Bilateral adhesive otitis media. What is dangerous adhesive otitis media

Adhesive otitis media is an inflammatory process of a chronic type, which leads to the appearance of adhesions and scars in the tympanic cavity. Adhesive otitis media occurs in the middle ear, which leads to violations of the auditory ossicles and conduction of the auditory tube.

The main manifestation of this inflammatory process is noise in the ear, which can increase with the further course of the disease. If adhesive otitis media is suspected, the doctor conducts an examination and other studies of the auditory cavity, after which the patient is prescribed a medical course of treatment. In case of ineffectiveness of the course, surgical intervention is prescribed.

The main cause of the development of adhesive otitis media is the otitis media preceding it of the following types:

• exudative;
• catarrhal nonperforative;
• chronic tubo-otitis.

The disease after these otitis could be provoked by the irrational use of antibiotic therapy. After the inflammation has been successfully resolved and the accumulated exudate has been resorbed, fibrin filaments remain in the tympanic cavity, resulting in scarring and connective tissue adhesions. Cicatricial strands begin to adhere to the auditory ossicles, which leads to impaired sound conduction and patency of the auditory tube.

It happens that adhesive otitis media can develop without previous otitis media. In this case, the causes are the following pathological processes:

• diseases of the upper respiratory tract - SARS, tracheitis;
• adenoids;
• inflammatory diseases of the nose and paranasal sinuses - sinusitis, sinusitis;
• tumors of the nose and pharynx;
• injury.

Symptoms

The leading symptoms of adhesive otitis media are tinnitus and gradual hearing loss. Otoscopy performed shows the presence of cicatricial bands and retraction of the tympanic membrane. Hearing loss occurs as a result of impaired sound conduction.

Symptoms of adhesive otitis media are quite similar to the clinical symptoms of other diseases. Therefore, a lot of diagnostic measures and studies are carried out to make a final diagnosis. Also, diagnostic studies are carried out in order to exclude other pathological processes - tubo-otitis, sulfur plug, atherosclerosis, etc.

Hearing loss is the main symptom in adhesive otitis media.

Diagnosis of this disease includes the following examinations:

• visual examination by an ENT doctor;
• audiometry;
• otoscopy;
• determination of the degree of patency of the auditory tube;
• impedancemetry;
• audiometry;
• endoscopic catheterization.

Audiometry is performed to determine the degree of hearing loss. To determine the degree of patency of the auditory tube, blowing through the Politzer is carried out. In the presence of adhesive otitis media, this procedure does not give almost any improvement in hearing. But to make a final diagnosis, catheterization of the tube is performed, followed by otoscopic control.

Otoscopic examinations are one of the most important points in the diagnosis of the disease. With the help of otoscopy, the degree of retraction of the tympanic membrane, the presence of scars and darkening are established. In the process of otoscopy, adhesions and strands are also detected.

Acoustic impedancemetry is performed to study the mobility of the auditory ossicles and the tympanic membrane. This study is carried out with the help of air, which thickens and liquefies. As a result, the eardrum retracts or straightens. if a person has adhesive otitis media, then the eardrum remains practically motionless.

Treatment

At the initial stage of the treatment of adhesive otitis media, the factors that lead to problems with the conduction of the auditory tube are eliminated. At this stage, the following is carried out:

• sanitation of the nasopharynx, nasal sinuses;
• adenotomy (in childhood);
• restoration of breathing through the nose - measures are taken to eliminate the curvature of the nasal septum.

A positive effect in the treatment is also provided by blowing through the Politzer. Pneumomassage of the tympanic membrane complements the efficiency of blowing. The following drugs are administered through a specially installed catheter:

• fluimucil;
• hydrocortisone;
• chymotrypsin.

To maintain the protective reactions of the body, the patient is recommended vitamin therapy, ATP and more. Antihistamines are also recommended.

In addition to drug therapy, physiotherapy is usually prescribed. There are the following procedures:

• ultrasonic massage;
• microwave therapy;
• mud treatment.

In some cases, conservative treatment does not have a positive effect. Surgical treatment is prescribed. With tympanometry, the mobility of the auditory ossicles is restored and the adhesive bands are dissected. Unfortunately, this method shows a temporary result, because the percentage of re-formation of adhesions is high. In such situations, a more effective result is shown by the replacement of damaged auditory ossicles with artificial specimens.

With bilateral adhesive otitis, which is accompanied by an intense hearing loss, hearing aids are recommended in the elderly and younger.

Remember, a timely appeal to a specialist will help to avoid serious complications and health problems.

Adhesive otitis media - a form of otitis media with the formation of adhesions in

tympanic cavity and scarring of the tympanic membrane.

Etiology. The disease is the result of errors in the diagnosis and treatment of acute otitis media. There are a number of objective reasons leading to the development of adhesive otitis media. These include:

Violation of the ventilation and drainage function of the auditory tube;

The formation of exudate containing a large amount of fibrin;

Allergic interstitial inflammation, accompanied by swelling of the mucous membrane of the tympanic cavity;

Development of granulation tissue;

Changes in atmospheric pressure with hemorrhages in the mucous membrane

irrational antibiotic treatment, etc.

In children:

Remains of myxoid tissue, serving as a plastic material for the formation of adhesions;

Entry of food and stomach contents into the tympanic cavity during regurgitation;

Pathogenesis. With poor drainage function of the auditory tube, paracentesis not performed in a timely manner, with antibiotic treatment that has only a bacteriostatic effect, the exudate is sterilized, the symptoms of intoxication (temperature, pain) disappear, and a visible recovery occurs.

If such a situation is not detected in a timely manner, subsequently the exudate begins to organize and the fibrinous filaments turn into adhesions. Their location is different: the windows of the bony labyrinth, the chain of the auditory ossicles or the tympanic membrane. As a result, persistent sound-conducting hearing loss occurs.

Clinical characteristics anddiagnostics. The general condition usually does not suffer. Information about previous acute otitis media and about diseases of the pharynx, nose and paranasal sinuses are important.

Otoscopy reveals retraction of the tympanic membrane, the light reflex is shortened, and the short process of the malleus protrudes sharply. Sometimes whitish blotches are visible on the tympanic membrane - petrificates, areas of thickening alternate with, as it were, floating scars, sometimes soldered to the labyrinth wall.

It is necessary to study the mobility of the tympanic membrane.

Of paramount importance is the study of the function of the auditory tube and the study of hearing. Audiological examination indicates the defeat of sound conduction. The most characteristic signs of the adhesive process in the ossicular chain are a high air conduction threshold, parallelism of the bone and air conduction curves, and a significant bone-air interval.

It should be borne in mind that the obliteration of the windows of the bony labyrinth with scars gives a hearing loss due to a decrease not only in air, but also in bone conduction, high tones are especially poorly perceived.

Treatment adhesive otitis media can be conservative and surgical. At the initial stages of the disease, systematic blowing of the ears according to Politzer, the introduction of medicinal substances into the tympanic cavity through a catheter, bougienage of the auditory tube, vibro- and pneumomassage of the tympanic membrane, electrotherapy (galvanization, pulsed magnetotherapy, etc.) can give a positive effect. These methods are combined with parenteral administration of aloe, hormonal preparations, enzymes. A good effect is noted with the introduction of lidase into the tympanic cavity using tympanopuncture.

Surgical treatment for adhesive otitis media is very difficult. It

is performed using an operating microscope and special instruments.In childhood, operations for adhesive otitis media are unpromising due to an increased tendency to develop granulations and re-scarring, which negates the results of the operation.

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Chronic adhesive otitis media is an inflammation that occurs in the middle ear cavity. With the disease, there is a possibility of adhesions and formations in the form of scars. Such connections entail a deterioration in the patency of the Eustachian tube (auditory tube) and a violation of the motor activity of the auditory malleus. The disease is difficult to treat, because after surgery, the likelihood of a new appearance of adhesions and scars is high.

Causes of the disease

Middle ear disease (adhesive type) develops as a complication after suffering catarrhal or exudative salpingo-otitis. Improper therapy leads to the disease, accompanied by the inappropriate use of drugs with an antibiotic.

The prescribed medications eliminate inflammation, dissolve the exudate that accumulates in the cavity of the eardrum. As a result, fibrin compounds are formed, which are the cause of scarring and adhesions.

The adhesions and scars are attached to the tympanic cavity, while covering the auditory malleus, and block their activity. The reduction in mobility entails a violation of the function of sound perception. On this partial hearing loss.

Adhesive middle ear disease can develop without inflammation. Such cases are rare, but sometimes recorded in otolaryngological practice. The disease occurs against the background of pathologies that block the patency of the Eustachian tube and are an obstacle to ventilation in the tympanic cavity.

The "culprits" of this state are:

1. complications after the transfer of pharyngitis, SARS, laryngitis, tracheitis;
2. tonsillitis in the chronic stage;
3. complication after suffering sinusitis, sinusitis, rhinitis;
4. curvature of the nasal wall;
5. malignant and benign formations in the nasal cavity and pharynx.

Todevelopment of adhesive otitis mediastopped, you should seek qualified help in time and pay attention to the inflammatory processes occurring in the body.

Symptoms of adhesive middle ear disease

Symptoms of adhesive otitis media indicate that immediate medical attention is required. The main symptom of the onset of the disease is a complete or partial loss of hearing. The patient complains that every time communication becomes more and more difficult for him. When interviewing a doctor, a person speaks of a previous and chronic stage).

Symptoms of otitis media in adults are similar in adhesive type to signs of other ear ailments. Therefore, to make the correct diagnosis, doctors conduct a large number of tests and studies (especially when symptoms of otitis media are observed on both sides). In this case, they talk about the suspicion of bilateral otitis media in adults. In this condition, there is a possibility of adhesions in both organs of hearing.

The symptoms of adhesive otitis should not be ignored, as long-term untreated disease will lead to a complete loss of hearing.

Diagnostics

Symptoms and treatment of otitis media are determined by the doctor - ENT. First, the doctor will examine the patient's ear, then conduct diagnostic tests. To determine the severity of the disease, audiometry is performed (measurements of auditory sensitivity and hearing acuity), otoscopy (a method of analysis that allows you to examine the cavity of the membrane and the external auditory canal), impedancemetry (a technique that determines diseases in the middle ear).

Diagnosis of otitis begins with determining the degree of damage to the membrane and the external auditory canal (otoscopy). Otoscopy is complex and enlarged. Diagnostics reveals the presence of adhesions and scars in the cavity of the membrane.

To determine the degree of patency of the Eustachian tube, otolaryngologists perform a Politzer blowing procedure. The method consists in introducing air under pressure through the Eustachian tube into the cavity of the membrane.

Acoustic impedancemetry is necessary to determine the elasticity of the tympanic membrane and the activity of the auditory hammers. In case of adhesive type middle ear disease, the tympanic membrane is inactive (does not move), there are no reflexes.

