How to cure exudative otitis media: antibiotics, shunting, surgery

Depending on the neglect of the inflammatory process, antibacterial preparations, proteolytic enzymes are introduced into the lumen of the auditory tube through the catheter. Conduct fizioprotsedury. Patients are prescribed vasoconstrictive drops in the nose and antihistamines if the disease has occurred against a background of severe allergies. Also from medicines use mucolytics, which dilute accumulated in the middle ear fluid.

Patients are prescribed fortifying agents, vitamins, immunocorrectors. If conservative therapy does not give the desired result within 1-2 weeks, then surgical methods of evacuating the secret from the tympanic cavity are shown.

Medicinal treatment

Treatment of the chronic form of otitis media should be comprehensive. Particular attention is paid to drug therapy, it is possible to use folk remedies. Medicines are prescribed by a doctor, focusing on the severity of the disease, the age of the patient and other nuances of the disease state.

Drug therapy consists of such groups of drugs:

• Antibiotics - the feasibility of their use is still in question. But if the disease is caused by bacteria or infection, then it is impossible to treat without antibiotics. For treatment appoint: Garazon, Deksona, Normaks, Otofa.
• Antihistamines - relieve mucosal edema, facilitate the work of the liver and other organs with enhanced medication. Effective in otitis allergic nature. Patients can be recommended such drugs: Zodak, Ketotifen, Otryvin, Suprastin, Tizin, Celfax
• Vasodilating nasal drops - facilitate nasal breathing and the work of the middle ear: Vibrocil, Nazivin, Naphthysine, Polydex, Protargol, Sanorin.
• Mucolytics - dilute the accumulated fluid in the middle ear, making it easier to remove. To this group of drugs are: Gelomirtol, Rinofluimucil, Sinupret, Fluviert.
• Anti-inflammatory drugs - stop the inflammatory process, apply both in the early stages of the disease, and in neglected cases. Relieve the pain. For treatment apply: Anauran, Beclomethasone, Betamethasone, Dexamethasone, Nimesulide, Fenazone, Choline Salicylate.
• Immunomodulators - have a regulatory effect on the immune system, strengthen it, increase resistance to pathogens: Gepon, Derinat, Imudon, IRS-19, Polyoxidonium.

All medications are selected by the attending physician, individually for each patient, guided by the results of the diagnostic.

Drops with exudative otitis

An obligatory component of the treatment of persistent serous inflammation of the mucous membrane of the auditory tube and the tympanic cavity are drops of topical application. As a rule, patients are prescribed disinfectant and anti-inflammatory drugs. If there are painful sensations, then anesthetics are used, to eliminate infection - antibacterial.

Expressed therapeutic effect in exudative otitis have such ear drops : Kandibiotik, Kombinil Duo, Otinum, Sofraks, Uniflox, Tsipromed, Sofraks, Uniflox, Tsipromed. All drugs are used strictly for medical purposes with the recommended dosage and duration of therapy.

[1], [2], [3], [4], [5], [6]

Nasonex in exudative otitis media

The drug with the active component is mometasone furoate 50 μg. Glucocorticosteroid topical application. Has anti-inflammatory and anti-allergic properties. Prevents systemic effects on the body, inhibiting the release of inflammatory mediators.

Nazonex helps to reduce the accumulation of exudate in the focus of inflammation, preventing the accumulation of neutrophils. Reduces the production of lymphokines, inhibits the migration of macrophages, reducing the rate of infiltration and granulation. Is highly active in the treatment of inflammatory and allergic processes.

• Indications for use: seasonal allergic rhinitis, all-the-year-round rhinitis in children and adults, exacerbation of chronic sinusitis in patients older than 12 years.
• Usage: the drug is used nasally, injecting 1 time into each nostril once a day. The maximum daily dosage is 4 injections, that is 400 micrograms.
• Side effects: nasal bleeding, pharyngitis, burning in the nose and irritation of the nasal mucosa. Also, headaches, sneezing, increased intraocular pressure are possible.
• Contraindications: hypersensitivity to the components of the drug, patients younger than 2 years, tuberculosis of the respiratory system, recent surgery in the nasal cavity or injury. It is not used for fungal, viral and bacterial lesions of the respiratory system. Use during pregnancy is possible only for medical purposes.
• Overdose: since the drug has low bioavailability and is not detected in the serum, no systemic reactions occur. With prolonged use, oppression of the hypothalamic-pituitary-adrenal system is possible.

