Average 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 canal.

[1], [2]

Causes of the serous otitis media

The causative agents of serous otitis media are bacteria and viruses. Among the microorganisms of bacteria that are capable of provoking the development of this disease, Streptococcus pneumoniae and Haemophilus influenzae are noted. In a series of studies, it was found that people with serous otitis have such viruses: respiratory syncytial, parainfluenza, influenza, enteroviruses, adenoviruses, rhinoviruses, coronaviruses that promote the progression of ear inflammation.

Isolate the bacterial nature of otitis, viral and the impact of both, and those microorganisms at the same time. When diagnosing the disruption of the structure and functioning of the Eustachian tube, the process becomes more complicated and the disease proceeds more quickly.

The Eustachian tube is a channel that connects the nasopharynx with the middle ear cavity. It clears the auditory cavity of mucus and promotes its displacement into the nasopharynx, and also equalizes the pressure. At the slightest violation in the anatomy or function of the auditory tube, stagnation of the liquid secret produced by the mucosa of the ear occurs.

[3], [4], [5], [6]

Risk factors

Serous otitis is especially affected by children. It directly depends on the anatomical features of their body. As a child, the Eustachian tube is much narrower than in an adult, so it is more susceptible to disturbances. Another factor that influences the spread of this disease among preschool children is their frequent contact with other children in kindergartens, and later in schools where respiratory viral infections often occur.

Children have a completely unformed immune system, low production of antibodies, so if the protective mechanisms of an adult can easily save a person from the development of serous otitis media, the situation is different in children.

Additional risk factors are passive smoking or a close relative living in the same apartment, who is diagnosed with this disease.

Adult people can get sick with serous otitis with a decrease in immunity against the background of taking antibiotics, other medications that reduce the level of antibody produced by the cells of the immune system. Also of considerable importance is the lack of vitamins and microelements, nutrients in the body.

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

[7], [8], [9], [10]

Pathogenesis

Inside the tympanum there is air, the volume of which is controlled by the auditory tube, there should not be any fluid there. When the functioning of the auditory tube is disturbed, a serous secret is collected in the ear cavity, which displaces the air. After this, hyperplasia of the mucous membrane of the tympanum develops - an increase in its size due to the growth of cells. The nature of the secret that fills the tympanum varies 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 the otitis flows, the shade changes to a darker shade and the viscosity increases. Because of this, the movements of the auditory ossicles are impaired, contributing to hearing loss.

[11], [12], [13], [14], [15], [16]

Symptoms of the serous otitis media

The symptomatology of exudative otitis is different and depends on the predominance of the stage, which four distinguish:

• eustachiitis (catarrhal stage);
• secretory stage;
• mucous stage;
• fibrous stage.

Eustachiitis is an inflammation of the Eustachian tube, because of which the inflow of air into the middle ear is disturbed. The empty space forms in the tympanic cavity, there appears the transudate. Because of the development of otitis, lymphocytes move to the focus of inflammation, irritation of the mucous glands begins, which develop secret. The patient has a partial hearing loss, congestion.

The second stage of serous otitis differs from the former in the presence of serous fluid in the tympanic cavity. It is characteristic of the development of metaplasia - the replacement of one type of epithelium by another, which is normally not in the ear canal. Increases the number of secretory glands. A person can feel the fullness and pressure in the ear. There is a feeling that the fluid inside is poured and at this moment the 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 impairment becomes dense and viscous. The symptom of the displacement of the liquid disappears. But the contents of the ear can stand out through the perforation. Among doctors there is such term as "sticky ear", characterizing the mucous stage of serous otitis. From the fact that inside the ear is filled with a sticky substance, the tympanic membrane has the property of thickening, becoming cyanotic.

If the disease flows into the fourth stage - fibrous, degenerative changes begin in the mucous membrane of the tympanic cavity. The production of mucus secretory glands is reduced, but the process of fibrous transformation includes auditory ossicles. The scarring process can provoke the progression of adhesive otitis media.

