Many people know about the need to protect their ears from school, when adults did not get tired of reminding children to wear a hat and refrain from long walks in windy weather. Hypothermia is dangerous by the development of a cold - and there it is not far from otitis media. In fact, otitis media, or otitis media, is more often a secondary condition. It occurs against the background of respiratory infections, in the overwhelming majority of cases it is caused by bacterial infectious agents. The disease proceeds with vivid general symptoms, which are explained by the intoxication of the body. In addition, with this disease, patients suffer from severe, sometimes unbearable ear pain, which is combined with an intense headache.
Classification
The middle ear is not a closed system. It communicates with the nasopharynx, as well as with the mastoid process. This makes it possible for infectious agents to penetrate from the respiratory organs into the tympanic cavity. This route of infection is called tubular (tubogenic) and is realized through the auditory tube.
The symptoms of otitis media differ depending on the variant of the pathological process. The exudate accumulating in the ear cavity is at first serous. Then it becomes more viscous (catarrhal inflammation) and subsequently turns into purulent. At the same time, there is no free exudate in the initial period of inflammatory changes. Acute lesions of the middle ear are classified as:
- tubo-otitis;
- serous otitis media;
- purulent otitis media;
- mycotic otitis media.
The adhesive, purulent and fungal form of otitis media is also spoken about when chronic forms are mentioned.
With scarlet fever or measles infection, necrotic changes in the tympanic membrane are observed, and there is also a high probability of chronic otitis media.
Tubo-otitis
Tubo-otitis is otitis media, the symptoms in adults in which are explained by the localization of inflammation in the auditory tube and tympanic cavity. With tubo-otitis, inflammatory effusion does not accumulate in the cavity (or a meager serous exudate appears), but tubular dysfunction is observed.
The defeat in tubo-otitis can be bilateral, accompanied by the onset of hearing loss.
The feeling of hearing loss with nasal congestion is familiar to many patients. With tubo-otitis, the patient hears a constant noise in the ear. Hearing returns after the release of the nasal cavity from secretions (blowing out), the introduction of vasoconstrictor drugs to improve nasal breathing - and worsens with repeated accumulation of mucus and an increase in edema. Temporary relief comes from yawning. Characterized by the simultaneous presence of symptoms of a respiratory infection, the appearance of complaints of hearing impairment against a background of severe rhinitis.
Serous otitis media
Serous otitis media is not accompanied by severe intoxication syndrome. Patient complaints do not always include pain, fever, and weakness; in the case of an increase in temperature, subfebrile indicators are observed.
How does middle ear inflammation manifest? Symptoms in an adult include:
- decreased hearing acuity;
- the appearance of noise in the ear, which becomes permanent;
- feeling of "fullness", "pressure" in the ear;
- "Splash" that occurs when the head is turned.
Hearing loss increases gradually, often very slowly. The anatomical integrity of the tympanic membrane is preserved.
During the change in the position of the head with the appearance of the splash, hearing improves for a short time.
The predominant variant of the course of serous otitis media are low-symptom "silent" forms. The absence of sudden bright changes (including pain syndrome), especially in unilateral lesions, causes the symptoms of otitis media in adults to be detected with a delay.
Acute suppurative otitis media
Symptoms of otitis media in adults with purulent inflammation are characterized, first of all, by intense pain. Pain syndrome is one of the leading manifestations - often it is he who makes the patient seek medical help. Pain descriptions may vary: someone
speaks of stabbing or shooting pain, someone complains of throbbing, excruciating, incessant pain.
How to understand that a patient has purulent otitis media? The symptoms are much more pronounced than with the variants of the disease described earlier. Of course, the possibility of an atypical course cannot be ruled out (absence of fever, severe pain, or, conversely, severe intoxication, the presence of not only pain, but also nausea, vomiting, unbearable headache). However, the following manifestations are most likely:
- fever, general malaise;
- headache, lack of appetite;
- feeling of "fullness", noise in the ear.
