Exudate solution. The study of serous fluid in the laboratory

The exudate is an inflammatory fluid filled with protein and containing formed blood proteins.

In the human body, it has its own character and is formed during inflammation. Such a process as the allocation and movement of inflammatory effusion in the cavities and tissues of the body is called exudation.

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Types of exudate

The species directly depend on the qualitative and quantitative composition of the protein present in the liquid.

There are the following types of exudates:

• fibrinous;
• serous;
• hemorrhagic;
• purulent;
• putrefactive;
• mixed.

The composition of the exudate

The composition depends on the cause of the formation of the inflammatory fluid, on the organ or tissue in which it is formed.

Serous exudate

The composition is mainly albumin and water. Appears when the inflammatory process of the skin and mucous membranes is still at an early stage.

It can be, for example, blisters on the palms after prolonged work with oars or a shovel. If the serous cavities and mucous membranes become inflamed - pericarditis, peritonitis, serous pleurisy.

fibrinous exudate

It is formed when the endothelium is sufficiently severely damaged and is accompanied by the loss of high-molecular fibrinogen. This type is typical for inflammation of the peritoneum, upper respiratory tract, colon, pericardium.

Purulent exudate

It is formed in most cases with infections that are caused by pyogenic bacteria - streptococci, pneumococci, staphylococci.

Purulent effusion in its composition has fragments of necrotic tissues lysed by enzymatic digestion, the vast majority of normal and destroyed leukocytes.

Hemorrhagic exudate

Characteristic for acute influenza pneumonia, phosgene poisoning, anthrax.

Exudate properties

The formation of an effusion is considered a significant component in the inflammatory response. Due to exudation, the concentration of existing toxins decreases, the formation of which occurs in the focus of inflammation, and they are destroyed by proteolytic enzymes coming from the blood plasma.

However, exudate can also be characterized by negative consequences. For example, if the swelling of the larynx is caused by exudation, then a person may die from suffocation; with inflammation of the meninges, life-threatening increased intracranial pressure can occur.

- inflammatory reaction of the pleura, proceeding with the accumulation of serous exudate in the pleural cavity. Symptoms of serous pleurisy are characterized by dull pain in the chest, dry cough, shortness of breath, cyanosis, tachycardia, signs of intoxication. Diagnosis of serous pleurisy is based on an assessment of the history, physical examination, thoracocentesis, laboratory examination of pleural effusion, ultrasound, radiography, pleuroscopy. Treatment of serous pleurisy includes etiotropic and symptomatic therapy, therapeutic pleural punctures, drainage of the pleural cavity, physiotherapy, exercise therapy, and massage.

ICD-10

J90 Pleural effusion, not elsewhere classified

General information

Serous pleurisy, along with hemorrhagic and purulent pleurisy (pleural empyema), is a type of exudative pleurisy. The stage of serous effusion usually serves as a continuation of fibrinous (dry) pleurisy. Serous pleurisy in pulmonology is differentiated by etiology (infectious and aseptic), by course (acute, subacute and chronic), by the nature of distribution (diffuse and encysted). Infectious serous pleurisy among themselves are divided according to the type of causative agent of the inflammatory process (viral, pneumococcal, tuberculosis, etc.), aseptic - according to the type of underlying pathology (carcinomatous, rheumatic, traumatic, etc.).

Causes of serous pleurisy

Aseptic serous pleurisy may be due to malignant tumors of the lungs and pleura (pleural mesothelioma, lung cancer) or metastases of tumors in other organs; diffuse connective tissue diseases (rheumatism, rheumatoid arthritis, systemic lupus erythematosus); myocardial infarction, pulmonary infarction, pulmonary embolism, uremia, leukemia and other pathological processes.

The development of serous pleurisy may be the result of injuries and surgical interventions on the chest, taking certain medications (bromocriptine, nitrofurantoin). The provoking factors of serous pleurisy are frequent hypothermia, malnutrition, physical inactivity, overwork, stress, drug hypersensitization, a decrease in general and local reactivity.

