Contents
What is otitis?
Otitis is an inflammation of the ear. The disease can be chronic or acute, purulent or catarrhal. The severity of the pathological process depends entirely on the virulence of microorganisms, and the state of human immune defense also plays an important role.
To affect the organ of hearing, causing otitis media, can:
Pneumococcus;
Streptococci;
Staphylococci;
Haemophilus influenzae and other microorganisms.
Any inflammation of the ear is extremely dangerous, and you should consult a doctor immediately after detecting the symptoms of the disease described below.
Symptoms of otitis media
Symptoms of otitis media, by which acute otitis media can be recognized, are the following signs: severe pain in the ear (according to patients, it is described as shooting), fever, and after 1-3 days – purulent discharge from the ear canal. After the appearance of pus, the patient’s condition usually improves, the temperature drops, the pain becomes less pronounced or disappears altogether.
Pus is secreted from a break through the eardrum. Such an outcome of the disease is considered positive, with proper treatment, the hole in the eardrum slowly overgrows, without affecting hearing.
With an unfavorable development of the disease, pus cannot find a way out, and this is fraught with the fact that the infection can begin to spread inside the skull. Such otitis can turn into meningitis, as well as into a brain abscess. In order to avoid such terrible consequences, at the first symptoms of otitis, contact an otolaryngologist for advice and proper treatment.
Otitis, depending on the location of inflammation, can be:
outdoor;
Medium;
internal.
Swimmers often suffer from otitis externa, which is why the disease is popularly called “swimmer’s ear”. Inflammation begins due to a mechanical injury to the auricle or external auditory canal. Damage to the protective cover leads to the ingress and reproduction of pathogenic microorganisms, then a boil forms at this place.
If appropriate treatment is not carried out immediately, otitis externa becomes severe and spreads to the parotid cartilage and bones. With this type of disease, the patient is disturbed by aching, throbbing pain, swelling of the ear and a moderate increase in temperature.
With otitis media, the inflammatory process extends to the air cavities of the middle ear, located immediately behind the tympanic membrane: the tympanic cavity, auditory tube and mastoid process.
The form of otitis media often flows from catarrhal to purulent.
Acute catarrhal otitis media occurs as a complication of acute respiratory infections or SARS, after the penetration of the infectious agent into the tympanic cavity. At the initial stage, the level of hearing may decrease, tinnitus may appear, but the temperature remains normal or slightly increases.
If these symptoms are ignored, then catarrhal otitis is manifested by a sharp and severe fever and shooting pain in the ear, spreading to the eye, neck, throat or teeth. Such otitis can be cured only by getting rid of the infection, for which you need to urgently consult a doctor.
Acute suppurative otitis media is an advanced catarrhal form. The disease is manifested by a rupture of the eardrum and the outflow of pus, followed by a decrease in body temperature. Treatment, in addition to fighting the infection, should include the permanent removal of pus from the ear, which can only be done by a healthcare professional.
In addition, pus does not always come out on its own. If the eardrum is very strong, surgery is needed to puncture the eardrum. This procedure is called “paracentesis” and is performed using a local anesthetic: a puncture is made with a special tool at the most favorable point, and the pus is completely removed.
After the pus is removed, the eardrum is scarred, and the quality of hearing is not further reduced.
If acute otitis media is not treated, pus spreads inside the skull. As a result, internal otitis develops, affecting the vestibular apparatus, causing a brain abscess and leading to at least partial or complete hearing loss. Therefore, at the first sign of otitis media, you should not try to drip anything into your ears, or put a swab with alcohol or other antiseptic, but you need to urgently go to the doctor!
Causes of Otitis
Each ENT disease is accompanied by increased mucus production. As its amount increases, with an unfortunate set of circumstances, mucus enters the Eustachian tube, disrupting the ventilation of the tympanic cavity. The cells of the tympanic cavity secrete an inflammatory fluid. In addition to blocking the lumen of the Eustachian tube, pathogenic microorganisms, which are normally part of the local microflora, also contribute to the aggravation of inflammation.
The causes of otitis media are:
Penetration of infection from other ENT organs – as a complication of a concomitant infectious viral disease;
Various diseases of the nose, its sinuses and nasopharynx. This includes all types of rhinitis, deviated septum, and in children – adenoids (adenoid vegetations);
Injuries of the auricle;
Hypothermia and weakened immunity.
Complications and consequences of otitis media
Although only the ears hurt with otitis media, complications from inadequate or no treatment can affect many organs. Incomplete treatment of otitis media leads to very terrible consequences – suppuration passes to the lower jaw, touching the salivary gland and often leading to disability.
But what makes otitis media even more dangerous is that this disease is not always easy to identify. For example, in some cases, the disease is not accompanied by acute pain in the ears. Often, due to otitis, the work of the gastrointestinal tract is disturbed. This is due to the fact that our abdominal region and ear are connected by one nerve. Therefore, during otitis, especially in a child, the intestines may swell, vomiting, and constipation may appear. That is, appendicitis can be suspected, in which case you will be referred to a surgeon. But the diagnosis of inflammatory diseases in young children must be carried out with the participation of an ENT doctor.
