Acute right-sided exudative otitis media. Symptoms and treatment of exudative otitis. Prevention of exudative otitis media

Otitis media (secretory or non-purulent otitis media) - otitis media, in which the mucous membranes of the middle ear cavities are affected.

Exudative otitis media is characterized by the presence of exudate and hearing loss in the absence of pain, with a intact eardrum.

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ICD-10 code

H65 Nonsuppurative otitis media

H66 Purulent and unspecified otitis media

H67* Otitis media in diseases classified elsewhere

Epidemiology

The disease often develops in preschool, less often in school age. Mostly boys are affected. According to M. Tos, 80% healthy people suffered from exudative otitis media in childhood. It should be noted that in children with congenital cleft lip and palate, the disease occurs much more often.

Over the past decade, a number of domestic authors have noted a significant increase in incidence. Perhaps there is not an actual increase in it, but an improvement in diagnostics as a result of equipping audiology offices and centers with audio-acoustic equipment and the introduction of objective research methods (impedance testing, acoustic reflexometry) into practical healthcare.

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Causes of exudative otitis media

The most common theories of the development of exudative otitis media:

“hydrops ex vacuo”, proposed by A. Politzer (1878), according to which the disease is based on reasons that contribute to the development of negative pressure in the cavities of the middle ear;
exudative, explaining the formation of secretion in the tympanic cavity by inflammatory changes in the mucous membrane of the middle ear;
secretory, based on the results of studying factors contributing to hypersecretion of the mucous membrane of the middle ear.

In the initial stage of the disease, the squamous epithelium degenerates into a secreting one. In the secretory period (the period of accumulation of exudate in the middle ear), a pathologically high density of goblet cells and mucous glands develops. In degenerative - secretion production decreases due to their degeneration. The process proceeds slowly and is accompanied by a gradual decrease in the frequency of goblet cell division.

The presented theories of the development of exudative otitis media are actually links in a single process, reflecting various stages of the course. chronic inflammation. Among the reasons leading to the onset of the disease, most authors focus on the pathology of the upper respiratory tract inflammatory and allergic in nature. A necessary condition for the development of exudative otitis media (trigger mechanism) is considered the presence of mechanical obstruction of the pharyngeal mouth of the auditory tube.

Pathogenesis

Endoscopic examination in patients with dysfunction of the auditory tube shows that the cause of exudative otitis media in most cases is a violation of the outflow pathways of secretions from the paranasal sinuses, primarily from the anterior chambers (maxillary, frontal, anterior ethmoid), into the nasopharynx. Normally, transport goes through the ethmoidal funnel and the frontal recess to the free edge of the posterior part of the uncinate process, then to the medial surface of the inferior nasal concha, bypassing the mouth of the auditory tube in front and below; and from the posterior ethmoidal cells and sphenoid sinus- behind and above the tubar opening, uniting in the oropharynx under the influence of gravity. With vasomotor diseases and sharply increased secretion viscosity, mucociliary clearance is slowed down. In this case, the merging of flows to the tubal opening or pathological turbulence with the circulation of secretions around the mouth of the auditory tube with pathological reflux into its pharyngeal mouth is noted. With hyperplasia of the adenoid vegetations, the path of the posterior flow of mucus moves forward, also to the mouth of the auditory tube. A change in the natural outflow tract may also be due to a change in the architectonics of the nasal cavity, especially the middle meatus and the lateral wall of the nasal cavity.

In acute purulent sinusitis (especially sinusitis), due to a change in the viscosity of the secretion, the natural outflow pathways from the paranasal sinuses are also disrupted, which leads to discharge of the discharge to the mouth of the auditory tube.

Exudative otitis media begins with the formation of a vacuum and tympanic cavity (hydrops ex vacuo). As a result of dysfunction of the auditory tube, oxygen is absorbed, the pressure in the tympanic cavity drops and, as a result, transudate appears. Subsequently, the number of goblet cells increases, and mucous glands are formed in the mucous membrane of the tympanic cavity, which leads to an increase in the volume of secretions. The latter can be easily removed from all sections through a tympanostomy. High density goblet cells and mucous glands leads to an increase in the viscosity and density of the secretion, to its transition into exudate, which is more difficult or impossible to evacuate through the tympanostomy. At the fibrous stage, degenerative processes predominate in the mucous membrane of the tympanic cavity: goblet cells and secretory glands undergo degeneration, mucus production decreases, then stops completely, fibrous transformation of the mucous membrane occurs, involving the auditory ossicles in the process. The predominance of shaped elements in the exudate leads to the development of the adhesive process, and the increase in shapeless elements leads to the development of tympanosclerosis.

Of course, inflammatory and allergic pathology of the upper respiratory tract, changes in local and general immunity affect the development of the disease and play a large role in the development of the recurrent form of chronic exudative otitis media.

The trigger, as mentioned above, is dysfunction of the auditory tube, which may be due to mechanical obstruction of its pharyngeal opening. More often this occurs with hypertrophy of the pharyngeal tonsil, juvenile angiofibroma. Obstruction also occurs with inflammation of the mucous membrane of the auditory tube, provoked by bacterial and viral infection upper respiratory tract and accompanied by secondary edema.

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Symptoms of exudative otitis media

Asymptomatic course of exudative otitis media is the reason for late diagnosis, especially in children early age. The disease is often preceded by pathology of the upper respiratory tract (acute or chronic). Hearing loss is typical.

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Forms

Currently, exudative otitis media is divided into three forms according to the duration of the disease

acute (up to 3 weeks);
subacute (3-8 weeks);
chronic (more than 8 weeks).

Considering the difficulties of determining the onset of the disease in preschool children, as well as the identity of treatment tactics for acute and subacute forms of exudative otitis media, it is considered advisable to distinguish only two forms - acute and chronic.

In accordance with the pathogenesis of the disease, accepted various classifications its stages. M. Tos (1976) distinguishes three periods of development of exudative otitis media:

primary or stage of initial metaplastic changes in the mucous membrane (against the background of functional occlusion of the auditory tube);
secretory (increased activity of goblet cells and epithelial metaplasia):
degenerative (decreased secretion and development of the adhesive process in the tympanic cavity).

O.V. Stratieva et al. (1998) distinguish four stages of exudative otitis media:

initial exudative (initial catarrhal inflammation);
pronounced secretory; According to the nature of the secretion, they are divided into:
- serous;
- mucous (mucoid):
- serous-mucosal (serous-mucoid);
productive secretory (with a predominance of the secretory process);
degenerative-secretory (with a predominance of fibrous-sclerotic process);

According to the form they are distinguished:

fibro-mucoid;
fibrocystic;
fibrous-adhesive (sclerotic),

Dmitriev N.S. et al. (1996) proposed an option based on similar principles (the nature of the contents of the tympanic cavity according to physical parameters - viscosity, transparency, color, density), and the difference lies in determining the tactics of treating patients depending on the stage of the disease. Pathogenetically, stage IV of the course is distinguished:

catarrhal (up to 1 month);
secretory (1-12 months);
mucosal (12-24 months);
fibrous (more than 24 months).

Therapeutic tactics for stage I of exudative otitis media: sanitation of the upper respiratory tract; in case of surgical intervention after 1 month. After the operation, audiometry and tympanometry are performed. If hearing loss persists and a type C tympanogram is recorded, measures are taken to eliminate the dysfunction of the auditory tube. Timely initiation of therapy at the catarrhal stage leads to a rapid cure of the disease, which in this case can be interpreted as tubo-otitis. In the absence of therapy, the process moves to the next stage.

