With catarrhal inflammation of the mucous membrane of the inner ear, tubootitis develops - a disease in which the ear tissue and hearing are gradually destroyed.
Treatment of tubo-otitis is aimed at quickly suppressing bacteria and reducing inflammatory processes inside the ear.
Tubootitis - what is it?
Inflammation has another name - eustachitis.
Tubootite and eustachite are considered synonymous, but in fact this is not the case. With eustachitis, the Eustachian tube and tympanic cavities become inflamed, and with tubootitis, the lining of the inner (middle) ear becomes inflamed.
All processes are interconnected - the disease begins with otitis, then progresses to eustachitis, and then to tubootitis. The signs of ear diseases are similar.
With inflammation of the middle ear, disruption of the functioning of the Eustachian tube is inevitable - with swelling of the mucous walls, the tube narrows, the eardrums no longer receive air, as a result, the pressure inside the middle ear decreases.
The narrowing of the lumen gives impetus to the development of the inflammatory process, the accumulation of excess fluid and deformation of the membranes. Liquid (pus or mucus) does not always seep out, and this becomes the main cause of hearing damage or the appearance of hearing loss.
Ear structure
The ear consists of the pinna, ear canal, eardrums, auditory ossicles, and nerve cells that transmit sound signals to the brain. Any external sound is first “felt” by the eardrum, then amplified by the auditory ossicles, and only then receives a “nervous” signal.
The nasopharynx and auditory tube connect to the middle ear, which is located just behind the eardrum. The auditory tube ensures uniform pressure in the mouth and nose, creating an atmosphere for the full functioning of the auricle.
Types of tubootitis
Tubo-otitis can be right-sided or left-sided and can develop in acute or chronic form. The acute form lasts from 15 to 30 days, the chronic form can last up to six months or longer.
With bacterial inflammation, staphylococcus, pneumococcus or streptococcus bacteria enter the auditory tube through the mouth or nose (most often through the nose). Children are often diagnosed with bilateral tubo-otitis. It always occurs in an acute form and is very difficult to treat. In adulthood, bilateral tubo-otitis is rare.
The acute infectious form occurs in the autumn-winter period, when the immune system is greatly weakened and is more susceptible to virus attack than usual. Tubootitis is diagnosed with adenovirus infection, influenza, pharyngitis, sore throat, sinusitis, rhinitis and other viral diseases.
The inflammatory process can begin due to a severe bruise or injury to the nasal septum, as well as after a complex operation (during the healing process, blood can enter the ear canal and provoke inflammation).
The main factors influencing the occurrence of tubootitis:
- Predisposition to allergies;
- fungal infections, tuberculosis bacillus;
- neoplasms on the mucous membranes of the nose (polyps);
- inflamed adenoids;
- proliferation of the nasal mucosa;
- vasomotor rhinitis (its consequences).
Untimely or improper treatment of tubo-otitis can provoke hearing loss, inflammation of the mastoid process of the temporal bone, purulent or adhesive otitis, adhesions, and in advanced cases leads to complete hearing loss.
Symptoms of tubootitis
The ear is filled with cotton wool, and a noise is periodically heard that vaguely resembles the sound when you press a shell to your ear. All sounds and voices become muffled, but one’s own voice can be clearly heard when speaking.
It seems that water has accumulated inside the auricle; when the head is tilted, the liquid “rolls” from side to side. The longer the inflammatory process goes on, the worse the person’s well-being: the head hurts and throbs, causeless weakness appears, attacks of nausea torment, and interest in food is lost.
Features: Swallowing or yawning may improve the perception of sounds for a short period.
In the acute form, the symptoms are the same, painful shooting in the ear is possible, and body temperature may rise. But most often the temperature remains normal.
In the chronic form, the symptoms are the same. If chronic tubo-otitis lasts more than one year, tissue necrosis may develop, and purulent fluid will leak into the brain.
Treatment of tubootitis
To make a diagnosis, you will need the help of an otolaryngologist. When examining the external auditory canal, deformation (retraction) of the eardrum is often detected.
For examination, they take serous fluid (if it is discharged from the ear), do an additional rhinoscopy - examine the nasopharynx. Blood and urine tests are also required.
If necessary, blowing is prescribed - a special bulb is inserted into the nostril and a stream of air is released to the eardrums. The ear canal expands and excess fluid comes to the surface. This procedure is performed on pregnant women.
Treatment of tubo-otitis is carried out with antibiotics Azithromycin, Amoxiclav, or using antibacterial drops Normax, Tsipromed, Otofa.
Drops for tubootitis can be antifungal or antiviral: “Polydex”, “Isofra”, “Cefazolin”, “Garazon”, “Sofradex”, “Avamys” (treats allergic rhinitis), “Otipax” (against pain and inflammation), “Anauran” " "Nasivin" and "Otrivin" have a vasoconstrictor effect.
“Remo-vax” helps with sulfur plugs, and “Aquamaris” is recommended for cleansing the nasal sinuses. Ultraviolet irradiation in a hospital reduces inflammatory processes. In some cases, tubo-otitis is treated with intramuscular injections of Netilmicin.
Treatment of tubootitis with folk remedies
Boric alcohol quickly destroys bacteria and suppresses inflammation in the ear. Inject 2-3 drops of boric liquid into the ear (use a pipette for convenience).
Before using the product, warm the bottle in your palm. You need to bury the ear 2-3 times during the day. To prevent boric alcohol from leaking out, do the procedure while lying on your side and do not get up from the couch for 5-7 minutes.
Camphor oil and alcohol compresses have a similar property. But be careful - if used incorrectly, you can burn the membrane. Be sure to consult your doctor before using traditional methods of treatment.
An onion baked in the oven and the juice squeezed out of it can be used instead of drops, but with caution - the tissues of the auricle are very delicate and can easily cause irritation. The same applies to garlic oil.
The best remedy is propolis mixed with vegetable oil. Mix propolis tincture with vegetable oil (1 to 4) and soak a cotton pad with the solution.
The cotton wool is kept in the sore ear for at least 9 hours for a week (it is better to do it at night). Shake the jar of solution before each use.
Do not use badger or hare fat for treatment - it will clog the ear canals.
Find out about the symptoms and treatment of sinusitis in our new article
You can find out more about treating otitis media at home here
Classmates
Tubootitis (syn. eustachitis) is an inflammatory lesion of the mucous membrane and cavity of the middle ear, which appears due to a malfunction of the auditory tube.
The function of the auditory tube and the mechanism of development of pathology
The auditory tube is an anatomical structure that connects the nasal cavity and the middle ear. Its key task is to equalize the pressure in the middle ear and nasal cavity, thereby creating equal pressure on both sides of the eardrum.