If a mother considers that her child simply has a disorder of the gastrointestinal tract, and takes up self-treatment, then otitis in the meantime can develop into a more serious disease – otoanthritis. This is a situation in which pus passes into the behind-the-ear region and another inflammation joins, as a result of which the ears protrude outwardly, edema appears and the temperature rises again. A complication can occur both in the coming days and in a month, that is, it cannot be predicted. If these symptoms of otitis are not noticed, then after a couple of months meningitis will develop, so be careful with otitis media.
Other common complications of otitis media include the transition to the chronic stage, damage to the vestibular apparatus and hearing loss.
In addition, a complication of otitis media can be:
Meningitis and other intracranial complications (brain abscess, encephalitis, hydrocephalus) – the stage following otoanthritis, if measures are not taken on time;
Paresis of the facial nerve;
Rupture of the eardrum and filling of the ear cavity with pus;
Cholesteatoma – overlapping of the ear canal with a tumor-like cystic formation in the form of a capsule with dead epithelium and keratin;
Mastoiditis – inflammation of the mastoid process, causing the destruction of the auditory ossicles in the middle ear;
Gastrointestinal dysfunction – bloating, vomiting, diarrhea;
Persistent hearing loss, hearing loss (up to complete deafness).
Chronic otitis is extremely difficult to treat and greatly reduces the quality of life – hearing is impaired, there is a constant inflammatory process in the ears and suppuration occurs. Often, to get rid of chronic otitis in adults, conservative treatment is not enough, and you have to resort to surgery.
Diagnosis of otitis media
A competent doctor diagnoses acute otitis without special devices and innovative technologies. A simple examination of the auricle and auditory canal with a head reflector (mirror with a hole in the center) or an otoscope is enough to diagnose otitis media.
How is otitis externa diagnosed?
With otitis externa, the doctor pays attention to the skin in the auricle, the size of the ear canal and the discharge from it. If the auditory lumen is severely narrowed, especially if the eardrum is not even visible, the skin is reddened, and liquid discharge is visible inside the ear, this allows the doctor to make a diagnosis of otitis externa.
How is otitis media diagnosed?
Acute otitis media is also diagnosed to a greater extent by external examination. The doctor is guided by some characteristic signs of this disease: a reddened eardrum, limitation of its mobility and the presence of perforation.
All these symptoms are easy to check – it is enough for the patient to puff out his cheeks without opening his mouth. “Ear blowing” – a technique called the Valsalva maneuver, is constantly used by divers and divers to equalize the pressure in the ear during deep-sea descent. As air enters the tympanic cavity, the membrane bulges noticeably, and if the cavity is filled with fluid, then there will be no bulging.
Perforation in the tympanic membrane with otitis is noticeable to the naked eye after the ear cavity is filled with pus and flows out during a breakthrough.
Clarification of the diagnosis of “internal otitis media”: audiometry
The study of hearing on a special apparatus – audiometry, as well as the measurement of pressure inside the ear – tympanometry – is used to clarify the diagnosis if chronic otitis media is suspected.
If hearing acuity with flowing otitis media drops sharply, and bouts of dizziness begin, there is a reasonable suspicion of otitis media (inflammation of the ear labyrinth). In this case, audiometry is used, resorting to the help of an otolaryngologist and a neurological examination.
X-ray and computed tomography
Radiography in acute otitis is used to confirm its complications – severe intracranial infections or mastoiditis. These are quite rare cases, but if these dangerous complications are suspected, a CT scan of the brain and temporal bones of the skull is necessary.
Determination of the bacterial flora in otitis media
Bacterial culture in otitis, at first glance, seems like a meaningless study. Indeed, the cultivation of bacteria takes time, and the result of the analysis will be visible only on the 6-7th day, and if timely treatment of otitis media is carried out, the disease should already have passed by this time. But not in all cases of otitis media, the usual antibiotics help, and if the doctor knows from the results of the smear which microorganisms caused the otitis media, he will prescribe a knowingly suitable drug.
What to do with otitis?
As soon as there are uncomfortable sensations in the ears, whether it be periodic congestion or aching pain, you should immediately consult a doctor for competent treatment. Otherwise, acute otitis media will most likely turn into chronic, leaving behind scars, thinning, retractions or a gap on the eardrum, after which the patient will experience frequent inflammation and hearing loss.
If it is impossible to see a doctor on the same day when the pain appeared, then the only thing that can be done is to use antihistamines inside (by reducing the pressure in the ear, the pain subsides), and with severe pain – painkillers.
But the worst thing is that pus gets into the brain, leading to irreversible consequences – a person can forever remain disabled!
How to treat otitis?
Regardless of the form of otitis media, the patient needs pain medication, as ear pain is unbearable to endure. Usually these are non-steroidal anti-inflammatory drugs, the most commonly prescribed today is ibuprofen. While taking NSAIDs, the patient should be under constant medical supervision.
What is the treatment for otitis externa?
If otitis externa is found in adults, the main treatment will be with ear drops. In a healthy person with normal immunity, otitis externa will pass using only drops, antibiotics in injections or tablets will not be needed. Drops can consist only of an antibacterial drug, or they can combine an antibiotic and an anti-inflammatory agent. Otitis externa is treated with drops on average for a week.
Basically, for the treatment of otitis externa appoint:
Antibiotics – norfloxacin (Normax), ciprofloxacin hydrochloride (Ciprolet), rifamycin (Otofa);
Antibiotics with corticosteroids – Candibiotic (beclomethasone, lidocaine, clotrimazole, chloramphenicol), Sofradex (dexamethasone, framycetin, gramicidin);
Antiseptics (Miramistin);
Antifungal ointments – clotrimazole (Candide), natamycin (Pimafucin, Pimafucort) – are prescribed if otitis externa is of a fungal origin.
Of the recently proven agents, an ointment with the active ingredient “mupirocin” is used, which does not have a pathological effect on the normal microflora of the skin, but is active against fungi.
How is acute otitis media of the middle ear and auditory labyrinth treated in adults?
Antibiotics
Otitis media is commonly treated with antibiotics. But the treatment of otitis media in adults is slightly different from the treatment of a childhood disease – the frequency of self-recovery from otitis media in an adult is more than 90 percent, which practically negates the need for antibiotics. But the remaining 10 percent come with very serious consequences, so if after the first two days of the disease there is no improvement, then antibiotics are prescribed.
Antibiotics should be prescribed by a qualified physician, as this class of drugs is extremely dangerous due to side effects. However, the death rate from complications of otitis media reaches 28000 people per year, therefore, as a rule, treatment justifies itself. Usually antibiotics are prescribed in the form of tablets, but if the patient cannot drink a tablet, injections are used.
To treat otitis media in adults, use:
Amoxicillin (Flemoxin Solutab, Ecobol, Ospamox or Amosin);
The combination of amoxicillin with clavunalic acid (Flemoclav, Augmentin, Ecoclave);
Cefuroxime (Cefurus, Aksetin, Zinnat, Zinacef).
It is possible to prescribe other drugs, but it is important to comply with the basic requirement of antibiotic therapy: to complete a course of treatment that lasts at least a week. If the microorganisms are not killed off due to the interruption of antibiotics, the bacteria develop resistance to this group of drugs, and the antibiotics stop working.
Ear drops for otitis media
Comprehensive treatment of otitis media often includes the use of drops. It is extremely important to know that not all ear drops are the same, and if the ear hurts, then not all drops will work. The difference is that before damage to the eardrum and after its perforation, the active substance for the treatment of otitis media is completely different.
If the eardrum is intact, then painkillers are used – Otipax, Otinum or Otizol – with lidocaine, benzocaine or choline salicylate. In the catarrhal form of otitis media in adults, antibiotic drops will not help at all, since the substance does not enter the source of inflammation – behind the eardrum.
When the pus has escaped and the tympanic cavity is open, on the contrary, drops with an analgesic effect are contraindicated, as they can lead to undesirable consequences. Moreover, with the flow of pus, the pain subsides.
In order to prevent re-suppuration or pus from entering the inner ear, antibiotics are prescribed to drip into the open tympanic cavity – these are Normax, Ciprofarm, Miramistin and others, only a doctor should prescribe them. It is strictly forbidden to use ototoxic antibiotics, preparations for alcohol, with phenazone or choline salicylate.
Paracentesis of the tympanic membrane – an extreme measure
When therapeutic treatment of otitis media with medication does not work, a large amount of pus accumulates behind the eardrum. This leads to very severe pain and increased absorption of bacterial waste products into the blood. There is a general intoxication of the body. As soon as such symptoms appear, doctors urgently prescribe paracentesis – an operation that prevents severe complications of otitis media.
The operation is performed under local anesthesia. In the process of paracentesis, the tympanic membrane is incised with a special needle in the thinnest place in order to minimally injure the tissues, and pus flows out through the resulting hole. Moreover, a neatly incised wound heals much faster than a hole with natural perforation, and after paracentesis, a minimal scar is formed.
The next day, there is a sharp improvement in well-being and the patient’s recovery is accelerated. This is especially true of paracentesis in the treatment of otitis media in children.
Urgent paracentesis is indicated for:
Inflammation of the inner ear;
Damage to the meninges, manifested in the form of headache and nausea;
Damage to the facial nerve;
If within three days after the start of antibiotic therapy the pain does not subside and suppuration does not subside.
Unlike external or otitis media of varying severity, inflammation of the auditory labyrinth is treated comprehensively, and only in a medical facility under the constant supervision of a neurologist and otolaryngologist. For the treatment of the labyrinth, not only antibiotics are required, but also neuroprotectors and drugs to improve blood microcirculation in the inner ear.
[Video] Dr. Berg – Best NATURAL Otitis Remedy: