Exudative otitis media: causes, consequences, diagnosis

A pathological process in the middle ear with the formation of thick secretion is exudative otitis. Let's consider the features of the disease, methods of diagnosis, treatment and prevention.

Exudate is a fluid that is released from small blood vessels into the tissues and cavities of the body. In otitis, the secreted secretion includes erythrocytes, leukocytes, proteins, fibrin, and platelets. The disease develops when the Eustachian tube, which connects the tympanic cavity with the nasopharynx and performs a drainage function, equalizes pressure, is damaged.

"Sticky" ear occurs due to the action of various factors and pathogens. The disease has a tendency to become chronic, which is manifested by acute relapses. For treatment, a comprehensive approach is used with a comprehensive impact on the lesion and strengthening the immune system.

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Epidemiology

According to medical statistics, otitis media is one of the most common diseases. About 25% of people face it every year, and 60% have suffered from ear inflammation at least once in their lives.

As for the exudative form, it occurs in 15% of cases of the disease and more often in pediatric patients. In 3% of patients, serious disorders develop with irreversible changes in the auditory apparatus and the development of hearing loss.

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Causes exudative otitis media

The tympanic cavity is lined with epithelial cells that produce a small amount of fluid. Normally, excess fluid is removed into the nasal cavity through the auditory tube. Impaired drainage function is one of the causes of exudative otitis. The disease may also be associated with the following factors:

• Chronic inflammatory diseases of the nasopharynx, nose and paranasal sinuses with changes in the mucous membrane of the auditory tube.
• Dysfunction of the Eustachian tube due to a malfunction of the muscles responsible for opening it.
• Neglected treatment of acute otitis media.
• Congenital anatomical features of the structure of the auditory apparatus.
• Physiological features of the development of the auditory tube in childhood.
• Obstruction of the auditory tube by adenoid growths, cicatricial changes.
• Benign and malignant neoplasms of the nasopharynx.

Treatment of the disease begins with eliminating the above-mentioned causes and preventing their further occurrence.

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Allergy as a cause of exudative otitis

One of the forms of serous otitis media is allergic. Most often, it develops after respiratory diseases. It manifests itself as an acute onset with high body temperature, mucous discharge from the ear cavity. When infectious agents are added, the discharge becomes purulent.

Allergic inflammation can be accompanied by rhinitis, sinusitis, adenoid growths, acute respiratory viral infections and other pathologies. Also, one should not exclude the impact of severe allergens on the body.

To treat the disease, hyposensitization and local glucocorticosteroid therapy are performed. The ear cavity is washed with a warm solution of 3% boric acid or hydrogen peroxide. Patients are prescribed vitamin-rich food and general tonics. If allergic otitis occurs with infectious complications, then antibacterial treatment is carried out.

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Risk factors

Otitis media occurs due to an infectious lesion of the nasopharynx and swelling of the mucous membranes. First of all, the Eustachian tube swells and the ventilation process of the ear is disrupted. Against this background, catarrhal otitis occurs, which without timely treatment turns into an exudative form.

Risk factors for the disease also include:

• Congenital anomalies of the auditory apparatus.
• Nasal defects: deviated septum, injuries.
• Inflammatory diseases of the nasopharynx.
• Adenoids.
• Inflammation of the auditory tube.
• Allergic reactions.
• General diseases of the body of infectious and inflammatory nature.
• Physical impact on the hearing organs: water ingress, pressure changes, injuries.

Risk factors also include a weakened immune system, the presence of chronic diseases of the body, and the patient’s childhood.

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Pathogenesis

The mechanism of development of serous lesion of the middle ear is based on the disruption of drainage and ventilation function of the Eustachian tube. Because of this, a vacuum is formed in the tympanic cavity and serous exudate accumulates.

The transudate is liquid, but due to hypersecretion of goblet cells of the tympanic mucosa and increased protein levels, it becomes viscous and thick. Because of this, the disease is called "sticky" ear.

The pathogenesis of exudative otitis media is associated with poor drainage of the tympanic cavity, dysfunction of the muscular system of the soft palate, cleft hard palate and active use of antibacterial drugs.

