Prevention of otitis

Prevention of otitis: timely treatment of ENT diseases

If you pay attention to the statistics, it shows that 80% of children who are not yet and three years old have already had otitis. However, those parents who have not yet touched this problem, to prevent their crumbs from a dangerous disease will help prevent otitis.

Favorable factors for otitis media

Average otitis media

The inflammatory process, known in otolaryngology as otitis, can have three forms - external, middle and inner. With the development of external otitis occurs inflammation of the skin of the auditory shell, which leads into the auditory canal. The average type of disease causes damage to the middle ear cavity, and with internal otitis, the drum cavity is affected.In children, otitis media usually arise, in some cases it develops against the background of external inflammation, when it was not suspended at the initial stage.

As practice shows, the average otitis usually develops against the background of a protracted runny nose, when the infection from the nasal cavity falls into the ear, because the Eustachian tube in children is still poorly developed. In addition, the emergence of this pathology contributes also to the presence in the child's ear of the embryonic tissue, which is very easily inflamed. As the child grows up, it gradually disappears, and with it the frequent chance of developing the inflammation of the middle ear. Otolaryngologists call another fairly common cause of illness in children - a hereditary predisposition. If the father or mother in the adult age has otitis, it is not surprising that their child also suffers from this problem. In this case, even after growing up, a child can continue to periodically get otitis.

Elimination of the common cold

To protect children's ears from penetrating into them infection from the nasal cavity, it is important to detect snot immediately to treat a cold. Care should be taken to ensure that there is not a lot of mucus in the nasopharynx, for this purpose it is necessary to clean the nasal passages using an aspirator or a means based on sea water.If the nose is clean and breathing free, the risk of otitis in the child is significantly reduced.

Known is the statement that a runny nose within seven days will pass without his treatment. This is a big mistake, the child does not know how to remark well yet, and the mucus accumulates and can put pressure on the middle ear. The consequences of untreated rhinitis are very serious, this can lead to hearing impairment, partial loss or complete deafness. The swelling of the nose also creates favorable conditions for the development of otitis. If the nasal breathing of a child or an adult is difficult, while the nasal cavity is cleaned of mucus, vasoconstrictive drugs should be used.

ARVI treatment

Against the background of ARVI or ARI in most cases, and there is an inflammatory process in the middle ear. Prevention of otitis in children should include tempering the child from an early age. So your child will develop strong immunity, and when cold, signs of a cold will no longer appear. To do this, the baby needs to be diluted during the cold season to walk barefoot around the apartment, bathe it in cool water, take a walk outdoors longer. However, it is necessary to approach to hardening with knowledge of this matter, consult with an expert beforehand in order to carry out the procedure according to all the rules.

During the epidemic of respiratory viral infections, do not underestimate the effect of antiviral prophylaxis. It is better to give preference to homeopathic preparations, they act on the children's body gently and carefully, increasing its protective forces.

If you still do not dare protect your child from a viral illness, it is important to create favorable conditions for a quick recovery. If there is a runny nose, it is important not to give the mucus in the nose thicken. Here, saline solutions will also come to the rescue. Also for this purpose, you need to drink more liquid, maintain optimal humidity in the room - at least 50%, the air temperature should be 18-20 degrees. Experts argue that in such conditions the body successfully fights against a viral infection. If you need to release the nose from the mucus, do not forget to blow your nose properly, you need to do this alternately with each nostril. If, in case of self-treatment, you did not manage to eliminate the runny nose, after a week show the child to a doctor who will prescribe a more effective treatment.

Refuse to cleaning the ears

Care of the child from the first days of his life is in such activities:

• Cutting nails;
• bathing the baby;
• cleaning of the ears.

If the first two actions are necessary for the health of the child, cleaning the baby ears with cotton swabs can severely damage the crumbs. It is strictly forbidden to climb anything in the ears, not that of an infant, but even of an adult.This is dangerous for several reasons:

1. By inserting a cotton swab in the ear and rotating it in the auditory canal, you risk damaging the epidermis and putting an infection on the background of which soon the otitis will develop;
2. If during the procedure a small child pulls the head, you may injure the eardrum;
3. Earwax, which collects in the outer ear, is the result of an independent cleansing of the ear canal. It accumulates as it accumulates and leaves on its own, it only remains on the surface of the ear canal.

Thus, if parents do not climb deep into the child's ears, they increase his chances of avoiding dangerous otitis media.

Other methods of prevention

In infants, frequent regurgitation is a common cause of otitis media development in the middle ear. Food that is pushed out of the stomach can get into the ear and cause an inflammatory process. Danger can also occur when ingestion of breast milk into the ear, so the baby needs to be fed only in a vertical or semi-vertical position.

In the prevention of otitis in children, proper nasal breathing plays an important role. In children after three years it can be disturbed because of the proliferation of adenoid tissue in the nose. Adenoids can cover the opening of the auditory tube in the throat, disrupting the circulation in it. It is for this reason that otolaryngologists strongly recommend that parents remove adenoids in children prone to frequent otitis.