Normally, the opening of the auditory tube opens and closes with the contraction of adjacent muscles, and the pressure spontaneously equalizes. The opening of the mouth occurs reflexively during the processes of chewing, swallowing, and yawning. This mechanism is used for artificial ventilation of the tympanic cavity during rapid changes in pressure (for example, when climbing mountains, scuba diving, etc.).
The structure of the auditory tube in a child and an adult
If the ventilation function is disrupted, the air in the tympanic cavity is absorbed by its mucous membrane, and a new portion of air does not enter. The pressure in the tympanic cavity begins to drop, and the membrane retracts, which is manifested by deterioration of hearing and other characteristic signs.
Causes of the disease
The main pathological conditions that can cause acute or chronic tubular dysfunction are:
- diseases of the respiratory tract, accompanied by a runny nose and swelling of the nose (flu, colds, etc.);
- chronic and acute diseases of the nose and paranasal sinuses (sinusitis, adenoiditis, chronic rhinitis, polypous degeneration of the mucous membrane, etc.);
- anatomical nuances in the structure of the nasal cavity (curved nasal septum, enlargement and shape of the nasal turbinates, etc.);
- tumor processes in the nasopharynx.
Separate forms of bilateral tubootitis are aerootitis (occurs due to pressure changes during takeoff and descent of an aircraft) and mareotitis (during the diving and ascent of scuba divers).
Tubootitis often develops against the background of acute respiratory viral infections
Symptoms
The acute form is characterized by the following symptoms:
- congestion and noise in the ear;
- slight hearing loss;
- feeling of pressure in the ear and fluid transfusion when tilting the head;
- autophony (feeling your voice in your head);
- pain in the ear is weak or completely absent.
Important! A feature of the disease is improved hearing and temporary disappearance of symptoms after yawning or swallowing saliva, which is associated with the opening of the lumen of the auditory tube.
Chronic tubo-otitis develops with long-term and persistent disruption of the auditory tube. In this case, irreversible changes occur in the mucous membrane of the tympanic cavity, and the auditory tube undergoes stenosis in certain areas or throughout its entire length. The chronic form is manifested by progressive and persistent hearing loss.
Diagnostic criteria
When making a diagnosis, the patient’s complaints and features of the otoscopic picture (retracted eardrum with vascular injection, etc.) are taken into account. Check the level and type of hearing loss using an audiogram.
To study the ventilation function of the auditory tube, a number of studies have been developed that evaluate its degree of patency on a five-point scale (empty throat test, Valsalva experience, etc.).
For symptoms of tubo-otitis, consultation with an ENT doctor is required.
Approaches to treating the disease
Treatment of tubo-otitis is aimed at eliminating the pathological condition that led to dysfunction of the auditory tube.
To eliminate swelling in the area of the outlet of the tube, vasoconstrictor nasal sprays (Otrivin, Nafazolin, etc.) are used. Taking antihistamines (Loratadine, Zyrtec, etc.) helps eliminate swelling in this area.
Medicines are administered into the auditory tube using a catheter.
The essence of the procedure: after preliminary anesthesia and anemization of the nose, the ENT doctor brings a special instrument to the mouth of the auditory tube, which is located in the nasopharynx. Through a catheter, vasoconstrictors, hormonal and antihistamines are administered directly into the auditory tube.
Self-blowing, pneumomassage of the eardrum, blowing with a Politzer balloon are prescribed after the disappearance of acute symptoms in the nasopharynx.
Physiotherapy is widely used in the complex therapy of tubootitis: ultraviolet irradiation, laser and magnetic therapy, UHF in the nose and others. Antibiotics are prescribed if the progression of the process and the development of purulent otitis media are suspected.
Important! The patient may be recommended to dissolve lozenges, inflate balloons and soap bubbles for regular training of the auditory tubes.
Patients with a high risk of developing certain types of tubo-otitis (divers, scuba divers, submariners, etc.) are taught methods of self-blowing of the auditory tubes.
With adequate treatment, the disease goes away within a few days. If left untreated, it can develop into purulent otitis media or a chronic form.
Tubootitis is an inflammatory phenomenon that forms in the Eustachian canals and tympanic septa. The disease is accompanied by a narrowing of the passage of the tympanopharyngeal tube and deterioration of air patency. In this case, inflammation can spread to the area between the outer and inner ear and cause otitis media. The pathological process in the middle ear and auditory canal is also called salpingo-otitis; eustachitis is considered its beginning. Treatment is aimed at eliminating the symptoms of the disease, suppressing the infection and involves a combined approach.
Reasons
The auditory tube is a conductor between the upper part of the pharynx and the middle ear. When the upper respiratory organs become infected, pathogenic microbes can easily penetrate the ear canal and then invade the tympanic septum. This is how the inflammatory process develops.
The most common causes of tubo-otitis are:
- chronic and acute diseases of the upper ENT organs - sore throat, runny nose, pharyngitis caused by pneumococcus, staphylococcus and other microorganisms;
- swelling of mucous surfaces resulting from allergies;
- overlap of the nasopharynx area with various defects, adenoids and polyps;
- neoplasms in the upper part of the respiratory tract;
- deformation or curvature of the septum in the nose;
- occasionally, pathology in adults can occur as a result of using tampons to stop nosebleeds;
- during dental procedures that cause excessive salivation;
- sharp fluctuations in atmospheric pressure.
In childhood, the likelihood of developing tubo-otitis is higher than in adults, since the auditory canals in children are shorter.
Classification
Symptoms and treatment of tubo-otitis depend on the type of disease. Depending on the form of the pathology, it can be chronic or acute.
Acute stage
Acute tubo-otitis is a pathological process accompanied by the echo of one’s voice in the head - autophony. However, pain symptoms are not always present. During an exacerbation of the disease, the patient's condition is stable, the temperature is within normal limits, and with yawning or swallowing, hearing abilities can be restored for a short time.
The acute form is accompanied by the following symptoms:
- stuffy ears;
- deterioration in the ability to distinguish sounds;
- sensation of noise;
- When you move your head, you may hear shimmering liquid.
Pathology can occur on one or both sides. Acute bilateral tubo-otitis is an inflammatory process that develops in two ears simultaneously.
Timely treatment can relieve symptoms within a few days. If it is not possible to restore the patency of the tube in time, stagnation of fluid in the ear cavity may occur, which often causes the growth of bacteria. In this case, there is a possibility that the disease will acquire a purulent form that is difficult to treat. This is how the pathology becomes chronic.
