Chronic otitis media
Synonyms in a broader sense
Medical: Chronic otitis media, Chronic otitis media, Chronic epi-tympanic otitis media
English: chronic otitis media
introduction
Under the term "chronic otitis media"one understands the recurrent occurrence of inflammatory processes in the area of the Middle ear. The Otitis media is generally one of the most common diseases and affects almost everyone at least once in a lifetime. Small children and adolescents in particular often develop inflammatory processes in the area of the middle ear (Otitis media).
While the acute otitis media is very common, chronic forms of otitis media are observed comparatively rarely.
Chronic otitis media is further divided into two distinct forms, the chronic mucosal suppuration and the chronic bone augmentation. Both forms are associated with long-lasting and / or frequently recurring painful inflammations of the middle ear. In addition, both types of chronic otitis media can become permanent Perforation of the eardrum and purulent discharge from the Ear canal to lead.
The causes for the development of a chronic otitis media are still largely unexplained. Anatomical misalignments or pronounced defenses are the most likely causes.
While the acute forms of otitis media often heal without medical intervention, one is needed chronic otitis media always a medical evaluation. In the event of inadequate treatment, the chronic inflammatory processes in the middle ear can lead to serious complications.
root cause
The exact causes that lead to the development of a chronic otitis media are still today largely unknown. In professional circles, however, there are various theories that are generally considered conclusive. As a result, the two typical forms of chronic otitis media have different causes.
The chronic bone augmentation should be closely related to repeated occurrence akuter inflammatory processes within the Middle ear stand. In addition, it is believed that traumatic injuries to the eardrum (for example, from a slap or a bang) can be the cause of chronic otitis media.
At Children there is also the possibility that anatomically or inflamed polyps in the area of the nasopharynx can be the cause of a chronic otitis media. The enlarged polyps cause a recurring or persistent pressure equalization and ventilation disorder of the middle ear over the Eustachian tube (Synonyms: Eustachian tube, tube). Reached to the affected children bacterial pathogens This connection from the nasopharynx into the middle ear can lead to the development of a chronic otitis media.
In rare cases you can also benign or malignant ulcers (Tumors) hinder proper ventilation and thus provoke the development of chronic otitis media.
In adult patients, it can also be frequently recurring Inflammation of the sinuses negatively affect the ventilation of the middle ear. In these cases there is often a Misalignment of the nasal septum fundamentally.
Furthermore apply allergic reactionleading to severe swelling of the lining of the upper airways, one of the possible causes of chronic otitis media.
Ultimately, it can be assumed that, regardless of the original mechanism of formation, in any case bacterial pathogens are involved in the development of chronic otitis media.
To the typical bacterial pathogens that play a role in this context include:
- Pseudomonas aeruginosa (in 60-80% of cases)
- Staphylococcus aureus (in 10% of cases)
- Proteus (in 10% of cases)
- Streptococcus viridans
- Enterobacteria
In addition, there is a special form of chronic otitis media which can be found under the technical term "chronic epi-tympanic otitis media"is known. This special form of chronic otitis media is one in most of the observed cases congenital disease. In addition, this special form of chronic otitis media can be caused by a traumatic fracture of the temporal bone arise. The affected patients often develop pronounced inflammatory processes in their lifetime, which are also difficult to treat.
Symptoms
The typical symptoms of chronic otitis media differ from the symptoms caused by acute inflammation of the middle ear.
While, in most cases, acute otitis media starts suddenly and is accompanied by the appearance of:
- stabbing earache
- Throbbing in the ear
- fever
- dizziness
is characterized, the chronic otitis media shows a different clinical picture.
The classic symptoms of chronic otitis media typically start rather insidiously and are hardly noticed by the affected patients at the beginning of the disease. For this reason, the chronic inflammatory processes within the middle ear usually progress very far before they can be diagnosed as such and targeted treatment can be initiated.
In most cases, the affected patients report:
- Hearing loss
- tinnitus
- Persistent discharge of fluid from the ear canal
- Growth of inflamed tissue
Furthermore, severe pain and general symptoms can also occur in the course of chronic otitis media. In the course of the process, the inflammatory processes can also spread to such an extent that the affected patients develop pronounced dizziness or develop pus in the ear.
In the case of chronic otitis media, however, the symptoms appear much more slowly than in the acute form. If young children are affected, the symptoms of chronic otitis media usually show up in their behavior. In most cases, the affected children become increasingly restless and whining. In addition, the children typically begin to grip the inflamed ear constantly.
If the child or adult is suspected of having a chronic otitis media, a suitable specialist (General practitioner or specialist in ear, nose and throat medicine) and initiate treatment. Otherwise, the inflammatory processes can spread and cause serious complications.
Chronic otitis media in babies / toddlers / children
The anatomical relationships and conditions of babies and toddlers are predestined to develop a chronic otitis media. In addition, their untrained immune system promotes the development of chronic otitis media. An immune deficiency in an older child is also a risk factor. It is also believed that allergies contribute to the fact that a child can develop chronic otitis media. Enlarged tonsils are another possible trigger. Some authors assume that excessive pacification can promote chronic otitis media. Passive smoking plays a role in the manifestation of chronic otitis media from babies through to childhood. Congenital anatomical misalignments, such as different shapes of the cleft palate, can also trigger them.
