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

• outer;
• average;
• interior

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

Ear pain, drainage and hearing loss are classic signs indicating 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 cause of the development of external otitis may be:

• hypothermia;
• infection acquired during ear cleaning;
• 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 secreted by small blood vessels appears in the lumen of the middle ear.

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

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

• injuries;
• complications of infectious diseases;
• acute otitis media;
• chronic otitis.

The infection enters the inner ear through the blood, meninges and middle ear.

Factors that cause otitis media:

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

With external otitis, a characteristic sharp throbbing pain occurs, which can calm down with chewing and talking. The pain radiates to the teeth, neck and eyes. The ear canal becomes red and swollen when it becomes filled with pus. Hearing also deteriorates.

In acute otitis media, shooting pain begins to bother you, and body temperature often rises. And after 1-2 days, perforation appears in the tympanic cavity and suppuration begins. The pain in the ear disappears or decreases. Body temperature returns to normal.

With chronic otitis, which comes from the acute form, there are complaints of periodic or constant suppuration from the ear, hearing loss and dizziness may occur. Sometimes I am bothered by pressure in the ear and pain in the temporal region.

Signs of internal otitis may include a sudden attack of dizziness, accompanied by nausea and vomiting, and possibly tinnitus.

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

Children most often suffer from otitis media.

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

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

• when feeding, the baby abruptly abandons the breast;
• breathes poorly through his nose;
• nasal congestion;
• wiggles his legs;
• crying is like screaming;
• body temperature rises quickly;
• 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 various types. Inflammation also occurs in the ear.

During the period of teething, otitis media also 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.

Is it possible to make a diagnosis yourself?

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

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

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

How common is this disease?

Among childhood pathologies, otitis media is the most common disease. Since anatomically, the ears of infants have a short auditory canal, and if you do not hold the child in a column after eating so that he burps and releases air, this can lead to otitis media. Foodborne otitis media also occurs quite often in young children and adults.

What is the threat?

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

You should be wary of:

• frequent colds;
• discharge from the ear;
• there is blood coming from the ear.

Does hygiene matter?

Otitis externa often occurs due to improper ear cleaning. That is, hygiene should be:

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

The above bad habits lead to a purulent process. And simply by scratching the skin of the ear inside, you can provoke otitis externa, and then medial.

There are special ear sticks on sale that are just the right length to fit into your ear. It should be taken into account that intensive rubbing of the ears stimulates the production of wax, and it is an excellent environment for microorganisms.

Very clean people like to clean their ears with cotton swabs, hairpins, matches and other objects. 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 throughout the day. Slow inwards and sharp outwards. 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 auditory ossicles and enters the cochlea. From the cochlea, the sound signal is synchronously transmitted by neurons to the brain. If swelling and inflammation occur in the path of sound, hearing decreases.

Is it possible to restore hearing quickly?

A lot is real today. It is impossible to just correct a congenital pathology. If a child was born deaf and mute, it is very rare that hearing can be restored.

Treatment of otitis media is simple. But usually little attention is paid to acute otitis, and it can “go away” on its own within 2 weeks and smoothly turn into chronic.

In the acute stage, the patient feels shooting pain. He doesn't hear well. Discomfort, headache and often elevated temperature up to 39-40°C, especially in children, force you to urgently consult a doctor.

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

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

Prevention of otitis is a good immune system. A body with good immunity copes with viruses and bacteria, and then otitis media can go away 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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To ensure that the immune system is always in order and colds occur as rarely as possible, it is recommended that adults and children undergo massage and gradual hardening.

In children, for the purpose of prevention, it is possible to prevent excessive water from entering the ears when bathing. To do this, before bathing, you need to take a cotton wool slightly moistened with simple Vaseline and put it in the child’s ears so that water does not penetrate into the auricle.

In search of the necessary information regarding the disease of interest, a person is faced with an abbreviation such as “ICD 10”. What does it mean? ICD stands for International Classification of Diseases, which describes the coding of each disease. The number 10 indicates that this directory was approved in accordance with the normative act of the tenth revision at the end of the nineties of the last century. Every 5-10 years the directory is reviewed and adjustments are made.

