How to treat acute and chronic suppurative otitis media in adults?

Local treatment includes the use of drops - to relieve pain, to improve the release of pathological mass, to reduce swelling of inflamed tissues.

General treatment consists of antibiotic therapy: medications are taken orally, injected, and also in the form of drops after the pus has broken through.

To reduce the severity of the inflammatory reaction, drugs such as Nurofen, Ibuprofen, and Diclofenac are often prescribed.

How long does purulent otitis take to treat? Standard treatment lasts about seven or ten days. However, sometimes therapy can be delayed - for example, if complications develop or if the patient has a weakened immune system.

With the onset of suppuration, regular ear toilet is performed for purulent otitis. The affected auricle is cleaned with a cotton pad soaked in hydrogen peroxide, after which they begin cleaning the ear canal. Doctors recommend performing this procedure in a polyclinic setting, with the help of a manipulation nurse. The fact is that too careless and deep cleaning can lead to damage to the eardrum. The ear canal is cleaned without excessive pressure, using cotton swabs soaked in isotonic sodium chloride solution or hydrogen peroxide.

After cleaning the ear, you can drip the medications prescribed by the doctor into the cavity - for example, solutions of furacilin or sodium sulfacyl. Some patients are prescribed Protargol to drip into the ear canal - an old proven drug that accelerates the healing of the damaged eardrum.

Ear irrigation for purulent otitis

The affected ear can be washed at home or in a clinic. Various antiseptic solutions can be used for washing - for example, furacilin, hydrogen peroxide, a weak solution of potassium permanganate, or a regular saline solution.

• How to perform rinsing at home?

Heat the rinsing solution to body temperature. Draw the heated solution into a syringe, remove the needle, tilt the patient's head so that the affected ear is on top. Pour 1 ml of the preparation into the ear cavity, then tilt the ear so that the liquid flows out onto a handkerchief or napkin. Repeat this several times. After the procedure, dry the ear with a clean napkin. If necessary, immediately drip the prescribed medications.

• How to perform lavage in a clinic or in a hospital?

The patient sits on the couch with the affected ear towards the nurse. A special curved tray is placed against the ear, into which the rinsing solution will flow. The nurse fills a large syringe with the heated solution, injects this solution into the ear so that it flows down the surface of the back wall. After all the solution has been injected, the patient tilts his head so that all the liquid flows into the tray. Then the nurse dabs the ear with a napkin and, if necessary, performs other therapeutic manipulations.

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Medicines

The main medications used in the treatment of purulent-inflammatory processes in the ears in adults are considered to be the following:

• Glucocorticosteroids – hormonal agents (for example, Prednisolone) – eliminate swelling and promote a rapid completion of the inflammatory process.
• Antibiotics – in the form of injections, tablets, capsules, ear drops. Most specialists begin therapy with drugs of the penicillin group or cephalosporin group. Second-choice drugs can be macrolides – for example, Azithromycin. Antibiotics such as aminoglycosides are not used for purulent otitis – due to their toxicity to the hearing organs.
• Antiallergic drugs - they are prescribed when purulent otitis is preceded by allergic rhinitis or other types of allergies. In such a situation, it is appropriate to prescribe Suprastin, Clemastine, etc.
• Vasoconstrictors - used to reduce swelling, to expand the patency of the auditory tube. Naphthyzinum, Sanorin and other similar drugs are suitable for these purposes.

Some of the medications are worth considering in more detail:

