What is acute otitis media? How to beat chronic otitis media: the basics of correct treatment Acute otitis media code 10.

Acute otitis media is one of the most frequent complications of community-acquired upper respiratory tract infections in children and currently occupies a dominant place in the structure of childhood pathology. This is due to the high prevalence of acute respiratory diseases, which play a significant role in the pathogenesis of acute otitis media and make up up to 90% of all pediatric infectious diseases. The incidence of influenza per 100,000 children and under 1 year of age is 2362 cases, 1-2 years - 4408 and 3-6 years - 5013 cases. Acute otitis media occurs in 18-20% of children with acute respiratory viral infection.

During the first year of life, at least one episode of acute otitis media is diagnosed in 62% of children, and in 17% it is repeated up to three times. By the age of 3 years, acute otitis media is tolerated by 83%, by 5 years - 91%, and by 7 - 93% of children.

In Ukraine, about 1 million people annually suffer from acute inflammation of the middle ear. The incidence of acute otitis media among the child population in European countries reaches 10%, in the United States this disease is annually recorded in 15% of the child population. The share of acute otitis media in the structure of diseases of the organ of hearing is 30%. Almost every fifth (18%) child with acute otitis media has a severe or complicated course of the disease. In 12% of patients, damage to the neuroepithelial cells of the spiral organ develops, followed by sensorineural hearing loss and deafness.

Causes of acute otitis media

The main etiological factors of acute otitis media are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, Staphylococcus aureus. A viral infection plays a certain role in the occurrence of acute otitis media. This, in particular, is confirmed by data on the correlation of indicators of the frequency of respiratory infections and acute otitis media, a high frequency (59%) of detection of viruses in the nasopharynx of patients with acute inflammation of the middle ear.

Risk factors

Risk factors for acute otitis media in children:

the presence of myxoid tissue in the middle ear cavities (in young children);
wide, straight, short and more horizontally located auditory tube;
a significant frequency of hypertrophy and chronic inflammation of the pharyngeal tonsil;
incomplete pneumatization of the temporal bone.

In addition, one should take into account the failure of the immune mechanisms of the child's body, the physiological (transient) immunodeficiency states of newborns.

Pathogenesis

The impact of pathogens (viruses, bacteria) on the mucous membrane of the nose and nasopharynx in acute respiratory diseases initiates a cascade of morpho-functional shifts, which play a key role in the development of inflammatory changes in the middle ear and the formation of clinical manifestations of acute otitis media. The sequential development of inflammatory changes in the middle ear in acute respiratory diseases (the most common cause of acute otitis media) is associated with the damaging effect of viruses and bacteria on the ciliated epithelium of the initial sections of the respiratory tract and auditory tube. The main role in the occurrence of acute inflammation of the middle ear is played by proinflammatory mediators, which control the intensity and direction of immune responses, and also ensure the implementation of the most important effects of the inflammatory response (increased vascular permeability, increased mucus secretion, migration of leukocytes to the inflammation focus and their degranulation, etc.).

Clinical equivalents of the listed disorders are hyperemia, edema of the nasal mucosa and nasopharynx, impairment of physiological transport routes of the detachable mucous membrane, accumulation of nasopharyngeal secretions in the region of the pharyngeal orifice of the auditory coarse, the formation of nasopharyngeal tubal reflux and dysfunction of the auditory coarse A natural consequence of morphofunctional shifts is a rapid decrease in intratympanic pressure and partial pressure of oxygen in the tympanic cavity, impaired air circulation, extravasation of fluid from the microvasculature, microbial contamination of the middle ear cavities, and the sequential development of acute inflammatory changes. Under these conditions, it is likely that superinfection, the protracted course of the inflammatory process and the formation of complications increase sharply.

Symptoms of Acute Otitis Media

Symptoms of acute otitis media are characterized by complaints of pain, congestion and a feeling of noise in the ear, hearing loss, and autophony. In newborns and children of the first year of life, the following symptoms are noted: anxiety, sleep disturbances, screaming, the desire to lie on the sore side, refusal to eat, possibly regurgitation. Body temperature reaches 38 ° C and above. The progression of the inflammatory process is accompanied by increased pain, severe hearing impairment, and an increase in symptoms of intoxication. There is a persistent increase in temperature (up to 39-40 ° C), the child becomes apathetic, does not respond to toys, refuses to eat, night anxiety, and a cry occurs. At this stage of development of acute otitis media, excitement can be replaced by adynamia, regurgitation becomes more frequent, "causeless" vomiting appears, twitching and short-term convulsions may occur. Otoscopic changes are characterized by severe hyperemia and swelling of the tympanic membrane due to the pressure of the exudate.

