Chronic otitis media

Proven content

Chronic otitis media always presents with permanent or intermittent discharge of mucous, mucopurulent or purulent contents from the ear, perforation of the eardrum and hearing impairment. The ailment occurs when otitis media lasts longer than three months. The disease can take many forms.

Chronic otitis media – definition

Chronic otitis media is a condition that lasts continuously for over three months. The cause of this ailment may be a persistent defect in the eardrum, which causes symptoms in the form of mucopurulent discharge from the ear, hearing damage, and even allergic rhinitis. A patient with chronic otitis media develops ear congestion and tinnitus. However, in a child after a long course of chronic otitis, there is no reaction to calling or asking questions. Attention! Otitis media poses a serious threat to the patient’s life.

Two groups of the disease

Different forms of chronic otitis can be classified into two groups, characterized by a different course of the significant symptoms of chronic inflammation.

1. In the first group (when the patient is not at risk of complications), the leakage from the ear may be mucopurulent or mucous, while the lesion affects only the mucosa of the tympanic cavity. The perforation is related to the tight area of ​​the membrane, and there is no risk of lump formation (cholesteatoma).
2. In the second group (requiring surgical treatment), the discharge is purulent, and the lesions are related to the tympanic cavity of the appendix chamber and other fragments of the temporal bone. The perforation is limited to the upper part of the flaccid eardrum, and symptoms of bone destruction and cholesteatoma can be seen.

Complications of chronic otitis media

In the course of chronic otitis media, microorganisms can spread beyond the middle ear and to the bones and the immediate vicinity. This leads to:

1. mastoiditis (the most common complication characterized by pulsating pain behind the ear and purulent discharge from the ear),
2. paresis of the facial nerve,
3. inflammation of the inner ear – labyrinth.

Infection can also spread through the damaged bone into the inside of the skull to the dura mater, causing meningitis, supra- and subdural abscesses, thrombophlebitis, and brain and cerebellar abscesses.

Symptoms of complications of chronic otitis media

Symptoms giving suspicion of the onset of complications are:

1. pain,
2. feeling of tension behind the ear in the mastoid area,
3. a large amount of purulent discharge from the ear,
4. emphasizing the soft parts behind the auricle with its inclination towards the front,
5. curvature of the face (limiting or abolishing the mobility of half of the face on the side of the affected ear),
6. tinnitus or its increase (while hearing deteriorates rapidly),
7. involuntary dizziness with accompanying nausea and vomiting,
8. nystagmus,
9. headaches,
10. severe earaches,
11. high temperature around 40 degrees C and its sudden drop during the day,
12. dripping sweat
13. general weakness
14. acceleration and slowing down of the heart rate,
15. stiff neck,
16. lower mental and physical efficiency.

General symptoms of chronic otitis media

The general symptoms of this ailment include:

1. odorous leakage from the ear
2. dizziness,
3. developing hearing loss,
4. dull headaches,
5. feeling of pressure in the head.

Types of chronic otitis media

1. Simple chronic inflammation – is the mildest variety of this ailment. It is characterized by defects in the eardrum and specific mucopurulent discharge from the ear, and may also cause hearing damage. Treatment of simple inflammation is local and consists in eliminating the leakage from the ear and removing the source of the infection in the throat and nose. Among other things, drainage and cleaning are used. In addition, it is recommended to use preparations that act locally from the side of the ear canal. However, there are times when surgery is the only solution.

2. Chronic granulationitis – similarly to simple inflammation, it is characterized by a defect in the eardrum, but it causes a bacterial infection and a rather intense leakage of mucopurulent material from the ear. Likewise, your hearing may be damaged. In addition, granulomatous inflammation manifests itself in granulation changes in the middle ear lining, ear polyps and bone damage to the inner structure of the ear. Local treatment in this case does not bring any effect, because overgrown granulation lesions cause ear obstruction and prevent the free flow of infected secretions. Thus, the treatment is based on a surgical procedure, which is difficult due to the high risk of structural damage to the middle ear, e.g. damage to the facial nerve may occur.

3. cholesteatoma – it is otherwise called the “pearl in the ear”. During the disease, cholesteatoma is formed from cholesterol masses, exfoliated ear epithelium, bacteria and dried secretions. Perlaki resembles a pearl (which, of course, is not real), but it is a dangerous complication that, as it develops, destroys the surrounding tissues, including nerves and auditory ossicles. As a result of the disease, the patient develops earache, tinnitus and dizziness. Treatment is based on a surgical procedure, i.e. excision of all diseased tissues.

Inactive types of otitis media

1.Tympanosclerosis – characterized by the formation of collagen-calcium deposits in the middle ear. In addition, dry perforation and low mobility of the tympanic membrane may occur due to its thickening and the presence of calcium deposits. Surgical treatment is not beneficial, wearing a hearing aid is recommended.

2. Atelektazja – it is an ailment characterized by drawing the eardrum into the tympanic cavity, then we are talking about retraction pockets (it is a kind of hernia). There is a risk of cholesteatoma, so retraction pockets should be checked periodically. Treatment is based on:

1. removal of the pharyngeal tonsil,
2. middle ear ventilation,
3. setting up a ventilation drain,
4. correction of a deviated nasal septum.

Diagnosis and treatment of chronic otitis media

The basis for diagnosis is to conduct a thorough medical interview with the patient. The patient describes the symptoms, their frequency and other relevant information. In addition, it is important to exclude other diseases – for this purpose, the so-called ear speculum. Doctors also perform:

1. otoscopy,
2. X-ray examination – to show bone destruction or the formation of new bone.

The type of treatment you get depends on the type of otitis media you have. In the presence of a tumor, it is imperative to perform myrinogoplastykiwhich consists in closing the perforated mucosa of the eardrum. In addition, it is important to cleanse the ear canal for exfoliated epithelium. In addition, the patient is prescribed special drops containing an antibiotic, which should be applied directly to the ear. The cholesteatoma of chronic otitis media requires surgical treatment (removal of the tumor).

The right type of treatment is very important as complications can occur. As mentioned above, the most common of these is mastoiditis. Treatment of complications should only take place in a hospital setting. If one or more of these symptoms occur during otitis media, the patient should be urgently transported to the hospital, to the otolaryngology ward.

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