Symptoms of purulent otitis media in adults. Purulent otitis: causes, symptoms and treatment. Anatomy and physiological features of the middle ear

Purulent otitis media is an acute form of inflammation in the middle ear cavity, in which the mucous membrane is damaged and the infection spreads deep into the ear canal. This pathology is accompanied by suppuration and swelling of the tissues of the middle and inner ear. As a rule, purulent otitis media does not act as a separate disease, but is accompanied by other painful conditions, most often occurring during colds.

In most cases, it is difficult for a person to determine whether he has an ear pathology, because the symptoms of otitis media are similar to other diseases of the nasopharynx, the clinical picture of influenza, respiratory and viral diseases.

Main stages and symptoms

Due to the fact that respiratory diseases often become provocateurs of otitis media, preventive methods should extend to the entire nasopharyngeal and respiratory tract system. In particular, regular sanitation of the respiratory system and minimizing the use of antibiotics for seasonal colds.

Suppurative otitis media most often becomes chronic due to the presence of infections in the sinuses or upper pharynx.

In such cases, it is important to keep the nasal cavity and sinuses clean, and treat rhinitis and sinusitis in a timely manner. Inflammation of the nasal sinuses makes it impossible to breathe properly, which significantly increases the risk of developing otitis media.

Preventive measures for a chronic purulent process in the ear are quick diagnosis and comprehensive. This includes the correctness and timeliness of performing paracentesis, antibiotics selected in accordance with all standards.

The aggravation of acute otitis is also facilitated by self-medication with antibacterial drugs, cessation of therapy before the time prescribed by the doctor, or, conversely, unauthorized extension of the course.

An important role in the prevention of chronic purulent otitis is played by how responsibly the patient himself approaches treatment. All patients who have recovered from otitis media must be observed by an otolaryngologist for six months after recovery.

After completing the course of treatment, the patient may continue to develop pathological conditions in the ear that are not expressed by any symptoms. In such cases, he will be prescribed a series of physiotherapeutic procedures for complete rehabilitation.

In conclusion, I would like to once again draw attention to the seriousness and dangerous consequences of this disease. Therefore, as soon as you discover a set of signs in yourself that indicate purulent otitis media, you should not wait until the disease begins to progress.

Remember that treatment not carried out on time can become a catalyst for the transition of acute purulent form of otitis to chronic - this is fraught with complications varying degrees and irreversible impairment of the sound-conducting function of the ear.

• Anatomy of the ear
• Causes of otitis media
• Pathogens
• General diagnostic principles
• Treatment of external otitis
• Prevention of otitis

Otitis is an inflammation of the ear, a general term for any infectious processes in the organ of hearing. Depending on the affected part of the ear, external, middle and internal otitis (labyrinthitis) are distinguished. Otitis is common. Ten percent of the world's population will suffer from otitis externa during their lifetime.

Every year, 709 million new cases of acute otitis media are registered worldwide. More than half of these episodes occur in children under 5 years of age, but adults also suffer from otitis media. Labyrinthitis, as a rule, is a complication of otitis media and occurs relatively rarely.

Anatomy of the ear

To better understand the topic being presented, it is necessary to briefly recall the anatomy of the hearing organ.
The components of the outer ear are the auricle and the auditory canal. The role of the outer ear is to capture sound waves and conduct them to the eardrum.

The middle ear is the eardrum, the tympanic cavity containing the chain of auditory ossicles, and the auditory tube.

IN tympanic cavity sound vibrations increase, after which the sound wave travels to the inner ear. The function of the auditory tube, which connects the nasopharynx and middle ear, is ventilation of the tympanic cavity.

The inner ear contains the so-called cochlea, a complex sensory organ in which sound vibrations are converted into an electrical signal. Electrical impulse follows the auditory nerve to the brain, carrying encoded information about sound.

Otitis externa

Otitis externa is an inflammation of the ear canal. It can be diffuse, or it can occur in the form of a boil. With diffuse external otitis, the skin of the entire ear canal is affected. A boil is a localized inflammation of the skin of the outer ear.

Otitis media

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.

The most common complications of otitis media include mastoiditis (inflammation of the behind-the-ear temporal bone), meningitis (inflammation of the membranes of the brain), brain abscess (abscess), labyrinthitis.

Labyrinthitis

Internal otitis is almost never an independent disease. It is almost always a complication of inflammation of the middle ear. Unlike other types of otitis, its main symptom is not pain, but hearing loss and dizziness.

Causes of otitis media

• After contact with contaminated water - most often, otitis externa occurs after water containing the causative agent gets into the ear. That is why the second name of this disease is “swimmer’s ear.”
• Trauma to the skin of the external auditory canal - in addition to the presence of infection in the water, there must also be local conditions that predispose to the development of inflammation: microcracks in the skin, etc. Otherwise, our every contact with unboiled water would end in the development of inflammation in the ear.
• A complication of ARVI, sinusitis - in this case, the causative agent of otitis media penetrates into the tympanic cavity from a completely different direction, the so-called rhinotubal route, that is, through the auditory tube. Usually the infection enters the ear from the nose when a person is sick with ARVI, runny nose or sinusitis. With severe inflammation of the middle ear, the infection can spread to the inner ear.
• In case of infectious diseases, kidney diseases, diabetes mellitus, hypothermia against the background of reduced immunity, the risk of developing inflammation in the middle ear increases. Blowing your nose through 2 nostrils (incorrectly), coughing and sneezing increase pressure in the nasopharynx, which leads to infected mucus entering the middle ear cavity.
• Mechanical removal of earwax - it is a protective barrier against infections.
• High air temperature and high humidity.
• Foreign objects entering the ear.
• Use of hearing aids.
• Diseases such as seborrheic dermatitis on the face, eczema, psoriasis.
• The causes of the development of acute otitis media are also genetic disposition, immunodeficiency states, and HIV infection.

Pathogens

Otitis externa can be caused by bacteria or fungi. Microorganisms such as Pseudomonas aeruginosa and staphylococcus are especially common in the ear canal. For fungi of the genus Candida and Aspergillus, the skin of the ear canal is generally one of the favorite places in the body: it is dark there, and after bathing it is also damp.

The causative agents of otitis media, and therefore internal, can be viruses and bacteria. Fungal infection of the middle ear also occurs, but much less frequently than the outer ear. The most common bacterial pathogens of otitis media are pneumococcus, Haemophilus influenzae, and Moraxella.

Clinical picture - symptoms of otitis media

• Pain is the main symptom of otitis media. The intensity of pain may vary:
  • from barely perceptible to unbearable
  • character – pulsating, shooting

  It is very difficult, most often impossible to distinguish on your own painful sensations with external otitis from pain due to inflammation of the middle ear. The only clue may be the fact that with otitis externa, pain should be felt when touching the skin at the entrance to the ear canal.

• Hearing loss is a variable symptom. It may be present in both otitis externa and otitis media, and may be absent in both of these forms of ear inflammation.
• Increased temperature - most often there is an increase in body temperature, however, this is also an optional sign.
• Discharge from the ear with external otitis almost always occurs. After all, nothing prevents the inflammatory fluid from being released.

With otitis media, if there is no perforation (hole) in the eardrum, there is no discharge from the ear. Suppuration from the ear canal begins after a communication appears between the middle ear and ear canal.

I would like to emphasize that perforation may not form even with purulent otitis media. Patients suffering from otitis media often ask, where will the pus go if it does not break out? It's very simple - it will come out through the auditory tube.

• Ear noise (see causes of tinnitus) and ear congestion are possible with any form of the disease.
• With the development of inflammation inner ear Dizziness may appear (causes).

Acute otitis media occurs in 3 stages:

Acute catarrhal otitis - the patient experiences severe pain, intensifying at night, when coughing, sneezing, it can radiate to the temple, teeth, be stabbing, pulsating, boring, hearing and appetite decrease, weakness and high temperature up to 39C appear.

Acute purulent otitis - accumulation of pus in the middle ear cavity occurs, followed by perforation and suppuration, which can occur on the 2-3rd day of illness. During this period, the temperature drops, the pain decreases, the doctor can make a small puncture (paracentesis) if the eardrum has not ruptured on its own.

Recovery stage - suppuration stops, the defect of the eardrum closes (fusion of the edges), hearing is restored within 2-3 weeks.

General diagnostic principles

In most cases, diagnosing acute otitis is not difficult. High-tech research methods are rarely needed; the ear is quite visible to the eye. The doctor examines the eardrum with a head reflector (a mirror with a hole in the middle) through the ear funnel or with a special optical device - an otoscope.

An interesting device for diagnosing otitis was developed by the famous Apple corporation. It is an otoscopic attachment for a phone camera. It is assumed that with the help of this gadget, parents will be able to photograph the child’s eardrum (or their own) and send the photos for consultation to their doctor.

Diagnosis of external otitis

Examining the ear of a patient suffering from otitis externa, the doctor sees redness of the skin, narrowing of the ear canal and the presence of liquid discharge in its lumen. The degree of narrowing of the ear canal may be such that the eardrum is not visible at all. In case of inflammation of the outer ear, other examinations other than examination are usually not necessary.

Diagnosis of otitis media and labyrinthitis

In case of acute inflammation of the middle ear, the main way to establish a diagnosis is also examination. The main signs that make it possible to diagnose “acute otitis media” are redness of the eardrum, limited mobility, and the presence of perforation.

• How is eardrum mobility checked?

The person is asked to puff out his cheeks without opening his mouth, that is, to “puff out his ears.” This maneuver is called the Valsalva maneuver, named after the Italian anatomist who lived at the turn of the 17th and 18th centuries. It is widely used by divers and divers to equalize pressure in the tympanic cavity during deep-sea descent.

When a stream of air enters the middle ear cavity, the eardrum moves slightly and this is noticeable to the eye. If the tympanic cavity is filled with inflammatory fluid, no air will enter it and there will be no movement of the eardrum. After the appearance of pus from the ear, the doctor may observe the presence of perforation in the eardrum.

• Audiometry

Sometimes, to clarify the nature of the disease, audiometry (hearing test using a device) or tympanometry (measurement of pressure inside the ear) may be needed. However, these hearing examination methods are more often used for chronic otitis media.

The diagnosis of labyrinthitis is usually made when, against the background of ongoing otitis media, hearing acuity suddenly drops sharply and dizziness appears. Audiometry in such a situation is mandatory. You also need an examination by a neurologist and a consultation with an ophthalmologist.

• CT and radiography

The need for X-ray examinations arises when there is a suspicion of complications of the disease - mastoiditis or intracranial spread of infection. Fortunately, such cases are rare. In situations where complications are suspected, it is usually performed CT scan temporal bones and brain.

• Bacterial culture

Is a smear to determine the bacterial flora necessary for otitis media? It is not easy to give a definite answer to this question. The problem is that due to the nature of bacterial cultivation, the response this survey will be received 6-7 days after the smear is taken, that is, by the time the otitis media has almost passed. Moreover, with otitis media without perforation, a smear is useless, since the microbes are behind the eardrum.

Still, it’s better to do a smear. In the event that the use of first-line medication does not bring recovery, after receiving the results of a bacterial study, it will be possible to adjust the treatment.

Treatment of external otitis

The main treatment for otitis externa in adults is ear drops. If a person does not have immunodeficiency (HIV infection, diabetes), antibiotic tablets are usually not needed.

Ear drops can contain only an antibacterial drug or be combined - contain an antibiotic and an anti-inflammatory substance. The course of treatment takes 5-7 days. Most often used for the treatment of external otitis:

Antibiotics:

• Cipropharm (Ukraine, ciprofloxacin hydrochloride)
• Normax (RUB 100-140, norfloxacin)
• Otofa (170-220 rubles, rifamycin)

Corticosteroids + antibiotics:

• Sofradex (RUB 170-220, dexamethasone, framycetin, gramicidin)
• Candibiotic (RUB 210-280, Beclomethasone, lidocaine, clotrimazole, Chloramphenicol)

Antiseptic:

• Miramistin (250-280 rubles, with spray)

The last two drugs also have antifungal properties. If external otitis is of fungal origin, antifungal ointments are actively used: clotrimazole (Candide), natamycin (Pimafucin, Pimafucort).

In addition to ear drops, for the treatment of external otitis, the doctor may recommend an ointment with the active ingredient Mupirocin (Bactroban 500-600 rubles, Supirocin 300 rubles). It is important that the drug does not have a negative effect on the normal microflora of the skin, and there is evidence of the activity of mupirocin against fungi.

Treatment of otitis media and labyrinthitis in adults

Antibacterial therapy

The main treatment for otitis media is an antibiotic. However, treatment of otitis media with antibiotics in adults is another controversial issue. modern medicine. The fact is that with this disease the percentage of spontaneous recovery is very high - more than 90%.

There was a period of time at the end of the 20th century when, in a wave of enthusiasm, antibiotics were prescribed to almost all patients with otitis media. However, it is now considered acceptable to do without antibiotics for the first two days after the onset of pain. If after two days there is no tendency to improve, then an antibacterial drug is prescribed. All types of otitis media may require oral pain medications.

In this case, of course, the patient must be under medical supervision. The decision about the need for antibiotics is a very important one and should only be made by a doctor. On the one hand, the scales weigh the possible side effects of antibiotic therapy, on the other, the fact that every year 28 thousand people die from complications of otitis media in the world.

The main antibiotics used in the treatment of otitis media in adults:

• Amoxicillin - Ospamox, Flemoxin, Amosin, Ecobol, Flemoxin solutab
• Amoxicillin with clavulanic acid - Augmentin, Flemoclav, Ecoclave
• Cefuroxime - Zinnat, Aksetin, Zinacef, Cefurus and other drugs.

The course of antibiotic therapy should be 7-10 days.

Ear drops

Ear drops are also widely prescribed for inflammation of the middle ear. It is important to remember that there is a fundamental difference between drops that are prescribed before perforation of the eardrum and after it appears. Let me remind you that a sign of perforation is the appearance of suppuration.

Before perforation occurs, drops with an analgesic effect are prescribed. These include drugs such as:

• Otinum - (RUB 150-190) - choline salicylate
• Otipax (220 rubles), Otirelax (140 rubles) - lidocaine and phenazone
• Otizol - phenazone, benzocaine, phenylephrine hydrochloride

There is no point in instilling antibiotic drops in this phase, since inflammation occurs behind the eardrum, which is impenetrable to them.

After the perforation appears, the pain goes away and you can no longer use anesthetic drops, as they can harm the sensitive cells of the cochlea. If perforation occurs, there is access for drops inside the middle ear, so drops containing an antibiotic can be instilled. However, ototoxic antibiotics (gentamicin, framycetin, neomycin, polymyxin B), drugs containing phenazone, alcohols or choline salicylate should not be used.

Antibiotic drops, the use of which is acceptable in the treatment of otitis in adults: “Tsipropharm”, “Normax”, “Otofa”, “Miramistin” and others.

Paracentesis or tympanotomy

In some situations, inflammation of the middle ear may require minor surgical intervention - paracentesis (or tympanotomy) of the eardrum. It is believed that the need for paracentesis arises if, against the background antibacterial therapy for three days the pain still continues to bother the person. Paracentesis is performed under local anesthesia: a small incision is made in the eardrum with a special needle, through which pus begins to emerge. This incision heals well after the suppuration stops.

Treatment of labyrinthitis is a complex medical problem and is carried out in a hospital under the supervision of an ENT doctor and a neurologist. In addition to antibacterial therapy, agents are needed that improve microcirculation inside the cochlea and neuroprotective drugs (protecting nervous tissue from damage).

Prevention of otitis

Preventive measures for otitis externa include thoroughly drying the ear canal after bathing. You should also avoid traumatizing the ear canal - do not use keys and pins as ear instruments.

For people who often suffer from inflammation of the outer ear, there are drops based on olive oil that provide skin protection when swimming in a pond, for example, Vaxol.

Prevention of otitis media consists of general strengthening measures - hardening, vitamin therapy, taking immunomodulators (drugs that improve immunity). It is also important to promptly treat nasal diseases, which are the main causative factor of middle ear inflammation.

What are the signs of otitis media in an adult?

Otitis media is a disease that affects hearing and other vital processes. Having discovered signs of otitis in an adult, treatment should be started immediately to avoid serious consequences (Fig. 1). Some types of otitis media have irreversible effects on hearing; the patient’s quality of life depends on its timely detection and effective treatment.

Figure 1. Diagnosis of otitis media in adults.

Classification of otitis media

Otitis is the name given to inflammatory processes that develop in the inner ear (labyrinth), middle ear or in the auricle and external auditory canals. Depending on the process of the disease, there are:

Figure 2. Diagram of otitis media.

• acute otitis media, which occurs suddenly with pronounced symptoms;
• chronic otitis, with prolonged inflammation and periodic exacerbations.
• For the reasons for the development of otitis media, the following forms are distinguished:
• allergic;
• bacterial;
• traumatic;
• viral.

During the course of the disease, according to the methods of its manifestation, they are distinguished:

• purulent otitis, in which pus accumulates behind the eardrum (Fig. 2);
• catarrhal otitis media with swelling and redness of the tissues, but without liquid or purulent discharge;
• exudative otitis media, which involves the accumulation of fluids (blood, lymph) in the middle ear, which create a favorable environment for the development of pathogenic microbes.

Otitis media manifests itself differently in everyone. Signs of the disease can vary significantly.

Causes of otitis media

For inflammation to appear in the external auditory canals, it is enough minor damage skin. From impact, scratches or careless cleaning auricle, the infection gets under the skin. Otitis media can be caused by an insect bite to the lobe or other area of ​​the ear.

During bathing or swimming, water that gets into the ear is a favorable environment for the development of microbes. Foreign objects (crumbs, soil, sawdust) provoke otitis media in adults.

Figure 3. Hydrogen peroxide for the treatment of otitis media.

In addition to the listed reasons, which cause the disease by accident or carelessness, there are otitis media caused by infection. They arise due to such factors:

1. Diseases of the nose and sinuses (sinusitis, sinusitis, sinusitis). With swelling of the respiratory tract, fluid stagnates in the middle ear, in which pathogenic microorganisms develop.
2. If you blow your nose incorrectly during a cold, the infection does not leave the body, but spreads to neighboring organs.
3. Against the background of diabetes, kidney disease, eczema, psoriasis and other diseases, the immune system is weakened, which is why any respiratory disease spreads to the middle ear.

Often the profession contributes to the development of the disease. Scuba divers or pilots constantly have to experience pressure changes, which negatively affect the health of their hearing organs.

Symptoms of otitis in an adult

Depending on the location of the source of inflammation, the sensations experienced by a patient with otitis differ. With external otitis, pain symptoms occur when pressure is applied to the skin. If a boil is present, the pain is localized near it, and as it matures, a purulent discharge forms. In the last phase, throbbing pain bothers the person constantly, without physical impact on the skin. If the source of inflammation is located in the ear canal, there is a feeling of pressure on the eardrum, a feeling of stuffiness in the ear.

