The ear includes the outer ear, middle ear and inner ear. The middle ear is the important structure that transmits sound through the auditory bone to the inner ear. The middle ear is connected to the nasopharynx via the eustachian tube, and the outer part is adjacent to the ear canal across the eardrum. Otitis media is an inflammatory lesion involving the structures of the middle ear and is most common in children. There are two types of otitis media: purulent and non-purulent. Purulent is subdivided into acute and chronic. Non-suppurative otitis media mainly refers to secretory otitis media.
Etiology
Acute upper respiratory tract infection, such as rhinitis, sinusitis and tonsillitis; or acute infectious diseases, such as measles and chicken pox, etc. Inflammation in the pharynx and nose spreads to the middle ear through the eustachian tube, and the common germs are pneumococcus and Haemophilus influenzae, etc.
2, improper blowing, such as both sides of the nostrils forceful blowing, or improper pharyngeal drum blowing Zhang, then the pressure to contain viruses and bacteria nasal snot to the posterior nostril, to reach the eustachian tube, triggering otitis media.
3, swimming or diving in sewage, sewage through the nasopharynx and into the middle ear.
4. In infants and young children, the eustachian tube is relatively straight, and the lumen is short and the inner diameter is wide.
5. Trauma or bad habits such as ear digging can cause damage to the eardrum and bacteria can enter the middle ear through the perforation.
6.When taking an airplane or diving, the pressure inside and outside the middle ear changes greatly, and the eustachian tube does not function well, resulting in air pressure injury to the middle ear.
7.Nasopharyngeal swelling or adenoid hyperplasia, causing blockage of the eustachian tube.
Clinical manifestations
1.Purulent otitis media
Acute purulent otitis media is an inflammation of the middle ear mucosa caused by purulent bacterial infection, and its symptoms are mainly ear pain and pus flow. The systemic symptoms in pediatric patients are more obvious than those in adults, and there may be fever and vomiting. Chronic suppurative otitis media is a chronic inflammation of the middle ear mucosa, periosteum, or deep bone, mainly due to improper or prolonged treatment of acute inflammation. The common symptoms are intermittent or persistent pus flow in the ear, tympanic membrane perforation, hearing loss, tinnitus, and in some cases, intracranial and extracranial complications.
2. Non-suppurative otitis media, also known as secretory otitis media. It is common in children and is mainly caused by the dysfunction of the eustachian tube. The symptoms are mainly hearing loss, ear pain, and a feeling of stuffiness or occlusion in the ear. There may be a phenomenon of “self-hearing enhancement”. In children, the symptoms are poor response to sound, inattention, or excessive volume when watching TV. 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.
Examination
1.Otoscopic examination, acute can see tympanic membrane congestion, perforation, pulsating flash point and pus. In chronic cases, tympanic membrane perforation, pus, granuloma or white bean-like cholesteatoma can be seen. In secretory otitis media, the tympanic membrane loses its normal luster and appears orange-red or amber oil-paper-like when the tympanic membrane is sunken and fluid accumulates in the tympanic chamber. The plane of fluid is sometimes seen through the tympanic membrane, and its parallel relationship with the ground remains unchanged when the head position is changed. Air bubbles can be seen in the tympanic chamber after blowing of the eustachian tube. On tympanic otoscopy, the tympanic membrane is restricted in movement.
2. Tuning fork test and pure tone audiometry show conductive deafness. Acoustic impedance test is type C or B in non-suppurative cases.
3. CT scan shows varying degrees of increased density in the air spaces of the middle ear system, and in chronic cases or cholesteatoma a shadow of bone destruction is seen.
Treatment
1.Actively treat focal diseases of the upper respiratory tract, such as rhinitis, sinusitis, tonsillitis, etc.
2.Medication
Antibiotics or dilute mucin can be taken. Local medication in the acute early ear pain can be used 3% phenol glycerin ear drops. If the ear is abscessed, antibiotic solution or a mixture of antibiotics and steroid hormones, such as oxyfloxacin ear drops and chloramphenicol cortisone solution, can be used. Before applying local medication, clean the outer ear canal and the pus in the middle ear cavity, use 3% hydrogen peroxide to clean it, then swab it with a cotton swab or use a suction device to suck up the pus before applying medication. Ear drip method: The patient is in a sitting or lying position with the affected ear facing upward. Gently pull the auricle backwards and upwards and put 2 to 3 drops of medicine into the external ear canal. After 5-10 minutes, the patient can change position. The ear drops should be as close to the body temperature as possible to avoid vertigo.
3. For non-purulent cases, 1% furosemide drops can be used to open the eustachian tube, and other treatments such as eustachian tube blowing, postauricular closure or tympanic chamber pumping can also be used, and if necessary, tympanic membrane placement can be performed.
4. If the tympanic membrane is perforated and affects hearing, tympanic membrane repair or tympanoplasty can be performed under the operating microscope or endoscope 1-2 months after the dry ear.
5. In cases of bone ulcer or middle ear cholesteatoma with poor drainage or suspected complications, mastoid radical surgery + tympanoplasty should be performed early to completely remove the lesion and prevent complications. At the same time, artificial hearing bones can be used to rebuild hearing.
Precautions for prevention and treatment of otitis media
1. Strengthen physical exercise, increase the quality of rest, and reduce the number of colds. If you have a cold, rhinitis, tonsillitis or other upper respiratory tract diseases, you should actively treat them so that the germs do not enter the middle ear and cause inflammation.
2. Do not blow your nose strongly and bilaterally at the same time and rinse your nasal cavity casually.
3. Avoid bad habits of ear digging. If a small worm enters the ear canal, soak the worm in cooking oil before taking it.
4. After swimming ashore, jump on one foot with your head sideways to let the water in your ear flow out and use a cotton swab to absorb the water. Those suffering from chronic otitis media should not swim.
5.When taking off or descending by airplane, you should make swallowing movements.
6.Do not use local ear drops arbitrarily or irregularly.
7.Eat more fruits and vegetables with anti-inflammatory effects, such as celery, loofah, eggplant, cucumber, bitter melon, etc.
8. Avoid eating pungent and spicy stimulating foods, such as ginger, pepper, wine, mutton, chili, etc.