Acute otitis media. Acute otitis media

Otitis media ranks second in the list of serious diseases of the upper respiratory tract after sinusitis. With incorrect or delayed treatment, the disease can lead to serious complications and even complete loss of hearing, so it is necessary to start treatment when the first symptoms appear. It is difficult not to notice the signs of otitis media, since the main symptom of the pathology is acute pain of high intensity, aggravated by turning the head and trying to lie on the affected side.

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

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

Doctors distinguish three stages of acute otitis media.

Stage	What is characterized?
catarrhal	The first clinical signs of pathology appear, exudate begins to accumulate in the middle ear. The patient has an increase in temperature to 38-39.5 degrees, there is a headache and ear pain
Purulent	There is an active reproduction of the bacterial flora and the formation of pus containing dangerous toxins - the waste products of bacteria. After perforation of the eardrum, pus begins to flow out
Decay (release) stage	Pus ceases to stand out. The hole through which the contents flowed out is gradually tightened

The catarrhal stage is characterized by a severe course and severe pain that can radiate to the teeth, head, temporal part and back of the head. The patient loses the ability to sleep and eat normally, any movement of the head causes acute pain. In addition to these symptoms, patients often complain of tinnitus, a feeling of congestion and hearing loss.

For a complete recovery at this stage, 6-7 days are enough (provided that treatment is started in the first 48 hours after the first signs appear). If the therapy was carried out incorrectly, the disease turns into a purulent form, which is the result of the multiplication of bacteria or fungus.

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

Important! The lack of timely medical care can lead to complications, among which there are deadly ailments: meningitis, sepsis, or accumulation of fluid in the brain space (abscess). For this reason, self-treatment is unacceptable - if you experience pain in the ears or any changes in the functioning of the hearing organs, you should contact a specialist.

How to treat otitis media in adults?

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

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

antibacterial therapy;
the use of local preparations in the form of drops;
adherence to strict bed rest;
physiotherapy methods;
vitamin therapy;
antimicrobial treatment;
the use of analgesics and NSAIDs for the relief of pain.

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

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

Video - Otitis media: causes, symptoms, treatment

Treatment regimen

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

the use of vasoconstrictor drugs for instillation into the nose in order to eliminate the swelling of the mucous membrane of the nasopharynx (" Naphthyzin», « Galazolin», « Nazivin»);
the use of antipyretic drugs to reduce temperature and eliminate febrile syndrome (" Paracetamol»);
instillation of medical alcohol 70% to eliminate pain (can be replaced with turunda soaked in hydrocortisone);
strengthening the body's defenses and increasing local immunity with the help of immunomodulating agents (" Immunal», « Interferon»);
recuperation (any multivitamin complexes).

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

Antibiotics

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

In this case, the therapeutic effect of therapy will be absent. In such a situation, the doctor will select an antibiotic of another group (taking into account the clinical picture of the disease).

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

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

No less popular in the treatment of otitis media of varying severity is ampicillin trihydrate (and preparations based on it). It belongs to the semi-synthetic analogues of antibiotics of the penicillin series and is prescribed for severe purulent forms of inflammation of the middle ear. Like drugs based on amoxicillin, ampicillin can cause allergic reactions: rash, itching, hives, eczema. Often, against the background of treatment with ampicillin, patients develop dysbacteriosis, cases of anaphylactic reactions have been recorded.

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

For the treatment of chronic otitis, the patient will need stronger broad-spectrum drugs, such as aminoglycosides. The most popular drug of this series is " Netilmicin". This drug is available in the form of a solution for injection, which are placed directly into the affected area. The tool quickly destroys the pathogenic flora and helps to stop inflammatory processes. Medicines of this group should not be used by elderly patients, as well as women who are carrying a child and breastfeeding.

Attention! In the event of an allergy or other medical indications, the doctor may prescribe a fluoroquinolone antibiotic for the patient (for example, " Ciprofloxacin"). They rarely cause allergies and are better tolerated by all categories of patients.

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

Physiotherapy

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

UVI (strengthens local immunity, destroys bacteria, relieves inflammation);
UVI pharynx and "tube-quartz";
light therapy ("blue lamp") - eliminates pain and inflammation;
electrophoresis.

