Chronic purulent medium otitis

Chronic purulent medium otitis characterized by a constant or occasional by gnomecanvas, a decrease of hearing and perforation of the eardrum. There are two main forms - epitympanum and mesotympanitis. For mesotympanitis characterized by loss of the mucous membrane of the middle division tympanic cavity with purulent (or mucopurulent) discharge from the ear odourless. Characteristic of Central (not reaching bone rings) perforation of the eardrum. Sometimes visible granulation and polyps. For epitympanitis characterized by loss of not only the mucous membrane, but also the bones with the spread even on the mastoid process. Often the cholesteatoma (pseudohastites) of the ear. It is the result of growing epidermis external ear canal or the eardrum in the middle ear. When growing in the middle ear epidermis loses its top properties. In the shedding of its cells is formed tumor formation, growth damaging the surrounding tissue, which contributes to the development of various complications. For epitympanitis is characterized by a purulent discharge with a strong odor, regional, reaching bone bezel, perforation. Often it is localized in shrapnell part of the ear.
Treatment: the elimination of pathological changes in his nose, his paranasal sinuses, nasopharynx. When mesotympanitis usually spend conservative treatment is systematic toilet ear drops of 3% solution of boric alcohol, the smallest injection of boric acid powder, sulfanilamidov. The main conservative treatment when epitympanitis is washed with a special cannula alcohol solutions (the doctor does). In the absence of the effect of conservative treatment and complications produce radical (omeprasol) the operation of the ear. The aim of the operation is the creation of a common cavity consisting of the external ear canal, tympanic cavity, caves and affected by the disease process areas of the mastoid process.
Complications of chronic suppurative otitis media: paresis, and paralysis of the facial nerve, meningitis, otogenny sepsis, abscess of the brain, arachnoiditis, extradural and subdural abscesses.
Chronic nagnoenie otitis media (chronic catarrh of the middle ear, adhesive otitis, dry ruptured ear, tympanosclerosis) is a group of diseases, precise differentiation between which to date is a controversial issue. The main complaint is the decrease in hearing, sometimes severe hearing loss. When otoscopy determined expressed retraction of the tympanic membrane, in some cases scar it changes, sometimes partial calcification, dry perforation. Treatment: systematic blowing ear, pneumomassage eardrum, physiotherapeutic measures.
If no effect make tympanoplasty (see).
Internal otitis - see Labyrinthitis.

chronic suppurative otitis media
Fig. 12. Chronic suppurative otitis media; perforation in predaniyam quadrant of the eardrum.

Chronic purulent medium otitis (otitis media purulenta chronica). The reason for the transition of acute otitis media in chronic are; great destruction in the tympanic cavity; inflammatory changes in the nose and nasopharynx, adenoid of razreshenia; improper treatment of acute otitis media.
Over and symptoms. The clinical course distinguish between benign and substandard chronic suppurative otitis - meso - and epitympanum. When mesotympanitis the process does not go beyond the mucous membrane; perforation eardrum does not reach the bone ring - Central perforation (printing. Fig. 12). When epitympanitis in the process usually involved and bone wall cavity, a rupture spreads to the bone ring (regional perforation) or is shrapnell part. When mesotympanitis mucosa hyperemic, thickened; discharge from the ear usually have mucopurulent character. Often abundant mucus discharge, which specifies and inflammation of the auditory tube (tubolit). The decrease in hearing while mesotympanitis does not usually sharp degree. With worsening mesotympanitis increases the amount of purulent discharge, fever. In their current aggravation of mesotympanitis reminds acute otitis media.
When epitympanitis are often granulation in the form of reddish bumps, or polyps, caries. Purulent discharge usually sparse, with the smell. Complication of epitympanitis is cholesteatoma, which is formed as a result of growing epidermis from the ear through the regional perforation in nadbramna space. Under the influence of irritation with pus epidermis starts to grow, and then swells, dies. Layering each other layers of dead epidermis lead to growth of cholesteatoma that fills nadbramna space and the cave. With its further increase is the destruction of the bone. The destruction of the bone wall horizontal semicircular canal and a fistula often accompanied by nystagmus, vertigo when pressing down on the trestle. At destruction of the fallopian channel comes paresis or paralysis of the facial nerve. The aggravation of epitympanitis and suppuration of cholesteatoma there are abundant foul-smelling pus, worsens the General condition of the patient, sometimes may develop symptoms of intracranial complications (sinus thrombosis, sepsis, meningitis, abscess of the brain). Hearing in epitympanitis usually sharply reduced.


