Adhesive otitis media

Adhesive otitis media is an inflammatory chronic process in the middle ear that leads to the formation of connective tissue cords and adhesions. This disease provokes a violation of the mobility of the auditory ossicles and the patency of the auditory tube.

The content of the article:
Causes of adhesive otitis media
Symptoms of adhesive otitis media
Diagnosis of adhesive otitis media
Treatment of adhesive otitis media
Prognosis of adhesive otitis media
Adhesive otitis media
The middle ear consists of two parts — this is the tympanic cavity, where the auditory bones (stirrup, anvil and hammer) and the auditory tube are located. The tympanic membrane serves to separate the tympanic cavity and the auditory tube. In addition, thanks to it, sound vibrations are transmitted to the auditory bones. The vibration then passes through the bones to the structures of the inner ear, which are directly responsible for the transmission and sound perception of sound signals along the auditory nerve. Only then does the sound enter the corresponding part of the brain.

Adhesive otitis media is characterized by the fact that hearing decreases under the influence of reduced mobility of the tympanic membrane and auditory ossicles. This occurs as a result of a violation of the mechanism of sound transmission from the eardrum to the cochlea of the inner ear. But over time, the disease can lead to sound perception disorders.

Causes of adhesive otitis media
The most common cause of adhesive otitis media is chronic tubotitis, catarrhal or exudative nonperforative otitis. After these diseases, the development of adhesive otitis media can be provoked by irrationally conducted antibiotic therapy. As a result, the inflammatory process expands, and the exudate accumulated in the tympanic cavity resolves. Patency is disrupted, as scar strands and connective tissue adhesions are formed in it, a thread of fibrin remains. Adhesions and scar cords are attached to the eardrum and entwine the auditory ossicles, blocking the mobility of these structures, without which normal sound transmission is impossible. At the same time, strands and adhesions of adhesive otitis media are formed in the auditory tube, which violates its patency.

In clinical otolaryngology, there are often cases when otitis media occurs as an independent disease, without previous chronic or acute otitis. In such situations, pathological processes that prevent normal ventilation of the tympanic cavity and complicate the patency of the auditory tube have a decisive influence on its occurrence. These include:

chronic tonsillitis;
acute diseases of the upper respiratory tract (pharyngitis, ARVI, laryngitis, tracheitis);
adenoids;
hypertrophic changes of the lower nasal conchs;
chronic inflammatory processes of the nasal cavity and paranasal sinuses (sinusitis, sinusitis, rhinitis);
curvature of the nasal septum;
tumors of the pharynx and nasal cavity.
Symptoms of adhesive otitis media
With adhesive otitis media, the main complaints of the patient are hearing loss and noise inside the ear. In the anamnesis, with a more detailed inquiry, chronic or acute otitis media noted earlier are revealed. With adhesive otitis media, the study of hearing determines the conductive nature of hearing loss — hearing decreases due to a violation of sound conduction.

The clinical symptoms of adhesive otitis media are similar to the picture of other ear diseases. That is why a number of diagnostic measures are used to diagnose the causes of hearing changes. Due to this, it is possible to exclude other pathological processes leading to conductive hearing loss (tubotitis, traumatic damage to the structures of the middle ear, sulfur plugs, otosclerosis, etc.).

Diagnosis of adhesive otitis media
In case of adhesive otitis media, the diagnostic examination includes:

determination of the patency of the eustachian tube;
visual examination by an otolaryngologist;
microtoscopy;
otoscopy;
impedance measurement;
endoscopic catheterization of the auditory tube;
audiometry.
In patients with adhesive otitis media, audiometry reveals hearing loss of varying degrees, even complete deafness. A trial purge of the Politzer is carried out to determine the patency of the auditory tube. As a rule, with adhesive otitis media, this gives a weak result or has no effect at all. But this is not always a sign of obstructed patency. Such a violation is detected by catheterization of the tube with otoscopic control.

In the diagnosis of adhesive otitis media, the most important point is to identify the characteristic otoscopic picture of the disease. The presence of cicatricial changes or turbidity of the tympanic membrane can be determined by otoscopy (with magnification or simple). It is worth noting that such deviations often lead to deformation of the membrane. Adhesions and cords are also visualized in the cavity of the auditory tube, which can sometimes completely obliterate its lumen.

The mobility of such parts of the ear as the auditory bone and the tympanic membrane is examined during acoustic impedance measurement. The essence of the study is the discharge and thickening of the air in the auditory tube. As a result of this process, the eardrum retracts and straightens. The movements of the membrane with adhesive otitis media are limited or completely absent, and there are also no acoustic muscle reflexes.

Treatment of adhesive otitis media
In the treatment of adhesive otitis media, the first stage is the elimination of factors that lead to impaired patency of the auditory tube. So, this includes adenotomy in children, rehabilitation of the nasal sinuses and nasopharynx, restoration of normal breathing through the nose (elimination of hypertrophy of the nasal concha and curvature of the nasal septum).

With adhesive otitis media, a positive effect is provided by a course of purges by Politzer, which is combined with a pneumatic massage of the eardrum. Transtubar administration of fluimucil, lidase, hydrocortisone, chymotrypsin is also practiced through a catheter. For patients diagnosed with otitis media, aloe, parenteral use of FiBC, ATP, B vitamins, etc. is recommended to stimulate the body’s protective reactions. Treatment of adhesive otitis media is difficult to imagine without antihistamines.

Physiotherapeutic treatment is an adjunct to the drug therapy of adhesive otitis media. Microwave therapy, mud therapy, UHF, ultrasonic massage of the rolls of the auditory tube are used. The introduction of lidase and potassium iodide is carried out by endural electrophoresis and ultraphonophoresis.

Conservative treatment of adhesive otitis media is often ineffective. Surgical treatment is indicated in such cases and with progressive hearing loss. Conducting a tympanotomy with restoration of the mobility of the auditory ossicles and dissection of the scar-adhesive cords often gives only a temporary result. The fact is that in most cases, after surgery, there is a re-formation of adhesions. Tympanoplasty is more effective with the replacement of the auditory ossicles with artificial ones. With bilateral adhesive otitis media with pronounced hearing loss, as well as elderly patients, hearing replacement is prescribed.

Usually, courses of complex treatment are repeated 2-3 times a year. It all depends on the specific case and the individual characteristics of the patient.

Prognosis of adhesive otitis media
Patients who have suffered acute otitis media, even with the normalization of the otoscopic picture and hearing, should be under the supervision of an otorhinolaryngologist for 6 months. At the end of this period, it is necessary to undergo an additional thorough examination to make sure that there are no changes in the ear (slight hearing loss, violation of tubar function, change in the otoscopic picture, etc.).

If certain deviations have been identified, the course of treatment should be repeated:

blowing the auditory tube;
biostimulants;
pneumomassage of the eardrum and more.
In some cases, repeated surgery is prescribed (tympanotomy, bypass surgery of the tympanic cavity).

Adhesive otitis media in the future can provoke fibrinous scarring changes in the structures of the middle ear. Unfortunately, these changes are irreversible. It is recommended to stop this process as soon as possible. Due to this, the patient’s hearing loss, which develops as a result of the disease, will be less pronounced.

With a prolonged course of the disease, in advanced cases, untimely or inadequate treatment, adhesive otitis media can cause complete ankylosis (immobility) of the joints of the auditory ossicles. All this further leads to deafness.

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