Отражение современных концепций патогенеза экссудативного среднего отита у детей в клинической практике

Abstract

The scientific work presents the data of observation of 52 patients with combined lymphoepithelial pharyngeal ring pathology and exudative otitis media (EOM), admitted for routine surgical treatment. The study results indicate, that the pathology of the lymphoepithelial pharyngeal ring was accompanied by a significant Eustachian tube dysfunction with the development of catarrhal and serous stages of secretory otitis media in 90.38% (47 patients) and mucoid stage (the «glue ear») in 9.62% (5 children) who needed tympanostomy tube. The authors have considered the key problems of etiopathogenesis of suppurative otitis media in children based on the analysis of their own clinical experience and the present-day clinical experimental works, reputable monographs. According to some authors, some cases of tympanic cavity exudate are supposedly the result of incomplete resolution of previous acute purulent inflammation. It is indirectly indicated by the data of inoculation of material for detection of bacterial flora and identification of cellular composition (the signs of infectious etiology). The results prove, that the viral and bacterial infections play an important role in the pathogenesis of EOM. The use of antibacterial therapy in some cases will probably result in a sluggish inflammatory process and the preservation of exudation in the tympanic cavity. However, in 46.2% cases, the patients diagnosed with the exudative otitis media had no acute otitis media in anamnesis. The aseptic nature of ear secret was revealed by bacteriological method in 88.5% cases, but the data of cytological analysis in 57.7% cases indirectly indicate the previous inflammation of infectious etiology. The allergic anamnesis in 73% (38 people), in particular, allergic rhinitis in 36.5% (19 people), could also accelerate and/or trigger the development of EOM.