Therapeutic tactics for stage II of exudative otitis media: sanitation of the upper respiratory tract (if it has not been performed previously); myringostomy in the anterior parts of the eardrum with the introduction of a ventilation tube. The stage of exudative otitis media is verified intraoperatively: at stage II, the exudate can be easily and completely removed from the tympanic cavity through the myringostomy opening.

Therapeutic tactics for stage III of exudative otitis media: simultaneous sanitation of the upper respiratory tract with shunting (if it has not been carried out previously); tympanostomy in the anterior parts of the tympanic membrane with the introduction of a ventilation tube, tympanotomy with revision of the tympanic cavity, washing and removal of thick exudate from all parts of the tympanic cavity. Indications for one-stage tympanotomy are the impossibility of removing thick exudate through a tympanostomy.

Therapeutic tactics for stage IV exudative otitis media: sanitation of the upper respiratory tract (if not previously performed): tympanostomy in the anterior parts of the eardrum with the introduction of a ventilation tube; one-stage tympanotomy with removal of tympanosclerotic lesions; mobilization of the auditory ossicular chain.

This classification is an algorithm for diagnostic, therapeutic and preventive measures acceptance.

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Diagnosis of exudative otitis media

Early diagnosis is possible in children over 6 years of age. At this age (and older), complaints of ear congestion and hearing fluctuation are likely. Painful sensations are rare and short-lived.

Physical examination

On examination, the color of the eardrum is variable - from whitish, pink to cyanotic against the background of increased vascularization. Air bubbles or exudate levels behind the eardrum may be detected. The latter, as a rule, is retracted, the cone of light is deformed, the short process of the malleus protrudes sharply into the lumen of the external auditory canal. The mobility of the retracted tympanic membrane with exudative otitis media is sharply limited, which is quite easy to determine using a Siegles pneumatic funnel. Physical data vary depending on the stage of the process.

Otoscopy at the catarrhal stage reveals retraction and limited mobility of the eardrum, a change in its color (from cloudy to pink), and shortening of the cone of light. Exudate behind the eardrum is not visible, but prolonged negative pressure due to impaired aeration of the cavity creates conditions for the appearance of contents in the form of transudate from the vessels of the nasal mucosa.

During otoscopy at the secretory stage, thickening of the tympanic membrane, a change in its color (to bluish), retraction in the upper and bulging in the lower sections are revealed, which is considered an indirect sign of the presence of exudate and the tympanic cavity. Metaplastic changes appear and increase in the mucous membrane in the form of an increase in the number of secretory glands and goblet cells, which leads to the formation and accumulation of mucous exudate and the tympanic cavity.

The mucosal stage is characterized by persistent hearing loss. Otoscopy reveals a sharp retraction of the tympanic membrane in the loose part, its complete immobility, thickening, cyanosis and bulging in the lower quadrants. The contents of the tympanic cavity become thick and viscous, which is accompanied by limited mobility of the chain of auditory ossicles.

During otoscopy at the fibrous stage, the eardrum is thinned, atrophic, and pale in color. A long course of exudative otitis media leads to the formation of scars and atelectasis, foci of myringosclerosis.

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Instrumental studies

The fundamental diagnostic technique is tympanometry. When analyzing tympanograms, the classification of V. Jerger is used. In the absence of pathology of the middle ear in a normally functioning auditory tube, the pressure in the tympanic cavity is equal to atmospheric pressure, therefore, the maximum compliance of the eardrum is recorded when a pressure equal to atmospheric pressure is created in the external auditory canal (taken as the initial one). The resulting curve corresponds to a type A tympanogram.

When the auditory tube is dysfunctional, there is negative pressure in the middle ear. Maximum compliance of the eardrum is achieved when a negative pressure is created in the external auditory canal, equal to that in the tympanic cavity. The tympanogram in such a situation retains its normal configuration, but its peak shifts towards negative pressure, which corresponds to a type C tympanogram. In the presence of exudate in the tympanic cavity, a change in pressure in the external auditory canal does not lead to a significant change in compliance. The tympanogram is represented by a flat or horizontally ascending line towards negative pressure and corresponds to type B.

When diagnosing exudative otitis media, the data of pure tone threshold audiometry are taken into account. The decrease in auditory function in patients develops according to the inductive type, the thresholds of sound perception lie in the range of 15-40 dB. Hearing impairment is fluctuating in nature, therefore, during dynamic observation of a patient with exudative otitis media, a repeated hearing test is necessary. The nature of the air conduction curve on the audiogram depends on the amount of exudate in the tympanic cavity, its viscosity and the value of intratympanic pressure.

With tone threshold audiometry at the catarrhal stage, the thresholds of air sound conduction do not exceed 20 dB, bone - remain normal. Violation of the ventilation function of the auditory tube corresponds to a type C tympanogram with a deviation of the peak towards negative pressure up to 200 mm water column. In the presence of transudate, a type B tympaiogram is determined, which often occupies an intermediate position between types C and B: the positive knee repeats type C. the negative knee - type B.

With pure tone threshold audiometry at the secretory stage, conductive hearing loss of the first degree is detected with an increase in airborne sound conduction thresholds to 20-30 dB. Bone conduction thresholds remain normal. With acoustic impedansometry, it is possible to obtain a type C tympanogram with a negative pressure in the tympanic cavity of over 200 mm of water column, but type B and the absence of acoustic reflexes are more often recorded.

The mucosal stage is characterized by an increase in airborne sound conduction thresholds to 30-45 dB with pure tone threshold audiometry. In some cases, bone sound conduction thresholds increase to 10-15 dB in the high-frequency range, which indicates the development of secondary NST, mainly due to blockade of the labyrinthine windows with viscous exudate. Acoustic impedansometry records a type B tympanogram and the absence of acoustic reflexes on the affected side.

At the fibrous stage, the mixed form of hearing loss progresses: the thresholds of air sound conduction increase to 30-50 dB, bone - up to 15-20 dB in the high-frequency range (4-8 kHz;). During impedance measurement, a type B tympanogram and the absence of acoustic reflexes are recorded.

Attention should be paid to the possible correlation of otoscopic signs and the type of tympanogram. Thus, when the tympanic membrane is retracted, the light reflex is shortened, and the color of the tympanic membrane changes, type C is more often recorded. In the absence of a light reflex, when the tympanic membrane is thickened and cyanotic, it bulges in the lower quadrants, and exudate is visible, type B tympanogram is determined.

Endoscopy of the pharyngeal opening of the auditory tube can reveal a hypertrophic granulation obstructive process, sometimes in combination with hyperplasia of the inferior turbinates. It is this study that provides the most complete information about the causes of exudative otitis media. With the help of endoscopy, it is possible to identify a fairly wide variety of pathological changes in the nasal cavity and nasopharynx, leading to dysfunction of the auditory tube and maintaining the course of the disease. A study of the nasopharynx should be carried out in case of relapse of the disease to clarify the cause of exudative otitis media and develop adequate treatment tactics.

X-ray examination of the temporal bones in classical projections in patients with exudative otitis media is of little information and is practically not used.

CT scan of the temporal bones is a highly informative diagnostic method; it must be carried out in case of relapse of exudative otitis media, as well as at stages III and IV of the disease (according to the classification of N.S. Dmitriev). CT scan of the temporal bones allows you to obtain reliable information about the airiness of all cavities of the middle ear, the condition of the mucous membrane, windows of the labyrinth, the chain of auditory ossicles, and the bony part of the auditory tube. If there is pathological content in the cavities of the middle ear, its location and density.

