The reasons Kinds Symptoms of chronic pharyngitis Diagnostics Treatment of chronic pharyngitis Complications Prevention Chronic pharyngitis is a disease in which persistent inflammation of the…
Chronic pharyngitis is a disease in which persistent inflammation of the pharyngeal mucosa develops.
Chronic pharyngitis occurs in adults with periods exacerbations and remission.
Acute viral infections, chronic physical and mental overstrain, and a decrease in the body’s defenses can provoke an exacerbation of the disease.
There are the following reasons for the development of chronic pharyngitis:
- frequent respiratory viral infections;
- undertreated cases of acute pharyngitis;
- prolonged exposure to irritating substances on the mucous membrane of the pharynx, upper respiratory tract;
- chronic inflammatory diseases ( sinusitis, tonsillitis, caries teeth, rhinitis);
- diseases of the gastrointestinal tract ( gastroesophageal reflux disease ( GERD ), pancreatitis);
- conditions after tonsillectomy (removal of the tonsils);
- alcohol abuse, smoking;
- violation of nasal breathing (curvature of the nasal septum, polyps and adenoids);
- use hot, hot foods.
There are three clinical forms of the disease in chronic pharyngitis:
- hypertrophic (granular);
The catarrhal form of chronic pharyngitis is the most favorable in the course of the disease. In this case, inflammation of the surface layers of the pharyngeal mucosa develops, characterized by moderate edema.
Hypertrophic form manifests itself in the form of growths of the mucous membrane of the pharynx (nodules, bumps).
Atrophic form is the most unfavorable form of chronic pharyngitis. At the same time, the pharyngeal mucosa becomes thinner and becomes dry. The treatment of this form takes a very long time.
If an adult has chronic pharyngitis, the following symptoms occur:
- persistent sore throat;
- sore throat;
- foreign body feeling in the throat;
- pain when swallowing;
- dry, unproductive frequent cough;
- presence of bad breath.
During the period of remission of the disease, the patient has only local signs of the disease. For pharyngitis aggravations characterized by the development of intoxication of the body (fever, weakness, malaise), increased local signs of the disease.
For the catarrhal form is characterized by the presence of more pronounced pain in the throat, which is aggravated after hypothermia, with viral infections, after overwork. When viewed from the mucous visible her hyperemia, swelling.
With the development of an adult hypertrophic or granulosis pharyngitis in the first place are complaints about the sensation of a foreign object in the throat. When granular form can be found random, chaotic growths of the mucous membrane in the form of nodules, elevations. And with a hypertrophic form, a thickening of the mucous membrane is observed without nodule formation.
In the atrophic form of chronic pharyngitis, the patient has mainly complaints about:
- dry throat;
- hacking cough;
- constant discomfort in the throat.
On examination, you can see the thinned mucous membrane of the pharynx, dry mucous membranes, crusts, small hemorrhages.
During exacerbations, there may be symptoms of inflammation of nearby organs ( laryngitis, tracheitis, tonsillitis ).
Diagnosis of chronic pharyngitis is based on a thorough survey and examination of the patient.
Be sure the doctor conducts pharyngoscopy – examination of the pharyngeal mucosa.
At the same time, he can detect the characteristic signs of any form of chronic pharyngitis.
So, with catarrhal form, you can detect the following changes in the posterior pharyngeal wall:
- small amount of mucus.
The presence of the following changes in the pharyngeal mucosa is characteristic of the hypertrophic form:
- thickening, swelling;
- developed venous network (stagnation);
- in case of a granular hypertrophic form, nodules of red color up to 0.5 cm are also detected.
In the atrophic form, the following changes are found on the pharyngeal mucosa:
- small hemorrhages;
- pale pink color.
To determine the causative agent of the disease take a scraping from the mucous membrane of the posterior pharyngeal wall, conduct bacterioscopic examination.
In general, a blood test during the remission of the disease may have no changes, and during an exacerbation, the general signs of inflammation are determined (an increase in leukocytes, ESR).
Treatment of chronic pharyngitis is carried out by an otolaryngologist.
Treatment is carried out in an outpatient setting, hospitalization is not required.
Treatment should be carried out strictly under the supervision of a specialist, and it is necessary to strictly follow all prescribed recommendations.
First of all, it is necessary to eliminate all harmful effects on the pharyngeal mucosa:
- the exclusion of spicy, salty, hot, cold foods;
- inhalation of harmful, irritating substances;
- alcohol exclusion;
- to give up smoking.
For the entire period of treatment, it is recommended to observe a heavy drinking regime.
It is necessary to maintain the humidity of the inhaled air in the room at a sufficient level (50-70%).
This can be done with the help of special devices – ultrasonic humidifiers, or by folk methods – you can hang wet sheets in the room, place containers with water.
Gargling with the following remedies has an effective therapeutic effect:
- decoction of chamomile, sage, calendula;
Antihistamines are prescribed to reduce tissue swelling:
Treatment of the pharynx is also used:
- Lugol solution.
Local antiseptics are used:
Antibacterial drugs are accepted only for exacerbations of the inflammatory process with a proven bacterial nature. The following antibacterial agents are mainly used:
- Flemoxin Solutab;
Self-treatment with antibacterial drugs can, on the contrary, lead to the progression of the disease.
In the presence of granular hypertrophic pharyngitis, the following treatments are used:
- Cauterization of silver;
- Laser coagulation (laser burning of pellets);
- Cryotherapy (liquid nitrogen).
Be sure to receive drugs aimed at restoring the microflora of the pharyngeal mucosa:
In the treatment of atrophic pharyngitis produce the following methods:
- removal of crusts from the mucous membrane;
- lubrication of the mucous membrane of the pharynx sea buckthorn, peach, apricot oil.
Effective use for chronic pharyngitis inhalation oil solutions, for this you can use:
- Peach oil;
- rose oil;
- menthol oil.
Applied and hardware methods of physiotherapy:
- laser therapy;
- magnetic therapy;
- electrophoresis of drugs;
- ultrasound therapy.
Incorrectly or unfairly treated pharyngitis is fraught with the spread of inflammation to neighboring organs with the development of the following diseases:
- regional lymphadenitis.
It is also possible the development of systemic inflammatory diseases:
The most serious complication of atrophic chronic pharyngitis is the transition to the malignant form – cancer.
To preventive measures include:
- quitting smoking and alcohol;
- avoid inhalation of harmful substances;
- timely and completely treat acute forms of pharyngitis, other inflammatory diseases of the nasopharynx;
- treat concomitant diseases of the gastrointestinal tract;
- rejection of spicy, hot, cold foods.
The main function of earwax is the protection of the ear canal. Earwax prevents dust or other small particles from entering the eardrum. But, despite their protective functions, excess sulfur must be periodically removed – because they contribute to the formation of the ear plug. Cork in the ears adversely affects the ear, and sometimes it can cause headaches.
The main reason for ear plug formation is the use of cotton swabs to clean the ears, with which, in fact, we press the sulfur back into the ear and tightly tamp it in the area of the eardrum. A large amount of sulfur on a cotton swab when cleaning the ear canals is not proof of clean ears. On the cotton swab gets only the liquid component of earwax, and denser structures firmly “settle” in the ear.
Ear plugs have most people. Many they do not bother, but only until a certain time.