Due to the pressure and proteolytic activity of the exudate, thinning and perforation of the tympanic membrane occurs, accompanied by suppuration from the ear. At the same time, there is a decrease in the intensity of pain sensations, a gradual decrease in temperature, and the disappearance of symptoms of intoxication. Hearing impairment persists. After removal of pus from the external auditory canal during otoscopy, a "pulsating reflex" is often detected - a jerky (pulsating) flow of pus from the tympanic cavity through a small perforation in the tympanic membrane. In the future, with a favorable course of the inflammatory process, there is a decrease and disappearance of purulent discharge from the ear, the normalization of the general condition of the patient. During otoscopy, the absence of exudate in the external auditory canal, residual hyperemia, injection of the vessels of the tympanic membrane, a small perforation, which in most cases closes on its own, is determined. With a favorable course of the disease, a gradual restoration of hearing occurs.

Often there is an atypical course of acute otitis media. At the same time, in some cases, acute inflammation of the middle ear may be accompanied by the absence of pain syndrome, a pronounced temperature reaction, the presence of a turbid, slightly thickened tympanic membrane with poorly defined identification landmarks. And others - a rapid rise in temperature (up to 39-40 ° C), a sharp pain in the ear, a pronounced hyperemia of the tympanic membrane, a rapid increase in intoxication, the appearance of neurological symptoms (vomiting, positive Kernig's, Brudzinsky's symptoms), signs of mastoiditis and other otogenic complications. Despite the favorable course of acute otitis media in most cases, there is a high probability of developing otogenic complications. This is largely due to a lack of immune response in young children, age-related features of the structure of the middle ear, pathogenicity and virulence of etiologically significant microflora.

Stages

Acute otitis media differs in a certain sequence of development of the pathological process and symptoms. From a practical point of view, it is advisable to distinguish between three stages of the typical course of acute otitis media.

Stage I catarrhal inflammation

This stage is characterized by complaints of pain in the ear, fever, hearing loss; examination reveals retraction and injection of vessels (hyperemia) of the tympanic membrane. The general condition (weakness, malaise, etc.) is largely determined by the severity of symptoms of acute respiratory disease.

II stage of purulent inflammation

a) non-perforated. Patients note an increase in pain, malaise, weakness, an increase in hyperthermia, and a marked hearing loss. Examination reveals protrusion, intense hyperemia of the tympanic membrane.
b) perforated. This stage is characterized by the presence of purulent exudate in the external auditory canal, a "pulsating reflex", a decrease in pain, a decrease in temperature, a decrease in the severity of symptoms of intoxication.

III stage of the resolution process

Possible outcomes:

recovery (restoration of the integrity of the eardrum and auditory function);
chronization of the process;
the formation of otogenic complications (mastoiditis, tympanogenic labyrinthitis, etc.).

Diagnostics of the acute otitis media

The diagnosis of acute otitis media in typical cases is usually not difficult and is based on the results of the analysis of complaints, anamnestic information (ear pain, congestion, a feeling of noise in the ear, hearing loss). A sharp pain in the ear in young children is accompanied by anxiety, hyperkinesis.

Laboratory diagnostics

In peripheral blood, neutrophilic leukocytosis and an increase in ESR are determined.

Instrumental diagnostics

Depending on the stage of acute otitis media during otoscopy, retraction and restriction of mobility of the tympanic membrane with vascular injection (stage I of catarrhal inflammation) can be determined; severe hyperemia and swelling of the tympanic membrane due to the pressure of the exudate (II and stage of purulent inflammation); "Pulsating reflex", which is a jerky (pulsating) flow of pus from the tympanic cavity through a small perforation in the tympanic membrane into the external auditory canal (II b stage of purulent inflammation).

When examining patients with acute otitis media, one should keep in mind the high probability of developing various complications in them. In this regard, one should pay attention to the presence (absence) of such signs as pasty skin in the behind-the-ear region, smoothness of the fold behind the ear, protrusion of the auricle, the presence of swelling (fluctuations) in the behind-the-ear region (antritis, mastoiditis); asymmetry of the face (otogenic neuritis of the facial nerve): meningeal symptoms (otogenic meningitis, etc.).