Differential diagnosis

Differential diagnosis of exudative otitis media is carried out with ear diseases. accompanied by conductive hearing loss with an intact eardrum. It can be:

anomalies in the development of the auditory ossicles, in which a type B tympanogram is sometimes recorded, a significant increase in airborne sound conduction thresholds (up to 60 dB), hearing loss from birth. The diagnosis is finally confirmed after multifrequency tympanometry;
otosclerosis, in which the otoscopic picture is normal, and during tympanometry a type A tympanogram is recorded with a flattening of the tympanometric curve.

Sometimes it becomes necessary to differentiate exudative otitis media with a glomus tumor of the tympanic cavity and a rupture of the auditory ossicular chain. The diagnosis of a tumor is confirmed by X-ray data, the disappearance of noise when the vascular bundle in the neck is compressed, as well as a pulsating thymnanogram pattern. When the chain of auditory ossicles is broken, a type E tympanogram is recorded.

Treatment of exudative otitis media

Treatment tactics for patients with exudative otitis media: eliminating the causes that caused dysfunction of the auditory tube, and then therapeutic measures, aimed at restoring auditory function and preventing persistent morphological changes in the middle ear. In case of dysfunction of the auditory tube caused by pathology of the nose, paranasal sinuses and pharynx, the first stage in treatment should be sanitation of the upper respiratory tract.

The goal of treatment is to restore hearing function.

Indications for hospitalization

The need for surgical intervention.
Impossibility of carrying out conservative treatment on an outpatient basis.

Non-drug treatment

Blowing the auditory tube:

catheterization of the auditory tube;
Politzer blowing;
Valsalva experience.

In the treatment of patients with exudative otitis media, physiotherapy is widely used - intra-auricular electrophoresis with proteolytic enzymes and steroid hormones. They prefer endaural phonophoresis of acetylcysteine (8-10 procedures per course of treatment at stages I-III), as well as on the mastoid process with hyaluronidase (8-10 sessions per course of treatment at stages II-IV).

Drug treatment

In the second half of the last century, it was proven that inflammation in the middle ear with exudative otitis media is aseptic in 50% of cases. The rest were patients in whom Haemophilus influenzae, Branhamella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes were cultured from the exudate; therefore, as a rule, antibacterial therapy is carried out. Antibiotics of the same series are used as in the treatment of acute otitis media (amoxicillin + clanulanic acid, macrolides). However, the issue of including antibiotics in the treatment regimen for exudative otitis media remains controversial. Their effect is only 15%, taking in combination with tableted glucocorticoids (for 7-14 days) increases the result of therapy only up to 25%. Nevertheless, most foreign researchers consider the use of antibiotics justified. Antihistamines (diphenhydramine, chloropyramine, hifenadine), especially in combination with antibiotics, inhibit the formation of vaccine immunity and suppress nonspecific anti-infectious resistance. Many authors for treatment acute stage Anti-inflammatory (fenspiride), anti-edema, nonspecific complex hyposensitizing therapy, and the use of vasoconstrictors are recommended. Children with stage IV exudative otitis media are administered hyaluronidase 32 units in parallel with physiotherapeutic treatment for 10-12 days. In everyday practice, mucolytics are widely used in the form of powders, syrups and tablets (acetylcysteine, carbocysteine) to thin the exudate in the middle ear. The course of treatment is 10-14 days.

An indispensable condition for conservative treatment of exudative otitis media is assessment of the results of immediate treatment and monitoring after 1 month. To do this, threshold audiometry and acoustic impedance measurements are performed.

Surgery

If conservative therapy is ineffective, patients with chronic exudative otitis media undergo surgical treatment, the purpose of which is to remove exudate, restore auditory function and prevent relapse of the disease. Otosurgical intervention is performed only after or during sanitation of the upper respiratory tract.

Myringotomy

Advantages of the technique:

rapid equalization of tympanic pressure;
rapid evacuation of exudate.

Flaws:

inability to remove thick exudate;
rapid closure of the myringotomy opening;
high relapse rate (up to 50%).

In connection with the above, the method is considered a temporary treatment procedure. Indication: exudative otitis media in the stage of surgical intervention aimed at sanitizing the upper respiratory tract. Tympanocentesis has similar disadvantages to myringotomy. The use of methods must be stopped due to their ineffectiveness and high risk of complications (trauma to the auditory ossicles, labyrinthine windows).

Timpacostomy with insertion of a ventilation tube

The idea of tympanostomy was first put forward by P. Politzer and Delby in the 19th century, but only A. Armstrong introduced shunting in 1954. He used a straight lance-shaped polyethylene tube with a diameter of 1.5 mm, leaving it for 3 weeks in a patient with unresolved after conservative therapy and myringotomy exudative otitis media. Subsequently, otiatrists improved the design of the ventilation tubes and used the best materials for their manufacture (Teflon, silicone, silastic, steel, gold-plated silver and titanium). Clinical studies, however, have not revealed significant differences in treatment effectiveness when using different materials. The design of the tubes depended on the treatment objectives. On initial stages tubes were used for short-term ventilation (6-12 weeks) by A. Armstrong, M. Shepard. A. Reiter-Bobbin. Patients treated with these tubes (so-called shot-term tubes) who are indicated for repeated tympanostomy are candidates for surgery using long-term tubes (so-called long-term tubes) by K. Leopold. V. McCabe. This group of patients also includes children with craniofacial anomalies, pharyngeal tumors after palatoresection or irradiation.

Currently, long-term tubes are made of silastic with a large medial flange and flexible keels for easier insertion (J. Per-lee, T-shaped, made of silver and gold, titanium). Spontaneous loss of long-term tubes occurs extremely rarely (for the Per-lee modification - in 5% of cases), the duration of wear is up to 33-51 weeks. The frequency of prolapse depends on the rate of migration of the tympanic membrane epithelium. Many otosurgeons prefer tympanostomy in the non-lower quadrant, while K. Leopold et al. noted that it is preferable to insert tubes of the Shepard modification into the anteroinferior quadrant, while Renter-Bobbin type tubes are inserted into the anteroinferior quadrant. I.B. Soldatov (1984) proposes to bypass the tympanic cavity through an incision in the skin of the external auditory canal in a limited area of its posteroinferior wall by separating it together with the eardrum, installing a polyethylene tube through this access. Some Russian authors form a myringostomy hole in the posteroinferior quadrant of the tympanic membrane using carbon dioxide laser energy. In their opinion, the hole, gradually decreasing in size, completely closes after 1.5-2 months without signs of gross scarring. Low-frequency ultrasound is also used for ringotomy, which causes biological coagulation of the edges of the incision, resulting in virtually no bleeding and reducing the likelihood of infection.

Myringotomy with insertion of a ventilation tube in the anterior quadrant

Equipment: operating microscope, ear specula, straight and curved microneedles, microraspator, microforceptor, microsuction tips with a diameter of 0.6: 1.0 and 2.2 mm. The operation is performed in children under general anesthesia; in adults, under local anesthesia.

The surgical field (parotid space, auricle and external auditory canal) is treated according to generally accepted rules. Using a curved needle, the epidermis is cut in front of the manubrium in the anterosuperior quadrant of the eardrum and peeled off from the middle layer. The circular fibers of the tympanic membrane are dissected, and the radial fibers are spread apart with a microneedle. If these conditions are correctly met, the myringotomy hole takes on a shape, the dimensions of which are adjusted with a microraspatory in accordance with the caliber of the ventilation tube.

