Secondary serous otitis media: acute and chronic

Serous (exudative) otitis is an inflammation of the ear, which is manifested by the accumulation of serous fluid in the ear cavity.

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Causes serous otitis media

The causative agents of serous otitis are bacteria and viruses. Among the microorganisms of bacteria that can provoke the development of this disease, Streptococcus pneumoniae and Haemophilus influenzae are noted. In a number of studies, it was found that people suffering from serous otitis have the following viruses: respiratory syncytial, parainfluenza, influenza, enteroviruses, adenoviruses, rhinoviruses, coronaviruses, which contribute to the progression of ear inflammation.

There are bacterial, viral and simultaneous effects of both microorganisms. When diagnosing a disorder in the structure and functioning of the Eustachian tube, the process becomes more complicated and the disease progresses faster.

The Eustachian tube is a canal that connects the nasopharynx with the middle ear cavity. It clears the ear cavity of mucus and helps it move into the nasopharynx, and also equalizes the pressure. The slightest disruption in the anatomy or function of the auditory tube causes stagnation of the liquid secretion produced by the mucous membrane of the ear.

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Risk factors

Serous otitis is most common in children. This directly depends on the anatomical features of their body. In childhood, the Eustachian tube is much narrower and smaller than in an adult, so it is more susceptible to disorders. Another factor influencing the spread of this disease among preschoolers is their frequent contact with other children in kindergartens, and later at school, where respiratory viral infections often occur.

Children have an immune system that is not yet fully formed, and their antibody production is low, so while an adult's defense mechanisms can easily protect a person from developing serous otitis, the situation is different in children.

Additional risk factors include passive smoking or having a close relative living in the same apartment who has been diagnosed with the disease.

Adults can get serous otitis when their immunity is reduced due to taking antibiotics and other medications that reduce the level of antibodies produced by immune system cells. Also of considerable importance is the lack of vitamins, microelements and nutrients in the body.

Exudative otitis can develop as a secondary disease against the background of inflammation in the nasopharynx, allergies, and tumor processes.

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Pathogenesis

There is air inside the tympanic cavity, the volume of which is controlled by the auditory tube, there should be no liquid there. If the functioning of the auditory tube is disrupted, serous secretion accumulates in the ear cavity, which displaces the air. After this, hyperplasia of the mucous membrane of the tympanic cavity develops - an increase in its size due to cell growth. The nature of the secretion that fills the tympanic cavity changes depending on the stage of the disease. If this is the beginning of the development of inflammation, it has a yellowish color and low viscosity. As otitis progresses, the shade changes to a darker one and the viscosity increases. Because of this, the movement of the auditory ossicles is disrupted, contributing to hearing loss.

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Symptoms serous otitis media

The symptoms of exudative otitis differ and depend on the prevalence of the stage, of which there are four:

• Eustachitis (catarrhal stage);
• secretory stage;
• mucosal stage;
• fibrous stage.

Eustachitis is an inflammation of the Eustachian tube, which disrupts the flow of air into the middle ear. An empty space forms in the tympanic cavity, and transudate appears. Due to the development of otitis, lymphocytes move to the site of inflammation, irritation of the mucous glands that produce the secret begins. The patient experiences partial hearing loss and congestion.

The second stage of serous otitis differs from the first by the presence of serous fluid in the tympanic cavity. Metaplasia development is typical - replacement of one type of epithelium with another, which is not normally found in the ear cavity. The number of secretory glands increases. A person may feel fullness and pressure in the ear. There is a feeling as if the liquid inside is overflowing and at this moment hearing improves. This happens when changing the position of the head.

In the mucous stage, the serous fluid that filled the tympanic cavity and contributed to hearing loss becomes dense and viscous. The symptom of fluid displacement disappears. But the contents of the ear can be released through perforation. Among doctors, there is a term such as "sticky ear", which characterizes the mucous stage of serous otitis. Because the ear is filled with a sticky substance inside, the eardrum tends to thicken and become cyanotic.

If the disease progresses to the fourth stage – fibrous, degenerative changes begin in the mucous membrane of the tympanic cavity. The secretory glands produce less mucus, but the auditory ossicles are involved in the process of fibrous transformation. The cicatricial process can provoke the progression of adhesive otitis.

First signs

The first signs that may prompt you to think about the need to see an otolaryngologist and suspect that you have serous otitis is hearing loss. In other words, the appearance of symptoms of partial hearing loss - hearing loss.

