Otitis in adults

Sharp pain in the ear is one of the most excruciating sensations. Many patients compare its strength to toothache and severe injuries, and women compare it to the process of childbirth. Most often, the ear hurts due to otitis media.

What is otitis

Otitis media is the general term for inflammation of the ear. Inflammation can be acute or chronic, affecting various parts of the ear.

If the inflammation is localized in the auricle and ear canal to the border of the tympanic membrane, it is otitis externa, inflammation in the tympanic cavity is otitis media, if the cochlea is affected, the inside of the ear is otitis media or labyrinthitis.

These pathologies are extremely painful, accompanied by fever, hearing impairment, discharge from the external passage. In addition, without treatment, otitis media can threaten with severe complications – hearing loss or complete deafness, paresis in the facial nerve, damage to the bones or brain.

Causes of otitis media in adults

The most common cause of otitis externa is injury, infection of the skin and underlying tissues in the ear canal. Chemical injury to the ear, irritation and inflammation due to sulfur plugs, water entering the ear, and the formation of boils are also possible.

Otitis media is the most common form of the disease. It is usually provoked by bacterial infections, less often by viruses, pathogenic fungi, and also mixed infection. The most common pathogens:

• Pneumococcus;
• hemophilic bacillus;
• influenza virus;
• various causative agents of SARS.

In recent years, cases of fungal otitis media have become more frequent.

Risk factors that increase the likelihood of otitis media are sniffing, excess mucus in the nasopharynx. pressure drop when diving, diving to depth. Often, otitis media becomes a complication of a cold, ENT pathologies (adenoiditis, tonsillitis, pharyngitis, rhinitis). The risk is higher in people with immunodeficiencies.

Symptoms of otitis media in adults

With otitis externa, the most common complaints are:

• pulsation in the ear, sharp pain radiating to the neck, eyes or teeth;
• increased pain when chewing food, talking, closing the jaw;
• redness of the ear canal and auricle;
• hearing impairment, if there is a discharge of pus in the area of ​​uXNUMXbuXNUMXbthe ear canal.

Acute otitis media begins with a fever along with shooting pain inside the ear. It grows as mucus and pus accumulate in the cavity, after 2-3 days the membrane ruptures, pus flows out of the ear and the condition improves. The temperature drops, the pain subsides. Then the rupture of the membrane heals without a trace.

In the chronic form, mesotympanitis may occur – inflammation is localized in the zone of the Eustachian tube and the lower, middle part of the tympanic cavity. A hole is formed in the membrane, but the membrane itself is stretched. Key complaints:

• hearing loss;
• periodic appearance of pus from the ear;
• noise in the ear;
• dizziness;
• during an exacerbation – pain and temperature.

With the development of epitympanitis, there is a sharp decrease in hearing, the release of foul-smelling pus, pressure in the ear, pain in the temples, dizziness. Periods of exacerbation are replaced by remissions, but hearing does not improve completely.

Treatment of otitis media in adults

In order for the treatment to be effective, it is necessary to accurately determine the localization of the inflammatory process, its severity and possible complications. To do this, you need to contact an ENT doctor.

Diagnostics

The diagnosis can be suspected on the basis of typical complaints, but the doctor will ask in detail – where and how the ear hurts, press the tragus, pull the earlobe down to determine if there is pain. In addition, the otorhinolaryngologist will examine the ear using instruments and lights to accurately examine the ear canal, eardrum, to understand if there is pus and perforation in it. To determine sensitivity to antibiotics, culture is performed. The doctor may also prescribe:

• blood tests (general, biochemistry) to determine the nature of the inflammation;
• x-ray of the paranasal sinuses, if a connection with sinusitis is suspected;
• radiography of the temporal bone in chronic otitis media.

All these data are needed in order to determine the tactics of treatment, the need for antibiotics, surgical interventions (perforation of the membrane or other interventions).

