Sinusitis

Exudative otitis in children treatment Komarovsky. Exudative otitis media in children is an insidious disease of the middle ear.

is a disease that leads to inflammation of the mucous membrane of the middle ear and increased secretory activity of the mucous glands, as a result of which it is filled with non-purulent fluid.

Inflammation of the mucous membrane of the middle ear

The middle ear is the tympanic cavity. On one side it is covered by the eardrum, on the other by the window of the labyrinth, at the top it has access to the mastoid process, and at the bottom there is an auditory tube. A chain of auditory ossicles stretches from the eardrum to the oval window.

In the development of the disease, the main role is played by obstruction of the auditory tube, which exits from the middle ear into the nasopharynx. It is designed for ventilation, drainage and protection. Through it, the air necessary to equalize the pressure of the external environment enters the tympanic cavity and the mucous secretion is released, which is secreted in the ear. When this channel is blocked for some reason, in the tympanic cavity, firstly, the pressure drops (since the necessary air does not flow), and secondly, inflammatory effusion accumulates.

These factors lead to hearing impairment of varying intensity, and the presence of fluid creates favorable conditions for the development of bacteria, which can lead to the transition of exudative otitis to.

Types of exudative (serous) otitis in children

This insidious disease can develop in one ear (unilateral otitis) or in both. With bilateral exudative otitis media in children, the risk of developing hearing loss and deafness is higher. Therefore, he must be treated in a hospital setting, under the supervision of specialists. It is worth noting that bilateral exudative otitis media in children occurs in most cases.

Exudative otitis in a child can have an acute or chronic form. Recently, there has been a tendency towards the predominance of sluggish forms. This is mainly due to the uncontrolled and irrational use of antibiotics, which leads to the development of bacterial resistance to them.

Chronic inflammation lasts for many years. If tubular dysfunction is not eliminated for a long time, the exudate becomes more viscous and sticky. It sticks to the walls of the eustachian tube, the tympanic cavity and membrane, and the auditory ossicles. As a result, adhesive processes develop that cannot be cured except by surgery.

Exudative otitis: causes of occurrence in childhood

The causes of exudative otitis in a child lie in infectious and non-infectious pathologies that affect the condition of the auditory tube. For example, severely enlarged adenoids, which are very common in children. Or bacterial and viral etiology: rhinitis, etc. As mentioned earlier, the mouth of the auditory tube opens into the nasopharynx, so an infection from the nose or pharynx can penetrate it and cause inflammation of the mucous membrane.

Increasingly, such ailments occur in people prone to allergies. Persistent allergic rhinitis, sinusitis, etc. lead to development.

The cause of serous otitis in children can also be. The most common pathogens are pneumococcus, Haemophilus influenzae, streptococcus and staphylococcus. Less commonly, catarrh of the ear is caused by viruses.

The state of immunity plays an important role in the development of inflammatory diseases, and in children of the first years of life, both local protection in the mucous membrane of the ENT organs and general immunity are not strengthened.

calendula;
nightshade;
Japanese Sophora;
echinacea;
propolis.

Such products are sold in pharmacies, but if desired, you can prepare them yourself. The natural components of such tinctures perfectly fight inflammation, relieve pain, and speed up the healing process. Place 2 drops in each ear, 3 times a day.

Decoctions of herbs also help: yarrow, chamomile, St. John's wort, calendula, eucalyptus. Choose one or more herbs, you will need 1 tbsp. raw materials per glass of boiling water. Just fill the herb with water, cover with a lid and let sit for half an hour. Strain the broth, soak cotton wool in it, and then insert it into the ear canal for 20 minutes. Repeat the manipulations 3 times a day.

Before you begin to treat exudative otitis media at home, you must first consult with your doctor. Since improper treatment can harm, but not help in any way. The doctor will tell you what you can’t do and what you can do. Then focus on the child’s well-being: if he gets worse from some medications, then stop using them.

Consequences of serous otitis in childhood

The concerns of parents and doctors about this disease in children are well founded: late detection increases the risk of developing permanent hearing loss. The consequences of serous otitis in childhood negatively affect the formation of speech and general development in the future.

