What Causes Drainage from Ear Tubes?

Adhesive otitis media, also known as otonic otitis media, refers to the formation of fibrosis and adhesion between the middle ear sounding structure and the tympanic wall caused by various causes, causing the middle ear sounding structure system to move and cause conductive deafness. . Most of the adhesions are located in the posterior part of the middle tympanum. The tympanic membrane becomes thicker and sticks to the head of the tympanum. The ossicle can be individually or completely adhered around the oval window. The oval window can be partially or completely closed. Histological examination of the mucosal subepithelium is solid fibrous tissue, which may have calcification or new bone formation, but it is much less than tympanosclerosis, and the pathology is difficult to distinguish between the two. The ossicular bone can also be partially absorbed and the ossicular chain is interrupted.

Basic Information

nickname: Atelectic otitis media
English name: adhesive otitis media
Visiting department: ENT

Multiple groups: child
Common locations: Middle ear
Common causes: Sequelae of previous middle ear infections
Common symptoms: Hearing loss, tinnitus, occasionally dizziness

Causes of adhesive otitis media

It is a sequela of a previous middle ear infection. When the pathological changes of suppurative otitis media or secretory otitis media are sufficient to damage the middle ear mucosa, fibroblasts in the granulation tissue can cause new fibrous tissue or fluid to mechanize. This process can cause adhesions between the mucosa of the tympanic cavity and the tympanic membrane. Even the ossicular chain was stuck and fixed.

Adhesive otitis media classification

Ojala (1953) divides adhesive otitis media into three phases:

Acute eustachian tube inflammation

The eustachian tube is blocked, and the tympanic chamber develops a negative pressure, exuding fluid.

2. Mechanized exudate

Adhesion occurred, the edema of the middle ear mastoid small chamber was edema, cholesterol crystals were contained in the exudate, and the mastoid small chamber was filled with connective tissue.

3. Air absorption in the mastoid atrium

Bone resorption in the atrium, early edema and obstruction of the eustachian tube, and later swelling and unobstructed. MacNaughtan (1956) believes that acute otitis media is treated with antibiotics and ignores tympanic membrane drainage, which is the main cause of tympanic adhesions. Buckingham (1969) believes that eustachian tube dysfunction is the main cause of the disease.

Clinical manifestations of adhesive otitis media

The main symptom is hearing loss, most of which are conductive, and a few are mixed, and even deaf. The main cause of inner ear damage is that inflammatory toxins from the middle ear enter the inner ear through the round window membrane. Patients often have tinnitus and occasional vertigo, which may be related to narrowing or obstruction of the eustachian tube.

Adhesive otitis media examination

Otoscope examination showed that the tympanic membrane was intact, and there were many changes such as thickening, turbidity, atrophy, scar or calcified plaque. The malleolus protrudes, and the tympanic membrane is inwardly adhered. Sometimes it seems to be a large perforation with the head of the drum, the tympanic light cone disappears, and the mobility is limited. Pure tone audiometry is mostly conductive deaf, sometimes mixed deaf. The tympanogram is flat and there are no obvious peaks.

Differential diagnosis of adhesive otitis media

Adhesive otitis media needs to be distinguished from closed tympanic sclerosis, ear sclerosis, epithelialization of the inner wall of the tympanic membrane with large perforation of the tympanic membrane.

Adhesive otitis media treatment

1. Actively prevent and treat the cause

Prevents fibrous adhesions. When adenoidal hypertrophy or nasal inflammation prevents eustachian tube function, it should be treated early. Secretory otitis media should be used for eustachian tube bloating, tympanic membrane puncture, or incision of the tympanic membrane to expel the middle ear effusion. If necessary, the ventilation tube can be left. For acute suppurative otitis media, the dose of antibiotics should be sufficient, and the administration time should not be less than 5 days after the symptoms have subsided.

2. Surgical treatment

After the adhesion is formed, the treatment is difficult, and the current surgical effect is not satisfactory. When there are indications for surgery, the adhesion and fixation of the tympanic membrane and the ossicular chain can be released under the operating microscope, the fiber lock of the two windows can be removed, and the middle ear cavity containing air can be reconstructed. To prevent re-adhesion, silicone or PTFE film can be placed in the tympanum and removed in two stages of surgery.

3. When the ossicular chain is widely fixed

Hearing aids can be worn.

The operation is not good, and the eustachian tube must be unblocked, otherwise the operation will fail.

Intraauricular incision is used to perform tympanoplasty as appropriate. Carefully separate the tympanic membrane from the promontory under the microscope without tearing. After separation, use a silicone film or gelatin sponge as a septum to prevent re-adhesion. The pine is dissolved, and the second stage surgery is performed 6 months later to perform the ossicular chain shaping, such as the replacement of the iliac crest or the ossicular bone transplantation, and the trial of fenestration can also be tried. The overall effect is not clear.

Adhesive otitis media prevention

Pay attention to indoor air circulation and keep the nasal cavity unobstructed. Active treatment of nasal diseases, blowing nose can not be forced and closed both nostrils at the same time, should be unilateral blowing nose. After swimming, let the water in the ears flow out. People with chronic otitis media should not swim. Actively prevent colds.

Adhesive otitis media daily attention

1. If you have a cold, especially if you have a nasal congestion, don't take it lightly and treat it early to avoid aggravating the condition of otitis media.

2. Treated patients with otitis media still need to undergo regular inspections for any signs of recurrence, understand the degree of hearing improvement, and receive guidance on how and when to perform middle ear inflation therapy.

3. Balanced diet and lifestyle. Reducing the use of tobacco, alcohol, and spicy and irritating foods, and avoiding occasions where a cold may be transmitted, can maintain the health of the nose, throat, and eustachian tube, thereby preventing the deterioration of otitis media.

4. Patients with otitis media should maintain the tranquility of the surrounding environment. Do not exercise excessively, do not play flutes and balloons, rinse your mouth at any time to maintain oral hygiene, try to breathe with your nose, lie down with your sick ears down while lying on your side, and do not blow your nose too hard And proper exercise also helps the nasal canal and eustachian tube to be unobstructed and maintains excretion and ventilation of the middle ear.

5. Develop correct medical habits, follow the guidance and treatment of ENT specialists, and never make your own claims. If you think that the symptoms have subsided, stop taking the medicine and discontinue the treatment, causing the disease to become chronic or cause side effects.

6. In patients with chronic otitis media with perforation of the eardrum, especially to prevent unclean water from entering the middle ear through the external ear canal, causing inflammation to increase. If necessary, earplugs can be used to prevent the ear canal. If water enters the ear, it can be dried with a hair dryer or The side jump allows water to escape, avoiding digging your ears and causing them to be injured again.