Eustachiitis is an inflammatory lesion of the auditory tube, which leads to deterioration of the ventilation of the tympanic cavity and the development of catarrhal otitis media. The main manifestations of eustachiitis are congestion in the ear, a feeling of fluid flowing in it, autophony, noise in the ear, hearing loss. The symptoms are bilateral and unilateral. Detection of eustachiitis is carried out with the help of a comprehensive examination, including hearing examination, otoscopy, rhinoscopy, determination of the patency of the auditory tube and its manometry, backpossing of a smear from the throat, acoustic impedancometry. Treatment of eustachiitis is carried out with antihistamines, vasoconstrictive nasal drops, physiotherapy methods, administration of drugs directly into the auditory tube and the middle ear cavity.
The content of the article:
Mechanism of development of eustachiitis
Causes of eustachiitis
Symptoms of eustachiitis
Diagnosis of eustachiitis
Treatment of eustachiitis
Prognosis and prevention of eustachiitis
Eustachitis
The Eustachian (auditory) tube is responsible for connecting the nasopharynx and the eardrum of the middle ear. This is a kind of multifunctional channel, thanks to which the pressure inside the drum cavity and the external atmospheric pressure are balanced. For the functioning of the sound-conducting apparatus of the middle ear, the chain of auditory ossicles and the eardrum, normal pressure in the tympanic cavity is necessary.
The width of the auditory tube is about 2 mm. Due to such a small diameter, even the slightest swelling of the walls of the auditory tube disrupts its patency and provokes the development of eustachiitis. Under the influence of this process, the air from the pharynx ceases to flow into the middle ear cavity. As a result, catarrhal inflammation develops there.
Eustachiitis due to the combined inflammatory lesion of the middle ear and the auditory tube is also called salpingootitis, tubootitis, tubotimpanitis. Depending on the nature of the course, chronic and acute eustachiitis are distinguished.
Mechanism of development of eustachiitis
With eustachiitis, a partial or complete violation of the patency of the auditory tube leads to a complete cessation of ventilation of the tympanic cavity or to a reduced intake of air. The air that remains in the tympanic cavity is absorbed over time, the pressure in it decreases. All this is manifested by the retraction of the eardrum. Due to a decrease in pressure, a transudate enters the tympanic cavity, which contains fibrin and protein in its composition. It is worth noting that in the later stages, the transudate also consists of neutrophils and lymphocytes, cells that are directly involved in inflammatory reactions.
After a while, catarrhal otitis media develops. A long-term violation of the ventilation of the tympanic cavity caused by eustachiitis can cause the development of an adhesive process with the subsequent occurrence of adhesive otitis media and the degeneration of catarrhal inflammation into purulent, especially for people with weak immunity.
Causes of eustachiitis
Acute eustachiitis occurs under the influence of the spread of infection from the upper respiratory tract and nasopharynx to the mucous membrane of the auditory tube and pharyngeal mouth. This can be observed with influenza, ARVI, sore throat, rhinitis and acute pharyngitis, scarlet fever, whooping cough, measles, infectious mononucleosis. At the same time, infectious agents of eustachiitis are most often viruses, staphylococci and streptococci. In children, this disease is caused by pneumococci.
Eustachiitis in rare cases may be caused by a specific microflora (pathogens of syphilis, chlamydia, tuberculosis) or a fungal infection. Quite often, the occurrence of acute eustachiitis is caused by edema of the auditory tube. Edema occurs due to an allergic disease (pollinosis, allergic rhinitis).
The cause of chronic eustachiitis is inflammatory chronic processes in the nasopharynx — tonsillitis, chronic rhinitis, sinusitis, adenoids. In addition, chronic eustachiitis can occur in diseases that disrupt the normal circulation of air through the airways — neoplasms of the pharynx and benign tumors of the nasal cavity, curvature of the nasal septum, hypertrophic changes in the lower nasal conchs, hoan atresia.
Otolaryngology refers to a rare and separate form of eustachiitis dysfunction of the auditory tube, which occurs with sudden changes in atmospheric pressure. A rapid increase or decrease in external pressure creates big problems, since it does not have time to be transmitted through the auditory tube into the tympanic cavity. Sudden pressure drops cause traumatization of the structures of the middle ear (aerotitis develops later) and compression of the mouth of the Eustachian tube.
Symptoms of eustachiitis
The main manifestations of eustachiitis are hearing loss, ear congestion, noise in the ear, heaviness in the head and autophony, which is characterized by a feeling of resonance of one’s voice in the ear. When tilting the head and turning, a number of patients with eustachiitis note a feeling of water flowing in the ear.
In patients with eustachiitis, in some cases, after yawning or swallowing saliva, hearing improves. This phenomenon is caused by the expansion of the lumen of the auditory tube, which in turn occurs due to the contraction of the corresponding muscles. Accordingly, these symptoms of eustachiitis may be bilateral in nature or observed only in one ear.
As a rule, ear pain is observed with eustachiitis, the occurrence of which is caused by a drop in atmospheric air pressure. It is also characterized by a feeling of pressure and bursting in the ear. With eustachiitis, there is no change in the general condition of the patient, while the body temperature remains normal. The appearance of common symptoms and a rise in temperature against the background of eustachiitis are a manifestation of the development of purulent otitis.
