Sulfisomidine treatment case

Cause of disease

Acute suppurative infection of the middle ear mucosa caused by bacteria entering the middle ear through certain routes is called acute suppurative otitis media. Pathogenic bacteria are more common with hemolytic streptococcus, Staphylococcus aureus, pneumococci, and Proteus. Because the position of the eustachian tube and the mouth of the eustachian tube is almost at the same level, and the eustachian tube is short and the diameter is relatively thick, the disease is more common in children. If it can not be treated in a timely and effective manner, it may cause acute suppurative otitis media or prolonged suppurative otitis media, and even intracranial and extracranial complications, so it should be noted.

Decreased body resistance, such as nutritional disorders, cold or wet, known as chronic diseases and allergic diseases, is the cause of this disease. The path of pathogenic bacteria into the middle ear is: (1) Eustachian tube pathway: 1 When the upper respiratory tract is acutely infected, the pathogen enters the middle ear through the eustachian tube. 2 acute infectious diseases, especially when scarlet fever and measles occur, may be complicated by the disease. 3 breastfeeding posture is not appropriate, such as the horizontal hug baby, or infants and children in the flat sucking bottle, the milk easily through the eustachian tube into the middle ear. 4 excessive force to the nose, swimming and diving in dirty water, inappropriate eustachian tube blowing and nasal irrigation, the bacteria can enter the middle ear through the eustachian tube. 5 acute otitis media with otitis, if bacterial invasion, can develop acute suppurative otitis media. (2) External ear pathway: Due to rupture of the tympanic membrane, pathogenic bacteria enter the middle ear through the rupture of the tympanic membrane, causing infection. (3) Hematopoietic: Although the pathogenic bacteria cause less inflammation through the blood circulation into the middle ear, the lesion often causes tympanic membrane necrosis. More common in scarlet fever and typhoid fever.

Acute middle ear symptoms

The pathological changes of acute suppurative otitis media are limited to the mucosa, which is characterized by hyperemia and edema, and there are round cell infiltration and mucosal epithelial necrosis. The exudate gradually changed from clear to purulent, and finally purulent. Due to the accumulation of pus on the outside of the drum, the internal pressure is increased, the tympanic membrane is compressed, or the tympanic membrane itself is softened by inflammation or an interstitial abscess occurs, and the tympanic membrane is broken, and the pus in the middle ear is drained to the external auditory canal. Due to the continuity of the middle ear structure, lesions often extend to the mastoid air chamber, and severe cases can develop acute suppurative otitis media.

The main symptoms and examination of acute suppurative otitis media are very different before and after perforation of the tympanic membrane, which is manifested in the following aspects:
(1) systemic symptoms: before the tympanic membrane perforation, systemic fever, aversion to cold, fatigue and other symptoms are more obvious. Children are often accompanied by acute gastroenteritis symptoms such as vomiting and diarrhea. The tympanic membrane is pierced with deep pain or tingling in the deep anterior ear. The pain can be radiated to the ipsilateral frontal part, ankle, and teeth. This is caused by the trigeminal nerve branch on the tympanic membrane (the external auditory canal of the deafness nerve). Infants and young children often cry and restless, refuse to eat. When the tympanic membrane is spontaneously perforated or the pus is discharged by treatment such as incision, the pain is suddenly reduced and the systemic symptoms are also improved.

(2) Deafness and tinnitus: the initial feeling of ear suffocation, followed by hearing loss, accompanied by tinnitus. After the perforation, the deafness is reduced. Sometimes it can be accompanied by dizziness.

(3) Pus in the ear: After the perforation of the tympanic membrane, there is pus out in the ear, the initial blood, and later white pus or yellow pus.

 (4) Otoscopy: the initial tympanic membrane is congested, and the radial bulging vessels are visible around the hammer stem and the tension. The tympanic membrane is diffusely congested with swelling, and the outer bulge is papillary, with yellow spots in the center. At the beginning of the perforation of the tympanic membrane, due to the small perforation, the scintillation beat point can be seen at the perforation of the tympanic membrane after the pus is removed, or there is a pus outflow there.

(5) Hearing examination: showing the transmission of deafness. Hearing improved after piercing.

(6) palpation examination: due to the inflammatory reaction of the mastoid periosteum, there may be tenderness at the tip of the mastoid. The tympanic membrane gradually disappears after perforation.
Acute otitis media treatment

The principle of treatment of acute suppurative otitis media is to control infection, patency and etiology.

(1) systemic treatment: 1 early and correct application of antibiotics or sulfa drugs to control the infection, until the symptoms disappeared 5 to 7 days after stopping the drug, must be completely cured to prevent chronic changes. Clinically, penicillin, compound sulfamethoxazole, sulfamethoxine or cephalosporin are used. After perforation of the tympanic membrane, pus is taken for bacterial culture and drug susceptibility test, and the drug can be administered according to the results. 2 1% ephedrine droplets before the perforation of the tympanic membrane can reduce the swelling of the eustachian tube throat to facilitate drainage. 3 At the same time, pay attention to rest, adjust the diet, and keep the stool smooth.
(2) topical treatment: before tympanic membrane perforation:

1 with 1% ~ 2% phenolic glycerol drops can sterilize swelling and pain, 3 times a day, but the tympanic membrane should be discontinued immediately after perforation. 2 If the systemic and local symptoms are heavier, the tympanic membrane bulges obviously, the general treatment is invalid, or the tympanic membrane perforation is too small, the drainage is not smooth, or there is the possibility of complications, tympanotomy can be performed to facilitate drainage. After perforation of the tympanic membrane: 1 first thoroughly clean the pus of the external auditory canal with 3% hydrogen peroxide or boric acid water, and wipe it with a cotton swab. 2 partial drops of antibiotics based on aqueous solutions, such as 0.25% to 1% chloramphenicol solution, 0.3% ofloxacin ear drops, compound rifampicin solution, sulfamethazine. 3 When the pus is reduced and the inflammation gradually subsides, 0.3% boric acid glycerin, 0.3% boric acid alcohol, 0.5% chloramphenicol glycerin or the like may be used. 4 inflammation completely subsides, and more perforation can heal itself. If the pus has stopped and the tympanic membrane perforation does not heal for a long time, it can be used for tympanoplasty.

(3) Etiology treatment: Active treatment of chronic diseases of the nose and throat, such as adenoid hypertrophy, chronic sinusitis, chronic tonsillitis.