Initially, when the ear plug is formed, the ear canal is not completely blocked. A person feels great and hears well. But this situation can be aggravated for several reasons:
- regular cleaning of the ears with a cotton swab, (with this the cork in the ear becomes more and more dense)
- water entering the ear (the tube in the ear swells and completely blocks the ear canal). The result of this can be a significant decrease in hearing.
The fact that the ear plug is actually present can be identified by several symptoms:
- decrease in hearing,
- in some cases, dizziness, cough, nausea or vomiting, and headache.
Normal hearing is not an indicator of the purity of the auditory canals. If there is at least a small opening between the walls of the auditory canal and the ear plug, the symptoms of the ear plug may not be observed at all. They can suddenly appear if water enters the ears – under the action of water the cork swells and completely blocks the auditory canal. Short-term congestion of the ear, not connected with the plug, may be caused by water ingress, but if the discomfort does not disappear with time, you should consult a doctor.
Do not self-medicate , because removing the ear plug without harm to health is not easy. There is a high probability of damage to the eardrum. Therefore, the removal of the ear plug should be carried out exclusively by qualified doctors who are familiar with the technology of ear plug treatment.
The principle of flushing is the basis for removing the ear plug, when a pulsating stream of water is directed into the auditory canal along the back wall. As a result, the ear plug comes out of the ear canal with water flowing from the ear. There are cases where this procedure is ineffective in removing congestion in the ears. Therefore, the second option may be the instillation of sodium hydrogen carbonate droplets heated to 37 degrees for 2-3 hours, depending on the size of the ear plug. Then the procedure of washing the ear with water is repeated.
As an independent measure for the prevention of ear plug and sulfur removal, use a wet cotton swab, a heating pad or special drops based on solvents.
With a cotton swab, only the outer ear is cleaned. However, it should not be very wet – excessive moisture can cause pain or irritation of the ear.
With the help of a moderately hot water bottle, you can pull out the cork from the ear canal. To do this, you need to lay a sore ear on a heating pad. Under the action of heat, sulfur softens and actively begins to emerge from the ear. Instead of a heating pad, you can use a hot water bottle.
Also home treatment of ear plugs may be based on the use of solvents based on carbamide peroxide which are capable of dissolving sulfur ( “Debroks” “Auro”, “E-W-0”, etc.) The maximum period of application of these drugs – 5 days . If the symptoms persist, you need to consult a specialist.
Rhinitis is the most common disease of the upper respiratory tract.
The main factor predisposing to the development of rhinitis can be considered hypothermia, which contributes to the violation of the protective mechanisms of the body and the activation of conditionally pathogenic microflora in the nasal cavity, nasopharynx and oral cavity. Another factor is the decrease in the resistance of the organism due to acute or chronic diseases.
Warming, moisturizing and filtering the inhaled air, the nasal cavity performs a protective function. The nasal cavity and bronchi are anatomically interrelated, covered with ciliated epithelium and equipped with an arsenal of congenital and acquired protective mechanisms. Therefore, conditions that cause a runny nose, can be a triggering factor for the development of diseases of the lower respiratory tract.
Rhinitis may be the first sign of an acute respiratory viral infection ( ARVI ), as well as the onset of an allergic reaction. The following types of rhinitis are distinguished:
- non-allergic, non-infectious rhinitis.
Seasonal and perennial allergic rhinitis, as well as intermittent and persistent course of each of these forms, are distinguished.
By non-allergic, non-infectious persistent rhinitis is understood as a heterogeneous group of nasal breathing disorders, including occupational rhinitis, drug rhinitis, hormonal rhinitis, elderly rhinitis, and idiopathic vasomotor rhinitis.
Infectious rhinitis occurs in about half of the adult population. In children, especially young children, the incidence of infectious rhinitis is much higher. It may be non-specific (the onset of a respiratory infection) and specific, for example, caused by pathogens of infectious diseases – diphtheria, measles, scarlet fever, tuberculosis.
In addition, acute traumatic rhinitis, caused by trauma of the nasal mucosa (foreign bodies, cauterization, surgical interventions, as well as environmental conditions – dust, smoke, inhalation of chemicals), is also isolated.
The classic signs of rhinitis are nasal congestion, nasal discharge, sneezing. Rhinitis begins quickly with a general deterioration of the patient’s condition: the body temperature rises, headache , worsening nasal breathing, decreased sense of smell, due to the spread of the inflammatory process in the olfactory region. The patient notes a burning sensation, tickling and scratching in the nasal cavity. Then there is a discharge due to the liquid, sweating from the vessels, and enhancing the function of the mucous glands. This discharge has an irritating effect, especially in children, on the skin of the vestibule of the nose and upper lip, manifested in the form of redness and painful cracks. Nasal breathing is impaired due to edema of the concha.
Characteristic tearing due to irritation of the sensitive reflexogenic zones of the nasal mucosa, sneezing. Swelling of the mucous membrane of the nasal cavity leads to impaired drainage of the paranasal sinuses and the middle ear, which creates favorable conditions for the activation of conditionally-pathogenic flora and contributes to the development of bacterial complications. The nature of the discharge from the nasal cavity changes, it becomes cloudy, then yellowish and greenish. This is due to the presence of pus in it.
The patient’s condition improves: the headache decreases, the amount of discharge, the discomfort in the nose disappears (sneezing, tearing), nasal breathing improves. The total duration of acute rhinitis is 8-14 days, it can vary in one direction or another for various reasons. Acute rhinitis can stop in 2–3 days if the child’s general and local immunity is not impaired. In weakened children (often ill with ARVI), in the presence of chronic foci of infection, acute rhinitis may be prolonged in nature – up to 3-4 weeks.
Acute rhinitis in infants has its own characteristics. It usually proceeds as rhinopharyngitis ; often the inflammatory process extends to the nasopharynx ( adenoiditis ), middle ear, larynx, trachea, bronchi, lungs. The child is disturbed by the act of sucking, which leads to loss of body weight, sleep disturbance , increased excitability. Especially severe acute rhinitis occurs in premature, weak children, with a sharply reduced body resistance.
Chronic catarrhal rhinitis characterized by a number of common manifestations: the main complaint is a violation of nasal breathing with alternate laying one or the other half of the nose. Depending on the contents of certain elements exudate, nasal discharge can be serous, mucous ormucopurulent -gnoynym. Chronic hypertrophic rhinitis is characterized by the duration of the course. Nasal congestion is more permanent than with the catarrhal form of rhinitis, and does not go away after instillation of vasoconstrictor agents. In addition to obstructed nasal breathing, patients suffer from headaches, poor sleep. The mucous membrane of the nose is usually pale pink, reddish or with a bluish tint. Abundant thick discharge fill the nasal passages and flow into the nasopharynx, but in rare cases, discharge may not be.
With chronic atrophic rhinitis patients complain of a feeling of dryness in the nose, the formation of crusts, a feeling of pressure and headaches. Discharge of the nose is thick, yellow-green; sometimes drying out, forms a crust. Increased patency of the nasal passages, purulent discharge in large quantities can cause the spread of chronic inflammation of the mucous membrane of the pharynx and larynx.
