Acute and chronic catarrhal otitis media: how and how to treat?

When otolaryngologists diagnose catarrhal otitis, then - from a morphological point of view - they mean a superficial type of inflammation that affects the mucous membranes of the middle ear (tympanic cavity and Eustachian tube) and is accompanied by their swelling with exudation.

Although with increased secretion of mucus, otitis is classified as exudative, and with the formation of purulent discharge - as purulent otitis media.

It should be noted that in otolaryngology (or otorhinolaryngology), as in many other areas of medicine, there are problems with terminological polysemy. Therefore, patients sometimes do not understand why catarrhal otitis can be called acute catarrh of the middle ear, and serous or exudative otitis media, and tubootitis, and salpingootitis...

In addition, many ENT doctors claim that catarrhal otitis is the initial stage of inflammation of the middle ear, defined as catarrhal otitis media or acute otitis media. And some consider catarrh to be only an acute inflammatory process, although catarrhal is inflammation of the mucous membranes.

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Epidemiology

According to clinical statistics, four out of ten adult patients have catarrhal otitis media as a result of the spread of infection from the nasopharynx with rhinitis accompanying acute respiratory infections, as well as nasopharyngitis, sinusitis, maxillary sinusitis or inflammation of the tonsils.

In children, catarrhal otitis accounts for at least two-thirds of cases. According to the latest data, about 90% of children in the first three years of life suffer from otitis (catarrhal, exudative or allergic) at least once, and in infancy - almost half. Doctors explain this by the anatomical features of the Eustachian tubes in children, the presence of a significant volume of loose embryonic tissue in the tympanic cavity, as well as insufficient development of general immunity in the first years of a child's life.

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Causes catarrhal otitis media

In most cases, the causes of catarrhal otitis are associated with a bacterial or viral infection affecting the upper respiratory tract. Among bacteria, the most common are Haemophilus influenzae (up to 25% of cases), pneumococcus Streptococcus pneumoniae (35%) and the pathogen of the mucous membranes Moraxella catarrhalis (4-13%). Additional pathogenic microorganisms are β-hemolytic pyogenic streptococcus (Streptococcus pyogenes), Staphylococcus aureus, various strains of Pseudomonas, and some gram-negative intestinal bacteria. Viral pathogens of catarrhal inflammation of the ears in 10-12% of cases are influenza viruses (Ortomyxoviridae of various serotypes), Adenoviridae, Human orthopneumovirus, Human rhinovirus (A, B, C), Coronaviridae, Reoviridae. At the same time, viruses can contribute to bacterial superinfection, disrupting the function of the Eustachian (auditory) tubes.

As a rule, inflammation of the mucous membrane of the middle ear in adults and catarrhal otitis during pregnancy develops against the background of inflammatory respiratory diseases with impaired patency of the Eustachian tubes. As a result, negative pressure is created in the tympanic cavity with transudation of fluid into it: infection enters the middle ear mainly through the tubogenic route. See - pathogenesis of tubootitis

It is precisely as a result of inflammation of the mucous membrane of the auditory tubes that the resulting mucous exudate with pathogenic microorganisms or viral virions induces catarrhal otitis media.

Children under five years of age are especially susceptible to it, due to the fact that the children's auditory tube is wider and shorter than that of adults. Because of this, bacteria and viruses, together with nasal secretions released during rhinitis or nasopharyngitis, easily penetrate the auditory tubes and the middle ear cavity, causing an inflammatory reaction.

Catarrhal otitis in a child can also be a complication of diphtheria, and in the case of measles and scarlet fever, the infection enters the ear through the hematogenous route.

In the neonatal period, catarrhal otitis in infants can develop when amniotic fluid enters the tympanic cavity during childbirth. In infants who frequently regurgitate, ear inflammation can occur due to reflux of stomach contents into the nasopharynx, and then into the auditory tubes. More information in the material - Acute otitis media in children

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Risk factors

Risk factors for the development of catarrhal otitis are considered to be:

• certain anatomical deviations in the structure of the nasopharynx and surrounding structures;
• frequent inflammatory diseases and chronic pathologies of the nasopharynx and sinuses;
• childhood;
• adenoids (hypertrophy of the pharyngeal tonsil) in children;
• in children – cleft palate, rickets, exudative diathesis;
• decreased body resistance; immune deficiency in diabetes, tuberculosis, leukemia and AIDS;
• vitamin deficiency (anemia).