Chronic form
Most often, the chronic form of the pathology is accompanied by:
- hearing impairment;
- redness of mucous surfaces;
- narrowing of the lumen of the Eustachian tubes;
- displacement of the tympanic septum.
On the side of the membrane separating the outer and middle ear, a protrusion of the membrane is often observed. Most often, symptoms of the chronic stage occur on an ongoing basis, with relapse alternating with remission.
Depending on the side of the lesion, the disease is divided into left-sided tubo-otitis, with inflammation affecting the left ear, and right-side tubo-otitis - the spread of inflammation in the right ear.
Diagnostics
An otolaryngologist can make a diagnosis based on a visual examination, as well as based on the patient’s complaints.. In addition, the ENT doctor prescribes:
- audiometry – a procedure that will detect deterioration in hearing abilities;
- tympanometry. This diagnostic method will reveal displacement of the tympanic septum.
The chronic form of the disease during exacerbation is accompanied by the same clinical picture as the acute one. During remission, a chronic process can only be detected visually. During diagnosis, the following symptoms are revealed:
- deformation of the tympanic septum, its retraction;
- redness of the mucous surfaces of the Eustachian canal or its individual sections;
- swelling of the tissues of the auditory process;
- narrowing of the lumen.
To determine the type of pathogen, swabs from the ear canal are prescribed. If there is a suspicion of an allergic type of disease, the patient undergoes allergy tests.
The presence of a chronic stage may be indicated by a decrease in the perception of sounds on an ongoing basis.
Treatment
Products for internal use, available in the form of tablets, suspensions and capsules, will help suppress the proliferation of pathogenic microorganisms. In severe forms of the disease, intravenous administration of drugs is used.
Treatment of tubo-otitis in adults involves an integrated approach:
- elimination of infection in the upper respiratory organs;
- reduction of symptoms of inflammation and swelling;
- improved ventilation of the auditory tube;
- restoration of the immune system.
Most often, the disease is treated at home, under the supervision of a doctor. A mild stage of the disease can be cured on your own, without the use of medications: usually the immune system itself copes with the infection. However, some cases require relief of acute symptoms. Analgesics are used for these purposes:
- To relieve swelling, antihistamines are prescribed - Suprastin, Cetrin. An allergic type of disease can be treated with antiallergic drugs, desensitizing drugs, the action of which is aimed at reducing sensitivity to allergens;
- To relieve the symptoms of inflammation, non-steroidal drugs are used - Paracetamol, Ibuprofen, Aspirin;
- to narrow blood vessels, drops are prescribed into the nasal cavity - Sanorin, Otrivin, Tizin;
- to pump out the fluid, glucocorticoids are injected into the area of the eardrum - Adrenaline, Hydrocortisone;
- For an infection caused by a fungus, antifungal medications are used.
Antibacterial agents are used in the absence of positive dynamics, and also if the disease becomes severe.
To treat bilateral tubo-otitis in adults caused by bacteria, antibiotics - sulfonamides - are used. If the disease is viral, Amoxicillin is prescribed. If necessary, it can be replaced with Amoxiclav or Azithromycin.
To restore ventilation of the passages, improve well-being and consolidate remission, a specialist additionally recommends physiotherapy, including:
- blowing, rinsing, irrigating the ear cavity with medications. In this way, excess fluid is removed from the ear and pipe;
- pneumomassage – alternating pressure on the tympanic septum;
- electromyostimulation. The procedure will help restore the muscle tone of the pipe walls;
- magnetic therapy;
- laser therapy and pulsed currents.
To restore the immune system in chronic forms of the disease, immunostimulants and vitamin complexes are used. As auxiliary measures, the patient is recommended to independently carry out home procedures:
- periodic pressure on the cartilage processes in the auricle;
- inhaling oxygen through closed nostrils. This promotes the opening of the auditory tube;
- frequent yawning.
Correctly prescribed treatment usually leads to relief of tubo-otitis symptoms within 3-6 days. If patency is impaired due to a tumor, surgical intervention is used.
Folk remedies
The disease should be treated using alternative medicine after consultation with a specialist.
Herbal medicine
Typically, herbs that have anti-inflammatory and decongestant properties are used in the treatment of pathology:
- eucalyptus;
- birch leaves;
- aloe;
- mint;
- celandine;
- blueberries;
- lavender;
- coriander and others;
With the help of decoctions, the nasal cavity and ear and throat are washed, as well as tampons soaked in herbal decoctions or pulp juices are placed.
Onion
An excellent folk remedy with a disinfecting effect. Onions are used in the following form:
- in the form of juice, which must be instilled into each passage, 4 drops;
- tampons are soaked in onion juice and inserted into the ear cavity;
- Another method can also help: a small piece of onion is slightly heated and placed in the ear canal. At the same time, onion juice is dripped into the nose. Treatment is carried out for 14 days;
- The following method successfully eliminates inflammation in the Eustachian tube. The core is removed from the onion and removed from the husk. Pour 5 g of cumin into the resulting glass, place it in a hot oven and keep it until the onion becomes soft. After this, juice is squeezed out of the onion and instilled into the passages, 1 drop per day.
Collection of herbs
The following collection will help relieve internal inflammatory processes. To prepare, you will need to mix in equal proportions:
- chamomile flowers;
- hop cones;
- angelica;
- nettle;
- mint;
- lingonberries.
The components are crushed. For 2 tablespoons of the mixture you will need a glass of boiling water. Infuse the mixture for 12 hours. Take 100 g orally three times a day on an empty stomach. Besides, in this infusion, moisten a tampon and place it in the ear cavity closer to the tympanic septum. The duration of treatment is until complete recovery.
Garlic drops
Ear drops made from garlic, sunflower oil and glycerin showed excellent results.. The head of garlic is ground through a meat grinder, mixed with 1/2 cup of oil, strained, left for 10-12 days and 2-3 drops of pure glycerin are added to the solution. Before instillation, the resulting mixture is warmed to room temperature.
Boric alcohol
Treatment with boric alcohol is carried out after consultation with the attending physician. Most often, this method is used if there are no defects in the tympanic septum..
Alcohol is instilled a few drops into both ear cavities or used in the form of tampons soaked in the solution.
This product has antibacterial and warming properties, and is quite effective even in childhood. However, you should be careful: boric alcohol can cause burns.
chicken egg
An ancient folk method used to relieve inflammation in the ear and relieve pain symptoms. A chicken egg is boiled soft-boiled. Place 3-4 drops of warm yolk into the affected ear, then cover it with cotton wool and go to bed. The next morning, cotton wool soaked in the following solution is inserted into the passage:
- onion juice;
- golden mustache juice;
- butter.