Vasomotor rhinitis is a disease caused by an organism’s hypersensitivity (allergic form) or neuro-vegetative disorders (neuro-vegetative form). These two forms have similar manifestations of the disease: sneezing, nasal congestion, and abundant liquid discharge.
A constant sign for allergic rhinitis is sneezing, accompanied by abundant transparent watery discharge from the nose and difficulty in nasal breathing. Discharge preceded by itching in the nose.
The diagnosis of acute rhinitis is made on the basis of complaints of the patient, subjective and objective signs, anterior rhinoscopy. Sometimes clinical observations are not enough for diagnosis. In these cases, they resort to laboratory methods of research: general blood analysis, the study of the cytological picture of imprints from the nasal concha mucosa, virological tests.
With signs of rhinitis on the background of normal body temperature prescribed
- home (not bed rest) mode,
- plenty of warm drink
- thermal procedures (hot foot baths and warm compresses on the back surface of the hands).
How to blow your nose correctly
The main thing is to blow your nose correctly, so that, firstly, to clean the nasal cavity, and secondly, so that the discharge from the nasal cavity does not fall into the paranasal sinuses and the middle ear cavity. To do this, it is necessary to blow your nose without effort, with a half-open mouth and free each half of the nose, alternately pressing the wing of the nose to the septum. In the case of drying of the crusts at the entrance to the nose, soften them with oil (olive, sunflower) and then carefully remove it with a cotton wick. But only After that, you can peel the mucus from the nose.
When rhinitis is recommended plenty of warm drinks (tea with lemon and raspberry, milk with honey). In cases of high temperature (above 38), antipyretic agents can be used. Although it must be borne in mind that antipyretic drugs, increasing sweating, can predispose to various kinds of complications and worsen the course of the disease, reducing the body’s resistance to infectious aggression.
In the period of exacerbation in chronic rhinitis use the same medicines as in acute rhinitis (vasoconstrictor drops, drops and ointments with drugs that have anti-inflammatory, antimicrobial action). Astringent drugs are used: 2-5% solution of protargol ( colargol ) in the form of drops in the nose (5 drops in each half of the nose 3 times a day).
Treatment of chronic subatrophic and atrophic rhinitis based on a specific program: topically prescribed drugs to improve the condition of the nasal mucosa and stimulate the function of the mucous glands. Used in the form of drops of alkaline solutions, spraying, lubrication with a light massage, furatsilinu ointment at the rate of 1: 5000. Conduct courses for restorative therapy (autohemotherapy, protein therapy, vaccine therapy, injections of aloe extract, cocarboxylase , vitreous body, FIBS), vitamin therapy, prozerin therapy according to generally accepted schemes.
Treatment of chronic hypertrophic rhinitis requires more radical measures: cauterization (produced by chemicals – trichloroacetic acid, lapis, chromic acid, etc.), galvanic caustic, diathermocoagulation, ultrasonic disintegration, cryosurgery , exposure to a laser beam.
With acute rhinitis from physiotherapy methods apply
- ultraviolet irradiation locally and in the area of the soles (6-8 bio doses);
- UHF (areas of the nose for 5-8 minutes, the first 3 days daily, and then every other day);
- microwave effect on the nose area;
- effective inhalation (warm-alkaline, alkaline-oil, oil-adrenaline, phytoncides, honey, etc.).
In chronic catarrhal rhinitis , UHF currents, sollux, ultraviolet irradiation, if there are no contraindications to them, microwave therapy, aerosols, and negatively charged electro- aerosols with antibiotics are more often prescribed.
Of the various forms of chronic rhinitis, low-energy laser radiation is more often used in the treatment of patients with chronic catarrhal rhinitis and subatrophic rhinitis, as well as the neuro-vegetative form of vasomotor rhinitis. The total irradiation time of each half of the nose is 3-4 minutes.The course of daily treatment 10-12 procedures.
In the treatment of rhinosinusitis The following methods of quantum hemotherapy are also used: intravenous irradiation of blood with a helium-neon laser in combination with skin irradiation in the projection area of the vessels with an infrared laser.
Treatment of vasomotor rhinitis should be comprehensive and focused. All types of proposed therapeutic effects on the body can be divided into specific and non-specific. The success of a specific hyposensitization depends on the early detection of an allergen, since over time, patients develop polyallergy . Novocaine blockades, exposure to cold, infrared coagulation, ultrasonic disintegration, vasotomy , hypobarotherapy combined with hyposensitization , ultraviolet irradiation, therapeutic exercises, air and sun baths and many other methods of physiotherapy are used, taking into account indications and contraindications. The beneficial effect of laser therapy for vasomotor rhinitis is associated with improved capillary exchange in the nasal mucosa, leading to the elimination of edema and swelling.
In the absence of the effect of conservative therapy, in the presence of irreversible changes in the mucous membrane of the nasal cavity, a gentle surgical treatment is recommended. Various variants of submucosal operations performed on the nasal conchs are also performed: galvano-acoustics, electrocautery, osteoconchotomy, submucosal microsurgery of vaccines , mucosotomy, conchotomy, and other methods.
The most effective method treatment of allergic rhinitis is the termination of the patient’s contact with the allergen. Drug therapy includes two main aspects of exposure: specific immunotherapy with a significant allergen and the use of antihistamine drugs (tavegil, terfenadine , loratadine ,cetiresin ). Antihistamines of the first generation have a number of side effects (pronounced hypnotic effect). Therefore, the use of these drugs must be carried out with caution (a certain group of people – drivers, etc., must abandon them).
Treatment of allergic rhinitis is also carried out comprehensively and in stages. The first step is the recovery of secretion through irrigation of the nasal mucosa using mineral water, decoction of black tea, massage of the nasal mucosa, acupressure of the nasal wings and collar area;enterosorption (removing metabolic products, toxins, immune complexes, using for this purpose sorbents – Polyphepanum, ultrasorb, sums et al.). The second stage is drug therapy. The third step is carried out specific and nonspecific immunotherapy, increases the content of immunoglobulin A. As bacterial immunostimulants used ribomunil, bronhovakson, bronhomunal. Specific immunotherapy is a causal allergen.
Otitis is a group of inflammatory diseases of the ear.
The ear consists of three parts.
- The outer ear is represented by the auricle and the external auditory canal. When inflammation of the outer ear develops otitis externa.
- The middle ear is bordered to the external by means of the eardrum and is represented by the tympanic cavity and the auditory ossicles (anvil, malleus and stapes). When inflammation of the middle ear develops otitis media. When talking about otitis, most often mean inflammation of the middle ear.
- The inner ear is made up of bone and membranous labyrinths and arises when it is inflamed. internal otitis or labyrinthitis. Otitis usually occurs in children.
Otitis by the nature of the flow are divided into acute and chronic.
Acute otitis media lasts no more than 3 weeks, subacute lasts from three weeks to three months, chronic otitis media is said when it lasts for more than three months.
By origin, ear inflammation is infectious and non-infectious (allergic or traumatic otitis).
Depending on the type of inflammation, otitis can be exudative (a bloody or inflammatory effusion is formed), purulent (local or diffuse) and catarrhal.
Ear inflammation occurs in two cases. Firstly, the penetration of the infectious agent into the middle ear from the inflamed nasopharynx, and secondly, otitis occurs as a result of an ear injury.