Among ear pathologies, the most common is otitis media. According to the ICD 10 reference book, it refers to diseases of the ear and mastoid process.

Each disease, including otitis media, in children and adults has its own code, consisting of large letters of the Latin alphabet and numbers. All groups are divided into several subgroups, and those, in turn, are divided into sections. The basis is what part of the organ is affected, what was the source of the disease, and in what form it occurs.

Otitis is an inflammatory disease that involves parts of the human hearing system. It occurs as a result of viruses and bacteria entering the ear, with the further development of pathology.

Contributing factors to the appearance of otitis media are weakened immunity, the presence of foci of inflammation in the nasopharynx, and underdevelopment of the eustachian tube in a child. The ICD 10 code is compiled for ear pathologies according to several criteria:

• location of the process (external, middle, inner ear);
• epidemiology (type of pathogen that provoked the pathology);
• in what form it occurs (acute, chronic);
• the nature of the exudate (purulent, serous, catarrhal, hemorrhagic).

Diseases of the external ear H60 – H62

Otitis externa (H 60) is a disease that affects the concha, cartilage, and ear canal. The main symptoms for this condition will be irritation, tissue swelling, purulent or serous discharge from the diseased organ.

The most common cause of outer ear diseases is a bacterial infection. Contributing factors to the development of pathology are:

• injuries;
• bites;
• burns;
• frostbite.

Otitis with external localization affects all groups of the population, regardless of age. But still, the disease is more often diagnosed in children and the elderly. The reason for this is the weakening of the body’s protective functions.

H60, according to ICD 10, is divided into the following subgroups:

• H60.0 – Abscesses. It is characterized by furunculosis of the external auditory canal and concha, carbuncles, and abscess after trauma. This condition is characterized by swelling, redness, throbbing pain, and the presence of purulent exudate at the site of inflammation.
• H60.1 – Wen (atheromas).
• H60.2 – Malignant form. For this group, acute symptomatic manifestations are not typical; it proceeds sluggishly. Bone, periosteum, and cartilage may be involved in the process. People who have undergone a course of chemotherapy, have a history of diabetes, or are infected with HIV are at risk.
• H60.3 – Other infectious forms. According to the ICD, this includes diffuse and hemorrhagic damage to the external ear, a disease called “Swimmer’s ear” - a pathology that is provoked by constant exposure to moisture on the organ.
• H60.4 – Choleastomy (keratosis). This disease has no pronounced symptoms; the patient may not know about its existence for a long time. It is characterized by fusion of the epidermis of the ear canal with the tissues of the eardrum, followed by the formation of a tumor-like formation in which keratin accumulates.
• H60.5 – Acute external otitis of non-infectious origin. In turn, the subgroup is divided into sections, depending on the origin:
  • chemical – occurs due to exposure to aggressive components such as acid, alkali;
  • reactive – accompanied by lightning-fast development of swelling;
  • actinic;
  • contact – occurs after contact with a potential allergen;
  • eczematous – characterized by the presence of rashes typical of eczema;
• H60.8 – Other forms of otitis externa NOS.
• H60.9 – Inflammation without specified etiology.

According to ICD 10, coded H61 encodes diseases of the external part of the hearing aid that are not associated with inflammatory processes. This includes concha deformation, cerumen plug, stenosis and evostosis of the auditory canal, and other unspecified pathologies.

Code H62 according to ICD 10 includes external otitis caused by systemic pathologies of an infectious nature. Inflammation can be caused by herpes zoster, herpes, mycosis, candidiasis, and impetigo.

Otitis media H65 – H66

Otitis media is a pathology, in most cases provoked by infectious pathogens. Often inflammation in this department occurs due to viruses entering the body. Penetrating the mucous membranes of the nasopharynx, they quickly multiply, penetrate the bloodstream, with which they spread throughout the body, including the ear apparatus. The pathogen can also enter directly from lesions in the nasopharynx and paranasal sinuses through the Eustachian tube. Children in the first years of life, who have a short and wide tube, are especially susceptible to this method of transmission.