As a result of the spread of infection, otitis media occurs. It affects the area between the external auditory canals and the inner ear. The patient complains of the following symptoms:

Figure 4. Ear drops for otitis media.

• temperature increase;
• severe headaches;
• shooting pain in the ear;
• noise, ringing in the ears;
• bloody or purulent discharge from the ear due to perforation of the eardrum;
• hearing impairment.

With inflammation in the labyrinth of the auditory canals (otitis interna), the most severe disturbances are observed. This form of the disease can appear some time after recovery from a cold. It is accompanied by the following symptoms:

• dizziness;
• lack of coordination;
• nausea; rapid motion sickness in transport;
• complete or partial hearing loss;
• frequent movements eyeballs.

Adhesive inflammation of the ear is characterized by thickening of the mucous membrane of the auditory tubes and eardrum. As a result, a gradual decrease in hearing occurs. Thickenings prevent the outflow of exudate, in which pathogenic bacteria develop. Ear inflammation is accompanied by fever, headaches and weakness.

With allergic otitis media, mucus is observed in the purulent discharge. The temperature does not increase, but hearing loss is present. The patient is bothered by severe itching in the ear and a feeling of iridescent fluid in the head.

Otitis media begins to manifest itself as symptoms of a general malaise, but gradually specific signs of the disease are revealed.

The sooner treatment is started, the less the body suffers. For example, with prolonged suppuration, there is a danger of infection of the blood and membranes of the brain, which provokes meningitis.

Therefore, even with slight ear congestion that does not go away for 2-3 days, you should consult an otolaryngologist.

Methods for treating otitis media

The most common treatment is pharmaceutical medications. They are aimed at relieving the main symptoms of the disease. After examination and diagnosis, the ENT prescribes drugs from the following groups to the patient:

1. Antihistamines. They will help alleviate the condition of allergic otitis media and reduce the manifestations of edema (Suprastin, Erius, Cetrin).
2. Analgesics. They will reduce attacks of pain and have an anti-inflammatory effect. For otitis media, they are prescribed in the form of ear drops. Adults should instill 5-8 drops into the ear 3-4 times a day. For prevention, they are instilled into both ears, even if the second one does not bother you (Otipax, Otix).
3. Vagotonics. These drugs relieve swelling and promote the outflow of pus and exudative without perforation of the eardrum (Nazivin, Naphthyzin).

Hydrogen peroxide and alcohol are used to clean the external auditory canal from pus (Fig. 3). Use a cotton swab to carefully remove all dirt, without plunging it deep into the ear, so as not to damage the eardrum.

If the cause of otitis is bacterial infection, the doctor will prescribe an antibiotic. The course of taking the drugs is 6-9 days. During this period, the doctor conducts visual observations and prescribes tests to determine the effectiveness of the prescribed drugs.

Physiotherapy (laser therapy, magnetic therapy, UHF, phototherapy, electrophoresis) helps speed up the healing process.

If drug treatment for several days does not bring significant relief, and the patient experiences severe pain due to pus accumulated behind the eardrum, surgical intervention is performed. Under local anesthesia, a puncture is made in the stretched tissues so that the pus can flow freely out. After the patient is cured, the puncture heals and hearing is restored.

Traditional methods of combating otitis media

Methods traditional medicine can be combined with home treatment. Here are some recipes for treating otitis media at home.

1. Add 3 tablespoons of olive oil to a tablespoon of pharmaceutical propolis tincture. Warm the mixture to body temperature. Soak a cotton swab in the mixture and place it in the ear, change it every 10-12 hours.
2. Crush the head of garlic and add 50 ml of purified sunflower oil to the pulp. Leave in the light for at least 4-5 days, then strain and store in the refrigerator. Place 2-3 drops in each ear several times a day (Fig. 4).
3. Peel a few aloe leaves and squeeze out the juice, which is instilled into the ear canal.

Prevention of ear diseases

• avoid contact with people suffering from colds, strengthen the immune system;
• prevent hypothermia of the head, wear a hat in the cold season;
• when swimming, swimming or diving, use special plugs that protect against water ingress;
• Avoid cleaning your ears too thoroughly to avoid damaging your skin and hearing.

Often otitis media becomes a complication of other diseases, so you shouldn’t test your body’s strength for a long time. The earlier treatment of diseases begins, the fewer additional ailments will have to be treated.

How to treat otitis in adults: main symptoms of the disease and diagnosis

Despite the fact that inflammation of the hearing organs in adults is much less common than in children, the question “how to treat otitis media in adults” remains quite relevant and in demand.

There are many prerequisites for the development of the disease in adults, as well as in the case of sinusitis.

Even a simple cold or hypothermia can turn into a serious form of otitis media.

In addition, the following factors can affect inflammation of the outer, middle or inner ear:

• viral diseases of the upper respiratory tract;
• viral diseases of the nasopharynx;
• advanced forms of runny nose;
• adenoids in the nasopharynx;
• violation of ear hygiene rules.

Depending on the infection of certain parts of the ear, otitis in adults and children is divided into three types:

• Otitis externa: Most often the cause of its occurrence is the accumulation of water in the ear canal, this form of the disease is often called “swimmer’s ear”.
• Otitis media: mainly develops as a complication of the upper respiratory tract; it is this form that is commonly referred to as “otitis”.
• Internal otitis: develops mainly against the background of advanced purulent inflammation, as well as infections.

In order to determine how to treat otitis in adults, it is necessary first of all to study the clinical picture and compare it with characteristic symptoms diseases, as well as diagnostics.

The main symptoms of otitis in an adult are considered to be:

• feeling of stuffiness and tinnitus;
• acute or It's a dull pain in the ears;
• a sharp increase in temperature;
• partial hearing loss;
• headache;
• general weakness and malaise;
• lack of appetite;
• sleep disturbance;
• purulent discharge, possibly mixed with blood from the ear canal.

It is important to know

Even the presence of the symptoms listed above does not give the right to self-medicate; in order to carry out a full diagnosis of the disease, it is necessary to urgently seek help from an otolaryngologist, who, using special ENT equipment, will install final diagnosis and prescribe a course of treatment.

To diagnose otitis, the doctor usually uses a supra-frontal reflector in tandem with an ear specula or a modern optical device called an otoscope. In most cases, examination of the ear does not cause any difficulties; first of all, the eardrum, ear canal and auricle are subject to examination.

So, when diagnosing otitis externa, redness of the skin in the ear, narrowing of the ear canal, and the possible presence of fluid in the lumen are observed. In this case, the ear canal can be so narrowed that it is simply impossible to see the eardrum through it.

On average, any inflammatory process in the ear (otitis media) lasts up to two weeks; during this entire period, the treatment process should in no case be stopped, even if significant improvement is observed. Otherwise, serious complications and the formation of chronic forms may occur.

How long is otitis in adults treated with basic medications?

Regardless of the nature of otitis media, viral or bacterial, it must be treated without fail. The disease itself may go away in rare cases, but it is quite likely that it will develop into chronic forms and complications with serious consequences. It is the course of prescribed therapy that determines how long it takes to treat otitis media in adults.

One of the main means for treating the disease is ear drops for otitis media.

They can be exclusively antibacterial or combined and consist of antibiotics and anti-inflammatory components. The course of treatment with such drops is 5-7 days, depending on the clinical picture of the disease.

Antibiotics are also often used in the treatment of otitis media in adults, especially acute and purulent forms. The course of their treatment is 7-10 days, depending on the drug and the degree of complexity of the disease. In this case, treatment of otitis in adults and children at home with folk remedies is undesirable.

It is important to know

Antibiotics should be taken only after a doctor’s prescription, strictly according to the regimen for the entire course. Even if after several days of taking the symptoms of the disease significantly decrease or some of them disappear altogether, stopping treatment of purulent otitis with antibiotics for adults and children is prohibited in order to avoid complications and re-exacerbation of the disease.

Analgesic for otitis media in adults is another type of drug used to alleviate the condition of particularly acute forms with severe pain.

Such treatment must be carried out under the supervision of the attending physician and must not cause allergic reactions or side effects.

Analgesic therapy for otitis symptoms does not have a specific course of action and is used if necessary in each specific case.

In some cases, otitis media of the middle ear requires little surgical intervention. This procedure is called paracentesis or tympanotomy of the eardrum. It is usually performed when there is no improvement after antibiotic therapy within the first three days. Its essence is to make, under the influence of local anesthesia, a small incision in the eardrum itself, through which the pus accumulated in the ear can flow freely. After the discharge stops, the incision heals successfully and closes without leaving a trace.

If there is no temperature with otitis and there is no purulent discharge, doctors often recommend using dry heat - this may be traditional methods warming up at home or physical therapy.

Based on the factors described above, it becomes quite obvious that it is impossible to give an unambiguous and accurate answer to the question of how long otitis media lasts in adults and how many days it needs to be treated.

The process of treatment and recovery depends on many factors, ranging from the form of the disease, its clinical picture, ending with correctly prescribed therapy, the conditions created for the patient, not to mention the individuality of each individual human body. One thing is obvious - the duration of the disease can be significantly reduced with timely access to an otolaryngologist and strict adherence to all his instructions.

Otitis media: treatment with drops and antibiotics. Otitis of the middle ear: chronic, catarrhal, acute, purulent

Ear is very important organ feelings, and if he gets sick, then the world becomes not nice to the person. Naturally, pathologies are different, but some are rare, others are not. Quite often people suffer from a disease such as otitis media. Treatment of this pathology must be comprehensive. That is, you must not only eliminate the symptoms, but also get rid of the root cause that caused the development of the problem.

How is the disease characterized?

So, otitis media of the middle ear, the treatment of which should be prescribed by a doctor, is an inflammation that is localized between the inner ear and a thin membrane (eardrum). This pathology most often affects children, as well as people with very weak immunity, diabetes and some other chronic problems.

It must also be said that an infection can develop due to the fact that a person does not fully treat otitis externa. In children, the disease appears due to structural imperfections hearing aid. Moreover, it can be caused by any reason, even the most “harmless” ones. Naturally, it is necessary to choose the right treatment methods, which the doctor will recommend. Otherwise, inflammation can lead to serious consequences (partial or complete loss of hearing, etc.).

Causes of pathology

Otitis media, which cannot be treated with antibiotics alone, occurs due to certain reasons. Among them are the following:

1. Respiratory viral pathologies (influenza, pharyngitis, laryngitis, sinusitis and others).

2. Infection due to any ear injury.

3. Hypothermia and sharp changes pressure.

4. Getting dirty water into the ear (during bathing or washing).

5. Other diseases that lead to decreased immunity.

Symptoms

Now let's look at what signs the disease has. If you have otitis media, treatment should begin only after a thorough examination by a doctor who will make an accurate diagnosis. You should not fight the disease on your own, as this can lead to undesirable consequences. As for the symptoms of pathology, they can be as follows:

Pain in the ear, which may be throbbing or aching.

Dullness of hearing, as well as a feeling of congestion.

Feeling of tinnitus.

An increase in temperature, and a significant one.

If the disease is advanced, then pus may leak from the hearing organ, and the eardrum ruptures. As for the pain, it can intensify at night, and it even radiates to the teeth and head. A person practically cannot sleep, his appetite disappears, and his performance is significantly reduced. A symptom of the pathology is also redness and swelling of the eardrum. However, you will not see this sign on your own; only a doctor can recognize it.

Types of pathology

Otitis media of the ear, the treatment of which is carried out under the supervision of a specialist, can be of different types:

1. Spicy. It develops after an infection enters the body. Most often, it is caused by acute respiratory diseases.

2. Purulent. It is accompanied by an unpleasant greenish or yellowish discharge from the ear.

3. Chronic purulent otitis media. It develops if the acute form has not been completely cured. This form of pathology can last several weeks or more. In this case, hearing can deteriorate significantly.

4. Serous otitis media. It is characterized by bloody discharge from the ear.

The symptoms are almost the same in all cases, so in any case you will have to consult a doctor.

How to correctly diagnose the disease?

If you think you have otitis media, you can begin treatment only after being examined by a doctor. For an accurate diagnosis, you will need not only your complaints and a list of symptoms. The fact is that these signs are not specific and may indicate another disease.

Next, the doctor palpates the ear and examines its inside using a special medical device (otoscope). Naturally, during the examination, he is obliged to take into account the patient’s age, note any structural features of the hearing aid, and record the condition of the lymph nodes.

The patient must undergo blood tests, in which some indicators will be overestimated if pathology is confirmed (ESR). Naturally, your doctor should check your hearing and the mobility of your eardrum. If a person is suspected of having any complications associated with otitis media, then he may be prescribed an X-ray examination. During the examination, not only mobility is taken into account, but also the position, as well as the color and condition of the eardrum.

Complications of pathology

If you have acute otitis media, treatment should begin immediately. The fact is that the disease is characterized by a high probability of complications. First of all, the acute form, with improper treatment, can quickly turn into purulent and chronic. In this case, you will constantly suffer from ear disease.

In addition, as the disease progresses, the mobility of the eardrum may deteriorate or it may rupture. This causes hearing loss or hearing loss. However, this function cannot always be restored. That is, the patient has a new problem: acquired deafness, which significantly worsens his quality of life.

The consequence of otitis media can be damage to the auditory nerve. It is also worth highlighting the following complications of the presented pathology:

1. Mastoiditis. In this case, the mastoid process is affected. This disease already requires surgery.

2. Purulent meningoencephalitis. It affects the brain.

3. Labyrinthitis.

4. Sepsis.

The latter complication can be fatal, so otitis media requires comprehensive and thorough treatment.

Features of treatment of different forms of otitis media

Now let's consider main question: “How to get rid of this pathology quickly and effectively?” It all depends on the type of disease, as well as the degree of its development. If you have acute suppurative otitis media, treatment involves the use of antibiotics. You will have to take the medications for about 7 days. Naturally, the patient will also have to clean the ear of pus using cotton wool moistened with hydrogen peroxide. However, this procedure should be carried out very carefully so as not to push unpleasant discharge deeper. As for heat treatment, it cannot always be used for purulent forms of pathology. That is, do not apply a heating pad to your ear. Perhaps the doctor will prescribe other physiotherapeutic procedures. If you have viral otitis media, antibiotic treatment will not help. Here it is already necessary to eliminate the root cause of the disease.

In case of severe pain, a person may be prescribed special drops that not only relieve the symptom, but also fight the infection. Sometimes the doctor prescribes tablets or suspensions. If you have otitis media, treatment (drops in this case are advisable) must be comprehensive. That is, you first need to find out the cause of the development of the pathology. Concerning medications, then the most effective today are Sofradex, Dexamethasone, Otipax, Otizol. Please note that before use, ear drops must be warmed to room temperature. In addition, these drugs cannot be used if the eardrum is damaged.

If a person has catarrhal otitis media, treatment involves the use of antipyretics and watchful waiting. If after a few days the pathology begins to develop further, then the patient is prescribed vasoconstrictor drops in the nose, dry thermal procedures.

For purulent otitis, the doctor can independently pierce the eardrum so that the contents can come out. Sometimes, to minimize discomfort during surgery, the patient may be given local anesthesia. Physiotherapeutic methods help very well: heating with ultraviolet rays, UHF and laser procedures.

Features of surgical and traditional treatment

If a patient is diagnosed with otitis media, the symptoms (treatment is not based solely on them) are a very important signal to go to the doctor. Sometimes, if conservative therapy is ineffective, the ENT is forced to resort to surgery. This procedure is especially important when there is a threat of pus entering the brain.

The most important action performed by the surgeon is the removal of discharge from the ear cavity. The operation is performed in two ways:

1. Opening the eardrum and removing pus using a special syringe or catheter.

2. Carrying out an antrotomy. It can only be done for urgent reasons. Its peculiarity is that even children can undergo this procedure.

Naturally, before carrying out the intervention it is necessary to assess the general condition of the patient and the risk of complications.

If you are diagnosed with purulent otitis media, treatment may involve the use of folk remedies. However, be sure to consult a doctor before using them. You can use home recipes for other forms of the disease. The most effective of them are considered to be:

1. Compress made from vodka (or alcohol). Its preparation is not difficult. All you have to do is take a gauze napkin and moisten it with vodka. Next, the compress is applied to the ear, and then covered with wax paper and cotton wool. For a good effect, you should leave the napkin on for several hours.

2. If the patient has chronic otitis media, treatment involves the use of juniper tincture, which not only helps eliminate pain, but also has an anti-inflammatory effect. You can buy it at the pharmacy.

3. Onion juice helps to cope with the disease. All you have to do is soak a cotton swab in it and put it in your ear. After a few hours, the turunda is changed.

4. Aloe juice has anti-inflammatory properties. Moreover, you can dilute it with warm boiled water in a 1:1 ratio. You can instill this homemade “medicine” using a pipette several times a day.

How to properly treat otitis media in children?

Not only adults can suffer from this disease. Children can very often catch this infection. In addition, otitis media is considered the most common disease of early childhood. Treatment for this pathology in children varies. It all depends on the degree of development of the disease, as well as the baby’s reaction to it.

Try to always keep your child's ears warm, even if it is not cold outside. Only in this case will you be able to cure the pathology quickly. If the cause of otitis media is an acute respiratory disease, you will have to treat it first. Often the baby is prescribed antibiotics (in the form of syrups, for example, the drug Ospamox, or tablets). Naturally, if the doctor allows it, you will need to use ear or nasal drops, which constrict blood vessels and make breathing easier, and also have an anti-inflammatory effect.

If the temperature rises to a very high level, the child should be given an antipyretic drug. One of the most best medicines Today, Nurofen has such an effect.

During treatment, the baby should not visit educational institution. It is best to provide him with bed rest with constant monitoring of body temperature. Be sure to give warm drinks. A cotton swab soaked in boric alcohol helps a lot. Please note that if the baby has a fever, compresses cannot be applied to the ear. Sometimes the doctor has to perform a minor operation on the child (if the pus does not come out on its own). Naturally, for this the baby is given anesthesia.

The most correct decision for parents in case of illness in their children is to contact a specialist - an ENT specialist. You should not self-medicate under any circumstances, as this pathology is fraught with serious complications that develop faster in a child than in an adult.

Disease Prevention

If you have chronic otitis media, home treatment can only be done after consulting a doctor. However, in order to significantly reduce the number of relapses of the disease, it is necessary to carry out certain preventive measures, which you will now learn about.

First of all, you need to try to promptly treat any colds that can provoke otitis media: ARVI, sore throat, laryngitis. Also learn how to blow your nose correctly (close your nostrils one at a time).