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

Important! With a significant decrease in hearing, the patient may need additional methods of treatment: pneumomassage of the tympanic membrane or blowing out the ear canal. The attending physician should decide on the appropriateness and necessity of their use.

Folk recipes

Aloe juice

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

Onion

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

Propolis tincture

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

Garlic

Garlic must be peeled and put a clove in a sore ear. It is important not to push the garlic deep, as it can get stuck. An alternative solution may be a compress of garlic juice, which must be placed on a sore ear 2-4 times a day for purulent otitis media.

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

Video - How to treat otitis media at home

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

Pain in the ear of varying intensity, which:
- may be constant or pulsating;
- can be pulling or shooting;
- can give in the teeth, temple, neck.
Ear congestion.
Hearing loss.
Noise in the ear.
Ear discharge.
Enlargement and soreness of the lymph nodes.
Soreness behind the ear.

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

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

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

nasal congestion;
nasal discharge;
pain or sore throat.

Forms

Stage of catarrh(catarrhal otitis media) - the initial stage of the disease.
- Appears:
  - ear pain;
  - stuffy ear;
  - deterioration in general well-being.
- When examining the ear:
  - the auricle is painless;
  - the external auditory canal is wide;
  - the tympanic membrane is reddened, without signs of fluid behind it.
- Discharge from the ear is not characteristic of catarrhal otitis media.
- Without treatment, acute catarrhal otitis media can turn into a purulent form.

Stage of purulent inflammation(purulent otitis media), in turn, is divided into two stages.
- Preperforative stage - at the same time, pus accumulates in the middle ear cavity due to progressive inflammation, but the eardrum remains intact.
  - This stage is characterized by increased pain in the ear, increased congestion in the ear, decreased hearing in the affected ear.
  - On examination, the eardrum is red, swells, sometimes a purulent discharge is visible behind it; no ear discharge.
- perforative stage - due to the growing pressure of pus in the cavity of the middle ear, the eardrum ruptures, pus begins to flow out of the ear canal. In this case, the pain in the ear often becomes less intense.
  - On examination, there is a purulent discharge in the ear canal, a violation of the integrity (perforation) of the tympanic membrane.
  - When blowing out the ears (exhalation through a tightly closed mouth, while the nose is clamped with fingers), pus flows out through a perforation in the eardrum.

Reparative stage(process resolution stage) - with adequate treatment:
- inflammation in the ear stops;
- the pain goes away;
- discharge stops;
- perforation of the tympanic membrane in most cases self-scarring.

At the same time, periodic ear congestion may still persist for some time.

On examination, the appearance of the tympanic membrane is normal.

Causes

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

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

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

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

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

Diagnostics

Analysis of complaints and anamnesis of the disease:
- pain, ear congestion;
- hearing loss;
- discharge from the ear;
- increase in body temperature;
- deterioration in general well-being;
- the presence of concomitant infections - influenza, SARS, diseases of the nose, paranasal sinuses, adenoids (pathologically enlarged pharyngeal tonsil), - against which complaints from the ear appeared.

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

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

With difficulty in nasal breathing, an examination of the nasopharynx and the area of \u200b\u200bthe mouth of the auditory tube (connecting the middle ear to the nasopharynx) should be performed using endoscopic techniques.

With ear congestion and hearing loss, a tuning fork examination (special tests with tuning forks that allow you to find out whether hearing loss is associated with the development of inflammation in the middle ear or with damage to the auditory nerve).

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

Audiometry is a study of hearing.
Consultation is also possible.

Treatment of acute otitis media

Treatment depends on the stage of the disease.