According to ICD 10, otitis media is divided into catarrhal and purulent.

Non-suppurative otitis media H65

This pathology is characterized by inflammation of the middle part of the ear apparatus, including the eardrum. The primary cause is viruses followed by bacterial infection. This form of the disease is called catarrhal; there is no purulent discharge.

Provoking factors for the development of otitis media in most cases are pathologies of the nasopharynx, such as sinusitis, tonsillitis, adenoiditis, deviated nasal septum, and rhinitis. Patients with this pathology express the following complaints:

• Severe pain syndrome of a different nature. The pain can be acute, aching, throbbing, shooting, bursting.
• Feeling of ear fullness, extraneous noise.
• Decreased hearing acuity.
• Impaired sound perception of one's own voice.
• Feeling of water transfusion inside the organ.

There are three forms of non-purulent otitis media, which are also divided into pathologies in ICD 10:

• acute, lasts up to three weeks;
• subacute, manifests itself within two months;
• chronic, appears when assistance is not provided in a timely manner or therapy is incorrectly selected; it is impossible to get rid of this form.

Non-suppurative otitis media according to ICD 10 is coded as H65 and is divided into the following subgroups:

• H65.0 – acute otitis media with serous discharge;
• H65.1 – other non-purulent lesions of the middle section;
• H65.2 – chronic serous otitis;
• H65.3 – mucous otitis media (chronic);
• H65.4 – other non-purulent chronic otitis;
• H65.9 – otitis media of unspecified etiology.

Suppurative otitis media H66

This form of the disease is characterized by the presence of purulent masses in the ear. The pathology is often accompanied by a rupture of the eardrum. The purulent process is dangerous with complications, including meningitis, brain abscesses, sepsis, and complete hearing loss.

According to the ICD 10 classifiers, H66 is divided into the following sections:

• H66.0 – acute purulent otitis media of the middle ear;
• H66.1 – otitis media, accompanied by rupture of the eardrum;
• H66.2 - chronic epitympano - antral purulent otitis media, accompanied by destruction of the auditory ossicles;
• H66.3 – other chronic purulent otitis media;
• H66.4 – purulent otitis media of unspecified etiology;
• H66.9 – otitis NOS.

Perforation of the eardrum H72

A ruptured eardrum, according to ICD 10, has code H72. Depending on the location of the perforation, the group is divided into several sections.

An inflammatory process in the middle ear, as a result of which a large amount of fluid is formed, can serve as the root cause of this condition. It puts pressure on the membrane and causes it to rupture.

Perforation can also occur due to trauma. In this case, the rupture will be followed by inflammation of the middle ear.

Conclusion

With the advent of the ICD reference book, maintaining analytics and statistics on morbidity and relapse rates has become significantly easier. All data is taken from reports of employees of medical institutions. One ICD 10 code encrypts the type of disease, its form, which system or organ is affected.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Otitis externa, unspecified (H60.9)

general information

Short description

Otitis externa includes all inflammatory conditions of the ear, external auditory canal, or outer surface of the eardrum. Otitis externa can be localized or diffuse, acute or chronic.

Localized external otitis (furuncle)- inflammation of the hair follicle of the external auditory canal, the causative agent is most often Staphylococcus aureus. The cause of diffuse external otitis in most cases is Pseudomonas aeruginosa or Staphylococcus aureus, as well as fungal infection, contact dermatitis, and allergic contact dermatitis.

Protocol code: P-S-016 "Otitis externa"

Profile: surgical

Stage: PHC

ICD-10 code(s): H60.9 Otitis externa, unspecified

Risk factors and groups

Water ingress into the external auditory canal, hot and humid climates, atopic and other allergic conditions, seborrheic eczema and other skin diseases, some systemic diseases (diabetes mellitus), some psychosocial problems, chronic otitis media, erysipelas, herpes zoster.

Diagnostics

Diagnostic criteria

Complaints and anamnesis: swelling and redness of the skin of the ear canal, peeling, weeping, mucous or purulent discharge. The sharp pain at first gives way to severe itching and a feeling of stuffiness in the ear.

Physical examination: diagnosis based on complaints, examination, hearing audiogram.

