Treatment and symptoms of purulent otitis in adults. Acute suppurative otitis media How to treat purulent otitis media in adults

Acute purulent otitis media (otitis media purulenta acuta) is an acute purulent inflammation of the mucous membrane of the tympanic cavity, in which all parts of the middle ear are involved to one degree or another in catarrhal inflammation.

This disease has some symptoms similar to the common cold. So, otitis media is also characterized by fever and headache.

In addition, otitis often occurs simultaneously with colds. But there are other symptoms characteristic of otitis media that indicate the development of an inflammatory process in the ear.

You can “survive a cold” without resorting to the help of doctors, but if signs of otitis media appear, you should seek help from an otolaryngologist. Because if you do not start timely treatment of purulent otitis media in adults, this disease can lead to a noticeable decrease in hearing and even cause the development of meningitis.

Causes

The cause of the disease is a combination of factors such as a decrease in local and general resistance and infection in the tympanic cavity. Purulent otitis media occurs as a result of inflammation of the auricle, affecting the middle ear cavity, mucous membrane and eardrum.

Causes of purulent otitis media:

entry of bacteria, viruses, fungi into the auricle;
complications of diseases of the nose, sinuses, nasopharynx;
severe ear bruise;
consequences , ;
hypothermia.

The most common route of infection is tubogenic - through the auditory tube. Less commonly, the infection enters the middle ear through a damaged eardrum due to injury or through a wound to the mastoid process. In this case, they talk about traumatic otitis media.

Symptoms of purulent otitis media

There are several signs that help determine that you have acute purulent otitis media and not another ear disease. But the main symptoms of various diseases in the field of otolaryngology usually coincide.

Traditional symptoms of otitis media:

throbbing pain in the ear area;
pain behind the ear;
heat;
chills;
extraneous noise in the ear;
decreased audibility.

These signs are characteristic of the initial stage of the disease, when inflammation causes extensive suppuration. Typically this process lasts 2-3 days. Next, acute purulent otitis of the middle ear passes into the phase of perforated damage to the eardrum, as a result of which pus flows out of the ear cavity through the formed hole in the eardrum, and the patient experiences significant relief and pain is reduced.

The third stage is the final stage, the body fights the infection, inflammation gradually decreases, pus ceases to be released, and the eardrum restores its integrity.

Signs of otitis media in a child

Each stage of the disease is characterized by certain symptoms.

Symptoms of purulent otitis in a child of the 1st stage:

earache;
heat;
hearing loss.

Stage 2 symptoms:

the temperature drops;
the pain subsides;
hearing loss continues;
Purulent discharge begins to come out of the ear.

Stage 3 symptoms:

the temperature drops;
the pain disappears;
hearing is restored;
the discharge stops;
the perforation of the eardrum heals.

This disease requires early diagnosis and antibiotic therapy.

Chronic purulent otitis media

This is an inflammation of the middle ear, which is characterized by recurrent flow of pus from the ear cavity, persistent perforation of the eardrum and progressive hearing loss (hearing loss can reach 10-50%).

This otitis is manifested by the following clinical picture:

Constant purulent discharge from the ear with a putrid odor;
Noise in the affected ear;
Hearing impairment.

It develops when acute otitis is treated untimely or inadequately. It can be a complication, etc., or a consequence of a traumatic rupture of the eardrum. Chronic otitis affects 0.8-1% of the population. In more than 50% of cases, the disease begins to develop in childhood.

Chronic purulent otitis media without bone destruction and complications can be treated with medications under the outpatient supervision of an otolaryngologist.

Complications

Lack of suitable treatment leads to irreparable damage to health. The consequences of otitis media in adults are the result of a structural transition of further inflammation into the temporal bone or inside the skull.

Complications may include:

violation of the integrity of the eardrum;
mastoiditis – inflammation of cells in the bone;
facial nerve paralysis.
meningitis - inflammation of the lining of the brain;
encephalitis - inflammation of the brain;
hydrocephalus - accumulation of fluid in the cerebral cortex.

To avoid these unpleasant diseases, you need to know how to treat purulent otitis media in adults.

Treatment regimen for acute purulent otitis media

In adults, treatment of purulent otitis media includes the following procedures and medications:

antibiotics;
, antipyretic drugs;
vasoconstrictor ear drops;
heat compresses (until pus appears);
physiotherapy (UHF, electrophoresis);
antihistamines;
surgical cleaning of the ear canal from pus.

It should be noted that after the appearance of purulent discharge, warming procedures should under no circumstances be performed. If the disease is chronic, puncture or dissection of the eardrum may be required.

How to treat purulent otitis media in adults

Diagnosis is usually not difficult. The diagnosis is made based on complaints and the results of otoscopy (visual examination of the ear cavity using a special instrument). If a destructive process in bone tissue is suspected, an x-ray of the temporal bone is performed.

Purulent otitis in adults requires outpatient treatment; at high temperatures in combination with fever, it is recommended to remain in bed. Hospitalization is required if a mastoid lesion is suspected.

To reduce pain in the initial stages of the disease, use:

paracetamol (one tablet 4 times a day);
Otipax ear drops (twice a day, 4 drops);
tampon according to Tsitovich (a gauze swab soaked in a solution of boric acid and glycerin is inserted into the ear canal for three hours).

