Chronic otitis media in adults: symptoms, treatment. Treatment of chronic otitis.

Chronic otitis media  is a manifest inflammatory process  in the middle ear and the tympanic cavity, which affects the eardrum, as well as adjacent bone and epithelial tissues, mucous membranes. This process is accompanied by constant hearing impairment and pathological changes in the tympanic cavity.

It borders on the temporal bone and is separated from the auditory canal by a special membrane. Chronic inflammation of the middle ear disrupts the integrity of this membrane, called the eardrum, leads to its deformation and the formation of holes of various sizes, of which there are long, sometimes even perennial, purulent discharge.

Forms of the disease

Purulent chronic otitis media of the middle ear, pathogens of which are pathogenic bacteria of different origin, conditionally divided into two types. To determine which of them is your disease, can only qualified and experienced specialist. It is very difficult for an ordinary person to distinguish between these symptoms and conditions:

• Mesotympanic - a milder form, affecting mainly the mucous part of the cavity of the middle ear. The bone tissue remains untouched. As a rule, multiple perforations are found in a patient. eardrum  in the central and lower parts of it.
• Epitimpanit - pretty dangerous diseasein which there is a defeat not only of the epithelium, but also of the bone tissue of the skull. This form of otitis media implies the appearance of small neoplasms consisting of numerous nodules - skin cells of the external auditory canal, ingrown into the cavity of the middle ear through the holes for excretion of pus. Such formations have the ability to grow and put pressure on neighboring healthy tissues, destroying them.

Chronic exudative otitis media is a constantly accumulating adhesive fluid in the middle ear cavity. The disease is remarkable in that viscous masses can be released for many months, but the perforation of the eardrum does not occur.

In other words, the patient does not observe suppuration from the ear, which makes it difficult for him to realize the seriousness of the situation. This pathology arises, as a rule, against the background of other otic inflammatory processes and defects of the tube connecting the auditory canals with the upper pharynx.

The chronic course is the process of scarring the tissues of both the tympanic cavity and the membrane itself.

The main components of the cavity of the middle ear, performing the auditory function, are deformed and fused with each other and the eardrum. As a result, irreversible loss of hearing in a patient and the spread of a purulent process to other tissues and organs.

Adhesive otitis media develops due to the lack of treatment of exudative otitis media, as well as against the background of regularly recurring other inflammatory processes in the ear.

Why does chronic otitis media occur?

In order to provoke this form of the disease, several types of pathogenic bacteria must develop simultaneously in the human body. depends on what microorganisms it is caused by.

Most common cause  the onset of the disease becomes streptococcal bacteria, and microorganisms from a number of anaerobes - Bacterioides, as well as Peptostreptococcus - cause the cholesteatoma.

The factors contributing to chronic overflow are the following:

• Numerous perforations in the eardrum and, as a result, the formation of adhesions;
• Constant swelling of the mucous membrane, narrowing of the ear canal;
• Ineffective treatment of acute otitis media, resistance of pathogens to most antibiotics;
• Oncological diseases, long-term chemotherapy;
• Hormonal disruptions;
• Disorders in the thyroid gland;
• Excess blood sugar.

People with weakened immunity, HIV patients, and pregnant women are especially susceptible to chronic otitis.

Clinical picture

The division of chronic ear disease into several different forms is due to the fact that the main focus of inflammation can be located in the central or upper part of the eardrum, where perforations are formed. Inflammation of the middle ear of the chronic stage are the following symptoms:

• Progressive hearing loss;
• Hearing loss;
• Pain in the ear;
• Pus and mucus released from the auditory canal;
• High body temperature;
• Heat, chills;
• Frequent migraines.

In other cases, the symptoms of the disease may carry a neurological nature. Acute otitis is different from chronic in that the latter is uneven - the periods of exacerbation alternate with the state of remission. Such a manifestation as hearing loss occurs mainly in children.

Any infection brought into the body, acute respiratory infections, acute respiratory viral infections, rhinitis, nasopharyngeal diseases and water ingress into the ear can provoke an exacerbation. During the next exacerbation, benign lesions, polyps, may begin to develop in the nasopharynx.

In many patients, suppuration or mucus secretion from the auditory canal is the main symptom of chronic inflammation.

Otitis, like others chronic diseasesIt does not do without a pronounced general intoxication of the body. These include persistent weakness, nausea, dizziness, fatigue, gastrointestinal disturbances and sleep disturbances.

When the onset of complications of the disease, symptoms quickly aggravated. The patient has a significant decrease in hearing, he begins to hear himself talking, it is also possible the transition of inflammation to the membranes of the brain and subsequent meningitis.

Treatment of chronic otitis

Treatment of the chronic should include a whole range of drugs and procedures. As a rule, therapy consists of taking antibacterial agents, antiallergic and vasoconstrictor drugs, as well as the use of disinfecting solutions to clean the ear canals from purulent secretions.

For the artificial removal of exudate from the tympanic cavity, a medical catheter is inserted into the patient's ear. In the same way, medicines are delivered inside the ear to relieve swelling and relieve the inflammatory process. Patients are often prescribed antibiotics in ampoules for insertion into the muscle or directly into the eardrum.

