Catad_tema Diseases of the ENT organs - articles

Otitis medium acute

ICD 10: H65.0, H65.1, H66.0

Year of approval (revision frequency): 2016 (reviewed every 3 years)

ID: KR314

Professional associations:

National Medical Association of Otolaryngologists

Approved

National Medical Association of Otorhinolaryngologists __ __________201_

Agreed

Scientific Council of the Ministry of Health Russian Federation __ __________201_

CT - CT scan;

NSAIDs- non-steroidal anti-inflammatory drugs

OGSO– acute purulent otitis media;

CCA- acute otitis media

ARVI– acute respiratory viral infection;

ROSO– recurrent acute otitis media;

HSSO– chronic purulent otitis media;

ESO- exudative otitis media

Terms and Definitions

Acute otitis media – inflammatory process, covering all three parts of the middle ear: the tympanic cavity, mastoid cells, auditory tube, manifested by one or more characteristic symptoms(ear pain, fever, hearing loss). Only the mucous membrane of these cavities is involved in the pathological process.

Protracted acute otitis media– determine the presence of symptoms of inflammation of the middle ear within 3-12 months after one or two courses of antibiotic therapy.

Recurrent acute otitis media– the presence of three or more separate episodes of AOM within 6 months or 4 or more episodes over a period of 12 months.

1. Brief information

1.1 Definition

Acute otitis media (AOM) is an inflammatory process that affects all three parts of the middle ear: the tympanic cavity, mastoid cells, and auditory tube, manifested by one or more characteristic symptoms (ear pain, fever, hearing loss).

Children with NDE may experience agitation, irritability, vomiting, and diarrhea. The disease usually lasts no more than three weeks, but it is possible to develop prolonged or recurrent AOM, which can lead to persistent changes in the middle ear and hearing loss. The recurrent course of acute otitis media leads to the development of chronic inflammatory pathology middle ear, to progressive hearing loss, causing disruption of speech formation and general development of the child.

1.2 Etiology and pathogenesis

The main etiological factor in the occurrence of acute otitis media is the effect on the mucous membrane of the middle ear of a bacterial or viral agent, often in conditions of altered reactivity of the body. In this case, the type of microbe, its pathogenic properties and virulence are of great importance.

At the same time, the development and nature of the inflammatory process in the middle ear is significantly influenced by the anatomical and physiological features of the structure of the middle ear in various age groups Oh. They are predisposing factors for the development acute inflammation and transition to protracted and chronic course.

The main theories of the pathogenesis of acute otitis media explain its development by dysfunction auditory tube.

Impairment of the patency of the auditory tube leads to the creation of negative pressure in the tympanic cavity and transudation of fluid, which is initially sterile, but due to the disruption of mucociliary cleansing of the middle ear and the attachment of opportunistic facultative anaerobic microflora from the nasopharynx, it becomes inflammatory in nature.

Thus, the prevailing mechanism of infection penetration into the middle ear cavity is tubogenic - through the auditory tube. There are other ways of infection entering the tympanic cavity: traumatic, meningogenic - retrograde spread of an infectious meningococcal inflammatory process through the aqueducts of the ear labyrinth into the middle ear. Relatively rarely, in infectious diseases (sepsis, scarlet fever, measles, tuberculosis, typhus), a hematogenous route of infection spreads into the middle ear.

Under conditions of inflammation, exudate accumulates in the cavities of the middle ear, the viscosity of which tends to increase in the absence of drainage.

In highly virulent infections, the eardrum may be melted by pus enzymes. Through the perforation that has arisen in the eardrum, the discharge is often evacuated from the tympanic cavity.

With a low-virulent infection and other favorable conditions, perforation does not form, but the exudate is retained in the tympanic cavity. In effect, the air space in the middle ear disappears. In conditions of inflammation, impaired aeration, gas exchange and drainage of the middle ear, irrational antibiotic therapy and immune disorders contribute to the transition of the acute process into sluggish inflammation of the mucous membrane (mucositis) of the middle ear and the development of chronic secretory otitis media.

The main causative agents of AOM are pneumococcus (Streptococcus pneumoniae) and Haemophilus influenzae, which together account for approximately 60% bacterial pathogens diseases, as well as various types of streptococci. Various strains of these microorganisms populate the nasopharynx in most children. Biological properties S. pneumoniae cause severe clinical symptoms and the risk of developing complications of AOM.

In children of a younger age group, gram-negative flora may be a significant pathogen.

About 20% of cultures from the tympanic cavity turn out to be sterile. It is believed that up to 10% of NDEs may be caused by viruses.

The spectrum of pathogens changes somewhat with prolonged acute otitis media (PAOM) and recurrent acute otitis media (RAOM). When bacteriological examination of residual exudate after AOM suffered from 2 to 6 months ago, H.influenzae is detected in more than half of the cases (56-64%), while S.pneumoniae is detected in only 5-29% of cases.

1.3 Epidemiology

20-70% of respiratory infections in adults and children are complicated by the development of AOM. More than 35% of children in the first year of life experience AOM once or twice, 7–8% of children experience it multiple times; under the age of 3 years, more than 65% of children experience AOM once or twice, and 35% of children experience it multiple times. By the age of three, 71% of children suffer from AOM.

The cause of the development of sensorineural hearing loss in adults in 25.5% of cases is a previous acute or chronic purulent otitis media.

1.4 Coding according to ICD-10

H65.0- Acute serous otitis media

H65.1- Other acute non-suppurative otitis media

H66.0- Acute purulent otitis media

1.5 Classification

Acute otitis media is a disease with a pronounced staged course. In accordance with the classification of V.T. Palchuna et al. identify 5 stages of acute inflammation of the middle ear:

Stage of acute eustacheitis
Catarrhal stage
Pre-perforative stage of purulent inflammation
Post-perforation stage of purulent inflammation
Reparative stage

According to the severity of the course: AOM can be mild, moderate or severe.

2. Diagnostics

2.1 Complaints and anamnesis

The main complaints are ear pain, fever, in some cases - purulence from the ear, and hearing loss. The history indicates an acute respiratory viral infection (ARVI). Patients often complain of a feeling of fullness in the ear, autophony, and tinnitus. Children, especially younger age groups, extremely rarely make complaints at this stage of AOM, since due to their age they cannot characterize their condition.

2.2 Physical examination

The clinical picture of acute otitis media is based on symptoms characteristic of an acute inflammatory process (pain, increased body temperature, hyperemia eardrum) and symptoms reflecting dysfunction of the auditory (hearing), less often vestibular (dizziness) receptors.

Hearing loss is of the nature of conductive hearing loss; rarely a sensorineural component can be added. Considering the pronounced staged nature of the course of AOM, it is advisable to give a clinical and diagnostic assessment of each stage.

Stage of acute eustacheitis – characterized primarily by dysfunction of the auditory tube, which causes further development pathological process.

Stage of acute catarrhal inflammation . On otoscopy: the eardrum is hyperemic and thickened, identification marks are difficult to determine or not determined.

Stage of acute purulent inflammation . This stage is caused by infection of the middle ear. Complaints: pain in the ear increases sharply. Symptoms of intoxication increase: the general condition worsens, the temperature reaches febrile levels.

Otoscopically - pronounced hyperemia of the eardrum is determined, identifying marks are not visible, there is a bulging of the eardrum of varying degrees of severity. Due to the pressure of purulent secretion and its proteolytic activity, a perforation may appear in the eardrum, through which pus is evacuated into the ear canal.

Post-perforation stage Otoscopically, a perforation of the eardrum is determined, from which purulent discharge comes.

Reparative stage . Patients have virtually no complaints at this stage. Acute inflammation in the middle ear is stopped. Otoscopy: restoration of the color and thickness of the eardrum. Perforation is often closed by a scar. However, restoration of the mucous membrane of the middle ear cavities has not yet occurred. To assess the restoration of aeration of the middle ear cavities, dynamic observation of the patient (otoscopy and tympanometry) is necessary.