To relieve swelling in the tissues of the auditory tube, the following is prescribed:

Nazivin;
tizin;
Santorini;
naphthyzin.

Antibiotics used for purulent otitis media:

amoxicillin;
augmentin;
cefuroxime

If after several days of treatment there is no improvement or the symptoms worsen, surgical treatment is performed; it is urgently indicated when signs of irritation of the inner ear or meninges appear. After paracentesis or self-perforation, it is necessary to ensure the outflow of pus from the middle ear: drain the ear canal with sterile gauze swabs 2-3 times a day or wash the ear with a warm solution of boric acid.

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Almost every person has experienced ear pain. It is important not to self-medicate when pain occurs, as this approach can lead to unpredictable and dangerous consequences. Inflammatory infectious processes in the ear can cause a lot of trouble, but if left untreated, they will lead to various kinds of serious complications.

What it is?

An inflammatory process of an infectious nature, which covers all parts of the middle ear, is called otitis. Purulent otitis may appear for various reasons - untreated infectious and viral diseases, decreased immunity. Heredity is also a risk factor for developing the disease.

If there is a suspicion of purulent otitis media, symptoms in adults will be as follows:

cutting, severe and persistent pain in the ear;
the appearance of extraneous noise;
temperature increase;
the appearance of purulent discharge mixed with blood and mucus.

Signs of purulent otitis may be different for each person. For some, the disease goes away quickly and without complications, for others it drags on for a long time, even with adequate treatment. If purulent otitis in the ear is not treated, it will turn from an acute form into a chronic one, and surgical intervention may be required.

Stages of purulent otitis

Stage one is the beginning of the inflammatory process. Body temperature rises, severe pain is present, and hearing problems appear. At this stage, exudate begins to accumulate, which puts pressure on the eardrum.
The second stage - the eardrum ruptures and pus begins to flow out of the ear. The pus may be mucus or mixed with blood. At the same time, body temperature decreases to normal levels, pain is significantly reduced. Purulent perforated otitis is characterized by moderate pain and resolves within 5-8 days.
Stage three is reparative. This is the healing stage. Purulent discharge stops, scarring occurs.

If the membrane rupture is large and scarring does not occur, the pathology becomes chronic.

Localization

The disease is also differentiated by location. The simplest form is external purulent otitis. Localization - external part of the ear. It can cover the entire ear canal or appear as a single boil. Treatment is selected individually; with the right approach, you can get rid of the disease quickly and without serious consequences.

Purulent otitis media is a more serious pathology than external otitis media. In this case, inflammation occurs in the middle ear. Pus accumulates in the area of the eardrum, pressing on it, as a result of which hearing is impaired and sharp, severe pain occurs. Purulent otitis media of the ear in adults threatens with serious complications if treatment, which should be comprehensive, is not promptly addressed. Home treatment will not help here; you need to contact specialists. This form of the disease occurs most often.

Labyrinthitis is internal purulent otitis media. The most serious form of the disease, which appears most often with advanced purulent otitis media and improper treatment. Labyrinthitis is characterized by inflammatory processes in the labyrinths of the ear. Accompanied by severe, sharp pain that radiates to the frontal part of the head, eyes, and neck. After experiencing labyrinthitis, in any case, hearing problems will appear, since hair cells die in the inner ear.

Chronic form

Chronic purulent otitis media does not occur on its own; it is preceded by an acute form. Sometimes the chronic form appears after infectious diseases, such as tonsillitis or scarlet fever. The chronic form is an insidious disease, as it can pass without obvious symptoms. That is why many people rarely see a doctor right away and the disease progresses.

The main symptom of chronic otitis is constant suppuration from the ear. In this case, the pain may not be severe, and the body temperature usually does not rise. If you do not consult a doctor, this form of the disease will lead to granulation - the growth of excess tissue that will close the ear canal. Complications can be different - at first the patient will suffer from dizziness, and balance will be impaired when walking. More serious complications are the appearance of meningitis, blood sepsis, and brain abscess. Such diseases can be fatal.

There are two forms of chronic otitis media:

epitympanic-antral purulent otitis - in addition to the mucous membrane, bone tissue is affected;
tubo-tympanic - damage occurs exclusively in the mucous membranes of the middle ear.

Not everyone knows how to treat purulent otitis, so when the first symptoms appear, you should not waste time, you should immediately consult a doctor. Self-medication and the wrong choice of medications will lead to complications. For example, at the stage of tubotympanic purulent otitis, drops with alcohol are strictly contraindicated - you can get a serious burn and aggravate the course of the disease.

Treatment of chronic purulent otitis is carried out comprehensively - medications and physiotherapy are indicated. Treatment should be prescribed by a doctor individually, depending on the stage of the pathology and the course of the disease.

Diagnostics

At the first symptoms of chronic or acute purulent otitis, you should consult an otolaryngologist:

the appearance of sharp throbbing pain;
the appearance of purulent discharge;
feeling of pressure in the ear;
hearing loss;
temperature increase.

The doctor prescribes tests that can show the presence or absence of inflammatory processes in the body. The specialist also conducts a visual inspection and a tuning fork examination. Tests such as MRI and X-ray may be prescribed. If it is not possible to determine an accurate diagnosis, a puncture is performed to determine the contents in the eardrum.