Naturally, you need to take care of your immunity. That is, use fresh vegetables and fruits, harden yourself, and if necessary, take multivitamin complexes (especially at the end of summer and winter). Temper yourself, give up bad habits. Be careful when cleaning your ears with cotton swabs (if you do this). Avoid any ear injuries, as well as hypothermia. Don't give up on a hat in winter.

A very important part of preventing otitis media is proper oral hygiene. That is, ordinary dental caries can be a good stimulus for the development of infection in your hearing organ.

As for infants, try to bathe them very carefully so that water does not get into the ear. If you can’t do this, then use special antibacterial drops after each bath.

If it has already happened that you are sick, then immediately go to the doctor. He will help you establish an accurate diagnosis and prescribe adequate therapy. The longer you delay visiting an ENT specialist, the more difficult the treatment will be, and the greater the likelihood of complications. Therefore, take care of your health on time.

Acute purulent otitis media

Acute purulent otitis media (otitis media purulenta acuta) is an acute purulent inflammation of the mucous membrane of the tympanic cavity, in which all parts of the middle ear are involved to one degree or another in catarrhal inflammation.

This disease has some symptoms similar to common cold. So, otitis media is also characterized by fever and headache.

In addition, otitis often occurs simultaneously with colds. But there are other symptoms characteristic of otitis media that indicate the development of an inflammatory process in the ear.

You can “survive a cold” without resorting to the help of doctors, but if signs of otitis media appear, you should seek help from an otolaryngologist. Because if you do not start timely treatment of purulent otitis media in adults, this disease can lead to a noticeable decrease in hearing and even cause the development of meningitis.

The cause of the disease is a combination of factors such as a decrease in local and general resistance and infection in the tympanic cavity. Purulent otitis media occurs as a result of inflammation of the auricle, affecting the middle ear cavity, mucous membrane and eardrum.

Causes of purulent otitis media:

• entry of bacteria, viruses, fungi into the auricle;
• complications of diseases of the nose, sinuses, nasopharynx;
• severe ear bruise;
• sepsis;
• consequences of meningitis, measles, tuberculosis;
• hypothermia.

The most common route of infection is tubogenic - through the auditory tube. Less commonly, the infection enters the middle ear through a damaged eardrum due to injury or through a wound to the mastoid process. In this case, they talk about traumatic otitis media.

Symptoms of purulent otitis media

There are several signs that help determine that you have acute purulent otitis media and not another ear disease. But the main symptoms of various diseases in the field of otolaryngology usually coincide.

Traditional symptoms of otitis media:

• throbbing pain in the ear area;
• pain behind the ear;
• heat;
• chills;
• extraneous noise in the ear;
• decreased audibility.

These signs are characteristic of initial stage diseases when inflammation causes extensive suppuration. Typically this process lasts 2-3 days. Next, acute purulent otitis of the middle ear passes into the phase of perforated damage to the eardrum, as a result of which pus flows out of the ear cavity through the formed hole in the eardrum, and the patient experiences significant relief and pain is reduced.

The third stage is the final stage, the body fights the infection, inflammation gradually decreases, pus ceases to be released, and the eardrum restores its integrity.

Signs of otitis media in a child

Each stage of the disease is characterized by certain symptoms.

Symptoms of purulent otitis in a child of the 1st stage:

Stage 2 symptoms:

• the temperature drops;
• the pain subsides;
• hearing loss continues;
• Purulent discharge begins to come out of the ear.

Stage 3 symptoms:

• the temperature drops;
• the pain disappears;
• hearing is restored;
• the discharge stops;
• the perforation of the eardrum heals.

This disease requires early diagnosis and prescription of antibacterial therapy.

Chronic purulent otitis media

This is an inflammation of the middle ear, which is characterized by recurrent flow of pus from the ear cavity, persistent perforation of the eardrum and progressive hearing loss (hearing loss can reach 10-50%).

This otitis is manifested by the following clinical picture:

1. Constant purulent discharge from the ear with a putrid odor;
2. Noise in the affected ear;
3. Hearing impairment.

It develops when acute otitis is treated untimely or inadequately. It can be a complication of chronic rhinitis, sinusitis, etc., or a consequence of a traumatic rupture of the eardrum. Chronic otitis affects 0.8-1% of the population. In more than 50% of cases, the disease begins to develop in childhood.

Chronic purulent otitis media without bone destruction and complications can be treated with medications under the outpatient supervision of an otolaryngologist.

Complications

Lack of suitable treatment leads to irreparable damage to health. The consequences of otitis media in adults are the result of a structural transition of further inflammation into the temporal bone or inside the skull.

Complications may include:

• violation of the integrity of the eardrum;
• mastoiditis – inflammation of cells in the bone;
• paralysis facial nerve.
• meningitis - inflammation of the lining of the brain;
• encephalitis - inflammation of the brain;
• hydrocephalus - accumulation of fluid in the cerebral cortex.

To avoid these unpleasant diseases, you need to know how to treat purulent otitis media in adults.

Treatment regimen for acute purulent otitis media

In adults, treatment of purulent otitis media includes the following procedures and medications:

• antibiotics;
• painkillers, antipyretics;
• vasoconstrictor ear drops;
• heat compresses (until pus appears);
• physiotherapy (UHF, electrophoresis);
• antihistamines;
• surgical cleaning of the ear canal from pus.

It should be noted that after the appearance of purulent discharge, warming procedures should under no circumstances be performed. If the disease is chronic, puncture or dissection of the eardrum may be required.

How to treat purulent otitis media in adults

Diagnosis is usually not difficult. The diagnosis is made based on complaints and the results of otoscopy (visual examination of the ear cavity using a special instrument). If a destructive process in bone tissue is suspected, an x-ray of the temporal bone is performed.

Purulent otitis in adults requires outpatient treatment; at high temperatures in combination with fever, it is recommended to remain in bed. Hospitalization is required if a mastoid lesion is suspected.

To reduce pain in the initial stages of the disease, use:

• paracetamol (one tablet 4 times a day);
• Otipax ear drops (twice a day, 4 drops);
• tampon according to Tsitovich (a gauze swab soaked in a solution of boric acid and glycerin is inserted into the ear canal for three hours).

To relieve swelling in the tissues of the auditory tube, the following is prescribed:

Antibiotics used for purulent otitis media:

If after several days of treatment there is no improvement or the symptoms increase, perform surgery, it is urgently indicated when signs of irritation of the inner ear or meninges appear. After paracentesis or self-perforation, it is necessary to ensure the outflow of pus from the middle ear: drain the ear canal with sterile gauze swabs 2-3 times a day or wash the ear with a warm solution of boric acid.

Symptoms, complications and treatment of acute and chronic purulent otitis

What is purulent otitis media

Purulent otitis is an inflammatory process of an infectious nature, covering all anatomical parts of the middle ear: the tympanic cavity, the auditory tube and the mastoid process.

Depending on the location, there are three types of otitis media:

External, occurring primarily due to the entry and accumulation of water in the ear canal;

Moderate, which is a complication of upper respiratory tract diseases;

Internal, developing against the background of advanced chronic purulent otitis media.

Otitis externa most often affects people who swim. Inflammation of the external auditory canal is limited, as a rule, mainly to skin manifestations: pustules, various rashes. Severe ear pain is usually accompanied by otitis media, so the term “otitis media” in most cases refers to otitis media of the middle ear.

This is a fairly common disease that can occur with varying degrees of severity. However, the lack of treatment may lead to the transition of the process to chronic stage and the development of various complications, including the formation of adhesions, hearing loss and complete hearing loss.

According to statistics, otitis media accounts for 25-30% of ear diseases. Most often it affects children under 5 years of age, in second place are the elderly, and in third place are adolescents aged 12-14 years. There is no specific pathogen for acute otitis media. In 80% of cases, the main causative agents of the disease are pneumococci (a type of streptococcus), Haemophilus influenzae (influenza), and more rarely - Staphylococcus aureus or associations of pathogenic microorganisms.

The main factors provoking the development of otitis media are respiratory viral infections (ARVI, influenza), inflammatory diseases nasopharynx and upper respiratory tract (sinusitis, rhinitis), the presence of adenoids. This also includes insufficient ear hygiene. The disease occurs against the background of a decrease in general and local immunity, when the infection penetrates through the auditory tube into the tympanic cavity.

The mucous membrane of the auditory tube produces mucus, which has an antimicrobial effect and performs a protective function. With the help of epithelial villi, the secreted secretion moves into the nasopharynx. During various infectious and inflammatory diseases, the barrier function of the epithelium of the auditory tube weakens, which leads to the development of otitis media.

Less commonly, infection of the middle ear occurs through an injured eardrum or mastoid process. This is the so-called traumatic otitis media. With diseases such as influenza, measles, scarlet fever, tuberculosis, typhus, a third, rarest variant of infection is possible - hematogenous, when pathogenic bacteria enter the middle ear through the blood.

Symptoms of purulent otitis media

The main symptoms of purulent otitis in adults:

Severe ear pain, which may be aching, throbbing or shooting;

Feeling of fullness and noise in the ear;

Purulent discharge from the ears;

Partial hearing loss;

As a result of inflammation of the mucous membrane of the auditory tube, it thickens, the tympanic cavity fills with exudate and bulges. During the pressure of the purulent fluid, the eardrum is perforated and pus flows out.

Mucopurulent discharge after a rupture of the eardrum is initially abundant, then becomes thicker and scarcer. As the inflammatory process subsides, the flow of pus gradually stops. The perforation of the eardrum undergoes scarring, but the feeling of stuffiness remains for some time.

During purulent otitis it is customary to distinguish three stages:

Pre-perforation stage. At this stage, the symptoms are clearly expressed: sharp, increasing pain in the ear, which can radiate to the temple or crown of the head; soreness of the mastoid process upon palpation; hearing impairment; temperature rise to 38-39 °C.

Perforated stage. After the eardrum ruptures, pus begins to flow (possibly with an admixture of ichor), pain in the ear gradually subsides, and body temperature drops.

Reparative stage. The flow of pus stops, and with scarring of the perforation of the eardrum, hearing is gradually restored.

This course of the disease is not necessarily typical. At any stage of the process, acute otitis media can become chronic, with mild symptoms. If this is observed at the first stage, then perforation of the eardrum does not occur; viscous, thick mucus accumulates in the tympanic cavity, which is difficult to evacuate.

If perforation does not occur for a long time when acute course illness, then due to the increasing volume of exudate in the middle ear, severe headaches, dizziness, high fever, vomiting and severe general condition are possible. In this case, the infection from the middle ear can spread deeper into the cranial cavity and lead to serious, life-threatening consequences.

If, after a perforation of the eardrum, outflow of pus and positive dynamics in general, the temperature rises again and pain in the ear resumes, this may indicate stagnation of purulent fluid in the tympanic cavity or the development of mastoiditis (inflammation of the mastoid process of the temporal bone). In this case, suppuration continues for 3-4 weeks. Massive pulsating discharge of pus may indicate an extradural abscess (accumulation of exudate between the inner surface of the temporal bone and the meninges).

For general clinical signs The disease is characterized by moderate or severe leukocytosis (depending on the severity of its course), a shift leukocyte formula, increased ESR. Severe leukocytosis in combination with eosinopenia may be a sign of mastoiditis or infection in the cranial cavity.

The acute stage of otitis lasts an average of 2-3 weeks. The reasons for an unfavorable outcome or the development of complications may be a significant weakening of the immune system or inadequate antibacterial therapy.

Acute and chronic purulent otitis media

Acute purulent otitis media

The acute form of the disease occurs as a result of the entry of a pathogenic environment into the middle ear through the auditory tube during acute diseases of the nasopharynx and upper respiratory tract, or during exacerbation of similar chronic diseases.

As mentioned above, acute otitis media goes through three stages in its development:

Stage I (catarrhal form of otitis). The beginning of the inflammatory process, accompanied by the formation of exudate. Catarrhal otitis is characterized by severe pain in the ear, which radiates to the corresponding half of the head (temple, teeth, back of the head), as well as significant hearing loss. On examination, dilated blood vessels, hyperemia of the eardrum and its protrusion are observed. This stage can last from 2-3 days to 1-2 weeks.

Stage II (purulent form of otitis). At this stage, the eardrum is perforated and pus begins to leak, and the bulging of the eardrum decreases. The pain gradually subsides, but may recur if the outflow of pus is delayed.

Stage III is characterized by attenuation of the inflammatory process, reduction and cessation of suppuration. The main complaint at this stage is hearing loss.

Inflammation of the mucous membranes of the tympanic cavity and auditory tube leads to their swelling. The mucous membrane of these sections is quite thin, and its lowest layer serves as the periosteum. As the pathological process develops, the mucous membrane thickens noticeably, and erosions appear on its surface. The middle ear is filled with exudate, which is initially serous and later becomes purulent. At the peak of the process, the tympanic cavity becomes filled with purulent fluid and enlarged mucous membrane, which leads to its bulging. The eardrum may be covered with a whitish coating. Pain occurs due to irritation of glossopharyngeal and trigeminal nerves, noise and congestion in the ear - due to limited lability of the eardrum and auditory ossicles. Under pressure from the exudate, the eardrum bursts and pus begins to leak out, which lasts approximately 6-7 days.

Over time, the amount of discharge decreases and its consistency becomes thicker. The resulting perforation is usually small, round in shape and accompanied by tissue defects. Perforations in the form of slits without membrane defects are observed less frequently. If the root cause of the disease is measles, scarlet fever, tuberculosis, then the perforations are larger.

In parallel with the completion of suppuration, hyperemia of the eardrum occurs. As the perforation heals, hearing is gradually restored. Small perforations, up to 1 mm in size, heal quite quickly and without a trace. With large perforations, the fibrous layer is usually not restored, and the hole in the membrane is closed with a mucous layer from the inside and an epidermal layer from the outside. This area of ​​the membrane looks atrophic; there are deposits of lime salts in the form of white spots. With pronounced tissue defects, the perforations often do not heal; in this case, along the edge of the round hole in the membrane, its mucous membrane fuses with the epidermis. Often, adhesions remain in the tympanic cavity, which limits the mobility of the auditory ossicles.

Chronic purulent otitis media

Chronic otitis media is an inflammation of the middle ear, which is characterized by recurrent flow of pus from the ear cavity, persistent perforation of the eardrum and progressive hearing loss (hearing loss can reach 10-50%).

Chronic otitis develops when acute otitis is treated untimely or inadequately. It can be a complication of chronic rhinitis, sinusitis, etc., or a consequence of a traumatic rupture of the eardrum. Chronic otitis affects 0.8-1% of the population. In more than 50% of cases, the disease begins to develop in childhood. Intracranial complications of otitis media pose a serious threat to health and even life.

As a result of bacteriological culture in chronic purulent otitis, aerobic microorganisms such as pseudomonas, staphylococci, and pneumococci are detected. Anaerobic bacteria, which are detected in 70-90% of patients, are represented by fusobacteria, peptococci, and lactobacilli. With long-term use of antibiotics and hormonal drugs, fungal microorganisms are encountered: fungi of the genus Candida, Aspergillus, and mold.

The transition from acute to chronic otitis is usually caused by the following unfavorable factors:

Low body resistance to infections and weakened immunity;

Incorrect selection of antibacterial drugs, to the effects of which associations of pathogens show resistance;

Pathologies of the upper respiratory tract (deviated nasal septum, adenoids, chronic rhinitis and sinusitis);

The presence of concomitant diseases, especially such as blood diseases and diabetes.

Concomitant ENT diseases contribute to the disorder drainage function auditory tube, which complicates the outflow of pus from the tympanic cavity, and this, in turn, prevents the timely healing of the perforation that appears in the eardrum. In some cases, the inflammatory process in the middle ear becomes chronic from the very beginning. This is most often observed with perforations that form on a loose part of the eardrum, as well as in people with tuberculosis, diabetes and the elderly.

Chronic otitis media is divided into two forms, depending on the severity of the disease and the location of the perforation of the eardrum:

Mesotympanitis. It's more light form a disease that primarily affects the mucous membrane of the auditory tube and tympanic cavity. The perforation is located in the central, stretched area of ​​the eardrum. Complications in this case are much less common.

Epitympanitis. In this form of the disease, in addition to the mucous membranes, the inflammatory process involves bone attic-antral region and mastoid process, which may be accompanied by its necrosis. The perforation is located in the upper, loose part of the eardrum, or covers both parts of it. With epitympanitis, such severe complications as sepsis, meningitis, osteitis, brain abscess are possible if purulent exudate enters the blood or meninges.

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Complications and consequences of purulent otitis media

Lack of treatment for purulent otitis is fraught with irreparable consequences when the purulent-inflammatory process begins to spread to the bone tissue.

In this case, the following complications may occur:

Violation of the integrity of the eardrum, leading to progressive hearing loss up to complete hearing loss;

Mastoiditis is an inflammation of the mastoid process of the temporal bone, accompanied by the accumulation of pus in its cells and subsequent destruction of the bone itself;

Osteitis (bone caries), with the formation of granulations or cholesteatoma, which develops as a tumor and leads to bone destruction.

Chronic inflammation of the middle ear can lead to libirintitis - inflammation of the inner ear and, subsequently, to intracranial complications, which include:

Meningitis is an inflammation of the membranes of the brain;

Hydrocephalus is an excessive accumulation of cerebrospinal fluid in parts of the brain.

Labyrinthitis and intracranial complications are quite rare, but you need to know that such a risk exists. Therefore, if symptoms of otitis media appear, you should contact an otolaryngologist at a medical facility to prescribe appropriate treatment. Treatment of otitis lasts an average of two weeks, and in order to avoid complications, it is impossible to stop the treatment process without permission, even if there are significant improvements.

Treatment of purulent otitis media

Diagnosis of otitis media is usually not difficult. The diagnosis is made based on complaints and the results of otoscopy (visual examination of the ear cavity using a special instrument). If a destructive process in bone tissue is suspected, an x-ray of the temporal bone is performed.

Purulent otitis is treated on an outpatient basis; at high temperatures in combination with fever, it is recommended to remain in bed. Hospitalization required if there is a suspicion of damage to the mastoid process.

Treatment for otitis media includes:

Vasoconstrictor or astringent drops;

Treatment tactics are determined depending on the stage of the disease and the severity of symptoms:

The pre-perforation stage is characterized by severe pain, for the relief of which osmotic drugs are used: a 3% alcohol solution of boric acid or chloramphenicol in a 1:1 ratio with glycerin. Ear drops Otipax (with phenazone and lidocaine), Anauran (with lidocaine, polymyxin and neomycin) have an analgesic effect. Due to the presence of antibiotics in Anauran, it is prohibited to use it at the perforative stage. These drops are buried in sore ear heated to a temperature of 38-40 ° C two to three times a day, after instillation, the ear canal is closed with cotton wool and Vaseline.