In adults, otitis prevention is carried out in exactly the same way as in children. Children and adults who at least once had had otitis, for the prevention should periodically visit the ENT room for examination of the ear canal.

NasmorkuNet.ru

Otitis in the child: symptoms, treatment, prevention

When the ears begin to ache, even experienced parents can lose self-control from whims and tears. In order to effectively combat the disease, it is necessary to know the enemy, which is called "in person", warned - means armed.

What is otitis media?

Under otitis means any inflammation of the ear. Distinguish:

• The external ear (the auricle and the external ear canal to the tympanic membrane) whose inflammation will be external otitis. Here, the first place is played by furuncles caused by staphylococci and fungal lesions of the auditory canal.
• The middle ear that begins behind the tympanic membrane and includes the tympanum, the Eustachian tube, the cells of the mastoid process and the antrum. Inflammations in this department are called otitis media. This is the most common ear pathology in children.
• Internal otitis is also called labyrinthitis. In this inflammation affects the cochlea, its vestibule or semicircular canals.

Who is guilty?

The average otitis develops against a bacterial (less often viral) infection. The most common cause of its development is aggressive streptococcal or staphylococcal flora. Most often, it enters the ear cavity through the Eustachian tube, balancing the pressure between the ear and the nasal cavity. Therefore very often otitis is the outcome of the common cold.

A prerequisite for the development of otitis media is a significant decrease in local immunity in the child's body, more prone to ear infections:

• suffering from rickets (see p. symptoms and treatment of rickets in infants)
• anemia
• lack of weight
• chronic pathologies of ENT organs
• exudative diathesis
• extreme forms of immunodeficiency takes with diabetes, AIDS and leukemia.

But even a child without severe somatic diseases can become a victim of otitis with trivial hypothermia. The fact is that the external ear canal of a child, unlike an adult, does not have an S-shaped curvature. Therefore, any flow of cold air can provoke otitis in a child, the symptoms of otitis will directly depend on the location of the inflammation.

Manifestations of otitis media

With external otitis, the symptoms in children may vary depending on the severity of the process.

• A furuncle of the ear or auditory canal will manifest reddening, swelling, the appearance of an inflammatory tubercle, which gradually will change color from red to bluish. In the center of inflammatory education a purulent stem will form. Until the tissues melt to pus, the pain will be very intense. After the death of the receptors, it will become a little less. After the boil opens and the necrotic stem leaves, there will be a deep wound that will heal with the formation of a hem.
• Fungal otitis externa is characterized by the appearance of crusts and scaling in the ear passage against the background of a fungal infection. There is also itching.
• The average otitis can be divided into catarrhal otitis and purulent. Qatar is when inflammation caused by microbes is manifested in the form of redness, swelling and inconstant pain of a stabbing or shooting character. Depending on the severity of the inflammation, the intensity of pain varies, from weak to unbearable. The pain may be located inside the ear or be given to the cheek, temple, throat. This is due to the common nerve, which supplies the tympanum and oropharynx. Pain can be combined with ear congestion.
• Since the formation of the abscess on the tympanic membrane, they speak of a purulent otitis. In addition to the pain for him is typical of hearing loss. If the abscess breaks, a purulent effusion with an admixture of blood follows from the ear. Later, the eardrum heals with the formation of a scar, after which the hearing is restored. With a significant defect, the membrane can not completely heal, and then there will be hearing problems.

Also, the child will be disturbed by temperature rises and intoxication (muscle, joint and headaches, weakness and weakness).

• In addition to acute otitis media, a chronic inflammatory process can develop, which is divided into exudative otitis media, purulent or adhesive. Exudative and adhesive otitis variants have mild manifestations in the form of noise in the ears (causes) and hearing loss. Adhesive (adhesive) otitis is the result of the proliferation of connective tissue and fibrosis of the tympanum and tympanic membrane.
• In chronic purulent process, there is a periodic leakage from the ear and a persistent decrease in hearing due to the perforating perforation of the tympanic membrane.
• The labyrinthitis is manifested by pain, hearing loss and dizziness (cause), since the body involved in the process is an organ of balance that is conjugated to the inner ear.

How to suspect an otitis at home?

Older children may well complain of pain in the ear and even talk about what kind of pain and where it gives. It is much harder with kids up to two years old who can not really talk and just cry in response to pain (including, and on otitis). Symptoms in infants at this pathology are not specific:

• on the thought of inflammation of the middle ear can push the child's anxiety
• his unmotivated crying
• abandonment of a breast or bottle
• also children can grasp handles for a sore ear
• to turn one's head from side to side
• if you press on a tragus of a sick ear, a child's anxiety or crying is aggravated by the intensification of pain

For any suspected otitis, the child should immediately be shown to a pediatrician or an ENT doctor.

How does a doctor determine otitis?

The otolaryngologist has such a simple and convenient device as an ear mirror. With its help, you can see changes in the external ear canal, the tympanic membrane. Thus, the average otitis corresponds to changes in the light cone in the eardrum. With the same purpose the doctor can use the otoscope.