Treatment

After the correct diagnosis is made, individual treatment is prescribed. Most often, it is performed inpatiently, if the form of otitis is not advanced and surgical intervention is not required. You should not use traditional medicine without knowing the specifics of the disease and its stage. For example, hydrogen peroxide is often used for purulent otitis media, but incorrect use of the product can cause burns and more serious complications.

Treatment of purulent otitis media in adults is complex and includes the following types of therapy:

anti-inflammatory;
desensitizing;
symptomatic.

Anti-inflammatory therapy usually prescribes antibiotics and atotoxic drugs. With hyposensitizing therapy, the doctor prescribes antihistamines, calcium, and vitamins. Physiotherapy is also not unnecessary. Physiotherapeutic procedures are prescribed that give a thermal effect - this is warming up the localization site using a Solux lamp, and dry warming bandages are made. Such procedures are carried out with great care and under the supervision of a doctor!

For symptomatic treatment, painkillers, antipyretics, and sedatives are taken.

In complex and advanced cases, surgery is prescribed. The method of surgical intervention is chosen individually. If purulent otitis is diagnosed, a puncture is made in the eardrum, the pus is pumped out, polyps and granulation are removed. Bypass surgery is prescribed. After surgery, a relapse is possible, so you should carefully monitor your health and, if necessary, immediately consult a doctor.

Complications

If purulent otitis is diagnosed, not every patient knows how dangerous this disease is. If left untreated, the pus will move into the deeper structures of the ear. Why is purulent otitis media dangerous? In advanced cases, perforation of the eardrum is often diagnosed, followed by complete hearing loss or hearing loss.

More serious complications are the development of dangerous diseases that can threaten the patient’s life.

Prevention

The basis for the prevention of purulent otitis media and its other forms is to carry out timely vaccination against viral and bacterial infections. It is also necessary to strengthen the immune system and prevent hypothermia. You should avoid being in a draft, and when swimming, make sure that water does not get into your ears. For various infectious diseases - ARVI, sore throat, influenza, you need to achieve a complete cure, and not suffer the disease on your feet.

To avoid complications, do not treat at home using traditional methods, contact an ENT specialist. Do not start the disease, because it is much easier to get rid of it in the early stages!

This is a purulent inflammatory process in the middle ear cavity, which has a chronic course. Chronic suppurative otitis media is characterized by conductive or mixed hearing loss, suppuration from the ear canal, pain and noise in the ear, sometimes dizziness and headache. Chronic suppurative otitis media is diagnosed based on otoscopy, hearing tests, bacteriological culture of ear secretions, X-ray and tomographic examinations of the temporal bone, analysis of the vestibular function and neurological status of the patient. Patients with chronic purulent otitis media are treated with both conservative and surgical methods (debridement surgery, mastoidotomy, anthrotomy, labyrinthine fistula closure, etc.).

General information

Chronic suppurative otitis media is otitis media, accompanied by constant suppuration from the ear for more than 14 days. However, many experts in the field of clinical otolaryngology indicate that otitis media with suppuration lasting more than 4 weeks should be considered chronic. According to WHO, chronic suppurative otitis media is observed in 1-2% of the population and in 60% of cases leads to persistent hearing loss. In more than 50% of cases, chronic suppurative otitis media begins its development before the age of 18 years. Chronic purulent otitis media can cause purulent intracranial complications, which in turn can lead to the death of the patient.

Causes

The causative agents of chronic purulent otitis media are, as a rule, several pathogenic microorganisms. Most often these are staphylococci, Proteus, Klebsiella, Pseudomonia; in rare cases - streptococci. In patients with a long course of chronic purulent otitis media, along with the bacterial flora, the causative agents of otomycosis - yeast and mold fungi - are often sown. Immediate reasons:

Acute otitis media. In the vast majority of cases, chronic suppurative otitis media is the result of the transition to the chronic form of acute otitis media or the development of adhesive otitis media.
Ear injuries. The development of the disease is also possible when the tympanic cavity becomes infected as a result of ear trauma, accompanied by damage to the eardrum.
Other diseases of the ENT organs. The occurrence of chronic purulent otitis media is caused by dysfunction of the auditory tube due to eustachitis, aerootitis, adenoids, chronic sinusitis;

Various immunodeficiency conditions (HIV infection, side effects of treatment with cytostatics or radiotherapy), endocrinopathies (hypothyroidism, obesity, diabetes mellitus), irrational antibiotic therapy or unjustified reduction in the duration of treatment of acute purulent otitis contribute to the development of chronic purulent otitis media from acute.

Classification

Chronic suppurative otitis media has 2 clinical forms:

Mesotympanitis(tubotympanic otitis). It makes up about 55% and is characterized by the development of an inflammatory process within the mucous membrane of the tympanic cavity without involving its bone formations.
Epitympanitis(epitympanic-antral otitis) Epitympanitis accounts for the remaining 45% of cases of chronic suppurative otitis media. It is accompanied by destructive processes in bone tissue and in many cases leads to the formation of cholesteatoma of the ear.

Symptoms

The main clinical signs of chronic suppurative otitis media are suppuration from the ear, decreased hearing (hearing loss), tinnitus, pain in the ear and dizziness. Suppuration can be constant or periodic. During the period of exacerbation of the disease, the amount of discharge usually increases. If granulation tissue grows in the tympanic cavity or there are polyps, then the discharge from the ear may be bloody.

