Acute and chronic purulent otitis in adults

Speaking of otitis, there is always an inflammatory reaction in the ear. However, the ear inflammation can be different - average, external, acute, chronic, catarrhal, purulent, etc. In this article we will consider purulent otitis in adults, and in addition we will answer many common questions of patients concerning purulent otitis media.

What is the danger of purulent otitis?

Most often, the development of ear inflammation is associated with common cold, but this is not always correct: ear inflammation is a more serious and dangerous disease. And, if the cold can "go through" independently, without definite treatment, then the purulent-inflammatory process must be treated necessarily - and only under the control of the doctor.

Adults suffer from ear inflammation less often than children. However, complications in adults occur no less often than in childhood. For example, chronic inflammation can cause hearing loss - a partial loss of auditory function, which can not be restored.

In damaged inflamed areas, spikes often form, bone tissue in the temporal region is affected - these changes increase the risk of developing meningitis or an abscess in the brain.

Most adverse effects develop if the patient consulted the doctor late. Therefore, the degree of danger in purulent otitis is directly proportional to the timeliness of seeking medical help.

Epidemiology

Inflammatory reaction in the ear with the release of pus is considered a fairly common illness of the hearing organs. Pathology can have a light course, or develop rapidly, leading to severe inflammation with affecting the entire body.

Acute purulent otitis is diagnosed mainly in childhood. The chronic form of the disease is more typical of adults.

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

Causes of the purulent otitis media in adults

Inflammatory purulence from the ear in most adults occurs as a secondary pathology - that is, initially microbes enter the middle ear from other nearby structures. Some risk factors are known, which have to the development of the disease - first of all, weakening the body's defenses.

We are talking about such factors:

• Strong cooling of the body - leads to a narrowing of the vessels, activation of the viability of microbial cells.
• Anemia, hypovitaminosis, malnutrition - significantly weaken the immune system.
• Chronic and lethargic infectious lesions of ENT organs.

In addition, the development of the disease can be preceded by sepsis, mechanical damage to the ear, measles, tuberculosis, ingestion of the foreign body, as well as immunodeficient conditions.

[7], [8], [9], [10]

Pathogenesis

The host infection for the development of the inflammatory process in adults can become, like bacteria, and fungal infection. Most often in the auditory cavity detect bacteria staphylococcus and Pseudomonas aeruginosa, or fungi - Candida or Aspergilla. The most common pathogens of purulent mean inflammation of the ear are pneumococci, morocelles, hemophilic rod.

In the ear cavity, the pathogen can get into several ways:

• through the auditory tube (tubogenic pathway);
• as a result of traumatic damage to the ear and tympanic membrane;
• by spreading from the intracranial cavity (retrograde pathway);
• on blood vessels from other infectious foci (for example, with viral infection, tuberculosis, measles, etc.).

The chronic form of purulent otitis in adults develops as a result of incomplete treatment of the acute stage of the inflammatory process in the ear.

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

Symptoms of the purulent otitis media in adults

A pyoinflammatory process in adults often occurs as a complication of a viral infection. Usually, this is due to a combination of reduced immunity and damage to the ENT organs. At the same time, people who have recently undergone surgery or chemotherapy, as well as alcoholics, drug addicts and people with HIV, have the highest risk of the disease.

The first signs of the disease are manifested by fever, chills, headaches. Of decisive importance is the local symptomatology:

• soreness, noise, ringing in the ears (more often - in one ear);
• feeling of pressure and presence of fluid in the ear;
• deterioration of hearing, feeling of stuffiness;
• the appearance of secretions from the auditory canal - as a rule, they are initially watery, translucent, and then become yellowish-gray, dense.

The disease is accompanied by a worsening of appetite, a violation of sleep.

The temperature with purulent otitis is an inherent natural reaction to inflammation and the introduction of infection into the body. The temperature can be different - it depends on the individual state of the immune defense, the age and the clinical features of the disease. Inflammation with pus in adults in most cases is accompanied by high temperature indices - while febrile condition usually lasts as long as pus will remain inside the ear canal. Simultaneously with the release of a purulent discharge (no matter whether it happens on its own, or by opening), the temperature begins to drop.

An increase in fever with purulent otitis may also indicate the development of complications-for example, meningitis, mastoiditis and an otogenic septic state are not without temperature . A characteristic feature of the development of complications is that the health of the ill seems to improve - but after a couple of days again, soreness in the ear arises, the temperature rises, and other typical symptoms appear.