Causes for otitis media are:
- acute respiratory viral infections SARS , resulting in swelling of the nasal mucosa, which leads to obstruction (blockage) of the external opening of the Eustachian tube (air passes through it), this leads to impaired ventilation and cleaning the tympanic cavity;
- available adenoids, nasal polyps or chronic tonsillitis , nasopharyngeal neoplasms;
- sudden jumps in atmospheric pressure (taking off and landing of an aircraft, while practicing mountaineering) – aerootite;
- pressure drop when diving deep into water and ascent ( mareotite );
- weakening of the body’s defenses (nervous strain, overwork, chronic diseases, such as diabetes);
- in children due to unformed immunity.
External otitis occurs with trauma of the auricle, with the development of a boil in the external auditory canal, or as a complication of otitis media with suppuration from the middle ear.
Labyrinthitis (inflammation of the inner ear) is a complication of otitis media.
Under the action of various factors (insect bites, scratches and pinch microtraumas and others), the infectious pathogen penetrates into the sebaceous glands or into the hair follicles into the external auditory canal.
In the case of the development of acute purulent local otitis externa (furuncle in the ear canal), the patient complains of earaches, which are aggravated by pressure or by pulling on him.
There is also pain when opening the mouth and pain with the introduction of the ear funnel in order to examine the external auditory canal. Externally, the auricle is edematous and reddened.
Acute infectious purulent diffuse otitis media develops as a result of inflammation of the middle ear and suppuration from it. At the same time, the external auditory canal is infected due to irritation with pus. Sometimes the eardrum is involved in the process.
On examination, edema and hyperemia of the skin of the ear canal is noted, and pus with an unpleasant odor is separated from it. The patient complains of pains that are replaced by itching and ear congestion.
Inflammation of the middle ear proceeds in several stages.
1. In the first stage, the patient complains of pain inside the ear, the nature of which may be different (pulsating, shooting, boring).
In the acute process, body temperature rises sharply (up to 38 ° C and higher). The peculiarity of the pain is that it increases by the night, interferes with sleep. This symptom is due to the pressure of the effusion in the tympanic cavity on the eardrum from the inside.
It is characteristic of the first stage that when the head is tilted to the side of the patient’s ear, there is an increase in pain. Pain radiates to the jaw, eye, or temple, and can spread to the entire half of the head.
The patient complains of hearing loss, noise and ringing in the ear.
2. The beginning of the second stage is associated with perforation (breakthrough) of the eardrum. The pain subsides, pus flows from the external auditory canal. Body temperature drops to normal numbers.
3. The third stage is marked by the gradual cessation of suppuration, the eardrum is scarring, the inflammation subsides. The main complaint of patients is hearing loss.
A characteristic sign of internal otitis is dizziness. In addition, dizziness is accompanied by nausea and vomiting, imbalance, significant tinnitus and hearing loss.
Internal otitis occurs as a complication or continuation of otitis media.
After collecting anamnesis and complaints, the doctor performs otoscopy (examination of the external auditory canal) with the help of a backlit reflector and other special tools.
In addition, the doctor will examine the nasal cavity and oropharynx and, if necessary, prescribe an x-ray examination of the nasal and frontal sinuses.
A complete blood count is also shown showing signs of inflammation (accelerated ESR, elevated white blood cell count).
An audiometry (assessment of air conduction) is assigned to check the level of hearing. To determine the bone conduction use tuning forks.
In the event of the expiration of pus from the external auditory meatus, it is collected for bacteriological examination, which will help identify the pathogen and its sensitivity to antibiotics.
In order to exclude a tumor of the ear or complications of otitis ( mastoiditis ) is assigned Computer tomography.
An otolaryngologist (ENT) doctor is engaged in treating otitis.
External form treatment
External otitis is treated on an outpatient basis. Local therapy is prescribed: turunds, soaked in 70% alcohol, warming compresses, vitamins and physiotherapy are inserted into the ear canal. Antibiotics are advisable to appoint only with significant inflammation and fever.
Treatment of inflammation of the middle ear
Patients with average otitis, as a rule, are hospitalized.
1. In the first stage, antibiotics are administered orally or parenterally (more often in the form of injections) – ceftriaxone, amoxiclav, clindamycin ; and nonsteroidal anti-inflammatory drugs to relieve pain and reduce inflammation (diclofenac, indomethacin ).
To restore the drainage in the Eustachian tube, drops are prescribed, which narrow the vessels in the nasal mucosa (naphthyzin, galazolin ) for a period of 4-5 days. Drops with anti-inflammatory and analgesic effects ( sofradex , otipax , camphor oil) are buried in the ear.
2. In some cases, for ejection of pus and relief of pain, the eardrum is dissected. After opening the eardrum (self-contained or therapeutic), antibacterial solutions ( cipromed, otofa ) are introduced into the tympanic cavity.
3. The third stage of therapy is designed to restore the patency of the auditory tube, the integrity of the eardrum or its elasticity. At this stage, the ear tube is blown out and the eardrum is massaged.
When labyrinthitis (otitis of the inner ear), patients are also hospitalized. Intensive therapy is carried out: bed rest, shock dose antibiotics and dehydration therapy.
The duration of treatment of otitis depends on the stage and severity of the process and must be at least 10 days.
If otitis was treated with inadequate treatment or it was not completed, then the following complications are possible:
- mastoiditis (inflammation of the mastoid process) – requires surgical intervention;
- brain abscess.
The prognosis for the correct and timely treatment of otitis media is favorable.
Pharyngitis – inflammatory process of the pharyngeal mucosa, in which the patient has pain and discomfort in the throat.
The reason for the development of pharyngitis may be the following factors:
- exposure to bacteria (streptococci, staphylococci, mycoplasma, chlamydia);
- exposure to viruses (adenovirus, rhinovirus , parainfluenza, PC-virus);
- exposure to fungi of the genus Candida;
- ingress of irritating substances to the pharyngeal mucosa;
- hit allergens on the pharyngeal mucosa;
- injuries of the pharyngeal mucosa.
The main role in the development of acute pharyngitis belongs to viral infections.
Predisposing factors for the development of pharyngitis are:
- the presence of chronic inflammation in the nasopharynx (otitis media, sinusitis, rhinitis, dental caries);
- mouth breathing during the cold season;
- living in large metropolitan areas with polluted air;
- inhalation of irritating substances at work;
- alcohol abuse;
- frequent hypothermia.
Pharyngitis with the flow can be acute and chronic.
Depending on the cause of pharyngitis, they are divided into:
- from the effects of chemical, irritating substances.
Depending on the clinical manifestations, morphological changes on the mucous membranes of the pharynx, the following forms of pharyngitis are distinguished:
- granular or hypertrophic, in which there is a thickening of the mucous membrane of the pharynx;
- subatrophic or atrophic, in which there is thinning of the mucous membrane of the pharynx.
Granular and atrophic forms of inflammation of the pharyngeal mucosa are characteristic of chronic pharyngitis.
The clinical manifestations of the acute form depend on the cause of the disease. So, in the viral nature of pharyngitis, in addition to signs of pharyngitis itself, symptoms are often found rhinitis, laryngitis, conjunctivitis.
