Chronic exudative otitis media
Chronic exudative otitis media is an inflammatory phenomenon in the middle ear cavity, which is characterized by a violation of the patency of air to the tympanic cavity. The results of many studies indicate that preschoolers and schoolchildren often suffer from chronic exudative otitis media: about a quarter of all patients with chronic exudative otitis media are children under 5 years old. Many adults suffered from chronic exudative otitis media in early childhood.
The content of the article:
Causes of chronic exudative otitis media
Symptoms of chronic exudative otitis media
Diagnosis of chronic exudative otitis media
Complications of chronic exudative otitis media
Treatment of chronic exudative otitis media
Chronic exudative otitis media
The diagnosis of chronic exudative otitis media is determined if the duration of the disease exceeds 8 weeks. When the disease lasts from twenty days to two months, the diagnosis is “subacute exudative otitis media”, when up to three weeks — “acute exudative otitis media”.
Causes of chronic exudative otitis media
The main provoking factor of the appearance of inflammatory processes and their development in the middle ear cavity in chronic exudative otitis media will be the hardening of the mouth of the Eustachian tube located in the pharynx. This leads to various violations of the air permeability to the auditory tube and causes a decrease in pressure in the ear cavity. Another cause of inflammation of chronic exudative otitis media will be various kinds of infections in the auditory tube accompanying otolaryngological diseases, in which the nasal mucosa swells and the air passage through the Eustachian tube becomes more complicated. As a result, there is impaired ventilation of the middle ear and impaired patency of the auditory tube, which is the main symptom of chronic purulent otitis media. The following causes of the development of chronic exudative otitis media can be called respiratory infectious diseases and improper use of antibiotics, which do not eliminate the inflammatory process in the auditory tube, but contribute to the reproduction of viruses resistant to them. Chronic exudative otitis media is formed with functional and mechanical disorders in the Eustachian tube due to an increase in the pharyngeal tonsil. In rare cases, chronic exudative otitis media manifests itself after a barometric ear injury. All these factors lead to significant damage to the patency of the Eustachian tube, violations of the auditory function of the middle ear.
Symptoms of chronic exudative otitis media
In young children, chronic exudative otitis media proceeds without any special symptoms. The child does not complain of hearing impairment or unpleasant sensations in the ear area, which are accompanied by chronic exudative otitis media. But parents notice that the child often asks to repeat the said phrase. Children with chronic exudative otitis media are often inattentive, have poor academic performance at school, because due to hearing loss they cannot fully assimilate the received material.
Adult patients with chronic exudative otitis media complain of hearing impairment, congestion in the ears. Also, with chronic exudative otitis media, there is noise in the ear with sudden movements of the head, squelching when swallowing and blowing your nose. The patient may complain of difficulty breathing with nasal congestion. When turning and tilting the head, patients experience sensations of fluid transfusion and short-term hearing improvement.
Diagnosis of chronic exudative otitis media
As practice shows, the first call for the diagnosis of chronic exudative otitis media are patient complaints. It is especially difficult to diagnose a chronic disease in children, because it is difficult for a child to explain his feelings. Complaints of hearing fluctuation, ear congestion, and sometimes short-term pain are noted by children older than 5-6 years. Exudative otitis media in younger children is detected in most cases by otolaryngologists during examination.
To study changes in the tympanic membrane, otoscopy is used, which gives information about:
the color of the liquid in the tympanic cavity;
the location of air and exudate;
the presence of scars or foci of myringosclerosis;
thickening of the eardrum.
To confirm the diagnosis of chronic exudative otitis media, microtoscopy, acoustic tubosonometry, and a study of the auditory system are performed. To study the auditory tube, tympanometry and audiometry are used. Since chronic exudative otitis media is sometimes accompanied by mastoiditis, it is recommended that the patient have an X-ray of the temporal bones.
