Acute otitis media diagnosis. Otitis - what is it, types, symptoms in adults, treatment of otitis media. Clinical symptoms of acute otitis media

Otitis is called a group inflammatory diseases ear.

The ear is made up of three parts.

The outer ear is represented by the auricle and outer ear canal. Inflammation of the external ear develops otitis externa.
The middle ear borders the outer ear eardrum and is represented by the tympanic cavity and auditory ossicles (anvil, hammer and stirrup). 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 a bony and membranous labyrinths, and when it becomes inflamed, otitis media or labyrinth. Otitis media is commonly seen in children.

Kinds

Otitis according to the nature of the course are divided into acute and chronic.

Acute otitis media lasts no more than 3 weeks, subacute otitis media lasts from three weeks to three months, chronic otitis media is said to last more than three months.

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

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

Causes

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

Causes of otitis media include:

acute respiratory viral infections SARS, resulting 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 impaired ventilation and cleaning of the tympanic cavity;
existing adenoids, nasal polyps or chronic tonsillitis, tumor-like formations of the nasopharynx;
sharp jumps in atmospheric pressure (takeoff and landing of an airplane, when doing mountaineering) - aerootitis;
pressure drop when diving deep into water and surfacing (mareotitis);
weakening of the body's defenses (nervous strain, overwork, chronic diseases e.g. diabetes)
in children due to immature immunity.

Otitis externa occurs with an injury to the auricle, with the development of a furuncle in the external auditory canal, or as a complication of otitis media with suppuration from the middle ear.

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

Symptoms of otitis media

Otitis externa

Under action various factors(insect bites, scratching and microtrauma of the auricle, etc.) the infectious agent 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 is aggravated by pressure or pulling on it.

There is also pain when opening the mouth and pain when the ear funnel is inserted to examine the external auditory canal. Externally, the auricle is edematous and reddened.

Acute infectious purulent diffuse otitis media 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 with pus. Sometimes the eardrum is involved in the process.

On examination, there is swelling and hyperemia of the skin of the ear canal, pus is separated from it with bad smell. The patient complains of pain, which are 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, boring).

In an acute process, the body temperature rises sharply (up to 38 ° C and above). The peculiarity of the pain is that it intensifies at night, making it difficult to sleep. This symptom is due to the pressure of the effusion in the tympanic cavity on the tympanic membrane from the inside.

It is characteristic of the first stage that when the head is tilted to the side of the diseased ear, the pain increases. Pain radiates to the jaw, eye, or temple and may extend 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, pus flows out of the external auditory canal. Body temperature drops to normal.

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

otitis media

A characteristic symptom of otitis media 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 an anamnesis and complaints, the doctor performs an otoscopy (examination of the external auditory canal) using a backlit reflector and other special tools.

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

Also shown general analysis blood, in which signs of inflammation are detected (accelerated ESR, increased number leukocytes).

To check the level of hearing, audiometry (assessment of air conduction) is assigned. Tuning forks are used to determine bone conduction.

In case of expiration of pus from the external auditory canal, it is taken 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), computed tomography is prescribed.

Treatment of otitis media

Otitis media is treated by an otorhinolaryngologist (ENT).

Treatment of the external form

Otitis externa is treated on an outpatient basis. Local therapy is prescribed: turundas soaked in 70% alcohol, warming compresses, vitamins and physiotherapy are inserted into the ear canal. Antibiotics should be prescribed 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 (more often 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 narrow the vessels in the nasal mucosa (naphthyzinum, 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, for the outflow of pus and pain relief, a dissection of the eardrum is performed. After opening the tympanic membrane (independent or therapeutic), enter into the tympanic cavity antibacterial solutions(tsipromed, otofa).

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

Treatment of labyrinthitis

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

The duration of treatment for otitis media 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 with otitis media 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.

- it's infectious inflammatory process, characterized by rapid development and localized in the cavity of the middle ear. The ear cavity is located inside the temporal bone and is covered from the outside by the tympanic membrane. This membrane separates the middle ear from the ear canal. When an infectious process begins to develop, it includes not only the ear cavity itself, but also nearby structures. We are talking about the air cells of the mastoid process, extending from the temporal bone, and the Eustachian tube.
This pathology is extremely common in otolaryngology and accounts for up to 30% of cases of all diseases of the ENT organs. In addition, otitis media is often concomitant disease and joins other ear pathologies - as a rule, this occurs in 30% of cases.

Both children and adults are susceptible to the disease, but babies suffer from otitis media more often, which is due to the structural features of the middle ear in childhood. As for men and women, they suffer from otitis media with the same frequency. Recent statistics indicate that cases of indolent progressive otitis media among the adult population and relapses in children have become more frequent. Up to 62% of babies suffer from acute otitis media during the first year of life.
Symptoms of otitis media

The duration of the disease averages 3 weeks. During this time, otitis media goes through all stages of its development.

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

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

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

The patient often suffers from autophony, which manifests itself in the resonation of his own voice during speech;

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

Sometimes there are extraneous noises;

Purulent or serous contents begin to separate from the ear. Although sometimes discharges are not observed or are present, they are quite insignificant;

In parallel, nearby lymph nodes increase and become painful;

The behind-the-ear area of a person suffering from otitis media begins to hurt, redden and swell. The pain is aching in nature;

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

Body temperature almost always rises. It can reach high values, up to 39 ° C and above. At very high temperature may be observed;

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

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

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

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

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

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

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

Stages of acute otitis media

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

initial stage

initial stage the disease, which is called preperforative, is characterized by the presence of severe pain and general symptoms. Its duration can vary from several hours to several days. Painful sensations arise against the background of the fact that irritation of the trigeminal and glossopharyngeal nerve occurs. Pain is given to both the temporal and parietal regions. A person's hearing is reduced due to the fact that the auditory ossicles in the tympanic region become less mobile.

At this stage, pus has accumulated but has not yet ruptured the eardrum. She herself becomes swollen, blushes. Pain is aggravated when a person lies down or leans towards the damaged ear. With otoscopy, the doctor observes a thickening of the eardrum, through which purulent contents shine through. Sometimes it can become covered with a white coating.

perforative stage

The eardrum ruptures under the influence of accumulated pus, and the contents come out. Allocations are mucopurulent in nature, at first there are a lot of them. Sometimes in the contents separated from the ear, blood impurities can be detected. The pain subsides, the person feels significant relief. The body temperature drops, the symptoms of intoxication weaken.

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

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

Reparative stage

The final (reparative stage) is the one in which scarring of the perforation occurs. At the same time, pus ceases to stand out, the patient's hearing begins to recover. The infiltration of the tympanic membrane decreases, its swelling decreases. With otoscopy, the doctor observes its brilliance and more or less outlined contours. If the perforation was insignificant and did not exceed 1 mm, then it is completely tightened without leaving a scar.

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

If otitis is uncomplicated, then a general blood test reveals a slight increase in ESR and a slight shift in the leukocyte formula to the left. Sometimes it happens that at the perforative stage, pus breaks out, but the patient's condition remains stably severe. This in most cases indicates the development of mastoiditis. If pus is secreted for a month and again begins to fill the ear after cleansing, then this condition is called mastoid empyema.

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

Acute otitis media

Acute otitis media begins suddenly, its symptoms increase rapidly. First, the patient complains of tingling in the ear, then the pain becomes more and more intense. If acute otitis media develops in childhood, then those children who do not know how to speak come in continuous crying. The pain may subside, but the time period is very short.

After the rupture of the eardrum and the release of purulent contents, the pain stops, the person's condition returns to normal. Then there is scarring of the tympanic membrane to restore hearing. Acute otitis media lasts up to 3 weeks on average. However, it is fraught with complications, such as inflammation of the process of the temporal bone - mastoiditis, temporary paralysis of the facial nerve - paresis, as well as inflammation of the inner ear, meningitis, brain abscess and other intracranial diseases. Therefore, it is so important to consult a doctor in time and start timely therapy.