2.3 Laboratory diagnostics

It is recommended to carry out general clinical research methods: general blood test; in severe cases, determination of other markers of inflammation (C-reactive protein, procalcitonin). In severe and recurrent cases, microbiological examination of discharge from the middle ear at the perforated stage or when performing paracentesis/tympanopuncture is recommended.

2.4 Instrumental diagnostics

Carrying out X-ray methods for studying the temporal bones such as: X-ray according to Schüller and Mayer, computed tomography of the temporal bones is recommended in cases of protracted course of the process, suspicion of mastoiditis and intracranial complications.

3. Treatment

3.1 Conservative treatment

It is recommended to carry out unloading (intranasal) therapy in all stages of AOM to restore the function of the auditory tube.

Comments: Intranasal therapy includes the use of:

irrigation-elimination therapy - nasal toilet using isotonic NaCL solution or sea water(nasal toilet in young children involves forced removal of discharge from the nose);
vasoconstrictors (decongestants) (see Appendix D1).
intranasal glucocorticosteroid drugs; (see Appendix D1).
mucolytic, secretolytic, secretomotor therapy (especially in young children when it is impossible to remove thick nasal secretions);
topical antibacterial therapy (see Appendix D2).

It is recommended to carry out a systemic and topical therapy for pain relief.

Comments: Therapy for pain relief includes:

Systemic non-steroidal anti-inflammatory drugs (NSAIDs).

Dosage in children: paracetamol** 10-15 mg/kg/dose, ibuprofen** 8-10 mg/kg/dose;

NSAIDs are an essential component in the complex treatment of acute inflammation of the middle ear. For clinical use, a classification is convenient, according to which NSAIDs are divided into drugs:

Drugs with a strong analgesic and weakly expressed anti-inflammatory effect (metamizole sodium**, paracetamol**, acetylsalicylic acid** at a dose of up to 4 g/day);
Drugs with an analgesic and moderately pronounced anti-inflammatory effect (derivatives of propionic and fenamic acids);
Drugs with strong analgesic and pronounced anti-inflammatory properties (pyrazolones, derivatives acetic acid, oxicams, acetylsalicylic acid** in daily dose 4 g or more and others).

In the treatment of pain, drugs with a predominant analgesic effect.

Local therapy;

Lidocaine**-containing ear drops;
Alcohol-containing ear drops.

Recommended on pre-perforative stage of acute inflammation middle ear continue unloading therapy, be sure to prescribe systemic or local analgesic therapy.

Comments: Topical osmotically active and antimicrobial drugs (ear drops) are prescribed to relieve pain, which is caused by swelling of the eardrum and its tension due to pressure from accumulated inflammatory exudate.

It is recommended to use ear drops containing the non-opioid analgesic-antipyretic phenazone** and lidocaine** as local analgesic therapy.

Comments: Ear drops are often used as local (endaural) therapy: framecitin sulfate, gentamicin**, neomycin.

Mucolytic, secretolytic and secretomotor therapy is recommended. .

Comments:in the treatment of AOM, no less important than restoring the airway is improving the drainage function of the auditory tube. Thanks to the coordinated vibrations of the ciliated epithelium cilia lining the lumen of the auditory tube, pathological contents are evacuated from the tympanic cavity. When the mucous membrane of the auditory tube swells, this function is completely lost. The viscous secretion filling the tympanic cavity is difficult to evacuate. The use of drugs with mucolytic and mucoregulatory action helps to drain the middle ear cavity regardless of the type and viscosity of the secretion. Preparations of direct mucolytic action based on N-acetylcysteine are used for administration, including into the tympanic cavity, as well as drugs based on carbocysteine.

It must be remembered that not every mucolytic that has proven itself in bronchial pathology can be used to treat AOM. Therefore, before prescribing a drug from this group, it is necessary to read the instructions for use and the registered indications indicated therein.

Systemic antibacterial therapy is recommended for purulent forms of AOM.

Comments: Considering that acute inflammation of the middle ear is often a complication of a respiratory viral infection, especially in childhood, prescribing antibacterial therapy according to indications reduces the risk of developing mastoiditis and other complications. Mandatory prescription of antibiotics in all cases of AOM in children under two years of age, as well as in cases of AOM and ROSO, in patients with immunodeficiency conditions.

It is recommended to consider it as the first choice drug for AOM. amoxicillin** .

Comments: The doctor should prescribe amoxicillin** for AOM if the patient has not taken it in the previous 30 days, if there is no purulent conjunctivitis, allergy history is not burdened.

It is recommended that if there is no sufficient clinical effect after three days, amoxicillin** should be replaced with amoxicillin + clavulanic acid** or replaced with a third-generation cephalosporin antibiotic (cefixime**, ceftibuten**), which are active against?-lactamase-producing strains of Haemophilus influenzae and Moraxella.
It is recommended to start treatment with oral amoxicillin + clavulanic acid for ZOSO and ROSO. ** .

Comments: Preference should be given to oral forms of antibiotics. If the intramuscular route of administration is preferred, ceftriaxone** is prescribed. It must be remembered that in patients who have recently received courses of ampicillin, amoxicillin** or penicillin, there is a high probability of isolating beta-lactamase-producing microflora. Therefore, for young children the drug is prescribed in the form of a suspension or dispersible tablets.

It is recommended to prescribe macrolides as the drugs of choice.

Comments: Macrolides are mainly prescribed for allergies to β-lactam antibiotics. The role of macrolides in the treatment of pneumococcal infections in last years decreased due to the increase in pneumococcal resistance especially to 14- and 15-membered macrolides. According to Russian multicenter study according to the determination of the sensitivity of pneumococcus, carried out in 2010-2013, the frequency of insensitivity to various macrolides and lincosamides varied from 27.4% (for 14 and 15 membered) to 18.2% (for 16 membered macrolides).

It is recommended to prescribe fluoroquinolones only as deep reserve drugs.

Comments: Recent reviews of the safety literature have shown that the use of fluoroquinolones is associated with disability and long-term serious side effects that may involve tendons, muscles, joints, peripheral nerves and central nervous system. The widespread use of fluoroquinols in primary care causes the development of drug resistance in M. tuberculosis, which has increased by an order of magnitude in recent years, which has begun to hinder timely diagnosis tuberculosis. The use of fluoroquinolones is contraindicated in pediatric practice due to their negative effect on growing connective and cartilage tissue.

Daily doses and regimen of antibiotics for acute otitis media are presented in Table 1.

Table 1. Daily doses and regimen of antibiotics for AOM

Antibiotic			Connection with food intake
Antibiotic	Adults		Connection with food intake
Drugs of choice
Amoxicillin*	1.5 g/day in 3 divided doses or 2.0 g/day in 2 divided doses	40-50 mg/kg/day in 2-3 doses	Regardless
Amoxicillin + Clavulanic acid 4:1, 7:1 (“standard” doses)**	2 g/day in 2-3 doses	45-50 mg/kg/day in 2-3 doses	At the beginning of a meal
Amoxicillin + Clavulanic acid 14:1 (“high” doses)***	3.5-4 g/day in 2-3 doses	80-90 mg/kg/day in 2-3 doses	At the beginning of a meal
Amoxicillin+Clavulanic acid ****	3.6 g/day IV in 3 injections	90 mg/kg/day in 3 administrations	Regardless
Ampicillin+[Sulbactam]****	2.0–6.0 g/day IM or IV in 3-4 injections	150 mg/kg/day IM or IV in 3-4 injections	Regardless
Ceftriaxone****	2.0-4.0 g/day in 1 administration	50-80 mg/kg/day in 1 administration	Regardless
For allergies to penicillins (non-anaphylactic)
Cefuroxime axetil	1.0 g/day in 2 divided doses	30 mg/kg/day in 2 divided doses	Immediately after eating
Ceftibuten*****	400 mg/day in 1 dose	9 mg/kg/day in 1 dose	Regardless
Cefixime*****	400 mg/day in 1 dose	8 mg/kg/day in 1 dose	Regardless

If you are allergic to penicillins and cephalosporins
Josamycin	2000 mg/day in 2 divided doses	40-50 mg/kg/day 2-3 doses	regardless
Clarithromycin******	1000 mg/day in 2 doses (SR form - in 1 dose)	15 mg/kg/day in 2 divided doses	Regardless
Azithromycin******	500 mg/day in 1 dose	12 mg/kg/day in 1 dose	1 hour before meals

*in the absence of risk factors for resistance, initial therapy

** in the presence of risk factors for the presence of resistant strains of Haemophilus influenzae and moraxella, in case of ineffectiveness of initial therapy with amoxicillin

*** in case of isolation, high probability or high regional prevalence of penicillin-resistant pneumococcal strains

**** if necessary parenteral administration(low compliance, impaired enteral absorption, severe condition)

*****in case of isolation or high probability of the etiological role of Haemophilus influenzae or Moraxella (limited activity against penicillin-resistant strains of pneumococcus)

******there is an increase in the resistance of all major pathogens of AOM to macrolides

There is a conventional scheme, using which, depending on the nature of the course of otitis or the presence of individual symptoms, you can assume the type of pathogen and select the optimal antibiotic(Fig. 1).