Therapy of adhesive otitis media in chronic form

Treatment of adhesive otitis media focuses on eliminating the cause that caused the development of the disease. First, the doctor will sanitize the nasopharynx and nasal sinuses, adenotomy in children (removal of adenoids) and resumption of breathing through the nose (straightening of the nasal wall, prevention of shell hypertrophy).

It consists in carrying out the Politzer blowing procedure and at the same time massaging the eardrum. It is recommended to administer hydrocortisone and FiBS, actovegin and B vitamins, chymotrypsin and ATP, fluimucil and cocarboxylase, and take antihistamine (anti-allergic) drugs.

UHF for otitis, massage with ultrasound, microwave therapy are also actively carried out according to the recommendations of the attending doctor.

Otitis media of the adhesive type is difficult to treat with medication. With the ineffectiveness of conservative treatment, surgical intervention is prescribed. At this stage, adhesions are dissected, and the activity of the auditory hammers improves.

After the operation, the likelihood that scars and adhesions will reappear is high. In this case, tympanoplasty is used, in which the auditory hammers are replaced with artificial materials.

Bilateral otitis media of the adhesive type with severe hearing loss is treated with hearing aids.

The treatment of adhesive-type otitis media is practiced by laying free elements of the buccal mucosa on the damaged surface (on the area of ​​​​the tympanic membrane deprived of epithelium).

This method has its drawbacks: in this case, there is a possibility of developing cholesteatoma (a tumor-like formation containing dead epithelial tissue), shifting parts of the mucosa due to poor fixation, swelling of the mucosa, and pus formation.

To prevent the appearance of scars and adhesions, otolaryngologists apply the method of applying special strips consisting of Teflon material to the area of ​​\u200b\u200bthe labyrinth wall of the tympanic cavity. This method resists the re-formation of scars and adhesions.

After 3-6 months, the film is removed, and enzymes are introduced into the tympanic cavity, which dissolve scar formations:

• hyaluronidase,
• ronidase,
• lidase.

Enzymes are administered by inserting a catheter through the Eustachian tube before or after surgery.

There are also disadvantages to this method. Enzymes injected into the ear dissolve only existing adhesions, but do not prevent the formation of new connections.

Treatment of adhesive otitis with home remedies is not possible. In this case, the development of the disease can be prevented. For this, it is necessary to eliminate the inflammatory processes occurring in the ear cavity in time.

The effectiveness of treatment

Adhesive otitis media can be difficult for a person. The problems relate to the inability to communicate with people and restrictions in work. Adhesive otitis is common among the working population, and it is difficult to cure it. Otolaryngologists resort to surgery, but after surgery, the likelihood that adhesions form again is high.

What is adhesive otitis

Adhesive (adhesive) otitis media is a disease characterized by inflammation of the mucous epithelium of the tympanic cavity, as a result of which the mobility of the auditory ossicles is impaired. Fibrous processes occurring in the middle ear lead to a narrowing of the diameter of the auditory tube, which affects the auditory function. ENT disease develops mainly after inadequate treatment of acute or chronic inflammation in the middle ear.

The tympanic cavity, inside which the auditory ossicles are located, is lined with mucous epithelium. The normal conduction of sound signals entering the ear is due to the mobility of these bones, which largely depends on the amount of fluid that lubricates the micro-joints. With the development of pathological processes in the ear, the volume of secreted fluid decreases sharply, as a result of which adhesive otitis media develops.

Due to insufficient production of liquid secretion, fibrin is deposited on the bones and eardrum. Within a short time, this substance hardens, resulting in the formation of fibrous scar tissue. Adhesions occur in the tympanic cavity, which prevent the normal drainage of the auditory tube. Pathological changes lead to a decrease in the amplitude of oscillations of the auditory ossicles, as a result of which hearing deteriorates.

The formation of cicatricial adhesions leads to the development of sound perceiving dysfunction, which is due to conductive hearing impairment.

The precursors of adhesive disease of the middle ear in 75% of cases are chronic turbootitis or healed nonperforative acute otitis media. As a result of the elimination of inflammatory processes, fibrin strands remain inside the tympanic cavity, the hardening of which inevitably leads to the formation of adhesive strands from the connective tissue. The cords envelop the auditory ossicles, as a result of which their mobility decreases.

In clinical otolaryngology, many cases of the development of the disease without previous destructive processes occurring in the ear have been recorded. In such cases, the main cause of ENT disease is infectious lesions of the upper respiratory tract. Among the main provocateurs of pathology, experts include:

Important! Untimely relief of inflammatory processes in the hearing aid leads to hearing loss, which practically cannot be restored even after outpatient treatment.

Clinical picture

Among the main symptoms of the development of adhesive disease of the middle ear are pain and auditory dysfunction, the manifestation of which is hearing loss. In the case of excessive growth of the connective tissue, the eardrum is deformed, as a result of which the patient feels “shoots” in the ear. A gradual increase in the number of scars at the mouth of the ear canal leads to a violation of its conduction and, as a result, an even greater hearing loss.

Further ankylosing of micro-joints in the auditory ossicles causes the development of hearing loss. However, to a greater extent, the violation of sound conduction is associated with the formation of a damper from scar tissue inside the ear canals. A few clinical manifestations of the disease are similar to the symptoms of otosclerosis, traumatic otitis media, etc. Therefore, when characteristic signs of the disease appear, it is necessary to be examined by an otolaryngologist.

Types of ENT diseases

There are several types of pathology, which are determined by the severity of the symptomatic picture. The scheme and duration of the course of treatment of the disease largely depends on the accuracy of the diagnosis. In clinical otolaryngology, there are three main forms of adhesive otitis media:

1. mild - accompanied by the formation of a small number of adhesions, resulting in a slight hearing loss;
2. medium - characterized by a curvature of the tympanic membrane, in which fibrin strands appear. Their hardening leads to a decrease in tissue elasticity and, accordingly, hearing impairment;
3. severe - accompanied by the growth of fibrous tissues, which inevitably leads to the appearance of atrophic scars that deform the auditory ossicles and membrane.

Fibrous-cicatricial neoplasms in the hearing aid are almost impossible to eliminate. Thanks to hardware and drug treatment, it is only possible to stop the process of adhesion formation.

Diagnostics

For adequate treatment of adhesive otitis media, it is necessary to undergo a complete diagnostic examination. The key point in the diagnosis is the determination of the otoscopic picture of the pathology. This allows you to find out the degree of deformation of the tympanic membrane, the number of adhesions in the tympanic cavity and the level of obliteration of the lumen of the auditory canal.

When examining a patient, the following types of activities are carried out:

• audiometry - allows you to accurately determine the degree of hearing loss. For these purposes, blowing the ear canal along the Politzer is performed. In the case of the development of the disease, the procedure does not contribute to the aggravation of hearing. However, to accurately determine the type of pathology, catheterization of the ear canal is additionally performed;
• acoustic impedancemetry - helps to determine the degree of elasticity of the tympanic membrane and the amplitude of oscillations of the auditory ossicles. If, when air is injected into the tympanic cavity, the membrane does not oscillate, this indicates that it is damaged by adhesions;
• otoscopy is an effective method for determining the degree of deformation of the auditory ossicles and membranes by the presence of blackouts on their surface.

With irreversible deformation of the auditory ossicles, prosthetics are performed, the effectiveness of which largely depends on the stage of development of the disease.

Principles of treatment

At the initial stage of treatment of an ENT disease, it is necessary to eliminate the factors that provoke a narrowing of the diameter of the ear canal. For these purposes, the nasal cavity and paranasal sinuses are sanitized through the transtubal administration of Fluimucil, Hydrocortisone and other drugs. Parenteral use of vitamins, FiBS and ATP helps to increase the reactivity of the immune system, thereby reducing the risk of developing infectious complications.

How to get rid of noise with adhesive otitis media? To stop the main symptoms of pathology, the following therapeutic measures are used:

• membrane pneumomassage;
• electrophoresis;
• adenotomy;
• microwave physiatry;
• ultraphonophoresis.

With the progression of the ENT disease, complications may occur, such as meningoencephalitis, neck phlegmon, or paresis of the auditory nerve.

In most cases, conservative treatment does not give the desired therapeutic results. For this reason, further development of hearing loss can be prevented through surgical intervention. Tympanotomy, i.e. dissection of adhesive strands and growths from connective tissue contributes to the restoration of normal mobility of both the tympanic membrane and the auditory ossicles.

It should be noted that surgery provides only temporary relief of symptoms. After the procedure, the process of formation of adhesions in 90% resumes. A more effective method of treating otitis media will be hearing aids. Replacing the auditory ossicles with prostheses made of artificial materials ensures the absence of scars, which prevents the development of auditory dysfunction.

Alternative Treatment

Trophic changes in the mucous epithelium, tympanic membrane and auditory ossicles can be prevented with the help of natural preparations. However, the treatment of adhesive otitis media with folk remedies will give positive results in the initial stages of the development of the disease. With the permission of the attending physician, the following types of drugs can be included in the complex therapy of ENT diseases:

• a mixture of butter and mummy: 1 tsp. mix the mummy with 250 g of melted butter. The prepared solution is instilled into the ears twice a day, 2-3 drops;
• propolis tincture: mix water with propolis tincture in equal proportions. Soak cotton pads in the prepared solution and insert them into the ear canal for 40-60 minutes. Do the procedure twice a day;
• saline with onion juice: mix onion juice with saline (proportion 1 to 1). Pour the heated liquid into the ear and place it with a cotton swab for 20 minutes. The procedure should be performed 2-3 times a day;
• infusion on garlic and vegetable oil: chop a clove of garlic and pour it over 2 tbsp. l. vegetable oil. Infuse the product for three days, then add 3 drops of eucalyptus oil to it. Bury 3 drops of the filtered emulsion into each of the auditory passages twice a day;

Self-medication is fraught with the progression of pathology and the development of deafness. For this reason, an otolaryngologist should be consulted before using alternative medicine.

Adhesive otitis: symptoms, treatment

Very often, inflammatory processes of varying severity develop in the body. Adhesive otitis media, the symptoms of which begin with hearing impairment, is not uncommon. This disease is accompanied by inflammation in the middle ear. As a result, adhesions with strands are formed, and the mobility of the auditory ossicles is impaired. Why does this disease occur? What treatments do doctors offer?

Features of adhesive otitis media

The middle ear is represented by two components: the cavity with the auditory ossicles and the Eustachian tube. They are separated by the eardrum, which is also responsible for the transmission of sound vibrations. They pass through the bones to the structures of the inner ear. This is where the subsequent transmission and perception of signals along the auditory nerves takes place. After that, the sound is received by the corresponding part of the brain. Adhesive otitis media appears due to a decrease in the mobility of the eardrum and bones. The disease is accompanied by partial or complete impairment of sound perception.

Causes

Most often, the cause of the pathology is inflammatory processes in the middle ear - acute otitis media and its various forms. The illiterate use of antibiotics during treatment can also provoke the disease. The drugs successfully fight inflammation in the ear cavity, but at the same time liquefy the exudate accumulated in it. As a result, scar bands and adhesions from the connective tissue are formed. They braid the bones, blocking the mobility of structures and disrupting the patency of the auditory tube.

