How to cure exudative otitis exudata: antibiotics, bypass surgery, surgery

Depending on the severity of the inflammatory process, antibacterial drugs and proteolytic enzymes are injected into the lumen of the auditory tube through a catheter. Physiotherapy procedures are performed. Patients are prescribed vasoconstrictor nasal drops and antihistamines if the disease has arisen against the background of severe allergies. Mucolytics are also used as medications, which thin the fluid accumulated in the middle ear.

Patients are prescribed general tonics, vitamins, and immunocorrectors. If conservative therapy does not produce the desired result within 1-2 weeks, surgical methods of evacuating secretions from the tympanic cavity are indicated.

Drug treatment

Treatment of chronic otitis media should be comprehensive. Particular attention is paid to drug therapy, and folk remedies may be used. Medicines are prescribed by a doctor, based on the severity of the disease, the patient's age, and other nuances of the disease.

Drug therapy consists of the following groups of drugs:

• Antibiotics - the appropriateness of their use is still questionable. But if the disease is caused by bacteria or infection, then treatment is impossible without antibiotics. For treatment, the following are prescribed: Garazon, Dexona, Normax, Otofa.
• Antihistamines – relieve swelling of the mucous membrane, facilitate the work of the liver and other organs with intensive drug therapy. Effective for otitis of allergic origin. Patients may be recommended the following drugs: Zodak, Ketotifen, Otrivin, Suprastin, Tizin, Tselfaks
• Vasoconstrictor nasal drops – facilitate nasal breathing and the functioning of the middle ear: Vibrocil, Nazivin, Naphthyzinum, Polidex, Protargol, Sanorin.
• Mucolytics - liquefy the fluid accumulated in the middle ear, facilitating its removal. This group of drugs includes: Gelomirtol, Rinofluimucil, Sinupret, Fluifort.
• Anti-inflammatory drugs – stop the inflammatory process, are used both in the early stages of the disease and in advanced cases. Relieve painful sensations. For treatment use: Anauran, Beclomethasone, Betamethasone, Dexamethasone, Nimesulide, Phenazone, Choline salicylate.
• Immunomodulators – have a regulatory effect on the immune system, strengthen it, increase resistance to pathogenic microorganisms: Gepon, Derinat, Imudon, IRS-19, Polyoxidonium.

All medications are selected by the attending physician, individually for each patient, based on the results of the diagnostics.

Drops for exudative otitis

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

The following ear drops have a pronounced therapeutic effect in exudative otitis: Candibiotic, Combinil Duo, Otinum, Sofradex, Uniflox, Cipromed, Sofradex, Uniflox, Cipromed. All drugs are used strictly as prescribed by a doctor, observing the recommended dosage and duration of therapy.

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Nasonex for exudative otitis

A medicinal product with the active component mometasone furoate 50 mcg. A glucocorticosteroid for local use. It has anti-inflammatory and anti-allergic properties. Prevents systemic effects on the body by inhibiting the release of inflammation mediators.

Nasonex helps reduce the accumulation of exudate in the inflammation focus, preventing marginal accumulation of neutrophils. Reduces the production of lymphokines, inhibits the migration of macrophages, reducing the rate of infiltration and granulation. It shows high activity in the treatment of inflammatory and allergic processes.

• Indications for use: seasonal allergic rhinitis, year-round rhinitis in children and adults, exacerbation of chronic sinusitis in patients over 12 years of age.
• Method of administration: the medicine is used nasally, spraying 1 time into each nostril once a day. The maximum daily dosage is 4 sprays, i.e. 400 mcg.
• Side effects: nosebleeds, pharyngitis, burning in the nose and irritation of the mucous membrane of the nasal cavity. Headaches, sneezing, increased intraocular pressure are also possible.
• Contraindications: hypersensitivity to the components of the drug, patients under 2 years of age, tuberculosis of the respiratory organs, recent surgical interventions in the nasal cavity or injuries. Not used for fungal, viral and bacterial lesions of the respiratory organs. Use during pregnancy is possible only on doctor's prescription.
• Overdose: Since the drug has low bioavailability and is not detected in the blood serum, systemic reactions do not occur. With prolonged use, suppression of the hypothalamic-pituitary-adrenal system is possible.

Release form: nasal spray in plastic bottles of 120 doses/18 g with a sprayer and a protective cap.

Otipax for exudative otitis

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, phlyctenular viral and barotraumatic inflammation of the middle ear.
• Method of application: nasally for adults and children over 1 month of age. The medicine is instilled 2-3 times a day, 4 drops in the affected external auditory canal of the auricle. Duration of treatment is 7-10 days.
• Contraindications: intolerance to the components of the drug, perforation of the eardrum of infectious or traumatic origin.
• Side effects: local allergic reactions, irritation and hyperemia of the external auditory canal, itching and skin rashes. No cases of overdose have been recorded.