The components are combined in the same ratio. After 4 hours, the tampon is removed. On the same day, mummy tincture is dripped into the passage. To do this, 1 tablet must be combined with 20 ml of vodka.
Surgery
If the disease is caused by abnormalities of the nasopharynx, surgical treatment is performed, for example, removal of adenoids, polyps, and straightening of the nasal septum.
In addition, the use of surgery will become advisable if the disease progresses and there is no positive dynamics after prescribed therapy.
To do this, special catheters are inserted into the ear cavity through a small incision to facilitate the flow of fluid.
Complications
As a rule, the acute stage of the disease is sluggish. Most often, this form is not accompanied by acute pain. That is why the patient does not consider it necessary to go to the hospital. Thus, the pathology becomes chronic.
Failure to visit a specialist in a timely manner often leads to:
- to deterioration of the function of the tympanic septum;
- to narrowing of the ear lumens;
- to scarring of the passage.
All this can negatively affect hearing abilities and cause irreversible deafness.
Another unpleasant consequence is suppurative otitis media, which often leads to brain infection and sepsis.
Prevention
If symptoms of an inflammatory process occur inside the ear cavity, the patient should not perform any actions associated with a sudden fluctuation in pressure, for example, diving to depths and flying by plane.
The following measures will help prevent the occurrence of tubo-otitis:
- timely visit to an otolaryngologist if ear congestion occurs;
- mandatory therapy for nasopharyngeal infections;
- strengthening the immune system, hardening;
- avoiding various injuries to the head, nose and ears;
- eliminating bad habits.
In addition, you need to learn how to blow your nose correctly. To do this, the patient should open his mouth and blow mucus out of each nostril alternately.
Most often, the prognosis of the disease is favorable. A timely visit to a doctor in the early stages of the inflammatory process will help you recover completely..
Tubootitisis a catarrhal inflammation of the mucous membrane of the middle ear, which developed as a result of dysfunction of the auditory tube.
To designate this pathology, in addition to the above, the following terms are used: acute or chronic catarrhal otitis media, salpingootitis, tubotympanitis etc. There is usually no free effusion in the tympanic cavity with this disease; the main role is played by the pathological process in the auditory tube, leading to disruption of its functions, with moderate inflammation in the tympanic cavity.
The cause of acute tubo-otitis is often a more or less severe dysfunction of the auditory tube, leading to impaired ventilation of the tympanic cavity. The patency of the pharyngeal mouth of the tube may be impaired when infection spreads from the upper respiratory tract to the mucous membrane of the auditory tube. Infection of the auditory tube occurs during acute respiratory diseases, influenza, and in children, in addition, during acute infectious diseases accompanied by catarrh of the upper respiratory tract. Anterior and posterior tamponade (during nosebleeds or after surgery) can also cause eustacheitis. The etiological factors are viruses, streptococci, staphylococci, etc.
Longer-acting causes of dysfunction of the auditory tube, leading to the development of chronic tubo-otitis, are adenoid vegetations, various chronic diseases of the nasal cavity and paranasal sinuses (chronic purulent or polypous rhinosinusitis, especially choanal polyp), curvature of the nasal septum, hypertrophy of the posterior ends of the inferior nasal turbinates, nasopharyngeal tumors.
The cause of peculiar forms of tubo-otitis can be sharp changes in atmospheric pressure during the ascent and descent of an aircraft (aerootite), and during the diving and ascent of divers and submariners (mareotite). An increase in pressure from the outside is less tolerated, since it is more difficult for air to penetrate into the tympanic cavity through the compressed auditory tube.
Impaired ventilation of the tympanic cavity, even partial, leads to the fact that the air contained in it is absorbed by the mucous membrane, and replenishment is difficult due to compression of the mouth of the tube. As a result, the pressure in the tympanic cavity decreases the more, the more the auditory tube is compressed, a vacuum develops in it. In this case, the eardrum is retracted, and a transudate may appear in the tympanic cavity, containing up to 3% protein and, less commonly, fibrin. Then inflammatory cells - neutrophils and lymphocytes - may appear, which is already a sign of the exudative stage of inflammation. There is no free exudate forming a fluid level in the tympanic cavity during this period. The noted changes allow us to consider acute tubo-otitis as inflammation of the middle ear with a predominance of pathology in the auditory tube.
Clinical picture. The main complaints with tubo-otitis are a feeling of ear congestion, decreased hearing, sometimes noise in the ear, autophony (the resonance of one's own voice in the affected ear). Often these complaints appear during an acute respiratory infection or during the period of convalescence after it. Ear congestion may occur during or after a change in atmospheric pressure, such as when flying on an airplane. The pain and sensation of pressure in the ear can be severe and appear immediately when there is a pressure drop, or they are mild and the general condition suffers little.
During otoscopy, retraction of the tympanic membrane is noted, as evidenced by the apparent shortening of the handle of the malleus, a sharp protrusion towards the auditory canal of the short process, the anterior and posterior folds, while the light cone disappears or is deformed. Sometimes a radial injection of the vessels of the tympanic membrane along the handle of the malleus or a circular one in the area is determined appi1ustympanicus(Fig. 5.34). Hearing in acute tubo-otitis is moderately reduced - up to 20-30 dB, according to the type of sound conduction disturbance, mainly at low frequencies. Sometimes patients note improved hearing after yawning or swallowing saliva, accompanied by the opening of the lumen of the auditory tube.
Rice. 5.34. Otoscopic picture in acute tubo-otitis
Diagnosis acute tubo-otitis does not cause difficulties in the presence of the noted signs of the disease.
Treatment The disease should be aimed primarily at eliminating unfavorable factors affecting the condition of the pharyngeal mouth of the auditory tube. In order to reduce swelling of the mucous membrane in this area, the patient is prescribed vasoconstrictor nasal drops: naphthyzin, sanorin, tizin, nazivin, etc. Antihistamines (suprastin, gismanal, claritin, etc.) help reduce swelling of the mucous membrane. To prevent the reflux of infected mucus from the nasopharynx through the auditory tube into the tympanic cavity, the patient should be warned against blowing his nose too vigorously. The nose should be cleaned one by one, each half of the nose without straining too much. For the same purpose, it is not recommended to blow the auditory tubes according to Politzer. A good therapeutic effect is achieved by catheterization (blowing) of the auditory tube, performed after thorough anemization of its pharyngeal mouth. Through a catheter, a few drops of 0.1% adrenaline solution or hydrocortisone suspension can be injected into the lumen of the auditory tube. The complex of therapeutic measures includes various physiotherapeutic procedures: UV irradiation, UHF
nose, laser therapy at the mouth of the auditory tube, pneumomassage of the eardrum.
