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Fluid in the middle ear
Last reviewed: 23.04.2024
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Fluid in the middle ear can be observed under the following conditions:
[Acute purulent inflammation of the middle ear
As a rule, it occurs after infection of the upper respiratory tract. Persons of any age are ill, but more often children. The patient complains of earaches, fever, a feeling of pressure in the ear and loss of hearing. When otoscopy is visible hyperemic tympanic membrane. Serous exudate accumulates in the middle ear cavity, which then becomes purulent. The eardrum fades and can protrude. If the tympanic membrane is perforated, the patient experiences relief, body temperature decreases. In uncomplicated cases (if the tympanic membrane is perforated, then recovery comes), gradually the discharge from the ear becomes serous, and then completely ceases. Most often the causative agent is pneumococcus, but etiologic microorganisms can also be streptococci, staphylococci and Haemophilus.
In adults, the choice drugs are penicillin G (600 mg intramuscularly at first) and then penicillin V (500 mg every 6 hours inside). Children younger than 5 years are recommended to appoint amoxicillin at the rate of 30-40 mg / kg per day inside for 7 days, because at this age the causative agent is most often Haemophilus. The point is also that penicillin does not enter the middle ear cavity at concentrations that are toxic to Haemophilus.
About 5% of Haemophilus strains are resistant to amoxicillin, but are sensitive to co-trimoxazole, but co-trimoxazole has not yielded better results in studies. It seems that short, 3-day courses of ai-biotics are in such cases quite effective. The use of decongestants (decongestants) does not affect the overall course of the disease. The patient should be given a sufficient dose of analgesics, for example paracetamol at a rate of 12 mg / kg every 6 hours inside. It is extremely rare, in the case of soreness and a sharp swelling of the tympanic membrane, an incision is required (Miriothogram). Such a patient should check his hearing after 6 weeks.
Rare complications of otitis media. Mastoiditis (1-5% of cases before antibiotics), petrositis, labyrinthitis, facial nerve palsy, meningitis, subdural and extradural abscesses, brain abscesses.
Exudative otitis media, serous otitis media
Non-perennial chronic effusions in the middle ear cavity occur when blocking eustachian tubes. Exudate in the middle ear can be watery (serous) or mucous and sticky. In recent cases, in children, exudate is usually infected, and this disease is called exudative otitis ("glued ear"). Exudative otitis is the most common cause of hearing loss in children, which can cause a serious backlog in school. The "glued ear" does not hurt, and the presence of a pathological process can not be suspected, although it is a frequent complication of otitis media - in 10% of children after an acute episode after 3 months there is still an effusion in the middle ear. The tympanic membrane loses its shine, becomes somewhat retracted. The presence of radially divergent vessels on its surface indicates that there is liquid behind it. This liquid can be colorless or yellowish, with air bubbles. In such cases, in 33% of patients in the middle ear, bacteria can be sown (and antibiotics may be useful).
Decongestants with a "glued ear" are usually ineffective. If the liquid in the cavity of the middle ear is longer than 6 weeks, then you should think about performing miriogotomy, sucking out fluid and installing a special tube for ventilation of the middle ear cavity - all this helps to restore hearing. Equally effective is adenoidectomy, it prevents the onset of tympanosclerosis (thickening of the tympanic membrane) after the ventilation tube is established or after repeated operation if the need arises very quickly. However, adenoidectomy is accompanied by a slight postoperative mortality.
In adults, in such cases, a tumor localized in the nasopharyngeal space should be excluded.