Sinusitis

Bilateral exudative otitis media in adults. Exudative otitis media - how to prevent hearing loss in a child

Exudative otitis is a pathology of the middle ear that occurs without pronounced signs inflammation, but with the formation in the cavity of first serous and then purulent exudate. This pathology is a type of otitis media, but occurs without severe symptoms and with characteristic changes. Exudative otitis media is the most common - it affects mainly young children (up to 7 years - 60% of cases, from 10 to 15 years - 10% of cases).

Despite the fact that with this disease there is no inflammatory process, and the eardrum remains intact, the child’s hearing is critically reduced, and if treatment for the pathology is not started on time, stage 3 development is possible.

The exudate formed during this disease in the tympanic cavity initially has a liquid consistency, but over time it becomes more and more viscous, and, finally, purulent. The temperature for such a pathology as exudative otitis media is absent or low-grade.

Etiology

Otitis media with the release of exudate appears due to infection entering the cavity from nearby ENT organs. For example, an infection can penetrate into the tympanic cavity during inflammatory processes in the nasopharynx, causing swelling of the mucous membrane.

First, swelling of the Eustachian tube occurs, which leads to a narrowing of its lumen and disruption of the outflow of exudate, which is normally produced in the middle ear. Stagnant exudate becomes viscous and its outflow becomes even more difficult, as a result of which catarrhal otitis develops, which over time takes on an exudative form. If the pathology is not treated at this stage of development, exudative otitis media develops, so the slightest hearing impairment and a feeling of discomfort in the ear canals require a visit to a doctor for examination.

Due to the development of inflammation in the middle ear, the fluid that is always produced there begins to be produced faster, however, due to the outflow disturbance, it is not excreted, but stagnates. Stagnant exudate is an excellent environment for the proliferation of bacteria and viruses. Over time, the fluid becomes purulent, which leads to persistent hearing loss, because sounds cannot penetrate into the ear cavity through the purulent exudate. In short, any diseases of the nasopharynx should be treated in a timely manner to avoid the development of exudative otitis media and other complications.

So, the diseases that can lead to the development of this pathology are the following:

diseases of the nasopharynx (, and others);
allergies to certain substances;
anatomical defects ();
general pathologies (,);
low immunity.

Besides, common cause the development of a disease such as exudative otitis media in children becomes physical pressure, for example, water getting into the ear.

Symptoms

The exudative form of otitis is quite difficult to diagnose, since the symptoms of this pathology are either mild or completely absent. It is especially difficult to identify the disease in a young child who cannot talk about his symptoms himself, so parents should be very careful and monitor changes in their child’s behavior.

The most important symptoms characterizing acute exudative otitis media are:

feeling of stuffiness in the ear;
impaired perception of sounds (if otitis media develops in a small child, parents notice that he does not respond to their call the first time);
nasal congestion.

When the child tilts his head, he feels a splash, as if water has gotten into his ears, which he can tell his parents about. In addition, the child has the feeling that he hears his own voice in his head, which echoes.

Pain is usually absent with this form of otitis or is expressed briefly and mildly. If the disease in a child or adult is not treated, then after a couple of years stable hearing loss develops.

Note that exudative otitis media has three stages and can be:

sharp;
subacute;
chronic.

The acute form is spoken of if the disease lasts less than 3 weeks and its symptoms are not expressed, the subacute form is spoken of when the disease progresses over 3–8 weeks, and the chronic form can be spoken of when the duration of the pathology exceeds 8 weeks.

There are also 4 stages of the disease: initial, secretory, mucosal and fibrous. It is easiest to treat the disease at the initial stage, when the symptoms are minor - only the ventilation in the eustachian tube is impaired and there is no exudate. At the second, secretory stage, the serous contents in the tympanic cavity become heated, causing hearing loss and a feeling of heaviness in the ear. At the third stage, mucosal, the exudate becomes a viscous substance. At this time, the child is tormented by the sensation of fluid transfusion in the ear when tilting and turning the head. The fourth stage is characterized by the development of persistent hearing loss and destructive processes in the middle ear, up to the appearance of holes in the eardrum and the development of choleastomy.

Diagnostics

The diagnosis of exudative otitis media is made based on the child’s complaints and examination of the patient using an otoscope. X-rays and endoscopy are also indicated - the choice of diagnostic method is determined by the attending physician.

Treatment

Treatment of this pathology in a child or adult can be conservative or surgical. Conservative treatment consists of the use of certain medications:

vasoconstrictor drops to facilitate breathing through the nose;
mucolytic agents for thinning mucus;
antiallergic drugs to relieve swelling;
antibiotics to eliminate the attached infection.

Treatment also involves taking vitamins to restore and strengthen the body’s protective functions.

Surgical treatment is carried out in two ways: by performing a one-time myringotomy procedure (to drain exudate) or by installing a reusable catheter for draining the tympanic cavity and introducing antibacterial agents into it. The second method is used more often and is more effective. Treatment also requires physiotherapeutic procedures, such as magnetic therapy, ultrasound, electrophoresis and Politzer blowing.

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Diseases with similar symptoms:

Earwax is a process in which the ear canal becomes blocked due to the accumulation of wax and dirt, which can lead to deterioration or complete loss of hearing. It should be noted that this pathology manifests itself not only in hearing impairment. Clinicians note that wax plugs in the ear can be accompanied by dizziness, headache, nausea and vomiting. It is strongly not recommended to remove the plug yourself (with the help of third-party objects or drops), as this can lead to aggravation of the pathological process and the development of serious complications.

Adenoids in children are an inflammatory process that occurs in the pharyngeal tonsils and is characterized by an increase in their size. This disease is typical only for children aged from one to fifteen years, the most frequent exacerbations occur between three and seven years. With age, such tonsils decrease in size and then completely atrophy. It manifests itself in various forms and degrees, depending on factors and pathogens.

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60% of children and 20% of adults suffer from otitis media at least once in their lives. The most common type of this disease is otitis media, or inflammation of the middle ear, which is accompanied by acute pain. Less common is exudative otitis, that is, associated with the release of fluid, in which there are no painful symptoms.

The hearing loss, congestion and gurgling sounds in the ears that accompany this disease can go unnoticed for a long time, especially in children. As a result, the exudative process can develop into chronic purulent inflammation or lead to significant hearing loss.

From the above study, it appears that the disease was considered a nonbacterial process because cultures were generally negative, showing that relapses were due to the presence of a biofilm containing one or more microorganisms. The fact that the bio-membrane is a natural barrier helps explain the ineffectiveness of antibiotics and the host's defense mechanisms against infection. Without suggesting ways to change current treatments, it is necessary to develop methods to prevent the formation or destruction of biofilms.

Causes and symptoms of exudative otitis media

In adults, these tonsils atrophy, and therefore do not cause as many problems as in childhood.

The main cause of exudative, also known as sedative, otitis is swelling of the mucous membrane of the nasopharynx and auditory tube. performs an important function - ventilates and ensures drainage. If the drainage of fluid from the ear is impaired, its excess occurs, which becomes the first prerequisite for the development of exudative otitis media.

Italian Study Group on Acute Otitis Medicine. Delayed prescription may reduce antibiotic use for acute otitis media: a prospective observational study in primary care. Adenoidectomy and tympanostomy tubes in the treatment of otitis media.

Migirov L. Duvdevani S. Kronenberg J. Otogenic intracranial complications: review of 28 cases. Abscess of the posterior cerebral fossa, description of 4 cases. Evidence of allergic inflammation in the middle ear and nasopharynx in atopic children with otitis media with effusion.

In children, a bilateral type of exudative otitis often occurs. It is provoked by inflamed adenoids. When they grow, they block the nasopharynx and squeeze the Eustachian canal. As a result, symptoms such as a stuffy nose and ears, runny nose, and a slightly open mouth in the child arise.

National Institute of Clinical Excellence. Otitis media and sinusitis are similar diseases. Pathogenic changes and changes in the healing rate for otitis media and tonsillopharyngitis. The role of laser tympanostomy in the treatment of allergic children with chronic serous otitis media.

Antimicrobial use for acute upper respiratory tract infections in family medicine. Mannose-binding lectin and upper respiratory tract infections in children and adolescents: a review. Comparative assessment video telescopy for the diagnosis of pediatric otitis media with effusion.

IMPORTANT TO KNOW!

To quickly get rid of a runny nose, our readers recommend Loromax® drops - a natural, certified remedy for adults and children. Instantly facilitates breathing, removes pus from the sinuses, restores mucous membranes and destroys infection. Loromax, unlike pharmacy nasal drops, does not just constrict blood vessels, but creates conditions for the natural healing of the nasal cavity. The natural hypoallergenic composition has no contraindications or side effects.

In addition, the following factors can provoke otitis media in the middle ear:

Scottish Intercollegiate Advice Network. Immune status and function of the Eustachian tube in recurrent otitis media with effusion. Acute otitis media in children under three months of age: clinical presentation, etiology and associated diseases. Effect of rupatadine versus placebo on allergen-induced symptoms in patients exposed to aeroallergens in the Vienna Trial Chamber. The role of antibiotics in the treatment of uncomplicated acute otitis media. Genetic relationship between pneumococcal populations originating from the nasopharynx, adenoid and tympanic cavities of children with otitis media.

deviated nasal septum;
infectious and viral diseases;
weakened immune system;
eustachitis;
injury;
allergic rhinitis;
barotrauma;
water ingress;
sulfur plug;
foreign object.

As soon as suspicious symptoms appear, it is necessary to begin treating the patient immediately, as the problem can become chronic.

Otitis media and its consequences: behind the ears. Pneumococcal conjugate vaccination in children with recurrent acute otitis media: a therapeutic alternative? Biofilms in ear, nose and throat infections: how important are they? Medical treatment of middle ear diseases in children under 2 years of age with sensorineural hearing loss.

Over the past decades, the incidence of allergic rhinitis has grown to epidemic proportions. Correct and timely diagnosis is the basis for AP management and is based on a thorough history and thorough medical examination. The origin of allergic rhinitis was documented and allergy tests were performed.

Symptoms and manifestation

Exudative otitis media manifests itself differently than other types of ear diseases. This is also an inflammation of the ear, but there is no acute process, and therefore symptoms such as high fever or severe pain are not observed. This is what complicates timely diagnosis.

Exudative otitis media produces the following symptoms:

ear congestion;
, gurgling and splashing when turning the head;
nasal congestion;
autophony;
deterioration of hearing acuity.

Basically, the problem is noticed when hearing deterioration becomes obvious without obvious reasons.

Depending on the intensity and duration of the disease, there are:

acute – about 3 weeks;
subacute – approximately 3-8 weeks;
chronic exudative otitis media – 8 weeks or longer.

There are also types of exudative otitis media based on the location of inflammation: unilateral and bilateral.

Exudative otitis media should not be confused with acute otitis media, which is inflammation of the middle ear caused by infection. A distinctive feature of the exudative form of the disease is the accumulation of sticky fluid – exudate – in the middle ear cavity. In addition, the disease is accompanied by hearing loss and preservation of the eardrum against the background complete absence pain syndrome. Exudative otitis, as well as other ear diseases, affects children more often, due to the greater vulnerability of children's immunity.

Types and causes of exudative otitis media

Depending on the duration of the disease, chronic, subacute and acute exudative otitis are distinguished. The acute form is observed within a period of up to three weeks, the chronic form is diagnosed after eight weeks from the moment of illness. Under acute form– intermediate, and is usually not used in diagnostics.

The diverse and numerous causes of exudative otitis or the so-called “sticky ear” can be divided into two groups of factors - general and local.

Reasons general include:

Reduced immunity due to chronic diseases;

Allergic reactions;

Poor ecology and living conditions;

Infectious diseases.

It should be noted that among the factors that provoke exudative otitis media in children, adenovirus infection accounts for approximately 30% of cases of the disease.

The main reason of a local nature is a mechanical or functional impairment of the ventilation qualities of the auditory tube. Usually, this occurs due to hypertrophy of the pharyngeal tonsil or a subtle inflammatory process occurring in it.

Symptoms and pathogenesis

Exudative otitis in children is not easy to diagnose. Symptoms, as a rule, are not pronounced enough. In fact, the only sign of the disease is decreased hearing, sometimes accompanied by noise. Considering that young children are unlikely to complain of hearing loss, the diagnosis of exudative otitis media is most often random. Main danger This trend has serious complications. If the disease is not detected in time or mild symptoms are ignored, then irreversible sad consequences are likely - atrophy of the eardrum and persistent, almost incurable hearing loss.

Of course, the pathogenesis of the disease is not clear, but it is most likely that the mechanism of occurrence of exudative otitis media is associated with insufficient ventilation and emptying of the tympanic cavity. This, in turn, may be a consequence of improper treatment of otitis media or various functional disorders of the soft and hard palate.

Diagnosis of exudative otitis media

For successful diagnosis, anamnesis of previous ear diseases is of particular importance. Particular attention should be paid to the course of the disease and the prescribed treatment. A routine otoscopy can provide fairly clear evidence of changes in the eardrum, which may appear slightly thickened, bulging, and bluish in color. Sometimes, the membrane can be so thin that the level of accumulated transudate can be seen through it.

In addition to otoscopy, the following measures are important in diagnosis:

Study of the ventilation functions of the auditory tube;

Acoustic tube sonometry;

Determination of the level of mobility of the eardrum.

The final and decisive word belongs to hearing research. With exudative otitis media, hearing loss is usually moderate, within 30-40 dB.

Today, thanks to acoustic impedansometry, it is possible to conduct a complete diagnosis of damage to the auditory sound-receiving and sound-conducting apparatus, including in the youngest patients.

Radiography can also help in diagnosis, with the help of which certain cellular pathology can be detected. If it is difficult to make a diagnosis, one has to resort to computed tomography of the temporal bones.

A detailed examination of the pharyngeal orifice and auditory tubes is provided through rigid and soft endoscopes, which make it possible to determine the exact cause and nature of the obstruction of the auditory tube. Typically, it is the results of this study that determine the choice between conservative and surgical treatment.

Treatment of exudative otitis media

Treatment tactics boil down to preliminary elimination of the causes that led to disruption of the auditory tube, followed by restoration of hearing and prevention of morphological processes in the middle ear. Thus, when choanal polyps, adenoids, and hypertrophy of the tonsils are identified, their mandatory elimination, as well as sanitization of the paranasal sinuses, is required.