Laboratory tests: not specific.

Instrumental studies: Sometimes bacteriological culture of pus and testing for fungi is necessary.

List of main diagnostic measures:

1. General blood test (6 parameters).

2. Microreaction.

List of additional diagnostic measures:

1. General urine test.

2. Determination of glucose.

3. Examination of stool for worm eggs.

Treatment abroad

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Treatment

Treatment tactics

Treatment goals:

Non-drug treatment: no.

Drug treatment

For diffuse external otitis, wash the ear with a warm solution of rivanol (1:5000), lubricate it with a 3-5% solution of silver nitrate, 1-2% alcohol solution of brilliant green, gauze swabs moistened with a 2% solution of aluminum subacetate or a 3% alcohol solution of boric acid.

Ear drops with gentamicin and ear drops with antibiotics in combination with corticosteroids are also used (Framecitin sulfate 5 mg + Gramicidin, 50 mcg + Dexamethasone metasulfobenzoate, 500 mcg/ml, ear drops prednisolone/neomycin, betamethasone/neomycin, gentamicin/hydrocortisone).

For external otitis of fungal etiology, ointments of hydrocortisone, oxycort and prednisolone provide a good anti-inflammatory effect. NSAIDs (paracetamol 0.5-1.0 4 times a day, ibuprofen 400 mg 3 times a day) are used for external otitis of fungal etiology.

Antibacterial therapy (amoxicillin 250/5 ml, erythromycin 250-500 mg 3 times a day) is prescribed for external otitis of bacterial etiology.

Indications for hospitalization: in case of severe pain in the ear or the presence of a boil, they are transferred to a hospital for surgical intervention.

List of essential medications:

1. Rivanol solution (1:5000)

2. Silver nitrate 3-5% solution

3. *Brilliant green alcohol solution 1%, 2% in a bottle of 10 ml, 20 ml

4. Aluminum subacetate 2% solution

5. *Boric acid alcohol solution 3% 10-50 ml powder

6. *Gentamicin solution (eye drops) 0.3% 5 ml

7. *Betamethasone injection solution in 1 ml ampoule

8. *Hydrocortisone ointment, gel 1%

9. *Methylprednisolone ointment

10. *Ibuprofen 200 mg, 400 mg tablet.

11. **Amoxicillin, oral suspension 250 mg/5 ml

12. **Amoxicillin + clavulanic acid powder for the preparation of suspension for oral administration 156.25/5 ml; 312.5 mg/5 ml

13. **Framecitin sulfate 5 mg + Gramicidin, 50 mcg + Dexamethasone metasulfobenzoate, 500 mcg/ml, ear drops

List of additional medications:

1. **Paracetamol syrup 2.4% in a bottle; suspension; suppositories 80 mg

2. *Diphenhydramine solution for injection 1% 1 ml

3. *Fluconazole capsule 50 mg, 150 mg; solution in a bottle for intravenous administration 100 ml

Indicators of treatment effectiveness: eliminating symptoms, eliminating infection, reducing the risk of recurrence, preventing complications.

* - drugs included in the list of essential (vital) medicines.

** - included in the list of types of diseases for outpatient treatment of which drugs are dispensed according to prescriptions free of charge and on preferential terms.

Information

Sources and literature

1. Protocols for diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007)
   1. 1. Hirsch BE. Infection of the external ear. Am J Otolaryngol 1992;17:207 2. Hirsch BE. Infection of the external ear. Am J Otolaryngol 1992;13:145-155 3. Otitis externa. Daniel Hajioff. Search date March 2005 BMJ 4. Prodigy Guidance – Otitis externa, 2004.

