Acute otitis media

There are catarrhal and forms of acute purulent medium otitis. Catarrhal otitis media (Qatar hearing, Evstafieva, pipes) develops when rhinitis, acute catarrh, influenza and other infectious diseases. Symptoms: feeling of stuffiness of the ear, the decrease in hearing, sometimes the noise in the ear. Some patients experience at change the position of the head of "pouring the water in the ear". Sometimes changing the hearing. Pain in the ear insignificant, often absent. When otoscopy noted retraction of the tympanic membrane, blurred her hyperemia. In the presence of specimens in the tympanic cavity it is yellow, less often greenish. Sometimes when otoscopy see the fluid level in the tympanic cavity. Treatment: sossoudossoujiwate drugs (2-3% solution of ephedrine, 0.1% solution of adrenaline, 1-3% solution of cocaine, sanorin) in the nose, blowing off the ear (see), ultraviolet irradiation through the tube, UHF. With the protracted processes produce paracentesis (see).
Acute purulent otitis media. Develops as a result of infection mainly through the auditory (Evstafieva) a pipe or hematogenous route. Symptoms: in the first stage, severe pain in the ear, smack in the mouth, head, stuffy ear, diminished hearing. Often the temperature rises (up to 38-38,5 degrees, children up to 40 degrees). The weakened patients can run at normal temperature. When otoscopy (see) eardrum hyperemic, smoothed contours. At the end of this stage appears bulging tympanic membrane. After the appearance of sickness (spontaneous breakthrough eardrum or paracentesis) comes the second stage. Pain in the ear subside, improves the General condition, normalization of temperature. In ear canal is seen pus (odourless, sometimes with admixture of mucus). Bulging tympanic membrane decreases, but hyperemia, smoothed contours remain. The third stage is characterized by the termination of sickness. Leading complaint is the lowering of the hearing. Eardrum gradually to normal. Treatment: in all stages conduct activities recommended for acute Qatar middle ear. In the first stage, you can also use the 5% carbol-glycerin-drops in the ear (to stop as soon as gnetaceae from the ear), tampons with alcohol. Inside appoint acetylsalicylic acid, amidopyrine, analgin. In the second stage - a thorough, systematic toilet ear (dry scrubbing or washing weak disinfectant solutions - boric acid 2% solution, the furatsilina - 0.02% solution). In the third stage it is necessary to make blowing, pneumomassage eardrum, UHF region ear to the normalization of hearing. When there are pronounced General phenomena used antibiotics.
Complication of acute purulent medium otitis is mastoiditis (see). In children of early age in the transition process to a drum cave develops Antrim (tantric, otitis-Antrim). The weakened children Antrim flows latent. Local symptoms are weak. Common symptoms expressed sharply: child drowsy or, on the contrary, restless, often cries, sleeps badly, no appetite, weight quickly drops, the skin is pale grey or cyanotic, heart sounds are muffled, pulse Ochsen, liquid stools, the temperature is raised to 38-39°, but more often low-grade or even normal. Treatment: hospitalization of the patient, in the absence of the effect of conservative treatment produce antrotomy (see Mastoidectomy).

acute otitis media
Fig. 4 - 8. Acute otitis media: Fig. 4-transudate in the tympanic cavity; Fig. 5 - the initial period of the disease, vascular injection along the handle of a little hammer; Fig. 6 - radial injection vessels eardrums; Fig. 7-diffuse redness of the eardrum, a sharp protrusion varnishing quadrant; Fig. 8-papillary bulging varnishing quadrant of the eardrum. Fig. 9. Residual changes in the eardrum after acute otitis media: scars, petrifikatov.