S. pneumoniae, if there is increasing otalgia and temperature, spontaneous perforation has appeared.
Penicillin-resistant S. pneumoniae if previous treatment was carried out with ampicillin, azithromycin, erythromycin, co-trimoxazole, if antibiotic prophylaxis was carried out or there is a history of ROSO.
Less likely to be present S. pneumoniae if the symptoms are mild and previous treatment was carried out with adequate doses of amoxicillin.
H. influenzae if there is a combination of symptoms of otitis and conjunctivitis.
?–lactamase-forming H. influenzae or M. catarrhalis: if antibacterial therapy was carried out during the previous month; if a 3-day course of treatment with amoxicillin is ineffective; in a child who is often ill or attends kindergarten.
Less likely to be present H. influenzae if previous therapy was carried out with third generation cephalosporins.

Rice. 1- Algorithm for treating AOM, ZOSO and ROSO with antibiotics.

Recommended standard The duration of the course of antibiotic therapy for AOM (new occurrence) is 7-10 days.

Comments: Longer courses of therapy are indicated for children under 2 years of age, children with otorrhea and concomitant diseases. The duration of antibiotic therapy for ZOSO and ROSO is determined individually; they are usually longer (for oral administration - at least 14 days). It is believed that the course of systemic antibacterial therapy should not be completed until otorrhea is relieved.

The reasons for the ineffectiveness of antibiotic therapy in AOM, AOM and ROSO may be the following factors:

inadequate antibiotic dosage;
insufficient absorption;
poor compliance;
low concentration of the drug at the site of inflammation.

Not recommended for the treatment of AOM, tetracycline**, lincomycin**, gentamicin** and co-trimoxazole**.

Comments: These drugs have little activity against S. pneumoniae and/or H. influenzae and are not without dangerous side effects (the risk of developing Lyell and Stevens-Johnson syndromes with co-trimoxazole** and ototoxicity with gentamicin**).

It is recommended to continue systemic antibacterial therapy in the post-perforation stage of AOM.

Comments: Perforation of the tympanic membrane and the appearance of suppuration significantly changes the picture of the clinical course of acute osteitis media and requires a corresponding restructuring of treatment tactics. Osmotically active ear drops containing aminoglycoside antibiotics should not be used due to possible ototoxic effects.

It is recommended to use transtympanic ear drops based on the group of rifamycin, fluoroquinolones and acetylcysteine + thiampinecol.

Recommended at the reparative stage of AOM carrying out measures aimed at restoring the function of the auditory tube.

Comments: The doctor should achieve the most complete restoration of hearing and aeration of the middle ear cavities, since at this stage there is a high risk of transition acute condition into chronic, especially in children with recurrent otitis media. Restoration of aeration of the middle ear cavities must be confirmed by objective research methods (tympanometry).

3.2 Surgical treatment

Paracentesis is recommended.

Comments: indicated for severe clinical symptoms (ear pain, increased body temperature) and otoscopic picture (hyperemia, infiltration, bulging of the eardrum) in non-perforated form of AOM. Paracentesis is also indicated when the clinical picture is “erased”, but when the patient’s condition worsens (despite antibiotic therapy) and the indicators of inflammation markers increase.

4. Rehabilitation

Sometimes it is necessary to perform therapeutic otorhinolaryngological procedures aimed at restoring aeration and gas exchange in the cavities of the middle ear.

5. Prevention and clinical observation

After the clinical manifestations of AOM have subsided, the patient should be observed by an otolaryngologist, especially children with recurrent or prolonged course of AOM. It is necessary to assess the restoration of not only the integrity of the eardrum, but also the aeration of the middle ear cavities after AOM using diagnostic procedures: otomicroscopy, tympanometry (including dynamics). Vaccination against pneumococcus and influenza is recommended.

6. Additional information affecting the course and outcome of the disease

Expect more severe course And high risk development of complications in patients with primary and secondary immunodeficiencies, diabetes mellitus and in children included in the “frequently ill” group.

Criteria for assessing the quality of medical care

table 2- Criteria for the quality of medical care

No.	Quality criteria	Levels of Evidence
	Examination by an otorhinolaryngologist was performed no later than 1 hour from the moment of admission to the hospital
	A detailed general (clinical) blood test was performed
	Paracentesis of the tympanic membrane was performed no later than 3 hours from the moment of admission to the hospital (if there are medical indications and in the absence of medical contraindications)
	A bacteriological study of discharge from the tympanic cavity was performed to determine the sensitivity of the pathogen to antibiotics and other drugs (during paracentesis or the presence of discharge from the tympanic cavity)
	Treatment with antibacterial drugs (under 2 years of age)
	Therapy with antibacterial drugs was carried out (if the age is over 2 years, in the presence of laboratory markers of bacterial infection and/or established diagnosis acute purulent otitis media)
	Anemization of the nasal mucosa with vasoconstrictor drugs was performed at least 2 times every 24 hours (in the absence of medical contraindications)
	Tympanometry and/or impedansometry and/or pure-tone audiometry and/or examination of the hearing organs using a tuning fork were performed before discharge from the hospital
	Absence purulent-septic complications during hospitalization
	Therapy was carried out with drugs from the group of analgesics and antipyretics and/or drugs from the group of non-steroidal anti-inflammatory drugs (in the presence of pain, depending on medical indications and in the absence of medical contraindications)
	Treatment with topical analgesics and anesthetics was carried out for non-perforative acute purulent otitis media

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Appendix A1. Composition of the working group

Karneeva O.V. Doctor of Medical Sciences, Professor. is a member of a professional association,
Polyakov D.P.. PhD, is a member of the professional association,
Gurov A.V., Doctor of Medical Sciences, professor is not a member of a professional association;
Ryazantsev S.V. Doctor of Medical Sciences, Professor is a member of the professional association;
Maksimova E.A. is a member of a professional association;
Casanova A.V. Ph.D. is a member of a professional association.

Developer institutions:

FSBI "Scientific Clinical Center otorhinolaryngology FMBA of Russia"

Department of Otorhinolaryngology, State Budgetary Educational Institution of Higher Professional Education, Russian National Research Medical University named after. N.I. Pirogov.

Conflict of interest absent.

Currently, it is common practice in the world to standardize approaches to the treatment of diseases to improve the quality and effectiveness of care provided. The standards created in our country for the treatment of acute otitis media (AOM) more than 10 years ago are outdated and have no practical value for a practicing physician.
AOM has never lost its relevance for otorhinolaryngologists, pediatricians, and therapists, since it is one of the most common complications of respiratory infections in adults and children, the main cause of acquired hearing loss. The main method of treatment today is conservative. Patients seek help more often. to your local doctor (generalist or pediatrician) to prescribe treatment. In our country today there is no single algorithm for the management of such patients. Adequate tactics for the management and treatment of patients with AOM is, in turn, the prevention of complications, the transition of an acute condition to a chronic one and the development of severe hearing loss.
Taking into account all of the above, we present methodological recommendations that outline modern views on the pathogenesis, diagnosis and treatment of AOM, based on the latest data from domestic and foreign authors.
Purpose: in clinical guidelines The authors' experience in the diagnosis and treatment of patients with acute otitis media is summarized. The classification, clinical picture and main diagnostic criteria of the disease are described. An algorithm for modern conservative and surgical treatment of patients with acute otitis media is outlined.