Information

List of developers: Sagatova G.S., City Clinical Hospital No. 5, Almaty

Attached files

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Included: with myringitis

To specify a perforated eardrum, use the additional code (H72.-)

Acute and subacute secretory otitis media

Otitis media, acute and subacute:

allergic (mucosal) (hemorrhagic) (serous) mucous non-purulent NOS hemorrhagic serous-mucosal

Excluded:

otitis due to barotrauma (T70.0) otitis media (acute) NOS (H66.9)

Chronic tubotympanic catarrh

Chronic otitis media:

mucous secretory transudative

Excludes: adhesive middle ear disease (H74.1)

Chronic otitis media:

allergic exudative non-purulent NOS serous-mucinous with effusion (non-purulent)

Otitis media:

allergic catarrhal exudative mucus-like secretory serous-mucous serous transudative with effusion (non-purulent)

In Russia International Classification of Diseases 10th revision ( ICD-10) was adopted as a single normative document for recording morbidity, reasons for the population’s visits to medical institutions of all departments, and causes of death.

ICD-10 introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions WHO 1990-2018.

Acute serous otitis media

Definition and general information [edit]

Synonyms: Secretory or non-purulent otitis media.

Otitis media is an otitis media in which the mucous membranes of the middle ear cavities are affected. Exudative otitis media is characterized by the presence of exudate and hearing loss in the absence of pain, with a intact eardrum.

The disease most often develops in preschool age, less often at school age. Mostly boys are affected. According to M. Tos, 80% of healthy people suffered exudative otitis media in childhood. It should be noted that in children with congenital cleft lip and palate, the disease occurs much more often.

Over the past decade, a number of domestic authors have noted a significant increase in incidence. Perhaps there is not an actual increase in it, but an improvement in diagnostics as a result of equipping audiology offices and centers with audio-acoustic equipment and the introduction of objective research methods (impedance testing, acoustic reflexometry) into practical healthcare.

Currently, exudative otitis media is divided into three forms based on the duration of the disease:

Acute (up to 3 weeks);

Subacute (3-8 weeks);

Chronic (more than 8 weeks).

Etiology and pathogenesis[edit]

The most common theories of the development of exudative otitis media:

“hydrops ex vacuo”, proposed by A. Politzer (1878), according to which the disease is based on reasons that contribute to the development of negative pressure in the cavities of the middle ear;

Exudative, explaining the formation of secretion in the tympanic cavity by inflammatory changes in the mucous membrane of the middle ear;

Secretory, based on the results of studying factors contributing to hypersecretion of the mucous membrane of the middle ear.

In the initial stage of the disease, the squamous epithelium degenerates into a secreting one. In the secretory (period of accumulation of exudate in the middle ear) - a pathologically high density of goblet cells and mucous glands develops. In degenerative - secretion production decreases due to their degeneration. The process proceeds slowly and is accompanied by a gradual decrease in the frequency of goblet cell division.

The presented theories of the development of exudative otitis media are actually parts of a single process that reflects various stages of chronic inflammation. Among the causes leading to the onset of the disease, most authors focus on the pathology of the upper respiratory tract of an inflammatory and allergic nature. A necessary condition for the development of exudative otitis media (trigger mechanism) is considered to be the presence of mechanical obstruction of the pharyngeal mouth of the auditory tube.

Endoscopic examination in patients with auditory tube dysfunction shows that the cause of exudative otitis media in most cases is a violation of the outflow pathways of secretions from the paranasal sinuses, primarily from the anterior chambers (maxillary, frontal, anterior ethmoid) into the nasopharynx. Normally, transport goes through the ethmoidal funnel and the frontal recess to the free edge of the posterior part of the uncinate process, then to the medial surface of the inferior nasal concha, bypassing the mouth of the auditory tube in front and below; and from the posterior ethmoidal cells and the sphenoid sinus - posterior and superior to the tubar opening, uniting in the oropharynx under the influence of gravity. With vasomotor diseases and sharply increased secretion viscosity, mucociliary clearance is slowed down. In this case, the merging of flows to the tubal opening or pathological turbulence with the circulation of secretions around the mouth of the auditory tube with pathological reflux into its pharyngeal mouth is noted. With hyperplasia of the adenoid vegetations, the path of the posterior mucus flow moves forward, also to the mouth of the auditory tube. A change in the natural outflow tract may also be due to a change in the architectonics of the nasal cavity, especially the middle meatus and the lateral wall of the nasal cavity.