Indications for consultation with other specialists

The indication for consultation of other specialists (neurologist, neurosurgeon, ophthalmologist, etc.) is a complicated course of acute otitis media.

Treatment of acute otitis media

The goals of treatment for acute otitis media: regression of inflammatory changes in the middle ear, normalization of hearing and general condition of the patient, restoration of working capacity.

Indications for hospitalization

The indication for hospitalization is the patient's age up to two years, as well as, regardless of age, severe and (or) complicated course of acute otitis media.

Drug-free treatment

Physiotherapeutic methods of influence have anti-inflammatory and analgesic effects at the initial stages of the development of the inflammatory process in the middle ear: sollux, UHF, a warming compress on the parotid region.

Drug treatment

In the first stage of the disease, the appointment of ear drops with a local anti-inflammatory and analgesic effect, intranasal vasoconstrictors (dekengestants), ensuring the restoration of nasal breathing and the patency of the auditory tube, is indicated.

The efficacy of topical antibiotics in the form of ear stones in acute otitis media requires confirmation. This is primarily due to the fact that when the antibiotic solution is instilled into the external auditory canal, its concentration in the middle ear cavities does not reach therapeutic values. In addition, one should be aware of the risk of complications in the inner ear when using drops containing ototoxic antibiotics.

In the presence of inflammatory changes in the nasal cavity, careful rinsing of the nose with a 0.9% sodium chloride solution, evacuation (aspiration) of nasal secretions are advisable.

Antipyretic drugs are used when the temperature rises to 39 ° C and above.

Systemic antibiotic therapy is indicated in all cases of moderate and severe acute otitis media, as well as in children under 2 years of age and in patients with immunodeficiency states. With a mild course [absence of severe symptoms of intoxication, pain syndrome, hyperthermia (up to 38 ° C)], antibiotics can be avoided. However, in the absence of positive shifts in the development of the disease throughout the day, antibiotic therapy should be used. In empiric antibiotic therapy of acute otitis media, preference should be given to drugs whose spectrum of action overlaps the resistance of the most likely causative agents of the disease. In addition, an antibiotic in an effective concentration should accumulate in the focus of inflammation, have a bactericidal effect, be safe and well tolerated. It is also important that oral antibiotics have good organoleptic properties, are easy to dispense and take.

For empiric antibiotic therapy of acute otitis media, amoxicillin is the drug of choice. Alternative drugs (prescribed for allergies to beta-lactams) are modern macrolides. In the absence of clinical efficacy for 2 days, as well as in patients who have received antibiotics during the last month, it is advisable to prescribe amoxicillin + clavulanic acid; alternative drugs are cephalosporins of II-III generations.

For mild to moderate severity, oral antibiotics are indicated. In case of a severe and complicated course of the process, antibiotic therapy should be started with parenteral administration of the drug, and after the patient's condition improves (after 3-4 days), it is recommended to switch to oral administration (the so-called stepwise antibiotic therapy).

The duration of antibiotic therapy in uncomplicated course is 7-10 days. In children under 2 years of age, as well as in patients with a burdened anamnesis, severe course of the disease, the presence of otogenic complications, the duration of antibiotic use can be increased to 14 days or more.

It is obligatory to evaluate the effectiveness of antibiotic therapy in 48-72 hours. In the absence of positive dynamics during acute otitis media, it is necessary to change the antibiotic.

An important component of the pathogenetic correction of changes in the mucous membrane of the auditory tube and middle ear cavities is the limitation of the action of pro-inflammatory mediators, for this purpose, it is possible to prescribe fenspiride.

Surgical treatment of acute otitis media

In the absence of spontaneous perforation of the tympanic membrane in patients with acute purulent otitis media (acute otitis media, stage II a), an increase (persistence) of hyperthermia and signs of intoxication, paracentesis of the tympanic membrane is shown.

The approximate terms of disability with an uncomplicated course of the disease are 7-10 days, with complications - up to 20 days or more.

Further management

With recurrent acute otitis media, an examination of the nasopharynx is indicated, in order to assess the condition of the pharyngeal tonsil, eliminate nasal obstruction and ventilation disorders of the auditory tube associated with adenoid vegetations. Consultations of an allergist and immunologist are also required.

