Chronic otitis media

Chronic otitis media is always carried out with permanent or periodic leakage from the ear of the mucous, mucocutaneous or purulent substance, piercing of the eardrum and hearing impairment. The condition occurs when the otitis media lasts longer than three months. The disease can have different forms.

Chronic otitis media - definition

Chronic otitis media is a condition that lasts continuously for over three months. The cause of this condition may be the persistence of a defect in the tympanic membrane, which gives symptoms in the form of a leak from the ear of the mucopurulent content and hearing damage, and even allergic rhinitis. In the patient with chronic otitis media, ear clogs and tinnitus appear. In contrast, after a long-term course of chronic ear infection, the child has no reaction to a cry or asking questions. Warning! Otitis media poses a serious threat to the patient's life.

Two groups of the disease

Different forms of chronic otitis can be systematized in two groups, characterized by different course of significant symptoms of chronic inflammation.

• In the first group (when the patient is not at risk of complications) the leak from the ear may be mucopurulent or purulent, whereas the change concerns only the mucous membrane of the tympanic cavity. The perforation refers to the tense area of ​​the membrane, moreover there is no danger of the formation of a bump (cholesteatoma).
• In the second group (requiring surgical treatment), the leak in turn is purulent, and the changes are associated with the tympanic cavity of the appendix and other temporal bone fragments. The perforation is limited to the upper part of the flaccid tympanic membrane, in addition to which the symptoms of bone destruction and cholestasis can be seen.

Complications of chronic otitis media

In the course of chronic otitis media outside the middle ear and into the bones and the surrounding area, microorganisms may spread. This leads to:

• inflammation of the mastoid (the most common complication characterized by pulsing pain behind the ear and purulent discharge from the ear),
• facial nerve paresis,
• inflammation of the inner ear - labyrinth.

The infection can also pass through the damaged bone into the skull's dura, causing meningitis, supra and epidural abscesses, venous thrombosis, cerebral abscesses and cerebellum.

Symptoms of complications of chronic otitis media

Symptoms that give rise to suspected complications are:

·         ache,

·         feeling of tension behind the ear near the mastoid process,

·         a large amount of purulent discharge from the ear,

·         the relief of soft parts behind the earlobe, with its inclination to the front,

·         curvature of the face (limitation or removal of facial half-face mobility on the side of the affected ear),

·         occurrence of noise or its intensity (at the same time the hearing deteriorates quickly),

·         involuntary dizziness with co-occurring nausea and vomiting,

·         nystagmus,

·         headaches,

·         severe earaches,

·         high temperature around 40 ° C and its sudden drop during the day,

·         sinking sweats,

·         general weakness,

·         acceleration and slow-down of the heart rate,

·         stiff neck,

·         less mental and physical fitness.

General symptoms of chronic otitis media

Among the general symptoms of this ailment we distinguish:

• leak from the ear with a bad smell,
• dizziness,
• developing hearing loss,
• blunt headaches,
• a feeling of pressure in the head.

Types of chronic otitis media

1. Chronic chronic inflammation - is the mildest variation of this disorder. It is characterized by the occurrence of defects in the tympanic membrane and a specific mucopurulent secretion from the ear, moreover, hearing damage may occur. The treatment of simple inflammation is local and consists of elimination of leakage from the ear and removal of the source of infection in the throat and nose. Drainage and purification are used, among others. In addition, it is recommended to use preparations having local effects from the side of the auditory canal. However, there are situations in which the only solution is surgery. 

2. Chronic granulomatous inflammation - just like in simple inflammation is characterized by a loss in the tympanic membrane, but causing a bacterial infection and a rather severe leakage of mucopurulent material from the ear. Similarly, damage to your hearing may occur. In addition, granulomatous inflammations are manifested by granulation lesions of the middle ear lining as well as ear polyps and bone damage of the inner ear structure. Local treatment in this case has no effect, because extensive granulomatous changes cause clogging of the ear and prevent the outflow of infected secretions. Therefore, the treatment is based on surgery, which is difficult due to the high risk of damage to the middle ear structure, e.g. facial nerve damage. 

3. Aching cholangitis - it is also called a "pearl in the ear". During illness, cholesteatoma from cholesterol masses, effervescent ear epithelium and bacteria and dried secretions form. Perlaki resemble a pearl in their appearance (which is obviously not true), but it is a dangerous complication which, as it develops, destroys the surrounding tissues, including nerves and ossicles. The patient suffers from ear pain, tinnitus and dizziness as a result of the disease. Treatment consists of surgery, i.e. the excision of all diseased tissues.

Inactive types of otitis media

1.Tympanosklerosis - is characterized by the formation of collagen-calcium deposits in the middle ear. In addition, dry perforation and small mobility of the eardrum may occur due to its thickening and the presence of calcium deposits. Surgical treatment has no beneficial effects; it is recommended to wear a hearing aid. 

2. Atelektazja - this ailment, which is characterized by pulling the eardrum into the tympanic cavity, we are talking about retraction pockets (it is a kind of hernia). There is a risk of cholesteatoma, which is why you should periodically check retraction pockets. Treatment is based on:

• removal of the pharyngeal tonsil,
• ventilation of the middle ear,
• assumption of ventilation drainage,
• correcting the contorted nasal septum.

Diagnosis and treatment of chronic otitis media

The basis for the diagnosis is to conduct an accurate medical interview with the patient. The patient describes the symptoms, their frequency and provides other relevant information. In addition, it is important to exclude other diseases - for this purpose, the so-called ear speculum. Doctors also do:

• otoscopy,
• X-ray examination - to show bone destruction or new bone formation.

What kind of treatment will be implemented depends on the type of otitis media? In the presence of a tumor, it is necessary to perform myrinoplasty , which involves closing the perforated mucous membrane of the tympanic membrane. In addition, it is important to clean the auditory canal behind the exfoliated epithelium. In addition, the patient is prescribed special drops containing antibiotic, which should be applied directly to the ear. Cholestile variety of chronic otitis media requires surgical treatment (tumor removal). 

The right type of treatment is very important because complications can occur. As mentioned above, the most common of them is mastoiditis. Treatment of complications should only take place in a hospital setting. If one or several of these symptoms occur during the inflammation of the middle ear, the patient should be urgently transported to the otolaryngology department.