Catarrhal otitis media of the middle ear. Course and prognosis. External diffuse otitis: causes

Acute catarrhal otitis media in a child it is a pathological inflammatory process that develops in the structures of the middle ear. The disease occurs at any age, but children are most affected.

There is probably no person who, at least once in his life, has not experienced ear pain and “lumbago” in the ears, or has not seen the suffering of people around him from otitis media.

Acute catarrhal otitis of the middle ear in children and adults is the most common and favorable form among all otitis. Timely treatment can cure this form of otitis literally within a few days.

But, despite this, the inflammatory process in catarrhal otitis covers the tympanic cavity, attic-antral area, cells mastoid process and an auditory tube. Moreover, the spread of the pathological process occurs quickly against the background of pronounced complaints in the patient.

Untreated catarrhal otitis media develops into more unfavorable forms of the disease with the presence of exudate and purulent discharge. Often further treatment such complications are carried out in ENT hospitals using surgical methods treatment, long-term antibiotic therapy, immunocorrective measures.

Therefore, the main task comes down to preventing the disease from becoming purulent and chronic stages. For adequate treatment, it is necessary to clearly determine the cause that caused acute catarrhal otitis media - and in this article we will look at not only the causes, but also the treatment of this disease.

Causes of acute catarrhal otitis

The development of the disease in most cases is facilitated by a descending infectious process from the nasopharynx, which spreads through the auditory tube. Main trigger mechanism Acute catarrhal otitis media in adults and children can be:

• sinusitis;
• adenoid vegetations;
• rhinoviruses;
• tonsillitis;
• influenza and ARVI;
• frontal sinusitis;
• bacterial flora (mainly staphylococcal and streptococcal);
• sinusitis;
• infectious diseases (scarlet fever, measles, tuberculosis and others).

Bacteria and viruses are spread by blowing the nose, sneezing, and coughing, but hematogenous infection (through blood) is also possible. This occurs more often with childhood infectious diseases.

The occurrence and course of otitis media are also facilitated by following states body:

• hypothermia and long stay in damp rooms;
• vitamin deficiencies;
• liver and kidney diseases;
• diabetes;
• weak immunity;
• severe coughing or sneezing, leading to overexertion and increased blood pressure. This condition pushes infected mucus into all the cavities of the middle ear.

In adults, right-sided or left-sided catarrhal otitis media is more often observed. IN childhood, due to short auditory tube, it is much easier for pathogenic microorganisms to reach the middle spirit, so children often suffer from acute bilateral catarrhal otitis media.

This can be explained by other reasons as well. Children blow their nose worse, refuse timely rinsing, and not every parent can immediately suspect that the baby has an earache.

Symptoms of acute catarrhal otitis

The development of acute catarrhal otitis occurs with severe symptoms:

• intense Ear ache, often tugging or aching. The patient cannot sleep. Children cry a lot, scratch their ears, and refuse to eat.
• pain radiates (gives) to the temples, jaw space or spreads to the part of the head where the otitis media is located;
• redness and swelling of the ear canal;
• slight strain when sneezing causes increased pain in the auricle;
• There may be dulling or decreased hearing, and sometimes there is noise, ringing and congestion in the ears;
• Body temperature rises sharply with pronounced symptoms of intoxication: loss of appetite, weakness, nausea, headache, aches in the calves and joints.

First aid for ear pain in children

How to treat acute catarrhal otitis media

For the treatment to be successful and without complications, immediately contact an otolaryngologist, where the doctor will examine the ears, nose, throat, and nearby lymph nodes, and based on the condition of the ENT organs, he will describe the necessary treatment regimen.

If by the will of fate you are far from hospitals and pharmacies, for example, at the dacha, you can take the following measures. Examine the patient's ear and make sure there is no discharge from the ear canal(no water, pus or bloody exudate leaks out). Then take a small gauze pad and moisten it (lightly) in boric alcohol. Turunda should be practically dry, and insert deep into ear.

At night, place a compress with vodka on the parotid area. To do this, take a small rectangular piece of gauze (in several layers), cut a hole in the middle so that you can stick your ear through it.

This gauze is also lightly moistened in vodka and placed over the ear. Place paper on top (you can use baking paper). A large piece of cotton wool is placed on the paper, and the parotid area is covered with a warm scarf on top. Effective this procedure before bedtime.

if you have blue lamp- warm your ear for 2-5 minutes three times a day. Do not bring the lamp close to the ear; the patient should feel only pleasant warmth. Perhaps in home medicine cabinet There are Otipax or Otinum drops. Then you are saved. These drops perfectly relieve pain and relieve inflammation. They are instilled into the sore ear up to four times a day; it is enough to use 2-3 drops in each ear canal.

Otolaryngologists prescribe treatment after examination, taking into account the age and complaints of the patient. First of all, the task comes down to eliminating swelling throughout the entire area of ​​the pathological process. To do this, use drops that constrict blood vessels: Nazivin, Galazolin, Otrivin, Tizin and others.

