Friday, July 27, 2012

Otitis media


Inflammation of the middle ear can be very painful and it is this reason enough to treat it vigorously. In addition, if unrecognized and untreated, may cause permanent damage to hearing.

One of the most common diseases in infants and young children, especially in winter, is an inflammation of the middle ear. Incurred at the time of penetration of infection from the nasal cavity in the middle ear cavity through the flattened tubule (the Eustachian tube) normally used to control pressure in the ear.
case of infection in the nose, the canal is also a link which the infection spreads to the middle ear, especially in infants and young children who were relatively wide and short. Because the middle ear to the child more or less. Since the membrane lining the nasal cavity, Eustahijevu tube and middle ear as it responds to infection with the virus, either by bacteria, a communication exists between them, so every time, even the lightest infection in the nose, is also being affected by middle ear. The doctor who examines the ears of a child with clear secretions from the nose will often say that both tympanic membrane red light. However, the contents of the middle ear is smooth empty Eustahijevu through a tube into the nose, there is no pain or retention of secretion in which the bacteria may proliferate. No need for special treatment, no antibiotics or nose drops. In a situation where the infection is bacterial, or when mucosal lymphoid tissue located at the entrance tube in the nasal cavity, swell and close Eustahijevu tube, and the bacteria multiply in the middle ear cavity, or just a bunch of discharge, without the possibility of emptying the contents, there is severe pain in the ear. Then the secretion from the nose, but usually thicker, yellow-green, or bright and very tough. When examining the eardrum is bright red and bulging. In some cases of spontaneous rupture of the eardrum and discharge of purulent content which then leaks out, after which the pain subside. In such a burst is strongly needed treatment.



View the drum a little child

Review the ear a little child is not easy. First, because this examination is to be a very good child to hold and fix his head, the head does not shift the injured to the instrument by which one enters the outer ear canal, and that during the 10-15 seconds, how long view, might well look otoscope slowly moving drum.Another reason for difficulty inspection can be very narrow external ear canal and cerumen clogging (thick yellowish mass secreted by glands in the ear canal), and sometimes the eardrum does not see or be seen only part of it. To view a successful cooperation is required of a parent or a child who nurses lap with the head resting on the sides and a reinforced shoulder with one hand, a second arm is fixed to the lower body. A child may be reviewed in a supine position on a side fixed to a solid surface. If cerumen is plentiful, can be mechanically removed to try, but most often recommended by instillation of hydrogen peroxide solution or lukewarm water rinse under the shower, and an overview of the delay for the next day.


How to treat inflammation of the middle ear

When it comes to bacterial inflammation, which can further complicate or leave permanent damage, it is necessary to treat the infection with antibiotics. I must mention that there are opinions that the antibiotic is not necessary. The causes of inflammation are the same bacteria found in the nose, and will be guided by your doctor when choosing antibiotics. The second part of the treatment of ear infections, which is equally important, the instillation of nose drops. These droplets have a role to reduce the swelling of the lining of the Eustachian tube and allow the smooth output of secretions containing bacteria from the middle ear. In addition to droplets that reduce swelling mucosa (ephedrine, etc..), It is recommended that several times a day to flush the discharge will be carrying saline, the instillation of a few milliliters of each nostril. After that it takes a special pump suction secretions which belongs to the necessary equipment and the newborn infant. This very important part of treatment of ear infections will be described separately, since the proper technique of toilets nose necessary to treat successfully. Finally, the third part of the therapy is the general lowering of temperature that includes physical measures (shower, tepid compresses) or medicines, and pain relief. For this purpose we recommend the use of paracetamol (Plicet) in the form of suppositories, or syrup.



Proper technique of toilets nose

In the first two years of life a child can not produce pressure and coordination that exhaust to discharge from the nose. Cleaning of the secretions from the nose of a small infant, and occasionally need a healthy child, but in the case of colds and easiest when the nose is clogged and prevents normal sucking, it's very important measure
alleviate the problems that child. Note that the timely initiation and proper execution of toilets supplementation can prevent a complication of inflammation in the nose and middle ear emergence.
Small infant is enough people to carry out the toilet of the nose itself, but for the older infant will be needed for two people. The child was required to lay on your back, with the head slightly hanging from the edge of the bed or surface coating on our hands (small babies can lie on a flat surface). The first one nostril ukapamo about half a milliliter (half dropper) which dilute saline drainage from the nose. The other nostril shut up his index finger left hand, and then pump in which we make a vacuum by squeezing the rubber parts, enter lightly into the nostril and release the grip, and "absorb" the secretions from the nose.Repeat in other nostril, and repeat it many times until almost all the discharge is removed. Only after such cleaning can put active droplets (Ephedrine or any other currently available in pharmacies in the free market, so called. OTC products). In their instillation head leaning slightly to the side to which nostril caps, to allow fluid to drain the ear.
Instillation of ear drops in otitis media is pointless. These apply only if it is an infection of external ear canal, which is in very young children is extremely rare.