Acute tubo-otitis with adequate treatment usually resolves within a few days. The effectiveness of treatment of chronic tubo-otitis depends on the timely elimination of pathology of the nasal cavity, paranasal sinuses and nasopharynx, which contribute to the occurrence and maintain the course of tubo-otitis.
Exudative otitis media
Exudative otitis media is a persistent serous inflammation of the mucous membrane of the auditory tube and tympanic cavity. This disease develops against the background of dysfunction of the auditory tube (eustacheitis), and is characterized by the presence of serous-mucosal effusion in the tympanic cavity.
There are different designations for the disease: “secretory otitis media”, “serous otitis media”, “mucosal otitis media” etc. The leading pathogenetic factor of exudative otitis media is a persistent violation of the ventilation function of the auditory tube. The very name of this form of otitis indicates increased secretion of mucus and a protracted course. Its characteristic signs are the appearance of a thick viscous secretion in the tympanic cavity, slowly increasing hearing loss and the long-term absence of a defect in the eardrum.
The basis of the disease, along with persistent tuberculous dysfunction, is a violation of general and local resistance. The cause may be a previous respiratory viral infection and irrational use of antibiotics, which do not eliminate the middle ear infection, but themselves can create favorable conditions for the proliferation of pathogens resistant to them. Immunopathological reactions are important, which indicate the development of sensitization of the mucous membrane of the middle ear.
Clinical picture. Taking into account the dynamics of the inflammatory process and the corresponding pathomorphological changes, four stages of exudative otitis media are distinguished.
Stage I is eustacheitis (catarrhal stage) (see above), in which catarrhal inflammation of the mucous membrane of the auditory tube occurs, the ventilation function is disrupted, and the flow of air into the middle ear decreases or stops. Suction
air in the mucous membrane leads to an increase in vacuum in the tympanic cavity, which causes the appearance of transudate, migration of a small number of neutrophilic leukocytes and lymphocytes, and irritation of the mucous glands. Clinically, this reveals a retraction of the tympanic membrane with injection of blood vessels along the handle of the malleus, a change in its color from cloudy to pink. Initially, mild autophony and slight hearing loss are observed (airborne sound conduction thresholds do not exceed 20 dB, bone conduction thresholds in the speech zone remain normal). The duration of the catarrhal stage can be up to 1 month.
Stage II- secretory - characterized by the predominance of secretion and accumulation of mucus in the tympanic cavity. Metaplasia of the mucous membrane of the middle ear is observed with an increase in the number of secretory glands and goblet cells. Subjectively, this is manifested by a feeling of fullness and pressure in the ear, sometimes noise in the ear and more pronounced conductive hearing loss (up to 20-30 dB). There is often a sensation of fluid transfusion (splashing) when the position of the head changes and hearing improves at this time. This can be explained by the fact that when tilted, the liquid in the tympanic cavity moves, which frees up at least one niche of the labyrinth window, which improves sound transmission and hearing. During otoscopy, the eardrum is retracted, its contours are sharp, the color depends on the contents of the tympanic cavity (pale gray, bluish, with a brownish tint). Sometimes the fluid level (meniscus) is visible through the membrane in the form of a slightly curved line that moves when the position of the head changes. The duration of the secretory stage can range from 1 to 12 months.
Stage III- mucosal - differs in that the contents of the tympanic cavity (and sometimes other cavities of the middle ear) become thick and viscous. At the same time, hearing loss increases (with thresholds up to 30-50 dB), and bone sound conduction thresholds usually increase. In cases where the entire tympanic cavity is filled with exudate or when the latter becomes viscous and thick, there is no symptom of fluid movement. In some cases, the contents released through the perforation are so thick and sticky that after touching it with a cotton swab on the probe, it stretches in the form of a thin thread for several tens of centimeters. To designate such otitis media with sticky, viscous contents in the tympanic cavity, some authors use the term “sticky ear.” The light reflex can
absent, and the tympanic membrane thickens and may be cyanotic, and bulges in the lower quadrants. The mucous stage develops over a period of 12 to 24 months.
IV stage- fibrous - characterized by the predominance of degenerative processes in the mucous membrane of the tympanic cavity. In this case, mucus production decreases and then stops completely, and fibrous transformation of the mucous membrane occurs, involving the auditory ossicles in the process. Mixed hearing loss progresses. The development of a scar process in the tympanic cavity leads to the formation adhesive otitis media.
It should be noted that in some cases there is a resorptive course of the disease with cessation of development at any stage, but a relapse of exudative otitis media in a patient with already formed adhesive otitis is also possible.
Diagnostics Treatment of exudative otitis media in some cases is difficult and is not always timely. This is often associated with an asymptomatic course of the disease, the absence of any pronounced pain and a disturbance in the general condition of the patient. The patient gets used to a slight decrease in hearing in one ear, which gradually increases. It must be taken into account that the asymptomatic course of exudative otitis media is now becoming more common.
Visual otoscopy (preferably with magnification) does not always reflect the true picture of the condition of the middle ear. To clarify the diagnosis, a study of the function of the auditory tube is performed using publicly available tests; the most informative diagnostic study is impedance measurement (tympanometry), which reveals a flattened curve (Fig. 5.35). Speech hearing testing, as well as using tuning forks and audiometry, completes the picture of the disease.
Persistent exudative otitis media may be accompanied by sluggish mastoiditis, so radiography of the temporal bones is recommended. Considering that an important factor supporting the disease is tubular dysfunction, a detailed examination of the nose and pharynx is performed.
Treatment exudative otitis media should be complex, its effectiveness is higher, the earlier it is started. First of all, one should strive to restore the function of the auditory tube. This is achieved by sanitizing diseases of the nose, paranasal
Rice. 5.35. Tympanometry for exudative otitis media
sinuses, pharynx. To improve tubular function, the ears are blown using the Politzer method or through an ear catheter (which is more effective) with simultaneous massage of the eardrum using a Siegle funnel.
Depending on the stage of the disease, hydrocortisone, antibiotics, dioxidine, trypsin, and chymotrypsin are injected into the lumen of the auditory tube through a catheter. The introduction of proteolytic enzymes and lidase through endaural electrophoresis is quite effective. Vasoconstrictor drugs are used in the nose in the form of drops, but their long-term use (more than 2 weeks) is unacceptable, since these substances reduce the mucociliary activity of the ciliated epithelium of the nasal cavity and auditory tube and disrupt the vasomotor function of the nasal mucosa.
