Chronic ekssudativny average otitis — a chronic not purulent inflammation of the mucous membrane covering a drum cavity. Chronic ekssudativny average otitis is characterized by the accruing deterioration in hearing, a congestion in the ear, an autofoniya, feeling of a raspiraniye from the affected ear, ear noise arising at the movements by the head. Chronic ekssudativny average otitis is diagnosed taking into account data of an otoskopiya, mikrootoskopiya, a research of an Eustachian tube, an audiogramma, acoustic impedansometriya and KT of a temporal bone. Treatment of the patients having chronic ekssudativny average otitis consists in sanitation of a nasopharynx, restoration of passability of an Eustachian tube and acoustical function, prevention of a sklerozirovaniye of a cavity of a middle ear.
Chronic ekssudativny average otitis
In otolaryngology chronic ekssudativny average otitis also carries names serous, sekretorny and not purulent average otitis, tubotimpanit, tubo-drum Qatar. Chronic ekssudativny average otitis is most often observed among children preschool children at whom it usually has bilateral character. Approximately in 20% of cases chronic ekssudativny average otitis is noted aged from 2 up to 5 years. According to some information most of adults (80%) in the childhood transferred this or that form of ekssudativny average otitis.
The diagnosis "Chronic ekssudativny average otitis" is considered competent if the disease lasts more than 8 weeks. Other forms belong to sharp (up to 3 weeks) and subsharp (3-8 weeks) to ekssudativny average otitis. Unlike them, it is long the proceeding chronic ekssudativny average otitis leads to irreversible decrease in hearing, and can cause a speech arrest of development in small children.
Reasons of chronic ekssudativny average otitis
The main reason for which there begins the development chronic ekssudativny average otitis is the obstruction of the mouth of an Eustachian (acoustical) tube located in a drink leading to emergence of an evstakhiit. As a result of violation of pneumatic and drainage function of an acoustical pipe there is a pressure decline in a drum cavity. At the same time begins to come to it , and in a mucous membrane there is a formation of glands producing a secret. These processes conduct to a congestion in a drum cavity of the liquid complicating mobility of acoustical stones.
Lead the diseases breaking normal outflow of a secret from additional bosoms of a nose (sinusitis, adenoides, allergic rhinitises, sinekhiya and tumors of a cavity of a nose, a tumor of a throat, a curvature of a nasal partition, a nose injury, a scleroma) to obstruction of an acoustical pipe which causes chronic ekssudativny average otitis; the inflammatory diseases causing hypostasis of a mucous nasopharynx (a SARS, quinsy, pharyngitis, chronic tonsillitis, laryngitis, chronic rhinitis), a barometric injury of an ear (aero otitis). Congenital anomalies of a facial skull (a wolf mouth) can promote developing of chronic ekssudativny average otitis.
Symptoms of chronic ekssudativny average otitis
Chronic ekssudativny average otitis often arises against the background of an acute or chronic inflammatory disease of the top airways. Adult patients usually show complaints to a hearing impairment (relative deafness), feeling of a congestion and a raspiraniye in an ear. The autofoniya at which patients feel in the affected ear the voice louder, than usually is possible. At the same time the patient with chronic ekssudativny average otitis has a feeling that its voice sounds as though under water or as when lowering the head in a barrel.
In mild cases, at a congestion in a cavity of a middle ear of a small amount of liquid, patients note the fluctuation phenomena: noise in an ear at turns and a ducking, a crash or a squelch at a smorkaniye and swallowing. If exudate borrows to a half of a drum cavity, then at a ducking forward or in a prone position on a stomach hearing improvement is observed. Chronic ekssudativny average otitis, as a rule, is not followed by a pain syndrome. In certain cases passing and low-intensive ear pain can be observed.
At children of younger age chronic ekssudativny average otitis often has an asymptomatic current. Children usually do not show complaints. The deterioration in hearing accompanying chronic ekssudativny average otitis comes to light parents who begin to notice that the child often does not respond when he his name is, asks to turn on the music or the animated film on - is louder. Besides, the children having chronic ekssudativny average otitis seem inattentive and can worse get on well at school.