• Otofa is prescribed for purulent otitis due to its pronounced antimicrobial activity. The active ingredient is rifampicin, which affects most gram (+) and gram (-) microorganisms that can cause inflammatory processes in the ear. Otofa drops are dripped daily, in the morning and evening, five drops into the diseased ear canal.
• Otipax has a combined effect in purulent otitis, as it contains a pair of active ingredients - phenazone and lidocaine. Thus, Otipax has a strong analgesic and anti-inflammatory effect - therefore it is used at the pre-perforation stage. Standardly, 4 drops of the product are dripped up to 3 times a day into the affected auditory canal. The duration of therapy is 7-10 days, no more.
• Dioxidine is prescribed for purulent otitis only to adult patients. Dioxidine is an antimicrobial agent with a broad spectrum of activity. It affects even those types of microorganisms that are insensitive to some antibiotics, sulfonamides, nitrofurans, etc. The drug is used to wash the diseased ear cavity using 10 ml of a 1% solution. Since Dioxidine can cause allergic reactions, the patient is observed for 5-6 hours after the first wash, and only then is therapy continued. The standard course duration is 20 days, but sometimes treatment can last up to 4-6 weeks.
• Miramistin is used for purulent otitis as an effective antimicrobial agent. For purulent otitis in adults, a turunda is soaked in Miramistin and inserted into the ear canal up to six times a day. The course of therapy lasts up to 2 weeks.
• Ceftriaxone for purulent otitis can be used to stop the inflammatory process, as well as to prevent and eliminate complications. The drug is a powerful antibiotic, so it should not be used by women during pregnancy. Ceftriaxone is usually prescribed at 1-2 g daily. The duration of the course is determined by the doctor.
• Anauran demonstrates simultaneous antimicrobial and anesthetic action in purulent otitis, and also has an antimycotic effect, which makes it possible to use the drug to combat otomycosis. Anauran is dripped into the ear canal before perforation, since the solution can subsequently have an ototoxic effect. At the pre-perforation stage, 5 drops of the solution are dripped up to 4 times a day, for no more than 10 days. In rare cases, skin irritation may occur when using Anauran.
• Ampicillin for purulent otitis is often the first-line drug. This medication is a representative of semi-synthetic penicillins, has a wide range of antimicrobial activity. Ampicillin is administered as an intramuscular injection, 0.5 g once every 7 hours. The duration of the course is determined by the doctor. It is noted that some patients experience dyspepsia, headache, and pain in the area of the drug administration after using Ampicillin.
• Boric alcohol for purulent otitis is dripped directly into the ear canal, 3 drops three times a day, but only until the eardrum is perforated. The drug cannot be used any longer. Boric alcohol is also used to treat cotton swabs, which are then inserted into the ear canal at night. The doctor will decide which treatment method to choose at the appointment. If boric alcohol is ineffective, it is recommended to switch to more powerful drugs.
• Suprax for purulent otitis is a cephalosporin antibiotic - a semi-synthetic drug with a pronounced bactericidal effect. The dose of Suprax is 400 mg per day, in 1-2 doses, regardless of the time of food intake. The duration of antibiotic therapy depends on the severity of purulent inflammation and the type of pathogen. The most common side effects are candidiasis, skin rash, headaches and dyspepsia.
• Polydexa is prescribed for purulent otitis if the eardrum is not damaged, for example, in case of infectious lesion of the external auditory canal. Polydexa is a combination of a corticosteroid and an antimicrobial component. Before using these drops, you must make sure that the eardrum is intact, since if there is damage, serious complications may develop, in particular, hearing loss and vestibular disorder. The dosage of Polydexa is 2-5 drops in each ear canal in the morning and at night. The average duration of therapy is one week.
• Cipromed is prescribed for purulent otitis when the disease does not have a viral etiology and does not respond to treatment with other antibiotics. Cipromed contains 0.3% ciprofloxacin, a second-generation fluoroquinolone drug. The standard dosage of the drug is five drops three times a day for 7-10 days.
• Zinnat for purulent otitis is prescribed for oral administration. The action of the drug is based on the effect of the main ingredient cefuroxime - a representative of cephalosporin antibiotics. Zinnat is not used if the patient has previously had an allergy to penicillins, monobactams and carbapanems. The average dosage of the drug is 250 mg twice a day, with food, for a week.
• Azithromycin for purulent otitis is prescribed to adult patients according to the following scheme: on the first day, take 500 mg, from the second to the fifth day - 250 mg / day. The total amount of the drug per course is 1.5 g. Azithromycin belongs to macrolide antibiotics, is available in capsules. Among the most common side effects are dizziness, abdominal pain, candidiasis, vaginitis.
• Levomekol for purulent otitis is allowed to be used only until the moment of rupture or cut of the eardrum. The ointment is applied 1-2 times a day, for 3-10 days. To apply the drug, use a gauze turunda, which is treated with ointment and inserted into the ear canal for about seven hours. Levomekol contains a pair of active ingredients - chloramphenicol and methyluracil. Their action is manifested in a complex: the antibacterial effect is complemented by strengthening the immune defense at the local level, which contributes to rapid tissue healing.
• Amoxiclav is often the drug of choice for purulent otitis. It is a polysynthetic antibiotic with a broad spectrum of activity, containing two active ingredients - amoxicillin and clavulanic acid. Contraindications to the use of the drug include a tendency to allergies to drugs of the penicillin, cephalosporin, and carbapanem groups. Adult patients with purulent otitis are prescribed 125-500 mg of the drug three times a day, depending on the severity of the disease. Therapy can last no more than 2 weeks.
• Otirelax has an anti-inflammatory and analgesic effect in purulent otitis, as it consists of a combination of such components as phenazone and lidocaine. Otirelax drops are used only with an intact eardrum, in the pre-perforation stage. Drops are dripped into the external auditory canal 3-4 drops, up to 3 times a day. Duration of use is no more than 7-10 days. After perforation and the release of pus, the use of Otirelax is prohibited.
• Dancil has a bactericidal effect on purulent otitis due to the component ofloxacin. Dancil is prescribed for external otitis, chronic purulent otitis, including perforation of the eardrum. Dancil should not be used to treat children and pregnant women. The standard method for purulent otitis in adults is to drip 10 drops of the medicine into the affected ear canal twice a day for 2 weeks. To prevent dizziness, the solution should be warmed up to body temperature before use.

