Middle ear catarrh: causes, symptoms, diagnosis, treatment

Acute catarrh of the middle ear (synonyms: exudative otitis media, salpingootitis, tubo-otitis, tubotimpanitis, tubothympanal catarrh, secretory otitis, etc.).

Under the acute catarrh of the middle ear in the domestic literature is understood as an inflammation of the middle ear, which develops as a result of the transition of the inflammatory process from the nasopharynx to the mucous membrane of the auditory tube and the tympanic membrane. In foreign literature (French, German and other European countries) under the middle ear catarrh, the easiest form of acute non-perforative otitis media, both rhinogenic (tubar) and any other (catarrhal, hematogenic, infectious, etc.) origin is implied. In fact, the inflammatory phenomena developing in the mucosa of the middle ear with acute catarrh of the middle ear can be identical to those arising from the banal acute otitis media at its initial stage. This, in particular, is demonstrated by the pathomorphological processes taking place during catarrhal inflammation of the mucous membrane of any localization.

Qatar, or catarrhal inflammation, is a kind of exudative inflammation that differs from its other species not by the character of exudate, which can be either serous or purulent, but by the fact that it develops exclusively in the mucosa and is accompanied by hypersecretion of mucus, resulting in exudate as This is admixed with mucus (a product of the mucous glands) and desquamated epithelial cells, resulting in a mixture of exudate and mucus secretion flowing into the inflamed hollow organ, filling its hour s and forming it kind of level. Depending on the basic composition of the exudate, serous-catarrhal and purulent-catarrhal inflammation are distinguished, typical for common forms of acute catarrhal and purulent otitis. With an abundance of lowered cells in the exudate, the inflammation is called catarrhal-desquamative, it is most typical for catarrhal processes in the upper respiratory tract, pharynx and esophagus, as well as for aerotitis.

Causes and pathogenesis. As the primary cause of acute catarrh of the middle ear is a violation of the ventilation function of the auditory tube as a result of catarrhal inflammation of its mucous membrane, which in its turn results from the spread of the inflammatory process from the nasopharynx (adenoiditis, rhinopharyngitis, etc.). The etiological factor of the inflammatory process in the nasopharynx can be streptococci, staphylococci, pneumococci or mixed microbiota. As a result of minimizing or completely eliminating the ventilation function of the auditory tube and due to absorption of the air in the drum cavity by the mucous membrane of the drum cavity, a "negative" pressure is created with respect to the partial pressure of the gases in the surrounding tissues. As a result of this, a transudate begins to sweat in the tympanic cavity - a transparent colorless or slightly yellowish liquid, which is close in composition to the lymph. Turbidity of the transudate is given to the deflated epithelium of the mucous membranes, droplets of fat, lymphocytes, etc. The joining inflammatory process stimulates the secretion of the mucous glands and gives rise to the process of exudation - the most important component of the inflammatory reaction, consisting in the exit from the vessels and surrounding the inflammatory focus of the tissues of the constituent parts of the blood: , proteins, uniform elements (erythrocytes, leukocytes, allergic inflammations - eosinophils, etc.). Infection of exudate with banal microbiota leads to acute catarrh of the middle ear, which under appropriate conditions can evolve into acute purulent perforated otitis media. However, with a typical acute catarrh of the middle ear, the virulence of the microbiota is minimal.

Thus, acute middle ear catarrh in the pathogenetic aspect is an example of a systemic disease of the middle ear, in which such heteromodal elements as the presence of inflammatory process in the nasopharynx and auditory tube, aerodynamic disturbances of the system "auditory tube - tympanic cavity", the occurrence of anomalous barometric pressure in the cavities of the middle ear, the inflammatory process in the mucosa of the tympanic cavity and the processes of transudation and exudation. Since this pathological system is formed in the organ responsible for the transmission of sound to the receptor formations of the inner ear, then there are disturbances of the auditory function.

Symptoms and clinical picture. Most often, the signs of acute catarrh of the middle ear appear after a catarrhal disease, manifested by a runny nose or catarrhal nasopharyngitis. The first symptom of the disease is the periodic stuffiness of one or both ears, passing after the intake of vasoconstrictive drops into the nose, sneezing or sneezing. Then the stuffiness of the ear becomes constant and low-frequency ear noise joins it, the autophony into the "causal" ear caused by the disruption of the air sound function, and as a result - the hearing loss of various degrees. If there is an effusion in the tympanic cavity, the hearing loss may be due to the viscosity of the exudate exudate, which increases the impedance of the tympanic membrane and the auditory ossicle chain, and with a large amount of effusion, the factor of almost total reflection of sound waves from the liquid medium is also attached. With a small amount of effusion or if it is absent, hearing loss can be due to the tympanic membrane retraction and, as a consequence, the rigidity of the auditory ossicle chain. At this stage of the disease, small pains in the ear may appear, more pronounced in children and irradiating to the lower jaw. The pain is mainly due to a sharp pull of the tympanic membrane and an excessive reflex reduction of the internal muscles of the tympanum.