After mnringotomy, exudate is removed from the tympanic cavity by suction: the liquid component - without difficulty in its entirety; viscous - through liquefaction by introducing solutions of enzymes and mucolytics (trypsin/chymotrypsin, acetylcysteine) into the tympanic cavity. Sometimes it is necessary to carry out this manipulation repeatedly until complete removal exudate from all parts of the tympanic cavity. If there is mucoid exudate that cannot be evacuated, a ventilation tube is installed.

The tube is taken by the flange with myringotomy forceps, brought to the myringotomy opening at an angle, and the edge of the second flange is inserted into the lumen of the myringostomy. Microforceps are removed from the external auditory canal, and with a curved microneedle, pressing on the cylindrical part of the tube at the border with the second flange located outside the eardrum, it is fixed in the myringotomy hole. After the procedure, the cavity is washed with a 0.1% dexamethasone solution, 0.5 ml of it is injected with a syringe: the pressure in the external auditory canal is increased using a rubber bulb. When the solution passes freely into the nasopharynx, the operation is completed. If the auditory tube is obstructed, the drug is aspirated and vasoconstrictors are administered; the pressure in the external auditory canal is again increased using a rubber bulb. Such manipulations are repeated until the patency of the auditory tube is achieved. With this technique, spontaneous untimely removal of the tube does not occur due to its tight fit between the flanges by the radial fibers of the middle layer of the eardrum.

By installing drainage in the anterosuperior part of the tympanic membrane, it is possible not only to achieve optimal ventilation of the tympanic cavity, but also to avoid possible injury to the chain of auditory ossicles, which is possible when fixing the tube in the posterosuperior quadrant. In addition, with this insertion option, the risk of developing complications in the form of atelectasis and myringosclerosis is lower, and the tube itself has minimal impact on sound conduction. The ventilation tube is removed according to indications at various times, depending on the restoration of patency of the auditory tube according to the results of tympanometry.

The localization of the myringostomy incision can be different: 53% of otorhinolaryngologists apply a tympanostomy in the posteroinferior quadrant, 38% in the anteroinferior quadrant. 5% - in the anterosuperior and 4% - in the posterosuperior quadrant. The latter option is contraindicated due to the high probability of injury to the auditory ossicles, the formation of a retraction pocket or perforation in this area, which leads to the development of the most severe hearing loss. The lower quadrants are preferable for tympanostomy due to the lower risk of trauma to the promontorial wall. In cases of generalized atelectasis, the only possible place for insertion of a ventilation tube is the anterosuperior quadrant.

Shunting of the tympanic cavity for exudative otitis media is highly effective in terms of removing exudate, improving hearing and preventing relapse only at stage II (serous) (according to the classification of N.S. Dmitriev et al.) subject to clinical observation for 2 years.

Tympanotomy

After applying a tympanostomy in the anterosuperior quadrant of the eardrum, an injection of 1% lidocaine solution is made at the border of the anterior superior wall of the external auditory canal in order to facilitate separation of the meatotympanic flap. Using a hoe knife under the magnification of an operating microscope, cut the skin of the external auditory canal, retreating 2 mm from the tympanic ring along the posterior superior wall in the direction from 12 to 6 o’clock according to the dial diagram. The meatal flap is separated with a microraspator, and the tympanic ring with the membrane is isolated with a curved needle. The entire resulting complex is retracted anteriorly until a good view of the windows of the labyrinth, promontorial wall and auditory ossicles is achieved; access to the hypotympanum and supratympanic recess. The exudate is removed by suction, the tympanic cavity is washed with acetylcysteine (or enzyme), after which the discharge is evacuated again. Particular attention is paid to the supratympanic recess and the malleus-caval joint located in it, since it is in this place that muff-like deposition of formed exudate is often observed. At the end of the manipulation, the tympanic cavity is washed with dexamethasone solution. The meatotympanic flap is placed in place and secured with a strip of rubber from a surgical glove.

Further management

If a ventilation tube is installed, the patient is warned about the need to protect the operated ear from water. After its removal, they are informed about the possibility of relapse of exudative otitis media and the need to visit an audiologist-otolaryngologist after any episode of inflammatory disease of the nose and upper respiratory tract.

Audiological monitoring is carried out one month after surgical treatment (otoscopy, otomicroscopy, and, if indicated, assessment of the patency of the auditory tube). With normalization of hearing acuity and function of the auditory tube after 2-3 months. the ventilation tube is removed.

After the treatment, a long, thorough and competent dispensary observation an otorhinolaryngologist and audiologist, since the disease is prone to recurrence. It seems rational to differentiate the nature of observation of patients according to the established stage of exudative otitis media.

In the case of stage I, after the first stage of treatment and in stage II, the first examination with audiometric control should be carried out 1 month after sanitation of the upper respiratory tract. Among the features in children, one can note the appearance of a crescent-shaped spot in the anterior quadrants of the tympanic membrane and the registration of a type C tympaiogram with acoustic impedancemetry. Observation of children in the future should be carried out once every 3 months for 2 years.

After shunting of the tympanic cavity, the first examination of the patient should also be carried out 1 month after discharge from the hospital. Otoscopy indicators should pay attention to the degree of infiltration of the eardrum and its color. Based on the results of tympanometry in the mode of studying the patency of the auditory tube, one can judge the degree of its restoration. Subsequently, audiological monitoring is carried out once every 3 months for 2 years.

Myringosclerosis may appear at the sites where ventilation tubes are inserted in patients with stages II and III of exudative otitis media.

During otoscopy in free patients with stage IV exudative otitis media, one can expect the appearance of atelectasis of the tympanic membrane, perforations, and secondary NST. In the presence of these complications, courses of resolving, simulating and improving microcirculation therapy should be carried out: injections of hyaluronidase, FiBS, vitreous intramuscularly in an age-related dose, phonophoresis with hyaluronidase endaurally (10 procedures).

At all stages of cured exudative otitis media, the patient or his parents are warned about mandatory audiological monitoring after episodes of prolonged rhinitis of any etiology or inflammation of the middle ear, since these conditions can provoke an exacerbation of the disease, untimely diagnosis of which leads to the development of a more severe stage.

In cases of relapse of the disease, before repeated surgical intervention, it is recommended to conduct a CT scan of the temporal bones in order to assess the condition of the auditory tube, verify the presence of exudate in all cavities of the middle ear, the preservation of the chain of auditory ossicles, and to exclude the scar process of the tympanic cavity.

The approximate period of disability depends on the stage of the disease and is 6-18 days.

Forecast

Dynamics in stage I of the disease and adequate treatment lead to complete cure patients. Primary diagnosis of exudative otitis media in stage II and subsequent stages and, as a consequence, delayed initiation of therapy lead to a progressive increase in the number of unfavorable outcomes. Negative pressure and restructuring of the mucous membrane in the tympanic cavity cause changes in the structure of both the eardrum and the mucous membrane. Their primary changes create the prerequisites for the development of retractions and atelectasis, mucositis, immobilization of the auditory ossicular chain, and blockade of the labyrinthine windows.