Chronic otitis media

As for chronic otitis media, this is a disease characterized by a sluggish course. Most often, the chronic form of the disease is a consequence of acute suppurative otitis media. The share of mesotympanitis, in the form of which chronic otitis occurs, accounts for up to 55% of cases of this type of disease. At the same time, the mucous membrane lining the auditory tube, the middle and the section of the tympanic cavity located under it becomes inflamed. It is there that the eardrum is perforated, but the main one often remains intact and stretched.

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

The course of mesotympanitis is favorable, the disease rarely leads to serious consequences. Hearing will be reduced depending on how much the auditory ossicles are damaged at the time of treatment. Diagnosis of acute otitis is based on the patient's complaints and culture of the microflora of the separated contents.

The second form, in the form of which chronic otitis media can occur, is purulent epitympantitis. In this case, the epitympanic space is damaged. The rupture site is localized in the upper part, so the purulent contents are not completely separated from the ear cavity. This form of chronic otitis is more often fraught with complications than mesotympanitis.

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

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

exudative otitis media

Exudative otitis media is characterized by the fact that exudate accumulates in the cavity of the middle ear, while there is no pain syndrome. Back to characteristic features This type of otitis media includes hearing loss in the patient and the safety of the eardrum. It is the absence of pronounced symptoms that makes it difficult to diagnose this type of otitis media. Most often, it develops against the background of previous pathologies of the upper respiratory tract, which are of an infectious nature. It is especially difficult to identify this type of disease in children who do not complain of hearing loss. Among other reasons leading to the development of exudative otitis media, smoking, unfavorable environmental conditions, allergic reactions, deviated nasal septum, autonomic dysfunction, acute otitis media, old age, decrease, nasal tamponade, etc. can be distinguished.

As for the pathogenesis of the disease, it originates from the fact that a vacuum forms inside the tympanic cavity, and the function of the auditory tube is disturbed. Against this background, oxygen is absorbed, pressure drops and transudate appears. Over time, the mucous glands are activated and the amount of secretion secreted increases. It becomes more and more dense, its viscosity increases. Against this background, degenerative processes begin to progress, which subsequently cause hearing loss. Depending on the duration of exudative otitis, there are several of its forms: chronic, which lasts more than 2 months, subacute, which lasts up to 2 months, and acute, which lasts less than 3 weeks.

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

Catarrhal otitis media

Catarrhal otitis media is another type of disease characterized by acute course and inflammation of the auditory tube, tympanic membrane, and mastoid process. This form of otitis is dangerous with formidable complications and, if not treated in time, can lead to complete hearing loss.

Among the reasons causing the development of catarrhal otitis, frequent infections, chronic diseases of the upper respiratory tract, growth, lack of vitamins, decreased immune forces, and sneezing, leading to increased pressure in the nasopharynx, can be distinguished.

The symptoms of catarrhal otitis are bright, the disease manifests itself with acute pain, most often shooting. She gives both to the temple and to. Therefore, it is not difficult to recognize this form of otitis media. If treatment is not started on time, then catarrhal otitis often turns into a purulent or exudative form.

Purulent otitis media

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

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

Viruses rarely cause the development of a purulent form of otitis media, in only 4% of cases. Most often, bacteria lead to inflammation.

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

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

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

For the diagnosis of serous otitis media, a standard examination of the eardrum and listening to the patient's complaints are most often sufficient. The danger of serous otitis is that it can transform into a more serious form of the disease and cause complications. This is especially true when a person long time ignores hearing loss and discomfort in the ear, and when the disease develops in young children.

Depending on what caused the development of otitis media, appropriate treatment will be prescribed. If serous otitis media does not go away within 3 months, then the patient is shown myringometry, that is, the artificial creation of a hole in the eardrum through which the necessary medications are administered.

If serous otitis often recurs, then it is necessary to look for and eliminate the cause that causes it. Behind recent times cases of development of serous otitis against the background of severe allergic reactions have become more frequent.

Adhesive otitis media

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

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

If the doctor suspects adhesive otitis in a person who has applied for help, then in addition to otoscopy, he is prescribed audiometry, impedancemetry, and a study on the patency of the auditory tube.

In most cases, catarrhal or exudative otitis media leads to the formation of adhesive otitis media. Incorrect and irrational antibiotic therapy also often serves as a trigger mechanism for starting the disease. Acute infectious processes in the body, as well as chronic sluggish infections and deviated nasal septum, can provoke the disease.

Therapy is primarily aimed at eliminating the cause that caused the disease. It is necessary to normalize nasal breathing as soon as possible. A course of special blowing and pneumomassage of the membrane is used. Showing antihistamines, as well as the introduction of chymotrypsin, lidase, hydrocortisone into the middle ear cavity. Often, conservative treatment alone is not enough, and if the hearing loss continues to progress, surgery is necessary. It is important to understand that formed scars do not tend to disappear. Therefore than faster man seek help from a doctor, the more optimistic will be the prognosis for a full recovery.

Treatment of otitis media depends on which form of the disease is determined in the patient. Also, therapy depends on the stage of the inflammatory process and the presence of complications. As for acute otitis media, it is treated in most cases on an outpatient basis. If the disease causes complications, then hospitalization of the patient is indicated.

To eliminate the pain symptom, drops with an anesthetic effect are instilled into the ears. It can be Otipax, Otinum, Anauran and others. Before carrying out the procedure, it is advisable to warm the drug 2 degrees above the normal temperature of the human body. After instillation into the ear, it is necessary to put a cotton swab and remove it after a few hours. If the doctor has not performed a preliminary examination and the risk of perforation of the membrane cannot be ruled out, then you can use a cotton swab dipped in a solution boric acid.

Antihistamines, as well as vasoconstrictor nasal drops, help relieve swelling. Among them are Tizin, Otrivin, Nazivin and others.

In order to relieve inflammation, the patient is shown drugs such as Nurofen, Ibuprofen, Diclofenac. When the pain is not stopped by the above remedies, and the temperature continues to rise, bacterial infection Better to stop with antibiotics.

When the disease is at the pre-perforative stage, a highly effective treatment is the blowing of the auditory tube according to the Politzer. The therapy is supplemented by washing the ear with antibiotic solutions, which are combined with glucocorticosteroid agents. If the purulent contents do not decrease, and the eardrum continues to protrude, then its artificial perforation is necessary. This is done in order to exclude a breakthrough of purulent masses into the cranial cavity.

When the disease has reached the perforative stage, the patient is shown an ear toilet and the introduction of agents to reduce swelling and thin the secretion, for example, ACC, Fluimucil and others.

Don't forget about physical therapy. UVI, laser therapy, UHF are effective.

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

Antibiotics for otitis media

If the disease requires the appointment of antibiotics, then it is worthwhile to understand that only their oral administration will not be enough. Local administration of antibacterial agents is also necessary. Doctors recommend taking ampicillin, amoxicillin, azithromycin, ciprofloxacin and others. As solutions for injection, netilmicin and cefazolin are used. Locally prescribed drugs such as tsipromed, otofa, normax, fugentin and others.

Do not prescribe antibiotics yourself. They are prescribed only by the attending physician, since the illiterate use of these drugs can not only help get rid of otitis media, but, on the contrary, aggravate the course of the disease.

Education: In 2009 he received a diploma in the specialty "Medicine" at Petrozavodsk State University. After completing an internship in the Murmansk Regional clinical hospital received a diploma in the specialty "Otorhinolaryngology" (2010)

Acute otitis media frequent illness which can affect both adults and children. Its symptoms manifest themselves intensely, causing discomfort to the sick person. To get rid of the problem, treatment should be started urgently, since the acute phase can give complications and become chronic.