With purulent otitis media, hearing worsens - this is an important differential diagnostic sign.
The onset of suppuration (otorrhea) is observed some time after the onset of the disease and is explained by the perforation of the tympanic membrane, through the opening in which pus enters the ear canal. The duration of the perforated stage is several days (up to a week). In this case, at first, an abundant amount of pus is released, which does not have a specific unpleasant odor. Over time, the volume of purulent discharge decreases until the otorrhea stops.
Chronic otitis media
Chronic purulent otitis media occurs for various reasons, however, untimely initiation of therapy and the wrong selection of drugs are essential. There are several forms of the disease, with doctors most often referring to the following classification:
- Mesotympanitis.
- Epitympanitis.
- Epimesotympanitis.
The patient complains of symptoms such as:
- discharge from the ears (purulent, mucopurulent);
- feeling of pulling pain, "aches", "filling" of the ear;
- headache on the side of the lesion;
- hearing impairment, the appearance of noise in the ear.
Allocations are noted periodically or constantly. In the acute period, they become abundant, the clinical picture is complemented by increased pain (both local in the ear and headache), dizziness. Fever may occur.
Mesotympanitis is manifested by the periodic release of mucous or mucopurulent masses that do not have an unpleasant odor. There is also noise in the ear, dizziness. During the period of exacerbation, pain syndrome, fever, a sharp increase in the amount of discharge, and increased headache are noted. Patients may experience nausea, vomiting. In addition, the dizziness becomes worse.
Epitympanitis is characterized by damage not only to the mucous membrane, but also to the bone tissue. This form of chronic otitis media is difficult and may be accompanied by the formation of a cholesteatoma. Patients are worried about the presence of a discharge with an unpleasant odor, sometimes in the form of "crumbs" or containing an admixture of blood. Abundant suppuration is observed against a background of increased body temperature, weakness, dizziness.
Epimesotympanitis combines the signs of each of the variants of the disease described above. With epimesotympanitis, signs of destruction of the temporal bone can be observed on the roentgenogram.
Hearing function deteriorates in all forms of chronic otitis media, however, the impairment is most pronounced with epimesotympanitis.
Mycotic otitis media (otomycosis)
Infection of a fungal nature in the case of a lesion of the middle ear most often becomes secondary. Otomycosis occurs against the background of a chronic course of an already existing purulent process.Otomycosis is not necessarily candidiasis (that is, an infection caused by a yeast-like fungus of the genus Candida). It can also be triggered by molds belonging to the genera Penicillum, Mucor, Aspergillus. Middle ear inflammation, the symptoms of which are caused by a fungal infection, can be summarized in the table:
| Infection variant | Patient complaints | Objective symptoms |
| Aspergillosis | the presence of abundant pathological discharge; intense itching of a constant or periodic nature; feeling of "fullness", ear congestion, noise in the ear; headache concentrated in the area of the affected ear. | Detachable (more often plaque) gray with black blotches, black, brown. Powdery discharge of a yellowish tint with an unpleasant pungent odor. |
| Candidiasis | Curd masses of liquid consistency, whitish shade. | |
| Mucorosis | Detachable looks like "fluffy plaque", can be compared with felt when describing. Has an unpleasant moldy odor. |
Mycotic otitis media can be accompanied by severe pain - this is due to the defeat of the deep layers of the skin.
Fungal infection of the middle ear is usually combined with a mycotic infection of the external auditory canal. Average otomycosis is characterized by a long protracted course, periodic exacerbations. Hearing loss is caused by the accumulation of fungal mycelium in the ear canal.
The infection can be one-sided or affect both ears - sometimes the patient himself contributes to its spread with improperly holding the ear toilet, forced scratching. Otitis media, the symptoms of which occur from time to time in the presence of a chronic purulent process and include pronounced itching, which is difficult for the patient to be tolerated, is an indication for examination regarding mycotic infection.