First signs

The first signs that may prompt you to think that you need to turn to an otolaryngologist and suspect that you have serous otitis media is a decrease in hearing. In other words, the appearance of symptoms of incomplete hearing loss - hearing loss.

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

With the use of otoscopy, it can be seen that the eardrum changes its color: it becomes gray or yellow - it depends on the stage at which the disease is located and which liquid fills the ear canal.

[17], [18], [19], [20]

Serous otitis in adults and children

Children are more often diagnosed with serous otitis - this is due to the peculiarities of the structure of the auditory tube, insufficiently developed immunity. The course of the disease in adults and children has no significant difference: the same symptoms prevail, the disease has four stages. Children may be more difficult to tolerate otitis due to the fact that most organs and systems in them are in the development stage and can not provide an adequate response of the organism to the presence of the pathogen. When choosing therapeutic therapy for children are chosen more sparing drugs that do not have strong side effects on the not fully formed organism.

Stages

There are four stages of serous otitis media.

1. The initial stage, which is difficult to diagnose because of the absence of obvious symptoms. All processes occur inside the hearing organ: drainage and ventilation dysfunction of the ear. Due to inflammation of the mucous membrane and glands, the flow of air from outside to the tympanic cavity stops. The tympanic membrane changes its hue and becomes a retracted form. The only complaint at this time may be a slight hearing impairment. 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, which causes the patient to hear gurgling sounds resembling a water transfusion during movements and changes in the position of the head. The duration of this stage is approximately one month to one year.
3. The third stage occurs when the ear cavity is completely filled with a serous secret, produced by the glands. Then this substance begins to thicken and becomes more viscous, sticky. Because of this, the processes of deformation in the ear begin. Observe this aggravation can be from one to two years.
4. At the fourth stage irreversible disturbances begin in the structure and functioning of the hearing organ: fibrotic changes in the auditory ossicles, the drum membrane, the ear mucosa develop.

[21], [22], [23]

Acute serous otitis media

This inflammation of the ear, which occurs almost immediately after exposure to the pathogenic factor, is characterized by the release of exudative fluid and a short course of the disease. Ends, as a rule, or recovery after treatment under the supervision of a doctor, or develop 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 are accustomed to uncomfortable sensations in the ear cavity and do not pay attention to the signs of the disease, they are late seeking medical help.

[24], [25], [26], [27], [28]

Chronic serous otitis

The stage of the development of the disease, which begins after the acute and subacute stage, most often due to the fact that the treatment is not started on time, is characterized by the duration of the process during which the remission is replaced by periods of exacerbation. It can be manifested in the case of using the wrong therapy in the treatment of acute serous otitis, or with a neglected, untreated case.

[29], [30], [31], [32], [33], [34], [35]

Forms

Serous otitis with middle ear damage is called serous otitis media. It can be of two types: one-sided and two-sided. According to statistics, most often people who seek help with symptoms of ear inflammation have bilateral otitis, since the structure of the hearing organ in humans promotes the spread of the inflammatory process from one ear to another. The diagnosis of "unilateral otitis" is put only in 10% of cases.

[36], [37], [38], [39], [40], [41]

Complications and consequences

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

If the patient is delayed with seeking medical help, complications may occur:

• Adhesive otitis - 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 tympanic membrane - the emergence of an end-to-end defect in the mucosa of the tympanic membrane.
• Ear abscess is a limited accumulation of purulent secretion in the ear cavity as a result of the inflammatory process.
• Hearing loss is a partial loss of hearing.
• Osteomyelitis is a purulent-necrotic process that develops in the bones, bone marrow and surrounding tissues.
• Lesion of the facial nerve
• Meningitis is an inflammation of the meninges.
• Encephalitis is an inflammation of the brain.
• Sepsis is a common infection of the body with microorganisms that have fallen into the bloodstream.

