Understanding chronic suppurative otitis media

Chronic suppurative otitis media is a chronic suppurative inflammation of the middle ear mucosa, periosteum or deep bone, often associated with chronic mastoiditis. Due to the delay in treatment or treatment of acute suppurative otitis media, prolonged to chronic.

What are the symptoms of chronic suppurative otitis media?

Chronic suppurative otitis media

Generally after the onset of acute inflammation6 ~ 8Week, middle ear inflammation still exists, collectively referred to as chronic. Clinically, it is characterized by repeated pus in the ear, perforation of the tympanic membrane and hearing loss. Some otitis media can cause serious intracranial and extracranial complications and endanger life. According to the pathology and clinical manifestations are divided into three types: simple type, bone type, cholesteatoma type.

(1Simple type: Inflammatory lesions are mainly located in the mucosa of the middle ear tympanic cavity, causing perforation of the tympanic membrane. Generally, there is no granulation formation, and the ossicle is rarely damaged. The typical symptom is intermittent pus in the ear. This type of chronic otitis media has pus like a sticky nose, generally no odor, and pus when it flows. The condition is good or bad. It often recurs after a cold or water flows into the ear, accompanied by mild to moderate hearing loss. After active anti-infective treatment, pus can be stopped, but the perforation of the tympanic membrane generally cannot heal itself.

(2Bone ulcer type: or chronic granulation type suppurative otitis media. This is a heavier otitis media with more pus in the ear and a longer duration. The pus can have bloodshot or intra-abdominal hemorrhage. This long-term pus in otitis media is difficult to control by systemic or topical antibiotic treatment. In severe cases, various complications may occur due to granule destruction of surrounding structures or poor drainage of pus. Because the small bones are often wrapped or corroded by granulation, the hearing is worse than the first type of otitis media.

(3Cholesteatoma type: or middle ear cholesteatoma. This is the most dangerous form of chronic suppurative otitis media. The cholesteatoma here is not a “malignant tumor” in the usual sense. It is because the long-term perforation at the tympanic membrane or at the edge causes the tympanic epithelial cells on the outer side of the tympanic membrane and the external auditory canal to grow into the middle ear cavity. The more the epithelial cells are energized, the squamous epithelium that is detached from the layers gradually accumulates and enlarges to form cholesteatoma, and further exerts compression and erosion on the surrounding bone, and the same effect as tumor invasion and destruction occurs. The most dangerous reason for cholesteatoma otitis media is that it is destructive, can destroy all hearing bones, cause hearing loss, invade the inner ear, cause dizziness, destroy facial nerve canal, cause facial paralysis of patients, and can destroy skull base bones deeper and deeper. And the meninges lead to intracranial infections, such as meningitis, brain abscess, and serious life-threatening. Patients with this type of chronic otitis media may have only pus and deafness for a long time, but once the pus becomes more, odor, blood, or headache, dizziness or mouth slant, it is necessary to be alert to cholesteatoma. damage.

How to treat chronic suppurative otitis media?

(1Drug treatment: including topical antibiotic ear drops and systemic antibiotics to control otitis media infectious inflammation. Many patients think that otitis media can be cured by simple medical treatment, which is actually the treatment misunderstanding of otitis media. Drug treatment can only temporarily relieve the local infectious inflammation of otitis media, the so-called palliative treatment is not a cure. In fact, only through the treatment of modern ear microsurgery can there be hope to completely solve the problem.

Topical medication considerations

1 Wash the external auditory canal and the middle ear cavity before using the medicine.3%Wash with hydrogen peroxide, then wipe with a cotton swab or suck the pus with a suction device before dropping the medicine.

2 medication method: ear drop method

The patient takes a sitting position or a lying position with the ear facing up. Gently pull the auricle back and up, and drip the liquid into the ear canal3~4drop. Then use your finger to gently press the tragus screen several times to force the liquid to perforate into the middle ear through the tympanic membrane. The position can be changed after a few minutes. Note that the ear drops should be as close as possible to the body temperature to avoid vertigo.