Immunity and exudative otitis

One of the reasons for the development of inflammation of the middle ear with increased secretion is a weakened immune system. It is the immune defense that prevents infection of the body with various pathogens.

The first symptoms of the disease are inflammatory reactions, which indicate that the immune system is trying to cope with the inflammation. If this does not happen, the disease progresses. Based on this, one of the mandatory components of the treatment of serous otitis is immunotherapy, aimed at strengthening the local and general immune system.

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Immune response in exudative otitis

The inflammatory response is the first line of the body's immune defense. It is realized by humoral factors and cells that are activated by the action of pathogenic microorganisms or tissue damage.

The early immune response begins with the recruitment of leukocytes from the bloodstream to the site of inflammation. Leukocyte mobilization is stimulated by proinflammatory cytokines, which are produced and secreted by macrophages during phagocytosis of the pathogen.

It is the inflammatory response of the immune system that allows for early diagnosis of the disease and the beginning of treatment.

Symptoms exudative otitis media

Exudative otitis has pronounced symptoms only in complicated cases. In other cases, the signs of the disease are blurred. But despite this, doctors identify a number of symptoms of damage to the hearing organs:

• Hearing loss and a feeling of fullness or noise in one/both ears.
• Sharp, shooting and quickly passing pain in the ear.
• Subfebrile body temperature.
• Discharge from the ear canal.

As the disease progresses, the symptoms increase. If otitis develops against the background of some other disease, then the signs of inflammation are quite difficult to recognize.

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Complications and consequences

One of the dangers of exudative inflammation of the middle ear is complications of the disease. If purulent otitis is left untreated or therapy is not started in a timely manner, this can cause the development of such problems with the organ of hearing:

• Degenerative persistent changes in inflamed structures: eardrum, mucous cavity.
• Immobilization of the auditory ossicles and decreased hearing acuity.
• Chronic adhesive otitis media.
• Formation of retraction pockets of the eardrum.
• Perforation, that is, pathological holes in the eardrum.
• Formation of cholesteatoma - a cavity with dead epithelial cells and other substances in a capsule of connective tissue.
• Intoxicating effect on the inner ear, which leads to a decrease in the function of auditory receptors and the progression of hearing loss.

In addition to the above problems, the disease can cause serious complications for the entire body: meningitis, brain abscess, cerebral sinus thrombosis, labyrinthitis, sepsis, mastoiditis. Such consequences of exudative otitis are difficult to treat.

Recurrence of exudative otitis

If inflammation of the middle ear recurs several times a year after complete recovery, this indicates a recurrent form of the disease. Most often, relapses are associated with the following factors:

• Frequent colds, pneumonia.
• Weakened immune system.
• Anomalies of the internal structure of the hearing organs.
• Exudative diathesis.
• Digestive disorders.
• Severe allergic reactions.
• Polyps in the nasal cavity.
• Sinusitis.
• Enlarged adenoid vegetations.
• Hypertrophy of the nasal conchae and palatine tonsils.

The nature of the pathogen is important in case of frequent relapses. Thus, when Pneumococcus, Staphylococcus aureus and epidermidis are detected, chlamydia, mycoplasma and other pathogenic microorganisms can be isolated.

In terms of its symptoms, a relapse is milder than the first case of the disease. But despite this, the inflammation leads to a progressive decrease in hearing acuity. Perforation of the eardrum, a feeling of congestion and pain in the ear are also possible.

During diagnostics, the clinical picture of the disease, laboratory and instrumental studies are studied. Treatment is carried out in two stages. First of all, the current exacerbation is eliminated: washing the ear cavity, taking antibiotics, physiotherapy, etc. The second stage consists of preventing relapses. For this, immunostimulants, multivitamin complexes and other means are prescribed to strengthen local and general immunity.

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Chronic otitis exudative progressed to sensorineural hearing loss

Impaired hearing acuity due to damage to the auditory analyzer is sensorineural hearing loss. One of the causes of this disease is a complication of chronic serous inflammation of the middle ear. The pathological process can affect the structures responsible for the perception of sound in different areas: in the cells of the inner ear, the brain stem or cortex, nerve conductors.