Target audience of these clinical recommendations

Otorhinolaryngologist.
Audiologist - otorhinolarygologist.
Pediatrician
Therapist

Table P1- Levels of evidence used

Class (level)	Credibility criteria
	Large, double-blind, placebo-controlled studies, as well as data from meta-analyses of several randomized controlled trials.
	Small randomized and controlled studies in which statistical data are based on a small number of patients.
	Non-randomized clinical researches on limited quantities patients.
	Development of a consensus by a group of experts on a specific problem

Table P2- Recommendation strength levels used

Scale	Strength of evidence	Relevant types of research
	Evidence is Convincing: There is strong evidence for the proposed claim.	High-quality systematic review, meta-analysis. Large randomized clinical trials with low error rates and consistent results.
	Relative strength of evidence: there is sufficient evidence to recommend the proposal	Small randomized clinical trials with mixed results and moderate to high error rates. Large prospective comparative but non-randomized studies. Qualitative retrospective studies on large samples of patients with carefully selected comparison groups.
	Insufficient evidence: The available evidence is insufficient to make a recommendation, but recommendations may be made based on other circumstances	Retrospective comparative studies. Studies on a limited number of patients or on individual patients without a control group. Personal unformalized experience of developers.

The # sign indicates that the indications are not included in the instructions for use of the medicinal product."

Procedure for updating clinical recommendations

Appendix A3. Related documents

PROCEDURE FOR PROVIDING MEDICAL CARE:

Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 905n “On approval of the Procedure for providing medical care to the population in the field of otorhinolaryngology.”

Order of April 9, 2015 N178n “On approval of the Procedure for providing medical care to the population in the field of audiology and otorhinolaryngology.”

Order of the Ministry of Health of the Russian Federation (Ministry of Health of Russia) dated December 29, 2014 N 930n, Moscow “On approval of the Procedure for organizing the provision of high-tech medical care using a specialized information system.”

Appendix B. Patient management algorithms

Appendix B: Patient Information

The presence of pain in the ear, febrile body temperature, decreased hearing, sometimes separated from the ear, are signs of AOM. This disease not only reduces the patient’s quality of life, but also increases the risk of developing life-threatening intralabyrinthine and intracranial complications. Timely seeking qualified help and prescribing adequate treatment of this disease is a prevention of the development of hearing loss and complications.

The patient should be examined by an otolaryngologist for diagnosis and prescription of adequate, timely therapy, including antibacterial therapy. For indications determined by an otorhinolaryngologist (pre-perforative form of AOM), surgical manipulations (paracentesis) are necessary.

Appendix D

Regardless of the stage and severity of AOM, intranasal therapy should be the basis of treatment.

For the stage of acute eustacheitis, methods local impact, aimed at restoring the function of the auditory tube are necessary (anemization of the mucous membrane of the nasal cavity and pharyngeal mouth of the auditory tube, catheterization of the auditory tube).

According to the mechanism of action, decongestants are β-adrenomimetics, acting on α1- or β2-receptors. The use of drugs in this group leads to quick withdrawal swelling of the mucous membrane of the nasal cavity, nasopharynx and auditory tube. 01% oxymetazoline** and phenylephrine** can be used in children from birth.

Vasoconstrictors (decongestants) are prescribed topically, namely in the form of nasal drops, aerosol, gel or ointment.

Nasal decongestants include ephedrine hydrochloride, naphazoline**, phenylephrine**, oxymetazoline**, xylometazoline**, tetrazoline, indanazoline and others. The choice of decongestants should correspond to the physiological capabilities of the structures of the nasal mucosa.

In young children, decongestants should be used in the form of phenylephrine-based drops or gel**. Phenylephrine** is an adrenergic agonist that predominates on the mucous membrane of young children. In children from two years of age, decongestants based on xylometazoline**, oxymetazoline** (0.01% and 0.05%) can be used.

Adrenergic agonists are approved for use in Russia and are effectively used in combination with other active drugs: Phenylephrine** with Dimetindene, Xylometazoline** with Ipratropium bromide**, Xylometazoline** with Dexpanthenol, Tuaminoheptane with N-Acetylcysteine. Combinations of a decongestant with antihistamines (dimetindene maleate + phenylephrine) can enhance the anti-edematous effect, especially in children with atopy. The combination of a decongestant with a mucolytic drug (tuaminoheptane with acetylcysteine) complements the vasoconstrictor effect with an anti-inflammatory one. Combinations of xylometazoline** with dexpanthenol (vitamin B5 substance) stimulate the regeneration of the nasal mucosa and restore mucociliary clearance, providing optimal hydration of the nasal mucosa. Combinations of xylometazoline** with dexpanthenol can be used in children and adults, including after surgical interventions in the nasal cavity, as it leads to increased reparative processes and rapid restoration of nasal respiratory function.

However, all vasoconstrictor drugs have their disadvantages and side effects. Therefore, the use of these drugs should be limited to 5–7 days.

The following intranasal glucocorticosteroid drugs are registered in Russia: mometasone furoate**, beclamethasone**, fluticasone furoate, fluticasone propionate, budesonide**.

Appendix G2. Topical antibiotic therapy for AOM

To prevent the development of one of the complications of ARVI, acute otitis media, nasal sprays are used: framycetin - a spray consisting of a combination of antibiotics (neomycin sulfate, polymyxin B sulfate, dexamethasone and phenylephrine**).

In children, inhalation therapy is used combination drug, containing two components in one dosage form: N-acetylcysteine** (direct-acting mucolytic) and thiamphenicol (semi-synthetic chloramphenicol, which has a bactericidal effect). Inhalations with a mucolytic are carried out only with a compression inhaler.

Otitis is an ENT disease, which is an inflammatory process in the ear. Manifested by pain in the ear (pulsating, shooting, aching), elevated body temperature, hearing loss, tinnitus, mucopurulent discharge from the external auditory canal. The severity of the pathological process depends entirely on the virulence of microorganisms, and the state of the human immune defense also plays an important role.

What it is, what are the first signs and symptoms of otitis media, as well as how to treat it in adults without consequences for the ear, we will consider further in the article.

What is otitis media?

Otitis is inflammatory lesion internal, middle or external department human ear occurring in chronic or acute form. The disease is characterized by damage to the structures of the outer, middle or inner ear, and patients present specific complaints. Symptoms in adults depend on the area of inflammation, the addition of local or systemic complications.

The pathology can develop at any time of the year, but the peak of visits to the hospital occurs in autumn and winter, when people have not yet had time to switch from heat to cold.

Causes

The causes and symptoms of otitis depend on the type of disease, the state of the immune system and environmental factors. The fundamental elements in the formation of the disease are the influence of air temperature, the purity of the water used for hygiene, and the time of year.

The causes of otitis are considered:

Penetration of infection from other ENT organs - as a complication of a concomitant infectious viral disease;
Various diseases of the nose, sinuses and nasopharynx. This includes all types of rhinitis, deviated nasal septum, (adenoid vegetations);
Injuries auricle;
Hypothermia and weakened immunity.

Conditions that significantly increase the risk of developing the disease include:

allergies;
inflammation of the ENT organs;
immunodeficiency states;
carrying out surgical operations in the area of the nasopharynx or nasal cavity;
infancy, childhood.

Otitis media in adults is a disease that needs to be taken seriously and you need to know its symptoms, consequences and treatment.

Types of otitis

The structure of the human ear is divided into three interconnected parts, which have the following names:

outer ear;
average;
inner ear.

