Exudative otitis media: causes, consequences, diagnosis

The pathological process in the middle ear with the formation of a thick secret is exudative otitis media. Let's consider the features of the disease, the methods of diagnosis, treatment and prevention.

Exudate is a fluid that is released from small blood vessels into the tissues and cavities of the body. When otitis in the secreted secretions are erythrocytes, white blood cells, proteins, fibrin, platelets. The disease develops with the defeat of the Eustachian tube, which connects the drum cavity with the nasopharynx and performs the drainage function, equalizes the pressure.

"Adhesive" ear arises from the action of various factors and pathogens. The disease has a tendency to transition to a chronic form, which is manifested by acute relapses. For treatment use a comprehensive approach with a comprehensive impact on the lesion and strengthen the immune system.

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

Epidemiology

According to medical statistics, otitis media is one of the most common diseases. Every year, about 25% of people face it, and 60% experience it at least once in their life, but they suffer from inflammation of the ears.

As for the exudative form, it occurs in 15% of cases of the disease and more often in patients of child age. 3% of patients develop serious disorders with irreversible changes in the hearing aid and development of hearing loss.

[6], [7], [8], [9], [10]

Causes of the exudative otitis media

The drum cavity is expelled by epithelial cells, which produce a small amount of fluid. Normally, excess fluid is removed to the nasal cavity through the auditory tube. Disturbance of drainage function is one of the reasons for the development of exudative otitis media. Also, the disease can be associated with such factors:

• Chronic inflammatory diseases of the nasopharynx, nose and paranasal sinuses with changes in the mucosa of the auditory tube.
• Dysfunction of the Eustachian tube due to a malfunction of the muscles responsible for its opening.
• Launched treatment for acute otitis media.
• Congenital anatomical features of the structure of the hearing aid.
• Physiological features of the development of the auditory tube in childhood.
• Obstruction of the auditory tube with adenoid outgrowths, cicatricial changes.
• Neoplasms of the nasopharynx of benign and malignant nature.

Treatment of the disease begins with the elimination of the above reasons and preventing their further appearance.

[11], [12]

Allergies as a cause of exudative otitis media

One form of medium serous otitis media is allergic. Most often it develops after respiratory diseases. It manifests as a sharp onset with a high body temperature, mucous secretions from the ear canal. When the infectious pathogens join, the discharge becomes purulent.

Allergic inflammation can be accompanied by rhinitis, sinusitis, adenoid enlargement, ARVI and other pathologies. Also, do not exclude the impact on the body of severe allergens.

To treat the disease, hyposensitization and local glucocorticosteroid therapy are performed. The ear canal is washed with a warm solution of 3% boric acid or hydrogen peroxide. Patients are prescribed vitamin-rich nutrition and fortifying agents. If allergic otitis occurs with infectious complications, then antibacterial treatment is performed.

[13], [14]

Risk factors

The average otitis occurs due to infectious damage to the nasopharynx and edema of the mucous membranes. First of all, the Eustachian tube swells and the process of ear ventilation is disturbed. Against this background, there is catarrhal otitis, which without timely treatment becomes exudative.

Also, the risk factors for the disease include:

• Congenital anomalies of the hearing aid.
• Defects of the nose: curvature of the septum, trauma.
• Inflammatory diseases of the nasopharynx.
• Adenoids.
• Inflammation of the auditory tube.
• Allergic reactions.
• Common diseases of the body are infectious and inflammatory in nature.
• Physical impact on the organs of hearing: water ingress, pressure drops, trauma.

Also, the risk factors include the weakened immune system and the presence of chronic diseases of the body, the child's age of the patient.

[15], [16], [17], [18], [19]

Pathogenesis

The mechanism of development of serous involvement of the middle ear is based on the violation of drainage and ventilation functions of the Eustachian tube. Because of this, a vacuum forms in the tympanic cavity and accumulates serous exudate.

The transudate is liquid, but because of the hypersecretion of the goblet cells of the mucous membrane of the tympanic cavity and the increase in the level of the protein, it becomes viscous and dense. Because of this, the disease is called a "sticky" ear.

The pathogenesis of exudative otitis media is associated with poor drainage of the tympanic cavity, a violation of the functions of the muscular system of the soft palate, cleft palate of the hard palate and active intake of antibacterial drugs.