Pharyngitis begins acutely with signs of intoxication, which includes the following symptoms:
- temperature rise;
- general weakness;
- fast fatiguability;
- increased fatigue.
Later, local signs of pharyngitis also appear:
- sore throat when swallowing;
- sore throat;
- discomfort in the throat;
- dry pharyngeal mucosa.
When viewed from the mucous membranes of the pharynx, the following symptoms can be detected:
- redness of the posterior pharyngeal wall;
- grit posterior pharyngeal wall.
There may also be an increase in regional lymph nodes (submandibular, cervical), with their palpation pain occurs.
For fungal pharyngitis is characterized by the presence of whitish raids, while the patient’s temperature can be normal or subfebrile (37 – 37.5 degrees).
If pharyngitis is not treated on time or treated illiterately, then inflammation can spread and arise:
At detection of signs of a disease, it is necessary to consult a local doctor or otolaryngologist.
The diagnosis is established on the basis of the characteristic complaints of the patient, local symptoms of pharyngitis.
The doctor conducts pharyngoscopy (examination of the pharynx), during which you can see:
- hyperemia of the posterior pharyngeal wall, palatine arches;
- grit posterior pharyngeal wall;
- swelling of the mucous membranes of the pharynx.
To clarify the pharyngitis pathogen, a smear from the pharyngeal mucosa is being studied. This study also identifies drugs to which the pathogen is sensitive.
From other tests carried out:
General blood analysis
- there may be signs of an inflammatory reaction (an increase in the number of white blood cells, an acceleration of the erythrocyte sedimentation rate);
Immunological studies are conducted to detect antibodies to various infections (if it is impossible to determine the pathogen using a swab from the pharyngeal mucous membranes).
The treatment of acute pharyngitis is prescribed by the local doctor or the otolaryngologist.
There are general recommendations for the treatment of acute pharyngitis:
- heavy drinking;
- elimination of hot and cold food;
- exclusion of spicy, irritating foods;
- regular room ventilation;
- Daily wet cleaning and moistening of inhaled air.
At a body temperature of 38.5 degrees or more, antipyretic drugs are used:
The treatment necessarily takes into account the etiology of pharyngitis.
In the viral nature of the disease, antiviral drugs are used, but it is worth noting that at the time of publication of the article (April 2016), the effectiveness of antiviral drugs has not been proven:
Antibiotics are used only with proven bacterial nature of pharyngitis, the following agents are prescribed:
- Flemoxin Solutab;
Antibiotic treatment is carried out from 5 to 7 days. Self-medication with antibacterial drugs is unacceptable.
To remove the swelling of the pharyngeal mucosa and allergic nature of pharyngitis antihistamines are prescribed:
A good therapeutic effect is achieved when conducting local treatment, it includes:
- treatment of the pharynx with various solutions;
- resorption of pills and lozenges.
Rinse hold the following solutions:
- Decoction of chamomile, calendula, sage.
For the treatment of pharynx using various sprays and aerosols:
For the resorption using drugs in the form of tablets and lozenges, in addition to the antiseptic effect, they have an analgesic effect:
- Dr. Mom;
Inhalations are carried out with the use of essential oils:
- pine buds;
To do this, use steam inhalers.
Attention! Do not conduct steam inhalation at elevated body temperature.
With a timely start, the duration of treatment is from 7 to 10 days.
Complications arise when the therapy is not started on time, self-treatment, and the duration of treatment is not followed.
Complications arise from the fact that the infection spreads to nearby organs.
The most common complications are:
- acute tonsillitis (tonsillitis);
The preventive measures of acute pharyngitis include:
- nasal breathing outside during the cold season;
- avoid hypothermia common and local;
- to give up smoking;
- increase the body’s defenses;
- timely treatment of inflammatory diseases of the nasopharynx.
With proper and timely treatment of acute pharyngitis, the disease carries a favorable prognosis.
Acute tonsillitis (angina) is an infectious disease, in which there is inflammation of the tonsils.
A person has a lymphoid ring in the pharynx, formed by several tonsils, but mostly palatine tonsils are exposed to angina.
It is still incorrect to call acute tonsillitis angina, because in world practice angina is the term “angina” (“ angina ”). pectoris “).
The following main causes of acute tonsillitis can be distinguished:
The most common causative agent among bacteria is Streptococcus, much less often Staphylococcus, Pneumococcus, atypical bacteria.
Any viral infection of the respiratory tract can lead to the development of tonsillitis.
The following factors contribute to the appearance of the disease:
- inhalation of polluted air at work, or during life in large metropolitan areas;
- hypothermia of the body;
- the presence of foci of chronic infections ( pharyngitis , sinusitis, adenoids, otitis media, caries);
- long-term uncontrolled intake of antibacterial drugs;
- poor nutrition;
- excessive smoking.
The spread of pathogens among the adult population occurs by airborne droplets (during coughing or sneezing), very rarely by contact-household.
When contact-household transfer spread occurs when using common utensils, household items, with non-compliance with the rules of personal hygiene.
Acute tonsillitis is divided by clinical manifestations:
- catarrhal (the mildest form of acute tonsillitis);
- follicular (purulent follicles are formed on the tonsils);
- lacunar (pus accumulates in lacunas of tonsils);
- ulcer-membranous (plaque forms on the tonsils, which, if removed, may cause the tonsil to ulcerate).
After infection and until the onset of clinical signs of tonsillitis (incubation period), it can take from several hours to three days.
The clinical symptoms of acute tonsillitis depend on the type of tonsillitis.
Signs of catarrhal acute tonsillitis
So, with the catarrhal form of acute tonsillitis, a shallow lesion of the tonsils develops.
Initially, the patient shows signs of intoxication, but the intoxication syndrome is mild. Intoxication is characterized by the following symptoms:
- temperature rises in the range of 37-38 degrees;
- moderate general weakness;
- slight headache.
It happens and catarrhal tonsillitis without increasing the temperature.
Local symptoms appear a little later:
- tickling and dry throat;
- mild pain when swallowing the throat;
- tonsils swollen;
- hyperemia (redness) of the tonsils.
There are no raids in catarrhal inflammation on the tonsils. Catarrhal tonsillitis is most often caused by viruses, sometimes it can be an early manifestation of other forms.
This type of acute tonsillitis has a favorable and easier course. In addition to the signs of the disease itself, with catarrhal tonsillitis, there may be signs of viral damage to neighboring organs:
- rin it;
After three days, the process goes into decline, or it changes to another, more serious, form of tonsillitis.
Signs of lacunar and follicular tonsillitis (purulent tonsillitis)
Lacunar and follicular tonsillitis are purulent types of tonsillitis, they develop with bacterial infections.
Both types begin with a pronounced intoxication syndrome:
- body temperature with follicular tonsillitis rises to 39 degrees;
- with lacunar tonsillitis, the temperature rises to 40 degrees or more;
- body aches;
- muscle pain;
- intense headaches;
- severe general weakness;
- increased salivation.
Local changes join:
- sore throat intense;
- when swallowing pain can be given in the ear;
- increased submandibular and cervical lymph nodes;
- pain on palpation of the regional lymph nodes;
- swelling of the tonsils;
- hyperemia of tonsils;
- in the follicular form, the tonsils contain purulent follicles — rounded formations up to 5 mm in diameter, white-yellow in color;
- when the lacunar form on the tonsils there are accumulations of pus in the gaps of the tonsils, also white-yellow;
- purulent discharge can cover the entire surface of the tonsils (purulent plaque).