Depending on which specific part of the organ the inflammatory process occurs, in medicine it is customary to distinguish three types of otitis:

Otitis externa

Otitis externa can be limited or diffuse, in some cases it spreads to the eardrum, and is more common in elderly patients. Occurs as a result of mechanical or chemical injury ear. A patient with otitis externa complains of throbbing pain in the ear, which radiates to the neck, teeth and eyes, and intensifies when talking and chewing.

Development is promoted by two factors:

Infection caused by a sharp object (hairpin, toothpick);
Entry and accumulation of moisture in the external auditory canal.

It often occurs when the ear is constantly in contact with water, such as when swimming, which is why it is called “swimmer’s ear.”

Otitis media ear

With otitis media, the inflammatory process occurs in the tympanic cavity. There are many forms and variants of the course of this disease. It can be catarrhal and purulent, perforated and non-perforated, acute and chronic. With otitis media, complications can develop.

Internal otitis

This type is also called labyrinthitis; its symptoms can vary in severity (from mild to pronounced).

Symptoms of otitis media are similar in all forms of the disease, but their intensity and some features depend on the type.

According to the nature of the disease, the following forms are distinguished:

Spicy. It occurs suddenly and has severe symptoms.
Chronic. The inflammatory process continues for a long time and has periods of exacerbation.

According to the ways in which otitis manifests itself, the following forms are distinguished:

Purulent. There is an accumulation of pus behind the eardrum.
Catarrhal. There is swelling and redness of the tissues, there is no liquid or purulent discharge.
Exudative. Fluid (blood or lymph) accumulates in the middle ear, which is an excellent breeding ground for microorganisms.

The otolaryngologist determines how and how to treat otitis media by establishing the type and degree of the disease.

Symptoms of otitis media in adults

The clinical picture of otitis directly depends on the location of the pathological process.

Symptoms:

earache . This symptom is constantly disturbing and is the main one that brings the greatest discomfort. Sometimes the pain shoots into the teeth, temple, lower jaw. The reason for the development of this condition in otitis media is considered to be increased pressure in the ear cavity;
redness of the ear canal, change in the color of the auricle;
gradual deterioration of hearing, caused by the opening of abscesses and filling of the ear canal with purulent masses;
temperature increase- most often there is an increase in body temperature, however, this is also an optional sign;
ear discharge with external otitis they almost always occur. After all, nothing prevents the inflammatory fluid from being released.

Symptoms of otitis media are often accompanied by a runny nose, which leads to swelling of the nasal mucosa and congestion of the auditory tube.

	Symptoms and first signs
Otitis externa	In the case of the development of acute purulent local external otitis (furuncle in the ear canal), the patient complains of pain in the ear, which intensifies with pressure or pulling on it. There is also pain when opening the mouth and pain when inserting an ear specula to examine the external auditory canal. Externally, the auricle is swollen and red. Acute infectious purulent diffuse otitis develops as a result of inflammation of the middle ear and suppuration from it.
Otitis media	How does otitis media manifest? heat; ear pain (throbbing or aching); decreased hearing function, which usually recovers a few days after the first onset of symptoms; nausea, general malaise, vomit; purulent discharge from the ears.
Internal otitis media	The onset of the disease is most often accompanied by: tinnitus, dizziness, nausea and vomiting, balance disorder
Acute form	The main symptom of the acute form is severe pain in the ear, which patients describe as jerking or shooting. The pain can be quite intense, worsening in the evening. One of the signs of otitis is the so-called autophony - the presence of constant noise in the ear, not associated with sounds from the outside, ear congestion appears. Acute otitis media should always be treated completely, as the pus will begin to spread into the skull.
Chronic form	Periodic purulent discharge from the ear. Dizziness or tinnitus. Pain appears only during periods of exacerbation. Possible increase in temperature.

If you have symptoms of otitis, you need to urgently consult a doctor, who will correctly diagnose and tell you how to treat the inflammation.

Complications

Do not think that otitis media is a harmless cold. In addition to the fact that it unsettles a person for a long time, reducing his ability to work for at least 10 days, it is possible to develop irreversible changes with persistent deterioration or complete loss of hearing.

When the disease is allowed to take its course, the following complications may occur:

rupture of the eardrum (as a rule, it takes 2 weeks for the hole to heal);
choleostomy (tissue growth behind the eardrum, hearing impairment);
destruction of the auditory ossicles of the middle ear (incus, malleus, stapes);
mastoiditis (inflammatory lesion of the mastoid process of the temporal bone).

Diagnostics

A competent doctor diagnoses acute otitis without special devices and innovative technologies. A simple examination of the auricle and ear canal using a head reflector (a mirror with a hole in the center) or an otoscope is sufficient to diagnose otitis media.

As methods to confirm and clarify the diagnosis, may be prescribed general analysis blood, which reveals signs of inflammation (increased ESR, increased number of leukocytes, etc.).

Instrumental methods include radiography and computed tomography of the temporal regions.

How to treat otitis media in adults?

Antibacterial drugs (antibiotics, sulfonamides, etc.) play a special role in the treatment of otitis media. Their use has a number of features - the medicine should not only act on the bacteria that cause otitis media, but also penetrate well into the tympanic cavity.

Treatment of inflammatory changes in the auricle begins with bed rest. Antibiotics, anti-inflammatory drugs, antipyretic drugs are prescribed simultaneously. A combination of drugs can effectively treat pathology.

Comprehensive treatment of otitis ear

Ear drops

It's no secret how acute otitis in adults is treated - drops in the ears. This is the most common medicine for otitis media. Depending on the type of disease they use different drugs. Ear drops can contain only an antibacterial drug or be combined - contain an antibiotic and an anti-inflammatory substance.

The following types of drops are distinguished:

glucocorticosteroids (Garazon, Sofradex, Deksona, Anauran);
containing anti-inflammatory non-steroidal drugs (Otinum, Otipax);
antibacterial (Otofa, Tsipromed, Normax, Fugentin).

The course of treatment takes 5-7 days.

Additional tools:

In combination with ear drops for otitis, otolaryngologists often prescribe vasoconstrictor drops into the nose (Naphthyzin, Nazol, Galazolin, Otrivin, etc.), thanks to which it is possible to relieve swelling of the mucous membrane of the Eustachian tube and thereby reduce the load on the eardrum.
In addition to the drops, the complex may also include antihistamines (anti-allergic) agents that have the same goal - relieving swelling of the mucous membrane. This could be Suprastin, Diazolin, etc.
To reduce temperature and reduce ear pain, non-steroidal anti-inflammatory drugs based on paracetamol (Panadol), ibuprofen (Nurofen), nise are prescribed.
Antibiotics for otitis in adults are added to the treatment of acute moderate form with the development of purulent inflammation. The use of Augmentin has proven itself well. Rulid, Amoxiclav, Cefazolin are also effective.

In addition to the measures listed, physiotherapy procedures are used:

UHF for the nose area;
laser therapy for the area at the mouth of the auditory tube;
pneumomassage focused on the area of the eardrum.

If all the above actions did not lead to regression of the process, or treatment was started at the stage of perforation of the eardrum, then first of all it is necessary to ensure a good outflow of pus from the middle ear cavity. To do this, regularly cleanse the external auditory canal of secretions.

During manipulation use local anesthesia. A puncture is made in the eardrum using a special needle, through which the pus is removed. The incision heals on its own after the discharge of pus stops.

You can’t prescribe for yourself medicines, choose the dosage, interrupt taking the drugs when the symptoms of otitis media disappear.
Wrong actions taken at your own discretion can cause harm to your health.
Before contacting a doctor, you can only take a paracetamol tablet to reduce pain. This drug is effective and has few contraindications. At correct use paracetamol rarely causes side effects.

Prevention

The main goal of preventing otitis in adults is to prevent the Eustachian tube from becoming blocked by thick mucus. This is not such a simple task. Usually, acute rhinitis accompanied liquid discharge, but during treatment the mucus often becomes much thicker, stagnating in the nasopharynx.

Foci of chronic infection increase the risk of otitis media.
After swimming, especially in open water, you need to thoroughly dry your ears to prevent water and bacteria from getting inside. Especially for people prone to otitis media, antiseptic drops have been developed that are placed in the ears after each bath.
Regularly clean your ears from dirt and wax and maintain hygiene. But it is better to leave a minimum of sulfur, since it protects the ear canal from pathogenic microbes.

