To fully eliminate the consequences of ear inflammation, it is important to know how to restore hearing after otitis media. A decrease in the acuity of perception of sound vibrations occurs for various reasons, and therefore the treatment of the problem must be selected individually. In this case, the manifestation of the symptom is observed equally in both an adult and a child. To properly eliminate deviations in the acuity of sound perception, it is necessary to understand the reasons for its occurrence and localization.
Causes of hearing loss
Hearing loss in an adult and a child after otitis media can occur for completely different reasons. Some of them are natural processes and do not have a negative effect on the human body. Others can be eliminated only with timely detection. Rarely, but still happens, complete loss of normal hearing as a result of the development of complications of otitis media and damage to key elements of the sound transmission chain.
Factors that can cause hearing loss due to otitis include:
- swelling of the ear tissues, in particular the ear canal;
- accumulation of exudate;
- perforation of the eardrum;
- retraction or swelling of the membrane;
- blocking the movement of the auditory ossicles;
- damage to auditory receptors;
- disruption of neurosensory transmission;
- spread of inflammation to the brain.
Typically, temporary hearing loss occurs when the middle ear cavity fills with exudate. The liquid prevents the full transmission of sound vibrations and affects the sensitivity of the eardrum.
For a child, the problem of swelling of the tissues of the Eustachian tube is relevant. Narrowing of the ear canal and loss of pressure leads to deformation of the eardrum. After the normal state of the organs is restored, the problem resolves itself.
Much more dangerous is the spread of inflammation to bone tissue and the cavity of the inner ear. In this case, there is a risk of impaired sensitivity of sensors and nerve endings, as a result of which deafness may develop. Incorrect or late treatment of otitis increases the risk of developing such complications. It is possible to partially restore the perception of sounds, but such treatment is more complex, time-consuming and expensive.
Elimination of residual effects
A temporary decrease in hearing acuity in a child and an adult may be associated with the development of swelling due to inflammation of the auditory cavity, ear congestion and accumulation of secretions when the drainage function of the Eustachian tube is impaired. With timely treatment of otitis media, natural hearing restoration occurs after the disease. In a child, this process is quite natural, since the auditory canal is subject to more significant damage than in adults.
Typically, deterioration in hearing acuity persists for some time after the cause of the disease has been eliminated. Such symptoms are called residual effects. It is impossible to reliably determine when exactly hearing will be fully restored after otitis media. This usually takes from a couple of days to several weeks.
If the treatment of otitis was complex and lengthy, additional procedures may be necessary. To restore the functioning of the Eustachian tube, the blowing method is used, pneumomassage of the eardrum, heating with a blue lamp and other physiotherapy are also performed. For medications, vasoconstrictor nasal drops are suitable.
If symptoms do not go away within a month, intensive treatment is required. If deviations occur, you should definitely consult a doctor to reduce the risk of developing hearing loss.
Treatment of hearing loss
Patients come not only with the question “how to restore hearing after otitis?”, but also “how to treat the resulting hearing loss after ear disease?”. In a small percentage of patients, as a result of disorders that have occurred in the body, there is a partial loss of hearing acuity after otitis media. This effect may be associated with irrational use of medications or violation of doctor’s recommendations. Delayed treatment, when the purulent process has already affected important parts of the organ, can also provoke hearing loss.
Hearing loss can be conductive, sensorineural, or mixed. It is easier to eliminate the conductive form, since this requires restoring the affected functional elements of the sound transmission chain. Treatment methods are:
- taking stimulant and antibacterial medications;
- physiotherapy aimed at restoring organ function and resolving scar tissue;
- surgical intervention.
Tympanoplasty is performed to restore ear function. It has many directions. Myringoplasty is used to correct and restore the eardrum. If the auditory ossicles are damaged or blocked, surgery is performed directly in the middle ear. Common approaches are stapedoplasty and ossiculoplasty, the essence of which is to prosthetize parts of the bones. If sound conduction is impaired, decompression and drainage of the inner ear may be necessary. It all depends on the specific situation.
If deafness that occurs after otitis is associated with a violation of neurosensory connections, its treatment should be aimed at receptors, nerve endings and the brain. To stimulate blood circulation and cell activity, as well as restore the sensitivity of fibers, a special group of medications are used. Some drugs are not suitable for a child, as they have an intense effect.
To activate the brain and inner ear, the hyperbaric oxygenation method is used, which involves supplying oxygen to the body.
Treatment also includes surgical methods. Sensorineural hearing loss can be partially compensated by implanting electrodes into the inner ear, restoring the connection between the main functional apparatus and the brain.
Treatment for sensorineural hearing loss may involve fitting a hearing aid. This method is applicable even for an infant. The device is selected individually and manufactured to suit the patient’s ear parameters.
With timely detection of inflammation and its proper treatment, the risk of a decrease in hearing acuity is minimal. If the process has already been started, you cannot waste a single day, since it is much easier to eliminate hearing loss at the initial stage.
Not everyone knows what otitis media is. This is a disease that affects the human ear. It consists of acute inflammation of the tissues that make up this important sensory organ. Thousands of people of different ages get sick with otitis media every year. And it is well known that otitis media cannot be called a harmless disease.
What is otitis media
To understand the principle of the occurrence of otitis, you need to remember what it is - the ear, what it is needed for and how it works. In fact, the ear is far from just the pinna, as some might think. The ear has a complex system hidden inside for converting sound waves into a form suitable for perception by the human brain. However, picking up sounds is not the only function of the ears. They also perform a vestibular function and serve as an organ that allows a person to maintain balance.
The three main sections of the ear are the middle, outer and inner. The outer ear is the pinna itself, as well as the auditory canal leading to the eardrum. Behind the eardrum is an air-filled tympanic cavity containing three auditory ossicles, the purpose of which is to transmit and amplify sound vibrations. This area makes up the middle ear. From the middle ear, vibrations enter a special area located in the temporal bone and called the labyrinth. It contains the organ of Corti - a cluster of nerve receptors that convert vibrations into nerve impulses. This area is called the inner ear. Also worth noting is the Eustachian tube, the entrance of which is located behind the palatine tonsils and which leads into the tympanic cavity. Its purpose is to ventilate the tympanic cavity, as well as to bring the pressure in the tympanic cavity into line with atmospheric pressure. The Eustachian tube is usually referred to as the middle ear.
