Chronic otitis media: symptoms and treatment

Chronic otitis is an inflammatory disease of the middle ear, which is characterized by the formation of a hole in the tympanic membrane with a constant or recurrent release of pus from the ear.



Etiology

Chronic otitis media develops on the basis of an acute form of the disease and with frequent episodes of inflammation of the tympanum. The initial reasons for the formation of such an ailment are infection or mechanical damage.

Pathogenic microbes first affect the tympanic membrane, nasopharynx, and then the ear. Often doctors diagnose the progression of the disease in humans due to the multiplication of bacteria such as streptococci, as well as influenza, parainfluenza and rhinovirus.

The disease is formed in the human ear for certain reasons:


  • scars in the ear due to relapse of exacerbation
  • auditory tube dysfunction;
  • diseases of an infectious nature, for example, scarlet fever

Also a provocative factor can become frequent smokers at once with two nostrils. Nasal and ear canals are interrelated, so if the nasal mucosa is affected or sinusitis begins, then it is possible otitis development.

The reasons for the transition of acute otitis to chronic can be:


  1. inflammatory diseases of the ENT organs
  2. obstruction of nasal breathing;
  3. diabetes;
  4. Immunodeficiencies
  5. prolonged use of chemotherapy;
  6. nicotine and alcohol
  7. an unbalanced diet
  8. inappropriate climate.

In children, chronic purulent otitis media develops from an infection that affects unstable immunity. Also, a provoking factor may be features of the structure of the ear and nasal septum, malnutrition and lack of vitamins in the body. To promote the progression of the disease can:


  • hypothermia
  • pressure drops
  • cold;
  • ingress of water into the ear.

Classification

Clinicians have established that chronic otitis occurs in 3 species:


  1. chronic purulent otitis media (HGCO) — is provoked by bacteria. It is divided into two subtypes: mesotympanitis, in which only the drum cavity is damaged, and the bone does not become inflamed, and epitimpanitis, characterized by bone damage,
  2. exudative otitis — for two or more months, a viscous fluid accumulates in the tympanum. In this case, the membrane is not damaged, but the person can severely disrupt the work of the auditory tube;
  3. chronic adhesive otitis — scars appear in the tympanum, as well as on the membrane, all the auditory ossicles coalesce, which causes a significant deterioration in hearing. Progression of this form from frequent relapses of the disease or with a prolonged course of the exudative form.

On the direction of the pain syndrome, doctors share three main types:


  • external — often formed from mechanical damage to the auricle and external auditory canal
  • Medium — appearance in the tympanum, auditory tube and mastoid process
  • internal — untreated otitis of the previous form provokes damage to the vestibular apparatus

At the time of exacerbation, pathology passes through several stages of development:


  1. inflammatory, also called eustachiitis, — inflammation in the auditory tube is formed
  2. catarrhal, inflammation begins on the middle ear shell
  3. deformative, manifested in the form of purulent clots in the middle ear;
  4. postperforative, purulent clusters begin to flow out of the ear;
  5. reparative, inflamed areas are reduced, the affected areas are tightened by scars.

Symptoms

Chronic otitis manifests itself in a variety of symptoms, which differ depending on the stage of exacerbation and the location of the focus of inflammation. Doctors note the main morphological signs of otitis progression — non-healing damage in the tympanic membrane, temporary purulent clusters and discharge from the ear and deterioration of hearing.

Depending on the location of the inflammation focus, the patient may experience different symptoms. The clinical picture with the progression of external otitis is a severe pain syndrome in the auricle, which increases with pressure drops. Also, discomfort is felt when opening the oral cavity and with the introduction of a special apparatus for examining the affected area. The external shell is noticeably swollen and reddens.