Complications of exudative otitis media in children in the form of adhesive adhesive processes and cholesteatoma require surgical removal. After sanitizing operations on the middle ear, plastic restoration of the excised areas will be required. Such procedures rarely allow one to return to their previous hearing acuity, and in some cases their results turn out to be completely opposite - hearing deteriorates even more.

Also, prolonged congestion in the tympanic cavity can lead to inflammation of the labyrinth, in which the auditory and vestibular analyzer is located. Development leads to deafness and the appearance of vestibular disorders, in the form of dizziness, unsteady gait, nausea and vomiting, due to which a person cannot lead a normal life.

Prevention of exudative otitis media in children

To prevent the development of otitis in children, first of all, you should pay attention to the condition of the nose and throat. This especially applies to adenoids, because they most often become the cause of the development of exudative otitis media. It is important to undergo preventive examinations that will help identify deviations before they become protracted.

Since it is very difficult to detect hearing loss in children, periodic hearing tests will be relevant.

Parents of children prone to viral diseases need to think about boosting their immunity. A healthy, fortified diet, good sleep, outdoor sports exercises, hardening, and visits to health resorts will help with this. During flu epidemics, you should refrain from visiting crowded places; for prevention, you can drink. Try to ensure that your child does not become hypothermic during the cold season.

The best prevention of exudative otitis media in children and adolescents is breastfeeding from the first days of life. It should last at least 3 months. Milk contains active substances such as interferon, immunoglobulin, etc. They increase the level of protection of the child’s body and suppress pathogenic infections.

To prevent milk from flowing from the throat into the auditory tube during feeding, you need to keep the baby reclining.

Quite common. You can find out how to properly treat it for expectant mothers by clicking on the link.

Informative video

Exudative otitis is an inflammation of the middle ear, in the cavity of which exudate forms and remains in the cavity for a long time. The disease develops in both children and adults. According to statistics, exudative otitis in children is much more common. than in adults.

Timely treatment does not require much effort; the disease “gives in” quite easily. The main thing is to start treatment on time! If you notice the first signs of otitis media, this is especially true for children, consult a doctor immediately. A qualified ENT specialist will prescribe an effective course of treatment.

It should be noted that this disease is the second form of otitis media. The first stage includes.

Any form of otitis media begins with an infection entering the middle ear cavity. It can get there through the nasopharynx with the development of any viral diseases, diseases of the ENT organs, in particular diseases associated with swelling of the mucous membranes (sinusitis). As a result of the development of infection, swelling of the mucous membranes (nose, pharynx, eustachian tube) occurs. This leads to impaired ventilation of the middle ear.

Then the infection begins to actively develop. The first stage is formed - catarrhal otitis media. If there is no proper and timely treatment, the form quickly develops into exudative otitis media, especially for children.

Why is this happening? Fluid is formed in the cavity of the middle ear, which, with normal, natural functionality of the auditory tube, is promptly removed to the outside. If an infection develops, the auditory tube narrows (swells), making the exit of fluid very difficult. Then more and more fluid begins to be produced (fluid production is a response to inflammation). The ear cavity fills with exudate, the auditory tube continues to narrow.

Lack of timely treatment leads to the formation of a purulent form of otitis.

Viruses and bacteria begin to develop safely in the accumulated liquid. Next, from a liquid state, the exudate turns into thick mucus, which subsequently turns into pus. What factors influence the development of this disease:

nasal injuries;
inflammatory diseases in the mucous membranes of the nose and nasopharynx;
decreased immunity;
inflammatory diseases of the auditory tube;
hypothermia;

The inflammatory process is the main cause of the development of the disease

Diagnosis of the disease

The form of ordinary and acute exudative otitis media is diagnosed as a result of a complete examination of the eardrum and nasal area. Diagnosis is carried out using audiometry, tympanometry and endoscopy.

An important role in diagnosis is played by the study of auditory function. Hearing loss should be moderate, with sound conduction of 30-40 dB. X-ray data are also not neglected, which can reveal a deterioration in the pneumatization of mastoid cells.

Symptoms of exudative otitis media:

hearing loss;
feeling of stuffiness in the ears;
autophony - you hear yourself;
nasal congestion;
sensation of fluid transfusion in the ear cavity.

As a rule, the patient does not experience acute pain in the ears or head, and there is no fever. These symptoms are inherent in the catarrhal form.