To stimulate the drainage function, vasoconstrictor drops (Otrivin, Sanorin, Naphthyzin, Galazolin, etc.) are used, which are instilled into the nose three times a day in a supine position, with the head tilted towards the sore ear. You should not blow your nose intensively, or suck the contents of your nose into the nasopharynx, as this leads to additional infection of the auditory tube.

Paracetamol or Diclofenac can be taken orally as painkillers.

Maybe local application warming alcohol compress to speed up the resolution of the inflammatory process. But if the ear pain intensifies, the compress should be removed immediately.

If necessary, paracentesis is performed (an artificial puncture of the eardrum to allow drainage of pus).

At the perforated stage, the use of vasoconstrictor nasal drops, antibacterial and antihistamines continues. In case of excessive discharge of pus, mucolytics (ACC, Fluimucil) are prescribed, as well as Erespal, which reduces swelling of the mucous membranes and reduces the secretion of secretions.

Physiotherapy (UVR, UHF, microwave) or hot compresses on the ear area at home has a positive effect. The patient must independently remove purulent discharge from the ear canal at least twice a day. This can be done using a cotton swab. The procedure should be carried out until the cotton wool remains dry. If the discharge is too thick and viscous, you can first drip a warm 3% solution of hydrogen peroxide into the ear, and then dry the ear canal well.

After cleansing the ear, ear drops prescribed by a doctor are instilled in a heated form (up to 37 ° C): Otofa, 0.5-1% solution of dioxidine, 20% solution of sodium sulfacyl, etc. Drops containing alcohol at the perforative stage are not used as it causes severe pain.

At the reparative stage, the use of antibiotics, thermal physiotherapy, and mechanical cleaning of the ear canal are stopped. In most cases, a small scar forms at the site of perforation. If fibrous adhesions form in the tympanic cavity, they usually do not limit the lability of the eardrum and auditory ossicles. However, to prevent adhesive process Enzyme preparations, pneumomassage of the eardrum, endaural iontophoresis with lidase may be prescribed.

The main goal at this stage is to restore hearing, strengthen the immune system and increase the body's resistance.

Antibiotics for purulent otitis media

Amoxicillin. This antibiotic is the main one in the treatment of purulent otitis media, as it is active against wide range infectious pathogens (staphylococci, E. coli, etc.), has an antiseptic and antimycotic effect. It can be used at any stage of the disease. Amoxicillin is taken orally at a dosage of 0.5 g 3 times a day for 8-10 days. Contraindications for taking Amoxicillin: liver dysfunction, pregnancy, lactation, mononucleosis. Side effects: allergic reactions, dyspeptic symptoms. If it is impossible to use Amoxicillin or if there is no effect within three days of taking it, any of the following drugs are prescribed.

Augmentin. This drug is a combination of amoxicillin and clavulanic acid. Usually used for severe symptoms of the disease. The dosage is determined by the attending physician. Contraindications: impaired liver and kidney function, phenylketonuria, pregnancy. Side effects: skin candidiasis, urticaria, itching; temporary leukopenia and thrombocytopenia; headache, dizziness.

Cefuroxime. It is used intramuscularly as an injection (cefuroxime sodium salt) if Amoxicillin and Augmentin are ineffective. For oral administration, cefuroximaaxetil is prescribed at a dosage of 0.25-0.5 g twice a day. Contraindications: high sensitivity to cephalosporins, early pregnancy, lactation. Side effects: drowsiness, headache, hearing loss; eosinophilia, neutropenia; nausea, constipation; renal dysfunction.

Ampicillin. Used in the form intramuscular injections. Contraindications: increased sensitivity to the drug, liver dysfunction, pregnancy. Side effects: dysbacteriosis, candidiasis, dyspeptic symptoms, allergic reactions, central nervous system disorders.

Phenoxymethylpenicillin. Taken 3 times a day, 250 mg. Contraindications: high sensitivity to penicillin. Side effects: dyspeptic and allergic reactions; severe acute hypersensitivity reaction that develops within 1–30 minutes after taking the drug.

Spiramycin. Macrolides are prescribed for allergic reactions to lactam antibiotics. Spiramycin is taken 1.5 million IU orally twice a day. Contraindications: hypersensitivity, lactation period, obstruction bile ducts. Side effects: nausea, diarrhea, esophagitis, colitis, skin rash.

Azithromycin. Take 250 mg once a day. Contraindications for Azithromycin: hypersensitivity to macrolides, severe functional disorders liver and kidneys, arrhythmia. Side effects: headache, dizziness, nausea, increased fatigue and nervousness, tinnitus, conjunctivitis.

Cefazolin. A semisynthetic antibiotic belonging to the group of first generation cephalosporins. It is used in the form of intramuscular injections. Contraindications: hypersensitivity to cephalosporins, intestinal diseases, renal failure, pregnancy, lactation. Side effects: dyspeptic symptoms, allergic reactions; convulsions; dysbacteriosis, stomatitis (with long-term use).

Ciprofloxacin. Take 2 times a day, 250 mg. Contraindications for Ciprofloxacin: pregnancy, lactation, epilepsy. Side effects: mild skin allergies, nausea, sleep disturbances.

Ceftriaxone. This is a drug for intramuscular injection, which is an antibiotic of last resort due to large quantity side effects. Ceftriaxone injections are given once a day. Contraindications for the use of the drug: hypersensitivity to cephalosporins, severe gastrointestinal diseases. Side effects: headache, dizziness, convulsions; thrombocytosis, nosebleeds; jaundice, colitis, flatulence, pain in the epigastric region; skin itching, fever, candidiasis, increased sweating.

Also, for purulent otitis, antibiotics are used in the form of ear drops:

Norfloxacin Normax ear drops have a broad antibacterial effect. Side effects: minor skin rash, burning and itching at the site of application. Use according to instructions.

Candibiotic. These drops contain several antibiotics: beclomethasone dipropionate, chloramphenicol, as well as the antifungal agent clotrimazole and lidocaine hydrochloride. Contraindications: pregnancy, lactation. TO side effects include allergic reactions.

Netilmicin. This is a semi-synthetic antibiotic made from third generation aminoglycosides. Netilmicin ear drops are most often prescribed for chronic otitis media.

Levomycetin. These drops are used primarily in ophthalmology, but can also be prescribed for mild forms of otitis media, since they do not penetrate deep into the ear canal.

Even with significant improvement during treatment and the weakening or disappearance of local symptoms, the course of taking antibacterial drugs should not be stopped prematurely. The duration of the course should be at least 7-10 days. Premature withdrawal of antibiotics can provoke a relapse, the transition of the disease to a chronic form, the formation of adhesive formations in the tympanic cavity and the development of complications.

Purulent otitis media

Purulent otitis is a common otorhinolaryngological disease, purulent inflammation of the middle ear involving pathological process all its anatomical sections.

Purulent otitis media most often affects children; in more than half of the cases, the pathological process occurs in persons under the age of 18 years. According to World Organization healthcare, the chronic form of purulent otitis is diagnosed in 1-2% of the population. In 10–60% of cases, chronic purulent otitis media leads to permanent decrease or loss of hearing.

Causes and risk factors

The main reasons that lead to the occurrence of purulent otitis include inflammatory processes in the upper respiratory tract of bacterial and viral etiology, infectious diseases(measles, scarlet fever, typhus, tuberculosis, etc.). The infectious agent is able to enter the ear through the Eustachian tube, damaged eardrum, hematogenously, retrogradely from the cranial cavity, labyrinth. The causative agents of purulent otitis are bacteria, viruses, and microscopic fungi.

Treatment of purulent otitis media, both acute and chronic, is usually carried out on an outpatient basis.

Most often, purulent otitis in adult patients is caused by S. pneumoniae, S. pyogenes, S. aureus, H. influenzae, M. catarrhalis.

Risk factors include:

• immunodeficiency states;
• anatomical features of the structure of the middle ear in children;
• injury to the eardrum and/or mastoid process;
• allergic diseases;
• swimming (water getting into the ear);
• severe vitamin deficiencies;
• advanced age;
• failure to comply with ear hygiene rules;
• Not balanced diet.

Chronic otitis usually develops in the absence of treatment or with inadequate treatment of the acute form of the disease, traumatic rupture of the eardrum, deviated nasal septum, or a history of diabetes mellitus.

Forms of the disease

Depending on the location of the pathological process, otitis media can be external (inflammatory process in the external auditory canal), middle (pathological process in the middle ear) or internal (inflammatory process in the inner ear). As a rule, otitis media refers to inflammation of the middle ear.

Purulent otitis media is divided into acute and chronic.

Stages of the disease

In the clinical picture of acute purulent otitis, three stages are distinguished.

1. Preperforative.
2. Perforated.
3. Reparative, or, in an unfavorable version, the stage of chronicity.

Chronic purulent otitis occurs with alternating stages of remission and exacerbation.

Symptoms of purulent otitis media

The main symptoms of purulent otitis are pain in the ear of an aching, shooting or pulsating nature, radiating to the temple, crown and teeth, congestion and noise in the ear, purulent discharge from the ear, hearing loss, headaches, increased body temperature to feverish values, weakness and rapid fatigue. Upon examination, the eardrum is covered with a white coating.

Purulent otitis media most often affects children; in more than half of the cases, the pathological process occurs in persons under the age of 18 years.

With the development of acute purulent otitis, the inflammatory process in the auditory tube leads to its thickening, the tympanic cavity is filled with exudate and bulges. Due to the pressure of the pathological contents, the eardrum is perforated and mucopurulent discharge flows out; subsequently, the exudate becomes thicker and scarcer. The attenuation of the inflammatory process leads to the cessation of the outflow of purulent contents, but the feeling of congestion in the ear remains for some time. The discharge of pus usually lasts 6-7 days. Gradual scarring of the perforation leads to hearing restoration. With severe tissue defects, hearing in the affected ear is not restored. Stagnation of purulent contents in the tympanic cavity may be indicated by an increase in body temperature and the occurrence of pain in the ear after the perforation of the eardrum and the outflow of purulent exudate. The acute stage of the disease usually lasts 2-3 weeks.

If perforation of the eardrum does not occur for a long time, headaches in patients with purulent otitis media intensify, accompanied by attacks of dizziness and vomiting; general condition worsens. There is a risk of further spread of the infectious process with the development of life-threatening conditions.

Acute purulent otitis media can become chronic at any stage of the pathological process; in this case, the severity of the inflammatory process subsides, the symptoms become less pronounced, and sometimes completely disappear, resuming sporadically. The discharge of pus in the chronic form of purulent otitis may be periodic or permanent. The discharge is often scanty; during the period of exacerbation, the amount of purulent exudate increases. If there are polyps in the tympanic cavity or the growth of granulation tissue, an admixture of blood is often found in the purulent discharge. Also, against the background of chronic purulent otitis, patients often develop disorders of the vestibular apparatus.

Diagnosis of purulent otitis media

Diagnosis of purulent otitis is usually not difficult; it is based on data obtained during the collection of complaints and anamnesis, an objective examination of the patient, and, if necessary, confirmed by instrumental and laboratory tests.

The main reasons that lead to the occurrence of purulent otitis include inflammatory processes in the upper respiratory tract of bacterial and viral etiology.

To clarify the diagnosis, an otoscopy is performed (after a thorough toilet of the external ear), and the patency of the Eustachian tube is assessed. For the purpose of clarification, computer or magnetic resonance imaging may be prescribed. If it is necessary to study the vestibular apparatus (in particular, in the presence of vestibular disorders in the chronic form of the disease), stabilography, indirect otolitometry, electronystagmography, etc. are performed. If bone tissue is suspected of being involved in the pathological process, radiography of the temporal bone is used.

In order to identify the pathogen and determine its sensitivity to antibiotics, a bacteriological examination of purulent discharge from the ear is carried out.

IN general analysis In the blood of patients with purulent otitis, a moderate or marked increase in the number of leukocytes and an increase in ESR are usually detected. The spread of the infectious process into the cranial cavity is indicated by pronounced leukocytosis and a decrease in the number of eosinophils.

In some cases, it is necessary to differentiate purulent otitis media from neoplasms and histiocytosis.

Treatment of purulent otitis media

Treatment of purulent otitis media, both acute and chronic, is usually carried out on an outpatient basis. In the presence of high temperature and fever, bed rest is recommended. Hospitalization is required if there is suspicion of involvement of the mastoid process in the pathological process and the development of other complications.

Early treatment increases the chances of recovery and preservation of hearing in patients.

Drug therapy for purulent otitis includes anti-infective medicines. As a rule, broad-spectrum antibiotics are used to treat acute purulent otitis; treatment of chronic otitis requires the prescription of the antibacterial agent to which the pathogen is most sensitive. Astringents or vasoconstrictors (to stimulate drainage function), analgesics and antihistamines are also prescribed. If necessary, the doctor punctures the eardrum to drain purulent exudate (paracentesis).

When treating purulent otitis at home, purulent discharge from the ear canal should be removed twice a day, and sometimes more often, using cotton swabs. If the discharge is too thick in consistency to prevent its evacuation, first instill a warm solution of 3% hydrogen peroxide into the ear, after which the ear canal is thoroughly dried.

To speed up the resolution of the inflammatory process, in some cases it is recommended to use warm alcohol compresses, however, if during the procedure the pain in the ear intensifies, the compress is immediately removed.

After the acute inflammation subsides, the main treatment can be supplemented with physiotherapy (ultrahigh-frequency therapy, ultra-high-frequency therapy, ultraviolet irradiation).

At the recovery stage, medications, physiotherapeutic thermal procedures and mechanical cleaning of the ear canal are stopped. To prevent the formation of fibrous adhesions in the tympanic cavity, endaural iontophoresis and pneumomassage of the tympanic membrane are prescribed. Patients with chronic purulent otitis are advised to take vitamin complexes, biostimulants.

Indications for surgical treatment of purulent otitis are: paresis of the facial nerve, neurological and/or vestibular disorders, severe headaches, high risk of complications. Depending on the prevalence of the pathological process, a sanitizing operation can be performed with tympanoplasty, mastoidoplasty, mastoidotomy, atticoanthrotomy, labyrinthotomy, and removal of cholesteatoma. If there is a threat of complications developing against the background of a diffuse inflammatory process, a radical general ear surgery is required, during which all pathological contents (polyps, granulations, cholesteatoma, etc.) are removed.

In 10–60% of cases, chronic purulent otitis media leads to permanent decrease or loss of hearing.

The postoperative period for purulent otitis in a child is usually more severe than in adult patients, which is due to frequent reinfection of the tympanic cavity through the auditory tube, difficulties in dressings, and a tendency to excessive growth of granulations.

In order to monitor the restoration of hearing function after completion of treatment, control audiometry is performed.

Possible complications and consequences

Purulent otitis may be complicated by hearing loss, further spread of the infectious-inflammatory process to bone structures, paralysis of the facial nerve, meningitis, encephalitis, hydrocephalus, and death is possible.

With timely and correctly selected treatment, the prognosis is favorable. Early treatment increases the chances of recovery and preservation of hearing in patients. The prognosis worsens if complications develop with a pronounced decrease in immunity and inadequate antibacterial therapy for the disease.

Prevention

In order to prevent the development of purulent otitis media, it is recommended:

• timely treatment of diseases that may be complicated by purulent otitis media;
• avoidance of unnecessary use of antibiotics, refusal of self-medication;
• increasing immunity, including a balanced diet and sufficient physical activity.

Acute purulent otitis: stages, symptoms and treatment of the disease

Otitis is one of the most common diseases, which can manifest itself independently, or may arise as a complication after an infection. The treatment of otitis media requires special attention. Because there are a number of serious complications.

Acute purulent otitis: description

Causes of the disease

Acute purulent otitis is an inflammation of the mucous membrane of the tympanic cavity, in which in most cases other parts of the middle ear are also involved.

There are many reasons for the appearance of otitis media. The main ones include:

1. Low immunity. As a rule, due to weak immunity, many diseases begin to develop, and otitis media is no exception.
2. Anomalies in the development of the craniofacial bone, which lead to the abnormal structure of certain organs.
3. Viral diseases. Very often, otitis media is a complication after undergoing viral disease. This happens due to improper treatment or neglect of doctors' recommendations. Typically, otitis media develops after influenza or ARVI.
4. Bacterial diseases caused by the penetration of harmful bacteria into the body. A weakened immune system is not able to resist them, and if the disease begins, it must be treated with antibiotics. But many patients hope either for treatment with folk remedies or simple medications. And in the end everything develops into acute purulent otitis media.
5. Allergy. Often, allergies cause inflammation of the mucous membranes not only in the nose and throat, but also in the ears. This happens due to the penetration of particles that irritate it. During an exacerbation (for example, in people suffering from an allergy to ragweed, this is the end of August), otitis media can develop, because the body thus reacts to the inflammatory process.
6. Inflammatory processes in the nasopharynx. It is generally accepted that if a runny nose is not properly treated, then everything can spread to the ears. This is actually true. All ENT organs are interconnected, and if not treated correctly, the infection and inflammatory process easily spread further.
7. Infection through the blood. This happens very rarely.
8. Hypothermia. Surprisingly, most cases of purulent otitis occur in the summer, when parents allow their children to swim in ponds, and the water there is not very warm and is not sterile.
9. An injury during which either the eardrum or the mucous membrane may be damaged. As a result of severe damage, infection can occur and inflammation may occur.
10. Diseases nervous system, which can provoke illness due to improper conduction of nerve impulses.

These are the main reasons why a person may develop acute purulent otitis media. The main thing is to recognize the disease in time and consult a specialist to avoid the development of even greater complications. People who suffer from otitis periodically are advised to avoid cold rooms, wear a hat, and immediately treat any viral or bacterial diseases, since their ears are a weak spot where the second and subsequent times the infection will penetrate much faster than the first time.

Disease frequency

Scientists have conducted many studies to find out who is most susceptible to developing acute suppurative otitis media. And, to our great regret, they came to the conclusion that these were children. After the child went to kindergarten, his body is attacked by many bacteria and viruses. And it will depend on what kind of immunity he has (and most often it is weak), whether they penetrate inside the body or not.

Some parents do not attach importance to a runny nose and take their children to kindergarten, even knowing that the snot has not been treated. This is a big mistake, since at the age of three to five years the risk of developing a complication (that is, the transition from a simple runny nose to acute purulent otitis media) increases.

Statistics show that about 70% of children have had otitis media at least once in their lives, and, as a rule, this happened either after the flu or after a simple runny nose.

Boys are considered more susceptible to the disease. Very rarely, otitis media can be found in adults, because most of them, during illness (with a runny nose, cough), immediately begin to be treated with broad-spectrum antibiotics that kill all harmful bacteria.

