Contents
What is purulent otitis
Purulent otitis media – This is an inflammatory process of an infectious nature, covering all the anatomical sections of the middle ear: the tympanic cavity, the auditory tube and the mastoid process.
Depending on the localization, three types of otitis media are distinguished:
External, arising mainly due to the ingress and accumulation of water in the ear canal;
Medium, which is a complication of diseases of the upper respiratory tract;
Internal, developing against the background of advanced chronic purulent otitis media.
Otitis externa most often affects people involved in swimming. Inflammation of the external auditory canal is limited, as a rule, mainly to skin manifestations: pustules, various rashes. Severe pain in the ear is usually accompanied by otitis media, so the term “otitis media” in most cases means otitis media.
This is a fairly common disease that can occur with varying degrees of severity. However, the lack of treatment can lead to the transition of the process to the chronic stage and the development of various complications, up to the formation of adhesions, hearing loss and complete hearing loss.
The main factors provoking the development of otitis media are respiratory viral infections (ARVI, influenza), inflammatory diseases of the nasopharynx and upper respiratory tract (sinusitis, rhinitis), and the presence of adenoids. Also here can be attributed insufficient hygiene of the ear cavity. 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 the villi of the epithelium, the excreted secret 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 often, infection of the middle ear occurs through an injured eardrum or mastoid process. This is the so-called traumatic otitis media. In diseases such as influenza, measles, scarlet fever, tuberculosis, typhoid, 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 pain in the ear, which may be aching, throbbing, or shooting;
Feeling of fullness and noise in the ear;
Discharge from the ears of a purulent nature;
Partial hearing loss;
Headache;
High fever, general malaise.
As a result of inflammation of the mucous membrane of the auditory tube, it thickens, the tympanic cavity is filled with exudate and swells. During the pressure of the purulent fluid, the tympanic membrane is perforated and the pus flows out.
Mucopurulent discharge after rupture of the tympanic membrane is at first abundant, then becomes thicker and scarce. As the inflammatory process subsides, the outflow of pus gradually stops. Perforation of the tympanic membrane undergoes scarring, but the feeling of congestion remains for some time.
During purulent otitis media, it is customary to distinguish three stages:
preperforative stage. At this stage, the symptoms are pronounced: a sharp, growing pain in the ear, which can radiate to the temple or crown; soreness of the mastoid process during its palpation; hearing impairment; temperature rise to 38-39 °C.
perforative stage. After the rupture of the eardrum, the flow of pus begins (possibly with an admixture of ichorus), the pain in the ear gradually subsides, the body temperature drops.
reparative stage. The outflow of pus stops, with scarring of the perforation of the tympanic membrane, hearing is gradually restored.
This course of the disease is not necessarily typical. At any stage of the process, acute otitis media can turn into chronic, with mild symptoms. If this is observed at the first stage, then perforation of the tympanic membrane does not occur, viscous, thick mucus accumulates in the tympanic cavity, which is difficult to be evacuated.
If perforation does not occur for a long time during the acute course of the disease, then due to the increasing volume of exudate in the middle ear, severe headaches, dizziness, high fever, vomiting and a serious 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 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. A massive outflow of pus of a pulsating nature may indicate an extradural abscess (accumulation of exudate between the inner surface of the temporal bone and the meninges).
The general clinical signs of the disease are characterized by moderate or severe leukocytosis (depending on the severity of its course), a shift in the leukocyte formula, and an increase in ESR. Severe leukocytosis in combination with eosinopenia may be a sign of mastoiditis or infection in the cranial cavity.
The acute stage of otitis media 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 antibiotic therapy.
Acute and chronic suppurative otitis media
Acute suppurative otitis media
The acute form of the disease occurs as a result of the pathogenic environment entering the middle ear through the auditory tube in 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:
I stage (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 (to the temple, teeth, occiput), as well as a significant hearing loss. On examination, dilated blood vessels, hyperemia of the tympanic membrane 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 perforation of the eardrum occurs and the outflow of pus begins, the swelling of the eardrum decreases. The pain gradually subsides, but may recur with a delay in the outflow of pus.
III stage 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 the auditory tube leads to their swelling. The mucous membrane of these departments is quite thin, and its lowest layer acts as a periosteum. As the pathological process develops, the mucous membrane noticeably thickens, erosions appear on its surface. The middle ear is filled with exudate, which at first has a serous character, and later becomes purulent. At the peak of the process, the tympanic cavity is filled with purulent fluid and an enlarged mucous membrane, which leads to its bulging. The eardrum may be covered with a whitish coating. Pain occurs due to irritation of the receptors of the glossopharyngeal and trigeminal nerves, noise and congestion in the ear – due to limited lability of the tympanic membrane and auditory ossicles. Under the pressure of the exudate, the eardrum bursts, and the outflow of pus begins, which lasts about 6-7 days.