Electrical stimulation of the muscles of the soft palate

Lidase electrophoresis;

Magnetotherapy;

Ultrasound;

Laser therapy.

Most often, to restore the tone and patency of the auditory tube and remove exudate, Politzer blowing, diadynamic currents or pneumomassage of the eardrums are used. All of these methods require the active support and participation of the patient, and therefore are not suitable for very young children.

Surgical methods include myringotomy and tympanopuncture, which are used to remove serous fluid once. Continuous drainage and administration of medications is ensured by tympanotomy, which involves the insertion of a special polyethylene tube for several weeks.

Widely used in the treatment of exudative otitis media in children, an operation that involves inserting a shunt through the incised eardrum. The shunt remains in the ear for 3-4 months, and serves both to aerate the tympanic cavity and to administer medications. Often, with a non-functioning auditory tube, aeration alone by shunting is enough for a complete cure.

medportal.su

Exudative otitis media in children and adults: treatment with medications and folk remedies

Exudative otitis media is a fairly common disease. It is accompanied by non-infectious inflammation of the middle ear, in which there is an accumulation of exudate in its cavity. Both adults and children are susceptible to this disease. And in the absence of timely treatment, the inflammatory process can lead to a host of irreversible complications. Therefore, information about the causes, symptoms and treatment of the disease will be useful to many readers.

What is the disease?

Exudative otitis media should in no case be confused with the catarrhal form. In this case, there is no infectious tissue damage, and the inflammatory process is sluggish. The main difference between this form of the disease is the accumulation of exudative fluid in the middle ear cavity. By the way, when examining the ear, you can observe both a thin layer of serous fluid and the formation of a rather thick layer of viscous exudate. Popularly, such a disease is often called “sticky ear.”

According to statistical data, exudative otitis in children is diagnosed much more often than in adult patients, which is associated with some anatomical features of a growing child’s body. Most often, children of preschool age (from two to five years) are prone to this disease. At proper treatment the disease is not dangerous, but the lack of timely treatment is fraught with a lot of negative consequences, including hearing loss.

The main reasons for the development of exudative otitis media

Exudative otitis media can develop under the influence of various factors. Normally, a small amount of fluid constantly forms in the middle ear cavity - this is completely normal, since it is removed from the cavity naturally.

But in some cases, the outflow of fluid is obstructed, which leads to its accumulation in the middle ear. What is this pathology associated with? First of all, it is worth noting that the disease may be associated with a violation of the normal patency of the auditory canal or the Eustachian tubes. This is often observed against the background of sinusitis, persistent allergic rhinitis, acute catarrhal otitis. The causes of obstruction may be adenoids. Some anatomical features are also important - for example, the risk of developing the disease increases with a deviated nasal septum, enlarged turbinates, and cleft palate.

Risk factors include the presence of tumors in the nasal passages or sinuses. Exudative otitis media can develop as a result of trauma, including barotrauma in divers and pilots. Sometimes the disease develops against the background of a sharp decrease in immunity and hypothermia.

Classification of the disease

Today, there are several classification schemes for this disease. For example, depending on the current, it is customary to distinguish:

the acute form of the disease lasts up to 3 weeks;
with subacute otitis, the duration of the process is 3-8 weeks;
if the disease is present in the patient for more than eight weeks, it is advisable to talk about the chronic form of the disease.

It is worth noting that the disease can affect either one or both ears. By the way, bilateral exudative otitis media in children is diagnosed much more often than unilateral one.

What symptoms accompany the disease?

It is worth noting that the clinical picture for this disease is slightly blurred - there is no pain, no increase in body temperature, no standard symptoms of intoxication, which significantly complicates the diagnostic process. Moreover, in the absence of disturbing factors, many patients simply do not consult a doctor, especially if we're talking about about a small child.

So what should you pay attention to? Perhaps the only symptom in most cases is hearing loss. Some patients complain of a feeling constant congestion ears or nose (there is no discharge). Symptoms include autophony - during a conversation, the patient can hear an echo of his own voice. If such violations occur, you should consult a doctor.

Exudative otitis in children is considered the most dangerous, since a small child may simply not notice the presence of symptoms. In turn, lack of treatment leads to the development of persistent hearing loss. In early childhood, hearing loss can disrupt normal speech development.

What diagnostic methods are used?

If you suspect exudative otitis media, you should go to an otolaryngologist. To begin with, the doctor will conduct an initial examination and collect a complete medical history (including information about previous diseases). In many cases, changes can be noticed already during a routine otoscopy - the doctor has the opportunity to examine changes in the eardrum.

In the future, additional studies are prescribed that will help determine the cause of exudative otitis media - treatment depends on this. For example, the ventilation function of the auditory tubes is being studied. In addition, the doctor determines the level of mobility of the eardrum. Acoustic tube sonometry is also considered quite informative, as it helps determine the level of hearing loss, even when it comes to the youngest patients.

Radiography can be used as an additional study. In controversial cases, the patient is recommended to undergo a computed tomography procedure. Sometimes during the diagnostic process, the doctor examines the middle ear cavity using a flexible endoscope.

Exudative otitis: treatment with drugs

Only a doctor can prescribe correct therapy, since the scheme in this case is drawn up individually. Treatment of exudative otitis media in children and adults is carried out in several directions at once.

In particular, it is extremely important to determine the cause of the obstruction of the auditory tubes and restore it. They treat runny noses and colds, and, if necessary, prescribe a procedure for removing adenoids or correcting the nasal septum.

As for medications, their choice depends on the patient’s condition and the stage of development of the disease. In some cases, it is advisable to use non-steroidal anti-inflammatory drugs. Patients are also prescribed mucolytic drugs, which dilute the exudate and promote its rapid elimination. In particular, the most effective are the means active ingredients which are acetylcysteine (“ACC”) or carbocysteine. The course of taking mucolytics lasts about two weeks.

The advisability of taking antibiotics is questioned by many doctors, since most often the inflammatory process with exudative otitis media is aseptic in nature. However, if infection activity was detected during the diagnostic process, then the course of treatment includes taking antibacterial agents, for example Amoxicillin. It is necessary to take antihistamines, which, on the one hand, inhibit the development of vaccine immunity, and on the other, reduce the likelihood of developing an allergic reaction to the medications taken by patients. Quite often, patients are recommended “Suprastin”, “Tavegil” and other drugs.

To facilitate nasal breathing, you can use vasoconstrictor nasal drops (for example, Otrivin), but such therapy should not last more than five days.

Other conservative treatments

Of course, drug therapy is not enough. Since exudative otitis media is associated with impaired patency of the auditory tubes, one of the doctor’s tasks is to restore it. For this purpose, a variety of techniques are used. For example, Politzer blowing is considered quite effective. This procedure is nothing more than pneumomassage of the eardrum. This treatment allows you to restore the muscle tone of the auditory tube, improve its patency, and also remove exudate from the tympanic cavity.

In addition, the therapy includes a variety of physiotherapeutic procedures, such as magnetic therapy, ultrasound and laser therapy. Intra-ear electrophoresis, which uses steroid hormonal drugs and proteolytic enzymes (mucolytics), is also considered quite effective.

When is surgery necessary?

Unfortunately, not always conservative means help eliminate exudative otitis media. Treatment in such cases is carried out with surgical intervention. Today, there are many therapeutic methods, ranging from a one-time removal of exudate from the ear cavity to extensive surgery involving neurosurgeons.

However, most often the patient undergoes middle ear bypass surgery. The eardrum is cut and a special shunt is inserted through it, which remains in the ear for several months. Similar procedure promotes aeration and removal of exudate, and also makes it possible to quickly and painlessly administer medications directly into the tympanic cavity.

Exudative otitis: how to treat using traditional medicine?

Of course, there are many non-traditional methods of treating inflammatory processes in the ear. So how to eliminate exudative otitis media? Treatment with folk remedies is only possible with the help of a doctor, since inept use of medications can lead to the development of complications.

Some healers recommend using chamomile decoction, in which you need to moisten a cotton swab and then inject it into the ear canal. It is advisable to carry out the procedure at night. This remedy helps relieve the inflammatory process and facilitate the discharge of exudate.

Can be cooked ear drops from mint. Two tablespoons of fresh crushed peppermint leaves should be poured into a glass of vodka and left to infuse for a week. Then the tincture needs to be strained. Place three drops in each ear several times a day (at intervals of three hours).

Chronic form of otitis

Most often, the chronic form develops against the background of acute exudative otitis media. A chronic process is said to exist if the disease cannot be eliminated within the first eight weeks. The causes and symptoms of chronic aseptic inflammation are approximately the same as in the acute form. It is worth noting that not in every case it is possible to completely restore the hearing of a patient with a similar diagnosis - some changes are already irreversible.

What complications are associated with the disease?

Unfortunately, the lack of therapy leads to extremely unpleasant complications:

The eardrum may retract, a condition medically called atelectasis.
A common complication is atrophy of the eardrum, in which it becomes very thin and loses its basic functions.
Much less often, the disease is associated with perforation of the membrane, which naturally leads to disruption of normal functioning hearing aid.
As a complication, the patient may develop adhesive otitis media, which is accompanied by scarring of the eardrum, atrophic change auditory ossicles and the proliferation of fibrous tissue inside the tympanic cavity.
As mentioned earlier, the disease often ends in the development of hearing loss.

Are there effective prevention methods?

Unfortunately, there are no effective means that can protect a child or adult from developing such a disease. Nevertheless, doctors recommend prompt treatment of all inflammatory diseases of the ears and upper respiratory tract, as well as the use of appropriate means to relieve allergic reactions - this will help reduce the risk of developing such a disease.

In addition, after a cold or catarrhal otitis, you need to carefully monitor changes in the child’s behavior. If you notice a decrease in hearing (for example, your baby begins to turn up the volume when watching TV or listening to music), you should be examined by an otolaryngologist. Exudative otitis media of the middle ear can be extremely dangerous.

syl.ru

Causes, symptoms and treatment of exudative otitis media

One of the diseases of the middle ear is called exudative otitis media. The name of the disease is associated with the fluid or exudate. Fluid enters a person's middle ear from external environment and becomes an excellent environment for the development of bacterial infection. During development, the number of viruses in the exudate increases, the liquid begins to thicken and turns into pus. This becomes very dangerous for humans. In addition to suppuration, exudative otitis media can cause severe thickening of the fluid and the formation of a saline solution.

Exudative otitis media can develop as an independent disease, or it can become a complication of other types of otitis, such as catarrhal. If left untreated, exudative otitis may turn into more serious form diseases - purulent otitis media.

Each person's middle ear contains a small amount of serous fluid, which, if functioning properly, should be drained through the auditory tube. Exudative otitis media occurs when the functioning of the auditory tube is disrupted, an infection enters the ear, or the amount of fluid exceeds the norm.

This disease has several forms: acute, subacute and chronic.

Causes of exudative otitis media

Impaired patency of the auditory tube and increased secretion of serous fluid and mucus can occur for a number of reasons.

The main cause of exudative otitis in people is past infectious diseases, which cause the development of viral and bacterial flora and its entry into the area of the inner ear.

Exudative otitis often occurs during the period of hypovitaminosis and reduced immunity of the population, which is observed in late winter and early spring. A decrease in the body's natural defenses allows bacteria to easily enter the human body, especially the ears. Over the course of several weeks, the infection actively multiplies and “saturates” the serous fluid of the middle ear, after which the disease occurs.

Signs of exudative otitis may occur with mechanical damage to the middle ear. Inflammation can occur due to a blow, puncture, or an object entering the ear from outside. Bacteria that were on an object or entered the ear during injury lead to the rapid development of the disease. In some cases, exudative otitis may develop when swimming in a pool, especially in open water. Therefore, it is not recommended to swim in rivers and lakes if you have frequent ear and throat diseases, a runny nose, recent infectious diseases, or low immunity.

Statistically, children are more likely to suffer from ear infections than adults. This is due to the low resistance of the child’s body to various infections. Children are more likely to experience various allergic reactions; they react more sharply to poor environmental conditions and a low standard of living.

Bilateral exudative otitis media can develop against the background of an adenoviral infection, which is accompanied by adenoids. Adenoids also explain high level morbidity among children. Nasal polyps become an ideal environment for the development of bacteria; in addition, adenoids fill the nasal passages and complicate the exit of exudate. With allergic rhinitis and a constantly stuffy nose, removal of the adenoids can cause infection to enter the middle ear, including its movement from the inflamed areas of the larynx, nose and tonsils. Exudative otitis media and adenoids must be treated comprehensively.

Symptoms of exudative otitis media

It is very difficult to diagnose this otitis media at the very beginning of the development of the disease. The clinical picture is quite unclear, especially in a child who cannot clearly explain what is happening to him.

The first symptoms of the development of exudative otitis media:

hearing loss, the occurrence of hearing loss, during the initial stage of the disease this symptom is almost invisible;
there is a feeling that the ear is blocked;
there is a feeling of “gurgling”, liquid in the auditory tube, intensifies when turning, shaking the head, jumping;
upon visual examination, the eardrum has a nonspecific bluish color;
as the disease develops, the fluid in the ear begins to thicken and forms a sticky exudate, which does not flow from the auditory tube, but stretches like a thin thread;
ear congestion causes incorrect sound perception, first of all, of your voice;
nasal congestion and rhinitis occurs;
All of the above symptoms can cause young children to feel restless and may have trouble sleeping or eating.

In the absence of treatment, towards the final stage of the disease, the fluid practically ceases to be released, exudative otitis media takes on a chronic form, which is complicated by permanent hearing loss.

Chronic form of exudative otitis media

With chronic exudative otitis media, the quality of a person’s hearing is significantly reduced, and sounds change. In this case, hearing loss may progress. Chronic rhinitis may develop.

In addition, in the chronic form of the disease, constant feeling distension in the damaged ear tube, as well as the occurrence of an incomprehensible noise, which intensifies when the head is tilted.

The stage of chronic exudative otitis begins two months after the onset of the acute form of the disease. Most often, this form develops in children of kindergarten age, since it is very difficult to diagnose the disease in its acute form. Exudative otitis in children in a chronic form develops in approximately every fifth case of the disease. In adults, the chronic form appears in the absence of treatment or with repeated illness.