Symptoms of acute purulent otitis media

It is very difficult to confuse acute purulent otitis media with some other disease, because its symptoms are so obvious that they force a person to consult a specialist.

The main symptoms of the disease include:

• Painful sensations in the ear area. First of all, the patient begins to feel severe pain, and sometimes it becomes unbearable. It worsens at the moment when a person tries to touch the ear. At the same time, some patients note that the pain is sometimes sharp and appears at the moment when you need to turn your head, bend over, or any other sudden movement.
• Hearing loss, which occurs against the background of severe inflammation. The mucous membrane is very thin, and therefore any penetration of infection is accompanied by hearing loss. In some cases, patients say that they hear practically nothing, all sounds are muffled. And you have to watch TV at almost the highest volume.
• Increased body temperature. The inflammatory process in the ear is accompanied by an increase in body temperature, and most often it rises to 39 degrees. It is problematic to knock it down in the first two days, since suppuration continues. And only on the third day, if treatment has been started, the temperature will gradually decrease. Patients note that in the first two days the temperature seems to “jump”, then it is at 39 degrees, then drops to 37.5. Because of this, the person is in a feverish state, when he is either hot or cold.
• Discharge of pus. Discharge from the ear does not appear immediately, since in the first days the focus of inflammation, one might say, matures, and pus accumulates in it. After the mucous membrane is no longer able to withstand it, it breaks through and the pus flows out. The discharge can be either purulent or mixed with blood due to the formation of a wound. In the first few hours after the breakthrough, the discharge will be very strong, but gradually, its amount decreases, but does not end.

The main thing is not to think that the disease will pass by her own. Such thoughts creep into people’s minds after their health improves. And it improves due to the breakthrough of suppuration. At the moment when pus flows out of the wound, the body temperature drops and the person feels comfortable. But the infection remains in place and at any moment can get even worse.

Stages of the disease

Doctors distinguish three stages of the disease, each of which is characterized by its own symptoms:

The pre-perforation stage is considered the most initial stage of the development of the disease. It is characterized by the onset of symptoms, the main one of which will be pain in the ear area. Moreover, the pain can radiate to the temple, forehead, which causes even greater discomfort. Over time, the pain intensifies as the source of inflammation grows and can become unbearable. Even painkillers may not have the desired effect. Along with the pain, tinnitus and congestion also appear, which further aggravate the person’s general condition. The patient begins to hear much worse, this is especially evident if otitis media develops during the flu. Then the inner ear is also involved, which is why general process perception of sounds.

In addition to the above symptoms, a person’s condition may deteriorate sharply, the body aches, the temperature rises to 39 degrees, and sometimes higher (it all depends on the immune strength). All signs of intoxication appear, which must be dealt with immediately. Otherwise, the condition will only get worse.

The pre-perforation stage can last from several hours to several days.

The next stage of the disease is perforative. It begins when the eardrum ruptures and pus leaks out. At this stage, the pain subsides sharply. The person begins to feel much better, the body temperature drops to acceptable values ​​or disappears altogether. At this moment, pus begins to flow out of the ear. On the first day after the rupture, the discharge will be quite strong and you can even notice the admixture of blood that appears there due to the wound formed. Patients note that it is as if their ear begins to pulsate. After a few days, the amount of discharge decreases, it becomes thicker and more like pus. This phenomenon lasts about 7 days.

More information about otitis media can be found in the video.

The reparative stage is characterized by the cessation of the flow of pus, as well as a sharp healing of the wound. When this happens, the patient begins to hear normally (hearing is gradually restored), body temperature remains at a normal level, and health improves even more. But the disease does not always proceed as described above. At any moment and at any stage the process can be disrupted. In most cases, the disease is sluggish and there is no rupture or leakage of pus. Because of this, a person’s body temperature is constantly elevated (but no longer to 39 degrees, but remains at 38), hearing is not restored, and the pain does not subside.

Also, there are cases when, during the first stage, ear pain is also accompanied by headache, vomiting, and dizziness.

This happens when pus matures for a long time and perforation forms. If this happens, and the period drags on for more than three days, then this can lead to the spread of inflammation deep into the skull, which will lead to irreparable consequences. Typically, the illness lasts from two to three weeks. It all depends on what medications the patient is treated with and whether he follows all the recommendations of the attending physician.

Diagnosis of the disease

Diagnosis of acute purulent otitis

Diagnosing acute purulent otitis media is not difficult. First of all, when a patient turns to a specialist, he will listen to all his complaints. Already at this stage, a specialist can make a preliminary diagnosis, since, as mentioned above, the symptoms of the disease are so obvious that it is quite difficult to miss it.

But in some cases the following procedures may be required:

• Examination of the ear, during which the doctor will see how inflamed the mucous membrane is.
• A computed tomography scan will show whether the infection has spread further and whether there are other lesions.
• A blood test to determine the degree of the inflammatory process.
• Analysis of ear contents. It is taken to determine which bacterium is causing the inflammation in order to choose the right antibiotics for treatment.

Sometimes a doctor can refer you for an examination to a dentist, because there have been cases when the cause of otitis was caries, or rather an infection that penetrated through the tooth. And if caries is not cured, then it will constantly affect the body. After receiving all the results, the doctor will be able to make a diagnosis and determine the stage of the disease.

Treatment of acute purulent otitis

During treatment, special attention is paid to the stage of the disease, since the use of a particular drug will depend on this. In the very first days, when the patient’s well-being deteriorates sharply, it is necessary to improve it a little. Antipyretic drugs are prescribed to reduce body temperature. As a rule, adults are recommended to drink Paracetamol three times a day, and children to give Nurofen, as it not only reduces fever, but also reduces pain.

In the first three days, it is recommended to adhere to bed rest, since a large load is placed on the body, and the general condition does not allow one to lead a normal lifestyle. If signs of mastoiditis (spread of infection inside the skull) appear, the patient should be hospitalized immediately.

To improve ear ventilation, the patient is prescribed vasoconstrictor drops, such as Otrivin, Nazivin. Moreover, they need to be instilled a little differently than for a runny nose. It is best to lie on your back and turn your head to the side. Place 5 drops into each nostril. After some time, you need to blow your nose, but under no circumstances should you do it forcefully. And besides, with otitis media, you should not draw mucus from your nose into your mouth (as many people like to do). This can worsen the condition and spread the infection. In the pre-perforation stage, the patient suffers from severe pain in the ear. To reduce them a little, it is better to instill special drops. So, doctors advise resorting to a solution of boric acid. And also Otipax drops, which have an analgesic effect.

It should be noted that cold drops should not be used. They must first be warmed in the palms to room temperature so that they do not irritate the mucous membranes.

Also, during acute purulent otitis, doctors prescribe antibiotics for oral administration, especially when the body temperature does not decrease for three days and remains at 39 degrees. This is very dangerous, especially if a small child is sick. Amoxicillin is most often prescribed, since it contains substances that can affect the suspected pathogens of the disease. They can also prescribe Augmentin, Spiramycin.

Typically, antibiotic therapy lasts from 7 to 10 days. You cannot suddenly stop taking antibiotics after taking a few days of the course. Although many people do this after they notice an improvement in their condition. This cannot be done because the bacteria become resistant to the drug, and next time you will have to take a stronger and more harmful drug.

During the removal of pus, the doctor may prescribe drinking antihistamines, microlytic agents to improve the process of pus secretion.

If otitis media is not treated correctly, serious complications may develop, which include:

• Transition of the disease to the chronic stage
• Development of facial nerve paresis
• Development of mastoiditis (infection entering the skull)
• Meningitis
• Brain abscess
• Adhesions and fusion of the eardrum

Acute purulent otitis is a very dangerous disease that requires timely treatment and a serious approach. You cannot be skeptical and think that the disease will go away on its own. If you ignore the symptoms, you can wait for a brain abscess or meningitis.

Purulent otitis media: causes, symptoms, treatment

Inflammation of the middle ear is accompanied by the development of acute otitis, and under unfavorable conditions the process becomes chronic. Acute suppurative otitis media is often observed in children. Necessary correct treatment this disease, so that signs of chronic inflammation do not appear. Purulent otitis is accompanied by the discharge of pus, increasing deafness and the formation of a hole (perforation) in the eardrum.

Causes of the disease

In childhood, almost every second person suffered from otitis media. Today, its prevalence among schoolchildren is 1%, and among young conscripts it increases to 4%. In 6 out of 10 children with persistent deafness, the cause of this condition was complications from ear inflammation.

Bilateral purulent otitis usually occurs after a respiratory illness or some kind of childhood infection. The disease can also be one-sided. The disease appears when, against the background of weakened local immunity of the mucous membrane, bacterial microorganisms enter through the opening connecting the nasopharynx and middle ear. There they multiply and cause symptoms of purulent otitis media.

Bacteria that cause purulent otitis media:

• hemolytic streptococcus;
• Proteus;
• staphylococcus;
• Pseudomonas aeruginosa;
• mycoplasma;
• chlamydia;
• anaerobic infection.

Acute purulent otitis media transforms into chronic under the influence of general and local unfavorable factors.

Common reasons for the process to become chronic:

• entry of highly active microbes into the middle ear cavity;
• starvation, exhaustion, vitamin deficiency;
• hereditary predisposition to pathology of the ENT organs;
• chronic allergic diseases (hay fever, asthma);
• diseases of the respiratory and digestive organs (bronchitis, peptic ulcer and others), which serve as a source of constant infection;
• improper treatment of purulent otitis media in adults and children;
• frequent acute inflammation in the middle ear.

Local factors favorable for the transition of acute to chronic form include:

• violation of the structure and patency of the auditory tube;
• adenoids;
• chronic rhinitis and sinusitis;
• nasal polyps;
• enlargement of the inferior turbinate, disrupting the function of the auditory tube;
• anatomical features in children that cause rapid swelling and stagnation of contents in the middle ear when it is inflamed;
• little airiness of the mastoid process.

Clinical signs

Acute inflammation of the middle ear is accompanied by the following signs of purulent otitis media:

• fever;
• sharp pain in the ear;
• weakness, headache, nausea;
• purulent ear discharge;
• on examination - redness of the eardrum.

If purulent otitis in adults or children becomes chronic, it can occur in two main forms:

• mesotympanitis (only the mucous membrane becomes inflamed);
• epitympanitis (bone tissue is involved).

There are two variants of the course of the disease. In the first case, there is a hole in the eardrum without discharge, which is accompanied by hearing loss. An exacerbation is provoked by water getting into the ear and is accompanied by the signs of acute otitis media listed above. Neurological complications of otitis may occur. They may be accompanied by unsteadiness when walking and dizziness.

The second option is accompanied by constant discharge of pus or light fluid from the ear. During exacerbations, the temperature rises and discharge increases. The constant release of purulent contents irritates the skin and causes external (that is, inflammation of the auricle) purulent otitis media. It manifests itself as itching and soreness of the skin.

With epitympanitis, a complication often occurs - cholesteatoma.

What is cholesteatoma

With purulent epitympanitis in children, more often in boys, a peculiar formation appears in the form of a tumor - cholesteatoma. It is not clear as a result of what processes it arises. Some scientists believe that cholesteatoma occurs when the epithelial cells of the middle ear change under the influence of hereditary disorders. Others believe that this formation appears as a result of penetration of the epithelial layer of the external auditory canal into the tympanic cavity due to defects in the eardrum.

Cholesteatoma is saturated with dead epithelial cells, microbial decay products, fatty substances and cholesterol. Its shell grows and destroys the temporal bone (previously this disease was called caries). With mesotympanitis, such formation is observed in only 3% of patients.

The destruction of the temporal bone is diagnosed by the clearing visible on the x-ray. Features of cholesteatoma in children:

• virtual absence of symptoms;
• short formation time;
• growth in the first 5 years of life;
• tendency to relapsing course.

Diagnostics

The patient is asked about the course of the disease, the frequency of exacerbations, symptoms and previous treatment. Are used additional methods diagnostics

The consequences of purulent otitis media are the formation of a hole in the eardrum and permanent hearing loss. When viewed, the hole may have different shapes and edges. If the edge is smooth, such perforation is called central and accompanies a milder form - mesotympanitis. If there is no edge, and the membrane is completely absent, this picture is characteristic of epitympanitis.

With mesotympanitis, profuse, odorless mucous discharge is visible. If the osteomyelitic process begins with bone decay, the contents of the middle ear become thicker and become putrefactive (ichorous).

If, with mesotympanitis affecting the mouth of the auditory tube, the hole in the membrane is located low, this causes very profuse mucous discharge from the ear.

With epitympanitis, bone tissue is destroyed, and granulations (growths) form in its place. Often during otoscopy they are visible through the hole in the eardrum. In this case, blood appears in the discharge. Growing granulations penetrate through the membrane defect into the outer ear in the form of a polyp. With mesotympanitis, an ear polyp is formed in rare cases.

Hearing test

The cause of hearing loss with epi- and mesotympanitis can be various pathological processes. They are usually associated with a defect in the eardrum and fusion of the middle ear bones. With epitympanitis, the inner ear often becomes inflamed, which also leads to deafness.

Proliferation of polyps or cholesteatoma tissue during epitympanitis, on the contrary, can improve hearing, since a dense environment conducts sound waves better.

Radiography

X-ray images in different projections can in some cases reveal cholesteatoma. However, this method is not decisive in the diagnosis of otitis media.

Differential diagnosis

To properly treat the disease, it is necessary to distinguish it from similar processes:

With histiocytosis, in addition to symptoms from the ENT organs, there is an enlargement of the liver and spleen, damage to the bones, skin and lymph nodes, proliferation of granulomas, and “protrusion” of the eyeballs (exophthalmos).

Middle ear sarcoma is a rare tumor that develops in children and quickly metastasizes. It is diagnosed using a biopsy of malignant tissue.

The duration of treatment for otitis depends on the stage of the disease, the state of hearing, the eardrum and other characteristics. An individual treatment plan is drawn up for each patient. Therapy for most forms of otitis is medicinal, and only in case of chronic epitympanitis with bone destruction is surgery prescribed.

Acute purulent otitis media

Bed rest and rest are indicated. Antibiotics and antipyretic drugs are prescribed. Treatment with a Sollux lamp (“blue lamp”) or UHF, as well as a helium-neon laser, is indicated. Vasoconstrictor nasal drops are prescribed to facilitate the outflow of contents through the auditory tube into the nasopharynx.

Warm anesthetic drops are used for otitis media:

• 96% medical alcohol;
• 5% solution of phenol in glycerin (if pus appears, they are canceled);
• Otipax (with an intact eardrum);
• Otofa (drops with antibiotic) and others.

Any treatment for otitis should only be prescribed by an ENT doctor! Many medications are contraindicated for perforated eardrums and can lead to complications and deafness.

If, despite treatment, pus remains in the middle ear, the membrane is punctured and this content is removed. Then the hole gradually heals.

Exacerbation of chronic otitis

Any treatment will be effective only after the pus is removed. To do this, thoroughly clean the ear canal with cotton wool wrapped around a thin probe. Solutions of boric acid, albucid, furatsilin, dioxidine and other antiseptics are instilled into the ear. Systemic antibiotic therapy is prescribed.

With persistent treatment, it is possible to stop the flow of pus from the ear, even with a chronic course of the disease, in 85% of patients.

Chronic otitis media in remission

If the patient comes without an exacerbation and does not have suppuration from the ear, the following are used:

• removal of adenoids, treatment of tonsillitis, caries, sinusitis;
• hardening;
• When bathing, you should cover your ears with cotton wool soaked in Vaseline.

To close the perforation of the membrane, its edges are cauterized, treated with a laser, or undergo plastic surgery (restoration).

With epitympanitis, when the bone is affected by a purulent process, treatment is much more difficult. If hearing has not yet been lost, very complex microsurgical interventions are used to remove purulent focus and preserving auditory function.

In case of complete hearing loss as a result chronic otitis All affected tissues are removed and the hearing aid is restored using tympanoplasty. If such an operation is not performed, in the future the patient is offered to use an auditory prosthesis.

Treatment and symptoms of purulent otitis in adults

Purulent Otitis is a serious inflammation of the ear, of a bacterial nature. Due to its high prevalence among ENT pathologies and the considerable risk of developing life-threatening complications, the problem of treating this disease remains very relevant today.

Otitis– a chronic or acute inflammatory process in the mucous membrane of certain parts of the ear, which is based on various infectious agents. Depending on the level of damage, it is divided into the following types: external, middle and internal. At the same time, otitis media accounts for the vast majority of calls to a specialist - an otolaryngologist.

Spreading

According to statistics, otitis occurs in 2.5% of the population. Among diseases of the ENT organs, they account for 50%, while in children - up to 70%. At the same time, acute or chronic otitis media is one of the main causes of the development of sensorineural hearing loss in adults – in 25% of cases.

Origin

There are several versions of the pathogenesis of the disease. The most significant is tubular dysfunction. The reasons for its development lie either in mechanical obstruction of the auditory tube (tumors of the nasopharynx, adenoid growths) or a functional failure that disrupts the normal process of its active opening. As a result, a reduced pressure is created in the tympanic cavity, facilitating the diffusion of fluid into the structures of the middle ear. If infectious pathogens are attached to it, an acute inflammatory process may develop.

Moreover, the leading position is given to pathogenic bacterial flora. Thus, in acute purulent otitis, the main pathogens are pneumococci and Haemophilus influenzae, and somewhat less commonly, Staphylococcus aureus. In the chronic form of the disease, Klebsiella and Pseudomonas are also found.

Some predisposing factors also play a certain role in the development of otitis media.:

• Immunodeficiency conditions: congenital or acquired (AIDS, chemotherapy);
• endocrinological pathologies (diabetes mellitus, hypothyroidism);
• systemic blood diseases (leukemia);
• dysfunction and narrowness of the eustachian tube;
• diseases of the upper respiratory tract (polyps, adenoids, sinusitis, deviated nasal septum, tonsillitis);
• abnormalities in the structure of the skull bones;
• iatrogenic factors;
• frequent acute respiratory viral infections and colds accompanied by acute runny nose;
• sensitization of the body (allergy, asthma, vasomotor rhinitis).

Symptoms of purulent otitis media

Acute course

Acute purulent otitis is characterized by a violent inflammatory reaction, manifested by one or more clinical symptoms:

• Pain: is aching, stabbing, shooting in nature with irradiation to the temporal region;
• temperature: at first subfebrile, and then reaches febrile levels;
• hearing: decreased hearing acuity;
• discharge: purulent, with an unpleasant odor;
• symptoms of intoxication: headache, weakness, nausea.

Chronic

Typically, chronic otitis media results from an acute episode, especially in the first five years of life.

