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Adhesive otitis media

The presence of transudate or exudate in the tympanic cavity during prolonged dysfunction of the auditory tube leads to an adhesive process with the formation of adhesions and scars that restrict the movement of the auditory ossicles, eardrum and labyrinth windows. Such a hyperplastic reaction of the mucous membrane with its subsequent fibrosis is treated as adhesive otitis media. Adhesive otitis media is essentially an unfavorable outcome for several ear diseases. Especially often it develops with acute serous otitis media, which is not accompanied by perforation of the eardrum, when viscous mucus cannot drain through the auditory tube on its own and creates the so-called “sticky ear”. A long delay in the restoration of the function of the auditory tube in acute suppurative otitis media after spontaneous closure of the perforation of the tympanic membrane also contributes to the organization of the remains of inflammatory exudate in the scar tissue. Acute serous otitis media with inadequate treatment can also go into the adhesive process. Exudate in chronic suppurative otitis media, as a rule, eventually leads to the formation of scars and adhesions in the tympanic cavity, especially in the attic, sometimes delimiting it completely from the mesotympanum. Finally, chronic tubo-otitis that occurs without visible inflammation of the mucous membrane of the tympanic cavity with untimely pathogenetic treatment can also lead to degeneration of the mucous membrane of the middle ear and tympanic membrane. Adhesive otitis media is divided into perforated and non-perforated.

Pathogenesis. When the pressure in the tympanic cavity is lowered for a long time, the mucous membrane swells and is infiltrated by lymphocytes with the formation of mature connective tissue. Inflammatory exudate or aseptic transudate is organized into fibrous cords. This leads to the formation of adhesions, adhesions, calcifications and ossifications in the middle ear cavity. Hyalinization of the mucous membrane that surrounds the auditory ossicles, as well as adhesions between the eardrum, auditory ossicles and the medial wall of the cavity, result in limitation or complete immobility of the sound-conducting system of the middle ear. A pronounced adhesive process with attic fusion, the development of scar tissue in the labyrinth window area, leading to ankylosis of the stapes and immobility of the round window, is called tympanosclerosis.

Tympanosclerosis is a lesion of the subepithelial layer, expressed in hyaline degeneration of connective tissue. A constant sign of this tissue is dystrophy of the mucous membrane and bone, as well as calcification. There are two types of tympanosclerosis: 1) sclerosing mucositis (more superficial localization, can be easily removed during surgery); 2) osteoclastic mucoperiostitis (invasive form). After the foci of tympanosclerosis are removed, granulations and scars are often formed in their place. A third of patients who have had chronic inflammation of the middle ear have tympanosclerotic plaques in the tympanic cavity. They are usually localized in zones of narrow spaces with insufficient aeration and a more pronounced inflammatory reaction (in the area of ​​the entrance to the cave, the vestibule window, on the auditory ossicles, especially the stapes).

Clinic. Adhesive otitis media is characterized by persistent progressive hearing loss, sometimes with tinnitus. When otoscopy is determined dull thickened, deformed or atrophied in some areas of the eardrum with retracts, lime deposits and thin movable scars without fibrous layer.
There are adhesive otitis with an almost normal otoscopic picture and severe hearing loss after serous otitis and tubootitis.

A characteristic limitation of the mobility of the tympanic membrane when examined with a Siegle pneumatic funnel. Blowing your ears does not give a noticeable improvement in hearing. The ventilation function of the auditory tubes is often impaired.

Hearing is reduced in the mixed type with a predominant violation of sound conduction. Limiting the mobility of both labyrinth windows and dystrophy of the auditory receptors during a prolonged course of the disease contribute to the deterioration of bone conduction. The experience of Jelle with ankylosis of stapes can be negative, as with otosclerosis, and in other cases of adhesive otitis media it is inconclusive. Using impedance audiometry, reduced pressure in the tympanic cavity, limitation of the mobility of the tympanic membrane (tympanogram type B) or, with extensive scars, its hyper compliance (tympanogram type D) are determined. Not recorded acoustic reflex of stapes. Using contrast x-ray of the auditory tube, a violation of its passage is determined.

Treatment. A complete treatment for adhesive average otitis media includes a set of measures.

Firstly, they eliminate the causes that caused the violation and prevent the restoration of the function of the auditory tube (sanitation of the nose, paranasal sinuses and nasopharynx). Secondly, the function of the auditory tube is restored by blowing, introducing various medicinal substances (lidase, emulsion of hydrocortisone, trypsin), UHF-therapy, topical application of vasoconstrictor drugs into the nose and oral administration of hypersensitizing agents. In the presence of a helium-neon laser, the walls of the auditory tube are irradiated by means of a fiber inserted into the ear catheter.

In order to increase the elasticity of adhesions and reduce their number, lidase (0.1 g of dry matter diluted in 1 ml of 0.5% novocaine solution), chymotrypsin (1 ml in a dilution of 1: 1000), hydrocortisone emulsion by tympanopuncture are introduced into the tympanic cavity. Lidase can be administered by endaural electrophoresis or by-ear metatympanic injection. The introduction of these drugs is combined with vibration massage of the tympanic membrane or its pneumatic massage using a Siegle funnel.

