Acute and chronic suppurative otitis media in adults

When talking about otitis, we always mean an inflammatory reaction in the ear. However, ear inflammation can be different - middle, external, acute, chronic, catarrhal, purulent, etc. In this article, we will consider purulent otitis in adults, and in addition, we will answer many common questions of patients regarding purulent otitis.

Why is purulent otitis dangerous?

Most often, the development of ear inflammation is associated with a common cold, but this is not always correct: ear inflammation is a more serious and dangerous disease. And if a cold can "go away" on its own, without specific treatment, then the purulent-inflammatory process must be treated - and only under the supervision of a doctor.

Adults suffer from ear inflammation less often than children. However, complications in adults occur no less often than in childhood. For example, chronic inflammation can cause hearing loss - a partial loss of hearing function that cannot be restored.

Adhesions often form on damaged inflamed areas, and bone tissue in the temporal region is affected - these changes increase the risk of developing meningitis or an abscess in the brain.

Most adverse effects develop if the patient seeks medical attention late. Therefore, the degree of danger in purulent otitis is directly proportional to the timeliness of seeking medical help.

Epidemiology

An inflammatory reaction in the ear with the release of pus is considered a fairly common disease of the hearing organs. The pathology can have a mild course, or develop rapidly, leading to severe inflammation affecting the entire body.

Acute purulent otitis is diagnosed mainly in childhood. The chronic form of the disease is more typical for adults.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Causes purulent otitis media in adults

Inflammatory purulent discharge from the ear in most adults occurs as a secondary pathology - that is, initially, microbes enter the middle ear from other nearby structures. There are certain risk factors that predispose to the development of the disease - first of all, by weakening the body's defenses.

We are talking about the following factors:

• Severe cooling of the body leads to narrowing of blood vessels and activation of the viability of microbial cells.
• Anemia, hypovitaminosis, and malnutrition significantly weaken the immune system.
• Chronic and sluggish infectious lesions of the ENT organs.

In addition, the development of the disease may be preceded by sepsis, mechanical damage to the auricle, measles, tuberculosis, a foreign body in the ear, as well as immunodeficiency states.

[ 7 ], [ 8 ], [ 9 ], [ 10 ]

Pathogenesis

Both bacteria and fungal infections can be a predisposing infection for the development of the inflammatory process in adults. Most often, bacteria such as staphylococcus and pseudomonas aeruginosa, or fungi such as candida or aspergillus are found in the ear cavity. The most common pathogens of purulent middle otitis are pneumococci, moraxella, and hemophilic bacilli.

The pathogen can enter the ear cavity in several ways:

• through the auditory tube (tubogenic pathway);
• as a result of traumatic damage to the ear and eardrum;
• by spreading from the intracranial cavity (retrograde pathway);
• through blood vessels from other infectious foci (for example, with a viral infection, tuberculosis, measles, etc.).

The chronic form of purulent otitis in adults develops as a result of incomplete treatment of the acute stage of the inflammatory process in the ear.

[ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ]

Symptoms purulent otitis media in adults

In adults, purulent-inflammatory process often occurs as a complication of viral infection. Usually, it is caused by a combination of decreased immunity and damage to ENT organs. At the same time, the highest risk of the disease is for people who have recently undergone surgery or chemotherapy, as well as alcoholics, drug addicts, and HIV patients.

The first signs of the disease are fever, chills, headaches. Local symptoms are of decisive importance:

• pain, noise, ringing in the ears (usually in one ear);
• a feeling of pressure and the presence of fluid in the ear cavity;
• hearing loss, feeling of congestion;
• the appearance of discharge from the ear canal - as a rule, they are initially watery, translucent, and then become yellow-grayish, thick.

The disease is accompanied by loss of appetite and sleep disturbances.

Temperature in purulent otitis is an integral natural reaction to inflammation and the introduction of infection into the body. Temperature may vary - it depends on the individual state of immune protection, age and clinical features of the disease. Inflammation with pus in adults in most cases is accompanied by high temperature indicators - while the feverish state usually lasts as long as the pus remains in the ear cavity. Simultaneously with the release of purulent discharge (it does not matter whether this happens on its own or with the help of an autopsy), the temperature begins to decrease.

An increase in temperature with purulent otitis may also indicate the development of complications - for example, meningitis, mastoiditis and otogenic septic condition cannot do without temperature. A characteristic feature of the development of complications is that the patient's health seems to improve - but after a couple of days, pain in the ear reappears, the temperature rises, and other typical symptoms appear.