First aid for otitis

If the visit to the doctor is postponed for objective reasons (although it is not possible to delay it), and the child is worried and crying, the first thing to do if you suspect otitis anesthetize the ear.

For this purpose, non-steroidal anti-inflammatory drugs can be used that have the property of suppressing inflammation, temperature and pain. Children are allowed paracetamol derivatives (tayled, kalpol, efferalgan, panadol, tylenol), ibuprofen (nurofen, ibuklin) and naproxen (cefecon) Review of all antipyretics for children, with dosages and prices. You can use syrup, tablets or rectal suppositories.

The second remedy for otitis media is ear drops Otypaks (170-250 rub), Otirelaks (140 rub) This combined a preparation containing anti-inflammatory phenazone and a local anesthetic of lidocaine hydrochloride. It must be remembered that otipaksom can be used only if the tympanic membrane has not been damaged (the ear did not flow). In infants instilled by 2 drops, and in children older than two years, 3-4 drops in each ear.

How correctly to drip drops?

• Before burying drops, the bottle should be warmed to room temperature. In infants, the temperature can be up to 36 degrees. Alternatively, the drops are poured from the vial into a warm spoon, and then pipetted.
• The child must be placed with the ear up and pull the auricle back and down to spread the auditory canal.
• After the drops are dipped, the child is kept up in his ear for at least ten minutes, so that the medicine does not leak.
• In children, drops are buried in both ears, since the process is usually two-sided.
• A baby sucking a pacifier needs to be removed before dropping drops. In combination with a stuffy nose, a pacifier can cause a barotrauma of the tympanic membrane.

Treatment of external otitis media

Furuncle of the external ear (purulent otitis) is treated according to the classical scheme. At the stage of infiltration (before the formation of the rod) with anti-inflammatory agents and alcohol compresses for the purpose of resorption. After the rod is formed - surgical opening of the abscess with drainage of the cavity, washing with Peroxide hydrogen or chlorhexidine, Miramistin and subsequent ointment bandages with levomelem to complete healing of the wound. When intoxication, high temperature, lymphadenitis, antibiotics are connected.

Fungal lesions of the auditory canal are treated with antifungal ointments (clotrimazole, candid, flucanazole), if necessary prescribe systemic antifungal agents in tablets (amphotericin, griseofulvin, mycosyst). As a rule, in children up to two years of age, systemic antifungal agents are not used.

Treatment of otitis media

The smallest preference is given to local treatment. For them, systemic antibiotics - too heavy a load on the immune system and intestines (see. list of probiotics, analogues of Linex). Therefore, very strict indications are given for antibiotics:

• Hyperthermia within three days of the onset of local therapy
• severe intoxication
• poorly docked pain that prevents a child from sleeping and eating normally

Drops in the ears are used by the course for seven to ten days. During this period, the child is necessarily examined by an otolaryngologist to be sure of the positive dynamics of the inflammation or to correct the treatment if the result is unsatisfactory.

In older (from two years) children, therapy also begins with ear drops, supplemented with anti-inflammatory drugs (see. First aid for otitis).

A prerequisite for the treatment of otitis media is getting rid of the common cold. With untreated rhinitis, there are risks of re-development of middle ear inflammation. For this purpose, antiviral (interferon), antibacterial (drops - isofra, polidex, protorgol) and combined (vibrocil) drops are used.

• Drops in the ears

- Otypaxcombines anti-inflammatory and analgesic effects.
- Sulfacil sodium (albucid) - a universal antimicrobial and antiviral agent.
- Otofa- antibacterial drug based on antibiotic rifamycin.
Albucid and otofa are not contraindicated in the case of perforation of the tympanic membrane.
- Polidex- children older than two and a half years have the opportunity to use polydix (a combination of antibiotics neomycin and polymyxin with the addition of hormonal anti-inflammatory dexamethasone).

Course treatment is carried out from seven to ten days. During this time, it is quite possible to cure uncomplicated catarrhal otitis in a child. Treatment should be prescribed and monitored by an ENT doctor.

• Antibiotics in tablets, suspensions or injections

Requirements for these drugs: safety, non-toxicity, achievement of sufficient concentrations in the site of inflammation, preservation therapeutic doses for a long time (no less than eight hours for a comfortable multiplicity of receptions per day). The duration of therapy with antibiotics is seven days, except for drugs that are able to accumulate and maintain therapeutic concentration in the blood for a week or ten days (for example, azithromycin, which is administered within three to five days).