It should be noted that otitis media can affect all three ear sections. Accordingly, if the disease affects the outer ear, then we talk about external otitis, if it is middle, then about otitis media, if the inner ear, then about internal. As a rule, we are talking only about one-sided lesions, however, with otitis media caused by infections of the upper respiratory tract, the disease can develop on both sides of the head.
Ear otitis is also divided into three types depending on the cause - viral, bacterial or traumatic. External otitis can also be fungal. The most common bacterial form of the disease occurs.
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How does the ear work?Otitis externa - symptoms, treatment
Otitis externa occurs as a result of infection of the surface of the skin of the ear with bacteria or fungi. According to statistics, approximately 10% of the world's population has suffered from external otitis at least once in their lives.
Factors contributing to otitis in adults are:
- hypothermia of the auricle, for example, during walks in the cold;
- mechanical damage to the auricle;
- removal of wax from the ear canal;
- entry of water, especially dirty water, into the ear canal.
Bacteria and fungi “love” the ear canal because it is damp, dark and quite humid. It provides an ideal place for their breeding. And, probably, everyone would have otitis externa, if not for such a protective feature of the body as the formation of earwax. Yes, earwax is not at all a useless substance that clogs the ear canal, as many people think. It performs important bactericidal functions, and therefore its removal from the ear canal can lead to otitis media. The only exception is when too much sulfur is released and it affects the perception of sounds.
Inflammation of the external auditory canal usually refers to a type of skin disease - dermatitis, candidiasis, furunculosis. Accordingly, the disease is caused by bacteria, streptococci and staphylococci, fungi of the genus Candida. In the case of furunculosis, inflammation of the sebaceous glands occurs. The main symptom of external otitis is, as a rule, pain, especially aggravated by pressure. There is usually no elevated temperature with otitis externa. Hearing loss rarely occurs with external otitis, except in cases where the process affects the eardrum or the ear canal is completely closed with pus. However, after recovery from otitis media, hearing is completely restored.
Diagnosis of external otitis in adults is quite simple. As a rule, a visual examination by a doctor is sufficient. A more detailed method of diagnosing otitis involves the use of an otoscope, a device that allows you to see the far end of the ear canal and the eardrum. Treatment of otitis media consists of eliminating the cause of ear inflammation. When treating otitis externa in adults, antibiotics or antifungal drugs are used. The type of antibacterial therapy should be determined by the doctor. Typically, ear drops are used for otitis externa rather than tablets. When external tissues of the auricle not located in the area of the auditory canal are affected, ointments are used. A frequent complication of external otitis is the transition of the inflammatory process to the middle ear through the eardrum.
Otitis media
Otitis media is an inflammation of the middle part of the hearing organ. This kind of ear inflammation is one of the most common diseases on Earth. Hundreds of millions of people suffer from ear infections every year. According to various data, from 25% to 60% of people have suffered from otitis media at least once in their lives.
Reasons
In most cases, inflammation of the middle ear is not a primary disease. As a rule, it is a complication of external otitis or infectious diseases of the upper respiratory tract - tonsillitis, rhinitis, sinusitis, as well as acute viral diseases - influenza, scarlet fever.
How does an infection from the respiratory tract get into the ear? The fact is that she has a direct path there - this is the Eustachian tube. When you have respiratory symptoms such as sneezing or coughing, particles of mucus or phlegm may be pushed up the tube into your ear. In this case, both inflammation of the Eustachian tube itself (eustachitis) and inflammation of the middle ear can occur. When the Eustachian tube is blocked in the tympanic cavity, which is deprived of ventilation, stagnation processes can occur and fluid can accumulate, which leads to the proliferation of bacteria and the occurrence of disease.
The cause of otitis media can also be mastoiditis, allergic reactions that cause swelling of the mucous membranes.
Otitis ear has several varieties. First of all, a distinction is made between chronic and acute otitis media. According to the degree of development, otitis of the middle ear is divided into exudative, purulent and catarrhal. Exudative otitis media is characterized by the accumulation of fluid in the tympanic cavity. With purulent otitis media of the middle ear, the appearance of pus and its accumulation are noted.
Otitis media, symptoms in adults
Symptoms in adults primarily include ear pain. Pain with otitis media can be acute or shooting. Sometimes pain can be felt in the temple or crown area, it can pulsate, subside or intensify. With exudative otitis media, there may be a sensation of water splashing in the ear. Sometimes there is ear congestion, as well as a feeling of hearing one's own voice (autophony) or just a vague noise in the ear. Tissue swelling, hearing loss, fever, and headaches are often observed. However, an increase in temperature is often not a symptom of otitis media, but only a symptom of the infectious disease that caused it - acute respiratory infections, acute respiratory viral infections or influenza.
The most complex course is observed in the purulent form of otitis media. In this case, the main symptom of otitis media is the discharge of pus. The tympanic cavity is filled with pus, and the body temperature rises to +38-39ºС. Pus can thin the surface of the eardrum and form a hole in it through which it leaks out. However, this process is generally beneficial, since the pressure in the cavity drops, and as a result the pain becomes less acute. The process of draining pus takes about a week. From this moment, the temperature drops to subfebrile levels and wound healing begins. The total duration of the disease is 2-3 weeks with proper and timely treatment.
The chronic form of the disease is characterized by a sluggish infectious process, in which there are seasonal surges, during which the disease becomes acute.
Diagnostics
If you have suspicious symptoms, you should consult a doctor. Diagnosis is carried out by an otolaryngologist. The following diagnostic sign can be used for this. If an otolaryngologist's patient puffs out his cheeks, then the immobility of the membrane indicates that air does not enter the tympanic cavity from the nasopharynx and, therefore, the Eustachian tube is blocked. Inspection of the eardrum is carried out using an optical device - an otoscope. It also helps to identify some characteristic signs, for example, protrusion of the eardrum and its redness. Blood tests, computed tomography, and radiography can also be used for diagnosis.
Treatment
How to treat the disease? Treatment of otitis media is quite complex compared to treatment of external otitis. However, in most cases conservative treatment is used. First of all, in case of acute otitis media, it makes no sense to instill ear drops with antibacterial drugs, since they will not reach the site of inflammation. However, for inflammation of the middle ear, the focus of which is directly adjacent to the eardrum, anti-inflammatory and analgesic drops can be instilled into the ear. They can be absorbed by the eardrum, and the substance will enter the region of the middle part of the hearing organ, into the tympanic cavity.
Antibiotics are the main method of treating otitis media in adults and children. Typically, medications are taken in tablet form. However, if the eardrum has ruptured, antibiotic ear drops can also be used. A course of antibiotics must be prescribed by a doctor. He also chooses the type of antibiotics, since many of them have an ototoxic effect. Their use can cause irreversible hearing loss.
The greatest effectiveness for otitis media of the middle ear was demonstrated by a course of treatment with penicillin antibiotics, amoxicillin, as well as cephalosporins or macrolides. However, cephalosporin has an ototoxic effect, so it is not recommended to inject it directly into the ear through a catheter or instill it into the ear canal in case of damage to the eardrum. Antiseptic agents, such as miramistin, can also be used for therapy.
When treating otitis media, it is often necessary to use painkillers. To relieve pain in diseases of the middle part of the hearing organ, drops with painkillers, for example, lidocaine, are used.
In case of membrane perforation, scar stimulants are used to speed up its healing. These include ordinary iodine solution and silver nitrate 40%.
Glucocorticoids (prednisolone, dexomethasone), as well as non-steroidal anti-inflammatory drugs, can be used as anti-inflammatory drugs and agents that can relieve swelling. In the presence of allergic processes or with exudative otitis, antihistamines are used, for example, suparastin or tavegil.
Also, for exudative otitis media, medications are taken to thin the exudate, for example, carbocisteine. There are also complex drugs that have several types of action, for example, Otipax, Otinum, Otofa, Sofradex. In case of purulent discharge, you should regularly clean the ear canal of pus and rinse it with a weak stream of water.
Is it possible to warm your ear? It depends on the type of disease. In some cases, heat can speed up healing, while in others, on the contrary, it can aggravate the disease. In the purulent form of middle ear disease, heat is contraindicated, and in the catarrhal stage, heat promotes blood flow to the affected area and speeds up the patient's recovery. Heat is also one of the effective ways to reduce pain during otitis media. However, only a doctor can give permission to use heat; self-medication is unacceptable. If heat is contraindicated, it can be replaced with physiotherapeutic procedures (UHF, electrophoresis).
They often resort to surgical treatment of the middle ear, especially in the case of a purulent version of the disease and its rapid development, which threatens severe complications. This operation is called paracentesis and is aimed at removing pus from the tympanic cavity. For mastoiditis, surgery can also be performed to drain the internal areas of the mastoid process.
Special catheters are also used to blow and clean the Eustachian tube. Medicines can also be administered through them.
Folk remedies for the treatment of middle ear inflammation in adults can be used only in relatively mild forms of the disease and with the permission of the attending physician. Here are some recipes suitable for treating otitis media.
Cotton wool is moistened with propolis infusion and inserted into the area of the external auditory canal. This composition has wound healing and antimicrobial properties. The tampon must be changed several times a day. Plantain juice, instilled into the ear in the amount of 2-3 drops per day, has a similar effect. To get rid of infections of the nasopharynx and larynx, which provoke middle ear infections, you can use rinses based on chamomile, sage, and St. John's wort.
Complications
With proper therapy, otitis media can go away without leaving any long-term consequences. However, inflammation of the middle ear can cause several types of complications. First of all, the infection can spread to the inner ear and cause internal otitis media - labyrinthitis. It can also cause permanent or transient hearing loss or complete deafness in one ear.
Perforation of the eardrum also leads to hearing loss. Although, contrary to popular belief, the membrane can become overgrown, even after it is overgrown, hearing sensitivity will be permanently reduced.
Mastoiditis is accompanied by acute pain in the parotid space. It is also dangerous due to its complications - the breakthrough of pus on the membranes of the brain with the appearance of meningitis or in the neck area.
Labyrinthitis
Labyrinthitis is an inflammation of the inner ear. Labyrinthitis is the most dangerous of all types of otitis. With inner ear inflammation, typical symptoms include hearing loss, vestibular disturbances and pain. Treatment of internal otitis is carried out only with the help of antibiotics; no folk remedies will help in this case.
Labyrinthitis is dangerous due to hearing loss as a result of the death of the auditory nerve. Also, with internal otitis, complications such as brain abscess are possible, which can lead to death.
Otitis ear in children
Otitis media in adults is much less common than this disease in children. This is due, firstly, to the weaker immunity of the child’s body. Therefore, infectious diseases of the upper respiratory tract are more common in children. In addition, the structural features of the auditory tube in children contribute to stagnant processes in it. It has a straight profile, and the expanded lumen at its entrance facilitates the entry of mucus and even pieces of food or vomit (in infants).
Careful treatment of otitis media in childhood is very important. If improper treatment is carried out, the disease can become chronic and make itself felt already in adulthood with chronic outbreaks. In addition, if otitis media is not treated in infancy, this can lead to partial hearing loss, and this, in turn, leads to a delay in the child’s mental development.
Prevention of otitis media
Prevention includes preventing situations such as hypothermia of the body, primarily the ear area, and dirty water getting into the ear canal area. It is necessary to promptly treat inflammatory diseases of the upper respiratory tract, such as sinusitis, sinusitis, and pharyngitis. It is recommended to use a cap while swimming, and after being in the water, you should completely clear the ear canal of water. During the cold and damp seasons, it is recommended to wear a hat when going outside.
Otitis externa– inflammation of the outer ear, consisting of the auricle, external auditory canal, and eardrum. Most often the disease is caused by bacteria, although there are other causes.
According to official statistics, acute external otitis is experienced annually by 4–5 people per 1000 people worldwide. Between 3% and 5% of people suffer from a chronic form of the disease. Otitis externa is common among residents of all countries. In warm, humid climates, the incidence is higher. People who have a narrow ear canal are more prone to otitis media.
The disease affects males and females equally often. The peak incidence occurs in children between 7 and 12 years of age. This is due to the anatomical features of the structure of the child’s ear and the imperfection of protective mechanisms.
Otitis externa is an occupational disease for divers, swimmers and other people who frequently get water into the external ear canal.