The information for the patient should contain recommendations on the correct implementation of medical prescriptions and manipulations (use of ear drops, rinsing the nose) at home, measures to prevent colds.

Prevention

The primary prevention of acute otitis media is to prevent acute respiratory infections. Of great importance is the implementation of sanitary and hygienic measures aimed at eliminating hypothermia, observing the rules of personal hygiene, and hardening the body.

Secondary prevention is a set of measures aimed at preventing exacerbations of existing chronic diseases of the upper respiratory tract, restoring the physiological mechanisms of nasal breathing and the ventilation function of the auditory tube. First of all, we are talking about patients with disorders of the intranasal anatomical structures, hypertrophy of the pharyngeal tonsil, chronic focal infection in the paranasal sinuses and palatine tonsils. Timely elimination of foci of chronic infection (caries, tonsillitis, sinusitis), correction of immune deficiency and other systemic disorders is of great importance in this regard.

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It is important to know!

Examination of a patient with complaints of dizziness implies establishing the very fact of dizziness and clarifying its topical and nosological affiliation. Often, patients put a wide variety of meanings into the concept of dizziness, including, for example, blurred vision, feeling of nausea, headache, etc.

Acute otitis media, code 10 of which is H65, is a common disease of the body. A local manifestation of acute otitis media is inflammation in the tissues of the tympanic cavity, mastoid and auditory tube. The inflammatory process is caused by microorganisms such as streptococci, staphylococci, as well as viruses and fungi.

Most often, microorganisms enter the middle ear through the auditory tube, but they can also enter the external auditory canal (in case of injury to the tympanic membrane). Ingestion through the blood is possible with infectious diseases (scarlet fever, measles, flu).

This disease can appear at any age, but most often occurs in children.

There are the following forms of the disease:

Causes of acute otitis media

Acute otitis media does not occur for reasons such as hypothermia, walking in cold weather without a cap, drafts, water entering the ear. The opinion that these reasons are the main ones is erroneous.

In fact, the main sources of the disease are as follows:

Pathogenic microorganisms - viruses and bacteria. Basically, they enter the tympanic cavity through the auditory tube.
Difficulty opening the auditory tube and the flow of air into the middle ear (this happens in the presence of adenoids, enlargement of the posterior ends of the turbinates, curvature of the nasal septum, pathologies in the region of the nasopharyngeal openings of the auditory tubes).
Infectious diseases.
Eardrum trauma, infection from the external environment.

Acute otitis media: symptoms of the disease

The disease manifests itself as follows:

Noise and pain in the ear (various: constant, pulsating, pulling, shooting, can radiate to the temple, back of the head and even teeth)
Loss of hearing
Ear congestion
Ear discharge
Soreness and swollen lymph nodes
Pain behind the ear
Fever, general malaise is common

All these symptoms appear on one side or on both (unilateral or bilateral otitis media).

In addition to the symptoms listed above, there may be such as:

Discharge and nasal congestion
Sore throat
Sore throat

Treatment of acute otitis media

In acute otitis media in the middle ear, various treatments can be prescribed, it depends on the stage of the disease.

At the very beginning of the disease, warming compresses are made on the parotid region, and physiotherapy is also prescribed. However, if a purulent process is observed, any warming procedures are prohibited.
If the structure of the tympanic membrane is not disturbed, then anesthetic drops are prescribed in the ear. Antibacterial drops are not prescribed because they do not pass through the eardrum. It is advisable to use such drops when it is perforated.

It is forbidden to use drops that contain alcohol and substances that are toxic to the ear - this can lead to hearing loss, and irreversible.

At the first symptoms of acute otitis media, you should immediately consult a doctor, you cannot self-medicate if you do not want complications.

The main remedies for treating the disease include the following:

Vasoconstrictor nasal sprays
Antipyretic and pain relievers
In severe cases, antibiotics are prescribed (in other cases, only local treatment). Amoxicillin and penicillin are widely used.
Allergy sufferers are prescribed suprastin, tavegil.

In the pre-perforated stage, a small puncture of the tympanic membrane (paracentesis) is performed to relieve pain and facilitate the penetration of drugs into the ear. Physiotherapy is prescribed at the stage of recovery.

If there is a runny nose, then you need to rinse your nose and blow your nose, relying on this technique: the mouth is open, pinch each nostril in turn).