Pathogenesis

Serous pleurisy is caused by a pathological protective reaction of the sensitized pleura to infectious-toxic irritation, which is expressed in excessive exudation and reduced absorption of fluid in the pleural cavity. The development of exudative inflammation in serous pleurisy is associated with an increase in the permeability of the blood and lymphatic capillaries of the lungs and pleura. Serous exudate is a clear yellowish liquid consisting of plasma and a small number of blood cells. Most often, a cloudy yellow serous effusion with fibrin flakes, an accumulation of lymphocytes, polymorphonuclear leukocytes, macrophages, mesothelial cells, and eosinophils is noted in the pleural cavity.

Infectious agents can penetrate into the pleural cavity from the primary foci by contact, lymphogenous or hematogenous routes and have a direct effect on the pleura or cause its sensitization with toxins and metabolic products. At the same time, the production of specific antibodies and biologically active substances is accompanied by local microcirculation disorders, damage to the vascular endothelium and the formation of exudate. The accumulation of serous exudate in the pleural cavity is observed in the acute stage of pleurisy, then the effusion can completely resolve, leaving fibrinous deposits (moorings) on the surface of the pleura that contribute to the development of pleurosclerosis. With pleurisy, a further change in the serous nature of the exudate towards purulent or putrefactive is possible.

Symptoms of serous pleurisy

Symptoms of serous pleurisy can complement the clinical manifestations of the underlying disease (pneumonia, tuberculosis, lung cancer, systemic vasculitis, etc.) or dominate over them. The initial stage of serous pleurisy is characterized by intense dull pain in the chest on the affected side, aggravated by inhalation; shallow, rapid breathing; dry cough, asymmetry of respiratory movements of the chest, pleural rub. With the accumulation of exudate in the pleural cavity, the pain gradually subsides, although it may persist, for example, with carcinomatous serous pleurisy. In some cases, polyserositis (pericarditis, pleurisy, and ascites) may develop.

There is heaviness in the side, shortness of breath begins to progress rapidly; with a large amount of effusion, cyanosis develops, tachycardia, swelling of the cervical veins, and sometimes swelling of the intercostal spaces. A patient with serous pleurisy is characterized by a forced position on the affected side. Increased pain during the recovery period may be associated with resorption of the serous fluid and contact of the pleural sheets or with suppuration of the exudate and the development of purulent pleurisy.

With serous pleurisy, there is an increase in intoxication, general weakness, an increase in body temperature to subfebrile, sweating, decreased appetite and disability. The severity of the general condition of a patient with serous pleurisy depends on the severity of intoxication and the rate of accumulation of free effusion. Serous pleurisy of tuberculous etiology is usually manifested by a more pronounced temperature reaction and intoxication.

Diagnostics

For the diagnosis of serous pleurisy, a comprehensive examination is carried out with an assessment of the anamnesis, symptoms, and the results of various laboratory and instrumental studies. In the diagnosis of serous pleurisy, information about the patient's pathology is important: trauma, surgery, pneumonia, tuberculosis, rheumatism, tumors of various localization, allergies, etc. Physical examination reveals an increase in the volume of the chest on the side of the lesion, swelling of the intercostal spaces and swelling of the skin; limitation of respiratory excursion, characteristic of serous pleurisy. Percussion, with the accumulation of pleural fluid in a volume of at least 300-500 ml, a massive dullness of sound is detected, breathing over the zone of dullness is significantly weakened.

In case of serous pleurisy, ultrasound of the pleural cavity is performed, if a background pathology is suspected, an additional examination is used (ECG, hepatography, measurement of venous pressure, tuberculin tests, determination of serum enzymes and protein-sedimentary samples, and other tests). Differential diagnosis is necessary to distinguish between serous pleurisy and lung atelectasis, focal pneumonia, circulatory disorders accompanied by the formation of transudate (with pericarditis, heart disease, liver cirrhosis, nephrotic syndrome).

Treatment of serous pleurisy

In the treatment of serous pleurisy, it is necessary to take into account the general condition of the patient, the presence of an underlying underlying disease. Treatment of serous pleurisy is carried out in a hospital with the appointment of bed rest, a diet with fluid and salt restriction, and complex pathogenetic therapy.

After establishing the cause of serous pleurisy, additional etiotropic treatment may include tuberculostatic agents - with the specific nature of the disease; sulfonamides and broad-spectrum antibiotics - for nonspecific pneumonic pleurisy. With a significant accumulation of pleural exudate, causing respiratory and circulatory disorders, and also because of the threat of empyema, pleural puncture or drainage of the pleural cavity with fluid evacuation is carried out as an emergency. Then antibiotics can be injected into the cavity, and in case of serous pleurisy caused by pleural cancer, antitumor drugs.