Immunity and exudative otitis media

One of the causes of inflammation of the middle ear with increased secretion is a weakened immune system. It is the immune defense that prevents infection of the body with various pathogens.

The first symptoms of the disease manifest inflammatory reactions, which indicate that the immune system is trying to cope with inflammation. If this does not happen, the disease progresses. Proceeding from this, one of the compulsory components of the treatment of serous otitis is immunotherapy aimed at strengthening the local and general immune system.

[20], [21], [22], [23], [24]

Immune response in exudative otitis media

The inflammatory reaction is the first line of the body's immune defense. It is realized by humoral factors and cells, which are activated by the action of pathogens or tissue damage.

The early immune response begins with the involvement of leukocytes from the bloodstream into the focus of inflammation. The mobilization of leukocytes is stimulated by proinflammatory cytokines, which are produced and secreted by macrophages during phagocytosis of the pathogen.

It is the inflammatory response of the immune system that allows early diagnosis of the disease state and treatment.

Symptoms of the exudative otitis media

Exudative otitis has a pronounced symptomatology only with complicated flow. In other cases, the symptoms of the disease are blurred. But despite this, doctors distinguish a number of symptoms of damage to the organs of hearing:

• Hearing loss and feeling of stuffiness, noise in one / both ears.
• Sharp, shooting and rapidly passing pain in the ear.
• Subfebrile body temperature.
• Excretions from the auditory canal.

As the disease progresses, symptoms increase. If the otitis develops against the background of some other disease, the signs of inflammation are difficult to recognize.

[25], [26]

Complications and consequences

One of the dangers of exudative inflammation of the middle ear is the complications of the disease. If left purulent otitis without treatment or untimely initiation of therapy, this can lead to the development of such problems with the organ of hearing:

• Degenerative persistent changes in inflamed structures: tympanic membrane, mucous cavity.
• Immobilization of auditory ossicles and reduction of acuity of hearing.
• Chronic adhesive mid otitis media.
• Formation of retraction pockets of the tympanic membrane.
• Perforation, that is, the pathological opening of the tympanic membrane.
• Formation of cholesteatoma - a cavity with dead cells of the epithelium and other substances in a capsule of connective tissue.
• Intoxicative effect on the inner ear, which leads to a decrease in the functions of the auditory receptors and the progression of hearing loss.

In addition to the above problems, the disease can cause serious complications for the whole body: meningitis, brain abscess, thrombosis of the sinuses of the brain, labyrinthitis, sepsis, mastoiditis. Such consequences of exudative otitis are difficult to treat.

Relapse of exudative otitis media

If the inflammation of the middle ear is repeated several times a year after complete recovery, this indicates a relapsing form of the disease. Most often relapses are associated with such factors:

• Frequent colds, pneumonia.
• Weakened immune system.
• Anomalies in the internal structure of the organs of hearing.
• Exudative diathesis.
• Digestive disorders.
• Severe allergic reactions.
• Polyps in the nasal cavity.
• Sinusites.
• Increased adenoid vegetation.
• Hypertrophy of nasal conchae, palatine tonsils.

Important in frequent relapses is the nature of the pathogen. So, if Pneumococcus, Staphylococcus aureus et epidermidis is detected, chlamydia, mycoplasma and other pathogens can be sown.

On the symptomatic relapse proceeds easier, than the first case of illness. But despite this, inflammation leads to a progressive decrease in hearing acuity. Also, perforation of the tympanic membrane, a feeling of congestion and pain in the ear is possible.

During the diagnosis, the clinical picture of the disease, laboratory and instrumental studies are studied. Treatment is carried out in two stages. First of all liquidate the current exacerbation: washing the ear canal, taking antibiotics, physiotherapy and others. The second stage consists of preventing relapses. To do this, prescribe immunostimulants, multivitamin complexes and other means to strengthen local and general immunity.

[27], [28], [29], [30], [31], [32]

Chronic exudative otitis switched to sensorineural hearing loss

Violation of the severity of hearing due to the loss of the auditory analyzer is a sensorineural hearing loss. One of the causes of this disease is the complication of chronic serous inflammation of the middle ear. The pathological process can affect structures responsible for the perception of sound in different areas: in cells of the inner ear, trunk or cortex of the brain, nerve conductors.