• Penicillins. Preferred semisynthetic (oxacillin, amoxicillin, flemoxin, ampicillin, carbenicillin) and inhibitor-protected, allowing resist resistant strains of microbes (amoksiklav, flemoklav, augmentin, unazin, sultamitsillin, ampaksid).
• Cephalosporins of the second (cefuroxime, cefaclor) of the third (ceftibutene, ceftriaxone, cefotaxime, cefazidime) and the fourth (cefepime) generations.
• Macrolides now displace cephalosporins. More convenient in dosing, the duration of the course and the forms of administration (tablets, suspension). Treatment of otitis media in children is carried out with azithromycin (azitral, sumamed, chemomycin), clarithromycin.
• Aminoglycosides are the drugs of choice if there is staphylococcal purulent otitis in a child. Treatment with kanamycin, gentamycin, sizomycin, amikacin is carried out mainly permanently due to nephrotoxicity.

The peculiarities of antibiotic therapy in children include refusal to use fluoroquinolones, since they are contraindicated for children under 18 years old, as well as to reduce the number of antibiotic-resistant infections.

To the question of antihistamines

Classic treatment regimens for otitis media suggest prescribing antihistamines to reduce the allergic component of inflammation and reduce edema. Recommended second and third generation drugs that do not cause drowsiness or have a minimal sedative effect: claritin, desloratadine, loratadine, clarixens, cetirizine, ketotifen (see. medicines for allergies).

However, today a number of specialists (primarily American, conducting selective clinical studies involving children-children) believe that the use of of this group of medicines in otitis is inexpedient, since there is no direct relationship between their use and the rate of cure for the disease. To date, the issue remains open, as there are still no full standards for the treatment of acute otitis in children.

Treatment of labyrinthitis

Since the process can easily be complicated by meningeal inflammation, sepsis and even disorders of cerebral circulation, the treatment is carried out under stationary conditions. Antibiotics, anti-inflammatory and dehydrating drugs are used. If necessary, surgical intervention is performed.

Treatment of otitis media folk remedies

Traditional methods of treating otitis in children are quite diverse, but it should be noted that turning a child into a testing ground is not humane and reckless. Of course, in the field, when a doctor and a pharmacy are unavailable, a person will resort to any improvised means to alleviate the pain, suffering of the child. Therefore, we will focus on the most appropriate and less harmful for children's health folk remedies against otitis (ear inflammation).

External otitis, flowing in the form of a furuncle in the stage of infiltration (with reddened tubercle without a purulent stem), as well as the average catarrhal otitis in children is susceptible to folk remedies. You can use a vodka or alcoholic compress or lotion:

• boric, camphor alcohol or vodka are applied to a gauze pad that is applied to the ear area
• Polyethylene film or wax paper is placed on top
• the dressing is strengthened with a scarf or scarf
• exposure time from 15 to 30 minutes (the younger the child, the shorter the procedure time)
• Decently resolves infiltrates and iodine
• Also apply and leaves of an aloe, cutting them in half and applying to an abscess a cut of a leaf

No heating procedures for otitis are allowed. Treatment with alcohol-containing solutions is strictly prohibited in children up to a year, even for external use. In older children it is also not desirable, especially it is contraindicated to use for medical purposes with medical alcohol in undiluted form. It is better to use camphor, boric spirits or vodka. Burying boric or camphor alcohol in the ear is acceptable, but only in children older than 6 years - not more than 2 drops.

In fungal lesions of the auditory canal, people rub it with a solution of soda (not to be confused with instillation or washing). Soda creates an alkaline environment in which mushrooms do not breed well, but can not completely cure the fungal infection.

Sollux (blue lamp) is a thermal procedure, shown with a noggin otitis. However, in everyday life, nocturnal otitis from purulent is difficult to distinguish, especially since a bacterial infection can not be heated. Therefore, any folk methods should be coordinated with the treating pediatrician.

Prevention of otitis

• Rational ear hygiene. It is inadmissible to clean the ears of a child with improvised means, to penetrate deep into the ear canal.
• After bathing, the baby needs to shake out or get wet from the ear.
• Children under one year should not be in drafts without head covers covering their ears.
• It is necessary to treat all diseases of ENT organs (sore throats, tonsillitis, rhinitis, pharyngitis) in time and fully. Bilateral otitis in the child often develops against the background of the common cold.

zdravotvet.ru

Treatment and prevention of otitis in children

Almost every child under 3 years old can tolerate otitis. Therefore, any parent should have full information about what to do with otitis in children, the treatment with which drugs will help to quickly get rid of the disease.

What is ear inflammation?

Otitis is an inflammatory process of the ear. In medicine, it is common to distinguish several types of ear inflammation:

1. Inside. Affected snail, its vestibule or semicircular canal.
2. The middle section. The eardrum is affected along with the Eustachian tube and antrum. This type is diagnosed in most cases in children.
3. Outside. The cause of development are staphylococcal and fungal infections, because of them are formed furuncles, which cause inflammation in the ear.

Most often the doctor diagnoses a unilateral ear inflammation, but there are also variants of bilateral otitis. The child, according to medical statistics, develops an inflammation of the middle ear, which occurs in several stages.

On the first there is an inflammation of the auditory tube, the pressure on the tympanic membrane changes. Gradually the inflammation affects the middle ear, which leads to the formation of an inflammatory fluid - exudate. This stage in medicine is usually called catarrhal, exudative (or secretory otitis media).