Acute otitis media: home treatment

Treatment of acute otitis media can be performed at home, but only after consulting a doctor. We recommend a few recipes that you can discuss with your doctor.

Tincture of birch buds with alcohol.

10 g of birch buds should be infused in 200 ml of alcohol or vodka for 1 week (the product is prepared in advance, the longer it costs, the more effective). Soak a cotton swab in the tincture, wring it out and insert it into the ear canal. Place compress paper, cotton wool on top and put on a warm scarf. Keep it this way throughout the night.

Propolis tincture on alcohol.

Put 2-3 drops of the warmed medicine into the ear and plug it with cotton wool. Hold the sore ear to the top for 20 minutes. If your second ear also hurts, then after carrying out this procedure with one ear, repeat it for the second.

Alcohol drops with a decoction of herbs.

Prepare a mixture of calendula, string, St. John's wort and celandine. Take 1 spoonful of the mixture, pour 70 ml of boiling water over it, leave for 8-10 hours. Then mix the tincture with 30 ml of alcohol and drip the solution in a warm state into the ears (2-3 drops each).

Warmed butter.

Heat the butter, soak a cotton swab in it and insert into your ear overnight.

Onion drops.

Take 1/3 of the onion head, grate and squeeze out the juice. Add boiled water in a 1: 1 ratio and drip into the sore ear. Cover your ear with a cotton swab and lie down for 20 minutes.

Otitis media is an inflammation of the ear. According to the International Classification of Diseases (ICD 10), otitis media is:

outer;
middle;
interior

It is impossible to name one specific code according to ICD 10 for otitis media, since its forms are diverse. Different forms of otitis media are assigned codes from H65 to H67.

Ear pain, discharge from it and hearing loss are classic signs that indicate an inflammatory process in the organ. The development of the disease can occur in different parts of the ear. The inflammatory process affects individual tympanic cavities, as well as the auditory tube.

The reason for the development of otitis externa can be:

hypothermia;
an infection brought in while cleaning your ears;
constant contact of the ear with water;
chemical injury;
mechanical injury.

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But otitis media can be caused by various pathogenic microorganisms:

microbes;
viruses;
mushrooms;
bacteria;
haemophilus influenzae;
mycobacteria;
staphylococci;
streptococci.

In most cases, the source of the disease is Haemophilus influenzae, streptococci and staphylococci. An existing infection from the nose or nasopharynx through the mouth of the auditory tube enters the mucous membrane of the middle ear. Because of this, the pressure in the tympanic cavity decreases and fluid appears in the lumen of the middle ear, secreted by small blood vessels.

In older people, otitis media occurs as a complication after ARVI and influenza.

If we consider otitis media, most often it develops due to:

trauma;
complications of infectious diseases;
acute otitis media;
chronic otitis media.

In the inner ear, the infection spreads through the blood, the meninges, and the middle ear.

Factors that cause otitis media:

allergy;
accumulation of fluid in the ear;
immunodeficiency;
respiratory tract infections not fully treated;
angina;
laryngitis;
sinusitis;
pharyngitis;
tracheitis;
regular and prolonged contact with water (swimming);
an infection brought in by sharp objects when cleaning the auricles;
surgical intervention on the nasal cavity and nasopharynx, which causes a deterioration in the patency of the auditory tubes;
inability to blow your nose.

With otitis externa, there is a characteristic sharp throbbing pain that can be soothed by chewing and talking. The pain radiates to the teeth, neck and eyes. The ear canal turns red and swells if filled with pus. Hearing also deteriorates.

In acute otitis media, shooting pain begins to disturb, and body temperature often rises. And after 1-2 days, perforation appears in the tympanic cavity and suppuration begins. At the same time, the pain in the ear disappears or decreases. The body temperature is normalized.

In chronic otitis media, which comes from an acute form, complaints of periodic or constant suppuration from the ear appear, hearing decreases and dizziness may occur. Sometimes pressure in the ear and pain in the temporal region are troubling.

Signs of internal otitis media can be an unexpected attack of dizziness, accompanied by nausea and vomiting, possibly the appearance of tinnitus.

If you have these symptoms, you should immediately consult an ENT doctor. The doctor will select the necessary treatment and explain how to avoid further complications and relapses of the disease.

Most often, children suffer from otitis media.

Their auditory tube is wide and short. This means that infections are easier to penetrate. In an infant, this disease is associated with the fact that he lies more motionless and is usually in a horizontal position. When feeding, milk may flow through the auditory tube.