This is due to the fact that the drug, administered in this way, begins to act faster and is more effective than antibiotics in the form of capsules or tablets. In acute exacerbations of chronic otitis use antibacterial drugs  penicillin (augmentin) or cephalosporin (cefuroxime, cefazolin) series.

In some cases, macrolides can also be assigned. During remission of the disease, local treatment is applied in the form of antiseptic drops and blowing the ear canals with powder solutions.

In order for exacerbations to occur as rarely as possible, it is necessary to regularly wash the nasopharynx with antiseptic solutions, restrict bathing in pools and open water bodies, and suspend tempering procedures.

Treatment of chronic mesotympanitis may be limited to conservative methods, but it is useless to treat chronic epitimpanitis with local means and even antibiotics, this form of otitis can only be treated with surgery.

The most radical methods used by otolaryngologists in the treatment of chronic otitis are standard surgical procedures as well as laser therapy. In case of purulent epitimpanitis, the most correct solution will be microoperation with preservation of the auditory ossicles of the middle ear cavity in integrity.

Despite all the advantages of the use of Leser, it is contraindicated in the treatment of mastoiditis, polyps, as well as in cases where inflammation has already risen to the region of the skull. However, doctors often use the laser method to cauterize or refresh the edges of the pus exit holes to prevent the formation of adhesions.

In case of pronounced and stable hearing loss, surgical treatment is obligatory, in which tumors, polyps and overgrown bone tissue are removed from the ear cavity.

If chronic otitis media is caused by reflux disease, treatment measures will include dramatic changes in the diet, as well as a transition to a healthy lifestyle. The main goal of all therapeutic measures, in this case, is to reduce the concentration of acid in the stomach.

Chronic otitis in adults is a long-lasting disease, accompanied by pain sensations  and periodic discharge from the auricle. Depending on the site of inflammation, the disease falls into three categories: external, middle and labyrinth.

Otitis appears in both adults and children. Only at a young age do people get sick much more often. About 70-80% of children aged 2-5 years at least once had otitis. This is due to a weak children's immune system. With the wrong treatment of the acute form of otitis, the disease becomes chronic. In addition, the transition to the complicated form can be caused by severe rickets, frequent catarrhal diseases  (runny nose), diabetes, the appearance of adenoids, traumatic curvature of the nasal septum.

Symptoms of chronic otitis

The initial stages of the disease are accompanied by copious secretions from the ear. Most often they are purulent, with an unpleasant smell. A decrease in hearing, noise, and a feeling of congestion in the ears are also noted. Some cases are marked by fever. Symptoms may be permanent or periodic. With the complication of otitis, the symptoms of the disease become more pronounced.

Symptoms chronic otitis  in adults, divided into two subgroups: benign and malignant. The course of the disease with a benign variant occurs in the mucous membrane of the eardrum. The disease can last for years, without bringing much discomfort to the patient.

In otitis media, the inflammatory processes are not limited to the eardrum. The neglected cases of inflammation are transferred to the bone tissue. As a result, granulation and destruction of the bone occurs. In the future, these processes can go to the meninges, and will end in death.

If the first symptoms of chronic otitis appear, then you should immediately contact a otolaryngologist.

Etiology of the disease in adults

Most often, chronic otitis is caused by improper or ineffective treatment of the acute form of the disease. This is due to the late treatment of the patient to the doctor. People tend to postpone the trip to the hospital. They are waiting for the disease to go away. In rare cases, unskilled doctors' actions lead to a worsening of the disease.

The cause of the disease may be increased humidity in the ears. Usually this is due to the kind of hobby - swimming. Also, otitis in adults begins due to inflammatory processes in the nose.

Treatment of chronic otitis

Depending on the complexity of the course of the disease, treatment can be performed surgically and therapeutically. Helping the patient without surgery is possible during the initial stages of chronic otitis. The severity and extent of the disease can only be determined by the doctor, after the examination. The treatment is carried out in a hospital or at home. The danger of conducting therapy at home is the ability to use folk remedies.

A man tries to help himself with grandmother's recipes without consulting a doctor. Therefore, for some patients it is better to carry out treatment in the hospital. The basis of the correct therapy lies in the conduct of procedures and intake of drugs.

Procedures

• Washing the ears with antibacterial agents.
• If there is pus, remove swabs with cotton swabs.
• Warming the ears, if it is not contraindicated.
• Treatment with special ointments.

Drug intake

1. Painkillers
2. Anti-inflammatory.
3. Antibacterial.

Reception of drugs is carried out orally in the form of tablets or with the help ear drops.

In order to begin treating chronic otitis media in an adult, it is imperative to eliminate the inflammatory focus. Often they are held in the ear, nose or nasopharynx. If necessary, remove the adenoids, the rear ends of the lower shells (hypertrophied). Treatment of complete recovery ends in rare cases. More often after the end of therapy, a person has problems with hearing.

Surgical treatment

If chronic otitis is accompanied by plentiful purulent discharge, then most likely therapeutic treatment  ineffective. The specialist prescribes surgery. It is performed under anesthesia. The doctor makes the necessary incisions and removes purulent foci.

Surgical intervention is necessary because there is a serious danger of infection entering the brain or other neighboring organs.