Anatomical features of the external auditory canal
The human hearing organ consists of three parts: outer, middle and inner ear.Structure of the outer ear:
- Auricle. It is cartilage covered with skin. The only part of the auricle that lacks cartilage is the lobe. In its thickness there is adipose tissue. The auricle is attached to the skull by ligaments and muscles behind the temporomandibular joint. It has a characteristic shape; at its bottom there is an opening leading to the external auditory canal. The skin around it contains many sebaceous glands; it is covered with hairs, which are especially strongly developed in older people. They perform a protective function.
- External auditory canal. Connects the external opening located in the auricle with the cavity of the middle ear (tympanic cavity). It is a canal 2.5 cm long and 0.7–1.0 cm wide. In the initial section under the canal there is the parotid salivary gland. This creates conditions for the spread of infection from the gland to the ear with mumps and from the ear to the tissue of the gland with otitis. 2/3 of the external auditory canal is located in the thickness of the temporal bone of the skull. Here the canal has its narrowest part - the isthmus. On the surface of the skin inside the passage there is a lot of hair, sebaceous and sulfur glands (which, in fact, are also modified sebaceous glands). They produce a secretion that combines with dead skin cells to form earwax. The latter helps remove pathogens and foreign bodies from the ear. Evacuation of earwax from the external auditory canal occurs during chewing of food. If this process is disrupted, then an ear plug is formed and natural protective mechanisms are disrupted.
- Eardrum separates the outer ear from the middle ear (tympanic cavity). It is involved in sound conduction, and during infection it serves as a mechanical barrier.
Features of the children's ear that increase the likelihood of developing otitis media compared to adults:
- Imperfect defense mechanisms. The child’s immunity continues to develop after birth; it cannot provide full protection.
- The child's ear has some anatomical features. The external auditory canal is shorter and looks like a slit.
- Children's ear skin is more delicate and is easier to damage when cleaning and combing the ears.
Causes of otitis externa
Classification of external otitis by origin:- Infectious – caused by pathogenic microorganisms.
- Non-infectious - caused by other reasons, for example, irritation or allergic reactions.
- Pseudomonas aeruginosa;
Improper hygiene of the outer ear:
- Lack of ear care. It is advisable to wash them daily with soap and dry with a towel. Otherwise, dirt will accumulate in them, which increases the risk of infection. For children in their first year of life, their ears are wiped with special wet wipes and cotton swabs.
- Cleaning the outer ear canals too often. Regularly cleaning your ears with a cotton swab helps remove remaining earwax and dirt. But this should not be done too often, otherwise the likelihood of developing cerumen plugs and otitis externa increases. 1 – 2 times a week is enough.
- Improper cleaning of the ear canals. Adults often do this with matches, metal objects (blunt ends of darning needles, knitting needles), and toothpicks. This leads to skin injury and infection. Pathogenic bacteria can enter the ear from objects. It is permissible to use only special cotton swabs to clean your ears. In children under one year old, ears are cleaned only with cotton wool; hard sticks cannot be used at this age.
- Ear cleaning too deep. The resulting earwax gradually moves towards the outer opening and accumulates near it in the form of a small rim. Therefore, it makes no sense to clean an adult’s ears deeper than 1 cm - this only increases the risk of infection.
Earwax formation disorder:
- Insufficient earwax production The natural protective mechanisms of the ear are reduced. After all, sulfur actively takes part in the removal of pathogens from the external ear canal.
- For excess earwax and disruption of its removal, ear cleansing is also disrupted, wax plugs form, and the risk of infection increases.
Foreign bodies and water getting into the ears:
- Foreign bodies, getting into the external auditory canal, injure the skin, cause irritation and swelling. Conditions are created for infection to enter.
- Along with water pathogenic microorganisms are introduced into the ear, creating a favorable environment for their reproduction. Earwax secretion and protection are impaired.
Decreased immunity and protective reactions:
- hypothermia, the effect of strong cold wind on the ear;
- chronic and severe diseases leading to depletion of immune forces;
- frequent infections;
- immunodeficiency states: AIDS, congenital immune defects.
Infectious diseases of neighboring organs (secondary otitis):
- Skin infections: boil, carbuncle, etc. The causative agents of the disease can enter the ear from pustules on the adjacent skin.
- Mumps- inflammation of the parotid salivary gland.
Taking certain medications:
- Immunosuppressants and cytostatics– drugs that suppress the immune system. With their long-term use, the risk of developing otitis media and other infectious diseases increases.
- Incorrect use of antibiotics over a long period of time and in high doses can lead to fungal external otitis. This applies to both injectable tablets and antibacterial creams and ointments applied to the ear area.
Dermatological diseases
At eczema and other skin diseases, the process can affect the area around the ear. In this case, the doctor can make a diagnosis of external non-infectious otitis.Manifestations of external otitis
Classification of external otitis depending on the form of the disease:- process limited in area - ear furuncle;
- widespread purulent external otitis;
- perichondritis (inflammation of the cartilage) of the auricle;
- otomycosis – fungal infection of the outer ear;
- eczema of the skin of the outer ear is the most common type of non-infectious external otitis.
- spicy;
- chronic.
Furuncle of the external auditory canal
Furuncle– purulent inflammation involving the sebaceous gland or hair follicle. It can only occur in the outer part of the ear canal, since the inner part lacks hair and sebaceous glands. Symptoms of a boil in the external auditory canal:
- Acute severe pain in the ear, which radiates to the jaw, neck, and spreads to the entire head.
- Increased pain while chewing, pulling the auricle to the side or pressing in the area of the external opening of the ear canal.
- Increased body temperature– Not observed in all patients.
- General health disorder– not present in all patients; it can be expressed to varying degrees.
A furuncle of the ear can be a manifestation of a systemic disease - furunculosis. In this case, boils periodically appear on different parts of the body. Furunculosis usually develops with decreased immunity.
Diffuse external otitis
Diffuse external otitis– a purulent inflammatory process that spreads to the entire external auditory canal, involves the subcutaneous layer, and can affect the eardrum. Signs of acute diffuse external otitis:
- itching in the ear;
- pain when pressing in the area of the external opening of the auditory canal;
- swelling in the ear area, narrowing of the external opening of the auditory canal;
- discharge of pus from the ear;
- increased body temperature, general deterioration.
With external otitis, hearing is not impaired. This is its main difference from otitis media, in which the tympanic cavity is affected.
