In clinical practice, many patients still have questions about the understanding of otitis media. In terms of treatment alone, many people only know that they can be treated medically, but they do not know that chronic otitis media can actually be completely cured by surgery. There are still many problems in the understanding of chronic otitis media among the general public.
Question 1: What is the typology of otitis media and how does chronic otitis media occur?
Acute otitis media is most often caused by bacteria entering the tympanic chamber due to blockage of the Eustachian tube after a cold, abnormal nose blowing, or retrograde reflux via the Eustachian tube from swimming and choking, or the presence of conditionally pathogenic bacteria within the tympanic chamber that produce an inflammatory response when resistance is weakened or bacterial virulence is increased, manifesting as pain in the ear (aggravated at night), fever, and even pus flowing from the ear canal.
According to statistics, most people will experience acute otitis media once in their lifetime. If the acute phase is not treated thoroughly, it will turn into chronic otitis media, which will flow regularly with pus in the ear, sometimes more and sometimes less, for many years, depending on the body type and climate change.
The classification of chronic otitis media can be generally divided into chronic purulent otitis media and chronic non-purulent otitis media, which is also known as secretory otitis media or middle ear effusion, and later transforms into glue ear.
The symptoms vary according to the classification. For example, the main symptom of chronic suppurative otitis media is pus flow, accompanied by hearing loss. The nature of the pus can be purulent or mucopurulent. If the purulent discharge is accompanied by a foul odor it often suggests combined cholesteatoma formation; if the mucopurulent discharge is odorless, it may belong to chronic simple otitis media.
Question 2: What are the serious complications caused by chronic otitis media and cholesteatoma type otitis media?
Otitis media can cause a variety of complications, some of which are even fatal.
Otitis media itself can destroy the inner ear, producing vertigo and even total deafness. The inner ear is the part of the ear responsible for hearing and balance.
If the inner ear is attacked, the patient will feel dizzy even when sitting, and will have to rest in bed, not daring to open his or her eyes. In severe cases, the cochlea can be damaged and total deafness can occur, which can cause great inconvenience to the patient’s life.
If a cholesteatoma destroys this layer of bone tissue, inflammation can easily invade the epidural membrane and form an epidural abscess, and further infection can lead to meningitis, intradural abscess, brain abscess, etc.
In addition to the fatal complications of cholesteatoma otitis media, it can also cause damage to the facial nerve. The osseous canal of the facial nerve passes through the mastoid cavity of the middle ear, and if this canal is destroyed by a cholesteatoma, it can compress the facial nerve and cause facial paralysis.
Therefore, in clinical practice, we see that patients with cholesteatoma otitis media sometimes have crooked mouths, which means that the facial nerve has been compressed, causing facial nerve paralysis, which is peripheral facial paralysis, usually total paralysis, causing the patient’s eyes on the affected side to fail to close, and then complicating exposure keratitis and drooling at the corners of the mouth, which has a serious impact on the patient’s quality of life.
Facial palsy caused by otitis media can be cured by timely surgical treatment; if the best time for surgery is delayed, permanent facial palsy will result.
Question 3: Is chronic otitis media and cholesteatoma-type otitis media curable?
Many patients with chronic otitis media simply do not know that a cure can be obtained through some surgical methods.
Most people now believe that treatment for otitis media can only be done with a few drops of medication and is very difficult to cure. In fact, microsurgery is now available to remove the entire lesion and rebuild hearing.
In the case of cholesteatoma-type otitis media, the bone is destroyed, and when surgery is performed, the lesion, including the cholesteatoma and granulation tissue, is first removed, the papillae are completely contoured, all air spaces that may lead to the recurrence of otitis media are removed, the auditory chain is reconstructed and the eardrum is repaired, so that the lesion is completely removed and the ear is kept free of pus, and at the same time, the patient is given a functional reconstruction – This results in the complete removal of the lesion, which allows the ear to be free of pus, and at the same time gives the patient a functional reconstruction – auditory reconstruction.
There is another type of chronic otitis media that can be treated with medication. After treatment, the patient can have a dry ear, but the patient’s hearing gradually deteriorates, forming a sclerotic tympanic chamber.
This is mainly caused by otitis media in the resting phase or adhesive otitis media, where the inflammation causes calcified tissue deposits around the auditory chain, which fixes the chain and causes a severe form of conductive deafness in the patient.
For patients with tympanosclerosis, if they want to improve their quality of life, we can now remove this type of calcification and reconstruct an artificial auditory chain under a surgical microscope, and the patient’s hearing can be improved again.
Question 4: Can I have surgery for pus in the ear?
There is still a misconception among the general public that surgery cannot be done when the ear is abscessed, otherwise it will be more serious.
In fact, this is not true. For example, cholesteatoma otitis media is unlikely to reach the level of dry ear, which is always in a state of pus flow, but it will not affect the effect of having surgery at all.
With surgery, the eardrum can be repaired and the auditory chain can be reconstructed to restore the patient’s hearing. The current success rate of the surgery is very high. The dry ear rate (i.e. the chance of no more pus flowing after surgery) can reach over 95%.
Question 5: Why might otitis media be more severe in children?
Clinically speaking, otitis media in children between the ages of 1 and 5 years old can cause very serious damage. Why is this?
Pediatric otitis media has its own characteristics. If a child develops a cholesteatoma-type otitis media, the presence of a cholesteatoma is accompanied by the growth of a large number of granules, and the entire ear cavity is filled with these inflammatory granules.
The defense system of a child is different from that of an adult, and the middle ear cavity in a child has more communication with the brain during early development, so if it is filled with inflammatory granules, it is more likely to develop intracranial complications, such as meningitis, and also to cause damage to the facial nerve, resulting in facial paralysis. Therefore, if not actively treated in time, the nodules will be very serious.
In some children, the tympanic membrane is thicker and it is difficult to penetrate the thicker membrane and drainage is poor. Therefore, these children may have pus accumulation in the mastoid process, bone destruction, severe high fever and other systemic symptoms, and in such patients, tympanotomy, etc. is required.
Question 6: How can acute otitis media be treated thoroughly?
Chronic otitis media is mostly caused by incomplete treatment during the acute period, so how can acute otitis media be treated thoroughly?
To completely cure acute otitis media, it is necessary to use sufficient amount of antibiotics for sufficient time. Now there is a situation where the patient is not compliant with the medication and the doctor instructs him/her to stick to the medication for how long, many patients often stop using the medication when they feel better, which is likely to make the treatment incomplete and not completely cured.
For acute otitis media, it is recommended to insist on using antibiotics for about 10 days. For exudative otitis media, amoxicillin is usually used and insisted on treatment for about 10 days, and if it is not effective, it is necessary to consider whether the patient has proliferative hypertrophy blocking the Eustachian tube.
If this does not work, the patient should be considered to have an enlarged proliferative body blocking the Eustachian tube. For patients with oozing otitis media that does not heal or has recurrent episodes of oozing otitis media, surgical scraping of the proliferative body and simultaneous tympanic tube placement should be considered.
In the case of acute suppurative otitis media, most cephalosporins are used, and the medication should be adhered to for 10 to 14 days. For those with poor results, one should check the CT of the middle and inner ear, and at the same time, pus culture and drug sensitivity tests can be performed, so that a sensitive antibiotic can be chosen according to which bacteria is causing the problem.