Otitis media

Otitis media
Otitis media is an inflammatory disease in the ear (Lat. oto — ear, itis- inflammation). The classification of otitis depends on their localization, size and etiology of inflammation. Otitis media can be medium, external and labyrinthitis (internal). As for the differentiation of otitis by form, they are catarrhal (initial form) and purulent. According to the nature of the course, acute and chronic forms of otitis are distinguished.

The content of the article:
Anatomy of the ear
Briefly about otitis externa
About otitis media
Symptoms of otitis media
Diagnosis of otitis media
Treatment of otitis media
Internal otitis media
Treatment of otitis media
Otitis media
Anatomy of the ear
To understand the essence of all the above terms, you first need to understand the anatomy of the ear. The human ear includes three divisions:

outer ear;
middle ear;
the inner ear.
The components of the outer ear are the auricle and the auditory canal. The external auditory canal is approximately two and a half centimeters (in an adult). The eardrum is considered the divider between the middle and outer ear. The physiological structure of the auricle and the auditory canal helps to perceive sounds and is their conductor. The shape of the shell and the auditory tube contribute to the recognition of sounds, in particular human speech and allows you to determine from which side the sound is reproduced.

The middle ear connects the tympanic cavity, the auditory tube and the mastoid process, which is located in the temporal bone. The tympanic cavity is represented by auditory bones — an anvil, hammer and stirrup, which radiate sounds into the inner ear, while amplifying them. The Eustachian tube serves as a link between the tympanic cavity and the nasopharynx, helps to equalize the pressure in the tympanic cavity to the atmospheric level.

The inner ear (labyrinth) has three components: semicircular canals, vestibule and cochlea. The organ of the Corti contributes to the transformation of the sound signal into an electric one, its location is in the cochlea. The auditory nerve is a conductor of sound signals to the central nervous system. The vestibular apparatus is located in the semicircular canals and vestibule. A special vestibular nerve transmits information from the vestibular apparatus. After leaving the inner ear, both of the above nerves merge into a single vestibular-cochlear nerve (vestibular-cochlear).

Briefly about otitis externa
Otitis externa is an inflammatory process in the outer ear. This disease has many etiological factors, infectious lesions are more frequent, but other causes also take place. Otitis externa is a very common disease, especially often they suffer in the summer, when the number of predisposing factors increases for it (high air temperature, humidity of the environment — under such conditions, even a small scratch of the ear canal can be dangerous). According to the statistics of medical clinics of ENT specialization, people suffer from external otitis after visiting reservoirs, pools with poor water filtration, sometimes external otitis is an integral part of otomycosis. Otitis externa is an occupational disease of swimmers, divers and others exposed to frequent water ingress into the ear canal. Also, the children’s age category is more susceptible to the disease of otitis externa for the reason that the skin in children’s ears is more tender than in adults and is more susceptible to injury.

About otitis media
Otitis media (inflammation of the middle ear) is very common in children, the main predisposing factor for the appearance of otitis media is the anatomical feature of children’s ears. There are several types of otitis media, the most frequent are medium catarrhal otitis, the second more severe is medium purulent otitis, there is also adhesive otitis. The causative agents of purulent otitis media are pathogenic microorganisms (pneumococci, streptococci and other coccoid bacteria), they enter the ear cavity from the nasopharynx, through the auditory tube, as a result of increased pressure in the nasal cavity, relative to the pressure in the auditory tube, for example, when sneezing. They can also provoke medium purulent otitis media hypothermia or other chronic diseases that reduce immunity. According to the nature of the course, otitis media is divided into acute and chronic. Acute otitis media is characterized by the formation of fluid in the middle ear cavity, sometimes serous fluid turns into purulent contents, as a result of the spread of bacterial pathogens from the nasopharynx into the middle ear and the accumulation of pus in it. The cause of chronic otitis media may be a defect in the auditory tube or the presence of a long-term untreated infection.

Complications of otitis media
Neglect of the treatment of inflammation in the ear can be fraught with very serious consequences, among them mastoiditis, meningitis, and brain abscess are particularly dangerous, which can lead to terrible consequences, up to death. Therefore, it is worth paying special attention to the appearance of symptoms such as headache, fever, dizziness, nausea, hearing loss, because they are symptoms of severe otitis media.