• Discharge: during an exacerbation, purulent discharge appears; perhaps over many months and even years;
• pain: feeling of fullness, pressure and congestion in the ear;
• hearing: increasing sensorineural hearing loss.

Diagnostics

• Physical examination: collecting anamnesis (complaints, identifying episodes of ARVI, influenza, rhinitis preceding the disease);
• otoscopy: pathological changes in the eardrum (swelling, redness); using optical instruments you can detect the presence of perforation;
• otomicroscopy: the use of special surgical optics for a more detailed examination;
• audiometry: determination of hearing acuity.
• tympanometry: assessment of the functioning of the Eustachian tube, determination of membrane mobility;
• CT scan of the temporal bones: especially if the diagnosis is difficult;
• laboratory test: blood test shows an increase in leukocytes, in particular neutrophils, lymphocytes.

Purulent otitis: symptoms and treatment

Purulent otitis - main symptoms:

• Noise in ears
• Fever
• Ear congestion
• Intoxication
• Earache
• Hearing loss
• Purulent discharge from the ear
• Redness of the ear

Purulent otitis is a common otorhinolaryngological pathology, which is characterized by inflammation of the epithelium lining the surface of the inner and middle ear. As a result, purulent exudate appears in the ear cavity.

If purulent otitis media is not treated in time, dangerous complications will begin to develop:

• membrane rupture;
• chronic hearing loss;
• decreased hearing function;
• cholesteatoma;
• facial nerve paresis;
• brain abscess;
• intracranial pathologies.

It is important that when the first symptoms appear that indicate the progression of the disease, immediately consult a doctor for diagnosis and treatment. It is worth noting that purulent otitis media affects both adults and children equally. There are also no restrictions regarding gender.

Reasons for the progression of purulent otitis media:

• penetration of infectious agents into the middle and inner ear;
• decreased body reactivity.

An infection can enter the ear in several ways:

• through the auditory tube. This route of penetration is called tubogenic;
• traumatic. Infectious agents enter the ear through a damaged eardrum;
• retrograde. The infection spreads from the cranial cavity;
• hematogenous. In this case, infectious agents enter the ear through the bloodstream. This is often observed against the background of influenza, typhus, scarlet fever, and tuberculosis.

The main reason for the progression of chronic suppurative otitis media is inadequate treatment of acute purulent inflammation ear.

• acute purulent otitis media;
• chronic purulent otitis media.

Acute form

Acute purulent otitis media begins to progress after pathogenic microorganisms penetrate the middle ear (through the auditory tube). It is observed in pathologies of the upper respiratory tract, nasopharynx, etc.

1. catarrhal The beginning of the progression of the inflammatory process. At this stage, exudate begins to accumulate in the ear. The first symptoms of the disease appear - pain in the ear, decreased hearing function. It is important to immediately contact a specialist and begin treating the disease with antibiotics and physiotherapeutic procedures;
2. purulent form. If treatment with antibiotics and other medications has not been previously carried out, the eardrum is perforated and purulent exudate begins to leak from the cavity. Symptoms subside;
3. the inflammatory process gradually subsides. The suppuration stops. The main symptom is decreased hearing function.

Chronic form

Chronic purulent otitis media is a disease characterized by inflammation of the middle ear. Characteristic pathology - recurrent flow of purulent exudate from the ear cavity. Other signs include persistent perforation of the eardrum, as well as a progressive decrease in hearing function. Chronic purulent otitis media progresses due to inadequate treatment of the acute form of the disease. But it is also worth noting that the disease can manifest itself as a complication of chronic rhinitis, sinusitis or rupture of the eardrum.

Chronic suppurative otitis media usually begins to progress in childhood. It is provoked by pneumococci, pseudomonas and staphylococci. Chronic suppurative otitis media has two subforms:

• mesotympanitis. The inflammatory process affects the mucous membrane of the eardrum and auditory tube. The perforation is located in the central part of the membrane;
• epitympanitis. In addition to the mucous membrane, the pathological process involves the bone structures of the mastoid process and the attic-antral region. The perforation is localized in the upper part of the membrane. This form is dangerous because dangerous complications often progress against its background - osteitis, sepsis, meningitis, brain abscess.

Symptoms

Symptoms of the initial stage of acute purulent otitis media:

• hearing loss;
• increasing pain in the ear, which can radiate to the temple, crown and dentition;
• intoxication syndrome;
• the patient notes the appearance of noise and congestion in the affected ear;
• hyperthermia;
• hyperemia.

The duration of the initial stage of purulent otitis ranges from several hours to 3 days. After this, the transition to the perforative stage occurs. The patient exhibits the following symptoms:

• membrane rupture. As a result, active release of purulent exudate occurs. This process can last one week;
• pain in the ear subsides;
• stabilization of the patient's condition;
• body temperature returns to normal levels.

Symptoms of the reparative stage of purulent otitis in children and adults:

• restoration of auditory function;
• purulent exudate stops separating;
• hyperemia of the membrane disappears;
• scarring of the formed perforation is observed.

The disease must be treated in a hospital setting. And especially if there is purulent otitis media in a child. The treatment plan is drawn up by the attending physician, taking into account the stage of the disease, the severity of the clinical picture, as well as the patient’s condition.

Treatment of the pre-perforation stage:

• cupping pain syndrome. Both systemic and local medications are used;
• antihistamines;
• It is recommended to apply semi-alcohol compresses to the ear;
• antibiotics. Necessary for the destruction of infectious agents. Doctors usually prescribe the following antibiotics: cefuroxime, amoxicillin, augmentin, etc.;
• paracentesis.

As the perforated stage progresses, it is necessary to continue taking antibiotics and antihistamines. The course of treatment is also supplemented with the following drugs:

• mucolytics;
• anti-inflammatory drugs;
• physiotherapeutic treatment: UHF, laser therapy, UV;
• removal of purulent exudate from the ear canal.

The treatment regimen at the reparative stage is supplemented by:

• vitamin therapy;
• blowing the auditory tube;
• taking biostimulants;
• by introducing drugs into the tympanic cavity that prevent adhesions from forming.

It is simply necessary to treat the disease with antibiotics, since these drugs help eliminate the cause of its progression - infectious agents. It is worth noting that this group of drugs should only be prescribed by the attending physician. It is unacceptable to take antibiotics without permission, as you can only make the situation worse. Antibiotics are prescribed to be taken according to a specific regimen. During treatment of a pathology, the doctor may change the drug if the chosen remedy does not have the desired effect. Also, the doctor can change the antibiotic after receiving the results of bacterial culture of the purulent exudate.

If you think that you have Purulent otitis media and symptoms characteristic of this disease, then doctors can help you: otolaryngologist, pediatrician.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Purulent otitis media

Modern drug therapy using medications such as antibiotics, painkillers and anti-inflammatory ear drops, as well as various folk remedies used at home, can relieve inflammation, restore hearing and avoid the development of serious complications.

Types of otitis

Otitis media is usually classified depending on location into:

• interior, the development of which is provoked by chronic purulent otitis media (if left untreated);
• average, which acts as a complication of ENT diseases;

Causes of purulent otitis media

The main factors that can trigger the occurrence and development of the disease in adults include:

• presence of adenoids;
• inflammation of the nasopharynx (rhinitis, sinusitis);
• viral infections (parainfluenza, ARVI, influenza);
• decreased immunity;
• improper ear hygiene.

There are several ways for infection to enter the eardrum cavity. Most often, it penetrates there through the auditory tube in the presence of various inflammatory diseases. The development of traumatic otitis occurs due to infection of the cavity of the tympanic membrane of the middle ear through the mastoid process or an injured tympanic membrane. Another, most rare, variant of infection is hematogenous: during diseases such as typhoid, tuberculosis, scarlet fever, measles, influenza, pathogenic bacteria enter the middle section organ of hearing through the blood.

Very often from various forms Otitis affects infants, which is explained by the peculiarities of the anatomy of the child’s ear. In an infant, the auditory tube is much wider and shorter than in an adult, and is located almost horizontally. In this regard, nasopharyngeal secretions can easily pass through the open auditory tube, delivering pathogenic microorganisms to the middle ear. A slight inflammation can close the already small lumen of the auditory tube in an infant, reducing hearing and complicating the course of the disease. The result is this anatomical feature often there are bilateral purulent otitises. As the baby grows, their number decreases due to the development of the hearing aid.

Signs of the disease

Purulent otitis in adults has the following main symptoms:

• shooting or aching ear pain and headache;
• purulent discharge from the ears;
• congestion and noise in the ear;
• heat;
• decreased hearing.

Course of the disease

The course of purulent otitis usually occurs in several stages:

Pre-perforation stage. The symptoms that appear at this stage are pronounced:

• sharp increasing pain;
• decreased hearing;
• painful palpation of the mastoid process;
• temperature increase.

Perforated stage during which, after a rupture of the eardrum, pus begins to be released, sometimes mixed with ichor. The temperature gradually drops, the ear pain subsides.

Reparative stage. After the cessation of the flow of pus and the gradual scarring of the openings of the eardrum, the patient’s hearing is restored.

Acute purulent otitis in adults lasts on average no more than 20 days. A weakened immune system or inadequate treatment may cause the development of any complication. At any stage, acute otitis media can transform into chronic purulent otitis media, which is characterized by mild symptoms.

Acute form of the disease

Acute purulent otitis in adults develops after a pathogenic medium enters the middle part of the ear through the auditory tube, which occurs during acute or exacerbation of chronic diseases of the ENT organs or upper respiratory tract.

The first, or catarrhal, form of otitis, which lasts from several days to 2 weeks, is characterized by the onset of an inflammatory process with the formation of exudate.

The next stage - purulent otitis - begins with a perforation of the eardrum, after which pus flows out, lasting about 6-7 days, and the subsequent subsidence of pain.

The third stage is characterized by attenuation of inflammation, reduction and cessation of suppuration, during which hearing may decrease. It can be restored gradually as the perforation of the eardrum becomes scarred.

Chronic form of the disease

Chronic purulent otitis media, which is an inflammatory process of the middle ear, is characterized by:

• perforated eardrum;
• recurrent flow of pus from the cavity of the hearing organ;
• decreased hearing, the loss of which can reach up to 50%.

Chronic purulent otitis media develops in cases where the patient did not treat or treated incorrectly acute purulent otitis media. It can appear as a complication of chronic sinusitis or rhinitis, as well as due to a rupture of the eardrum after an ear injury. Chronic otitis media affects one in 100 people worldwide. In almost half of all cases, the disease makes itself felt in childhood, manifesting itself even in infants. Possible intracranial complications pose a real danger not only to the health, but also to the life of the baby.

Acute otitis in adults can become chronic due to the presence of such unfavorable factors as: low resistance of the human body to infections, the presence of concomitant diseases of the respiratory tract, blood and ENT organs.

Chronic purulent otitis media, depending on the location of the perforation of the eardrum and the severity of the disease, is divided into 2 forms:

• mesotympanitis, which affects the mucous membrane of the tympanic cavity and auditory tube;
• epitympanitis, in which bone tissue is already involved in the inflammatory process, which can lead to its necrosis.

Complications

Incorrect treatment for purulent otitis, after which the purulent-inflammatory pathology begins to cover the bone tissue, is fraught with severe irreversible consequences.

In this case, the following complications are possible:

• damage to the eardrum, after which you can completely lose your hearing;
• mastoiditis (inflammatory process of the temporal bone);
• osteitis (bone caries);
• labyrinthitis (inflammation of the inner ear);
• meningitis (inflammatory disease of the lining of the brain)
• encephalitis (inflammatory pathology of the brain).

Treatment of purulent otitis media

Diagnosing the disease in adults is usually not difficult. The diagnosis of “acute purulent otitis media” is made based on the patient’s complaints and otoscopy results. If bone tissue destruction is suspected, an x-ray of the temporal bone is taken.

Treatment of the disease in adults is carried out on an outpatient basis; in the presence of fever and high temperature, the patient is prescribed bed rest. Treatment of acute otitis in a hospital setting is necessary if damage to the mastoid process is suspected.

Drug treatment includes:

• antibiotics;
• astringent or vasoconstrictor drops;
• painkillers.

Treatment of acute purulent otitis media is necessary based on the severity of symptoms and stage of the disease.

At the pre-perforative stage of the disease, the following drugs are used to relieve severe pain: alcohol solutions (boric acid or chloramphenicol with glycerin), heated ear drops (otipax, anauran), oral medications (diclofenac, paracetamol);

Means for simulating the drainage function: vasoconstrictor drops (galazolin, otrivin), warming alcohol compresses on the ear area to accelerate the resolution of the inflammatory process at home.

If necessary, paracentesis is used. During this operation, the eardrum is punctured to allow the unhindered drainage of pus.

At the second, perforated stage, experts recommend treating the disease using drug therapy:

• vasoconstrictor nasal drops;
• antibiotics;
• antihistamines;
• mucolytics (fluimucil, ACC);
• Heated ear drops after cleansing the ear with a hydrogen peroxide solution.

In addition, effective physiotherapeutic treatment includes:

• warming compresses at home on the ear area.

Treatment at the reparative stage, the main goal of which is to strengthen the immune system and restore hearing, is stopped: antibiotics, mechanical cleansing of the ear canal, and thermal procedures are canceled. To prevent adhesions in the tympanic cavity, the following may be prescribed: endaural iontophoresis using lidase, pneumatic massage of the tympanic membrane, and enzyme agents. To restore hearing, surgery may be necessary to remove adhesions and straighten the eardrum.

1. Instill a sore ear with an imperforated eardrum twice a day with a mixture prepared from mummy and rose oil mixed in a ratio of 1 to 10.
2. As a pain reliever, insert a cotton swab soaked in a solution prepared from 100 grams of water and 2 grams of mumiyo into the ear.

1. Place drops prepared from freshly squeezed lemon juice into the ear three times a day.
2. Treat the ear canal of the affected ear with a mixture prepared from honey and pomegranate juice taken in equal quantities.
3. For 3 weeks, insert a flagellum soaked in 20% into the ear. alcohol solution propolis.

These and other folk remedies can be successfully used at home for both adults and children who have first consulted with their doctor.

Choice of antibiotics

Antibiotics for the treatment of acute purulent otitis are selected based on the spectrum of the causative bacterial flora. Today in otolaryngology wide application found cephalosporins (ceftriaxone, cefaclor, cefazolin), aminopenicillins (Amoxil) and macrolides (Klacid). These antibiotics effectively block with their activity those pathogenic microorganisms that cause inflammatory ear diseases.

Antibiotics for children are prescribed with extreme caution, depending on the severity of the disease and the age of the baby. The most popular antibacterial agents in children: suprax, flemoxin, amoxiclav, amoxicillin. Antibiotics are available in a form convenient for use in the form of soluble tablets, suspensions and syrups.

The duration of the course of these drugs should be at least 7-10 days. If antibiotics are stopped earlier, this may provoke a relapse of the disease, its transition to a chronic form and the development of complications.

Otipax ear drops are well known to both patients and doctors. Being a combination of drugs such as phenazone and lidocaine hydrochloride, otipax is a non-steroidal drug that has an anti-inflammatory effect and provides a local analgesic effect.

Otipax is effective as a symptomatic treatment for some forms of chronic purulent otitis, as well as after surgery.

In addition, otipax has found its application in:

• otitis media in the acute period;
• viral otitis;
• barotraumatic otitis.

In adults, otipax is used 4 drops 3-4 times a day, in children under one year old - 1-2 drops, 1-2 years old - 3 drops, older children - 4 drops three times a day. Treatment with Otipax should be carried out for 3 to 10 days. When using the drug in the recommended dosage, an overdose is unlikely.

Timely use of Otipax prevents the development of purulent complications and perforation of the eardrum.

Disease prevention

Everyone knows the truism that it is easier to prevent a disease than to treat it later. To prevent a disease such as acute purulent otitis media, it is necessary to eliminate the main factors that can lead to its occurrence. For this it is important:

• harden the body;
• keep your ear canals clean at home;
• promptly treat infectious and chronic diseases and visit the dentist.

The best preventative measure for infants is breastfeeding.

By making it a rule of life to carry out these simple activities, you can forever forget about such a disease as purulent otitis media and keep your ears healthy and your hearing sensitive.

How to recognize purulent otitis media in a child

Purulent otitis is quite common in children, and this disease is often recurrent. Provoking factors may be infectious diseases, a weakened immune system, or enlarged adenoids.

In any case, the symptoms of the disease should be the basis for contacting a specialist. Only a doctor can prescribe effective treatment which will help defeat this disease.

Purulent otitis in a child

This term refers to a purulent lesion of the middle ear, a component of the auditory system, the main link of which is the tympanic cavity. It is a small space in the temporal bone that is responsible for processing sound vibrations.

In the purulent form of otitis, the mucous membrane of the ear becomes inflamed, which is accompanied by the production and accumulation of pus. This type of disease is much more dangerous than catarrhal disease, as it can cause hearing loss and intracranial complications.

The main cause of the appearance of a purulent form of otitis is considered to be inflammation of the nasopharynx, the appearance of adenoids, chronic forms of rhinitis and acute respiratory viral infections. All these pathologies lead to excess mucus in the nose.

When you blow your nose too much, these secretions penetrate the Eustachian tube and block it. As a result, ventilation is impaired, which leads to infection and inflammatory damage to the ear mucosa.

When inflammatory fluid is secreted, the child experiences pain and hearing loss. Bacteria that penetrate the middle ear begin to actively develop. As a result, after a few days or even hours, the baby develops purulent discharge.

Illustration of changes in the ear during purulent otitis media

Then his health seriously deteriorates - the temperature rises, the pain syndrome increases. At strong pressure it ruptures on the eardrum, causing pus to leak out.

This disease is diagnosed much more often in children than in adults. This is due to objective reasons:

1. The Eustachian tube in a child is much narrower than in an adult. Therefore, violations of its patency occur much more often.
2. Many children have enlarged adenoids. These formations lead to compression of the Eustachian tube, which makes the lumen in it much smaller.
3. Children are more likely than adults to suffer from acute viral infections.

In addition, there are additional factors that significantly increase the risk of developing purulent otitis media in a child. These include the following:

• hypothermia;
• lack of vitamins;
• prolonged use of antibacterial drugs;
• penetration of fluid into the ear;
• decrease in the body's defenses.

The appearance of purulent otitis in children is accompanied by severe pain in the ears. This symptom is accompanied by constant tearfulness. The pain may be cutting, aching or throbbing.

At night, discomfort increases significantly, causing sleep disturbances. In addition, children often experience the following symptoms:

• pale skin;
• general weakness;
• hearing loss;
• purulent discharge with bloody impurities;
• temperature increase.

If you ask your baby what exactly hurts, he will point to his ear. It is much more difficult to identify pathology in infants.