[42], [43], [44], [45], [46], [47],

Diagnostics of the serous otitis media

More often the diagnosis of serous otitis media is complicated. This is due to the fact that this pathology occurs without obvious manifestations, most often people do not pay attention to the symptoms indicating that they have an ENT disease. Hearing loss is noticeable only at the initial stages, with time the patient gets used to it and does not feel any discomfort: sensation of fullness or stuffiness.

To make this diagnosis, you need to consult a doctor who will pay attention to the patient's complaints, will conduct an examination and additional research methods, on the basis of which individual treatment will be selected.

[48], [49], [50], [51], [52], [53]

Analyzes

If suspected of ear inflammation, the patient must pass the basic tests: a biochemical and general blood test, a general urine test.

To confirm the diagnosis, the results can be increased indicators, which are responsible for the body's response to the ingestion of a pathogenic agent and the development of inflammation. Depending on how much the patient's analysis differs from the norm, it is possible to determine the course of the disease: acute is the stage or chronic.

In the general analysis of blood, there may be an increase in leukocytes and the rate of erythrocyte sedimentation (ESR).

In a biochemical blood test, a specific marker of inflammation may appear-C-reactive protein, which is normal in the blood.

If the disease is too slow and slow, the tests may not reveal abnormalities in indicators indicating inflammation.

[54], [55], [56], [57], [58], [59]

Instrumental diagnostics

To make a diagnosis it is necessary to use otoscopy - the method of examining the ear with the help of a frontal reflector. At the same time, the appearance of the tympanic membrane is visible - it becomes obsolete, changes its color.

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

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

Conduct an endometrium to assess the condition of the mucosa of the auditory canal. Radiography can exclude the presence of tumors that could cause otitis media.

Differential diagnosis

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

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

Differences in symptoms with serous otitis media and external: the pain syndrome in serous otitis media has a pulsating character, is felt inside the ear, there may be complaints of hearing loss, congestion. If the patient has acute otitis externa, the pain is aggravated by squeezing the tragus, stretching the auricle, and hearing loss is not observed. The fluid with acute otitis media has a serous-purulent character, while in the outer one it is purulent.

[60], [61],

Treatment of the serous otitis media

Medicamentous treatment of serous otitis media includes a complex of drugs:

• Antihistamines that relieve swelling. Loratadin is taken 1 tablet once a day. Side effects are rare, there may be dry mouth and vomiting.
• Vasodilating drops for the nose, among which are isolated, Otrivin. In the form of drops used 2-3 drops in each nasal passage 3-4 times a day. Itching and burning in the mouth, in the nose, local irritation, a feeling of dryness can be felt.
• Anti-inflammatory tablets - Diclofenac is attributed in the form of tablets 2-3 times a day for 50 mg.
• Attributed analgesic ear drops: Otypax in the form of ear drops used 4 drops 2-3 times a day in the external auditory meatus.
• If the cause that provoked the development of otitis media 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: attributed ampicillin, azithromycin, ciprofloxacin. Azithromycin is drunk 1 time per day, one hour before a meal or 2 hours after a meal. 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.

Vitaminotherapy includes vitamins A, B, C.

Physiotherapeutic procedures

For complex treatment, physiotherapeutic procedures are prescribed:

• UHF.
• Irradiation with laser beams of the initial segment of the auditory tube.
• Pneumatic massage.
• Photophoresis.
• Electrophoresis with the use of hormonal drugs.

Alternative treatment

1. The bay leaf is used as a decoction for otitis treatment. It is necessary to pour 5 bay leaves with a glass of water, boil, insist the resulting broth for two hours. It is applied simultaneously for external and internal use. 3-4 times a day, the broth of the laurel is buried in the ear, 3-5 times a day you need to drink 1 tablespoon of the collection.
2. Onion juice is obtained after baking the bulb in the oven, you can still cut it into small pieces and put one piece in the ear canal for the night. In case of juice from the onion, a little butter is added to it and this mixture is moistened with a tampon that is placed in the ear.
3. A 0.5% solution of hydrogen peroxide is moistened with a tampon, placed in the ear for 5 minutes. It is possible, after diluting the peroxide in boiled or distilled water, to pour the resulting mixture into the ear by 5 drops and is in a lying position for 10-15 minutes.
4. The tampon is wetted in a 30% tincture of propolis on 70-degree alcohol and inserted into the auditory canal.

