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.