It is difficult to determine that it is the ear that hurts the baby. Its middle part is reliably closed by the eardrum. However, there are some signs that you should still see a doctor:

when feeding, the child suddenly throws the breast;
bad nose breathing;
nasal congestion;
twisting with legs;
crying is like screaming;
body temperature rises rapidly;
the child tries to lie on the side where the ear hurts.

In children, otitis externa occurs due to frequent diathesis and allergic diseases of a different nature. Inflammation also occurs on the auricle.

During teething, otitis media often occurs in young children. The pediatrician must examine the condition of the child's eardrum, and if it is slightly retracted, this indicates an inflammatory process and otitis media in the middle ear.

Can you diagnose yourself?

It is visually impossible to distinguish otitis externa from the middle one, and the outer ear hurts in the same way as the middle one. The available codes for ICD 10 indicate a wide variety of complications of this disease. Therefore, you cannot treat a diseased organ on your own! This will only make matters worse.

It is permissible to give yourself only first aid. If there is no discharge from the ear, you can apply dry heat or put turundas dipped in boric alcohol.

When treating otitis media itself, it is very important to establish and eliminate its cause. Otherwise, therapy will be useless.

How common is this disease?

Among pediatric pathologies, otitis media is the most common disease. Since anatomically, the ears in infants have a short ear canal, and if you do not hold the child after eating with a column so that he regurgitates and releases air, this can lead to otitis media. Food otitis media in young children and adults is also quite common.

What is the threat?

If the disease is not treated correctly, then the person can become deaf. This is a terrible and serious illness, which is sometimes taken very lightly.

Alertness should be caused by:

frequent colds;
discharge from the ear;
blood comes from the ear.

Does Hygiene Affect?

Otitis externa is often caused by improper ear cleaning. That is, hygiene should be:

without violence;
gently;
with an ear stick, do not stick it far into the ear;
do not scratch your ear with hairpins or sharp objects.

The above addictions lead to a purulent process. And just by scratching the skin of the ear inside, you can provoke otitis externa, and then the middle one.

There are special ear sticks on sale that are exactly the length that you can stick them in your ear. It should be borne in mind that with intensive rubbing of the ears, the production of sulfur is stimulated, and it is an excellent medium for microorganisms.

Very clean people like to clean their ears with cotton swabs, hairpins, matches and other items. But the ear cleans itself and does not need help. Hair follicles and hairs, which are located on the surface of the skin of the ear canal, make constant oscillatory movements during the day. Slow inward and sharp outward. Due to this, the ear pushes out all the dirt that gets into it.

How are sounds perceived?

First, the sound wave enters the eardrum, where it is processed through the ossicles and enters the cochlea. From the cochlea, a sound signal is synchronously transmitted by neurons to the brain. If swelling and inflammation occurs in the path of sound, hearing decreases.

Is it possible to restore hearing quickly?

A lot is real today. It is impossible only to correct the congenital pathology. If a child is born deaf and dumb, it is very rare to restore hearing.

Otitis media treatment is simple. But usually little attention is paid to acute otitis media, and it by itself can “pass” within 2 weeks and smoothly turn into chronic.

In the acute stage, the patient feels a shooting pain. He is hard of hearing. Discomfort, headache and often fever up to 39-40 ° C, especially in children, make you urgently consult a doctor.

And adults are more likely to self-medicate, and the acute stage of otitis media without proper treatment turns into a chronic form. There are cases when, due to a purulent process, the auditory ossicles rot, hearing deteriorates sharply, and only then an adult turns to an otolaryngologist.

Insufficient blood supply and impaired microcirculation of the inner ear lead to hearing loss in old age. The source or impetus to this process may be developing atherosclerosis, so it is imperative to carry out prevention or treatment for this disease. It is not recommended for the elderly to turn on the radio or TV loudly for listening, as this aggravates the development of hearing loss.

Prevention of otitis media is a good immune system. An organism with good immunity copes with viruses and bacteria, and then otitis media can pass in a mild form, even without medical intervention. But if there is pain and after sleep there is discharge from the ear on the pillow (gray-reddish), you should immediately go to the doctor.

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So that the immune system is always in order and colds occur as rarely as possible, it is recommended for adults and children to do massage and gradual hardening.