Herbal Treatment

1. With the help of a warm chamomile, you can do the washing. Method of dilution: 1 teaspoon of herbs for a glass of hot water.
2. Infusion of medicinal clover and chamomile can be used as a compress, moistening the tissue in this mixture and attaching it to the diseased ear. One tablespoon of dry herb drunk medicinal and one tablespoon of chamomile is taken, it is bred in one glass of boiling water, insisting for half an hour.
3. They make medical dressings impregnated with the collection of four herbs: rhizome of common ara, bark of oak, rhizome of cinquefoil erect, herb of thyme. Take on the floor spoons of each component - all in all, you get two tablespoons of the mixture, wrapped in cloth and falls for 5 minutes in a glass of boiling water.
4. Mint peppermint, lavender spice, forest doodnika - three tablespoons, a medicinal dumpling - 2 tablespoons, a squishy ivy - 1 tablespoon. This mixture is placed in 0.5 liters of boiling water, and you can also insist on vodka. A tampon is moistened and applied to the diseased ear.

Homeopathy

1. 4-5 drops of Aflubin are bred in a teaspoonful of vodka, carefully bury it in the ear and apply a cotton-tampon swab 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 with the first symptoms of inflammation. Assigned to children - one tablet several times a day, adults - two tablets 2-3 times a day. At the same time in the diet should be present food, rich in iron - liver, eggs, fish, beef.
3. Beladonna - a tool that has analgesic and spasmolytic effects, and it also reduces secretion of glands. Dosage: a drop of the liqueur is diluted in three tablespoons of water. When an overdose of this drug can occur poisoning, accompanied by headache, dizziness, nausea, vomiting.
4. Aconite - anesthetic, anti-inflammatory drug. When otitis is used as a tincture for external use. Side effects can be allergic reactions.

Surgery

If medication fails to produce results, or the patient seeks medical care after a long time after the first signs of the disease, surgical methods of treatment can be used. They are aimed at evacuating the secret, which is filled with the ear canal. To do this, the shunting of the tympanic cavity is used - paracentesis. A cut is made on the tympanic membrane with a special surgical needle with a spear-shaped blade. Thus, a path is formed for the outflow of exudate and the injection of various antiseptic medicines.

Another method of surgical intervention is bypass, during which ventilation tubes are introduced into the tympanum, through which the serous fluid can escape, a secretion of the secretion occurs and the injection of various drugs into the tympanic cavity.

Prevention

Prevention of serous otitis media among children includes methods that protect the body from pathogenic agents to the fullest. On the formation of the immune system in the period of the newborn baby, the choice of feeding the baby has a big influence: breast milk has lysozyme in its composition, immunoglobulins are factors of nonspecific humoral protection.

For both adults and children, a healthy lifestyle is important, avoiding hypodynamia, walking outdoors, eating well, no bad habits.

If a person seeks a doctor with any complaints and needs to undergo a course of treatment, it is necessary to prescribe the best antibiotic therapy and when prescribing any medications, care should be taken to ensure that side effects, a negative effect on both the immune system and the entire body, are the minimum.

In our time, specific prevention of influenza and acute diseases of the respiratory system, which can cause ear inflammation, is performed, the upper respiratory tract is cleared.

It is also important to timely cure sources of infection in the nasopharynx, oropharynx, which have the property to be reintroduced into the ear cavity and cause serous otitis.

[62], [63], [64], [65], [66], [67], [68], [69]

Forecast

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

In the absence of correct and timely treatment, serous otitis may have complications.

[70], [71], [72]