It is not necessary to panic when hearing loss occurs during the development of otitis media, because usually hearing is subject to restoration, after draining the liquid contents from the middle ear cavity and after removing the inflammatory process. Unfortunately, otitis media tend to recur, especially in childhood, in the presence of adenoiditis. This is due to poor ventilation of the auditory tube due to overgrown adenoids. If the inflammatory process in the middle ear is not treated in time, the perforation of the eardrum will occur, which is not always treatable, which can provoke complete or partial hearing loss. The main key to success in the treatment of otitis media is timely access to an ENT doctor and mandatory implementation of the doctor’s recommendations.

Complications of otitis media are also tympanosclerosis (with prolonged chronic inflammation in the ear), adhesive otitis media (atrophic changes of the auditory ossicles occur) and atelectasis (formation of retraction pockets, after which perforative changes of the eardrum occur).

Prevention of otitis media
Preventive measures to avoid otitis media are to protect against factors that affect the development of the inflammatory process in the middle ear and prevent the transition of an acute inflammatory process into a chronic one. Considering that otitis media most often appears as a result of mucus entering the middle ear, that is, due to a runny nose, it is important to treat the root cause. If, during the treatment of otitis media, the inflammation is not removed even with antibiotics and the protrusion of the eardrum is visualized, it is recommended to perform diagnostic tympanopuncture (puncture of the eardrum and aspiration of the patient for diagnosis), and, if necessary, paracentesis (incision of the eardrum to eliminate pus from the middle ear). Paracentesis is performed not only to prevent otitis media, but also to avoid bone destruction.

An important task in the prevention of otitis media is to identify the source of infection. If such a source is adenoids, then it is recommended to remove them.

Symptoms of otitis media
In childhood, otitis media occurs very often and it can be determined by shooting pain in the ear, parotid tissues are in tension, the whole process is usually accompanied by prolonged baby crying.

A small bloody discharge from the ear may appear, sometimes even with an admixture of pus. This phenomenon happens when the eardrum ruptures — after its perforation, the fluid (pus or blood) comes out, the pressure on the membrane is removed, the general condition is relieved and the pain immediately becomes less.

With otitis media, body temperature often rises, which is an absolute sign of the presence of infection in the body. Nausea and vomiting, temporary hearing loss, a feeling of heaviness and overflow in the ear may also join.

Diagnosis of otitis media
In 90% of cases, it is very easy to diagnose otitis media. It is possible to do this both with the help of an otoscope, and with the use of a funnel, a reflector and a lamp, that is, by visualization. But if there are unclear signs, it will not be possible to accurately diagnose and additional time will be required. To clarify the diagnosis, the doctor may suggest a diagnostic tympanopuncture. Sometimes an obstacle to a full examination of the eardrum may be a significant accumulation of sulfur in the ear canal or on the eardrum itself.

In some cases, hospitalization in a specialized hospital is recommended for accurate differentiation of the diagnosis and proper treatment of otitis media. During inpatient treatment, the stage of the disease is determined, the need for atibiotic therapy, an infectious or viral pathogen is isolated, the processes of complications are excluded or confirmed (hearing loss, rupture of the eardrum). The level of hearing loss can be determined using an audiogram. It is also recommended to take an X-ray of the paranasal sinuses to exclude sinusitis, because otitis media are often paired with inflammation of the maxillary sinuses. If bone changes are suspected, an X-ray of the mastoid process according to Schuller and Mayer is shown. In the absence of informative radiographs, a computed tomography of the head is indicated. Otitis media often occurs as a result of a prolonged runny nose, therefore, taking into account the physiological connection of the ENT organs, an X-ray of the paranasal sinuses is also shown to exclude inflammation in the Maxillary sinuses (sinusitis).

From laboratory tests, preferably clinical blood and urine tests are taken.

Treatment of otitis media
The tactics of treatment of otitis media depends on the stage of the inflammatory process. The main emphasis during therapeutic measures is on the normalization of the functions of the auditory tube. To restore the work of the auditory tube, the appointment of vasoconstrictive drops in the nose is shown, topical glucocorticosteroids, catheterization of the auditory tube, blowing of the auditory tube (according to Politzer), indirect massage of the auditory tube (occurs during chewing) are used to eliminate mucosal edema.