In otolaryngology, there are cases when adhesive otitis media develops as an independent disease. It is preceded by a variety of pathological processes that significantly impede the patency of the auditory tube and prevent full ventilation of the tympanic cavity. Such violations include:

• prolonged tonsillitis;
• adenoids;
• damage to the nasal septum;
• neoplasms in the pharynx;
• diseases affecting the upper respiratory tract (laryngitis, SARS);
• chronic inflammation in the nasal cavity (sinusitis, sinusitis).

Regardless of the cause of the disease, having noticed its first signs, it is necessary to consult a doctor. Timely prescribed treatment can prevent the development of serious complications, avoid surgical intervention.

Clinical manifestations of the disease

The development of the pathological process begins gradually. The first symptom that patients pay attention to is tinnitus. Adhesive otitis media is characterized by a conductive type of hearing impairment, when there is a persistent deterioration in the mechanical conduction of sound vibrations. The clinical symptoms of the disease are in many ways similar to the picture of other ailments. Therefore, many diagnostic measures are used to determine the cause of the hearing change. They allow to exclude other pathological processes that can lead to conductive hearing loss (accumulation of sulfuric secretion, tubo-otitis, otosclerosis, etc.).

Establishing diagnosis

What principles guides the doctor when choosing treatment tactics? "Adhesive otitis media" is a serious diagnosis, for confirmation of which a complete examination of the patient is required. It usually includes:

• visual inspection;
• otoscopy (examination of the ear cavity using a light source and a reflector);
• catheterization (examination of the auditory tube, which connects the ear to the nasopharynx);
• audiometry (hearing acuity test);
• impedancemetry (detection of changes in the structure of the Eustachian tube, eardrum).

The fundamental manipulations in the diagnosis of the disease are audiometry and subsequent catheterization. Impedancemetry allows you to check the mobility of the bones and identify adhesions. Due to the latter, the tympanic membrane gradually loses its functions, which provokes a sharp decrease in hearing in the patient.

Based on the results of the examination, the doctor prescribes the appropriate treatment. Adhesive otitis media, detected in the early stages, responds well to drug therapy and does not require surgical intervention. With the advanced form of the disease, an operation is prescribed. In especially serious cases, the patient is shown the use of a hearing aid. What other ways of treating pathology exist?

Drug therapy

At the very initial stage of the pathological process, the patient is prescribed injections of B vitamins, aloe, and the vitreous body. To improve the elasticity of adhesions and prevent their further spread to the Eustachian tube, Lidaza, Fluimucil, and Chymotrypsin are prescribed.

Physiotherapy

Conservative drug treatment is usually supplemented with physiotherapy. The most effective are the following procedures:

To prevent recurrence of the disease, it is recommended to repeat the course of treatment 2-3 times a year.

Politzer method and adhesive otitis media

Treatment with the blowing of the Eustachian tube according to the Politzer method gives a positive effect. The procedure involves constant monitoring with an otoscope. One olive is inserted into the ear of the patient, the other - by the doctor. A catheter is also attached to the patient's nostril, from which the balloon departs. The second nostril is clamped with a finger, after which the patient is asked to slowly pronounce the word "steamer". With each pronunciation of the stressed syllable, the pear is squeezed. If there are no adhesions in the Eustachian tube, air passes unhindered.

This procedure is often combined with pneumomassage of the tympanic membrane. With the help of a special apparatus, the membrane is exposed to a jet of air, the strength of which is controlled. Such a procedure has a positive effect on the mobility of the tympanic membrane, prevents the formation of adhesions.

Surgery

It is far from always possible to defeat adhesive otitis media with the help of drugs and physiotherapy. Treatment with conservative methods does not bring results? In such situations, when the disease is characterized by a bilateral nature, the patient is prescribed an operation - tympanotomy. During surgery, the doctor opens the eardrum, thereby providing access to the auditory ossicles. Tympanotomy allows you to get rid of the accumulated exudate, eliminate adhesions.

Even the operation does not give a 100% guarantee of a positive result. Often, against the background of a large area of ​​\u200b\u200bdamage by adhesions, adhesive otitis media recurs. Symptoms of the disease after surgery do not differ from those before the start of treatment. Patients are diagnosed with scars that gradually deform the eardrum, which affects the quality of hearing. It may be impossible to stop the pathological process and improve the patency of the Eustachian tube. In such situations, they resort to replacing the bones with artificial polymer prostheses, and ventilation is carried out through the auditory canal.

Danger of relapse

Patients who have undergone adhesive otitis media should be under the supervision of an otorhinolaryngologist for six months after treatment. After this period, it is recommended to undergo a second examination to make sure that there are no pathological changes in the ear cavity. If abnormalities are detected, the course of treatment is repeated. In the future, the disease can provoke fibrinous-cicatricial changes in the structure of the middle ear. Unfortunately, such violations are irreversible. In the absence of adequate treatment, pathology can cause ankylosis of the joints of the auditory ossicles, which leads to total deafness.

Prevention measures

An acute inflammatory process in the middle ear often ends with a diagnosis of adhesive otitis media. Treatment with folk remedies or drugs does not always bring a positive result. Surgical intervention is very time consuming and does not prevent recurrence of the disease. Therefore, it is necessary to engage in the prevention of the disease. It is recommended to start from the first days of a child's life. Breastfeeding ensures the full formation of the muscles of the ear, resulting in a reduced susceptibility to the effects of pathological agents. Moreover, it strengthens the body's immune system and reduces the risk of developing respiratory diseases.

Modern pharmacology offers a number of drugs to increase resistance to viral pathologies and quick recovery from colds. They are also excellent prevention of adhesive otitis media. Among such medicines, Influvac, Imudon, Bronchomunal should be singled out. Before using the drugs, it is recommended to consult with a specialist on the dosage and duration of the prophylaxis course. If inflammation could not be avoided, it is necessary to follow the treatment regimen suggested by the doctor. Any deviation from the recommendations of a specialist is dangerous for a relapse of the disease.

Adhesive otitis media

Adhesive otitis media is an inflammatory process in the middle ear, accompanied by the formation of fibrous tissue, adhesions, and hearing loss.

With an unfavorable course of the healing process in catarrhal, serous, exudative otitis media, connective fibrous tissue is formed in the tympanic cavity, adhesions, rough scars are formed, the mobility of the auditory ossicles and the eardrum is impaired.

The formation of rough scar tissue leads to conductive hearing loss, deterioration of sound conduction. Prolonged inflammation also affects the sound-perceiving function of the organ of hearing.

Adhesive - from lat. adhaesio - adhesion.

Adhesive otitis media occurs against the background of catarrhal, serous, exudative inflammation with a delay in restoring the patency of the auditory tube.

The disease also occurs after acute purulent otitis media with perforation of the eardrum. With rapid spontaneous fusion of the membrane, part of the purulent contents of the middle ear cavity is not evacuated and causes the formation of scar tissue.

With serous inflammation without perforation of the tympanic membrane, the mucous contents become the basis for the formation of a sticky ear.

With a long course of acute or repeatedly recurring exacerbations of chronic otitis media, the fluid accumulated in the cavity of the middle ear does not completely dissolve, leaving threads of connective tissue - fibrin.

The connective tissue forms rough scars, thickenings, bridges between the auditory ossicles, the tympanic membrane, and the walls of the middle ear cavity.

Spikes grow into the middle ear cavity, the Eustachian tube, disrupt the conduction of sound, lead to stiffness of the auditory ossicles, which adversely affects hearing. The patient's conduction of sound is disturbed, hearing loss occurs, progressing as the adhesive process intensifies.

When otoscopy of the middle ear, cicatricial changes are detected, causing retraction, deformation of the tympanic membrane. Scar tissue impairs the patency of the auditory tube, which leads to a violation of pressure in the middle ear cavity, the appearance of noise in the ear.

Scar tissue forms between the auditory ossicles, causing them to ankylose (fuse). Ankylosis of the stirrup is formed, tympanosclerosis develops. Plaques of tympanosclerosis in the tympanic cavity are a sign of adhesive otitis media.

The cause of the adhesive process and the occurrence of adhesive disease of the middle ear can be chronic tubo-otitis, accompanied by a violation of the patency of the auditory tube, pharyngitis, laryngitis, adenoids, sinusitis, tonsillitis.

The main symptoms of adhesive otitis media are hearing loss accompanied by low-frequency noise in the ear. Hearing impairment occurs by the type of conductive, when the mechanical conduction of sound vibrations in the ear cavity worsens.

When making a diagnosis, differential diagnosis is of particular importance, since the symptoms of adhesive otitis media coincide with signs of otosclerosis, the presence of accumulation of earwax in the auditory canal, and mechanical trauma.

Diagnostics

When diagnosing adhesive otitis media, the impedancemetry method is used to determine the degree of compliance of the tympanic membrane.

Research is also carried out with a Sigle pneumatic funnel. In the course of studies with adhesive otitis, a limitation of the mobility of the tympanic membrane is found.

If the blowing of the Eustachian tube by the Politzer method fails, the patient is catheterized, controlling the actions with an otoscope.

The penetration of air into the cavity of the middle ear is accompanied by a whistling sound. When the auditory tube is completely clogged with adhesions, catheterization cannot be performed.

Adhesive otitis media with prolonged hearing loss is difficult to treat with drugs, physiotherapy procedures are ineffective.

Means of conservative therapy are used only as maintenance therapy.

The main methods of treatment of adhesive otitis media are:

If surgical treatment is ineffective, the patient is referred to an audiologist for the selection of a hearing aid.

Drug therapy

At an early stage of adhesive otitis, the patient is prescribed injections of vitamins of group B, vitreous body, aloe, actovegin, ATP.

To improve the elasticity of adhesions, lidase, fluimucil, chymotrypsin, hydrocortisone are injected into the auditory tube to prevent the spread of adhesion formation to the Eustachian (auditory) tube.

Politzer Method

A positive effect of treatment is noted when a course of blowing the auditory tube according to the Politzer method is prescribed.

The procedure is controlled with an otoscope, for which one olive of the otoscope is inserted into the patient's ear, and the doctor inserts the other olive into his ear.

A catheter attached to a balloon is inserted into the patient's nostril. The opposite nostril is clamped, the patient is asked to say "steamer". At the moment of pronouncing the stressed syllable, the pear is squeezed.

If the patient's auditory tube is free from adhesions, the air passes freely, the doctor will hear a rustling sound in the olive of the otoscope.

With the help of a Sigle funnel, pneumomassage of the tympanic membrane is carried out. A special device acts on the eardrum with a jet of air of controlled force.

As a result, the mobility of the tympanic membrane improves, the formation of scars and adhesions is prevented.

Physiotherapy for adhesive otitis media

Comprehensive treatment with physiotherapeutic methods improves the patient's well-being, reduces noise in the ear, but, as a rule, does not give a complete recovery.

