Acute and chronic purulent otitis media of the middle ear in adults: causes, symptoms, treatment

Purulent otitis is a common infectious disease. The acute form is 25-30% of all ear diseases. Infection penetrates through a special tube. With ailments of the nose and nasopharynx, pathological changes are formed in this part, which allow the microbes to enter the middle ear without any problems.

Purulent otitis ICD-10: aetiology

etiology of purulent titre The ICD-10 classification has codes from H66.0 to H 66.9.There are two main factors leading to the development of the problem: a violation of the functions of the auditory tube and the presence of infection in the middle ear. Eustachian tube allows to equalize the pressure in the tympanum.

Thanks to special cilia, the mucus moves from the middle ear to the nasopharynx. If there is swelling of the mucous membrane, a foreign body, a tumor, then the tube may become clogged. Additional causes of the disease include:

  • trauma,
  • immunoglobulin deficiency,
  • genetic predisposition.

Provoking factors and causes of the disease

Purulent processes occur

as a result of increased activity of streptococci, staphylococci, diphtheria and tubercle bacillus. To develop an acute form of purulent otitis, certain conditions are necessary, for example, sensitization of the organism to microbes. Most often purulent otitis appears against the background of viral diseases, is their complication.

Predisposing factors include:

  • hypothermia,
  • hypovitaminosis,
  • overstrain,
  • inflammation in the nasopharynx,
  • ingestion in the ear of the microflora in the corresponding virulent amount.

Symptoms of

The first call to start the development of a purulent form of otitis is an increase in body temperature, the appearance of chills. A headache begins, which is accompanied by:

  • with the stuffing of the ear,
  • with a pain in the ears,
  • with a sensation of a fluid transfusion,
  • with secretions from the auditory canal.
  • the latter first have a light and watery character.

What happens in the ear with otitis

symptoms of purulent otitis


Separate the purulent otitis into two types:

  • acute,
  • chronic.


This form is caused by ingress of bacteria into the middle ear. Inflammation leads to swelling of the auditory tube.

The mucosa of the sections is thin, and the lower layer functions as a periosteum. As the pathology develops, the mucosa thickens, erosions appear on the surface. The middle ear itself is filled with exudate. First he wears a serous form, but eventually becomes purulent.

At the peak of the development of the disease, the drum cavity is completely filled with pus, and the drum film itself is covered with a white coating. Under the pressure, the latter bursts, the outflow of pus begins, which lasts 6-7 days.

Symptoms and causes of acute purulent otitis:


Inflammation characterized by persistent flow of pus from the ear, persistent violation of the integrity of the membrane and progressive hearing loss. This species usually develops in the absence of proper treatment at an acute stage or is a consequence of a traumatic rupture of the tympanic membrane.

According to statistics, 0.8-1% of the population suffer from this form. In 50% of cases, the disease develops in childhood, beginning as catarrhal otitis. Due to serious intracranial complications, the disease is one of serious not only for health, but also for life activity. Most often the chronic form of otitis is bilateral and very rarely right-sided or left-sided.

The transition from the acute form to the chronic is associated with several factors:

  • low resistance to immunity,
  • by improper selection of antibacterial drugs,
  • by pathologies of the upper respiratory tract,
  • by the presence of concomitant diseases.

Stages of

For the purulent form of otitis characterized by the stages:

  • dopers,
  • perforated,
  • reparative.

Not all diseases go through all three stages. With the right treatment, the disease can already acquire abortifacial course at the first stage.

At the initial( preperforative) stage, patients complain of a sharp pain that gives to the temporal region. Growing up, it becomes intolerable. Pain occurs due to inflammatory infiltration of the mucous membranes. Sometimes pain occurs when you feel and study the mastoid process. This is due to inflammation of the mucosa. There is noise and stuffiness. There are signs of intoxication, body temperature reaches 38-39 degrees.

The perforated stage is characterized by perforation of the tympanic membrane and the appearance of suppuration. With this, the pain quickly subsides, the well-being improves. Allocations are very abundant at first, sometimes with an admixture of blood. Then they begin to gradually decrease, but on average they last 5-7 days. If the disease is acute, the perforation is small and round.