Features of the disease and causes

First you need to understand the features of this disease and the mechanism of its occurrence. Acute otitis media is a lesion of the mucous epithelium in the middle ear cavity. The main causative agent is pathogenic microflora. Bacteria enter the ear through the nasopharynx or transtymally, begin to multiply actively and cause inflammation itself.

Acute left-sided or right-sided otitis usually occurs. If the bacteria affect both ears at the same time, they speak of a bilateral type of disease. Its symptoms can manifest unevenly, depending on the degree of organ damage on each side.

In adults, otitis occurs less frequently than in children, as the number of risk factors decreases. Adults have stronger immunity, and the anatomical component of the ear-nose-throat system is normalized, and it becomes more difficult for infections to get into the ear.

The main causes of acute otitis media are considered to be:

infectious diseases;
viral diseases;
pathology of the nasopharynx;
tumors and neoplasms;
trauma;
hypothermia;
allergy;
chronic problems with the upper respiratory tract;
weak immunity;
changes in atmospheric pressure;
sulfur plug;
foreign body in the ear;
water ingress.

Acute otitis media proceeds rapidly and intensely. The main pathogens are microorganisms of coccal groups, as well as fungi, proteus and diphtheria bacillus.

They can enter the middle ear through the bloodstream, the nasopharynx and Eustachian tube, a damaged eardrum, and even from the cranial cavity and inner ear.

Poor-quality treatment of colds, infectious and viral diseases often gives a complication in the form of acute otitis media. Especially often this disease worries people with chronic sinusitis, sinusitis, tonsillitis or allergic rhinitis. Irritation of the mucous membrane of the auditory tube during medical procedures can also provoke inflammation. And if there is a curvature of the nasal septum or there are often problems with the tonsils, which is especially true for children, the number of episodes of otitis media increases significantly.

Symptoms and stages

It is impossible not to notice this disease. It starts suddenly and quickly picks up speed. Symptoms of acute otitis media are bright and intense. The main difference between this form of the disease is sharp pain inside the ear and fever. Mostly, the symptoms of otitis intersect with signs of a cold. There is swelling and nasal congestion, with the spread of infection, concomitant diseases of the upper respiratory tract occur.

The main symptoms of acute otitis media in adults:

sharp pain;
temperature;
malaise;
hearing loss;
nasal and ear congestion;
runny nose;
hyperemia of soft tissues;
accumulation of fluid behind the eardrum;
the appearance of secretions;
noise and sensation of fluid transfusion.

Symptoms initially increase as the disease progresses. After perforation of the tympanic membrane and discharge of secretions to the outside, discomfort decreases.

The disease proceeds in several stages:

catarrhal stage. The onset of the disease is when the mucous membrane lining the Eustachian tube is damaged. When bacteria enter, inflammation increases. A swollen auditory tube does not allow internal exudate to escape.
exudative stage. Due to the blockage of the middle ear, exudate accumulates in it. The body temperature rises to fight infection and microorganisms that feel great in the resulting environment and actively multiply in the absence of appropriate treatment measures.
Purulent stage. Pus begins to form and accumulate in the ear cavity. It fills the free space and puts pressure on the eardrum. This causes a feeling of congestion and increases pain. Symptoms of intoxication may be observed due to an increase in the concentration of waste products of pathogenic microflora. Before and inclusive of this stage, acute otitis media occurs in the preperforative stage.
perforative stage. The next stage, when the pus accumulated inside the ear leads to the destruction of the most vulnerable zone of the eardrum and its breakthrough occurs - perforation. Sharp pain is accompanied by a temporary hearing loss and the onset of intense suppuration from the external auditory canal. Along with this, body temperature normalizes, and pain becomes less pronounced. It is important that the pus is completely drained out. In adults, perforation often occurs on its own, but in children, forced paracentesis may be necessary, due to the greater thickness of the tympanic membrane. During this period, you can not use the usual preparations for instillation of the ears.
reparative stage. It is marked by the restoration of the integrity of the eardrum. Healing occurs independently and quickly enough. Scars can form on the membrane, but in most cases they do not affect the quality of hearing. At proper treatment no bacteria and secretions remain in the middle ear, and therefore, after the rupture has healed, the patient recovers completely.

Constantly heard, especially from young mothers, one hears such a word as otitis media. Usually, it means an inflammatory process located at the level of the ears. But in order to understand what otitis media is and to clearly imagine the overall picture of the disease and its consequences, it is necessary, according to at least read this article.

With the further development of the pathological process, inflammation passes to the bone of the mastoid process. The general condition is much worse. Inside the tympanic cavity, and in the mastoid cells, a large amount of pus accumulates, which significantly increases the pressure inside them. If drainage is not performed, then purulent masses can break through: through the eardrum, through the meninges, with induction severe complications in the form of an inflammatory brain pathology. Ways of penetration of pus into the cervical region are also possible.

Local symptoms in this stage of the disease are:

Feeling of pressure in the ear.
Unbearable pain in the head and parotid space.
On examination, you can clearly see the ear anteriorly, and the protrusion and severe redness with a cyanotic shade behind the auricles. If you press on this area, then there will be a sharp pain.
A sharp drop in body temperature and improvement in the general condition of the patient, combined with suppuration from the ear, will indicate that there is a rupture in the eardrum.
Hearing is significantly impaired.

Chronic suppurative otitis media

This is a disease characterized by a chronic lesion of the middle ear region, and is manifested mainly by three characteristic symptoms.

First, periodic acute purulent processes melt the eardrum. It collapses and ceases to function normally.
Secondly, pus is constantly present in the tympanic cavity, which flows out through extensive holes in the tympanic membrane.
Thirdly, in a chronic inflammatory process, not only the eardrum is destroyed, but also the auditory ossicles. The function of sound conduction is disturbed and the patient's hearing loss is constantly progressing.

The disease is common in the general population. Usually, the initial signs of the disease appear from childhood. A frivolous attitude to the treatment, a late visit to the doctor, or persistent colds that reduce, general resistance body - all this is a predisposing factor in the development of a chronic purulent-inflammatory process in the middle ear.

Diagnosis of otitis media

Diagnosis of lesions of the middle ear consists of a set of survey data on the onset of the disease, characteristic symptoms, as well as important information is obtained with special instrumental research.
The presence of general symptoms of inflammation in combination with local signs of the presence of an infectious process indicate a pathology in the middle ear. From instrumental methods diagnostics, a simple otoscopy has become widespread.

Otoscopy- This is one of the most common and publicly available methods for studying the external auditory canal and the outer part of the tympanic membrane. Otoscopy reveals pathological changes associated with inflammatory processes occurring in the middle ear. The otoscope is a cylinder, one end of which is narrowed, and the other funnel-shaped expands for the convenience of examining the external auditory canal. Modern otoscopes are equipped with optical systems that allow you to magnify the visible image.

The main changes during otoscopy are as follows:

With tubootitis, the tympanic membrane is retracted inward, since the rarefaction of air creates vacuum conditions in the tympanic cavity.
With exudative or purulent otitis media, the tympanic membrane, on the contrary, swells outward, due to pus or mucus accumulated in the tympanic cavity. Its color changes from pale gray to bright red.
If suppuration is present, then otoscopy will most likely reveal defects in the wall of the tympanic membrane.

With mastoiditis, to confirm the diagnosis, as well as to identify intracranial complications, assign execution x-rays heads in special lateral projections. In this case, various defects are found in the bones around the mastoid process.

Chronic sluggish processes in the middle ear are often accompanied by partial hearing loss, therefore, in such cases, auditory functions are examined. Hearing is checked with the help of special devices - audiometers, as well as tuning forks.

Audiometry
To find out the cause of acute otitis media, in without fail check the nasal cavity, nasopharynx for the presence of infectious diseases and other pathological changes.

