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Otitis
(from ancient Greek οὖς, in the genus ὠτός – ear) – an ENT disease, which is an inflammatory process in the ear.
Depending on the localization of the pathological process (in the structures of the outer, middle or inner ear) there are:
- otitis externa
- otitis media
- labyrinthitis (inflammation of the inner ear).
Otitis occurs at any age, most often in children. Inflammatory diseases of the middle ear are the most common. By age 3, 80% of children have at least one episode of otitis media.
otitis externa
Otitis externa can be limited or diffuse. Limited inflammation of the external ear is often represented by furunculosis. Diffuse inflammation of the external auditory canal is observed mainly in chronic purulent otitis, due to the penetration of various bacteria into the skin and subcutaneous layer, as well as fungal infection. The inflammatory process often spreads to the eardrum.
Average otitis media
Otitis media is an inflammation of the middle ear.
Classification of otitis
According to the speed of development and duration of the course, otitis media is divided into acute and chronic
Depending on the nature of the resulting inflammatory exudate, otitis is divided into catarrhal and purulent.
Epidemiology
The most common causative agents of otitis media are cocci, including pneumococci, staphylococci, Haemophilus influenzae, as well as other pathogenic and opportunistic bacteria (genus Moraxella, Acinetobacter, Klebsiella, Pseudomonas aeruginosa).
They are activated by viral or bacterial inflammation of the nasal mucosa. Thus, especially when chronic otitis media, infection can occur as a superinfection, reinfection or autoinfection
The mechanism of penetration of bacterial pathogens can be as follows: when coughing, sneezing, especially with inept nose blowing, bacteria enter through the auditory tube into the middle ear (along the tubal tract).
Much less often, the infection enters the middle ear through the hematogenous route and, in exceptional cases, through a damaged eardrum.
Inflammation of the middle ear in infectious diseases it is rarely primary; more often it is a complication of the inflammatory process in the upper respiratory tract or a complication of the infectious disease itself.
It occurs as acute catarrhal otitis, eustachitis or as purulent otitis media.
Otitis media is possible, both bacterial and viral (for example, with measles, influenza) nature.
Patients are usually bothered by shooting pains in the ear. Upon examination, signs of inflammation of the middle ear are detected, and in advanced cases, suppuration.
Influenza otitis media characterized by a rapid course with severe intoxication; characterized by hemorrhagic inflammation with hemorrhages in the eardrum and sanguineous discharge from the ear.
With scarlet fever, otitis media is characterized by severe pain in the ear, high fever, and profuse suppuration.
Acute otitis media
Acute inflammation of the middle ear – a disease of the body, the local manifestation of which is an inflammatory process in the tissues of the tympanic cavity, auditory tube and mastoid process.
Inflammation of the middle ear can spread to surrounding tissues: the skin of the outer ear, mastoid process, parotid salivary gland. p> Usually, otitis media in various infectious diseases does not lead to hearing loss. The exception is cases of purulent otitis media, when the morphofunctional structures of the middle ear are destroyed.
Stages of acute otitis
There are five stages of acute inflammation of the middle ear:
- The stage of acute eustachitis is a feeling of congestion, noise in the ear, normal body temperature (increased in the case of an existing infection).
- The stage of acute catarrhal inflammation in the middle ear is a sharp pain in the ear, the temperature rises to low-grade, aseptic inflammation of the mucous membrane of the middle ear, noise and a feeling of congestion increase.
- Pre-perforative stage of acute purulent inflammation in the middle ear – the pain intensifies sharply, becomes unbearable, radiating to the teeth, neck, pharynx, eye; there is a decrease in hearing and increased noise in the ear; body temperature reaches febrile levels, the blood picture becomes inflammatory in nature.
- Post-perforation stage of acute purulent inflammation in the middle ear – the pain subsides, suppuration begins from the ear, noise and hearing loss do not go away, the temperature returns to normal.
- Reparative stage – the inflammation is stopped, the perforation is closed with a scar.
Acute purulent otitis media
Ear pain, purulent discharge from the ear canal, and fever are symptoms of acute purulent otitis media.
An increase in temperature is observed, and pus begins to discharge from the ear (the onset of suppuration is associated with the breakthrough of pus through the eardrum).
After the discharge ends, the patient’s condition improves and the pain subsides. Usually this leads to final recovery, but sometimes the pus does not find a way out, which can cause the infection to spread into the cranial cavity (possible development of meningitis, brain abscess).
Chronic otitis media
Chronic secretory otitis mediaassociated with gastroesophageal reflux
With pathological “high” gastroesophageal refluxes reaching the pharynx and oral cavity and called pharyngolaryngeal refluxes (PLR), aggressive stomach contents reach the nasopharynx and can cause various otorhinolaryngological diseases.
Chronic otitis associated with gastroesophageal reflux usually does not respond to standard treatment. For its diagnosis, it is important to determine the presence and frequency of pharyngolaryngeal reflux, for which pH-metry of the esophagus and larynx is used.
Treatment of otitis media
It is necessary to visit an otolaryngologist immediately if ear pain occurs and if it does not go away after two days. Self-treatment of otitis using only non-traditional methods is fraught with the development of complications. Therefore, treatment with these drugs should only be carried out with the permission of a doctor.
Therapy should take into account the individual characteristics of the patient, the severity of the inflammatory reaction, the stage of the process, concomitant pathology and the degree of sensitization of the body.
otitis externa
For external otitis, it is advisable to introduce gauze turundas soaked in 70% alcohol into the external auditory canal, a warm compress, physiotherapeutic procedures, and vitamin therapy. Antibiotics and sulfa drugs are used for severe inflammation and fever. When an abscess or boil forms, its opening is indicated. In case of diffuse inflammation, the ear canal is washed with disinfectant solutions.
Average otitis media
General treatment for otitis media: bed rest and complete rest to prevent the development of complications. Depending on the form of damage to the middle ear, treatment can be conservative or surgical.
Conservative therapy consists of careful and systematic removal of pus from the ear and the use of disinfectant astringents to affect the mucous membrane of the middle ear.
Local therapy should be carried out in parallel with antibacterial therapy.
The second aspect of drug therapy is the elimination of pain. For oral use, drugs are recommended that have antipyretic, analgesic and anti-inflammatory effects, which help to significantly reduce swelling of the mucous membrane of the upper respiratory tract.
Due to the fact that otitis media more often develops in weakened people suffering from more or less severe immunodeficiency, it is also necessary to carry out a set of measures aimed at stimulating the body’s defenses.
In persons with a certain allergic mood, the administration of various medications, especially antibiotics, should be combined with the use of antihistamines.
In addition to therapeutic methods, surgical interventions can be used in the treatment of chronic purulent otitis.
For acute otitis media, laser therapy with a helium-neon laser is an integral part of complex treatment.
In case of complicated treatment of acute otitis, ultraviolet irradiation of blood can be used to stimulate nonspecific immunological mechanisms of reactivity.
For the treatment of chronic secretory otitis media associated with gastroesophageal reflux, in addition to other treatment procedures, antireflux therapy is carried out, including lifestyle changes aimed at reducing the number of refluxes, drug reduction of gastric acidity, etc.