Modern treatments

We asked to talk about how otitis in adults is treated today otorhinolaryngologist Svetlana Komarova. According to her, drug therapy may include:

• drops in the ear containing the analgesic Phenazon and local anesthetic Lidocaine – to relieve pain and reduce inflammation, if discharge from the ear appears, antibacterial drops containing Rifampicin or Ciprofloxacin should be used;

• vasoconstrictor drops containing Xylometazoline 0,1%, Oxymetazoline 0,05%, Naphazoline 0,1%, Phenylephrine 0,025% are instilled into the nose to reduce swelling of the nasopharyngeal mucosa around the mouth of the auditory tubes;

• with the ineffectiveness of local drugs – analgesics and non-steroidal anti-inflammatory drugs (Acetylsalicylic acid, Paracetamol, Tramadol, Ketoprofen, Ibuprofen) are prescribed orally;

• antipyretic drugs (Paracetamol) are used when the temperature rises above 38,5 C;

• antihistamines (Diphenhydramine, Clemastine, Chloropyramine) are prescribed to reduce swelling;

• broad-spectrum antibacterial drugs: penicillins, cephalosporins, macrolides, respiratory fluoroquinolones.

Non-pharmacological methods of treatment:

• procedures prescribed by an otorhinolaryngologist: washing the external auditory canal, catheterization of the auditory tube, blowing the auditory tubes according to Politzer, pneumomassage of the tympanic membrane;
• physiotherapy: UV, UHF, microwave therapy, electrophoresis with anti-inflammatory drugs as prescribed by a physiotherapist.

Non-drug treatments help relieve pain, restore hearing and prevent complications.

In case of complicated course of otitis or non-effectiveness of conservative therapy, surgical treatment (myringotomy, shunting of the tympanic cavity, radical operation on the middle ear) is indicated, aimed at sanitizing the focus of infection, restoring hearing, and preventing relapses.

What antibiotics are effective for otitis media?

– Systemic antibiotic therapy is indicated in all cases of moderate and severe acute otitis media, – says otorhinolaryngologist Svetlana Kovaleva, as well as in immunocompromised patients. With a mild course of otitis media (the absence of pronounced symptoms of intoxication, pain syndrome, hyperthermia up to 38 ° C), you can refrain from prescribing antibiotics. However, in the absence of positive dynamics within 48 hours, antibiotic therapy should be resorted to.

With otitis, broad-spectrum antibiotics are prescribed that are effective against typical pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, Staphylococcus aureus.

The drug of choice is Amoxicillin.

Alternative agents for allergy to β-lactams are modern macrolides (Josamycin, Azithromycin, Clarithromycin). In case of ineffectiveness, as well as in patients who received antibiotics for a month, it is advisable for patients over 60 years of age to prescribe a complex – amoxicillin + clavulanic acid. Alternative drugs are II-III generation cephalosporins (Cefuroxime axetil, Ceftibuten) or fluoroquinolones (Levofloxacin, Moxifloxacin).

In mild to moderate cases, oral antibiotics are indicated. In severe and complicated otitis, start with intravenous or intramuscular administration of the drug, and then continue treatment orally.

The duration of antibiotic therapy is 7-10 days. With complicated otitis – 14 days or more.

You should not use antibiotics on your own, you should consult with an otorhinolaryngologist. Otitis can be caused by a fungal flora or a herpes infection. The use of antibiotics in this case can aggravate the course of the disease.

Prevention of otitis media in adults at home

To prevent otitis media, it is necessary to avoid hypothermia, wash hands after the street, irrigate the nasal mucosa with sea water after visiting places with a large crowd of people, harden the body, exercise, eat fresh fruits, vegetables, and dairy products daily.

If it so happened that you fell ill and began to worry about a runny nose, then you need to blow your nose very carefully, while freeing only one nostril, otherwise the discharge from the nose can get through the auditory tube into the ear and provoke otitis media.

Proper ear hygiene is essential. It is not recommended to use cotton swabs – they can bring a bacterial or fungal infection into the ear. For ear hygiene, use drops consisting of a combination of surfactants (Allantoin, Benzetoin chloride) that cleanse, moisturize and protect the skin of the external auditory canal.

Popular questions and answers

We discussed the risks of complications of otitis and the possibility of their treatment using traditional methods of therapy with ENT doctor Svetlana Kovaleva.