Erysipelas of the ear
Erysipelas (erysipelas)– a special type of bacterial otitis caused by streptococcal bacteria. Manifestations of erysipelas:
- severe pain, itching in the ear;
- swelling of the skin in the ear area;
- redness of the skin: it has clear contours, often involving the lobe;
- increased skin temperature in the area of inflammation;
- the formation of bubbles on the skin with transparent contents is observed only in isolated cases;
- increase in body temperature to 39 – 40 ⁰C;
- chills, headache, general malaise.
There are periods of improvement, followed by new relapses.
Otomycoses
Otomycoses– inflammatory diseases of the ears caused by fungi, most often belonging to the genus Aspergillus or Candida. Often during external otitis, a combination of fungi and bacteria is detected, for example, Candida and Staphylococcus aureus. Signs of fungal infection of the outer ear:
- All symptoms increase gradually as the fungus grows into the skin and toxins accumulate.
- Itching and pain in the ear. The patient may feel as if there is a foreign body in the outer ear canal.
- Feeling stuffed up.
- Headaches on the affected side.
- Films and crusts on the skin of the auricle are usually formed when infected with fungi of the genus Candida.
- Discharge from the ears varies in color and consistency, depending on the type of fungus.
Perichondritis of the auricle
Perichondritis of the auricle- a type of external otitis that affects perichondrium(the shell of the ear cartilage) and the skin of the ear. Perichondritis is usually caused by an ear injury followed by infection. Symptoms:
- Pain in the ear or in the external auditory canal.
- Swelling of the ear. Spreads throughout the entire earlobe, including the earlobe.
- Accumulation of pus in the ear. During palpation, a cavity with liquid is felt. Usually this symptom occurs after a few days, when the ear tissue melts.
- Increasing pain. Touching the ear becomes very painful.
- Increased body temperature, general malaise.
Diagnosis of external otitis
The diagnosis and treatment of external otitis is carried out by an otolaryngologist (ENT doctor). First, the doctor examines the skin in the ear area, presses in different places, and checks for pain.Studies and tests that a doctor may prescribe if otitis externa is suspected
| Study title | Description of what it detects | How is it carried out? |
| General blood test | A general blood test is a test that is prescribed for most diseases. It helps to identify the presence of inflammation in the body. This is evidenced by an increase in the number of leukocytes and some other indicators. | Blood is drawn from a finger, usually done in the morning. |
| Otoscopy | Examination of the external auditory canal, during which the doctor evaluates its condition, as well as the appearance and condition of the eardrum. Otoscopy helps to identify swelling and other pathological changes in the wall of the ear canal and detect discharge. | Otoscopy is performed using special metal funnels that the doctor inserts into the ear. For ease of inspection, the auricle is usually slightly retracted:
 |
| Hearing test | Helps the doctor evaluate the patient's hearing. With external otitis it should be normal. At otitis media accompanied by defeat tympanic cavity, it is reduced. | The doctor asks the patient to move 5 meters away (to the opposite corner of the office) and cover one ear with his palm. He pronounces phrases in a whisper, the patient must repeat them. Then the function of the second ear is examined in the same way.  |
| Bacteriological examination of ear discharge | Helps identify the causative agent of the disease and prescribe the correct treatment. | Using a cotton swab, the doctor takes a small amount of discharge from the ear and sends it to the laboratory for examination under a microscope and bacteriological examination (culture). The result is usually ready within a few days.  |
Treatment of external otitis
Treatment of boils in the external auditory canal
| Preparation | Description | Directions for use |
| Oxacillin | An antibiotic effective against staphylococcal bacteria - the main causative agents of boils. | Release forms:
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| Ampicillin | Broad-spectrum antibiotic - effective against a large number of pathogens, except for some types of staphylococci. | Release forms:
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| Amoxicillin | Broad-spectrum antibiotic. Effective against many types of bacteria, including those that are resistant to other drugs from this group. | Release forms:
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| Cefazolin | Broad-spectrum antibacterial drug. Effective against most types of pathogenic bacteria, including staphylococci. Has no effect against bacteria and viruses. Usually used for severe ear boils. | Release forms: The drug is available in powder form for dissolution in sterile water and injection in 0.125, 0.25, 0.5, 1.0 and 2.0 g. Directions for use:
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| Cephalexin | An antibiotic that is effective mainly against streptococci and staphylococci. It is used, as a rule, for severe ear boils. | Release forms:
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| Augmentin (Amoxiclav) | A combined drug consisting of two components:
| Release forms:
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| A mixture of boric alcohol (an alcohol solution of boric acid) and glycerin. | Boric alcohol has antibacterial, astringent, anti-inflammatory effects. Glycerol increases the viscosity of the solution and serves to give it the required consistency. | The composition is used as a local anti-inflammatory agent. They impregnate a cotton pad, which is placed in the external auditory canal. Boric alcohol and glycerin are mixed in different proportions. |
Antipyretic and anti-inflammatory drugs:
| These drugs are used to combat elevated body temperature and inflammation. | Prescribed in usual dosages according to indications when body temperature rises above 38⁰C, with severe pain. |
| UV therapy | A physiotherapeutic technique involving the use of ultraviolet radiation. Effects:
| Irradiation is carried out using a special device for 10 – 15 minutes. The course usually consists of 10 – 12 procedures.  |
| UHF therapy | The affected area is affected using ultra-high frequency currents. Effects:
| Electrodes are applied to the area of the pathological focus, with the help of which the effect is carried out. The duration of the procedure is on average 8 – 15 minutes. The course of treatment usually includes from 5 to 15 procedures. A repeat course can be carried out after 2 – 3 months.  |
| Opening a boil | Surgical opening of the boil is performed to clean the abscess and speed up healing. This is usually done on days 4–5, when the abscess has matured. | An ear boil is opened by a surgeon using a scalpel under sterile conditions. A bandage is applied, which must be changed every 3 to 4 hours during the first day. |
Treatment of diffuse external otitis
| Preparation | Description | Directions for use |
| Antibacterial therapy (use of antibiotics) | See “Treatment of a boil in the external auditory canal.” | |
Antipyretic and anti-inflammatory drugs:
| See “Treatment of a boil in the external auditory canal.” | See “Treatment of a boil in the external auditory canal.” |
Antiallergic drugs:
| The mechanism of development of diffuse external otitis always contains an allergic component. The patient’s immune system reacts violently to pathogen toxins and breakdown products that form in the area of inflammation. Antiallergic medications help fight symptoms that occur. | The choice of drug and dosage is made by the attending physician. |
| Rinsing the external auditory canal with furacillin solution. | Furacilin is an antiseptic that destroys pathogens. In addition, a stream of solution flushes out pus and accumulated wax from the ear. The prepared solution of furatsilin is sold in glass bottles. | Carrying out the procedure:
|
| Autohemotherapy | Treating the patient with his own blood. It is performed for severe diffuse external otitis and furunculosis. | 4–10 ml of blood is taken from the patient’s vein using a syringe, which is injected intramuscularly. The procedure is repeated every 48 hours. This helps to enhance defense mechanisms. |
| UHF, microwave | See “Treatment of a boil in the external auditory canal.” | See “Treatment of a boil in the external auditory canal.” |
What drops are prescribed for otitis externa?