Clinical manifestations of chronic otitis media of the middle ear differ depending on the stage of development:





  • Stage 1 — lays the ears, the temperature does not go up, the noise and ringing in the ears, pain syndrome
  • Stage 2 — the stuffiness of the affected ear is increasing, the pain is intense, piercing and there is an unpleasant noise, the body temperature may rise
  • Stage 3 — purulent formations appear in the middle ear, pain syndrome progresses and changes to teeth, eyes and neck, body temperature is very high, hemorrhage to the eardrum is noted, hearing may vanish
  • Stage 4 — pain syndrome and noise decrease, but purulent inflammation intensifies, pus begins to flow out of the auricle
  • Stage 5 — the intensity of symptoms is reduced, hearing loss may occur.

The development of internal otitis can be recognized by dizziness, nausea, vomiting, disturbed balance during walking, severe noise in the ears and hearing impairment. Also, when this form of ailment appears, symptoms of a worsening of the middle ear will appear.

Diagnostics

During the diagnosis of chronic purulent otitis, it is important for the doctor to clarify complaints, to collect an anamnesis of the disease and the life of the patient. For this, the physician needs to know:


  1. were there purulent discharge in the patient from the auricle
  2. hearing loss decreased
  3. how long the symptoms have become acute;
  4. were there relapses of inflammation, and how the disease progressed
  5. Are there chronic ailments and disorders in nasal breathing

Then the ear canal is examined — the otoscopy. If there is pus or sulfur plugs in the ear canal, it must be removed so that the doctor can carefully examine and analyze the condition of the tympanic membrane and auditory canal.

It is also important to determine the hearing of the patient by conducting tuning fork tests and audiometry.

In the whole tympanic membrane, the patient undergoes tympanometry, due to which it is possible to determine the mobility of the membrane. If there is fluid in the cavity or scars formed, the mobility of the membrane can be reduced or completely absent. This can be seen from the curved shape of the tympanogram.

To detect the bacteria that caused the development of the pathology, the doctor makes a smear from the ear.

Tomography of temporal bones and vestibular samples can also be performed.

If necessary, the patient can refer to a consultation with a neurologist.

Treatment

At times of exacerbation of symptoms, a person is concerned about issues related to how to treat chronic otitis media. To cure this form of pathology, the patient needs a considerable period of time, and sometimes also surgical help. Drug therapy is often prescribed together with traditional medicine, but non-traditional drugs do not need to be taken without doctor’s advice. The patient can only aggravate his condition and provoke the development of complications.

Treatment of chronic otitis media is to comply with such doctor’s recommendations:


  • reduce the ingress of bacteria into the ear — do not dive, do not visit beaches and swimming pools, wash your head with closed ears in your shower
  • the use of drops with antibacterial effect.

If conservative therapy does not help the patient, he is given a more effective remedy for treating ear inflammation — surgical help. As part of this therapy, the patient undergoes an operation to restore the structure of the tympanic membrane and prevent infection into the interior.

Surgery can be performed in several ways:


  1. through the ear canal
  2. by cutting behind the ear.

Thanks to radical treatment, the doctor manages to not only significantly improve the patient’s condition, but also to remove polyps, tumor-like formations that could form from the inflammatory process.

Chronic tubotimponal purulent otitis media is also cured by surgery. Drug treatment is used only as a preparation in the operation. With this therapy the patient can get rid of all possible foci of infection — inflammation in the nose, nasopharynx and paranasal sinuses.

After the operation, the patient has a rehabilitation period that lasts 2 weeks and consists in the course of physiotherapy.

Complications

If the exacerbation of otitis was not rectified in time, then a person can develop serious complications:


  • Mastoiditis
  • meningitis and / or encephalitis
  • thrombosis of venous sinuses
  • neuritis of the facial nerve
  • otogenic sepsis
  • cholesteatoma;
  • total hearing loss.

Prevention

In order not to provoke the development of chronic purulent otitis media, doctors recommend timely treatment of diseases of the ENT organs. Also, the ailment can be prevented by correct elimination and correction of the immunodeficiency state.




Doctors forbid self-treatment with drops or warming, as serious complications can start.