Treatment of otitis media

Treatment of acute otitis media is not an easy task. A timely and correct diagnosis will make it easier for the doctor to perform therapeutic measures. early treatment and A complex approach necessarily lead to favorable results already at the initial stages of treatment procedures.

An integrated approach provides for the creation of favorable conditions for the normal functioning of the auditory tubes, since air flows into the tympanic cavity through them, and infection from the nasopharynx is also possible. For this purpose, first of all, effective treatment sinusitis, rhinitis, adenoids, and other pathological processes occurring in the upper respiratory tract.

Blowing and washing of the auditory tubes is performed using a special catheter inserted through the mouth into the tympanic cavity. Drugs are injected into the lumen of the auditory tube to reduce inflammation and kill pathogenic bacteria.

The main drugs used to treat acute otitis media are as follows:

Glucocorticoids. Hormonally active drugs (prednisolone, dexamethasone) - reduce the swelling of inflamed tissues, reduce the activity of the inflammatory process

Antibacterial drugs. These are antibiotics that are administered intramuscularly, and, if necessary, inside the tympanic cavity, after preliminary washing with antiseptic drugs. Modern doctors otolaryngologists prefer to use penicillin antibiotics (augmentin, penicillin), and cephalosporins (cefazolin, cefuroxime, ceftriaxone and others). The macrolide group of antibiotics (clarithromycin, azithromycin) is also widely used in cases where there are no drugs from the above groups.

Precautions should be taken in choosing an antibiotic by carefully reading the instructions for its use, since there are some that are toxic to hearing. For example, a group of aminoglycosides is very toxic to hearing. It includes drugs such as: gentamicin, neomycin, and streptomycin.

Antihistamine medicines. These are anti-allergic drugs that are taken in cases where the disease was preceded by any allergic process in the nasal cavity. Allergic reaction causes tissue edema, increased mucus formation, while the nasopharyngeal cavity swells and closes the lumen of the auditory tubes, which causes the appearance of congestion and the occurrence infectious disease middle ear cavity. Antiallergic drugs include: clemastine, tavegil, suprastin and many others.

Vasoconstrictor drugs. In order to expand the lumen of the auditory tubes and thereby increase their patency, solutions of naphthyzinum, galazolin, or sanorin are used topically.

These drugs are instilled into the nose several times a day. Infants must first clean the nasal passages by lubricating the nasal cavity with sterile vaseline. At the same time, the formed dry crusts soften and can be easily removed.

Surgery

In cases where conservative methods of treatment do not help, they resort to surgery. There are cases of lightning-fast development of acute purulent otitis, in which the general condition of the patient is significantly impaired, there is a high risk of developing complications in the form of infection under the membranes of the brain, the development of an abscess of the brain, or generalization of the infection. If the tympanic cavity is not opened in time and its purulent contents are not removed, the consequences can be disastrous.

Paracentesis- one of the types of surgical intervention in which the eardrum is opened and purulent masses are pumped out of the tympanic cavity. After that, drugs are administered through a catheter.

Anthrotomy- also a surgical method of treatment, which consists in opening the entrance (cave, antrum) of the cells of the mastoid process and draining with antiseptic solutions. Anthrotomy is indicated for the development of acute mastoiditis in adults, or anthritis in young children, according to urgent indications.

The method of surgical intervention, and the volume of the operation performed, is determined by the doctor strictly according to indications. After operations on the middle ear, as a rule, a special drainage tube is left in the cavity to be cleaned, for subsequent rinsing with antibiotics or other antiseptic solutions. Drainage is carried out until signs of intoxication disappear and purulent masses cease to form.
The choice of treatment methods depends entirely on the current clinical situation, the attending physician, anatomical and physiological features, as well as the patient's condition.

Prevention of otitis media

Prevention is a set of measures aimed at preventing the occurrence of a disease, or complications associated with the chronic course of the disease. Prevention of the appearance of otitis media includes a set of measures that increase immunity, harden the body. It also includes rules general hygiene, not be exposed to hypothermia and other factors that reduce the body's defenses.

General hardening procedures are that:

The body is constantly exposed to medium physical stress, that is, it is necessary to actively engage in sports or do gymnastics in the morning.
The body-swallowing actions also include wiping the body with a cool, damp towel, and for those who have strong immunity, dousing can also be done. cold water after taking a shower.
Staying in the fresh air, sunbathing, of course, are an important factor that increases the body's immune forces.

Eating a diet rich in all the nutrients, vitamins and minerals protects the body from harmful effects pathological factors external environment.

Clothing must be in season. In this regard, those periods of the year are dangerous when it is cool in the street in the morning and hot in the afternoon. At the same time, the body experiences increased stress in the form of significant changes in body temperature and can easily get sick with any cold.

Local preventive measures include: hygienic care of the external auditory canals, monitoring the cleanliness of the oral cavity, timely treatment of any colds upper respiratory tract.
For children with a history of acute otitis media, periodic check-ups with a family doctor will prevent the occurrence of complications associated with hearing loss.

How to treat otitis media with folk remedies?

Otitis media or inflammation of the middle ear is a very common condition. Most often, children suffer from it due to anatomical features, but the disease also occurs in adults. The main symptom is usually mild ear pain. Not all patients pay attention to it and postpone a visit to the doctor. Treatment of otitis media at home with folk remedies is not recommended. The fact is that inflammation is most often caused by an infection that has entered the middle ear through the Eustachian tube ( from the nasal cavity). Microbes multiply behind the eardrum and can damage sensitive anatomical structures in the middle ear. Therefore, at the first symptoms of otitis media, it is necessary to consult a doctor to start qualified medical treatment.

Folk remedies for treatment this disease may be used with the permission of the attending physician. First you need to determine the nature of the inflammatory process and check the integrity of the eardrum. The point is that some folk methods suggest instillation into the ear of various infusions or solutions. If the purulent process has damaged the eardrum, then the remedy can penetrate directly into the middle ear, causing increased pain and aggravating the course of the disease. Any infusions and decoctions medicinal herbs you need to drip into the ears only when the eardrum is intact.

Of the folk remedies used in the treatment of otitis media, the most effective are the following:

Propolis infusion. In the pharmacy you can buy ready-made propolis infusion at 96-degree ethyl alcohol. Ordinary cotton swabs are moistened with 20% infusion and gently inserted into the ear canal by 1-2 cm. Swabs are changed every day or twice a day. The tool helps to destroy microbes, reduce inflammation, and heal tissues. It can also be used after purulent otitis ( if middle ear pus has been surgically removed).
Garlic. A few small cloves of garlic are baked with lard until the cloves soften. After that, the garlic clove is cooled to a moderately hot temperature ( bearable) and inserted into the external auditory meatus. The procedure is repeated 1-2 times a day for 10-15 minutes. This destroys pathogenic microbes. This method not recommended for accumulation of pus in the tympanic cavity ( purulent otitis media).
elderberry flowers. Dry elderberry flowers are scalded with boiling water and, not allowing to cool, are applied to the ear, wrapped in bags. Warming up is done 2-3 times a day with the permission of the attending physician.
plantain juice. Juice should be squeezed from young carefully washed plantain leaves. 2-3 drops of juice are instilled into the sore ear ( can be diluted with water in equal proportions). This reduces pain.
Melilot officinalis. Dry leaves of sweet clover are mixed in equal proportions with dry chamomile flowers. For 2 tablespoons of a mixture of these herbs, 200 - 250 mg of boiling water is needed. Insist them in a large glass or mug ( maybe in a thermos), covered with a saucer on top. After 40 - 60 minutes, a clean cotton swab is dipped in the infusion and inserted into the ear canal. The procedure is repeated 2-3 times a day for a week.
walnut leaves. From young washed leaves walnut squeeze juice. It is diluted in equal proportions with boiled water and instilled into the sore ear 2-3 drops 1-2 times a day. The remedy is recommended for the accumulation of pus in the tympanic cavity.
Pomegranate juice with honey. Pomegranate juice ( better squeezed at home) is heated with a little honey. When the honey is melted, the juice is well mixed and cooled to room temperature. Dip a swab into the resulting mixture and smear the walls of the ear canal with it. This helps relieve pain and inflammation.