In some cases, they are selected antihistamines(eliminating allergies) - Erius (instructions), clarititn, suprastin, citrine, tavegil, loratadine and others. Silver-based drops may also be offered: protargol or collargol.

Otipax drops will help relieve local pain and inflammation. To normalize body temperature and relieve inflammation, medications will help: pentalgin, paracetamol, nurofen, aspirin.

If there is ARVI- the otolaryngologist will select antiviral agent or refer you to an infectious disease specialist. In most cases, otitis media is caused by bacteria. For selection antibacterial agents carry out preliminary seeding for bacterial flora from the nose, throat, and auricle.

Unfortunately, this analysis will be ready in at least a week, but in case of complications or inadequate treatment, after 5 days there will be a clear picture of the disease: what caused acute otitis media, and what antibiotic will help eliminate the bacteria.

At the beginning of the disease, they try to get by with local antibacterial drops for the ears (Normax, Tsipromed, Fugentin), and only if the effectiveness is insufficient local therapy antibiotics are prescribed orally.

Popular and combined ear drops, which contain an antibiotic and glucocorticoids: sofradex, polydex, anaurin. Such drops kill bacteria, eliminate swelling, inflammation, and allergies. When treating catarrhal otitis media in children, a mandatory consultation with a doctor is required.

To reduce secretion into the lumen of the tympanic cavity and the area of ​​the auditory tube, it is recommended the following drugs: sinupret, fluimucil, erespal, others.

Important! Instillation of the ears is best done while lying down. Drops should be at room temperature. After instillation, be sure to close it ear canal cotton or gauze turunda.

Physiotherapeutic methods for the treatment of catarrhal otitis media

The goal of physiotherapeutic treatment is to stabilize and regress the pathological process. The following methods can be used for this:

• warming up the ear area with a Minin reflector (blue lamp);
• vibration massage of the tragus;
• treatment infrared rays(Sollux lamp);
• electrophoresis (endonasal);
• laser therapy;

Physiotherapeutic treatment effectively suppresses the development of the disease, and after a few days the patient forgets about otitis media. The number of procedures is prescribed by the otolaryngologist. After physiotherapeutic treatment, you cannot go outside.

At a minimum, the patient should rest for 30 minutes. It is advisable to get home by personal transport in order to minimize contact with cold air, especially in the autumn-winter period. Otherwise everything the treatment will work down the drain.

Prevention of inflammatory ear diseases

In order for your ears to always remain healthy, it is necessary to minimize the incidence of colds., and viral infections. And if rhinitis or a sore throat begins, swelling of the mucous membranes, which is one of the causes of otitis, should be immediately eliminated.

Increasing the body's defenses is an integral key to the treatment of all infectious and viral diseases. Balanced diet, physical training, Fresh air, hardening is the best steps towards health.

Start with simple exercises and improve your body using meditation, yoga, and breathing techniques. It is also important to maintain an adequate level of psycho-emotional health, which often reduces a person’s immunity.

If you have a predisposition to otitis media, then always after swimming in natural water treat your ears disinfectant solution(suitable boric alcohol or calendula tincture). This treatment is especially necessary if you swam in a lake or river.

For minor ear complaints, immediately contact an ENT specialist. Do not put off going to the doctor until the morning; sometimes even twelve hours is enough for otitis media to become more active. Remember that the development of otitis media is rapid, and this is where its insidiousness lies! Take care of your health!

How to treat Acute catarrhal otitis in children - Dr. Komarovsky answers

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Catarrhal otitis media- an inflammatory process that spreads to the mucous membranes of all structures of the middle ear - the ear cavity, the Eustachian tube, the cells of the mastoid process.

Acute catarrhal otitis is observed in adults and children, and is dangerous due to hearing loss up to deafness. Acute otitis is characterized by a rapid course.

The disease serves as the initial form of inflammation in the middle ear. At this stage, inflammation begins, accompanied by active secretion of mucous glands, adding epithelial cells and leukocytes to the secretion.

Changes in the mucosa are noted in ciliated epithelium auditory tube, nasopharynx. The action of viruses and bacteria causes increased permeability of blood vessels and lymphatic vessels, the influx of blood leukocytes into the site of inflammation, stimulates the secretion of mucus.

As a result of the changes, swelling of the mucous membrane occurs at the mouth of the auditory tube, and air circulation in the tympanic cavity is disrupted.

The catarrhal stage of otitis lasts up to 4 days, during these days exudate accumulates in the middle ear. When exudate stagnates, pus appears in the tympanic cavity, and otitis media passes into the purulent stage.

Why does acute otitis media occur?

The causes of catarrhal otitis are considered viral or bacterial infection. Common pathogens that cause the disease are: Streptococcus pneumonia, Streptococcus pyogenes, Haemophilus influenzae, Staphylococcus aureus.

Features of otitis media in children

Unilateral and bilateral catarrhal otitis media are observed in newborns.

Otitis mediates inflammation of the adenoids, as well as:

What contributes to otitis

Acute catarrhal otitis of the middle ear can spread from foci of infection through the blood of tuberculosis and measles.