Sensorineural hearing loss is divided according to the level of lesion, duration and severity of the course, the severity of hearing loss and the time of onset of symptoms. The main signs of this complication include:

• Decreased acuity of hearing.
• Noise in ears.
• Headaches and dizziness.
• Somatoform disorders.

In the first stages, a normal conversation is clearly heard from 5-7 meters, whispering from 2-3 meters. With severe violations, these indicators are significantly reduced, we can hear from a distance of less than a meter.

Diagnosis of neurosensory hearing loss on the background of persistent serous inflammation of the mucous membrane of the auditory tube and the tympanic cavity consists of such methods: otoscopy, tuning forks, tonal audiometry, vestibulometric tests. Also, the research is aimed at identifying the accompanying pathologies of the nervous system, spinal and brain lesions, and damage to the bones of the facial skull.

Treatment consists of restoring hearing functions and eliminating painful symptoms. Patients are prescribed physiotherapy, reflexology, medication. In particularly severe cases, hearing and surgical treatment is performed. With timely detection and treatment of this complication, the forecast is relatively favorable. In other cases, there is a high risk of hearing loss.

[33], [34], [35], [36], [37]

After exudative otitis left nasal congestion

Another common complication that occurs after a "sticky" ear is the stuffiness of the hearing organs. Normally, the pressure in the external ear canal is similar to the pressure in the middle ear. If the pressure on both sides of the tympanic membrane is different, there is a feeling of congestion. Another reason for the unpleasant condition is the defeat of the Eustachian tube, that is, the connecting channel between the pharynx and the ear.

As a rule, after elimination of otitis manifestations, the stuffiness passes by itself. The recovery period is individual for each patient, but takes about 2 weeks on average. To accelerate recovery, patients are prescribed vasoconstrictor ear drops, as they relieve edema, improve the drainage functions of the auditory tube and the passage of pathogenic exudate. Anti-inflammatory drugs are also used. As an auxiliary method, physiotherapy is carried out: heating, elimination of edema, strengthening of local immune defense.

[38], [39], [40]

Diagnostics of the exudative otitis media

Serous form of inflammation of the middle ear has a meager range of symptoms, so its diagnosis requires a comprehensive, comprehensive approach. First of all, the doctor collects an anamnesis, asks the patient about the early infectious-inflammatory diseases of the nasopharynx and ears, allergic reactions, diagnostic and any other medical manipulations.

After the survey, further examinations are scheduled. The diagnosis is aimed at:

• Determination of the stage of the pathological process.
• Detection of inflammation in the tympanum.
• Determination of the type of pathogen and its sensitivity to antibacterial drugs.

It is also necessary to confirm or exclude complications: perforation of the tympanic membrane, reduction of acuity, purulent processes. For these purposes a set of laboratory and instrumental methods is used, differentiation with similar diseases.

[41], [42], [43], [44], [45], [46],

Analyzes

Since a persistent serous lesion of the mucous membrane of the auditory tube and the tympanic cavity is accompanied by an inflammatory process, then laboratory diagnostics is carried out for its detection. Analyzes appoint a doctor, they are necessary for the study of secreted from the ear cavity secretion and the determination of the type of pathogenic microorganisms, their sensitivity to antibiotics.

The patient shows a general clinical blood test, a C-reactive protein, an ESR for assessing inflammation and drawing up a treatment regimen. If there is a suspicion of the development of complications, then an extensive blood test is conducted in the study of which the results of computed tomography and other instrumental examinations are taken into account.

[47], [48], [49], [50], [51], [52], [53]

Cytology at Exams

One of the most informative and operational methods for diagnosing various organs is cytology. With a "sticky" ear, it reveals inflammatory processes, the severity of the pathological condition, complications.

To conduct cytology in exudative inflammation, the secretion of the secreted secretion from the ear is performed. The analysis reveals purulent-inflammatory processes in the external auditory canal, on the tympanic membrane and in other structures of the organ. Also, cytology identifies the causative agent and determines its sensitivity to antibacterial drugs.

If the disease state is associated with allergic reactions of a bacterial or non-bacterial nature, then cytology reveals a large number of eosinophils in the ear secret. The results of cytology allow to make an effective treatment and control its effectiveness.