With purulent otitis, newborn babies cry constantly and have serious problems with sleep. The following symptoms may also appear:

• refusal to eat;
• the occurrence of gag reflexes;
• the child's attempts to lie on his side, where the affected ear is located.

How to recognize

The doctor identifies the disease based on complaints, medical history and otoscopy data. The following types of studies are usually prescribed:

1. General examination, endoscopic examination of the ear cavity, nose and nasopharynx - usually performed after cleaning the canals.
2. Audiological and vestibular examination.
3. Valsalva maneuver - in this case, the exudate is pushed into the ear canal.
4. Laboratory analysis of secretions - carried out to assess susceptibility to antimicrobial agents.
5. Assessment of the state of immunity.
6. Computed tomography and radiography.

There are a number of types of purulent otitis in children, each of which is characterized by certain features.

The acute form of the disease is accompanied by severe pain and leads to the appearance of purulent discharge in the ear cavity. If adequate treatment is not started immediately, there is a risk of the process becoming chronic. It is characterized by persistent damage to the eardrum. The child's hearing may also gradually decrease.

Double sided

This form of purulent otitis is characterized by inflammatory damage to both ears. This is very serious illness, which poses a particular danger to young children.

Almost 90% of all otitis media are bilateral. After a few years, the number of such diseases decreases. This is due to the development of the hearing aid.

Recurrent

This diagnosis is made if a second disease occurs within a short period of time after the first one. It is the result of improper therapy or violations of doctor’s recommendations. Also, inflammation of the adenoids often leads to relapses.

To cope with pathology, prevent the development dangerous complications and hearing loss, it is necessary to diagnose the pathology in a timely manner. Treatment should be selected by a doctor depending on the stage of the disease and its manifestations, and how long to treat it depends on the stage and complexity of the disease.

Medication

For purulent otitis, especially in children under 3 years of age, antibiotics are usually prescribed. Such medications can be used in the form of tablets, injections or suspensions - it all depends on the age of the patient and the stage of the disease.

Penicillins, as well as their combinations with clavulanic acid, are most often used to treat this form of the disease.

The most effective drugs include amoxicillin, augmentin, amoxiclav, etc.

If penicillins cannot be used or treatment with them does not produce results, cephalosporins are prescribed - ceftriaxone, cefazolin.

If the listed means are ineffective or there is allergic reactions Doctors prescribe macrolides. To the most popular medicines This category includes azithromycin and clarithromycin.

If a child has purulent otitis, he must be prescribed vasoconstrictor nasal drops. With their help, it is possible to cope with swelling of the mucous membrane and make the lumen of the auditory tube wider. Doctors usually prescribe galazolin, otrivin, naphthyzin.

In case of intense pain, anti-inflammatory drugs are prescribed - paracetamol or ibuprofen. These drugs also help reduce fever. The doctor may prescribe tablets, syrup or suppositories.

If there is no perforation of the eardrum, drops are prescribed in the ear. Otipax has excellent anti-inflammatory and analgesic effects. This harmless drug can be used even for infants.

If a child has a chronic form of purulent otitis, he is indicated for the use of immunomodulators. These include Viferon, biological products, and restorative medications.

Traditional methods

Before using any folk remedy at home, you should definitely consult a pediatrician and otolaryngologist.

When purulent otitis appears, a lot of foods with vitamin C should be included in the baby’s diet. It helps strengthen the immune system and ensures a quick recovery. This substance is present in kiwi, sweet peppers, and citrus fruits.

An excellent remedy for this form of otitis is a decoction made from raspberry roots. It has pronounced anti-inflammatory properties.

The rhizome needs to be crushed, take 3 tablespoons of raw material and add 1 liter of boiling water. The product must be infused for 12 hours. Take 3/4 cup twice a day for a month. During this time, the damaged membranes will heal successfully.

Frequent purulent otitis in a child, what to do?

If a child often has such problems, you need to establish the reasons for their occurrence. Quite often this is caused by immune failure. Therefore, treatment is carried out by administering gamma globulins, ascorbic acid, lysozyme, etc.

During the period of remission, blowing of the auditory tubes is often prescribed. Massage of the eardrum may also be performed. If necessary, punctures are performed to eliminate sinusitis. The doctor may prescribe a tonsillotomy or removal of the adenoids.

He will tell you how to avoid complications with purulent otitis media. experienced doctor in our video:

Prevention

To prevent the occurrence of purulent otitis, you need to engage in its prevention. It includes a number of components:

• prevention of viral infections;
• strengthening the immune system;
• water procedures;
• proper nutrition;
• timely treatment of nasopharyngeal diseases.

Purulent otitis media is considered a very dangerous disorder that can cause hearing loss. To prevent this from happening, you need to contact a specialist in time and strictly adhere to his recommendations.

Purulent otitis in adults: treatment

First of all, you should determine what purulent otitis media is. This disease is associated with an inflammatory process that is infectious in nature. It involves almost all parts of the middle ear: the mastoid process, as well as the auditory tube with the tympanic cavity.

Purulent otitis in adults: treatment

Types of otitis by localization

It is customary to distinguish three types of disease in accordance with the localization of inflammation.

1. Internal otitis usually develops due to the neglect of purulent otitis media.
2. The accumulation of moisture in the ear canal often provokes the development of external purulent otitis.
3. Otitis media becomes a common complication when various diseases of the upper respiratory tract are observed.

Experts note that otitis externa usually appears in people who are professional swimmers and are often in the water. Usually the inflammatory process affects only the external auditory canal. It manifests itself on the skin: various rashes, irritation, and small pustules are observed there.

Internal otitis and its symptoms

Severe pain is characteristic of otitis media, which is why it is customary to mean the disease of the middle ear by the definition of “otitis media”. It occurs in different ways, with different consequences and symptoms. If otitis media is not treated, it gradually becomes chronic and causes severe complications. Sometimes adhesions begin to form, partial deafness occurs, and the ears become blocked. The most dangerous thing in this case is complete loss of hearing, and if pus breaks inside, it even becomes a threat to human life.

Features of purulent otitis media

Experts provide statistical data. According to them, the percentage of otitis media among all kinds of ear ailments is quite large: it is 25-30%. Most often, this disease affects children under five years of age, as well as the elderly. In third place were teenagers aged 12-14 years. Scientists have not identified a specific pathogen. However, it is mainly provoked by pneumococci, which are a special type of streptococci, as well as Staphylococcus aureus, influenza, and complexes of pathogenic microorganisms.>

Purulent otitis in an adult

Causes of purulent otitis media

Let's consider possible reasons diseases in a little more detail. Most often, the key provoking factors are:

• infections (flu, ARVI);
• upper respiratory tract diseases of any kind;
• presence of adenoids;
• rhinitis and sinusitis;
• inflammatory diseases affecting the nasopharynx;
• failure to comply with hygiene rules;
• decreased level of immunity;
• Through the auditory tube, infection penetrates directly into the tympanic cavity under appropriate conditions favorable for the development of the disease, for example, when the body is weakened, a person experiences emotional and physical overload.

Causes of purulent otitis media

It is very important to take preventive measures: to minimize the risk of infection respiratory diseases, avoid hypothermia, maintain immunity. If symptoms of otitis media are identified, it is necessary to begin treatment in a timely manner. Otherwise, the disease develops quickly and may well provoke serious complications.

Causes of otitis media according to type

1. Bacterial infections most often provoke the development otitis externa. A layer of wax protects the ear from harmful microorganisms. If the sulfur layer is produced in insufficient quantities, or if too much of it accumulates, pathogens, the pathogenic environment begins to multiply sharply. Here it is worth remembering the need to observe hygiene rules. Also, otitis of the external ear often occurs after damage to the external auditory canal, for example, when people clean their ears using pencils and long sticks, matches, and all sorts of objects that are not suitable for these purposes. As soon as harmful microorganisms enter the human body, having entered through damaged skin, the first symptoms of otitis externa begin to appear.

Purulent external otitis

Suppurative otitis media

It is necessary to monitor your health and take measures to prevent the development of otitis media.

Video - Otitis media: symptoms and signs

Symptoms

It is necessary to know all the key symptoms in order to be able to identify the disease on early stage, begin treatment and prevent the development of complications.

1. The first sign of otitis media is pain in the ear canals and in the head. There are all kinds of pain: aching, pulling, shooting and throbbing. The intensity ranges from barely noticeable to unbearable, where it is difficult to hold back moans and painkillers are of little help. Unfortunately, it is quite difficult to distinguish between the pain characteristic of external and otitis media. True, when otitis externa, unpleasant sensations arise when a person only touches the skin near the entrance to the internal auditory canal.
2. An increase in body temperature is an optional sign. But with purulent otitis media of the middle ear, the temperature usually rises, especially at the initial stage of development of the disease.
3. A typical warning sign is hearing loss. A person begins to hear worse, has difficulty distinguishing sounds, and suffers from a feeling of congestion in the ears. In addition, it can be determined that the level of hearing in different ears is different. However, the disease can also occur with stable hearing, without failures.
4. The ears become blocked, an unpleasant sensation arises in them due to congestion, when sounds reverberate sharply in the head. As a result, a person not only hears poorly, but also suffers from constant headaches.
5. Discharge from the ear is a very significant symptom of purulent otitis media. However, they may also be absent if purulent deposits begin to accumulate inside the ear canal. This also causes hearing loss, and ultimately can lead not only to education purulent plug, but also to the breakthrough of purulent masses inside, which already poses a serious threat to human life and health. When otitis externa occurs, the pus almost always comes out calmly. When there is communication between the ear canal and the middle ear, pus begins to flow out of the ear canal.
6. Head pain, regular migraines and dizziness are also characteristic of otitis media of all forms, especially at the stage of pus discharge. This is due to the inflammatory process, as well as the fact that there are accumulations of purulent masses in the ear canals.

Stages of purulent otitis

It is advisable to have a good understanding of the symptoms. In any case, as soon as the first signs appear, you must immediately contact a specialist.

Consequences

Purulent otitis is a serious disease that is extremely important to pay appropriate attention to. When the necessary treatment is not organized in a timely manner, the consequences can be very serious. In addition, the disease progresses quickly.

Remember! If the disease is neglected, purulent otitis media can even lead to meningeal syndrome. This irritation of the membranes of the brain, which ultimately threatens not only the health, but also the life of the patient, can cause death.

Symptoms of meningeal syndrome are as follows:

• the person begins to vomit;
• convulsions appear, arms and legs twitch, fingers tremble;
• physical activity decreases sharply;
• the patient suffers from severe weakness, it may be difficult to even hold a cup in his hands;
• consciousness becomes confused, delirium begins;
• severe pain and dizziness.

Symptoms of meningeal syndrome

When such signs are observed, you should immediately call an ambulance.

When it comes to therapy for purulent otitis media, a key point must be taken into account: all features, principles and methods of treatment completely depend on the stage of the disease, the characteristics of its development and the condition of the patient. Besides, great importance have accompanying signs and ailments of the patient. Therapy should be selected as competently as possible in order to bring only benefit, give maximum effect and at the same time not harm or provoke side effects.

The following strategy for the treatment of purulent otitis is known, associated with suppressing symptoms and alleviating the patient’s condition. There are three main directions of such therapy.

Anesthesia

Suffering due to discomfort and pain is really serious. The patient suffers from sleep disturbances, weakness, and ultimately all this negatively affects the condition of the body as a whole.

Paracetamol for pain relief in purulent otitis media

1. At the initial stage of inflammation, it is usually prescribed Paracetamol. It is taken 4 times during the day, one gram each. It is advisable to select doses carefully, taking into account body weight.
2. Special ear drops also help a lot. Experts recommend using Otipax. The composition of the drug included glycerin with ethyl alcohol, sodium thiosulfate with phenazone, as well as Lidocaine G hydrochloride. It is necessary to instill drops directly into the external auditory canal, approximately 4-5 drops. This is done 2-3 times during the day.
3. Doctors recommend making pain-relieving compresses. The best option is compressByTsitovich. A solution is prepared from glycerin with boric acid, as well as ethyl alcohol. The boron solution should be three percent. All components are taken in equal parts and mixed. A gauze swab is impregnated with the composition and carefully inserted into the ear canal. It is advisable to leave the compress on for at least 3 hours. The optimal duration of the procedure is 5 hours, once a day.

Otipax ear drops for the treatment of purulent otitis media

Of course, to improve your general condition, you need to remain at rest, not tense up or get nervous, avoid any stress, sleep more and maintain bed rest.

It is important! Remember that eliminating symptoms and relieving pain in itself only improves the patient’s quality of life and improves his general condition. However, the root of the problem – inflammation in the ear – remains. It is also extremely important to eliminate it by curing the disease itself, and not just getting rid of the symptoms.

Relieving swelling

The drug Telfast eliminates swelling from the auditory tube and the mucous membrane of the auditory tube

Swelling must be eliminated from the auditory tube and the mucous membrane of the auditory tube. When otitis media has developed against the background of allergic reactions, it is appropriate to prescribe antihistamine-type drugs. The group of drugs of this type includes Telfast And Claritin, Tavegil With Suprastin, and Diphenhydramine. When it is important to reduce swelling of the auditory tube, as well as stimulate the outflow of purulent masses from the middle ear, drops should be prescribed: Nazivin With Tizin, Sanorin With Galazolin.

Sanorin drops to reduce swelling of the auditory tube

Antibiotics in the treatment of purulent otitis media

Experts admit: when fighting purulent otitis media, the greatest effect is provided by antibiotic drugs from the well-known penicillin group. They have the optimal ratio of side effects and benefits for the body. In addition, it is penicillin drugs that perfectly suppress the pathogenic environment. It is advisable to entrust the prescription of specific medications to a specialist, since only an experienced doctor will be able to correctly select the right option, taking into account all the nuances.

Let's look at the main drugs and their important features.

When talking about otitis media, we always mean an inflammatory reaction in the ear. However, ear inflammation can be different - moderate, external, acute, chronic, catarrhal, purulent, etc. In this article we will look at purulent otitis in adults, and in addition we will answer many common questions from patients regarding purulent otitis.

Why is purulent otitis media dangerous?

Most often, the development of ear inflammation is associated with a common cold, but this is not always correct: ear inflammation is a more serious and dangerous disease. And, if a cold can “go away” on its own, without specific treatment, then the purulent-inflammatory process must be treated without fail - and only under the supervision of a doctor.

Adults get ear infections less often than children. However, complications in adults occur no less often than in childhood. For example, chronic inflammation can cause hearing loss, a partial loss of hearing function that cannot be restored.

Adhesions often form in damaged inflamed areas, and bone tissue in the temporal region is affected - these changes increase the risk of developing meningitis or an abscess in the brain.

Most adverse effects develop if the patient consults a doctor late. Therefore, the degree of danger in case of purulent otitis media is directly proportional to the timeliness of seeking medical help.

ICD-10 code

H66 Purulent and unspecified otitis media

Epidemiology

An inflammatory reaction in the ear with the release of pus is considered a fairly common disease of the hearing organs. The pathology can have a mild course, or develop rapidly, leading to severe inflammation affecting the entire body.

Causes of purulent otitis media in adults

In most adults, inflammatory suppuration from the ear occurs as a secondary pathology - that is, microbes initially enter the middle ear from other nearby structures. There are certain risk factors that predispose one to the development of the disease - first of all, by weakening protective forces body.

We are talking about the following factors:

• Strong cooling of the body leads to constriction of blood vessels, activation of the viability of microbial cells.
• Anemia, hypovitaminosis, malnutrition - significantly weaken the immune system.
• Chronic and sluggish infectious lesions of the ENT organs.

Pathogenesis

The underlying infection for the development of the inflammatory process in adults can be either bacteria or a fungal infection. Most often, bacteria found in the auditory cavity are staphylococcus and Pseudomonas aeruginosa, or fungi - candida or aspergillus. The most common causative agents of purulent otitis media are pneumococci, moraxella, and hemophilus influenzae.

The pathogen can enter the ear cavity in several ways:

• through the auditory tube (tubogenic pathway);
• as a result of traumatic damage to the ear and eardrum;
• by spreading from the intracranial cavity (retrograde route);
• through blood vessels from other infectious foci (for example, viral infection, tuberculosis, measles, etc.).

The chronic form of purulent otitis in adults develops as a result of incomplete treatment of the acute stage of the inflammatory process in the ear.

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Symptoms of purulent otitis media in adults

The purulent-inflammatory process in adults often occurs as a complication of a viral infection. This is usually due to a combination reduced immunity and damage to the ENT organs. Wherein highest risk The disease affects people who have recently undergone surgery or chemotherapy, as well as alcoholics, drug addicts, and HIV patients.

The first signs of the disease are fever, chills, and headaches. Local symptoms are of decisive importance:

• pain, noise, ringing in the ears (usually in one ear);
• feeling of pressure and fluid in the ear cavity;
• hearing loss, feeling of congestion;
• the appearance of discharge from the ear canal - as a rule, it is initially watery, translucent, and then becomes yellow-grayish and thick.

The disease is accompanied by loss of appetite and sleep disturbances.

Temperature during purulent otitis is an integral natural reaction to inflammation and the introduction of infection into the body. The temperature may vary - it depends on the individual state of immune defense, age and clinical features diseases. Inflammation with pus in adults is in most cases accompanied by high temperatures - and the feverish state usually lasts as long as the pus remains inside the ear cavity. Simultaneously with the release of purulent discharge (it does not matter whether this happens on its own or with the help of an autopsy), the temperature begins to decrease.

An increase in temperature during purulent otitis may also indicate the development of complications - for example, meningitis, mastoiditis and otogenic septic condition cannot be avoided without fever. Characteristic feature The development of complications is that the patient’s well-being seems to be improving - however, after a couple of days, pain in the ear reappears, the temperature rises, and other typical symptoms appear.

Purulent otitis without fever is characteristic of a disease that was initially provoked not by an infectious pathogen, but by injury. So, when the ear is bruised, a painful wound forms in the cavity, which suppurates when bacteria enter. In addition, purulent otitis without pain and fever can become a sign of fungal infection - the so-called otomycosis, or eczema of the hearing organ. The listed symptoms may be absent with diffuse external damage, as well as with atypical form inflammatory process.

Acute pain, which patients often describe as “cutting the ear with purulent otitis media,” is characteristic of the early stage of the disease, in which the inflammatory process is accompanied by the appearance of an abscess. As a rule, this stage lasts about 2-3 days. Further, after the eardrum is perforated and pus comes out, the acute pain disappears.

Forms

Doctors diagnose different kinds otitis, depending on the anatomical and physiological characteristics of the disease, as well as on the form of its course.