Diabetes, vitamin deficiency, rickets, hypothermia, and kidney disease contribute to catarrhal otitis media. Otitis media causes increased nose blowing during colds and flu.

If a woman suffered from otitis media during pregnancy, then the child may have severe consequences, up to .

Symptoms

The first symptoms of catarrhal otitis are manifested by ear congestion, increased body temperature radiating to the teeth, and deterioration of hearing.

The changes are often unilateral; bilateral catarrhal otitis media is rare.

A frequent complaint at the onset of catarrhal otitis in adults and children is autophony - a phenomenon in which the patient hears his own voice in a blocked ear. As the middle ear cavity fills with serous exudate, autophony disappears, and the noise in the diseased ear increases.

A symptom of catarrhal otitis is severe pain when pressing on the tragus, gradually increasing as inflammation develops, and pain in the ear.

Particularly painful for the patient is the addition of shooting pains. General health worsens, malaise and fatigue are noted. In adults and children with catarrhal otitis, the temperature rises to 38 o C.

A particularly strong temperature reaction is observed in young children. In a child under one year old, in a newborn the temperature can rise to 40 o C.

In this state, children refuse to eat, become indifferent to others, and do not react to toys.

As the symptoms of intoxication increase, the child’s condition worsens, he may experience convulsions and vomiting. This condition threatens the transition of otitis media from catarrhal to purulent.

Diagnostics

Otoscopy reveals changes in the eardrum:

• blood vessels are filled with blood, the membrane is red;
• There is a retraction of the eardrum and a violation of its mobility.

Retraction of the eardrum into the middle ear cavity leads to impaired mobility auditory ossicles, appearance

Treatment

Children under two years of age are treated for acute otitis media in hospital. Adults are hospitalized with a severe, complicated course of the disease.

At the stage of catarrhal otitis media, the patient is treated with physiotherapeutic methods and medications. The patient is advised to apply warm compresses to the sore ear, UHF therapy, and Sollux.

The goal of treatment for catarrhal otitis is to reduce swelling of the mucous membrane of the nasopharynx, auditory tube, and restore natural ventilation of the middle ear cavity.

Forecast

The prognosis for catarrhal otitis media is favorable.

Otitis catarrhal is an inflammatory disease of the middle ear, characterized by the appearance catarrhal symptoms. It rarely becomes chronic and occurs in children and adults of all ages. Treatment is conservative, outpatient, without the use of antibiotics. With timely contact with an ENT doctor, recovery is complete, without complications. Lack of adequate treatment leads to hearing loss, up to complete deafness.

Who is susceptible to the disease

The anatomical features of the auditory tube lead to the fact that catarrhal otitis media occurs more often in children than in adults. But the disease occurs in all people age categories, which is facilitated by past influenza or ARVI. Complication respiratory disease– This is the most common cause of acute otitis media. Factors contributing to its development:

• avitaminosis;
• decrease in the body's defenses;
• frequent suppression of sneezing.

Many doctors believe that excessive nose blowing causes inflammation of the middle ear. But this hypothesis has no scientific evidence.

Catarrhal otitis in a child occurs for several reasons:

• diseases of the nasopharynx of viral etiology;
• hypothermia of the body;
• water getting into the ears with a tendency to inflammatory diseases;
• inflammation infectious nature on mucous membranes respiratory tract.

Acute otitis media infant may occur against the background of frequent regurgitation, being in horizontal position. To reduce the chance of fluid building up in the middle ear, you should let your baby burp air after each feeding.

Clinical picture of the disease: symptoms

Symptoms of the disease in adults and children develop quickly. Acute catarrhal otitis media is manifested by the following symptoms:

1. Ear congestion causing unpleasant phenomenon– autophony. With it, the patient hears his voice in the sore ear. Autophony changes loud noise when filling the cavity with serous exudate.
2. Shooting, throbbing severe pain in the inflamed ear. It impairs performance and interferes with proper rest and sleep. Children become capricious and constantly touch the sore ear.
3. Increase in body temperature to 38 degrees or more. In infants the temperature reaches 40 degrees.
4. Fatigue, nervous disorders associated with constant pain and high fever.
5. The patient refuses food and usual activities. Tries to find privacy in a quiet room; loud sounds intensify the pulsation in the ear.

As the symptoms increase, the sensations intensify, and intoxication of the body begins. Serous otitis becomes purulent, which poses a threat to the patient's life.

If the patient has bilateral catarrhal otitis, which is rare, listed symptoms intensify, hearing acuity decreases. The pain is felt not only in the ears, but also in the head.

Methods of treating the disease

If catarrhal otitis media is diagnosed, treatment is carried out on an outpatient basis.

Hospitalization is required in several cases:

• complication of pathology, formation of purulent exudate and progressive hearing loss;
• the patient's age is less than 2 years;
• the child has a fever due to high temperature;
• bilateral otitis media brings unbearable pain, dizziness, and vomiting.

