Otitis media
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms of otitis media
- Diagnosis of otitis media
- Otitis media treatment
- Possible complications and consequences
- Forecast
- Prevention
Otitis media is an infectious and inflammatory disease of the middle ear, which is one of the most common pathologies, especially in pediatric otorhinolaryngology. Approximately 50% of children experience at least one episode of illness during the first year of life. The most common form of pathology is acute otitis media, while one ear is affected. In rare cases, the inflammatory process spreads to the second ear. According to the World Health Organization, chronic suppurative otitis media is recorded in 2% of the population, in 60% of patients it becomes the cause of persistent hearing loss.
Source: gippokrat.com
The human ear consists of 3 sections: outer, middle and inner. The middle ear is the cavity between the inner edge of the outer ear, which is the eardrum, and the inner ear. The Eustachian (auditory) tube opens into this cavity, connecting this section with the pharynx. In addition, the auditory ossicles are located in the cavity, which transmit and simultaneously amplify sound vibrations. The middle ear converts air vibrations into fluid vibrations that fills the inner ear.
Causes and risk factors
The causative agents of otitis media are usually streptococci, staphylococci, pneumococci, Haemophilus influenzae, moraxella, influenza and parainfluenza viruses, adeno- and rhinoviruses. Less commonly, infectious agents are proteus, diphtheria corynebacteria, microscopic fungi. The penetration of the pathogen into the tympanic cavity usually occurs through the Eustachian tube (tubogenic), that is, from the nasopharynx - for this reason, otitis media often becomes a complication of upper respiratory tract infections. In some cases, the pathogen enters the middle ear through a damaged tympanic membrane (transtympanic pathway) or through the bloodstream in infectious diseases (measles, scarlet fever, tuberculosis, etc.).
Source: cf.ppt-online.org
Risk factors include:
- acute respiratory diseases;
- immunodeficiency states;
- neoplasms of the nasal cavity and pharynx;
- endocrine disorders;
- allergy;
- anatomical features of the structure of the ear;
- tympanic membrane injury;
- the ingress of amniotic fluid into the middle ear of the child during the passage through the birth canal;
- foreign body getting into the ear;
- sudden changes in atmospheric pressure;
- hypothermia of the body;
- bad habits;
- poor nutrition;
- irrational use of antibacterial drugs.
Forms of the disease
Otitis media can be acute and chronic. Depending on the nature of the exudate, the catarrhal and purulent form of the disease is determined.
Disease stages
In the clinical picture of acute otitis media, three stages are distinguished:
- preperforative - lasts from the moment the inflammation begins and until the integrity of the tympanic membrane is disturbed; the stage of the most pronounced manifestations;
- perforated - lasts from the moment of perforation of the tympanic membrane and until the completion of purulent discharge from the external auditory canal;
- reparative - the stage of recovery. In an unfavorable variant of development - the stage of transition to a chronic form.
Chronic otitis media proceeds with alternation of two stages - exacerbation and remission.
Source: babyzzz.ru
Symptoms of otitis media
The symptoms of otitis media usually come on suddenly. Patients complain of ear pain and hearing loss. The pain is constant or shooting in nature, radiating to half of the head on the affected side; aggravated at night, interfering with sleep, and during eating and talking. In addition, congestion and noise in the ear is felt, regional lymph nodes on the affected side increase. In some cases, with otitis media, there are signs of inflammation of other ENT organs: nasal congestion and discharge from it, sore throat and sore throat. On examination, a hyperemic eardrum is found, its protrusion is noted.
Source: cf.ppt-online.org
Acute otitis media is accompanied by the development of general symptoms: headache, fever, weakness, aches in muscles and joints, loss of appetite.
In newborns and children in the first years of life, the clinical picture of otitis media is somewhat different from that in older children. In newborns, the disease is often latent until the appearance of suppuration. During this period, the child wakes up at night, is restless, can turn his head and reach for the affected ear.
Acute otitis media in young children usually presents with fever, serous discharge from the ear, decreased appetite up to a complete refusal to eat, lethargy, rapid fatigue, irritability, tearfulness, vomiting and / or diarrhea, and meningeal symptoms.
The preperforative stage, characterized by the most pronounced pain syndrome and poor general condition, lasts from several hours to 6 days. When a large amount of purulent exudate accumulates in the tympanic cavity, perforation of the tympanic membrane occurs, and suppuration begins. At the same time, the general condition improves, the body temperature is normalized, the acute pain subsides. When viewed at this stage, the eardrum is hyperemic, there is a smoothness of its contours and a decrease in protrusion. The duration of suppuration in acute otitis media usually does not exceed one week. In the event that it lasts longer, there are grounds to suspect the development of mastoiditis. If the perforation of the eardrum does not occur for a long time, life-threatening complications can develop.
In some cases, there is a protracted oligosymptomatic course of acute otitis media, with the absence of spontaneous perforation of the tympanic membrane. This form of the disease is manifested mainly by persistent headache and attacks of dizziness.
At the reparative stage, the discharge of pus stops. In most patients, at this time, the perforation of the tympanic membrane is scarred and hearing is restored. With a perforation larger than 1 mm, the fibrous layer of the tympanic membrane is not restored, the perforation site remains thin, atrophic, since it is formed without a fibrous component only by epithelial and mucous layers.
