otitis media
Introduction
Introduction to otitis media Otitis media refers to the majority of inflammatory lesions involving the middle ear (including the eustachian tube tympanic cavity, sinus sinus and mastoid air chamber). Most of the inflammatory lesions are non-specifically arranged for inflammation, especially in children, which can be divided into non-suppurative And purulent two major categories. Commonly there are secretory otitis media, acute suppurative otitis media, cholesteatoma otitis media and air pressure otitis media. basic knowledge The proportion of sickness: 0.9% Susceptible people: no specific population Mode of infection: non-infectious Complications: acute suppurative otitis media chronic otitis media
Cause
Otitis media
Listening to songs loudly can also cause otitis media (15%):
Listening to the music of big rock in the rock with headphones, if it is a long time, it is easy to cause chronic otitis media, causing tissue damage to the ear, severe hearing loss and other complications such as otitis media.
Smoking, including secondhand smoke, can also cause otitis media (20%):
Smoking can cause systemic arteriosclerosis, especially when nicotine in cigarettes enters the bloodstream, causing small blood vessels to smash and increase viscosity, and the arterioles supplying blood to the inner ear are hardened, resulting in insufficient blood supply to the inner ear, which seriously affects hearing.
Breastfeeding can lead to otitis media in infants (20%):
If the infant is breast-feeding in the supine position, because the eustachian tube of the child is relatively straight, and the lumen is short, the inner diameter is wide, and the milk can cause otitis media through the eustachian tube into the middle ear. Therefore, the mother should take the seat when feeding the child, hold the baby in an oblique position, and suck the milk vertically.
Swimming can cause otitis media (25%):
In the hot summer days, there are more and more people swimming. Avoid swimming in the mouth when swimming, so as to prevent water from entering the middle ear through the nasopharynx and causing otitis media. Perforation of the tympanic membrane caused by trauma is not allowed to drip any water-like liquid, so as not to affect the healing of the wound. The external auditory canal can be blocked by a sterile cotton ball to prevent infection and induce otitis media.
Incorrect snoring can lead to otitis media (5%):
Some people often use two fingers to pinch the two sides of their nose when they blow their noses, and force the nose out. This method of blowing your nose can not only completely remove the nose and is very dangerous. Therefore, you should advocate the correct method of blowing your nose: hold your finger on one side of the nostril, use a little force to pull out the nose of the opposite nostril, and use the same method. The other side.
A cold can cause otitis media (15%):
After the cold, the inflammation of the pharynx and nose spreads to the eustachian tube. The eustachian tube and the mucosa of the eustachian tube are congested and swollen, and the ciliary movement is impeded. The pathogenic bacteria invade the middle ear and cause otitis media. Common pathogens are mainly pneumococci, Haemophilus influenzae, etc., so preventing colds can reduce the chance of otitis media.
Prevention
Otitis prevention
1, pay attention to rest, to ensure sleep time.
2, pay attention to indoor air circulation, keep the nasal cavity open.
3, active treatment of nasal diseases, blowing nose can not force and simultaneously close the two nostrils, should cross the unilateral snot.
4, after swimming to let the water out of the ear, suffering from chronic otitis media should not swim.
5. Actively prevent colds.
Complication
Otitis media complications Complications Acute suppurative otitis media chronic otitis media
1. Acute suppurative otitis media: If the treatment is not timely or incomplete, most of them may turn into chronic otitis media. In addition, if there is chronic rhinitis, chronic sinusitis and chronic tonsillitis, the bacteria may repeatedly invade the middle ear cavity, and the otitis media is lurking. Down causes chronic otitis media.
2. Chronic otitis media: According to the time of illness, the severity of the disease is divided into three types: simple, abscess and cholesteatoma. Their common performance is that there are ear pus, repeated, and sometimes there are bloody secretions in the pus, in addition, there are tinnitus and hearing loss, if there are complications, there will be dizziness and headache.
3. Chronic suppurative otitis media: can be divided into extracranial complications and intracranial complications.
4. Extracranial complications are:
1, a variety of abscesses, such as subperiosteal abscess, subarachnoid abscess, posterior wall abscess of the external auditory canal, etc., after the appearance of abscess, local can feel very soft mass, redness, severe pain, and high fever. If the treatment is not timely, the abscess spreads to the neck, causing pain when the neck rotates. In severe cases, it will damage the large blood vessels in the neck and cause death.