The treatment method is selected depending on the patient’s age, the presence of other infectious diseases, and the stage of otitis media. For cupping pain syndrome The patient is prescribed painkillers:

• for oral administration: Peracetamol, Ibuprofen;
• For local application: ear drops containing lidocaine (Otipax);
• antipyretic drugs: Paracetamol, Panadol, Nurofen.

If the patient's age is less than 2 years, then antibiotic therapy is used. In adults, a wait-and-see approach is used, consisting of treatment with anti-inflammatory and painkillers.

Antibiotics are prescribed for fever, severe pain in children of all ages. For adults, treatment with these drugs does not show effectiveness, but only worsens the patient’s condition due to the suppression of favorable microflora. But the prescription depends on the severity of the symptoms and the stage of the disease.

If fluid has collected in the ear, you should immediately consult a doctor to rule out a ruptured eardrum. An alarming symptom is and a sharp decline hearing.

In some cases, patients are prescribed physiotherapy:

• pneumomassage;
• laser therapy.

Alternative medicine methods

Purpose alternative treatment is to restore microcirculation of air in the ear cavity, eliminate inflammation, reduce swelling and ear pain.

• A compress consisting of cotton wool soaked in glycerin, medical alcohol and resorcinol, inserted into the sore ear for a day. The compress helps relieve inflammation and reduce pain.
• A compress of diluted alcohol is placed behind the ear. It is allowed to hold for 12 hours, after which the gauze is removed.
• To relieve swelling, protargol is instilled into the ear.

Facilities alternative medicine are applied subject to several rules:

• Compresses should not be applied at high temperatures;
• alcohol drops should not be used to treat children;
• if the patient's age is less than 10 years, then semi-alcohol compresses are not used.

Complications of acute otitis media

The acute form of the disease lasts about 5 days, then otitis media becomes purulent and the likelihood of such complications increases:

• rupture of the eardrum;
• hearing loss, hearing loss;
• the spread of pus throughout the body, the occurrence of meningitis, labyrinth, sepsis;
• chronic otitis media

Chronic form of the disease: features

Acute catarrhal otitis media in the absence of adequate treatment and weak immunity becomes chronic. It is divided into two types:

1. Hypertrophic otitis media - implies constant swelling of the mucous membrane, reducing the ear cavity, which reduces hearing acuity.
2. Atrophic otitis - the death of the epithelium occurs, which leads to an increase in space and a decrease in the function of sound perception.

Can only be treated hypertrophic form diseases during the period of exacerbation. Application drug therapy for atrophic otitis is aimed at improving well-being. Eliminate pathological process is no longer possible.

The acute stage rarely turns into chronic; in most cases, the disease can be cured immediately, without waiting for complications. But with a weakened immune system and the presence of other infectious or inflammatory diseases Chronic otitis media is almost inevitable.

Preventive measures for children and adults

You can protect yourself and your children from catarrhal otitis by following the basic rules healthy image life:

• absence bad habits, protecting children from tobacco smoke;
• regular rest away from the noisy, polluted city;
• hardening, regular physical activity;
• nutrition with quality products;
• supporting immunity with vitamins in the autumn-winter period;
• wash your hands thoroughly after public places to prevent infectious diseases;
• timely treatment of respiratory diseases;
• cleaning ears, protecting against penetration of water and other liquids;
• long lasting breast-feeding babies;
• examination by doctors according to the patronage schedule for children under one year old.

Preventive measures are aimed at preventing respiratory and infectious diseases that can lead to otitis media and other complications. If it was not possible to protect yourself or your children from ARVI, you must immediately begin treatment for a speedy recovery.

Catarrhal otitis media does not threaten human life, manifests itself mainly in an acute form and disappears without a trace within 6 days. A favorable outcome is possible with adequate treatment prescribed by a doctor. If measures are not taken to eliminate inflammation, complications are possible, leading to deafness and infection of other body systems.

Inflammation in the ears causes many uncomfortable symptoms in babies. One of the variants of the disease is medial - catarrhal otitis. What parents should know about this pathology is described in this article.

What it is?

Inflammation of the middle ear leads to the development of symptoms of otitis in a child, which can occur in a variety of clinical options. Catarrhal otitis media occurs quite often in children. In most cases, this type of disease is replaced by another - purulent, which is much more severe.

Conduct differential diagnosis between these pathological conditions only a pediatric ENT can differentiate between these pathological conditions.

Most common cause leading to the development of inflammation in the middle ear are various bacterial infections.

The development of catarrhal otitis can also lead to entry of viruses and fungal flora into the Eustachian tube. These types of diseases are much less common.

You can get catarrhal otitis at any age. Adverse symptoms of the disease occur in both infants and school-age children.

The Eustachian tube is the main structural element, which is present in the middle ear cavity. Infection can enter through it and the development of catarrhal otitis is possible from the nasal passages.

Normally, there are anatomical communications between the nasal cavity and the ears. Having a small size, pathogenic viruses and bacteria easily reach the Eustachian tube, contributing to the development of severe inflammation in it.

The pathological process can be one- or two-sided. Babies suffering from immunodeficiency conditions or having severe chronic diseases often have damage to both ears at once. Right-sided otitis media, according to statistics, is somewhat more common in children. Typically, the catarrhal version of this disease is usually milder than the purulent one.