Form release: nasal spray in plastic bottles of 120 doses / 18 g with a nebulizer and protective cap.

Otypax in exudative otitis media

Ear drops used in otology. Contain two active components: phenazone and lidocaine. The first substance has anti-inflammatory and analgesic properties, and lidocaine is a local anesthetic of the amide group. The interaction of these components provides an analgesic and anti-inflammatory effect.

• Indications for use: acute otitis media, phlyctenulosis viral and barotraumatic inflammation of the middle ear.
• Method of application: nasally for adults and children over 1 month of age. The medicine is digested 2-3 times a day for 4 drops in the affected external ear canal of the ear. Duration of treatment is 7-10 days.
• Contraindications: intolerance of the components of the drug, perforation of the tympanic membrane of an infectious or traumatic origin.
• Side-effects: local allergic reactions, irritation and hyperemia of the external auditory canal, itching and skin rashes. Cases of overdose are not fixed.

Form release: ear drops in the bottles-droppers.

Erespal with exudative otitis

Anti-inflammatory drug with an active component - fenspiride hydrochloride. It inhibits exudation and prevents bronchoconstriction. Inhibits the metabolism of arachidonic acid. Has an anti-bronchoconstrictive effect by reducing the production of serotonin, histamine, bradykinin.

• Indications for use: otitis, sinusitis, rhinitis, rhinopharyngitis, allergic rhinitis, bronchial asthma, chronic bronchitis. Reduction of painful symptoms in ARI, measles, whooping cough.
• Method of administration: for patients older than 14 years, 1 capsule of medication is prescribed in the morning and in the evening or 3-6 tablespoons of syrup. In severe cases, the daily dosage can be increased to 320 mg, divided into 2-3 doses. For patients under 14 years of age, only syrup is used, 4 mg / kg of patient's body weight twice a day. The medicine is taken before meals.
• Side effects: nausea, vomiting, discomfort in the epigastric region, allergic reactions, increased drowsiness, tachycardia.
• Contraindications: intolerance of the components of the drug, pregnancy and lactation.
• Overdose: nausea, vomiting, increased excitement, drowsiness. There is no specific antidote. For treatment, gastric lavage and further symptomatic therapy are indicated.

Product: syrup of 150 and 100 ml, tablets with enteric coating of 30 pieces per package.

[7], [8]

Mucolytics with exudative otitis

When the chronic form of inflammation of the middle ear in the tympanic cavity accumulates exudate. For its dilution and excretion, mucolytic agents are used.

1. ACC

Mucolytic and expectorant with the active component - acetylcysteine. Reduces the viscosity of the secretion and accelerates its separation. It acts as an antidote for acute intoxications with aldehydes, phenols, paracetamol.

• Indications for use: average exudative otitis media, tracheitis, bronchiolitis, acute and chronic bronchitis, laryngitis, sinusitis, cystic fibrosis, bronchiectatic disease and other diseases with accumulation of viscous sputum and its poor separation.
• Directions for use: by mouth, after eating. For patients older than 14 years, 400-600 mg, for children 6-14 years, 300-400 mg, 2-5 years, 200-300 mg, divided into two doses. For babies from the 10th day of life and up to two years, 50 mg 2-3 times a day are prescribed.
• Side effects: allergic reactions, nausea, vomiting, heartburn, diarrhea, headaches, tinnitus, heart palpitations, arterial hypotension.
• Contraindications: hypersensitivity to the components of the drug, intolerance to fructose, pulmonary hemorrhage and hemoptysis, hepatitis, renal insufficiency. Application during pregnancy and lactation is possible only according to the doctor's prescription.
• Overdose: hypersecretion reactions in patients of infantile age. Treatment is symptomatic.

Form release: effervescent tablets of 20 pieces, powder for making a hot drink for 6, 20 bags. Effervescent tablets of prolonged action of 10 pieces in a tube and a powder for the preparation of a suspension for children.