Sensorineural hearing loss is classified by the level of damage, duration and severity of the course, degree of hearing loss and time of onset of symptoms. The main signs of this complication include:

• Decreased hearing acuity.
• Tinnitus.
• Headaches and dizziness.
• Somatoform disorders.

In the early stages, normal conversation is clearly audible from 5-7 meters, and a whisper from 2-3 meters. In severe cases, these indicators are significantly reduced, and speech is audible from a distance of less than a meter.

Diagnostics of sensorineural hearing loss against the background of persistent serous inflammation of the mucous membrane of the auditory tube and tympanic cavity consists of the following methods: otoscopy, tuning fork tests, tone audiometry, vestibulometric tests. The studies are also aimed at identifying concomitant pathologies of the nervous system, lesions of the spine and brain, and damage to the bones of the facial skull.

Treatment consists of restoring hearing functions and eliminating painful symptoms. Patients are prescribed physiotherapy, reflexology, and medication. In particularly severe cases, hearing aids and surgical treatment are used. With timely detection and treatment of this complication, the prognosis is relatively favorable. In other cases, there is a high risk of hearing loss.

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After exudative otitis, ear congestion remains

Another common complication that occurs after "sticky" ear is congestion of the hearing organs. Normally, the pressure in the external auditory canal is similar to the pressure in the middle ear. If the pressure on both sides of the eardrum is different, then a feeling of congestion occurs. Another cause of the unpleasant condition is damage to the Eustachian tube, that is, the connecting channel between the pharynx and the ear.

As a rule, after the symptoms of otitis are eliminated, the congestion goes away on its own. The recovery period is individual for each patient, but on average it takes about 2 weeks. To speed up the recovery, patients are prescribed vasoconstrictor ear drops, as they relieve swelling, improve the drainage functions of the auditory tube and the discharge of pathogenic exudate. Anti-inflammatory drugs are also used. Physiotherapy procedures are used as an auxiliary method: warming up, eliminating swelling, strengthening local immune defense.

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Diagnostics exudative otitis media

The serous form of inflammation of the middle ear has a poor spectrum of symptoms, so its diagnosis requires a comprehensive, all-round approach. First of all, the doctor collects anamnesis, asks the patient about previous infectious and inflammatory diseases of the nasopharynx and ears, allergic reactions, diagnostic and any other medical manipulations.

After the survey, further examinations are prescribed. Diagnostics are aimed at:

• Determination of the stage of the pathological process.
• Detection of inflammation in the tympanic cavity.
• Determination of the type of pathogen and its sensitivity to antibacterial drugs.

It is also necessary to confirm or exclude complications: perforation of the eardrum, decreased hearing acuity, purulent processes. For these purposes, a set of laboratory and instrumental methods is used, differentiation with similar diseases.

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Tests

Since persistent serous damage to the mucous membrane of the auditory tube and tympanic cavity is accompanied by an inflammatory process, laboratory diagnostics are carried out to identify it. The tests are prescribed by a doctor, they are necessary to study the secretion from the ear cavity and determine the type of pathogenic microorganisms, their sensitivity to antibiotics.

The patient is shown a general clinical blood test, C-reactive protein, ESR to assess inflammation and draw up a treatment plan. If there is a suspicion of complications, then a detailed blood test is carried out, during the study of which the results of computed tomography and other instrumental examinations are taken into account.

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Cytology in otitis media with exudation

Cytology is one of the most informative and efficient methods of diagnosing various organs. In the case of a "sticky" ear, it reveals inflammatory processes, the severity of the pathological condition, and complications.

To conduct cytology in case of exudative inflammation, a sample of the secretion from the ear cavity is taken. The analysis reveals purulent-inflammatory processes in the external auditory canal, on the eardrum and in other structures of the organ. Cytology also identifies the pathogen and determines its sensitivity to antibacterial drugs.

If the disease is associated with allergic reactions of bacterial or non-bacterial nature, then cytology reveals a large number of eosinophils in the ear secretion. The results of cytology allow for effective treatment and monitoring of its effectiveness.