The inflammatory process, which triggers the appearance of characteristic symptoms of the disease in a sick baby, also leads to the development of pronounced swelling of the mucous membranes lining the middle ear cavity. This pathological condition contributes to plethora blood vessels, as well as pronounced lymphocytic infiltration.

With catarrhal otitis in the damaged ear, a large number of pathological secretion - mucus. It can be quite dense in consistency.

Usually the first symptoms of the disease appear 3-5 days after pathogenic microorganisms enter the ear cavity.

Prolonged accumulation of inflammatory exudate can lead to secondary bacterial flora joining the inflammation. This pathological condition quite often leads to the development purulent otitis.

Pediatric doctors note that the development chronic form leads pronounced decrease in immunity. This condition usually occurs in children with chronic diseases of internal organs.

Children suffering from diabetes mellitus or various cardiovascular pathologies have more high risk chronicity acute form catarrhal otitis in the future.

Symptoms

The very first clinical signs of this disease may be mild. The classic symptom of the disease is the appearance of congestion in the affected ear. Usually this symptom leads to a disturbance in the perception of various sounds. As a rule, pronounced hearing loss does not occur with catarrhal otitis media.

The inflammatory process contributes to the development of intoxication symptoms in the child. Body temperature with catarrhal otitis usually reaches 37.5-39 degrees. Against the background of such an increase, the baby may feel fever or severe chills.

The baby’s well-being is significantly worsened by the appearance of severe headaches and rapid fatigue, which develops in a sick child during acute period diseases.

Severe intoxication syndrome leads to severe thirst in the baby. The child’s lips become very dry and may even crack. The tongue is usually covered with a white coating.

When a bacterial infection spreads from the ear cavity to the paranasal sinuses, this leads to severe congestion when breathing. Some babies may also develop a runny nose.

Severe pain in the area of ​​the affected ear can also spread to the neck, area lower jaw, and in some cases even occupy half the face.

Enough common symptom inflammation of the middle ear - autophony. This is a pathological condition when the baby hears his own voice while pronouncing words or sounds.

With the development inflammatory process this symptom completely disappears in the child. This already indicates that the cavity of the ear is completely filled with pathological exudate, and the pressure inside the Eustachian tube has increased significantly. This leads to the fact that the baby begins to feel a strong sensation of “bloating” inside the damaged ear.

The mood and behavior of a sick child change noticeably. The child becomes more capricious, refuses his usual favorite foods, feels severe drowsiness even during the daytime.

Severe ear pain can also disturb sleep at night. The child becomes more restless and may wake up several times during the night.

Characteristic symptom, which occurs with this type of disease, is the appearance of pain when pressing on the tragus of the ear. This clinical sign intensifies as this pathology develops.

This symptom allows parents to identify and suspect the disease on their own, even in the youngest children who cannot yet complain to them about the deterioration of their health.

Diagnostics

When the first symptoms appear or the child’s behavior changes, parents should definitely seek advice from a pediatric otolaryngologist. Install correct diagnosis and a full differential diagnosis can only be carried out through special examinations.

During the initial clinical examination and examination, the pediatric otolaryngologist examines the ear cavity. For this purpose, special medical instruments are used.

To determine the cause of the disease, as well as to determine the severity of the disease, laboratory tests are performed.

A general blood test reveals moderate leukocytosis. In this pathological condition, the number of leukocytes in the peripheral blood increases. Inflammatory changes are also accompanied by an acceleration of ESR.

During a clinical examination, the doctor may collect biological material for bacterial culture. Using such a test, you can also quite accurately determine the causative agent of the disease. Results usually take 3 to 10 days.

This test allows not only to identify a specific type of microorganism, but also to select specific therapy that will lead to the baby’s recovery.

Treatment

Therapy for the youngest patients is carried out in a hospital setting. This is necessary to prevent the development of secondary complications of the disease, as well as for a quick recovery.

The duration of hospitalization may vary and depend on the initial severity of the disease.

Treatment of the most severe cases diseases are carried out in intensive care units.

the main objective- eliminate inflammation in the cavity of the inflamed ear, as well as prevent the transition from an acute form of the disease to a chronic one. Usually, to eliminate the unfavorable symptoms of catarrhal otitis, a complex of medications and physical therapy are prescribed.

To restore hearing and reduce high blood pressure V eustachian tube successfully applied UHF therapy, ultrasound and phonophoresis. To achieve a positive effect, a whole course of physiotherapy, consisting of 8-12 procedures, is usually required.

If the cause of the disease is a bacterial infection, use different kinds antibacterial drugs. Currently, doctors give preference to drugs that have wide range actions.

Clavulanic acid-protected penicillins are the most commonly used medicines, used to treat bacterial forms of otitis.

Many types chronic otitis occur against the background of reduced work immune system. To normalize immunity, doctors prescribe multivitamin complexes and interferon-type drugs. These funds are also used for course admission.