At the initial stage of the disease, a warming compress is prescribed for the parotid region, physiotherapy. With the development of a purulent process, any heating of the ear (compresses, blue lamp) is strictly prohibited.
In the absence of a defect in the eardrum, anesthetic drops are prescribed in the ear. In such a situation, instillation of antibacterial drops is impractical, since they do not penetrate the eardrum.
In the presence of perforation (rupture) of the eardrum, drops with an antibiotic are prescribed in the ear.
- It is important to avoid the use of drops containing substances that are toxic to the ear, as well as alcohol, as this can lead to permanent hearing loss.
- Self-medication in such a situation is extremely dangerous.
Necessarily appointment of vasoconstrictor sprays in the nose.
Painkillers, antipyretics if necessary.
Treatment of diseases of the nose, nasopharynx.
Immediate administration of systemic antibiotics is recommended in severe otitis media or in the presence of severe comorbidity or immunodeficiency (impaired immunity). In other cases, local treatment is recommended, observation for 2-3 days and only then a decision on the appointment of an antibiotic.
In the preperforative stage of acute purulent otitis media (there is an accumulation of pus in the tympanic cavity, but the tympanic membrane is intact, accompanied by severe pain in the ear, fever), paracentesis is recommended (a small puncture of the tympanic membrane under local anesthesia). This allows you to relieve pain, speed up recovery, and facilitate the delivery of drugs to the ear.
At the stage of resolution, it is possible to prescribe physiotherapy, exercises for the auditory tube, blowing out the ears.
In acute otitis media, it is recommended to protect the ear from water, especially if there is a perforation of the eardrum.

Complications and consequences

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

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

All of the above complications require immediate hospitalization.

Chronization of the process is also possible, the development of persistent hearing loss (deafness).

Prevention of acute otitis media

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

Restoration of normal nasal breathing in case of difficulty.

With the development of acute respiratory infections with a runny nose, the correct technique of blowing your nose (each nostril in turn, the mouth is open) and washing the nose (smooth jet, followed by a gentle blowing of your nose).
Timely visit to the doctor at the first signs of otitis media. Self-medication, independent use of ear drops (they may be ineffective or even dangerous), warming up the ear without a doctor's prescription is unacceptable.

Additionally

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

hammer;
anvil;
stapes.

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

Normally, the tympanic cavity is filled with air.

Otitis media is an acute infectious disease, manifested by specific symptoms. The disease must be treated, as it is dangerous for the development of complications. Not a single person is immune from the disease, therefore it is necessary to be able to recognize otitis media in time, the symptoms and treatment of which depend on the form of inflammation.

The disease refers to infectious diseases and occurs in the form of acute or chronic inflammation. Pathology develops as a result of the entry of pathogenic microorganisms into the Eustachian tubes, and from there into the middle ear.

Ear inflammation is one of the most common diseases.

Causes:

infection of the ear with bacteria or viruses;
complication after influenza or SARS;
inflammation of the nasopharynx;
sinusitis;
mechanical damage to the ear.

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

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

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

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

Symptoms and signs of the disease

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

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

Classical clinical picture:

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

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

Types and stages of otitis media

There are two forms of otitis media - acute and chronic. Against the background of the inflammatory process, exudate accumulates. According to the type of this fluid, otitis media is divided into purulent and catarrhal.

With improper or untimely treatment, the disease can lead to serious complications.

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

Acute otitis media

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

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

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

Acute otitis media occurs in 3 stages or stages:

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

Acute eustachitis is accompanied by tinnitus, a feeling of pulsation and congestion, a slight increase in temperature (up to 37-37.4). This stage lasts up to several days, and then turns into acute catarrhal inflammation, which is accompanied by severe pain and fever to subfebrile values. At the same time, aseptic inflammation of the middle ear, strong noise and pulsation in the ears, severe congestion, accompanied by hearing loss, are noted.

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

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

After complete cleansing of the inflamed cavity and removal of purulent contents to the outside, the perforation is gradually tightened, the disease completely disappears.

Chronic otitis media

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

The disease can lead to temporary or permanent hearing loss.

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

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

Diagnostic measures

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

There are no problems with the diagnosis. It is enough for an experienced doctor to interview the patient and examine the ears with an endoscope and an otoscope in order to suspect the cause of the ailments. To confirm the presence of purulent inflammation, an x-ray of the temporal bone or a computed tomography is prescribed.

Treatment of otitis media in adults at home

Otitis media should be treated on an outpatient basis. The treatment regimen depends on the form and stage of inflammation. In the absence of purulent discharge, therapy is carried out by local means, using ear drops. In the presence of an abscess, antibiotic therapy is prescribed. Alternative methods of treatment also take place, but they are recommended to be used as an auxiliary, and not the main therapeutic agent.

Improper treatment can lead to deafness!

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

The most effective drops for otitis media

For treatment, antiseptics and antibacterial drugs in the form of drops are used.

Popular medicines:

Sofradex;
Tsipromed;
Otipax;
Normax.

