Chronic otitis media

Synonyms in the broader sense

Medical: chronic otitis media, Chronic otitis media, Chronic epi-tympanic otitis media

English: chronic otitis media

introduction

The term " chronic otitis media " refers to the recurrent occurrence of inflammatory processes in the middle ear. Otitis media is generally one of the most common diseases and affects almost every person at least once in their lives. Especially small children and adolescents often develop inflammatory processes in the middle ear ( middle ear inflammation ).

While acutely occurring otitis media is very common, chronic forms of otitis media are relatively rarely observed.

Chronic otitis media is further divided into two distinct forms, chronic mucosal suppuration and chronic bone suppuration. Both forms are associated with long-lasting and / or recurrent painful inflammation of the middle ear. In addition, both types of chronic otitis media can lead to permanent perforation of the eardrum and purulent discharge from the ear canal.

The causes for the development of a chronic otitis media are still largely unexplained. Anatomical deformities or pronounced defensive weaknesses are the most likely causes.

While the acute forms of otitis media often heal without medical intervention, a chronic otitis media always requires a medical clarification. Inadequate treatment may cause chronic inflammatory processes in the middle ear, causing serious complications.

reason

The exact causes that lead to the development of chronic otitis media are still largely unknown. In professional circles, however, circulating various theories that are generally considered to be conclusive. As a result, the two typical forms of chronic otitis media have different causes.

Chronic occlusion should be closely related to the recurrence of acute inflammatory processes within the middle ear. In addition, it is believed that traumatic injury to the eardrum (for example, by a slap or a blast trauma) may be the cause of chronic otitis media.

In children, there is also the possibility that anatomically or inflammatory enlarged polyps in the area of ​​the nasopharynx may be responsible for the development of chronic otitis media. The enlarged polyps provide for a recurring or permanently persistent pressure equalization and ventilation disorder of the middle ear via the Eustachian tube (Synonyms: Eustachian tube , Tube ). If bacterial pathogens from the nasopharyngeal space reach the middle ear of the affected children, this can lead to the development of a chronic middle ear infection.

In rare cases, even benign or malignant tumors ( tumors ) can hinder the proper ventilation and thus provoke the emergence of chronic otitis media.

In adult patients, frequent recurrent inflammation of the paranasal sinuses may have a negative effect on the ventilation of the middle ear. In these cases is often based on a misalignment of the nasal septum.

In addition, allergic reactions that cause excessive swelling of the mucous membranes of the upper respiratory tract are among the possible causes of chronic otitis media.

Ultimately, it can be assumed that, regardless of the original mechanism of origin, in each case bacterial pathogens are involved in the development of chronic otitis media.

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, a special form of chronic otitis media known under the term " chronic epithymal otitis media " exists . This special form of chronic otitis media is a congenital disease in most of the cases observed. In addition, this special form of chronic otitis media may be caused by a traumatic fracture of the petrous bone. The affected patients often develop pronounced inflammatory processes during their lifetime, which are difficult to treat.

symptoms

The typical symptoms of chronic otitis media are different from those caused by acute inflammation of the middle ear.

While acute otitis media in most cases starts suddenly and by the appearance of:

  • stinging earache
  • Tapping in the ear
  • fever
  • dizziness

is marked, the chronic middle ear inflammation clinically shows a different picture.

The classic symptoms of chronic otitis media typically begin gradually 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 go very far before they are diagnosed as such and targeted treatment can be initiated.

The affected patients report in most cases of:

  • hearing loss
  • tinnitus
  • Persistent fluid excretion from the ear canal
  • Proliferation of inflamed tissue

Furthermore, it can also come in the course of chronic otitis media to severe pain and a general symptomatology. In the course of the inflammatory processes can also spread so far that the affected patients develop a pronounced dizziness or it comes to pus development in the ear.

However, the symptoms appear much more slowly in the case of chronic otitis media than in the acute form. If small children are affected, the symptoms of chronic otitis media usually show up in their behavior. The affected children become increasingly restless and queasy in most cases. In addition, the children typically begin to constantly attack the inflamed ear.

If there is a suspicion of a chronic otitis media infection in the child or adult, a suitable specialist ( general practitioner or otorhinolaryngologist ) must be promptly consulted and treatment initiated. Otherwise, the inflammatory processes may spread and cause serious complications.