Chronic suppurative otitis media is characterized by a conductive type of hearing loss caused by impaired mobility of the auditory ossicles. However, long-term chronic suppurative otitis media is accompanied by mixed hearing loss. The resulting disturbances in the functioning of the sound-perceiving part of the auditory analyzer are caused by decreased blood circulation in the cochlea as a result of prolonged inflammation and damage to the hair cells of the labyrinth by inflammatory mediators and toxic substances formed during the inflammatory reaction. Damaging substances penetrate from the tympanic cavity into the inner ear through the windows of the labyrinth, the permeability of which increases.

The pain syndrome is usually moderate and occurs only during periods when chronic purulent otitis media enters the acute phase. An exacerbation can be triggered by ARVI, pharyngitis, rhinitis, laryngitis, sore throat, or fluid getting into the ear. During an exacerbation, there is also an increase in body temperature and a feeling of pulsation in the ear.

Complications

Epitympanitis has a more severe course than mesotympanitis. This chronic purulent otitis media is accompanied by bone destruction, which results in the formation of skatole, indole, and other chemicals that give the ear discharge a foul odor. When the destructive process spreads to the lateral semicircular canal of the inner ear, the patient experiences systemic dizziness. When the wall of the bony facial canal is destroyed, paresis of the facial nerve is noted. Epitympanitis often leads to the development of purulent complications: mastoiditis, labyrinthitis, meningitis, brain abscess, arachnoiditis, etc.

Diagnostics

Chronic purulent otitis media can be diagnosed using endoscopy, hearing analyzer studies, bacteriological culture of ear discharge, skull radiography, CT and MSCT of the skull with a targeted examination of the temporal bone.

Ear examination. Otoscopy and microotoscopy are carried out after toileting the outer ear with thorough cleansing of the external auditory canal. They detect the presence of perforation in the eardrum. Moreover, chronic purulent otitis media, which occurs as mesotympanitis, is characterized by the presence of perforation in the tense area of the tympanic membrane, while epitympanitis is characterized by the location of perforation in the loose area.
Examination of auditory function. Chronic purulent otitis media is characterized by decreased hearing according to audiometry, conductive or mixed hearing loss according to threshold audiometry, impaired mobility of the auditory ossicles according to acoustic impedance measurement. Eustachian tube patency, electrocochleography, and otoacoustic emissions are also assessed.
Research of the vestibular analyzer. Chronic purulent otitis media, accompanied by vestibular disorders, is an indication for electronystagmography, stabilography, videooculography, pressor test, indirect otolitometry.

If there are neurological disorders in the clinic, consultation with a neurologist and an MRI of the brain are necessary.

Treatment of chronic suppurative otitis media

Purulent otitis without bone destruction and complications can be treated with medications under the outpatient supervision of an otolaryngologist. This drug therapy is aimed at relieving the inflammatory process. In cases where chronic purulent otitis media occurs with bone destruction, it is essentially a preoperative preparation of the patient.

If chronic purulent otitis media is accompanied by paresis of the facial nerve, headache, neurological disorders and/or vestibular disorders, then this indicates the presence of a destructive process in the bone and the development of complications. In such a situation, it is necessary to hospitalize the patient as soon as possible and consider surgical treatment.

Conservative therapy

Chronic suppurative otitis media is usually subject to conservative or preoperative treatment for 7-10 days. During this period, the ear is cleaned daily, followed by washing the tympanic cavity with antibiotic solutions and instilling antibacterial drops into the ear. Considering that chronic purulent otitis media is accompanied by perforation in the eardrum, ototoxic aminoglycoside antibiotics cannot be used as ear drops. You can use ciprofloxacin, norfloxacin, rifampicin, as well as their combination with glucocorticosteroids.

Surgery

For the purpose of complete sanitation and functional restoration, chronic purulent otitis media with bone destruction requires surgical treatment. Depending on the prevalence of the purulent process, chronic purulent otitis media is an indication for sanitizing surgery with mastoidoplasty or tympanoplasty, aticoantrotomy, mastoidotomy, labyrinthotomy and labyrinthine fistula plastic surgery, and removal of cholesteatoma. If chronic purulent otitis media is accompanied by diffuse inflammation with the threat of complications, then general ear surgery is performed.

Forecast

Timely sanitation of a chronic purulent focus in the ear ensures a favorable outcome of the disease. The earlier treatment is carried out, the greater the chances of restoration and preservation of hearing. In advanced cases, when chronic suppurative otitis media leads to significant bone destruction and/or the development of complications, reconstructive surgery is necessary to restore hearing. In some cases, with the most unfavorable outcome, patients require

When talking about otitis media, we always mean an inflammatory reaction in the ear. However, ear inflammation can be different - moderate, external, acute, chronic, catarrhal, purulent, etc. In this article we will look at purulent otitis in adults, and in addition we will answer many common questions from patients regarding purulent otitis.

Why is purulent otitis media dangerous?

Most often, the development of ear inflammation is associated with a common cold, but this is not always correct: ear inflammation is a more serious and dangerous disease. And, if a cold can “go away” on its own, without specific treatment, then the purulent-inflammatory process must be treated without fail - and only under the supervision of a doctor.