The duration of the clinical manifestations of these two forms is usually up to 7-10 days.
Ulcerative-membranous form of tonsillitis
Ulcerative membranous tonsillitis does not cause disruption of the general condition of the body. The distinguishing point is the presence of grayish raids, when removed, there are ulcerative lesions of the tonsils mucosa.
If signs of acute tonsillitis appear, it is imperative that you contact your local doctor or otolaryngologist.
It is not necessary to engage in self-treatment, it can lead to the development of complications or to the transition of tonsillitis to the chronic form.
The diagnosis is established on the basis of characteristic complaints, anamnesis of the disease, and of course, inspection data.
The doctor conducts pharyngoscopy – examination of the oral cavity and pharynx, which detects local changes.
A smear is taken from the mucous tonsils to determine the causative agent of the disease, and to select drugs for the treatment of the inflammatory process. It is determined to which drugs the pathogen is sensitive.
Be sure that acute tonsillitis is carried out smear from the tonsils to exclude diphtheria .
In general, blood tests can be inflammatory changes – accelerated ESR, leukocytosis.
Treatment of acute tonsillitis should be strictly under the supervision of a physician.
There are general recommendations during treatment:
- isolation of the patient in a separate room;
- regular room ventilation;
- wet room cleaning daily;
- the allocation of separate dishes for the patient;
- heavy drinking;
- elimination of too hot products;
- food should be warm, puree;
- You can not eat spicy, acidic foods (this further irritates the throat mucosa).
Antipyretic drugs should be taken at a temperature of 38.5 degrees or more. The following drugs are prescribed:
Be sure to conduct etiotropic therapy (aimed at the causative agent).
Antiviral drugs are used in the viral etiology of acute tonsillitis, however, there is still intense debate in the scientific community about the effectiveness of such drugs. Opponents of antiviral therapy rightly argue that its action has little effect. The following antiviral drugs are currently the most popular:
Antibiotics for acute tonsillitis
Antibacterial drugs must be taken for purulent (bacterial) forms of tonsillitis. Antibiotics are prescribed with a wide range of antibacterial action:
- Penicillins (Amoxiclav, Flemoklav, Augmentin );
- Macrolides (Hemomycin, Azithromycin, Klacid );
- Cephalosporins (Cefixime, Zinnat, Ceftriaxone ).
Dosage, frequency and duration of administration are determined only by the attending physician.
Usually the course of antibacterial treatment is about ten days, but not less than seven.
Antihistamines are used to relieve swelling of the tonsils:
Local therapy for acute tonsillitis is a must.
- irrigation of tonsils with sprays;
- lozenges, pills.
For gargling use:
- hydrogen peroxide;
- soda solution;
- sea salt;
- infusions of herbs.
Rinsing can be carried out every 1.5-2 hours, alternating several means.
After the procedure, do not drink for 30 minutes.
Irrigation of mucous tonsils is carried out:
Tablets for sucking and lozenges have not only anti-inflammatory effect, but also analgesic:
- Dr. Mom;
Therapy of acute tonsillitis should be comprehensive, then recovery occurs much faster.
Be sure to adhere to the course of treatment.
Removal of tonsils in acute tonsillitis is not performed. It can be only if the patient has a complication of acute tonsillitis – paratonsillar edema or difficulty breathing due to the large size of the tonsils.
But for surgical treatment there are also contraindications:
- severe concomitant diseases;
- blood disorders with coagulation disorders;
- active tuberculosis.
Complications of acute tonsillitis are divided into local and general.
Local complications include:
- paratonsillar abscess;
- neck phlegmon;
Common complications include:
- rheumatic lesion of the heart, joints;
- glomerulonephritis (inflammation of the kidneys);
- meningitis (inflammation of the lining of the brain);
- infectious-toxic shock (intoxication of the waste products of microorganisms);
- sepsis (getting bacteria into the bloodstream and spreading throughout the body).
To prevent the development of complications, timely treatment of acute tonsillitis is necessary.
Prevention of acute tonsillitis includes:
- personal hygiene.
- increase the body’s defenses.
- avoid hypothermia.
- balanced diet.
- treatment of chronic diseases of other organs (otitis, sinusitis, caries, pharyngitis).
- to give up smoking.
- refusal of alcohol.
The prognosis for timely treatment and in compliance with all the recommendations of the otolaryngologist is favorable.
Acute respiratory viral infections (ARVI) – this is the most extensive group of infections transmitted by airborne droplets and causing respiratory manifestations of varying severity: from a mild rhinitis to bronchitis or pneumonia. SARS at least several times in my life every person is sick.
ARVI belongs to a separate group of respiratory infections caused exclusively by viruses, as there is still a fairly large group Colds (acute respiratory diseases) that can be caused by microbial agents – pathogenic and conditionally pathogenic microbes.
ARVI is widespread among children and adults, on average, children suffer from three to 10-12 times a year, adults from one to four times a year.
SARS is highly relevant due to the fact that they do not have specific treatment and methods for specific prophylaxis (there is no vaccine against all known ARVI).
In addition, it is more difficult to accurately identify the specific virus that caused the disease in each patient, and therefore a collective term emerged – it implies the similarity of the manifestations and principles of treatment of this group of diseases.
SARS is caused by viruses, which today are known about 250 species. All of them belong to certain groups: rhinoviruses, adenoviruses, coronaviruses, enteroviruses, parvavirusy, paramyxoviruses, influenza viruses, parainfluenza viruses, respiratorno- sentitsialnye viruses, Coxsackieviruses and other respiratory viruses.
Infection occurs by airborne droplets. Particles of the virus are transmitted by coughing, talking, sneezing.
For children, the contact route of infection is also relevant – when kissing adults, using common dishes and using dirty hands.
Predicting to the spread of viruses are season changes due to:
- long-term preservation of viruses in the air due to relatively warm and wet weather,
- temperature fluctuations and supercooling of the body,
- crowded population in enclosed spaces,
- small stay in the fresh air and rare airings,
- weakening the body of a lack of vitamins and monotonous nutrition,
- exacerbations of chronic pathology.
SARS usually proceeds in stages , the period of incubation from the moment of infection to the onset of the first signs is different, ranging from several hours to 3-7 days. During the period of clinical manifestations, all acute respiratory viral infections have similar manifestations of varying severity:
- nasal congestion, runny nose, nasal discharge from scarce to heavy and watery, sneezing and itchy nose,
- sore throat, discomfort, pain when swallowing, red throat,
- cough (dry or wet),
- moderate fever (37.5–38 degrees) to severe (38.5–40 degrees),
- general malaise, refusal to eat, headaches, drowsiness,
- red eyes, burning, tearing,
- digestive disorders with loose stools,
- rarely is the reaction of the lymph nodes in the jaw and neck, in the form of an increase with mild soreness.
Manifestations depend on the specific type of virus, and can vary from a minor runny nose and coughing to pronounced febrile and toxic manifestations. On average, the manifestations last from 2-3 to seven or more days, the febrile period lasts up to 2-3 days.