Atelectasis is a retraction of the eardrum due to prolonged dysfunction of the auditory tube.
Atrophy is a thinning of the eardrum, accompanied by a weakening or cessation of its function due to inflammation.
Myringosclerosis is the most common outcome of exudative otitis media: characterized by the presence of white formations of the eardrum located between the epidermis and the mucous membrane of the latter, developing as a result of the organization of exudate in the fibrous layer. During surgical treatment, the lesions are easily detached from the mucous membrane and epidermis without bleeding.
Retraction of the eardrum. Appears as a result of prolonged negative pressure in the tympanic cavity, can be localized both in the loose part (panflaccida) and in the tense part (pars tensa), be limited and diffuse. The atrophic and retracted eardrum sags. Retraction precedes the formation of a retraction pocket.
Perforation of the eardrum.
Adhesive otitis media. It is characterized by scarring of the tympanic membrane and proliferation of fibrous tissue in the tympanic cavity, immobilization of the chain of auditory ossicles, which leads to atrophic changes in the latter, up to necrosis of the long process of the incus.
Tympanosclerosis is the formation of tympanosclerotic foci in the tympanic cavity. Most often located in the epitympanum. around the auditory ossicles and in the niche of the window of the vestibule. During surgical intervention, tympano-sclerotic lesions are peeled off from the surrounding tissues without bleeding.
Hearing loss. It manifests itself in conductive, mixed and neurosensory forms. Conductive and mixed, as a rule, are caused by immobilization of the chain of auditory ossicles by scars and tympanosclerotic foci. HCT is a consequence of intoxication inner ear and blockades of the labyrinth windows,

The listed complications can be isolated or in various combinations.

The creation of an algorithm for treating patients depending on the stage of exudative otitis media made it possible to achieve restoration of auditory function in the majority of patients. At the same time, observations of children with exudative otitis media for 15 years showed that 18-34% of patients develop relapses. Among the most significant reasons are the persistence of manifestations of chronic disease of the nasal mucosa and the late start of treatment.

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It is important to know!

Survey radiographs of the skull do not give a complete picture of the condition temporal bone. In this regard, specialists in the field of radiation diagnostics mainly use targeted images and X-ray computed tomography or magnetic resonance imaging.

Diseases do not always cause pain and discomfort in a child. In many cases, the disease manifests itself only as unpleasant sensations, which often go unnoticed. One of these diseases is exudative. It is important for parents to know its symptoms in order to begin treatment for their baby on time and protect him from possible complications.

What is exudative otitis media in a child?

Pathology of the hearing organ, in which exudate (sticky mass) collects in the middle ear without an inflammatory process, is called “ exudative otitis media" It occurs at any age, but children are most often affected.

According to statistics, the disease is diagnosed in 60% of children aged 3 to 7 years and in 10% in adolescence. Moreover, 5% of children experience recurrent otitis media within a year.

As a rule, pain with this type of otitis is insignificant or completely absent. However, the child feels congestion in the ears, and hearing loss becomes noticeable.

The exudate that accumulates near the eardrum is usually liquid, which is why doctors often call the disease serous otitis. If the disease enters the chronic phase, and the fluid becomes sticky and thick, you can come across the name “secretory otitis media”, “sticky ear”, “tight tympanic catarrh”.

The frequent and asymptomatic nature of the disease leads to a delayed visit to the doctor or lack of treatment, which provokes the occurrence of various disorders in the functioning of the hearing organ. In children, pathology can cause not only a decrease in memory and attention, but also developmental delays.

Classification of the disease

The disease is a type of otitis media, which affects the mucous membrane of the ear canal and the tympanic cavity, sparing the eardrum. However, it should not be confused with acute otitis media, when inflammation occurs in the middle ear caused by an infection.

According to the duration of the course, several phases of the disease are distinguished:

acute - up to 3 weeks;
subacute - from 3–8;
chronic - more than 8.

Exudative otitis media develops gradually, in the form of stages:

initial - primary deviations occur on the mucous membrane, when some cells are replaced by others;
secretory - the work of goblet cells that produce secretion increases;
mucosal - the exudate thickens and becomes viscous;
degenerative - secretory function decreases, structures stick together. During this period, various fibrotic processes may appear: cystic, mucoid and adhesive.

Pathology happens:

unilateral - one ear is affected;
bilateral - both ears are affected.

In most cases, specialists diagnose bilateral exudative otitis; unilateral inflammation occurs only in 10–12% of cases.

Causes

The Eustachian tube in a child is almost 2 times shorter than in an adult, which facilitates the movement of infection through it

The main cause of serous otitis is the presence of an infection that comes from the nasopharynx. As a result, the Eustachian tube becomes blocked, oxygen circulation is disrupted, and a vacuum is created in the ear canal.

The provoking factors for the occurrence of the disease are:

decreased immunity after illness;
poor environmental conditions;
frequent colds or infectious diseases;
water getting into the outer ear;
inflammatory processes in the nasopharynx;
severe swelling due to prolonged;
structural abnormalities of the ear and nasopharynx;
adenoids.

In children, pathology often develops due to the proliferation of adenoid tissue. In this case, it is better to remove the adenoids.

Symptoms and signs

The signs of serous otitis are mild, which is the main reason for the late detection of the disease. Body temperature and general condition are usually within normal limits. Children do not show any complaints at all, so exudative otitis media is detected only during examination by an otolaryngologist.

Main signs of the disease:

hearing loss;
sensation of fullness or gurgling in the ear canal;
crackling in the ear, impaired hearing of your voice;
ringing in the ears when turning or tilting the head.

At the initial stage (acute period), ear pain and a slight increase in temperature are possible. At this time, exudation is not yet observed; only air circulation in the ear canal is disrupted.

In the subacute period, fluid concentrates in the tympanic cavity and transforms into a viscous substance. The patient is concerned about decreased hearing, a feeling of water transfusion, and heaviness in the ear.

If the disease is started, it gradually becomes chronic. The clinical picture is characterized by the development of persistent hearing loss and destructive processes in the tympanic cavity, up to the appearance of a tumor in the middle ear.

The main symptom of serous otitis in children is hearing loss. Parents should be attentive to their child's behavior, especially if he constantly asks questions or asks to increase the TV volume

Infants or newborns cannot yet talk about their well-being, so parents should pay attention to the baby’s behavior.

If a child has otitis media, he tries to sleep on the side where the sore ear is located to reduce discomfort. Infants are capricious and refuse to feed, as sucking increases discomfort. The baby can take only one breast to keep the sore side warm. If intoxication is present, the child sleeps poorly and his appetite decreases. In some cases, a decrease in motor activity, lethargy, and drowsiness may be observed.

Adults should be attentive to the condition and behavior of the baby in order to notice the first signs of illness in time and consult a doctor.

If a child has suffered from an upper respiratory tract disease, the likelihood of developing serous otitis increases.

Features of otitis media in children - video

Diagnosis of serous otitis media

Only an otolaryngologist diagnoses exudative otitis media. To do this, a survey is carried out about previous diseases, as well as an examination of the middle ear using special instruments (otoscopy). During the examination, the doctor can identify any modifications to the eardrum, the presence of exudate and bubbles in the ear cavity, and deformation of the auditory bone.

Additional instrumental diagnostic methods are:

Tympanometry. Measuring the degree of mobility of the eardrum and the ventilation function of the auditory tube by creating pressure in the ear canal. In combination with other diagnostic methods, tympanometry is used to judge hearing sensitivity.
Audiometry. Study of the level of hearing and perception of sounds of different heights. The method makes it possible to detect damage to the hearing aid even in the youngest patients.
Radiography. Helps identify cellular pathology.
Computed tomography of the temporal bones. Performed in case of relapse of the disease or difficulty in making a diagnosis. In this way, the condition of the mucous membrane, ear canal, and middle ear cavities is determined.