Release form: ear drops in dropper bottles.

Erespal for exudative otitis

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

• Indications for use: otitis, sinusitis, rhinitis, nasopharyngitis, allergic rhinitis, bronchial asthma, chronic bronchitis. Reduction of painful symptoms in acute respiratory infections, measles, whooping cough.
• Method of administration: for patients over 14 years of age, 1 capsule of the medicine is prescribed in the morning and 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 the 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 to the components of the drug, pregnancy and lactation.
• Overdose: nausea, vomiting, increased agitation, drowsiness. There is no specific antidote. Gastric lavage and further symptomatic therapy are indicated for treatment.

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

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Mucolytics for exudative otitis

In chronic otitis media, exudate accumulates in the tympanic cavity. Mucolytic agents are used to liquefy and remove it.

1. ACC

A mucolytic and expectorant with the active component acetylcysteine. Reduces the viscosity of secretions and accelerates their separation. Acts as an antidote for acute intoxications with aldehydes, phenols, paracetamol.

• Indications for use: middle exudative otitis, tracheitis, bronchiolitis, acute and chronic bronchitis, laryngitis, sinusitis, cystic fibrosis, bronchiectasis and other diseases with accumulation of viscous sputum and its poor discharge.
• Method of administration: orally, after meals. For patients over 14 years old, 400-600 mg, for children 6-14 years old, 300-400 mg, 2-5 years old, 200-300 mg, divided into two doses. For children from the 10th day of life and up to two years, 50 mg is prescribed 2-3 times a day.
• Side effects: allergic reactions, nausea, vomiting, heartburn, diarrhea, headaches, tinnitus, increased heart rate, arterial hypotension.
• Contraindications: hypersensitivity to the components of the drug, fructose intolerance, pulmonary hemorrhage and hemoptysis, hepatitis, renal failure. Use during pregnancy and lactation is possible only as prescribed by the attending physician.
• Overdose: hypersecretion reactions in infants. Treatment is symptomatic.

Release form: effervescent tablets of 20 pieces, powder for making a hot drink of 6, 20 sachets. Extended-release effervescent tablets of 10 pieces in a tube and powder for making a suspension for children.

2. Carbocisteine

Liquefies phlegm, increases its volume and facilitates its removal from the body. Promotes the normalization of the physical and chemical properties of exudate components.

• Indications for use: acute and chronic diseases of the respiratory system with the release of large amounts of viscous secretions.
• Method of administration: orally 2 tablets 3 times a day. The syrup is taken 15 ml 3 times a day, then reducing the dose to 10 ml 3 times a day. The dosage for children depends on their age, on average 10-2.5 ml 3-4 times a day is prescribed. The duration of treatment is determined by the attending physician.
• Side effects: skin allergic reactions, gastrointestinal bleeding. Treatment is symptomatic with drug withdrawal.
• Contraindications: individual intolerance to the components of the drug, exacerbation of gastric ulcer and duodenal ulcer. Use during pregnancy and lactation is possible only for vital indications.

Release form: capsules for oral administration, 20 and 1000 pieces per package, syrup in bottles.

3. Fluimucil

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

• Indications for use: purulent and catarrhal otitis, sinusitis, maxillary sinusitis and other conditions with poor secretion discharge. Respiratory diseases with impaired sputum discharge. Removal of viscous secretion from the respiratory tract in the postoperative period or after injuries.
• The method of administration and dosage depend on the form 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 is manifested by more pronounced reactions, treatment is symptomatic.
• Contraindications: intolerance to the components of the drug, gastric ulcer and duodenal ulcer, pregnancy and lactation. Effervescent tablets are prohibited for patients under 18 years of age.

Release form: soluble granules in 1 g sachets, injection solution in ampoules, tablets for the preparation of an effervescent solution.

4. Mucosol

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

• Indications for use: poor exudate drainage in otitis media. Infectious and inflammatory diseases of the respiratory system: tracheitis, bronchial asthma, bronchitis, bronchiectasis.
• Directions for use: Orally after meals, 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 a day. The course of treatment is 8-10 days. For the treatment of children, syrup is prescribed, 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. Not used in early pregnancy and during breastfeeding.
• Overdose: gastrointestinal disorders, abdominal pain, nausea, vomiting. Treatment is symptomatic.

Release form: capsules for oral use of 375 mg in blisters of 10 pieces, 2 blisters per package.