In case of adhesive otitis media, tympanosclerosis, in the absence of the effect of conservative treatment, an endaural opening of the tympanic cavity (tympanotomy) is performed with its revision and possibly more complete excision, under the control of an operating microscope, of scar tissue. With severe tympanosclerosis, adhesive otitis media, tympanoplasty with prosthetics of the auditory ossicles, eardrum and restoration of patency of the tympanic orifice of the auditory tube have to be done.

Due to the complexity of the surgical treatment of adhesive otitis media, soldiers suffering from this disease, with severe hearing loss, are sent to the district (central) hospital or otolaryngology clinic of the Military Medical Academy.

Prevention of adhesive otitis media is timely adequate treatment of inflammatory diseases of the middle ear.

Survey of military personnel is carried out according to Art. 38 of the order of the Ministry of Defense of the Russian Federation N 315 1995
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Adhesive otitis media

  1. Adhesive otitis media
    It is an adhesive and cicatricial formation of the mucous membrane of the tympanic cavity and auditory tube, which occur as a reparative (productive) phase of usually long-lasting inflammation. Adhesive otitis media (otitis media adhaesive) often develops as a consequence of acute, especially sluggish otitis media. Et and about l about d and I. Because healing is always accompanied
  2. Adhesive middle ear disease. H-74.1
    {foto97} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (lowering
  3. Acute otitis media
    Acute otitis media (otitis media acuta) is an acute inflammation of the mucous membrane of the middle ear, mainly of the tympanic cavity, usually of an infectious nature. The frequency of this disease is about 2.5% among the population. Among the total number of people with pathology of ENT organs, acute otitis media is diagnosed in 20-30% of cases. Because acute inflammation of the middle ear is always
  4. Chronic mean serous otitis media
    Chronic mean serous otitis media is characterized by a painless accumulation of fluid in the tympanum in the absence of inflammation. Infants and young children are sick more often. Chronic otitis media is the most common cause of hearing loss in children in the United States. About 30% of children with chronic average serous otitis media require allergological examination and treatment of allergies. A.
  5. Chronic suppurative otitis media
    Chronic purulent inflammation of the middle ear causes persistent pathological changes in the mucous membrane and bone tissue, leading to a violation of its transformation mechanism. A pronounced hearing loss in early childhood entails a speech impairment, complicates the upbringing and education of the child. This disease can limit the suitability for military service and the choice of certain professions.
  6. Acute and recurrent otitis media
    Acute otitis media — acute inflammation of the mucous membranes of the cavities of the middle ear — is common in children (25–40% of cases), especially before the age of 5 years. The cause of acute otitis media is a bacterial, viral, viral and bacterial infection against the background of altered local and general reactivity of the body. The clinical picture of acute otitis media is diverse and depends on the etiology and
  7. Acute otitis media
    Acute otitis media proceeds in stages: first, inflammation of the mucous membrane develops, then suppuration occurs, perforation of the tympanic membrane. It can proceed relatively easily, without a noticeable general reaction of the body, or take a severe course with sharp reactive phenomena from the whole body. The cause of acute otitis media is infection in the tympanic cavity.
  8. Exudative allergic otitis media
    The named disease is an exudative inflammation of the mucous membrane of the middle ear, usually allergic in nature, without the development of classical signs of acute inflammation, while the microflora does not play a significant role in the pathogenesis of the disease. In recent years, allergic otitis media (otitis media allergica), which is characterized by specific
  9. Otitis media
    Inflammation of the middle ear - the most common bacterial disease in children - is caused by pneumococci, hemolytic streptococci, hemophilic bacillus, less often staphylococci, usually against the background of acute respiratory viral infections. In Russia, these pathogens are usually sensitive to antibiotics, but with repeated otitis media are often resistant to first-choice drugs. CLINICAL PICTURE Symptoms: “causeless” fever, earaches,
  10. Chronic suppurative otitis media
    Chronic purulent middle omum (otitis media purulenta chronica), due to its prevalence among the population and danger to hearing, and often for life, deserves much attention in the practical work of a doctor. Its prevalence among the population currently remains quite high - 0.8-1%. For chronic purulent inflammation of the middle ear, the presence of persistent
  11. Acute purulent otitis media. Etiology, pathogenesis, clinic
    Acute otitis media - inflammation of all cavities of the middle ear (tympanic cavity, auditory tube, cells of the mastoid process). There are two stages in the development of the disease: 1. Doperforative stage (acute catarrhal otitis media) 2. Perforated stage (acute purulent otitis media). Etiology Pathogens - streptococci, pneumococci, staphylococci and much less often other types of microbes. The way
  12. Acute otitis media in children
    Acute inflammation of the middle ear in newborns, in infancy and early childhood, is much more common than in adults, and has a number of features. The peculiarity of the symptoms is determined by the features of general and local immunity, the morphology of the mucous membrane of the middle ear and the structure of the temporal bone. In newborns, the remains of the myxoid tissue, which is
  13. Acute otitis media in infectious diseases
    During acute otitis media in infectious diseases, the most severe changes are observed with septic toxic forms of scarlet fever, especially with necrotic lesions in the pharynx, as well as, although less pronounced, with measles and flu. The course of such otitis media is more severe due to toxic damage to the walls of small vessels and a violation of the trophism of inflamed tissue under the influence of
  14. Otitis media, unspecified. H-66.9
    {foto68} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, hearing loss, discharge from
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