Using soft and hard endoscopes (devices for examining the ear), the pharyngeal part of the Eustachian tube and auditory tubes is examined to determine ventilation functions, the nature of the lesion and clarification of the diagnosis.

In case of damage to the auditory ossicles, dysfunction of the Eustachian tube, decreased auditory perception, suspected otosclerosis (abnormal growth bone tissue) carry out differential diagnosis by multifrequency tympanometry.

In some cases, it is necessary to distinguish between serous otitis media with a rupture of the auditory ossicular chain and a tumor in the tympanic cavity. To do this, an x-ray and tympanogram are performed.

Treatment

Treatment is prescribed only after full examination and making the correct diagnosis. Therapy boils down to eliminating the cause of the disease and restoring the patient’s hearing. If adenoids or polyps are detected, they must be removed followed by treatment of the paranasal sinuses.

Conservative therapy

Treatment in most cases is carried out in a hospital, since the patient is prescribed an extensive list of activities.

Therapy includes taking such groups of medications as:

antibacterial (in the presence of infection): Azithromycin, Amoxiclav;
mucolytics for thinning sputum: Ambroxol, Ambrobene;
anti-inflammatory and antihistamine (to relieve swelling of the nasopharynx and Eustachian tube): Suprastin, Tavegil;
vitamin complexes;
vasoconstrictors (to restore aeration of the auditory tube and improve the outflow of exudate): Sanorin, Nazivin.

To improve the patency of the Eustachian tube, it is recommended to carry out physical procedures:

Procedures such as catheterization, the introduction of medications into the ear canal using a special catheter, require the active participation of the patient in the process, and therefore are not suitable for children. Young patients are usually prescribed drug therapy in the form of vasoconstrictor nasal drops, anti-inflammatory and antibacterial drugs.

Treatment is prescribed only by an otolaryngologist, depending on the stage of the disease and the age of the child. Independent use medicines unacceptable, as it can lead to complications and an unpredictable course of the disease.

The course of therapy depends on the severity of the pathology and can last up to 14 days. The results are assessed after 1 month by repeating diagnostic measures. If conservative treatment is ineffective or in the later stages of the disease, surgery is recommended.

Surgical intervention

TO operational methods treatments include:

myringotomy - used for a one-time removal of fluid using a special tube under pressure;
tympanopuncture - installation of permanent drainage and administration of medications into the ear cavity using a plastic tube (shunt) until the patient’s condition improves.

Folk remedies

Alternative medicine offers its own methods of treating exudative otitis media. It must be remembered that folk recipes are an addition to the main treatment, and not a replacement for it. Before using them, you should definitely consult your doctor.

Wash the basil and squeeze the juice out of it. Place 5 drops into the ear canals for one week.
Pour 1 cup of boiling water over mint leaves (2 tablespoons) and leave to steep for an hour. Strain and rinse your ears with the resulting liquid.
Combine elderberry, yarrow and chamomile flowers in equal proportions and brew with boiling water for 15 minutes. Strain the infusion, moisten a cotton swab in it and insert it into the diseased ear canal for 30 minutes. Repeat for 14 days.
Bake the onions in the oven, cut off the top and pour 1 tsp into the cavity. cumin. Cover with the cut part of the onion and place in the oven for another half hour. Cool the onion. Place the resulting juice in the ear canal at night, 3 drops each, for 10 days.

Traditional medicine in the photo

Chamomile is included in many folk remedies; for example, its decoction can be used to rinse the ear with otitis media. Onions - an ancient antibacterial remedy Mint relieves inflammation and pain
Basil juice has antimicrobial properties

In addition to the prescribed treatment, it is necessary to comply with certain conditions that contribute to a speedy recovery:

In the first two weeks, swimming is strictly prohibited. If treatment was carried out in a timely manner and the disease was stopped in acute form, in order to avoid relapse, you should not bathe your baby for several days. In the future, you need to make sure that water does not get into your ears;
after physiotherapy and in the acute phase of the disease it is not recommended to walk;
in the chronic form of the disease, before washing your hair, it is necessary to cover your ears with cotton swabs, since water entering the ear canal will aggravate the disease;
during a walk you should avoid hypothermia and reduce physical activity. Before going outside, you should tightly cover your ears with cotton swabs.

Prognosis and possible complications

Untimely consultation with a doctor and thoughtless infatuation with traditional medicine recipes can lead to:

purulent or chronic otitis media;
cholesteatoma (enlargement of the tissues of the tympanic cavity);
chronic mastoiditis (inflammation of the process of the temporal bone);
thinning and perforation of the eardrum.

If you do not pay attention to the symptoms and do not treat the disease for 2–3 years, this leads to persistent hearing loss, which occurs as a result of irreversible processes.

Early diagnosis and properly selected therapy lead to complete recovery. It should be taken into account that in 30% of cases a relapse of serous otitis is registered. As a rule, this is due to the presence of adenoids and chronic throat diseases in the child.

Preventive measures

To prevent exudative otitis media, diseases that contribute to the appearance of exudate and the development of pathology should be treated in a timely manner:

rhinitis;
adenoids;
sinusitis;
polyps;
sinusitis.

The risk group includes children who are predisposed to respiratory diseases.

Preventive measures include:

hardening procedures;
walks in the open air;
compliance with personal hygiene rules;
active lifestyle and sports.

In addition, it is important to ensure that the child avoids hypothermia and does not walk without a hat, and when swimming, water does not get into the ears.

Otitis in a child - video by Dr. Komarovsky

Exudative otitis is a disease that passes without any special symptoms, with only minor discomfort. But if parents do not pay attention to the first signs of illness in their child and do not contact a specialist in a timely manner, this can lead to irreversible consequences, including hearing loss.

Bilateral exudative otitis is a disease that occurs at any age, but children most often suffer from it. According to statistics, this non-infectious disease manifests itself in 60% of children in preschool age. Some of them (about 5%) experience the disease repeatedly throughout the year.

Mechanism of disease development

The disease goes through 4 stages of development. At the initial stage, a slight inflammation of the Eustachian tube occurs, which is accompanied by a slight decrease in hearing. The secretory stage is characterized by a violation of the outflow of fluid from the ear, which causes the accumulation of wax in the ear canal.

During the mucosal stage, the fluid in the ear becomes more viscous, and patients complain of a feeling of fullness and a feeling of constant fluid in the ear. The last stage of the disease - adhesive - is characterized by changes in the tissues of the middle ear and eardrum. They lead to hearing loss and the development of hearing loss.

Doctors distinguish two types of pathology:

catarrhal;
exudative average.

The disease of the first form is characterized by the rapid onset of symptoms, which makes it much easier to diagnose. Exudative otitis media in a child is more difficult to determine: often there are no clear clinical signs.

The disease does not affect the muscle or bone structures of the ear canal, but a sticky substance called exudate begins to accumulate in the middle ear. This occurs due to inflammation and swelling of the auditory tube.

The ear cavity is filled with fluid, which is a favorable environment for the development and reproduction of viruses or bacteria. Third-party microorganisms turn exudate into pus, which causes a purulent form of the disease. It is accompanied by dullness of hearing, gurgling in the ear and congestion of the hearing aid. If the disease is not stopped at this stage, it can spread to the second organ of hearing, thus causing bilateral exudative otitis media.

Etiological factors

The causes of bilateral exudative otitis media in children are usually divided into two groups: local and communication. The first include inflammation or obstruction of the auditory canal or eustachian tubes. Such conditions develop due to chronic rhinitis, frequent allergies and sinusitis.