Over time, the amount of secretions decreases, their consistency becomes thicker. The resulting perforation is usually small, round, and accompanied by tissue defects. Perforations in the form of slits without membrane defects are less common. 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 tympanic membrane passes. As the perforation heals, hearing is gradually restored. Small perforations, up to 1 mm in size, overgrow fairly quickly and without a trace. With large perforations, the fibrous layer usually does not recover, and the hole in the membrane is closed with a mucous layer from the inside and an epidermal layer from the outside. Such a section of the membrane looks atrophic, there are deposits of lime salts in the form of white spots on it. With pronounced tissue defects, perforations often do not heal; in this case, along the edge of a 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 suppurative otitis media
Chronic otitis media– this is an inflammation of the middle ear, which is characterized by a recurrent course of pus from the ear cavity, persistent perforation of the tympanic membrane and progressive hearing loss (hearing loss can reach 10-50%).
Chronic otitis media develops with delayed or inadequate treatment of acute otitis media. It can be a complication of chronic rhinitis, sinusitis, etc., or a consequence of a traumatic rupture of the eardrum. Chronic otitis media 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 danger to health and even life.
As a result of bacteriological culture in chronic purulent otitis, aerobic microorganisms such as pseudomonas, staphylococci, pneumococci are found. Anaerobic bacteria, which are detected in 70-90% of patients, are represented by fusobacteria, peptococci, lactobacilli. With prolonged use of antibiotics and hormonal drugs, fungal microorganisms occur: fungi of the genus Candida, Aspergillus, and molds.
The transition of acute otitis into chronic is usually caused by the following adverse factors:
Low resistance of the body to infections and weakened immunity;
Incorrect selection of antibacterial drugs, to which associations of pathogens are resistant;
Pathologies of the upper respiratory tract (curvature of the nasal septum, adenoids, chronic rhinitis and sinusitis);
The presence of concomitant diseases, especially such as blood diseases, diabetes mellitus.
Concomitant ENT diseases contribute to the disruption of the drainage function of the auditory tube, which makes it difficult for the outflow of pus from the tympanic cavity, and this, in turn, prevents the timely healing of the perforation that has appeared in the tympanic membrane. In some cases, the inflammatory process in the middle ear becomes chronic from the very beginning. This is most often observed in perforations that form on a loose area of the eardrum, as well as in people with tuberculosis, diabetes, and in the elderly.
Chronic otitis media is divided into two forms, depending on the severity of the disease and the localization of the perforation of the tympanic membrane:
Mesotympanitis. This is a milder form of the disease, in which the mucous membrane of the auditory tube and tympanic cavity is predominantly affected. The perforation is located in the central, stretched area of the tympanic membrane. Complications in this case are much less common.
epitympanitis. With this form of the disease, in addition to the mucous membranes, the bone tissue of the attic-antral region and the mastoid process is involved in the inflammatory process, which may be accompanied by its necrosis. Perforation is located in the upper, loose area of the tympanic membrane, or covers both of its departments. With epitympanitis, such severe complications as sepsis, meningitis, osteitis, brain abscess are possible, if purulent exudate enters the blood or meninges.
Complications and consequences of purulent otitis media
The lack of treatment for purulent otitis media 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 – inflammation of the mastoid process of the temporal bone, accompanied by accumulation of pus in its cells and subsequent destruction of the bone itself;
Paralysis of the facial nerve;
Ostitis (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 libyrinthitis, an inflammation of the inner ear and, later, to intracranial complications, which include:
Meningitis – inflammation of the lining of the brain;
Encephalitis – inflammation of the brain;
Hydrocephalus is an excessive accumulation of cerebrospinal fluid in the brain.
Labyrinthitis and intracranial complications are quite rare, but you need to know that such a risk exists. Therefore, when symptoms of otitis media appear, you should contact a medical facility with an otolaryngologist to prescribe the appropriate treatment. Treatment of otitis media 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 average otitis usually does not present difficulties. The diagnosis is made on the basis of complaints and the results of otoscopy (visual examination of the ear cavity with a special instrument). If a destructive process in the bone tissue is suspected, an x-ray of the temporal bone is performed.
Purulent otitis is treated on an outpatient basis, at high temperature in combination with fever, bed rest is recommended. Hospitalization required if mastoid involvement is suspected.
Treatment for otitis media includes:
Antibacterial drugs;
Vasoconstrictor or astringent drops;
Anesthetics.
