Chronic suppurative otitis media (CHSO) is an infectious otolaryngological pathology characterized by purulent inflammation of the main parts of the middle ear. The causative agents of infection can be aerobic and anaerobic bacteria, as well as a fungus such as Candida or Aspergillus. The main clinical manifestations of CHS are suppuration from the ear and persistent perforation of the ear membrane.
At the initial stages of development, otitis media is easily diagnosed and treated with the help of pharmacotherapy. However, untimely therapy leads to the development of serious intracranial complications, which is fraught with not only hearing loss, but also death. For this reason, when the first signs of the disease are detected, you need to undergo a thorough examination by an otolaryngologist.
Causes of the disease
Infectious agents in chronic otitis media are bacterial and fungal microorganisms. When carrying out bacterial inoculation in the foci of inflammation, staphylococci, pseudomonia, pneumococci, Klebsiella and Proteus are often found. In many patients adhering to long-term antibiotic therapy, the causative agents of otomycosis are additionally sown, i.e. mold or yeast-like fungus.
In 90% of cases, chronic otitis media is the result of inadequate treatment of the acute form of ENT disease.
The development of purulent pathology is due to the high virulence of pathogens and reduced reactivity of the immune system, as a result of which there are disturbances in the functioning of the Eustachian tube. The following factors can provoke the onset of chronic purulent otitis media:
- immunodeficiency states;
- endocrinopathy;
- sinusitis;
- intracranial injury;
- irrational antibiotic therapy;
- dysfunction of the auditory tube;
- blood disease (anemia, leukemia);
- upper respiratory tract infection.
The complexity of the treatment of purulent inflammations lies in the fact that many strains of bacteria localized in the foci of inflammation are resistant to the effects of antibacterial drugs. It is for this reason that during the development of ENT disease is not observed
regeneration of the tympanic membrane.
Development mechanism
As already mentioned, in most cases, HCVO develops as a result of untimely or ineffective treatment of the acute form of ENT pathology. The appearance of a purulent process in the ear cavity is due to the influence of a number of unfavorable factors:
- low body resistance;
- failures in general and local protection;
- high virulence of pathogens;
- resistance of pathogens to antibiotics.
The risk of ear suppuration is significantly increased with curvature of the nasal septum, Eustachian tube dysfunction, adenoids, and hypertrophic rhinitis. Diseases of the nasopharynx can cause accumulation of fluid in the middle ear. This leads to an even greater weakening of local immunity, as a result of which colonies of pathogenic bacteria are formed in the lesions.
Violation of the aeration of the main parts of the middle ear is the cause of chronic perforation of the tympanic membrane.
Due to the violation of the processes of evacuation of fluid from the ear, perforation of the tympanic membrane occurs. Constant suppuration prevents the restoration of membrane integrity, which contributes to the emergence of persistent perforation.
Clinical picture
To diagnose the development of the disease simply by the presence of a triad of characteristic signs: suppuration from the auditory canal, progressive conductive hearing loss and permanent perforation of the ear membrane. At the initial stages of development of chronic otitis media of the middle ear, patients complain of hyperthermia and constant tinnitus. With the progression of the disease, dizziness, nausea and pain syndrome additionally occur.
The aggravating process of inflammation of the middle ear leads to the appearance of granulations in the mucous membrane and the growth of polyps. For this reason, with an exacerbation of CHS, purulent exudate with bloody impurities is released from the ear cavity. As a result, fibrin threads are formed in the tympanic cavity and on the auditory ossicles, which harden over time. This leads to a limitation of the mobility of the auditory ossicles and, accordingly, the development of conductive hearing loss.
Vertigo is usually caused by destruction of the semicircular canals located in the inner ear. The presence of a symptom signals the progression of the disease and the development of labyrinthitis.
Pain syndrome occurs, as a rule, in the phase of exacerbation of ear pathology. It is caused by the presence of acute inflammation in the ear, which leads to tissue edema and subsequent melting. Water entering the ear canal can cause severe throbbing pain and tinnitus.
Forms of otitis media
In otolaryngology, two forms of CHS are distinguished, the difference between which is due to the severity of the inflammatory processes and the presence of corresponding symptoms. However, in medical practice, it is extremely rare to draw a clear line between the two forms of the disease:
- mesotympanitis is a relatively mild form of a purulent disease, characterized by the formation of foci of inflammation only within the mucous membrane of the tympanic cavity. Lesions are localized, as a rule, in the middle or lower part of the ear cavity, therefore, perforation is observed in the stretched part of the membrane;
- epitympanitis is a severe form of ear pathology, in which not only soft, but also bone tissues are involved in the inflammatory process. This leads to destruction of the auditory ossicles, as a result of which hearing loss develops.
Epitympanitis leads to the spillage of cholesteatoma in the ear cavity, which is fraught with serious complications. Neoplasms are epidermal granules that have a matrix covered with stratified epithelium. Cholesteatomas appear as a result of ingrowth of the epidermis of the external auditory canal into the tympanic cavity. This is due to the occurrence of marginal perforations in the ear membrane.
Complications
Purulent inflammation is the main reason for the appearance of changes in the anatomical structures of the ear, many of which cannot be subsequently eliminated.
The emergence of infectious complications is fraught not only with auditory dysfunction, autophony, or the formation of cholesteatoma, but also with an abscess. What are the underlying consequences of the development of chronic suppurative otitis media?
- mastoiditis - purulent inflammation of the main structures of the mastoid process and mucous membranes of the antrum;
- arachnoiditis - a serous inflammatory process in the arachnoid membranes of the brain and spinal cord;
- labyrinthitis - an infectious lesion of the main parts of the inner ear, which leads to the development of dysfunction of the vestibular apparatus;
- brain abscess - a limited accumulation of purulent masses in the cranium.
Inadequate treatment of chronic otitis media of the middle ear sometimes leads to inflammation of the facial nerve, which is fraught with the development of paresis. In the presence of severe infectious complications, therapy is not performed in stationary conditions, which is associated with a high risk of death.
Treatment principles
How to cure chronic otitis media? Conservative treatment of a purulent disease practically does not give special results, which is due to the resistance of pathogenic bacteria to the effects of antibiotics. Therefore, drug treatment is used only as an adjunct to eliminate the main signs of an exacerbation of the disease.
According to experts, HGSO is one of the surgical diseases, the further development of which can be prevented only by surgical intervention. For the treatment of chronic suppurative otitis media of the middle ear, the following types of operations can be used:
- tympanostomy - a surgical procedure for inserting tubes into the ear to drain pus from the tympanic cavity;
- removal of adenoids - an auxiliary operation that normalizes the drainage function of the Eustachian tube;
- general cavity operation - incision behind the ear cavity with subsequent removal of purulent contents from the middle ear.
Purulent inflammation in the organ of hearing leads to the development of hearing loss and a number of serious complications. However, timely treatment provides relief of inflammatory processes and quick recovery even without the use of surgical operations.
