1. What is the definition of chronic otitis media?
Chronic otitis media is a chronic purulent inflammation of the middle ear mucosa, periosteum or deep into the bone, often in combination with chronic mastoiditis.
2. What is the structure of the middle ear like?
We often dig our ears, and this channel is called the external auditory canal. At the end of the external auditory canal (about 3.5 cm deep in adults) is a wall, the tympanic membrane. The structure inside the tympanic membrane is like a building, in fact, there are many rooms inside, which only have air and no other, for example, purulent secretions. These rooms are invisible when we stand at the entrance of the building.
3. What is the cause of chronic otitis media?
Chronic otitis media is caused by delayed treatment or improper treatment of acute suppurative otitis media. The duration of the disease is usually more than 6 to 8 weeks, and the main clinical features are repeated ear discharge, tympanic membrane perforation and hearing loss.
4. What are the symptoms of otitis media?
Pus flowing from the affected ear is the main common symptom of this disease. It is obvious when there is less pus. It is important to note that the mere “yellowing” of the swab when digging into the ear is not necessarily a case of otitis media.
Deafness: It varies in severity and sometimes it is just a feeling of “stuffy ears”.
Tinnitus, which can occur in some patients.
Others: vertigo (spinning around in the sky), vomiting, facial palsy (tilting the corners of the mouth on one side and closing the eyes to show white eyes), etc. are relatively rare.
5.What tests are needed?
Audiological examination: to understand the degree of hearing loss.
High-resolution CT scan of the temporal bone: The middle ear is like a building with many rooms. Under normal circumstances, there is only air and no pus in these rooms, so CT mainly looks at how many rooms have lesions.
Endoscopy: The main purpose is to examine the outermost part of the ear, the tympanic membrane and the outer ear canal. Part of the tympanic chamber can also be seen.
6. Why does chronic otitis media always runny and recurring?
As I said before, the middle ear is a building, and when there is pus in a room in this building during otitis media, it means that the room is filled with water. If there is water in only one layer, it will flow easily and the time of pus flow will be short. If there is water in many rooms, it will take a long time to flow out; if at the same time there are granules (new organisms commonly found in the ear), it will actually block the outflow channel and it will be more difficult to flow out.
7. How is chronic otitis media treated?
Etiological treatment, timely cure of acute otitis media, and active treatment of upper respiratory tract infections.
Topical treatment, mainly ear drops: local medication is chosen according to different lesions, usually aqueous antibiotic solution or a mixture of antibiotics and glucocorticoids are used for ear drops.
In severe cases such as growing granulation or long time treatment with poor results, topical medication can be taken for observation and surgery depending on the condition.
8.Does chronic otitis media have to be operated?
Chronic otitis media is actually a recurrent infection of the tympanic membrane due to the perforation of the eardrum and the flow of pus, but in a small percentage of patients, the perforation heals on its own and no pus flows. In most patients, the perforation does not heal for a long time, and once the water enters, the pus will flow again, thus recurring, so most of them need surgery.
9.What are the types of otitis media surgery?
In some patients, the lesion is relatively mild, and the performance is not pus flowing for a long time, only the tympanic membrane is perforated, so this surgery is relatively simple and mainly involves tympanic membrane repair. The surgery is usually performed by cutting a small incision in the scalp above the ear and removing a piece of cloth-like material (medically called fascia), which is used to repair the broken eardrum. In some patients, the lesion is heavy and there is a lesion like a sarcoid that blocks the passage, which often does not stop the flow of pus and requires surgery to remove the sarcoid and then repair the eardrum, which is a relatively complicated procedure.
10. What is a middle ear cholesteatoma?
There is a lesion in the middle ear cavity that is somewhat like a beanbag. It is characterized by a foul odor, and as time goes on, more and more of these bean residue will accumulate and accelerate the destruction of the walls of the building and the ears, so these lesions are more serious and require early surgery to remove them.
11. What is the artificial hearing bone all about?
There are three small bones in the human ear, the size of a toothpick head, called the auditory bones, which are the smallest bones in the human body. These bones are easily damaged, and once they are damaged, hearing loss will occur. These damaged bones need to be removed during surgery, and parts are needed to replace the damaged bones, otherwise hearing will not improve. These parts are called artificial hearing bones, and are commonly used to sculpt the bones behind the ear itself, and titanium hearing bones. Titanium alloy hearing bone is relatively light, not easy to fall off to improve the hearing effect is good, currently in the world are the mainstream products.
12.How do I take care of my otitis media after surgery?
Leave it to the doctor during hospitalization. After discharge from the hospital, it is important to avoid water in the ear; in addition, it is necessary to clean the crusts in the ear canal regularly, about once every 3-6 months after the surgery. Although it needs to be cleaned constantly, the cleaning process is relatively simple.
13.What happens when otitis media becomes serious?
Middle ear infections are mainly associated with recurrent pus flow and hearing loss. In severe cases, complications can occur, such as: facial palsy if the facial nerve is damaged (one side of the mouth is tilted, and white eyes are exposed when the eyes are closed); vertigo if the labyrinth is damaged (seeing things spinning, unsteadiness, nausea and vomiting); meningitis and brain abscess (high fever, headache, nausea and vomiting) if the bone wall between the ear and the brain is damaged, and other more serious problems.
14. What is the doctor’s advice?
Aggressively control chronic inflammation, as repeated attacks can aggravate ear damage and worsen hearing loss.
Surgery should be performed as early as possible if conditions permit. Chronic otitis media is mostly a slow process, but as time lengthens, hearing gets worse and the lesions get heavier, so that the damage is relatively greater during surgery and the possibility of hearing recovery is relatively low; in addition, when you are older and have more underlying diseases such as hypertension and diabetes, the risk of surgery becomes greater.
Different degrees of lesions determine different surgical methods and different surgical times. At present, the surgery is performed under a microscope, using a high-speed electric drill and microscopic instruments for surgery with a high degree of delicacy.