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52ETIOLOGICAL FACTORS OF RECURRENCE OF CHRONIC PURULENT
OTITIS MEDIA IN CHILDREN
F. S. Ikramova
Bukhara State Medical Institute
ABSTRACT
In the period from 2020-2021, we examined 53 patients who came with chronic purulent otitis media to the ENT department of the Bukhara Regional Children's Multidisciplinary Medical Center. All patients underwent a standard examination: clarification of complaints and anamnestic data. The examination of the ENT organs was carried out according to the generally accepted scheme. We also studied the etiological factors of exacerbation of chronic purulent otitis media in children. The incidence of exacerbation of chronic purulent otitis media in children increased by more than 18% due to local, general and mixed negative factors affecting the structures of the middle ear through perforation of the tympanic membrane and /or causing pathology of the auditory tube.
Keywords: chronic purulent otitis media, acute purulent otitis media.
Relevance. Chronic inflammation of the middle ear is a very common disease. To date, in the structure of ent pathology in children, it is 13.2% [1;3]. A dangerous consequence of chronic suppurative otitis media (CHSOM) is the development of complications associated with the spread of the pathological process to the inner ear or the cranial cavity: facial nerve paresis, labyrinthitis, meningitis, sigmoid sinus thrombosis, abscesses of the brain and cerebellum [2;5]. CHSOM is one of the causes of hearing loss in childhood, which determines its social significance. In children, a decrease or loss of hearing, especially at an early age, leads to impaired speech formation, mental and emotional development, and a significant deterioration in the quality of life and learning [4;5].
In children, due to a number of anatomical and physiological characteristics of the body, acute inflammation of the middle ear is more common than in adults. This, of course, largely determines the frequency of transition of an acute process into a chronic one. The views of otiatrists on the pathogenesis and course of CHSOM differ in many respects, but there is a consensus that persistent perforation of the tympanic membrane, periodic or permanent otorrhea are its integral features [ 1-13].
In this regard, the purpose of this research work was to identify the etiological factors of exacerbation of chronic suppurative otitis media in children.
Materials and methods. The work methodology is based on systemic and complex data analysis.
Between 2020 and 2021 we examined 53 children who applied to the Bukhara Regional Children's Multidisciplinary Medical Center, ENT Department. Of these, 32 children (60.4%) suffered from chronic suppurative otitis media and 21 children (39.6%) - acute suppurative otitis media. Among the examined children there were 19 (35.8%) boys and 34 (64.1%) girls aged 2 to 18 years. The duration of the disease ranged from 2 days to 20 years or more.
When questioning, we found that children before the recurrence of CHSO had the following diseases: 18 children (34%) - frequent acute respiratory infections (ARI), 1 (1.8%) measles, 15 children (28.3%) suffered from acute otitis media, 12 patients (22.6%) were observed with hypertrophy of the adenoids, and 7 children (13.3%) - with hay fever and food allergies. In 18 children (34%), we identified a significant anamnestic fact, namely, the appearance of the following symptoms after water enters the external auditory canal: otorrhea, otalgia, deterioration in well-being, fever. Similar symptoms also occurred in 56 patients (23.2%) after the onset of acute respiratory infections.
Complaints of pain in the ears were more common in patients with APOM -85.2% of cases, otalgia during exacerbation of CHSOM in children of the main group was noted only in 56.4% of cases, and the appearance of discharge from the external auditory - in 31.4%.
With the help of an endoscope, we identified a number of otoscopic signs characteristic of an exacerbation of CHSOM: maceration of the skin of the external auditory canal (30.1%), up to the effects of external otitis in the presence of mucous or purulent discharge from the middle ear, perforation of the tympanic membrane (100%), discoloration of the tympanic membranes from pale pink to bright red with hyperemia (63.9%) mucosa of the tympanic cavity from bright pink to red, hyperemic (81.1%) presence of edema and pastosity of the mucosa of the tympanic cavity (79.2%), swelling of the tympanic membrane, infiltration, translucence of the contents of the tympanic cavity , air bubbles, "pulsating reflex" (2.8%). The most common otoscopic signs of exacerbation of CHSOM in the main group were discoloration of the tympanic membrane - redness (63.9%) and hyperemia of the mucous membrane of the tympanic cavity (81.1%), the same was noted in the control group - 83.7% and 78.9%, respectively. In the children of the main group, in 17.5% of cases, a scanty discharge was found, which was not felt by the sick and was not always visualized during standard otoscopy. In 13.1% of cases, the course of exacerbation of CHSOM was accompanied by hyperemia of the mucous membrane of the tympanic cavity, together with or without changing the color of the tympanic membrane, but without the formation of secretions. In 79.2% of cases in the main group, edema of the mucous membrane of the tympanic cavity was noted, which was also observed in children with CHSOM - 52.1%. During endoscopy of the nasal cavity and nasopharynx in children with OHSO and
exacerbation of CHSO, we most often diagnosed adenoiditis: 44 (83.6%) and 33 (61.7%) patients, respectively. Such an inflammatory process supported periodic exacerbations of CHSOM, which confirmed the absence of adenoiditis in children with CHSOM remission.
In groups of children with CHSOM and exacerbation of CHSOM, in most cases, adenoids were noted not of the third, but of the second degree, which were accompanied by compression on the tubal folds or hypertrophy of the tubal folds, which, as is known, could cause dysfunction of the auditory tube. In the group of children with CHSOM remission, of which 32 children (31.4%) had previously undergone adenotomy, we did not observe significant hypertrophy of the adenolymphoid tissue [14-30].
The analysis of the above results of the examination of patients allowed us to formulate a definition, identify possible causes and identify various options for exacerbation of CHSOM in children. Exacerbation of CHSOM in children is a stage of the disease characterized by an increase in existing and / or the appearance of new signs of the current chronic inflammatory process in the middle ear. Causes of exacerbation of CHSOM in children: local causes - entry into the external auditory canal and then into the tympanic cavity of various substances that contribute to contamination by pathogenic flora and irritation of the tympanic membrane and mucous membrane of the middle ear. For example: ingress of water, inorganic, organic, living foreign bodies, jets of cold air. Common causes: 1) infectious inflammatory or allergic reaction at the level of the whole organism (SARS, various infectious diseases, sensitization of the body and allergic reactions) affecting the middle ear; 2) an infectious process, allergic reactions localized in the nasal cavity, paranasal sinuses, pharynx, larynx (allergic rhinitis, rhinosinusitis, adenoiditis, tonsillitis, pharyngitis, laryngitis), spreading to the middle ear through the auditory tube. Mixed causes - a combination of various local and general factors described above that affect the condition of the middle ear. The factors that maintain the frequency of exacerbations of CHSOM, non-infectious-inflammatory and non-allergic, include various pathologies that disrupt the architectonics and normal functioning of the ENT organs, especially the auditory tube, such as hypertrophy of the adenoids and tubal folds, scarring in the nasopharynx after surgical interventions, deviated nasal septum.
The frequency of cases of exacerbation of chronic suppurative otitis media in children increased by more than 18% due to local, general and mixed negative factors affecting the structures of the middle ear through perforation of the tympanic membrane and / or causing pathology of the auditory tube.
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