The diagnosis. Differentiation between epitympanitis and mesotympanitis is sometimes difficult. Diagnosis helps sensing perforation specially curved Pugovkina probe. At the edge perforations probe freely falls into nadbramna space. In the presence of caries process probe is possible to feel the bare bone, and when cholesteatoma - discover kroshkovatymi mass of the epidermis. For the diagnosis of cholesteatoma sometimes washed nadbramna space using special cannula, produce x-rays of the ear.
Treatment. Washed ear disinfectant solutions, pour in drops (hydrogen peroxide, alcohol with hydrogen peroxide, boric alcohol). Applied with success injection into the middle ear pressure of a solution of penicillin and streptomycin. Large granulation and polyps removed surgically. When cholesteatoma appoint systematic washing nabraboogo space slightly warmed with alcohol. Epitympanum often difficult to conservative treatment. In some cases the cure can be achieved only radical, or abseolutley, surgery of the ear. Surgery is indicated if, after the systematic treatment of gnetaceae remains abundant, the smell of evil-zone, the removed polyps to form again (while there are frequent complaints about headaches, occasional dizziness, potashnaya). The indication for surgery are also exacerbation of chronic otitis media with mastoiditis with subperiosteal abscess and the appearance of facial nerve paresis. Signs of intracranial complications requires emergency surgery.
Radical, or omeprasol, the operation is done usually vneshnim way, but it can be done and custom way through the ear canal. When vneshnem the way incision behind the ear and the separation of soft tissues carry out the same as when the operation is over mastoiditis. After that a thin respetaron prepare the chin skin back and upper bone walls of the ear canal up to the ear drum and remove the back bone wall ear canal and a small section of the bone wall - bridge hanging over aditus ad antrum (this moment the operation is very important in view of the risk of injuries to the facial nerve and horizontal semicircular canal). Then remove granulation and carious the hammer and the anvil. To ensure wide messages with external auditory passage and epidermizatsii bone walls of the newly created cavity produce plastic ear canal. Cut back the skin wall in the middle of it for the entire length from the free end to the ear, where they perpendicular to the first second slit up and down. Thus obtained two triangular flap impose on wall operating cavity and lock stitch or tampons. After epidermizatsii cavity gnetaceae stops. Further requires periodic monitoring cavity, as it often accumulate epidermal mass, striking a delicate layer of the newly formed skin and again causing gnetaceae from the ear. In certain indications produce custom radical surgery. Its advantages are that the path to pathological nidus much reduced and therefore not have to remove a lot of healthy bones. This makes it easier postoperative treatment and shorten its duration. However, technically this operation is more complex than vneshnaya.
Option radical surgery is the so-called conservative radical surgery, or Attico-antrotomy in which reveal only antrum and attic, and the eardrum and ear bones remain. This operation can be used only with limited damage Attica and antrum (with cholesteatoma this area).
Fundamentally new operation is tympanoplasty (see), which aims not only the removal of the pathological focus and termination of sickness, but the improvement of hearing.
Prevention. The best measure is full treatment of acute otitis media. To prevent infection of the middle ear through the ear canal for patients with persistent perforation of the eardrum, followed while bathing and washing of the head close to the ear of the cotton wool moistened with vaseline or other oils. The hole formed as a result of a perforation of the eardrum may be eliminated by careful searing its edges trichloroacetic acid or with the help of plastic surgery.