With chronic otitis media, hearing loss, sometimes severe pain, ringing in the ears and constant ear secretions are in the foreground at any age. In some cases you may feel dizzy, especially if your ears get water. In babies, the hearing loss manifests itself in that they do not respond to acoustic stimuli. In young children, hearing loss can lead to difficulties in language development. Older children can have problems at school because of the hearing loss, because they do not notice a lot, especially in group situations. If the chronic otitis media and associated hearing problems are unknown, the child's behavior can be misinterpreted. This happens quite often. If chronic otitis media is not treated at a young age, it can have fatal consequences, including numbness. There is also the risk of facial nerve paralysis and meningitis (see also: Meningitis in children). Since the so-called blood-brain barrier only develops during childhood, it is more permeable to pathogens.
A visit to the pediatrician is absolutely necessary if a chronic otitis media is suspected. Surgical intervention is also often required in children to avoid further complications. If enlarged tonsils are the cause of chronic tonsillitis, surgical removal is advisable. For the prophylaxis of chronic otitis media, parents are given a few pieces of advice by specialists: If possible, the baby should be breastfed for at least 4 months. It has been shown that a child's risk of developing chronic otitis media has been reduced by more than half. The baby should not have a pacifier in the mouth all the time. In addition, it is recommended that the baby be spared passive smoking from the very beginning into old age. “Pulling your nose” should not only be allowed, but rather should be preferred to blowing your nose.
Children's upper respiratory diseases should always be treated promptly. Children at risk should always wear a close-fitting bathing cap when swimming. In windy or rough weather, the children's ears should be protected by earmuffs, hat or headband.A general strengthening of the immune system through a balanced diet, an appropriate balance between activity and rest, as well as time for free play in nature also help to reduce the risk of chronic otitis media.
Read more on the topic: Otitis media in toddlers and otitis media in babies
diagnosis
Symptoms that indicate the presence of a chronic otitis media urgently need one medical evaluation. The actual diagnosis of chronic otitis media comprises several essential steps.
At the beginning there is usually an extensive Doctor-patient conversation (anamnese) with a description of the complaints. During this conversation it should be clarified which Symptoms exist, since when this was noticed by the affected patient and in what causal connection the symptoms arise. In addition, you should pay attention to whether the symptoms increase or decrease with certain measures (for example cooling or warming the affected ear). In addition, during the doctor-patient conversation, you will be asked whether it is within the Family heaped cases of chronic otitis media or other pre-existing conditions.
The doctor-patient interview is usually followed by an extensive physical examination. In the course of this investigation, the Nasopharynx and the Oral cavity inspected. Furthermore, the investigation of the lung are not neglected for abnormalities. To be able to rule out an acute infection, the regional lymph nodes in the area of Neck be keyed.
This orientating physical examination is usually followed by a targeted one Consideration of the ear canal. During the optical examination of the auditory canal and the eardrum, the attending physician uses a special one Ear specula (Otoscope). With the help of this examination method redness and perforations of the eardrum can be detected.
In addition, a diagnosis of chronic otitis media is performed Hearing test (Listening to Rinne and Weber).
If the findings are abnormal, more extensive diagnostic measures can be initiated to assess the hearing ability. With these additional measures, the air conduction of the sound is tested in comparison to the bone conduction. If there is chronic middle inflammation, only the Air duct (which is transmitted through the middle ear) may be impaired.
therapy
In contrast to acute inflammation of the middle ear exists with the chronic otitis media no chance that the disease will heal without medical intervention. Rather, it can be assumed that failure to initiate a suitable therapy promptly will result in the development serious complications can provoke.
For this reason, in the presence of chronic otitis media, the causal disease should be treated in particular. In many cases, this is just it surgically possible. Should be oversized Polyps The cause of chronic otitis media must be urgently surgically removed become.
Lie anatomical causes can be based on a operative renovation of the nose and the Sinuses respectively.
Because it increases in most cases in the course of chronic otitis media Ruptures of the eardrum comes and thus a open access to the middle ear affected patients should take care that no water in the ears penetrates. Otherwise you can bacterial pathogens get into the middle ear and aggravate the inflammatory processes. In addition, the water in the middle ear can cause one acute dizziness trigger. For this reason, a tight-fitting bathing cap should be worn while showering or bathing. Ideally, the affected patients can get a so-called "Earmold“Can be made individually.
In addition, the Closure of the ear canal with cotton wool is urgently avoided become. If the affected ear is clogged with cotton wool, this too can aggravate the inflammatory processes in the middle ear. The reason for this is the fact that through the closure of the ear canal one moist, warm environment which is the ideal habitat for bacterial pathogens. They also have a similar effect In the ear- or Behind-the-ear hearing aids on.