The otolaryngologist also needs to determine the stage of chronic exudative otitis media. Diagnosis also includes examination of the nose and pharynx. Taking into account the dynamics and degree of the inflammatory process, as well as the corresponding pathological changes in the eardrum, there are four stages of chronic exudative otitis media. The first stage of chronic exudative otitis media is secretory. During this period of the disease, mucus accumulates in the tympanic cavity, the number of secretory glands increases. During otoscopy at this stage of chronic exudative otitis media, the tympanic membrane has sharp contours, is retracted, and when the position of the head changes, the meniscus is visible — the level of fluid in the tympanic cavity. The color of the eardrum varies from pale gray to shades of blue. This stage of chronic exudative otitis media lasts up to 12 months. The second stage of chronic exudative otitis media is mucosal. The exudate in the tympanic cavity is viscous and thick, it sometimes lines the surrounding cavities of the middle ear, this period is characterized by significant violations of the auditory function of the ear. The eardrum is significantly thickened, bulging in the lower part. The mucous stage of chronic exudative otitis media lasts up to 24 months. The third stage of chronic exudative otitis media is fibrous, characterized by progressive hearing loss, transformation of the mucous membrane and the onset of inflammatory phenomena in the auditory ossicles.
Complications of chronic exudative otitis media
Complications after chronic exudative otitis media include adhesive otitis media. Adhesive otitis occurs when scars form in the tympanic cavity. Chronic exudative otitis media can turn into chronic forms of otitis media or into recurrent acute otitis media. Chronic exudative otitis media can also be the cause of microperforation of the eardrum. The transferred disease leads to the development of hearing loss and the appearance of tympanosclerosis. Chronic exudative otitis media is the cause of mastoiditis (subacute or chronic). After chronic exudative otitis media, the patient may experience the appearance of a choleastoma (a dense tumor-like formation that destroys the bone structures of the inner and middle ear). If drainage of the tympanic cavity does not lead to recovery of the patient, then exudative inflammation spreads to the areas of the mastoid process. In this course of events, an antrotomy is used, if necessary, mastoidotomy with drainage of the affected cells of the mastoid process. In the absence of proper treatment of exudative otitis media, it can cause the development of chronic ear diseases.
In children, the disease of chronic exudative otitis media very often entails not only a speech disorder, but also a delay in the mental development of the child.
Treatment of chronic exudative otitis media
Treatment of chronic exudative otitis media has the highest effectiveness if started in the early stages of chronic ear cavity disease. Chronic exudative otitis media is treated surgically and conservatively. The cause of violations of the function of the auditory tube are often pathologies of the pharynx and nose. Therefore, the treatment of chronic exudative otitis begins with the elimination of the inflammatory process. To do this, the pharynx, nose, and sinuses are sanitized. Then procedures are carried out to restore the auditory function of the ear and prevent the development of sclerotic changes. For the development of tubar function, ear blowing is performed using an ear catheter.
The most common drug treatment for chronic exudative otitis media, it involves the use of vasoconstrictors, antibacterial, anti-inflammatory (fenspiride), decongestant, hyposensitizing, enzyme, mucolytic (carbocysteine) therapy by patients. A month after undergoing conservative treatment for chronic exudative otitis media, the patient must undergo an examination of the auditory function of the ear. If chronic exudative otitis develops against the background of allergies, the patient is prescribed antihistamines (hifenadine, diphenhydramine).
The non-drug treatment of chronic exudative otitis media includes a set of physiotherapy procedures (hormonal and enzyme electrophoresis, endaural phonophoresis). Conservative methods of treatment are carried out on an outpatient basis. But if the use of a conservative method is not possible on an outpatient basis or the patient needs surgery, the patient is placed in a hospital.
Surgical intervention is necessary for patients who do not have an improvement in hearing, the fluid does not dissolve and the patency of the eustachian tube does not recover within two weeks. The most frequent surgical method of eliminating chronic exudative otitis media is bypass surgery of the tympanic cavity. Also, if standard methods of treating chronic exudative otitis media are ineffective, patients are prescribed surgical treatment (myringotomy, tympanostomy, tympanotomy).
Treatment of chronic exudative otitis media in children is limited to shunting of the tympanic cavity.
In case of repeated disease with chronic exudative otitis media, the patient undergoes computed tomography of the temporal bones to study the condition of the ear cavity. If it is necessary to restore the auditory function of the ear, the patient is prescribed tympanoplasty.