Pathogenetically, stage IV of the course is distinguished:

Catarrhal (up to 1 month);

Secretory (1-12 months);

Mucosal (12-24 months);

Fibrous (more than 24 months).

Clinical manifestations[edit]

The asymptomatic course of exudative otitis media is the reason for late diagnosis, especially in young children. The disease is often preceded by pathology of the upper respiratory tract (acute or chronic). Hearing loss is typical.

Acute serous otitis media: Diagnosis[edit]

Early diagnosis is possible in children over 6 years of age. At this age (and older), complaints of ear congestion and hearing fluctuation are likely. Painful sensations are rare and short-lived.

Upon examination, the color of the eardrum is variable - from whitish, pink to cyanotic against the background of increased vascularization. Air bubbles or exudate levels behind the eardrum may be detected. The latter, as a rule, is retracted, the cone of light is deformed, the short process of the malleus protrudes sharply into the lumen of the external auditory canal. The mobility of the retracted tympanic membrane with exudative otitis media is sharply limited, which is quite easy to determine using a pneumatic Siegle funnel. Physical data vary depending on the stage of the process.

Otoscopy at the catarrhal stage reveals retraction and limited mobility of the eardrum, a change in its color (from cloudy to pink), and shortening of the cone of light. Exudate behind the eardrum is not visible, however, prolonged negative pressure due to impaired aeration of the cavity creates conditions for the appearance of contents in the form of transudate from the vessels of the mucous membrane.

Otoscopy at the secretory stage reveals thickening of the tympanic membrane, a change in its color (to bluish), retraction in the upper and bulging in the lower sections, which is considered an indirect sign of the presence of exudate in the tympanic cavity. Metaplastic changes appear and increase in the mucous membrane in the form of an increase in the number of secretory glands and goblet cells, which leads to the formation and accumulation of mucous exudate in the tympanic cavity.

The mucosal stage is characterized by persistent hearing loss. Otoscopy reveals a sharp retraction of the tympanic membrane in the loose part, its complete immobility, thickening, cyanosis and bulging in the lower quadrants. The contents of the tympanic cavity become thick and viscous, which is accompanied by limited mobility of the chain of auditory ossicles.

During otoscopy at the fibrous stage, the eardrum is thinned, atrophic, and pale in color. A long course of exudative otitis media leads to the formation of scars and atelectasis, foci of myringosclerosis.

The fundamental diagnostic technique is tympanometry. When analyzing tympanograms, the classification of V. Jerger is used.

Differential diagnosis[edit]

Differential diagnosis of exudative otitis media is carried out with ear diseases accompanied by conductive hearing loss with an intact eardrum.

Acute serous otitis media: Treatment[edit]

Therapeutic tactics for stage I exudative otitis media: sanitation of the upper respiratory tract; in case of surgical intervention, audiometry and tympanometry are performed 1 month after surgery. If hearing loss persists and a type C tympanogram is recorded, measures are taken to eliminate the dysfunction of the auditory tube. Timely initiation of therapy at the catarrhal stage leads to a rapid cure of the disease, which in this case can be interpreted as tubo-otitis. In the absence of therapy, the process moves to the next stage.

Therapeutic tactics for stage II exudative otitis media: sanitation of the upper respiratory tract (if not performed previously); myringostomy in the anterior parts of the eardrum with the introduction of a ventilation tube. The stage of exudative otitis media is verified intraoperatively: at stage II, the exudate is easily and completely removed from the tympanic cavity through the myringostomy hole.

Therapeutic tactics for stage III exudative otitis media: simultaneous sanitation of the upper respiratory tract with shunting (if it has not been carried out previously); tympanostomy in the anterior parts of the tympanic membrane with the introduction of a ventilation tube, tympanotomy with revision of the tympanic cavity, washing and removal of thick exudate from all parts of the tympanic cavity. Indications for one-stage tympanotomy are the impossibility of removing thick exudate through a tympanostomy.

Therapeutic tactics for stage IV exudative otitis media: sanitation of the upper respiratory tract (if it has not been carried out previously); tympanostomy in the anterior parts of the eardrum with the introduction of a ventilation tube; one-stage tympanotomy with removal of tympanosclerotic lesions; mobilization of the auditory ossicular chain.

