Infection routes of acute suppurative otitis media, 3 common routes

There are many routes of infection for acute suppurative otitis media, such as the Eustachian tube route and bloodstream infection, which is also common in children. High fever symptoms will appear in the early stages of suppuration. Antibiotics should be used in time for anti-inflammatory treatment to avoid suppuration.

1. Infection route of acute suppurative otitis media

1) Eustachian tube route: infection through this route is the most common. In acute infectious diseases such as upper respiratory tract infection, scarlet fever, measles, whooping cough, etc., the nasopharynx and Eustachian tube mucosa become congested, swollen, and dysfunctional, allowing pathogenic bacteria to invade the tympanic cavity and cause the disease.

2) Through the external auditory canal and tympanic membrane: When the tympanic membrane is injured or ruptured during surgery, the pathogenic bacteria invade the tympanic cavity through the external auditory canal and the tympanic membrane perforation.

3) Hematogenous infection: When the body's resistance is extremely low, the bacteria can infect the middle ear through the blood circulation, but this is rare.

2. Clinical manifestations

(I) Eustachian tube obstruction

The tympanic membrane is retracted, low-pitched tinnitus and mild conductive hearing loss occur. Children cannot describe it, but feel discomfort in the ear, which affects their normal play. The handle of the malleus is congested and protrudes, and its position is relatively horizontal. The short process is obviously raised like a bone spur. In the early stage, there is exudate in the tympanic cavity, and bubbles or fluid levels can occasionally be seen through the tympanic membrane. At this stage, patients often think it is a cold.

(II) Pre-suppurative period

The tympanic membrane shows radial concentric congestion, the handle of the malleus becomes a red rod, followed by redness, swelling and bulging of the flaccid part, and soon the entire tympanic membrane becomes red and bulging. During this period, children have high fever, convulsions, shake their heads and scratch their ears, cry and are restless, often have diarrhea and vomiting, and are often misdiagnosed as gastrointestinal diseases. Adults have obvious tinnitus, deafness and severe ear pain, and fever reaches 38-40℃. If effective antibiotic treatment is actively carried out during this period, the condition can gradually subside, otherwise it will enter the suppuration stage.

(III) Purulent stage

There is a large amount of pus in the tympanic cavity, the tympanic membrane is extremely bulging, the shape of the malleus disappears, there is throbbing tinnitus, severe deafness, and severe ear pain that can radiate to the maxillary teeth and temporal top, and obvious tenderness in the McBurney triangle, i.e. the mastoid sinus area, on the posterior wall of the external auditory canal opening. The child has a high fever, refuses to eat, is restless, and has a pale face and other signs of poisoning.

(IV) Dissipation period

After 4 to 5 days of infection, the center of the eardrum turns yellow and necrotic, and finally perforates and oozes pus, which is initially serous and later becomes sticky pus and pure pus. The perforation changes from a small central hole to a large kidney-shaped perforation. Once the perforation oozes pus, all symptoms except tinnitus and deafness disappear suddenly, the body temperature returns to normal, children can fall asleep after drinking milk, and adults can work normally.