Anti-inflammatory and hyposensitizing agents, glucocorticosteroids are shown. Symptomatic therapy of serous pleurisy includes cardiotonic and diuretic drugs. In the absence of contraindications, after resorption of the exudate, physiotherapy (ultrasound and electrophoresis with calcium chloride), active breathing exercises, and massage are prescribed to prevent pleural adhesions in serous pleurisy. With a persistent course of serous pleurisy, its surgical treatment may be required - obliteration of the pleural cavity, thoracoscopic pleurectomy, etc.

Forecast and prevention

The prognosis for serous pleurisy is largely determined by the nature and severity of the underlying disease: usually in the case of timely and rational treatment of pleurisy of infectious etiology, it is favorable. The most severe prognosis is associated with tumor pleurisy, indicating a far advanced oncological process. Prevention consists in the timely detection and treatment of the primary disease that caused the production and accumulation of exudate in the pleural cavity.

Exudate I Exudate (exsudatum; lat. exsudare go out, stand out)

liquid rich in protein and containing; formed during inflammation. The process of moving E. into the surrounding tissues and cavities of the body is called exudation. The latter occurs following damage to cells and tissues in response to mediators (see Inflammation) .

Exudate, serous-hemorrhagic(e. serohaemorrhagicum) - serous E., containing an admixture of erythrocytes.

Serous-fibrinous exudate(e. serofibrinosum) - serous E., containing a significant admixture of fibrin.

Serous exudate(e. serosum) - E., consisting mainly of plasma and poor in blood cells.

Mucous hemorrhagic exudate(e. mucohaemorrhagicum) - mucous E., containing an admixture of erythrocytes.

Mucous exudate(e. mucosum) - E., containing a significant amount of mucin or pseudomucin.

Fibrinous exudate(e. fibrinosum) - E., containing a significant amount of fibrin.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what "Exudate" is in other dictionaries:

Exudate is a turbid, protein-rich and hematogenous and histogenic fluid that oozes from small blood vessels at the site of inflammation. Contains protein, leukocytes, erythrocytes, minerals, cellular elements ... Wikipedia

- (lat. exsudatio, from proposition ex, and sudare to sweat). Seeping, escaping liquid or condensed matter in the body through the blood vessels or through the pores of the skin, like sweat; sweating. Dictionary of foreign words included in the Russian language. ... ... Dictionary of foreign words of the Russian language

Modern Encyclopedia

- (from Latin exsudo I sweat out), inflammatory effusion is a serous, purulent, bloody or fibrinous fluid that seeps from small blood vessels into tissues or body cavities during inflammation (for example, with exudative pleurisy). Wed… … Big Encyclopedic Dictionary

Muddy, rich in protein and cells of hematogenous and histogenic nature, the fluid is formed at the site of inflammation. Acute inflammation is characterized by a predominance of neutrophils in E., for chronic lymphocytes and monocytes, for allergic ... ... Dictionary of microbiology

Exist., number of synonyms: 1 effusion (3) ASIS synonym dictionary. V.N. Trishin. 2013 ... Synonym dictionary

exudate- and EXUDAT a, m. exsudat m. lat. exsudare to go outside. 1. spec. Fluid that oozes out during inflammation from small vessels in tissues or body cavities; effusion. ALS 1. My illness, which prevented a timely response, was an epileptic, ... ... Historical Dictionary of Gallicisms of the Russian Language

EXSUDATE- English exudate German Exsudat French exsudât see > ... Phytopathological dictionary-reference book

Exudate- (from the Latin exsudo I sweat, exude), inflammatory effusion is a serous, purulent, bloody or fibrin-filamented liquid that seeps from small blood vessels into tissues or body cavities during inflammation (for example, with exudative ... ... Illustrated Encyclopedic Dictionary

BUT; m. [from lat. exsudare highlight] Med. Fluid leaking from small blood vessels into tissues or body cavities when inflamed; inflammatory effusion. ◁ Exudative, oh, oh. E. diathesis. E. pleurisy. * * * exudate (from lat. exsudo ... ... encyclopedic Dictionary

- (exsudatum; ex + lat. sudo, sudatum to sweat) a protein-rich liquid containing blood cells that comes out of small veins and capillaries into the surrounding tissues and body cavities during inflammation ... Big Medical Dictionary

There is far from one difference between transudate and exudate, although for an ignorant person both of these terms are incomprehensible. But a professional doctor must be able to distinguish one from the other, because these types of effusion fluid require a different approach. Let's try to talk about transudates and exudates in such a way that it is understandable even to a person without a medical education.