Physiotherapy procedures are carried out in courses, the most effective are:

Tympanotomy operation

In the absence of a result of treatment with conservative methods in the case of bilateral adhesive otitis media, the patient is prescribed a tympanotomy (myringotomy) operation. The operation is carried out under the control of a medical microscope with special instruments.

During the tympanotomy operation, the tympanic membrane is opened, providing open access to the auditory ossicles in the middle ear cavity.

The operation allows you to get rid of the accumulation of liquid exudate in the tympanic cavity, eliminate adhesions, restore the functionality of the tympanic membrane, auditory ossicles.

The tympanotomy operation does not always give a 100% positive result. Due to the high activity of the adhesive process, especially in children, scars form again after the operation, deforming the eardrum, causing hearing impairment.

In some cases, it is impossible to improve the patency of the auditory tube and stop the development of the adhesive process. In such cases, they resort to replacing the auditory ossicles with artificial ones and carry out artificial ventilation through the external auditory canal.

If the adhesive process is bilateral, a hearing aid is selected for the patient.

Complications

The adhesive process in adhesive otitis causes a violation of the sound-conducting function. With an unfavorable course of the disease, the sound-perceiving ability of the organ of hearing also deteriorates.

Launched adhesive otitis media leads to hearing loss, in severe cases - to deafness.

Prevention

Prevention of adhesive otitis media is regular examination by an otolaryngologist for any inflammatory disease of the middle ear within 6 months after the disease.

Patients with chronic otitis media should be registered at the dispensary and undergo a follow-up examination at least once a year.

To prevent adhesive otitis media, it is necessary to promptly eliminate foci of infection in the oral cavity, nasopharynx, and ears.

Changes in the middle ear with adhesive otitis media are irreversible. With early diagnosis, it is possible to stop the formation of adhesions, fusion of the auditory ossicles, and hearing loss.

Adhesive otitis media: causes, symptoms and treatment

A disease such as adhesive otitis media can lead to a gradual deterioration in hearing in a person. The causes can be both some ear diseases and extraneous factors. To prevent complications, it is important to carry out the correct treatment, otherwise, scarring of the soft tissues of the ear occurs, followed by immobilization of the auditory ossicles.

Features of the disease, symptoms and causes

Adhesive otitis media is a violation of the normal functioning of the middle ear, resulting from the formation of growths of the epithelium. Such scars are adjacent to one of the most important parts of the sound-perceiving mechanism - the auditory ossicles. If there is an obstacle to their free oscillation, it becomes impossible to accurately transmit sounds and vibrations. This is what causes hearing loss in humans.

Adhesive disease of the middle ear cavity is expressed by the following symptoms:

• noise in the ear of unknown origin;
• retraction of the eardrum;
• poor sound conduction;
• discomfort;
• sometimes there may be a feeling of congestion.

There is no particular pain, so it is important to monitor the quality of hearing for the timely detection of symptoms. In order for further treatment to give results, it is necessary to prevent the occurrence of tubo-otitis, the formation of sulfur plug and other disorders in the body.

Most often, adhesive otitis media is a complication of a previous ear disease. Basically, it is the result of insufficient or improper treatment of diseases such as:

When treated with antibiotics, side effects are possible. At first, it may seem that the therapy was effective, since the inflammation and the source of the infection will be eliminated. After a while, hearing loss occurs for no apparent reason. In fact, it is provoked by scar tissue that forms in the middle ear and interferes with the normal functioning of the auditory ossicles.

Other conditions can also provoke the disease. The most common alternative causes include:

• SARS;
• inflammation of the upper respiratory tract, nose and paranasal sinuses;
• tumors in the nasopharynx;
• adenoids;
• consequences of injury.

Adhesions of connective tissue and strands may be the result of previous surgical intervention. To reduce the likelihood of tissue scarring at the site of the operation, in some cases, patients are prescribed special therapy.

Diagnostics

To minimize the risk of hearing loss and eliminate the consequences of ear diseases, it is necessary to listen to your body during the rehabilitation period. An important factor on which the complete recovery of the patient is based in the future is the timely detection of the disease. Diagnosing adhesive otitis media is not as easy as it might seem. The main reason is the similarity of the signs of the disease with other pathologies of the ear.

To clarify the diagnosis, it is necessary to conduct a number of studies. First of all, the otolaryngologist needs to collect an anamnesis and conduct a visual examination of the affected organ. An otoscope is used to get a more accurate picture.

If there is a suspicion of an adhesive form of otitis, it is also necessary to measure the level of hearing. For this, methods such as:

• Audiometry. Determination of the degree of perception of sounds by a person.
• Impedancemetry. By supplying air into the ear passage, changes in the tympanic membrane are monitored. Normally, it should retract and straighten when exposed to it. During scarring, there are practically no vibrations of the membrane.
• Endoscopic catheterization. If after the procedure there are no changes for the better, the diagnosis is most likely confirmed.
• Study of the patency of the auditory tube. This eliminates the possibility of the presence of tumors, serous plugs and other obstacles to the passage of sound.

Further treatment must necessarily be accompanied by control measurements of hearing quality. If improvements are detected, we can talk about the effectiveness of therapy. Otherwise, there is a risk of making an initially incorrect diagnosis.

Traditional treatment and folk methods

Comprehensive treatment is required to eliminate adhesive otitis media. It consists in a combination of medication and physiotherapy, as well as surgical intervention in case of urgent need.

First of all, it is necessary to eliminate the cause that provoked the disease. After getting rid of extraneous factors of influence, ear therapy is performed directly.

Adhesive otitis media can be relieved by using the ear canal blowing method. After the path is cleared, drugs are introduced into the cavity, which contribute to the resorption of neoplasms and the restoration of normal patency. To stimulate the immune system, vitamins are additionally introduced.

Good results are obtained by treatment with courses of physiotherapy:

If adhesive bands continue to affect the elements of the middle ear, surgical intervention is required. Using this method, it is possible to free the auditory ossicles and cut off excess scar tissue. If the bones have been damaged or their mobility cannot be restored, their prosthesis is possible. In this case, the chances of a complete restoration of hearing increase significantly, but are not guaranteed, since there remains a risk of complications in the future.

Treatment of the adhesive form of otitis with folk remedies is extremely rare, since, in fact, this method is not able to save a person from the main problem of the disease - connective tissue adhesions. Some recipes can only temporarily eliminate certain symptoms and discomfort.

Treatment of ear pain with folk remedies is possible with the help of such means as:

• propolis;
• chamomile infusion;
• elder;
• yarrow;
• geranium;
• wild garlic juice;
• plantain juice;
• honey with mint decoction;
• basil leaf juice.

These funds are used externally. Compresses are made to eliminate pain and inflammation. It is necessary to bury infusions and fresh juice with caution, since there are many contraindications for this method of use, in particular, the acute course of the inflammatory process.

To relieve swelling of the ear and alleviate the general condition, you can take a decoction of camel thorn inside. To relieve pain, relax and reduce inflammation, it is recommended to drink herbal teas with the addition of honey. As tea leaves, you can use a collection of field chamomile flowers, St. John's wort, raspberry leaves, mint and other plants.

Forecast and prevention of complications

Despite all efforts and timely treatment, the course of the disease may have an unfavorable prognosis. Most cases of adhesive otitis media still have a positive outcome and restoration of the auditory function of the affected ear. Even with the need for prosthetics of the auditory ossicles and the development of functional hearing loss, the patient's condition can be improved in some way.

Nevertheless, adhesive otitis media can cause various complications, in particular if sterility conditions have been violated during surgical procedures. But even effective, at first glance, treatment does not give a 100% guarantee that the disease will not overtake the patient again. The formation of strands and adhesions can be triggered even by ordinary inflammation of the ear. Significantly increases the risk of their reappearance when using surgical intervention. Much depends on the characteristics of the human body and the existing congenital and acquired pathologies.

If it is impossible to restore hearing function due to the destruction of the bones or other elements of the organ, a hearing aid can help.

To prevent a bad development of the scenario of events, it is necessary to undergo an examination by a doctor after the treatment. If there are any deviations, seek help from an otolaryngologist and do not self-medicate. Also strengthen the immune system and do not expose the ears to the negative effects of external factors.

Adhesive otitis media

Adhesive otitis media- a chronic inflammatory process in the middle ear, leading to the formation of adhesions and connective tissue cords, causing impaired patency of the auditory tube and mobility of the auditory ossicles. Adhesive otitis media is manifested by the appearance of tinnitus and hearing loss that worsens over time. Mandatory diagnostic studies for suspected adhesive otitis media are an examination by an ENT doctor, otoscopy, audiometry, a study of the patency of the auditory tube, and impedancemetry. Therapeutic measures for adhesive otitis media include the introduction of proteolytic enzymes, lidase, hydrocortisone, and physiotherapy. If they are ineffective, surgical treatment (tympanotomy, tympanoplasty), hearing aids are indicated.

Adhesive otitis media

The middle ear includes the auditory tube and the tympanic cavity, which contains the auditory ossicles (stapes, malleus and anvil). The tympanic cavity is separated from the auditory tube by the tympanic membrane, which transmits sound vibrations to the auditory ossicles. Further, through the bones, the vibration enters the structures of the inner ear, which are responsible for sound perception and the transmission of sound signals along the auditory nerve to the corresponding part of the brain.

Hearing loss in adhesive otitis media is associated with a decrease in the mobility of the auditory ossicles and the tympanic membrane, leading to a violation of the mechanism of sound conduction from the tympanic membrane to the cochlea of ​​the inner ear. However, over time, long-term adhesive otitis media can lead to impaired sound perception as a result of a decrease in the sensitivity of hair cells to endolymph fluctuations and a decrease in the impulses coming from them to the brain.

Causes of adhesive otitis media

The most common cause of adhesive otitis media is previous exudative or catarrhal non-perforated otitis media, chronic tubo-otitis. The development of adhesive otitis media after these diseases can be triggered by irrational antibiotic therapy. As a result of the resolution of the inflammatory process and the resorption of the exudate accumulated in the tympanic cavity, fibrin filaments remain in it and connective tissue adhesions and scar bands are formed. The latter braid the auditory ossicles and are attached to the tympanic membrane, blocking the mobility of these structures necessary for normal sound conduction. At the same time, adhesions and strands of adhesive otitis media can also form in the auditory tube, which leads to a violation of its patency.

In clinical otolaryngology, it is not uncommon for adhesive otitis media to occur without prior acute or chronic otitis media. In such cases, the cause of its development are various pathological processes that impede the patency of the auditory tube and prevent normal ventilation of the tympanic cavity. These include: acute diseases of the upper respiratory tract (ARVI, pharyngitis, tracheitis, laryngitis), chronic tonsillitis, adenoids, chronic inflammation of the paranasal sinuses and nasal cavity (sinusitis, sinusitis, rhinitis), hypertrophic changes in the inferior nasal concha, tumors of the pharynx and cavity nose, deviated septum.

