Otitis( ear inflammation) - Causes, symptoms and treatment. MF.

Otitis is a common definition of inflammatory diseases of the ear.

The ear is a rather fragile organ, the work of which depends on the accuracy of the smallest movements of all the elements of which it is composed, so nature has taken care of its protection. The main part of the ear is in the depth of the temporal bone. With the outside world, the hearing organ is communicated via two channels. This channel for sound - the outer ear canal, and the duct for air - the Eustachian tube.
External auditory meatus ends blindly. From the cavity of the middle ear it separates the eardrum. Eustachian( auditory) tube is an element that communicates the cavities of the middle ear and nose. In addition to the ventilation function, it is responsible for maintaining equal pressure on both sides of the tympanic membrane, which is necessary for normal sounding.

Ear structure

Causes of otitis

Since the inflammatory effects of the nasopharynx are already almost common for us, it is clear that the auditory tube is the most frequent way of penetrating pathogens and viruses into the organ of hearing. This is facilitated by any decrease in immunity, both as a result of hypothermia, and in other diseases.

Recently, more and more often, our compatriots decide on fashion classes such extreme kinds of dispute as diving and mountaineering. And fall into the risk group for inflammation in the ear. This is due to sudden changes in pressure in the environment, which hurts the hearing aid( barotrauma).

There are also mechanical damages to the ear with various objects, with a stroke or in combination with head injuries.

The hearing organ is divided into several departments performing different functions. What is commonly called the ear in everyday life - the auricle and the external auditory meatus serves to catch sounds and carry them to the eardrum. The latter converts sounds into vibrations, which transmit to the system of ossicles of the middle ear. In the inner ear is a snail in which the delivered vibrations are transformed into nerve impulses. Next to the cochlea in the cavity of the inner ear is an organ of balance-a labyrinth that gives the brain information about the position of the body in space.

Symptoms of otitis

According to anatomical features, otitis media, as a disease, is classified into external, middle and inner. Clinically, this will be manifested by a violation of the function of a department.

Otitis externa is an inflammatory change in the skin and subcutaneous tissue of the external auditory canal. It can proceed as a local inflammation( boil) or have a diffuse nature.

The furuncle of the external auditory meatus occurs when the infection penetrates into the sebaceous or hair sacs of the auditory canal. The main manifestations of this will be pain in the area of ​​the ear canal, which is amplified by movements of the lower jaw( chewing, talking), since the joint of the lower jaw exerts pressure on it. The general condition suffers insignificantly, there may be a slight increase in temperature. Usually the boil is opened by itself after ripening, and this leads to an improvement in well-being. The hearing of the patient with this disease does not suffer.

Diffuse otitis externa in most cases develops as a complication of chronic purulent otitis media of the middle ear. The reason for this is a constant purulent discharge through the damaged eardrum and infection of the tissues of the external auditory canal. It appears with pain, reddening in the auditory canal. Sometimes diffuse otitis can be caused by irritation of the skin of the auditory canal with chemicals or with mechanical trauma with infection.

The most common acute inflammation of the middle part of the hearing organ.

Tubotite( eustachiosis) is an inflammation of the auditory tube. She is the first to respond to the penetration of infection from the nasal cavity with swelling, redness. In this case, the lumen of it is most often closed due to edema and the pressure in the middle ear decreases. The patient will feel it in the form of a decrease in hearing, a feeling of stuffiness and a sense of his own voice in the big ear. Usually, the stuffiness is somewhat reduced by swallowing the saliva or chewing, since the lumen of the auditory tube is opened for a short time.

If at this stage the disease has not been stopped by the immune system or with the help of a physician, the inflammation covers the entire cavity of the middle ear. There are pains in the ear, shooting, giving to the lower jaw, temple and neck, the temperature rises to significant figures, the hearing decreases. This is due to the appearance in the cavity of the middle ear fluid( exudate), which soon becomes purulent.