Indications for hospitalization

The need for surgical intervention.

Impossibility of conservative treatment on an outpatient basis.

Blowing the auditory tube:

Catheterization of the auditory tube;

Politzer blowing;

In the treatment of patients with exudative otitis media, physiotherapy is widely used - intra-auricular electrophoresis with proteolytic enzymes and steroid hormones. They prefer endaural phonophoresis of acetylcysteine ​​(8-10 procedures per course of treatment at stages I-III), as well as on the mastoid process with hyaluronidase (8-10 sessions per course of treatment at stages II-IV).

In the second half of the last century, it was shown that inflammation in the middle ear with exudative otitis media in 50% of cases is aseptic in nature. The rest were patients in whom Haemophilus influenzae, Branhamella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes were cultured from the exudate; therefore, as a rule, antibacterial therapy is carried out. Antibiotics of the same series are used as in the treatment of acute otitis media (amoxicillin + clavulanic acid, macrolides). However, the issue of including antibiotics in the treatment regimen for exudative otitis media remains controversial. Their effect is only 15%; taking in combination with tableted glucocorticoids (for 7-14 days) increases the result of therapy only up to 25%. Nevertheless, most foreign researchers consider the use of antibiotics justified. Antihistamines (diphenhydramine, chloropyramine, hifenadine), especially in combination with antibiotics, inhibit the formation of vaccine immunity and suppress nonspecific anti-infective resistance. For the treatment of the acute stage, many authors recommend anti-inflammatory (fenspiride), anti-edematous, nonspecific complex hyposensitizing therapy, and the use of vasoconstrictors. Children with stage IV exudative otitis media are administered hyaluronidase 32 units in parallel with physiotherapeutic treatment for 10-12 days. In everyday practice, mucolytics are widely used in the form of powders, syrups and tablets (acetylcysteine, carbocysteine) to thin the exudate in the middle ear. The course of treatment is 10-14 days.

If conservative therapy is ineffective, patients with chronic exudative otitis media undergo surgical treatment, the purpose of which is to remove exudate, restore auditory function and prevent relapse of the disease. Otosurgical intervention is performed only after or during sanitation of the upper respiratory tract.

Prevention[edit]

Prevention of exudative otitis media - timely sanitation of the upper respiratory tract.

Other [edit]

Dynamics in stage I of the disease and adequate treatment lead to complete recovery of patients. Primary diagnosis of exudative otitis media in stage II and subsequent stages and, as a consequence, delayed initiation of therapy lead to a progressive increase in the number of unfavorable outcomes. Negative pressure and restructuring of the mucous membrane in the tympanic cavity cause changes in the structure of both the eardrum and the mucous membrane.

The creation of an algorithm for treating patients depending on the stage of exudative otitis media made it possible to achieve restoration of auditory function in the majority of patients. At the same time, observations of children with exudative otitis media for 15 years showed that 18-34% of patients develop relapses. Among the most significant reasons are the persistence of manifestations of chronic disease of the nasal mucosa and the late start of treatment.

Classification of otitis according to ICD 10

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

Otitis is an inflammatory disease that is based in the ear. Depending on which part of the hearing organ the inflammation is localized in, ICD 10 divides otitis into three main groups: external, middle, internal. The disease may have additional markings in each group, indicating the cause of development or the form of the pathology.

Otitis externa H60

External ear inflammation, also called swimmer's ear, is Inflammatory disease of the external auditory canal. The disease received this name due to the fact that the risk of contracting the infection is greatest among 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, or use hearing aids or earplugs. A minor scratch on the external auditory canal can also cause the development of the disease.

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

Attention! If your ear is clogged with purulent masses, do not clean the infected ear at home; this may result in complications of the disease. If you notice discharge from the ear, it is recommended to consult a doctor immediately.

According to ICD 10, the code for external otitis has additional markings:

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

Otitis media H65-H66

Doctors are trying 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 also non-purulent types with the absence of inflammatory processes in the middle ear.