Otoscopic signs of acute catarrh of the middle ear correspond to the stages of development of the inflammatory process. The stage of hyperemia is characterized by the injection of vessels along the handle of the malleus and a slight reddening and retraction of the tympanic membrane. Then there is a radial injection of vessels, an increase in the injection of vessels along the handle of the malleus and the relaxed part of the eardrum, a shortening of the light cone.

At the stage of catarrhal inflammation, the amount of translucent effusion increases in the tympanic cavity, the color of the tympanic membrane depends on the color. It can be opaque gray, yellowish, and with hemorrhagic character, the eardrum of the tympanic membrane acquires a cyanotic or purple color. Hemolysis enhances the color of the tympanic membrane and allows more clearly to determine the level of effusion in the tympanum, which is a pathognomonic sign of acute middle ear catarrh. When the fluid state of effusion and good mobility, its level remains horizontal regardless of the position of the head.

In acute catarrh of the middle ear, the tympanic membrane stays fixed, due to the presence of effusion in the tympanic cavity and retraction of the tympanic membrane. This sign is revealed using a pneumatic funnel and a Ziegle magnifier due to the absence of changes in the shape of the light reflex when blown in the external ear canal of air.

When blowing the auditory tube with a balloon or catheter, in some cases it is possible to determine the permeability of the auditory tube. With a positive result, there is a temporary improvement in hearing and a decrease in the tying of the tympanic membrane.

Normally, when using a Lutz otoscope during a Valsalva test or blowing through a Politzer, a characteristic blowing sound without tonal harmonics is heard. With a narrowed auditory tube, the sound acquires a whistling high-frequency character. With complete obturation, no sound phenomena are detected.

If the auditory tube is passable and there is a mobile effusion in the tympanum with a detectable level, then by blowing the acoustical tube through the Politzer, this effusion can be smeared over the walls of the tympanic cavity, and then its level disappears for a while, but after a while appears again. Sometimes after this test, air bubbles may appear on the inner surface of the tympanic membrane.

A characteristic feature of the acute catarrh of the middle ear is the retraction of the tympanic membrane, in which the handle of the malleus acquires an almost horizontal position, and its short process protrudes into the lumen of the auditory canal (symptom of the index finger); the relaxed part of the tympanic membrane, if it is not protruded by the transudate, is drawn in and almost directly adjacent to the medial wall of the above-drum space, the light cone is sharply truncated or completely disappears. Sometimes you can see the descending branch of the anvil, on which the tympanic membrane rests.

In rare cases, with acute catarrh of the middle ear, which is manifested by the sharp retraction of the tympanic membrane, which increases the pressure on the threshold, the patient may feel slight dizziness, the most common non-systemic nature.

In the study of hearing, a conductive type of hearing loss is detected predominantly at low frequencies. When the purulent middle otitis media is complicated with acute purulence, pre -ceptive hearing loss occurs, due to intoxication of the inner ear. In the study of hearing, live speech reveals a decrease in hearing to low-octave words, while whisper speech can be perceived at the shell or from a distance of no more than 1-2 m, spoken language - from 3-6 m.

Clinical development of acute middle ear catarrh can occur in various directions: self-healing, rapid cure with minimal but targeted treatment, cure with residual phenomena, exudate administration with the formation of intrapotamal scars and the process transition to tympanosclerosis, infection with pathogenic microorganisms of exudate and development of acute and chronic purulent otitis media. Most often, with etioprocess and pathogenetic treatment, the disease is eliminated without trace in 1-2 weeks.

Diagnostics. Direct diagnosis of difficulties does not cause and is based on complaints of the patient, otoscopic picture and the presence of chronic inflammatory conditions of the upper respiratory tract and auditory tube, as well as on the patency of the latter and data of impedance and tympanometry. Differentiation of acute middle ear catarrh follows from acute purulent inflammation of the middle ear in the preperforative phase, which is characterized by severe ear pain and a number of other general clinical and otoscopic symptoms described below. It is more difficult to differentiate this disease from the latent forms of otitis in infants and elderly people.

The prognosis for acute catarrh of the middle ear depends on the nature of the pathological condition of the nasopharynx and the auditory tube, the general allergic background on which the middle ear disease, the virulence of the pathogen and the quality of the treatment activities develop.