What are effusion fluids

Exudative fluids form and accumulate in the serous cavities, which include the pleural, abdominal, pericardial, epicardial, and synovial spaces. In the listed cavities, it is present, which ensures the normal functioning of the corresponding internal organs (lungs, abdominal organs, heart, joints) and prevents them from rubbing against the membranes.

Normally, these cavities should contain only serous fluid. But with the development of pathologies, effusions can also form. Cytologists and histologists are engaged in their research in detail, because a competent diagnosis of transudates and exudates allows prescribing the correct treatment and preventing complications.

transudate

From Latin trans - through, through; sudor - sweat. Effusion of non-inflammatory origin. It can accumulate due to problems with blood circulation and lymph circulation, water-salt metabolism, and also due to increased permeability of the vascular walls. The transudate contains less than 2% protein. These are albumins and globulins that do not react with colloidal proteins. In terms of characteristics and composition, the transudate is close to plasma. It is transparent or has a pale yellow hue, sometimes with cloudy impurities of epithelial cells and lymphocytes.

The occurrence of transudate is usually due to congestion. It can be thrombosis, renal or heart failure, hypertension. The mechanism of formation of this fluid is associated with an increase in internal blood pressure and a decrease in plasma pressure. If at the same time the permeability of the vascular walls is increased, then the transudate begins to be released into the tissues. Some diseases associated with the accumulation of transudates have special names: hydropericardium, abdominal ascites, ascites-peritonitis, hydrothorax.

By the way! With proper treatment, the transudate can resolve, and the disease will go away. If you start it, the extravasation will increase, and over time, the stagnant fluid can become infected and turn into exudate.

Exudate

From Latin exso - go outside sudor - sweat. Formed in small blood vessels as a result of inflammatory processes. The fluid exits through the vascular pores into the tissues, infecting them and contributing to the further development of inflammation. The exudate contains 3 to 8% protein. Also, it may contain blood cells (leukocytes, erythrocytes).

The formation and release of exudate from the vessels is due to the same factors (an increase in blood pressure, an increase in the permeability of the vascular walls), but inflammation in the tissues is additionally present. Because of this, the effusion fluid has a different composition and inflammatory nature, which is more dangerous for the patient. This is the main difference between transudate and exudate: the latter is more dangerous, so more time is devoted to its research.

Important! They try to get rid of the detected exudate as soon as possible. Otherwise, cancer cells may begin to form in it, causing an oncological disease of the organ in the cavity of which the exudate is located.

Exudate and its types

Different types of exudates differ from each other in their composition, the causes of inflammation and its features. It is possible to determine the type of exudative fluid using a puncture, after which the evacuated (pumped out) contents of a particular cavity are sent for laboratory research. Although the doctor can sometimes draw primary conclusions from the appearance of the liquid.

Serous exudate

In fact, a serous effusion is a transudate that has begun to be modified due to infection. Almost completely transparent; the protein content is moderate (up to 5%), there are few leukocytes, no erythrocytes. The name reflects the fact that such an exudate occurs in the serous membranes. It can form as a result of inflammation caused by allergies, infection, deep wounds or burns.

fibrinous exudate

It contains a large amount of fibrinogen - a colorless protein, the increased content of which indicates the presence of acute inflammatory or infectious diseases: influenza, diphtheria, myocardial infarction, pneumonia, cancer. Fibrinous exudate is found in the bronchi, gastrointestinal tract, and trachea. The danger of fibrinous deposits lies in the risk of their germination in the connective tissue and the formation of adhesions.

Purulent exudate

Or just pus. Contains dead or destroyed cells, enzymes, fibrin threads and other elements. Due to their decomposition, such an exudate has a pronounced bad odor and a pathological color for organic liquids: greenish, brownish, bluish. Purulent exudate is also distinguished by increased viscosity, which is due to the content of nucleic acids in it.

