Pathology of acute otitis media

2021-01-31 12:00 AM

Examination of the eardrum: the whole eardrum is red, the hammock is not seen, the hammock and the light cone.


Acute otitis media is a common disease, most commonly in children with upper respiratory tract infections, especially when measles, flu, diphtheria, whooping cough ... happen in less than 3 weeks.

If not treated promptly and properly, the disease often leads to dangerous complications such as:

Chronic otitis media.

Mastoid ear infections.

Intracranial complications such as meningitis, brain abscess.

Vascular complications: lateral thrombophlebitis.

Connect peripheral VII.


Acute otitis media with seepage secretion.

Acute congestive otitis media.

Acute purulent otitis media.

Acute purulent otitis media


Acute infection in the nasopharynx.

Appears after diseases such as flu, measles or after diseases such as rhinitis, sinusitis, VA inflammation, tonsillitis, nasopharyngeal tumour.

Stuffing the posterior nose for too long.

Bacterial etiologic: usually caused by S. pneumoniae, H. influenzae, M. catarrhalis,

  1. aureus.

After trauma: tearing, puncturing the eardrum such as picking ears with a hard object, trauma caused by explosions, pressure ... 


Symptoms of acute otitis media vary widely depending on the cause of the disease and the physical condition. The typical form of purulent acute otitis media in children, progresses through two stages:

Onset: no pus in the ear canal.

Body: patient a few days earlier was suffering from rhinitis: runny nose and stuffy nose. Suddenly have a high fever of 39-40 0 C

Functions: ear pain, itching at first, pressure in the ear, after severe ear pain, hearing loss.

Entity: Examination of the red congested tympanic membrane in the upper posterior angle or vertically at the base of the hammer bone or in the reticular region (Shrapnel).

Full-play stage:

Usually through two periods: the period of stasis and the rupture period of pus.

Purulent period (the eardrum has not yet broken):

Mechanical symptoms:

Long-lasting high fever of 39C- 40 0 C, fatigue, difficulty sleeping, weight loss ... may convulsions, fatigue.

Gastrointestinal disturbances are a common symptom, especially in the fetus: diarrheal, stools or vomiting, bloating, accompanied by digestive disorders: with 70-80% of children passing out the stool Going many times, anti-gastrointestinal disturbances are less effective only when dealing with the cause of otitis media.

Ear pain: increasing severe ear pain, deep pain in the ear, pounding pain, pain spreading to the temples and behind the ear that prevents the patient from sleeping, the baby is fussy, stops eating, stops breastfeeding drowsiness, convulsions, fussiness, hand rubs in painful ears, or shakes head.

Picture: Pus in the ear canal

Physical symptoms:

Examination of the eardrum: the whole eardrum is red, the hammock is not seen, the hammock and the light cone. At a heavier level, the eardrum swells up like a clock glass. The bulging point is usually located at the back.

Nasopharyngeal examination: the patient has acute rhinitis.

Pus rupture (ruptured eardrum): usually occurs on day 4.

Mechanical symptoms: gradually reduced, ear pain stopped, body temperature decreased, the baby refused to play, stopped crying.

Physical symptoms: the ear canal is full of pus, when cleaning the eardrum, the hole will be different depending on whether the eardrum is injected or not?

If injected: the hole will be wide and the lower corner of the eardrum will stop swelling.

If you do not prick to let the eardrum rupture, the hole can be anywhere, the edge is thick and messy.


Based on two-stage clinical symptoms of the disease.


There are many dangerous complications such as mastoiditis, inner ear infections, meningitis, encephalitis and peripheral cord VII paralysis ...


Depending on each stage, there is an appropriate treatment attitude.

Onset: mainly treating the nose and throat.

Anti-congestion: re-establishes nasal ventilation and sinus opening to ensure drainage of inflamed sinuses, reduce pressure differences between the sinus and nasal cavities.

Get rid of a runny nose.


Prevention of recurrence of sinusitis.


Nasal removal: with vasoconstrictors to make the nose clear. Before rinsing the nose need to blow the nose to flush secretions stagnant in the nose (Ephedrine, Naphazoline, Gomenon oil) flush from 5-10 times.