The Pus discharge in the presence of a chronic otitis media can through the regular Application of ear drops be treated. Affected patients should make the choice of the most suitable ear drops however urgently discuss this with the treating specialist.
In the case of severe complications that arise in the course of chronic otitis media Antibiotics can be used both in tablet form and as an infusion. In this way, the reproduction of bacterial pathogens can be inhibited or even killed.
OP
The recommended treatment for chronic otitis media is a so-called tympanoplasty (surgical procedure in the middle ear). The aim is to improve hearing and avoid the progression of inflammation and possible complications.
There are different techniques and materials that can be used in the middle ear. The techniques are becoming more and more targeted and individually tailored to the person concerned. The eardrum often has a comparatively large tear in the sick (see also: Torn eardrum). This is called a pronounced perforation of the eardrum. A distinction is made between the closure of the torn eardrum, the so-called myringoplasty, from the exposure of the middle ear and from measures to improve hearing with the help of tympanoplasty.
The measures to improve hearing are based on the existing condition of the ossicular chain. There are 4 different types of surgery depending on the severity. The primary goal of any surgical procedure for chronic otitis media is the complete removal of inflammatory tissue in order to minimize a so-called relapse (recurrence). Another goal is to prevent pathogens from entering the middle ear by closing the eardrum. In addition, an attempt is made to restore the destroyed auditory ossicles if necessary.
If the surgical procedure does not provide sufficient hearing improvement, aids such as hearing aids should be considered.
Complications
A untreated chronic otitis media can be serious Complications entail. In this context, however, the present form of chronic otitis media plays a decisive role.
In case of chronic mucosal suppuration are serious ones Complications are rare. This fact is due to the fact that the surrounding bone structures are usually not affected by the inflammatory processes. In rare cases, this form of chronic otitis media becomes involved The inflammation spreads to the ossicles observe.
Another, extremely rare, complication of mucosal expansion is the so-called "Tympanic fibrosis". With this disease there is one excessive morbid proliferation of the Connective tissue inside the tympanic cavity. In the worst case, this increase can go so far that the entire tympanic cavity is permeated with connective tissue. In addition, this form of chronic otitis media can lead to the development of a Eardrum sclerosis come. In the affected patients there is a Deposition of cell-poor connective tissue in the eardrum. As a result, the eardrum becomes increasingly stiff and immobile. The As a result, hearing decreases steadily (Conductive disturbance).
In the case of a chronic bone augmentation can they Complications more serious be. If left untreated, this form of chronic otitis media leads to one progressive destruction of the bony structures of the ear. If the ossicles are destroyed, the transmission of the sound impulses is increasingly weakened. The affected patients develop strong ones because of this Limitations in hearing (Conductive hearing loss). In addition, due to its spatial relationship to the middle and inner ear, the inflammatory processes can also affect the mastoid process (Mastois) spread. As a result, the inflammation from the middle ear can reach the inner ear via the mastoid process and thus the Balance organ attack. The affected patients suffer from severe pain and increasing dizziness. Kick the bacterial pathogen into the bloodstream, a so-called "Blood poisoning“ (sepsis) be the result.
forecast
The Prognosis of chronic otitis media depends both on the type of disease present and on the time at which treatment is started. In general one can assume that the The prognosis in the case of chronic mucosal dilatation is significantly better is.
Complications
There is hardly any risk of complications with chronic mucosal dilatation (chronic mesotympanic otitis media), since the surrounding bony structures are not attacked and destroyed by the inflammation.
Occasionally, the hammer or anvil (parts of the ossicular chain) become ill, whereby one must rule out an interruption of the ossicular chain when the sound is conducted through the middle ear.
Another possible complication is one Tympanic fibrosis, in which a pathological increase in connective tissue takes place in the tympanic cavity and the cavity can even be completely filled with connective tissue.
In addition, a Eardrum sclerosis occur in which an accumulation of cell-poor connective tissue takes place in the eardrum and whitish, chalky foci are deposited. The eardrum is therefore stiffer and less able to vibrate, which is why hearing loss (Conductive hearing loss) can occur.
Can you fly with a chronic otitis media?
In general, flying with a chronic otitis media is not prohibited, but the flight crew and medical specialists usually advise against it. Even for healthy ears, the pressure load on the ears when flying is enormous. In the healthy ear, the difference in pressure between the environment and the ear is balanced out by opening the so-called ear trumpet. This compensation option is limited even in healthy people.
A person suffering from chronic otitis media is extremely limited. As a result, the symptoms of previously damaged ears can be exacerbated and the risk of complications occurring. Severe pain, nausea and vomiting as well as irreversible damage to the eardrum can occur or be intensified. There is a risk of (further) irreversible hearing damage. Bleeding into the middle ear may occur less frequently.
If the person concerned decides to fly, they should use nasal drops that are decongestant (see also: Otriven®) to promote ventilation of the middle ear. In addition, the person concerned should test beforehand which method is most suitable for him personally in order to cope with the pressure changes. This is very individual. Some passengers help chewing gum, others help certain movements of the jaw joint, as well as swallowing or yawning.
