Exudative otitis media
Introduction
Introduction to exudative otitis media Exudative otitis media is a non-suppurative inflammation of the middle ear characterized by tympanic effusion and hearing loss. The high incidence of children is one of the common causes of hearing loss in children. According to foreign statistics, about 50% of babies have this disease, and the child's high-risk age is 5 years old. In China, about 90% of preschool children have exudative otitis media, mostly between June and 4 years old. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: allergic rhinitis secretory otitis media tympanosclerosis adhesive otitis media
Cause
Etiology of exudative otitis media
Infection factor (40%):
The high incidence of children is related to a variety of factors. First, the eustachian tube of the child is close to the horizontal position, and the lumen is short and the inner diameter is wide. Therefore, the pharyngeal infection of the child is easily introduced into the tympanum through the tube. Secondly, adenoid hypertrophy and coexistence with chronic sinusitis can oppress and block the eustachian tube. Finally, the children's eustachian tube mucociliary clearance system does not effectively discharge secretions from the middle ear and lumen.
Tumor (30%):
Adult patients are closely related to various benign or malignant lesions in the nasopharynx (such as nasopharyngeal carcinoma, nasopharyngeal fibroma, etc.), nasal and sinus diseases (nasal septum deviation, hypertrophic rhinitis, nasal polyps, etc.). In addition, radioactive damage to the Eustachian tube after radiotherapy is also one of the reasons.
Other factors (20%):
Immune response and eustachian tube dysfunction.
Prevention
Exudative otitis media prevention
Strengthen your body and prevent colds. Carry out health education, raise awareness of parents and teachers about this disease, and regularly conduct screening acoustic impedance tests for children under 10 years of age. Actively treat nasal and pharyngeal diseases.
1. Anyone who has a occlusion in the ear can find the cause in time and remove it in time, which is beneficial to the recovery of the disease.
2. When the inflammation of the nose and nasopharynx interferes with the obstruction of the eustachian tube, the nose should be used as soon as possible with the 1% ephedrine solution to make the nasal mucosa contract, the eustachian tube is smooth, fresh air enters the middle ear, and the ear exudate is immediately absorb.
3. If there is a perforation of the tympanic membrane, it is forbidden to beat the nose and drop the medicine in the ear; to prevent infection of the middle ear.
4. Use antibiotics to prevent infection by doctors. 5. If there is tympanic effusion or blood in the tympanum, you should go to the hospital for treatment.
Complication
Exudative otitis media complications Complications allergic rhinitis secretory otitis media tympanosclerosis adhesive otitis media
In addition to colds, rhinitis, sinusitis, allergic rhinitis, nasopharyngeal space-occupying lesions, adenoid hypertrophy in children, infection, head and neck radiotherapy and other factors can also induce secretory otitis media. If the otitis media with effusion is not treated promptly, the fluid in the ear is not completely absorbed, which may lead to secondary diseases such as tympanosclerosis, adhesive otitis media, and cholesterol granuloma. The treatment of these diseases will be more complicated than secretory otitis media. Pediatric patients, due to hearing loss, can affect their speech development and learning, and affect their ability to communicate with others.
Symptom
Exudative middle ear inflammation symptoms Common symptoms Ear pain Hearing loss Tinnitus baby talking late ear occlusion
1. The main symptoms are hearing loss, earache, occlusion in the ear, and tinnitus. Adults and children also have differences. Most children have no complaints about hearing loss. Children can be delayed in speech development. Preschool children often show up for their parents' call, and parents mistakenly think that their attention is not concentrated.
2. School-age children have a decline in academic performance, and the demand for excessive volume when watching TV is the main performance. If the child has only one ear and the other ear has normal hearing, it can be detected for a long time without being detected and routinely examined.
3, the feeling of occlusion in the ear or swell is a common complaint in adults, strong pinch nose, press the ear screen, yawning ear suffocation symptoms can be temporarily relieved, sometimes with tinnitus. Generally, the hearing loss is not obvious, the patient complains that the sound is too loud, and the hearing can change with the change of the head position. When the middle ear liquid is thick, the hearing does not change due to the change of the head position. In addition, most cases of acute secretory otitis media have a history of colds. Ear pain will occur later, the pain can be light and heavy, and the child will come to the emergency room at night due to earache, and there is no earache in the chronic.
Examine
Examination of exudative otitis media
Inspection Method
(1) Tympanic membrane: the slack or full tympanic membrane invagination, which is characterized by shortening, deforming or disappearing of the light cone, and the hammer stem is displaced backwards and upwards, and the short bones of the humerus are obviously protruding, and the angle between the front and rear folds becomes smaller. When the tympanic effusion is in the tympanic membrane, the tympanic membrane loses its normal luster. It is single yellow, orange-red oil or amber, and the cone is deformed or displaced. In chronic cases, it may be grayish blue or milky white. The tympanic membrane has dilated microvessels in the tension zone. The short protrusion is more smeared than the sacral color, and the humeral stem is embossed. If the liquid is serous and does not fill the tympanic cavity, the liquid level can be seen through the tympanic membrane. The liquid surface is like a curved hair, which is called a hairline, and the concave surface faces upward. When the head position changes, the relationship parallel to the ground does not change. Bubbles are visible through the tympanic membrane, and the air bubbles can be increased after the eustachian tube is blown. The tympanic membrane of the tympanic membrane is limited.
(2) The sound of the bottle stopper: the pressure is released after the tragus is pressed, and the ears are tested separately. The patient consciously has an ear sound similar to that of the bottle stopper.
(3) Hearing examination: The results of the tuning fork test and the pure music listening valve test show that the conductivity is paralyzed. The hearing loss is different for the government, and the heavy one can reach about 40dBHL. Since the amount of effusion often changes, the hearing threshold may fluctuate. Hearing loss is generally low frequency, but due to the structure of the middle ear ship and the impedance changes of the two springs, the high frequency air conduction and bone conduction hearing can also be objectively reduced, and the hearing is improved after the effusion is discharged. The acoustic guide chart has important value for diagnosis. The flat type (type B) is a typical curve of secretory otitis media; the high negative force type (type C3) shows that the pharyngeal tube is dysfunctional, and some have tympanic effusion. If the hearing impairment is significant, auditory brainstem response and otoacoustic emission examination should be performed to determine whether it affects the inner ear.
(4) CT scan showed that the air cavity of the middle ear system had different degrees of density increase.
(5) Secretory otitis media can progress to adhesive otitis media or complicated tympanosclerosis.
Diagnosis
Diagnosis and differentiation of exudative otitis media
The clinical manifestations of secretory otitis media are mainly hearing loss, which can change with body position, slight ear pain, tinnitus, ear swelling and occlusion, and the sound of water can be heard by shaking his head. Otological examination showed that the tympanic membrane was invaginated, amber or dark, and the gas-liquid level or air bubbles were also observed, and the tympanic membrane activity was reduced.
Infants and young children are characterized by poor response to surrounding sounds, scratching ears, easy to wake up, and irritating. The baby does not respond to the surrounding sound and cannot turn the head accurately to the sound source; even if the child does not complain about hearing loss, the family finds that the child is careless, changes behavior, does not respond to normal conversation, is watching TV or using hearing equipment. It is very loud; for acute otitis media with recurrent episodes, it should be alert to secretory otitis media that may persist during the seizure period; poor academic performance; poor balance, unclear clumsy; and slow speech language development.