• Purulent external otitis occurs due to the introduction of an infectious pathogen when the ear is injured, or due to pathological accumulation of moisture in the external auditory canal. This type of disease is typical for swimmers and divers, due to constant contact of the hearing organs with water. The disease occurs with pain, itching, swelling and purulent wet crusts in the area of ​​the external auditory canal.
• Acute purulent otitis media often provoked by ARVI, and also occurs against the background of an infectious lesion of the upper respiratory tract. Patients usually do not complain of unpleasant sensations of stuffiness and pain in the ear. In a healthy person, the middle ear cavity is sterile. When bacteria enter it, a purulent process begins, and the purulent mass begins to put pressure on the walls. In this condition, a diagnosis of “suppurative otitis media” is made. If the process is not stopped at this stage, the membrane breaks under the pressure of the purulent mass, and the pus escapes into the external auditory canal.
• Chronic purulent otitis media characterized by the presence of a perforated membrane and an active inflammatory reaction in the middle ear for a month or more. In chronic purulent otitis, otorrhea is detected - that is, there is discharge of a purulent mass from the ear canal. The amount of discharge can vary from significant to small, almost invisible to the eye. The chronic process is often accompanied by deterioration of hearing function.
• Purulent otitis with perforation. Purulent perforated otitis is characterized by the presence of an inflammatory process with the constant formation of secretions that have strong proteolytic characteristics. This means that the discharge can melt nearby tissue. Under the influence of pus and the pressure it exerts, the membrane wall cannot withstand it - a hole is formed through which the purulent mass begins to exit into the external auditory canal. After the hole is formed, the pain subsides, signs of intoxication disappear, and the temperature returns to normal.
• Tubotympanic purulent otitis occurs with acute inflammation of soft tissues and the release of purulent-serous masses. The main feature of this pathology is the extent of the lesion, an increased risk of complications and prolonged complex treatment. The main complication of tubotympanic otitis is considered to be damage to bone tissue - the auditory ossicles and cells of the mastoid process.
• Bilateral purulent otitis is infectious inflammation, which affects both organs of hearing. This type of disease occurs somewhat less frequently than unilateral lesions, and the course of such otitis is more complicated. Often, to alleviate the condition, you have to seek the help of a surgeon.
• Left-sided purulent otitis is a lesion of the hearing organ on the left side. This type of disease occurs no less frequently than right-sided purulent otitis media - both pathologies are considered varieties of purulent otitis media by localization.
• Catarrhal purulent otitis manifested by a sharp decrease in pressure in the ear cavity - this is explained by the strong secretion of effusion. Exudate accumulates in the tympanic cavity - the patient himself feels this and describes it as a “transfusion” of fluid in the ear cavity. On examination, the eardrum protrudes outward. This type of disease is otherwise called “exudative purulent otitis media.”
• Purulent otitis with blood is a pathology that indicates damage to small vessels in the ear cavity. We can say that the infection begins to penetrate the soft tissues. If blood appears during chronic purulent otitis, then one can suspect the development of complications in the form of damage to the facial nerve.
• Recurrent purulent otitis media– this term refers to an inflammatory purulent process in the ear, which is recorded several times throughout the year, and after the patient has fully recovered (with normalization of hearing, tightening of the perforation hole). This type of purulent otitis is diagnosed more often in childhood.

Complications and consequences

The inflammatory process in the ear is prone to spreading to other tissues and organs. Lack of therapeutic measures, or incorrect or incomplete treatment can lead to the purulent reaction spreading to salivary glands, lower jaw area, etc. Such processes can make the patient disabled.

However, according to statistics, the greatest danger lies in the fact that patients with suppuration and otitis media arrive for treatment late, when the disease has reached its peak. In this case, complications may not arise immediately, but after some time - for example, after a month or even more. The most common complication is the transition of inflammation to the chronic stage, against the background of vestibular disruptions and the development of hearing loss.

Other complications of purulent otitis include:

• intracranial spread of the process with the development of meningitis, abscess, encephalitis);
• damage to the facial nerve, paresis;
• damage to the eardrum;
• development of cholesteatoma - blockage of the auditory canal by an encapsulated cyst;
• inflammatory process in the mastoid process with further destruction of bone elements in the middle ear (development of mastoiditis);
• violation of digestive function (diarrhea, nausea, vomiting - signs of intoxication);
• dynamic deterioration of hearing, up to its complete loss.

If the purulent-inflammatory phenomenon becomes chronic, then it becomes extremely difficult to treat. Many patients have all the indications for surgical intervention.

Patients often complain: hearing loss after purulent otitis media, will it be restored? In fact, hearing can actually be restored in the following cases:

• in the chronic course of the inflammatory process;
• with cholesteatoma;
• with atrophy of the auditory ossicles;
• with slight tissue perforation;
• in the presence of patency of the auditory canal.

If an obstruction is detected in the auditory canal, or atrophy has affected the eardrum, or there is damage to the auditory nerve, then restoration of auditory function becomes impossible.

Temperature after purulent otitis is a natural reaction of the body to inflammation and the presence of infection in the body. That is, a slight increase in temperature can be observed for another 3-7 days after purulent otitis media - this is exactly how long it takes the body to restore immune defense. If the temperature first normalizes and then rises strongly again, this may indicate the development of complications - namely, the spread of infection to other tissues and organs.

Exacerbation of purulent otitis media can occur when the disease becomes chronic. Thus, exacerbation often develops against the background of acute respiratory viral infections or colds, with sinusitis or sore throat. Chronic course usually characterized by the development of mesotympanitis (inflammation of the mucous tissue of the tympanic cavity) or epitympanitis (inflammation of the mucous and bone tissues). The clinical picture of exacerbation resembles the symptoms of an acute inflammatory process.

Blood poisoning from purulent otitis media is not uncommon. The development of bacteremia in purulent otitis occurs by otogenic means, when pathogenic microorganisms enter the general bloodstream. A healthy person's blood is sterile. Blood poisoning - or, in other words, sepsis - means that infectious pathogens from an inflammatory focus have entered the blood. Here it is necessary to be able to distinguish sepsis from bacteremia. With bacteremia, the infection enters the blood, causing damage to certain tissues or an organ. With sepsis, the entire body is affected - all organs and systems suffer, which ultimately can even lead to the death of the patient.

Most often, the development of such complications occurs due to lack of treatment, or due to incomplete or illiterate treatment of a patient with a purulent-inflammatory disease.

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Diagnosis of purulent otitis in adults

Diagnostic measures in case of ear inflammation with pus, it is not complicated - in most patients the disease can be identified during a routine survey and examination. So, the doctor will definitely ask the patient about the moment of onset of the disease, the order in which the symptoms appeared, and also what the patient did to alleviate his well-being.

The doctor examines the affected ear using a special head reflector and a funnel, or using an otoscope.

If there are external inflammatory phenomena, the doctor will pay attention to the redness of the skin, the presence of ichor or pus. The auditory canal may be narrowed, so much so that it visually blocks the membrane.

In the acute form of otitis media, the redness of the membrane and its stiffness are noticeable. When pus breaks through, perforation becomes visible.

To properly test the motor ability of the membrane, the patient is asked to draw air into his cheeks and strain so that the ears “blow out”. This method is called the Valsalva maneuver and is often used by scuba diving enthusiasts. When air enters the ear cavity, the membrane makes movements that the doctor sees. If there is discharge in the tympanic cavity, the motor activity of the membrane will be impaired.

Blood tests for ear inflammation can only indicate general signs inflammation in the body. Such signs are usually leukocytosis, accelerated ESR, increased amount neutrophils and lymphocytes.

Bacterial culture is much more informative - but its disadvantage is that the results are obtained only a week after taking a smear, and treatment of the disease must begin immediately. However, many experts still advise carrying out a bacterial culture of the discharge, since accurate identification of the pathogen will make it possible to prescribe more effective therapy if conventional antibiotics do not have the expected effect.

With purulent otitis media, an intense inflammatory process develops in the ear canal, which is accompanied by the formation of pus. The causative agent of this disease is an infection that develops as a result of hypothermia, water entering the ear canal, and a weakened immune system.

There are often situations when such an illness is a complication after suffering an acute respiratory viral disease. It is very important not to ignore the symptoms, consult a doctor in time and carry out timely and competent therapy to prevent the development of consequences.

What is purulent otitis media?

Among all otolaryngological diseases, it occurs in every third patient. Most often, doctors diagnose it in. As this disease develops, pus appears in the ear and inflammation begins. The disease can occur in any area of ​​the ear canal.

The disease is more often diagnosed in children because anatomical structure The structure of the ear apparatus in a child is different from that of an adult. The auditory canal in children is shorter and wider than in adults. And inside the ear canal in the middle section in infants there is a small amount of fluid, which is an ideal environment for the development of pathogens.

When infectious agent penetrates into the ear cavity, the development of the inflammatory process begins. The result is swelling and hyperemia of the mucous membrane and eardrum, the formation of erosions and ulcers on the walls, expansion blood vessels, reducing the permeability of the walls of the eardrum.

If there is no timely and adequate treatment for otitis, it can become chronic. This form of the disease is characterized by periodic outbreaks and remissions.

In this case, treatment is difficult and longer. Also, if this disease is neglected, surgical intervention may be required.

Signs of purulent otitis media

Symptoms of the disease in a child manifest themselves as follows:

• there is a sharp pain inside the ear of a shooting nature;
• febrile hyperthermia;
• the appearance of tinnitus;
• deterioration in hearing quality;
• increased irritability and crying;
• the presence of purulent contents;
• the child throws his head back and shakes it in different directions;
• sleep and appetite worsen.

To make a correct diagnosis for your child, you must visit a doctor. Since collecting complaints is difficult, a more thorough diagnosis will be required.

Symptoms of the disease in adults include:

• appearance painful sensations inside the ear. This symptom appears against the background of irritation nerve endings due to swelling and the presence of purulent contents. Soreness occurs inside the ear canal, then goes to the temples and back of the head. When purulent contents are removed from the ear canal, pain decreases;
• hyperthermia due to inflammation and intoxication, usually febrile;
• separation of purulent contents from the ear canal;
• deterioration in the quality of hearing due to swelling and accumulation of exudate, congestion in the ears. Such signs persist for several days after treatment. Then they are eliminated on their own. If inflammation spreads to the internal region, a significant deterioration in hearing quality may persist for a longer period.

In some cases, the course of the disease can be rapid, it passes easily and without complications. But only if the natural resistant functions of the body are high, or if treatment is started in a timely manner, competent therapy prescribed by the doctor is carried out.

If the immune system weakened, the inflammatory process can last a long time, the cure will be long, and consequences may develop.

Why does pus occur in the ears of adults and children?

With the development of this disease, severe inflammation occurs throughout the ear. The development of such a disease may be due to the following provoking factors:

1. Penetration of infectious agents from the nasal passages and upper respiratory tract. The infection can travel through the ear canal to the eardrum. This happens when a person coughs or sneezes. With strong pressure on the ears, the infection along with mucus can penetrate into the middle part of the ear.
2. Also, the infectious process can penetrate into the ear canal when various injuries eardrum.
3. The disease may be a consequence of an acute respiratory viral disease.
4. Penetration of water into the ear canals, local hypothermia.
5. Development of allergic reactions.
6. Weakened immune system.
7. Hereditary tendency.

The ear festers most often due to sinusitis, rhinitis and adenoiditis. In the presence of chronic processes in the nasopharynx, the drainage system of the ear canal is disrupted, due to which pathogenic microflora can easily penetrate into it.

What are the stages of purulent otitis media?

There are only 3 degrees of this disease.

Pre-perforation stage

Its duration ranges from several hours to two to three days. When the infection reaches the ear, severe inflammation begins. The result is pain and hyperthermia.

An accumulation of purulent contents occurs in the area of ​​the eardrum, causing pressure on it. At this stage, the pain is intense and very sharp. There is a deterioration in the quality of hearing.

Perforated stage

The duration of this stage is about five days. During this period, perforation of the eardrum occurs with subsequent separation of purulent exudate. The discharge is copious, with bloody impurities.

After a few days, the amount of discharge decreases. The state of health improves, the severity of the disease process decreases, and the temperature decreases.

Reparative stage

This stage is the final one. Within a few days, the inflammatory process is eliminated and the perforation is scarred.

If there is a small tear, the scar will go away quickly. And if the disease is not treated, if the perforation does not heal completely, the disease becomes chronic. Its development is characterized by periodic exacerbation, deterioration in the quality of hearing and pronounced defects in the middle ear.

Basic rules of treatment for adults

In order for the treatment to be correct, you need to see a doctor. Based on the examination results, the doctor will draw up a competent treatment regimen. The goal of treatment is to eliminate pain, get rid of the inflammatory process, and restore the quality of hearing. For this purpose, the doctor prescribes the following procedures:

1. In order to restore drainage and ventilation, a procedure is performed to blow out the ear canal. It is performed in a medical facility using a special probe through which the medicinal mixture is supplied. Typically, drugs such as Dexamethasone, Amoxicillin, and Adrenaline are used for the procedure. Data therapeutic measures are very effective, they significantly increase the healing rate, and hearing is restored much faster.
2. A set of physiotherapeutic measures. Typically, heating, microwave, and ultraviolet radiation are used. The course of procedures lasts about ten days. Such activities have a positive effect on hearing restoration, improve blood microcirculation and metabolic processes. As a result of such procedures, the protective barrier of the mucous membrane is restored.
3. Medications for nasal use. With their help, blood vessels narrow, mucus production decreases, the Eustachian tubes are cleared, and full breathing is restored. Doctors usually prescribe the following drops or sprays: Rinazolin, Pinosol, Delufen, Otrivin, Nazivin, Evkazolin, Vibrocil, Noxprey, Farmazolin. They need to be instilled three times a day for a week.
4. Perform regular cleansing of pus. To do this, you can use regular peroxide and ear sticks.
5. Taking medications that reduce fever: Paracetamol, Ibuprofen. Such remedies are usually used within the first few days after severe inflammation develops.
6. Painkillers. In this case, doctors prescribe ear drops that have analgesic properties. For example, Ototon, Otipax, Otizol. Such drugs have an analgesic, anti-inflammatory, and antiseptic effect.
7. Tampons made from glycerin. Such products are introduced into the ear canal at night.
8. Measures must be taken to eliminate the pathogen. If the causative agent is a pathogenic microflora, you need to undergo a course of treatment with antibacterial drugs. When the disease is caused by a fungus, you need to undergo a course of treatment with antifungal agents.
9. Administration of saline or Dexamethasone to eliminate swelling and inflammation.

If chronic otitis develops, it is difficult to eliminate it only with the help of conservative therapy. Therefore, doctors are considering the advisability of surgical intervention. This method can get rid of granulations and adhesions and restore the quality of hearing.

Treatment of purulent otitis in a child

The main goal of therapy for children is to eliminate painful sensations, get rid of the inflammatory process, reduce hyperthermia, and restore the quality of hearing.

Doctors prescribe antibacterial drugs for oral use. Only a doctor can decide which drugs can be used in a particular case, depending on the susceptibility of the pathogenic microflora to the active components of the drug.

Often, specialists prescribe medications that belong to the group of penicillins or cephalosporins. If there is a tendency to develop allergic reactions to the constituent components antibacterial agents, medications from the macrolide category are prescribed.

At the first stage of the disease, local antibacterial drugs in the form of ear drops are not prescribed. At this stage, it is necessary to use only medications that have analgesic and decongestant properties.

In the presence of chronic otitis or perforation, you need to use drops with antibacterial components in the composition. Additionally, doctors prescribe nasal use of vasoconstrictor drops. With their help, you can restore blood microcirculation and get rid of swelling.

If there is no pus, warming is allowed. Only they warm up not the ear canal itself, but the area nearby. When purulent exudate begins to be released, no warming procedures should be performed.

To get rid of painful sensations, doctors prescribe ear drops, which have an anti-inflammatory and analgesic effect:

1. Otipax.
2. Otinum.

To get rid of hyperthermia, antipyretic drugs are used - Nurofen, Panadol.

Treatment is carried out on an outpatient basis in most cases. If there are complications, the child may be hospitalized. Perforation of the eardrum heals on its own after two to three weeks. Sometimes you may need surgical treatment. Also, in some cases, doctors recommend laser therapy.

After an illness, the doctor prescribes measures in order to strengthen the natural resistant functions of the body and increase the protective barrier of the mucous membrane. For this purpose, a course of taking multivitamins, a balanced diet, and immunostimulants is prescribed.

Regular walks in the fresh air are important. Additionally, during the recovery period, the doctor may prescribe physiotherapeutic procedures - microwave, electrophoresis.

Prevention of purulent otitis media

Main preventive measures for adults are:

• timely treatment of nasopharyngeal diseases;
• preventing dirty water from entering the ear canal;
• treatment of diseases that negatively affect the immune system;
• direct strength to strengthen the immune system - balance the diet, walk more in the fresh air, devote time to sports activities.

When the first alarming symptoms You should contact an otolaryngologist as soon as possible. You should not carry out any treatment measures on your own; this is fraught with unpleasant consequences.

To prevent the development of purulent otitis media in children, you should adhere to the following recommendations from specialists:

• The child should not be allowed to become hypothermic. For example, if you are going for a walk with him in windy weather, be sure to wear a hat. When leaving the room in cold weather, you should not go out without a hat;
• promptly treat any diseases of the nasopharynx and oropharynx;
• It is recommended to use a rubber cap when swimming in the pool;
• After bathing, carefully clean the ear canal of water using a cotton swab.

Additionally, efforts should be directed toward strengthening the body’s natural protective functions so that it can resist pathogenic microflora and other pathogens.

It is important to harden your child, do exercises with him, and follow the vaccination schedule. In order to prevent the occurrence of otitis media in infants, mothers are advised to:

• after feeding, hold the baby in an upright position for some time;
• make sure that milk does not come out of the bottle in large drops;
• Do not feed the baby in a lying position; his head should be slightly elevated.

Under no circumstances should you warm up your child’s ears or do any treatment on your own. Only a doctor can make the correct diagnosis and prescribe proper treatment.

What are the consequences of purulent otitis media?

Often, the duration of the illness is about two weeks. In each specific case, this period is individual and may vary. At the first stage of the development of the disease, there is a danger of the formation of adhesions, scars, and the appearance of hearing loss. Such consequences can develop if the membrane does not open for a long period and the accumulated exudate does not come out.

There is a danger of transformation of the inflammatory process in brain tissue. This is how an abscess can develop. In this case, surgical intervention is necessary. Mastoiditis, meningitis, and facial paralysis can also be consequences.

Conclusion

If purulent otitis develops, you should visit a doctor as soon as possible and do not delay treatment of the disease. Also, do not ignore the symptoms and hope that they will go away on their own. A complex regimen is often prescribed for treatment, including medications, physiotherapeutic procedures. In some cases, surgery may be necessary.