In children, for the purpose of prevention, it is possible to exclude abundant ingress of water into the ears when bathing. To do this, before bathing, you need to take a cotton swab slightly dipped in simple petroleum jelly and put it in the child's ears so that water does not penetrate into the auricle.

ICD 10 is an international classification of diseases of the 10th revision, adopted in 1999. Each disease is assigned a code or cipher for the convenience of storing and processing statistical data. The ICD 10 is revised periodically (every ten years), during which the system is corrected and supplemented with new information.

Otitis media is an inflammatory type disease that is located in the ear. Depending on in which department the inflammation is localized, in ICD 10 otitis media is divided into three main groups: external, middle, internal. The disease may have additional labeling in each group, indicating the cause of the development or the form of the pathology.

External ear infection, also called swimmer's ear, is inflammatory disease of the external auditory canal... The disease got this name due to the fact that the risk of catching infection is greatest in swimmers. This is explained by the fact that exposure to moisture for a long time provokes infection.

Also, external ear inflammation often develops in people who work in a humid and hot atmosphere, use or. A minor scratch on the external ear canal can also cause the development of the disease.

The main symptoms:

itching, pain in the ear canal of the infected ear;
discharge of purulent masses from the affected ear.

Otitis externa

Attention! If the ear is clogged with purulent masses, do not clean the infected ear at home, this may be fraught with complications of the disease. If you find discharge from the ear, it is recommended that you contact immediately.

According to ICD 10, the otitis externa code has additional marking:

H60.0 - formation of an abscess, abscess, accumulation of purulent discharge;
H60.1 - cellulite of the outer ear - damage to the auricle;
H60.2 - malignant form;
H60.3 - diffuse or hemorrhagic otitis externa;
H60.4 - the formation of a tumor with a capsule in the outer ear;
H60.5 - uninfected acute external ear inflammation;
H60.6 - other forms of pathology, including the chronic form;
H60.7 - unspecified otitis externa.

Otitis media H65-H66

Physicians try to penetrate as deeply as possible into the secrets of diseases for their more effective treatment. At the moment, there are many types of pathology, among which there are non-purulent types with the absence of inflammatory processes in.

Nonsuppurative middle ear inflammation characterized by the accumulation of fluid, which the patient does not feel immediately, but already at a later stage of the disease. Pain during the course of the disease may be completely absent. The absence of damage to the tympanic membrane can also make diagnosis difficult.

Reference. Most often, non-suppurative inflammation in the middle ear is observed in boys under 7 years of age.

This disease can be divided into many factors, including especially highlight:

time of the course of the disease;
clinical stages of the disease.

Depending on the time of the course of the disease, the following forms are distinguished:

in which ear inflammation lasts up to 21 days. Untimely treatment or its absence can lead to irreversible consequences.
Subacute - a more complex form of pathology, which is treated on average up to 56 days and often leads to complications.
Chronic - the most complex form of the disease, which can fade and return throughout life.

The following clinical stages of the disease are distinguished:

catarrhal - lasts up to 30 days;
secretory - the disease lasts up to a year;
mucous - protracted treatment or complication of the disease up to two years;
fibrous - the most severe stage of the disease, which can be treated for more than two years.

The main symptoms of the disease:

discomfort in the ear area, its congestion;
feeling that your own voice sounds too loud;
a feeling of overflowing fluid in the ear;
sustained hearing loss.

Important! At the first suspicious symptoms of ear inflammation, contact immediately. A timely diagnosis and the necessary therapy will help to avoid many complications.

Non-suppurative otitis media (ICD code 10 - H65) is additionally marked as:

H65.0 - Acute serous otitis media;
H65.1 - other acute non-suppurative otitis media;
H65.2 - chronic serous otitis media;
H65.3 - chronic mucous otitis media;
H65.4 - other chronic non-purulent otitis media;
H65.9 - non-suppurative otitis media, unspecified.

Chronic suppurative otitis media

Purulent otitis media (H66) is divided into blocks:

H66.0 - Acute suppurative otitis media;
H66.1 - Chronic tubotympanic purulent otitis media or mesotympanitis, accompanied by rupture of the ear membrane;
H66.2 - chronic epithympano-antral purulent otitis media, in which the auditory ossicles are destroyed;
H66.3 - other chronic suppurative otitis media;
H66.4 - purulent otitis media, unspecified;
H66.9 - otitis media, unspecified.