2, facial paralysis, facial nerve is very close to the middle ear cavity, if it is damaged, it will cause the eye to be skewed.
3, labyrinthitis, if the inflammation invades inward, into the inner ear will cause labyrinth, leading to dizziness and nausea, vomiting and so on.
5. Intracranial complications: including meningitis, extra-abdominal abscess and brain abscess. No matter what happens, it will be life-threatening.
Symptom
Symptoms of middle ear inflammation Common symptoms Ear flow, pus, ear pain, tinnitus, earache, neurological tinnitus, persistent dizziness, fever, ear bleeding
1, acute suppurative otitis media
Suppurative otitis media is commonly known as the ear. It is inflammation of the middle ear caused by purulent bacterial infection. The symptoms are mainly ear pain and pus. Children have systemic symptoms more obvious than adults, and may have fever and vomiting. The consequences are complications, serious complications such as intracranial complications such as meningitis, brain abscess, etc. Other complications include extracranial complications such as labyrinthitis and facial paralysis.
2, secretory otitis media
(1) Deafness: Hearing can be improved after a cold, when the plane descends or when diving, suddenly hearing loss occurs, and when the tragus or head position is changed.
(2) Ear pain and bloating in the ear.
(3) Tinnitus: Most of the bass is "booming" like tinnitus. When you yawn or nose, you can hear the sound of gas.
(4) Child patients may be slow to respond, misunderstood or inattentive.
(5) otoscopy: acute tympanic membrane congestion, invagination, light cone deformation or shortening, the hammer bone short protrusion external protrusion is obvious, the tympanic membrane color changes after tympanic effusion, is pale yellow, orange red or amber, if the disease course is longer , the tympanic membrane is gray and turbid. If the secretion is serous and does not fill the tympanic cavity, the liquid level can be seen through the tympanic membrane, and the curved line is concave upward. The air bubbles are sometimes seen through the tympanic membrane, and the air bubbles are increased after the eustachian tube is blown. If there is more liquid, the tympanic membrane will protrude.
3, catarrhal otitis media
Chronic catarrhal otitis media, due to long-term congestion and edema of the eustachian tube mucosa, thickening or adhesion, causing dysfunction of the eustachian tube, due to long-term negative pressure in the tympanic cavity, the tympanic membrane is invaginated, active The range becomes smaller, so symptoms of deafness and tinnitus occur.
Deafness: Often due to repeated acute attacks, the hearing is good and bad, gradually increasing. It can be conductive at first, followed by mixing, and it can also have "self-acoustic enhancement" in the early stage. When the effusion is thick, the hearing does not change due to changes in the head position. Tinnitus: Tinnitus often makes the patient feel very distressed. It can be low-pitched at the beginning and high-pitched (such as humming) in the late stage, but there is no regularity. Some patients can feel the occlusion in the ear, and can be temporarily relieved after pressing the tragus. .
4, exudative otitis media
(1) There is occlusion and swelling in the ear: In the acute phase, there are different degrees of obstruction and dizziness in the ear, dizziness. Chronic people have only a sense of obstruction. Children are unclear.
(2) Hearing loss: Acute exudative otitis media shows upper respiratory tract infection before, hearing loss is behind, there is echo in self-listening, and symptoms may increase or decrease when the head swings. Chronic exudative otitis media is insidious, often unable to tell the onset time. When children have both ears, they often have a slow response to the sound. Watching TV should increase the volume and the energy is not concentrated. If one side of the ear is normal, it can be not found by parents for a long time.
(3) Tinnitus: In the acute phase, there is excessive sound of water and water. In the middle and late stages, due to the accumulation of liquid in the middle ear cavity, fibrous adhesions are formed, and tinnitus of different degrees and forms appear.
(4) earache, a small number of patients with exudative otitis media may also appear in the ear.
5, chronic otitis media
(1) Ear pus: is the main common symptom of this disease. May be mucus, pus, or pure purulent. Non-hazardous pus is thin and odorless. Although there are not many dangerous pus, it is thicker, mostly purulent, and has a bad smell.
(2) Deafness: Light and heavy, because it is mostly a single ear, easy to be ignored. Such deafness is more proportional to the progress of the disease, that is, the lesion is heavier and the deafness is also aggravated. It is generally conductive.
(3) In addition to the above symptoms, if symptoms such as dizziness, vomiting, facial paralysis, severe headache, chills, and high fever appear to prove that complications have occurred, they should go to the hospital immediately.