In conclusion, it is worth noting that otitis media is a very unpleasant disease. Do not think that all symptoms will go away on their own. Be sure to consult a doctor when the first signs appear. People often treat otitis unduly frivolously, not realizing that complications from this infection can lead to the most tragic consequences.

Otitis of the middle ear is an inflammatory process of an infectious nature that affects the middle ear and the cavities connecting to it. The disease occurs in both adults and children, although children get sick more often, which is associated with the anatomical and physiological characteristics of the internal structure of the ear. Men and women are equally susceptible to this pathology, and people with chronic infections oropharynx and nasopharynx - tonsillitis, caries, sinusitis, sinusitis, etc.

Often the inflammatory process is localized on one side, but in children, acute otitis media progresses rapidly, and both ears are affected.

Causes

The middle ear has connections with other parts hearing aid, and they, in turn, communicate with the outside world, the nasopharynx and oropharynx, which means that the infection can penetrate in any way - with diseases such as, etc.

Viral or infectious diseases in the acute stage can also lead to the development of pathology such as acute otitis media. The infection spreads through oral cavity or nasopharynx. The reason may also lie in an allergic reaction, in which, due to swelling, the flow of air into the ear cavity is disrupted, which contributes to the development of congestion and the proliferation of bacteria. Acute otitis media can also be caused by catarrhal otitis, the treatment of which is not started in a timely manner.

Chronic pathologies with a decrease in the body’s defenses can also cause the spread of infection throughout the body and damage to this organ, with the development of inflammation in it.

Predisposing factors are:

general hypothermia of the body (also leads to local hypothermia, giving an excellent opportunity for bacteria to actively multiply);
decrease in protective forces due to, as well as physical and emotional overload;
poor nutrition (lack of nutrients) also leads to a decrease in defenses;
Infections dormant in the body, under favorable conditions, can be activated and cause pathology of the middle ear.

In young patients, the causes of this pathology may be associated with:

anatomically shortened auditory tube, which allows infection to more easily penetrate inside the hearing aid;
the fact that the cavity is lined with embryonic tissue, which is an excellent breeding ground for microorganisms;
infants being in a horizontal position, which is why they more often develop congestion;
proliferation of adenoid tissue, which closes the Eustachian tube from the oropharynx;
unformed immune system of babies.

Varieties

Depending on the severity, there are several types of this disease. The most severe symptoms has acute otitis media, which occurs when infected with viruses. Usually, along with this lesion, other viral diseases are observed in adults and children.

If the infection is bacterial, acute suppurative otitis media occurs. Sometimes a viral pathology without proper treatment also develops into, as a bacterial infection is attached - most often this happens in young patients. It is important to distinguish between these two forms, since treatment for bacterial pathology requires taking antibiotics, while for viral pathology other drugs are used.

When acute suppurative otitis media is not treated in a timely manner, the pus spreads to other cavities adjacent to the middle ear, causing purulent or acute otitis media. Pus has proteolytic properties, which means that it is capable of dissolving tissue, so its accumulation in the tympanic cavity can lead (without treatment) to the dissolution of the membrane with the formation of holes of different diameters through which the contents will flow out. In addition, pus can penetrate into the meninges. This is why acute purulent otitis media is often complicated, especially in young children. Treatment of this pathology must be timely to avoid complications.

Catarrhal otitis media is a form that is dangerous for its complications, in which complete hearing loss may occur. The causes of such a disease as catarrhal otitis media are becoming frequent respiratory diseases in children and adults. It is not difficult to recognize catarrhal otitis - the pain with it is of a shooting nature and radiates to the temple and teeth.

There is also a form of the disease known as exudative otitis media, which occurs as a consequence of impaired ventilation due to tissue swelling. The accumulation of serous exudate in the tympanic cavity in this form of the disease leads to hearing impairment and causes painful sensations in the area of the affected organ, arising as a result of increased pressure in it.

With a disease such as exudative otitis media, the density of the fluid in the tympanic cavity increases over time, which can cause partial or complete inflammation. To extract the exudate, surgical treatment is performed.

Another type is chronic suppurative otitis media. They talk about it when the membrane breaks and pus flows out of the patient's ear. Sometimes there can be a lot of discharge, sometimes there can be little, but in any case, in the chronic form, the symptoms of the disease are not expressed - painful sensations subside, the temperature drops, etc. But chronic purulent otitis media is terrible for its complications, because as a result of the rupture of the membrane, scars subsequently form on it, which prevent the normal passage of sounds, which leads to the development of hearing loss, which is already irreversible.

Signs

In the acute form, adults experience the following symptoms:

severe pain in the area of the affected ear, which either subsides or becomes stronger;
swelling of the neck on the affected side;
hearing loss, subsequently with the development of persistent hearing loss;
(38–39);
(weakness, headache etc.);
the appearance of purulent exudate in a form of pathology such as chronic purulent otitis media.

Depending on the stage, the disease can manifest itself in different ways. Distinguish initial stage, in which all the symptoms described above are present, and the patient may also complain of severe pain on the affected side (shooting in nature). Treatment of the pathology is carried out precisely during this period of the disease and gives good results, but if the disease is not treated, the second stage develops - perforative. As the name implies, at the second stage a breakthrough of the tympanic membrane occurs, after which the symptoms weaken - the temperature drops, the pain decreases, and the condition stabilizes. And the third is reparative, in which the exudate completely drains and the membrane heals with the formation of scars, leading to hearing impairment.

The symptoms of such a pathology as are similar to those indicated, with the only difference that the membrane does not melt, so the exudate has nowhere to flow out and the person experiences severe pain that is not relieved by analgesics.

If the exudate (serous or purulent) spreads deeper, complications develop, the symptoms of which may vary depending on the affected organs. A person may experience nasal congestion, an inflammatory formation behind the ear, characterized by pain (mastoiditis). The most severe complication is meningitis, in which pus enters the brain, causing neurological symptoms in adults and young patients.

The symptoms of this disease in very young children are as follows:

refusal to eat (from the breast or bottle);
irritability and tearfulness;
sleep disturbance;
severe pain when pressing on the base of the ear.

Catarrhal and other forms, including chronic purulent otitis media, are not the only pathologies that can cause similar symptoms in children, therefore, before starting treatment, you need to examine the child and make sure that the cause of the manifestations lies precisely in this disease.

Diagnostics

The diagnosis can be made by a visual examination, during which a protruded or, conversely, retracted eardrum, its redness and severe pain in the ear are noted.

Are used and instrumental methods research, namely otoscopy. With a disease such as chronic suppurative otitis media, the doctor can see a hole of different diameters in the membrane and pus pouring out of the cavity behind it. A hearing test can reveal a pathology such as exudative otitis media, since there are no visible signs of it, except for the protrusion of the eardrum.

Features of treatment

Treatment of pathology begins with the treatment of the diseases that caused it, if any. In adults, this is a sore throat, tonsillitis, or viral rhinitis, sinusitis. In children, otitis media often becomes a complication of and, as well as diseases such as tonsillitis and scarlet fever.

Treatment includes taking medications, the main ones being antibiotics. In such forms of the disease as exudative otitis media, acute purulent and chronic purulent otitis media, taking penicillin drugs, as well as cephalosporins, is indicated. In their absence, macrolide antibiotics are prescribed.

In other forms, glucocorticoids are prescribed that can reduce inflammation, antihistamines, removing swelling, vasoconstrictor. Drug treatment is combined with special procedures for washing and blowing out the middle ear cavity. As mentioned above, if the patient has exudative otitis media, surgery is indicated - myringotomy.

Surgical treatment is indicated when the disease does not respond to conservative therapy, progresses rapidly, or when complications develop.

There are two types of surgical treatment - paracentesis and anthrotomy. Most often, paracentesis is performed, which involves opening the eardrum and draining the contents of the cavity. Antrotomy is performed only in cases of severe mastoiditis in adults or anthritis in young children.