Chronic otitis media in the baby / toddler / child

The anatomical conditions and conditions of a baby and toddler are predestined for being able to develop a chronic otitis media. In addition, their untrained immune system promotes the development of chronic otitis media. Even an immunodeficiency of an older child is a risk factor. It is also believed that allergies contribute to a child suffering from chronic middle ear infections. Enlarged throat almonds are another possible trigger. Some authors assume that excessive pacifiers can promote chronic middle ear infections. From childhood to adolescence, passive smoking plays a role in the manifestation of chronic middle ear infections. Even congenital anatomical deformities, such as various forms of the cleft palate, can trigger this.
In the case of chronic middle ear inflammation, hearing loss, sometimes severe pain, tinnitus and constant secretion of the ear are at the forefront in every age group. In some cases dizziness may occur, especially if water is in the ears. In babies, the hearing loss manifests itself by not responding to acoustic stimuli. In infants, hearing loss can lead to difficulties in speech development. Older children can have problems with hearing loss because they do not get much, especially in group situations. If chronic otitis and associated hearing problems are not known, the child's behavior may be misinterpreted. This happens often. If chronic middle ear infection is not treated at a young age, it can have fatal consequences, including deafness. In addition, the risk of facial nerve palsy and meningitis ( see also: meningitis in children) is given. Since the so-called blood-brain barrier develops only in the course of childhood, it is more permeable to pathogens.
A visit to a pediatrician is immediately essential in cases of suspected chronic otitis media. Even in children, a surgical procedure is often required to avoid further complications. If enlarged tonsils are the cause of chronic tonsillitis, surgical removal is advisable. To prevent chronic otitis media, parents are given some advice by medical specialists: if possible, the baby should be breastfed for at least 4 months. It could be shown that the risk of a child suffering from chronic middle ear infection decreased by more than half. The baby should not permanently put a pacifier in his mouth. In addition, it is recommended that the baby from the beginning to older age to avoid passive smoking. The "pull up nose" should not only be allowed, but be preferred to the strong whining.
Diseases of the upper respiratory tract of children should always be treated immediately. Endangered children should always wear a tight fitting bathing cap when swimming. In windy or rough weather, the ears should be protected by earmuffs, hat or headband. A general strengthening of the defense system through balanced nutrition, adequate balance between activity and rest, as well as time to play freely in nature, also help to reduce the risk of chronic middle ear infection.

diagnosis

Symptoms that indicate the presence of chronic otitis media require urgent medical attention. The actual diagnosis of chronic otitis media involves several essential steps.

At the beginning, a comprehensive doctor-patient interview (case history ) is usually performed with a description of the symptoms. During this conversation, it should be clarified what symptoms exist, since when this was noticed by the affected patient and in what causal relation to the occurrence of the complaints. In addition, care should be taken to see if the symptoms increase or decrease in certain measures (for example, when the affected ear cools or heats up). In addition, it is asked during the doctor-patient interview whether there are frequent cases of chronic middle ear infection or other pre-existing conditions within the family.

Following the doctor-patient interview is usually a comprehensive physical examination. In the course of this examination, especially the nasopharynx and the oral cavity are inspected. Furthermore, the examination of the lung for abnormalities should not be neglected. In order to be able to rule out an acute infection, the regional lymph nodes in the area of ​​the neck must also be palpated.

Following this orienting physical examination, a targeted examination of the auditory canal usually follows. In the optical examination of the ear canal and the eardrum, the attending physician uses a special ear funnel ( otoscope ). Redness and perforation of the eardrum can be detected with the aid of this examination method.

In addition, in the diagnosis of chronic otitis media, a hearing test ( hearing test after gutter and Weber ).

If abnormal, more extensive diagnostic measures to assess hearing can be initiated. In these further measures, the air conduction of the sound is tested in comparison to the bone conduction. If there is chronic middle ear inflammation, then only the air line (which is conveyed over the middle ear) should be impaired.

therapy

In contrast to the acute inflammation of the middle ear, chronic middle ear infection has no chance that the disease heals without medical intervention. Rather, it can be assumed that failure to promptly initiate a suitable therapy can provoke the development of serious complications.

In the case of chronic otitis media, the causative disorder should be treated first of all. In many cases this is only possible surgically. If oversized polyps are the cause of chronic otitis media, they must be surgically removed.

Based on anatomical causes, surgical repair of the nose and paranasal sinuses can be carried out.

Since in the course of chronic middle ear inflammation in most cases ruptures of the eardrum and thus there is an open access to the middle ear, the affected patients should take care that no water penetrates into the ears. Otherwise, bacterial pathogens can enter the middle ear and aggravate inflammatory processes. In addition, the water in the middle ear area can trigger an acute dizzy spell. For this reason, a snug bathing cap should be worn while showering or bathing. Ideally, the affected patients in a hearing aid specialist can have a so-called " earmold " made individually.

In addition, should be urgently dispensed with the closure of the ear canal with cotton wool. Clogging the affected ear with cotton wool may aggravate inflammatory processes in the middle ear. The reason for this is the fact that closing the ear canal creates a moist, warm environment, which is the ideal habitat for bacterial pathogens. In addition, in-the-ear or behind-the-ear hearing aids have a similar effect.