The prescription of antihistamines is recommended in cases where serous otitis media develops against the background of allergies. General strengthening agents and vitamins are also indicated; immunocorrectors have recently increasingly been included in the complex of therapeutic measures (for example, polyoxidonium 0.006 g intramuscularly every other day - a total of 6-10 injections).
In cases where the function of the auditory tube is not sufficiently restored within 1-2 weeks, the exudate does not resolve and
hearing does not improve, needs to be used surgical methods to evacuate secretions from the tympanic cavity. Most widely shunting of the tympanic cavity is used(Fig. 5.36). For this purpose, paracentesis of the tympanic membrane is performed in its posteroinferior quadrant and a shunt made of bioinert material - Teflon, silicone, polyethylene, ceramics - is inserted through the incision. There are many forms of shunts: a drainage tube with holes, a coil, a tube with a semi-permeable membrane, etc. Through the shunt, medicinal substances are injected into the tympanic cavity and the contents are aspirated from it. Typically, drainage is left until recovery occurs with improvement in tubular function - from several weeks to 1-2 years. A shunt inserted through an incision in the eardrum often falls out spontaneously, so it sometimes has to be reinserted.
Rice. 5.36. Shunting of the tympanic cavity
In some cases, a shunting technique is used through a subcutaneous tunnel formed in the area of the posterior inferior wall of the ear canal - percutaneous (meatotympanic) shunting of the tympanic cavity. Intrameatal tympanotomy with bypass of the tympanic cavity is performed with a thin silicone drainage tube that passes under appi1us 1utratesiz, without damaging the eardrum. At the entrance to the ear canal, the tube is fixed to the skin with a silk suture. Through this drainage tube
Rice. 5.37. Meatotympanic shunting of the tympanic cavity
Secretions from the tympanic cavity are aspirated, and various medications are administered (Fig. 5.37).
In a number of patients, drainage of the tympanic cavity does not lead to recovery. This may be due to the fact that exudative inflammation is not limited only to the tympanic cavity, but extends to the antrum and cells of the mastoid process, and sometimes becomes delimited as a result of the development of a block of the entrance to the mastoid cave. In this case it is done anthrotomy and, if necessary, mastoidotomy with elimination and drainage of affected areas of the mastoid process. The sound conduction system is reviewed and tympanoplasty is performed according to indications.
Acute purulent otitis media
Acute purulent otitis media (otitis media purulenta acuta) is an acute purulent inflammation of the mucous membrane of the tympanic cavity, in which all parts of the middle ear are involved to one degree or another in catarrhal inflammation.
This is a fairly widespread disease of the middle ear, which can either be mild or develop rapidly.
cause a severe general inflammatory response in the body. However, in both cases, it often leaves behind an adhesive process, accompanied by difficult-to-treat hearing loss, or becomes chronic, often progressive, also leading to hearing loss and often severe complications. Acute purulent otitis media is especially common in children under 3 years of age. A distinctive feature of this disease at present is a less acute onset and sluggish course, and in childhood - a tendency to relapse.
Etiology. The cause of the disease is a combination of factors such as a decrease in local and general resistance and infection in the tympanic cavity. Through the auditory tube, microflora often enters the tympanic cavity, saprophytizing in the pharynx, but this does not cause inflammation if local and general reactivity is normal. If the influx of microflora was massive or it was highly virulent even in small quantities, acute otitis media occurs, as well as in the case of a small influx of saprophytic microflora with reduced reactivity. The main causative agents of acute otitis media (up to 80%) in adults and children are S. pneumoniae And H. influenzae somewhat less frequently M. catarrhalis, S. pyogenes, S. aureus or associations of microorganisms. Viral otitis is more often observed during epidemics of viral diseases.
The most common route of infection is tubogenic- through the auditory tube. Usually there is no microbial flora in the cavities of the middle ear, which is explained by the barrier function of the mucous membrane of the auditory tube. Here mucus is produced, which has an antimicrobial effect, and the villi of the ciliated epithelium constantly move the mucous secretion towards the nasopharynx. With various general infectious diseases, local acute exacerbations and chronic, inflammatory diseases of the upper respiratory tract, the protective function of the epithelium of the auditory tube is disrupted, and the microflora penetrates into the tympanic cavity. Less commonly, the infection enters the middle ear through a damaged eardrum due to injury or through a wound to the mastoid process. In this case they talk about traumatic otitis media. The third route of infection into the middle ear is relatively rare - hematogenous. It is possible for infectious diseases such as influenza, scarlet fever, measles, typhus, tuberculosis
etc. In extremely rare cases, acute otitis media develops as a result retrograde spread of infection from the cranial cavity or labyrinth.
Pathogenesis. Acute otitis media begins with inflammation of the mucous membrane of the auditory tube and tympanic cavity. In this case, swelling of the mucous membrane and its leukocyte (neutrophil and lymphocytic) infiltration are observed. The mucous membrane of the tympanic cavity is very thin (0.1 mm) and is a mucoperiosteum (i.e., integral with the periosteum), so the inflammatory reaction is in the nature of mucoperiostitis. As a result of a sharp dysfunction of the auditory tube, the middle ear is filled with exudate, which at first may be serous and then becomes purulent (liquid, thick, viscous). The mucous membrane becomes significantly thickened (tens of times), erosion and ulceration appear on its surface. At the height of inflammation, the tympanic cavity is filled with exudate, granulations and thickened mucous membrane. When the drainage function of the auditory tube is impaired, this leads to the outward bulging of the eardrum. As a result of strong pressure from purulent exudate and circulatory disorders, melting of some area and perforation of the eardrum, followed by otorrhea, often occur.
The initially abundant mucopurulent discharge gradually becomes thick and purulent, and as the inflammation subsides, their quantity decreases and the suppuration stops completely. After this, the perforation of the eardrum may heal, but ear congestion persists for some time. The criterion for recovery is the normalization of the otoscopic picture and complete restoration of hearing.
Clinical picture. In typical cases, acute purulent otitis media is characterized by a staged course. Local and general symptoms of the disease are expressed differently depending on the stage and severity of the process. There are three stages of acute suppurative otitis media:
Preperforative;
Perforated;
Reparative.
It should be noted that not in all cases the process necessarily goes through all three stages. As a result of the mobilization of sufficient natural defenses of the body and with timely
In intensive care, the disease can already acquire an abortive course at the first stage.
