Acute otitis media

Acute otitis media
Acute otitis media is an infectious disease characterized by a rapid course that affects the middle ear cavity. Clinically, the disease is manifested by pronounced specific pain, a feeling of a blocked ear and a characteristic incessant noise. There may also be a decrease in hearing, the formation of a perforated hole in the eardrum itself with further leakage of pus from it.

The content of the article:
Causes of acute otitis media
Symptoms of acute otitis media
Diagnosis of acute otitis media
Treatment of acute otitis media
Prognosis of acute otitis media
Acute otitis media
The basis for the diagnosis of acute otitis media is the data obtained after taking a clinical blood test. It is also possible to diagnose the disease with the help of various hearing studies, X-rays of the skull, rhinoscopy and pharyngoscopy and examination of the auditory tube. Treatment of acute otitis media is carried out with antibiotics, anti-inflammatory drugs and antihistamines. Local therapy involves blowing the auditory tube, as well as instilling the ear with ear drops. Washing of the tympanic cavity and the introduction of proteolytic enzymes is also part of the mandatory treatment.

As you know, acute otitis media is one of the most common pathologies in pediatric and adult otolaryngology. Acute otitis media is the most common form of otitis media. According to the frequency of manifestations in men and women, it can be said that this form of otitis occurs equally often in both sexes. In recent years, world practice has shown a frequent tendency of acute otitis media to the most sluggish course in adults, but also to frequent recurrence in young children. It should be said that it is in children that the involvement of the antrum (that is, the cave of the mastoid process) is often observed, which is explained by the peculiarities of the structure of the child’s ear. Acute otitis media can be a complication after eustachiitis, aerotitis, various ear injuries and an exudative type of otitis media.

Causes of acute otitis media
About 63% of acute otitis media are caused by streptococcal infection. Also, the causative agents of this type of otitis can be pneumococci and staphylococci. Rarely, but it happens that otitis occurs due to diphtheria bacillus or mushrooms.

Most often, pathogens of acute otitis media penetrate into the tympanic cavity tubogenically, that is, through the auditory (or Eustachian) tube. As you know, it is the auditory tube that is the barrier that protects the middle ear from the ingress of various microorganisms from the nasopharynx. But in the case of the course of various diseases, the function of the auditory tube may weaken. This will lead to the spread of infection in the tympanic cavity with the further development of acute otitis media.

Factors that cause dysfunction of the auditory tube are inflammatory diseases of the upper respiratory tract (this includes ozen, laryngitis, rhinitis, pharyngitis, sore throat, laryngotracheitis, tonsillitis, adenoids and others). Also, a benign or malignant tumor of the pharynx (fibroma, angioma, neurinoma) and nose may be a factor causing a violation of the function of the auditory tube. Unsuccessful surgical intervention in the pharyngeal and nasal cavity can also be one of the reasons for such therapeutic actions as, for example, purging, catheterization of the auditory tube, tamponade for nosebleeds.

Acute otitis media can also develop when the tympanic cavity is infected, for example, by the transtimpanal route, in other words, by way of a damaged area of the tympanic membrane. The latter can happen if a foreign body gets into the ear, as well as with injuries. The patient may also encounter a hematogenic infection of the middle ear cavity. This variant occurs during the course of common infections (influenza, measles, rubella, scarlet fever, syphilis, diphtheria, tuberculosis). What relates to casuistic cases is expressed in the occurrence of acute otitis media due to the penetration of infection from the side of the skull or even the inner ear.

The state of human immunity also matters. With reduced immunity, saprophytic flora entering the tympanic cavity from the nasopharynx can become the main cause of infection, which will lead to acute otitis media. Not so long ago it was proved that the cause of the occurrence and development of this disease can be a common ear allergy, which is a manifestation of a systemic type of allergy, along with allergic rhinitis, diathesis, bronchitis of asthmatic nature and bronchial asthma itself. A significant role in the occurrence and subsequent development of otitis media is assigned to unfavorable environmental conditions, which may be hypothermia, sudden temperature changes or pressure drops.