Symptoms of adhesive otitis media

The main complaints that a patient with adhesive otitis media presents are gradual hearing loss and the presence of tinnitus. When questioned in the anamnesis of such patients, it is possible to identify previously noted acute or chronic otitis media. The study of hearing in adhesive otitis media determines the conductive nature of hearing loss - hearing loss due to impaired sound conduction.

Clinical symptoms of adhesive otitis media are few and similar to those of other ear diseases. Therefore, to diagnose the cause of the identified hearing changes, it is necessary to carry out a number of diagnostic measures and exclude other pathological processes leading to conductive hearing loss (cerumen plugs, traumatic damage to the structures of the middle ear, tubo-otitis, otosclerosis, etc.).

Diagnostic examination for adhesive otitis media includes a visual examination by an otolaryngologist, determination of the patency of the Eustachian tube, otoscopy, microotoscopy, audiometry, impedancemetry, endoscopic catheterization of the auditory tube.

Conducting audiometry reveals hearing loss of varying severity in patients with adhesive otitis media, up to complete deafness. To determine the patency of the auditory tube, its trial blowing according to Politzer is carried out. In adhesive otitis media, it usually produces little or no improvement in hearing. However, this does not always clearly indicate impaired patency. For the final confirmation of such a violation, catheterization of the tube with otoscopic control is resorted to.

The most important point in the diagnosis of adhesive otitis media is the identification of a characteristic otoscopic picture of the disease. Otoscopy (simple and with magnification) determines the retraction of the tympanic membrane, its clouding and the presence of cicatricial changes, in some cases causing deformation of the membrane. In the cavity of the auditory tube, strands and adhesions are also visualized, sometimes completely obliterating its lumen.

The study of the mobility of the tympanic membrane and auditory ossicles is carried out during acoustic impedancemetry. The study consists in thickening and discharging the air in the auditory tube, as a result of which the tympanic membrane is retracted and straightened. With adhesive otitis media, the movements of the membrane are limited or completely absent, acoustic muscle reflexes are not caused.

Treatment of adhesive otitis media

The first step in the treatment of adhesive otitis media is the elimination of factors that lead to impaired patency of the auditory tube. This includes sanitation of the nasopharynx and nasal sinuses, adenotomy in children, restoration of normal breathing through the nose (elimination of deviated nasal septum and turbinate hypertrophy).

A positive effect in adhesive otitis media has a course of blowing according to Politzer in combination with pneumomassage of the tympanic membrane. Transtubal administration of hydrocortisone, acetylcysteine, chymotrypsin, hyaluronidase through a catheter is used. To stimulate the body's defense reactions, patients with adhesive otitis media are recommended to use parenteral aloe, vitreous, B vitamins, ATP, etc. Antihistamine drugs are shown.

Medical therapy for adhesive otitis media is usually complemented by physiotherapy. UHF, microwave therapy, ultrasonic massage of the auditory tube rollers, mud therapy are used. By endoural ultraphonophoresis and electrophoresis, potassium iodide and hyaluronidase are administered.

Often, conservative treatment of adhesive otitis media is ineffective. In such cases and with progressive hearing loss, surgical treatment is indicated. Tympanotomy with dissection of cicatricial adhesive bands and restoration of mobility of the auditory ossicles in adhesive otitis media often gives only a temporary result, since after the operation in most cases re-formation of adhesions occurs. More effective is tympanoplasty with the replacement of the auditory ossicles with artificial ones. Elderly patients and with bilateral adhesive otitis media with severe hearing loss are shown hearing aids.

Prognosis of adhesive otitis media

Prognostic value in adhesive otitis media is the prevalence and depth of fibrinous-cicatricial changes occurring in the structures of the middle ear. Unfortunately, these changes are irreversible and can only be stopped. The earlier it was possible to stop the process, the less pronounced the patient's hearing loss, which developed as a result of the disease. In advanced cases, with a long course of the disease, inadequate or untimely treatment, the outcome of adhesive otitis media can be complete ankylosis (immobility) of the joints of the auditory ossicles, leading to deafness.

Symptoms and treatment of adhesive otitis media

Adhesive otitis media is a chronic inflammation of the middle ear cavity, which is characterized by the formation of scars and adhesions at the sites of perforations of the tympanic membrane. Due to defects in the ear cavity that occur against the background of adhesive otitis, the sound-conducting function of the tympanic ossicles and the patency of the auditory tube are disturbed.

The main manifestations of this disease are expressed in the appearance of specific tinnitus and a stable deterioration in the quality of hearing.

Diagnostic measures for this pathology include primary otoscopic examination of the patient, audiometry, examination of the state of the Eustachian tube, as well as impedancemetry to localize and determine the nature of auditory impairment.

Causes and symptoms of the disease

The most common cause of adhesive otitis media is the previous form of inflammation in the ear. The following types of otitis media can provoke this pathology:

It also happens that adhesive otitis media develops not as a complication of other ear diseases, but as a result of the following pathologies that affect the body:

• Diseases of the bronchopulmonary system;
• Transferred ARVI or ARI;
• Tracheitis;
• Chronic adenoiditis;
• Inflammatory processes in the nasopharynx;
• Neoplasms in the pharynx of any nature;
• Ear canal injury.

The external symptoms of adhesive otitis media include congestion and noise in the diseased ear, as well as a deterioration in the quality of hearing.

Manifestations of the disease, noticeable only during otoscopic examination, are multiple scars and adhesions in the auditory canal, as well as a significant deformation of the tympanic membrane. Hearing loss indicates that the harmful process has already spread to the auditory ossicles of the middle ear.

Symptoms in adhesive otitis media do not have any manifestations inherent only to it. It is practically impossible to identify the disease without consulting a doctor. Even experienced professionals conduct a huge amount of clinical research before establishing an accurate diagnosis.

Diagnosis is also important in order to identify concomitant diseases in time, which may not make themselves felt for quite a long time. Pathologies that often occur against the background of adhesive otitis media include atherosclerosis, eustasiitis, ear plug, and so on.

Diagnosis of adhesive otitis media

With the help of an audiometric study, the doctor is able to assess the nature and degree of hearing impairment, up to the detection of absolute deafness. To verify the correctness of the alleged diagnosis, the patient is given a test blowing of the Eustachian tube.

If suspicions of this type of otitis media are confirmed, then this method does not have any effect on auditory perception in the middle ear.

However, using this method alone, it is impossible to say for sure whether the patency is impaired. It is impossible to finally verify or refute the diagnosis without installing a catheter and a detailed otoscopic examination of the ear canal.

The most significant factor in the detection of adhesive otitis is the presence of its inherent clinical picture.

Otoscopy can be either conventional or carried out with magnification. The latter allows you to consider in more detail the state of the tympanic membrane, the absence or presence of scars and adhesions on it, the degree of its deformation and the nature of turbidity.

Equally important is the inspection of the entire auditory tube. Adhesions and choleostomies can also form in its cavity, and sometimes in critically large quantities.

Acoustic impedancemetry is a study aimed at assessing the condition of the tympanic membrane and ossicles of the middle ear. The essence of the study involves the artificial straightening of the eardrum, by exposing it to air masses of various strengths.

In the case when the patient has confirmed adhesive otitis media, the tympanic membrane will remain inactive or immobile at all.

Adhesive otitis media, especially in its advanced form, is very rarely amenable to drug therapy using tablet preparations. Physiotherapy in this case also does not bring the proper effectiveness.

The main treatment for this form of otitis media is surgery. If tympanotomy does not give the desired result, the patient will have to select a hearing aid.

At the very beginning of the development of the disease, the patient is prescribed an intensive course of drug therapy. First of all, the patient needs to saturate the body with vitamin B, which is administered by injection.

He is also prescribed a course of actovegin. In order to get rid of existing and the formation of new adhesions, solutions of fluimucil, hydrocortisone, chymotropsin, and also lidase are injected directly into the Eustachian tube.

As practice shows, the treatment method, which includes several procedures for blowing the ear tube according to Politzer, is sufficiently effective. Manipulation is carried out under mandatory otoscopic supervision.

A special catheter is inserted into one of the patient's nostrils, the other end of which is attached to the balloon. The patient clamps the free nostril with his fingers. The patient is asked to say aloud any word of three syllables. At the same time, the doctor squeezes the pear in his hand. If the patient's ear freely passes air, then the doctor will hear a characteristic sound through the otoscope.

A visit to the physiotherapy room, as you already understood, will not eliminate the cause of adhesive otitis media, but it will have a beneficial effect on the general well-being of the patient. Such procedures can reduce discomfort in the ear and minimize extraneous noise in it.

To feel the maximum possible effect, the course of physiotherapy must be completed. The most popular procedures are: exposure to ultrasonic waves, therapeutic mud, electric therapy, electrophoresis.

Tympanotomy for adhesive otitis media

Despite the fact that the vast majority of doctors try to limit themselves to prescribing conservative methods of treatment, with bilateral adhesive otitis media, or its especially severe form, surgery may be necessary.

The surgical method of treating this disease is called myringotomy or tympanotomy. The operation can be left-sided (if the left ear is affected to a greater extent) or right-sided (when the right ho has suffered from pathological changes).

Its essence lies in the artificial removal of exudate from the middle ear cavity and the normalization of the auditory ossicles.

During the operation, the patient's eardrum is opened using medical instruments. The whole process is carried out using a special microscope, because every detail is important to obtain a good outcome of tympanotomy.

Having received direct access to the sound-conducting bones, the doctor eliminates the formed adhesions and choleastomy in the middle ear cavity. The auditory tube itself is cleaned of purulent discharge with a catheter and treated with antiseptic solutions.

Unfortunately, the performed myringotomy is not yet a guarantee of a 100% cure for the patient. The adhesive process, especially in childhood, develops rapidly, which provokes problems with the ear that arise again and again.

In the postoperative period, slight improvements may be observed, but after some time the tympanic membrane begins to deform again, which negatively affects the auditory function of the ear.

It is almost impossible to permanently normalize the patency of the Eustachian tube, and stop hearing loss with adhesive otitis media.

As a rule, the patient requires surgery to replace the auditory ossicles with artificial ones and install a special drain to keep the auditory tube ventilated.

With a bilateral pathological process, the patient may need a hearing aid.

This disease, being a complication of another form of ear inflammation, carries many dangers to human health and life.

It is possible to prevent the aggravation of the pathology if you receive qualified help in time and do not neglect the doctor's recommendations. In cases where there is no treatment for a long time, the auditory ossicles are completely destroyed and die.

For the patient, this means absolute and irreversible hearing loss. It should be remembered that this disease belongs to the category of chronic, which means that it is quite typical for it to lack unbearable pain and vivid symptoms.

Regular examinations by an otolaryngologist will help to identify the next exacerbation in time and take timely measures aimed at sanitizing the affected ear.

What is the danger of adhesive otitis and how to treat it

Adhesive otitis media is a complex inflammatory disease that can cause hearing loss.