Acute otitis media (AOM) is an acute inflammatory process localized in the tissues of the middle ear, namely in the tympanic cavity, the area of ​​the auditory tube and the mastoid process. This disease is more often diagnosed in children, but in adults it also accounts for about 30% of all ENT pathologies.

Etiology, classification and mechanisms of disease development

Acute otitis media is an infectious disease that can be caused by viruses, bacteria or viral-bacterial associations.

Viruses that cause acute illnesses play a major role in the development of AOM. respiratory infections, namely:

• parainfluenza,
• adenoviruses,
• enteroviruses,
• respiratory syncytial viruses,
• coronaviruses,
• rhinoviruses,
• metapneumoviruses.

In 70% of patients, when examining exudate obtained from the middle ear, bacteria are detected. Most often this is:

• Streptococcus pneumoniae,
• Haemophilus influenzae,
• Moraxella catarrhalis.

Contribute to the development of the disease:

• reduced immune status body (congenital immunodeficiencies, recent acute infectious diseases, concomitant severe somatic pathology ( bronchial asthma, diabetes mellitus, kidney disease);
• the presence of a cleft palate in a child;
• active and passive smoking;
• low socioeconomic status of the patient.

Based on the nature of inflammation, there are 3 stages of AOM:

• catarrhal,
• exudative (serous),
• purulent.

The mechanisms of their development also differ.

Catarrhal otitis media(other names - tubootitis) often develops with acute respiratory viral infections - swelling caused by inflammation in the upper respiratory tract spreads to the mucous membrane of the auditory tube, which impairs its patency. As a result, all 3 functions of the pipe are disrupted:

• ventilation (the air contained in the pipe is sucked in, and the entry of new air is difficult),
• protective (due to insufficient ventilation, the partial pressure of oxygen decreases - the bactericidal activity of the pipe cells weakens),
• drainage (impaired free flow of fluid from the pipe - leads to the proliferation of bacteria in the middle ear).

The consequence of these processes is a decrease in pressure in the tympanic cavity, leading to the suction of secretions from the nasopharynx and the release of non-inflammatory fluid - transudate.

Eustachitis can also be caused by sudden changes atmospheric pressure - during diving and ascent of submariners (mareotite), ascent and descent of an aircraft (aerootite).

Exudative otitis media(secretory, serous, mucosal otitis media) is a consequence of catarrhal: against the background of dysfunction of the auditory tube, a decrease in general and local immunity the inflammatory process progresses - inflammatory fluid, or exudate, is intensely released into the tympanic cavity. Restoring the ventilation function of the middle ear at this stage will lead to recovery, and if the patient is not provided assistance, the process may take chronic course, transforming into fibrosing otitis media (scarring process in the tympanic cavity), leading to severe.

Acute purulent otitis media- it's spicy purulent inflammation mucous membrane of the tympanic cavity with the involvement of other parts of the middle ear. The causative agent of this form of the disease is bacteria. They enter the tympanic cavity most often through the auditory tube - tubogenically. Through a wound of the mastoid process or with an injury to the eardrum, the infection can also enter the tympanic cavity - in this case, otitis is called traumatic. There is also a third possible way penetration of infection into the middle ear - with blood flow (hematogenous). It is observed relatively rarely and is possible in some infectious diseases (measles, scarlet fever, tuberculosis, typhoid).

In acute purulent otitis media, inflammatory changes occur not only in the mucous membrane, but also in. An inflammatory fluid is released, first serous and then purulent. The mucous membrane sharply thickens, ulcerations and erosions appear on its surface. At the height of the disease, the tympanic cavity is filled with inflammatory fluid and thickened mucous membrane, and since drainage function the pipe is broken, this leads to the bulging of the eardrum outward. If the patient is not given assistance at this stage, a section of the eardrum melts (its perforation), and the contents of the eardrum flow out (this is called otorrhea).

During treatment, the inflammation subsides, the amount of exudate decreases, and suppuration from the ear stops. The hole in the eardrum is scarred, but the patient still long time feels stuffy in the affected ear. The criteria for recovery are normalization of the picture during ear examination - otoscopy, plus complete restoration of hearing.

Why acute otitis media occurs more often in children

Exist age characteristics structures of the middle ear that contribute to a more rapid spread of infection from the nasopharynx to the middle ear. The auditory tube in children is short, wide and located almost horizontally (devoid of physiological bends characteristic of adults). Tympanic cavity of children early age filled with a special, so-called myxoid, tissue - this is a gelatinous, loose embryonic connective tissue, which is favorable soil for the development of the infectious process.

In addition to anatomical and physiological characteristics, children are characterized by some pathological conditions, contributing to the development of CCA. First of all, this (hypertrophic changes lymphoid tissue nasopharynx) – streptococci and Haemophilus influenzae are often found in them.

Children attending children's groups are constantly in contact with each other's infectious agents. For one child, a particular pathogen may be opportunistic and not cause disease, but for another it may be virulent, aggressive and cause inflammation of the upper respiratory tract, from where the process may spread to the middle ear.