2. Karbotsistein

It dilutes sputum, increases its volume and facilitates excretion from the body. Promotes normalization of physical and chemical properties of exudate components.

• Indications for use: acute and chronic diseases of the respiratory system with the release of a large amount of viscous secretions.
• Usage: Orally 2 tablets 3 times a day. The syrup is taken 15 ml 3 times a day, followed by a decrease in the dose to 10 ml 3 times a day. Dosage for children depends on their age, on the average prescribe 10-2.5 ml 3-4 times a day. The duration of treatment is determined by the attending physician.
• Side effects: skin allergic reactions, gastrointestinal bleeding. Treatment is symptomatic with withdrawal of the drug.
• Contraindications: individual intolerance of the components of the drug, exacerbation of peptic ulcer of the stomach and duodenum. Application during pregnancy and lactation is possible only for life indications.

Form release: capsules for oral administration of 20 and 1000 pieces per pack, syrup in vials.

3. Fluimuite

Mucolytic, effectively dilutes sputum, increases its volume and facilitates separation. Contains the active ingredient - acetylcysteine. The active substance retains its activity in purulent exudate and has an antioxidant effect.

• Indications for use: purulent and catarrhal otitis, sinusitis, sinusitis and other conditions with poor secretion. Diseases of the respiratory system with violation of sputum discharge. Removal of a viscous secretion from the respiratory tract during the postoperative period or after the trauma.
• The way of application and dosage depends on the form of release of the medication, so they are selected by the doctor individually for each patient.
• Side effects: nausea, vomiting, diarrhea, skin allergic reactions, tinnitus, nosebleeds. Overdose manifests more pronounced reactions, treatment is symptomatic.
• Contraindications: intolerance of the components of the drug, peptic ulcer of the stomach and duodenum, pregnancy and lactation. Effervescent tablets are prohibited for patients under 18 years of age.

Form release: soluble granules in bags of 1 grams, solution for injections in ampoules, tablets for the preparation of effervescent solution.

4. Mucosol

Contains carbocysteine, which affects the sialic transferase of goblet cells of the mucous membranes. Regulates the viscosity of bronchial secretion, normalizes the visco-elastic properties of mucus, improves its excretion.

• Indications for use: poor exudation during exacerbation of the middle ear. Infectious and inflammatory diseases of the respiratory system: tracheitis, bronchial asthma, bronchitis, bronchiectatic disease.
• Directions for use: by mouth after eating, with warm water. Adults are prescribed 2 capsules 3 times a day. When the desired therapeutic effect is achieved, the dosage is reduced to 1 tablet 4 times per day. The course of treatment is 8-10 days. To treat children prescribe a syrup, the dosage is selected individually.
• Side effects: nausea, vomiting, inflammation of the gums, pain in the epigastric region, diarrhea, runny nose, gastrointestinal bleeding, headache, allergic reactions.
• Contraindications: hypersensitivity to the components of the drug, ulcerative lesions of the digestive tract, erosive and ulcerative diseases of the digestive system. It is not used in early pregnancy and during breastfeeding.
• Overdose: disorders of the digestive tract, abdominal pain, nausea, vomiting. Treatment is symptomatic.

Form release: capsules for oral administration of 375 mg in blisters for 10 pieces, 2 blisters per package.

Vitamins

Serous inflammation of the middle ear refers to diseases of inflammatory-infectious nature. It develops due to the action of various factors, one of which is a weakened immune system. Vitamins in exudative otitis are aimed at strengthening the body and accelerating the healing process.

With ear diseases it is recommended to use such vitamins:

• C - ascorbic acid has an antioxidant effect.
• A - retinol strengthens the immune system.
• Group B - improve the quality of hearing, positively affect the endocrine, nervous and cardiovascular systems.

To enrich the body with useful substances, you can buy a ready-made multivitamin complex at the pharmacy or carefully revise your diet. The most useful products for maintaining health of hearing organs are:

• Carrots - provides a normal blood supply to the tympanic membrane.
• Walnuts - improve the functioning of the inner ear and stimulate its self-cleaning function.
• Spinach is rich in nutrients that protect the ear from loss and loss of hearing.
• Sea kale - contains a large amount of iodine, which is responsible for the normal functioning of the vestibular apparatus, that is, the middle ear.
• Fatty varieties of fish - contain omega-3, prevent auditory hallucinations, tinnitus.
• Chicken meat and eggs - the chicken is rich in protein, that is, the building material for the internal structures of the organs of hearing. Eggs contain lutein, which increases the range of ear-perceptible sounds.
• Black chocolate - improves blood circulation and oxygen supply.