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Pathogenesis

Today, the pathogenesis of acute catarrhal otitis is considered in light of two main theories. The classical explanation suggests that this disease occurs due to dysfunction of the Eustachian tube, which balances the pressure between the middle and outer ear, provides cleansing and protection of the middle ear. With persistent

Dysfunction of the auditory tubes in the middle ear - from the absorption and/or diffusion of nitrogen and oxygen into the cells of the mucous membrane of the middle ear - the pressure becomes negative, which causes transudation of serous exudate from the mucous membrane. Exudate accumulates, and this is an ideal environment for the reproduction of anaerobic pathogenic bacteria.

Another, more recent theory is that inflammation of the middle ear mucosa is caused by a reaction to bacteria already present in the middle ear. In particular, studies have shown the presence of pepsin in the middle ear, aspirated as a result of gastroesophageal reflux. This theory suggests that the middle ear mucosa is sensitized by previous bacterial exposure, and the inflammation is caused by an ongoing antigen reaction.

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Symptoms catarrhal otitis media

The first signs of catarrhal otitis may be manifested by ear congestion and autophony. At the initial stage, the inflammatory process is diagnosed as acute catarrhal otitis. As noted above, some ENT specialists believe that this is simply the initial stage of otitis development.

As the inflammation progresses, the swelling of the mucous membrane increases, spreading to the tympanic cavity, obstruction of the Eustachian tubes and retraction of the eardrum occur. As a result, symptoms of acute catarrhal otitis appear, such as hearing loss and tinnitus; headache; otalgia (ear pain - shooting, pulsating, radiating to the jaw and temple, intensifying when swallowing, sneezing, coughing or blowing your nose); serous or mucoid discharge from the ear canal.

At the onset of the disease in adults - against the background of a deterioration in the general condition - the temperature in catarrhal otitis can be subfebrile or fluctuate within the range of +37.8-38 ° C. But very quickly, especially in children, it rises even higher - to +39 ° C.

Symptoms of catarrhal otitis in infants are non-specific: increased anxiety of the child, unmotivated crying, frequent sharp turns of the head, refusal to feed. Parents can check for inflammation in the ear by pressing on its tragus: with otitis, this causes increased pain and crying.

The exudate presses on all structures of the middle ear, resulting in perforation of the eardrum with the release of purulent contents. The intensity of pain is significantly reduced, temperature readings are reduced, and hearing is gradually restored.

If individual symptoms – hearing loss (due to the formation of fibrous scars at the site of perforation of the eardrum) and the sensation of noise in the ears – appear in patients for more than one or two months or there is a periodic relapse of inflammation, then chronic catarrhal otitis is determined.

Inflammation can be one-sided – left-sided or right-sided catarrhal otitis; in children, the inflammatory process very often develops in both ears at once, causing bilateral catarrhal otitis.

In addition, there are such types of this disease as:

• adhesive otitis media (with sticky exudate), which is considered to be a consequence of chronic catarrhal otitis and the result of connective tissue proliferation and fibrosis of the tympanic cavity and eardrum;
• catarrhal purulent otitis, in which otorrhea, that is, the discharge of purulent exudate from the ear, is added to all the listed symptoms.

Since there is no mucous membrane in the auricle and external auditory canal, there can be no external catarrhal otitis: it is simply external otitis - an acute or chronic infectious inflammation of the epithelial tissues with localization from the auricle along the entire auditory canal to the eardrum, which separates the outer ear from the middle. Often, this form of the disease occurs due to manipulations in the ear canal with sharp objects and traumatic damage to the skin. External otitis can manifest itself as a furuncle localized in the ear canal or as a diffuse infection - diffuse inflammation of the external auditory canal

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Complications and consequences

It should be borne in mind that acute catarrhal otitis of bacterial origin can easily turn into a purulent form. And the air cells of the mastoid process of the temporal bone can be filled with pus, causing inflammation in the form of mastoiditis, as well as perilabyrinthine cells - with the development of inflammation of the inner ear (labyrinthitis).

Accumulating, purulent exudate can reach the subcutaneous tissue layer. It is possible to form an atypical cholesteatoma of the middle ear - a cystic tumor-like cavity that can grow to the mastoid process of the temporal bone and lead to labyrinthitis, inflammation of the membranes of the brain (meningitis), brain abscess (extra- and subdural), incomplete peripheral paralysis of the facial nerve and even sepsis.

In addition, complications of catarrhal otitis include constant tinnitus, preceptive hearing loss or complete hearing loss, and in the case of labyrinthitis, impaired coordination of movements when walking.

The infection can affect the brain tissue with the development of meningitis. Consequences Catarrhal otitis of viral origin is fraught with such a complication from the eardrum as bullous myringitis.

