Chronic suppurative otitis media
Otitis – Elite Treatment in Europe
ENT Diseases -2005
Treatment of the Deaf in GERMANY
Chronic suppurative otitis media quite a common disease that represents a greater danger to hearing. Typically, a continuation of acute suppurative otitis media, which can not be cured more than a month as a consequence of different reasons.
The clinical course and severity of the disease a chronic suppurative otitis media medium is divided into two forms:
- attic disease.
Mezotimpanit occurs in 55% of cases. In this form of otitis media in the process involves mainly the mucous membrane of the middle and lower parts of the tympanum and the auditory tube. When mezotimpanite determined Intact slack portion of the tympanic membrane and the presence of perforation, perforation is different in their location, shape and size.
Subjective symptoms are a little pronounced. Patients complain of intermittent or persistent suppuration of the ear and hearing loss, in rare cases – the sensation of noise in the ear and dizziness. Ear pain occurs only during exacerbation of the process, sometimes it appears in the secondary diseases of the ear – outer, or diffuse external otitis limited.
Isolation of the ear is purulent mucous character. Hearing for mezotimpanite reduced lesion type conductive device. Therefore, the intensity of hearing loss in one and the same patient depends on the activity of inflammation in the ear, auditory ossicles safety functions and functional state of the labyrinthine windows. The value of the holes perforated eardrum has no significant effect on the degree of hearing loss.
During mesotympanitis normally quiet, release from the ear continued sometimes for years, causing no serious complications. Suppuration often stop on their own, resuming an exacerbation.
The causes of exacerbation of the process can be a cold, water in ear, nose disease, nasopharyngeal. In these cases, increased suppuration, increased body temperature, there is a feeling of pulsation in the ear, sometimes not sharp pain in the ear.
Under favorable conditions, and appropriate treatment after complete cessation of suppuration small perforated holes can heal. Despite the favorable course in chronic mezotimpanite may develop severe intracranial complications.
In chronic suppurative inflammation of attic disease is localized predominantly in the nadbarabannom space – attic, perforated hole is usually in the slack side of the eardrum.
Attic disease is characterized by more severe than mesotympanitis over. Suppurative process takes place in an area rife with narrow and winding pockets formed by folds of mucous membrane and auditory ossicles.
Usually accompanied by epitimpanitam polyps. Carious process, extending in depth, can capture large portions of the temporal bone, including the capsule of the labyrinth. When the bone destructive process in the formation of substances such as indole, skatole, so that the pus becomes fetid smell, which is one of the hallmarks of epitimpanita. Also this may be a periodic pain in the temporo-parietal region, as well as feelings of pressure in the ear. With the defeat of caries capsule horizontal semicircular canal, patients may complain of dizziness.
Especially great destruction in the temporal bone occur in the ear cholesteatoma, which is formed at the boundary of perforation, when the skin between the ear canal and nadbarabannym space is not a barrier in the form of the remainder of the eardrum. Under these conditions, there are growing into the epidermis of the skin of external auditory canal into the middle ear to the granulating surface of his bony walls. Thus, the epidermis is a wrapper cholesteatoma. The epidermal layer is constantly growing, and are exfoliated, while under the influence of irritation of pus and decomposition products of this process is enhanced. Holesteatomnye mass increases grow, and therefore the cholesteatoma starts to put pressure on surrounding tissues, destroying them.
Auditory function at epitimpanitah downgraded in severe degree. When the phenomenon of headache, paresis of the facial nerve or vestibular disorders in patients with epitimpanitom it should be immediately hospitalized for examination and surgery on the ear.
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