Antibiotics for purulent otitis

When pus forms in the ear, semi-synthetics and so-called protected penicillins are often used. These include Amoxiclav, Amoxicillin. Analogues of the listed drugs are Azithromycin, Cefuroxime, Ciprofloxacin.

Injections for purulent otitis may also contain antibiotics. In most cases, these are the following groups of medications:

• fluoroquinolone series, represented by Ofloxacin, Ciprofloxacin;
• β-lactams, represented by Imipenem, Meropenem;
• cephalosporin series, represented by Cefotaxime, Ceftriaxone;
• a number of protected penicillins (for example, Co-amoxiclav).

Injections of β-lactams and fluoroquinolone antibiotics are reserved for “extreme” cases – they are prescribed for severe forms of inflammation, with a high probability of complications.

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Drops for purulent otitis

Drops are considered essential drugs for the treatment of inflammation with the formation of pus in adults. However, not all ear drops can be used at any stage of inflammation. Let's consider this issue in more detail.

• Until the eardrum ruptures (cuts), drops with analgesics are used, for example:
  • Otizol;
  • Otinum;
  • Otipax.

Antimicrobial drops are inappropriate at this stage, as they will not be able to show their effect due to the presence of a barrier in the form of a membrane.

• After perforation, drops with analgesics are not used: they can damage the receptors of the cochlea. At this stage, it is the turn of antibiotics - they are instilled into the diseased ear, taking into account the resistance of bacteria. But here, too, there are some restrictions: ototoxic drugs such as gentamicin, polymyxin B, as well as alcohol solutions, choline and phenazone cannot be used.

The optimal antimicrobial drugs to choose are Miramistin, Ciprofarm, Normax, etc.

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Compresses for purulent otitis

Applying a compress - hot or cold - is prohibited in case of purulent-inflammatory processes in the ear. The fact is that the effect of the compress can lead to the spread of the lesion to the surrounding tissues, as well as to the breakthrough of the pathological mass not outward through the eardrum, but into the cranial cavity.

Compresses and any warming procedures are carried out only in case of acute otitis at an early stage of the disease, provided that there is no high temperature and visible damage to the skin.

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Ointments for purulent otitis

It is generally believed that ointment is simply necessary for otitis. But this has nothing to do with inflammatory discharge of pus in adults - if the doctor has not prescribed any ointment, then independent use of such products is not welcomed at all. All external preparations have different compositions and different effects. At the same time, the purulent-inflammatory process occurs in stages, and ointments will not help in all of them (and sometimes can even harm).