A distinctive feature of the disease is the formation of adhesions and bands that disrupt the mobility of the auditory ossicles and the patency of the canal. All this leads to serious problems and complications.

Therefore, at the first manifestations of pathology, you should contact an otolaryngologist.

Adhesive otitis media

According to the ICD-10, this disease is coded under the code H74.1 "Adhesive disease of the middle ear." This term is understood as an inflammatory pathology, which is the result of prolonged fluid retention in the middle ear.

With the development of pathology, the patency of the tubes that connect the nasal cavity with the middle ear is disturbed. As a result, adhesive changes, dense areas of connective tissue, adhesions are formed. All this makes the auditory ossicles less mobile and reduces the conduction of sounds.

Causes

In most cases, the adhesive form of the disease develops as a result of catarrhal or exudative otitis media. Also, chronic tubo-otitis can lead to the disease. After these pathologies, adhesive otitis media can develop if antibiotics are not used correctly.

With the progression of inflammation in the tympanic cavity, exudate accumulates, which leads to impaired patency. This process is accompanied by the appearance of scar bands, fibrin filaments, adhesions.

Sometimes this form of otitis media develops as an independent pathology. In this case, the provoking factors are the following:

• chronic form of tonsillitis;
• adenoid growths;
• acute respiratory pathologies - for example, pharyngitis or tracheitis;
• hypertrophy of the lower conchas of the nose;
• deviated septum of the nose;
• chronic inflammation of the nasopharynx and paranasal sinuses - these include sinusitis, sinusitis;
• tumor lesions of the nasopharynx.

Sectional diagram of a human hearing aid

Symptoms, diagnosis

In order for the treatment of adhesive otitis media to bring the desired results, it is very important to make an accurate diagnosis in a timely manner. To do this, the doctor must analyze the clinical picture and conduct special studies.

In adults

Obvious symptoms are not characteristic of adhesive otitis media, therefore, patients very rarely experience pain in the ear or discharge from the ear canal. The general state usually also remains unchanged.

To diagnose pathology, the ENT must interview the patient and find out if he had acute or chronic forms of otitis media in the past. Then the specialist performs an otoscopy. During the examination of the tympanic membrane, it is necessary to evaluate its retraction, deformation, cicatricial processes.

Preservation of the mobility of the tympanic membrane can be assessed by tympanometry. Valsalva tests and Sigle funnels are also of great diagnostic value. In the case of a running process, the membrane loses its mobility.

With the help of tympanometry, the work of the joints located between the bones is evaluated. With adhesive otitis media, ankylosis occurs, which manifests itself as a lack of mobility. These changes lead to hearing loss.

To assess the degree of hearing loss, special tests are performed - audiometry, tests with a tuning fork. To identify the adhesive process, you can perform blowing. In the absence of air in the tympanic cavity, we are talking about a complete fusion of the tube.

To determine the severity of the disease, computed or magnetic resonance imaging of the temporal bone is performed. With the help of these studies, it is possible to examine inaccessible structures of the ear.

Right-sided and left-sided adhesive otitis media

Signs in a child

The main manifestation of adhesive otitis media in children is progressive hearing loss, which may affect one or both ears at the same time. The baby also has tinnitus.

Initially, the child has symptoms of intoxication. The baby can become lethargic, moody and irritable. He has a decrease in attention, increased fatigue and loss of appetite. Quite often, children refuse meat dishes.

In some cases, the temperature rises to 39 degrees. In this case, the child's sleep is disturbed and there is increased sweating. In the morning the temperature can drop to 37 degrees.

Catarrhal symptoms are manifested in the form of nasal congestion, pain in the throat, sneezing. Older children often complain of headaches and discomfort inside the ear.

The disease may have a different course. In addition, each phase of adhesive otitis media is accompanied by characteristic manifestations.

In the acute form of otitis media, inflammation occurs in the tympanic cavity, which is accompanied by a weakening of ventilation and outflow of fluid. Over time, the exudate becomes thicker and forms dense threads. They braid the auditory ossicles, disrupting their mobility.

Chronic

If treatment is not started on time, the mucous membrane undergoes serious changes. In this case, scars and adhesions form on its surface. As a result, there is a violation of the mechanism of conduction of sounds, which leads to hearing loss. This pathology is characterized by the appearance of low-frequency noise and increasing hearing loss.

How to treat

For treatment to be as effective as possible, it must be started at the initial stage of the development of the disease.

To do this, perform the following activities:

• sanitation of the nasopharynx and sinuses;
• adenotomy - relevant in childhood;
• restoration of nasal breathing - measures may be required to eliminate the curvature of the nasal septum.

Good results with this form of otitis media can be achieved by blowing through the Politzer. To make them more effective, pneumomassage of the tympanic membrane is also performed.

Medically

After performing first aid measures, the following medicines are administered through a special catheter:

To strengthen the immune system, patients are prescribed vitamin preparations, ATP, etc. Often there is a need for the use of antihistamines. To increase the effectiveness of drug therapy, the following procedures are carried out:

• microwave exposure;
• massage using ultrasound;
• mud treatment.

Sometimes conservative measures do not work. In such a situation, surgical intervention is indicated. Thanks to the performance of tympanometry, the mobility of the bones is restored and the adhesions are dissected.

But usually this procedure gives only a temporary result. In such cases, the affected bones are replaced with artificial ones. If the bilateral form of adhesive otitis media is accompanied by rapid hearing loss, hearing aids are indicated.

Eardrum before and after bypass surgery

Folk remedies

It is impossible to cope with adhesive otitis with folk remedies. Such measures can give results in the treatment of acute otitis media. Thanks to this, it will be possible to prevent the occurrence of more severe pathology.

To do this, you can perform nasal lavage with decoctions of medicinal plants or saline.

Effects

If treatment is not started on time, there is a risk of negative consequences. The prognosis of the disease is affected by the severity of fibrinous-cicatricial changes that occur in the middle ear.

Such processes are irreversible, and therefore doctors can only stop their progression. The sooner this is done, the less severe the hearing loss will be.

Prevention

To prevent the development of abnormal processes in the tympanic cavity, it is necessary to treat otitis media in time. Preventive measures include the following components:

1. It is categorically impossible to delay the catarrhal form of the disease until the stage of fluid accumulation.
2. With the development of purulent otitis media, it is necessary to strictly adhere to all medical recommendations - take antibacterial drugs, undergo preventive examinations.
3. In chronic purulent otitis media, surgical sanitation of the affected area is mandatory.

Watch in our video how to do pneumomassage of the eardrum at home:

Profile clinics

To cope with adhesive otitis, you should immediately contact a qualified otolaryngologist. For you can visit one of the specialized clinics in Moscow:

1. Family clinic "Miracle Doctor".
2. Network "Family Doctor".
3. International Center "MEDLUX".
4. "Family Clinic" near metro station Kashirskaya.
5. Multidisciplinary medical center "In Maryino".

Bilateral adhesive otitis media is a rather complex pathology that can lead to complete hearing loss. To prevent this from happening, it is important to immediately consult a doctor. After a thorough diagnosis, the otolaryngologist will select an adequate treatment that will help stop the abnormal process.

Adhesive otitis media: symptoms and treatment of the disease

The adhesive type of otitis is a dangerous inflammatory process that can provoke a loss of functionality of the hearing organ. How to identify the onset of this particular disease? How to treat the adhesive form of otitis media?

Characteristics of the disease

The adhesive form of otitis is characterized by impaired patency in the Eustachian tube with inflammation of various locations. As a result of adhesive processes, the walls of the cavities and canals stick together, and the mobility of the auditory ossicles is lost. Against the background of these changes, patients begin to have problems with sound conduction.

Adhesive processes can also occur with a long course of an acute form of otitis media or against the background of relapses of a chronic type of the disease. The purulent masses accumulated in the middle ear cavity are not completely evacuated into the auditory canal, which leads to the formation of connective tissue filaments. Fibrin creates rough scars inside the organ of hearing and immobilizes the auditory ossicles and the membrane of the eardrum over time.

As the disease develops, the sticky ear syndrome goes beyond its location - adhesive processes spread to neighboring areas, most often the Eustachian tube is affected. Violation of the functionality of this part of the ENT system leads to retraction of the tympanic membrane into the middle cavity, its gradual deformation due to prolonged stretching and loss of mobility.

All these pathological processes lead to a gradual deterioration in the functionality of the hearing organ. Due to the loss of mobility of the auditory ossicles and the tympanic membrane, as well as the overgrowth of the walls of the middle cavity, patients with adhesive otitis media develop progressive hearing loss.

Reasons for the development of pathology

The disease can occur against the background of the following inflammatory processes of the ENT system:

• chronic tubootitis;
• exudative otitis;
• prolonged catarrhal otitis;
• pharyngitis;
• laryngitis;
• inflammation of the adenoids;
• sinusitis;
• tonsillitis;
• curvature of the nasal septum;
• hypertrophy of the nasal concha;
• tumors located in the nasopharynx.

The adhesive type of otitis media can be a consequence of inflammation in the organ of hearing, or it can act as an independent ear disease provoked by infectious processes in the nasopharynx or pathological conditions that cause low patency of the Eustachian tube (curvature of the nasal septum, hypertrophy of the turbinates).

Symptoms of the disease

Since scarring and adhesion during adhesive otitis media can significantly impair the quality of sound perception and cause hearing loss, it is important to identify the disease in time and differentiate adhesive otitis media from other pathologies that have similar symptoms.

With adhesive otitis media, there are no specific symptoms, the disease is accompanied by "traditional" signs for hearing loss:

• patients rarely have a fever;
• practically no discharge comes out of the ear canal;
• there is no pain syndrome;
• there is a gradual progressive hearing loss;
• as the quality of sound perception is lost, subjective tinnitus increases.

In children, the symptoms of the disease are brighter than in adults.

So, against the background of the appearance of noise and hearing loss, babies may experience loss of appetite, lethargy, fever as a result of intoxication. The child may have trouble sleeping at night and sweating may increase.

Since adhesive otitis media in children most often occurs against the background of inflammation of the ENT organs, the concomitant symptoms of stuffy ears are added:

• nasal congestion;
• pain in the throat;
• discomfort when sneezing.

The only sign by which an otolaryngologist can determine that an adult or child is developing adhesive otitis media is the occurrence of conductive hearing loss due to a decrease in the mobility of the auditory ossicles and eardrum.

Phases of adhesive otitis media

Specialists classify the course of adhesive otitis by phases, in each of which certain specific changes occur in the hearing organ.

1. The acute phase of adhesive otitis usually takes a long time. During this period, exudate accumulates in the tympanic cavity, which does not have time to be evacuated from there through the auditory tube in a timely manner. The weakening of the ventilation of the ENT system and the insufficient intensity of the outflow of masses lead to their thickening. Fibrin filaments formed in the viscous exudate bind the auditory ossicles and immobilize them. As a result of these processes, conductive hearing loss occurs.
2. The chronic phase occurs due to ignoring the growing hearing loss and the lack of adequate treatment for the disease. Viscous masses, acting on mucous membranes, cause adhesive processes on their surface. Scars appear on the walls of the cavity, the connective tissue actively grows, leading to gluing of opposite parts of the cavity to each other.