Symptoms of acute otitis media
As a rule, acute otitis media lasts no more than 3 weeks. There are three stages of acute otitis media: the initial stage (or pre-perforative), the second stage (perforative) and the third stage (reparative). Each stage is characterized by its own special clinical manifestations. If treatment is started in a timely manner, the course of acute otitis media can become abortive. So, let’s take a closer look at each stage.

Pre – perforative stage
The pre-perforative stage can last from several hours to several days. This stage is characterized by a sudden appearance accompanied by intense pain in the ear, as well as general symptoms. Ear pain is explained by the increasing infiltration in the mucous membrane, which lines the tympanic cavity. As a result, irritation of the nerve endings of two nerves begins — the trigeminal and the pharyngeal. Ear pain is always acute and sometimes has an unbearable character, which causes a violation or complete lack of sleep and a decrease in appetite. Pain can usually radiate to the parietal and temporal regions. Pain syndrome in patients suffering from acute otitis media is often accompanied by congestion and noise, as well as hearing loss. This is due to a decrease in the mobility of the auditory ossicles, which are located in the tympanic cavity and are responsible for the quality of sound transmission. Mobility decreases due to the spread of inflammatory changes.

Among the common manifestations of acute otitis media, the following can be distinguished: an increase in body temperature to 39 degrees, chills, a feeling of general weakness, fatigue and a broken state. If acute otitis media is influenza, measles or scarlet fever, then labyrinthitis and hearing loss due to sound perception disorders are added to the general symptoms.

Perforating stage
The perforative stage in acute otitis media occurs at the moment when the tympanic membrane ruptures due to the accumulation of a significant amount of pus in the tympanic cavity. The hole that has formed in the eardrum begins to serve as an outlet for purulent and sometimes blood secretions. At the same time, the patient feels a noticeable improvement in his condition — he ceases to feel pain acutely. The body temperature drops, and the pain in the ear is dulled. The outflow of pus lasts about a week, after which the disease passes to the third stage.

The reparative stage
The reparative stage of acute otitis media differs from the previous two by a sharp decrease in the amount of pus in the ear cavity. At this stage, many patients have scarring of the perforation, which is a spontaneous factor. Scarring occurs in the eardrum, which leads to a complete restoration of hearing. If the size of the perforation is more than one millimeter, then the restoration of the fibrous layer of the tympanic membrane does not occur. In case of overgrowth of the hole, the place that is the site of perforation will remain atrophic and thinner, since it will be formed only by the mucous and epithelial layers, not including the fibrous component. It should also be said that large perforations of the tympanic membrane will not close, and the outer epidermal layer of the membrane will fuse with the inner layer of the mucous membrane, while forming the edges of the residual perforating hole.

Diagnosis of acute otitis media
The diagnosis of acute otitis media is established by an otolaryngologist. This happens on the basis of a description of the patient’s complaints, also on the basis of otoscopy, microtoscopy and various hearing studies. Usually, in the blood test of patients suffering from acute otitis media, moderate leukocytosis and acceleration of the ESR index can be detected. In more severe forms of acute otitis media, doctors detect leukocytosis with a characteristic shift of the formula to the left, as well as a significant acceleration of the ESR index. A bad indicator that will indicate developing mastoiditis is missing eosinophils.

Of course, the results of otoscopy of acute otitis media will depend on the stage of the disease. At the initial stage, the injection of radical vessels penetrating the eardrum is usually determined. Further, concomitant hyperemia will be characterized by spillage, infiltration will be noted, as well as possible protrusion of the membrane to the side of the auditory canal. Occasionally there is a white plaque. During otoscopy, a slit-like perforation characteristic of the tympanic membrane is usually visible at the perforating stage. There is also a pulsating light reflex, in other words, synchronous pulsation of pus and pulse. Sometimes the development of the disease at this stage is characterized by prolapse by means of a perforated opening of the mucous membrane in the tympanic cavity. As for the reparative stage of acute otitis media, otoscopy makes it possible to distinguish the growth of perforation and the sealing of the edges.