Pus secretion in the presence of chronic otitis media can be treated by the regular use of ear drops. However, affected patients should urgently discuss the choice of the most suitable ear drops with the attending physician.

In severe complications arising in the course of chronic middle ear infection, antibiotics can be used both in tablet form, as well as an infusion. In this way, the multiplication of bacterial pathogens can be inhibited or even killed.

operating room

The recommended treatment for chronic middle ear inflammation is a so-called tympanoplasty (operative procedures in the middle ear area). The aim is to achieve a hearing improvement, as well as to avoid the progression of the inflammation and possible complications.
There are different techniques and materials that can be used in the middle ear. The techniques are increasingly targeted and individually geared to the person concerned. The eardrum often has a comparatively large tear in the patients ( see also: eardrum torn). This is called pronounced eardrum perforation. One differentiates the closure of the eardrum tear, the so-called myringoplasty, from the exposure of the middle ear and from hearing-improving measures by means of tympanoplasty.
The hearing improvement measures depend on the existing condition of the ossicular chain. Depending on the severity, there are 4 different types of operations. The primary goal of any surgery for chronic middle ear infection is the complete removal of inflammatory tissue to minimize a so-called recurrence. Another goal is to prevent the entry of pathogens into the middle ear, in which the eardrum is closed. In addition, if necessary, the destroyed ossicles will be restored.
If surgery does not provide sufficient hearing improvement, then aids such as hearing aids should be considered.

complications

An untreated chronic otitis media can cause serious complications. In this context, however, the present form of chronic otitis media plays a crucial role.

In the case of chronic mucosal proliferation, serious complications are rare. This fact can be explained by the fact that the surrounding bone structures are usually not affected by the inflammatory processes. In rare cases, in this form of chronic otitis media an infection spreading to the ossicles can be observed.

Another extremely rare complication of mucosal lining is the so-called " tympanic fibrosis ". In this disease, there is an excessive pathological proliferation of connective tissue within 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 type of chronic otitis media can lead to the development of tympanic sclerosis. In the affected patients there is an accumulation of cell-poor connective tissue in the eardrum. As a result, the eardrum becomes increasingly stiffer and immobile. The hearing thus steadily decreases ( sound conduction disorder ).

In the case of chronic bone suppuration, the complications may be more severe. If untreated, this form of chronic otitis media leads to a progressive destruction of the bony structures of the ear. In the destruction of the ossicles, the transmission of the sound pulses is increasingly weakened. The affected patients therefore develop severe hearing impairment ( conductive hearing loss ). Moreover, due to its spatial relationship to the middle and inner ear, the inflammatory processes may also spread to the mastoid. As a result, the inflammation of the middle ear can pass through the mastoid to the inner ear and thus attack the organ of equilibrium. The affected patients suffer from severe pain and dizziness. If the bacterial pathogens pass into the bloodstream, so-called "blood poisoning" ( sepsis ) can be the result.

forecast

The prognosis of chronic otitis media depends on the type of disease present as well as on the start of treatment. In general, it can be assumed that the prognosis in case of chronic mucosal proliferation is significantly better.

complications

Chronic mucous membrane suppuration (chronic mesotympanic otitis media) poses little risk of complications since the surrounding bony structures are not attacked and destroyed by the inflammation.

Occasionally there is a disease of the hammer or the anvil (parts of the ossicular chain), which must exclude an interruption of the ossicular chain in the conduction of sound through the middle ear.

Another possible complication is a tympanic fibrosis in which a diseased growth of connective tissue takes place in the tympanic cavity and the cavity can even be completely filled with connective tissue.

In addition, a tympanic sclerosis may occur in which a deposition of cell-poor connective tissue takes place in the eardrum and whitish, calcareous foci are stored. The eardrum is thus stiffer and less capable of vibration, which is why a hearing loss (conductive hearing loss) may occur.

Can I fly with a chronic middle ear infection?

Generally speaking, flying with chronic otitis media is not banned, but the flight crew and medical specialists usually advise against it. Even for healthy ears, the pressure load when flying on the ears is enormous. In healthy ears, the pressure difference between the environment and the ear is compensated by opening the so-called Eustachian tube. This compensation option is limited even for healthy people.
A person suffering from chronic otitis media is extremely restricted. As a result, diseased ears can increase discomfort and increase the risk of complications. Severe pain, nausea and vomiting, as well as irreversible eardrum damage can occur or be exacerbated. The danger of (further) irreversible hearing impairment is present. Rarely, it can come to hemorrhage in the middle ear.
If the person still decides to fly, he should use decongestant nasal drops (see also: Otriven®) to promote the ventilation of the middle ear. In addition, the person concerned should first test which method is most suitable for him personally in order to come to terms with the pressure changes. This is very individual. Some passengers chew gum, others help with certain TMJ movements, as well as swallowing or yawning.


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