Diagnostics

For a correct diagnosis, it will be important for a specialist to collect a complete patient history. During the interview, the otolaryngologist will be interested in episodes of colds, the presence of otitis media in the medical history and the duration of their course. It is also important for Laura to know what concomitant symptoms accompany hearing loss and the appearance of subjective tinnitus.

Diagnosis of adhesive otitis is carried out according to the standard scheme:

1. Otoscopy allows you to assess the condition of the tympanic membrane: the presence of retraction, deformation and the degree of scarring of the membrane.
2. The degree of compliance of the tympanic membrane is assessed using impedancemetry and a Siegle funnel.
3. Tympanometry is used to assess the degree of mobility of the tympanic membrane and the functionality of the joints connecting the auditory ossicles.
4. To determine the degree of hearing loss, audiometry and tuning fork tests are performed.
5. The specialist can fix the presence of an adhesive process in the tympanic cavity by blowing the auditory tubes.
6. To clarify the severity of adhesions and cicatricial processes, the otolaryngologist will need the results of CT and MRI of the temporal bone in the affected ear.

Treatment of adhesive otitis media

The treatment of adhesive otitis media is aimed at stopping the development of irreversible adhesive and cicatricial processes, but it will not be possible to restore hearing in patients with medication. In addition, experts have not yet found a guaranteed method of how to get rid of a pathological condition, which is why it is important to visit a doctor on time and do therapy. Launched adhesive otitis media can cause complete hearing loss.

In the acute phase, the disease is treated with the following measures and medications:

• to restore the functionality of the auditory tube, sanation of the nasopharynx and sinuses and blowing courses according to Politzer are carried out;
• antihistamines and vasoconstrictor drops in the nose help to increase the lumen of the auditory tube;
• to improve the ventilation of the ENT system and to increase the outflow of exudate from the middle cavity, pneumomassage of the tympanic membrane helps;
• in children, adenotomy is performed to avoid a long course of inflammatory diseases;
• in the presence of a curved nasal septum, measures are taken to restore its physiological shape;
• to relieve the inflammatory process in the tympanic cavity by catheterization, steroids and anti-inflammatory drugs are introduced into it through the membrane.

If you have been diagnosed with adhesive otitis media, you will not be able to eliminate the disease with the treatment of folk remedies.

To stop the development of the pathological process, it is important to follow the recommendations of the attending physician and not replace his appointment with homemade recipes. Self-medication in this case can lead to the development of concomitant ear pathologies and complete deafness.

Surgery

If fibrin filaments and adhesive processes have significantly immobilized the auditory ossicles or conservative treatment does not bring the desired positive effect, the otolaryngologist directs the patient with adhesive otitis media for surgery.

During tympanometry, the surgeon dissects the adhesions and cleans the auditory ossicles from fibrin filaments, and carefully sanitizes the opened tympanic cavity. Thanks to such measures, the mobility of the sound-transmitting complex located in the middle ear is restored.

The operation is not able to completely restore hearing to patients and is not a reliable method of how to get rid of adhesive otitis media - it gives only a temporary result. Gradually, the exudate will again begin to accumulate in the cavity, and the development of adhesive and scar processes will continue.

Hearing aid

Such a measure is indicated for patients whose auditory ossicles adhesive disease of the middle ear has led to significant irreversible changes.

Hearing prosthesis is performed during tympanometry, the surgeon, in addition to sanitation of the tympanic cavity, removes damaged auditory ossicles and replaces them with implants. To improve the ventilation of the ENT system, in some cases, shunting of the tympanic membrane is performed.

If the measures taken do not help the patient to save his hearing, he is referred to an audiologist who will select the best option for a hearing aid.

Symptoms and treatment of adhesive otitis media

Adhesive otitis media (AO) is a complex inflammatory disease that can cause hearing loss. Adhesion (gluing) in the middle ear is irreversible once formed. Therefore, the most effective clinical intervention is to prevent or reduce adhesion formation in the middle ear. Currently, almost all cases of AO are considered as the final stage or complication of purulent otitis

General information

Adhesive otitis media is an inflammation of the middle ear and adjacent pneumatic (hollow) spaces. It tends to become chronic and is characterized by blockage of the Eustachian tube and the formation of adhesions in the tympanic cavity. Three phases of the disease can be distinguished:

• early stage (middle ear secretion is often mucous and has a reversible process);
• adhesive stage (inflammation progresses);
• terminal stage (reduction of inflammation).

Recently, cases of detection of adhesive otitis media have become more frequent, and this is apparently due to the following factors:

• antibiotic therapy;
• latent mastoiditis;
• inadequate treatment of acute otitis media (neglect of myringotomy and air insufflation).

In childhood, in particular, there are some other factors leading to the disease - these are nasopharyngeal adenoids and sinusitis. If these diseases are not treated in time and properly, they can lead to a complication in the form of adhesive otitis media.

Types of adhesive otitis media

There are types of adhesive otitis media - infectious and non-infectious.

Bacterial infection (40% of all cases)

Bacterial infection caused by repeated suppurative otitis media can damage the middle ear mucosa and cause fibroblasts to form in the granulation tissue, which leads to the formation of new fibrous tissue or fluidization. This process can lead to mucus on the eardrum and its adhesion, i.e. sticking together. It is believed that such a complication from acute otitis media can only occur if antibiotic treatment is used.

Neglect of the use of tympanic drainage to restore Eustachian tube function is the main cause of tympanic membrane adhesions.

Tympanal fibrous hyperplasia (20%)

Adhesion is in the center of the tympanic cavity, the tympanic membrane thickens and adheres to the malleus, then the anvil, and this process may be accompanied by the growth of fibrous tissue, which partially or completely closes the oval window in the ear. This abacterial type of adhesive middle ear disease is divided into three phases:

• acute pharyngeal inflammation;
• Eustachian tube obstruction;
• the formation of negative pressure in the tympanic cavity with the release of a sticky liquid.

Signs and symptoms

Common manifestations for adhesive otitis media are hearing loss. The clinical symptoms are the following:

• The patient has recently had otitis media. In this case, the main symptoms are hearing loss and tinnitus.
• when checking the tympanic membrane, atrophy of the tympanic membrane, its thickening, turbidity, uneven surface, limited mobility can be noticed. Sometimes atrophy of the tympanic membrane is accompanied by retraction adhesions, scarring, and false perforation. Otoscopy shows that the activity of the tympanic membrane is reduced or absent.
• hearing tests detect hearing loss, in severe cases, partial deafness can sometimes occur.

Signs and symptoms of the disease may develop gradually or rapidly.

Diagnostics

Otoscopy remains the standard examination for patients with suspected adhesive otitis.. In addition to a well-documented examination of the external ear and tympanic membrane, examination of the entire head and neck area is also necessary in patients with suspected AO. The diagnosis of "adhesive otitis media" is made in the following case:

1. Hearing loss with conductive hearing loss and tinnitus.
2. The tympanic membrane is intact, but cloudy, contracted, calcium deposits are visible on it, it is noticeably thickened or atrophied. Membrane atrophy is accompanied by saclike retraction, and the tympanic structure can be clearly seen, sometimes misdiagnosed as tympanic membrane perforation.
3. Dysfunction of the Eustachian tube, which is detected during the acoustic impedance test and expressed as a change in pressure.

Ancillary screening methods such as tympanometry measure the acoustics in the tympanic membrane and middle ear and, using changes in air pressure in the external auditory canal and acoustic reflectometry, measure the sound reflected from the tympanic membrane.

Adhesive otitis media is hyperplasia or overgrowth of the fibrous tissue of the middle ear due to chronic inflammation. Often the disease appears in childhood.

Surgical measures and maintenance therapy for 2-4 weeks are used as treatment.

In the early stage, treatment for adhesive otitis media consists of routine evacuation of secretions from the middle ear, proper ventilation, and keeping the Eustachian tube functioning. The formation of adhesions can lead to the disappearance of the air space in the middle ear. Restoration of ventilation of the air space in the tympanic cavity and the sound-conducting mechanism is in many cases possible with proper treatment. Airspace can be maintained with a polyethylene tube inserted through an incision in the eardrum or through the Eustachian tube. Air must be pumped into the middle ear daily through a polyethylene tube, through which medications can also be administered.

Commonly used drugs:

During treatment it is necessary to drink freshly squeezed orange juice, eat orange, bananas, apples and other fruits, as well as broccoli, spinach and other green vegetables.

Risk Factors in Children

Adhesive otitis media most often occurs in children aged 1 to 6 years, in winter. Most cases follow an episode of acute otitis media, especially in children under 3 years of age..

In addition, the disease may occur due to one or more of the following reasons:

1. Dysfunction of the Eustachian tube reduces the ventilation of the middle ear.
2. Subfebrile infection (bacterial or viral).
3. Chronic inflammation of the adenoids, which can act as a source of bacteria that enter the cleft middle ear.
4. Constant inflammatory process.
5. Adenoid infection or hypertrophy.
6. Adhesion is more common in children with craniofacial malformations, especially those with cleft palate.
7. It is also common in infants with Down's syndrome, allergic rhinitis, and ciliary dysmotility conditions, including cystic fibrosis.

Possible risk factors:

1. Male gender.
2. Visiting kindergartens.
3. Frequent upper respiratory tract infections.
4. Low parental socio-economic group.
5. Parents who smoke.
6. Cold season.

There have been studies that have shown an association between gastroesophageal reflux in children and adhesive otitis media: it is suggested that reflux increases the levels of inflammatory cytokines present in the nasopharynx and middle ear.

Risk factors in adults

The main factor in the development of this disease in adults is the presence of dysfunction of the Eustachian tube.. Reasons also include:

1. A severe nasopharyngeal infection (such as sinusitis) inflames the entrance to the Eustachian tube, causing adhesion.
2. Severe or chronic allergies can have the same effect.
3. Anatomical causes: severe deviation of the nasal septum with airway valve.
4. The presence of tonsils and adenoids with obstruction of the Eustachian tube.
5. Tumor of the nasopharynx near the opening of the Eustachian tube.
6. Exposure to radiation on the head and neck after cancer treatment.
7. Radical surgery of the head and neck, on the maxillary sinuses and/or palate, which cuts the Eustachian tube.
8. Secondary inflammation from allergic rhinitis.
9. Frequent respiratory infections of the upper respiratory tract. Some viruses can directly damage the surface of the Eustachian tube, reducing ciliary play movements.
10. Trauma (usually barotrauma - for example, after diving or flying).

AO is uncommon in adults and thus is not a common precursor to suppurative otitis media. Often the diagnosis is misdiagnosed as a head or neck tumor.

