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Chronic suppurative otitis media

Chronic purulent otitis media is accompanied by prolonged suppuration from the ear, the perforated opening of the tympanic membrane is persistently preserved, and hearing is reduced, mainly as a violation of the function of the sound-conducting apparatus. In most cases, the disease occurs due to acute purulent inflammation. This is facilitated by the high virulence of microbes, a decrease in the reactivity of the body, a chronic pathological process of the nasal cavity and nasopharynx, and irrational treatment.

Symptoms, course. Hearing loss. Otoscopically reveal the perforated opening of the tympanic membrane. Depending on the nature of the process and the location of the perforation, chronic purulent mesotympanitis and chronic purulent epithympanitis are distinguished. With mesotympanitis, the perforated hole is in the central section of the eardrum, with epithympanitis is in the upper, it often occupies both sections, and then they talk about epimesothympanite. Mesothympanitis proceeds, as a rule, more benignly than epithympanitis, with it complications are much less frequent. Epitympanitis or epimesothympanitis is accompanied by bone caries (osteitis) with the formation of granulations, polyps. The occurrence of the so-called cholesteatoma, which clinically manifests itself as a tumor, that is, causes destruction of the bone and this creates the risk of intracranial complications.

The diagnosis is based on anamnesis and otoscopy. In the anamnesis, as a rule, acute purulent inflammation of the middle ear, followed by periodic or constant suppuration. To assess the nature and prevalence of the destructive process of the bone, an X-ray examination of the temporal bones is important.

Treatment. Conservative treatment is possible with a free outflow of pus and the access of medications through the perforation in the tympanic membrane to the mucous membrane of the middle ear. If the hole is closed with granulations or a polyp, then they are cauterized with silver nitrate or removed surgically. Introduce certain medications into the tympanic cavity only after careful removal of pus. For this purpose, the ear is wiped with cotton wool wrapped in a probe until the cotton wool removed from the ear is dry. For instillation into the ear, most often used are solutions of albucide, furatsilina or salicylic acid in alcohol and other disinfectants. If the granulations are small, then cauterizing substances (protargol solutions, silver nitrate in the form of drops) are used. With epithympanitis, the drum space is washed with disinfectant solutions. If the opening in the tympanic membrane is large and there is little discharge, then a fine powder of boric acid, sulfonamide preparation or antibiotic is blown into the ear. Surgical treatment is used to eliminate the pathological process in the ear (general cavity or radical surgery), as well as to improve hearing (tympanoplasty).