Children often suffer from respiratory viral infections, which can be complicated by AOM. In addition, these infections not only weaken the immune system, but also lead to morphological changes in the mucous membrane of the respiratory tract, reducing its immunity (resistance) to potentially dangerous (pathogenic) microflora.

There are so-called transient (physiological) immunodeficiency states that are characteristic of young children - they are also a favorable background for the occurrence of infectious diseases.

Clinical picture of acute otitis media

Often AOM occurs with pronounced symptoms, but latent otitis also occurs - when clinical manifestations diseases are expressed insignificantly.

For OSO, as for any other infectious disease, characteristic general symptoms:

• general weakness;
• feeling unwell;
• loss of appetite;
• increase in body temperature to febrile levels.

With catarrhal otitis media, patients complain of:

• slight hearing loss – disturbance of sound conduction mainly at low frequencies; after swallowing saliva or yawning, hearing temporarily improves;
• resonating your voice in the affected ear – autophony.

Ear pain is usually of low intensity or absent at all.

Flow exudative otitis media usually asymptomatic. The patient notes:

• a feeling of pressure, sometimes noise in the ear;
• slight autophony;
• some hearing loss.

Painful sensations, as a rule, are absent, and after a while the patient adapts to hearing loss and stops noticing it.

Acute purulent otitis media can occur easily and resolve quickly, sluggishly and continue for a long time, acutely and violently. Usually it ends full recovery, but sometimes the inflammatory process becomes chronic. With absence timely treatment purulent otitis media can be complicated by mastoiditis, intracranial infectious processes and even sepsis.

Clinically, during acute purulent otitis media, it is customary to distinguish 3 stages:

• pre-perforative;
• perforative;
• reparative.

It is not necessary that a specific otitis will go through all 3 stages - it can resolve already at the initial (pre-perforative) stage.

1. Preperforative stage. The patient's leading complaint is pain in the ear, especially when lying on the affected side. The pain is pronounced, sharp, shooting, radiating to the temple. Gradually increasing, it becomes unbearable, painful, depriving the patient of peace and sleep. There may be pain when touching the mastoid process. At the same time with painful sensations there is a feeling of ear congestion, noise in it, and hearing loss. The general condition of the patient is disturbed: there are signs of intoxication, body temperature is elevated to febrile levels. Duration initial stage: 2–3 hours – 2–3 days.
2. The perforated stage is determined by the onset of suppuration from the ear, resulting from a perforation of the eardrum. Discharge from the ear is initially profuse, mucopurulent or purulent in nature, often mixed with blood. Over time, the amount of discharge decreases, it thickens and becomes purulent in nature. The patient’s condition at this stage improves sharply: the pain in the ear subsides, the body temperature decreases, sometimes even returns to normal. The duration of suppuration is 5–7 days.
3. At the reparative stage, the suppuration of their ear stops, the perforation is scarred, and hearing is gradually restored.

The typical course of acute otitis media is described above, but in some cases its clinical manifestations are sharply different from the classic ones.

• Sometimes the disease is extremely severe: with sharp deterioration general condition, high fever, up to 40 C, nausea and vomiting, headache and dizziness.
• In some cases, the eardrum does not perforate, but purulent masses spread from the middle ear into the cranial cavity, causing complications, threatening the patient's life.
• Otitis may already at the initial stage become asymptomatic, sluggish, and protracted. In this case, the general symptoms are mild, the pain is not intense, the eardrum is not perforated, and thick, viscous pus accumulates in the middle ear cavity.

If the patient’s condition does not improve and the temperature does not decrease after perforation of the eardrum, this means that the inflammatory process has moved to the mastoid process - it has developed.

If it does not stop within 5-7 days, but lasts up to a month, it indicates an accumulation of pus inside the mastoid process, or empyema.

In children of early and preschool age diagnosing acute otitis media can present some difficulties, since the child does not always correctly voice his complaints, and parents and the pediatrician may mistake the child’s fever and whims for symptoms of ARVI (acute respiratory viral infection).

The child should be referred for consultation to an ENT specialist if:

• Severe disturbances in the general condition of the child;
• 2 sleepless nights;
• severe pain and prolonged fever;
• protruding auricle;
• smoothness of the postauricular fold;
• leakage of fluid from the ear - otorrhea;
• pain when suddenly pressing on the tragus of the affected ear;
• pain when palpating or tapping the mastoid process.

Diagnosis of acute otitis media

Based on the patient’s complaints and medical history, the doctor will only assume the presence of an inflammatory process in the middle ear. Otoscopy will help confirm or refute this diagnosis - visual inspection eardrum using a special device - an otoscope. The eardrum has an appearance specific to each stage of the disease:

• on the stage acute tubo-otitis the membrane is only slightly retracted;
• the exudative stage is characterized by hyperemia (redness) and thickening of the eardrum, and the hyperemia first covers the loose part of it, then spreading to the entire surface of the eardrum;
• the pre-perforative stage of acute purulent otitis is otoscopically manifested by bright hyperemia and swelling of the eardrum and its bulging into the cavity of the external ear varying degrees expressiveness;
• at the perforated stage, the presence of a hole in the eardrum is determined, from which serous-purulent, purulent or bloody exudate is released;
• at the reparative stage, the perforation hole is closed with scar tissue, the eardrum gray, cloudy.