Otitis is a group of inflammatory diseases of the ear.

The ear consists of three parts.

The external ear is represented by the auricle and the external ear canal. When inflammation of the outer ear develops otitis externa.
The middle ear borders the outer ear through the tympanic membrane and is represented by the tympanic cavity and the auditory ossicles (incus, malleus and stapes). When inflammation of the middle ear develops otitis media. When people talk about otitis media, they most often mean inflammation of the middle ear.
The inner ear consists of the bony and membranous labyrinths and when it becomes inflamed, internal otitis or labyrinthitis. Otitis media is usually observed in children.

Kinds

Otitis, according to the nature of its course, is divided into acute and chronic.

Acute otitis lasts no more than 3 weeks, subacute lasts from three weeks to three months, o chronic otitis media they say when it lasts more than three months.

By origin, ear inflammation can be infectious or non-infectious (allergic or traumatic otitis).

Depending on the type of inflammation, otitis can be exudative (bloody or inflammatory effusion is formed), purulent (local or diffuse) and catarrhal.

Causes

Ear inflammation occurs in two cases. Firstly, the penetration of an infectious agent into the middle ear from an inflamed nasopharynx, and secondly, otitis media occurs as a result of ear injury.

The causes of otitis media include:

acute respiratory viral infections ARVI, which results in swelling of the nasal mucosa, which leads to obstruction (blockage) of the external opening of the Eustachian tube (air passes through it), this leads to disruption of ventilation and cleaning of the tympanic cavity;
existing adenoids, nasal polyps or chronic tonsillitis, tumor-like formations of the nasopharynx;
sudden changes in atmospheric pressure (airplane takeoff and landing, during mountaineering) - aerootitis;
pressure difference when diving deep into water and surfacing (mareotite);
weakening of the body's defenses (nervous overstrain, overwork, chronic diseases, for example, diabetes);
in children due to immature immunity.

External otitis occurs due to injury to the auricle, with the development of a boil in the external auditory canal, or as a complication of otitis media with suppuration from the middle ear.

Labyrinthitis (inflammation of the inner ear) is a complication of otitis media.

Symptoms of otitis media

Otitis externa

When in action various factors(insect bites, scratching and microtrauma of the auricle and others) the infectious pathogen penetrates into sebaceous glands either in hair follicles into the external auditory canal.

In the case of the development of acute purulent local external otitis (furuncle in the ear canal), the patient complains of pain in the ear, which intensifies with pressure or pulling on it.

There is also pain when opening the mouth and pain when inserting an ear specula to examine the external auditory canal. Externally, the auricle is swollen and red.

Acute infectious purulent diffuse otitis develops as a result of inflammation of the middle ear and suppuration from it. In this case, the external auditory canal becomes infected due to irritation by pus. Sometimes the eardrum is involved in the process.

On examination, swelling and hyperemia of the skin of the ear canal is noted, pus with unpleasant smell. The patient complains of pain, which is replaced by itching and ear congestion.

Otitis media

Inflammation of the middle ear occurs in several stages.

1. In the first stage, the patient complains of pain inside the ear, the nature of which can be different (pulsating, shooting, drilling).

During an acute process, body temperature rises sharply (up to 38°C and above). The peculiarity of the pain is that it intensifies at night and interferes with sleep. This symptom is caused by the pressure of the effusion in the tympanic cavity on the eardrum from the inside.

A characteristic feature of the first stage is that when the head is tilted to the side of the sore ear, the pain intensifies. The pain radiates to the jaw, eye, or temple and can spread to the entire half of the head.

The patient complains of hearing loss, noise and ringing in the ear.

2. The beginning of the second stage is associated with perforation (breakthrough) of the eardrum. The pain subsides, and pus flows out of the external auditory canal. Body temperature drops to normal levels.

3. The third stage is marked by a gradual cessation of suppuration, the eardrum is scarred, and inflammation subsides. The main complaint of patients is hearing loss.

Internal otitis

A characteristic symptom of internal otitis is dizziness. In addition, dizziness is accompanied by nausea and vomiting, imbalance, significant tinnitus and hearing loss.

Internal otitis occurs as a complication or continuation of otitis media.

Diagnostics

After collecting anamnesis and complaints, the doctor performs an otoscopy (examination of the external auditory canal) using a backlit reflector and other special instruments.

In addition, the doctor will definitely examine the nasal cavity and oropharynx and, if necessary, prescribe X-ray examination nasal and frontal sinuses.

A general blood test is also shown, which reveals signs of inflammation (accelerated ESR, increased number of leukocytes).

To check your hearing level, audiometry (air conduction assessment) is prescribed. Tuning forks are used to determine bone conductivity.

If pus leaks from the external auditory canal, it is collected for bacteriological examination, which will help identify the pathogen and its sensitivity to antibiotics.

In order to exclude an ear tumor or a complication of otitis media (mastoiditis), a computed tomography scan is prescribed.

Treatment of otitis media

Otitis media is treated by an otorhinolaryngologist (ENT).

Treatment of external form

Otitis externa is treated on an outpatient basis. Appointed local therapy: turundas soaked in 70% alcohol are inserted into the ear canal, warm compresses, vitamins and physiotherapy. It is advisable to prescribe antibiotics only for significant inflammation and fever.

Treatment of inflammation of the middle ear

Patients with otitis media are usually hospitalized.

1. In the first stage, antibiotics are prescribed orally or parenterally (usually in the form of injections) - ceftriaxone, amoxiclav, clindamycin; and non-steroidal anti-inflammatory drugs to relieve pain and reduce inflammation (diclofenac, indomethacin).

To restore drainage in the Eustachian tube, drops are prescribed that constrict blood vessels in the nasal mucosa (naphthyzin, galazolin) for a period of 4-5 days. Drops with anti-inflammatory and analgesic effects (sofradex, otipax, camphor oil) are instilled into the ear.

2. In some cases, the eardrum is dissected to drain pus and relieve pain. After opening the eardrum (independent or therapeutic), inject into the tympanic cavity antibacterial solutions(tsipromed, otofa).

3. Therapy at the third stage is designed to restore the patency of the auditory tube, the integrity of the eardrum or its elasticity. At this stage, blowing of the auditory tube and massage of the eardrum are prescribed.

Treatment of labyrinthitis

With labyrinthitis (otitis media of the inner ear), patients are also hospitalized. Held intensive therapy: bed rest, antibiotics in loading doses and dehydration therapy.

The duration of treatment for otitis depends on the stage and severity of the process and should be at least 10 days.

Complications and prognosis

If inadequate treatment was carried out for otitis or it was not completed, then the following complications are possible:

mastoiditis (inflammation of the mastoid process) - requires surgical intervention;
meningitis;
brain abscess.

The prognosis for correct and timely treatment of otitis media is favorable.

Otitis is one of the most common diagnoses in the daily practice of an otolaryngologist. In acute otitis media, we observe an inflammatory process affecting one of the parts of the human hearing organ. The appearance of acute pain in the ear - main symptom, signaling the onset of inflammation.

The disease is common among both children and adults. Although children are at increased risk of developing acute inflammation. This is due to the structural features of the child’s ear and weak, fragile immunity.

Diseases of the hearing organ, like any other disease concentrated in the head area, must be treated carefully and responsibly, since an infection through the bloodstream can easily reach the brain and cause irreversible consequences. Therefore, it is necessary to treat an acute inflammatory process as soon as the first prerequisites for the disease appear. Treatment of the disease should be carried out in a hospital, under the supervision of a competent doctor.

In this article we will look at how the disease develops, what treatment methods are available today, how complications of otitis manifest themselves and how to avoid them.

Types of disease

Inflammation that occurs in the organ of hearing can be chronic or acute. In acute cases of otitis, the disease lasts for up to three weeks, in chronic cases - more three months. The chronic process starts when treatment of the acute form of otitis was not carried out or was not carried out at the proper level. There is also an intermediate form - subacute, when the duration of the disease ranges from three weeks to three months.