Adhesive otitis media: diagnosis and treatment

Adhesive otitis media is an inflammatory process of a chronic type, which leads to the appearance of adhesions and scars in the tympanic cavity. Adhesive otitis media occurs in the middle ear, which leads to violations of the auditory ossicles and conduction of the auditory tube.

The main manifestation of this inflammatory process is noise in the ear, which can increase with the further course of the disease. If adhesive otitis media is suspected, the doctor conducts an examination and other studies of the auditory cavity, after which the patient is prescribed a medical course of treatment. In case of ineffectiveness of the course, surgical intervention is prescribed.

Reasons for the development of the disease

The main cause of the development of adhesive otitis media is the otitis media preceding it of the following types:

• exudative;
• catarrhal nonperforative;
• chronic tubo-otitis.

The disease after these otitis could be provoked by the irrational use of antibiotic therapy. After the inflammation has been successfully resolved and the accumulated exudate has been resorbed, fibrin filaments remain in the tympanic cavity, resulting in scarring and connective tissue adhesions. Cicatricial strands begin to adhere to the auditory ossicles, which leads to impaired sound conduction and patency of the auditory tube.

It happens that adhesive otitis media can develop without previous otitis media. In this case, the causes are the following pathological processes:

• diseases of the upper respiratory tract - SARS, tracheitis;
• adenoids;
• inflammatory diseases of the nose and paranasal sinuses - sinusitis, sinusitis;
• tumors of the nose and pharynx;
• injury.

The leading symptoms of adhesive otitis media are tinnitus and gradual hearing loss. Otoscopy performed shows the presence of cicatricial bands and retraction of the tympanic membrane. Hearing loss occurs as a result of impaired sound conduction.

Symptoms of adhesive otitis media are quite similar to the clinical symptoms of other diseases. Therefore, a lot of diagnostic measures and studies are carried out to make a final diagnosis. Also, diagnostic studies are carried out in order to exclude other pathological processes - tubo-otitis, sulfur plug, atherosclerosis, etc.

Hearing loss is the main symptom in adhesive otitis media.

Diagnostics

Diagnosis of this disease includes the following examinations:

• visual examination by an ENT doctor;
• audiometry;
• otoscopy;
• determination of the degree of patency of the auditory tube;
• impedancemetry;
• audiometry;
• endoscopic catheterization.

Audiometry is performed to determine the degree of hearing loss. To determine the degree of patency of the auditory tube, blowing through the Politzer is carried out. In the presence of adhesive otitis media, this procedure does not give almost any improvement in hearing. But to make a final diagnosis, catheterization of the tube is performed, followed by otoscopic control.

Otoscopic examinations are one of the most important points in the diagnosis of the disease. With the help of otoscopy, the degree of retraction of the tympanic membrane, the presence of scars and darkening are established. In the process of otoscopy, adhesions and strands are also detected.

Acoustic impedancemetry is performed to study the mobility of the auditory ossicles and the tympanic membrane. This study is carried out with the help of air, which thickens and liquefies. As a result, the eardrum retracts or straightens. if a person has adhesive otitis media, then the eardrum remains practically motionless.

At the initial stage of the treatment of adhesive otitis media, the factors that lead to problems with the conduction of the auditory tube are eliminated. At this stage, the following is carried out:

• sanitation of the nasopharynx, nasal sinuses;
• adenotomy (in childhood);
• restoration of breathing through the nose - measures are taken to eliminate the curvature of the nasal septum.

A positive effect in the treatment is also provided by blowing through the Politzer. Pneumomassage of the tympanic membrane complements the efficiency of blowing. The following drugs are administered through a specially installed catheter:

To maintain the protective reactions of the body, the patient is recommended vitamin therapy, ATP and more. Antihistamines are also recommended.

In addition to drug therapy, physiotherapy is usually prescribed. There are the following procedures:

In some cases, conservative treatment does not have a positive effect. Surgical treatment is prescribed. With tympanometry, the mobility of the auditory ossicles is restored and the adhesive bands are dissected. Unfortunately, this method shows a temporary result, because the percentage of re-formation of adhesions is high. In such situations, a more effective result is shown by the replacement of damaged auditory ossicles with artificial specimens.

With bilateral adhesive otitis, which is accompanied by an intense hearing loss, hearing aids are recommended in the elderly and younger.

Remember, a timely appeal to a specialist will help to avoid serious complications and health problems.

Chronic inflammatory process in the middle ear, leading to the formation of adhesions and connective tissue cords, causing impaired patency of the auditory tube and mobility of the auditory ossicles. Adhesive otitis media is manifested by the appearance of tinnitus and hearing loss that worsens over time. Mandatory diagnostic studies for suspected adhesive otitis media are an examination by an ENT doctor, otoscopy, audiometry, a study of the patency of the auditory tube, and impedancemetry. Therapeutic measures for adhesive otitis media include the introduction of proteolytic enzymes, lidase, hydrocortisone, and physiotherapy. If they are ineffective, surgical treatment (tympanotomy, tympanoplasty), hearing aids are indicated.

The middle ear includes the auditory tube and the tympanic cavity, which contains the auditory ossicles (stapes, malleus and anvil). The tympanic cavity is separated from the auditory tube by the tympanic membrane, which transmits sound vibrations to the auditory ossicles. Further, through the bones, the vibration enters the structures of the inner ear, which are responsible for sound perception and the transmission of sound signals along the auditory nerve to the corresponding part of the brain.

Hearing loss in adhesive otitis media is associated with a decrease in the mobility of the auditory ossicles and the tympanic membrane, leading to a violation of the mechanism of sound conduction from the tympanic membrane to the cochlea of ​​the inner ear. However, over time, long-term adhesive otitis media can lead to impaired sound perception as a result of a decrease in the sensitivity of hair cells to endolymph fluctuations and a decrease in the impulses coming from them to the brain.

Causes of adhesive otitis media

The most common cause of adhesive otitis media is previous exudative or catarrhal non-perforated otitis media, chronic tubo-otitis. The development of adhesive otitis media after these diseases can be triggered by irrational antibiotic therapy. As a result of the resolution of the inflammatory process and the resorption of the exudate accumulated in the tympanic cavity, fibrin filaments remain in it and connective tissue adhesions and scar bands are formed. The latter braid the auditory ossicles and are attached to the tympanic membrane, blocking the mobility of these structures necessary for normal sound conduction. At the same time, adhesions and strands of adhesive otitis media can also form in the auditory tube, which leads to a violation of its patency.

In clinical otolaryngology, it is not uncommon for adhesive otitis media to occur without prior acute or chronic otitis media. In such cases, the cause of its development are various pathological processes that impede the patency of the auditory tube and prevent normal ventilation of the tympanic cavity. These include: acute diseases of the upper respiratory tract (ARVI, pharyngitis, tracheitis, laryngitis), chronic tonsillitis, adenoids, chronic inflammation of the paranasal sinuses and nasal cavity (sinusitis, sinusitis, rhinitis), hypertrophic changes in the inferior nasal concha, tumors of the pharynx and cavity nose, deviated septum.

Symptoms of adhesive otitis media

The main complaints that a patient with adhesive otitis media presents are gradual hearing loss and the presence of tinnitus. When questioned in the anamnesis of such patients, it is possible to identify previously noted acute or chronic otitis media. The study of hearing in adhesive otitis media determines the conductive nature of hearing loss - hearing loss due to impaired sound conduction.

Clinical symptoms of adhesive otitis media are few and similar to those of other ear diseases. Therefore, to diagnose the cause of the identified hearing changes, it is necessary to carry out a number of diagnostic measures and exclude other pathological processes leading to conductive hearing loss (cerumen plugs, traumatic damage to the structures of the middle ear, tubo-otitis, otosclerosis, etc.).

Diagnosis of adhesive otitis media

Diagnostic examination for adhesive otitis media includes a visual examination by an otolaryngologist, determination of the patency of the Eustachian tube, otoscopy, microotoscopy, audiometry, impedancemetry, endoscopic catheterization of the auditory tube.

Conducting audiometry reveals hearing loss of varying severity in patients with adhesive otitis media, up to complete deafness. To determine the patency of the auditory tube, its trial blowing according to Politzer is carried out. In adhesive otitis media, it usually produces little or no improvement in hearing. However, this does not always clearly indicate impaired patency. For the final confirmation of such a violation, catheterization of the tube with otoscopic control is resorted to.

The most important point in the diagnosis of adhesive otitis media is the identification of a characteristic otoscopic picture of the disease. Otoscopy (simple and with magnification) determines the retraction of the tympanic membrane, its clouding and the presence of cicatricial changes, in some cases causing deformation of the membrane. In the cavity of the auditory tube, strands and adhesions are also visualized, sometimes completely obliterating its lumen.

The study of the mobility of the tympanic membrane and auditory ossicles is carried out during acoustic impedancemetry. The study consists in thickening and discharging the air in the auditory tube, as a result of which the tympanic membrane is retracted and straightened. With adhesive otitis media, the movements of the membrane are limited or completely absent, acoustic muscle reflexes are not caused.

Treatment of adhesive otitis media

The first step in the treatment of adhesive otitis media is the elimination of factors that lead to impaired patency of the auditory tube. This includes sanitation of the nasopharynx and nasal sinuses, adenotomy in children, restoration of normal breathing through the nose (elimination of deviated nasal septum and turbinate hypertrophy).

A positive effect in adhesive otitis media has a course of blowing according to Politzer in combination with pneumomassage of the tympanic membrane. Transtubal administration of hydrocortisone, acetylcysteine, chymotrypsin, hyaluronidase through a catheter is used. To stimulate the body's defense reactions, patients with adhesive otitis media are recommended to use parenteral aloe, vitreous, B vitamins, ATP, etc. Antihistamine drugs are shown.

Medical therapy for adhesive otitis media is usually complemented by physiotherapy. UHF, microwave therapy, ultrasonic massage of the auditory tube rollers, mud therapy are used. By endoural ultraphonophoresis and electrophoresis, potassium iodide and hyaluronidase are administered.

Often, conservative treatment of adhesive otitis media is ineffective. In such cases and with progressive hearing loss, surgical treatment is indicated. Tympanotomy with dissection of cicatricial adhesive bands and restoration of mobility of the auditory ossicles in adhesive otitis media often gives only a temporary result, since after the operation in most cases re-formation of adhesions occurs. More effective is tympanoplasty with the replacement of the auditory ossicles with artificial ones. Elderly patients and with bilateral adhesive otitis media with severe hearing loss are shown hearing aids.

Prognosis of adhesive otitis media

Prognostic value in adhesive otitis media is the prevalence and depth of fibrinous-cicatricial changes occurring in the structures of the middle ear. Unfortunately, these changes are irreversible and can only be stopped. The earlier it was possible to stop the process, the less pronounced the patient's hearing loss, which developed as a result of the disease. In advanced cases, with a long course of the disease, inadequate or untimely treatment, the outcome of adhesive otitis media can be complete ankylosis (immobility) of the joints of the auditory ossicles, leading to deafness.