TO common reasons the appearance of pathology include:

decreased body reactivity;
disruption of the endocrine system.

In addition, professional activity can be an etiological factor of the disease. Pilots, divers and submariners often suffer from exudative otitis media - their work is associated with constant barotrauma. Another cause of the disease is features anatomical structure organs of hearing and breathing.

People with enlarged turbinates, deviated nasal septums and cleft palates are at risk. The likelihood of damage also increases with frequent exposure to water in the ears, as well as constant hypothermia.

Symptoms of exudative otitis media in children

At the first stage, the disease, as a rule, does not manifest itself in any way. Children do not experience fever or sudden deterioration general condition. This is one of the reasons why pathology cannot be diagnosed immediately.

At the first stage of the disease, the child may feel slight pain or crackling in the ear. Exudate has not yet accumulated, but there is a violation of air circulation in the ear canal.

Other signs indicating the appearance of bilateral exudative otitis media in children include:

hearing impairment;
the appearance of gurgling in the ears;
constant congestion;
presence of tinnitus when tilting the head;
deterioration in hearing one's own voice.

If treatment for the disease is not started at this stage, it will become chronic. This is fraught with the development of hearing loss, the onset of destructive processes in the tympanic cavity, and even the appearance of a tumor in the middle ear.

To determine the onset of inflammation in a baby, you need to monitor its behavior. Babies, as a rule, begin to be capricious and refuse to eat (sucking on the breast or bottle causes discomfort). In addition, babies become less active and more sleepy.

Methods for eliminating pathology

Only an otolaryngologist can diagnose the disease in an adult or child. To do this, he examines the eardrum and ear cavity. Additional diagnostic tools are used:

audiometry (testing your hearing level);
CT scan of the temporal bones (determining the condition of the mucous membranes, auricle, ear canal);
tympanometry (measuring the mobility of the eardrum);
radiography (determination of cellular pathologies).

Only after receiving the test results can the doctor prescribe treatment. Conservative therapy(inpatient treatment) involves taking the following medications:

antibacterial agents(to fight infection);
antihistamines and anti-inflammatory drugs (to relieve swelling);
vitamin complexes;
mucolytics (to thin the fluid);

Vasoconstrictors improve the outflow of fluid inside the ear and have a positive effect on restoring aeration of the ear canal.

The patency of the Eustachian tubes is improved with the help of physiotherapy. At the initial stage of the disease, laser therapy, blowing of the ear canals and ultrasound therapy are performed. Other methods are also effective. For example, electropharesis with steroids, magnetic therapy, insertion of a catheter into the ear.

Most of the procedures listed above are not suitable for children, so they are prescribed drug treatment. It includes taking antibacterial and anti-inflammatory drugs, as well as instilling vasoconstrictors.

Traditional medicine methods are used as a complement to treatment. The ears are washed with mint infusion, and freshly squeezed basil juice is used as drops. For lotions, brew an infusion of chamomile, elderberry and yarrow flowers, mixed in equal quantities. A cotton swab dipped in the broth is inserted into the ear for half an hour. The procedure is carried out over two weeks.

Remember: traditional medicine is not always beneficial, so any treatment actions must be coordinated with an otolaryngologist.

Delayed contact with a specialist or self-medication is the cause of complications in the future. For example, sometimes patients experience hearing loss or develop a chronic form of exudative otitis media.

Treatment takes at least half a month, but for a complete recovery you need to limit bathing in the first days of treatment, not walk after the procedures, delay physical activity and avoid hypothermia.

Exudative otitis: surgery in children

Drug treatments are not always effective. Sometimes it is necessary to resort to the help of surgeons to combat the disease. A single pumping of fluid from the ear cavity is performed during myringotomy.

Tympanocentesis is a more radical operation. It is carried out to install drainage to remove sticky liquid. The tube is also used to administer medications directly into the patient's ear.

Prevention

It is almost impossible to protect a person of any age from exudative otitis media. To reduce the risk of the disease, doctors recommend completely getting rid of diseases of the ears and respiratory tract. For example, sinusitis, rhinitis, inflammation of the adenoids.

As preventive measures, it is recommended to carry out hardening procedures, walk in parks and squares as often as possible, play sports and do not forget about the rules of personal hygiene.

Bilateral exudative otitis is a disease that affects both ears. However, she does not have a bright severe symptoms. If your child complains of hearing loss and becomes less active, there is no need to hesitate. Timely contact an otolaryngologist and start proper treatment will save the baby from hearing loss and other complications.

Exudative otitis should be distinguished from acute otitis media, which is an inflammatory process of the middle ear due to infection. Exudative otitis media is a unique form of otitis media. It is characterized by the accumulation of sticky fluid (exudate) in the middle ear when there is no acute inflammatory process.
Pain syndrome is completely absent, the eardrum remains intact, but hearing begins to decline. Children are most often susceptible to this disease. 60% get sick at the age of 3-7 years, and 10% at 12-15 years.

Causes of exacerbation

Otitis media develops as a result of infection during inflammation of the nasopharynx, which is accompanied by swelling of the mucous membranes.

The Eustachian tube also swells, which leads to impaired ventilation in the ear. Catarrhal otitis occurs, which without proper treatment leads to an exudative form.

The middle ear constantly produces secretions, which, during normal functioning of the auditory tube, are removed from the cavity.

When an infection occurs, swelling (narrowing) of the Eustachian tube () occurs, which makes the outflow of fluid very difficult.

As a reaction to the inflammatory process, fluid begins to be produced more intensely, and the ear cavity becomes filled with exudate. It turns into a favorable environment for the growth of viruses and bacteria.

Gradually, the liquid transforms into thick mucus, which eventually turns into a purulent state.

Factors influencing the occurrence of exudative otitis media:

Symptoms and clinical manifestations

Unlike catarrhal otitis, the exudative form is much more difficult to identify, since its symptoms are not so pronounced.

The main signs of acute exudative otitis media:

hearing impairment;
feeling of stuffiness in the ear;
when changing the position of the head, there is a feeling of liquid splashing inside the ear;
Possible nasal congestion;
hearing your voice in your head.

Exudative otitis has acute (up to 3 weeks), subacute (3-8 weeks) and chronic (more than 8 weeks) forms. The course of the disease depends on its stage. They are distinguished 4.

Diagnosis of the disease

To successfully diagnose the disease, it is necessary to have a picture of previous ear infections. Thanks to otoscopy, clear deformations in the structure of the eardrum can be determined.

If the membrane is very thin, then through it you can see the degree of accumulated exudate.

What do you know about Wilson-Konovalov disease, which you can read about in the article below the link.

About what ear candidiasis is page.

About the symptoms of chronic sinusitis it is written on the page: immediately read about the possible complications of the disease in the middle ear.

Other diagnostic methods that a doctor may use are:

audiometry – measurement of hearing level and its sensitivity to sounds of different frequencies;

examination of the Eustachian tube to determine its ventilation functions;

studying the level of membrane mobility (Valsalva maneuver or Siegle funnel);

endoscopy;

radiography (helps identify cellular pathologies);

computed tomography (if diagnosis is difficult).

Treatment methods

It is necessary to treat exudative otitis media comprehensively, using several methods.

First of all it is necessary to eliminate the cause that led to dysfunction of the auditory tube (diseases of the ENT organs, allergies, etc.).