It is worth noting that in children these symptoms are less pronounced. The only important and true symptom is hearing loss. If treatment for exudative otitis in a child has been neglected or was completely absent, then after 3-4 years a persistent form of hearing loss may develop.

Hearing loss is one of the main symptoms of exudative otitis media

Treatment

Treatment of exudative otitis media is prescribed depending on the condition of the hearing, the ear itself, the duration of the infection, and the cause of the disease.

In most cases, patients suffer from difficulty breathing. Therefore, procedures are carried out to restore it - this is the treatment of nasal diseases, troubleshooting problems in the nasal septum, treatment of acute respiratory viral infections, etc.

The next stage is to restore the patency of the auditory tube, i.e. restoration of its drainage function. As a rule, physical procedures are used for this - ultrasound, laser therapy, electrophoresis, magnetic therapy, etc. To remove exudate from the tympanic cavity, to tone the muscles of the auditory tube and for better patency, pneumomassage of the eardrums and special blowing (Politzer blowing) are used.

In some cases, antibiotic therapy is prescribed to treat exudative otitis media. However, the inclusion of antibiotics in primary treatment is still controversial. Surgery is also prescribed.

The goal of surgical treatment is to restore hearing function and prevent further development of the disease.

Bypassing (cutting) the eardrum and installing a special shunt has become widespread. Through the installed shunt, special medications are administered that help dilute the exudate.

Inflammation of the hearing organs is one of the most common diseases in children. Otitis is not always accompanied by pain and severe discomfort. Sometimes pathological processes in the ears are painless, manifesting only as gurgling and a slight decrease in hearing acuity. This is the insidiousness of exudative otitis media, because if not treated in a timely manner, the disease often leads to serious consequences, including hearing loss in the child. How to detect and treat the disease?

What is exudative otitis media

With exudative otitis media, the auditory tube is filled with exudate

With exudative otitis media, due to a pathological process, a mucous secretion - exudate - begins to accumulate in the middle ear. According to doctors, the main causes of the disease are viral infection and inflammation of the nasopharyngeal tonsil.

The human hearing organs are structured as follows: the ear is connected to the pharynx by the Eustachian tube, covered with mucous tissue. Swelling of the nasopharynx, observed during a cold, causes a decrease in the lumen of the auditory tube.

As a result of a decrease in the lumen in the Eustachian tube, a vacuum occurs in the middle ear, and exudate gradually forms

If the lumen in the Eustachian tube completely disappears, then a vacuum arises in the middle ear due to lack of air and pressure increases. The mucous membrane begins to actively secrete fluid, and after a certain time the ear cavity is filled with exudate.

After the mucous secretion, under the influence of various microorganisms, turns into a kind of jelly, the auditory ossicles in the ear become inactive. The result of such changes is decreased hearing in the child.

In medicine, there are other names for the exudative form of otitis:

secretory otitis;
non-purulent;
mucosal;
effusional;
tubotympanitis;
tubotympanic catarrh;
sticky ear.

The main difference between exudative otitis and other types of inflammatory diseases of the auditory organs is that pain practically does not occur, so the pathology is extremely difficult to detect.

Doctor Komarovsky about otitis media in children - video

Types of disease

Based on the duration of the pathological process, otolaryngologists divide exudative otitis into 3 forms:

acute - inflammation persists for up to 3 weeks;
subacute - an intermediate form of pathology, lasting from 3 to 8 weeks;
chronic - the disease lasts more than 2 months.

The following typology is based on the characteristics of the exudate - viscosity, transparency, shade, density, as well as the duration of inflammation. According to this classification, the disease goes through 4 stages:

catarrhal (initial);
secretory;
mucosal;
fibrous (degenerative).

The disease can affect only one ear, but most often in childhood a bilateral inflammatory process with the formation of exudate is diagnosed.

Causes of the disease

Typically, the pathology occurs in children aged 2 to 5 years, which is associated with underdevelopment of the Eustachian tube. This physiological feature leads to the spread of edema and infection from the nasopharyngeal cavity to the organ of hearing.

Often the development of otitis media is provoked by past illnesses. The incorrect use of antibacterial drugs also negatively affects the mucous membrane of the middle ear cavity.