Purulent otitis without temperature is characteristic for the disease, which was originally triggered not by an infectious agent, but by trauma. Thus, with a contusion of the ear in the cavity a morbid wound is formed, which, after ingestion of bacteria, is suppressed. In addition, purulent otitis without pain and temperature can become a sign of fungal damage - the so-called otomycosis, or eczema of the organ of hearing. The listed symptoms may be absent even in diffuse external lesions, as well as in atypical forms of the inflammatory process.

Acute pain, which patients often describe as "cuts the ear with purulent otitis," is characteristic of the early stage of the disease, in which the inflammatory process is accompanied by the appearance of an abscess. As a rule, this stage lasts about 2-3 days. Further, after the perforation of the tympanic membrane and the outflow of pus outward, the acute pain disappears.

Noise in the ear with purulent otitis can accompany all stages of the disease. So, the disease often begins with the appearance of noise and stuffiness in the ear - sometimes during the conversation there is the effect of "echo". Noise and hearing impairment accrue as the process develops, and after the outflow of pathological detachable noise gradually passes, and the auditory function is restored.

Purulent otitis in pregnancy

The appearance of purulent inflammation in women during pregnancy is a frequent occurrence. This can be closely related to two reasons: with pronounced hormonal changes in the body, as well as with a strong drop in immunity.

Inflammatory otorrhoea develops more often against a background of viral and respiratory diseases, and has corresponding signs that are common to adult patients. The only difference is the peculiarities of treatment. With the development of purulent otitis of the pregnant woman, it is necessary to start medical measures as soon as possible in order to prevent the negative impact of infection on the developing fetus. At the same time, not all medicines can be prescribed during pregnancy, since many of them may be dangerous for the unborn child, or may disrupt the course of pregnancy.

At the first sign of the disease, you should not rely on self-medication - you should immediately visit a doctor who will prescribe the appropriate therapy.

Stages

Inflammation of the ear with the formation of pus flows through the stages:

1. The initial stage is characterized by noise and obstruction of the ear from the affected side. During the speech, the effect of "echo" can be created. If there is no viral infection or catarrhal disease, the temperature can remain stable.
2. The catarrhal stage is characterized by the appearance of exudate and sensation of the flowing fluid in the ear. There is a growing pain, the temperature rises.
3. The stage of dopperforation is characterized by infection of exudate and development of purulent inflammation. At this stage, the pain senses subside, but there are "shooting" sensations in the eye or lower jaw area. The auditory function is violated.
4. The stage of postperforation - at this stage, the membrane bursts with the release of purulent mass from the ear. Simultaneously, the pain subsides and the temperature decreases.
5. The stage of reparation is characterized by the attenuation of the inflammatory process and scarring of the membrane. Often, the sense of noise in the ear continues to bother, but gradually the hearing ability is restored.

[16], [17]

Forms

Physicians diagnose various types of otitis, depending on the anatomical and physiological characteristics of the disease, as well as the shape of its course.

• Purulent otitis externa occurs as a result of the introduction of an infectious agent in the traumas of the ear, or in the pathological accumulation of moisture in the external auditory passage. This kind of disease is typical for swimmers and divers, because of constant contact of the hearing organs with water. The disease proceeds with pain, itching, swelling and purulent wet cortices in the zone of the external auditory canal.
• Acute purulent otitis is often provoked by ARVI, and also occurs against the background of an infectious infection of the upper respiratory tract. Patients usually complain of not unpleasant sensations of stuffiness and pain in the ear. In a healthy person, the middle ear cavity is sterile. When bacteria enter it, a purulent process begins, and a purulent mass begins to press against the walls. At such condition diagnose "a purulent average otitis". If the process is not stopped at this stage, then the membrane under pressure of the purulent mass breaks out, and the pus enters the external auditory passage.
• Chronic purulent otitis is characterized by the presence of a perforated membrane and an active inflammatory response in the middle ear for a month or more. With chronic purulent otitis, otorrhea is found - that is, there are secretions of purulent mass from the ear canal. The number of secretions can be different from significant to small, almost not detectable by the eye. The chronic process is often accompanied by a worsening of the auditory function.
• Purulent otitis with perforation. Purulent perforated otitis is characterized by the presence of an inflammatory process with a constant formation of secretions having strong proteolytic characteristics. This means that secretions can melt nearby tissues. Under the influence of pus and the pressure that it exerts, the membrane can not withstand - an opening is formed through which the purulent mass begins to exit into the external auditory passage. After the formation of the hole, the pain subsides, signs of intoxication disappear, the temperature returns to normal.
• Tubotimponalny purulent otitis proceeds with acute inflammation of soft tissues and the release of purulent-serous masses. The main feature of this pathology is the extent of the lesion, an increased risk of complications and prolonged complex treatment. The main complication of tubotympanal otitis is the destruction of bone tissues - the auditory ossicles and the cells of the mastoid process.
• Bilateral purulent otitis is an infectious inflammation that affects both organs of hearing. This kind of disease happens a little less often than a one-sided lesion, and such otitis occurs more difficultly. Often, to relieve the condition, you need to seek the help of a surgeon.
• Left-sided purulent otitis is a lesion of the hearing organ on the left side. A similar kind of disease happens at least as often as right-sided purulent otitis - both pathologies are considered as a form of purulent otitis by localization.
• Catarrhal purulent otitis manifests itself by a sharp decrease in pressure in the ear cavity - this is due to the strong secretion of effusion. Exudate accumulates in the tympanum - the patient himself senses this and describes it as a "transfusion" of fluid in the ear canal. The tympanic membrane is bulged out when viewed. A similar type of disease is called "exudative purulent otitis" in another way.
• Purulent otitis with blood is a pathology that indicates damage to small vessels in the ear canal. You can say that the infection begins to penetrate into soft tissues. If the blood appears in chronic purulent otitis, then it is possible to suspect the development of complications in the form of lesion of the facial nerve.
• Recurrent purulent otitis - this term is called the inflammatory purulent process in the ear, which is recorded several times throughout the year, and after complete recovery of the patient (with normalization of hearing, tightening of the perforation hole). This kind of purulent otitis is diagnosed more often in childhood.