Complications of chronic ekssudativny average otitis
Inflammatory process at chronic ekssudativny average otitis often passes into a fibrous and sclerous stage with development of adhesive average otitis. Penetration of an infection into a cavity of a middle ear can lead to emergence of recurrent sharp average otitis, and also chronic purulent average otitis. Besides, chronic ekssudativny average otitis can be followed by perforation of an eardrum, formation of a holesteatoma, development of a subsharp or chronic mastoidit. If chronic ekssudativny average otitis develops in the early childhood, then it leads to violation of development of speech function of the child and a delay of his psycho-emotional development.
Diagnosis of chronic ekssudativny average otitis
Early diagnosing of ekssudativny average otitis at children up to 5-6 years it is extremely difficult due to the lack of complaints. Chronic ekssudativny average otitis can be revealed at them incidentally at medical examination at the otolaryngologist. Confirmation of the diagnosis requires carrying out an otoskopiya, mikrootoskopiya, researches of hearing and passability of an acoustical pipe.
During the otoskopichesky researches can come to light: the raised vaskulyarization and a thickening of an eardrum, its changed (whitish, red or tsianotichny) color, vials of air located behind a membrane or level of liquid. Chronic ekssudativny average otitis is characterized by a vtyanutost and restriction of mobility of an eardrum, deformation of a light cone, a vypiraniye in external acoustical pass of the handle of a hammer. At development in a cavity of a middle ear of fibrous and sclerous changes the eardrum looks thinned and atrofichny. It is long the proceeding chronic ekssudativny average otitis leads to education on an eardrum of soyedinitelnotkanny hems and centers of a miringoskleroz.
The research of passability of an acoustical pipe defines obstruction of its mouth. Data of a threshold audiometriya speak about existence of conductive relative deafness. Results of an acoustic impedansometriya indicate restriction of movements of acoustical stones. Patients, it is long having chronic ekssudativny average otitis, in addition there pass skull KT with an aim research of a temporal bone. KT allows to estimate degree of lightness of all cavities of this area, a condition of anatomical structures of an ear (windows of a labyrinth, acoustical stones, a bone part of an acoustical pipe), density and an arrangement of pathological contents of cavities of an ear.
Chronic ekssudativny average otitis needs to be differentiated from an otoskleroz, cochlear neuritis, chronic purulent average otitis, some tumors of an ear, an otomikoz, congenital anomalies of formation of acoustical stones.
Treatment of chronic ekssudativny average otitis
Medical tactics at the patients having chronic ekssudativny average otitis consists in elimination of violations of passability of an Eustachian tube, elimination of inflammatory changes in a drum cavity, restoration of hearing and prevention of irreversible sclerous changes.
Begin to treat chronic ekssudativny average otitis from elimination of the reasons which caused it, i.e. from sanitation of a nasopharynx and therapy of inflammatory processes in okolonosovy bosoms, a cavity of a nose and a throat. For this purpose if necessary make an adenotomiya, a tonzillektomiya, endofaringealny instillations of medicines, washings of okolososovy bosoms by method a sine evacuation or the Cuckoo method, medical punctures or drainage of bosoms.
Allows to eliminate the violation of passability of an Eustachian tube which caused chronic ekssudativny average otitis a kateterization of an acoustical pipe, blowing off on Polittsera, application of antiedematous means, anti-inflammatory and antihistaminic medicines. For fluidifying of the liquid which accumulated in a drum cavity to the patients having chronic ekssudativny average otitis appoint mucolytics, endouralny an atsetiltsesteina, an intra ear electrophoresis of proteolytic enzymes. The good anti-inflammatory effect is gained at application of an electrophoresis of glucocorticosteroids.
Application of antibiotics in treatment of chronic ekssudativny average otitis remains still very diskutabelny as it is known that in half of cases chronic ekssudativny average otitis represents aseptic inflammatory process.
At development of complications or lack of result from therapy by conservative methods, chronic ekssudativny average otitis is subject to surgical treatment. Depending on a clinical situation chronic ekssudativny average otitis can become the indication to carrying out a paratsentez of an eardrum, a timpanotomiya or shunting of a drum cavity. Surgeries are made with use of local anesthesia, and demand the general methods of anesthesia from children of younger age.