The main symptom of ARVI is high infectivity for others, whose terms depend on the type of virus. On average, the patient is infectious during the last days of the incubation period and the first 2-3 days of clinical manifestations, gradually the number of viruses decreases and the patient becomes not dangerous in terms of the spread of infection.
Usually, viral infections are treated very superficially, without consulting a doctor, and self-healing. This can lead to the formation of such complications as:
- sharp sinusitis ( inflammation of the sinuses with the addition of purulent infection),
- lowering the infection down the respiratory tract with the formation bronchitis and pneumonia,
- spread of infection to the auditory tube with the formation otitis ,
- the accession of a secondary bacterial infection (for example, the development of sore throats )
- exacerbation of foci of chronic infection in the broncho- pulmonary system, as well as in other organs.
Diagnostics in the acute period is not difficult – the manifestations are typical, sometimes to exclude a purulent infection, a smear from the throat and nose with bac. Additional diagnostic methods for uncomplicated ARVI is not carried out.
If necessary, the diagnosis of complications apply x-rays of the paranasal sinuses of the nose or chest.
Therapists, pediatricians and infectious disease specialists are involved in the treatment. First of all, the basis of therapy is:
- isolation from other children and adults
- bed rest
- abundant fluid intake, nutrition according to appetite (vegetable-milk table),
- airing and moistening of air.
Specific antiviral drugs for acute respiratory viral infections are not developed, for these infections only symptomatic drugs are used. These include:
- antipyretic drugs with fever above 38.5-39 degrees and feeling unwell (lower temperature is usually not knocked down),
- drugs for rhinitis – otrivin , sanorin , pinosol , etc.,
- antiseptic and anti-inflammatory drugs for pharynx ( tantum verde, Hexoral, cameton , etc.)
- antitussives (sinekod, Codelac), expectorants (Tussin syrup plantain), vasospasm sputum means (Ascoril, ACC).
- vitamin C in high dosages, multivitamins.
- You can apply the methods of folk therapy – decoctions of herbs, tea with honey, raspberries, milk with honey.
With ARVI contraindicated:
- immune drugs.
The prognosis for timely and complete treatment is favorable, the disease passes within one to two weeks.
Ozena – This is a disease of the nasal mucosa. Women get sick more often than men.
Predisposing factors for ozone development are unsatisfactory living conditions (poor housing, insufficient nutrition).
The reasons for the development of ozena are still unexplained. Some authors believe that the cause of the disease is congenital excessive width of the nose, shortening of the anterior- posterior dimensions of the nasal cavity, hypoplasia of the paranasal sinuses and a wide facial skull.
Other authors have attributed the origin of ozena to the rebirth of the nasal mucosa. Reborn mucous disintegrates, emitting an unpleasant smell. Scheenemann ( Schonemann ) found mucosal degeneration in 65 of 75 patients with ozone. Bayer ( Woweg ) and Tsarniko ( Zarniko ) believe that ozena is caused by a malnutrition of tissues leading to the destruction of bone and the regeneration of the epithelium.
Microbiology research has proven a wide variety of microflora in the nasal mucus of ozen patients, and this fact has allowed some authors to consider ozen as an infectious disease.
Of all the hypotheses, the most reliable can be considered the one according to which ozena develops when nerve function is impaired, in particular when it is damaged, irritated, etc. pterygopalatine node.
With a completely free nasal breathing, painful dryness in the nose and the presence of something foreign are felt.
These manifestations cause the need to clear the nose, and the patient tries to remove the accumulated crusts. In some cases, the crusts accumulate in such large quantities that they completely clog the nasal cavity. Then comes the difficulty of nasal breathing, which quickly passes after vigorous blowing out or mechanical removal of crusts.
Another manifestation of ozena is the loss of smell. The patient, being a carrier in the nose of fetid crusts, does not smell them and learns about it only from those around them. Loss of smell is due to the death of the olfactory receptor. The stench from the nose reaches such strength that others avoid the presence of the patient. The patient notices this and avoids society himself.
Frequent concomitant disease is inflammation of the auditory tube and middle ear, which leads to tinnitus and hearing loss. Ozena can spread to the mucous membranes of the pharynx, larynx and trachea. Then there is dry throat, hoarseness and difficulty in breathing, especially when there is a heavy accumulation of crusts in the trachea.
Diagnosis is made ozeny ENT doctor. When rhinoscopy revealed signs characteristic of ozena – the presence of fetid crusts, the removal of which is visible overly wide nasal cavity.
Conservative treatment of ozena involves the elimination of dry nose, accumulation of crusts and deodorization. Wash your nose with 3% hydrogen peroxide solution, a weak pink solution of potassium permanganate or a simple saline solution. To do this, use a special nasal watering can or Esmarch mug.
In order to prevent the liquid from entering the auditory tube, flushing should be done with caution: the patient tilts the head forward, opens the mouth slightly, and then the washing liquid is not swallowed, but is poured out through one or the other half of the nose. Gottstein’s tamponade is made by a doctor: the nasal cavity is filled with a gauze pad moistened with a 1-2% solution of iodine in glycerin. The tampon is left in the nose for 2-3 hours. At removal of a tampon fetid crusts leave.
In some cases, daily nasal lubrication with 2-5% iodoglycerol may be recommended.
The treatment is applied with chlorophyll- carotene paste, manufactured according to F. T. Solodky’s method. One candle is inserted from the paste into both halves of the nose once a day for one month. After a few minutes, the bad smell from the nose disappears, and this state lasts for 2 days. With the re-introduction of the paste, the period of deodorization is extended to 3-5 days. The course of treatment should be carried out 4 times during the year.
Some authors have observed an improvement in the condition of ozone patients from the use of physiotherapeutic procedures, for example, from diathermy and iontophoresis. Good results are observed after inhaling ionized air (therefore, patients are advised to keep an air ionizer at home).
The essence of the surgical treatment of ozena lies in the artificial narrowing of the nasal cavity. Of all surgical techniques, the most benign is the introduction of fat, bone, and cartilage into the submucosal tissue. As a result of the implantation of the material, there is a strong reaction from the perchondrium and the mucous membrane, expressed in enhanced formation of connective tissue, blood vessels and an increase in the size and number of mucous glands. These changes after surgery and cause improvement.
Recently, instead of bone, foam plastic ( hyalon ) is used, followed by the introduction of deoxycorticosteroid acetate as a hormone under the skin of a patient, promoting the development of blood vessels and connective tissue.
A more radical surgical technique is the operation of Lautenschleger , which consists in pushing the inner wall of the maxillary sinus to the nasal septum. The wall of the sinus is separated and fixed in the desired position with a swab. Subsequently, the separated wall is held in a new position by the fusion of the surfaces of the nasal septum and nasal conchas.
Sensorineural hearing loss develops when the sensory nerve cells of the inner ear, the auditory nerve and the central formations of the auditory system are damaged.
In the occurrence of neurosensory hearing loss play a role:
- infectious diseases ( flu and ORVI, mumps, syphilis );
- vascular disorders ( hypertension, vertebrobasilar circulation , cerebral atherosclerosis);
- stress, mechanical, acoustic and barotrauma;
- exposure to industrial and household substances, a number of drugs ( aminoglycoside antibiotics, some antimalarial and diuretic drugs, salicylates).
