Chronic purulent average otitis — the purulent inflammatory process in a cavity of a middle ear having a chronic current. Chronic purulent average otitis is characterized by the conductive or mixed relative deafness, a gnoyetecheniye from acoustical pass, pain and noise in an ear, sometimes dizziness and a headache. Chronic purulent average otitis is diagnosed according to an otoskopiya, researches of hearing, bacteriological crops of ear allocations, radiological and tomographic inspections of a temporal bone, the analysis of vestibular function and the neurologic status of the patient. The patients having chronic purulent average otitis are treated by both conservative, and surgical methods (the sanifying operation, a mastoidotomiya, an antrotomiya, closing of a fistula of a labyrinth, etc.).
Chronic purulent average otitis
By definition of WHO chronic purulent average otitis is the otitis, more than 14 days which is followed by a constant gnoyetecheniye from an ear. However many experts in the field of otolaryngology point that chronic it is necessary to consider average otitis with a gnoyetecheniye, proceeding more than 4 weeks. According to WHO data chronic purulent average otitis is observed at 1-2% of the population and in 60% of cases leads to permanent decrease in hearing. More, than in 50% of cases chronic purulent average otitis begins the development aged up to 18 years. Chronic purulent average otitis can become the reason of purulent intra cranial complications which in turn can lead to death of the patient.
Reasons of chronic purulent average otitis
Activators at chronic purulent average otitis, as a rule, are several pathogenic microorganisms. Most often it staphylococcus, proteas, klebsiyella, psevdomoniya; in rare instances — streptococci. At patients with the long course of chronic purulent average otitis along with bacterial flora activators of an otomikoz — barmy and mold mushrooms are often sowed. In most cases chronic purulent average otitis is result of transition to a chronic form of sharp average otitis. Development of a disease is also possible at infection of a drum cavity as a result of the injury of an ear which is followed by injury of an eardrum.
Developing of chronic purulent average otitis is caused by high pathogenicity of activators; malfunction of an acoustical pipe at an evstakhiita, aero otitis, adenoides, chronic sinusitis; development of adhesive average otitis as a result of the repeating sharp otitises. Development of chronic purulent average otitis is promoted from sharp by various immunodeficiency (HIV infection, side effect of treatment by cytostatics or X-ray therapies), endokrinopatiya (a hypothyroidism, obesity, diabetes), irrational antibiotic treatment or unjustified reduction of terms of treatment of sharp purulent otitis.
Classification of chronic purulent average otitis
Chronic purulent average otitis has 2 clinical forms: mezotimpanit and epitimpanit. Mezotimpanit (tubotimpanalny otitis) makes about 55% and differs in development of inflammatory process within a mucous membrane of a drum cavity without involvement of its bone educations. Other 45% of cases of chronic purulent average otitis fall to the share of an epitimpanit (epitimpano-antralny otitis). It is followed by destructive processes in a bone tissue and in many cases leads to formation of a holesteatoma of an ear.
Symptoms of chronic purulent average otitis
The main clinical symptoms of chronic purulent average otitis are a gnoyetecheniye from an ear, the hearing impairment (relative deafness), ear noise, pain in an ear and dizziness. Gnoyetecheniye can have constant or periodic character. In the period of an exacerbation of a disease the quantity separated, as a rule, increases. If in a drum cavity there is a growth of granulyatsionny fabric or there are polyps, then separated from an ear can have bloody character.
Chronic purulent average otitis is characterized by the conductive type of relative deafness caused by violation of mobility of acoustical stones. However it is long the proceeding chronic purulent average otitis is followed by the mixed relative deafness. The violations arising at the same time in work of a zvukovosprimayushchy part of the acoustic analyzer are caused by the blood circulation lowered as a result of a long inflammation in a snail and damage of voloskovy cages of a labyrinth by the mediators of an inflammation and toxic substances which are formed during inflammatory reaction. The damaging substances get from a drum cavity into an inner ear through labyrinth windows which permeability increases.
