Acute suppurative otitis media

Introduction to acute suppurative otitis media Acute suppurative otitis media is an acute suppurative inflammation of the middle ear mucosa caused by bacterial infection. This disease is more common in children. Clinically, it is characterized by ear pain, pus in the ear, tympanic membrane congestion, and perforation. If the treatment is timely and appropriate, the secretions are circulated smoothly. After the inflammation subsides, the perforation of the tympanic membrane can heal itself, and most of the hearing can return to normal. Improper treatment or severe illness may leave tympanic membrane perforation, middle ear adhesions, tympanosclerosis or conversion to chronic suppurative otitis media, and even cause various complications. The main pathogens are Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus hemolyticus, Staphylococcus and Pseudomonas aeruginosa. The first two are more common in children. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: acute mastoiditis abscess facial paralysis purulent meningitis

Causes of acute suppurative otitis media

Causes

The main pathogens are Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus hemolyticus, Staphylococcus and Pseudomonas aeruginosa. The first two are more common in children.

Pathogenesis

The main pathogens affecting the pathogen include the following:

1. The eustachian tube approach is the most common.

(1) Acute upper respiratory tract infection: such as acute rhinitis, acute nasopharyngitis, acute tonsillitis, etc., inflammation spreads to the eustachian tube, eustachian tube mucosal congestion, swelling, ciliary dyskinesia, local immunity decline, pathogen invasion Middle ear.

(2) During acute infectious diseases: such as scarlet fever, measles, whooping cough, influenza, pneumonia, typhoid, etc., pathogenic microorganisms can invade the middle ear through the eustachian tube; secondary to other pathogenic bacteria through the eustachian tube infection.

(3) Diving in the unclean water, swimming, improper nose, eustachian tube blowing, nasal irrigation and nasopharynx filling, etc., the pathogen can invade the middle ear through the eustachian tube.

(4) Infant breastfeeding position is not appropriate, such as lying flat milk, milk can flow into the middle ear through a short and wide eustachian tube.

2. The external auditory canal-tympanic membrane is contaminated by tympanic membrane trauma, tympanic membrane puncture or catheterization, and pathogenic bacteria can invade the middle ear from the external auditory canal.

3. Blood infections are rare.

Acute suppurative otitis media prevention

First of all, we should pay attention to exercise, improve physical fitness, actively prevent and treat upper respiratory tract infections, disable hard objects and prevent tympanic membrane damage, and prohibit swimming for patients with old tympanic membrane perforation or tympanic catheter. For patients, it should be noted that:

(1) When the initial heat is high, drink plenty of water.

(2) Keep the external auditory canal clean, but do not re-swipe.

(3) The ear should be on the underside when sleeping, and be careful not to be oppressed.

(4) If it is a child, when breastfeeding, it is necessary to take appropriate position, it should be high and low, and it is forbidden to feed in a lying position.

(5) Take the medicine on time and change the medicine for external use.

(6) When changing the medicine, the patient should be placed on the side of the patient or the head should be inclined to one side of the shoulder, and the auricle should be pulled. The auricle of the adult can be pulled back and forth, and the child can be moved backwards, and then the medicine is dripped or incorporated.

(7) Avoid spicy food and alcohol, and the lactating mother of the sick child should also avoid the above.

(8) The water used for dripping in winter should be warmed up, and the temperature should be close to the body temperature. Simple method: 10 minutes before the dropping of the medicine, the medicine is hidden in the pocket of the close-fitting clothes.

(9) The perforation of the tympanic membrane and the tympanic catheter are prohibited from swimming, and the sewage is prevented from flowing into the ear during bathing.

Acute suppurative otitis media complications Complications Acute mastoiditis abscess facial purulent meningitis

Acute suppurative otitis media is not treated properly or the body resistance is weak. Inflammation can directly enter the mastoid formation through the sinus sinus to form acute mastoiditis. The subcortical abscess can be formed through the cortical bone. It can also enter the skull through the congenital skull gap to form intracranial concurrency. Symptoms, facial paralysis occurs in the facial nerve. In the past, acute otitis media in children was complicated by purulent meningitis. After extensive use of broad-spectrum antibiotics, such complications have rarely occurred.

Acute suppurative middle ear inflammation symptoms Common symptoms Earache, deafness, high fever, tympanic membrane, redness, swelling, tinnitus, tympanic membrane, congestion, external auditory canal, congestion, antifeeding

The system has severe systemic and local symptoms, and multiple children. There may be chills and fever, and children often have vomiting and diarrhea. Ear pain is severe and lasts longer. Hearing loss can be accompanied by tinnitus. The performance of the tympanic membrane before and after perforation is completely different. Once the tympanic membrane is perforated, the pus in the ear is leaked and the symptoms can be alleviated.