In addition, general and local causes can lead to illness in a child. The first include:

reduced immunity;
allergic manifestations;
infectious diseases (adenoviruses, etc.);
frequent hypothermia.

The main local reasons are:

proliferation of the nasopharyngeal tonsil (adenoids);
chronic inflammatory process in the pharyngeal tonsil (adenoiditis);
abnormal structure of the oral cavity - “cleft palate”;
displacement of the nasal septum.

Adenoids are one of the reasons for the development of exudative otitis in children

Provoking factors for the development of pathology can be passive smoking (substances contained in tobacco smoke destroy the mucous membrane of the ear) and the child’s inhalation of dry, polluted air.

Symptoms

In children, the disease is most often asymptomatic. Deteriorating hearing can be detected by parents who notice that the child does not respond to his name and asks to make the cartoon louder.

At primary school age, children suffering from chronic exudative otitis media become inattentive, lose concentration and do not perceive the material in class.

Symptoms of exudative otitis depending on the stage of the disease - table

Stage	Duration	Symptoms and signs
Catarrhal	up to a month	inflammation of the mucous membrane of the auditory tube; violation of its ventilation (air flow into the middle ear cavity decreases or stops); slight decrease in hearing acuity; “echo in the head” - the feeling of one’s own voice.
Secretory	up to 12 months	accumulation of fluid in the middle ear cavity; heaviness and pressure in the ear; hearing loss continues; the child “hears splashing” when turning his head (at this time his hearing improves).
Mucosal	from one year to 2 years	the exudate becomes viscous and thick; the fluid inside the ear no longer moves; hearing decreases significantly.
Fibrous	from 2 years	the production of mucous secretion stops; the eardrum degenerates; the mucous membrane of the middle ear cavity is deformed; the auditory ossicles become inactive; hearing loss develops.

Diagnostics

First of all, the otolaryngologist studies data on recent infectious diseases of the nasopharynx and hearing organs, their course and characteristics of therapy (medications used, duration of treatment).

Due to the blurred clinical picture, exudative otitis media in a child is most often diagnosed accidentally - during a routine examination or during a consultation about another problem.

To make an accurate diagnosis, otolaryngologists use the following instrumental methods for examining the hearing organs:

The chronic form of the disease is differentiated from otosclerosis (pathological bone growth in the middle ear), purulent otitis media, tumor formations of the hearing organs and abnormal structure of the auditory ossicles.

Treatment

Therapy for exudative otitis media depends on the provoking factor and the stage of the disease. First of all, it is necessary to eliminate the cause (for example, adenoids) that caused the pathology, and only then carry out therapeutic measures. Among them are:

treatment with medications and folk remedies;
physiotherapeutic procedures;
surgical intervention.

Drug therapy

Self-treatment of exudative otitis in a child is excluded. Only a qualified otolaryngologist can prescribe medications depending on the severity of symptoms and diagnostic results.

Most often, experts prescribe medications that relieve inflammation, soften mucous secretions and constrict blood vessels. If the cause of the disease is an infection, taking antibacterial drugs is allowed. In the case of an allergic nature of the disease, antihistamines are prescribed.

Drugs for the treatment of exudative otitis media - table

Group of drugs	Product name	Action provided	Age restrictions	Contraindications
Antibiotics		relieves inflammation, suppressing exudation and normalizing capillary permeability; reduces local redness and swelling; destroys pathogenic bacteria.	from 6 years old	intolerance to the components of the drug;
Antibiotics		prevents the growth of bacteria; has a local bacteriostatic effect.	from birth	Hypersensitivity to the components of the drug.
Combined preparation for topical use		It has an antibacterial and local anesthetic effect.	from 1 year	Hypersensitivity to the components of the drug.
		Has antibacterial, antiallergic, anti-inflammatory effects.	from 1 year	hypersensitivity to the components of the drug; damage to the eardrum.
	Otipax	relieves inflammation; has an analgesic effect.	from birth
Antihistamines		has an antiallergic effect; has an antiexudative effect.	from 1 year	Intolerance to the components of the drug.