Primary, preperforative stage The disease is characterized by pronounced local and general symptoms. The leading complaint is pain in the ear, often very sharp, radiating to the temple and crown. Steadily growing, it sometimes becomes painful and unbearable. Pain occurs as a result of inflammatory infiltration of the mucous membrane of the tympanic cavity and the accumulation of exudate in it; in this case, irritation of the receptor endings of the branches of the trigeminal and glossopharyngeal nerves occurs. Sometimes there is pain on palpation and percussion of the mastoid process, which is caused by inflammation of its mucous membrane. At the same time, congestion and noise in the ear occur as a result of inflammation and limited mobility of the eardrum and the chain of auditory ossicles. Objectively, conductive hearing loss is detected with a slight deterioration in bone conduction of sound. With influenza otitis, as well as measles and scarlet fever, the inner ear is sometimes involved in the process, which is manifested by a more significant impairment of sound perception.
During this period, the general condition of the patient is often disturbed - signs of intoxication appear, body temperature rises to 38-39 ° C, changes characteristic of the inflammatory process are detected in the peripheral blood.
During otoscopy, the injection of blood vessels along the handle of the malleus and the radial vessels of the membrane is first visible, accompanied by shortening of the light cone. Then the hyperemia of the tympanic membrane increases, becomes diffuse, its identifying points disappear, the membrane protrudes, becomes infiltrated, and sometimes becomes covered with a whitish coating (Fig. 5.38 a). The duration of the initial stage of acute otitis media is from several hours to 2-3 days. Signs of this stage can be expressed differently - from obvious to imperceptible, however the main symptom - hyperemia of the eardrum (all or part of it) - is always present.
The perforated stage is characterized by perforation of the eardrum and the appearance of suppuration(Fig. 5.38 b). At the same time, the pain in the ear quickly subsides, the patient’s well-being improves, and the body temperature decreases. Discharge from the ear is initially profuse, mucopurulent, sometimes mixed with blood. During otoscopy it may
Rice. 5.38. Otoscopic picture (a) in acute otitis media (pre-perforative stage); acute otitis media, perforated stage (b)
a so-called pulsating reflex is observed, when pus is visible through the perforation and pulsates synchronously with the pulse. A pulsating light reflex appears when a beam of light is reflected, which falls on a drop of discharge located in the perforation. This pulsation is associated with the pulsation of the blood-filled mucous membrane, in contrast to the same light reflex in chronic purulent destructive otitis media, where dura mater causes pulsation.
Sometimes the thickened mucous membrane of the tympanic cavity prolapses through the perforation of the tympanic membrane in the form of a formation resembling granulation. After a few days, the amount of discharge decreases, it becomes thick and becomes purulent. Suppuration usually lasts 5-7 days. Perforation in acute otitis media is usually small, round with a membrane defect. Slit-like perforations without a tissue defect are less common. More extensive perforations occur with scarlet fever, measles, and tuberculosis.
Reparative stage characterized not only by the cessation of suppuration and, in most cases, spontaneous scarring of the perforation, but also by the restoration of hearing. Along with a gradual decrease and then cessation of discharge, hyper-
remia and infiltration of the tympanic membrane, its shine appears, and identification contours become distinguishable. Small perforations (up to 1 mm) close quite quickly, leaving no marks. With a large perforation, the middle fibrous layer at the site of the defect usually does not regenerate, and then, if the perforation does close, the epidermal layer on the outside and the mucous layer on the inside are restored. This area looks atrophic, has the appearance of tissue paper, and sometimes there are deposits of lime salts. Round-shaped perforations with a pronounced tissue defect often do not close; in this case, the mucous membrane of the membrane along the edge fuses with the epidermis and a persistent perforation with calloused edges is formed. Fibrous adhesive changes after otitis media often remain in the tympanic cavity itself, limiting the mobility of the auditory ossicles, which indicates an adhesive process, which in some cases can progress.
The typical course of acute purulent otitis media can be disrupted at any stage of the process. In some cases, the disease immediately takes on a sluggish, protracted nature with mild general symptoms. Perforation of the eardrum does not occur, but a viscous, thick secretion accumulates in the tympanic cavity, which is difficult to evacuate. Following this, an adhesive (adhesive) process often develops in the tympanic cavity.
Sometimes, on the contrary, in the first period the course of the disease can be extremely severe, with high fever, severe headache, vomiting, dizziness and a sharp deterioration in general condition. The reason for such a violent reaction is often long-term persistent perforation of the eardrum in the presence of exudate in the middle ear. In some cases, even before perforation, the infection can quickly spread from the middle ear into the cranial cavity and lead to severe intracranial complications and even death.
In some patients, despite perforation of the eardrum, the temperature does not decrease and the patient's condition does not improve. This course of the process is usually associated with the active development of inflammation in the mastoid process, i.e. the appearance of mastoiditis.
Sometimes, during the normal course of the disease after perforation of the eardrum, when the patient’s condition has already improved and the temperature has returned to normal, a rise in
temperature, ear pain appears. This clinical picture indicates a violation of the outflow and retention of pus in the cavities of the middle ear and may be a consequence of the formation of granulations in the mucous membrane, which create conditions for stagnation of exudate in the tympanic cavity, or it is associated with the onset of mastoiditis.
Suppuration that does not stop for a long time (3-4 weeks), when after cleaning the ear pus fills the ear canal again, indicates empyema of the mastoid process (mastoiditis), which usually causes melting of its bone bridges. Sometimes profuse suppuration, especially with pulsation of pus, is a sign of an extradural abscess.
In the normal course of acute otitis, changes in the peripheral blood are manifested by moderate leukocytosis without a pronounced shift to the left, and a slight increase in ESR. With a severe disease, pronounced leukocytosis is observed (sometimes up to 20.0x10 9 /l and higher) with a noticeable shift to the left. These changes, sometimes combined with the disappearance of eosinophils, are an unfavorable sign, especially in the late stage of the disease, when they may indicate the development of a complication (mastoiditis) or possible spread of infection into the cranial cavity.
The duration of the disease usually does not exceed 2-3 weeks. The complicated course and unfavorable outcomes of acute purulent otitis media may be due to a decrease in the local and general immune defense of the body, the high virulence of the pathogen and its resistance to the antibiotics used, and irrational treatment of the disease.
Diagnostics in the typical course of acute purulent otitis media it is not difficult. The diagnosis is made on the basis of complaints, anamnesis and features of the otoscopic picture. Sometimes otitis media has to be differentiated from otitis externa.
Treatment treatment of a patient with acute purulent otitis media should be differentiated depending on the stage of the disease, the severity of clinical symptoms and take into account the characteristics of the patient’s somatic status.
In the acute stage of the disease, an outpatient regimen is recommended, and in case of a pronounced increase in temperature or general malaise, bed rest is recommended. If there is a suspicion of an incipient complication - mastoiditis, especially intracranial, the patient should be urgently hospitalized.