At the second stage, purulent otitis begins to develop.An infection that causes the formation of pus on the middle ear joins. When the maximum amount of this pus is reached in the ear, the tympanic membrane ruptures. This facilitates the child's condition, it reduces the temperature, painful feelings decrease. Particular attention should be paid to the flow of catarrhal otitis in children up to 2 years. Because of their anatomical features, their purulent form can develop within 24 hours.

The third stage is recovery. The tympanic membrane is gradually restored, and the normal function of the ear resumes.

What causes otitis in children?

It can be the following factors:

1. Children suffer from ear inflammation more often than adults, because of the anatomical features of the auditory tube. It is much shorter, so the infection very quickly penetrates from the nasopharynx into the ear.
2. Frequent acute respiratory infections, acute respiratory infections, bronchitis weaken the immune system and give complications of otitis media in untimely treatment.
3. A common cause is a runny nose. Since air ventilation is restricted, mucus stagnates in the nasopharynx, a nutrient medium is created for the propagation of the pathogenic flora, which excites inflammation of the ear.
4. Otitis in newborns causes amniotic fluid that enters the nose during delivery.
5. Hereditary predisposition.

Manifestations of otitis media in children

All symptoms of the disease will depend on the type of otitis and severity of the disease.

With external inflammation, the auditory passage acquires a reddish hue, a small tubercle develops in the place of the future furuncle, the color of which will vary from red to bluish. The pain will be localized, only in the place where the purulent stem is formed.

Many cases of inflammation and furuncle formation in the auditory canal. This causes problems with the outflow of secretions to the outside.

Also, external otitis is accompanied by edema of the ear canal, lymph nodes near the ear increase, children complain of pain when chewing and swallowing. The temperature may rise, chills occur.

Inflammation of the middle ear feels pressing pain, high fever, nasal congestion. Some children with grinding symptoms grind their teeth.

At the initial stage of otitis media the children begin to sleep badly, tossing and turning, to turn their heads, to press the sick ear to the pillow. These are the first signals that should alert any parent.

Proper help is the key to a quick recovery

Treatment of otitis in children should begin with a conservative method, in difficult cases - with a surgical method.

To cure otitis, you need to start with taking antibiotics. This will help to avoid further complications. The preparation itself can take the form of tablets or suspensions, injections. Everything depends on the age of the patient and the chosen treatment regimen.

Given that all antibiotics in childhood have a destructive effect on the intestinal microflora, it is necessary to take probiotics or bifidobacteria, vitamin complexes.

The course of treatment includes drops containing 3% boric acid. For the introduction into the ear, the drops need to be heated. Bury one by one in each ear and leave the head on its side for up to 5 minutes. Then the buried ear is covered with a cotton swab, and the same manipulations are performed with the second ear.

In parallel, the nose must also be treated. For this, vasoconstrictive potassium is prescribed, which makes it possible to keep the nose in order and neutralize the mucus as a source for the reproduction of bacteria.

For children under 4 years, it is important to carry out mechanical cleaning of nasal passages. To do this, use cotton or gauze turundas, water the nose with salt or soda solutions. For treatment it is necessary to inject 5 ml of solution into each nostril, for prevention - 1 pipet.

In order to relieve heat and pain, with inflammation children can be given paracetamol, nurofen, panadol, babies are best suited candles.

When purulent otitis recommended to use alcohol solutions or camphor oil.

To make a compress, you need to take gauze or a wide bandage, fold it in several layers (up to 10), moisten it in a prepared solution and apply it to a sick auricle. With purulent inflammation, gauze bandages fall on the parotid region.

Virtually all compresses can be kept up to 2 hours or all night.

When the patient stops raising the temperature, you can conduct warming up. For this, a linen bag is taken, heated salt is put in it, and it is applied to the auricle. The "blue" lamp works well when warmed up.

Despite the fact that purulent otitis can give serious complications, with a competent therapeutic effect, you can quickly get rid of the disease itself.

Purulent discharge from the ear should be properly and timely removed, as they are the cause of complications. To do this, sterile wipes are used, which accumulate pus accumulated at the entrance to the auditory canal. Since the child feels pain even when touching the ear, it is not advisable to perform cleansing with hard objects. This can provoke mechanical damage to the tympanic membrane.

Basically, all procedures for extracting pus are performed by a doctor or nurse. If it happens that the inflammation leads to a decrease in hearing, then pneumomasses and a purge of the tympanic membrane are prescribed.

When the otitis is already cured, physiotherapy procedures can be recommended to fully restore the function of the ear.

In cases of inability to excrete pus, therapeutic intervention is performed externally.

Prevention of otitis in children

After the recovery of the child, it is necessary first of all to take care of the correct and balanced nutrition, the introduction of vitamin complexes to strengthen immunity. That is, correct prophylaxis of otitis in children is necessary.

To prevent repeated manifestations of ear inflammation it is recommended to visit specialized sanatoria, resorts of the Black Sea coast.

It is very important to teach the child to flaunt correctly. You must first clean one nostril, then another, while holding one of the passages with your finger.

Nasal cleansing procedures must be performed every day, this will ensure good ventilation of the aisles.

Than to treat an otitis? What medicines to choose for the child? These questions will be answered only by a specialist, but with a thorough understanding of the disease itself and its consequences each parent can help his child recover quickly and forget about painful symptoms.

lor03.ru

Symptoms and treatment of otitis in adults

Content:

• Ear anatomy
• Causes of otitis media
• Pathogens of the disease
• The clinical picture is the symptoms of otitis
• General principles of diagnosis
• Treatment of external otitis media
• Treatment of otitis media and labyrinthitis in adults
• Prevention of otitis

Otitis is an ear inflammation, a general term for any infectious processes in the hearing organ. Depending on the affected area of ​​the ear, the outer, middle and inner otitis (labyrinthitis) are secreted. Otitis occurs frequently. Ten per cent of the world's population suffered from external otitis during their lifetime.

Annually in the world 709 million new cases of acute otitis media are registered. More than half of these episodes occur in children under 5 years of age, but adults also suffer from inflammation of the middle ear. Labyrinthitis, as a rule, is a complication of otitis media and is relatively rare.

Ear anatomy

For a better understanding of the subject, it is necessary to briefly recall the anatomy of the organ of hearing.
The components of the outer ear are the auricle and auditory canal. The role of the external ear is to trap the sound wave and carry it to the eardrum.

The middle ear is the tympanic membrane, the drum cavity containing the chain of auditory ossicles, and the auditory tube.

In the tympanic cavity, there is an increase in the sound vibrations, after which the sound wave follows the inner ear. The function of the auditory tube connecting the nasopharynx and the middle ear is the ventilation of the tympanum.

The inner ear contains the so-called "cochlea" - a complex sensory organ in which sound vibrations are converted into an electrical signal. An electrical impulse follows the auditory nerve into the brain, carrying coded information about the sound.

External otitis media

Otitis externa is an inflammation of the auditory canal. It can be diffuse, and can proceed in the form of a furuncle. When diffuse external otitis affects the skin of the entire ear canal. Furuncle is a limited inflammation of the skin of the external ear.

Average otitis media

With an average otitis inflammation occurs in the tympanum. There are many forms and variants of the course of this disease. It can be catarrhal and purulent, perforative and non-perforative, acute and chronic. When otitis can develop complications.

The most common complications of otitis media include mastoiditis (inflammation of the occipital bone of the temporal bone), meningitis (inflammation of the brain membranes), abscess (abscess) of the brain, labyrinthitis.

Labyrinthite

Internal otitis almost never is an independent disease. Almost always it is a complication of the inflammation of the middle ear. Unlike other types of otitis, its main symptom is not pain, but hearing loss and dizziness.

Causes of otitis media

• After getting contaminated water - most often the external otitis occurs after the ingestion of water containing the causative agent of the disease into the ear. That is why the second name of this disease is "swimmer's ear".
• Injury of the skin of the external auditory canal - in addition to the presence of infection in the water, there must also be local conditions predisposing to development inflammation: microcracks of the skin, etc. Otherwise, every contact with unboiled water would result in the development of inflammation in the ear.
• Complication of SARS, sinusitis - in this case, the causative agent of middle otitis penetrates into the tympanum completely from the other side, the so-called rhinotubar path, that is, through the auditory tube. Usually, the infection gets into the ear from the nose, when a person is sick with ARVI, runny nose or sinusitis. In case of a serious inflammation of the middle ear, the infection can spread to the inner ear.
• With infectious diseases, kidney diseases, diabetes mellitus, hypothermia against a background of reduced immunity, the risk of inflammation in the middle ear increases. Bruising through 2 nostrils (wrong), coughing and sneezing increase the pressure in the nasopharynx, which leads to the ingress of infected mucus into the middle ear cavity.
• Mechanical removal of earwax - it is a protective barrier against infections.
• High air temperature and high humidity.
• Contact with foreign objects in the ear.
• Use of hearing aids.
• Such diseases as seborrheic dermatitis on the face, eczema, psoriasis.
• The causes of development of acute otitis media are also genetic location, immunodeficiency states, HIV infection.

Pathogens of the disease

Pathogens of external otitis can be bacteria or fungi. Especially often found in the ear canal are microorganisms such as Pseudomonas aeruginosa and staphylococcus aureus. For the fungi of the genus Candida and Aspergillus, the skin of the ear canal is one of the favorite places in the body: it's dark, and after bathing it's still wet.

The causative agents of otitis media, and therefore internal, can be viruses and bacteria. Fungal infection of the middle ear is also found, but much less often than the external one. The most common bacterial pathogens of otitis media are pneumococcus, hemophilic rod, moraxella.

The clinical picture is the symptoms of otitis

• Pain is the main symptom of otitis media. The intensity of pain can be different:
  • from barely perceptible to unbearable
  • character - pulsing, shooting

  It is very difficult, it is often impossible to independently distinguish painful sensations with external otitis from painful sensations with inflammation of the middle ear. The only clue can be the fact that with external otitis pain should be felt when touching the skin at the entrance to the ear canal.

• Hearing loss is a fickle symptom. It can be present with both external otitis media, and with an average, may be absent in both these forms of ear inflammation.
• Increase in temperature - most often there is an increase in body temperature, however, this is also an optional feature.
• Discharge from the ear with external otitis occur almost always. After all, nothing prevents the inflammatory fluid from escaping outward.

With the average otitis, if the perforation (hole) is not formed in the tympanic membrane, there is no secretion of their ear. The suppuration from the ear canal begins after the appearance of a communication between the middle ear and the auditory meatus.

I emphasize that perforation can not be formed even with purulent otitis. Patients suffering from otitis media often ask where pus will go if it does not break out. It's very simple - he will go out through the auditory tube.

• Ear noise (see Fig. causes of noise in the ears), ear congestion is possible with any form of the disease.
• When the inflammation of the inner ear develops, dizziness (causes) may appear.

Acute otitis media occurs in 3 stages:

Acute catarrhal otitis - the patient experiences severe pain, which increases by night, when coughing, sneezing, she can give in the temple, teeth, be stabbing, pulsating, drilling, hearing loss, appetite, weakness and high temperature up to 39C.

Acute purulent otitis - there is accumulation of pus in the middle ear cavity, followed by perforation and suppuration, which may be on day 2-3 of the disease. In this period, the temperature drops, the pain decreases, the doctor can make a small puncture (paracentesis), if there is no independent rupture of the tympanic membrane.

Restorative stage - suppuration stops, the defect of the tympanic membrane closes (fusion of the edges), the hearing is restored within 2-3 weeks.

General principles of diagnosis

In most cases, the diagnosis of acute otitis media does not cause difficulties. High-tech research methods are needed infrequently, the ear is well visible to the eye. The doctor examines the tympanic membrane with a head reflector (a mirror with a hole in the middle) through the ear funnel or a special optical device - the otoscope.

An interesting device for the diagnosis of otitis was developed by the famous corporation Apple. It is an oscopic attachment for the camera phone. It is assumed that with the help of this gadget, parents will be able to photograph the baby's eardrum (or their own) and send photos for consultation to their doctor.

Diagnosis of external otitis media

Examining the ear of a patient suffering from external otitis, the doctor sees redness of the skin, narrowing of the auditory canal and the presence of liquid secretions in its lumen. The degree of narrowing of the ear canal is such that the tympanic membrane is not visible at all. When inflammation of the external ear of other examinations except for the inspection is usually not necessary.

Diagnosis of otitis media and labyrinthitis

In acute inflammation of the middle ear, the main way to establish a diagnosis is also an examination. The main signs that allow diagnosing "acute otitis media" are reddening of the tympanic membrane, limitation of its mobility, and the presence of perforation.

• How is the mobility of the tympanic membrane checked?

People are asked to inflate their cheeks without opening their mouths, that is, "blowing their ears". This reception is called the maneuver of Valsalva, named after the Italian anatomist, who lived at the turn of the 17th and 18th centuries. It is widely used by divers and divers to equalize the pressure in the drum cavity in deep water descent.

When a jet of air enters the middle ear cavity, the eardrum moves slightly and this is noticeable with the eye. If the drum cavity is filled with inflammatory fluid, no air will enter it and the eardrum will not move. After the appearance of suppuration from the ear, the doctor can observe the presence of perforation in the tympanic membrane.

• Audiometry

Sometimes to determine the nature of the disease may need audiometry (hearing on the apparatus) or tympanometry (measurement of pressure inside the ear). However, these methods of hearing tests are more often used in chronic otitis media.

The diagnosis of the labyrinthitis is usually made when the acuteness of the middle otitis suddenly sharply decreases acuteness of the hearing and dizziness appears. Audiometry in this situation is mandatory. You also need an examination of a neurologist and an oculist.

• CT and X-ray

The need for X-ray studies occurs when there is a suspicion of complications of the disease - mastoiditis or intracranial infection. Fortunately, such cases are rare. In a situation where complications are suspected, a computer tomography of the temporal bones and brain is usually performed.

• Bacterial sowing

Do I need a smear to determine the bacterial flora? A unequivocal answer to this question is not easy. The problem is that, due to the peculiarities of bacterial culture, the response of this examination will be received 6-7 days after the removal of the smear, that is, by the time when the otitis is almost gone. Moreover, with a medium otitis without a perforation, a smear is useless, since the microbes are behind the tympanic membrane.

And yet a smear is better to do. In the event that the application of the first-line drug does not bring recovery, after receiving the results of a bacterial study, treatment can be adjusted.

Treatment of external otitis media

The main treatment for external otitis media in adults is ear drops. If a person does not have immunodeficiency (HIV infection, diabetes mellitus), antibiotics in tablets are usually not needed.