The cure of the disease folk remedies

Treat chronic otitis folk methods  possible only in the early stages of its appearance. Before using any folk remedies, it is necessary to consult a doctor. During self-treatment, you must follow several rules. It is recommended to comply with bed rest. Reduce noise load on the ears. In case of purulent otitis, it is forbidden to apply warm compressors to the affected area. It is allowed only to put a scarf made of natural fabrics.

In the people there are many means for treating a patient with otitis. The greatest demand is for the infusion of herbs. To do this, use these herbs: chamomile, nettle, wild rose, aloe, geranium. The grass is crushed, brewed and allowed to infuse. Then pipette digs (2-4 drops) decoction in each ear. If otitis is not purulent, then you can warm the sore spot with a warm compress. For this warmed sea or food salt  and falls into a rag bag. After that, a warm compress is applied to the sore ear for 20-30 minutes. In case of purulent otitis, it is recommended to wash the ear with antiseptics. For this, a cotton swab is wetted with hydrogen peroxide or boric alcohol. Further neatly processed auricle  to completely get rid of purulent secretions.

If after a few days of treatment folk remedies  there is no improvement in the condition, it is time to stop self-treatment. It is better to seek help from a specialist.

Treatment of folk remedies is best done only for adults. For children, such experiments are not recommended. In a child, the immune system is weak and the disease progresses very quickly. Therefore, you can not waste time trying to cure at home.

Diagnostics

For the decision of the correct diagnosis should be examined by a doctor otolaryngologist. To the patient, it is necessary to tell as broadly as possible about the disturbing symptoms and the course of the disease. This will help the doctor determine the cause of otitis in an adult.

Then the specialist designates the passage of the diagnosis using the devices:

• Audiometry. Gives information about the location of the inflammatory process. Determines the degree of hearing loss.
• Vidiometriya. Allows you to enlarge and save the image. In the future, it is possible to compare pictures before and after treatment. What will show the effectiveness of the selected method of therapy.
• Tympanometry. With it, a specialist examines the function of the middle ear. Also determines the mobility of the eardrum. In addition, it recognizes the conductivity of the auditory ossicles.

Some cases require additional examinations - computed tomography and radiography. Only after collecting all the data from the examination, the specialist makes the correct diagnosis and begins to effectively treat the patient.

What is the risk of chronic otitis in adults?

If you run chronic otitis, do not treat it, it will lead to a number of unpleasant consequences. In some cases, the complications resulting from improper treatment with the help of folk remedies.

1. Mastoiditis. Inflammation of the process of the temporal bone.
2. Paresis facial nerve. Characterized by temporary paralysis of the facial nerve.
3. Labyrinth. Inflammation goes into inner ear  because of the appearance of caries of the bone.
4. Intracranial complications. Inflammations move to the lining of the brain and neighboring organs.
5. Partial or total hearing loss. Even after recovery, lost hearing does not fully return.

How to protect yourself from acute to chronic otitis media

To prevent the transition of the acute form of otitis in chronic, in an adult, you must adhere to the following steps:

• First of all it is necessary to treat the appeared acute otitis. With timely treatment, complications can be avoided.
• Since viral diseases can cause otitis respiratory tract, then vaccination will give a chance to avoid complications.
• When enlarged tonsils, it is necessary to remove them.
• Strengthen the immune system. Carry out stabbing of the body Eat healthy foods rich in vitamins.
• Avoid hypothermia.
• If independently treated with folk remedies, then first, you need to consult with your doctor.

The started form of chronic otitis cure is almost completely impossible to cure. Emerging complications leave a mark in the patient's body forever. Therefore, it is much easier to prevent the transition of acute to chronic otitis, than to treat it later. You also need to be careful when taking folk remedies in the fight against the disease.

Useful video about otitis

Chronic otitis media is a prolonged infection in the middle ear. The infection, in turn, is formed due to the non-healing hole (perforation) in the area of ​​the eardrum. In most cases, the chronic form develops against the background of acute otitis media, the treatment of which occurred incorrectly or out of time.

Symptoms of chronic otitis media vary depending on the part in which the eardrum disorder is located, on the form of chronic otitis media. There are three forms:

1. mesotympanal - perforation in the center of the eardrum;
2. epitimpanal - perforation of the upper part of the eardrum;
3. epimezotympanal - perforation of both parts of the eardrum.

If the hole is in the central part of the eardrum (central perforation)chronic otitis media becomes aggravated after infectious diseases  nose, throat (orz), or while swimming (if water enters the ear).

Bacteria that aggravate otitis media lead to the fact that pus is periodically released from the ear, and an unpleasant smell appears. If these exacerbations occur constantly, then it can lead to the formation of polyps (protruding growths). These growths begin to increase in volume and “germinate” from the middle ear to outer passage  through the hole in the eardrum.

If the hole is near the edge of the eardrum (marginal perforation)In this case, conductive hearing loss may be formed, and there may be increased discharge from the ear. With marginal perforations the following complications are possible:

• labyrinthitis (inflammation inner ear);
• facial paralysis;
• in extreme cases, brain infections.

Also, marginal perforation is accompanied by the appearance of cholesteate (tumor formation in the middle ear). Cholesteatomas are dangerous in that they destroy bone tissue, thereby increasing the risk of the formation of intracranial infections and complications.

