OTITIS - inflammation of the ear. There are external, middle and internal otitis media.
Otitis externa. There are limited external otitis media (boil of the external auditory meatus) and diffuse (diffuse) external otitis media.
Limited otitis externa occurs as a result of the introduction of infection pathogens (most often staphylococcus) into the hair follicles and sebaceous glands of the fibro-cartilaginous part of the external auditory canal, which is facilitated by minor injuries when manipulating the ear with matches, hairpins, etc. More often observed in individuals suffering from diabetes mellitus, gout, hypovitaminosis. Sometimes the process extends to the parotid fiber. Ear pains are noted, aggravated by pressure on the tragus and pulling on the auricle. With the localization of the boil on the front wall of the external auditory meatus, pain occurs during opening of the mouth. For therapeutic purposes, gauze turundas moistened with 70% alcohol are injected into the external auditory canal, warming compresses, physiotherapy (sollux, UHF currents) are used, vitamins are prescribed. Antibiotics and sulfonamide drugs are used for severe inflammatory infiltration and elevated body temperature. In the case of an abscess, an autopsy is indicated.
Diffuse external otitis media develops mainly as a complication of chronic suppurative otitis media due to suppuration. Itching and pain in the ear are noted, there are purulent discharge with an unpleasant odor. Treatment - washing the external auditory canal with a 3% alcohol solution of boric acid, a solution of furatsilin 1: 5000 and lubricating it with oxycort, sintomycin emulsion.
Otitis media. Acute otitis media develops as a result of penetration into the middle ear of infection pathogens mainly through the auditory tube during the inflammatory process in the mucous membrane of the nose and nasopharynx (for example, with rhinitis). In newborns, otitis media occurs as a result of getting 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 stage I, severe pain in the ear is noted, radiating to the corresponding half of the head, teeth, high body temperature (38 - 39 ° C), and a significant decrease in hearing. With otoscopy, hyperemia of the eardrum is detected, all contours are smoothed, then the eardrum protrudes. Leukocytosis , an increase in ESR are observed in the blood .
In stage II, suppuration occurs as a result of perforation of the eardrum (acute purulent otitis media), the pain subsides (delay of pus causes the resumption of pain). The general condition of the patient improves, body temperature normalizes.
In stage III, the inflammatory process subsides, suppuration decreases and the suppuration ceases, the edges of the perforated hole in the tympanic membrane grow together. After cessation of suppuration, the main complaint of the patient may be hearing loss.
In newborns and infants, the disease often proceeds imperceptibly to others until the appearance of suppuration. In some cases, the child is anxious, wakes up at night, screams, twists his head, rubs the sore ear against the pillow, reaches for the ear, refuses to breast (pain in the ear when sucking and swallowing intensifies due to increased pressure in the middle ear).
Treatment includes complete rest, bed rest. According to indications, antibiotics are prescribed (with suppuration, taking into account the sensitivity of microflora to them), sulfonamide drugs. At high temperatures, antipyretic drugs are indicated. Locally apply warming compresses, heating pads, physiotherapy (sollux, UHF currents). Short-term (for 20-30 minutes) antiseptic and analgesic effect is exerted by 96% ethyl alcohol in the form of warm drops in the ear. To reduce pain in the ear, a drop of a 5% solution of carbolic acid in 6-anhydrous glycerin is instilled in the form of heat, which should be discontinued when suppuration occurs from the ear. Vasoconstrictors are instilled into the nose. In case of failure of such treatment, paracentesis is performed. After the appearance of suppuration from the external auditory canal, it is necessary to ensure a good outflow of pus. If, after the cessation of purulent discharge and scarring of the tympanic membrane, the hearing remains reduced, then ear blowing, pneumatic massage and UHF therapy on the ear area are indicated.
Chronic catarrhal otitis media usually develops with chronic eustachitis, often associated with acute catarrhal otitis media. Clinically noted a decrease in hearing, a feeling of stuffiness in the ear, transfusion of fluid in it. Otoscopically, the eardrum is muddy, retracted, its identification points are smoothed out. The level of fluid (transudate) is often visible, remaining constant when the patient tilts the patient’s head back and forth,
Apply transudate suction with a special tip, the introduction of a solution of antibiotics and hydrocortisone into the middle ear. If necessary, the tympanic cavity is drained with a special polyethylene tube, which is inserted into it after paracentesis. Prescribe ear blowing, apply UHF currents, microwave therapy.
Chronic purulent otitis media is accompanied by prolonged suppuration from the ear, while the perforated hole in the eardrum is persistently preserved and hearing is reduced. In most cases, the disease is associated with acute purulent otitis media with periodic or constant suppuration. Otoscopically in the tympanic membrane reveal a perforated hole. Depending on the nature of the process and the location of the perforation, chronic purulent mesothympanitis and epithympanitis are distinguished. With mesotympanitis, the perforated hole is in the central section of the eardrum, with epithympanitis - in the upper; often it occupies both departments (epimesotympanitis). Mesothympanitis proceeds, as a rule, more benignly than epithympanitis, with it complications are much less frequent. Epitympanitis, or epimesothympanitis, is accompanied by bone caries (osteitis) with the formation of granulations, polyps. Ear cholesteatoma may occur, which clinically appears as a tumor, i.e. causes destruction of the bone and thereby creates a risk of intracranial complications. Exacerbation of epithympanitis or suppuration of ear cholesteatoma can lead to the development of mastoiditis.
Conservative treatment is possible with a free outflow of pus and the access of drugs through the perforated hole in the tympanic membrane to the mucous membrane of the middle ear. Enter certain drugs in the tympanic cavity only after careful removal of pus. To this end, the external auditory meatus is wiped with cotton wool, screwed onto the probe until the cotton wool removed from the ear becomes dry. For instillation into the ear, a solution of boric acid in 70% alcohol is most often used, as well as solutions of sulfacyl sodium (albucide), furatsilin or salicylic acid in alcohol and other antiseptic agents. If the granulation is small, then cauterizing substances (solutions of protargol, silver nitrate in the form of drops) are used. With epithympanitis, the drum space is washed with antiseptic solutions. If the opening in the tympanic membrane is large and there is little discharge, then a fine powder of boric acid, sulfonamide preparation or antibiotic is blown into the ear.
Adhesive (adhesive) 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. Its development is often facilitated by the irrational use of antibiotics in acute catarrhal otitis media. The main symptom is hearing loss. Often there is a noise in the ears. With otoscopy, a thinned, scarred eardrum with areas of calcium salt deposits is visible. Mobility of the eardrum and patency of the auditory tube are impaired. Ear blowing, pneumo- and vibration massage, introduction of proteolytic enzymes into the tympanic cavity, diathermy to the ear area, mud therapy, as well as surgical treatment are used.
Internal otitis media - see Labyrinthitis .