Medicines suitable for the treatment of exudative otitis media - gallery

Sofradex is a combined drug for local use in otolaryngology. Otofa is an antibacterial drug and is used in the treatment of chronic and acute otitis in infants. Zodak is an antiallergic drug.
Garazon is a combined drug with anti-inflammatory and antibacterial effects for local use. Anauran is a combined drug for local use that has antibacterial and local anesthetic effects.

Physiotherapy

To restore the drainage function of the auditory tube, remove exudate from the middle ear cavity and prevent purulent infection, doctors prescribe the following physiotherapeutic procedures:

ultrasound;
electrophoresis;
laser and magnetic therapy.

A common method of physical therapy is Politzer blowing of the auditory tubes. The tip of a special rubber balloon is inserted into one nostril of the child. In this case, the second nostril must be kept closed. When a small patient pronounces certain words, the doctor compresses the balloon, and air from the nasal cavity enters the Eustachian tube, and then into the cavity of the middle ear. Since this procedure requires the active participation of the baby, it is not always applicable at an early age.

Folk remedies

Traditional medicine offers the following recipes for the treatment of exudative otitis media in children:

Kalanchoe. The leaves are crushed and poured with boiled olive or sunflower oil. The resulting mixture is infused for 3 weeks and the turundas soaked in the product are inserted into the auricle.
Hare fat. Warm fat is instilled into the ears 2 times a day, and then a dry bandage is applied. First, the affected ear is warmed up a little using a bag of heated salt.
Onions. Cut out the core and add crushed cumin seeds inside. Place the onion in a preheated oven and bake until soft. Then rub through a sieve and strain through cheesecloth. The resulting juice is instilled into the ears.
Basil oil. This remedy can be purchased at a pharmacy or prepared at home (25 leaves or inflorescences of the plant are softened and poured with 1/2 cup of olive oil, left for a week). Before use, the oil is slightly warmed.

Pay attention! Folk remedies cannot replace drug treatment and physiotherapeutic procedures. In addition, before using them, it is imperative to consult with an otolaryngologist to eliminate the risk of undesirable consequences for the child.

Traditional medicine for the treatment of exudative otitis - gallery

Cumin activates the beneficial properties of onions Onion juice is dropped into the ears Kalanchoe relieves inflammation and destroys pathogenic bacteria Basil oil can be prepared at home

Surgical intervention

If conservative therapy does not bring the desired effect or the disease threatens serious complications, the attending doctor may prescribe surgical methods to cleanse the tympanic cavity from viscous and sticky fluid.

Depending on the severity of the condition and the clinical picture of the disease, the following surgical methods are indicated:

tympanopuncture is a medical procedure that involves suctioning pathological exudate from the ear through a small puncture in the eardrum;
tympanotomy (paracentesis) involves cutting the eardrum to improve the outflow of fluid accumulated in the middle ear;
shunting - under local anesthesia, a shunt (tube) is inserted into the incision in the eardrum, through which drugs are injected to liquefy the pathological contents of the ear or accumulated exudate is pumped out.

The above surgical methods are performed under local anesthesia. If the child is under 3 years old, general anesthesia may be used.

Treatment of exudative otitis in a child at home using heating pads, various compresses and folk recipes is possible only after consultation with a doctor. Thermal procedures can lead to increased inflammation and spread swelling to the inner ear.

Bathing a child is not prohibited, but experts recommend adhering to the following recommendations:

make sure that the baby does not have a fever;
Before bathing, plug your ears with cotton swabs to prevent liquid from entering the ear canals;
After water procedures, the child should be in a warm room without drafts.

Important! After surgery, swimming is strictly prohibited. It is better to replace a warm bath and shower with wiping with wet wipes.

You shouldn’t give up walking in the fresh air, but you should follow a few rules:

the hat should fit tightly to the ears, into which cotton pads must first be inserted;
it is necessary to reduce the duration of walks and eliminate heavy physical activity on the street;
It is recommended to wait for some time after physiotherapeutic procedures.

Treatment prognosis

With timely detection of the disease and proper treatment, the prognosis is favorable. If exudative otitis media is not treated or the otolaryngologist’s recommendations are not followed, the following complications are possible:

chronicity of the disease, when acute periods are replaced by remission;
the occurrence of purulent otitis media;
deformation or formation of a hole in the eardrum.

The result of such consequences can be incurable hearing loss and, as a consequence, a slowdown in mental development in the child.