Decrease in hearing is almost always observed.

Complications

Chronic otitis media is accompanied by suppuration, which periodically resumes. The duration of suppuration can be 6 weeks. In addition to purulent discharge, mucous membranes with an unpleasant odor may appear. During allergic otitis, watery discharge is observed.

Complications are characterized by the following symptoms:

• noise in ears;
• autophony;
• feeling of heaviness in the head;
• persistent hearing loss.

In some cases, the patient may be bothered by dizziness and headaches. Only during an exacerbation can pain occur.

  - This is an infectious inflammatory process, characterized by rapid development and localized in the cavity of the middle ear. The ear cavity is located inside the temporal bone and is covered outside by the eardrum. This membrane separates the middle ear from the ear canal. When an infectious process begins to develop, it includes not only the ear cavity itself, but also a number of existing structures. We are talking about air cells mastoidextending from the temporal bone, and the Eustachian tube.

This pathology is extremely common in otolaryngology and accounts for up to 30% of cases of all diseases of the upper respiratory tract. In addition, otitis media is often concomitant disease  and joins other pathologies of the ear - as a rule, this occurs in 30% of cases.

Both children and adults are susceptible to the disease, but toddlers suffer from otitis more often, due to the peculiarities of the structure of the middle ear in childhood. As for men and women, they suffer from otitis with equal frequency. Recent statistics indicate that cases of sluggishly progressing otitis media in the adult population and relapses in children have become more frequent. Up to 62% of babies suffer from acute otitis media during the first year of life.

Symptoms of otitis media

The duration of the disease is on average 3 weeks. During this time, otitis passes through all stages of its development.

Symptoms of the disease appear brightly, among them are the following:

The first symptom that characterizes the onset of the disease is the occurrence of pain. Moreover, it can manifest itself in different ways: it can be pulsating and incessant, it can be pulling and shooting, with short breaks. Sometimes the pain is localized not only in the ear, but also radiates to the temporal region or the back of the head. With otitis, teeth may begin to hurt;

The disease is manifested in the fact that a person's hearing is reduced. This symptom can appear both at the initial stage of otitis, and at all subsequent ones. A feeling of ear congestion may disappear after swallowing saliva or deep yawning;

The patient often suffers from autophony, which is manifested in the resonance of his own voice during speech;

A person experiences congestion in the ear, sometimes there is a feeling foreign object  inside or pressing feeling;

Sometimes there are extraneous noises;

Purulent or serous contents begin to separate from the ear. Although sometimes the discharge is not observed or there are, but very small;

In parallel, the adjacent lymph nodes become enlarged and painful;

The earloth of the person suffering from otitis starts to ache, blush and swell. The pain is aching in nature;

In the inflammatory process can be involved both one and both ears. In the latter case, it is advisable to talk about bilateral otitis;

Almost always the body temperature rises. It can reach high values, up to 39 degrees and above. When very high temperature  can be observed;

A person suffers from general intoxication of the body: sleep is disturbed, appetite decreases, fatigue increases, a feeling of general weakness and malaise appears;

Often, the ENT-organs are involved in the process, the patient suffers from, may experience pain and dryness in the throat.

Symptoms of the disease can be both bright and blurry. The clinical picture varies, the disease can proceed very hard, with and purulent-bloody discharge from the ear canal. In some cases, on the contrary, the symptoms are mild, for example, in an exudative form of the disease.

The causes of otitis media are diverse, among them are the following:

The first reason for the development of the disease, which is leading among other factors, is the infection of a person streptococcal infection. The next most common germs that cause otitis are pneumococci and. In 65% of cases, hit in the tympanic cavity of streptococcus causes the development of an acute infection process in the middle ear. This is facilitated by diseases of the nasopharynx, nose, paranasal sinuses, and throat;

Improper blowing of nose often causes otitis media to develop. If a person tries to remove mucus from the nose, and at the same time closes the mouth, then under the influence of the pressure that has arisen, some of it can penetrate the middle ear;

As a secondary pathology, otitis media of the middle ear can occur against the background of many diseases, in particular, other diseases lead to it.

Stages of acute otitis

There are several stages of acute otitis. They follow each other and have characteristic clinical manifestations. However, it is not necessary that the disease should go through all stages of development. With timely and adequate treatment, otitis media is a reversible process.

initial stage

The initial stage of the disease, which is called pre-perforated, is characterized by the presence of severe pain and general symptoms. Its duration can vary from several hours to several days. Pain sensation  arise on the background of the fact that irritation of the ternary and glossopharyngeal nerve occurs. Pain give and in the temporal, and in the parietal region. In humans, hearing is reduced due to the fact that the auditory ossicles in the tympanic region become less mobile.

At this stage, the pus accumulates, but does not penetrate the eardrum. She herself becomes swollen, blushing. The sensations of pain are exacerbated when a person lies down or leans toward the damaged ear. When otoscopy doctor observes the thickening of the eardrum, through which the purulent contents shine. Sometimes it can become covered with a bloom of white.

Perforating stage

The eardrum under the action of accumulated pus erupts, and the contents come out. The secretions are mucopurulent, at first there are many. Sometimes blood can be found in the discharge from the ear. The pain at the same time subsides, the person feels a significant relief. Body temperature drops, symptoms of intoxication subside.