Adults get ear infections 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 hearing function that cannot be restored.

Adhesions often form in damaged inflamed areas, and 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 consults a doctor late. Therefore, the degree of danger in case of purulent otitis media is directly proportional to the timeliness of seeking medical help.

ICD-10 code

H66 Purulent and unspecified otitis media

Epidemiology

An inflammatory reaction in the ear with the release of pus is considered a fairly common disease of the hearing organs. The pathology can have a mild course, or develop rapidly, leading to severe inflammation affecting the entire body.

Causes of purulent otitis media in adults

In most adults, inflammatory suppuration from the ear occurs as a secondary pathology - that is, microbes initially enter the middle ear from other nearby structures. There are certain risk factors that contribute to the development of the disease - first of all, by weakening the body's defenses.

We are talking about the following factors:

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

Pathogenesis

The underlying infection for the development of the inflammatory process in adults can be either bacteria or a fungal infection. Most often, bacteria found in the auditory cavity are staphylococcus and Pseudomonas aeruginosa, or fungi - candida or aspergillus. The most common causative agents of purulent otitis media are pneumococci, moraxella, and hemophilus influenzae.

The pathogen can enter the ear cavity in several ways:

through the auditory tube (tubogenic pathway);
as a result of traumatic damage to the ear and eardrum;
by spreading from the intracranial cavity (retrograde route);
through blood vessels from other infectious foci (for example, 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.

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Symptoms of purulent otitis media in adults

The purulent-inflammatory process in adults often occurs as a complication of a viral infection. This is usually 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 HIV patients are at the highest risk of the disease.

The first signs of the disease are fever, chills, and headaches. Local symptoms are of decisive importance:

pain, noise, ringing in the ears (usually in one ear);
feeling of pressure and fluid in the ear cavity;
hearing loss, feeling of congestion;
the appearance of discharge from the ear canal - as a rule, it is initially watery, translucent, and then becomes yellow-grayish and thick.

The disease is accompanied by loss of appetite and sleep disturbances.

Temperature during purulent otitis is an integral natural reaction to inflammation and the introduction of infection into the body. The temperature can be different - it depends on the individual state of immune defense, on age and on the clinical characteristics of the disease. Inflammation with pus in adults is in most cases accompanied by high temperatures - and the feverish state usually lasts as long as the pus remains inside the ear cavity. Simultaneously with the release of purulent discharge (it does not matter whether this happens on its own or with the help of an autopsy), the temperature begins to decrease.

An increase in temperature during purulent otitis may also indicate the development of complications - for example, meningitis, mastoiditis and otogenic septic condition cannot be avoided without fever. A characteristic feature of the development of complications is that the patient’s well-being seems to improve - however, after a couple of days, pain in the ear reappears, the temperature rises, and other typical symptoms appear.

Purulent otitis without fever is characteristic of a disease that was initially provoked not by an infectious pathogen, but by injury. So, when the ear is bruised, a painful wound forms in the cavity, which suppurates when bacteria enter. In addition, purulent otitis without pain and fever can become a sign of fungal infection - the so-called otomycosis, or eczema of the hearing organ. The listed symptoms may be absent with diffuse external damage, as well as with an atypical form of the inflammatory process.

Acute pain, which patients often describe as “cutting the ear with purulent otitis media,” 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 eardrum is perforated and pus comes out, the acute pain disappears.

Forms

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

Purulent external otitis occurs due to the introduction of an infectious pathogen when the ear is injured, or due to pathological accumulation of moisture in the external auditory canal. This type of disease is typical for swimmers and divers, due to constant contact of the hearing organs with water. The disease occurs with pain, itching, swelling and purulent wet crusts in the area of the external auditory canal.
Acute purulent otitis media often provoked by ARVI, and also occurs against the background of an infectious lesion of the upper respiratory tract. Patients usually do not complain of 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 the purulent mass begins to put pressure on the walls. In this condition, a diagnosis of “suppurative otitis media” is made. If the process is not stopped at this stage, the membrane breaks under the pressure of the purulent mass, and the pus escapes into the external auditory canal.
Chronic purulent otitis media characterized by the presence of a perforated membrane and an active inflammatory reaction in the middle ear for a month or more. In chronic purulent otitis, otorrhea is detected - that is, there is discharge of a purulent mass from the ear canal. The amount of discharge can vary from significant to small, almost invisible to the eye. The chronic process is often accompanied by deterioration of hearing function.
Purulent otitis with perforation. Purulent perforated otitis is characterized by the presence of an inflammatory process with the constant formation of secretions that have strong proteolytic characteristics. This means that the discharge can melt nearby tissue. Under the influence of pus and the pressure it exerts, the membrane wall cannot withstand it - a hole is formed through which the purulent mass begins to exit into the external auditory canal. After the hole is formed, the pain subsides, signs of intoxication disappear, and the temperature returns to normal.
Tubotympanic purulent otitis occurs 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 long-term complex treatment. The main complication of tubotympanic otitis is considered to be damage to bone tissue - the auditory ossicles and cells of the mastoid process.
Bilateral purulent otitis is an infectious inflammation that affects both organs of hearing. This type of disease occurs somewhat less frequently than unilateral lesions, and the course of such otitis is more complicated. Often, to alleviate the condition, you have to seek the help of a surgeon.
Left-sided purulent otitis is a lesion of the hearing organ on the left side. This type of disease occurs no less frequently than right-sided purulent otitis media - both pathologies are considered varieties of purulent otitis media by localization.
Catarrhal purulent otitis manifested by a sharp decrease in pressure in the ear cavity - this is explained by the strong secretion of effusion. Exudate accumulates in the tympanic cavity - the patient himself feels this and describes it as a “transfusion” of fluid in the ear cavity. On examination, the eardrum protrudes outward. This type of disease is otherwise called “exudative purulent otitis media.”
Purulent otitis with blood is a pathology that indicates damage to small vessels in the ear cavity. We can say that the infection begins to penetrate the soft tissues. If blood appears during chronic purulent otitis, then one can suspect the development of complications in the form of damage to the facial nerve.
Recurrent purulent otitis media– this term refers to an inflammatory purulent process in the ear, which is recorded several times throughout the year, and after the patient has fully recovered (with normalization of hearing, tightening of the perforation hole). This type of purulent otitis is diagnosed more often in childhood.