Treatment. The most effective results with respect to both current disease and relapse and process chronicity are etiotropic and pathogenetic treatment, consisting in the following activities: elimination of chronic foci of infection in the nasopharynx and pharynx (chronic adenoiditis, chronic tonsillitis, chronic tubo-otitis, etc.); carrying out of medical actions at presence of an allergic background and chronic inflammatory processes in paranasal sinuses; normalization of nasal breathing in the presence of polyps, deformities of the septum of the nose; local treatment, and if it is ineffective - "small" surgical interventions (paracentesis, myringotomy, tympanotomy, shunting the tympanum with Teflon insert inserted into the incision of the tympanic membrane for a long time (2-3 weeks to 2-3 months).

Local treatment consists of a series of successive measures aimed at restoring the patency of the auditory tube, removing the transudate from the tympanum, normalizing the state of the sound-conducting system, and restoring hearing. Treatment is advisable to start with the introduction of vasoconstrictive solutions and aerosols (naphthysine, sanorin, galazoline, etc.) into the nose. In the conditions of a polyclinic or a hospital, blowing of the auditory tube with preliminary anemization of the pharyngeal mouth is performed, and then their catheterization with the introduction of 10-15 drops of hydrocortisone suspension per injection into the tympanic cavity per administration daily for 3-5 days, and in the presence of viscous contents in the tympanum - and a freshly prepared proteolytic enzyme such as chymotrypsin (10 mg per 5 ml sterile isotonic sodium chloride solution). Usually, 1 ml of the enzyme solution is used. At the same time, antihistamines and decongestants are prescribed (dimedrol, diazolin, pipolfen, etc. In combination with ascorbic acid and calcium gluconate per os). If there is a suspected purulent complication (the appearance of pulsating pain in the ear, an increase in the hyperemia of the tympanic membrane and its protrusion) prescribe antibiotics of a wide spectrum of action per os.

To speed up the resorption of the contents of the tympanum, various physiotherapeutic procedures are used (warming compress, solux, UHF, laser therapy, etc.).

Chronic middle ear Qatar. The chronic catarrh of the middle ear is understood as the primary or secondary chronic catarrhal inflammation of the mucous membrane of the middle ear, complicated by the organization and sclerosis of the exudate, resulting in adhesions and scars in the middle ear cavity limiting the mobility of the elements of the sound-conducting system and causing hearing loss in terms of the type of disturbance in sound production. Secondary chronic middle ear Qatar is a consequence of chronic acute catarrhal otitis media, which occurs in persons whose tissues have the property of false keloid scarring. The appearance of chronic catarrh of the middle ear is promoted by the same factors as the emergence of an acute catarrh of the middle ear.

Symptoms and clinical picture. As a rule, a history of often recurring tubootids and acute catarrh of the middle ear, the treatment of which gave only a temporary and incomplete effect. The main complaint is a slowly progressing one-, more often bilateral bradyacuia. Otoscopy reveals signs of adhesive otitis, a sharp retraction and deformation of the tympanic membrane, its immobility when blown by a Zigle pneumatic funnel. When blowing the auditory tube through the Politzer or with the help of a cannula, its obstruction is revealed. With the organization of the transudate and its scarring, ankylosing of the joints of the auditory ossicles and contracture of the internal muscles of the tympanic cavity occurs, which leads to pronounced conductive hearing loss. Gradually, the adhesive process in the middle ear turns into the stage of tympanosclerosis with immobilization of the base of the stapes, and in some far-reaching cases and in sclerosis of the vestibule of the cochlea. Such patients are doomed to hearing loss of III-IV degree or even to complete deafness.

Treatment. In the arsenal of therapeutic measures for chronic catarrh of the middle ear are the same funds as in the treatment of acute catarrh of the middle ear. These attempts to blow the auditory tube, their catheterization and blocking, the introduction of proteolytic enzymes, hydrocortisone suspension, lidase or potassium iodide electrophoresis, eardrum pneumomassage, etc. VT Palchun (1978) to increase the elasticity of the scars and restore the mobility of the auditory Bones are recommended to be injected into the tympanum through a catheter or by injection through the tympanic membrane lidase (0.1 g is dissolved in 1 ml of 0.5% solution of novocaine). The course of treatment - 4 injections with an interval of 4 days.

When inoperative treatment is ineffective, they resort to tympanotomy and under a microscope - to dissecting and removing scars in the patency of the auditory tube. However, such invasive treatment infrequently produces a positive result, since scars develop again in the tympanic cavity and are often more pronounced. Many patients do not agree to surgical treatment, and then they are offered hearing care.

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