The drug is prescribed by a doctor, you should not self-medicate.

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

Quite a popular drug in the practice of ENT doctors.

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

Before use, you should consult with a specialist.

Otipax is an analgesic and anti-inflammatory agent. The drug contains phenazone and lidocaine. Drops are used in acute otitis to reduce pain. With severe suppuration, the drug is combined with antibiotics. The tool is allowed to use 4 drops 4 times a day.

Use with caution!

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

Antibiotics for otitis media in adults

With otitis, broad-spectrum antibacterial drugs are used. The combination of ear drops with antibiotic tablets helps to minimize the risks of complications and the transition of the disease to a chronic form.

The doctor will prescribe a course of treatment and dosage.

Most often prescribed drugs of the following groups:

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

The first-line drugs of choice are penicillins. Amoxicillin, Amoxiclav or Augmentin is prescribed. Fluoroquinolones are broad-spectrum antimicrobials used when penicillins are intolerant or ineffective. Cephalosporins or macrolides are also prescribed as substitutes for intolerance to penicillins.

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

Treatment with folk remedies

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

Improper treatment can lead to hearing loss.

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

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

Possible complications of the disease

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

Timely and proper treatment will help to quickly cope with the disease.

Complications are characteristic of the advanced chronic form of the disease and are manifested:

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

Timely detected otitis media is quite successfully treatable. As a rule, treatment of otitis media takes about one week. Pain and discomfort disappear on the second day after the start of drug therapy.

Prevention of otitis media

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

It is also important to prevent weakening of the immune system and treat any viral and infectious diseases in a timely manner.

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

Etiology, classification and mechanisms of the development of the disease

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

An important role in the development of CCA is played by viruses that cause acute respiratory infections, namely:

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

Bacteria are found in 70% of patients in the study of exudate obtained from the middle ear. Most often it is:

Streptococcus pneumoniae,
haemophilus influenzae,
Moraxella catarrhalis.

Contribute to the development of the disease:

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

According to the nature of inflammation, 3 stages of AOM are distinguished:

catarrhal
exudative (serous),
purulent.

The mechanisms of their development also differ.

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

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

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

Also, the cause of eustachitis can be sudden changes in atmospheric pressure - when diving and ascent of submariners (mareotitis), ascent and descent of the aircraft (aerootitis).

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

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

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

Against the background of treatment, the inflammation subsides, the amount of exudate decreases, suppuration from the ear stops. The hole in the eardrum is scarred, but the patient still feels stuffiness in the affected ear for a long time. The criteria for recovery are the normalization of the picture when examining the ear - otoscopy, plus a complete restoration of hearing.

Why is acute otitis media more common in children?

The structure of the child's ear is such that an infection from the nasopharynx can spread to the structures of the middle ear in a short time.

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

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

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

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

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

Clinical picture of acute otitis media

Often acute otitis media occurs with pronounced symptoms, however, there are also latent otitis media - when the clinical manifestations of the disease are mild.

For CCA, as for any other infectious disease, common symptoms are characteristic:

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

With catarrhal otitis media, patients complain of:

slight hearing loss - a violation of sound conduction mainly at low frequencies; after swallowing saliva or yawning, hearing temporarily improves;
resonation of one's voice in a diseased ear - autophony.

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

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

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

Pain sensations, as a rule, are absent, and after a while the patient adapts to hearing loss and ceases to notice it.

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

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

preperforative;
perforative;
reparative.

Not necessarily a specific otitis media will go through all 3 stages - already at the initial (pre-perforative) stage, it can be resolved.

preperforative stage. The leading complaint of the patient is pain in the ear, especially when lying on the side of the lesion. The pain is pronounced, sharp, shooting, radiating to the temple. Gradually growing, it becomes unbearable, painful, deprives the patient of rest and sleep. There may be pain when touching the mastoid process. Simultaneously with pain sensations, there is a feeling of congestion in the ear, noise in it, and hearing is reduced. The general condition of the patient is disturbed: there are signs of intoxication, the body temperature is elevated to febrile numbers. Duration of the initial stage: 2-3 hours - 2-3 days.
The perforative stage is determined by the onset of suppuration from the ear, which arose as a result of perforation of the eardrum. The discharge from the ear is at first abundant, their character is mucopurulent or purulent, often with an admixture of blood. Over time, the amount of secretions decreases, they thicken and become purulent. The patient's condition at this stage improves dramatically: the pain in the ear subsides, the body temperature decreases, sometimes even normalizes. The duration of suppuration is 5-7 days.
At the reparative stage, the suppuration of their ear stops, the perforation is scarred, and hearing is gradually restored.