The tactics of treatment is determined depending on the stage of the disease and the severity of the symptoms:
Preperforative stage characterized by a strong pain syndrome, for the relief of which osmotic preparations are used: a 3% alcohol solution of boric acid or levomycetin 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 forbidden to use it at the perforative stage. These drops are instilled into the sore ear heated to a temperature of 38-40 ° C two to three times a day, after instillation, the ear canal is closed with a cotton swab with petroleum jelly.
To stimulate the drainage function, vasoconstrictor drops are used (Otrivin, Sanorin, Naphthyzin, Galazolin, etc.), which are instilled into the nose three times a day in the supine position, while the head should be tilted towards the sore ear. You can not blow your nose intensively, as well as draw the contents of the nose into the nasopharynx, as this leads to additional infection of the auditory tube.
Paracetamol or Diclofenac can be taken orally as pain relievers.
Perhaps the local application of a warming alcohol compress in order to accelerate the resolution of the inflammatory process. But if the pain in the ear increases, the compress should be removed immediately.
If necessary, paracentesis is performed (artificial puncture of the eardrum to allow the outflow of pus).
At the perforation stage continued use of vasoconstrictor nasal drops, antibacterial and antihistamines. With abundant outflow 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 (UVI, UHF, microwave) or hot compresses on the ear area at home have a positive effect. The patient must independently remove purulent discharge from the ear canal at least twice a day. You can do this with 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% hydrogen peroxide solution 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% dioxidine solution, 20% sodium sulfacyl solution, etc. Drops with an alcohol content at the perforative stage do not apply as it causes severe pain.
At the reparative stage stop the use of antibiotics, thermal physiotherapy, mechanical cleaning of the ear canal. 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 tympanic membrane and auditory ossicles. However, to prevent adhesions, enzyme preparations, pneumomassage of the tympanic membrane, endaural iontophoresis with lidase can 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, since it is active against a wide range of infectious pathogens (staphylococci, Escherichia 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, dyspepsia. If it is impossible to use Amoxicillin or if there is no effect within three days of taking it, any of the following drugs is prescribed.
Augmentin. This drug is a combination of amoxicillin and clavulanic acid. It is 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 in the form of injections (cefuroxime sodium salt), if Amoxicillin and Augmentin were ineffective. For oral administration, cefuroxime axetil 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; impaired renal function.
Ampicillin. It is used in the form of intramuscular injections. Contraindications: hypersensitivity to the drug, liver dysfunction, pregnancy. Side effects: dysbacteriosis, candidiasis, dyspepsia, allergic reactions, disorders of the central nervous system.
Phenoxymethylpenicillin. It is taken 3 times a day for 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 at 1,5 million IU orally twice a day. Contraindications: hypersensitivity, lactation period, obstruction of the bile ducts. Side effects: nausea, diarrhea, esophagitis, colitis, skin rash.
Azithromycin. It is taken once a day for 1 mg. Contraindications for Azithromycin: hypersensitivity to macrolides, severe functional disorders of the liver and kidneys, arrhythmia. Side effects: headache, dizziness, nausea, increased fatigue and nervousness, tinnitus, conjunctivitis.
Цефазолин. Semi-synthetic antibiotic belonging to the group of cephalosporins of the first generation. It is used in the form of intramuscular injections. Contraindications: hypersensitivity to cephalosporins, bowel disease, renal failure, pregnancy, lactation. Side effects: dyspepsia, allergic reactions; convulsions; dysbiosis, stomatitis (with prolonged use).
Ciprofloxacin. It is taken 2 times a day, 250 mg. Contraindications for Ciprofloxacin: pregnancy, lactation, epilepsy. Side effects: mild skin allergy, nausea, sleep disturbances.
Ceftriaxone. This is an intramuscular drug that is the antibiotic of last resort due to the large number of 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, with purulent otitis media, antibiotics are used in the form of ear drops:
NorfloxacinNormaks ear drops have a broad antibacterial effect. Side effects: small skin rash, burning and itching at the application site. Use according to instructions.
Candibiotic. The composition of these drops includes several antibiotics at once: beclomethason dipropionate, chloramphenicol, as well as the antifungal agent clotrimazole and lidocaine hydrochloride. Contraindications: pregnancy, lactation. Side effects include allergic reactions.
Netilmicin. It is a semi-synthetic antibiotic from third generation aminoglycosides. Netilmicin ear drops are more 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, as they do not penetrate deep into the ear canal.
Even with a significant improvement in the course of treatment and the weakening or disappearance of local symptoms, it is impossible to stop the course of taking antibacterial drugs ahead of schedule. The duration of the course should be at least 7-10 days. Premature cancellation of antibiotics can provoke a relapse, the transition of the disease into a chronic form, the formation of adhesive formations in the tympanic cavity and the development of complications.
[Video] Dr. Berg – Best NATURAL Otitis Remedy: