OTITIS - ear inflammation. Distinguish between external, middle and internal otitis.
External otitis. Allocate a limited external otitis (furuncle of the external auditory canal) and diffuse (diffuse) external otitis.
Limited otitis externa 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, aided by minor injuries during manipulation in the ear with matches, hairpins, etc. It is more often observed in persons suffering from diabetes, gout, hypovitaminosis. Sometimes the process extends to the parotid tissue. There are pains in the ear, aggravated by pressing on the trestle and stifling the auricle. With the localization of the boil on the front wall of the external auditory canal there is pain during the opening of the mouth. For the purpose of treatment, gauze turunds moistened with 70% alcohol are introduced into the external auditory meatus, warming compresses, physical therapy (sollux, UHF currents) are used, and vitamins are prescribed. Antibiotics and sulfa drugs are used for severe inflammatory infiltration and elevated body temperature. If an abscess is formed, an autopsy is indicated.
Diffuse external otitis develops mainly as a complication of chronic suppurative otitis media due to suppuration. There are itching and pain in the ear, there are purulent discharge with an unpleasant odor. Treatment - washing the external auditory canal with a 3% alcoholic solution of boric acid, furatsilinov 1: 5000 solution and lubricating it with oxycort, syntomycin emulsion.
Otitis media Acute otitis media develops as a result of penetration of infectious agents into the middle ear, mainly through the auditory tube during the inflammatory process in the nasal mucosa and nasopharynx (for example, in rhinitis). In newborns, otitis occurs as a result of the amniotic fluid entering the middle ear during labor. Of great importance is also the anatomical structure of the auditory tube (in children it is wider and shorter), the weakening of the body's defenses.
In stage I, there is severe pain in the ear, radiating to the corresponding half of the head, teeth, high body temperature (38–39 ° C), a significant decrease in hearing. Otoscopy reveals hyperemia of the eardrum, its contours are smoothed, then protrusion of the eardrum occurs. In the blood, there is leukocytosis , an increase in ESR.
In stage II, suppuration appears as a result of perforation of the eardrum (acute purulent otitis media), the pain subsides (delayed pus causes renewed pain). The general condition of the patient improves, body temperature returns to normal.
In stage III, there is a remission of the inflammatory process, suppuration is reduced and stopped, the edges of the perforated opening in the tympanic membrane grow together. After the cessation of suppuration, the main complaint of the patient may be a decrease in hearing.
In newborns and infants, the disease often goes unnoticed by others until the appearance of suppuration. In some cases, the child is restless, waking up at night, screaming, turning his head, rubbing a sore ear on a pillow, reaching for an ear with a hand, refusing a chest (ear pain during sucking and swallowing increases due to increased pressure in the middle ear).
Treatment includes complete rest, bed rest. According to the indications prescribed antibiotics (for suppuration, taking into account the sensitivity to them of the microflora), sulfa drugs. At high temperatures, antipyretics are indicated. Locally apply warming compresses, heating pads, physiotherapy (Solux, UHF currents). 96% ethyl alcohol in the form of warm drops in the ear has a short-term (for 20–30 minutes) antiseptic and analgesic effect. To reduce ear pain, instill in a warm form a drop of 5% solution of carbolic acid in 6-soluble glycerin, which should be canceled when suppuration appears from the ear. Vasoconstrictor agents are instilled into the nose. In case of failure of such treatment, 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 the cessation of purulent discharge and scarring of the eardrum, hearing remains low, then ear blowing, pneumatic massage and UHF-therapy to the ear area are indicated.
Chronic catarrhal otitis media usually develops with chronic eustachitis, often associated with acute catarrhal otitis. Clinically note a decrease in hearing, feeling of ear congestion, the transfusion of fluid in it. Otoscopically, the eardrum is cloudy, retracted, its identification points are smoothed out. The level of fluid (transudate) is often seen, remaining constant when the patient's head is tilted back and forth,
Apply suction of the transudate with a special tip, the introduction of a solution of antibiotics and hydrocortisone into the middle ear. If necessary, the drum cavity is drained with a special polyethylene tube, which is inserted into it after the paracentesis. They prescribe ear blowing, apply UHF currents, microwave therapy.
Chronic suppurative otitis media is accompanied by prolonged suppuration from the ear, while the perforated hole in the eardrum is firmly preserved and hearing is reduced. In most cases, the disease is associated with postponed acute purulent otitis with periodic or permanent suppuration. Otoscopically in the eardrum reveal perforated hole. Depending on the nature of the process and localization of the perforated hole, chronic purulent mesotympanitis and epitimpanitis are distinguished. In case of mesotympanitis, the perforated opening is located in the central part of the eardrum, and in case of epitimpanity, in the upper one; often it takes both divisions (epimesotimpanitis). Mesotympanic proceeds, as a rule, more benign than epitimpanitis, with it there are complications much less often. Epitimpanit, or epimesitimpanit, is accompanied by caries of the bone (osteitis) with the formation of granulations, polyps. Ear cholesteatoma can occur, 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 the free outflow of pus and the access of drugs through a perforated opening in the eardrum to the mucous membrane of the middle ear. To enter into the tympanic cavity of one or other drugs should be only after careful removal of pus. To this end, the external auditory canal is wiped with cotton wool, screwed onto the probe, until the cotton wool removed from the ear becomes dry. For instillation into the ear most commonly used is a solution of boric acid in 70% alcohol, as well as solutions of sulfacyl-sodium (albucid), furacilin or salicylic acid in alcohol and other antiseptic agents. If the granulations are small, then cauterizing substances are used (solutions of protargol, silver nitrate in the form of droplets). When epitimpanite washed over drum space with antiseptic solutions. If the hole in the eardrum is large and the discharge is small, then a fine powder of boric acid, sulfanilamide drug or antibiotic is blown into the ear.
Adhesive (adhesive) otitis media occurs more often after acute or chronic suppurative inflammation of the middle ear, characterized by the formation of adhesions in the tympanic cavity. Its development is often promoted by the irrational use of antibiotics in acute Catarrhal otitis media. The main symptom is hearing loss. Often there is tinnitus. When otoscopy visible thinned, scar-modified eardrum with areas of sediment calcium. The mobility of the eardrum and the patency of the auditory tube are impaired. They use ear blowing, pneumatic and vibratory massage, introduction of proteolytic enzymes into the tympanic cavity, diathermy on the ear area, mud therapy, as well as surgical treatment.
Internal otitis - see Labyrinthitis .