Complications and consequences

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

However, according to statistics, the greatest danger lies in the fact that patients with suppuration and otitis media arrive for treatment late, when the disease has reached its peak. In this case, complications may not arise immediately, but after some time - for example, after a month or even more. The most common complication is the transition of inflammation to the chronic stage, against the background of vestibular disruptions and the development of hearing loss.

Other complications of purulent otitis include:

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

If the purulent-inflammatory phenomenon becomes chronic, then it becomes extremely difficult to treat. Many patients have all the indications for surgical intervention.

Patients often complain: hearing loss after purulent otitis media, will it be restored? In fact, hearing can actually be restored in the following cases:

in the chronic course of the inflammatory process;
with cholesteatoma;
with atrophy of the auditory ossicles;
with slight tissue perforation;
in the presence of patency of the auditory canal.

If an obstruction is detected in the auditory canal, or atrophy has affected the eardrum, or there is damage to the auditory nerve, then restoration of auditory function becomes impossible.

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 for another 3-7 days after purulent otitis media - this is exactly how long it takes the body to restore immune defense. If the temperature first normalizes and then rises strongly again, this may indicate the development of complications - namely, the spread of infection to other tissues and organs.

Exacerbation of purulent otitis media can occur when the disease becomes chronic. Thus, exacerbation often develops against the background of acute respiratory viral infections or colds, with sinusitis or sore throat. The chronic course is usually characterized by the development of mesotympanitis (inflammation of the mucous tissue of the tympanic cavity) or epitympanitis (inflammation of the mucous and bone tissues). The clinical picture of exacerbation resembles the symptoms of an acute inflammatory process.

Blood poisoning from purulent otitis media is not uncommon. The development of bacteremia in purulent otitis occurs by otogenic means, when pathogenic microorganisms enter the general bloodstream. A healthy person's blood is sterile. Blood poisoning - or, in other words, sepsis - means that infectious pathogens from an inflammatory focus have entered the blood. Here it is necessary to be able to distinguish sepsis from bacteremia. With bacteremia, the infection enters the blood, causing damage to certain tissues or an organ. With sepsis, the entire body is affected - all organs and systems suffer, which ultimately can even lead to the death of the patient.

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

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Diagnosis of purulent otitis in adults

Diagnostic measures for ear inflammation with pus are not complicated - in most patients the disease can be identified even with a routine survey and examination. So, the doctor will definitely ask the patient about the moment of onset of the disease, the order in which the symptoms appeared, and also what the patient did to alleviate his well-being.

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

If there are external inflammatory phenomena, the doctor will pay attention to the redness of the skin, the presence of ichor or pus. The auditory canal may be narrowed, so much so that it visually blocks the membrane.

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

To properly test the motor ability of the membrane, the patient is asked to draw air into his cheeks and strain so that the ears “blow out”. This method is called the Valsalva maneuver and is often used by scuba diving enthusiasts. When air enters the ear cavity, the membrane makes movements that the doctor sees. If there is discharge in the tympanic cavity, the motor activity of the membrane will be impaired.

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

Bacterial culture is much more informative - but its disadvantage is that the results are obtained only a week after taking a smear, and treatment of the disease must begin immediately. However, many experts still advise carrying out a bacterial culture of the discharge, since accurate identification of the pathogen will make it possible to prescribe more effective therapy if conventional antibiotics do not have the expected effect.

With purulent otitis media, an intense inflammatory process develops in the ear canal, which is accompanied by the formation of pus. The causative agent of this disease is an infection that develops as a result of hypothermia, water entering the ear canal, and a weakened immune system.

There are often situations when such an illness is a complication after suffering an acute respiratory viral disease. It is very important not to ignore the symptoms, consult a doctor in time and carry out timely and competent therapy to prevent the development of consequences.

What is purulent otitis media?

Among all otolaryngological diseases, it occurs in every third patient. Most often, doctors diagnose it in. As this disease develops, pus appears in the ear and inflammation begins. The disease can occur in any area of the ear canal.

The disease is more often diagnosed in children, since the anatomical structure of the ear apparatus in a child differs from the structure in an adult. The auditory canal in children is shorter and wider than in adults. And inside the ear canal in the middle section in infants there is a small amount of fluid, which is an ideal environment for the development of pathogens.

When an infectious pathogen enters the ear cavity, the development of an inflammatory process begins. The result is swelling and hyperemia of the mucous membrane and eardrum, the formation of erosions and ulcers on the walls, dilation of blood vessels, and a decrease in the permeability of the walls of the eardrum.

If there is no timely and adequate treatment for otitis, it can become chronic. This form of the disease is characterized by periodic outbreaks and remissions.

In this case, treatment is difficult and longer. Also, if this disease is neglected, surgical intervention may be required.

Signs of purulent otitis media

Symptoms of the disease in a child manifest themselves as follows:

there is a sharp pain inside the ear of a shooting nature;
febrile hyperthermia;
the appearance of tinnitus;
deterioration in hearing quality;
increased irritability and crying;
the presence of purulent contents;
the child throws his head back and shakes it in different directions;
sleep and appetite worsen.

To make a correct diagnosis for your child, you must visit a doctor. Since collecting complaints is difficult, a more thorough diagnosis will be required.

Symptoms of the disease in adults include:

the appearance of painful sensations inside the ear. This symptom appears against the background of irritation of the nerve endings due to swelling and the presence of purulent contents. Soreness occurs inside the ear canal, then goes to the temples and back of the head. When purulent contents are removed from the ear canal, pain decreases;
hyperthermia due to inflammation and intoxication, usually febrile;
separation of purulent contents from the ear canal;
deterioration in the quality of hearing due to swelling and accumulation of exudate, congestion in the ears. Such signs persist for several days after treatment. Then they are eliminated on their own. If inflammation spreads to the internal region, a significant deterioration in hearing quality may persist for a longer period.

In some cases, the course of the disease can be rapid, it passes easily and without complications. But only if the natural resistant functions of the body are high, or if treatment is started in a timely manner, competent therapy prescribed by the doctor is carried out.

If the immune system is weakened, the inflammatory process can last a long time, the cure will be long, and consequences may develop.

Why does pus occur in the ears of adults and children?

With the development of this disease, severe inflammation occurs throughout the ear. The development of such a disease may be due to the following provoking factors:

Penetration of infectious agents from the nasal passages and upper respiratory tract. The infection can travel through the ear canal to the eardrum. This happens when a person coughs or sneezes. With strong pressure on the ears, the infection along with mucus can penetrate into the middle part of the ear.
Also, the infectious process can penetrate the ear canal due to various injuries to the eardrum.
The disease may be a consequence of an acute respiratory viral disease.
Penetration of water into the ear canals, local hypothermia.
Development of allergic reactions.
Weakened immune system.
Hereditary tendency.

The ear festers most often due to sinusitis, rhinitis and adenoiditis. In the presence of chronic processes in the nasopharynx, the drainage system of the ear canal is disrupted, due to which pathogenic microflora can easily penetrate into it.

What are the stages of purulent otitis media?

There are only 3 degrees of this disease.

Pre-perforation stage

Its duration ranges from several hours to two to three days. When the infection reaches the ear, severe inflammation begins. The result is pain and hyperthermia.

An accumulation of purulent contents occurs in the area of the eardrum, causing pressure on it. At this stage, the pain is intense and very sharp. There is a deterioration in the quality of hearing.

Perforated stage

The duration of this stage is about five days. During this period, perforation of the eardrum occurs with subsequent separation of purulent exudate. The discharge is copious, with bloody impurities.

After a few days, the amount of discharge decreases. The state of health improves, the severity of the disease process decreases, and the temperature decreases.

Reparative stage

This stage is the final one. Within a few days, the inflammatory process is eliminated and the perforation is scarred.

If there is a small tear, the scar will go away quickly. And if the disease is not treated, if the perforation does not heal completely, the disease becomes chronic. Its development is characterized by periodic exacerbation, deterioration in the quality of hearing and pronounced defects in the middle ear.

Basic rules of treatment for adults

In order for the treatment to be correct, you need to see a doctor. Based on the examination results, the doctor will draw up a competent treatment regimen. The goal of treatment is to eliminate pain, get rid of the inflammatory process, and restore the quality of hearing. For this purpose, the doctor prescribes the following procedures:

In order to restore drainage and ventilation, a procedure is performed to blow out the ear canal. It is performed in a medical facility using a special probe through which the medicinal mixture is supplied. Typically, drugs such as Dexamethasone, Amoxicillin, and Adrenaline are used for the procedure. These therapeutic measures are very effective, they significantly increase the rate of healing, and hearing is restored much faster.
A set of physiotherapeutic measures. Typically, heating, microwave, and ultraviolet radiation are used. The course of procedures lasts about ten days. Such activities have a positive effect on hearing restoration, improve blood microcirculation and metabolic processes. As a result of such procedures, the protective barrier of the mucous membrane is restored.
Medications for nasal use. With their help, blood vessels narrow, mucus production decreases, the Eustachian tubes are cleared, and full breathing is restored. Doctors usually prescribe the following drops or sprays: Rinazolin, Pinosol, Delufen, Otrivin, Nazivin, Evkazolin, Vibrocil, Noxprey, Farmazolin. They need to be instilled three times a day for a week.
Perform regular cleansing of pus. To do this, you can use regular peroxide and ear sticks.
Taking medications that reduce fever: Paracetamol, Ibuprofen. Such remedies are usually used within the first few days after severe inflammation develops.
Painkillers. In this case, doctors prescribe ear drops that have analgesic properties. For example, Ototon, Otipax, Otizol. Such drugs have an analgesic, anti-inflammatory, and antiseptic effect.
Tampons made from glycerin. Such products are introduced into the ear canal at night.
Measures must be taken to eliminate the pathogen. If the causative agent is a pathogenic microflora, you need to undergo a course of treatment with antibacterial drugs. When the disease is caused by a fungus, you need to undergo a course of treatment with antifungal agents.
Administration of saline or Dexamethasone to eliminate swelling and inflammation.