Spray the medicine: by hitting the drug-bearing hot steam, the heat has the effect of reducing congestion of the nasal mucosa, allowing the drug to seep into the interstitial spaces of the nose and can seep into the sinuses through the nasal passages. sinuses. Medicines used to inhale are eucalyptus oil, Gomenon oil, wind oil with 5-10 minutes duration.

Nasal nebulizer: must have a nebulizer. The impact machine disperses the drug solution into small particles (from 1-10mm) dissolved in the air. Drugs taken into the body by aerosol are 5 times more effective than oral or parenteral, so the dosage can be reduced, the volume used is 5ml.

Therapy: infrared and shortwave radiation


Antibiotics commonly used are gram (+): Amoxicillin, Co-trimazole or Erythromycin.

Anti-inflammatory, analgesic.

Lifting the body with vitamins

In the ears: ear drops Glycerine bosphate 3%, Otipax ...

Full-play stage.

Always monitor and inject the eardrum at the right time: if the patient comes to have ruptured pus, the ear should be done daily: wipe the pus and remove antibiotics in combination with nasal and throat treatment.

Systemic antibiotic.


Body support.

Acute otitis media with seepage secretion

Acute hydrocephalus is increasingly common, in both adults and children.


Due to obstruction of the atrial tubes: children often experience excessive inflammation of VA. Adults due to changes in the air pressure in the ear canal when high or diving deep.

Due to a topic, overreaction of lymphoid organizations in the nose and throat.


Body as a whole: no special effects.


Ear pain is uncommon, often feeling like the earplugs.

Hearing loss clearly, can change with head position and echoes (hearing your own voice change like when you cover your ears and speak).

Tinnitus is low, constantly annoying.


The eardrum is red at first, slightly concave, with prominent blood vessels, then there is water or bubbles in the ear canal.

The Valsalva manoeuvre was negative.

Progression and complications

It can resolve by itself when the ear canal is back, leaving no sequelae.

Becomes chronic with thick fluid in the ear canal or fibrous otitis media, with colloidal fibres that attach the eardrum to the inner wall, limiting vibrations. Sticky fibres can spread to the inner ear, limiting vibrations.

To solve

Clear the eardrum by inflating or dilating the eardrum.

Anti-fibrosis: 2% Glycerine phosphate insertion warm several times a day or Hydrocortisone, Alpha-chymotrypsin through the eardrum into the ear canal.

Place the eardrum catheter in the posterior corner of the eardrum.

Rub the eardrum: use a rubber ball to attach the end of the tube to the ear canal to gently squeeze the ball to move the eardrum.


Addresses the causes of atrial obstruction such as VA curettage, rhinitis treatment.

Implementation of protective measures: sucking candy, blowing air, clearing the atrium when there is a sudden change of pressure for divers, working in sinks, climbers, people on aeroplanes...

Acute congestive otitis media

Congestive acute otitis media is also called acute otitis discharge, the same type of acute otitis without pus, which is rarely detected because of poor symptoms and inflammatory symptoms of sugars. Upper respiration blurred.


Due to nasopharyngitis, a common disease in children due to rhinitis, inflammation of VA spreads into the tubes and clogs the tubes, causing discharge and creating conditions for bacteria to grow, but bacteria with low toxins should less lead to purulent inflammation.



Ear pain is the main and unique symptom, sometimes throbbing pain for a few minutes, pain deep in the ear canal, pain spreading down the lower jaw.

Other symptoms, such as tinnitus and hearing loss, are often absent or very small that do not catch the patient's attention.

Overall condition is generally good and is dependent on VA inflammation, rhinitis, and sinusitis.


The eardrum is pinker than usual, the longitudinal blood vessels are around red, the eardrum is concave, and the eardrum has little fluid.

The disease progresses in a short time, each time the baby has rhinitis, VA inflammation, the pain reappears, some cases can turn into acute otitis media with pus.


The spot is very simple: put 3% Glycerine bosphate, Otipax in the ear 2 hours.

Treatment of the cause: rhinitis, sinusitis with nasal rinsing, nasal sinus aerosolization, atrial opening (if there is a phenomenon of obstruction)

VA curettage, septum orthopaedic surgery, lower nose curl removal ...



Anti-inflammatory, analgesic.