Preventive measures

Prevention of exudative otitis media in children consists of a set of measures. First of all, it is necessary to strengthen the child’s immune system by:

dietary adjustments (more fruits and vegetables);
taking vitamins;
hardening;
compliance with personal hygiene rules;
playing sports;
maintaining clean air (exclude passive smoking).

promptly treat inflammatory diseases of the nasopharynx (sinusitis, adenoids);
do not let colds and allergic reactions take their course;
Contact a doctor at the first signs of hearing loss in a child or complaints of discomfort in the ears.

You can cope with exudative otitis media in a child with the help of medications, physiotherapeutic procedures, and folk remedies. In extreme cases, surgical intervention is indicated. However, it is better not to wait for the inflammatory process in the ears to take dangerous forms. At the first unfavorable signs, you should show the child to the doctor and begin proper treatment. By being attentive to children's health, parents can prevent the occurrence of complications.

And although 60% of 3-7-year-old patients suffering from otitis suffer from the disease at least once, most often doctors still manage to prevent such a turn of events in the form of otitis media: more often in children, the development of this form of the disease can be prevented, but in some circumstances the development of this form of otitis is inevitable.

Fortunately, treatment of exudative otitis in children is successful in most cases: undesirable consequences, as well as the transition of the disease to a chronic condition, are practically excluded with adequate drug treatment.

The “catch” of the disease in children, as in adults, is the almost complete absence. The child does not suffer from acute pain in the ear, so very often children with this disease go for an initial examination to an otolaryngologist when the disease has already reached one of the complicated stages. There are 4 such stages in total:

initial- gradual deterioration of hearing due to impaired air circulation in the entire ear, a feeling of stuffiness in the ears, increased audibility of one’s own voice;
secretory- filling of the middle ear with fluid (pathological secretion), proliferation of bacteria. The patient may feel the sounds of a “splash” of water when he changes the position of his head;
mucosal- is the completion of the process of filling the ear with fluid. The secretion becomes extremely viscous and sticky. At this stage, the child continues to feel increased hearing loss, the “water” in the ears stops “splashing”;
fibrous- in the middle ear cavity, as a result of scarring and pressure provided by the fluid, irreversible changes often occur: the auditory ossicles are damaged, degenerative changes in the eardrum are observed.

Exudative otitis in a child whose treatment was not started on time does not give the proper signals for the need to visit an otolaryngologist. The only thing a child can complain about with this form of the disease is poor hearing, an “echo” of his own voice. Only an otolaryngologist can recognize the disease, its stage and complications that have already arisen: even a doctor cannot always accurately describe the condition of a sick child with exudative inflammation of the middle ear, so sometimes even tomography is used for diagnosis.

In the case of children, the only sure signal to go to an ENT specialist is deterioration in hearing, as well as a slowdown in the development of speech abilities - children sometimes have bilateral exudative otitis media, which is characterized by such signs.

Exudative otitis media in children: treatment

In adults and children, the methods of treating the disease in the described manifestation are practically no different: the otorhinolaryngologist first of all deals with eliminating the causes of inflammation in the ear, and then, through medications and physical therapy, eliminates the otitis media itself.

However, in the case of young children, treatment is complicated because most physiotherapy procedures require the patient to actively participate in the process. With older children, this problem is usually no longer relevant.

Drug treatment

Treatment of exudative otitis in children always occurs in a complex manner. Regardless of what form the disease has acquired, the doctor prescribes the following groups of drugs to the young patient:

antibiotics. If the disease is caused by bacteria and infections, then successful treatment without antibiotics is not considered for young children. Depending on the age of the patient, the ENT specialist may prescribe, for example, “Otofa” (for children from birth) or “Garazon” (for children from 6 years old), but there are other drugs that the doctor may consider more suitable - such serious drugs are always are selected individually;
mucolytics. Special medications that will help thin the fluid accumulated in the middle ear also have age restrictions: the doctor may prescribe, for example, “ACC” or “Carbocysteine”;
antihistamines. To “unload” the liver and other organs during active drug therapy, antihistamine drugs are prescribed. In particular, the doctor may prescribe Zodak, Suprastin, Celfax or Ketotifen, depending on the age of the patient;
vasoconstrictor drops. To facilitate the work of the middle ear, nasal drops such as Naphthyzin, Nazivin, Sanorin, Polidex, Xylometazoline or Tizin (different age restrictions) can also be prescribed;
combination drugs for local use. Combination drugs that are applied topically also help fight intra-ear infections. For example, children are often prescribed Otipax (from birth) or Sofradex (from 1 year).

