How Do I Choose the Best Treatment for Chronic Otitis Media?

Chronic suppurative otitis media is a chronic suppurative inflammation of the middle ear mucosa, periosteum, or deep bone, often coexisting with chronic mastoiditis. It is usually caused by delayed treatment or improper treatment of acute suppurative otitis media; or it is a direct continuation of acute otitis media. The course of the disease usually exceeds 6 to 8 weeks. Repeatedly suffering from ear pus, tympanic membrane perforation and hearing loss are the main clinical features. Severe cases can cause intracranial and extracranial complications.

Basic Information

English name: chronic otitis media
Visiting department: ENT
Common locations: ear

Common causes: Proteus, Pseudomonas aeruginosa, E. coli, Staphylococcus aureus, etc.
Common symptoms: Suffering from empyema, deafness, tinnitus, dizziness, vomiting, facial paralysis, severe headache, chills, high fever, etc.

Causes of chronic otitis media

Acute otitis media is not treated promptly or improperly, the body is poorly resistant, and the pathogenic bacteria are too toxic, which is the main reason for the chronicity of acute otitis media. Chronic lesions in the nasal cavity, sinuses, and pharynx are another reason for the recurrence of otitis media and its chronic development.

The most common pathogenic bacteria are Proteus, Pseudomonas aeruginosa, E. coli, Staphylococcus aureus and so on.

Clinical manifestations of chronic otitis media

According to the pathology and clinical manifestations, the disease is traditionally divided into three types: simple type, bone ulcer type and cholesteatoma type. Research at home and abroad has divided it into stationary and active phases. Its main symptoms are:

Suffering from ear pus

It is the main common symptom of this disease. It can be mucus, mucus or pure purulent. Simple pus is generally thin and has no odor, while bone ulcer type and cholesteatoma type pus are not much, but they are thick, mostly pure purulent, and accompanied by a strange odor.

Deafness

Different degrees of severity, such as the onset of one ear, are easily overlooked. This kind of deafness is mostly proportional to the progress of the disease course, that is, the lesion is more serious, and the deafness is also worsened. It is usually conductive deaf.

3. Tinnitus

Tinnitus may develop in some patients.

4. Other

In addition to the above symptoms, if symptoms such as dizziness, vomiting, facial paralysis, severe headache, chills, and high fever appear, suggesting that patients may have complications, they should seek medical treatment immediately and take active and effective treatment.

Chronic otitis media examination

Tympanic membrane inspection

The tympanic membrane perforations are mostly located in the tension part of the tympanic membrane. They are of different sizes and can be divided into central and marginal. From the perforation, you can see the congestion in the tympanic mucosa, swelling and thickening, or granulation and polyps.

2. audiology examination

Conductive or mixed deafness varies in severity, with a few being severe sensorineural hearing loss.

3. High-resolution CT scan of the temporal bone

Simple inflammation is mainly confined to the tympanic mucosa, and the mastoids are mostly vaporized. Bone ulcer type mucosa is thickened or has granulation growth, and the mastoid is mostly plate type or sclerosis type. Cholelipoma type can appear bone destruction.

Diagnosis of chronic otitis media

According to the medical history, the diagnosis of the test results is not difficult, and it is necessary to make a differential diagnosis with the following diseases.

Chronic tympanitis

Long-term pus discharge in the ear and more granulation on the tympanic membrane, but CT of the temporal bone showed that the tympanic cavity and mastoid were normal.

Middle ear cancer

Middle-aged and older patients have long-term ear discharge, recent bleeding and pain in the ear, new organisms in the tympanum, CT shows bone damage, and pathological diagnosis is feasible.

3. Tuberculous otitis media

Ear pus is thin, hearing loss is severe, facial paralysis occurs early, and tuberculosis lesions may be present in other parts of the body.

Chronic otitis media treatment

The principle of treatment of this disease is to eliminate the cause, control the infection, clear the focus, clear the drainage, and restore hearing as much as possible.

Cause treatment

Acute otitis media is cured in time, and upper respiratory tract infection is actively treated.

Local treatment

(1) Local medication is mainly used during the quiescent period. Local medication can be selected according to different lesions. Usually, the ears are washed with hydrogen peroxide and then dripped with antibiotic aqueous solution or a mixture of antibiotic and glucocorticoid.

(2) During the active period, the focus is to remove lesions and prevent complications, and try to retain hearing-related structures. Local medication can be used for observation and surgical treatment according to the condition.