In adhesive otitis media, possible consequences and complications are associated with the formation of adhesions and obstruction of the auditory tube, which leads to progressive hearing loss. And the necrotic form of external otitis - in the elderly, as well as with diabetes and weakened immunity - can transform into osteomyelitis of the temporal bones of the skull.

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Diagnostics catarrhal otitis media

The main diagnosis of catarrhal otitis is based on the anamnesis, analysis of the clinical symptoms manifested in patients and examination of the ears.

The key diagnostic method is otoscopy in catarrhal otitis, which allows assessing the condition of the eardrum and identifying effusion of the middle ear. Details are covered in the publication - Ear Examination

To clarify the nature of the pathology, instrumental diagnostics (X-ray, CT) are also carried out; in the chronic form of the disease, audiometric methods are used to study hearing functions.

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Differential diagnosis

The task of differential diagnosis is to distinguish between acute otitis media and otitis media with effusion, since in the presence of non-purulent exudate, antibiotics are not recommended.

Treatment catarrhal otitis media

As otolaryngologists note, treatment of catarrhal otitis should be aimed at ensuring the patency of the auditory tubes and clearing the secretion of the middle ear from effusion as soon as possible - to ventilate the tympanic cavity in order to avoid possible complications.

The medications used in the treatment of catarrhal otitis are, in principle, the same as for any inflammation of the middle ear. Their names and methods of application are described in detail in the article - What to do with otitis?

One of the most important components of treatment is antibacterial therapy. In particular, it is necessary to prescribe antibiotics to children under two years of age. What antibiotics for catarrhal otitis do doctors prescribe? Amoxiclav (Augmentin), Ciprofloxacin, Cefixime, Roxithromycin, etc. More details about their dosage, contraindications and side effects are in the publication Antibiotics for otitis

In the absence of additional unfavorable factors - hyperthermia within three days from the start of treatment and / or severe intoxication - treatment of catarrhal otitis is carried out without antibiotics: the patient is prescribed local analgesics (usually in the form of ear drops with painkillers). For example, Otipax drops containing phenazone and lidocaine for catarrhal otitis are instilled into the ear (including in infants) - 3-4 drops no more than three times a day. Contraindication is damage to the eardrum.

Universal antimicrobial and antiviral drops - Sodium sulfacyl (Sulfacetamide). But the drugs Otofa and Polydex contain antibiotics: rifamycin and neomycin, respectively. Otofa drops for catarrhal otitis can also be used in cases of acute and chronic external and middle otitis, including perforation of the eardrum. They are instilled for a week: adults - five drops three times a day: children - two times three drops.

Also, to reduce swelling and restore the patency of the ear canal, vasoconstrictor nasal drops (Galazolin, Nazivin, Otrivin, etc.) can be effective for otitis. But these products cannot be used for more than five days in a row.

What other drops for catarrhal otitis are prescribed by doctors, more details in the article - Drops for otitis

In addition, semi-alcoholic compresses are made, the ear is warmed with a blue lamp. However, warming procedures can only be carried out at normal body temperature.

By taking vitamins A, C and E during any inflammatory diseases, we reduce the oxidative stress of the body at the cellular level, and the inflammation goes away faster.

Physiotherapeutic treatment of catarrhal otitis is carried out using UHF, electrophoresis, tube quartz, darsonvalization, etc. For more details, see - Physiotherapy for otitis

If the general condition worsens and the hyperemic eardrum bulges, surgical treatment is required - in the form of paracentesis (puncture), which allows for a significant improvement in the clearance of middle ear effusion (removal of accumulated exudate, most often purulent) and thereby eliminate the source of inflammation and protect the patient from complications.

For the treatment of catarrhal otitis, homeopathy suggests instilling mullein oil (Verbascum phlomoides) into the sore ear.

Traditional medicine is also carried out using this plant, from the flowers of which an oil extract should be prepared by infusing fresh inflorescences in refined vegetable oil (sunflower or olive) for a month.

In addition, oils such as almond, walnut and tea tree oils (it is recommended to instill two drops twice a day) relieve pain and inflammation in the ear.

Prevention

The main prevention of catarrhal otitis is timely treatment of upper respiratory tract diseases and strengthening the immune system.

Prevention of adenoids in children plays an important role.

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Forecast

As with any inflammatory process in otolaryngology, the prognosis for inflammation of the mucous membrane of the middle ear depends on the degree of its damage and functional damage. When the eardrum is perforated, there is a risk of its significant thickening and atrophy (due to scars), and, consequently, hearing impairment.

Acute catarrhal otitis media can become chronic, often with temporary and sometimes permanent sensorineural hearing loss. However, the prognosis for catarrhal otitis media is generally good.

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