It is also recommended to use gargles based on medicinal herbs ( chamomile, St. John's wort, etc.). Special charges for such rinsing can be found in pharmacies. The point is that the infection especially in children) enters the middle ear mainly from the nasopharynx. If otitis media has developed, this suggests a parallel ongoing infectious process on the tonsils. It is against him that these rinses are directed. Such an integrated approach to treatment will avoid chronic infection.

All these funds should be used with the knowledge of the attending physician and in parallel with pharmacological preparations for more strong action. none medicinal plant in terms of antimicrobial effect cannot be compared with modern antibiotics Therefore, folk remedies in the treatment of otitis media play a rather auxiliary role. At the same time, many herbs accelerate tissue healing. This effect is very useful after suffering from otitis media ( especially with tear or perforation of the eardrum). In these cases, the use of folk remedies will help restore hearing faster.

What ear drops are best for otitis media?

Exist various groups pharmacological preparations that are available in the form of ear drops. Each of these groups has its own effect on the organ of hearing and is used in various types of otitis media. Self-use of any drops without examination by a doctor can be dangerous, as the patient is not able to correctly make a correct diagnosis. There are different types of inflammation in the middle ear, and each of these types has its own characteristics in the treatment.

With otitis media ear drops are the optimal form of drug administration for the following reasons:

Fast action. Taking medicines by mouth in the form of tablets and capsules) or injections are associated with a certain delay therapeutic effect. This is due to the fact that the active substances are first absorbed at the injection site, then enter the bloodstream and only with the blood are delivered to the affected area. Ear drops immediately deliver the active substance to the focus.
Good local effect. Ear drops fall through the ear canal to the eardrum. In most cases, with otitis media, there are no holes in it. However, the drug is quickly absorbed by the walls and the membrane itself and has a good effect on the tissues of the tympanic cavity, where the pathological process usually occurs.
Ease of drug administration. Often to achieve good effect from treatment, it is necessary to administer the drug regularly. This is especially important in the treatment of antibiotics. Microbes do not die from a single contact with the drug. Need to support it high concentration within a few days. Drops are convenient in that the patient can use them independently at work, at home or on the road. When prescribing, for example, injections, hospitalization may be required if no one can regularly administer the medicine to the patient at home.
low probability adverse reactions . Almost all drugs used for otitis media are also available in the form of tablets or solutions for intramuscular injections. However, this administration of the drug assumes that the drug is absorbed by the body and enters the ear with the bloodstream. At the same time, it will also enter other organs and tissues, which increases the likelihood of various complications and side effects. When using drops, the medicine is absorbed through the mucous membrane in small quantities, and only a small part of it enters the bloodstream.

With a serious course of the disease, ear drops may not give the desired effect. Then it is recommended to introduce necessary drugs through a special catheter in the Eustachian tube. This is unpleasant procedure performed by an ENT doctor. As a result medicinal solutions enter directly into the tympanic cavity. A similar effect is possible with perforation of the tympanic membrane, when ear drops enter the tympanic cavity through a hole in the membrane. This usually happens during a purulent process.

In the form of ear drops with otitis media, the following medications can be used:

Antibiotics. Antibiotics are the basis of treatment for any infectious process. With otitis media right choice an antibiotic can only be done by an ENT doctor after examining the patient. Some antibiotics ( cephalosporin, augmentin) can be toxic to the auditory nerve. Their use will only aggravate the course of the disease. The most common are norfloxacin, rifampicin, chloramphenicol, clotrimazole ( antifungal drug), ciprofloxacin, miramistin ( antiseptic). For the exact choice of antibiotic, it is necessary to establish to which drug the infection is most sensitive.
Painkillers. Most often, ear drops contain a small amount of lidocaine. It has a strong local anesthetic effect and is safe to use. In rare cases, some people may have hypersensitivity ( allergy) to this drug.
Anti-inflammatory. For fast withdrawal inflammation, glucocorticoid drugs are used. Drops based on dexamethasone, beclomethasone are used.
Scar stimulants. Sometimes, after perforation of the tympanic membrane, scarring of the opening is delayed. Then a solution of iodine or silver nitrate 40% is prescribed in the form of drops. They cauterize the edges of the hole and granulations begin to form there. The process of scarring of the membrane is accelerated.

In practice, there are many factors that influence the choice of drops for the treatment of a particular patient. The most important of them are the stage of the process, the type of infection, the presence of allergies in the patient, the presence of perforation of the eardrum. To achieve maximum effect, doctors often prescribe so-called combined preparations. These drops contain substances from various pharmacological groups, and therefore the effect of them will be complex. The most common drugs are Otipax, Otinum, Otofa, Sofradex and others. However, without examination by an ENT doctor, the use of any of them can only aggravate the situation.

Do I need to warm the ear with otitis media?

One of the most common means of dealing with ear pain is warming it with dry heat. Dry heat is understood as flour, sand or other similar substances wrapped in cloth and heated to a temperature of 50-60 degrees. In otitis media, dry heat treatment can have a variety of effects. The fact is that inflammation in the middle ear can be of a different nature. In some forms of the disease, heat really helps, while in others it can, on the contrary, aggravate the situation.

Dry heat in otitis media can have the following effects:

Expansion of blood vessels in the ear. Under the action of heat, small vessels dilate and fill with blood. Due to this, tissue nutrition is improved and their regeneration is faster. It is easier for the body to fight infectious processes, since there are more blood cells ( neutrophils, eosinophils and others) migrate to the area of inflammation.
The release of fluid from the vessels. The expansion of blood vessels increases the permeability of their walls. Because of this, the liquid part of the blood ( plasma) without cells can leave the vascular bed. This leads to mucosal edema or accumulation of a large number fluid in the tympanic cavity. This effect in some cases can increase pain.
Impact on microorganisms. In the early stages of the disease, when there are few microbes, dry heat can inhibit their growth and prevent the development of infectious tissue damage. However, this depends on the type of microorganism. The so-called pyogenic microflora, which leads to the formation of pus, can, on the contrary, accelerate its growth at elevated temperatures. Therefore, dry heat should never be used for purulent otitis media.
Neutralization of pain receptors. Recent studies show that heat modifies the structure of pain receptors in tissues, which reduces pain. This effect is especially noticeable in young children. This is usually effective in the initial stages of the disease. In the later stages, with severe structural disorders, thermal exposure is not enough to relieve pain.

Thus, the effect of heat in inflammation of the middle ear is dual. On the one hand, it improves blood circulation and relieves pain, on the other hand, it increases the risk of developing a purulent process. Only an ENT doctor can give an unambiguous answer whether it is necessary to apply heat after examining the patient. It is necessary to find out the type of inflammation and its stage. In the early stages, this method is usually justified. With the intensive development of microbes, it is contraindicated due to the risk of severe complications.

Dry heat can be safely used after surgical treatment otitis media. A few days after the operation usually to remove pus) the edema subsides and you can start warming up. This accelerates tissue regeneration and hearing restoration.

In cases where dry heat is contraindicated, you can consult a doctor and find a good alternative. Some physical therapy treatments also have a warming effect. However, due to improper action and careful regulation of the waves, the negative effects of warming can be avoided. On the contrary, the procedures will prevent the development of microbes and stop the accumulation of pus. The expediency of physiotherapy should also be consulted with the attending physician.

Can otitis media cause inflammation of the brain?