The person feels a stuffiness in the ear and a feeling of pressure, noise in the ears. These symptoms increase when swallowing. Sometimes there is a pain syndrome in one or both ears.

When using otoscopy, it is clear that the eardrum changes color: it becomes gray or yellow - this depends on what stage the disease is at and what kind of fluid fills the ear cavity.

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Serous otitis in adults and children

Children are more often diagnosed with serous otitis - this is due to the structural features of the auditory tube, underdeveloped immunity. The course of the disease in adults and children does not have a significant difference: the same symptoms prevail, the disease has four stages. Children can tolerate otitis more severely due to the fact that most of their organs and systems are in the development stage and cannot provide an adequate response of the body to the presence of the pathogen. When choosing therapeutic therapy for children, more gentle drugs are chosen that do not have strong side effects on the not fully formed organism.

Stages

There are four stages of serous otitis.

1. The initial stage, which is quite difficult to diagnose due to the lack of obvious symptoms. All processes occur inside the organ of hearing: drainage and ventilation dysfunction of the ear. Due to inflammation of the mucous membrane and glands, the flow of air from the outside into the tympanic cavity stops. The eardrum changes its shade and becomes retracted. The only complaint at this point may be a slight deterioration in hearing. It lasts from the first to the fourth week
2. The second stage is characterized by the formation of an excessive amount of serous fluid, due to which, when moving and changing the position of the head, the patient can hear gurgling sounds reminiscent of pouring water. The duration of this stage is approximately from one month to a year.
3. The third stage occurs when the ear cavity is completely filled with serous secretion produced by the glands. Then this substance begins to thicken and becomes more viscous, sticky. Because of this, deformation processes begin in the ear. This exacerbation can be observed from one to two years.
4. At the fourth stage, irreversible disturbances in the structure and functioning of the hearing organ begin: fibrous changes in the auditory ossicles, tympanic membrane, and mucous membrane of the ear develop.

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Acute serous otitis

This ear inflammation, which occurs almost immediately after exposure to a pathogenic factor, is characterized by the release of exudative fluid and a short course of the disease. It usually ends either with recovery after treatment under the supervision of a doctor, or develops into a chronic stage.

In most cases, acute serous otitis occurs without obvious symptoms of inflammation, so this disease is difficult to diagnose. The reason for this is that patients get used to the uncomfortable sensations in the ear cavity and do not pay attention to the signs of the disease, seek medical help late.

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Chronic serous otitis

The stage of disease development that begins after the acute and subacute stage, most often due to the fact that treatment is not started on time, is characterized by the duration of the process, during which remission is replaced by periods of exacerbation. It can manifest itself in the case of improper therapy in the treatment of acute serous otitis or in an advanced, untreated case.

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Forms

Serous otitis with damage to the middle ear is called serous otitis media. It can be of two types: unilateral and bilateral. According to statistics, bilateral otitis is most often found in those seeking help with symptoms of ear inflammation, since the structure of the human hearing organ contributes to the spread of the inflammatory process from one ear to the other. The diagnosis of "unilateral otitis" is made in only 10% of cases.

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Complications and consequences

If the disease is diagnosed in time and optimal treatment is prescribed, then the prognosis for the disease is favorable - complete recovery.

If the patient delays seeking medical help, complications may arise:

• Adhesive otitis is an inflammation of the ear with impaired functioning caused by the formation of epithelial growths, scars that immobilize and restrain the movement of the auditory ossicles.
• Labyrinthitis is an inflammation of the inner ear.
• Mastoiditis is an inflammation of the mastoid process.
• Perforation of the eardrum is the occurrence of a through defect in the mucous membrane of the eardrum.
• An ear abscess is a limited accumulation of purulent secretion in the ear cavity as a result of an inflammatory process.
• Hearing loss is a partial loss of hearing.
• Osteomyelitis is a purulent-necrotic process that develops in bones, bone marrow and surrounding tissues.
• Facial nerve damage
• Meningitis is an inflammation of the meninges.
• Encephalitis is an inflammation of the brain.
• Sepsis is a general infection of the body with microorganisms that have entered the bloodstream.

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Diagnostics serous otitis media

Most often, the diagnosis of serous otitis is complicated. This is due to the fact that this pathology proceeds without obvious manifestations, most often people do not pay attention to the symptoms indicating the presence of ENT disease. Hearing loss is noticeable only in the initial stages, over time, the patient gets used to it and does not feel any discomfort: a feeling of fullness or congestion.

