1.Purulent otitis media
(1) Acute purulent otitis media is an inflammation of the middle ear caused by purulent bacterial infection, and its symptoms are mainly ear pain and pus flow. The systemic symptoms in children are more obvious than those in adults, and there may be fever and vomiting. Serious complications include intracranial complications, such as meningitis and brain abscess. Other complications include vaginitis, facial nerve palsy, etc.
(2) Chronic purulent otitis media is a chronic purulent inflammation of the middle ear mucosa, periosteum or deep to the bone. This disease is more common in clinical practice, and is often characterized by intermittent or persistent pus flow in the ear, tympanic membrane perforation, and hearing loss as the main clinical manifestations.
Systemic symptoms may vary in severity. There may be fear of cold, fever, fatigue, and loss of appetite. In children, systemic symptoms are more severe, often accompanied by vomiting, diarrhea and other gastrointestinal symptoms. Once the tympanic membrane is perforated, the body temperature gradually decreases and the systemic symptoms are significantly reduced.
②Ear pain in the deep part of the ear, which gradually worsens. Such as pulsating throbbing pain or stabbing pain, which may radiate to the ipsilateral head or teeth. The earache worsens when swallowing and coughing, and those with severe earache cannot sleep at night and are irritable. After the eardrum is perforated and the pus flows, the ear pain will be relieved.
(iii) Ear pus is the main symptom of the disease, which can be mucus, mucopurulent or purely purulent. The non-hazardous type of pus is thin and odorless. The dangerous type of pus is thicker, though not much, and is mostly pure pus with a foul odor.
④ Hearing loss and tinnitus. At first, hearing is stuffy, and then hearing is gradually reduced with tinnitus. Deafness may be ignored in those with severe ear pain. In some patients, deafness may be accompanied by vertigo, and deafness is reduced after perforation instead.
⑤ Deafness varies in severity and is easily overlooked because of its monaural onset. It is usually conductive deafness.
2. Non-suppurative otitis media secretory otitis media.
(1) Hearing loss in acute secretory otitis media can occur mostly after a cold, when descending by airplane or diving, and there can be “self-acoustic enhancement”. The severity of deafness often fluctuates in patients with chronic otitis media. Hearing may improve when pressure is applied to the ear screen or when the head position is changed, but hearing does not change with a change in head position when middle ear fluid is thick. Children tend to have no complaints of hearing loss, but show signs of ignoring their parents’ calls, inattentiveness, or asking for excessive volume when watching TV.
(2) Earache may be mild in acute otitis media and may occur in chronic otitis media when secondary infection occurs.
(3) A feeling of stuffiness or occlusion in the ear.
(4) Tinnitus is usually not heavy and may be intermittent. When the head moves, yawns or blows the nose, the sound of air passing water can be heard. A few patients with secretory otitis media may also have water running in the ear, but the duration is very short, only a few hours or a day or so.
(5) In the acute stage of otoscopy, there are radiating vascular patterns around the tympanic membrane. In the acute stage, the tympanic membrane is surrounded by radiating vascular patterns. The tympanic membrane loses its normal luster and becomes yellowish, orange-red or amber in the case of tympanic effusion; in chronic cases, the tympanic membrane is milky white or grayish blue and opaque. If the secretion is plasma and not filled with tympanic chamber, the plane of fluid can be seen through the tympanic membrane, which is a concave surface upward curved line, bubbles can sometimes be seen through the tympanic membrane, and the bubbles increase after pharyngeal tube blowing; if there is more fluid in the tympanic chamber, the tympanic membrane protrudes and the mobility of the tympanic membrane is limited.
Treatment.
1, active treatment of focal diseases of the upper respiratory tract
Such as chronic sinusitis, chronic tonsillitis.
2, drug treatment
Simplex type is mainly local medication, available antibiotic aqueous solution or antibiotic and steroid hormone drug mixture, such as 0.25% chloramphenicol solution, chloramphenicol cortisone solution, oxyfloxacin ear drops, etc., to treat otitis media and otitis externa, etc.
3.Precautions for local medication
(1) Clean the pus in the external ear canal and middle ear cavity before using medication.
(2) When the amount of pus is large, use water, and when the amount is small, use boric acid alcohol.
4, tympanic membrane large perforation affects hearing, feasible tympanic membrane repair or tympanoplasty.