Complications of Otitis Media

Inflammation of the middle ear can be very painful and it is this reason enough to treat it vigorously. In addition, if unrecognized and untreated, may cause permanent damage to hearing.
Much less common, but serious complications of middle ear infections as meningitis caused by one of two dangerous bacteria - Haemophilus influenzae and Streptococcus pneumoniae (against this aggressive form of haemophilus infection today is a successful vaccine protection) and the penetration of bacteria into the blood and the occurrence of sepsis.
What is important to remember is that timely and appropriate treatment of inflammation in the nose can prevent the further penetration of infection and the abstraction of the middle ear


Patients with otitis media often complain of ear pain, constipation, or feeling of "fullness" in the ear, hearing impaired, sometimes to leak from the ear, the temperature can be raised and, almost always (through shorter or longer time), with defects Breathing through the nose.


Ear connection with the environment


To understand that there is a middle ear infection, you should know something about the anatomical relations of the upper airway (nose and upper throat - epipharynx) and otitis media. The middle ear is a small air space that is associated with a narrow groove epipharynx (Eustahijevom tube), through which ventilates the middle ear. But aside from the air through the duct can penetrate and cause infection (bacteria and viruses). In addition, the long-term congestion Eustachian tube, the middle ear to create conditions conducive to the development of chronic inflammation. In practice this means that the ear is almost never occurs alone, but as a result of inflammation of the upper airway and impaired function of the Eustachian tube (with the exception of ear infections in people who have hurt the eardrum and cause comes from the outer ear through the ear canal).




The different causes of inflammation


Acute ear infections can be caused by bacteria and viruses. Viral (cataral) respiratory infections common in the upper respiratory tract infection (common cold "viruses", flu, etc..). The ear has no pus, but the serous fluid accumulates, and the pain is caused by the vacuum in the ear that develops as a result of clogged tube.
Purulent inflammation caused by bacteria. In this case, pus builds up in the middle ear and stretches the eardrum, causing very severe pain. If taakvo condition is not treated, pus penetrate the eardrum and pain suddenly stops. Treatment of ear infections in the first place should focus on combating conditions that favor the development of ear infections, then the cause of inflammation. So, primarily to establish the function of the Eustachian tube putting intranasal decongestant. The pain be controlled with analgesics, with a purulent inflammation of the given antibiotic.
Sometimes ear infections are inadequate or insufficiently treated. In some cases, problems breathing through the nose are less pronounced and do not bother the patient significantly, but ear infections are common (eg, septal deviation, allergy, adenoid vegetation - the "third tonsil." These are conditions that favor smoldering infection in the middle ear and development of chronic otitis media. Chronic otitis media usually do not cause pain, developing a gradual hearing loss, while in some patients there is discharge from the ear.



Types of inflammation


There are numerous classifications of chronic otitis media. The simplest of them is divided into negnojne and chronic purulent inflammation. Negnojne may be serous or adhesive. Chronic serous otitis media develops primarily in children with prolonged clogged tube, where it accumulates in the middle ear clears up, sometimes thick mucus secretions. For children to gradually weaken hearing. It is treated by removing the causes of congestion and miringotomijom tube (procedure in which the operational break drum, remove the hole in discharge tube is placed for ventilation of the middle ear). Adhesive otitis also occurs as a result of tube blockage, and frequent ear infections, formation of scar tissue in the ear, which prevents the normal conduct of sound.
Chronic purulent otitis media developing as a result of neglected and inadequately treated acute inflammation, or in case of increased virulence in pathogens and a weakened immune response.Frequently in this type of inflammation found mixed bacterial flora. Patients usually ear pain, hearing progressively weakens, otoscopic regularly find eardrum perforation; secretion from the ear may or may not be present. If no secretion from the ear, it's called. "Dry" chronic otitis media with central perforation, and usually does not damage the ossicles and other bony structures. In chronic otitis media with secretion are common ostitički processes other than damage the ossicles, and can damage parts of temporal bone (in which the middle ear) and cause the spread to surrounding areas (mastoidzaušnu bone, intracranial - meningitis, abscess of the meninges in the neck, etc..). These complications can sometimes be life threatening. The risk of developing these complications is increased if, with an ear infection, and cholesteatoma present rastpom which also damages the bone and spread to the surrounding structures (although its name suggests the tumor, cholesteatoma is not a tumor, but a cluster of dead skin cells, ear canal and eardrum ).


Treatment of inflammation

Treatment of adhesive and chronic suppurative otitis media is exclusively surgical, different methods of tympanoplasty, with the first must remove the inflamed tissue is altered, damaged parts of bone and cholesteatoma. In addition, tympanoplasty is trying to reconstruct the ossicular chain by placing different materials to transmit sound so that, except for removal of the inflammatory process, almost always expected postoperative improvement of hearing in surgery patients.

No comments:

Post a Comment