To make this diagnosis, a consultation with a doctor is necessary, who will pay attention to the patient’s complaints, conduct an examination and additional research methods, on the basis of which he will select an individual treatment.

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Tests

If an ear infection is suspected, the patient should undergo basic tests: biochemical and general blood tests, general urine tests.

To confirm the diagnosis, the results may show elevated values that are responsible for the body's response to the pathogen and the development of inflammation. Depending on how much the patient's analysis differs from the norm, the course of the disease can be determined: whether it is an acute or chronic stage.

A general blood test may show an increase in leukocytes and erythrocyte sedimentation rate (ESR).

A biochemical blood test may show a specific inflammation marker – C-reactive protein, which is not normally present in the blood.

If the disease progresses too slowly and sluggishly, tests may not reveal abnormalities in the indicators that indicate inflammation.

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Instrumental diagnostics

To make a diagnosis, it is necessary to use otoscopy - a method of examining the ear with a forehead reflector. In this case, a change in the appearance of the eardrum is visible - it becomes swollen, changes its color.

In addition, tympanometry is prescribed. It helps diagnose the presence of exudate in the ear cavity, compaction and loss of mobility of the tympanic membrane and auditory ossicles. During tympanometry, the otolaryngologist can check the light reflex, which is impaired or not detected in serous otitis.

Audiometry is used to determine the hearing threshold, hearing sensitivity to sound waves of various frequencies. Based on the results of the audiogram, the doctor can check the degree of hearing loss.

Endometrial examination is performed to assess the condition of the mucous membrane of the auditory canal. Radiography can exclude the presence of neoplasms that could cause the development of otitis.

Differential diagnosis

An otolaryngologist can differentiate serous otitis from other types of otitis by a specific change in the color of the eardrum: it becomes yellow or gray, depending on the stage of inflammation.

Symptoms characteristic of serous otitis may overlap with signs of other diseases: labyrinthitis, external otitis, otosclerosis, glomus tumor formed in the middle ear cavity.

Differences in symptoms of serous otitis media and external otitis: the pain syndrome in serous otitis media has a pulsating character, is felt inside the ear, there may be complaints of decreased hearing, congestion. If the patient has acute external otitis, the pain intensifies when pressing the tragus, pulling the auricle, hearing loss is not observed. The fluid in acute otitis media has a serous-purulent character, in external - purulent.

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Treatment serous otitis media

Drug treatment of serous otitis includes a range of drugs:

• Antihistamines that relieve swelling. Loratadine is taken 1 tablet once a day. Side effects are rare, may include dry mouth and vomiting.
• Vasoconstrictor nasal drops, among which Otrivin stands out. In the form of drops, 2-3 drops are used in each nasal passage 3-4 times a day. Itching and burning in the mouth, nose, local irritation, a feeling of dryness may be felt.
• Anti-inflammatory tablets - Diclofenac is prescribed in the form of tablets 2-3 times a day, 50 mg.
• Analgesic ear drops are prescribed: Otipax in the form of ear drops is used 4 drops 2-3 times a day in the external auditory canal.
• If the cause that provoked the development of otitis is a bacterial or viral infection, antibacterial and antiviral agents are used. Cefazolin is administered intramuscularly and intravenously. 0.5 - 1 g every 12 hours. Allergic reactions, nephrotoxicity and gastrointestinal disorders are possible.
• Sometimes it is necessary to undergo a course of antibiotic therapy: ampicillin, azithromycin, ciprofloxacin are prescribed. Azithromycin is taken once a day, an hour before meals or 2 hours after meals. On the first day, the dosage is 0.5 g, from the second to the fifth day - 0.25 g. Side effects are manifested in gastrointestinal disorders.

Vitamin therapy includes vitamins A, B, C.

Physiotherapy procedures

For complex treatment, physiotherapeutic procedures are prescribed:

• UHF.
• Laser irradiation of the initial section of the auditory tube.
• Pneumatic massage.
• Photophoresis.
• Electrophoresis using hormonal drugs.