A type of pus is putrefactive exudate. It is formed as a result of inflammation caused by anaerobic (oxygen-free) bacteria. It has a more pronounced disgusting smell.

Hemorrhagic exudate

It has a pinkish hue, which is explained by the increased content of red blood cells in it. Hemorrhagic exudate often forms in the pleural cavity as a result of tuberculosis. Some of the fluid may be coughed up.

Other types of exudates (serous, fibrinous, purulent) can be modified into hemorrhagic with a progressive increase in vascular permeability or with their destruction. Other diseases reported by hemorrhagic exudate: smallpox, anthrax, toxic influenza.

Slimy

It contains a large amount of mucin and lysozyme, which provides it with a mucous structure. More often it is formed in inflammatory diseases of the nasopharynx (tonsillitis, pharyngitis, laryngitis).

Chylous exudate

Contains chyle (lymph), as evidenced by its milky color. If chylous exudate stagnates, a more oily layer with lymphocytes, leukocytes, and a small number of erythrocytes forms on its surface. Most often, such an inflammatory effusion is found in the abdominal cavity; less often - in the pleural.

There is also pseudochylous exudate, which is also formed by lymph, but the amount of fat in it is minimal. Occurs with kidney problems.

Cholesterol

Quite thick, with a beige, pinkish or dark brown (in the presence of a large number of erythrocytes) shade. It contains cholesterol crystals, from which it got its name. Cholesterol exudate may be present in any cavity for a long time and be discovered by chance during surgery.

Rare exudates

In exceptional cases, neutrophilic (consists of neutrophils), lymphocytic (from lymphocytes), mononuclear (from monocytes) and eosinophilic (from eosinophils) exudates are found in the cavities. Outwardly, they almost do not differ from those listed earlier, and their composition can be clarified only with the help of chemical analysis.

Laboratory studies of effusion fluids

The importance of determining the type and composition of effusion fluids is evidenced by the fact that their first laboratory studies began in the 19th century. In 1875, the German surgeon Heinrich Quincke pointed out the presence of tumor cells isolated from the fluids of serous cavities. With the development of chemical analysis and the advent of new research methods (in particular, staining of biological fluids), it has also become possible to determine the characteristics of cancer cells. In the USSR, clinical cytology began to develop actively since 1938.

Modern laboratory analysis is based on a specific algorithm. The nature of the effusion fluid is initially clarified: inflammatory or not. This is determined by the content of several indicators:

• protein (key indicator);
• albumins and globulins;
• cholesterol;
• the number of leukocytes;
• absolute amount of liquid (LDH), its density and pH.

A comprehensive study allows you to accurately distinguish exudate from transudate. If the inflammatory nature is determined, then a series of analyzes follows, allowing to determine the composition of the exudate and its appearance. Information enables the doctor to make a diagnosis and prescribe treatment.

Exudate is a special liquid that can accumulate in various inflamed tissues of the human body. It is formed due to a violation of the walls of blood vessels and the ingress of blood there. The appearance of such a fluid is typical at the initial (acute) stages of various pathologies.

Serous exudate

A yellowish liquid is called serous exudate. It is most often found in lesions of the body with various infectious diseases, as well as in tuberculosis. It contains no more than 3% protein, as well as a large amount of folded fibrin.

Serous exudate is a fluid whose composition varies depending on the disease. For example, in tuberculosis or syphilis, a large number of lymphocytes may be present, but not at all stages of the disease. If a person's tuberculosis has passed into a chronic (protracted) form, then the exudate is also present, but the number of plasma cells is already increasing in its composition.

Eosinophilic exudate

This type of exudate is characterized by a high content of eosinophilic granulocytes. They are in sweat. Also in medical practice, there is a certain list of diseases in which a liquid of a similar composition is found. Eosinophilic exudate is often found in:

• tuberculosis;
• severe infectious diseases;
• abscess;
• serious injuries;
• metastasis of lung cancer, etc.

There are also various forms of eosinophilic exudate. It can be serous, hemorrhagic and purulent. All of them differ in composition, from which they received various names.

Purulent exudate

This type of exudate can occur for completely different reasons. As a rule, this fluid is formed only in the presence of secondary infection. The infection can be in the lungs or in any other organ of the body. It is also sometimes found in serous cavities.

In addition, there are various stages of exudate.