At this stage, otoscopy gives the following picture: discharge comes through the damaged membrane in portions, it pulses synchronously. Over time, they become less, the amount of mucus decreases, the main contents become purulent masses.

This stage can last up to one week. As for the size of the perforation, then with purulent otitis, they are small. Extensive perforation is observed when the disease occurs on the background of scarlet fever, or measles. Sometimes the perforating stage can be characterized by the fact that purulent masses do not break out, but into the cavity of the skull. In this case, there is a serious threat not only to health, but also to the life of the patient.

Reparative stage

The final (reparative stage) is the one at which the perforation is scarred. In this case, the pus ceases to stand out, the hearing of the patient begins to recover. Infiltration of the tympanic membrane decreases, its swelling decreases. When otoscopy doctor observes its brilliance and more or less contoured contours. If the perforation was insignificant and did not exceed 1 mm, then it is fully tightened, leaving no scar.

If the breakthrough was significant, then in its place fibrous tissue is formed, which does not have the ability to regenerate. Often in this place salt deposits form. Often, fibrous adhesions can also be observed in the cavity of the middle ear, which helps to reduce the mobility of the auditory ossicles and, as a result, hearing impairment.

If otitis is uncomplicated, then general analysis  blood reveals a slight increase in ESR and a slight shift in the formula of leukocytes to the left. Sometimes it happens that at the perforated stage, pus erupts outside, but the patient's condition remains stably heavy. In most cases, this indicates the development of mastoiditis. If the pus is released throughout the month and begins to fill the ear again after cleansing, then this condition is referred to as the mastoid empyema.

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Otitis media can be both acute and chronic. Each of these forms has its own characteristics, differs in its course and recommended methods of treatment. The main difference between otitis media is the speed of development and duration of the disease.

Acute otitis media

Acute otitis media begins suddenly, and its symptoms quickly increase. First, the patient complains of tingling in the ear, then the pain becomes more intense. If acute otitis media develops in childhood, then those children who cannot speak speak in continuous crying. The pain may subside, but the time period is quite short.

After the eardrum breaks through and the purulent contents come out, the pain stops, the human condition returns to normal. Then there is a scarring of the eardrum about the restoration of hearing. Acute otitis media on average lasts up to 3 weeks. However, it is fraught with complications, such as inflammation of the temporal bone process - mastoiditis, temporary - as well as inflammation of the inner ear, meningitis, and other intracranial diseases. Therefore, it is so important to consult a doctor in time and start timely therapy.

Chronic otitis media

As for chronic otitis media, this disease is characterized by a sluggish course. Most often, the chronic form of the disease is a consequence of acute purulent otitis. The share of mesotympanitis, in the form of which chronic otitis media occurs, accounts for up to 55% of cases of this type of disease. This causes inflammation of the mucous membrane lining auditory tube, middle and below the tympanic cavity. It is there that the eardrum is perforated, but its main part often remains intact and taut.

For the chronic form of otitis, the following complaints of the patient are characteristic: hearing loss, constant or periodic appearance of purulent discharge from the auditory canal, and in rare cases - and. The pain can only bother a person when otitis enters an acute phase.

For mesotympanitis favorable, the disease rarely leads to serious consequences. Hearing will be reduced depending on how much the auditory ossicles are damaged at the time of treatment. Diagnosis of acute otitis media is based on patient complaints and seeding microflora of dischargeable contents.

The second form, in the form of which chronic otitis media can occur, is purulent epitimpantitis. In this case, the drummed space is damaged. The gap is localized in the upper part, so the purulent content is not completely separated from the ear cavity. This form of chronic otitis is more often fraught with complications than mesotympanic.

In order to adequately assess the condition of the bone structures, often standard examinations are not enough, and an x-ray examination is required.

There are other forms of otitis, to which exudative, catarrhal, purulent, serous and adhesive otitis media can be attributed. Each of them has its own characteristic features that allow you to diagnose the disease and prescribe adequate treatment.

Exudative otitis media

Exudative otitis media is distinguished by the fact that exudate accumulates in the middle ear cavity and there is no pain syndrome. Another characteristic feature of this type of otitis is the patient's hearing loss and the preservation of the eardrum. It is the absence of pronounced symptoms that makes it difficult to diagnose this type of otitis. Most often, it develops against the background of previous pathologies of the upper respiratory tract that are infectious in nature. It is especially difficult to identify this type of disease in children who do not complain of hearing loss. Among other reasons leading to the development of otitis exudative, it is possible to distinguish smoking, unfavorable environmental conditions, allergic reactions, curvature of the nasal septum, autonomic dysfunction, acute otitis media, advanced age, reduction, nasal tamponade, etc.

As for the pathogenesis of the disease, it takes its origin from the fact that a vacuum is formed inside the tympanic cavity, and the function of the auditory tube is impaired. Against this background, oxygen absorption, pressure drop and the appearance of transudate occur. Over time, the mucous glands are activated and the volume of secreted secretion increases. It becomes more and more dense, its viscosity increases. Against this background, degenerative processes begin to progress, which subsequently cause a decrease in hearing. Depending on the duration of the course of exudative otitis, several forms are distinguished: chronic, which lasts more than 2 months, subacute, which lasts up to 2 months, and acute, which lasts less than 3 weeks.