On the third - fourth day of the disease, the next stage of the inflammation develops, when the pus formed an opening in the tympanic membrane( perforation), and through it an outflow of exudate to the external auditory meatus occurs. That is, the patient will see that fluid is released from the ear canal. After perforation, there is usually some improvement in the patient's condition, the temperature decreases, and pain decreases.

If the otitis is not properly treated, the fluid in the cavity becomes dense, fibrin strands appear and spikes and scars are formed. The latter make it difficult to properly operate the auditory ossicles, which is fraught with persistent hearing impairment.

The main complaint of patients with internal otitis( labyrinthitis) is dizziness, combined with persistent hearing loss and tinnitus. This is due to the location in the cavity of the inner ear of the labyrinth( an organ of equilibrium).Dizziness can be with various diseases, but if it appeared suddenly, after a cold, accompanied by nausea and vomiting, it is worth getting a consultation about ear disease. Infection can get into the inner ear with inflammation of the middle part of it, with blood flow from other sources of inflammation or with inflammation of the brain region adjacent to it.

Diagnosis of otitis

How to recognize otitis media? For this, consultation of the ENT doctor is absolutely necessary. The otorhinolaryngologist deals with problems of ear, nose and throat diseases, as the diseases of these organs are most often interrelated. If consultation with an ENT doctor is not possible, then you should consult a general practitioner or therapist.

The doctor should conduct an examination of the ear, nose and throat with the help of special tools and, after evaluating the patient's questionnaire, prescribe a follow-up( if necessary) and treatment.

As a method of confirming and specifying the diagnosis, a general blood test can be assigned, in which signs of inflammation( increased ESR, increase in the number of leukocytes, and others) are revealed.

Audiometry is used to check the degree and severity of hearing loss. The penetration of sound waves occurs in the organ of hearing through the air and bone pathways. The work of the bone path is checked with the help of tuning forks. Air conduction is examined using an audiogram. The patient puts on the headphones, and he is asked to press the signal button as soon as he hears the sound. The doctor gradually increases the strength and frequency of the audio signal delivered to the audiogram, noting the level of perception of the patient.

If the visit to the doctor coincides with the stage of suppuration during the eruption of the tympanic membrane, then a microscopic and bacterioscopic examination is performed to determine the pathogen more accurately. That is, they try to see the pathogen by means of a microscope, or to grow a larger number of "individuals" on a nutrient medium and determine the type of microbe. This can take 3-4 days. But the results of this survey allow us to prescribe a treatment specific for the detected microbe.

Otitis in a child

Almost every child before the age of three even tolerates otitis at least once. There are a number of predisposing factors for this.

• Anatomically, the ear in children is characterized by a wider and short auditory tube, which is also horizontally located. This facilitates the penetration of the infection.
• The mucosa of the middle ear cavity in children is thicker and friable. This worsens her nutrition, and promotes the development of inflammation in her.
• Imperfection of the immune system of the child, lack of acquired immunity leads to frequent occurrence of colds in the child, which in turn is complicated by otitis.
• In the period from one to three years, lymphoid tissue is actively developing. This is the thymus and tonsils( adenoids).They are not only a hotbed of chronic infection, but, when reaching a significant size, can cover the lumen of the auditory tube, disrupting the air exchange between the middle ear and nose.
• During delivery, due to anatomical features, amniotic fluid can enter the middle ear cavity. They carry not only a nutrient medium for microbes, but they can also be infected with them directly.
• Breast children are constantly in a horizontal position. When food arrives in this position, it helps to drain milk or mixture into the auditory tube. Therefore, the children should be fed in a position elevated to 45 °.
• The eardrum in children is thicker, its rupture is very difficult. Since the normalization of the outflow of fluid from the middle ear cavity greatly improves the patient's condition and accelerates recovery, the tightening of the perforation is an indication for the puncture of the tympanic membrane.