For example, the popular ointment Sofradex for purulent otitis can be used only up to the perforation stage. The ointment is applied to a small cotton swab and inserted into the ear canal for a quarter of an hour, and no more than half an hour. The swab should not be inserted too deeply.

Vishnevsky ointment is also used only at the early stage of otitis development. With the onset of the purulent process, the use of the ointment should be stopped.

Vitamins

When inflammation develops with the release of pus, patients often lose their appetite and eat meager food. However, it is during the illness that it is necessary to supply the body with vitamins and other useful substances as much as possible. The diet should include products containing ascorbic acid, vitamin A, and various microelements in sufficient quantities.

Citrus fruits and kiwi contain a lot of ascorbic acid, which can correct the immune defense in the body. If you are particularly reluctant to eat, it is recommended to at least drink fresh orange juice or water with lemon juice. Tomato and carrot juice will also be beneficial.

When preparing food, it is advisable to add natural antibiotics - onions and garlic. This will help to cope with the infectious process faster.

When you have an ear infection, it is recommended to eat foods that reduce the amount of mucus secreted, as well as those that strengthen the immune system. These foods include:

• any greens;
• bell pepper;
• citrus fruits;
• chicken broth;
• real honey;
• kiwi;
• any berries;
• carrot;
• ginger root;
• beet;
• nuts, beans.

Physiotherapy treatment

Physiotherapy is especially necessary as a comprehensive approach to the treatment of inflammatory otorrhea in adults. The most popular are UHF and laser treatment, UFO, and sollux. The listed procedures will speed up blood circulation in the affected organ, stop the inflammatory process, and strengthen the immune system. In addition, such procedures help to trigger recovery reactions.

For example, UHF treatment is prescribed for 5 sessions at the initial stage of otitis, and with the formation of pus - 10-15 sessions. When pus is released, the sessions become longer to speed up the reparative processes. The plates are installed on the side of the bridge of the nose opposite the affected ear.

Is it possible to warm the ear with purulent otitis? It is not recommended to warm the ear when pathological discharges are formed in it, as this can lead to the penetration of infection into nearby tissues, as well as to an intracranial breakthrough of pus. Such processes threaten serious complications, therefore the ear should not be warmed with a purulent-inflammatory process.

Darsonval is used for purulent otitis only when the doctor insists on these procedures. Darsonvalization should be used with extreme caution, so the doctor determines the session schedule individually. A direct contraindication to such treatment is high body temperature.

• The Bioptron tube device is not used for purulent otitis - it is used only for mild ear pain without secretion of pathological discharge. For general pathologies, Bioptron is prescribed more often for colds, arthritis, polyarthrosis, etc. You should not start treatment with the device without consulting a doctor - this can lead to negative consequences.

Traditional treatment at home

Trying traditional medicine recipes is only allowed with the permission of a doctor who considers such treatment safe. The point is that the purulent-inflammatory process often entails the development of various complications, and quite serious ones. Therefore, the use of traditional methods often leads to a loss of time, during which complications can arise. Consult a doctor: he will assess the situation and indicate the possibility of using such treatment.

Traditional healers offer the following affordable remedies for inflammatory purulent discharge from the ear in adults:

• Grind the raspberry rhizomes, separate three tablespoons of the raw material and brew it in one liter of boiling water. Then insist overnight and drink twice a day, 500 ml. The intake should be continued for 4 weeks.
• Dip a gauze turunda into a 20% propolis tincture and place it in the ear. Keep it in the ear canal for as long as possible. Treatment can last up to one month. The same recipe can be used to get rid of mesotympanitis.
• Place a gauze ball soaked in fresh cabbage juice or a gauze knot with crushed cabbage leaf pulp inside the ear. It is better to do this procedure at night.

It is also possible to use simpler recipes:

• Chew a quarter of a lemon with the peel every morning.
• Take 18-22 drops of peony tincture with water in the morning, afternoon and at night.
• Apply a compress to the area around the ear using 70% calendula tincture. Keep the compress on for 2 hours.
• Soak a gauze turunda in freshly squeezed onion juice, squeeze it out and insert it into the ear canal. Tie a scarf around it. Hold for 1-2 hours.
• Horseradish rhizome juice is dripped into the ear, 3 drops at a time. Alternatively, you can use the juice of wild garlic leaves.
• Before going to bed, insert a tampon soaked in 2.5% mumiyo into the affected ear. Tampons may be changed several times a day.