Acute catarrhal otitis media, or Qatar hearing (Evstafieva) pipe (otitis media catarrhalis, catarrhus tubae auditivae), usually develops when you spread inflammation of the mucous membrane of the nose and of the nasopharynx by the auditory tube. Lumen of the tube is reduced or closed and the flow of air into the middle ear is difficult or stops altogether. The part is available in the middle ear of air (oxygen) absorbed, the pressure in it falls, is the rush of blood to the vessels of the mucous membrane (hyperemia ex vacuo) with the formation of effusion - transudate (printing. Fig. 4) and indrawing of the eardrum.
Symptoms. Congestion, noise in ears, decreased hearing, the severity of head and discomfort due to the strong sound of his own voice (autophone). Sometimes patients feel that in my ear exposed to water, since the change of position of the head of the transudate moves and they feel as if pouring water in the ear. Pain is minor, there is only tingling. Temperature is normal or slightly increased. Otoscopy - eardrum involved, the color depends on the color translucent transudate - green, red, and so on
Treatment. Vasoconstrictive drops in the nose and blowing off the ear. If the specimens or fluid in the middle ear does not disappear, and hear not improving, you need to make a cut of the eardrum (paracentesis), which opens the exudate way out.
Acute purulent otitis (otitis media purulenta acuta) usually develops as a result of infection in the middle ear through the auditory tube. Hematogenous route of infection occurs only sometimes when some heavy infectious diseases. The most common causative agents are hemolytic Streptococcus, pneumococcus. Morphological changes in the tympanic cavity impact in the mucosal hyperemia, infiltration and exudation. Eardrum becomes red, thickened; the private and mucous layers occur destructive changes, leads to its softening.
Symptoms. Ear pain, fever, decreased hearing, hyperemia eardrum. Ear pain is usually strong, stabbing, shooting, throbbing; radiating to the crown, teeth; at the height of the disease when the cavity is performed by the exudate, it becomes unbearable. The results otoscopy (printing. Fig. 5-8): at the beginning of the disease hyperemia in the top-rear quadrant of the eardrum, injected vessels on the handle of a hammer; in the future, the redness becomes spilled; the parts of the ear are not distinguishable. Membrane protrudes outward due to its infiltration and pressure of the fluid. Modified under the influence of the inflammatory process eardrum as a result of pressure of the exudate breaks and receive the discharge from the ear (otaria). At first they liquid, serous-bloody, then become mucous-purulent and thicker. At growth of granulation in the middle ear, and anemia otitis is a mixture of blood. Significant gnetaceae usually lasts 6-7 days, then it down and stops. Eardrum returns to normal and the hearing is restored.
The diagnosis. In typical cases, the diagnosis is fairly easy. Often the symptoms of acute otitis media are erased or even absent; the disease has no acute onset occurs without obvious changes eardrum, without pain, perforation and sickness. Such atypical disease may be caused by the properties of infection, the reduction of General and local responsiveness, irrational antibiotic therapy. The diagnosis in such cases is put on the basis of clinical observations and x-ray study of the temporal bones. A slight fever and a chilling, the turbidity of the eardrum and smeshannoi its contours must be considered as a possible manifestation of atypical otitis.
Differential diagnosis between the outer and middle Acting is conducted by the following features: at the external O. allocation purely purulent, admixture of mucus does not happen; medium O. typically decrease of hearing; for topical - pain in zatragivanija to the walls of the ear canal, while pulling for the ear, especially when pressed on the trestle, when chewing; ripple of pus in the ear typical for middle O.


The forecast. Recovery with full hearing is the most frequent outcome of acute otitis media. However, there are other outcomes: in the tympanic cavity formed spikes and growths between tympanic membrane and cavity wall, between the bones; on the eardrum visible scars, white spots, which are deposits of limestone salt - petrifikatov (printing. table, Fig. 9). Sometimes a perforation remains stable, gnetaceae periodically renewed and O. takes chronic. Acute O. may be complicated by mastoiditis (see). To threatening complications of acute O. include labyrinthitis, meningitis, sepsis.
Treatment. To alleviate pain, until the pus) in the ear canal pour drops (Ac. carbolici crystallisati 0,5; Cocaini 0,3; Glycerini 10,0) or injected deep into the ear canal cotton pads soaked in 5% of all alcohol (3-4 times daily). Successfully apply heat in different types. The primary importance sulfa drugs and antibiotics. Success of their activities is the sensitivity to him flora otitis. When rational antibiotic therapy in cases of acute otitis takes abortifacient for - ends in a few days without education perforation sickness.
If after a few days of treatment of improvement does not occur or phenomena grow, produce paracentesis (see), which immediately shows if signs of irritation of the inner ear or meninges. After paracentesis or self-perforation it is necessary to ensure the outflow of pus from the middle ear: dry the ear canal sterile gauze swab 2-3 times a day or washed ear warm solution of boric acid. When thick mucous-purulent discharge poured into the ear of a 3% solution of hydrogen peroxide (8-10 drops) and leave it there for 10 - 15 minutes formed foam helps to remove thick or dried pus. Boric alcohol useful to appoint a transition of otitis media in the subacute stage. If after the termination of sickness hearing is not restored, do blowing off the ear (see) and pneumomassage (see) eardrum.
Prevention: the restoration of normal nasal breathing, sanation of the nose and of the nasopharynx, the treatment of purulent sinuitis. A great role is played by the removal of the adenoid razreshenii, as they often wears pharyngeal mouth auditory tubes and are the source of infection of the middle ear.