Purulent otitis media
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms of purulent otitis media
- Diagnostics of the purulent otitis media
- Treatment of purulent otitis media
- Possible complications and consequences
- Forecast
- Prevention
Purulent otitis media is a common otorhinolaryngological disease, purulent inflammation of the middle ear with involvement of all its anatomical parts in the pathological process.
Purulent otitis media often affects children, in more than half of the cases, the pathological process manifests itself in persons under the age of 18. According to the World Health Organization, chronic purulent otitis media is diagnosed in 1-2% of the population. In 10-60% of cases, chronic suppurative otitis media leads to permanent hearing loss or loss.
Source: gorlonos.com
Causes and risk factors
The main reasons that lead to the onset of purulent otitis media include inflammatory processes in the upper respiratory tract of bacterial and viral etiology, infectious diseases (measles, scarlet fever, typhoid, tuberculosis, etc.). The infectious agent is able to enter the ear through the Eustachian tube, damaged tympanic membrane, by hematogenous route, retrograde from the cranial cavity, labyrinth. The causative agents of purulent otitis media are bacteria, viruses, microscopic fungi.
Most often, purulent otitis media in adult patients is caused by S. pneumoniae, S. pyogenes, S. aureus, H. influenzae, M. catarrhalis.
Risk factors include:
- immunodeficiency states;
- anatomical features of the structure of the middle ear in children;
- injury to the tympanic membrane and / or mastoid process;
- allergic diseases;
- swimming (water getting into the ear);
- severe vitamin deficiencies;
- advanced age;
- non-observance of the rules of hygiene of the ear cavity;
- poor nutrition.
Chronic otitis media usually develops in the absence of treatment or with inadequate therapy for the acute form of the disease, traumatic rupture of the tympanic membrane, curvature of the nasal septum, and a history of diabetes mellitus.
Forms of the disease
Depending on the localization of the pathological process, otitis media can be external (inflammatory process in the external auditory canal), medium (pathological process in the middle ear) or internal (inflammatory process in the inner ear). As a rule, otitis media refers to inflammation of the middle ear.
Purulent otitis media is divided into acute and chronic.
Disease stages
In the clinical picture of acute purulent otitis media, three stages are distinguished.
- Pre-perforative.
- Perforated.
- Reparative, or, in an unfavorable variant, the stage of chronicity.
Source: bezotita.ru
Chronic purulent otitis media proceeds with alternating stages of remission and exacerbation.
Symptoms of purulent otitis media
The main symptoms of purulent otitis media are pain in the ear of a aching, shooting or pulsating nature, radiating to the temple, crown and teeth, congestion and noise in the ear, purulent discharge from the ear, hearing loss, headaches, fever up to febrile values, weakness and rapid fatigue. On examination, the tympanic membrane is coated with a white coating.
With the development of acute purulent otitis media, the inflammatory process in the auditory tube leads to its thickening, the tympanic cavity is filled with exudate and bulges out. Due to the pressure of the pathological contents, the tympanic membrane is perforated and mucopurulent secretions flow out, and later the exudate becomes thicker and more scarce. Attenuation of the inflammatory process leads to the cessation of the outflow of purulent contents, but the feeling of stuffiness in the ear remains for some time. The flow of pus, as a rule, lasts 6-7 days. The gradual scarring of the perforation leads to hearing restoration. With severe tissue defects, hearing in the affected ear is not restored. Stagnation of purulent contents in the tympanic cavity may be indicated by an increase in body temperature and the occurrence of pain in the ear after perforation of the tympanic membrane and outflow of purulent exudate. The acute stage of the disease usually lasts 2-3 weeks.
If the perforation of the tympanic membrane does not occur for a long time, the headaches in patients with purulent otitis media intensify, they are joined by attacks of dizziness, vomiting; the general condition worsens. There is a risk of further spread of the infectious process with the development of life-threatening conditions.
Acute purulent otitis media can turn into a chronic form at any stage of the pathological process, in this case the severity of the inflammatory process subsides, the symptoms become less pronounced, and sometimes completely disappear, renewing episodically. The outflow of pus in the chronic form of purulent otitis media can be periodic or permanent. Allocations are often scarce, during an exacerbation, the amount of purulent exudate increases. If there are polyps in the tympanic cavity or the growth of granulation tissue, an admixture of blood is often found in purulent secretions. Also, against the background of chronic purulent otitis media, patients often develop disorders of the vestibular apparatus.