Systemic symptoms

Before perforation of the tympanic membrane, the systemic symptoms are obvious, and there may be chills, fever, burnout, loss of appetite, etc. The systemic symptoms of children are usually more serious than adults. They may have high fever, convulsions, often accompanied by gastrointestinal symptoms such as vomiting and diarrhea, and body temperature after perforation of the tympanic membrane. Gradually decreased, systemic symptoms were significantly reduced.

Earache

It is an early symptom of this disease. The patient has deep dull pain or pulsating jump pain. The pain can be radiated to the ipsilateral frontal, temporal, apical, dentate or entire half of the head through the trigeminal nerve. The earache is aggravated when swallowing, coughing, sneezing, and the earache is severe. Cant be embarrassed Infants and young children are crying. Once the tympanic membrane appears spontaneous perforation or tympanotomy, the pus vents outward and the pain is reduced.

Tinnitus and hearing loss

The affected ear may have pulsating tinnitus and a gradual decrease in hearing. If the earache is severe, mild deafness may not be detected by the patient. After the tympanic membrane is perforated, the hearing is increased. If the lesion invades the inner ear, vertigo and sensorineural hearing loss may occur.

Ear leak

After the perforation of the tympanic membrane, there is liquid in the ear, which is initially serous and bloody, and later becomes mucopurulent or purulent. If the amount of secretion is very large, it indicates that the secretion is not only from the tympanic cavity, but also from the sinus and mastoid.

Examination of acute suppurative otitis media

Physical examination

Ear circumference examination may have slight tenderness in the mastoid tip and sinus sinus area. Mild redness may occur in the skin of children with papillary areas.

Under the otoscope, the tympanic membrane is congested, and the dilated, radioactive blood vessels are visible around the tension and the hammer stem. As the disease progresses further, the entire tympanic membrane is diffusely congested, swollen, and bulged outward, and its normal signs are difficult to identify. The tympanic membrane perforations are mostly located in the tension. Before the perforation, a small yellow spot appears first. At the beginning of the perforation, the perforation is a beating highlight, from which secretions emerge. After the perforation is slightly enlarged, the boundary can be clearly seen.

Infants and young children's tympanic membrane is thick, flexible, not easy to perforate, should be vigilant.

Necrotic otitis media can produce multiple perforations and rapidly fuse to form large perforations.

Hearing test

Mostly, there is conductive hearing loss, and the hearing threshold can reach 40~50dB. If the inner ear receives bacterial toxin damage, mixed hearing loss may occur.

Blood

The total number of white blood cells increased and the proportion of polymorphonuclear white blood cells increased. The blood picture gradually became normal after perforation.

Diagnosis and differentiation of acute suppurative otitis media

diagnosis

According to medical history and physical signs, adult diagnosis is easier, and children are more difficult. First, there is a history of ear symptoms, which is a serious gastrointestinal reaction. Second, pediatric external auditory canal stenosis, tympanic membrane is not easy to find, in case of high fever in children, suitable After respiratory infections occur, often shaking your head and grasping the ear, you should think about this disease, first check for pharyngeal infection and sprouting, ear area with or without tenderness and enlarged lymph nodes, tympanic membrane hypertrophy, light cone and congestion It is difficult to find out, even mild hyperemia may be the reaction of crying too long and sprouting, and if necessary, tympanostomy should be performed.

The eustachian tube mucosa is inflamed, the pharynx is blocked, the oxygen in the tympanic chamber is absorbed into a negative pressure, and the tympanic cavity is exuded in a large amount to become a bacterial culture medium. The bacteria enters a large number of reproductions, and the early tympanic membrane is invaginated, dark gray, and then congested and convex. Blocked by the blood flow, the central tympanic membrane necrosis through the pus, from the infection to the perforation of the tympanic membrane pus, generally takes 5 to 7 days, individual bacteria are more toxic, 2 to 3 days that rupture pus.

Differential diagnosis

(1) External auditory canal inflammation and edema: diffuse swelling in the external auditory canal and ear canal, exudation of pulpy secretions, late limitation of edema and pus, secretion without mucus, deafness is not a feature, pressing the tragus Pain, the lymph nodes are often swollen behind the ear.

(B) acute tympanitis: often complicated by influenza and herpes zoster, tympanic membrane congestion forming a cannon, severe ear pain, but no perforation and pus, hearing loss is not heavy, blood leukocytes do not increase.

(C) secretory otitis media: secretory otitis media with numbness or blockage in the ear, hearing loss and tinnitus as the most common symptoms, and acute suppurative otitis media systemic symptoms, high fever before the tympanic membrane perforation, earache continued The tympanic membrane is diffusely congested, and once perforated, it will overflow.

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