The danger of chronic exudative otitis media:

in young children it can not only reduce hearing, but also cause a disruption in the normal development of speech and understanding of words and phrases;
promotes development serious illnesses nasal sinuses (chronic rhinitis, sinusitis, sinusitis, nasopharyngeal tumors);
a violation of the structure and curvature of the nasal septum may occur;
causes a predisposition of the body to various infectious diseases that affect the nasopharynx (tonsillitis, pharyngitis, tonsillitis and ARVI);
mastoiditis may develop - inflammation of the mastoid process of the temporal bone of the skull.

Chronic exudative otitis requires more serious treatment than the acute form of the disease.

Treatment of exudative otitis media

Diagnosis of exudative otitis media includes acoustic diagnostics of hearing and visual examination by an otolaryngologist. Upon examination, the eardrum is distinguished by a blue tint and surrounded by viscous exudate. X-rays and CT scans of the temporal part of the head may be prescribed as additional diagnostic tools. If the cause of the disease is an infectious disease, it is necessary to undergo a general blood test for ESR and the number of leukocytes in the blood.

Before treating exudative otitis, it is necessary to exclude all its causes: completely cure ARVI, get rid of adenoids and inflamed tonsils, increase the level of immunity.

If otitis is complicated by rhinitis or sinusitis, it is necessary to sanitize the nasopharynx to avoid re-infection. The condition of the nasal septum is also diagnosed. When treating otitis media, it is very important to restore correct breathing in the nose.

To reduce hearing loss, excess exudate is removed from the auditory tube. Such an operation can be carried out using the following methods:

electrical stimulation or electrophoresis;
laser therapy;
ultrasound;
the effects of magnetic therapy.

For a bacterial infection, medications can be administered into the cavity of the auditory tube: steroid drugs and antibiotics. If the cause of the disease is an allergy, it is necessary to take a course of antihistamines.

In children, treatment can be done with surgery. During the operation, a special shunt is inserted into the cavity of the ear canal, which cuts the eardrum. This element remains in the auditory tube for a month and serves as a tool for administering medicine and freeing the tube from excess thickened liquid.

Treatment of exudative otitis media must necessarily be accompanied by the use of vitamin complexes. They must contain vitamins A, B and C, as well as the microelement sulfur.

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Otitis media - symptoms and treatment

Thanks to the hearing organs, a person has many possibilities. He enjoys the beautiful facets of life: listens to music, birdsong and the sound of the sea, hears the voices of loved ones, taking it for granted. Do you know what can cause inflammation of the hearing organs and, as a consequence, a temporary decrease or even complete loss of hearing? In this article you will learn everything about otitis media - symptoms and treatment of this disease using traditional and traditional medicine. You will understand how to effectively cope with such a disease and quickly get back into shape.

Symptoms of otitis media

Otitis media is an inflammatory infectious disease, which is often a complication after a cold, sore throat or flu. When the nasal mucosa is infected with viruses or bacteria, these pathogens from the nasopharynx through the Eustachian tube can enter the cavity of the middle ear. An infection develops in this area, causing incredibly painful sensations. Depending on which ear hurts, right-, left-sided or bilateral otitis is diagnosed. Doctors distinguish three stages of this inflammation. Let's look at their symptoms.

Exudative

This is the initial phase of inflammation. Exudative otitis media is often also called catarrhal; it has the following symptoms:

the ear is blocked, pressure is felt in it, because fluid collects in the middle section, which cannot flow normally from the cavity;
pain shoots through the head, teeth, temple, worsens at night;
body temperature rises to 38-39 degrees;
noise in the ears, hearing deteriorates;
Dizziness and coordination problems are possible.

Sometimes in the middle ear there is an accumulation of non-purulent serous fluid without a clear manifestation of inflammation. In such cases, serous otitis media is diagnosed. It occurs due to dysfunction of the Eustachian tube. The natural removal of fluid from the ear cavity worsens. This disease is sluggish and does not cause acute painful sensations, but if you notice noise in your ear and a decrease in hearing acuity, you need to consult a doctor to stop progressive hearing loss.

Acute

If catarrhal otitis media is not treated in a timely manner, the disease develops into a form of purulent inflammation. The fluid collecting in the cavity becomes more and more, it puts pressure on the eardrum. The patient has the following symptoms:

soreness increases, fever rises;
pallor, weakness in the body due to intoxication;
perforation occurs - a rupture of the eardrum, and pus begins to flow out into the auricle.

Chronic

After perforation, ear pain decreases and body temperature decreases. With the onset of relief, treatment cannot be stopped so that purulent otitis media does not progress to the chronic stage. With this outcome, the disease will periodically become more active as immunity decreases. This form does not cause severe pain, but discharge appears constantly or periodically from the ear, and patients note a decrease in hearing.

Periodic relapses of chronic otitis media cause the next form of the disease – adhesive otitis media. At this stage, due to disruption of the normal outflow of fluid from the middle ear, adhesions are formed in it, which do not allow the auditory ossicles to move correctly, so the patient feels constant noise in the ears and increasing hearing loss.

Treatment of otitis media in adults

This inflammation is very dangerous due to its complications (from hearing loss to purulent meningitis), therefore, otitis media - its symptoms and treatment should be determined by a doctor. For a successful recovery, it is necessary to treat the infectious disease that provoked the development of ear inflammation. For this, treatment regimens often include the use of antibiotics, and drops will help relieve painful symptoms. Treating otitis at home with folk remedies also gives good auxiliary results. Let's talk about the use of these methods in more detail.

At home using folk remedies

The very first aid will be this: put a warming bandage with cotton wool on the patient’s ear or wrap him in a woolen scarf. Heat will help reduce pain. To alleviate the condition, the following means are used:

Tampons made from onion slices wrapped in cotton wool are inserted into the ear.
The onion is crushed to a pulp, the juice is squeezed out, which is heated to body temperature. To avoid burns, add a couple of drops of vegetable or butter to this liquid. A swab is moistened with this mixture and used to close the ear canal.
The baked clove of garlic is cooled so as not to burn itself and placed in the ear.

But it is extremely important to understand that the ear can hurt for various reasons and you cannot self-medicate, as this will actually only mitigate the consequences of the infection. The necessary treatment to eliminate the causes of the disease will be prescribed only by an experienced otolaryngologist, who will establish an accurate diagnosis after analyzing existing complaints and examination. Visiting a doctor will protect you from developing complications and deteriorating hearing function.

Drops

When treating otitis media, nasal drops are used as prescribed by a doctor, for example, the drugs Naphthyzin, Otrivin, Nazivin or others. This relieves swelling of the mucous membrane by narrowing the vessels of the nose, and then the liquid can be removed from the ear cavity into the nasopharynx. It is important to know that these medications should not be used for more than a week so as not to cause addiction.

Alcohol-based anti-inflammatory ear drops, such as Oticaine, Otipax, Droplex, contain lidocaine to relieve acute pain. If the causative agent of the infection is determined by analysis of the fluid secreted from the ear, drops with targeted spectrum antibiotics are prescribed, which are effective in combating these microorganisms.

Antibiotics

These drugs are prescribed when the treatment of otitis media in adults is acute stage doesn't bring desired result. In this case, the patient develops intoxication of the body. Broad-spectrum drugs are used, for example, Amoxicillin tablets. For comprehensive treatment, physiotherapy is used. It is aimed at strengthening the immune system, helping to improve blood supply to the inflamed area and reduce swelling of the ear. Using alternating air pressure, the eardrum is massaged to prevent the occurrence of adhesions in the middle ear.

Treatment in children

Children suffer from otitis media much more often, because they are more susceptible to colds than adults, and their Eustachian tubes are narrower. For treatment, nasal drops (Naphthyzin, Nazol, Galazolin, etc.) and ear drops (Otipax, Sofradex, etc.) are used. Antibiotics for otitis media in children are used strictly under medical supervision. We emphasize that if a child is suspected of having otitis media, its symptoms and treatment should be determined by an otolaryngologist. This way, time will not be wasted and every chance will be taken to prevent hearing loss or other complications from developing.

Video: what is otitis media

To understand the mechanism of inflammatory processes in the ear and why infection often affects the middle part of the ear, watch a short video. The video clearly shows the structure of the organ. You will see which parts of it become inflamed during otitis media, and why temporary hearing loss is possible during the disease. Don’t forget that when treating your hearing organs, you need to see an ENT specialist to prevent irreversible complications!

Exudative otitis media (EO) is a non-purulent ENT disease characterized by the accumulation of fluid (serous exudate) in the tympanic cavity. The clinical manifestations of the disease are mild, which is due to the absence of pathological flora in the affected tissues and perforations in the eardrum. Serous exudate contains a lot of protein, so over time its consistency becomes thicker, which complicates the evacuation of fluid from the ear cavity.

A distinctive feature of middle ear catarrh is its painless course. In 70% of cases, patients turn to an otolaryngologist when infectious and inflammatory processes develop in the mucous membranes of the mastoid process and the tympanic cavity, which are accompanied by “shooting” pain and perforation of the ear membrane.

There are many reasons for the development of sedative otitis media, which are conventionally divided into two categories: local and general. The former include dysfunction of the Eustachian tube, which occurs as a result of its mechanical damage or hypertrophy of the pharyngeal tonsils. As a result, the drainage and ventilation functions of the tube are disrupted, which leads to the appearance of negative pressure in the ear cavity and, accordingly, the formation of an excess amount of serous content in the middle ear.

Common causes of serous otitis media include:

infectious diseases;
endocrine disorders;
decreased body reactivity;
eustacheitis and adenoiditis;
allergic reactions.

In 30% of cases, the development of ENT pathology in children is facilitated by an adenoviral infection, which affects the mucous membrane of the nasopharynx and the mouth of the Eustachian tube.

The development of pathology is caused by impaired ventilation of the ear cavity, which leads to the appearance of a low vacuum in it. Negative pressure stimulates the activity of goblet cells located in the mucous membrane of the ear. This leads to hypersecretion of serous exudate, which over time becomes sticky due to the increased protein content.

In the mechanism of development of exudative otitis, a key role is played by poor emptying of the ear cavity, which is associated with obstruction of the Eustachian tube. Its blockage may be due to obstruction of the mouth by adenoid vegetations, the formation of benign or malignant tumors in the nasopharynx, hyperplasia of the tubal tonsil, or allergic tissue edema.

IN in rare cases Catarrh of the middle ear occurs due to a decrease in the turgor of the tissues lining the inner surface of the Eustachian tube. Their inelasticity leads to a narrowing of the diameter of the tube, which can lead to the formation of low pressure in the ear cavity.

Stages and forms of otitis

Untimely treatment of acute non-infectious inflammation causes the development of chronic exudative otitis media. Ear pathology is practically asymptomatic, which is due to the absence of local manifestations of the disease. Depending on the location of the inflammation, otitis media is divided into two types:

unilateral - one-sided non-infectious inflammation of only the right or only the left ear;
double-sided – catarrh in both ears.

According to statistics, left-sided or right-sided exudative otitis media develops only in 10% of cases. Often, inflammatory processes occur in both ears at once.

If you do not receive treatment in a timely manner, exudative otitis may develop into diffuse otitis, which entails the development of sound-conductive hearing loss.

During the development process, the disease goes through several main stages, namely:

Diagnosis of the disease is often random, so the appearance of the slightest signs of pathology (congestion, autophony, hearing loss) is a reason to undergo examination by an otolaryngologist.

Diagnostics

To diagnose ear pathology, an audiological examination is performed, through which the type of disturbance in the transmission of sound signals by the auditory ossicles is determined. In case of a recurrent course of the disease, a computed tomography is required, which makes it possible to determine the level of accumulation of serous effusions in the ear. During a medical examination, a specialist performs the following types of procedures:

otomicroscopy - examination of the ear cavity using a microscope, which allows one to determine the degree of retraction of the smart membrane into the cavity of the middle ear;
audiometry – a method for determining the sound sensitivity of the hearing aid to waves of different lengths (frequencies);
acoustic reflexes - a way to determine the degree of resistance of ear structures to very loud sounds;
endoscopy – assessment of the visual condition of the retropharyngeal opening of the Eustachian tube;
tympanometry – determination of the level of mobility of the ear membrane and auditory ossicles.

If bilateral exudative otitis is diagnosed in time and adequate treatment is prescribed, pathological processes in the ear cavity can be eliminated within 10-12 days. Ignoring the problem leads to persistent hearing loss, which is caused by the occurrence of adhesions on the auditory ossicles and eardrum.

Basic principles of treatment

The treatment tactics for ENT diseases are determined by the stage of development of inflammatory processes and the presence of morphological changes in the affected tissues. Non-advanced forms of ear pathology are amenable to drug treatment. To eliminate swelling of the mucous membranes and restore the ventilation function of the Eustachian tube, decongestants and mucolytic drugs are used. The former relieve swelling, and the latter dilute effusions in the ear, which facilitates their evacuation.

In the case of a bacterial or fungal infection, middle ear catarrh is treated with antibiotics and antifungals of the penicillin and cephalosporin series. They stop inflammation and inhibit synthesis cellular structures pathogens, which leads to a decrease in their numbers.

If drug treatment is ineffective, physiotherapeutic procedures are prescribed. Most of them are aimed at improving tissue trophism and accelerating their regeneration processes. This helps eliminate inflammatory processes and, accordingly, increase the internal diameter of the Eustachian tube.

Surgical treatment of bilateral exudative otitis media is prescribed only when purulent-destructive changes occur in the tissues of the mucous epithelium. Puncture of the eardrum followed by suction of purulent contents helps eliminate inflammation and further spread of lesions into the inner ear.

Surgical intervention is fraught with the formation of adhesions in the ear, which affect hearing acuity. Therefore, surgical intervention is resorted to only in extreme cases.

Features of pharmacotherapy

In more than 50% of cases, non-purulent inflammation of the middle ear is aseptic in nature, therefore, when using pharmacotherapy, it is not always advisable to use antibiotics. In the absence of pathogenic bacteria in the serous exudate, their use will lead to a decrease in local immunity. But if the disease develops as a complication general infection, fungus or bacteria are usually found in effusions.

To relieve symptoms of pathology and eliminate inflammatory processes, the following types of pharmaceuticals are used:

The drug treatment regimen for non-suppurative otitis media should be determined only by a specialist after an appropriate examination. Self-medication or unreasonable cessation of therapy can lead to the development of complications.

What is exudative otitis and how to treat it?

Exudate is a liquid that, for various reasons, is released from small blood vessels into the tissues and cavities of the body. In the case of otitis media, exudation occurs into the tympanic cavity. The exudate in otitis media includes red blood cells, platelets, leukocytes and proteins, including a significant amount of fibrin.