Important! All of the above drugs are contraindicated to be “prescribed” to a child on your own, since they all have a number of contraindications. Only a qualified ENT specialist can select the optimal treatment regimen for exudative otitis in a child, based on the symptoms, stage and cause of the disease.

Physiotherapy

It is often almost impossible for young children to undergo physiotherapeutic procedures for such diseases. The fact is that the child often has to help the doctor implement this or that procedure. However, depending on the age of the patient, the doctor may prescribe:

magnetotherapy- the positive south pole is usually used, which helps reduce the rate of bacterial growth, improve the elasticity of blood vessels in the ears, eliminate pain and help reduce inflammation;
ultrasound- for such a disease, low-frequency ultrasound is preferable, which is used to irrigate the sore ear through special medications. One session of such therapy lasts about 25-30 seconds, thanks to the procedure the patient simultaneously receives hydromassage of the affected tissues and antibacterial procedures;
laser- such therapy is aimed at improving patency in the Eustachian (auditory) tube; thanks to laser therapy in the initial stages of the disease, swelling can be effectively relieved;
electrophoresis- the procedure is similar to ultrasound therapy, only it replaces ultrasound with direct current. The procedure is not painful, the patient only feels a slight tingling sensation. The purpose of the procedure is to eliminate inflammation in the nasopharynx, nasal cavity and tympanic cavity of the ear.

There are other physiotherapeutic procedures, but they are most often relevant for adult patients.

Surgical intervention

Advanced disease sometimes requires surgical intervention. In the case of children, the ENT can resort to only two procedures, which have one goal - to ensure that local medications reach the site of the disease and to create a channel through which the fluid accumulated in the middle ear will be removed.

Myringotomy. In cases where medications do not give the expected effect, the doctor may prescribe a myringotomy - the essence of the procedure is to create a hole in the child’s eardrum. A day before the procedure, the patient’s ear is treated with antiseptic drugs using turundas, and the operation itself is performed under local or general anesthesia. During the operation, accumulated fluid is sucked out of the auricle, and the ear cavity is disinfected.
Tympanocentesis. This procedure is used to allow medications to enter the eardrum. A hole is made in the eardrum into which a thin polyethylene tube is inserted. Through it, accumulated fluid is drained, as well as local medications are instilled.

Both procedures are painful and undesirable in cases where they can be avoided - only in severe cases, when conservative medicine turns out to be de facto powerless, does the ENT resort to similar methods of treating children.

Thus, we can conclude that the sooner exudative otitis media was diagnosed in a child, the easier and faster it can be cured. With such a disease, it is important not to delay with qualified treatment: when moving from one stage to another, the disease can create the illusion of an improvement in the patient’s condition, which is often incorrectly interpreted as recovery.

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

What is exudative otitis media in a child?

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

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

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

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

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

Classification of the disease

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

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

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

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

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

Pathology happens:

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

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

Causes

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

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

The provoking factors for the occurrence of the disease are:

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

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

Symptoms and signs

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

Main signs of the disease:

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

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

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

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

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

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

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

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

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

Features of otitis media in children - video

Diagnosis of serous otitis media

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

Additional instrumental diagnostic methods are:

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

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

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

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

Treatment

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

Conservative therapy

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

Therapy includes taking such groups of medications as:

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

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

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

Treatment is prescribed only by an otolaryngologist, depending on the stage of the disease and the age of the child. Self-administration of medications is unacceptable, as it can lead to complications and an unpredictable course of the disease.

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

Surgical intervention

Surgical treatment methods include:

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

Folk remedies

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

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

Traditional medicine in the photo

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

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

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

Prognosis and possible complications

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

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

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

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

Preventive measures

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

rhinitis;
adenoids;
sinusitis;
polyps;
sinusitis.

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

Preventive measures include:

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

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

Otitis in a child - video by Dr. Komarovsky

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