Inflammation of the brain is a very rare, but also the most dangerous complication of otitis media. It can occur due to the spread of infection from the tympanic cavity. This usually occurs during purulent processes. Pyogenic microorganisms have a special ability to slowly destroy ( how to melt tissue). Prolonged accumulation of pus in the tympanic cavity can lead to its spread to the mastoid process ( mastoiditis) or into the inner ear ( labyrinthitis). If pus breaks into the cranial cavity, it can endanger the life of the patient.

Actually, inflammation of the brain tissue does not occur. Encephalitis ( inflammation of the brain) occurs more often with other infections. However, the purulent process in the skull causes tissue damage in the immediate vicinity of the brain, which is also very dangerous.

Otitis media in severe cases can give the following complications:

Purulent meningitis. This complication arises from purulent inflammation meninges. At the same time, the brain tissue itself is not involved in the pathological process. However, irritation of the dura mater leads to the appearance of severe headaches. Without treatment, the pressure in the cranium greatly increases and the brain is squeezed, which can lead to death.
epidural abscess. Having broken into the cranial cavity, pus can be localized on top of the dura mater. Its local accumulation will lead to the so-called epidural abscess. This complication is dangerous by the further spread of pus or the growth of the abscess cavity, which causes compression of the brain.
brain abscess. Unlike an epidural abscess, in this case we are talking about a cavity with pus located directly in the brain. Such abscesses are very difficult to treat, since surgical access to the cavity is associated with the risk of brain damage. At the same time there high risk compression of brain tissue.
Thrombosis of the venous sinus. In the brain, the outflow of venous blood is carried out through wide cavities - venous sinuses. If pus gets into these sinuses, their thrombosis can occur. Then the blood circulation in the entire area will be disturbed. The veins of the brain begin to overflow with blood, squeezing the sensitive nerve tissue. There is also a problem with arterial blood flow, and the brain does not receive enough oxygen. With the spread of pus from the temporal bone ( it is in it that otitis media develops) there is a risk of thrombosis of the lateral and sigmoid sinuses.

Thus, in none of these cases is there inflammation of the nervous tissue of the brain. However, squeezing this tissue is no less dangerous. The transmission of impulses between neurons is disrupted. Because of this, the patient may experience a variety of disorders - paresis, paralysis, sensory disturbances, respiratory and palpitations disorders. With any options for a breakthrough of pus into the brain, there is a danger to life. Even urgent hospitalization and intervention of specialists cannot always save the patient. Therefore, it is important to pay attention to the first manifestations of inflammation in the cranium.

The following symptoms may indicate the spread of a purulent process with otitis media:

rapid rise in temperature 38 - 39 degrees or more);
severe headache ( aggravated by head movement);
nausea and vomiting that do not depend on food intake ( vomiting of central origin);
inability to tilt head forward until the chin touches the sternum), as this causes severe pain in the patient;
mental disorders ( drowsiness, confusion, lethargy, coma)
specific meningeal symptoms of Kernig and Brudzinsky ( determined by the doctor during the examination).

All these symptoms are not characteristic of otitis media. They are associated with irritation of the meninges and speak of the spread of a purulent process. In these cases, doctors transfer the patient to the intensive care unit or intensive care unit ( as of) and change the tactics of treatment. Neurosurgeons are involved for consultation.

To avoid such serious complications, the following preventive measures must be observed:

timely start of treatment of otitis media;
examination by an ENT doctor without self-treatment);
following the instructions of a specialist bed rest if necessary, regular medication);
preventive examinations during the recovery period;
notifying the doctor of new symptoms or a change in general condition.

Thus, directly encephalitis ( inflammation of brain neurons) cannot develop with otitis media. But all purulent complications associated with infection in the cranial cavity inevitably affect the functioning of the brain. In a broad sense, they can be grouped under the term "inflammation of the brain." Timely started intensive treatment can save a patient's life. But residual effects in the form of chronic headaches, motor and sensitive disturbances. Therefore, patients need to do everything to stop the disease at the stage of otitis media, when there is still no direct threat to life.

Can deafness occur after otitis media?

Hearing loss is one of the important symptoms of otitis media. This disease is characterized by an inflammatory process in the middle ear and without adequate treatment can lead to serious consequences. In particular, in some patients, after the actual recovery, hearing problems remain. In severe cases, the disease can result in deafness.

Deafness and hearing loss after otitis media can occur for the following reasons:

Pressure disorders in the tympanic cavity. The cause of otitis media is often the spread of an infection from the nasal or oral cavity. Microbes enter the tympanic cavity through the Eustachian tube, which opens in the nasopharynx. In this case, swelling of the mucous membrane of the Eustachian tube occurs. The tympanic cavity is, as it were, isolated from the outer space, and pressure is not regulated in it. Because of this, the eardrum is constantly retracted or, conversely, bulges. This prevents its vibrations and reduces the acuity of hearing. This deafness is temporary. After the edema is removed and the inflammation is eliminated, the pressure in the tympanic cavity equalizes, and the membrane again begins to transmit vibrations normally.
Filling the tympanic cavity with fluid. With an infectious process in the tympanic cavity, cells in the mucous membrane begin to secrete more fluid. As microbes multiply certain types) pus also begins to form in the cavity. As a result, it is filled with liquid. This makes it difficult for the eardrum to vibrate and impairs the movement of the auditory ossicles. Because of this, hearing acuity is greatly reduced. After removal of fluid from the tympanic cavity ( spontaneous resorption or surgically ) hearing is usually fully restored.
Perforation of the tympanic membrane. Perforation is a perforation or rupture of the membrane. With otitis media, it may appear due to intense purulent inflammation. Pus tends to melt tissue. If a hole forms in the eardrum, then it ceases to perceive sound waves normally. Because of this, hearing deteriorates. Usually small holes scar on their own or are surgically sutured after recovery. However, hearing acuity is usually permanently reduced after this.
Sclerosis of the joints of the tympanic ossicles. Normally, sound waves are converted on the eardrum into mechanical vibrations. From here they are transmitted to the inner ear through a system of three auditory ossicles - the hammer, anvil and stirrup. These bones are located in the tympanic cavity of the middle ear. They are interconnected small joints, which gives them the necessary limited mobility. As a result of inflammation in the middle ear ( especially with purulent processes) these joints may be affected. Their mobility increases, decreases or completely disappears. In all cases, vibrations begin to be transmitted worse to the inner ear, and hearing acuity decreases.
Scarring of the eardrum. After inflammation or perforation of the eardrum, a layer of connective tissue may form on it over time. This makes it thicker and less sensitive to vibrations, which can make hearing worse for a patient after otitis media. The introduction of special drugs ( breaking down and softening connective tissue) or physiotherapy can help restore hearing acuity.
Complications in the inner ear. Purulent processes in the middle ear can spread to the inner ear. It contains sensitive receptors, damage to which is fraught with complete and irreversible hearing loss. Usually, such complications occur with delayed or incorrect treatment of otitis media.
Auditory nerve injury. It occurs quite rarely and is associated with irreversible hearing loss. Directly purulent process from the middle ear reaches the auditory nerve very rarely. However, in some cases, antibiotics that treat inflammation have an ototoxic effect, killing neurons in the auditory nerve. As a result, the inflammation subsides, all sound transmission mechanisms in the ear work, but the signals from them are not transmitted to the brain.

In the above cases, it is mainly a temporary hearing loss. However, in severe cases, pathological changes may be irreversible. Thus, deafness is one of the most severe complications of otitis media. It can occur as in children ( for whom this disease is, in principle, more characteristic) as well as in adults.