1. Initially, it can be serous, and then - purulent. Its color becomes cloudy with a greenish tint, and the density increases. Occasionally, blood impurities may appear in it. Such a transition indicates a complication of the disease.
2. The exudate may lighten, which indicates a positive course of the disease.
3. Also, sometimes a transparent exudate can become simply cloudy, while not changing its density. This condition also indicates an unfavorable development of the established pathology.

It is worth noting that this type of exudate is considered one of the most dangerous, since it almost always indicates the development of the disease and the ineffectiveness of the prescribed treatment.

Putrid exudate

Putrid exudate is a neglected form of purulent. Usually its color ranges from brown to yellow-green. It contains a huge amount of substances that appear due to the decay products of leukocytes, fatty acids and cholesterol.

The appearance of such a liquid requires special attention from doctors. During therapy, antibiotics and other medications are additionally prescribed. Putrid exudate exudes a very unpleasant odor due to putrefaction processes.

Hemorrhagic exudate

This type of exudate is usually noted when:

• mesothelioma;
• metastasis of oncological neoplasms;
• hemorrhagic diathesis, which is supplemented by infectious infection;
• chest injuries.

The blood mixes with the serous effusion, and the mass itself acquires a liquid consistency.

It is worth noting that with this form it is very important to examine this exudate in the laboratory. Treatment should also be prescribed depending on the results.

During the study, it is necessary to pay attention to the presence and number of erythrocytes contained. By this indicator, you can determine the presence or absence of bleeding. If "dead" erythrocytes and their decay products are noted in the hemorrhagic exudate, this indicates the cessation of bleeding. If, during a repeated test, the number of fresh red blood cells increased, then in this case it can be concluded that there is repeated bleeding.

It is also very important to monitor the condition of the hemorrhagic exudate during a purulent infection. There are frequent cases when serous-hemorrhagic effusion turns into a purulent form. Impurities of pus are easily determined with the help of special samples, and after that appropriate drugs are prescribed.

Also, according to hemorrhagic exudate, you can monitor the course of the disease. If eosinophilic granulocytes were recorded in its composition, then the doctor can conclude that the course of the disease is favorable. If their concentration rises to 80%, then this already indicates a gradual recovery of the patient.

Cholesterol exudate

Cholesterol exudate can be present in the human body for a long time. As a rule, it is found in any chronic pathologies. Almost always, its appearance was preceded by an existing inflammatory exudate.

There are very few other elements in the composition of cholesterol exudate, except for cholesterol. It may also be already in a decayed form.

In appearance, it is thick with a brown or yellow tint. It is characterized by a pearly overflow. If there are a lot of red blood cells in the cholesterol exudate, then its shade can vary up to chocolate.

Chylous, chyle-like and milky exudate

All these three exudates can be combined into one type, since outwardly they are very similar (they have, but there are still differences.

1. Chylous exudate is filled with lymphocytes. It is noted with various injuries, tumors or inflammations. Its milky color is due to the presence of a small fat content.
2. chyle-like exudate. Its appearance always occurs due to the active breakdown of fat cells, which also gives it a milky tint. This type of fluid is very common in liver cirrhosis and developing malignant tumors. Chylus-like exudate is completely devoid of microflora.
3. Milky exudate is a pseudochylous effusion (its second name). In its composition, unlike the first two, there are no fat cells. It is worth noting that milky exudate is present in lipoid lesions of the kidneys.

Exudate in the ear

This type of exudate appears only in one case - with chronic exudative otitis media. To designate this disease is not at all difficult. Just a visual inspection is enough. Diseases are more common in children and adolescents.

So, during examination, the otolaryngologist may note a change in the color of the eardrum. It can be whitish, pink. If there are fluid bubbles in the ear, then this once again proves the presence of exudate, but already behind the eardrum.

The exudate is often liquid, but in advanced cases it can become very thick. In this case, the patient begins to complain of hearing loss and pain.

With such a disease, it is very important to apply treatment on time. The fact is that a very thick effusion affects all areas of the inner ear. Exudate is present behind the membrane and near the malleus. In addition, it is very difficult to remove it in the usual way. In order to get rid of the exudate in the ear, the otolaryngologist has to carry out repeated washing. In this case, not only the ear itself, but also the pharynx, as well as the nose.