OTITIS

OTIT is an inflammation of the ear. There are external, middle and inner otitis media.

External otitis media. Isolate limited external otitis (a furuncle of the external auditory canal) and diffuse (diffuse) external otitis.

Limited external otitis occurs as a result of the introduction of infectious agents (most commonly staphylococcus) into the hair follicles and sebaceous glands of the fibrous cartilaginous part of the external auditory canal, facilitated by minor injuries when manipulating the ear with matches, pins, etc. More common in people with diabetes, gout, hypovitaminosis. Sometimes the process extends to parotid fat. There are pains in the ear, intensifying when pressing on the tragus and sipping the auricle. When the furuncle is localized on the anterior wall of the external auditory canal, pain occurs when the mouth is opened. With the medical purpose in the external auditory megus enter gauze turundas, moistened with 70% alcohol, apply warming compresses, physiotherapy (solux, UHF currents), prescribe vitamins. Antibiotics and sulfonamide preparations are used for severe inflammatory infiltration and increased body temperature. In the case of an abscess, an autopsy is shown.

Diffuse external otitis develops primarily as a complication of chronic purulent otitis media due to suppuration. There are itching and pain in the ear, there are purulent discharge with an unpleasant odor. Treatment - washing of the external auditory canal with 3% alcohol solution of boric acid, furatsilin solution 1: 5000 and lubrication with oxycorte, sintomycin emulsion.

Average otitis media. Acute otitis media develops as a result of penetration into the middle ear of infectious agents mainly through the auditory tube in the inflammatory process in the mucous membrane of the nose and nasopharynx (for example, in rhinitis). In newborns, otitis occurs as a result of entering the amniotic fluid in the middle ear during childbirth. Of great importance is also the anatomical structure of the auditory tube (in children it is wider and shorter), weakening of the body's defenses.

In the first stage, severe pain in the ear, irradiating to the corresponding half of the head, teeth, high body temperature (38-39 ° C), a significant decrease in hearing is noted. With otoscopy, the hyperemia of the tympanic membrane is detected, all contours are smoothed out, then the eardrum is protruded. In the blood there is leukocytosis , an increase in ESR.

In the II stage appears suppuration as a result of perforation of the tympanic membrane (acute purulent otitis media), the pain subsides (the delay of pus causes the resumption of pain). The general condition of the patient improves, the body temperature normalizes.

In the third stage, the inflammation slows down, the suppuration stops and the edges of the perforation hole coalesce in the eardrum. After cessation of suppuration, the main complaint of the patient may be a decrease in hearing.

In newborns and infants, the disease often goes unnoticed to others until the appearance of suppuration. In some cases, the child is restless, wakes up at night, screams, turns his head, rubs a sick ear on the pillow, reaches out to the ear, refuses to breast (earache with sucking and swallowing increases due to increased pressure in the middle ear).

Treatment includes complete rest, bed rest. According to the indications, antibiotics are prescribed (with pyrexia taking into account the sensitivity of microflora to them), sulfanilamide preparations. At high temperature, antipyretic agents are indicated. Locally apply warming compresses, warmers, physiotherapy (sollyks, UHF currents). A short-term (for 20 - 30 min) antiseptic and analgesic effect renders 96% ethyl alcohol in the form of warm drops in the ear. To reduce pain in the ear, drop in a warm form drops of 5% solution of carbolic acid in 6zvodnom glycerin, which should be discarded with the appearance of purulence from the ear. Vessels are instilled with vasoconstrictors. In the case of ineffectiveness of such treatment, a paracentesis is produced. After the appearance of suppuration from the external auditory canal it is necessary to ensure a good outflow of pus. If, after cessation of purulent discharge and scarring of the tympanic membrane, the hearing remains low, then the ear purging, pneumatic massage and UHF therapy on the ear area are shown.

Chronic catarrhal otitis media usually develops with chronic eustachitis, often associated with acute acute catarrhal otitis. Clinically, they note a decrease in hearing, a feeling of stuffiness of the ear, a transfusion of fluid in it. Otoscopically, the tympanic membrane is cloudy, retracted, its recognition points are smoothed out. Often seen the level of fluid (transudate), which remains constant when the patient's head tilts forward and backward,

Apply suction of the transudate with a special tip, the introduction into the middle ear of a solution of antibiotics and hydrocortisone. If necessary, the drum cavity is drained with a special polyethylene tube, which is injected into it after paracentesis. Assign ear blowing, apply UHF currents, microwave therapy.

Chronic suppurative otitis media is accompanied by prolonged suppuration from the ear, while the perforating hole in the tympanic membrane is persistently maintained and the hearing decreases. In most cases, the disease is associated with acute acute purulent otitis with periodic or persistent suppuration. Otoskopicheski in the tympanic membrane reveal a perforation. Depending on the nature of the process and the localization of the perforated aperture, chronic purulent mesotympanitis and epitimpanitis are distinguished. When mesotiminate, the perforating aperture is located in the central part of the tympanic membrane, with epitimpanitis in the upper; Often it occupies both departments (epimezotimpanit). Mesotimpanite proceeds, as a rule, more benignly than epitimpanitis, with it there are much less frequent complications. Epitimpanitis, or epimezotimpanit, is accompanied by caries of bone (ostitis) with the formation of granulations, polyps. There may be a cholesteatomy of the ear, which is clinically manifested as a tumor, i.e. Causes destruction of the bone and this creates the danger of intracranial complications. Exacerbation of epitimpanitis or suppuration of the cholesteatoma of the ear can lead to the development of mastoiditis.

Conservative treatment is possible with free outflow of pus and access of medicines through a perforated hole in the eardrum to the mucosa of the middle ear. To introduce into the tympanum, these or other medicines should only after careful removal of pus. For this purpose, the external auditory canal is wiped with cotton wool wrapped on the probe, until the cotton wool removed from the ear becomes dry. For instillation in the ear, a solution of boric acid in 70% alcohol is often used, as well as solutions of sulfacyl sodium (Albucida), furacilin or salicylic acid in alcohol and other antiseptic agents. If the granulations are small, then cauterizing substances (solutions of protargol, silver nitrate in the form of drops) are used. When epitimpanite is washed over the drum with antiseptic solutions. If the hole in the tympanic membrane is large, and the discharge is small, then a small powder of boric acid, sulfanilamide preparation or antibiotic is injected into the ear.

Adhesive (adherent) otitis media occurs more often after acute or chronic purulent inflammation of the middle ear, characterized by the formation of adhesions in the tympanic cavity. Development of it is often promoted by irrational use of antibiotics in acute Catarrhal otitis media. The main symptom is deafness. Often there is a noise in the ears. With otoscopy, a thin, scar-modified tympanic membrane with deposits of calcium salts is visible. The mobility of the tympanic membrane and the patency of the auditory tube are disturbed. Applying blowing the ears, pneumo- and vibromassage, the introduction of proteolytic enzymes into the drum cavity, diathermy on the ears, mud therapy, as well as surgical treatment.

Internal otitis media - see Labyrinthitis .