[18], [19]

Complications and consequences

The inflammatory process in the ear is prone to spread to other tissues and organs. Absence of medical measures, or incorrect or incomplete treatment can lead to a purulent reaction to the salivary glands, the area of the lower jaw, etc. Such processes can make a patient disabled.

However, according to statistics, the greatest danger lies in the fact that patients with gnotecheniyem and otitis arrive on treatment with delay, when the disease has reached its peak. In this case, complications can occur not immediately, but after a while - for example, a month or even more. The most common complication is the transition of inflammation to the chronic stage, against the background of vestibular failures of development of deafness.

Other complications of purulent otitis can be considered:

• intracranial spread of the process with the development of meningitis, abscess, encephalitis);
• damage to the facial nerve, paresis;
• damage to the tympanic membrane;
• development of cholesteatoma - blockage of the auditory canal by a capsular cyst;
• inflammatory process in the mastoid process with further destruction of bone elements in the middle ear (development of mastoiditis);
• violation of the digestive function (diarrhea, nausea, vomiting - signs of intoxication);
• dynamic deterioration of hearing, until its complete loss.

If a purulent-inflammatory phenomenon acquires a chronic course, then it becomes extremely difficult to treat it. In many patients, all indications for surgical intervention appear.

Often patients complain: the hearing is gone after purulent otitis, will it recover? In fact, hearing can really recover in such cases:

• in the chronic course of the inflammatory process;
• with cholesteatoma;
• with atrophy of auditory ossicles;
• with a small perforation of tissues;
• in the presence of patency of the auditory canal.

If obstruction is detected in the auditory canal, or atrophy affects the tympanic membrane, or there is damage to the auditory nerve, then the restoration of the auditory function becomes impossible.

The temperature after purulent otitis is a natural reaction of the body to inflammation and the presence of infection in the body. That is, a slight increase in temperature can be observed even for 3-7 days after purulent otitis - this is how much time is required for the body to restore immune defenses. If the temperature first normalizes and then rises again, it can indicate the development of complications - namely, the spread of infection to other tissues and organs.

Exacerbation of purulent otitis may occur when the disease passes into a chronic form. So, the exacerbation often develops against the background of acute respiratory infections or colds, with genyantritis or sore throat. Chronic course is usually characterized by the development of mesotympanitis (inflammation of the mucous tissue of the tympanic cavity) or epitimpanitis (inflammation of the mucous and bone tissues). The clinical picture of an exacerbation resembles the symptoms of an acute inflammatory process.

Infection of blood from purulent otitis is not uncommon. The development of bacteremia in purulent otitis occurs otogenically, when pathogenic microorganisms enter the general bloodstream. In a healthy person, the blood is sterile. Infection of the blood - or, in another way, sepsis, means that infectious agents from the inflammatory focus have got into the bloodstream. Here it is necessary to be able to distinguish sepsis from bacteremia. With bacteremia, the infection enters the bloodstream, provoking damage to certain tissues or some organ. When sepsis affects the whole body - all organs and systems suffer, which ultimately can lead even to the death of the patient.

