist or increase.

Ear numbness. Temporary desensitization of the skin in and around the ear is a common consequence of ear surgery. Numbness can cover the entire ear and last for about 6 months.

Drainage behind the ear. During the operation, the surgeon may bring the drainage tubes behind the ear. The need for this technique is not always obvious before the operation. In cases where it is necessary, the tubes are removed through the skin in the behind-the-ear region and after surgery, drugs are administered through them for 1-10 days.

Operational risk and complications. Fortunately, serious complications are rare in ear surgery for chronic suppurative otitis media.

Ear infection. As a rule, after the operation, there is aseptic inflammation of the ear with discharge from it, swelling and pain. Sometimes this can lead to slow wound healing and poor graft engraftment. In some cases, a second operation may be needed to resolve the inflammation.

Hearing loss. In 3% of cases, further hearing loss may occur in the operated ear, associated with further progression of the disease or with a complication in the healing process of the ear. Very rarely there is a complete hearing loss in the operated ear. In most cases, a two-stage operation is necessary to improve hearing and completely remove the pathological focus. In this case, hearing after the first operation, as a rule, is worse than before the operation.

Dizziness. In the first days after the operation, dizziness may occur due to swelling in the ear and a reaction to the operation of the inner ear (labyrinth). During the first week, there may be a slight instability (impairment of balance). In rare cases, these phenomena may be longer. 10% of patients with chronic suppurative otitis media in combination with cholesteatoma have a labyrinth fistula - a hole in the wall of the capsule of the vestibular apparatus. If there is such a complication, dizziness after surgery may last 6 months or more.

Facial paralysis. The path of the facial nerve passes through the ear. It is located next to the auditory ossicles, and lies in the wall of the tympanic cavity and mastoid process. A rare postoperative complication of ear surgery is short-term paralysis of one half of the face. This can happen if the facial nerve passes in an unusual place for it or with edema, which usually develops spontaneously, especially if the integrity of the wall of the facial nerve canal is violated. In very rare cases, the facial nerve may be damaged during surgery or it may need to be transected for complete debridement of the ear.

Complications associated with mastoidectomy. Leakage of cerebrospinal fluid (the fluid that bathes the brain) is an extremely rare complication. In this case, reoperation may be necessary.

Intracranial (cerebral) complications of chronic suppurative otitis media, such as meningitis, brain abscess, and even paralysis, were common before antibiotics were used. These complications are extremely rare today.

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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Hearing problems can occur for various reasons, and in some cases, the essence of the disease is reduced to a deterioration in the functions of the middle ear. In order to restore it, tympanoplasty is used - an operation during which the eardrum itself is reconstructed directly. This form of treatment has repeatedly proven its effectiveness.

The essence of the problem

When it comes to such a form of surgical intervention as tympanoplasty (middle ear surgery), a specific method for the treatment of chronic purulent otitis media in the eardrum area is implied. It is important to note that such an impact is complex and has a significant restorative effect, making it possible to reconstruct the middle ear.

It makes sense to pay attention to the fact that chronic otitis is diagnosed quite often. It causes an opening in the eardrum called a perforation. For this reason, it becomes possible for pathogenic bacteria to penetrate into it, which, in turn, leads to the release of pus, which can disturb for more than one year.

Tympanoplasty is an operation without which it will be extremely difficult to overcome purulent otitis media. In addition, a neglected disease of this type can result in the occurrence of an abscess and thrombosis of cerebral vessels, and in some cases, meningitis.

Indications for surgery

There are a number of conditions under which the above-mentioned surgery is necessary. The bottom line is the following health problems:

The formation of marginal or central perforation of the tympanic membrane, which causes displacement of the auditory ossicles;

Polyps that develop in the middle ear;

Tympanosclerosis;

Not accompanied by inflammatory processes;

Fibrosis of the middle ear.

Obviously, there are many reasons why surgery may be relevant.

Contraindications

It is important to understand that there are cases where ear surgery (tympanoplasty) may not be able to have the desired effect. Here are the diagnoses in which the use of such a technique is categorically not recommended:

Exacerbation of chronic diseases;

Adhesive otitis media;

Complete deafness;

Severe general condition of the patient;

Sepsis and purulent complications.

Sanitizing surgery on the middle ear with tympanoplasty is also contraindicated in the case when a persistent violation of the patency of the auditory tube is recorded. This category includes congenital anomalies, as well as scars, as well as adhesions resulting from inflammation.

Relative contraindications

In this case, we are talking about those diseases against which the operation is undesirable, but possible. In this case, the final decision will be made by the doctor, based on his experience and the condition of the particular patient. So, the contraindications themselves:

Acute inflammatory process in the middle ear;

Allergic type diseases in the acute stage;

problems with the upper respiratory tract;

epidermalization process.

Only taking into account all the contraindications described above, it is possible to prescribe such a type of treatment as tympanoplasty. Reviews after the operation are an important sign of the quality of treatment, so it is always worth asking about the opinion of patients about a particular clinic. The forums can help with this.

It is worth remembering that the doctor is obliged to examine the other ear and make predictions about the risk of damage to it. After that, a decision will be made regarding the operation on the second eardrum.