To avoid hearing loss in otitis media, you need to follow a few simple rules:

Timely visit to the doctor. If you experience pain in the ear, discharge from the ear, or a decrease in hearing acuity, you should immediately contact an ENT doctor. At each stage of the development of the disease, there are effective methods of treatment. The sooner they are applied, the less significant the damage will be.
Refusal of self-medication. Sometimes patients during the first days of the disease try to cope with it on their own. At the same time, they begin to use folk remedies or pharmacological preparations without knowing the features of the pathological process. In some cases, this leads to a worsening of the situation. For example, warming or putting alcohol in the ear can sometimes cause pus to develop faster. This will increase the risk of hearing loss in the future.
Treatment respiratory diseases . As mentioned above, otitis media is often the result of the spread of infection from the pharyngeal cavity. Especially often this reason occurs in childhood, when the Eustachian tube is wider and shorter. Prevention of otitis is the treatment of tonsillitis, tonsillitis and rhinitis. The chronicity of infectious processes increases the risk of infection and hearing loss.
Compliance with doctor's orders. After examining the patient, the specialist prescribes certain procedures and drugs. They are necessary for the speedy suppression of the inflammatory process and the destruction of microbes. It is important to follow the doctor's instructions regularly. This is especially true when taking antibiotics ( delaying intake even by a few hours can weaken the antimicrobial effect). After recovery, there is no more pus or inflammation in the middle ear. However, hearing can be restored gradually. To speed up this process, certain procedures are also assigned ( physiotherapy, preventive examinations, etc.). Conscientiously following the doctor's instructions for several weeks ( How long does the average treatment last?) is the key to success.

If these simple rules are followed, the risk of complete hearing loss from otitis media is minimal. Ignoring the prescriptions of a doctor and attempting self-treatment can lead to irreversible deafness.

When to see a doctor for otitis media?

Otitis media is a very serious disease in which the inflammatory process is localized in the middle ear. It consists of the tympanic cavity ( located just behind the eardrum), the cavities of the mastoid process and the Eustachian tube connecting the middle ear to the nasopharynx. This anatomical region is located in close proximity to the inner ear ( where are sensory receptors located) and the cranial cavity. In this regard, otitis media should be taken very seriously. It is recommended to consult a doctor at the first symptoms of the disease.

Most often, otitis media in the early stages manifests itself as follows:

Earache. The pain can be of a different nature - from acute, unbearable to dull, constant. This symptom occurs due to inflammation of the mucous membrane in the tympanic cavity. With purulent processes, pain can radiate ( give away) in the lower jaw on the side of the lesion.
Ear congestion. The symptom is characteristic of tubo-otitis, when the lumen of the Eustachian tube closes due to edema. The pressure in the tympanic cavity decreases, the tympanic membrane retracts, and there is a feeling of congestion.
Hearing loss. Often the disease begins with a subjective feeling of hearing loss, which the patient himself complains about. After a few days, pain or congestion may appear.
General anxiety. The symptom is noted in young children who cannot complain of pain. They do not sleep well, are capricious, often cry. This may be the first manifestation of the inflammatory process.
autophony. This symptom consists in duplicating the patient's own voice when he speaks. The symptom occurs due to isolation of the tympanic cavity ( closure of the Eustachian tube).
Noise in the ear. Usually called pathological process in the Eustachian tube.
Temperature. In the early stages, the temperature may not be at all. With otitis media, it is rarely the first manifestation of the disease. Most often, this course is noted if otitis media has developed against the background of an upper respiratory tract infection ( angina, rhinitis, tonsillitis, etc.)

If these symptoms appear, it is recommended to consult an ENT doctor for more thorough examination. Your doctor will usually notice other signs as well. developing disease. Then otitis media can be stopped even in the first stages of the disease, and the risk to health is minimal. If you go to the doctor because of a feeling of fullness in the ear ( it gives strength paroxysmal pain ) or about discharge from the ear, which means that the disease is already in full swing. Fluid accumulates in the tympanic cavity inflammatory exudate) or pus forms, which cause these symptoms. At this stage, the treatment is already more complex, and it is more difficult to predict the course of the disease.

Prolonged ignoring of symptoms and attempts at self-treatment can be dangerous for the following reasons:

further deterioration of the general condition;
the development of purulent inflammation, which will require more complex healing procedures (administration of drugs through a catheter in the Eustachian tube);
perforation ( gap) eardrum, which will increase the recovery time;
irreversible hearing loss and with the development of complications, deafness is also possible);
need for surgical intervention incision of the tympanic membrane and removal of pus);
the transition of the purulent process to the region of the inner ear, into the cranial cavity ( with severe brain complications);
generalization of infection entry of microbes into the blood);
child's delay mental development (prolonged hearing loss and slow recovery inhibit the development of speech skills and the learning process in general).

Thus, a doctor should be consulted at the first symptoms of the disease. The more time passes from the beginning of the inflammatory process, the longer the treatment will be and the higher the risk of dangerous complications. In most cases, contacting a specialist at the first stage of the disease allows you to achieve complete recovery after 5 to 7 days. Otherwise, treatment full recovery hearing can drag on for many weeks.

Rapidly occurring infectious and inflammatory lesion of the middle ear cavity. The clinical picture of the disease includes a pronounced pain syndrome, general manifestations, sensations of congestion and noise in the ear, hearing loss, the occurrence of a perforated hole in the eardrum, followed by suppuration. The diagnosis of acute otitis media is based on data from a clinical blood test, otoscopy, various hearing studies, skull radiography, rhinoscopy and pharyngoscopy, and examination of the auditory tube. General treatment diseases are treated with antibiotics, antihistamines and anti-inflammatory drugs, local therapy consists in blowing the auditory tube, instilling ear drops, washing the tympanic cavity, introducing proteolytic enzymes into it, etc.

General information

Acute otitis media is a widespread pathology in both pediatric and adult otolaryngology. Acute otitis media is the most common form of otitis media. It occurs with equal frequency in women and men. Recently, there has been a tendency of acute otitis media to a more sluggish course in adults and frequent recurrence in children. In children younger age in connection with the peculiarities of the structure of the ear in acute otitis media, the antrum-cave of the mastoid process is immediately involved in the inflammatory process and the disease is in the nature of otoantritis. Acute otitis media can occur as a complication of eustachitis, exudative otitis media, aerootitis, ear injury, inflammatory diseases of the nasopharynx.

Causes of acute otitis media

Up to 65% of acute otitis media are due to streptococcal infection. In second place in terms of frequency of occurrence are pneumococcus and staphylococcus aureus. In rare cases, acute otitis media is caused by diphtheria bacillus, Proteus, fungi (otomycosis).

Most often, the penetration of infectious agents into the tympanic cavity occurs tubogenically - through the auditory (Eustachian) tube. Normally, the auditory tube serves as a barrier that protects the middle ear from the entry of microorganisms in the nasopharynx into it. However, with various general and local diseases, its function may be impaired, which leads to infection of the tympanic cavity with the development of acute otitis media. Factors provoking dysfunction of the auditory tube are: inflammatory processes of the upper respiratory tract (rhinitis, ozena, pharyngitis, laryngitis, laryngotracheitis, tonsillitis, adenoids, chronic tonsillitis); benign tumors of the pharynx (angioma, fibroma, neurinoma, etc.), tumors of the nasal cavity; surgical interventions in the nasal cavity and pharynx; diagnostic and therapeutic manipulations (blowing according to Politzer, catheterization of the auditory tube, tamponade for nosebleeds).

The development of acute otitis media can occur when the tympanic cavity is infected by the transtympanic route - through a damaged tympanic membrane, which happens with injuries and foreign bodies of the ear. The hematogenous route of infection of the middle ear cavity with the occurrence of acute otitis media can be observed with common infections(measles, influenza, scarlet fever, rubella, diphtheria, syphilis, tuberculosis). A casuistic case is the appearance of acute otitis media due to infection from the cranial cavity or inner ear.