(2)Surgical treatment:

The purpose of otitis media surgery is threefold: first, to completely remove the lesion, to obtain a “dry ear” (not long-term pus); secondly, to prevent serious complications caused by otitis media, such as facial paralysis, meningitis, brain abscess, etc.; Third, repair or re-establish the “tympanic membrane” by surgeryListen to small bonesThe sound structure of the inner ear restores or partially improves the patient’s impaired hearing.

Common surgical methods include: tympanic membrane repair, exploration and reconstruction of tympanoplasty of the ossicular bone; for patients with otitis media with granulomatous or cholesteatoma invagination, a modified mastoidectomy is needed to remove the sinus and mastoid processes. Lesions in the lesions, and as appropriate, laparoscopic or open tympanoplasty.

If the patient’s ossicle is destroyed or is not suitable for retention due to cholesteatoma, artificial ossicles are needed to reconstruct the ossicular chain. Mature artificial bone types for clinical use include:TeflonPolymeric artificial ossicles, bioceramic artificial ossicles and titanium ossicles. The doctor selects the appropriate type of artificial ossicle according to the degree of osseoinjury and residual osseointegration.

For some serious and complicated chronic suppurative otitis media, in order to prevent inner ear infection and reduce the chance of recurrence of the disease, it may be necessary to perform staged surgery for the patient to complete the lesion cleaning and osseointegration separately. In order to minimize the patient’s financial burden and save treatment time, the doctor will strive to complete the removal of the lesion and reconstruct the hearing in the same operation (the first phase completes the hearing reconstruction). However, some patients are still not satisfied with postoperative hearing recovery. This is because the new tympanic membrane is pulled by the scar during the healing process, and the connection between the ossicular bone may be misaligned. For this case, it is only after one year. Second stage surgery. Therefore, the doctor will explain and communicate the condition of the lesion and the possible effects after the operation before the operation, and the doctor and the patient will jointly discuss to develop the most suitable surgical plan.

Why should chronic suppurative otitis media be treated as soon as possible?

Chronic suppurative otitis media has a pathological process that progresses slowly and gradually worsens.

In the early stages of the disease, there may be only tympanic membrane perforation with inflammatory edema in the mucosa of the middle ear tympanic cavity. Effective anti-infective treatment can limit the lesion to the tympanic membrane and tympanic cavity, manifesting as tympanic membrane perforation and lighter hearing loss. If the infection can be actively controlled at this stage, surgical treatment should be performed in time after the dry ear. Not only is the operation scope small, the time required is short, and the risk of surgery is also low. Patients usually get better hearing after surgery and rarely have pus.

If it is not treated early, as the otitis media recurs and the purulent secretions continue to stimulate, the inflammation spreads to the deep and posterior, the tympanic cavity in the tympanic cavity and the sinus and the mastoid, and the passage in the middle ear cavity is blocked by the granulation. The inflammation is gradually aggravated, the anti-infective treatment effect is not ideal, and the ear is in a pus or wet state for a long time. At this time, the perforation of the tympanic membrane will expand, the ossicle may be damaged or wrapped by the granulation, or the hardened lesion may be formed to fix the ossicle, and the hearing is obviously lowered. Once combined with middle ear cholesteatoma will further aggravate the condition, there may be facial nerve canal, inner ear lost, and neurological deafness. It is worth noting that with the prolongation of the course of chronic otitis media, the eustachian tube function will irreversibly damage, so that the middle ear cavity loses the ability to maintain normal air pressure and maintain the normal position of the tympanic membrane. Surgical treatment at this stage will not only expand the scope, but also increase the difficulty and risk. This is because with the aggravation of the disease, the purpose of the operation is to clear the tympanic cavity, the sinus sinus, the mastoid and the small bone around the ear, and the eustachian tube area is the main disease, as appropriate, self- or artificial hearing bone reconstruction, or the second phase of the ossicle Reconstruction. The postoperative outcome depends not only on the surgeon’s surgical technique, but also on the extent, nature and severity of the middle ear lesion and the functional status of the Eustachian tube.

It can be seen that the surgical treatment of chronic suppurative otitis media should be as early as possible.

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