The pain syndrome is usually expressed moderately and arises only during the periods when chronic purulent average otitis passes into an aggravation phase. The aggravation can be provoked by a SARS, pharyngitis, rhinitis, laryngitis, quinsy, hit of liquid in an ear. In the period of an aggravation temperature increase of a body and emergence of feeling of a pulsation in an ear also takes place.
Epitimpanit has heavier current, than mezotimpanit. This chronic purulent average otitis is followed by bone destruction as a result of which are formed rolled, an indole and so forth the chemicals giving ear separated a fetid smell. At distribution of destructive process on a lateral polukruzhny tubule of an inner ear, at the patient system dizziness is observed. At destruction of a wall of the bone front channel paresis of a facial nerve is noted. Epitimpanit leads to development of purulent complications more often: mastoidita, labirintita, meningitis, abscess of a brain, arakhnoidit and so forth.
Diagnosis of chronic purulent average otitis
These endoscopies, researches of the acoustic analyzer, bacteriological crops separated from an ear of a X-ray analysis of a skull, skull KT and MCKT with an aim research of a temporal bone allow to diagnose chronic purulent average otitis.
Otoskopiya and mikrootoskopiya are carried out after a toilet of an external ear with careful clarification of external acoustical pass. They reveal existence of perforation in an eardrum. And the chronic purulent average otitis proceeding as a mezotimpanit differs in existence of perforation in the tense area of an eardrum while the perforation arrangement in loose area is typical for an epitimpanit.
Chronic purulent average otitis is characterized by a hearing impairment according to an audiometriya, the conductive or mixed relative deafness according to a threshold audiometriya, violation of mobility of acoustical stones according to an acoustic impedansometriya. Also assessment of passability of an Eustachian tube, an elektrokokhleografiya, otoakustichesky issue is carried out. The chronic purulent average otitis which is followed by vestibular frustration is the indication for a research of the vestibular analyzer by an elektronistagmografiya, a stabilografiya, a videookulografiya, pressor test, an indirect otolitometriya. At existence in clinic of a disease of neurologic violations consultations of the neurologist and MRT of a brain are necessary.
Treatment of chronic purulent average otitis
Chronic purulent average otitis without bone destruction and complications can be treated by medicamentous methods under out-patient observation of the otolaryngologist. Such medicamentous therapy is directed to removal of inflammatory process. In cases when chronic purulent average otitis proceeds with bone destruction, it is in fact preoperative training of the patient. If chronic purulent average otitis is followed by paresis of a facial nerve, a headache, neurologic violations and/or vestibular frustration, then it demonstrates existence of destructive process in a bone and development of complications. In such situation it is necessary the fastest hospitalization of the patient in a hospital and consideration of a question of its surgical treatment.
Chronic purulent average otitis usually is subject to conservative or preoperative treatment within 7-10 days. During this period daily make an ear toilet with the subsequent washing of a drum cavity solutions of antibiotics and an instillation in an ear of antibacterial drops. Considering that chronic purulent average otitis is followed by perforation in an eardrum, as ear drops it is impossible to apply ototoksichny antibiotics of an aminoglikozidny row. It is possible to use ciprofloxacin, , rifampicin, and also their combination with glucocorticosteroids.
For the purpose of full sanitation and functional restoration chronic purulent average otitis with bone destruction needs surgical treatment. Depending on prevalence of purulent process chronic purulent average otitis is the indication to the sanifying operation with mastoidoplastiky or timpanoplastiky, atikoantrotomiy, mastoidotomiy, a labirintotomiya and plasticity of a fistula of a labyrinth, removal of a holesteatoma. If chronic purulent average otitis is followed by the poured inflammation with threat of development of complications, then obshchepolostny ear operation is performed.
Forecast of chronic purulent average otitis
In due time carried out sanitation of the chronic purulent center in an ear provides a favorable outcome of a disease. The earlier treatment is carried out, the it is more than chances of restoration and preservation of hearing. In the started cases when chronic purulent average otitis leads to considerable bone destructions and/or development of complications, restoration of hearing requires carrying out reconstructive operations. In some cases at most failure patients need hearing aid.