| Name of drops | Mechanism of action | Directions for use |
| Anauran | The effect is ensured by three active components included in the drug:
| Anauran instilled into the affected ear using a special pipette. They tilt their head and try to keep it in the external auditory canal for as long as possible. Dosages:
|
| Garazon | The effect is due to the action of two active components included in the drug:
| Directions for use:
|
| Otinum | The active ingredient in this drug is cholim salicylate. It has anti-inflammatory and analgesic effects. | Instill 3–4 drops of the drug into the affected ear 3–4 times a day. Instillation is carried out in a lying position, so that the sore ear is on top. After this, you need to lie on your side for a little longer so that the drug does not leak out and has time to act. |
| Otipax | The drug contains two active ingredients:
| Instill 4 drops of the drug into the sore ear 2 – 3 times a day. The course of treatment can be continued for no more than 10 days. |
| Otofa | Drops contain antibiotic rifampicin, which destroys streptococci and staphylococci. It is highly effective, but in some cases can cause allergic reactions. |
|
| Polydexa | The effect of the drops is due to the active components that are included in their composition:
| Instill 1–5 drops of the drug into the ear affected by otitis media 2 times a day. The course of treatment is continued for 6–10 days, no more. |
| Sofradex | The drug contains three active components that determine its effects:
| Instill 2-3 drops of the drug into the affected ear 3-4 times a day. |
How to properly instill ear drops?
- The ear must first be thoroughly cleaned using cotton swabs.
- The patient is placed on his side so that the affected ear is on top.
- Before use, the bottle with the solution must be heated. To do this, just hold it in a warm hand for a while.
- Instillation is carried out using a pipette (a special pipette may be included with the drops).
- In order for the external auditory canal to straighten and the drops to easily penetrate into it, you need to pull the auricle up and back (in children - down and back).
- After instillation, you need to lie on your side for a little longer so that the drops linger in the ear and take effect.
Treatment of erysipelas of the ear
- The patient must be isolated from healthy people to prevent the spread of infection.
- Antibacterial therapy is carried out, as for ear boils and diffuse external otitis.
- Treatment with antibiotics is supplemented with antiallergic drugs, as with diffuse external otitis.
- Vitamin complexes and adaptogens (aloe extract, ginseng root, Schisandra chinensis, etc.) are prescribed.
- Physiotherapy includes ultraviolet irradiation of the affected area.
Treatment of otomycosis
| Preparation | Description | Directions for use |
| Otomycoses caused by Aspergillus fungi | ||
| Nitrofungin (Nihlofen, Nichlorgin) | The solution is yellow. This medicine is used to treat fungal skin lesions in various areas. | Lubricate the affected areas of the skin with the solution 2 – 3 times a day. Insert a piece of cotton wool soaked in the solution into the external auditory canal. The solution is sold in pharmacies in bottles of 25, 30 and 50 ml. |
| Apply the drug solution to the affected areas twice a day or insert a moistened piece of cotton wool into the external auditory canal. The solution is sold in pharmacies in 10 ml bottles. |
|
| Lamisil (Terbinafine, Terbinox, Termicon, Exifin) | A broad-spectrum antifungal drug – effective against a large number of types of pathogens. Penetrates the skin very quickly and has an effect. | The drug can be used topically in three forms:
|
| Otomycoses caused by Candida fungi | ||
| Clotrimazole (Vikaderm, Antifungol, Candide, Candibene, Clofan, Clomazole) | An antifungal drug that has a broad spectrum of action and is effective against many types of fungi. For local use only. | Clotrimazole is available in the form of ointment, cream, lotion and aerosol. These products are applied in small quantities to the skin 2 – 3 times a day. The duration of treatment is from 1 to 4 weeks. |
| Nizoral (Ketoconazole, Mycozoral, Oronazole) | A drug similar in properties to clotrimazole. | Available in the form of cream and ointment. Apply to the affected area in a small amount 2 times a day. |
| Mycozolon | Combined drug. Compound:
| The drug is an ointment that is applied to the affected area 1 – 2 times a day. |
| Pimafucin (Natamycin) | An antibiotic effective against fungi and other pathogens. | For otitis, it is used in the form of a cream, which is applied 1 - 2 times a day for 10 - 14 days. |
| Otitis externa caused by a combination of fungi and bacteria | ||
| Exoderil (Naftifin, Fetimin) | Effects:
| The drug is available in the form of a cream and solution for external use. Apply to skin once a day. The course of treatment is from 2 to 6 weeks, depending on the type of pathogen and the severity of the disease. |
| Batrafen (Ciclopirox, Dafnegin) | The drug is active against fungi and certain types of bacteria. | Available in the form of solution and cream. The drug is applied to the affected area 2 times a day. The average duration of treatment is 2 weeks. |
| Systemic drugs used for severe forms of mycoses | ||
| Fluconazole (Diflucan, Medoflucan, Diflazon) | A modern antifungal drug that has a pronounced effect against different types of fungi. | Release forms:
|
| Itraconazole (Orungal, Kanazol, Sporanox) | A broad-spectrum drug. Effective against most types of pathogenic fungi. | Release forms:
Adults take 0.1 - 0.2 g of the drug daily. Duration of treatment – 1 – 2 weeks. |
| Ketoconazole | See above | Orally, systemically, the drug is taken in the form of tablets of 0.2 g. Take 1 tablet 1 time per day before meals. Duration of treatment – 2 – 8 weeks. |
| Other drugs | ||
| Boric acid | Available in the form of solutions of 3%, 2%, 1% and 0.5%. To treat otitis externa, a cotton swab soaked in a solution of boric acid is inserted into the ear. |
|
| Silver nitrate (silver nitrate) | It is an antiseptic and disinfectant. | In otolaryngology it is used in the form of a 30% - 50% solution. The product is carefully applied to the affected area by a doctor using a probe, so that silver nitrate does not get on healthy skin. The procedure is performed once every 3 days. |
Treatment of perichondritis of the auricle
- Antibiotic therapy. For perichondritis of the auricle, the same groups of antibacterial drugs are prescribed as for ear furuncle and diffuse external otitis.