[54], [55], [56], [57]

Instrumental diagnostics

If you suspect a chronic form of inflammation of the middle ear, patients are assigned a set of various studies. Also shown is the conduct of instrumental diagnostics, which is represented by such methods:

• Otoscopy is an examination of the external auditory canal and tympanic membrane with the help of an otoscope or an ear funnel.
• Otomikroskopiya - examination of the ear canal with a microscope. In the otitis eardrum inflamed, cyanotic shade, may be cloudy, retracted or vice versa vybuhshey. Mobility is limited, but through it serous fluid can be visible.
• Valsalna / Zygle funnel - determine the degree of mobility of the tympanic membrane.
• Audiometry - measuring the severity of hearing and sensitivity to sound waves of different frequencies.
• Acoustic reflexes - changes in the resistance of the structures of the outer and middle ear with the contraction of the stremna muscle and the impact of loud sounds.
• Timpanometry - determination of the mobility of the tympanic membrane and conduction of the auditory ossicles. In inflammation there is a decrease in the mobility of structures due to accumulation of exudate.
• Timpanopuncture - a puncture of the tympanic membrane for the fence to analyze its contents. Most often, paracentesis is carried out, that is, the formation of a hole with a special tool and its bypass.
• Endoscopy of the pharyngeal opening of the auditory tube - reveals pathologies of the nasopharynx, which could cause otitis and visualize the narrowing of the opening of the auditory tube.
• Computer tomography of the temporal bone - is performed in especially severe cases. On the roentgenogram, the airiness of the cavities of the middle ear, the damage to the mucous membrane and the chain of the auditory ossicles are determined. The density and localization of the serous fluid is also determined.

The complex of instrumental diagnostic methods allows you to put a reliable diagnosis and begin treatment.

Timpanometry with exudative otitis

The technique for assessing the pressure in the tympanum, the functional features of the tympanic membrane, auditory ossicles and the tube is tympanometry. In exudative inflammation of the middle ear, it refers to mandatory research.

To conduct tympanometry use a special probe, which is installed in the ear canal. The device is connected to a pump, sound generator and microphone. The generator creates sounds of different tonality, the pump adjusts and changes the pressure in the ear canal, and the microphone determines the reverse signals reflected from the walls of the tympanic membrane and the middle ear.

With the help of this study, the degree of mobility of bones and eardrums, the presence of inflammatory exudates and other pathologies are determined. By duration, the procedure takes no more than 10 minutes.

Type of tympanogram with exudative otitis

Testing for acoustic immitance is a study aimed at obtaining data on the expiration of the middle ear. Timpanometry determines the elasticity of the tympanic membrane. If the internal structure of the hearing organ has cicatricial changes, scratches due to pressure difference or accumulation of secretions in the middle ear, this increases acoustic impedance and reduces acoustic elasticity, that is, conductivity for sounds.

The tympanogram has several types:

• Type A is a record characteristic of high total conductivity at steep gradient and air pressure at the middle ear. Reflects the normal status of the organ of hearing.
• Type B - a record of low conductivity and negative / non-extended pressure on the middle ear. Indicate violations in the middle ear with increased impedance.
• Type C - reduced conductivity with gradual gradient or negative pressure in the middle ear.

Type B and C may indicate the presence of fluid in the middle ear, that is, the process of exudation, perforation of the tympanic membrane or its scar deformities, the presence of neoplasms in the middle ear, or the lack of interrelation between the surfaces of the sound-conducting bones of the middle ear.

The data of the tympanometric study do not have independent diagnostic value and require additional studies with an assessment of the threshold of bone and air conduction, threshold of audibility, otoscopy and other audiometric indicators.

Differential diagnosis

When examining the body for the diagnosis - exudative otitis, differential diagnosis is mandatory. Inflammation of the middle ear is differentiated from pathologies in which conductive hearing loss occurs in the intact tympanic membrane:

• Otosclerosis - with this disorder, the otoscopic picture is normal, and tympanometry reveals a tympanogram of type A with flattening of the curve.
• Anomalies and degenerative changes in the auditory ossicles. The diagnosis is confirmed after multifrequency tympanometry.
• Glomusnye tumors of the tympanic membrane and rupture of auditory ossicles. Tumor neoplasms are confirmed by X-ray and tympanogram type E.