Manifestations of hearing loss consist in a decrease in hearing. Hearing loss can be combined with
Most cases of neurosensory hearing loss occur with vestibular disorders in the presence of subjective manifestations (dizziness, incoordination, nausea or vomiting). In some cases, a violation of the vestibular function is detected only when conducting a specific neurological examination in combination with computed tomography, magnetic resonance imaging, Doppler ultrasound and rheoencephalography.
Diagnosis of neurosensory hearing loss is carried out by the ENT doctor. A modern approach to the diagnosis of hearing loss involves the study of the function of the sound-conducting and sound-receiving systems, the vestibular analyzer, the study of blood coagulation and liver function, assessment of the cardiovascular, excretory and endocrine systems, which makes it possible to establish the cause of the disease and develop the most effective treatment tactics.
In practice, the initial assessment of the auditory function requires the analysis of acoustic and audiological indicators, among which the carrying out of dial- tuning samples, the recording of a tone threshold audiogram are mandatory . An additional, more informative method to clarify the type of hearing loss is audiometry performed in the frequency range above 8000 Hz.
Inclusion in the examination plan of patients with neurosensory impedance -impairment hearing loss is a method for detecting a break in the circuit of the auditory ossicles, the presence of effusion in the tympanic cavity, and dysfunction of the auditory tube.
The treatment plan is individual for each patient, determined based on the causes and duration of the disease, the presence of concomitant diseases. However, there are general rules for the treatment of:
- treatment of a patient with acute sensorineural hearing loss in a specialized otorhinolaryngological hospital;
- immediate start of treatment immediately after hospitalization;
- observance of a sparing diet;
- quitting smoking and drinking alcohol
Taking into account the peculiarities of the disease, drugs are used to improve the blood supply to the inner ear. Such drugs as Vinpocetine , pentoxifylline , Cerebrolysin , Piracetam are used intravenously for the first 10 days, gradually increasing the dose of the drug from the 1st to the 4th day and keeping the permanent therapeutic dose from the 5th to the 10th day of treatment. Subsequently, they switch to intramuscular and tablet use of drugs, with a total duration of the first course of treatment of 1–1.5 months.
For the treatment of neurosensory hearing loss, accompanied by dizziness, drugs with a specific effect on the inner ear (for example, betahistine ) are successfully used . The drug should be taken during or after a meal to prevent a possible adverse effect on the gastric mucosa, in the absence of a patient’s stomach ulcer and bronchial asthma.
Increases the effectiveness of drug treatment of sensorineural hearing loss and stabilizes the positive clinical dynamics of the inclusion of non-drug methods into the complex of therapeutic measures: reflexotherapy – acupuncture or laser puncture (10 sessions immediately after the completion of intravenous therapy, then 10 sessions after 1 month and, if necessary, 10 sessions after 2–3 months after the first course of inpatient treatment), as well as hyperbaric oxygenation (the duration of a session is 30 minutes, the course of treatment is 10 sessions).
Rehabilitation of hearing by implanting electrodes into a cochlea in order to electrically stimulate the fibers of the auditory nerve is becoming more common.
It should be emphasized that even adequately selected therapy of a patient with acute sensorineural hearing loss does not exclude the likelihood of disease recurrence under the influence of a stressful situation, exacerbation of cardiovascular disease, acute viral infection or acoustic trauma.
To eliminate tinnitus: Sit on a chair with the head tilted 30 ° forward and upside down, eyes closed. Close your ears tightly with your palms and press them to the temples, placing your fingers on the occipital region. With the tip of the middle finger of your right hand, make 60 rhythmic tapping on the middle finger of your left hand.
With adequate treatment and compliance with preventive measures (stopping smoking, taking alcohol and drugs, sufficient physical activity, the ability to overcome episodes of neuropsychiatric stress and stressful situations) – the prognosis is favorable.
Meniere’s disease is a pus-like disease of the inner ear, characterized by an increase in the volume of the labyrinth fluid and an increase in intralabirint pressure, resulting in bouts of progressive deafness, tinnitus, dizziness and imbalance, as well as autonomic disorders (nausea, vomiting)
Usually, Meniere’s disease is a unilateral process, in 10-15% of cases it is bilateral.
The disease develops without a preceding purulent process in the middle ear and organic diseases of the brain and its membranes. The severity and frequency of attacks may decrease with time, but the hearing loss progresses.
The prevailing age for the development of Meniere’s disease is 30-50 years.
- The classic form of Meniere’s disease – a simultaneous violation of the auditory and vestibular functions (approximately 30% of cases)
- Cochlear form – the disease begins with hearing impairment (50% of cases)
- Vestibular form – the disease begins with vestibular disorders (15-20% of cases).
There are several theories linking the occurrence of this disease with the reaction of the inner ear (in the form of increasing the amount of labyrinth fluid and increasing pressure inside the maze) to various injuries.
- Violations of water-salt metabolism
- Allergic diseases
- Endocrine diseases
- Vascular diseases
- Viral diseases
- Dysfunction of endolymphatic duct and endolymphatic sac
- Deformation valve Basta
- Blockage of the pipeline
- Decreased airiness of the temporal bone.
In recent years, the theory that explains the occurrence of this disease by impaired function of the nerves innervating the vessels of the inner ear is in the center of attention.
- Paroxysmal flow (during the interictal period, signs of the disease are usually absent, with the exception of hearing loss).
- Gradual hearing loss, predominantly low-frequency in the early stages of the disease; periodic deterioration and sudden improvement in hearing
- Vertigo – spontaneous attacks lasting from 20 minutes to several hours
- Noise in ears
For severe attacks of Meniere’s disease, the following manifestations are characteristic: nausea and vomiting, pallor, severe sweating, decrease in body temperature, loss of the ability to maintain balance, the severity of manifestations increases with movement.
The diagnosis is made by the ENT doctor. Laboratory studies are aimed at the exclusion of other diseases with similar manifestations.
- Specific serological tests to detect pale treponema
- Examination of thyroid function
- Research on fat metabolism.
- Hearing study
- Study of the vestibular apparatus
- Visualization – magnetic resonance imaging to exclude the auditory nerve neuroma.
Outpatient treatment is usually indicated for Meniere’s disease. The attack can be stopped on an outpatient basis. If necessary, surgery of the patient is hospitalized.
Physical activity is limited during seizures. Recommended full physical activity in the interictal period
Diet in the treatment of Meniere’s disease: limiting food intake during bouts of nausea. In some cases it is advisable to limit the consumption of salt. Diet does not belong to the factors that provoke the occurrence of seizures.
Patients with Meniere’s disease should not work in extreme conditions (on underground, underwater or high-altitude works), in the zone of increased risk of injury (for moving machinery), while servicing any types of vehicles
The peculiarity of patients with Meniere’s disease is pronounced emotional lability, so they need increased attention.
It is extremely important to conduct a periodic assessment of hearing due to its progressive deterioration.
Drugs of choice during an attack (one of the drugs):
In the interictal period:
- meklozin 25-100 mg orally before bedtime or in several doses,
- phenobarbital or diazepam,
- hydrochlorothiazide together with potassium preparations,
In most cases, conservative treatment of Meniere’s disease is effective, but in 5-10% of cases surgical treatment is necessary in connection with dizziness.