Treatment of acute otitis media
Treatment of acute otitis media is prescribed depending on the stage of the disease. Usually, treatment takes place on an outpatient basis. If the treatment does not lead to recovery or complications appear, the patient is transferred to the hospital.

In order to stop the pain syndrome even at the pre-perforative stage, doctors use drugs that contain anesthetics for treatment. Usually such drugs include ear drops such as otinum, otipax and anauran. It is necessary to instill it only after the medicine is heated to a temperature of at least 38 degrees. After instillation, it is necessary to close the auditory canal with cotton wool. The patient will be able to remove the cotton wool after a couple of hours. Turunds are also often used, which are pre-moistened in alcohol or in a solution of boric acid. In order to relieve swelling, as well as improve drainage function in the auditory tube, an otolaryngologist prescribes antihistamines and vasoconstrictor drops, for example, sanorin, tizin, nazivin or galazolin.

If we talk about general therapy, it is carried out using anti-inflammatory drugs such as diclofenac, nurofen, ibufen. If the patient’s body temperature is elevated and pain syndrome is intensively overcome, then antibiotics (amoxicillin, spiramycin, augmentin and cefuroxine) are used. The use of antibiotics usually stretches for at least 7 days. It should be remembered that the unauthorized cessation of the use of antibiotics can be fraught with the occurrence of relapses and various kinds of complications. Also, otitis media can become chronic, and the formed adhesions in the tympanic cavity and scars on the eardrum can cause a decrease in the patient’s hearing acuity.

If the patient’s disease is at the preperforative stage of acute otitis media, then the most effective method of treatment will be blowing the auditory tube, as well as washing the middle ear with certain solutions of antibiotics, combining them with glucocorticosteroid drugs. If, during the treatment of a patient with acute otitis media, an otolaryngologist observes a protrusion of the eardrum, then this indicates that too much pus has accumulated in the tympanic cavity. This condition is dangerous for the development of complications, which means that paracentesis of the tympanic membrane is necessary for treatment.

If we are talking about the perforating stage of acute otitis media, then in addition to the use of antihistamines, antibacterial and vasoconstrictors, the otolaryngologist prescribes the toilet of the outer ear, as well as the administration of drugs in a transtimpanal way. In order to reduce swelling, as well as the secretion of mucosal secretion, erespal is usually used. In order to dilute the thick secret, mucolytics are used (for example, flumucil). At this stage, UHF, laser therapy and UFO are also prescribed.

As for the traditional treatment of acute otitis media in the reparative stage, the treatment will be aimed primarily at preventing the possible formation of adhesions, as well as restoring the natural function of the auditory tube, increasing the body’s defenses. To achieve this goal, the auditory tube is blown, proteolytic enzymes are injected into the tympanic cavity, pneumomassage of the eardrum itself is performed, vitamin therapy, ultraphonophoresis and more are performed.

Prognosis of acute otitis media
If competent treatment is carried out in a timely manner, the culmination of acute otitis media will be a complete recovery and final restoration of hearing. If a patient suffering from acute otitis media turns to a doctor late, then recovery will be accompanied by possible complications. The occurrence of complications is also influenced by various unfavorable external conditions, low immunity and more.

It should be said that acute otitis media in the course of its development can be transformed into chronic purulent otitis media. The latter, as a rule, is accompanied by hearing loss, which progresses all the time, and possible relapses of suppuration. It also happens that the inflammatory process can lead to the appearance of scars and adhesions in the tympanic cavity, which will disrupt the mobility of the tympanic bones and cause the transition of the classical form of otitis media into adhesive otitis media, characterized by persistent hearing loss.

In rare cases, acute otitis media will be accompanied by the development of a number of complications, including mastoiditis, purulent labyrinthitis, facial nerve neuritis, meningitis, petrositis, as well as sigmoid sinus thrombosis, sepsis and brain abscess. Each of these complications can lead to a fatal outcome. Therefore, as soon as the patient discovered the first symptoms of acute otitis media, felt a strong piercing pain that abruptly appeared in the ear cavity, it is necessary to immediately seek medical help and not self-medicate in order not to start his disease.

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