Suppurative otitis media is a purulent disease of the middle ear mucosa that occurs in the middle ear cavity and usually manifests as perforation of the eardrum and pus flowing from the ear. There are acute and chronic cases.
Acute suppurative otitis media is a relatively common and serious purulent inflammation of the middle ear, which is often encountered in daily life, especially in children, who have weak resistance and are prone to upper respiratory tract infections and acute infectious diseases, which are most likely to be combined with acute suppurative otitis media. If the disease is not controlled in time, it can become chronic and persist for years or even years, causing not only hearing loss but also repeated pus flow, which brings great pain to the patient. Therefore, it is especially important to recognize this disease, prevent and control it in time, and prevent it from becoming chronic.
Chronic suppurative otitis media is often referred to as “ear infection”, which is a common disease that not only affects hearing but can also be life-threatening. Its main features are repeated ear discharge, tympanic membrane perforation, and hearing loss.
I. Causes of acute suppurative otitis media
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How do septic bacteria infect the middle ear? Whenever there is an upper respiratory tract infection or acute rhinitis or sinusitis, bacteria from the nasal cavity and pharynx enter the middle ear through the eustachian tube, especially in children, who have a physiological weakness in that the tube is relatively short and horizontal, with a relatively wide caliber, creating favorable conditions for bacterial infection.
Sometimes, when feeding a child, the posture is not appropriate and the head is too low, it is easy to choke and cough, and milk can enter the middle ear through the eustachian tube after eating milk, stimulating middle ear inflammation. In addition, when swimming or diving in summer, sewage chokes into the middle ear through the nose and also enters the middle ear through the eustachian tube. Furthermore, forceful nose blowing, inappropriate eustachian tube blowing or nasal irrigation can cause infected material to enter the middle ear through the eustachian tube.
In addition to the eustachian tube route, there is also the external ear route, where the tympanic membrane is perforated by ear digging or trauma, and when it is improperly handled or contaminated, pathogenic bacteria can invade the middle ear through the ruptured tympanic membrane and cause otitis media.
In addition, there is also the blood route, where bacteria enter the middle ear with the blood circulation and cause otitis media, which is extremely rare.
Causes of chronic suppurative otitis media
Chronic suppurative otitis media, mainly from acute suppurative otitis media, due to the acute period did not receive timely, effective and thorough treatment, repeated attacks, delayed formation, if the acute inflammation subsided 2 ~ 3 months after the continued flow of pus, the disease has entered the chronic phase. The course of this disease can be from several months to several years or even decades, not only damage hearing, certain types can also cause a variety of complications, serious cases can be life-threatening.
In recent years, with the improvement of people’s living standard and health awareness, as well as the application of antibiotics, the incidence of chronic suppurative otitis media has decreased, but it still accounts for a large proportion of otologic diseases, so if you have chronic otitis media, you should not take it lightly, but pay enough attention to it, check it as early as possible, treat it in time, preserve your hearing as much as possible, and prevent complications.
Symptoms of acute suppurative otitis media
After recently suffering from upper respiratory tract infection, or cold and flu, there suddenly appears a severe pain in the deep part of the ear, the pain is severe, and it is throbbing pain with the pulse, which may be accompanied by fever, general weakness, with ipsilateral head and face pain, dizziness and other sensations, as well as ear stuffiness and hearing is obviously not as good as before.
Most of the ear pain occurs in the early stage, before the perforation of the eardrum, and can be felt as a deep pain in the ear, a sharp pain, like a pinprick. The pain can be radiated to the same side, head and neck, teeth and the whole half of the head and face. The intense ear pain often makes the patient sleepless at night and depressed. In infants and young children, they often cry and do not eat milk. This pain is relieved immediately after the eardrum is perforated and the pus flows out.
Treatment of acute purulent otitis media
The treatment of acute suppurative otitis media before and after tympanic membrane perforation is different, but one thing is the same, that is, early application of sufficient amount of antibiotics against infection to prevent its transformation into chronic.
(a) Treatment before perforation: Apply 1% to 2% phenol glycerin to dot the ear, which can penetrate the tympanic membrane and play the role of anti-inflammation and pain relief, and stop applying it after perforation because it contains carbolic acid, which has a damaging effect on the mucosa of the middle ear. Furosemide solution is dotted on the nose to contract the edematous mucosa around the pharyngeal opening of the eustachian tube in order to induce it to open and allow the effusion of fluid from the middle ear. After the above treatment, the ear pain is still intense, the high fever does not subside, the inflammation cannot be controlled, and the tympanic membrane protrudes outward to perform tympanotomy.
(B) Treatment after perforation: After perforation, make sure that the pus in the middle ear flows out unimpeded.
1. Thoroughly clean up the pus accumulated in the external ear canal. Only after the pus is cleared up can the medication that is dripped into the middle ear be guaranteed to have a therapeutic effect. It is best to use 3% hydrogen peroxide to clean the ear before each drop.