Purulent otitis without fever is typical for a disease that was initially provoked not by an infectious agent, but by trauma. Thus, when the ear is bruised, a painful wound forms in the cavity, which becomes purulent when bacteria get in. In addition, purulent otitis without pain and fever can be a sign of a fungal infection - the so-called otomycosis, or eczema of the organ of hearing. The listed symptoms may be absent with diffuse external damage, as well as with an atypical form of the inflammatory process.

Acute pain, which patients often describe as "cutting the ear with purulent otitis", is characteristic of the early stage of the disease, in which the inflammatory process is accompanied by the appearance of an abscess. As a rule, this stage lasts about 2-3 days. Then, after the perforation of the eardrum and the release of pus, the acute pain disappears.

Noise in the ear with purulent otitis can accompany all stages of the disease. Thus, the disease often begins with the appearance of noise and congestion in the ear - sometimes during a conversation, an "echo" effect occurs. Noise and hearing loss increase as the process develops, and after the pathological discharge flows out, the noise gradually passes, and the hearing function is restored.

Purulent otitis during pregnancy

The occurrence of purulent inflammation in women during pregnancy is a common occurrence. This can be closely related to two reasons: with pronounced hormonal changes in the body, as well as with a strong drop in immunity.

Inflammatory otorrhea develops more often against the background of viral and colds, and has the corresponding symptoms that are common to adult patients. The only difference is the treatment features. When purulent otitis develops, a pregnant woman needs to begin treatment as soon as possible to prevent the negative impact of the infection on the developing fetus. At the same time, not all medications can be prescribed during pregnancy, since many of them can be dangerous for the unborn child, or can disrupt the course of pregnancy.

At the first signs of the disease, you should not rely on self-medication - you should immediately visit a doctor who will prescribe the appropriate therapy.

Stages

Inflammation of the ear with the formation of pus occurs in stages:

1. Initial stage – characterized by noise and congestion in the ear on the affected side. During speech, an “echo” effect may be created. In the absence of a viral infection or cold, temperature readings may remain stable.
2. Catarrhal stage – characterized by the appearance of exudate and a feeling of fluid flowing in the ear. Growing pain occurs, the temperature rises.
3. Pre-perforation stage – characterized by infection of the exudate and development of purulent inflammation. At this stage, the painful sensations subside, but there are “shooting” sensations in the eye or lower jaw area. The auditory function is impaired.
4. Postperforation stage – at this stage, the eardrum ruptures, with purulent mass coming out of the ear canal. At the same time, the pain subsides and the temperature drops.
5. The reparation stage is characterized by the fading of the inflammatory process and scarring of the eardrum. The sensation of noise in the ear often continues to bother, but hearing ability is gradually restored.

[ 16 ], [ 17 ]

Forms

Doctors diagnose different types of otitis depending on the anatomical and physiological characteristics of the disease, as well as the form of its course.

• Purulent otitis externa occurs as a result of the introduction of an infectious agent during an ear injury, or with a pathological accumulation of moisture in the external auditory canal. This type of disease is typical for swimmers and divers, due to the constant contact of the hearing organs with water. The disease occurs with pain, itching, swelling and purulent wet crusts in the area of the external auditory canal.
• Acute purulent otitis is often provoked by acute respiratory viral infections, and also occurs against the background of an infectious lesion of the upper respiratory tract. Patients usually complain of unpleasant sensations of congestion and pain in the ear. In a healthy person, the middle ear cavity is sterile. When bacteria get into it, a purulent process begins, and the purulent mass begins to press on the walls. In this condition, the diagnosis is "purulent otitis media". If the process is not stopped at this stage, then the eardrum breaks under the pressure of the purulent mass, and the pus comes out into the external auditory canal.
• Chronic purulent otitis is characterized by the presence of a perforated membrane and an active inflammatory reaction in the middle ear for a month or more. Chronic purulent otitis is characterized by otorrhea, that is, there is a discharge of purulent mass from the ear canal. The amount of discharge can vary from significant to small, practically not noticeable to the eye. The chronic process is often accompanied by a deterioration in hearing function.
• Purulent otitis with perforation. Purulent perforative otitis is characterized by the presence of an inflammatory process with the constant formation of secretions that have strong proteolytic characteristics. This means that the secretions are capable of melting nearby tissues. Under the influence of pus and the pressure it exerts, the membranous wall cannot withstand - a hole is formed through which the purulent mass begins to exit into the external auditory canal. After the formation of the hole, the pain subsides, signs of intoxication disappear, the temperature returns to normal.
• Tubotympanic purulent otitis occurs with acute inflammation of soft tissues and the release of purulent-serous masses. The main feature of this pathology is the extent of the lesion, the increased risk of complications and long-term complex treatment. The main complication of tubotympanic otitis is considered to be damage to bone tissue - the auditory ossicles and mastoid cells.
• Bilateral purulent otitis is an infectious inflammation that affects both organs of hearing. This type of disease occurs somewhat less frequently than unilateral damage, and such otitis proceeds more difficultly. Often, to alleviate the condition, you have to seek help from a surgeon.
• Left-sided purulent otitis is a lesion of the hearing organ on the left side. This type of disease occurs no less frequently than right-sided purulent otitis - both pathologies are considered varieties of purulent otitis by localization.
• Catarrhal purulent otitis is manifested by a sharp decrease in pressure in the ear cavity - this is explained by strong secretion of effusion. Exudate accumulates in the tympanic cavity - the patient himself feels it and describes it as "overflowing" of fluid in the ear cavity. The eardrum protrudes outward upon examination. This type of disease is otherwise called "exudative purulent otitis".
• Purulent otitis with blood is a pathology that indicates damage to small vessels in the ear cavity. It can be said that the infection begins to penetrate into soft tissues. If blood appears with chronic purulent otitis, then one can suspect the development of complications in the form of damage to the facial nerve.
• Recurrent purulent otitis is a term used to describe an inflammatory purulent process in the ear that occurs several times a year, and after the patient has fully recovered (with normalization of hearing, tightening of the perforation hole). This type of purulent otitis is diagnosed more often in childhood.