A full examination of a general nature should also be carried out: a coagulorogram, a biochemical and general analysis of blood and urine, as well as a blood test for syphilis, HIV, hepatitis B and C. The examination program also includes an ECG.

The process of preparing for surgical treatment

Before performing surgery, a conservative treatment is performed, which is designed to prepare the ear for tympanoplasty. Various agents are introduced into the cavity of the middle part, where the tympanic membrane is located, designed to have an anti-inflammatory, vasoconstrictive and antibacterial effect. All of them have a wide range of activities.

Such procedures are very important because they allow you to clean the operated area from infection. It is thanks to this procedure that safe tympanoplasty becomes possible. Reviews after the operation, respectively, will also be predominantly positive, since sanitation (cleaning) initially blocks the effect of infection on the middle ear, and subsequently promotes rapid healing of the postoperative wound.

Moreover, such a measure leads to an improvement in the patency of the auditory tube, which has the most direct impact on the quality of the result of surgical intervention.

If the patient has chronic diseases, then it is necessary to consult a specialized doctor. 7 days before the operation, you need to stop taking the funds used to thin the blood. We are talking about non-steroidal anti-inflammatory drugs (Paracetamol, Aspirin) and Warfarin.

Types of impact

There are various techniques that allow you to get a significant improvement in the condition of the middle ear after surgery. Tympanoplasty for this reason can also be performed in different ways. It makes sense to highlight three key areas:

- Recovery using ossiculoplasty. It is relevant for those patients in whom, due to a serious inflammatory process, the auditory ossicles were damaged, and their rehabilitation is possible only with the help of prosthetics. In this case, materials such as titanium, cement and plastic are used.

- The essence of the second type is reduced to the closure of the eardrum by means of the own tissues of the middle ear.. The most common and least complicated is just such a tympanoplasty. Reviews after this type of operation are overwhelmingly positive.

- Myringoplasty without prosthetics. It is used to treat patients with damaged but prostheses are not used. To restore enough native bone tissue.

Sometimes doctors are faced with such a problem as the fusion of the two surfaces of the middle ear, which is caused by a complication after otitis media. In this case, to restore the tympanic cavity, both grafts and the tympanic membrane itself, or rather, its remnants, are used.

Recovery period

In order for the feedback after the operation to be positive when using such a treatment method as tympanoplasty, it is necessary to organize a high-quality recovery of the patient.

First of all, this is a stay for 1-3 days in a hospital. Rehabilitation includes the use of antibiotics during the first postoperative week. Along with these restorative measures, daily anemization is relevant. This means the introduction of vasoconstrictor drugs into the pharyngeal mouth of the auditory tube.

Since the release of the ear canal from tampons occurs gradually, at first the patient must come for examinations on a regular basis.

In order to return to normal after the operation as quickly as possible, you need to sneeze less, blow your nose and protect the auricle from water getting into it. As for effective methods of protection against moisture while taking a shower, it is better to consult with your doctor. Lifting heavy objects will also have to be abandoned. In fact, you need to exclude any load that can cause severe stress in the middle ear.

Possible Complications

If we consider all facets of surgical intervention, then it is worth noting that there are certain risks during a procedure such as tympanoplasty. Complications after surgery can be completely different: damage to the labyrinth, tympanic cavity, facial nerve, and even the dura mater. The latter, by the way, sometimes causes bleeding from the jugular vein or otoliquorrhea.

It is also worth paying attention to the risk of aseptic inflammation of the ear. This condition is usually accompanied by discharge, swelling and pain.

Sometimes suppuration in the ear may appear after tympanoplasty. Reviews confirm the fact that such a problem exists. For this reason, a stationary regimen during recovery is important, since in case of possible complications, doctors will be able to provide qualified and timely assistance.

General complications can also include prolonged headache (the consequences of a labyrinth fistula), imbalance and dizziness.

What's the deal with transplants?

Those who have undergone surgery with prosthetics should follow the recommendations of the doctors exactly, because in the case of inflammation of the middle ear, the process of rejection can begin.

The fact of inflammation will also affect the speed of recovery. After using tympanoplasty using prostheses, there is a risk of displacement of the latter, as well as necrosis or atrophy. So, if prosthetics took place, you need to take care of yourself thoroughly.

hearing loss

The group of complications includes the manifestation of hearing loss in the operated ear, which can reach the level of complete deafness. This problem makes itself felt after a complicated or non-radical tympanoplasty. Violation of sound perception is sometimes the result of reactive labyrinthitis, which can pass without medical procedures. If this does not happen, then competent therapy under the supervision of a doctor will help neutralize this problem.

Thus, it must be understood that hearing impairment caused by labyrinthitis is temporary in nature and can be treated.

But the good news is that such complications are observed in only 3% of patients who underwent surgery. Tympanoplasty reviews are mostly positive, so you should not be afraid of this technique.

Brief paralysis

This is another complication that can occur after middle ear surgery. The good news is that this problem is temporary. The cause of short-term paralysis is postoperative swelling of the facial nerve.

In some cases, this nerve may be damaged due to intraoperative transection. Plastic is used as a restorative measure. We are talking about suturing the saphenous nerve of the neck. Alternatively, the facial nerve is sutured to the hypoglossal. With such an intersection during surgery, even after plastic surgery, there is a risk of residual weakness of the facial muscles.