There are harmful to the organs of hearing and the body as a whole products:

• Alcoholic drinks - provoke vascular spasms, which lead to auditory hallucinations.
• Strong coffee and tea - contain caffeine, which interferes with blood circulation.
• Fat and fried meat - increases the level of cholesterol in the blood, negatively affects the blood supply of the auricles.
• Products of long-term storage - contains ingredients that disrupt the work of the vestibular apparatus.
• Salt - causes swelling, raises blood pressure because of what there is a sense of noise in the ears.

Balanced healthy nutrition in combination with multivitamin preparations strengthens the body's immune defenses, preventing various diseases, including hearing damage.

Physiotherapeutic treatment

To increase the effectiveness of other therapeutic methods, with purulent inflammation of the middle ear, patients are prescribed physiotherapy. This type of treatment has a pronounced anti-edematous, bacteriostatic, anti-inflammatory, vasodilating and regenerative action.

For the treatment of otitis with serous discharge, these physiotherapy techniques are most often used:

1. Stimulant - remove puffiness and normalize the blood flow.
   1. Pneumatic massage - a special apparatus alternates air masses of high and low pressure, stimulating the oscillations of the tympanic membrane and increasing muscle tone.
   2. Magnetotherapy - a magnet with a low-frequency field is applied to the affected organ. This activates lymphatic drainage processes and reduces swelling. The method is effective for inflammatory lesions of internal organs, traumatic injuries.
   3. DiaDinamotherapy - the device generates rhythmic current flows, which activates cortical and subcortical centers, enhances blood flow in the middle ear and normalizes the mobility of the auditory ossicles.
2. Cleansing - aimed at cleaning the ear canal, removing accumulated secretions.
   1. Blowing - restores the patency of the Eustachian tube with inflammation of the middle ear. The procedure is carried out by a qualified doctor on an outpatient basis.
   2. Washing - is carried out with a purulent form of the defeat of the middle ear, to prevent the spread of infection and the development of complications. Procedures are performed before each use of ear drops. For washing use hydrogen peroxide, warm vodka or other antiseptic agents. Treatment is carried out by a doctor, attempts to wash the inflamed organ of hearing on their own can negatively affect its functioning and cause perforation of the tympanic membrane.
3. Warming - eliminate inflammation, reduce pain syndrome.
   1. Electrophoresis - the introduction of medicines into the body through the skin and mucous membranes. Has a minimum of adverse reactions and a pronounced therapeutic effect.
   2. UHF - is used for exacerbations of chronic inflammation. The affected organ is exposed to an air gap. Due to this, the puffiness decreases, the acute inflammatory process descends. With purulent otitis spend 10-15 sessions for 7-10 minutes each.

Physiotherapeutic treatment is carried out for medical purposes. The otolaryngologist selects the most effective procedures, taking into account the patient's anamnesis and the clinical picture of the disease.

Electrophoresis with exudative otitis media

A popular method of physiotherapy, effective in persistent serous inflammation of the mucosa of the auditory tube and the tympanic cavity is electrophoresis. With exudative otitis, it allows drugs to penetrate into the affected tissue, minimizing adverse reactions. The procedure is carried out using special apparatus.

Useful properties of electrophoresis:

• Reduces the inflammatory process.
• Removes edema.
• Anesthetizes.
• Stimulates the production of biologically active substances.
• Soothing effect on the central nervous system.
• Accelerates the restoration of damaged tissues and mucous membranes.
• Activates the body's defenses.
• Relaxes and relieves increased muscle tone.
• Improves blood microcirculation.

The mechanism of therapeutic action of this physiotherapy procedure is that the drug is transformed into ions with an electric charge for better penetration into the skin. The majority of the drug remains in the skin, and the rest with lymph and blood is spread throughout the body. In transporting the drug, I participate in excretory ducts of sweat and sebaceous glands, hair follicles, and intercellular zones.