In order to determine the quality of hearing, a tuning fork study is carried out, the results of which are different stages also vary.

Changes in general analysis blood are nonspecific - signs of an inflammatory process are determined (leukocytosis, neutrophilia (if there is a bacterial infection), increased ESR).

A bacterioscopic examination of exudate taken from the source of inflammation will determine the type of pathogen and its sensitivity to antibacterial drugs.

Treatment of acute otitis media

Since the course of acute otitis media is characterized by a clear stage, the treatment of this disease is also specific at each stage.

In general, treatment for NDE may include:

• osmotically active analgesic and anti-inflammatory drugs local action(as ear drops);
• systemic and topical decongestants ();
• systemic antibiotic therapy;
• antihistamines;
• toilet and anemia of the nasal cavity;
• anemization and catheterization of the auditory tube;
• myringotomy and shunting of the tympanic cavity.

Ineffective means in in this case are considered:

• decongestant therapy in the form of tablets and syrups (taken by mouth) – there is no evidence of their effectiveness, but side effects happen often;
• mucolytics (drugs that thin mucus) orally - the reasons are the same;
• antibacterial drugs local action (in the form of ear drops) - the antimicrobial component of these drugs does not have the desired effect on microorganisms located in the tympanic cavity; the use of drugs in this group is justified only at the perforated stage of acute purulent otitis, since there is a hole in the membrane through which active substance will enter the tympanic cavity. In this case, the prescribed drug should not have an ototoxic effect (antibiotics such as Polymyxin B, Neomycin, Gentamicin have this effect).

Ear drops

Ear drops are often used in the treatment of acute otitis media. Many patients prescribe them to themselves, which risks causing irreparable harm to their health. Drops containing anti-inflammatory and analgesic components are used only when the eardrum is intact, since their entry through the perforation into the tympanic cavity can negatively affect the patient’s hearing.

For more accurate administration of drops, use the hand opposite the inflamed ear to slightly pull auricle up and back - this technique will align the ear canal and the drops will fall exactly to their destination. After instillation, it is necessary to close the ear canal with cotton wool soaked in Vaseline for 2–3 hours - in this case active remedy will not evaporate and will provide maximum healing effects.

As stated above, antibacterial drops are prescribed only in the case of perforated otitis media.

Drops with an antihistamine component in their composition are prescribed to reduce swelling and eliminate a possible allergic factor.

Topical decongestants (xylometazoline, oxymetazoline) are a necessary part of the treatment of AOM, since dysfunction of the auditory tube develops precisely against the background of swelling of the mucous membrane of the upper respiratory tract. Drugs in this group can be addictive, so they are prescribed only in short courses - no more than 4-5 days.

Antibacterial therapy

Not all forms of acute otitis media require antibiotic treatment, but treatment with drugs in this group reduces the risk of developing complications of this disease. With absence serious symptoms intoxication, such as vomiting, intense increasing headache, prescribing an antibiotic can be delayed for 48–72 hours, since AOM often resolves on its own, without their use. Antibiotics are required for any form of acute otitis media in children under 2 years of age and in patients with immunodeficiencies. First, an antibiotic is prescribed empirically, taking into account the range of typical pathogens of the disease. In the case when the pathogen is laboratory determined and known medicinal substances, to which it is most sensitive, the drug should be replaced.

At the first stage of AOM, catheterization of the auditory tube is recommended, which should be done daily. A mixture of naphthyzine solution and a water-soluble corticosteroid, which have a vasoconstrictor and anti-inflammatory effect, is injected through a catheter. Among medications, the patient may be prescribed topical decongestants.

At the second stage of AOM, some experts recommend inserting a thin cotton wool moistened with osmotol (a mixture of ethyl alcohol 90% and glycerin in a 1:1 ratio) into the external auditory canal. The turunda must be closed from the outside with a cotton swab and Vaseline. This technique prevents the turunda with osmotol from drying out and the effects are fully achieved. this tool– warming, analgesic, dehydrating. The compress remains in the ear for 24 hours. In parallel with the compress, it is necessary to use vasoconstrictor drops into the nose.

At stage 3 of the process, the patient is recommended to catheterize the auditory tube and microcompresses with osmotol. Systemic antibiotic therapy is also indicated. If after 24–48 hours there is no effect from the treatment, the patient needs a paracentesis or tympanopuncture procedure. From medications The use of strong analgesics (based on paracetamol and ibuprofen) is indicated.

At the perforative stage, local antibacterial drugs in the form of ear drops are added to the preliminary treatment; in addition, the patient continues to receive vasoconstrictor nasal drops and analgesic drugs. Catheterization of the auditory tube is also indicated, frequent toilet external auditory canal.

At the reparative stage of acute otitis, observation by an ENT specialist is not always necessary. However, if the perforation was large enough, it is important to control the scarring process in order to prevent the inflammatory process from becoming chronic.