To prevent otitis media, it is necessary to treat nasopharyngeal infections such as acute sinusitis, chronic nasopharyngitis, adenoiditis in time, because such diseases lead to tubar dysfunction, after which acute otitis media often occurs. If these points are not taken into account, recurrent otitis media may develop.

To date, there is an established set of therapeutic measures aimed at eliminating inflammatory processes in the middle ear. There are several basic standard types of therapy. The first is taking painkillers, anti—inflammatory drugs orally or intravenously (nimesil, ibuprofen p / o, naklofen i / m). The second mandatory rule is the use of nasal vasoconstrictive drops. The third important component is the use of antibiotic therapy.

A big mistake in the treatment of otitis media is considered to be an exaggeration of the effectiveness of ear drops. As a rule, ear drops, which are prescribed for otitis media, have mainly an analgesic effect and do not affect the cause of the inflammatory process in any way. Also, patients can often use ear drops that they were prescribed earlier, and this can be very dangerous. For example, a patient has an earache, he was previously prescribed drops to eliminate otitis externa, and if he does not go to the doctor in time for a diagnosis, starts using these drops, and then it turns out that he does not have otitis externa at all, but medium perforated, then he may lose his hearing. In any case, it is very important to see a doctor, because otitis media is an insidious disease and if it is treated incorrectly, a lot of unnecessary problems may arise.

With purulent (perophoric) otitis media, it is permissible to use non-ototoxic antibiotic therapy transtimpanally. But such procedures are by no means a substitute for general antibiotic therapy.

In acute eustacheitis, it is necessary to perform a pneumatic massage of the eardrum along the Zigle and catheterization of the auditory tube. Catheterization of the auditory tube is performed without prior anesthesia or anemia, at least once a day. A mixture of water-soluble cortexosteroid (dexamethasone, solucortef) and 0.1 or 0.05% naphthyzine solution is injected through a catheter. In combination with catheterization, vasoconstrictive nasal drops are prescribed.

Also, according to the standards of treatment, it is worth conducting bacteriological analyses of the discharge from the ear (for candida and aspergillus). In addition to anti-antibiotics during inpatient treatment of otitis, the use of detoxification therapy, vitamin therapy, bed rest and observation of an ENT doctor is indicated.

Internal otitis media
Inflammation of the inner ear (labyrinthitis) is a serious, but not very common disease. Internal otitis is extremely rarely the main pathology, it usually develops as a consequence of the complicated course of acute or chronic otitis media due to injury or serious infectious disease.

Labyrinthitis occurs when an infection enters the inner ear in different ways. With all kinds of infections — through the blood, with meningitis — through the meninges, with purulent otitis media — through the middle ear.

The main clinical symptom of internal otitis is dizziness. It is very important to remember that dizziness is a symptom of many diseases and differential diagnosis is necessary to prevent adverse events. With internal otitis, dizziness has a sudden character and usually appears about a week and a half after a bacterial infection. Attacks of dizziness can be so intense that nausea and vomiting appear. Further sharp turns or tilts of the head can also provoke dizziness.

Labyrinthitis is also manifested by hearing loss and tinnitus (tinnitus). There are cases when hearing loss is permanent (with some bacterial infections).

Diagnosis of internal otitis includes measures to examine the patient and clarify his complaints. To determine the etiology of vertigo, there are special tests. There are also well-known studies, including audiometry, ABR test, computed tomography and magnetic resonance imaging.

Treatment of otitis media
Treatment of internal otitis involves the use of antibiotic therapy (if there is a bacterial infection), in other cases, symptomatic treatment will be sufficient, bed rest and dehydration therapy. A similar set of measures is carried out in Meniere’s disease. Symptomatic treatment includes the appointment of antiemetic drugs (compazine, cerucal), antihistamines (suprastin, diphenhydramine, loratodine, cetrilev), sedatives (lorazepam, diazepam), steroid drugs (methylprednisolone), as well as hollinoblockers (scopolamine).

If the cause of labyrinthitis is a bacterial infection, dizziness, nausea and vomiting may not pass for a long period. But after a while, such symptoms still pass.

Summing up the above, I would like to say that inflammatory ear diseases are very dangerous, so you should not neglect your health and it is better to seek qualified help in time.

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