The effectiveness of electrophoresis depends on the degree of absorption of the medication, which is influenced by such factors as the age of the patient, the strength of the current supplied by the apparatus, the concentration and dosage of the drug, the duration of the procedure, and the location of the electrodes. The procedure is carried out in the physiotherapy room. The session takes 10-15 minutes, and the duration of the entire course is about 10-20 procedures, daily or every other day.

[9], [10], [11], [12], [13], [14], [15]

Exercise to remove fluid in exudative otitis media

Therapeutic gymnastics is an auxiliary method for many diseases, including otorhinolary. There is a set of exercises that facilitate the removal of fluid / viscous secretion in otitis exudative form.

• Circular movements pound the pits under the lobes of the ears: on the left side in a clockwise direction, and on the right side against. The first week, perform 7 movements per ear, and then add up to 21 movements.
• Between the middle and index finger, clamp the auricle. Rotate it in a circular motion. The first week is performed on 7 grindings, gradually adding 1 to 21 movements.
• Grasp the ear so that the thumb holds it from the back, and the other fingers - in front. Pull both ears at the same time. The number of repetitions is similar to the exercises described above.
• Press your palms against your ears and release them sharply, so that there is cotton. The scheme is the same as in the previous exercises.

The therapeutic complex must be done until an acute inflammatory process passes. Exercises are recommended for patients prone to otitis and frequent colds.

[16], [17], [18], [19],

Blowout with exudative otitis

In some cases, the only effective method for normalizing the pressure in the eardrum is purging. With exudative otitis this method is used to remove a thick secretion and prevent perforation of the tympanic membrane. The procedure is performed by an otolaryngologist, applying the method of the Politzer.

The procedure is indicated if there is such a symptomatology:

• Violation of the vestibular apparatus.
• Significant reduction in hearing acuity.
• Prolonged congestion in the ears.
• Auditory hallucinations and sensation of a click in the head.
• Accumulation of viscous exudate.
• Dangerous ear inflammation.

The blowing is carried out with the help of a Polytzer device, which is a rubber bulb with tubes of various sizes. The tip of the tube is inserted into the nasal sinuses and pressed with fingers, creating tightness. Using the otoscope, the doctor connects the external ear passage. The patient needs to swallow saliva and repeat in the hearing a few words that the doctor will indicate.

When the muscles of the lower jaw move, the ENT compresses the balloon and a stream of air enters the Eustachian tube. Their auditory tube flows into the region of the tympanic membrane. If there is purulent or mucous deposits, the patient feels a sharp increase in sounds and noise. The duration of the procedure depends on the severity of the disease state. As a rule, blowing takes no more than 20 minutes. It is carried out 2 times a week for 2-3 weeks.

A technique for purging the ears and at home has also been developed. But in carrying it out, the risk of perforation of the membrane and a number of other complications should be considered. Procedure is carried out in the event that the reasons of zalozhennosti are established. The patient needs to prepare a rubber bulb, which comes complete with an oval tip. The blowdown technique is similar to the above.

[20], [21], [22]

Surgery

If conservative treatment of inflammation of the middle ear with the release of exudate did not bring the desired result, then surgical treatment is indicated. With exudative otitis, myringotomy is performed, i.e. The incision of the tympanic membrane for the insertion of a shunt or adenotomy.

• Myringotomy is a section of the tympanic membrane with aspiration of its contents or installation of a special shunt. Despite the speed and effectiveness of this method, it can cause recurrence of the disease. In this case, tissue healing occurs within a week, and restoration of functions of the auditory tube within 1-2 months.

• Shunting the tympanum cavity is aimed at restoring the functional abilities of the hearing organs and reducing the incidence of otitis media. When the shunt is installed for a long time, the structure of the mucosa of the middle ear is normalized.

In some cases, after surgical treatment, patients develop complications: otorrhoea, tympanosclerosis, perforation of the tympanic membrane. It is also possible to form granulations, cholesteatoma, sensorineural hearing loss.

