Concept of the disease Acute suppurative otitis media is an acute purulent inflammation of the middle ear mucosa. It occurs in children. It is common in winter and spring. Causes of the disease The disease is caused by pathogenic bacteria such as pneumococcus, Haemophilus influenzae, and staphylococcus. Decreased body resistance due to various causes, chronic systemic diseases and focal diseases in adjacent areas, such as chronic tonsillitis, chronic sinusitis, and adenoid hypertrophy, are the causative factors of the disease. The most common route of infection is the eustachian tube route. The eustachian tube is the tube connecting the nasopharynx at the back of the nasal cavity to the middle ear. During acute upper respiratory tract infections or acute respiratory infections, bacteria can invade the middle ear via the eustachian tube and cause infection. When swimming or diving in sewage and blowing the nose inappropriately, bacteria can invade the middle ear via the eustachian tube. In infants, the eustachian tube is close to the horizontal position, with a short lumen and a wide inner diameter. If the breastfeeding position is improper, such as lying down to suckle, milk can flow into the middle ear via the eustachian tube and cause secondary infection. It is rare for the causative organism to invade the middle ear through the external ear canal or bloodstream infection. Early symptoms Early symptoms are ear pain, most patients have severe ear pain that can radiate to the ipsilateral head or teeth. Early in the course of the disease, patients often have significant ear congestion, low-pitched tinnitus, and hearing loss. Pediatric patients present with irritability, crying, and scratching of the ears with both hands. Systemic symptoms vary in severity. There may be chilliness, fever, lethargy, and loss of appetite. Children are often accompanied by vomiting, diarrhea and other similar gastrointestinal symptoms. Early otoscopic examination by a doctor can reveal congestion or redness of the tympanic membrane. The progression of the disease can usually be cured with early and proper treatment. If the ear pain is not diagnosed and treated in time, the ear pain worsens and becomes pulsating and throbbing or stabbing. Hearing loss is significant. Systemic symptoms are also more severe. Children may cry and become restless, have temperatures as high as 40°C, and even have convulsions. When exudate accumulates in the middle ear, the inflammation spreads to the tympanic membrane, leading to necrotic ulceration of the tympanic membrane and the formation of tympanic membrane perforation, the secretions are drained, the local and systemic symptoms improve, the ear pain decreases, and the body temperature drops. The discharge is initially bloody and aqueous, then mucopurulent or purulent. After the tympanic membrane perforation is drained, the inflammation gradually subsides, the mucosa of the tympanic chamber returns to normal, the ear pus gradually disappears, and small perforations can repair themselves. In the case of acute necrotic otitis media with heavy lesions that reach deep into the bone, the disease may become chronic. Acute suppurative otitis media may enter the mastoid directly through the tympanic sinus to form acute mastoiditis, or through the bone cortex to form a subperiosteal abscess. If the facial nerve is involved, facial paralysis may occur. In the past, acute otitis media in children was easily complicated by septic meningitis, but nowadays, with the widespread use of broad-spectrum antibiotics, such complications rarely occur. The main treatment methods and principles The principles of treatment are to control the infection, improve drainage, and remove the cause of the disease. 1, systemic treatment: early application of sufficient antibiotics or other antibacterial drugs to control the infection, to ensure complete cure. Generally, penicillin and cephalosporin antibiotics are available. If early treatment is timely and appropriate, the tympanic membrane perforation can be prevented. After tympanic membrane perforation, pus is taken for bacterial culture and drug sensitivity test. Refer to the results and change to a sensitive antibiotic. Antibiotics should be administered for about 10 days, with rest and bowel evacuation. If the systemic symptoms are severe, give supportive therapy such as rehydration. 2. Local treatment: (1) Before tympanic membrane perforation: 2% phenol glycerin drops can be used to relieve pain and inflammation. If the systemic and local symptoms are severe, the tympanic membrane is obviously bulging, and there is no significant reduction after general treatment; or the perforation is too small for drainage; or there are suspected complications, but there is no need for immediate mastoid surgery, tympanotomy should be performed under aseptic operation to facilitate unobstructed drainage. (2) After tympanic membrane perforation: 1) First, clean and swab the pus in the external ear canal as thoroughly as possible with 3% hydrogen peroxide or aspirate the pus with an aspirator (note that the negative pressure of the aspirator should not be too high). 2) Use local aqueous antibiotic drops, such as 0.25%-1% chloramphenicol solution, 0.3% oxyfloxacin (Telbital) drops, compound rifampicin solution, etc. It is not recommended to use powder to avoid clumping with pus and affecting drainage. (3) When the pus is reduced and the inflammation gradually subsides, ear drops can be used with glycerin or alcohol preparations; for example, 3% boric acid glycerin, 3% boric acid alcohol, 5% chloramphenicol glycerin. (4) After the infection is completely controlled and the inflammation is completely subsided, the perforation can mostly heal on its own. If the perforation does not heal for a long time, tympanic membrane repair can be performed. 3, etiological treatment: actively treat chronic diseases of the nose and pharynx, such as adenoid hypertrophy, chronic sinusitis, chronic tonsillitis, etc. Basic preventive measures 1.Take correct nasal blowing action, and adopt correct nursing posture for nursing children. 2.Actively prevent and treat upper respiratory tract infections and respiratory infectious diseases. 3.People with tympanic membrane perforation or tympanic tube placement should avoid activities that may lead to water in the tympanic chamber.