[ 18 ], [ 19 ]

Complications and consequences

The inflammatory process in the ear tends to spread to other tissues and organs. The absence of treatment measures, or incorrect or incomplete treatment can lead to the purulent reaction spreading to the salivary glands, the lower jaw area, etc. Such processes can make the patient disabled.

However, according to statistics, the greatest danger lies in the fact that patients with suppuration and otitis are admitted for treatment late, when the disease has reached its peak. In this case, complications may not occur immediately, but after some time - for example, after a month or even more. The most common complication is the transition of inflammation to a chronic stage, against the background of vestibular failures in the development of hearing loss.

Other complications of purulent otitis include:

• intracranial spread of the process with the development of meningitis, abscess, encephalitis);
• facial nerve damage, paresis;
• damage to the eardrum;
• development of cholesteatoma – blockage of the auditory canal by a capsulated cyst;
• inflammatory process in the mastoid process with further destruction of bone elements in the middle ear (development of mastoiditis);
• disruption of digestive function (diarrhea, nausea, vomiting – signs of intoxication);
• dynamic hearing deterioration, up to and including complete hearing loss.

If a purulent-inflammatory phenomenon becomes chronic, then it becomes extremely difficult to treat. Many patients have all the indications for surgical intervention.

Patients often complain: hearing is lost after purulent otitis, will it be restored? In fact, hearing can really be restored in such cases:

• in chronic inflammatory process;
• for cholesteatoma;
• with atrophy of the auditory ossicles;
• with minor tissue perforation;
• if the ear canal is patent.

If an obstruction is detected in the auditory canal, or atrophy has affected the eardrum, or there is damage to the auditory nerve, then restoration of hearing function becomes impossible.

Temperature after purulent otitis is a natural reaction of the body to inflammation and the presence of infection in the body. That is, a slight increase in temperature can be observed for another 3-7 days after purulent otitis - this is how much time the body needs to restore immune protection. If the temperature first normalizes, and then rises sharply again, this may indicate the development of complications - namely, the spread of infection to other tissues and organs.

An exacerbation of purulent otitis may occur when the disease becomes chronic. Thus, an exacerbation often develops against the background of acute respiratory viral infections or colds, with sinusitis or tonsillitis. The chronic course is usually characterized by the development of mesotympanitis (inflammation of the mucous tissue of the tympanic cavity) or epitympanitis (inflammation of the mucous and bone tissue). The clinical picture of an exacerbation resembles the symptoms of an acute inflammatory process.

Blood poisoning from purulent otitis is not uncommon. The development of bacteremia in purulent otitis occurs otogenically, when pathogenic microorganisms enter the general bloodstream. In a healthy person, the blood is sterile. Blood poisoning - or, in other words, sepsis, means that infectious agents from the inflammatory focus have entered the blood. Here it is necessary to be able to distinguish sepsis from bacteremia. In bacteremia, the infection enters the blood, causing damage to certain tissues or an organ. In sepsis, the entire body is affected - all organs and systems suffer, which can ultimately even lead to the death of the patient.