Communication with young children is difficult, they can not express their complaints, the doctor is difficult to assess the subjective results of treatment. Little patients are worried, wake up at night, screaming, rubbing a sick ear on the pillow, touching it with a pen. The appetite also worsens, as the pain in the ear increases with sucking due to increased pressure in the ear. The general condition of the child also worsens: the temperature rises( to 38-40 degrees), weakness, sluggishness, sometimes nausea and vomiting due to severe intoxication.

The so-called children's infections - scarlet fever, measles, chickenpox - are also often complicated by otitis. In this case, it proceeds particularly hard, sometimes hitting even the inner ear, and leads to a significant loss of hearing.

All children with acute otitis should be immediately hospitalized in the ENT - hospital. After all, deterioration sometimes requires urgent professional action.

Treatment of otitis

Treatment of otitis differs depending on the area and extent of the lesion, but in any case it should be complex.

An obligatory condition is the appointment of antibiotic therapy. Only at local displays of an external otitis there is enough appointment of antibacterial agents is local. In all other cases, the intake of drugs inside and sometimes in injections is added to the local treatment. To protect the intestinal microflora in parallel, appropriate drugs are taken( Hilak forte, baktisuptil).

For the removal of edema, it is possible to prescribe antihistamine( antiallergic) drugs.

If the cause of otitis is inflammatory diseases of the nasopharynx, then they perform treatment aimed at their elimination. Necessarily appointed vasoconstrictive drops in the nose, preferably in the form of a spray. They are used after sanation of the nasal passages, so that the medicine enters the auditory tube( this allows removing the swelling from its lumen and improving the patency).

These drugs do not apply for longer than 4-5 days, as they become addictive. In addition, they are contraindicated for children up to a year, so the child can only be injected into the spout with protargol or sodium sulfacil( albucid) for the same purpose.

For non-steroidal anti-inflammatory drugs based on paracetamol( panadol), ibuprofen( nurofen), naz.

Local treatment depends on the stage of the disease. In the preperforative stage of otitis, the actions are aimed at restoring the drainage function of the auditory tube. It is possible to use anesthetic and anti-inflammatory drops in the external ear canal( otipax, otilabrax).Sometimes, to facilitate the condition, a microrefine of the tympanic membrane( paracentesis) is required.

Physiotherapy also helps: UHF, microwave, sunflower lamp, semi-alcoholic compresses on the diseased ear.

If all of the above actions did not lead to regression of the process, or the treatment was started at the perforation stage of the tympanic membrane, first of all it is necessary to ensure a good outflow of pus from the middle ear cavity. To do this, regular cleaning of the external auditory canal from secretions is carried out. Sometimes through the hole in the tympanic membrane it is possible to administer medicinal substances into the area of ​​inflammation, including the appointment of antibacterial drops( tsipromed, otofa, etc.).

After the process is quiet, it is desirable to perform several sessions of tympanic massage and blowing the auditory tubes. This greatly contributes to the removal of fluid residues from the middle ear cavity and rupture of thin fresh adhesions that result from the inflammatory process.

When improving the patient's condition for recovery, a course of multivitamin therapy is recommended.

Complications of otitis

Do not think that otitis is an innocuous cold cure. In addition to the fact that he permanently knocks people out of the rut, reducing his ability to work for at least 10 days, it is possible to develop irreversible changes with permanent deterioration or complete loss of hearing.

One of the terrible complications of otitis is otogenic meningitis( inflammation of the meninges caused by infection from the ear).Since the ear has a rather complicated structure with many small cavities, it is very often that the process with the suppuration of the mastoid process( mastoiditis), the transition of the inflammation to the joint of the lower jaw and the salivary gland occurs during the unreasonably early cessation of antibiotic therapy or the absence of treatment. Often, treatment of these processes requires surgical treatment. In this case, patient disability is also common.

Otitis requires a serious and attentive attitude.

Prevention of otitis

To prevent otitis, it is necessary to avoid hypothermia, to treat infections of the nasopharynx in time, to clean the nasal passages correctly during the runny nose( not abruptly, at one time only on the one hand, not to draw mucus into oneself), and also to prevent other situations to reduce immunity.

Physician-therapist Moskvina Anna