Non-purulent inflammation of the middle ear characterized by the accumulation of fluid, which the patient does not feel immediately, but only at later stages of the disease. Pain during the course of the disease may be completely absent. The absence of damage to the eardrum can also make diagnosis difficult.

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

This disease can be divided according to many factors, including Especially highlight:

duration of the disease; clinical stages of the disease.

Depending on the duration of the disease, the following forms are distinguished:

Acute, in which ear inflammation lasts up to 21 days. Delayed treatment or lack thereof 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; Mucosal- prolonged treatment or complication of the disease for up to two years; Fibrous- the most severe stage of the disease, which can be treated for more than two years.

Main symptoms of the disease:

discomfort in the ear area, its congestion; feeling that your own voice is too loud; sensation of iridescent fluid in the ear; persistent decrease in hearing level.

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

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

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

Suppurative otitis media (H66) is divided into blocks:

H66.0- acute purulent otitis media; H66.1- chronic tubotympanic purulent otitis media or mesotympanitis, accompanied by rupture of the eardrum; H66.2- chronic epitympanic-antral purulent otitis media, in which destruction of the auditory ossicles occurs; H66.3- other chronic purulent otitis media; H66.4- purulent otitis media, unspecified; H66.9- otitis media, unspecified.

Internal otitis H83

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

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

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

Clinical manifestations:

Dizziness, which can last for quite a long time and disappear instantly. This condition is very difficult to stop, so the patient may suffer from weakness and disorders of the vestibular system 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 independently, since labyrinthitis can be deadly and lead to complete deafness. It is very important to start proper treatment as early as possible, this is the only way to avoid consequences.

Thanks to the presence of a clear classification (ICD-10), it becomes possible to conduct analytical research and accumulate statistics. All data is taken from citizens’ requests and subsequent diagnoses.

Acute otitis media lasts on average about 2-3 weeks. During a typical acute otitis media, 3 successive stages are distinguished: pre-perforation (initial), perforation and reparative. Each of these stages has its own clinical manifestations. With timely treatment or high immunological resistance of the body, acute otitis media can take an abortive course at any of the indicated stages.
The pre-perforative stage of acute otitis media can take only a few hours or last 4-6 days. It is characterized by a sudden onset of intense ear pain and severe general symptoms. Ear pain is caused by rapidly increasing inflammatory infiltration of the mucous membrane lining the tympanic cavity, resulting in irritation of the nerve endings of the glossopharyngeal and trigeminal nerves. Ear pain in acute otitis media is sharply painful and sometimes unbearable, leading to sleep disturbances and decreased appetite. It radiates to the temporal and parietal regions. Pain syndrome in patients with acute otitis media is accompanied by noise and congestion in the ear, and hearing loss. These symptoms are due to the fact that due to inflammatory changes, the mobility of the auditory ossicles located in the tympanic cavity, which are responsible for sound conduction, decreases.
General manifestations of acute otitis media are an increase in body temperature to 39°C, general weakness, chills, fatigue and weakness. Influenza, scarlet fever and measles acute otitis media often occur with simultaneous involvement in the inflammatory process of the inner ear with the development of labyrinthitis and hearing loss due to sound perception disorders.
The perforated stage of acute otitis media occurs when, as a result of the accumulation of too much purulent content in the tympanic cavity, the eardrum ruptures. Through the resulting hole, mucopurulent, then purulent, and sometimes bloody discharge begins to emerge. At the same time, the health of the patient with acute otitis media improves noticeably, the pain in the ear subsides, and the body temperature improves. Suppuration usually lasts no more than a week, after which the disease progresses to the next stage.
The reparative stage of acute otitis media is characterized by a sharp decrease and cessation of suppuration from the ear. In most patients at this stage, spontaneous scarring of the perforation in the eardrum occurs and complete restoration of hearing occurs. If the perforation size is more than 1 mm, the fibrous layer of the eardrum is not restored. If healing of the hole does occur, then the perforation site remains atrophic and thin, since it is formed only by the epithelial and mucous layers without a fibrous component. Large perforations of the eardrum do not close; along their edge, the outer epidermal layer of the membrane fuses with the internal mucous membrane, forming calloused edges of the residual perforation.