Folk remedies

1. Bay leaf is used in the form of a decoction to treat otitis. It is necessary to pour 5 bay leaves with a glass of water, boil, and leave the resulting decoction for two hours. It is used both externally and internally. 3-4 times a day, the laurel decoction is dripped into the ear, 3-5 times a day you need to drink 1 tablespoon of the collection.
2. Onion juice is obtained after baking an onion in the oven, you can also cut it into small pieces and put one piece in the ear canal overnight. In the case of using onion juice, add a little butter to it and soak a tampon with this mixture, which is placed in the ear.
3. A tampon is moistened with a 0.5% solution of hydrogen peroxide and placed in the ear for 5 minutes. After diluting the peroxide in boiled or distilled water, the resulting mixture can be poured into the ear, 5 drops at a time, and the patient remains in a lying position for 10-15 minutes.
4. The tampon is soaked in 30% propolis tincture in 70-degree alcohol and inserted into the ear canal.

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Herbal treatment

1. You can do rinsing with warm chamomile infusion. Method of dilution: 1 teaspoon of the herb per glass of hot water.
2. An infusion of sweet clover and chamomile can be used as a compress by soaking a cloth in the mixture and applying it to the sore ear. Take one tablespoon of dry sweet clover and one tablespoon of chamomile, dilute in one glass of boiling water, and leave for half an hour.
3. They make medicinal bandages soaked in a mixture of four herbs: calamus rhizome, oak bark, cinquefoil rhizome, and thyme herb. Take half a spoon of each ingredient – a total of two tablespoons of the mixture, wrap it in a cloth and place it in a glass of boiling water for 5 minutes.
4. Mix peppermint, lavender, angelica - three tablespoons each, sweet clover - 2 tablespoons, ground ivy - 1 tablespoon. This mixture is placed in 0.5 liters of boiling water, you can also infuse it with vodka. Moisten a tampon and apply to the sore ear.

Homeopathy

1. 4-5 drops of "Aflubin" are diluted in a teaspoon of vodka, carefully dripped into the ear and a cotton-gauze swab is placed on top. The drug increases the body's immunity, relieves inflammation and has an analgesic effect. It is necessary to adhere to the ratio of drops and vodka so that there is no place for side effects: allergic reactions.
2. Ferrum phosphoricum has an immunostimulating property and fights the first symptoms of inflammation. Prescribed for children - one tablet several times a day, for adults - two tablets 2-3 times a day. At the same time, the diet should include food rich in iron - liver, eggs, fish, beef.
3. Belladonna is a remedy that has an analgesic and antispasmodic effect, it also reduces the secretion of glands. Dosage: a drop of tincture is diluted in three spoons of water. In case of overdose of this drug, poisoning may be observed, accompanied by headache, dizziness, nausea, vomiting.
4. Aconite is an analgesic, anti-inflammatory drug. For otitis, it is used as a tincture for external use. Side effects may include allergic reactions.

Surgical treatment

If drug treatment does not produce results or the patient seeks medical help long after the first signs of the disease have appeared, surgical treatment methods can be used. They are aimed at evacuating the secretion that fills the ear cavity. For this purpose, shunting of the tympanic cavity is used - paracentesis. An incision is made on the eardrum with a special surgical needle with a spear-shaped blade. This creates a path for the outflow of exudate and the introduction of various antiseptic medications.

Another method of surgical intervention is bypass, during which ventilation tubes are inserted into the tympanic cavity, through which serous fluid can exit, secretion is aspirated, and various drugs are introduced into the tympanic cavity.

Prevention

Prevention of serous otitis among children includes methods that provide full protection of the body from pathogenic agents. The choice of feeding the child has a great influence on the development of the immune system during the neonatal period: breast milk contains lysozyme, immunoglobulins - factors of non-specific humoral protection.

For both adults and children, a healthy lifestyle, avoiding physical inactivity, walking in the fresh air, a balanced diet, and the absence of bad habits are important.

If a person goes to a doctor with some complaints and must undergo a course of treatment, it is necessary to prescribe optimal antibiotic therapy and when prescribing any drugs, it is necessary to pay attention to the fact that side effects, negative impact on both the immune system and the whole body, are minimal.

Nowadays, specific prevention of influenza and acute respiratory diseases that can cause ear inflammation is carried out, and the upper respiratory tract is cleaned.

It is also important to promptly treat sources of infection in the nasopharynx and oropharynx, which tend to be re-introduced into the ear cavity and cause serous otitis.

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Forecast

Most often, with correct and timely treatment, the course of the disease has a favorable prognosis - recovery.

In the absence of proper and timely treatment, serous otitis can have complications.

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