- Physiotherapy: ultraviolet irradiation, UHF therapy.
- Opening an abscess. If a cavity with liquid pus is felt under the skin, then surgical treatment is performed: the doctor makes an incision, releases the pus and applies a bandage with an antiseptic or antibiotic. Dressings are done daily until complete healing.
Features of the treatment of external otitis in children
- If signs of illness appear in a child, especially younger ones, you should immediately show him to a doctor. Children have imperfect defense mechanisms. Incorrect treatment or lack thereof can lead to serious complications.
- In general, the same drugs are used in childhood as in adults. But some medications are contraindicated in certain age groups, you need to remember this.
- When instilling drops into a child’s ear, the pinna should be pulled not up and back, as in adults, but down and back.
- Often otitis in children occurs against the background of colds, adenoiditis(inflammation adenoids– palatine tonsils). These conditions also need treatment.
Folk remedies for treating otitis
Turunda with propolis
You need to take a small piece of cotton wool, soak it in propolis and place it in your ear. Walk like this throughout the day. Propolis is an antiseptic and contains biologically active substances that restore protective mechanisms.
Turunda with onion juice
Soak a cotton swab in onion juice. The juice must be freshly squeezed, otherwise it will lose its quality and turn into a breeding ground for pathogens. Onion juice contains phytoncides - powerful natural antiseptics.
Turunda with vegetable oil
Heat some vegetable oil (sunflower or olive) in a water bath. Cool to room temperature. Soak a small piece of cotton wool in the oil and place it in the external ear canal overnight.
Geranium leaf
This herbal remedy will help relieve pain and other unpleasant symptoms. Wash the geranium leaf thoroughly, dry it, then crumple it and place it in the outer ear canal. Do not take a leaf that is too large and place it too deep in the ear.
Drops from chamomile infusion
You can collect and dry chamomile flowers yourself, or you can buy ready-made raw materials at the pharmacy. You need to take a teaspoon of the dried plant and pour a glass of boiling water. Leave for 15 minutes. Strain. Cool. Instill 2–3 drops 3–4 times a day.
To get otitis media, it is not at all necessary that a cold wind “blows through” your ear, as many people mistakenly think. The cause of the disease is always an infection. A sluggish infectious process can worsen - for example, after you are very cold, walk in the cold without a hat, or do not recover from a cold or flu.
According to statistics, complication of the middle ear or otitis media– one of the most common complications after influenza and ARVI. Since the ears and nose communicate, the infection can pass through the nose into the auditory tube, and from there into the middle ear. By localization otitis media is external(inflammation of the skin of the external auditory canal), "average"(inflammation of the tympanic cavity) or "internal"(labyrinthitis, otitis of the inner ear). The most common and dangerous is otitis media.
Middle ear- this is a cavity that is located inside the temporal bone, it has only one entrance - the auditory tube, the other bone opening is covered by the eardrum. When an infection gets into the middle ear, inflammation begins, pus accumulates, which begins to put pressure on the eardrum, causing ear pain. It is the strong, sharp, very often shooting pain that is the most a characteristic symptom of otitis media. Pain in the ear is almost impossible to tolerate, so a sick person immediately runs to the doctor, and advanced cases (as, for example, with sinusitis) are few and far between.
Usually the temperature during otitis is subfebrile - up to 37.4 degrees. But the feeling of stuffiness in the ears with otitis always happens - the ears are blocked, approximately like on an airplane during takeoff and landing. Another characteristic symptom of otitis media is hearing loss. If it happened perforation of the eardrum– discharge from the ear usually appears (serous, bloody, purulent).
What should be the treatment for otitis media?
Otitis in our country is treated only by an ENT doctor, not a therapist. The patient is examined using a special device - otoscope, and based on the patient’s complaints and examination results, a diagnosis is made and treatment is prescribed. Typically this is antibiotics, secretolytics(drugs that dilute the secretions of the tympanic cavity), antibacterial ear drops. Already on the second or third day of treatment it becomes easier, the pain goes away, but ear congestion may persist for another 2-3 weeks. Afterwards is often prescribed physiotherapy, which helps to quickly remove the effects of inflammation.
Evgenia Shakhova
Doctor of Medicine, Professor, doctor of the highest category, chief otorhinolaryngologist of the Health Committee of the Administration of the Volgograd Region
It is important to know the cause of inflammation of the middle ear (maybe: fungal, viral, bacterial infections). Thus, the correct Treatment for otitis media can only be prescribed by a specialist, having made a diagnosis. Warm compresses should not be used without a doctor's prescription, as this can accelerate the development of infection. Also, without consulting and examining a doctor, you should not put any alcohol-containing drops into the ear: if alcohol enters the tympanic cavity through a possible perforation of the eardrum, degeneration of the epithelium of the mucous membrane may occur. And this can subsequently lead to various complications (chronization of the process, formation of cholesteatoma, etc.). Whether there is perforation or not - only a doctor can determine.
Untreated otitis media, which occurs without acute pain, may go in chronic otitis media, and a chronic focus of inflammation, in turn, leads to gradual hearing loss. Otitis media, which occurs as a result of influenza, is especially dangerous. The influenza virus is very toxic and can cause auditory neuritis (cochlear neuritis) or sensorineural hearing loss, which affects the auditory receptors. And these are more serious problems, which, if adequate treatment is not started within 1-2 weeks, can result in partial or complete hearing loss.
Otitis is one of the most common otolaryngological diseases resulting from inflammation of the ear. Late diagnosis and treatment of ear pathology provokes complications. The most serious consequences of otitis occur with the development of inflammatory processes in the middle ear and labyrinth.