Most often, the development of such complications occurs due to the lack of treatment, or due to incomplete or illiterate treatment of a patient with a purulent-inflammatory disease.

[ 20 ], [ 21 ], [ 22 ], [ 23 ]

Diagnostics purulent otitis media in adults

Diagnostic measures for inflammation of the ear with pus are not complicated - in most patients the disease can be identified already during a routine survey and examination. Thus, the doctor will definitely ask the patient about the moment of the onset of the disease, about the sequence of the appearance of symptoms, as well as about what the patient did to relieve the condition.

The doctor examines the affected ear using a special forehead reflector and funnel, or using an otoscope.

If there are external inflammatory phenomena, the doctor will pay attention to the redness of the skin, the presence of ichor or pus. The auditory canal can be narrowed, so much so that it visually blocks the eardrum.

In acute otitis media, the redness of the eardrum and its stiffness are noticeable. When pus breaks through, perforation becomes visible.

To properly test the motor ability of the eardrum, the patient is asked to take air into the cheeks and strain so that the ears "blow out." This method is called the Valsalva maneuver - it is often used by scuba diving enthusiasts. When air enters the ear cavity, the eardrum makes movements that the doctor sees. If there is discharge in the tympanic cavity, the motor activity of the eardrum will be impaired.

Blood tests for ear inflammation can only indicate general signs of inflammation in the body. Such signs usually include leukocytosis, increased ESR, increased number of neutrophils and lymphocytes.

Bacterial culture is much more informative – but its disadvantage is that the results are obtained only a week after taking the smear, and treatment of the disease must be started immediately. However, many specialists still recommend conducting a bacterial culture of secretions, since accurate identification of the pathogen will allow prescribing more effective therapy in the event that conventional antibiotics do not have the expected effect.

Instrumental diagnostics includes the following procedures:

• The hardware audiometry method is used to study the auditory function in the chronic form of the disease.
• Tympanometry is a method of measuring the pressure inside the organ of hearing, which is also necessary for the diagnosis of chronic otitis.
• X-rays and computed tomography are performed if complications are suspected, such as intracranial infection or mastoiditis.

If necessary, additional examinations are carried out by other specialists, for example, a neurologist and/or an ophthalmologist.

[ 24 ], [ 25 ], [ 26 ], [ 27 ]

Differential diagnosis

Differential diagnosis is carried out with furuncle of the auditory canal, articular mandibular arthritis, and tonsillitis.

[ 28 ], [ 29 ], [ 30 ], [ 31 ]

Treatment purulent otitis media in adults

An otitis is treated by an ENT doctor, or otherwise an otolaryngologist. The treatment regimen may include medication, external treatment and surgery. Read about how to treat purulent otitis in adults here.

Prevention

In order to not give inflammation a chance to develop, it is necessary to promptly treat any otolaryngological diseases - sinusitis, rhinitis, etc.

The specific recommendations of doctors sound like this:

• In case of a runny nose or sinusitis, it is necessary to use vasoconstrictors in order to soothe the swollen mucous membrane.
• With any cold or viral disease, you need to drink a lot of fluids to reduce the symptoms of intoxication and prevent the increase in mucus viscosity.
• If the temperature rises to 39°C or more, you must take an antipyretic.
• It is necessary to maintain adequate humidity and temperature in the room (optimal humidity levels are 45-65%, optimal temperature levels are from 18 to 22°C).
• When a runny nose appears, it is important not to try too hard to blow your nose - excessive zeal can lead to blockage of the auditory tubes and deeper penetration of the infection. It is recommended to clean each nasal passage separately, pinching the other nostril.

Perhaps the most important preventative measure is a timely visit to the doctor.

[ 32 ], [ 33 ], [ 34 ]

Forecast

Acute ear inflammation, if medical help is sought in a timely manner, most often ends in recovery. The hearing function is restored. If treatment was started late, the outcome may be different:

• purulent inflammation becomes chronic, the eardrum is perforated, the discharge of pus becomes recurrent, and the auditory function is persistently reduced;
• complications develop in the form of diseases such as mastoiditis, labyrinthitis, facial paresis, petrositis, as well as diseases of intracranial localization - intracranial abscess, meningitis, sigmoid sinus thrombus, etc.;
• adhesions and scars form, the auditory ossicles become stiff, persistent hearing loss occurs, and adhesive otitis develops.

Purulent otitis in adults is most dangerous because patients often ignore timely visits to the doctor, hoping for successful self-treatment. Therefore, doctors strongly recommend seeking advice and diagnosis as early as possible.

[ 35 ], [ 36 ]