2. Apply antibiotic ear drops, commonly used are 2.5% chloramphenicol solution, Telbivitol ear drops, etc.
During the period of illness, you should take proper rest, regulate your diet, listen to the doctor’s orders, and take the needle and medicine on time. Don’t stop the medicine without permission when you feel slightly better, and remember to use the medicine when you feel bad again, which can only make the condition worse and more easily turn into chronic, or make the bacteria resistant to the medicine, which increases the difficulty of treatment. After the perforation, each time before dropping the medicine should first wash the ear with 3% hydrogen peroxide, wipe dry and then drop the medicine. Nose dripping with furosemide should be done in a proper posture, with the head tilted to the edge of the bed and slightly to the affected side by 30°. It is necessary to go to the hospital frequently for review, so that the doctor can grasp the condition and adjust the treatment plan according to the condition in time.
V. Symptoms of chronic suppurative otitis media
(a) Pus flow: Ear pus flow is one of the main symptoms of chronic suppurative otitis media. Attention should be paid to the duration and number of times of pus, the color and smell of pus. Simple purulent otitis media is mostly intermittent, mucopurulent fraction, which disappears soon after treatment and has no odor. Once there is frequent recurrence of foul-smelling pus, sometimes purulent and bloody, it is suggestive of bone ulcer type or cholesteatoma type
(b) Deafness: Most patients suffering from chronic suppurative otitis media have different degrees of deafness. In the early stage, the lesion is mild, usually mild conductive deafness, and simple otitis media is the most common type. With the aggravation of the lesion, there can be different degrees of hearing loss due to different degrees of destruction of the auditory bone, and mixed deafness or even neurological deafness can occur.
(iii) Other complications: numbness or twitching of the affected side and tight eye closure in patients with long-term ear drainage are early manifestations of facial nerve involvement, and vaginal vertigo with nausea and vomiting should be considered as vagal fistula. If there is a decrease in ear pus flow, headache on the affected side, stiffness of the neck, persistent high fever, vomiting, mental depression and indifferent expression, intracranial complications should be considered first, and once such symptoms appear, it indicates a serious and dangerous condition, which is the most serious complication of chronic suppurative otitis media.
Treatment of chronic suppurative otitis media
(a) Non-surgical treatment: For simple otitis media and osteochondritis media without complications, conservative treatment can be used. The systemic application of antibiotics and local application of ear drops can also be used. The positive and negative pressure replacement method can also be used, that is, the pus can be sucked out with high negative pressure through the special otoscope, and then the positive and negative pressure replacement method can be used to instill the medicine into the tympanic chamber. Ear drip treatment should be done with a non-otoxic solution, and be careful not to use it for too long. For some otitis media, the effect of medicated ear drops is better if the pus is wiped clean with 3% hydrogen peroxide first and then the medication is ordered. For some otitis media, the medicated ear drops are less effective, so a small amount of pus can be taken for bacterial culture and antibiotic sensitivity test, and the medication can be chosen according to the type of bacteria and their sensitivity, which will increase the treatment effect.
(2) Surgical treatment: Simple otitis media can be stopped after complete drying, and if there is no recurrence in 2 to 3 months, tympanic membrane repair or tympanoplasty can be considered, which can close the perforation and eliminate the way of invasion of lesions, and also can preserve or improve hearing as early as possible. For cholesteatoma and osteoid otitis media, surgery should be performed as early as possible to eradicate the lesion and prevent complications. When you have chronic suppurative otitis media, you should cooperate with your doctor’s treatment.
First, it is important to follow up regularly according to the doctor’s requirements. Because the doctor’s treatment is constantly adjusted and changed according to the results of each examination and changes in the treatment plan after the use of medication, it is important to have follow-up examinations.
Second, when your doctor prescribes ear drops, you should ask him/her about the method and dosage of the medication. There is a lot to learn about the application of ear drops, and improper use of the medication can directly affect the effectiveness of the treatment. The correct method of medication is to clean the pus in the ear with 3% hydrogen peroxide repeatedly, wipe off the medication with a dry cotton swab, and then put 3 to 4 drops of the medication in the ear, with the affected ear upwards, lie down for a moment, and wipe off the outflow of the medication after standing upright. It is also possible to pinch the nose and inflate the air after the drops are put in, using negative pressure to make the solution enter the middle ear smoothly.
Third, if non-surgical treatment fails, you should listen to your doctor’s advice and consider surgery as soon as possible.
VII. Prevention of purulent otitis media
1. Prevention of acute suppurative otitis media
Exercise, enhance physical fitness, prevent and treat upper respiratory tract infections. Quit bad habits, do not blow the nose with force, publicize the correct breastfeeding posture, and hold the child up with the head upright after breastfeeding. Prevent trauma to the tympanic membrane. For those who have already had trauma, remember to never pour in sewage when swimming or washing the face, otherwise the infection will definitely flow.
2. Prevention of chronic suppurative otitis media
The main measure to prevent chronic suppurative otitis media is to treat acute otitis media thoroughly, so as not to leave any problems behind, and to prevent upper respiratory tract infections such as acute infectious diseases. If the eardrum is already perforated, avoid swimming in the water and do not pour dirty water into it. Simple otitis media with small perforations can heal on their own if they are kept dry and do not recur. For perforations that do not heal easily, the tympanic membrane should be repaired at the earliest possible time at a hospital in a position to do so, so as to avoid bacterial infection from the perforation.