The occurrence of symptoms of acute eustachiitis is often caused by respiratory infection. Also, this may occur during the recovery period. Acute eustachiitis in the presence of anatomical changes in the nasopharynx, a tumor, a focus of chronic infection, which exacerbate violations of the ventilation of the auditory tube, takes a prolonged course. In some cases, its degeneration into a chronic one is observed.
If we talk about chronic eustachiitis, it is primarily characterized by recurrent exacerbations that have pronounced symptoms of acute eustachiitis. There are also periods of remission, during which low hearing and slight noise in the ear remain. Subsequently, the walls of the auditory tube stick together and a persistent decrease in its diameter develops. As a result, the symptoms of eustachiitis remain on an ongoing basis. That is why doctors emphasize that when symptoms of eustachiitis appear, treatment should be started as early as possible to prevent its development.
Diagnosis of eustachiitis
The study of eustachitis is carried out by an otolaryngologist. This disease is diagnosed on the basis of anamnesis data (the occurrence of the disease during a respiratory infection or after, against the background of impaired nasal breathing) of the patient’s complaints and additional studies.
In the diagnosis of eustachiitis, microtoscopy and otoscopy, audiometry, determination of the patency of the eustachian tube, examination of hearing with a tuning fork, ear manometry, acoustic impedance measurement are used.
With eustachiitis, during otoscopy, a retracted tympanic membrane is observed with the disappearance or deformation of the light cone, and with a sharply protruding process of the malleus.
In patients with eustachiitis, hearing studies using a tuning fork and audiometry reveal moderate hearing loss (up to 20-30 dB). This applies exclusively to the low frequency range, which is due to a violation of sound transmission.
Diagnosis of the condition of the auditory tube can be carried out by objective and subjective methods. With eustachiitis, an objective examination of the patency of the auditory tube is carried out by blowing it. The result of this procedure is checked during otoscopy and audiometry. A decrease in the retraction of the eardrum and an improvement in hearing, which are observed after purging, are confirmation of the connection of the disease with the patency of the auditory tube.
Subjective methods include: the Valsalva test, the Toynbee test, the empty-mouthed test. The Valsalva test is performed after a deep breath, the patient clamps his nostrils, closes his mouth and tries to exhale. When testing with an empty sip, the patient should take an enhanced sip. In turn, the Toynbee test is characterized by the fact that the patient must pinch his nostrils during swallowing.
The results of each of the tests are evaluated according to the patient’s feelings. If the patient has good patency of the auditory tube, then this will manifest itself in the form of a “crackle” in the ears during the test. The patient notes squeaking, gurgling or other phenomena in the affected ear with swelling of the tube, but with some degree of its patency.
The determination of the antibiotic sensitivity of the microflora of eustachiitis and the identification of its infectious nature is carried out by bacteriological and microscopic examination of a smear from the throat. To identify background diseases that affect the nasopharynx, pharyngoscopy, rhinoscopy, radiography and CT of the paranasal sinuses are performed. Very often it is background diseases that provoke the development of eustachiitis. Allergic tests are performed if the allergic nature of eustachiitis is suspected.
Treatment of eustachiitis
Most people who have encountered this disease do not know how to treat eustachiitis. Therapeutic measures for eustachiitis are focused on the removal of puffiness, rehabilitation of the nasopharynx, relief of an allergic reaction or inflammation. With eustachiitis, antihistamines for oral administration (suprastin, claritin, desloratadine) and vasoconstrictive nasal drops (nasol, nazivin, tizin, vibrocil, sanorin) are prescribed to reduce swelling of the auditory tube.
To improve the patency of the auditory tube, it is necessary to catheterize it, followed by the introduction of a solution of adrenaline or hydrocartisone. With eustachiitis, a good effect is given by pneumomassage of the eardrum. In the case of the formation of a transudate of the tympanic cavity, the introduction of proteolytic enzymes is used to dilute it. The manipulation itself is carried out through the auditory tube by catheterization.
In the acute period of eustachiitis, it is not recommended to carry out purging by Politzer. The fact is that infected mucus can get from the pharynx through the auditory tube into the middle ear cavity.
Complex treatment of eustachiitis includes various physiotherapy techniques – microwave therapy, UHF, laser therapy, electrical muscle stimulation, UFOs.
In the process of treating eustachiitis, it is imperative to eliminate the causes of its appearance. If necessary, adenoids are removed, systemic antibiotic therapy, removal of a benign tumor of the pharynx and nose, etc.
Prognosis and prevention of eustachiitis
With adequate treatment, acute eustachiitis passes within a few days. However, it can transform into adhesive otitis media or into chronic eustachiitis. This can happen if there are concomitant diseases that worsen the ventilation of the auditory tube.
Prevention of eustachiitis consists in the timely treatment of allergic and infectious diseases of the nasopharynx. Also, for respiratory diseases that are accompanied by nasal congestion, it is necessary to use decongestants (antihistamines, nasal vasoconstrictor drops).