6, acute otitis media
Sudden ear pain, often accompanied by a cold or cough. If the patient is a baby, he will cry and rub the earlobe of the ear. Fever, body temperature can be as high as 39 degrees Celsius. There may be vomiting, or the ear canal may be soft earwax or pus. The affected ear may be hearing impaired.
7, chronic suppurative otitis media
Chronic suppurative otitis media refers to chronic suppurative inflammation of the middle ear mucosa, periosteum or deep bone. The disease is more common in the clinic, often with intermittent or persistent pus, perforation of the tympanic membrane, and hearing loss as the main clinical manifestations. In severe cases, it can cause intracranial and extracranial complications.
1, systemic symptoms: light and heavy. There may be chills, fever, fatigue, loss of appetite. Pediatric system is more severe, often accompanied by gastrointestinal symptoms such as vomiting and diarrhea. Once the tympanic membrane is perforated, the body temperature gradually decreases and the systemic symptoms are significantly alleviated.
2, earache: deep pain in the ear, gradually worsening. Such as pulsating jump or tingling, can be radiated to the same side of the head or teeth, aggravation of ear pain when swallowing and coughing, severe earache can not sleep at night, irritability. After the perforation of the tympanic membrane was pus, the ear pain was reduced.
3, ear pus: is the main symptom of this disease. May be mucus, pus, or pure purulent. Non-hazardous pus is thin and odorless. Although there are not many dangerous pus, it is thicker, mostly purulent, and has a bad smell.
4, hearing loss and tinnitus: beginning to feel ear suffocation, followed by hearing loss, accompanied by tinnitus. Ear pain players, deafness can be ignored, some patients can be accompanied by dizziness, and the deafness is reduced after perforation.
5, deafness: light and heavy, because most of the disease is single ear, easy to be ignored. Such deafness is more proportional to the progress of the disease, that is, the lesion is heavier and the deafness is also aggravated. It is generally conductive.
Examine
Examination of otitis media
(1) Tympanic membrane:
The slack or the full tympanic membrane is invaded, which is characterized by shortening, deforming or disappearing of the light cone, and the hammer stem is displaced backwards and upwards, and the short protrusion of the tibia is obviously protruding, and the angle between the front and the back is 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. Chronic patients may be grayish blue or milky white, the tympanic membrane has dilated microvessels, 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 cork stopper:
After pressing the tragus and then releasing the amps separately, the ears were tested separately, and the patient consciously had ears that sounded like a cork.
(3) Hearing examination:
Tuning fork test and pure music listening valve test results show conductivity . Hearing loss is different, and the weight can be as high as 40dB HL. Since the amount of effusion often changes, the hearing threshold may fluctuate. Hearing loss is generally low frequency, but due to changes in the impedance structure of the middle ear, 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, and the high negative force type (C3 type) indicates 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 diagnosis of otitis media
Differential diagnosis
1, otitis media
It is the most common cause of tympanosclerosis. It is characterized by thickening of the tympanic membrane and invagination. The soft tissue density is filled in the tympanic cavity and or the mastoid sinus and the mastoid air chamber. The gas in the mastoid air chamber is reduced or disappeared. There may be signs of fluid accumulation in the tympanic cavity and the mastoid, and the small bone may be destroyed or even disappeared. A small number of patients may have milk. Bone destruction of the tympanic wall, but no calcification.
2, adhesive otitis media
Tympanic atherosclerosis and adhesive otitis media are permanent and inactive irreversible lesions caused by otitis media prolonged, including mechanized adhesions, called adhesive otitis media, and transparent degeneration and calcification. Even the ossification is called tympanosclerosis. The clinical symptoms and manifestations and medical history of the two are very similar. After calcification or ossification of the tympanic plaque, it can be clearly diagnosed on HRCT, and it is difficult to distinguish HRCT before calcification or ossification, which is characterized by normal or thickening of the tympanic membrane and invagination. The soft tissue density shadow in the tympanic chamber is connected to the bone wall and the ossicular chain. The identification method is mainly confirmed by pathology or surgery.
3, secretory otitis media
It is a non-suppurative inflammatory disease of the middle ear characterized by tympanic effusion and hearing loss. The middle ear effusion can be serous leakage or exudate, or mucus. The name of the disease is not uniform, there are called exudative otitis media, catarrhal otitis media, serous otitis media, serous-mucinous otitis media, non-suppurative otitis media. The middle ear is coated with a sticky and gelatinous shape, which is called a rubber ear.