Anatomically, the Eustachian tube plays a decisive role in the development of the disease. This organ connects the tympanic cavity with the nasopharynx, performs the drainage function of the tympanic cavity, and maintains pressure in it equal to atmospheric pressure, which is critical for the operation of the apparatus that transmits sounds from the eardrum to the inner ear.

Exudative otitis media in adults

Exudative otitis media is a long-term pathological process in the middle ear. The full cycle from the onset to the formation of irreversible hearing loss takes about 2 years. Long duration of disease progression increases the chances of cure, even if time was lost initially.

The cause of the exudative form of otitis media is a chronic inflammatory process or acute viral disease of the upper respiratory tract. Since the spread of inflammation in the middle ear begins from the auditory tube, factors that predispose to the reflux of the nasopharyngeal environment into the auditory tube are of paramount importance in the development of the disease. These include:

Anatomical features of the nasal cavity
Neoplasms in the nasopharynx
Reduced immunity
Cold weather

At the first stage, which is also called catarrhal otitis or tubo-otitis, the entry of a pathogenic medium into the Eustachian tube leads to its swelling and narrowing of the lumen.

Under normal conditions, the entrance to the auditory tube is closed. When swallowing, a temporary opening of the entrance occurs, due to which air rises through the pipe, and, reaching the tympanic cavity, equalizes the pressure in it relative to that which exists on the other side of the eardrum - in the outer ear. Anyone can hear the penetration of air into the eardrum by the characteristic internal sound that appears as a result of the tension of the eardrum.

With catarrhal edema, the above mechanism stops working. The walls of the pipe are narrowed so much that they poorly or do not allow air into the tympanic cavity. Symptoms of the first stage of exudative otitis media:

Itching in the nasopharynx and ears
Ear congestion
Sneezing and blowing your nose improves hearing
Staying in cold air worsens congestion
A runny nose is a common background symptom of the catarrhal stage

Treatment of the exudative form of otitis at the initial stage is aimed at restoring the patency of the Eustachian tube and preventing the reflux of pathogenic media from the nasopharynx. Of primary importance are:

Therapy and cleansing of infectious foci of the nasal cavity, sinuses, inflammation in the oral cavity and pharynx.
Correction of anatomical defects of the nasopharynx.

At this stage use:

Vasoconstrictors (eg, Galazolin)
Drugs that improve the flow of mucus from the tube (eg, Rinofluimucil)
Immunostimulating agents (eg, IRS-19)
Anti-inflammatory drugs (eg, fenspiride)
Antibiotics – in cases probable occurrence inflammation
Blowing and other physical procedures (electrophoresis, laser therapy, electrical stimulation, etc.)

A positive response to the therapy allows you to avoid the transition of tubo-otitis to the chronic stage. It is very important to achieve a cure at this stage.

With further progression, the disease enters the secretory stage, which marks the beginning of liquid effusion (exudate) into the tympanic cavity.

The reason for the transition of exudative otitis media to the stage of secretion accumulation is long-term blocking of the Eustachian tube due to severe swelling of its walls. On the one hand, this leads to a thinning of the air in the tympanic cavity, and on the other, to swelling of its mucous membrane. Both factors individually and in combination stimulate the process of exudation.

The symptoms of the first stage of otitis media in exudative form are superimposed on those characteristic of the secretory phase of the disease:

Feeling of heaviness and pressure in the ear
Sensation of fluid and its “fluctuating” in the ear
Significant hearing loss

A decrease in pressure in the tympanic cavity and excess pressure in the ear canal causes retraction of the eardrum into the middle ear and curvature of its plane. At the same time, this leads to a deformed position of the malleus relative to the incus. Taken together, these factors lead to two consequences:

Chronic hearing loss.
Increased risk of cholesteatoma formation.

Conservative treatment used at the catarrhal stage of the disease is also used in the secretory phase. If it is impossible to normalize the functioning of the Eustachian tube, they resort to puncture of the eardrum, suction of fluid from the tympanic cavity or shunting it - deeper cleaning with pumping medications into the ear.

If the fluid has not been pumped out of the middle ear cavity within a year from the beginning of exudation, it begins to acquire a thick, sticky consistency. The disease progresses to the mucosal stage, during which hearing decreases significantly.

After another year, the exudate becomes so thick that the formation of adhesions, hard compactions, and fibrosis begins in it, which, among other things, lead to immobilization of the auditory ossicles and deafness.

At the mucosal and fibrotic stages, conservative treatment is not effective. Complete suction of the contents through the puncture is also not possible. Treatment of exudative otitis media at these stages involves opening the eardrum and thoroughly sanitizing the middle ear cavity.

Exudative otitis in children

The dynamics and nature of the course of otitis with exudative effusion do not differ from those that apply to adults. Some points you should pay attention to:

Absence pain symptom often does not allow timely diagnosis of this type of otitis in children. The child does not always complain of dullness of hearing. Parents should be attentive and pay attention to the state of hearing, especially during periods of respiratory diseases.
Since a timely and high-quality immune response to the penetration of a pathogenic environment into the Eustachian tube is a key factor protecting against otitis media, insufficient “training” of children’s immunity makes the risk of developing this disease in children significantly higher.
The likelihood of otitis media in children is higher than in adults, also due to the relatively short length of the Eustachian tube.

Treatment of exudative otitis in children is similar to that described above.

Prevention

Preventive measures should be aimed at increasing immunity and include:

Physical activity
Proper nutrition
Vitamin intake
Quitting smoking, which reduces local immunity of the nasopharynx

With an individual tendency to colds it is necessary to avoid hypothermia, do not go outside after visiting the bathhouse, taking a bath, or swimming in the pool.

Exudative otitis: symptoms and treatment

Exudative otitis - main symptoms:

Nasal congestion
Ear congestion
Hearing loss
Echo of your own voice in your head
Feeling of splashing water in the ears
Impaired perception of sounds
Heaviness in the ear

Exudative otitis is a pathology of the middle ear that occurs without pronounced signs of inflammation, but with the formation of first serous and then purulent exudate in the cavity. This pathology is a type of otitis media, but occurs without severe symptoms and with characteristic changes. Exudative otitis media is the most common - it affects mainly young children (up to 7 years - 60% of cases, from 10 to 15 years - 10% of cases).

So, the diseases that can lead to the development of this pathology are the following:

In addition, a common cause of the development of a disease such as exudative otitis media in children is physical pressure, for example, water getting into the ear.

The most important symptoms characterizing acute exudative otitis media are:

feeling of stuffiness in the ear;
impaired perception of sounds (if otitis media develops in a small child, parents notice that he does not respond to their call the first time);
nasal congestion.

Pain is usually absent with this form of otitis or is expressed briefly and mildly. If the disease in a child or adult is not treated, then after a couple of years stable hearing loss develops.

Note that exudative otitis media has three stages and can be:

Diagnostics

The diagnosis of exudative otitis media is made based on the child’s complaints and examination of the patient using an otoscope. X-rays, CT scans of the ear, and endoscopy are also indicated - the choice of diagnostic method is determined by the attending physician.

Treatment of this pathology in a child or adult can be conservative or surgical. Conservative treatment consists of the use of certain medications:

vasoconstrictor drops to facilitate breathing through the nose;
mucolytic agents for thinning mucus;
antiallergic drugs to relieve swelling;
antibiotics to eliminate the attached infection.

Treatment also involves taking vitamins to restore and strengthen the body’s protective functions.

If you think that you have Exudative otitis media and symptoms characteristic of this disease, then an otolaryngologist can help you.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Otitis media exudative

Or: Secretory otitis media, serous otitis media, non-suppurative otitis media

Symptoms of otitis media exudative

Ear congestion.
Hearing loss.
Ear pain is usually absent or short-lived.
Sensation of fluid transfusion in the ear (usually when the position of the head changes).
Feeling your own voice in your head when speaking.
Possibly difficult nasal breathing, constant or periodic nasal congestion.

Stages of the disease:

initial (catarrhal) - characterized by inflammation of the mucous membrane of the auditory tube, disruption of its ventilation function, reduction or cessation of air flow into the middle ear. This stage is characterized by a feeling of one’s own voice “in the head” and a slight decrease in hearing. Duration - up to 1 month;
secretory - characterized by the accumulation of mucus in the tympanic cavity. The patient complains of a feeling of fullness (heaviness) and pressure in the ear, sometimes noise, and more pronounced hearing loss. There is often a sensation of liquid transfusion (splashing) when the head position changes and hearing improves at this time. Duration - up to 12 months;
mucosal - differs in that the contents of the tympanic cavity become thick and viscous. There is no symptom of fluid movement at this stage, and hearing loss increases. Duration - 12-24 months;
degenerative, or fibrous, is characterized by the fact that mucus production decreases and then stops altogether. Are developing persistent changes eardrum, middle ear mucosa, immobilization of the auditory ossicles and, as a consequence, persistent hearing loss (adhesive otitis media). Duration - more than 24 months.

The main reason is a violation of the drainage and ventilation function of the auditory tube as a result of its inflammation or the presence of mechanical obstacles (for example, adenoids - a pathological enlargement of the nasopharyngeal (pharyngeal) tonsil) from the nose and nasopharynx.
Bacterial and viral diseases of the upper respiratory tract (for example, with sinusitis (inflammation of the paranasal sinuses)).
Diseases of the auditory tube (for example, eustachitis).
Often acute exudative otitis media occurs in combination with the common cold, accompanied by severe runny nose. As a rule, it ends on its own when the function of the auditory tube is restored (after nasal breathing is normalized).
Pathology of the nasopharynx - adenoids, enlarged tubal tonsils, benign and malignant tumors etc.
Allergies.
Pathologies of the structure of the nose (for example, deviated nasal septum).
Chronic rhinitis.
Autonomic dysfunction (functional disorder of the nervous system, which controls the work of internal organs, which entails disruption of their work).
Undertreated acute otitis media.
Immunodeficiency (pathological conditions accompanied by a significant decrease in immunity (the body's defenses)).
Epstein-Barr virus. Infection with herpes of this type is possible by any of the existing methods: airborne droplets, through dishes and common hygiene items, through kissing, sexual contact, etc.
Assumes availability genetic predisposition(the disease occurs within the same family).
Old age.
Intubation (insertion of a special tube into the larynx and trachea when they are narrowed, threatening suffocation).
Nasal tamponade (a method of stopping incessant nosebleeds).

Predisposing factors may be:

smoking or secondhand smoke;
inhalation of polluted, gassed environmental air.

An ENT doctor (otolaryngologist) will help in treating the disease

Diagnostics

Analysis of complaints and medical history: ear congestion, hearing loss, possible short-term pain in the ear; a history of nasopharyngeal pathology, nasal breathing disorders, bacterial and/or viral diseases of the upper respiratory tract, exacerbations of allergies, etc.
Otoscopic examination (examination of the external auditory canal and eardrum using an ear specula or otoscope), otomicroscopy (examination of the ear using a microscope): the eardrum is pinkish to bluish, may be cloudy, retracted or bulging, its mobility is limited, it can show the liquid through (its level or air bubbles are noticeable).
The mobility of the eardrum is examined using the Valsalva maneuver or Siegle's funnel.
Hearing examination using tuning forks.
Audiometry is a method for measuring hearing acuity and determining auditory sensitivity to sound waves of various frequencies.
Tympanometry is the study of the mobility of the eardrum and the conductivity of the auditory ossicles. Exudative otitis is characterized by a decrease in the mobility of the eardrum as a result of the accumulation of fluid behind it.
Acoustic reflexes are based on recording changes in the resistance of the structures of the outer and middle ear, caused by loud sounds, during contraction of the stapedius muscle.
Endoscopy of the pharyngeal opening of the auditory tube - visualization of narrowing of the opening of the auditory tube, other pathologies of the nasopharynx (adenoids, tumors, etc.).
Computed tomography (CT) of the temporal bone is prescribed in diagnostically difficult cases (as a rule, this procedure is not required). Radiographs visualize the airiness of all cavities of the middle ear, the condition of the mucous membrane, and the chain of auditory ossicles. The presence of pathological contents, its localization and density.
Diagnostic tympanocentesis is a puncture of the eardrum in order to collect the contents of the tympanic cavity for analysis for further diagnostics. In most cases, paracentesis of the eardrum is performed. This procedure involves creating a hole (larger in diameter than with tympanocentesis) in the eardrum using a special instrument; if necessary, a shunt (a thin tube through which fluid drains from the middle ear cavity) is inserted into it.

Treatment of exudative otitis media

First of all, nasal breathing is restored: correction of a deviated nasal septum, treatment of sinusitis, runny nose, diseases of the nasopharynx, etc.
Prescribing antibiotics ( antimicrobials), for example, with sinusitis.
Prescription of antiallergic drugs (if the cause of the disease is an allergy).
Mucolytics are medications that dilute exudate (accumulation of pathological fluid, mucus) in the tympanic cavity and facilitate its removal.
Vasoconstrictor nasal drops for a short course (no more than 7 days).
Ear blowing is the introduction of air under pressure through the auditory tube into the tympanic cavity.
Catheterization of the auditory tube - the introduction of drugs into the auditory tube from the nasopharynx through a special catheter to relieve swelling and improve the outflow of exudate .
Physiotherapy - intra-ear electrophoresis with anti-inflammatory drugs.
Prescribing multivitamins.
If there is no effect from the treatment, fluid from the ear is sucked out through a special puncture in the eardrum (tympanopuncture).
With a long course of the disease, with viscous exudate, the effect of tympanocentesis may be insignificant or absent altogether. In this case, long-term drainage (removal of fluid) from the middle ear is carried out, the so-called shunting: under the control of a microscope and local anesthesia, a small Teflon tube (shunt) is installed into the eardrum, through which the accumulated fluid drains out; it is also possible to introduce medicinal substances into the eardrum through the shunt. middle ear cavity. After the shunt is removed, the hole in the membrane usually closes completely.

Complications and consequences

Persistent changes in the eardrum, mucous membrane of the middle ear, immobilization (immobility) of the auditory ossicles, as a result, persistent hearing loss - the formation of chronic adhesive otitis media.
Purulent otitis media.
Formation of retraction pockets (persistent retraction) of the eardrum towards the middle ear .
Persistent perforation (formation of a pathological hole) of the eardrum.
Formation of cholesteatoma (a cavity containing dead epithelial cells and a mixture of other substances, surrounded by connective tissue in the form of a capsule).
Toxic effect on the inner ear - progression of hearing loss due to decreased function of auditory receptors.