If chronic otitis develops, it is difficult to eliminate it only with the help of conservative therapy. Therefore, doctors are considering the advisability of surgical intervention. This method can get rid of granulations and adhesions and restore the quality of hearing.

Treatment of purulent otitis in a child

The main goal of therapy for children is to eliminate painful sensations, get rid of the inflammatory process, reduce hyperthermia, and restore the quality of hearing.

Doctors prescribe antibacterial drugs for oral use. Only a doctor can decide which drugs can be used in a particular case, depending on the susceptibility of the pathogenic microflora to the active components of the drug.

Often, specialists prescribe medications that belong to the group of penicillins or cephalosporins. If there is a tendency to develop allergic reactions to the constituent components of antibacterial agents, medications from the macrolide category are prescribed.

At the first stage of the disease, local antibacterial drugs in the form of ear drops are not prescribed. At this stage, it is necessary to use only medications that have analgesic and decongestant properties.

In the presence of chronic otitis or perforation, you need to use drops with antibacterial components in the composition. Additionally, doctors prescribe nasal use of vasoconstrictor drops. With their help, you can restore blood microcirculation and get rid of swelling.

If there is no pus, warming is allowed. Only they warm up not the ear canal itself, but the area nearby. When purulent exudate begins to be released, no warming procedures should be performed.

To get rid of painful sensations, doctors prescribe ear drops, which have an anti-inflammatory and analgesic effect:

Otipax.
Otinum.

To get rid of hyperthermia, antipyretic drugs are used - Nurofen, Panadol.

Treatment is carried out on an outpatient basis in most cases. If there are complications, the child may be hospitalized. Perforation of the eardrum heals on its own after two to three weeks. Sometimes surgical treatment may be necessary. Also, in some cases, doctors recommend laser therapy.

After an illness, the doctor prescribes measures in order to strengthen the natural resistant functions of the body and increase the protective barrier of the mucous membrane. For this purpose, a course of taking multivitamins, a balanced diet, and immunostimulants is prescribed.

Regular walks in the fresh air are important. Additionally, during the recovery period, the doctor may prescribe physiotherapeutic procedures - microwave, electrophoresis.

Prevention of purulent otitis media

The main preventive measures for adults are:

timely treatment of nasopharyngeal diseases;
preventing dirty water from entering the ear canal;
treatment of diseases that negatively affect the immune system;
direct strength to strengthen the immune system - balance the diet, walk more in the fresh air, devote time to sports activities.

When the first alarming symptoms appear, you should contact an otolaryngologist as soon as possible. You should not carry out any treatment measures on your own; this is fraught with unpleasant consequences.

To prevent the development of purulent otitis media in children, you should adhere to the following recommendations from specialists:

The child should not be allowed to become hypothermic. For example, if you are going for a walk with him in windy weather, be sure to wear a hat. When leaving the room in cold weather, you should not go out without a hat;
promptly treat any diseases of the nasopharynx and oropharynx;
It is recommended to use a rubber cap when swimming in the pool;
After bathing, carefully clean the ear canal of water using a cotton swab.

Additionally, efforts should be directed toward strengthening the body’s natural protective functions so that it can resist pathogenic microflora and other pathogens.

It is important to harden your child, do exercises with him, and follow the vaccination schedule. In order to prevent the occurrence of otitis media in infants, mothers are advised to:

after feeding, hold the baby in an upright position for some time;
make sure that milk does not come out of the bottle in large drops;
Do not feed the baby in a lying position; his head should be slightly elevated.

Under no circumstances should you warm up your child’s ears or do any treatment on your own. Only a doctor can make the correct diagnosis and prescribe proper treatment.

What are the consequences of purulent otitis media?

Often, the duration of the illness is about two weeks. In each specific case, this period is individual and may vary. At the first stage of the development of the disease, there is a danger of the formation of adhesions, scars, and the appearance of hearing loss. Such consequences can develop if the membrane does not open for a long period and the accumulated exudate does not come out.

There is a danger of transformation of the inflammatory process in brain tissue. This is how an abscess can develop. In this case, surgical intervention is necessary. Mastoiditis, meningitis, and facial paralysis can also be consequences.

Conclusion

If purulent otitis develops, you should visit a doctor as soon as possible and do not delay treatment of the disease. Also, do not ignore the symptoms and hope that they will go away on their own. For treatment, a complex regimen is often prescribed, including medications and physiotherapeutic procedures. In some cases, surgery may be necessary.