This type of otitis is fraught with such complications as the development of purulent otitis of the middle ear, the immobility of the auditory ossicles and hearing loss, the formation of perforation or cholesteatoma, persistent traction of the eardrum.

Catarrhal otitis media

Catarrhal otitis media is another type of disease, characterized by acute and inflammation of the auditory tube, eardrum and mastoid process. This form of otitis is dangerous with terrible complications and, if delayed, can lead to complete hearing loss.

Among the causes of the development of catarrhal otitis are frequent infections, chronic diseases of the upper respiratory tract, overgrowth, lack of vitamins, reduced immune forces, and sneezing, leading to increased pressure in the nasopharynx.

Symptoms of catarrhal otitis bright, the disease declares itself acute painmost often shooting. She gives and in the temple, and in. Therefore, to recognize this form of otitis is easy. If time does not begin treatment, then catarrhal otitis  often goes into purulent or exudative form.

Purulent otitis media

Purulent otitis media is characterized by the fact that inflammation of the mucous membrane of the middle ear proceeds with the appearance of purulent contents. All parts of the middle ear are involved in the pathological process, and not just the tympanic cavity. Acute purulent otitis  occurs most often among other types of otitis and can lead to hearing loss, which can not be restored.

Another danger of purulent otitis is that it can cause intracranial complications, such as meningitis, brain abscess, and otogenic.

Viruses rarely cause the development of purulent otitis, only 4% of cases. Most often, bacteria cause inflammation.

The infection gets into the ear through the auditory tube, this process is especially easy against the background of diseases of the nose and nasopharynx. But bacteria can also penetrate the cavity of the middle ear through blood, which most often occurs during the flu. In childhood purulent otitis occurs much more often than in adults.

After infection on the mucous membrane of the middle ear, the processes are triggered that cause the accumulation of exudate, which in a short time from serous transforms into purulent. Its volume gradually increases, which leads to increased pressure on the eardrum and its subsequent breakthrough. The danger lies in the fact that purulent contents can not go outside, and get into the cavity of the skull. Treatment is based on washing the ear cavity with a special solution, antibiotics and disinfectants.

Serous otitis media is an inflammation of the middle ear, with mild symptoms and characterized by the accumulation of non-purulent exudate. The liquid begins to accumulate in the tympanic cavity, and the person at the same time feels some pressure, congestion in the ears, and unexpressed hearing loss.

For the diagnosis of serous otitis most often is a standard examination of the eardrum and hearing complaints from the patient. The danger of serous otitis is that it can transform into a more serious form of the disease and cause complications. Especially often this occurs when a person for a long time ignores hearing loss and a feeling of discomfort in the ear, and when the disease develops in young children.

Depending on what caused the development of otitis, appropriate treatment will be given. If for 3 months serous otitis does not pass, then the patient is shown myringometry, that is, an artificial creation in the eardrum, a hole through which the necessary medications are injected.

If serous otitis often recurs, then it is necessary to find and eliminate the cause of it. Recently, there has been an increase in cases of serous otitis on the background of pronounced allergic reactions.

Adhesive otitis media

Adhesive otitis media, like other types of this disease, is determined by the presence of inflammation in the middle ear cavity, however, the process is chronic and leads to the formation of adhesions and cords, which significantly reduces hearing in humans.

Symptoms of this type of otitis are expressed in the fact that the patient complains about the appearance of noises in the ear.

If a doctor suspects an adherent otitis media from a person who has applied for help, then in addition to otoscopy, he is prescribed audiometry, impedancemetry, and an examination of the patency of the auditory tube.

In most cases, catarrhal or exudative otitis. Improper and irrational antibiotic therapy also often serves as a trigger to trigger the disease. Acute infectious processes in the body, as well as chronic low-intensity infections and curvature of the nasal septum can provoke the disease.

Therapy is primarily aimed at eliminating the cause of the disease. It is necessary to normalize nasal breathing as soon as possible. A course of special blowing and pneumomassage of the membrane is used. Antihistamines are shown, as well as the introduction of chymotrypsin, lidaza, hydrocortisone into the middle ear cavity. Often, conservative treatment alone is not enough, and if hearing loss continues to progress, surgical intervention is necessary. It is important to understand that formed scars do not have the property to fade. Therefore, the sooner a person turns to a doctor for help, the more optimistic the prognosis for full recovery will be.

Treatment of otitis media depends on which form of the disease is determined by the patient. Also, therapy depends on the stage of the inflammatory process and the presence of complications. As for acute otitis media, it is usually treated in an outpatient setting. If the disease causes complications, then the patient is hospitalized.

In order to eliminate the painful symptom, drops are instilled into the ears, which have an anesthetic effect. This may be Otipaks, Otinum, Anauran and others. Before the procedure, the drug is advisable to heat up 2 degrees above the normal temperature of the human body. After instillation into the ear, it is necessary to insert a cotton swab and remove it after a few hours. If the doctor did not carry out a preliminary examination and the risk of perforation of the membrane is not excluded, then you can use a cotton wool moistened in a solution of boric acid.

