Acute otitis media is more common in infants and young children in winter and can lead to deafness in severe cases. The causative agents of acute otitis media are mostly Staphylococcus aureus and Streptococcus haemolyticus. There are three routes of invasion, via the eustachian tube, the external auditory canal or the middle ear. A small number of cases may lead to perforation of the tympanic membrane. A proportion may turn into chronic otitis media with more secretions and lead to deafness and ear pain.
I. Causes.
Infection of the eustachian tube
After an upper respiratory tract infection (after a cold), nasopharyngeal secretions can enter the tympanic chamber due to nose blowing, swallowing and vomiting, which is also the most common route causing otitis media. Early in acute otitis media, viral antibody titers tend to be elevated, probably for adenovirus and influenza virus infections, followed by bacterial invasion, mostly pneumococci, hemolytic influenza bacilli and beta-hemolytic streptococci in children, and hemolytic streptococci, Staphylococcus aureus and Staphylococcus pyogenes in adults. A little later, the tympanic membrane is perforated, which is a mixed infection.
Infection of the external auditory canal
Rarely, such as wartime firearm shocks, ear-digging injuries, boxing and diving-induced tympanic membrane rupture after infection. Severe otitis externa can also lead to tympanic chamber infections when the tympanic membrane is eroded and ulcerated over time.
Bloodstream infection
At least, acute severe infectious diseases and sepsis, bacteria enter the tympanic chamber directly through the artery, and can also enter the tympanic chamber by venous thrombosis.
II. Typical symptoms.
Sudden onset of earache, often accompanied by a cold or cough. If the patient is an infant, he or she will cry and rub the earlobe of the affected ear. Fever, which can be as high as 39 degrees Celsius. Vomiting may occur, or the ear canal may be drained of soft earwax or pus. The affected ear may lose its hearing.
III. Diagnosis
Early examination: Congestion in the relaxed part of the tympanic membrane and radially dilated blood vessels visible around the tense part and the hammer bone stalk. This is a short period of time and is often overlooked, especially in children.
Mid-stage examination: Diffuse congestion of the tympanic membrane with swelling and outward expansion, initially seen in the upper posterior part. Later, the tympanic membrane is gradually more and more convex. Normal signs are difficult to recognize. Blood picture: increased total leukocyte count and increased percentage of neutrophils.
Late examination: The tympanic membrane perforation is preceded by a small local yellow spot. The perforation is usually very small at first and not easily visible. After thorough cleaning of the external ear canal, one can see a flashing and pulsating bright spot at the tympanic membrane perforation with pus gushing out from the area (ear). Hearing examination shows conductive deafness.
Recovery examination: small perforations in the tense part of the tympanic membrane are visible, and there is purulent discharge or dryness in the external ear canal.
IV. Examination
1. Tympanic membrane
The relaxed part or the whole tympanic membrane is invaginated, which shows shortening, deformation or disappearance of the light cone, posterior and superior displacement of the hammer bone stalk, obvious protrusion of the short protrusion of the hammer bone, and small angle between the anterior and posterior folds. The tympanic membrane loses its normal luster and becomes mono-yellow, orange-red or amber in the case of tympanic effusion, and the light cone is deformed or displaced. In chronic cases, the tympanic membrane may appear grayish or milky white, with dilated microvessels in the tense part of the tympanic membrane, the short protrusions appearing chalkier than chalk, and the whammy bone stalk appearing in relief. If the fluid is plasma and does not fill the tympanic chamber, a fluid plane can be seen through the tympanic membrane. This fluid plane is like an arc-shaped hair, called the hairline, with the concave surface upward. When the head position changes, the relationship with the ground parallel remains unchanged. Bubbles can sometimes be seen through the tympanic membrane and can increase after the eustachian tube is blown open. On tympanic otoscopy, the tympanic membrane is restricted in movement.
2.Pulling cork sound
The patient will feel a sound in the affected ear similar to the sound of a bottle cork being pulled.
3.Hearing test
The results of tuning fork test and pure music listening valve test showed conductive deafness. Hearing loss varies from positive to negative, and can reach about 40dB HL in severe cases. In those with significant hearing impairment, auditory brainstem response and otoacoustic emission tests should be performed to determine if there is an effect on the inner ear.
4.CT scan
The air spaces of the middle ear system can be seen to have varying degrees of increased density.
V. Treatment
Response
Remove more clothes and cover the patient with less blanket. Use a sponge dipped in warm water to cool the body. Reducing fever is especially important for infants and pediatric patients. A small amount of antipyretic medication may also be given under medical supervision to relieve discomfort and reduce fever. If the child continues to cry even after the temperature has been lowered or if the infant’s fontanelle bulges or sinks significantly when he or she is not crying, go to the hospital promptly. Administer antibiotics under medical supervision. Those who have previously suffered from otitis media or those who have been affected in the pallium should be checked again after recovery.
1. Give the patient plenty of fluids, such as water and milk, to replace the water lost due to fever.
2. Cure the cold and cough carefully to reduce the risk of middle ear infection due to coughing.
Treatment principles
1. Etiological treatment: control the source of infection and remove obstructive lesions.
2. Improve drainage, function of the eustachian tube, and remove fluid in the middle ear.
Principle of medication
1. Apply antibiotics to prevent and control infection.
2.Use antihistamine and hormone drugs to facilitate the eustachian tube.
3. Promptly investigate the cause of the disease and actively treat the cause.
Sixth, prevention
First of all, you should pay attention to exercise, improve physical quality, and actively prevent and treat upper respiratory tract infections. It is forbidden to pull out the ear with hard objects to prevent damage to the eardrum. For patients with old tympanic membrane perforation or tympanic chamber tube placement, swimming should be prohibited. For patients should pay attention to.
(1) Drink plenty of boiled water during the initial high fever.
(2) Keep the external ear canal clean, but do not swab and rub heavily.
(3) The affected ear should be on the lower side during sleep, while taking care not to be compressed.
(4) In the case of a small child, adopt a proper position when breastfeeding, preferably with the head high and feet low, and prohibit breastfeeding in the prone position.
(5) Take medication and change topical medication on time. Pay attention to the strict disinfection of the medication changing apparatus.
(6) When changing medication, the patient should be asked to lie on his side or incline his head to one shoulder and tug on the auricle, the auricle can be tugged upward to the back in adults and downward to the back in children, and then drip or incorporate the medication.
(7) Avoid spicy food and alcohol. The nursing mother of the sick child should also avoid the above items.
(8) In winter, the drip should be warmed up and the temperature should be close to the body temperature. Simple method: Hide the medicine in a pocket of your clothes 10 minutes before the drip.
VII. Complications
Acute mastoiditis, subperiosteal abscess, facial paralysis, meningitis.