Prevention of exudative otitis media

Timely treatment of diseases that predispose to the development of exudative otitis media (sinusitis, inflammatory diseases of the upper respiratory tract, allergies, etc.).
Timely detection and treatment of colds and infectious diseases.
If you have any ear pain, hearing loss, or a feeling of stuffiness in your ears, you should immediately contact an otolaryngologist.

Additionally

Over time, the accumulated fluid in the middle ear cavity turns into thick mucus, which can fester, making it difficult for the auditory ossicles to function. With a long course of the disease, exudate can have a toxic effect on auditory receptors, thus disrupting not only sound transmission, but also sound perception.

As a result of these changes, a persistent decrease in hearing function develops.

What is exudative otitis media: symptoms, signs, treatment

Exudative otitis is an inflammatory disease of the ear, characterized by the presence of fluid (transudate) inside the middle ear. Clinical symptoms of the nosology: increasing hearing loss, mild pain, redness of the eardrum.

Exudative otitis: symptoms

Symptoms of exudative otitis media depend on the stage:

Primary (initial manifestations);
Secretory (epithelial metaplasia, goblet cell activity);
Degenerative (adhesive process, decreased secretion).

Pathogenetic classification of inflammation of the middle ear:

Catarrhal degree is characterized by superficial inflammation of the epithelial membrane. There are no specific symptoms of the disease.

The secretory stage is characterized by increased activity of goblet cells. Mucus accumulates inside the tympanic cavity. The addition of bacteria promotes the formation of transudate.

The mucous form is accompanied by the penetration of leukocytes, lymphocytes, platelets with the formation of connective fibers.

Fibrinous appearance is the appearance of scar tissue inside the middle ear.

Exudative otitis media is often observed in children. Minor inflammatory changes are asymptomatic. Hearing loss increases slowly.

Adhesive processes inside the tympanic cavity disrupt the mobility of the auditory ossicles. The condition is irreversible.

Otitis media in a child is detected in the mucosal or fibrinous (adhesive) stage, when serious complications arise.

Hearing loss in children is noticed after the age of 3, when the baby cannot hear normal speech.

Symptoms of infectious exudative otitis media are treated with antibiotics. Taking medications begins from the pre-perforation stage. The most common drug of choice is amoxicillin (0.5 grams three times a day). The course of treatment for exudative otitis media lasts 10 days. The antibacterial drug should be replaced with another analogue if there is no effectiveness for 3 days. Augmentin (0.625 grams three times daily) or cefuroxime (0.5 grams twice daily) are alternative antibiotics.

Intolerance to beta-lactam antibiotics requires the prescription of macrolides. Complicated forms of exudative otitis media are treated with fluoroquinolones (3-4 generation). The duration of therapy depends on the stage of the disease.

A sharp improvement in the patient's condition is not a reason to discontinue antibiotic therapy. The duration of treatment is 7-10 days. Early cessation of antibiotic therapy leads to repeated relapses of the disease. For pain relief at the pre-perforation stage, it is recommended to use paracetamol (dosage 1 gram 4 times daily). A pronounced analgesic effect is provided by a Tsytovich microcompress containing an alcohol-glycerin mixture. The compress has an analgesic effect. Instead, you can use intra-ear drops based on alcohol, sodium thiosulfate, lidocaine (otipax).

Conservative procedures are effective for uncomplicated inflammation of the middle ear. Complicated types of the disease cannot be cured with medications. In such a situation, paracentesis is performed - an incision of the eardrum to remove pus or transudate. Manipulation reduces intra-auricular pressure. The manipulation is carried out according to emergency indications.

The perforated form of exudative otitis media is accompanied by the discharge of pus. The leaking liquid is removed with a turunda moistened with a 3% solution of hydrogen peroxide. Cotton wool wrapped around the probe helps remove purulent secretions.

Otitis media: symptoms, signs, manifestations

Inflammation of the middle ear occurs in all age groups. The incidence of the disease due to inflammation of the ENT organs is 30%. It is better to treat pathology in the early stages, which will avoid the following complications:

Tubootitis;
Inflammation of the respiratory tract;
Eustachian tube dysfunction;
Ear congestion;
Hearing impairment.

Morphological changes of the ear during otoscopy:

Protrusion of the eardrum;
Protrusion of the bony process;
Shortening of the malleus;
Light cone deformation;
Injection of capillaries of the mucous membrane.

Tubootitis is characterized by a violation of sound conductivity at low frequencies.

Acute ear inflammation is the cause of pathology of the auditory tube. Complications are more pronounced when otitis is combined with inflammatory changes paranasal sinuses nose (sinusitis, frontal sinusitis). Adenoids aggravate the course of nosology in children.

The formation of an exudative reaction leads to the accumulation of serous-mucosal effusion inside the tympanic cavity. The leading pathogenetic link is changes in the drainage and ventilation function of the auditory tube. Increased secretion of mucus is accompanied by the formation of thick secretion. Hearing loss is slowly increasing. The absence of perforation of the eardrum does not lead to the release of pus out. Tubal dysfunction is characterized by changes in immunological reactions and a decrease in overall resistance.

Rarefaction of the transudate, the entry of lymphocytes and leukocytes into the tympanic cavity increases the viscosity of the mucus. Difficulty in the mobility of the auditory ossicles (stapes, incus, malleus) gradually forms deafness. Autophony is characterized by hearing loss. Otoscopically, exudative otitis media is accompanied by the following symptoms:

Gray color of the eardrum;
Vascular sheath injection;
Air bubbles in the cavity.

The increase in exudative fluid increases intra-ear pressure and causes hearing loss. Patients talk about fluid movement within the labyrinth. When changing the position of the head, a person feels a splash inside the ear.

Restoration of ventilation function is accompanied by a violation of tubular function and an increase in intra-ear secretions. With timely treatment, the chronic course of the disease is prevented.

Treatment of otitis media

The treatment tactics for exudative otitis media should be determined based on etiological factor. Diseases are caused by many reasons.

Elimination of tubular dysfunction requires restoration of intra-auricular aeration. Vasoconstrictor drops that relieve intra-ear pressure:

Antihistamines are rational for children:

Preventing the entry of bacteria requires proper nasopharyngeal hygiene. Cleansing of the nostrils is carried out one by one. A rational technique is to blow pipes according to Politzer. The procedure involves catheterization of the inner ear followed by oral administration of dexamethasone or epinephrine.

Physiotherapeutic procedures are useful: membrane pneumomassage, laser therapy, UHF, ultraviolet radiation.

Eustacheitis - inflammatory changes in the Eustachian tube are treated with antibiotics. Amoxicillin has wide range antibacterial action. The drug can be used in children, but has side effects.

Complex therapy of exudative otitis media prevents complications:

Chymotrypsin (proteolytic enzyme);
Antibiotics;
Dexamethasone;
Introduction of proteolytic enzymes;
Electrophoresis;
Vasoconstrictor drugs.

The scheme also includes stimulation of the activity of the ciliated epithelium of the auditory tube and the cilia of the nasal cavity.

The use of antihistamines is rational for allergic conditions. Complex therapy includes the use of B vitamins, anti-inflammatory drugs (erespal, fenspiride), immunocorrectors (polyoxidonium).

If the effectiveness of the above scheme is low, surgical removal of the transudate of the tympanic cavity is performed. A common method is bypass surgery.

Suppurative otitis media requires hospital treatment. Often catheterization of the auditory tube, blowing, and drainage of the ear are performed. Amoxicillin clavulanate, dexamethasone, and other antiseptics are administered through the tube. Catheterization helps to achieve an abortive course of the disease.

Otitis externa: symptoms

The diffuse form of external ear inflammation affects the entire ear canal. Inflammatory process of the eardrum, external auricle provoked by bacteria, fungi, viruses.

Factors provoking external otitis:

Frequent improper toileting of the outer ear;
Reducing sulfur grease;
Long-term use ear drops;
Decreased acid-base balance of the ear;
Heavy sweating;
Burns;
Frostbite;
Insect bites;
Leakage of pus through the membrane;
Using a hearing aid;
Using in-ear headphones.

Symptoms of the chronic form last for several years even with constant treatment.

Early detection of signs of pathology helps prevent complications. Main manifestations of the disease:

Itchy ear;
Pain when talking, eating, pressing on the tragus;
Radiation of pain to the temples;
Hearing loss;
Swelling of the ear;
Increase in temperature;
Hearing loss.

Treatment of inflammation of the outer ear

Otitis externa is treated antibacterial agents by transtympanic injection. The combination of dexamethasone with an antibiotic has a good effect. Long-term therapy of the disease requires the use of proteolytic enzymes - lidase, chymotrypsin, trypsin by infusion into external passage. For injection, 1 ml of solution is enough. The procedure is carried out by pressing the tragus into the ear. The manipulation allows the medicine to be distributed into the eardrum through the membrane.

Not only transtympanic injection, but also catheterization is considered effective treatment.

Thick discharge is eliminated with mucolytic agents (sinupret, fluifort, ACC, fluimucil). The combination of drugs with erespal allows you to relieve swelling and hypersecretion of the mucous membrane. Stimulation of the ciliated epithelium of the auditory tube is carried out using physiotherapeutic methods: laser therapy, microwave, UHF, ultraviolet radiation.

Removal of purulent secretion by infusion into the inner ear of a solution heated to 37 degrees (dioxidine, ciprofloxacin, otofa, rifampicin). Alcohol drops have a warming effect. They help relieve pain and reduce swelling of the mucous membrane.

Otitis externa with suppuration most often stops on its own. The perforative stage ends with the reparative stage with a favorable course of the disease. Self-closing perforation is characterized by a small scar that does not impair hearing. This course of the disease requires the abolition of antibacterial agents.

After the acute stage of the pathology has been cured, it is necessary to monitor the ventilation of the inner ear: Politzer blowing, rinsing through a catheter, administration of enzyme agents, pneumomassage, endural iontophoresis, vitamin therapy, and the use of biostimulants (Tsygapan, Actovegin, Apilak).

The rehabilitation stage requires control audiometry.

Symptoms and treatment of exudative otitis media

There are several types of otitis, but exudative is more common in children. According to statistics, the peak of the disease occurs at the age of 3-7 years. The acute form is found in 60%. By the age of 12-15, this disease is detected in 10%.

Exudative otitis media

This is an inflammatory disease of the middle ear, which is characterized by the appearance of serous-mucous fluid in the ear cavity.

This form of the disease occurs against the background of decreased immunity, allergic diseases, and poor ecology. Its development is often associated with the appearance of an adenoviral infection in the body. Exudative otitis media often occurs during periods of hypovitaminosis.

The body at this moment is most sensitive to various bacteria. Over the course of several weeks, the infection multiplies in and “permeates” all the serous fluid of the middle ear. This leads to the development of the disease.

The physiological cause is obstruction of the auditory tube. It leads to catarrhal eustachitis. The pipe has a small diameter, so it closes due to swelling and inflammation.

The consequence is a disruption of the air supply and drainage of the middle ear. Happening sharp decline pressure, a vacuum is created. In the tympanic cavity, the mucous membrane begins to secrete transudate (edematous fluid). It gradually accumulates, which leads to dysfunction of the auditory ossicles.

Among the reasons leading to the development of the disease are:

swelling on the background of sinusitis,
adenoids,
nasopharyngeal tumors,
deviated nasal septum,
allergic rhinitis,
tuberculosis of ENT organs and some others.

Structure of the human ear

Exudative otitis media comes in several types. Mainly differentiated by the affected part of the ear. Divided into:

The inflammatory process can be triggered by viruses, bacteria, and fungi. Among the factors stimulating the development of the disease are:

reduction of serous lubrication,
long-term use of medications
decrease in acid balance,
insect bites,
using in-ear headphones.

Inflammation can affect the entire ear canal. During the examination, its narrowing and enlargement of regional lymph nodes are detected.

Chronic

The chronic form occurs if treatment was not started in a timely manner and was not completed.

Non-purulent inflammation leads to increasing inflammation of the ear, congestion, and a feeling of fullness on the affected side. Noise appears in the ears, especially worse when moving the head.

The chronic form is said to exist if the disease lasts more than eight weeks. Its main consequence is irreversible hearing loss and delayed speech development in children.

We are talking about an acute form if symptoms and signs persist for up to three weeks. It occurs in three stages. First, superficial inflammation of the epithelium occurs. No special symptoms of acute otitis are detected.

At the secretory stage, goblet cells are activated. Inside the cavity, mucus heats up, which is an excellent environment for the development of bacteria. At the last stage, secretion decreases and an adhesive process is observed.

Middle ear

It can be right-sided, left-sided, double-sided. It often becomes a consequence of diseases leading to the development of negative pressure in the cavities of the middle ligament and the formation of secretions.

There is a disruption of the secretion outflow pathways, especially from the anterior chambers to the nasopharynx. First a vacuum is formed. Oxygen begins to be absorbed, the pressure in the eardrum drops.

Since symptoms in adults are poorly expressed, it is difficult to determine the presence of the disease in a timely manner. The only one sure sign The disease becomes hearing loss, which is accompanied by noise.

The following symptoms may be noticed:

feeling of fullness on one or both sides,
the appearance of a “splash of liquid” inside the ear when changing heads,
nasal congestion,
hearing your voice in your head.

Signs of exacerbation in children

In children, the problem is often not detected in a timely manner, which can lead to third-degree hearing loss. Therefore, it is better to show the baby to an otolaryngologist after suffering from upper respiratory tract diseases. They are the ones that most often lead to problems.

Signs of exacerbation in children include hearing loss. Possible problems with speech. Children more often develop a bilateral form. Children who can speak report noise in the ear.

Body temperature remains at normal levels, but can sometimes be low-grade. The latter is more often observed in the presence of a sluggish infectious process in the nasopharynx.

The eardrum during exudative otitis media when examined with an otoscope

Treatment tactics are aimed at establishing the causes of the disease, carrying out therapeutic measures aimed at restoring ear functions and preventing persistent morphological changes in the middle ear. In some cases, hospitalization is indicated:

if surgical intervention is necessary,
impossibility of carrying out treatment in an outpatient setting.

Medication

Treatment of otitis media is carried out using drops, antibiotics and other medications. Antibacterial drugs for the first few days are prescribed only if a bacterial infection is associated with otitis media.