Operation with exudative otitis

One of the most common and effective operations with exudative otitis is the shunting of the tympanic membrane. This method is based on the installation of a special shunt in the tympanic membrane. The shunt performs the function of temporary communication between the external ear canal and the tympanum.

In the serous form of inflammation, the operation is aimed at removing the accumulated exudate and normalizing the work of the Eustachian tube. In addition to bypass surgery, paracentesis can be performed, that is, the incision of the tympanic membrane without the installation of a shunt. With this method, exudate is excreted through the incision.

For patients younger than 7 years, the operation is performed under general anesthesia, and for patients older than 7 years and adults under local anesthesia. Surgical intervention can alleviate the patient's morbid condition and stop the progressive deterioration of hearing.

Puncture in exudative otitis

Paracentesis or tympanotomy is a puncture of the tympanic membrane for emptying its cavity from the accumulated exudate. Treatment is carried out if there are such indications:

• Acute pain.
• Progressive reduction of hearing acuity.
• High fever and fever.
• Strong protrusion of the tympanic membrane.

Puncture of the tympanic membrane improves overall well-being and lowers the temperature. The procedure is performed on day 3-4 of the disease. First, the auditory canal is sanitized and disinfected with antiseptics. In most cases, the operation is performed without anesthesia, but if the patient is hypersensitive, then anesthesia is placed behind the ear, freezing the nerve endings. Local treatment of the tympanic membrane with lidocaine is also possible.

After the operation, careful care of the drum cavity is shown. It is necessary to regularly change turundas and clean the ears. As soon as the amount of exudate is reduced, the doctor performs otoscopy. If the edges of the wound are stitched, then the puncture is repeated.

Despite the effectiveness of this method, it can cause a number of complications. First of all, these are traumas of the ear canal, damage to the medial wall of the tympanic membrane. If the exudate is not completely eliminated, then there is a risk of developing acute infection and hearing loss.

Shunting of the tympanum in exudative otitis media

Surgery with a cut of the tympanic membrane and the installation of a shunt is bypass. Treatment has strict testimony to conduct:

• Accumulation of a large amount of secretion and hearing loss.
• Large adenoids and cleavage of the hard palate in children.
• Inflammation of the middle ear.
• Tumor neoplasms in the nasopharynx with the inability to excrete the exudate.

The procedure is carried out under general anesthesia. The incision is performed under a microscope, then a serous fluid is removed from the middle ear and a shunt is installed. After the operation, the patient is under medical supervision for several hours, and then goes home, performing all the doctor's appointments.

Patients should be careful with water procedures so that the liquid does not get into the shunted ear, as this can provoke inflammation. Of complications of treatment are: infection of the middle ear cavity and premature dropout of the shunt. In the first case, antibiotics are used for treatment, and in the second case, a second operation is performed. Gradually, the hole in the eardrum is tightened, and hearing damage does not occur.

Removal of adenoids in exudative otitis media

Some of the most frequent calls to the otolaryngologist are adenoids and otitis. Both pathologies are typical for patients from 1 to 15 years old and require serious treatment. Adenoids are pathological proliferation of nasopharyngeal tonsil tissues. It is the large adenoids that cause the symptoms of the "sticky" ear.

If after the course of drug therapy the desired recovery does not occur, then the operation is shown. Adenotomy is performed under general or local anesthesia. In the area of the nasopharynx is introduced adentotom, that is, a special ring-shaped knife. He is taken to the affected tissues and cuts them in one motion.

In most cases, after removal of adenoids, exudative otitis yields to conservative therapy. If this does not happen, an operation is performed on the tympanum to clean it.

Laser tympanotomy with exudative otitis media

The operation at which the opening of the tympanic cavity is carried out and the tympanostomy is performed is tympanotomy. Treatment is indicated with prolonged or recurrent inflammation of the middle ear. With exudative forms of otitis, laser tympanotomy is possible.

The operation allows to withdraw viscous accumulations of exudate from all parts of the middle ear. To do this, use a special suction. Empty the cavity washed with solutions of antiseptics and carry out a thorough audit.

After the operation, the tissues are placed on the wound and fixed with flat glove rubber. This significantly reduces the risk of intracranial or septic complications. The effectiveness of the treatment depends on the duration of the disease and the severity of pathological changes in the middle ear.