Internal otitis media H83

Doctors consider one of the most dangerous types of inflammation of the organ of hearing labyrinthitis or internal otitis media (ICD 10 code - H83.0)... In the acute form, the pathology has pronounced symptoms and develops rapidly, in the chronic form, the disease proceeds slowly with periodic manifestation of symptoms.

Attention! Untimely treatment of labyrinthitis can lead to very serious consequences.

The disease is localized inside the auditory analyzer. Because of the inflammation that is near the brain, the signs of this disease are very difficult to recognize, as they can indicate different diseases.

Clinical manifestations:

Dizzinesswhich can go on for quite a long time and disappear instantly. This condition is very difficult to stop, so the patient may suffer from weakness and disorders with the vestibular apparatus for a very long time.
Impaired coordination of movements, which appears due to pressure on the brain.
Constant noise and hearing loss - sure signs of the disease.

This type of disease cannot be treated on its own, since labyrinthitis can be deadly and lead to complete deafness. It is very important to start the correct treatment as early as possible, this is the only way to avoid the consequences.

Thanks to the presence of an understandable classification (ICD-10), it becomes possible to conduct analytical research and accumulate statistics. All data is taken from citizens' appeals and subsequent diagnoses.

Treatment goals:

Relief of the inflammatory process in the middle ear cavity;

Elimination of symptoms of general intoxication;

Hearing restoration;

Disappearance of pathological discharge from the ear;

Improved health and appetite.

Non-drug treatment: regimen - general, diet with the restriction of sweets.

Drug treatment:
1. Relief of fever (\u003e 38.5) - paracetamol ** 10- 15 mg / kg, up to 4 times daily.

2. Toilet of the ear (drain the ear with turunda), after which the transtymponal introduction of local antimicrobial and antibacterial drugs (for example, ear drops withamoxicillin, ciprofloxacin). Topical antibiotics from the quinolone group andsemi-synthetic penicillins are the safest for topical use in childrenpractice.

3. In the presence of an allergic component, desensitizing therapy (for example, diphenhydramine hydrochloride, in an age-related dosage 2 times a day, for 5 days).

4. Antibiotic therapy: antibiotics are prescribed empirically with the predominant use of oral forms. The selection of antibacterial agents according to the sensitivity of the flora in vitro is carried out only if the empirical tactics are ineffective.
The drugs of choice are semisynthetic penicillins, macrolides, alternative - cephalosporins of the II-III generation.

Amoxicillin ** 25 mg / kg 2 times a day for 5 days, or protected penicillins (amoxicillin + clavulanic acid ** 20-40 mg / kg, 3times a day).

Azithromycin * 10 mg / kg 1 day, 5 mg / kg daily for the next 4 days orally or clarithromycin * - 15 mg per kg in divided doses, 10-14 days orallyor erythromycin ** - 40 mg per kg in divided doses, 10-14 days orally.

Cefuroxime * 40 mg / kg / day, divided into 2 divided doses, orally for 10-14 days. Cefuroxime has a maximum dose of 1.5 g in children.

Ceftazidime - powder for solution for injection in a bottle of 500 mg, 1 g, 2 g.

For the treatment and prevention of the onset of mycosis with prolonged massive antibiotic therapy - itraconazole.

Preventive actions:

Prevention of viral diseases;

Avoid getting water in the ears (up to 1 month);

Permanent nose toilet;

Do not bottle feed while lying down.

Prevention of complications:

Timely paracentesis;

Timely hospitalization.

Further management: 5 days after treatment if symptoms persist antibiotic therapy is extended for another 5 days if symptoms persist 2weeks or more, it is necessary to confirm the diagnosis of chronic otitis mediaotoscopically and prescribe appropriate therapy.

List of essential medicines:

1. ** Paracetamol 200 mg, 500 mg table; 2.4% syrup in a bottle; 80 mg suppositories

2. ** Amoxicillin 500 mg, 1000 mg table; 250 mg, 500 mg capsule; 250 mg / 5 ml oral suspension

3. ** Amoxicillin + clavulanic acid, tab. 250 mg / 125 mg, 500 mg / 125 mg, 875 mg / 125 mg, powder for suspension preparation 125 mg / 31.25 mg / 5 ml, 200 mg / 28.5 mg / 5 ml,400 mg / 57 mg / 5 ml

4. * Cefuroxime 250 mg, 500 mg tablet; 750 mg in vial, powder for preparation injection solution