Sea buckthorn oil is especially popular for purulent otitis. You should drip one drop of oil and the same amount of liquid honey into the affected ear canal, after which you need to close the ear with a cotton swab for about an hour. This procedure is carried out daily - for 1-4 months, depending on the course of purulent otitis.

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Herbal treatment

• A medicinal mixture is prepared from such plants as succession, yarrow, calendula, plantain and eucalyptus leaves, pine buds, and licorice rhizomes. 1 teaspoon of the mixture is poured with 200 ml of boiling water, kept under a lid for half an hour, and then taken little by little throughout the day. The duration of administration is up to six months.
• Before perforation occurs, it is recommended to drip tincture of eucalyptus, mint leaves, chamomile, plantain leaves or calendula into the ear - 6 drops in the morning, afternoon and at night.
• Take 5% celandine tincture orally - five drops in water, for a week. Tincture of walnut pericarp can be used as an analogue.

Bay leaf for purulent otitis

Bay leaf drops are prepared using vodka and vinegar. The proportional composition is as follows:

• 60 ml vodka;
• 2 ml of regular table vinegar;
• ground bay leaf on the tip of a knife.

All ingredients are mixed and left for 2 weeks. The course of therapy should last 6-8 weeks. First, one drop of this remedy is dripped into the sore ear, then the dose is gradually increased to 3 drops, and then the amount is reduced again to 1 drop, and so on until the end of the course.

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Homeopathy

Some doctors successfully practice homeopathy as an alternative method of therapy for inflammatory suppuration from the ear in adults. The main remedies recommended for use in such situations are:

• Aurum is prescribed for severe burning pain that spreads to the entire head area and even to the neck.
• Barita carbonica is used for damage to the auditory ossicles and severe discharge of purulent mass, especially in the chronic form of the disease.
• Calcarea fluorica is used for ear pain, noise, crackling, inflammation of the parotid lymph nodes, and chronic otitis.
• Calcarea iodate is prescribed for damage to the skeletal system and calcification of the eardrum.
• Causticum is used to remove thick purulent discharge, to relieve hearing loss and nagging pain.
• Graphites - will help with pulsation in the ear, with glue-like discharge, with the "echo" effect.

As a rule, for ear inflammation in adults, the 3rd or 6th decimal dilution is used, or the 3-6th centesimal dilution. Dilute 2-3 grains in 100 ml of water and drink in small sips every half hour. As your health improves, take it in the morning and evening until your condition returns to normal.

Surgical treatment

In situations where the use of medications for ear inflammation with the formation of pus has not brought the expected results, the doctor may prescribe surgery. The help of a surgeon is also required if there is an increased risk of intracranial complications or the development of a septic condition. Indeed, if the cavity is not opened in a timely manner and the pathological discharge is not ensured, complications will not take long to appear.

What types of surgery can be used for purulent otitis in adults?

• Antrotomy is an operation to open the mastoid cavity, followed by drainage and administration of antiseptics. This type of operation is performed only in emergency situations.
• Tympanotomy is an operation to open the eardrum to facilitate the removal of pathological discharge from the ear cavity. Catheterization may be used later to administer medications.

The doctor will decide what kind of operation to perform. Drainage after opening is performed until all intoxication symptoms are relieved.

Surgery for purulent otitis media

Tympanotomy - otherwise this operation is called paracentesis, refers to minor surgical interventions. It is generally accepted that this procedure is advisable if the patient does not feel relief within three days after the start of drug therapy.

The intervention is performed under local anesthesia. Using a special needle instrument, the doctor makes an incision in the membrane to ensure the removal of necrotic mass. There is no need to worry: this incision will heal on its own as soon as the pus stops forming.

After surgery, healing occurs faster. Additionally, as a postoperative treatment, the doctor prescribes complex drugs - antibiotics, neuroprotectors, as well as means to improve microcirculation in the hearing organs.