The human hearing organ is divided into three parts: the outer, middle and inner ear. Otitis may appear in each of these areas. Based on the location of the inflammation, acute otitis media is distinguished, and inflammation of the inner ear, otherwise known as labyrinthitis.

External manifestations of inflammation, in turn, are divided into limited, manifesting mainly in the form of a boil of the auricle, and diffuse otitis media. With diffuse otitis, a significant area of the outer ear is affected.

Acute inflammation of the middle ear involves the tympanic cavity of the ear, the auditory (Eustachian) tube and the mastoid process. This type of hearing disease is the most common.

The disease of the internal part is called labyrinthitis (this part of the ear is called the labyrinth because of the similarity of its shape to the cochlea). As a rule, inflammation covers the internal part, if treatment inflammatory disease middle ear was carried out late or the treatment for otitis was chosen incorrectly.

Based on the causes of occurrence, infectious otitis media is distinguished, caused by various pathogens, and non-infectious (for example, arising due to exposure to allergens or ear injuries).

Otitis in acute form can occur in catarrhal (without the formation of secretion in the ear cavity), exudative (with the formation of fluid in the tympanic cavity) and purulent (with the presence of purulent masses) forms.

Acute otitis media of the middle ear: what causes inflammation?

The inflammatory process is always caused by pathogenic microorganisms, which means that the prerequisites for their activation must be present in the body. The causes of otitis media are:

hypothermia;
diseases caused by infection (flu, ARVI, measles);
inflammatory processes of the ENT organs (the tympanic cavity is connected to the nasopharynx via the Eustachian tube, it is not surprising that the infection from the nasopharynx easily penetrates into the middle ear);
improper nose blowing;
hypertrophy of adenoid vegetations;
rhinitis, sinusitis;
allergic reactions;
deviated nasal septum;
foreign object in the ear;
hearing damage.

Outer and inner ear: causes of inflammation

Otitis externa can develop due to improper ear hygiene. If you don't take care of your ears, dirt will accumulate in them, and this is a favorable environment for the growth of bacteria. Excessive hygiene is also harmful: earwax is a natural barrier against the penetration of bacteria into the ear. If you diligently clean the ear canals every day, a person loses this barrier and opens the way for pathogens. Another mistake that leads to acute ear inflammation is cleaning the ears with sharp objects that are not intended for this (toothpicks, matches, hairpins). Such actions can lead to damage to the auricle, which in turn leads to infection entering the wounds. Another factor is getting into the ear. dirty water, which contains pathogens. “Swimmer’s ear” is another name for this type of disease.

As we have already said, inflammation of the internal region occurs due to undertreated otitis media, if due attention has not been paid to the treatment of otitis media. Bacteria can also get here from meninges, for example, with meningitis. This type of inflammation can be caused by injuries and fractures of the skull or temporal bone.

In order to recognize the disease in time and select correct treatment, you need to be able to identify its signs.

Symptoms

The acute course of the disease is characterized by a rapid onset and pronounced symptoms.

When the outer ear is diseased, a person experiences pain inside the ear, which intensifies when pressing on it with outside. Acute pain occurs when swallowing and chewing food. The ear itself swells and turns red. The skin of the auricle is itchy, the patient's complaints are reduced to a state of stuffiness and ringing in the ear.

In acute otitis media, the main sign of inflammation is the sudden appearance of sharp shooting pains, which become stronger by night. The pain can radiate to the temples, left or right frontal parts, to the jaw - it is very difficult to endure even for an adult, not to mention children. The following symptoms are also characteristic of acute otitis media:

fever (up to 39°C);
tinnitus;
hearing loss;
lethargy, malaise, loss of appetite;
in the exudative form, discharge comes from the ear (usually this discharge is transparent or white);
Acute purulent otitis media is characterized by suppuration from the ear.

The main symptom of labyrinthitis is dizziness. They can last a few seconds, or they can last for several days.

If you notice one or more of the symptoms described above, you should immediately consult a doctor for treatment.

Stages of disease development

Treatment of acute otitis lasts from one to three weeks. There are several stages in the development of the disease. But it is not at all necessary that the patient will go through all of them. If treatment for infectious otitis is started on time and treatment acute illness A competent ENT doctor is involved, recovery will not take long.

So, the course of the disease is conventionally divided into several stages:

Catarrhal. Pathogenic microorganisms begin to actively multiply, triggering an inflammatory process in the ear. At this time, catarrhal edema and inflammation are observed.
Exudative. Inflammation leads to active formation of fluid (secret). It accumulates and pathogenic microorganisms continue to multiply here. Carrying out timely treatment at this stage will allow you to cure otitis media, avoiding complications.
Purulent. Acute purulent inflammation characterized by increased formation of purulent masses in the middle ear cavity. They accumulate, the patient experiences pressure from the inside. The state of congestion does not go away. This phase usually lasts from several days to several hours.
Perforated. At this stage, accumulated pus causes a rupture of the eardrum, and purulent masses emerge from the tympanic cavity to the outside. At this moment, the patient begins to feel noticeable relief, the high temperature decreases, and the pain gradually disappears. It happens that the eardrum is unable to rupture, then the doctor manually punctures the eardrum (paracentesis) and thereby releases purulent masses out into the ear canal.
Reparative phase - the release of pus is completed. The hole in the eardrum closes. As a rule, after proper symptomatic treatment, the patient quickly recovers.

Complications and preventive measures

As a rule, if you start treating the disease on time, treatment of acute purulent otitis, exudative or inflammation of any other kind, you can avoid any complications.

However, if treatment is not carried out and the disease progresses, the diagnosis can become chronic. The most serious consequences are: meningitis, encephalitis, brain abscess, neuritis facial nerve, hearing loss. But these dangerous conditions can manifest themselves only when patients persistently neglect treatment of otitis media.

Preventive measures include the fight against existing foci of inflammation in the body, competent and timely treatment of ENT diseases, proper ear hygiene and, of course, strengthening the immune system.

Carrying out treatment

It is much easier to cure acute otitis media if treatment for the disease begins as early as possible. Treatment should be carried out under the supervision of an otolaryngologist. Complex treatment includes the following activities:

for acute pain, taking analgesics is indicated to relieve pain syndrome;
to bring down the temperature you need to take antipyretic drugs;
in difficult cases, antibiotic treatment is carried out;
local treatment consists of using special ear drops, which are prescribed individually in each case. Independent selection of drops, as well as antibacterial drugs, is fraught dangerous consequences for good health.
Antihistamines help relieve swelling;
good effect achieved during physiotherapeutic procedures;
surgical intervention: opening of the eardrum (paracentesis) is carried out if spontaneous rupture has not occurred.

All ENT doctor’s prescriptions must be followed in full: after all, following treatment recommendations is the key to a quick recovery.

What not to do during treatment

Some patients are overly self-confident and believe that a disease such as otitis media can be easily cured with folk remedies and “grandmother’s” recipes. A wide variety of methods are used. This is a huge misconception!

The first mistake is that no foreign objects should be placed in the ear canal. Some are trying to use phytocandles, others, for example, geranium leaves. Such measures are fraught with the fact that leftover leaves may get stuck in the ear, which will provoke increased inflammation.

The second mistake is the use of heat and warming compresses for the purulent form of the disease. Some people replace compresses with a heating pad. At this stage of the disease, thermal heating will only increase the proliferation of bacteria.

The third mistake is trying to put drops in your ears. various oils or variations of alcohol. If during such treatment a perforation of the eardrum occurs, such instillations will not only cause pain, but will also cause scarring in the middle ear and eardrum.

Where to treat?

This is a question asked by many patients who unexpectedly encountered ear diseases. Among the variety of clinics and medical centers It is very difficult to choose the best one, especially when due to acute pain it is not possible to concentrate on anything.

“ENT Clinic of Doctor Zaitsev” specializes exclusively in diseases of the ear, nose and throat.

Treatment of ear diseases, including otitis media, is our specialty.

Reception is conducted by highly qualified specialists with extensive practical experience.

Please do not delay treatment!

Call, make an appointment and come.

We will definitely help you!