Ear drops can contain only an antibacterial drug or be combined - have an antibiotic and an anti-inflammatory substance. The course of treatment takes 5-7 days. Most often for the therapy of external otitis media apply:

Antibiotics:

• Ciprofarm (Ukraine, ciprofloxacin hydrochloride)
• Normax (100-140 rubles, norfloxacin)
• Otofa (170-220 rubles, rifamycin)

Corticosteroids + antibiotics:

• Sophradex (170-220 rub., Dexamethasone, Framicetin, gramicidin)
• Candybiotic (210-280 rub., Beclomethasone, lidocaine, clotrimazole, Chloramphenicol)

Antiseptic:

• Miramistin (250-280 rubles, with a nebulizer)

The last two drugs also have antifungal properties. If the external otitis has a fungal origin, antifungal ointments are actively used: clotrimazole (Candide), natamycin (Pimafucin, Pimafucort).

In addition to ear drops, the doctor can recommend an ointment with the active substance Mupirocin (Bactroban 500-600 rub, Supirocin 300 rubles) for the treatment of external otitis media. It is important that the drug does not have a negative effect on the normal skin microflora, and there are data on the activity of mupirocin against fungi.

Treatment of otitis media and labyrinthitis in adults

Antibiotic therapy

The main treatment for middle otitis media is an antibiotic. However, the treatment of otitis antibiotics in adults is another controversial issue of modern medicine. The fact is that with this disease is very high percentage of self-recovery - more than 90%.

There was a period of time in the late 20th century, when on a wave of enthusiasm antibiotics were prescribed to almost all patients with otitis. However, it is now considered permissible the first two days after the onset of pain to dispense with antibiotics. If after two days there is no tendency to improve, then an antibacterial drug is already prescribed. For all types of otitis media may be required for oral administration.

In this case, of course, the patient must be under medical supervision. The decision on the need for antibiotics is very responsible and should only be taken by a doctor. On the scales on the one hand, the possible side effects of antibiotic therapy, on the other - the fact that every year in the world of complications of otitis deaths of 28 thousand people.

The main antibiotics, which are used in the treatment of otitis media in adults:

• Amoxicillin - Ospamox, Flemoxin, Amosin, Ecobol, Flemoxin solute
• Aamoxicillin with clavulanic acid - Augmentin, Flemoclav, Ecoclav
• Cefuroxime - Zinnat, Aksetin, Zinacef, Cefurus and other drugs.

The course of antibiotic therapy should be 7-10 days.

Ear drops

Ear drops are also widely prescribed for inflammation of the middle ear. It is important to remember that there is a fundamental difference between drops, which are prescribed before the perforation of the tympanic membrane and after its appearance. Let me remind you, the sign of perforation is the appearance of suppuration.

Before the appearance of perforation, droplets with an analgesic effect are prescribed. These include drugs such as:

• Otinum - (150-190 rub) - choline salicylate
• Otipaks (220 rubles), Otirelaks (140 rubles) - lidocaine and phenazone
• Otizol - phenazone, benzocaine, phenylephrine hydrochloride

Drops with an antibiotic does not make any sense to dig in this phase, as the inflammation goes behind the impenetrable eardrum for them.

After the appearance of the perforation, the pain passes and it is no longer possible to drip painkillers, as they can damage the sensitive cells of the cochlea. When a perforation occurs, access for drops inside the middle ear appears, so you can instill drops containing an antibiotic. However, ototoxic antibiotics (gentamicin, Framicetinum, Neomycin, Polymyxin B), preparations containing phenazone, alcohols or choline salicylate can not be used.

Drops with an antibiotic, the use of which is acceptable in the treatment of otitis in adults: "Tsiprofarm", "Normaks", "Otofa", "Miramistin" and others.

Paracentesis or tympanotomy

In some situations with inflammation of the middle ear may need a small surgical intervention - paracentesis (or tympanotomy) of the tympanic membrane. It is believed that the need for paracentesis arises, if the background of antibiotic therapy for three days, the pain still continues to bother the person. Paracentesis is performed under local anesthesia: a special incision in the tympanic membrane makes a small incision through which pus begins to exit. This incision is beautifully overgrown after the cessation of suppuration.

Treatment of labyrinthitis is a complex medical problem and is conducted in a hospital under the control of an ENT doctor and neurologist. In addition to antibiotic therapy, funds are needed to improve microcirculation inside the cochlea, neuroprotective drugs (protecting the nervous tissue from damage).

Prevention of otitis

Preventive measures for external otitis are the thorough drying of the ear canal after bathing. Also, avoid traumatizing the ear canal - do not use keys and pins as an ear instrument.

For people who often suffer from inflammation of the external ear, there are drops based on olive oil, which protect the skin when swimming in a pond, for example, "Vaxol".

Prevention of otitis media consists of general strengthening measures - hardening, vitamin therapy, administration of immunomodulators (drugs that improve immunity). It is also important to treat diseases of the nose in a timely manner, which are the main causative factor in inflammation of the middle ear.

zdravotvet.ru

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