The duration of the disease ranges from several days to several weeks. With adequate treatment undertaken, acute otitis media can take on an abortive nature (that is, interrupt) at any stage.
Chronic otitis media in remission usually does not manifest itself in anything. Exacerbations have manifestations similar to the acute form of the disease, but usually less pronounced. In addition to the main symptoms, autophony is often observed, in which the patient hears his own voice in the affected ear louder than usual. In young children, chronic otitis media is usually asymptomatic, but hearing loss can make children appear inattentive, absent-minded, and poor school performance.
Suppuration from the affected ear with chronic otitis media can be either scanty, constant or recurrent. During periods of exacerbation, purulent discharge becomes more abundant, pulsation occurs in the affected ear, body temperature rises to subfebrile values. With the growth of granulation tissue in the tympanic cavity or in the presence of polyps, an admixture of blood appears in the exudate. Exacerbations are usually provoked by acute respiratory diseases, hypothermia, water ingress into the ears and other adverse factors.
Diagnosis of otitis media
Diagnosis of otitis media is usually straightforward. The preliminary diagnosis is made on the basis of data obtained during the collection of complaints and anamnesis, as well as an otolaryngological examination.
The otoscopic picture depends on the stage of the disease at which the diagnosis is carried out. In the initial stages of acute otitis media, an injection of blood vessels of the tympanic membrane is detected. With the course of the pathological process, the hyperemia becomes diffuse, the protrusion of the tympanic membrane is determined, it can be covered with a whitish coating. At the stage of perforation, a perforation of the tympanic membrane (round or slit defect) is visualized. In the reparative stage, scarring of the perforation is noted or, with chronic inflammation, perforation with calcified edges.
Tympanometry is used to determine the degree of mobility of the tympanic membrane and the conductivity of the hearing aid. In order to assess hearing acuity and auditory sensitivity to sound waves of various frequencies, audiometry is performed. If you suspect the development of intraosseous or intracranial complications, you may need computed or magnetic resonance imaging, X-ray examination of the bones of the skull.
Laboratory examination of ear discharge can identify an infectious agent and determine its sensitivity to anti-infectious drugs.
Differential diagnosis of otitis media is carried out with sulfur plugs, otosclerosis, cochlear neuritis, ear neoplasms, congenital anomalies in the formation of the auditory ossicles.
Otitis media treatment
Otitis media is usually treated on an outpatient basis. In some cases (in particular, with the catarrhal form of the disease), it is limited to expectant tactics. Hospitalization is indicated for patients with suspected purulent complications.
The acute form of otitis media in most cases requires conservative treatment. At the stage of purulent inflammation, antibacterial agents of a wide spectrum of action are prescribed for at least 5 days. In some cases (prolonged discharge of pus, severe course of the disease), a combination of local and intramuscular antibiotics is indicated. To relieve pain and normalize body temperature, nonsteroidal anti-inflammatory drugs are prescribed inside in a short course. Thermal procedures for acute otitis media are contraindicated, as they can serve as a factor contributing to the development of complications. To reduce inflammatory edema and restore the patency of the Eustachian tube, vasoconstrictor nasal drops are prescribed.
In the absence of a positive effect of conservative treatment (preservation of pain, protrusion of the tympanic membrane, fever), paracentesis is resorted to - a procedure during which the tympanic membrane is punctured in the place of its greatest protrusion in order to create an outflow of purulent exudate. Paracentesis is performed under local or general (in young children) anesthesia. After a puncture, a sterile turunda is inserted into the ear canal. Further treatment is to ensure a free outflow of purulent contents from the middle ear. Cotton swabs are changed as they soak, the external auditory canal is thoroughly cleaned of pus. If necessary, the ear cavity is washed with an antiseptic solution.
In the perforated stage, according to the indications, antihistamines, vasoconstrictor drugs, mucolytics are prescribed. After the cessation of suppuration, the perforation usually closes with the formation of an inconspicuous scar.
Chronic otitis media generally follows the same treatment approach as acute otitis media. Antibacterial drugs are prescribed taking into account the identified sensitivity of the pathogen; physiotherapy, which is used to stimulate reparative processes, provides a good effect.
In chronic purulent otitis media with a high risk of complications, therapeutic measures may not be enough, in this case, they resort to surgical intervention, which consists in sanitizing the infectious focus, removing granulations.
Possible complications and consequences
With complicated otitis media, the ear is involved in the inflammatory process with damage to internal structures (labyrinthitis), further spread of infection with the development of mastoiditis (inflammation of the mucous lining of the cave and the cells of the mastoid process of the temporal bone), epidural abscess, brain abscess, thrombosis of the sigmoid (lateral) sinus is possible, meningitis, neuritis of the facial nerve, sepsis.
Otitis media in children of the first years of life can lead to impaired speech function and delayed psychoemotional development.
Forecast
With timely adequate treatment, the prognosis is favorable. In advanced cases, reconstructive surgery may be required to restore hearing. If intracranial complications develop, lethal outcome is possible.
Prevention
Prevention of otitis media consists in the timely treatment of diseases that can be complicated by inflammation of the middle ear, avoidance of uncontrolled intake of antibacterial drugs, ear injury and water ingress into the ears, as well as increasing immunity.
Vaccination against pneumococcal infection and influenza helps to reduce the incidence and severity of otitis media in children.
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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!