At the next stage, it is necessary to restore auditory function and minimize the risk of irreversible transformations of the middle ear.

Conservative therapy

Traditional methods include medication and physical therapy.

Drug therapy consists of taking drugs with a different spectrum of action:

In order to improve the patency of the Eustachian tube, physiotherapeutic procedures are carried out:

electrophoresis using steroids;

endaural phonophoresis with acetylcysteine (course of 8-10 procedures);

magnetic therapy;

ultrasound;

laser therapy (in the initial stages of the disease);

pneumomassage of membranes;

Politzer blowing.

Many methods (catheterization, transtubal administration of drugs, etc.) not suitable for small children, because they require their participation in the process.

Often, manipulations can be carried out, but the catheter must be elastic so as not to injure the child’s ear when the head moves.

Surgical intervention

If traditional therapy is ineffective, especially in the later stages of exudative otitis, the question of surgical treatment in a hospital setting is raised. Today, myringotomy and tympanopuncture are used as surgical methods.

During myringotomy, a hole is made in the eardrum so that accumulated fluid can be released from the ear cavity. To maintain drainage, a tube is inserted into the hole.

This method is effective only for a while; it is used for one-time removal of exudate.

Tympanocentesis is used to ensure continuous drainage. and for administering medications into the ear cavity. To do this, a polyethylene tube (shunt) is placed and left until the patient's condition improves.

Usually it is 2-3 weeks, sometimes longer. In addition to anti-inflammatory drugs, drugs that dilute the fluid (hydrocortisone, trypsin) and reduce secretion are administered through the tube.

Possible complications

In case of untimely examination or delay of medical intervention, as well as excessive and thoughtless hobby folk remedies treatment for exudative otitis media, the following complications will certainly arise:

purulent otitis;

stable retraction of the membrane into the ear cavity;

persistent hearing loss;

pathological perforation of the eardrum;

cholesteatoma (a cavity with dead cells and tissues that are located in a connective tissue capsule).

If you start treating diseases predisposing to the formation of exudate in time:

sinusitis (how is it different from sinusitis),

eustachitis,

otitis media (about adhesive), etc.

then you can avoid this problem.

At the first signs of illness (deterioration of hearing, congestion), you should contact an ENT specialist as soon as possible. It is especially important not to miss the disease in a child in order to prevent the development of persistent hearing loss.

What is otitis media and how to independently diagnose whether you or your loved ones have the disease, you will learn while watching the episode of the program “Live Healthy!”

Chronic non-purulent inflammation of the mucous membrane lining the tympanic cavity. Chronic exudative otitis media is characterized by increasing hearing loss, congestion in the ear, autophony, a feeling of fullness in the affected ear, and tinnitus that occurs when moving the head. Chronic exudative otitis media is diagnosed taking into account data from otoscopy, microotoscopy, examination of the Eustachian tube, audiogram, acoustic impedance measurement and CT scan of the temporal bone. Treatment of patients with chronic exudative otitis media consists of sanitizing the nasopharynx, restoring the patency of the Eustachian tube and auditory function, and preventing sclerosis of the middle ear cavity.

General information

Symptoms of chronic exudative otitis media

Chronic exudative otitis media often occurs against the background of acute or chronic inflammatory disease of the upper respiratory tract. Adult patients usually complain of decreased hearing (hearing loss), a feeling of fullness and fullness in the ear. Autophony is possible, in which patients feel their voice louder than usual in the affected ear. In this case, a patient with chronic exudative otitis media has the feeling that his voice sounds as if under water or as if lowering his head into a barrel.

In mild cases, when a small amount of fluid accumulates in the middle ear cavity, patients note fluctuation phenomena: noise in the ear when turning and tilting the head, crackling or squelching when blowing the nose and swallowing. If the exudate occupies up to half of the tympanic cavity, then when tilting the head forward or lying on the stomach, an improvement in hearing is observed. Chronic exudative otitis media, as a rule, is not accompanied by pain syndrome. In some cases, transient and low-intensity ear pain may occur.

In young children, chronic exudative otitis media often has an asymptomatic course. Children usually do not complain. Hearing deterioration accompanying chronic exudative otitis media is detected by parents who begin to notice that the child often does not respond when his name is called, asks to turn on music or a cartoon louder. In addition, children with chronic otitis media appear inattentive and may perform worse in school.

Complications of chronic exudative otitis media

The inflammatory process in chronic exudative otitis media often passes into the fibrosclerotic stage with the development of adhesive otitis media. Penetration of infection into the middle ear cavity can lead to the appearance of recurrent acute otitis media, as well as chronic suppurative otitis media. In addition, chronic exudative otitis media may be accompanied by perforation of the tympanic membrane, the formation of cholesteatoma, and the development of subacute or chronic mastoiditis. If chronic exudative otitis media develops in early childhood, it leads to impaired development of the child’s speech function and a delay in his psycho-emotional development.

Diagnosis of chronic exudative otitis media

Early diagnosis of exudative otitis media in children under 5-6 years of age is extremely difficult due to the lack of complaints. Chronic exudative otitis media can be detected in them by chance when medical examination at the otolaryngologist. To confirm the diagnosis, it is necessary to conduct otoscopy, microotoscopy, hearing tests and patency of the auditory tube.

Otoscopic examinations may reveal: increased vascularization and thickening of the eardrum, its changed color (whitish, red or cyanotic), air bubbles located behind the eardrum or fluid level. Chronic exudative otitis media is characterized by retraction and limited mobility of the eardrum, deformation of the light cone, and protrusion of the hammer handle into the external auditory canal. With the development of fibrosclerotic changes in the middle ear cavity, the eardrum looks thinned and atrophic. Long-term chronic exudative otitis media leads to the formation of connective tissue scars and foci of myringosclerosis on the eardrum.

A study of the patency of the auditory tube determines the obstruction of its mouth. Threshold audiometry data indicate the presence of conductive hearing loss. The results of acoustic impedance measurement indicate limited movement of the auditory ossicles. Patients suffering from chronic exudative otitis media for a long time additionally undergo a CT scan of the skull with a targeted examination of the temporal bone. CT allows you to assess the degree of airiness of all cavities in this area, the state of the anatomical structures of the ear (windows of the labyrinth, auditory ossicles, bone part of the auditory tube), the density and location of the pathological contents of the ear cavities.

Chronic exudative otitis media must be differentiated from otosclerosis, cochlear neuritis, chronic purulent otitis media, some ear tumors, otomycosis, congenital anomalies formation of auditory ossicles.

Treatment of chronic exudative otitis media

Therapeutic tactics for patients with chronic exudative otitis media consist of eliminating obstructions in the patency of the Eustachian tube, eliminating inflammatory changes in the tympanic cavity, restoring hearing and preventing irreversible sclerotic changes.

Treatment of chronic exudative otitis media begins with eliminating the causes that caused it, i.e., with sanitization of the nasopharynx and therapy inflammatory processes in the paranasal sinuses, nasal cavity and pharynx. For this purpose, if necessary, adenotomy is performed,

The use of antibiotics in the treatment of chronic exudative otitis media remains highly controversial, since it is known that in half of the cases chronic exudative otitis media is an aseptic inflammatory process.

If complications develop or there is no result from therapy with conservative methods, chronic exudative otitis media is subject to surgical treatment. Depending on the clinical situation, chronic exudative otitis media may be an indication for paracentesis of the tympanic membrane, tympanotomy or shunting of the tympanic cavity. Surgical interventions are performed using local anesthesia, and for young children they require common methods pain relief.