Doctors and scientists are still arguing about the advisability of using antibiotics to treat this form of the disease. Antihistamines, as well as anti-inflammatory drugs in combination with vasoconstrictors, help relieve swelling of the mucous membrane.

Physiotherapy and other treatments

In addition to drug therapy, physiotherapy is prescribed. Lidase electrophoresis and electrical stimulation of the soft palate help restore the patency of the ear canal. If the disease is detected at an early stage, laser therapy is prescribed.

Babies undergo catheterization and bougienage of the passage. These manipulations allow you to restore the normal functioning of the auditory tubes. If there is no positive effect from the drugs, myringotomy is prescribed.

An incision into the eardrum is made with a sharp needle. Liquid exudate is removed through a small hole. If it is very viscous, make a larger incision. Sometimes a special suction is used.

Shunting the eardrum will help provide ventilation to the ear. A shunt is a tube that is placed in the eardrum. Now there are a large number of doctors opposing this method of treatment, especially in children. The tube can remain in place for a long time, simultaneously performing a drainage function.

Eardrum bypass

Operation, puncture

If the previous methods did not help, tympanocentesis is prescribed. This method allows fluid to drain from the ear cavity. Performed once only to retrieve content. The latter, if necessary, can be sent to additional examination. A tube is also inserted to ensure a regular supply of medication to the affected area.

Surgery is usually performed in people with frequent episodes of significant hearing loss that have lasted for many years. At the same time, the nasopharynx, paranasal sinuses, and tonsils are sanitized.

Traditional methods

Before using traditional medicine methods, it is recommended to consult a doctor. Onions help with the described form of otitis. Its juice is heated in a teaspoon, and then 1 drop is instilled into each ear canal.

You can make tampons with wild garlic or plantain juice. For exudative types of the disease, basil, which has antiseptic properties, is also suitable. The decoction is buried in sore ear, used as lotions.

Complications

The main problem if left untreated will be hearing loss. The chronic form often progresses to the fibrosclerotic stage. Adhesions and cords appear that impair the mobility of the auditory ossicles. This form can lead to mastoiditis.

If the development of the disease occurred in early childhood, then speech impairment and delayed psycho-emotional development are possible.

Consequences

Frequent consequences include the formation of a pathological hole, the formation of a cavity with dead epithelial cells, toxic effects on the inner ear.

Because of this, hearing loss progresses due to a decrease in the function of auditory receptors.

Reviews from Dr. Komarovsky about the treatment of otitis media with antibiotics in our video:

Prevention

It is better to show children to a doctor after any infectious diseases, since exudative otitis media often occurs without pain. This will allow you to start treatment in a timely manner and prevent the development of a chronic form. Doctors remind you that you need to bathe carefully and clean your ears in a timely manner. Hardening and good immunity will help prevent the onset of disease.

Causes of development of exudative otitis media and methods of its treatment

Exudative otitis media is a disease characterized by inflammation of the middle ear and excessive secretion formation. This disorder most often affects children from 7 to 10 years old; this age category accounts for up to 60% of patients.

This type of otitis develops against the background of infectious pathology of the upper respiratory tract. In most cases, the disease has an erased onset, but later the serous exudate can be replaced by purulent. Thus, if the course is unfavorable, the entire ear canal may become clogged.

Symptoms of exudative otitis media

Exudative otitis media is difficult to diagnose in the early stages of its development, since this pathological condition manifests itself sparingly. In most cases, up to 5 years of age, children experience redness of the outer shell with this disease, and in addition, an increase in body temperature, which indicates an inflammatory process occurring in the body.

In young children, this pathological condition causes short-term pain. However, such manifestations are not very typical for this disease. Often, only with a specific study can changes in the mucous membrane of the middle ear and the appearance of fluid - exudate - be detected. Exudative otitis in adults does not lead to severe pain.

The distinctive symptomatology of exudative otitis media is considered to be a dysfunction of auditory perception. Often patients feel slight pressure in the ear. Exudative otitis media is an inflammatory process that over time leads to the following symptoms:

severe hearing loss;
change in perception of one's own voice;
gurgling in the ear;
feeling of fullness;
tinnitus when tilting the head;
crackling in the ear.

IN acute period patients may experience illness slight increase body temperature and the appearance of signs of general intoxication. During this period, the patient may have complaints of fatigue, headaches, mild chills, etc. Later, the characteristic symptoms disappear completely. Without targeted treatment, the disease can cause hearing loss to develop within a few days after its acute onset. From the video you will learn more about the disease:

Diagnosis of the disease

Since exudative otitis media in children often leads to the development of severe complications, if characteristic signs of this disease appear, you should immediately contact an otolaryngologist. This specialist can not only conduct an examination and make a diagnosis, but also prescribe adequate therapy to quickly cure the pathology. First, the doctor examines the outer ear for foreign bodies and collects anamnesis.

A characteristic feature of this pathological condition is the presence of severe deformations, swelling, retraction and clouding of the eardrum. These changes can be detected during otoscopy. If the membrane is very thin, using an otoscope, a specialist can see the accumulated exudate underneath it.

Considering that this inflammatory disease of the ear is often accompanied by signs of hearing loss, the diagnosis of pathology is supplemented by audiometry. This study allows you to determine your hearing level and sensitivity to sounds of different frequencies.

In addition, the eustachian tube is examined to determine its ability to perform a ventilation function. The specialist also studies the level of membrane mobility. These diagnostic methods can confirm the presence of exudative otitis media. In severe cases of the disease, the temporal bone is examined using radiography and MRI. This allows you to identify the presence of complications.

A puncture puncture of the eardrum is often performed to collect accumulated exudate. After this, the resulting content is sent for analysis. In addition, during this procedure, if necessary, a shunt may be placed to ensure rapid drainage of fluid from the middle ear cavity.

Stages of the disease

When considering what exudative otitis is, it is necessary to take into account that this disease can be:

Acute and chronic forms of exudative otitis media can be right-sided or left-sided. The longer patients with this pathology are treated without proper attention from the doctor, the higher the risk of the disease becoming chronic.

According to another classification, there are 4 stages of exudative otitis media:

The initial stage of development of the disease is accompanied by the appearance of an inflammatory process in the Eustachian tube. This leads to impaired ventilation of the middle ear. The duration of this phase does not exceed 1 month. During this period, patients do not experience any symptoms, but there may be a slight decrease in hearing.

The secretory stage of development of the pathological process is characterized by the accumulation of fluid in the eardrum. In this case, hearing loss becomes more pronounced. Some patients feel splashing in the affected ear. The duration of the stage is about 1 year.

The mucous stage of the pathology is characterized by the transformation of the existing exudate into a thick substance. This leads to severe hearing impairment. The duration of the mucosal stage is 1-2 years.

The fibrous stage of exudative otitis is expressed in the complete cessation of mucus production. The processes of destruction of the tympanic cavity are started. This leads to the development of permanent hearing loss. This stage of the disease lasts no more than 2 years.

Causes

The reason for the development of such a pathological condition as exudative otitis media lies in the penetration of bacteria into this area. Most often, the infection ascends through the eustachian tube, which leads to its inflammation and swelling. Subsequently, the bacteria penetrate into the middle ear, where fluid begins to be released, which becomes a medium for pathogenic microflora.

With the development of otitis, accompanied by the release of exudate, immunological aspects are of particular importance. For such a disease to appear, an additional weakening effect on the body’s defense mechanisms is required. Factors contributing to the development of exudative otitis media include:

weakened immunity of any etiology;
cold water entering the ear cavity;
infectious diseases;
pressure changes;
shell injuries;
anatomical defects of the nasal septum;
tendency to allergic reactions;
inflamed adenoids;
passive smoking;
chronic sinusitis;
inflammatory lesion of the nasopharynx.

Often the appearance of exudative otitis is promoted by hypothermia and being outside in the cold without a hat.

Features of treatment

With a disease such as exudative otitis media, symptoms and treatment are almost not interconnected, since the manifestations of the pathology are not very distinct. Only when conducting a comprehensive study is it possible to identify characteristic changes and prescribe adequate therapy. Depending on the existing disorders, treatment of this pathological condition can be carried out using both conservative and surgical methods.

Physiotherapeutic procedures

To eliminate such a pathological condition as otitis media, various methods of physiotherapy are often used. If the patient has rhinitis and inflammation of the ear canal, a procedure is prescribed that involves moving special medicinal compositions through the nasal passages using a rubber bulb. Such washing allows you to eliminate pathogenic microflora and improve the patient’s condition. In the treatment of otitis media, the following physiotherapy procedures are most often used:

electrical stimulation of the soft palate;
lidase electrophoresis;
ultrasound therapy;
magnetic therapy;
laser therapy.

These procedures help eliminate inflammation in the middle ear and suppress infection.

Surgical methods

Treatment of exudative otitis in children and adults is carried out exclusively in severe chronic cases, accompanied by hearing loss over several years.

The most common procedure is to shunt the tympanic cavity for exudative otitis media. This is a minimally invasive surgical intervention that involves the installation of a special tube passing through the eardrum. The tube performs a drainage function in this pathological condition.

In addition, tympanocentesis is often performed. This procedure involves puncturing the eardrum and removing accumulated exudate. This method of surgical treatment is used once.

Drug therapy

Treatment of exudative otitis in most cases is carried out with the help of medications. Drugs have already been developed that can suppress the inflammatory process even in infants. To suppress the infection that caused the development of exudative otitis media, antibiotics are selected. The most commonly used for this disease are:

To thin the mucus and facilitate its removal during otitis media, mucolytics are prescribed. Medicines of this type include Ambrobene and Ambroxol. To suppress the inflammatory process in the middle ear, dimethyl sulfoxide dimexide is used.

Antihistamines are often used to treat this pathological condition. Means of this type include Tavegil and Suprastin. To restore aeration of the auditory tube and increase the outflow of exudate, vasodilators are prescribed, for example Nazivin and Sanorin. In addition, vitamin complexes are introduced into the treatment regimen.

Folk remedies

With a disease such as exudative otitis media, treatment exclusively with folk remedies can be dangerous. Such methods can only be used as an adjunct to drug therapy. Treatment of exudative otitis with folk remedies must be agreed with a doctor. It is safe to use an herbal mixture that includes:

All plant components should be taken in equal proportions. To prepare the product you need to take 1 tbsp. l. vegetable collection and pour 1 cup of boiling water. The resulting mixture must be infused for 8 hours in a thermos. The product should be used ¼ cup 3 times a day.

In addition, when treating exudative otitis media, you can use oil based on Kalanchoe leaves. To prepare such a remedy, you need to thoroughly chop 1 Kalanchoe leaf and pour in 200 ml of sterilized oil. The product must be infused for 1 week. It should be used to wipe the inside of the ear.

How long does the treatment take?

How long therapy for exudative otitis lasts largely depends on the characteristics of the patient’s immunity and the presence of other pathologies. Treatment is carried out at home, but under the supervision of a specialist. With an integrated approach to the treatment of this pathological condition, complete elimination of the inflammatory process can be achieved in 2 weeks. In particularly severe cases, therapy may take several months.

Contraindications for exudative otitis media

If a child feels unwell and has complaints of discomfort in the ear, under no circumstances should oily liquids be used for instillation. This causes the eustachian tube to become clogged. Do not pour into the ear cold water and various aggressive substances, because this will worsen the course of exudative otitis media.

During the acute phase of the disease, it is not recommended to stay outside for a long time, especially in cold weather. Hypothermia can cause a worsening of such a pathological condition as exudative otitis media in children. If you need to go outside, you need to insulate your ears well so that cold air does not get into them.

Avoid getting your head wet and getting water in your ears while swimming. In the chronic form of the disease, it is necessary to block the ear canals with cotton swabs so that water does not penetrate into them while taking a shower.

Prevention

To reduce the risk of developing such a pathological condition as exudative otitis media in a child, it is necessary first of all to protect him from hypothermia. You need to bathe your child in warm water. When walking, your baby should be dressed appropriately for the weather. In addition, it is important to protect him from passive smoking. To reduce the risk of developing pathology, adults need to give up all bad habits.

It is necessary to direct efforts to increase immunity. In the summer, it is advisable to do hardening. In addition, you should maintain your level of physical activity to avoid a decrease in your metabolic rate. You have to stick to the rules healthy eating. This will help strengthen the immune system. It is advisable to take vitamins in spring and autumn. It is necessary to promptly treat any infectious diseases of the upper respiratory tract.

Possible complications

The chronic form of exudative otitis media with an unfavorable course becomes the cause of the development of mastoiditis, i.e. inflammation of the process of the temporal bone. Exudative otitis media can cause the development of cholesteatoma, i.e. thickening of the tissues of the tympanic cavity.

In addition, people suffering from this pathology are at an extremely high risk of thinning and perforation of the eardrum. Hearing loss, hearing impairment and dysfunction of the auditory tube in young children can cause delayed psycho-emotional development.

Disease code according to ICD-10

Exudative otitis media has an international code according to ICD-10 in the classification of diseases - H65.4. If there is severe perforation of the eardrum, an additional code is indicated - H72. Treatment of the middle ear by doctors is prescribed after making a diagnosis and indicating its specific code.

A healthy lifestyle is the best cure for colds and a way to prevent many viral diseases.

Exudative otitis media

Otitis media (secretory or non-purulent otitis media) is 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.

ICD-10 code

Epidemiology

The disease often develops in preschool, less often in school age. Mostly boys are affected. According to M. Tos, 80% of healthy people suffered 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 what is taking place 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 introducing practical healthcare objective research methods (impedansometry, acoustic reflexometry).

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 stage (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 parts of a single process that reflects various stages of chronic inflammation. Among the causes leading to the onset of the disease, most authors focus on the pathology of the upper respiratory tract of an inflammatory and allergic 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.

Endoscopic examination in patients with auditory tube dysfunction 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 turbinate, bypassing the mouth of the auditory tube in front and below; and from the posterior ethmoidal cells and the sphenoid sinus - posterior and superior to 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 mucus flow 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.

For 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. The high density of 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 influence 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.

Symptoms of exudative otitis media

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

What's troubling?

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, various classifications of its stages have been adopted. 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 earlier); 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 foci; mobilization of the auditory ossicular chain.

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

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 observed rarely, short-term.

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 a 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.

Otoscopy at the secretory stage reveals thickening of the eardrum, a change in its color (to bluish), retraction in the upper and bulging in the lower sections, which is considered indirect sign presence of exudate and 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. The long course of exudative otitis media leads to the formation of scars and atelectasis, foci of myringosclerosis.