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Instrumental diagnostics

If chronic inflammation of the middle ear is suspected, patients are prescribed a range of different studies. Instrumental diagnostics are also indicated, which are represented by the following methods:

• Otoscopy is an examination of the external auditory canal and eardrum using an otoscope or ear funnel.
• Otomicroscopy is an examination of the ear cavity using a microscope. In otitis, the eardrum is inflamed, bluish in color, and may be cloudy, retracted, or, on the contrary, bulging. Mobility is limited, but serous fluid may be visible through it.
• Valsalny's test/Siegle's funnel - determines the degree of mobility of the eardrum.
• Audiometry is the measurement of hearing acuity and sensitivity to sound waves of different frequencies.
• Acoustic reflexes are changes in the resistance of the structures of the outer and middle ear when the stapedius muscle contracts and when exposed to loud sounds.
• Tympanometry – determination of the mobility of the eardrum and the conductivity of the auditory ossicles. Inflammation is accompanied by a decrease in the mobility of structures due to the accumulation of exudate.
• Tympanopuncture is a puncture of the eardrum to collect its contents for analysis. Most often, paracentesis is performed, that is, a hole is formed using a special instrument and its shunting.
• Endoscopy of the pharyngeal opening of the auditory tube – reveals pathologies of the nasopharynx that could cause otitis and visualizes the narrowing of the opening of the auditory tube.
• Computer tomography of the temporal bone – is performed in particularly severe cases. The radiograph determines the airiness of the middle ear cavities, damage to the mucous membrane and the chain of auditory ossicles. The density and localization of the serous fluid is also determined.

A set of instrumental diagnostic methods allows us to make a reliable diagnosis and begin treatment.

Tympanometry in otitis exudative

The method of assessing the pressure in the tympanic cavity, the functional features of the eardrum, auditory ossicles and tube is tympanometry. In case of exudative inflammation of the middle ear, it is considered a mandatory study.

Tympanometry is performed using a special probe that is inserted into the ear canal. The device is connected to a pump, a sound generator, and a microphone. The generator creates sounds of different tones, the pump regulates and changes the pressure in the ear canal, and the microphone detects return signals reflected from the walls of the eardrum and middle ear.

This study determines the degree of mobility of the bones and eardrums, the presence of inflammatory exudate and other pathologies. The procedure takes no more than 10 minutes.

Tympanogram type in exudative otitis

Acoustic impedance testing is a study aimed at obtaining data on the flow of the middle ear. Tympanometry determines the elasticity of the eardrum. If there are cicatricial changes on the internal structure of the organ of hearing, scratches due to pressure differences, or accumulation of secretion in the middle ear, then this increases the acoustic impedance and reduces the acoustic elasticity, that is, the conductivity for sounds.

Tympanogram has several types:

• Type A – these are records that are characteristic of high full conductivity with a steep gradient and air pressure on the middle ear. Reflects the normal status of the hearing organ.
• Type B - Low conductivity and negative/non-prolonged middle ear pressure recordings. Indicate a high-impedance middle ear disorder.
• Type C - decreased conductivity with a gradual gradient or negative pressure in the middle ear.

Types B and C may indicate the presence of fluid in the middle ear, i.e. the process of exudation, perforation of the eardrum or its cicatricial deformations, the presence of neoplasms in the middle ear or the lack of connection between the surfaces of the sound-conducting bones of the middle ear.

Tympanometric examination data do not have independent diagnostic value and require additional studies to assess the threshold of bone and air conduction, hearing threshold, otoscopy and other audiometric indicators.

Differential diagnosis

When examining the body to establish a diagnosis of exudative otitis, differential diagnostics are mandatory. Inflammation of the middle ear is differentiated from pathologies in which conductive hearing loss occurs with an intact eardrum:

• Otosclerosis - in this disorder, the otoscopic picture is normal, and tympanometry reveals a type A tympanogram with a flattening of the curve.
• Anomalies and degenerative changes of the auditory ossicles. The diagnosis is confirmed after multifrequency tympanometry.
• Glomus tumors of the tympanic membrane and rupture of the auditory ossicles. Tumor formations are confirmed by X-ray and type E tympanogram.

The results of differentiation allow us to make a correct final diagnosis or prescribe a number of additional studies for a more detailed study of the pathological condition.