Most often, the development of such complications occurs due to lack of treatment, or with incomplete or illiterate treatment of a patient with a purulent-inflammatory disease.

[20], [21], [22], [23],

Diagnostics of the purulent otitis media in adults

Diagnostic measures for inflammation of the ear with pus are not complex - in most patients the disease can be identified already in the usual survey and examination. So, the doctor will necessarily ask the patient about the moment of the onset of the disease, about the sequence of the appearance of the symptoms, and also about what the patient has done to facilitate his well-being.

The doctor examines the affected ear with a special head reflector and funnel, or with the use of an otoscope.

If there are external inflammatory phenomena, then the doctor will pay attention to the redness of the skin, the presence of a syphilis or pus. The auditory canal can be narrowed, and so much that visually overlaps the membrane.

With an acute form of otitis media, the redness of the membrane and its stiffness are noticeable. When pus breaks, perforation becomes visible.

To correctly check the motor capacity of the membrane, the patient is encouraged to collect air into the cheeks and tense to make the ears "blown out". This method is called Valsalva maneuver - it is often used by fans of scuba diving. When the air enters the ear cavity, the membrane makes movements that the doctor sees. If there are excretions in the tympanum, the motor activity of the membrane will be disrupted.

Blood tests for inflammation of the ear can only indicate common signs of inflammation in the body. Such signs usually become leukocytosis, accelerated ESR, an increased number of neutrophils and lymphocytes.

Much more informative is bacterial culture - but its drawback is that the results are obtained only a week after taking the smear, and the treatment of the disease must be started immediately. However, many experts still advise to carry out bacteroscopy of the secretions, since the precise identification of the pathogen will allow us to prescribe more effective therapy in the event that the usual antibiotics do not have the expected effect.

Instrumental diagnostics includes such procedures:

• The method of hardware audiometry is used to study the auditory function in the chronic form of the disease.
• Timpanometry is a technique for measuring pressure inside the hearing organ, which is also necessary for the diagnosis of chronic otitis media.
• X-rays and computed tomography are performed with suspicion of complications, for example, intracranial infection or mastoiditis.

If necessary, additional examination is carried out by other specialists - for example, a neuropathologist or / and an ophthalmologist.

[24], [25], [26], [27]

Differential diagnosis

Differential diagnosis is carried out with a furuncle auditory motion, articular mandibular arthritis, angina.

[28], [29], [30], [31],

Treatment of the purulent otitis media in adults

Otitis is treated by an ENT doctor, or otherwise - an otorhinolaryngologist. The scheme of therapy may include taking medications, external treatment and performing an operation. How to treat purulent otitis in adults read here.

Prevention

In order not to give the inflammation a chance for development, you need to timely treat any otolaryngological diseases - sinusitis, rhinitis, etc.

Specific recommendations of doctors are as follows:

• With a cold or sinus, it is necessary to use vasoconstrictors in order to soothe the swollen mucous membrane.
• For any cold or viral illness, you need to drink plenty of fluids to reduce intoxication and prevent the increase in mucus viscosity.
• If the temperature rises to 39 ° C and more, then it is necessary to take an antipyretic.
• In the room it is necessary to maintain adequate humidity and temperature (optimal humidity levels are 45-65%, optimum temperature values are from 18 to 22 ° C).
• When a cold occurs, it is important not to make too strong attempts to blow your nose - excessive diligence can lead to blockage of the auditory tubes and a deeper penetration of the infection. It is recommended to clean each nasal passage separately, clamping the second nostril.

Perhaps the most important preventive tool is a timely visit to the doctor.

[32], [33], [34]

Forecast

Acute ear inflammation with timely access to medical care often ends in recovery. The auditory function is restored. If the treatment was started with a delay, the outcome may be different:

• suppurative inflammation passes into the chronic stage, the tympanic membrane is perforated, the excretion of pus becomes relapsing, and the auditory function steadily decreases;
• complications develop in the form of diseases such as mastoiditis, labyrinthitis, facial paresis, petrositis, as well as diseases of intracranial localization - intracranial abscess, meningitis, sigmoid sinus thrombus, etc .;
• spikes and scars are formed, the auditory ossicles become stiff, a persistent deterioration of hearing occurs, and an adhesive otitis occurs.

Purulent otitis in adults is most dangerous because patients often ignore a timely visit to the doctor, hoping for a successful self-treatment. Therefore, doctors are strongly advised to seek advice and diagnosis as early as possible.

[35], [36]