Diagnostics of the purulent otitis media
Diagnosis of purulent otitis media is usually not difficult, it is based on data obtained during the collection of complaints and anamnesis, an objective examination of the patient, and, if necessary, is confirmed by instrumental and laboratory studies.
To clarify the diagnosis, an otoscopy is performed (after a thorough toilet of the outer ear), the patency of the Eustachian tube is assessed. For the purpose of clarification, computed or magnetic resonance imaging can be assigned. If it is necessary to study the vestibular apparatus (in particular, in the presence of vestibular disorders in the chronic form of the disease), stabilography, indirect otolithometry, electronystagmography, etc. are performed.
Source: doctor-neurologist.ru
In order to identify the pathogen and determine its sensitivity to antibiotics, a bacteriological study of purulent discharge from the ear is carried out.
In the general analysis of the blood of patients with purulent otitis media, a moderate or pronounced increase in the number of leukocytes, an increase in ESR are usually found. The spread of the infectious process into the cranial cavity is indicated by pronounced leukocytosis and a decrease in the number of eosinophils.
In some cases, it is necessary to differentiate purulent otitis media with neoplasms and histiocytosis.
Treatment of purulent otitis media
Treatment of purulent otitis media, both acute and chronic, is usually carried out on an outpatient basis. In the presence of high fever and fever, bed rest is recommended. Hospitalization is required if there is a suspicion of involvement of the mastoid process in the pathological process and the development of other complications.
Drug therapy for purulent otitis media includes anti-infectious drugs. As a rule, broad-spectrum antibiotics are used to treat acute purulent otitis media; treatment of chronic otitis media requires the appointment of the antibacterial agent to which the pathogen is most sensitive. Astringent or vasoconstrictor drugs (to stimulate drainage function), analgesic and antihistamines are also prescribed. If necessary, the doctor punctures the tympanic membrane in order to drain purulent exudate (paracentesis).
When treating purulent otitis media at home, you should twice a day, and sometimes more often, remove purulent discharge from the ear canal using cotton swabs. If the discharge is too thick to prevent its evacuation, a warm solution of 3% hydrogen peroxide is first instilled into the ear, after which the ear canal is thoroughly dried.
To accelerate the resolution of the inflammatory process, in some cases, it is recommended to use warming alcohol compresses, but if the pain in the ear increases during the procedure, the compress is immediately removed.
After the acute inflammation subsides, the main treatment can be supplemented with physiotherapy (ultra-high-frequency therapy, ultra-high-frequency therapy, ultraviolet radiation).
At the recovery stage, taking medications, physiotherapeutic thermal procedures and mechanical cleaning of the ear canal are stopped. To prevent the formation of fibrous adhesions in the tympanic cavity, endaural iontophoresis and pneumomassage of the tympanic membrane are prescribed. Patients with chronic purulent otitis media are shown taking vitamin complexes, biostimulants.
Indications for surgical treatment of purulent otitis media are: paresis of the facial nerve, neurological and / or vestibular disorders, severe headaches, a high risk of complications. Depending on the prevalence of the pathological process, a sanitizing operation with tympanoplasty, mastoidoplasty, mastoidotomy, atticoanthrotomy, labyrinthotomy, removal of cholesteatoma can be performed. With the threat of complications developing against the background of a diffuse inflammatory process, a radical general cavity operation on the ear is required, during which all pathological contents (polyps, granulations, cholesteatoma, etc.) are removed.
Source: iphotostocks.ru
The postoperative period with purulent otitis media in a child is usually more severe than in adult patients, which is due to the frequent reinfection of the tympanic cavity through the auditory tube, difficulties in dressing, and a tendency to excessive growth of granulations.
In order to monitor the restoration of auditory function after completion of treatment, control audiometry is performed.
Possible complications and consequences
Purulent otitis media can be complicated by hearing loss, further spread of the infectious and inflammatory process to bone structures, paralysis of the facial nerve, meningitis, encephalitis, hydrocephalus, and death is possible.
Forecast
With timely and properly selected treatment, the prognosis is favorable. Starting treatment early improves patients' chances of hearing recovery and preservation. The prognosis worsens in the case of complications with a pronounced decrease in immunity and inadequate antibiotic therapy of the disease.
Prevention
In order to prevent the development of purulent otitis media, it is recommended:
- timely treatment of diseases that can be complicated by purulent otitis media;
- avoidance of unreasonable use of antibiotics, refusal of self-medication;
- increased immunity, including good nutrition and sufficient physical activity.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