The cavities of the inner and middle ear are separated from the environment by the eardrum, which prevents the penetration of pathogenic flora. Infection most often occurs through tuberculosis, i.e. through the eustachian tube, which connects the nasopharynx to the tympanic cavity in the middle ear. Rapidly developing catarrhal processes lead to the destruction of epithelial and bone tissue, which is fraught with complications.
Statistics
Why is otitis media dangerous? When analyzing more than a hundred cases of ear pathology requiring surgical intervention, experts recorded the following frequency of serious complications:
- perforation (perforation) of the eardrum - 47%;
- cholesteatoma (benign neoplasm) - 36%;
- mastoiditis (damage to the mastoid process) - 10%;
- meringitis (degenerative changes in the eardrum) - 7%.
Most often, the consequence of ENT disease is a violation of the integrity of the eardrum. Membrane perforation is one of the simplest and most reversible complications, but only with proper and timely treatment. In the chronic course of the inflammatory process, persistent perforation is observed, which is fraught with the occurrence of conductive hearing loss, i.e. hearing loss.
There are at least 10 more severe complications of otitis media, many of which lead not only to the development of auditory dysfunction, but also to disability or death. That is why, if alarming symptoms are detected, you should seek help from an otolaryngologist.
Cholesteatoma is a cyst-like neoplasm in the ear cavity that occurs with otorrhea, i.e. discharge of hemorrhagic or purulent contents from the ear.
The tumor consists of epithelial cells, which over time begin to secrete a liquid secretion that destroys soft and bone tissue. Destruction of the auditory ossicles, responsible for conducting sound signals, causes hearing loss.
The growth of the tumor leads to damage to the ear labyrinth, as a result of which the semicircular canals, which are responsible for spatial orientation, are damaged. Spontaneous rupture of cystic neoplasms leads to the evacuation of pathogenic exudate, which is fraught with generalization of inflammatory processes. When cholesteatoma ruptures, the following complications of otitis media occur in adults:
- meningitis;
- brain abscess;
- otogenic sepsis;
- facial nerve paresis;
- mastoiditis.
Important! Cholesteatomas are practically not amenable to conservative treatment. If tumors are detected in the ear, surgical intervention is required.
Otogenic sepsis is the generalization of purulent-inflammatory processes in which the lesions are localized in the ear cavity. Pathology occurs as a complication of labyrinthitis, external or purulent otitis media. Due to a decrease in the body's reactivity, aggressive pathogenic flora takes over the immune system, resulting in intensive spread of infection in the blood.
Often, pathogenic flora spreads through the venous sinuses located inside the skull. The sigmoid and petrosal sinuses are connected to the boundaries of the labyrinth and middle ear. In the presence of catarrhal or purulent processes, large veins are damaged, as a result of which phlebitis develops.
The development of phlebitis is fraught with the formation of blood clots in the vessels, which subsequently leads to tissue necrosis and the development of gangrene.
The main symptom of sepsis is hyperthermia, characterized by a sharp increase in temperature. When the thermoregulation mechanism is triggered, severe sweating is observed, which very quickly leads to dehydration. If characteristic signs occur, immediate hospitalization of the patient is required, followed by surgical and drug treatment.
Mastoiditis
Mastoiditis is called inflammation of the antrum and cellular structures that are located behind the auricle (mastoid process). Penetration of infection into the porous bone structure leads to its softening and the development of osteomyelitis. As a rule, the provocateurs of pathological changes in bone tissue are Pseudomonas aeruginosa, anaerobic microbes, mycobacteria and aerobic bacilli.
The development of complications after otitis media in adults is most often indicated by the following clinical manifestations:
- hyperthermia;
- tumor behind the ear;
- shooting pain in the ear;
- hearing loss;
- tinnitus.
A serious illness requires immediate medical intervention. In the early stages of pathology development, therapy is carried out using antibiotics. However, the components of antibacterial drugs are difficult to penetrate into the cavernous structures of the mastoid process. To prevent Bezold's abscess, characterized by the formation of large abscesses under the neck muscles, a sanitizing operation is performed. This allows you to clear the cells of the bone process from purulent foci.
Facial nerve paresis
Among the most dangerous consequences of otitis in adults is paresis of the facial nerve, in which impotence of the facial muscles is observed. The development of neuropathology is characterized by contractures of muscle tissue. This manifests itself in the inability to close the right or left eye, smile or speak clearly.
Untimely therapy can cause muscle atrophy. In this case, even after regeneration of the inflamed nerves, absolute restoration of facial movements is impossible.
Inflammatory processes in the ear cavity lead to damage to the processes of the facial nerve, which are located in the pyramid of the temporal bone, stapes, mastoid process, etc. The destruction of the protective sheath of the nerves provokes severe pain that radiates to the teeth, temple, back of the head, neck and other parts of the body.
When otitis media becomes chronic, it is possible to develop persistent conductive hearing loss, which occurs as a result of a mechanical disruption of the sound-conducting function of the auditory analyzer. 
Tinnitus after otitis media is caused by the inability of the sound signal to pass unhindered through the ear canal, eardrum and auditory ossicles.
Sound barriers most often appear at the level of the eardrum, in which large perforations are formed. This helps to reduce its working area and, accordingly, reduce hearing acuity. Pathologies can also appear at the level of the auditory ossicles. With purulent inflammation, fibrin filaments are formed in the tympanic cavity, which, when hardened, limits the amplitude of vibrations of the auditory ossicles.
Conservative treatment of deafness after otitis media is ineffective. Complete immobilization of the stapes on the eardrum can only be eliminated by performing a stapedectomy.
Surgical intervention prevents further mineralization of the stapes, which leads to the regeneration of elastic tissues and restoration of its sound-conducting function.
Prevention of complications
The first step towards preventing serious complications is an adequate and timely response to the appearance of alarming symptoms. It should be understood that even ARVI and allergies can provoke swelling of the Eustachian tube, which will lead to disruption of its drainage function. As a result, serous effusions will begin to accumulate in the ear cavity, which will lead to the development of ENT disease.
You should not postpone a visit to an otolaryngologist if you have the following symptoms:
- stuffy ears;
- shooting pain in the ear;
- hearing impairment;
- increase in temperature;
- serous or purulent discharge from the ear canal.
If you start a course of treatment on time, local and general manifestations of otitis media can be stopped within a week.
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