Instrumental studies

The fundamental diagnostic technique is tympanometry. When analyzing tympanograms, the classification of V. Jerger is used. In the absence of middle ear pathology, 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 significant change pliability. 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 pure 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 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. With acoustic impedancemetry, a type B tympanogram and the absence of acoustic reflexes on the affected side are recorded.

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;). Impedance measurements record a type B tympanogram and the absence of acoustic reflexes.

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 full information about the causes of exudative otitis media. Endoscopy can reveal sufficient great variety 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, the windows of the labyrinth, the chain of auditory ossicles, the bony part of the auditory tube. If there is pathological content in the cavities of the middle ear, its location and density.

What needs to be examined?

How to examine?

Differential diagnosis

Differential diagnosis of exudative otitis media is carried out with ear diseases. accompanied by conductive hearing loss with an intact eardrum. These could 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.

Who should I contact?

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 carrying out 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 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, steroid hormones. They prefer endaural phonophoresis of acetylcysteine (8-10 procedures per course of treatment at stages I-III), as well as mastoid 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. 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. For the treatment of the acute stage, many authors recommend anti-inflammatory (fenspiride), anti-edematous, nonspecific complex hyposensitizing therapy, and the use of vasoconstrictors. 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.

Surgical treatment

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

rapid equalization of tympanic pressure;
rapid evacuation of exudate.

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 bypass surgery 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 ventilation tubes and used the best materials for their manufacture (Teflon, silicone, silastic, steel, gold-plated silver and titanium). Clinical studies, however, did not reveal 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 repeat 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, under the influence of which biological coagulation of the edges of the incision occurs, 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 is completely removed without difficulty; 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 the exudate is completely removed 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 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 a 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 eardrum 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.

Exudative otitis of the middle ear (serous otitis)

Exudative otitis of the middle ear (another name is secretory or serous otitis, sticky ear) is a common phenomenon among adults and children. This disease is fraught with permanent hearing loss and deafness. Often the cause of such complications is late detection of the disease, which is associated with the absence of pronounced symptoms.

What is exudative otitis media?

This type of otitis is considered stage 2 after catarrhal. Exudative otitis is characterized by inflammation of the mucous membrane of the middle ear, accompanied by increased secretion of serous fluid (exudate) against the background of impaired patency of the Eustachian (or auditory) tube. As you know, this tube connects the tympanic cavity with the nasopharynx. It carries air into the ear, and out comes wax and mucus, which is constantly secreted by the mucous membrane to protect the ear from bacteria.

If the lumen of the auditory tube is blocked, mucus will begin to accumulate in the ear. Stagnation of liquids leads to deterioration of sound conductivity and also increases the likelihood of joining secondary infection. If treatment is not started, the mucus will begin to thicken and turn into pus.

Also, due to the narrowing of the Eustachian tube, air does not enter the tympanic cavity. A vacuum is created, the eardrum swells and retracts. These factors negatively affect the state of hearing function.

Serous otitis in children has its own characteristics. You can get acquainted with them by following the link.

Types of exudative (serous) otitis

There are 2 forms of the disease: acute and chronic. Acute exudative otitis media is more common. It usually goes away after the patency of the auditory tube is restored. Under the influence of factors such as reduced immunity and improper treatment methods, the acute form may be prolonged. If symptoms remain after 1 month or more, or a person experiences 2-3 relapses in a year, then they speak of chronic exudative otitis media.

The inflammatory process in the middle ear with chronic otitis media does not go away completely. Persistent swelling is replaced by hypertrophy of the mucous membrane. Prolonged retraction of the eardrum negatively affects the condition of its muscles. The mucus becomes viscous and sticks to the walls of the tympanic cavity and the auditory ossicles. All this is accompanied by increasing hearing loss on one side. Often, protracted serous otitis turns into adhesive, which is characterized by the occurrence of adhesions and tissue scarring.

If the inflammation affects only one ear, then otitis media is called unilateral. Bilateral exudative otitis media is considered a more severe form of the disease, because damage to both ears is more painful, it is more difficult to treat and it entails complete deafness.

Exudative otitis media: causes

The most common cause of serous otitis is ENT diseases that affect the Eustachian tube. These include:

In such diseases, bacteria from the nose or throat can spread to the auditory tube and cause it to swell. Viruses are sometimes the cause of exudative otitis media. During a flu or cold, when immunity is noticeably reduced, inflammation may develop in any part of the ear.

Often, obstruction of the tube is a consequence of non-infectious factors, for example: polyposis, tumors, atresia of the nasal turbinates, trauma, and deviated nasal septum. In many cases, the development of serous otitis media is observed against the background of allergic processes in the nose.

What causes exudative otitis media? The occurrence of the disease is facilitated by reduced resistance of the body. This is influenced by various chronic and systemic illnesses, poor nutrition, and bad habits. Immunity is significantly reduced during pregnancy, so otitis media in pregnant women is not a rare occurrence.

Exudative otitis: symptoms

This form of otitis is characterized by the absence obvious signs such as pain, elevated temperature and discharge in the ear canal.

The first symptoms of exudative otitis media are congestion in the ears and hearing loss. Many people complain that they hear their own voice. As fluid accumulates, tinnitus and pressure appear. “Gurgling” in the ears. Hearing loss increases. Often the disease occurs along with nasal congestion and runny nose.

When a person makes swallowing, chewing, or sneezing movements, the lumen of the tube expands slightly and ear congestion temporarily goes away.

If treatment is started in time and the patency of the Eustachian tube is restored, then these symptoms of serous otitis go away. With a protracted process and transition to adhesive form there is permanent hearing loss.

Diagnosis of serous otitis

The first thing the doctor will do is examine the eardrum. Using an otoscope with an optical system, an ENT specialist will be able to identify characteristic signs of serous inflammation: the eardrum looks retracted, with clear contours and dilated vessels; its color changes immediately to gray, then to blue or brown.

These data and the patient’s complaints give grounds to diagnose exudative otitis media. Additionally, the following tests are performed as needed:

blowing the auditory tube. The tip of a rubber balloon is hermetically inserted into the patient's nostril and air is supplied through it. The air enters the Eustachian tube, and through it into the tympanic cavity. The absence of any sounds and vibrations of the eardrum indicate complete obstruction of the tube;
tympanometry. This is a method that allows you to evaluate the pressure in the tympanic cavity, the function of the eardrum, the auditory ossicles and the auditory tube. Tympanometry is carried out using a probe, which is installed in the ear canal. A pump, a sound generator and a microphone are connected to the device. With the help of a generator, sounds of a certain tonality are supplied, the pump changes the pressure in the ear canal, and the microphone registers the return signals that are reflected from the walls of the middle ear and eardrum. Using a tympanogram, the doctor determines the mobility of the membrane and bones, the presence of fluid and other anomalies. This type of research is especially necessary for diagnosing chronic exudative otitis media. In total, tympanometry is performed in 10 minutes;
audiometry. This hearing test will help accurately determine hearing acuity and detect hearing loss. Audiometry is not a complicated procedure. The patient is taken to a soundproofed chamber and put on headphones that play sounds of varying volumes. A person must signal when he hears something. This is how air conductivity is checked. Then, using a device attached to the head, vibrating sounds are given and the state of bone conduction is determined.

Exudative otitis in a child is more difficult to diagnose, since children cannot accurately describe what worries them.

Exudative otitis media: treatment

Treatment of exudative otitis in adults should be comprehensive, including anti-inflammatory therapy and restoration of the patency of the auditory tube.

Often this disease occurs against the background of chronic nasal diseases, so for a cure it is necessary to restore nasal breathing. Doctors perform polyp removal, resection of atrophied areas, adenotomy or other sanitizing operations. For sinusitis, the maxillary sinuses are washed. If the patient has allergic rhinitis, desensitizing therapy will be required. If you have ARVI, be sure to treat them.

In many cases, after treatment for diseases of the nose and throat, the function of the Eustachian tube improves, and the exudate leaves the middle ear. If this does not happen or there is a risk of developing hearing loss, the following procedures are prescribed:

blowing or catheterization of the Eustachian tube. Politzer blows, which are done for diagnostic purposes, also have healing effect. The air flow opens the lumen of the auditory tube and blows out the mucus that has stuck to its walls. The exudate comes out through the nose. In severe cases, blowing does not help, then they resort to catheterization - a catheter is inserted through the nose, which goes directly into the opening of the auditory tube and a solution of adrenaline or hydrocortisone is infused to relieve swelling. In several such procedures, it is possible to wash out the most dried-on pieces of mucus. Catheterization is used to treat chronic exudative otitis media. It cannot be done if there is a perforation in the eardrum. Both procedures are performed after anemization of the nasal cavity to avoid pain.
electrophoresis. This is a type of physical therapy that uses a direct current electrode inserted into the ear canal. A layer of medication is applied to it (usually Lidaza is used), which, under the influence of current, penetrates into the deep layers of the skin. This way it comes directly, increasing its effectiveness and duration. Electrophoresis for exudative otitis media has a good anti-inflammatory and analgesic effect. Blood microcirculation and lymph circulation improves, muscles relax, and the process of tissue regeneration accelerates. You will need to undergo approximately 12 sessions of 10-20 minutes each.
pneumomassage of the eardrum. It is done using a device that creates negative and positive pressure. Such manipulations are aimed at improving the mobility of the eardrum. You can perform the massage yourself by placing your palm on your ear to create pressure. Remove and re-adjust your hand after a couple of seconds about 10 times.
massage of the pharyngeal mouth of the auditory tube. The following exercises give some results: you need to perform swallowing and chewing movements 10 times, then yawn 10 times. During this “gymnastics,” the mouth of the auditory tube opens and ear congestion goes away. You need to repeat it regularly, every day.
laser irradiation. As the name suggests, the ears are irradiated with a laser. This is a painless and simple procedure. The energy flow, collected in a beam, is directed to certain points. It activates biochemical processes in tissues, which makes swelling and inflammation go away faster. The course of laser therapy is 8-12 sessions.

For the treatment of prolonged otitis media, it is useful to visit health resorts. The sooner you start treatment of bilateral exudative otitis media, the more successful it will be!

If symptoms such as nasal congestion and runny nose are present, use vasoconstrictor nasal drops. In the pharmacy you will find a lot of drugs: Nazol, Sanorin, Nazivin, Tizin, etc. The effectiveness of nasal medications with glucocorticoids (Nasonex, Flixonase) has also been proven. Such drops for exudative otitis media help improve nasal breathing and relieve swelling in the auditory tube. Mucolytics (nasal drops or sprays Sinuforte, Rinofluimucil) are used to thin mucus.

In case of allergic edema, antihistamines (antiallergic) drugs are prescribed: Suprastin, Zyrtec. An important point for people with weak immunity is to strengthen it. For this purpose, vitamins and immunomodulators are prescribed.

These are the main methods of treating secretory otitis media. If desired, you can resort to homeopathic remedies. Exudative otitis and homeopathy are quite compatible things, but it is better for a specialist to select the drug.

If you have exudative acute otitis, treatment includes some methods, but when it turns into a purulent form, completely different medications are needed. Therefore, it is important to pay attention to the occurrence of ear discharge.

How is exudative otitis treated if conservative methods do not help?

Exudative otitis media: surgery

If after treatment with the methods described above there is no improvement, then paracentesis of the eardrum is performed. This is a simple operation during which, under local anesthesia, the membrane is pierced with a needle in order to free it from exudate. After the puncture, the fluid is sucked out of the ear with a syringe, washed with hydrocortisone, and recovery occurs. If the exudate is very viscous, it is possible to introduce splitting enzyme agents. If necessary, the manipulations are repeated several times. At the end, the incision is closed on its own, or it is sealed with special glue or closed surgically.

In case of chronic inflammation or advanced acute serous otitis media, long-term drainage of the tympanic cavity will be required. This is done by installing a shunt into the paracentesis hole, through which the fluid will flow out. Shunting for exudative otitis makes it possible to rinse the middle ear cavity with antibiotics and corticosteroids. This continues until otoscopy shows that the inflammatory process has been eliminated. The shunt may remain in place for several months.

Often the desire to treat exudative otitis media without surgery leads to severe hearing loss and intracranial complications. The operation is aimed at preventing such consequences. Of course, they don’t just do it like that. This requires certain indications.

When the disease enters the fibrotic stage, they resort to sanitation of the middle ear, since other methods will no longer produce results. This operation is performed after opening the eardrum. Using a microscope, the surgeon removes adhesions and all parts of the ear that have undergone changes. They are then restored by tympanoplasty. Finally, the eardrum is closed (myringoplasty). This is a very difficult job; doctors are not always able to recreate the structure of the ear in such a way as to cure hearing impairment.

Antibiotics and drops in the ears for serous otitis media

Doctors usually prescribe antibiotics, which is not always justified. If the patient’s condition is not serious, then you can try to recover without the use of such drugs. Of course, in case of infection with dangerous bacteria or in the absence of improvement from other types of treatment, antibiotics cannot be avoided. What drugs are used for exudative otitis media?

First of all, medications with amoxicillin or a combination of amoxicillin and clavulanic acid are prescribed. If they do not help, then use macrolides or fluoroquinols (Cefuroxime, Clarithromycin, Azithromycin, Ciprofloxacin, Ofloxacin, etc.). To select the drug accurately, it is necessary to take a bacterial flora test and determine the causative agent of the disease.

Additionally, ear drops with antibacterial and anti-inflammatory effects are used to treat serous otitis. You will find their names in the table.

Bilateral acute exudative otitis media

It is worth knowing the difference between exudative otitis media and acute otitis media, which occurs as a result of a dangerous infection deep into the ear. Chronic exudative otitis media is one of the types of otitis. The characteristic features of the disease are the accumulation of exudate (viscous fluid) deep in the ear, without an inflammatory process preceding the onset of the disease. The disease is difficult to detect in a timely manner, since there are no characteristic symptoms, including sharp pains, present in ordinary otitis media. The presence of the disease can be determined solely by hearing loss, as well as strange discharge from the ear. As a rule, children aged 4 to 8 years are susceptible to exudative otitis media, and also partly in adolescence. In adults, the disease manifests itself quite rarely, in a slightly aggressive form.

The main cause of exudative otitis in a child is considered to be the transition from a primary disease to a more complex form. Most experts are inclined to believe that this disease is a complication of a common illness. There are a number of reasons that can provoke the occurrence of exudative otitis media:

inflammatory processes in the nasopharynx;
severe damage to the nose due to trauma and complex fractures:
complex infectious diseases;
adenoids grade 2-3;
weak body resistance;
allergic reactions;
The most common cause is water getting into the ear while taking a bath or shower.

It is worth noting that in 50% of cases, otitis media initially develops, and then bilateral exudative otitis media develops.

The difficulty in identifying the disease is that uh Xudative otitis media has hidden symptoms that interfere with treatment. In medical practice, there have been cases where the disease smoothly turned into a chronic form, while the symptoms did not manifest themselves.

Let's consider the main symptoms of exudative otitis media:

hearing impairment, up to short-term loss;
it feels like there is a hard plug in the ear;
when you turn your head sharply, you feel the presence of fluid in the ear;
possible inflammatory processes in the nasopharynx;
your own voice echoes in your ears.

Pain may be absent or short-lived. Unlike otitis media, body temperature remains normal.

Stages and forms of otitis

Exudative otitis media in children and adults has several types, as well as stages of development. It is worth considering each type separately in order to timely diagnose which form of exudative otitis is developing in a person.

This variety develops under the influence of an acute infection, and is also characterized by severe inflammatory processes that extend even to the inner layer of the ear (the lobe and outer concha are affected). The provoking elements of this form are:

overdose of pharmacological agents;
absence or sharp decline of immunity;
poisonous insect bites;
listening to music on headphones.

Complications include hearing loss, lack of sensitivity in the outer ear, and enlarged lymph nodes.

Chronic

This is a transitional stage of ordinary otitis, which occurs as a result of lack of timely treatment or incompletely implemented therapeutic measures.

The inflammation is not purulent, but large-scale, as it affects almost the entire ear. It feels like from the inside auditory organ is bursting or there is a constant presence of a plug. When you move your head suddenly, an unusual noise appears.

Chronic exudative purulent otitis media occurs if the disease was not cured within the first two months. Unfortunately, some consequences of the disease are irreversible, including complete hearing loss.

Acute exudative otitis media is a complication resulting from purulent inflammation inside the auricle. Fluid accumulates in the ear, which are pus-like microorganisms that can affect the sensitive and weakened membrane. Among characteristic features this form, it is worth noting that hearing loss cannot be stopped, and further rehabilitation process takes a lot of time and money.

Middle ear

The final stage of development of exudative otitis media. A secretion forms in the ear, which creates high pressure in it. As a result, as in all previous stages, there is a decrease in auditory activity.

When the amount of secretion exceeds permissible norm, it begins to seep into the nasopharynx in the form of colorless mucus. Afterwards, an empty space is formed, the pressure of which disrupts the sensitivity of the eardrum.

Reference. Bilateral exudative non-purulent otitis is easy to treat and does not have irreversible consequences, unlike the chronic or acute form. Timely treatment will help avoid all unpleasant consequences.

Chronic exudative otitis media

Like the acute form of the disease, chronic exudative otitis media develops in adolescents, as well as children of the younger age group. This form of the disease develops if the duration of exudative otitis exceeds two months.

As experts in the field of otolaryngology note, the presence of this disease indicates that the eardrum is under enormous pressure, as a result of which its deformation can occur. The consequences of this include hearing loss, hearing loss, and tympanosclerosis.

Diagnostics

For successful diagnosis, it is necessary to have records of all previous diseases the patient suffered on the ear. Among diagnostic measures The following mandatory procedures can be identified:

otoscopy. The presence of deformation in the auricle is determined;
audiometry. Current hearing level measurements;
Mandatory procedures include the Valsalva maneuver and endoscopy;
To clarify the diagnosis, as well as confirm the presence of exudative otitis media, an x-ray is taken, as well as computed tomography(as an additional measure).

All other measures necessary for successful diagnosis of the disease are prescribed by a qualified otolaryngologist.

The therapeutic course consists of a number of procedures, including drug treatment, physiotherapy, etc. Initially, the provoking cause of the disease must be eliminated.

Throughout the entire therapeutic course, the child must be under the supervision of a doctor, and also take all prescribed medications in a timely manner. A child’s body reacts to medications used differently than an adult, therefore, in case of incompatibility with medicine or too strong therapeutic effect It is urgent to change the drug to another drug. Also, in case of complications, the baby must urgently provide first aid. Therefore, to avoid dangerous precedents, doctors strongly recommend that the child remain within the hospital.

Drug treatment

Let's look at the drugs used to eliminate this disease.

This type of otitis is considered stage 2 after. Exudative otitis is characterized by inflammation of the mucous membrane of the middle ear, accompanied by increased secretion of serous fluid (exudate) against the background of impaired patency of the Eustachian (or auditory) tube. As you know, this tube connects the tympanic cavity with the nasopharynx. Air enters through it, and wax and mucus come out, which is constantly secreted by the mucous membrane to protect the ear from bacteria.

Diagnosis of middle ear disease

If the lumen of the auditory tube is blocked, mucus will begin to accumulate in the ear. Stagnation of fluids leads to a deterioration in sound conductivity, and also increases the likelihood of a secondary infection. If treatment is not started, the mucus will begin to thicken and turn into pus.

It has its own characteristics. You can get acquainted with them by following the link.

Types of exudative (serous) otitis

There are 2 forms of the disease: acute and chronic. Acute exudative is more common. It usually goes away after the patency of the auditory tube is restored. Under the influence of factors such as reduced immunity and improper treatment methods, the acute form may be prolonged. If symptoms remain after 1 month or more, or a person experiences 2-3 relapses in a year, then they speak of chronic exudative otitis media.

If the inflammation affects only one ear, it is called unilateral. Bilateral exudative otitis media is considered a more severe form of the disease, because damage to both ears is more painful, it is more difficult to treat and it entails complete deafness.

Exudative otitis media: causes

The most common cause of serous otitis is those that affect the Eustachian tube.

These include:

rhinitis;

What causes exudative otitis media? The occurrence of the disease is facilitated by reduced resistance of the body. This is affected by various chronic and systemic illnesses, poor nutrition, and bad habits. Immunity is significantly reduced during pregnancy, so it is not a rare occurrence.

Exudative otitis: symptoms

This form of otitis is characterized by the absence of obvious signs, such as pain, fever and discharge in the ear canal.
The first symptoms of exudative otitis media are congestion in the ears and hearing loss. Many people complain that they hear their own voice. As fluid accumulates, tinnitus and pressure appear. “Gurgling” in the ears. Hearing loss increases. Often the disease occurs along with nasal congestion and runny nose.

When a person makes swallowing, chewing, or sneezing movements, the lumen of the tube expands slightly and ear congestion temporarily goes away.
If treatment is started in time and the patency of the Eustachian tube is restored, then these symptoms of serous otitis go away. With a prolonged process and transition to an adhesive form, persistent hearing loss is present.

Diagnosis of serous otitis

These data and the patient’s complaints give grounds to diagnose exudative otitis media. Additionally, the following tests are performed as needed:

blowing the auditory tube. The tip of a rubber balloon is hermetically inserted into the patient's nostril and air is supplied through it. The air enters, and through it, into the tympanic cavity. The absence of any sounds and vibrations of the eardrum indicate complete obstruction of the tube;
tympanometry. This is a method that allows you to evaluate the pressure in the tympanic cavity, the function of the eardrum, the auditory ossicles and the auditory tube. Tympanometry is carried out using a probe, which is installed in the ear canal. A pump, a sound generator and a microphone are connected to the device. With the help of a generator, sounds of a certain tonality are supplied, the pump changes the pressure in the ear canal, and the microphone registers the return signals that are reflected from the walls of the middle ear and eardrum. Using a tympanogram, the doctor determines the mobility of the membrane and bones, the presence of fluid and other anomalies. This type of research is especially necessary for diagnosing chronic exudative otitis media. In total, tympanometry is performed in 10 minutes;
audiometry. This hearing test will help accurately determine hearing acuity and detect hearing loss. Audiometry is not a complicated procedure. The patient is taken to a soundproofed chamber and put on headphones that play sounds of varying volumes. A person must signal when he hears something. This is how air conductivity is checked. Then, using a device attached to the head, vibrating sounds are given and the state of bone conduction is determined.

Exudative otitis in a child is more difficult to diagnose, since children cannot accurately describe what worries them.

Exudative otitis media: treatment

Treatment of exudative otitis in adults should be comprehensive, including anti-inflammatory therapy and restoration of the patency of the auditory tube.

Often this disease occurs against the background of chronic nasal diseases, so for a cure it is necessary to restore nasal breathing. Doctors perform polyp removal, resection of atrophied areas, adenotomy or other sanitizing operations. When do . If the patient has allergic rhinitis, desensitizing therapy will be required. If present, be sure to treat them.

blowing or catheterization of the Eustachian tube. Politzer blows, which are done for diagnostic purposes, also have a therapeutic effect. The air flow opens the lumen of the auditory tube and blows out the mucus that has stuck to its walls. The exudate comes out through the nose. In severe cases, blowing does not help, then they resort to catheterization - a catheter is inserted through the nose, which goes directly into the opening of the auditory tube and a solution of adrenaline or is infused to relieve swelling. After several such procedures, it is possible to wash out the most dried-on pieces of mucus. Catheterization is used to treat chronic exudative otitis media. It cannot be done if there is a perforation in the eardrum. Both procedures are performed after anemization of the nasal cavity to avoid pain.
electrophoresis. This is a type of physical therapy that uses a direct current electrode inserted into the ear canal. A layer of medication is applied to it (usually Lidaza is used), which, under the influence of current, penetrates into the deep layers of the skin. This way it comes directly, increasing its effectiveness and duration. Electrophoresis for exudative otitis media has a good anti-inflammatory and analgesic effect. Blood microcirculation and lymph circulation improves, muscles relax, and the process of tissue regeneration accelerates. You will need to undergo approximately 12 sessions of 10-20 minutes each.
pneumomassage of the eardrum. It is done using a device that creates negative and positive pressure in the ear canal. Such manipulations are aimed at improving the mobility of the eardrum. You can perform the massage yourself by placing your palm on your ear to create pressure. Remove and re-adjust your hand after a couple of seconds about 10 times.
massage of the pharyngeal mouth of the auditory tube. The following exercises give some results: you need to perform swallowing and chewing movements 10 times, then yawn 10 times. During this “gymnastics,” the mouth of the auditory tube opens and ear congestion goes away. You need to repeat it regularly, every day.
laser irradiation. As the name suggests, the ears are irradiated with a laser. This is a painless and simple procedure. The energy flow, collected in a beam, is directed to certain points. It activates biochemical processes in tissues, which makes swelling and inflammation go away faster. The course of laser therapy is 8-12 sessions.

For the treatment of prolonged otitis media, it is useful to visit health resorts. The sooner you start treatment of bilateral exudative otitis media, the more successful it will be!

In case of allergic edema, antihistamines (antiallergic) drugs are prescribed: Zyrtec. An important point for people with weak immunity is to strengthen it. For this purpose, vitamins and immunomodulators are prescribed.

If you have exudative, treatment includes some methods, but when it turns into a purulent form, completely different medications are needed. Therefore, it is important to pay attention to the occurrence of ear discharge.

How is exudative otitis treated if conservative methods do not help?

Exudative otitis media: surgery

Antibiotics and drops in the ears for serous otitis media

First of all, medications with amoxicillin or a combination of clavulanic acid are prescribed. If they do not help, then use macrolides or fluoroquinols (Cefuroxime, Clarithromycin, Azithromycin, Ciprofloxacin, Ofloxacin, etc.). To select the drug accurately, it is necessary to take a bacterial flora test and determine the causative agent of the disease.

Additionally, ear drops with antibacterial and anti-inflammatory effects are used to treat serous otitis. You will find their names in the table.

NAME	PHARMACOLOGICAL PROPERTIES
	These drops include 2 antibiotics: framecitin sulfate and gramecidin. This combination has an antibacterial effect against many bacteria. Sofradex also contains the glucocorticoid dexamethasone, which relieves inflammation and allergy symptoms
	The active ingredients are phenazone and lidocaine. Otipax for exudative otitis helps relieve inflammation and pain
	A strong drug that contains the antibiotics neomycin and polymyxin B, as well as dexamethasone
Futoralgin	The active ingredients of Futoralgin are the antiseptic nitrofural, the local anesthetic tetracaine and phenazone (an analgesic and antipyretic). Thanks to this composition, these drops have an anti-inflammatory and analgesic effect, and also destroy infection.

Drops are instilled into the sore ear in a horizontal position. For right-sided exudative otitis media, dripping right ear, and with left-sided exudative otitis – left.

Exudative otitis: treatment at home

If you have been diagnosed with otitis media, it should not be your only choice. It should only be used as an adjunct to hospital procedures.

Let's consider popular folk remedies for exudative otitis media:

a decoction of lavender, yarrow, plantain and eucalyptus. Take 1 tsp. each herb and mix well. Place in a thermos, pour 0.5 liters of boiling water and close overnight. Soak a tampon in this decoction and insert it into the ear canal several times a day for 20 minutes. Additionally, take the decoction orally, 50 ml 3 times a day;
for acute serous otitis, instill 2-3 drops of warmed basil mint oil into the ear canal (sold in a pharmacy);
Cut off half the onion, put cumin seeds in the middle and place in the oven for 10-20 minutes. Then you need to squeeze the juice out of the onion and bury it in the sore ear;
place turundas soaked in chamomile decoction into the ear canal;
As ear drops for exudative otitis media, it is recommended to use natural remedies such as propolis tincture, calendula tincture or Japanese Sophora.

Complications of serous otitis

This disease is very insidious, as its signs are often ignored. In this regard, the hearing organs are exposed to destructive phenomena for a long time. A common complication after exudative otitis media is persistent hearing loss. In the most advanced cases, you can even go deaf.

The consequence may be or. Both diseases often result in hearing loss. Bilateral exudative otitis is especially dangerous.

Life-threatening consequences of serous otitis occur if the inflammation becomes purulent and spreads to the brain.

Prevention of exudative otitis media

Preventive measures that will help prevent exudative otitis media:

increase immunity through vitamin therapy, physical exercise, and hardening;
visit health resorts;
carry out sanitation of the nasal and oral cavity. Start treatment of diseases such as rhinitis, sinusitis, polyps, hypertrophy and adenoids as early as possible.

It is advisable for people who have already suffered from exudative otitis media to undergo regular medical examination. It will help identify the remaining exudate that causes hearing loss.