The results of differentiation make it possible to deliver the correct final diagnosis or to assign a number of additional studies for a more detailed study of the pathological condition.

Treatment of the exudative otitis media

The key to successful treatment of serous inflammation of the middle ear is a complex approach, it can be combined with folk remedies. In this case, the earlier the therapy is started, the higher its effectiveness and the better the prognosis for recovery. The main task of treatment is the restoration of the functions of the auditory tube. To do this, sanation of the nasal cavity, paranasal sinuses and pharynx is carried out.

How much exudative otitis is treated?

The duration of treatment of serous inflammation of the mucosa of the auditory tube and the tympanic cavity depends on many factors. If the disease is diagnosed at an early stage and treatment is started, then full recovery occurs within a week. To do this, use antibacterial, anti-inflammatory and antimicrobial agents.

With the advanced form of inflammation, the treatment is longer and consists of a set of different therapeutic techniques. The patient is prescribed medication to eliminate infection, mucolytics and other medications. Also shown are physiotherapy procedures for removing exudate from the ear canal. Recovery takes 10 to 14 days.

If you leave the disease not fully cured, then it threatens with serious complications, the most dangerous of which is total hearing loss. Children have a risk of developing meningitis, mastoiditis, encephalitis and other life-threatening diseases.

Prevention

To prevent inflammation of the middle ear, a set of preventive measures is shown that are aimed at increasing the body's resistance to pathogens:

• Regular preventive examinations at the otolaryngologist.
• Physical activity and hardening of the body.
• Balanced diet.
• Sanitation of the nasal cavity and nasopharynx.
• Timely treatment of any foci of infection in the body.

In addition to the above recommendations, it is necessary to take vitamins and minerals to improve the protective properties of the immune system.

• Can I walk with exudative otitis?

Walking in the open air with the diagnosed "sticky" ear is allowed, provided that the patient is dressed in the weather, and the ears are protected from cold air.

If the disease has arisen against the background of ARVI, influenza and other infectious diseases, then walks are not recommended until full recovery, since there is a risk of infecting others.

With increased body temperature and worsening of overall well-being, bed rest should be observed, so it is better to postpone the walk.

• Is it possible for a child to go to kindergarten with exudative otitis?

Practical all ENT doctors adhere to the opinion that with otolaryngic diseases the child should observe a bed rest with minimal contact with the outside world. This reduces the risk of progression of pathology and infection of others if the inflammation is of an infectious nature. Proceeding from this, it is better to go to the kindergarten until the child is fully recovered. Read also about the course and symptoms of exudative otitis media in children in this article.

• Can I rest on the sea with exudative otitis?

During treatment of serous forms of inflammation of the middle ear, you should protect your head from hypothermia or water ingestion. Trips to the sea are allowed, provided that the patient does not dive or dive with scuba diving. Recommended moderate water and air procedures with an emphasis on strengthening and tempering the body. As for flights to the sea in warm countries, it all depends on the recommendations of the otolaryngologist, since flights with otitis are prohibited.

• Can I fly on an airplane with exudative otitis?

Everyone who flies on an airplane, knows that during the flight and landing lays ears. With inflammatory lesions of the hearing organs, unpleasant sensations increase several times, causing acute pain.

Because of this, almost all otolaryngologists are against any flights during otitis media, and especially with its serous form. This is due to the fact that with a change in pressure, a capsule with a liquid or purulent exudate can break through, and its contents will pass into the inner ear, exacerbating an already painful condition.

There are a number of recommendations that help prevent critical situations due to pressure spikes:

• To reduce pressure in the auditory tube, open the mouth wide.
• The upper edge of the lower jaw is connected to the osseous base of the middle ear, so frequent and intense swallowing contributes to the release of excess air and the tympanum. Also for these purposes you can chew nuts or candies.
• Keep vasoconstrictive drops close at hand.

If the flight is unavoidable, then you should consult your doctor and follow all of his appointments, both before the flight and after.

[58], [59], [60], [61], [62], [63], [64],

Forecast

If exudative otitis is diagnosed at early stages and effective treatment is prescribed, then the prognosis for recovery is favorable. With aggravation of the disease state, a complex of complications develops, some of them lead to irreversible hearing loss, damage to brain structures. In this case, the disease has an unfavorable prognosis.

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