Vitamins

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

For ear diseases, it is recommended to take the following vitamins:

• C – ascorbic acid has an antioxidant effect.
• A – retinol strengthens the immune system.
• Group B – improves hearing quality, has a positive effect on 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 review your diet. The most useful products for maintaining the health of the hearing organs include:

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

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

• Alcoholic drinks provoke vascular spasms, which lead to auditory hallucinations.
• Strong coffee and tea contain caffeine, which disrupts blood circulation.
• Fatty and fried meat increases the level of cholesterol in the blood and negatively affects the blood supply to the ears.
• Long-term storage products – contain ingredients that disrupt the functioning of the vestibular apparatus.
• Salt – causes swelling, increases blood pressure, which causes a feeling of noise in the ears.

A balanced healthy diet in combination with multivitamin preparations strengthens the body's immune defenses, preventing various diseases, including damage to the hearing organs.

Physiotherapy treatment

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

For the treatment of otitis with serous discharge, the following physiotherapeutic methods are most often used:

1. Stimulating – relieve swelling and normalize blood flow.
   1. Pneumatic massage – a special device alternates air masses of high and low pressure, stimulating vibrations of the eardrum 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. Diadynamic therapy – the device creates rhythmic current flows that activate the cortical and subcortical centers, increases blood flow in the middle ear and normalizes the mobility of the auditory ossicles.
2. Cleansing – aimed at cleansing the ear canal and removing accumulated secretions.
   1. Blowing – restores the patency of the Eustachian tube in case of inflammation of the middle ear. The procedure is performed by a qualified doctor on an outpatient basis.
   2. Washing is performed in case of purulent form of middle ear damage, to prevent the spread of infection and development of complications. The procedures are performed before each use of ear drops. Hydrogen peroxide, warm vodka or other antiseptic agents are used for washing. Treatment is performed by a doctor, attempts to independently wash the inflamed hearing organ can negatively affect its functioning and cause perforation of the eardrum.
3. Warming – eliminate inflammation, reduce pain.
   1. Electrophoresis is the introduction of medications into the body through the skin and mucous membranes. It has a minimum of side effects and a pronounced therapeutic effect.
   2. UHF – used for exacerbations of chronic inflammation. The affected organ is exposed to an air gap. Due to this, swelling decreases and the acute inflammatory process subsides. For purulent otitis, 10-15 sessions are performed for 7-10 minutes each.

Physiotherapy treatment is carried out according to the doctor's prescription. The otolaryngologist selects the most effective procedures, taking into account the patient's medical history and the clinical picture of the disease.

Electrophoresis for exudative otitis

A popular method of physiotherapy, effective in persistent serous inflammation of the mucous membrane of the auditory tube and tympanic cavity is electrophoresis. In exudative otitis, it allows medicinal substances to penetrate into the affected tissues, minimizing side effects. The procedure is performed using special devices.

Useful properties of electrophoresis:

• Reduces inflammation.
• Reduces swelling.
• It relieves pain.
• Stimulates the production of biologically active substances.
• Calming 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 the therapeutic effect of this physiotherapy procedure is that the drug is transformed into ions with an electric charge for better penetration into the skin. Most of the drug remains in the skin, and the rest is carried throughout the body with lymph and blood. The excretory ducts of sweat and sebaceous glands, hair follicles, and intercellular zones participate in the transportation of the drug.

The effectiveness of electrophoresis depends on the degree of absorption of the drug, which is affected by the following factors: the patient's age, the strength of the current supplied by the device, the concentration and dosage of the drug, the duration of the procedure, the location of the electrodes. The procedure is carried out in a 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.

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Exercises to remove fluid in exudative otitis

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

• Rub the pits under your earlobes in a circular motion: clockwise on the left side and counterclockwise on the right. Do 7 movements on each ear for the first week, then increase until you reach 21 movements.
• Between the middle and index fingers, pinch the auricle. Rub it in a circular motion. The first week, perform 7 rubbings, gradually adding 1 to 21 movements.
• Grasp the ear so that the thumb holds it from behind and the other fingers from the front. Pull both ears to the sides at the same time. The number of repetitions is similar to the exercises described above.
• Press your palms to your ears and release them sharply to make a clap. The procedure is the same as in the previous exercises.

The treatment complex must be done until the acute inflammatory process passes. The exercises are recommended for patients prone to otitis and frequent colds.

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Blowing off the ear for exudative otitis

In some cases, the only effective method for normalizing the pressure in the eardrum is blowing. In case of exudative otitis, this method is used to remove thick secretion and prevent perforation of the eardrum. The procedure is performed by an otolaryngologist, using the Politzer method.

The procedure is indicated in the presence of the following symptoms:

• Vestibular disorder.
• Significant reduction in hearing acuity.
• Long-term ear congestion.
• Auditory hallucinations and a clicking sensation in the head.
• Accumulation of viscous exudate.
• Dangerous ear infections.