Antihistamines help relieve puffiness, and vasoconstrictor drops  for the nose. Among them are Tizin, Otrivin, Nazivin and others.

In order to relieve inflammation, drugs such as Nurofen, Ibuprofen, Diclofenac are shown to the patient. When the pain is not stopped by the above means, and the temperature continues to increase, bacterial infection  better to stop antibiotics.

When the disease is in the pre-perforative stage, a high-performance treatment method is blowing the auditory tube according to Politzer. Complementary therapy is washing the ear with antibiotic solutions that are combined with glucocorticosteroid drugs. If the purulent content does not decrease, and the eardrum continues to bulge, then its artificial perforation is necessary. This is done in order to exclude the breakthrough of purulent masses into the cavity of the skull.

When the disease has reached the perforated stage, the patient is shown an ear toilet and the introduction of means to reduce swelling and dilute the secret, for example, ACC, Fluimucil and others.

Do not forget about physiotherapy. Effective UV, laser therapy, UFCH.

It is important to prevent the formation of adhesions and prevent hearing loss. To do this, you need to increase immunity, using vitamin therapy and taking biostimulants - Actovegin and Apilak.

Antibiotics for otitis media

If the disease requires prescription of antibiotics, then it is worth understanding that only oral administration will not be enough. Local administration of antibacterial agents is also necessary. Take inside the doctors recommend ampicillin, amoxicillin, azithromycin, ciprofloxacin and others. Netilmicin and cefazolin are used as injection solutions. Topically prescribed drugs such as tsipromed, otofa, normax, fugentin and others.

Do not prescribe antibiotics yourself. They are prescribed only by the attending physician, since illiterate use of these medicines may not so much help to get rid of otitis, as on the contrary, aggravate the course of the disease.

Author of the article: Lazarev Oleg Vladimirovich, ENT doctor, specifically for the site of the site

Inflammation in the ear can appear at any age, but more often it is diagnosed in children. Indeed, according to statistics, the chances of up to three years are quite high - about 80%. This disease often becomes chronic. Mostly the ailment affects the middle ear. The disease develops for various reasons, but often it becomes chronic if the patient neglects his own health.

In many cases, chronic otitis media acquires this form as early as childhood. Over the years, the long course of pathology contributes to the flow of inflammation from the mucous membrane of the ear cavity to the bone tissue and submucosal. This leads to the development of sepsis, and also increases the risk of a number of complications. Therefore, it is important to carry out competent and timely treatment of chronic otitis media in adults and children. And in order for therapy to be effective, one should be aware of the features of this disease.

Chronic otitis appears only after an acute form of the disease or a regularly recurring inflammation of the ear. Often Staphylococcus aureus, enterobacteria and Pseudomonas aeruginosa contribute to the development of the pathological process.

Sometimes in children and some adults, the pathogenic microorganisms reside in the tympanic cavity of the organ of hearing, and do not immediately manifest themselves. Also, the pathology develops against the background of a weakened immune system, dysbacteriosis and antibiotic intake.

Attention!  If acute otitis media was transferred, it may become chronic in the course of a year, and with constant relapses, chronicity lasts 3-5 years.

Weakened immunity is the cause of many diseases, because the body is not able to independently fight against pathogenic bacteria.

The main factors that make inflammation in the sluggish ear:

• anemia;
• increased virulence of infectious agents;
• avitaminosis;
• weakening of immunity;
• incorrect use of corticosteroids;
• illiterate or late treatment of acute otitis media;
• constant moisture in the ear;
• difficulty in breathing with the nose, which occurs on the background of sinusitis, the presence of adenoids, polyps, or septum curvature;
• diabetes;
• incomplete antibiotic treatment.

Chronic otitis media: types

ICD 10 chronic otitis media is marked   depending on the type and form of the disease:

1. Average serous chronic otitis media - H65.2.
2. Chronic average mucous otitis - H65.3.
3. Other non-purulent forms of the disease - H65.4.
4. Purulent forms of the disease have code H66.3

By location  otitis media can leak into

• outdoor;
• average;
• inner ear.

The shape of the flowthe disease happens

• catarrhal;
• adhesive;
• tuboimpanal;
• serous;
• without perforation.

Chronic suppurative otitis media

Depending on the nature of the development of inflammation  Chronic otitis in children and adults is divided into:

• epitimpanitis;
• exudative otitis media;
• mesotympanic;
• adhesive type.

Epitimpanit  proceeds with dysfunction of the middle ear and the top of the eardrum. Sometimes this form leads to the spread of the pathological process on the bone tissue. This type of otitis can occur for a long time, disrupting the brain, which often requires surgical intervention.

Exudative otitis  occurs when inflammation affects the auditory tube, and the eardrum remains untapped. With a similar form of the disease, a purulent substance is collected in the ear, causing a number of intolerable symptoms.

Reference.  Chronic otitis media is divided into benign and malignant, in which bone formations are destroyed.

With mesotympanitis  a hole forms in the eardrum. This leads to the spread of the pathological process on the auditory ossicle and middle part  ear.

Adhesive typeis a complication of recurrent otitis media. The disease is manifested by scarring the cavity of the eardrum. But sometimes a connection occurs. auditory ossicles  with a membrane that significantly affects the auditory function.