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

Sometimes the disease is extremely difficult: with a sharp deterioration in the general condition, high, up to 40 C, temperature, nausea and vomiting, headache and dizziness.
In some cases, perforation of the eardrum does not occur, and purulent masses spread from the middle ear into the cranial cavity, causing complications that threaten the life of the patient.
Otitis can already at the initial stage take an asymptomatic, sluggish, protracted character. In this case, the general symptoms are slightly pronounced, the pain is not intense, the eardrum is not perforated, and thick, viscous pus accumulates in the middle ear cavity.

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

Not stopping in 5-7 days, but lasting up to a month, indicates the accumulation of pus inside the mastoid process, or empyema.

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

The child should be referred for a consultation with an ENT in the presence of:

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

Severe violations of the general condition of the child;
2 sleepless nights;
severe pain and prolonged fever;
protrusion of the auricle;
smoothness of the behind-the-ear fold;
leakage of fluid from the ear - otorrhea;
soreness with sudden pressure on the tragus of the diseased ear;
pain when probing or tapping on the mastoid process.

Diagnosis of acute otitis media

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

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

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

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

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

Treatment of acute otitis media

Since a clear staging is determined during acute otitis media, the treatment of this disease is also specific at each stage.

In general, treatment for AOM may include:

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

In this case, the following are considered ineffective means:

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

Ear drops

Ear drops in the treatment of acute otitis media are often used. Many patients prescribe them to themselves, which risks causing irreparable harm to their health. Drops containing anti-inflammatory and analgesic components are used only with a whole tympanic membrane, since getting them through a perforated hole into the tympanic cavity can adversely affect the patient's hearing.

For a more accurate introduction of drops, one should use the hand opposite the inflamed ear to slightly pull the auricle up and back - this technique will align the ear canal and the drops will fall exactly to their destination. After instillation, it is necessary to close the ear canal with cotton wool moistened with petroleum jelly for 2-3 hours - in this case, the active agent will not evaporate and will have maximum therapeutic effects.

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

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

Topical decongestants (xylometazoline, oxymetazoline) are a necessary part of the treatment of AOM, since the dysfunction of the auditory tube develops against the background of edema of the mucous membrane of the upper respiratory tract. It is possible to get used to the drugs of this group, therefore they are prescribed only in short courses - no more than 4-5 days.

Antibacterial therapy

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

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

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

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

At the 3rd stage of the process, catheterization of the auditory tube and microcompresses with osmotol are recommended to the patient. Systemic antibiotic therapy is also indicated. If after 24-48 hours the effect of the treatment is absent, the patient needs a paracentesis or tympanopuncture procedure. Of the medications, the use of strong analgesics (based on paracetamol and ibuprofen) is indicated.

At the perforative stage, local antibacterial drugs in the form of ear drops are added to the preliminary treatment, in addition, the patient continues to receive vasoconstrictor nasal drops and analgesics. Also shown is the catheterization of the auditory tube, a frequent toilet of the external auditory canal.

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

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

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

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

Acute otitis externa

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

Acute otitis media

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

Acute otitis media (or labyrinthitis)

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

Clinical symptoms of acute otitis media

This is a strong “shooting” pain in the ear, a rise in temperature, a decrease in hearing, noise in the ear, accompanied by a feeling of “congestion”. When the eardrum ruptures, which usually occurs on the 2nd or 3rd day of the disease, there is an outflow of pus from the ear, and the symptoms begin to subside. If the rupture of the tympanic membrane did not occur on its own, then a small puncture is necessary to allow the pus to flow out (the tympanic membrane then heals safely).

Treatment of otitis media

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

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

With success in the treatment of otitis media, physiotherapy is used. This, along with the above-mentioned phototherapy with a blue lamp, can be other procedures: UV, UHF, etc. However, physiotherapy is contraindicated in the midst of an acute period in the presence of an active purulent process in the ear.

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

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

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