Treatment exudative otitis media

The key to successful treatment of serous inflammation of the middle ear is a comprehensive approach, which can be combined with folk remedies. At the same time, the sooner the therapy is started, the higher its effectiveness and the better the prognosis for recovery. The main objective of the treatment is to restore the functions of the auditory tube. For this, the nasal cavity, paranasal sinuses and pharynx are sanitized.

How long does exudative otitis take to heal?

The duration of treatment for serous inflammation of the mucous membrane of the auditory tube and tympanic cavity depends on many factors. If the disease is diagnosed at an early stage and treatment is started, then complete recovery occurs within a week. Antibacterial, anti-inflammatory and antimicrobial agents are used for this.

In advanced cases of inflammation, treatment is longer and consists of a complex of various therapeutic methods. The patient is prescribed medications to eliminate the infection, mucolytics and other drugs. Physiotherapy procedures are also indicated to remove exudate from the ear cavity. Recovery takes from 10 to 14 days.

If the disease is not fully cured, it can lead to serious complications, the most dangerous of which is complete hearing loss. Children are at risk of developing meningitis, mastoiditis, encephalitis and other life-threatening diseases.

Prevention

To prevent inflammation of the middle ear, a set of preventive measures is indicated, which are aimed at increasing the body's resistance to pathogens:

• Regular preventive examinations by an otolaryngologist.
• Physical activity and hardening of the body.
• Balanced nutrition.
• Sanitation of the nasal cavity and nasopharynx.
• Timely treatment of any foci of infection in the body.

In addition to the above recommendations, it is necessary to take vitamins and minerals to enhance the protective properties of the immune system.

• Is it possible to walk with exudative otitis?

Walking in the fresh air with a diagnosed “sticky” ear is allowed, provided that the patient is dressed according to the weather and the ears are protected from cold air.

If the illness arose against the background of acute respiratory viral infections, flu and other infectious diseases, then walks are not recommended until complete recovery, as there is a risk of infecting others.

If your body temperature rises and your general health deteriorates, you should stay in bed, so it is better to postpone walks.

• Can a child go to kindergarten with exudative otitis?

Almost all ENT doctors are of the opinion that in case of otolaryngological diseases in a child, bed rest with minimal contact with the outside world should be observed. This reduces the risk of progression of the pathology and infection of others if the inflammation is of an infectious nature. Based on this, it is better to postpone going to kindergarten until the child has fully recovered. Read also about the course and symptoms of exudative otitis in children in this article.

• Is it possible to go on holiday to the sea if you have exudative otitis?

During the treatment of the serous form of inflammation of the middle ear, the head should be protected from hypothermia or water getting into the ears as much as possible. Trips to the sea are allowed, provided that the patient does not dive or scuba dive. Moderate water and air procedures with an emphasis on strengthening and hardening the body are recommended. As for flights to the sea in warm countries, everything depends on the recommendations of the otolaryngologist, since flights are prohibited with otitis.

• Is it possible to fly on an airplane if you have exudative otitis?

Anyone who has flown on an airplane knows that during the flight and landing the ears become blocked. In case of inflammatory lesions of the hearing organs, the unpleasant sensations increase several times, causing acute pain.

Because of this, almost all otolaryngologists are against any flights during otitis, and especially with its serous form. This is due to the fact that when the pressure changes, the capsule with liquid or purulent exudate can break through, and its contents will pass into the inner ear, worsening the already painful condition.

There are a number of recommendations that can help prevent critical situations due to pressure surges:

• To reduce the pressure in the auditory tube, open your mouth wide.
• The upper edge of the lower jaw is connected to the bony base of the middle ear, so frequent and intense swallowing helps to release excess air from the tympanic cavity. You can also chew nuts or candies for these purposes.
• Keep decongestant drops on hand.

If a flight is unavoidable, you should consult with your doctor and follow all his instructions both before and after the flight.

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Forecast

If exudative otitis is diagnosed at an early stage and effective treatment is prescribed, the prognosis for recovery is favorable. As the painful condition worsens, a complex of complications develops, some of which lead to irreversible hearing loss and damage to brain structures. In this case, the disease has an unfavorable prognosis.

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