Acute serous (exudative) otitis media is a serous inflammatory process that affects the mucous membrane of the Eustachian tube and tympanic cavity. Otolaryngological disease occurs due to the development of eustachitis and the accumulation of serous effusions in the tympanic cavity.
The key pathogenetic factor in the development of pathology is the dysfunction of the Eustachian tube associated with a violation of its drainage and ventilation functions. A hallmark of the development of the disease can be called the accumulation of viscous secretions inside the ear cavity, which causes discomfort and increasing hearing loss.
Etiopathogenesis
In the course of experimental studies, experts found out that in the pathogenesis of secretory otitis media, the decisive factor is disturbances in the work of the Eustachian tube. Due to the violation of its ventilation function, it creates negative pressure in the tympanic cavity, which becomes the main reason for the accumulation of serous effusions in it.
During a histopathological examination, it turned out that catarrhal processes lead to collagenization of the inner layers of the mucous membranes of the ear cavity and the auditory tube. Metaplasia of the ciliated epithelium and its enhanced infiltration by lymphocytes are also observed. In this regard, the secretory function of the mucous membranes is disrupted, which leads to overproduction of liquid secretion.
At the initial stage of development of acute serous otitis media, the liquid secretion in the tympanic cavity does not contain pathogenic microorganisms. However, against the background of a decrease in general immunity, provoked by dysfunction of the Eustachian tube, opportunistic microorganisms begin to actively develop. Subsequently, the serous or mucous fluid in the ear becomes cloudy and purulent. A change in its consistency, color and odor always signals the development of bacterial, fungal, and in rare cases, viral flora.
Causes of serous otitis media
The development of ear pathology is based on a violation of local or general resistance of the body, which is supported by tubular dysfunction. The cause of pathological changes can be infectious diseases, which lead to a decrease in the reactivity of the body. Irrational use of antibiotics, which contributes to intoxication and, accordingly, a decrease in the barrier function of the auditory tube, can also provoke malfunctions in immunity.
The main factors contributing to the appearance of secretory otitis media include:
- changes in the structure of the mucous membranes in the organ of hearing, provoked by the development of general infections;
- decreased muscle tone, which entails the development of dysfunction of the Eustachian tube;
- untimely or ineffective therapy for otitis media;
- curvature of the nasal septum and cranial trauma;
- obturation of the mouth of the Eustachian tube with cicatricial changes, adenoid growths, etc.
In preschool children, the disease is most often provoked by vasomotor rhinitis, chronic adenoiditis or rhinosinusitis.
Symptomatic picture
Taking into account the results of the pathomorphological examination and the dynamics of the development of infectious and inflammatory processes, the specialist was able to determine several stages of the disease. This made it possible to quickly make differential diagnostics when making a diagnosis and, accordingly, accurately determine the course of treatment for ear pathology.
There are 4 stages of development of acute exudative otitis media:
- catarrhal (eustachitis) - blockage of the auditory canal associated with edema of the mucous membrane of the Eustachian tube. As a result of the suction of air by the mucous membrane of the tympanic cavity, the vacuum in it increases, as a result of which a transudate is formed in the ear. A local manifestation of eustachitis is the retraction of the ear membrane into the tympanic cavity, which leads to the development of autophony and hearing loss;
- secretory - the accumulation of a large amount of serous mucus in the ear cavity. There is metaplasia of epithelial tissues in the middle ear, due to which the number of secretory glands in the mucosa increases. Subjectively, the manifestation of pathological changes will be increasing conductive hearing loss and a sensation of fluid transfusion in the ear;
- mucous - a change in the consistency of a viscous secretion in the ear cavity, accompanied by a deterioration in sound conduction by the auditory ossicles. Due to the increase in the density of the liquid secretion, perforation of the ear membrane occurs, as a result of which the liquid flows into the ear canal;
- fibrous - degenerative changes in the mucous membrane of the ear cavity, leading to a decrease in the amount of viscous secretion in the ear. As a result of fibrous tissue transformations on the mucous membrane, adhesions are formed, which leads to the progression of hearing loss. Cicatricial processes in the ear membrane lead to the development of adhesive otitis media.
In the case of the formation of fibrous adhesions on the ossicles and eardrum, it is almost impossible to cure hearing loss.
Differential diagnosis
The symptomatology of secretory otitis media overlaps with the clinical manifestations of other types of ear diseases. In particular, the development of conductive hearing loss and autophony is inherent in labyrinthitis, otitis externa, otosclerosis, etc. In some cases, it becomes necessary to differentiate ear pathology with a glomus tumor that forms in the middle ear cavity.
For a complete examination of the ear and determine the causes of auditory dysfunction, the following procedures are performed:
- endoscopy is the best way to assess the condition of the mucous membrane of the ear canal and the development of adenoid vegetations;
- audiometry - determination of the level of auditory sensitivity, which allows you to find out the degree of development of hearing loss;
- X-ray is an overview analysis of the state of tissues in the ear cavity, which allows to determine the presence of cellular pathologies, i.e. tumors and other neoplasms;
- Valsalva test - a method for determining the mobility of the ear membrane and the presence of perforations in it;
- tomography is a computerized method for assessing the state of the temporal bones and the extent of inflammation in the middle ear.
In most cases, patients are diagnosed with bilateral acute exudative otitis media, which is characterized by inflammation of the mucous membranes in both ears. However, in the case of timely examination and treatment, specialists manage to stop catarrhal processes that begin either in the right or in the left ear. This prevents the hematogenous spread of the infection and contamination of the second ear.
Therapy methods
The tactics of treating patients suffering from otitis media consists in eliminating the causes of its occurrence and stopping the clinical manifestations of the disease.
To prevent morphological changes in the tissues of the middle ear and to normalize the work of the Eustachian tube, the following procedures are performed:
- Eustachian tube catheterization;
- magnetotherapy;
- endaural phonophoresis;
- pneumomassage of the membrane;
- electrophoresis with hormonal agents;
- blowing through Politzer.
Important! Transtubal administration of drugs is fraught with complications in the presence of purulent discharge in the auditory canal.
To improve the blood supply to the affected tissues, cotton turundas with alcohol solutions ("Burov's Liquid", "Boric alcohol") can be used. They are able to disinfect the auditory canal and normalize blood microcirculation. This leads to more intensive nutrition of the mucous membranes with the necessary substances, thereby accelerating the epithelialization of tissues.
Pharmacotherapy
In the framework of conservative treatment, pharmacotherapy is used, based on the use of anti-inflammatory, antibacterial and analgesic drugs. The standard treatment regimen may include drugs such as:
- "Xylometazoline" - vasoconstrictor nasal drops that normalize the drainage function of the Eustachian tube;
- "Claritin" is an antiallergic drug that removes puffiness from mucous membranes and relieves inflammation;
- "Rinofluimucil" is a mucolytic drug that helps to thin and remove mucus;
- "Nasonex" is an endonasal corticosteroid drug that normalizes intratympanic pressure in the ear;
- "Augmentin" is a bacteriolytic drug that prevents the development of microbial flora.
With serous otitis media, fluid accumulates in the ear, which increases the risk of ear membrane perforation. For the treatment of ENT disease, it is necessary to use anti-edematous, antiphlogistic and bacteriostatic drugs.