Reparative stage. It is characterized by the cessation of pyesis. In most cases, spontaneous scarring of the perforation and restoration of the hearing occurs. Small damage to the tympanic membrane is restored quickly enough.


For the medical history, an analysis of an anamnesis of the disease is collected. Lor introduces a preliminary diagnosis with the appearance of pulsating pain, which is intensified in the process of chewing, with hearing impairment and a feeling of pressure. The increase in body temperature and the appearance of secretions from the ear are also symptoms of a purulent form.


The patient is then sent to give a general blood test. It will show the presence of inflammation of the bacterial nature in the body. Usually there is leukocyte, elevated ESR and shift of the leukocyte formula to the left.

It is taken for examination and exudate directly from the source of inflammation. It is studied for the definition of bacteria and increased sensitivity to antibiotics.


The doctor conducts:

  1. Otoscopy. Examination of the external auditory canal with the aid of an ear funnel or otoscope.
  2. Capercount examination. It identifies whether hearing loss is associated with inflammation or auditory nerve disease.
  3. Radiography, MRI.Allow to establish precisely the presence of inflammation in the cavities of the middle ear and mastoid process.
  4. Paracentesis. Held sometimes. A tympanic puncture is performed to determine the content.


Because the diagnosis is not difficult, a patient can be assigned a set of therapeutic effects.


To eliminate bacterial infection, various drops, antibiotics, and medications are prescribed to eliminate associated symptoms.


Most drops with a ruptured eardrum and purulent otitis are prohibited. Because they can only exacerbate the course of the disease. Despite good reviews in the treatment of otitis in adults and children with perforation of the tympanic membrane, otipax can not be used. The exception is Otof drops. They are indicated in the treatment of purulent discharge. It is an antimicrobial drug.

Another drop that has not only anti-inflammatory, but analgesic action - Anauran. Such a medicine is indicated in acute and chronic forms.


In addition to using ear drops, antibiotics are prescribed. A popular remedy is amoxicillin, which has an antimicrobial and antiseptic effect. Aminoglycoside is also a drug for local injection use, but is allowed to be taken no more than 14 days. Drugs can be administered in the form of tablets or capsules, in severe cases, injections are used.

Other drugs

With fever above 39 degrees, antipyretic agents are prescribed. They can be based on paracetamol or ibuprofen. If purulent otitis is a consequence of ARVI, then for a faster recovery the doctor prescribes antiviral and immunostimulating drugs.

Folk remedies

Purulent otitis with the help of traditional medicine methods is not recommended for treatment. This is due to the fact that you can not guess how this or that method will work in a particular case.

How to treat purulent otitis without complications in our video:


Physiotherapeutic effects are prescribed to reduce symptoms and restore hearing. Among the methods of exposure are:

  • UHF therapy,
  • laser therapy,
  • ultrasound exposure.

If it is necessary to deliver a rapid antibiotic to the affected area, then electrophoresis with antibiotics is prescribed.

Surgical intervention

If conservative treatment does not lead to the desired effect, then the operative effect is used. In the inflammatory process, a good outflow of contents is important.

To do this, it is assigned to delete granulations and polyps. Assigns and shunting the tympanum. A small hole is made in the membrane, into which a small tube is inserted. Through her drugs are introduced. It is possible to perform surgery on the labyrinth and middle ear.

The photo shows the paracentesis with shunt


installation. Complications of

The main complication is hearing loss. In advanced stages, bone tissue in the temple area is also affected. This leads to the development of meningitis and brain abscess. Sometimes it happens:

  • destruction of small auditory ossicles,
  • mastoiditis,
  • neuritis of the facial nerve,
  • development of cholesteatoma.


Prognosis for correct treatment is favorable. The disease ends in convalescence and restoration of hearing. If a person has started the disease, it can go on into a chronic form with the formation of a stable perforation of the tympanic membrane.


Preventative measures include:

  1. Treatment of chronic diseases of the nose, throat.
  2. Prevention of viral infections.
  3. Timely treatment of inflammatory diseases.
  4. Do not allow dirty water into the ears.
  5. Correction of immunodeficiency states.

At the first sign of any otitis, you should immediately consult a doctor. Self-medication, like using ear drops without a specialist's testimony, is not allowed.

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