In the occurrence of acute otitis media, the state of general and local immunity. With its decrease, even saprophytic flora entering the tympanic cavity from the nasopharynx can cause inflammation. Relatively recently, it has been proven that the so-called ear allergy plays an important role in the appearance of acute otitis media, which is one of the manifestations of systemic allergies along with allergic rhinitis, exudative diathesis, allergic dermatitis, asthmatic bronchitis and bronchial asthma. An important role in the development of acute otitis media is played by unfavorable environmental factors: hypothermia, dampness, sudden changes in atmospheric pressure.

Symptoms of acute otitis media

Acute otitis media usually lasts about 2-3 weeks. During a typical acute otitis media, 3 successive stages are distinguished: preperforative (initial), perforative and reparative. Each of these stages has its own clinical manifestations. With timely treatment or high immunological resistance of the organism, acute otitis media can take an abortive course at any of the indicated stages.

Preperforative stage acute otitis media may take only a few hours or last 4-6 days. It is characterized by a sudden onset with intense pain in the ear and pronounced common symptoms. Ear pain is caused by a rapidly growing inflammatory infiltration of the mucous membrane lining the tympanic cavity, resulting in irritation of the nerve endings of the glossopharyngeal and trigeminal nerves. Ear pain in acute otitis media is sharp, painful and sometimes unbearable, leads to sleep disturbance and loss of appetite. It radiates to the temporal and parietal regions. Pain syndrome in patients with acute otitis media is accompanied by noise and congestion in the ear, hearing loss. These symptoms are due to the fact that due to inflammatory changes, the mobility of the auditory ossicles located in the tympanic cavity, which are responsible for sound conduction, decreases.

Common manifestations of acute otitis media are an increase in body temperature up to 39 ° C, general weakness, chills, fatigue and weakness. Influenza, scarlet fever and measles acute otitis media often occur with simultaneous involvement in the inflammatory process of the inner ear with the development of labyrinthitis and hearing loss due to sound perception disorders.

perforative stage Acute otitis media occurs when, as a result of the accumulation of too much purulent content in the tympanic cavity, the tympanic membrane ruptures. Through the hole formed, mucopurulent, then purulent, and sometimes bloody issues. At the same time, the patient's state of health with acute otitis media noticeably improves, the pain in the ear subsides, the body temperature rises. Suppuration usually lasts no more than a week, after which the disease passes into the next stage.

Reparative stage acute otitis media is characterized by a sharp decrease and cessation of suppuration from the ear. In most patients at this stage, spontaneous scarring of the perforated hole in the tympanic membrane occurs and complete restoration of hearing occurs. With a perforation size of more than 1 mm, the fibrous layer of the tympanic membrane is not restored. If overgrowth of the hole still occurs, then the perforation site remains atrophic and thin, since it is formed only by the epithelial and mucous layers without a fibrous component. Large perforations of the tympanic membrane do not close; along their edge, the outer epidermal layer of the membrane fuses with the internal mucosa, forming callused edges of the residual perforative opening.

Acute otitis media does not always proceed with a typical clinical picture. In some cases, there is an initially prolonged and mild nature of the symptoms, the absence of spontaneous rupture of the eardrum. On the other hand, an extremely severe course of acute otitis media is possible with severe symptoms, temperature up to 40 ° C, headache, nausea and dizziness. The delay in the formation of perforation of the tympanic membrane in such cases leads to the rapid spread of infection into the cranial cavity with the development of intracranial complications. In cases where, after perforation of the tympanic membrane, there is no improvement in the condition, there is an aggravation of symptoms after some improvement, or a long-term (more than a month) suppuration is observed, one should think about the development of mastoiditis.

Diagnosis of acute otitis media

The diagnosis of acute otitis media is established by an otolaryngologist on the basis of the patient's complaints, the characteristic sudden onset of the disease, the results of otoscopy and microotoscopy, and hearing studies. AT clinical analysis blood in patients with a typical course of acute otitis media revealed moderate leukocytosis and mild acceleration of ESR. severe forms diseases are accompanied by severe leukocytosis with a shift of the formula to the left, a significant acceleration of ESR. An unfavorable sign indicating the development of mastoiditis is the absence of eosinophils.

The otoscopic picture of acute otitis media depends on the stage of the disease. In the initial period, an injection of the radial vessels of the tympanic membrane is detected. Then the hyperemia becomes diffuse, there is infiltration and protrusion of the membrane towards the ear canal, sometimes there is a whitish coating. In the perforative stage, otoscopy shows a slit-like or rounded perforation of the tympanic membrane, a pulsating light reflex is observed - a pulsation of pus, visible through the perforation, synchronous with the pulse. In some cases, there is a prolapse through the perforation of the mucous membrane of the tympanic cavity, resembling granulation tissue. In the reparative stage of acute otitis media, otoscopy may show overgrowth of the perforation or its organization in the form of compaction and callosity of the edge.

Treatment of acute otitis media

Acute otitis media is treated depending on the stage and, as a rule, in outpatient settings. With the development of complications, hospitalization of the patient is indicated. In order to relieve pain in the preperforative stage of acute otitis media, ear drops containing anesthetics are used. Effective instillation of drops heated to 38-39 ° C, followed by closing the ear canal with cotton wool with petroleum jelly, which is removed after a few hours. Turundas moistened with alcohol solution of boric acid are also used. To relieve swelling and improve the drainage function of the auditory tube, antihistamines and nasal vasoconstrictor drops are prescribed: oxymetazoline, xylometazoline, naphazoline, tetrizoline, xylometazoline.

General therapy of patients with acute otitis media is carried out with anti-inflammatory drugs: diclofenac, ibufen, etc. In case of fever and intense pain, antibiotic therapy is indicated. The drugs of choice are amoxicillin, cefuroxine, spiramycin. Having started taking an antibiotic, it is necessary to drink it within 7-10 days, since early termination of antibiotic therapy can lead to relapses and complications, chronic otitis media, and the formation of adhesions inside the tympanic cavity.

A good effect in the preperforative stage of acute otitis media is given by blowing the auditory tube according to Politzer and washing the middle ear with antibiotic solutions in combination with glucocorticosteroid drugs. The protrusion of the eardrum against the background of the treatment suggests that despite all medical measures, in the tympanic cavity there is an accumulation of a large amount of pus. This condition is fraught with the development of complications and requires tympanic membrane paracentesis.

In the perforative stage of acute otitis media, along with the use of antihistamines, vasoconstrictors and antibacterial agents, the toilet of the outer ear and transtympanic administration of drugs are performed. To reduce edema and secretion of the mucosa, fenspiride is used, and mucolytics (acetylcysteine, herbal preparations). Physiotherapeutic treatment is prescribed: UV, UHF and laser therapy.

Treatment in the reparative stage of acute otitis media is aimed at preventing the formation of adhesions, restoring the functions of the auditory tube, and increasing the body's defenses. Blowing the auditory tube, introducing proteolytic enzymes through it into the tympanic cavity, pneumomassage of the tympanic membrane, ultraphonophoresis with hyaluronidase, vitamin therapy, taking biostimulants (royal jelly, calf blood hemoderivative) are used.

Prognosis of acute otitis media

With timely and competent treatment, sufficient activity of immune mechanisms, acute otitis media ends with a complete recovery and 100% restoration of hearing. However, later visits to the doctor bad condition immunity, adverse external influences and underlying diseases can cause a completely different outcome of the disease.

Acute otitis media can transform into chronic suppurative otitis media, which is accompanied by progressive hearing loss and recurrent suppuration. In some cases, the inflammatory process leads to pronounced cicatricial-adhesive changes in the tympanic cavity, which impair the mobility of the tympanic ossicles and cause the development of adhesive otitis media with persistent hearing loss.

In severe cases, acute otitis media is accompanied by the development of a number of complications: purulent labyrinthitis, mastoiditis, facial neuritis, petrositis, meningitis, sigmoid sinus thrombosis, brain abscess, sepsis, some of which can be fatal.