Clinical manifestations

Chronic otitis, whose symptoms may be present up to 60 daysrecurs four or more times a year. Many symptoms of the disease are similar, but most of them depend on the type of disease.

So,   during exacerbation of the catarrhal form occurs:

• slight impairment of hearing;
• the process of swallowing saliva, accompanied by the appearance of sound in the ear;
• increased symptoms on the background of hypothermia;
• ear congestion at the time of sneezing or blowing.

With non-purulent long-term inflammation of the middle ear  hearing is significantly deteriorated and distorted, the quality of which depends on the position of the head. There is also a feeling of congestion and transfusion.

In the absence of therapy, the symptoms become more pronounced. Fibrous-protein liquid is collected in the tympanic cavity, with time it becomes dense. As a result, adhesions that interfere with the functioning of the auditory ossicles are formed.

Reference.  If a exudative stage 1-2 years, then the patient has a severe hearing loss.

Purulent average chronic otitis  has the following symptoms in adults:

• fever;
• hearing impairment;
• aggravated pain.

Also perforation of a membrane remains and episodic suppuration is noted. If the ear is damaged, then the eardrum curvature, the formation of polyps and granulations is possible.

Often with otitis note headachepoor coordination and dizziness.  These manifestations are often observed, as the inflammatory process takes place near the brain. A migraine often occurs on the background constant noise  in the ear. Sometimes a long course of the disease affects the functioning of the facial muscles.

Attention!  In children, otitis followed almost always.

Diagnostics

To detect chronic otitis, a thorough study is needed. This will establish the nature and nature of the disease, which will make it possible to choose the optimal method of treatment.

The analysis consists of such diagnostic procedures.:

• examination of vestibular functions;
• microtostoscopy and endoscopy - allow you to determine the type of inflammation and learn about the damage to the membrane;
• laboratory studies of secretions;
• radiography of the skull;
• MRI of the brain.

Often, in addition to endoscopic examination, no additional procedures are required to clarify the diagnosis or its details.

Treatment of chronic otitis

When a diagnosis of chronic otitis media is established, doctors prescribe a comprehensive treatment aimed at eliminating the cause, signs of the disease and subsequent recovery. If the disease is diagnosed at an early stage, then it may be enough to recover. antiseptic and anti-inflammatory drugs.

Drug treatment of otitis media in children

The choice of the method of conservative therapy depends on the severity of the disease, the causative agent and the symptoms of the pathology.

If a the child has purulent discharge, the doctor prescribes antibiotics:

• Clarithromycin;
• Ceferoxime acetal;
• Azithromycin.

When joining a fungal infection  it is advisable to use:

• Nizoral;
• Brutal;
• Diflucan.

Attention!  Conservative therapy is effective only when the free flow of the exudative substance.

Putting medication in your ear is necessary only after cleansing it from pus. Then you can bury in auditory canal  antiseptics such as Protargoleither. In the presence of otomycosis for 30 days in the ear lay with Nizoral, Levaril,  or Travogenom.

To restore general and local immunity is used. Viferon and Megasin.

When instilling the ear drops into a child: gently pull the ear down and back to straighten the ear canal, slowly drop the prescribed number of drops

Therapy of chronic otitis in adults

At the beginning of treatment should take care of the normal outflow of fluid and its subsequent removal from the ear cavity. For this purpose is used drainage  or vacuum suction The task of therapy is the resumption of the structures of the eardrum.

You also need to constantly treat your ear with antiseptics. With minor damage, funds are assigned that accelerate the regeneration process.

If infection of the tympanum occurs, then antibiotics are necessary. To the first line of drugs belongs, which take from 5 to 10 days.  Carry to the second row Ceftriaxone, Cefuroxime, Nirofetz, .

Reference.  With inefficiency traditional therapy  Surgical intervention is used - tympanolastic, radical or general cavity operation.

As local treatment  brings good results physiotherapy:

• Ultrasound;
• UV radiation.

Folk remedies

As part of complex therapy, you can use some non-traditional recipes. So, in the acute stage of chronic otitis helps. To do this, cover the ear with a towel, and on top of it, apply warm salt in a bag or bottle filled with hot water.

As antiseptic  You can use onion juice.  It is prepared as follows: in one onion the top is cut off and the core is removed. In the hole fall asleep 1 tsp. cumin, and then put everything in the oven for 30 minutes. The resulting juice is instilled into the inflamed ear canal at night in the amount of 3-4 drops.

Attention!  It is not advisable to dig in the ear pure alcohol, undiluted onion, garlic juice and aloe extract.

Often, with prolonged inflammation of the ear, treatment with folk remedies is used, which means using mummy. Cotton wool moistened in a solution of mummy and grape juice (1: 1), and then placed in the ear canal. Also, the mummy can be infused in a decoction of rose petals. 3 drops of medicine are instilled overnight for 14-21 days.

There are a number of factors that increase the likelihood of developing chronic otitis. These include frequent respiratory exposure. viral diseases, inappropriate use of antibiotics, poor nutrition, artificial feeding of children and low-active lifestyle.

Chronization of inflammation contribute. Therefore, in order to prevent the development of otitis, all risks should be minimized and not to forget about timely treatment of the acute phase of the disease.