Blowing is performed using a Politzer device, which is a rubber balloon with tubes of different sizes. The tip of the tube is inserted into the nasal sinuses and pressed with fingers, creating a seal. Using an otoscope, the doctor connects the external ear canal. The patient needs to swallow saliva and repeat a few words that the doctor says out loud.

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

A method for blowing out the hearing organs at home has also been developed. But when carrying it out, the risk of perforation of the eardrum and a number of other complications should be taken into account. The procedure is carried out if the causes of congestion have been established. The patient needs to prepare a rubber bulb, which comes with an oval tip. The blowing technique is similar to that described above.

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Surgical treatment

If conservative treatment of inflammation of the middle ear with exudate release does not bring the desired result, then surgical treatment is indicated. In case of exudative otitis, myringotomy is performed, that is, an incision of the eardrum to install a shunt or adenotomy.

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

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

In some cases, after surgical treatment, patients develop complications: otorrhea, tympanosclerosis, perforation of the eardrum. Formation of granulation, cholesteatoma, sensorineural hearing loss is also possible.

Surgery for exudative otitis

One of the most common and effective surgeries for exudative otitis is eardrum shunting. This method is based on the installation of a special shunt in the eardrum. The shunt serves as a temporary connection between the external auditory canal and the tympanic cavity.

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 shunting, paracentesis can be performed, that is, an incision of the eardrum without installing a shunt. With this method, the exudate is removed through the incision.

For patients under 7 years of age, the operation is performed under general anesthesia, and for patients over 7 years of age and adults - under local anesthesia. The surgical intervention allows to alleviate the patient's painful condition and stop the progressive deterioration of hearing.

Puncture for exudative otitis

Paracentesis or tympanotomy is a puncture of the eardrum to empty its cavity from accumulated exudate. Treatment is carried out in the presence of the following indications:

• Acute pain.
• Progressive loss of hearing acuity.
• High body temperature and feverish condition.
• Severe protrusion of the tympanic membrane.

Puncture of the eardrum improves general well-being and lowers the temperature. The procedure is performed on the 3rd-4th day of illness. First, the ear canal is sanitized and disinfected with antiseptics. In most cases, the operation is performed without anesthesia, but if the patient has increased sensitivity, then anesthesia is placed behind the ear, freezing the nerve endings. Local treatment of the eardrum with lidocaine is also possible.

After the operation, careful care of the tympanic cavity is indicated. It is necessary to regularly change turundas and clean the ears. As soon as the amount of exudate released decreases, the doctor performs an otoscopy. If the edges of the wound are stuck together, the puncture is repeated.

Despite the effectiveness of this method, it can cause a number of complications. First of all, these are injuries to the auditory canal, damage to the medial wall of the eardrum. If the exudate is not completely removed, there is a risk of developing an acute infection and hearing loss.

Shunting of the tympanic cavity in exudative otitis

Surgical intervention with an incision in the eardrum and installation of a shunt is called bypass. The treatment has strict indications for implementation:

• Accumulation of a large amount of secretion and hearing loss.
• Large adenoids and cleft palate in children.
• Inflammation of the middle ear.
• Tumor formations in the nasopharynx with the impossibility of removing exudate.

The procedure is performed under general anesthesia. The incision is made under a microscope, then 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, following all the doctor's instructions.

Patients should be careful when taking water procedures so that liquid does not get into the shunted ear, as this can provoke inflammation. Complications of treatment include: infection of the middle ear cavity and premature loss of the shunt. In the first case, antibiotics are used for treatment, and in the second case, a repeat operation is performed. Gradually, the hole in the eardrum tightens, and hearing impairment does not occur.

Removal of adenoids in case of exudative otitis

Some of the most common cases of visits to an 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 tissues of the nasopharyngeal tonsil. It is large adenoids that cause the symptoms of "sticky" ear.

If the desired recovery does not occur after a course of drug therapy, then surgery is indicated. Adenotomy is performed under general or local anesthesia. An adenotome, that is, a special ring-shaped knife, is inserted into the nasopharynx. It is applied to the affected tissues and they are cut off with one movement.

In most cases, after adenoid removal, exudative otitis responds to conservative therapy. If this does not happen, then an operation is performed on the tympanic cavity to clean it.

Laser tympanotomy for otitis media with effusion

An operation in which the tympanic cavity is opened and a tympanostomy is applied is tympanotomy. Treatment is indicated for prolonged or recurrent inflammation of the middle ear. Laser tympanotomy is possible for exudative forms of otitis.

The operation allows removing viscous accumulations of exudate from all parts of the middle ear. A special suction device is used for this. The emptied cavity is washed with antiseptic solutions and a thorough revision is performed.

After the operation, tissues are applied to 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.