In order to restore or improve the ventilation and drainage functions of the auditory tube, vasoconstrictor or astringent drops are prescribed (solutions of Otrivin, Naphthyzin, Sanorin or Galazolin, etc., 3% solution of Protargol), which are poured 5 drops into the nose 3 times a day , it is better to have the patient lying on his back with his head turned towards the sore ear.
The patient should be warned not to blow his nose forcefully or simultaneously through both nostrils. He should be prohibited from drawing mucus from his nose into his mouth, as this leads to the entry of infected nasal secretions into the nasopharynx and auditory tube.
IN pre-perforation stage Acute otitis media may cause severe pain, which is caused by swelling of the tympanic membrane and its tension due to the pressure of the inflammatory exudate from the side of the tympanic cavity. To relieve pain, topical osmotically active drugs are used. These drugs include an alcoholic 3% solution of boric acid or chloramphenicol in half with glycerin. In order to achieve an analgesic effect in acute otitis media, Otipax ear drops are also used; they contain the non-opioid analgesic-antipyretic phenazone and lidocaine.
The local analgesic lidocaine is also included in Anauran ear drops; however, it also contains the antibiotics polymyxin and neomycin, which makes it impossible to use these drops in the presence of perforation of the eardrum. Anauran is effective in the combination of external and otitis media before the appearance of perforation.
These drops, preheated to 38-40 ° C, should be poured into the ear, then hermetically closing the external auditory canal with cotton wool and Vaseline for several hours. It is recommended to repeat such administration of drugs 2-3 times during the day.
Prescribing antibiotics in pre-perforation stage It is certainly indicated for severe pain and increased body temperature. The drug of choice for the treatment of uncomplicated forms of otitis in adults is amoxicillin 0.5 g orally 3 times a day for 7-10 days. If there is no effect after three days of amoxicillin therapy, the antibiotic should be changed to augmentin (0.625-1.0 g orally 2-3 times a day) or cefuroxime axetil orally (0.25 or 0.5 g 2 times a day). If you are allergic to β-lactam antibiotics, modern macrolides are prescribed (Rulid according to
0.15 g orally 2 times a day; spiramycin 1.5 million IU orally 2 times a day). Even if there is a sharp improvement in the patient’s general condition and local symptoms are alleviated, the course of antibiotic therapy should not be stopped prematurely; its duration should be at least 8-10 days. Premature discontinuation of drugs contributes to relapse of the disease and the formation of adhesions in the tympanic cavity, which leads to persistent hearing loss.
For the purpose of pain relief in the initial stage of the disease, paracetamol 0.5 g 4 times a day or diclofenac (Voltaren) 0.05 g 3 times a day is prescribed orally.
A warming semi-alcohol compress is also applied topically to the ear, which accelerates the resolution of the inflammatory process. However, if after applying a compress the patient notices increased pain in the ear, the compress should be removed immediately so as not to provoke the development of complications.
An important place in the treatment of acute purulent otitis media is occupied by catheterization of the auditory tube. The catheterization technique was discussed earlier in the section “Methods for examining the ear.” Blowing of the auditory tube in acute otitis media with the help of a catheter is performed in order to drain the middle ear, eliminate the vacuum in the tympanic cavity that always occurs with this disease, and also introduce medications into it. In addition, catheterization helps normalize the function of the auditory tube and has a beneficial effect on the course of inflammation. The fear of infection from the pharyngeal cavity into the middle ear is unfounded, since in acute otitis media the pharyngeal microflora has already penetrated into the middle ear, and the auditory tube has largely lost its protective function. Catheterization is carried out from the very beginning of the disease and this often makes it possible to achieve an abortive course of the process; in stages II-III of acute inflammation of the middle ear, blowing with a catheter also gives a good therapeutic effect. Most often, after blowing through a catheter, 2-3 drops of 0.1% adrenaline solution are injected into the tympanic cavity, and then a mixture of a suspension of hydrocortisone and penicillin (or another antibiotic, taking into account the nature of the flora), dissolved in an isotonic solution of sodium chloride. You should first determine the patient’s tolerance to the drug that is intended to be used; Ototoxic antibiotics should never be injected into the ear.
If, despite the treatment, protrusion of the eardrum is observed during otoscopy, then paracentesis is indicated - an incision of the eardrum (Fig. 5.39). Protrusion of the eardrum in one place or another occurs from the pressure of the inflammatory fluid, which can be the cause of labyrinthine and intracranial complications. After inflammation subsides, the fluid locked in the tympanic cavity is organized into connective tissue, which forms adhesive otitis media with severe hearing loss.
Rice. 5.39. Paracentesis of the eardrum
Paracentesis should be performed as an emergency if signs of irritation of the inner ear or meninges appear (dizziness, vomiting, severe headache, etc.). In children, especially in infancy, the eardrum is thicker
Tubootitis, also called eustachitis, is an inflammation of the mucous membranes of the tympanic cavity and the Eustachian tube. There are two forms of this disease: acute and chronic, each of which differs in symptoms, causes and treatment methods.
Causes of the disease
In most cases, acute tubo-otitis develops as a complication after previous diseases of the nasopharynx - rhinitis, tonsillitis, pharyngitis. But there are other causes of eustachitis:
- acute infectious diseases (measles, whooping cough, scarlet fever, etc.);
- an allergic reaction that causes inflammation of the mucous membranes;
- congenital or acquired anatomical defects of the nasopharynx or obstruction in any part of it (deviated nasal septum, adenoids, polyps).
Tubo-otitis (eustachitis) becomes chronic in the following cases:
- prolonged course of acute eustachitis;
- lack of treatment;
- interruption of the course of treatment (a common situation when symptoms weaken, when it seems that the disease has gone away).
If tubo-otitis moves along the infectious path of development, pathogenic microorganisms penetrate from the nasopharynx into the auditory tube and provoke inflammation of the mucous membranes, as a result of which the lumen of the tube narrows and the communication between the nasopharynx and the tympanic cavity is disrupted.
This gradually leads to changes in pressure in the tympanic cavity, the eardrum bends inward and from this moment eustachitis makes itself felt with symptoms.
Symptoms
Depending on the form of the disease - acute or chronic - tubo-otitis can manifest itself with the following symptoms:
Acute form of tubootitis
- constant or periodic noise appears in the ears;
- the patient complains of “fluid flowing in the ear,” especially when changing the position of the head;
- autophony develops (sounds spoken out loud echo in the ears);
- hearing acuity decreases;
- body temperature, as a rule, remains within normal limits. Exceptions are cases of tubo-otitis, combined with other diseases (ARVI, tonsillitis, etc.), causing an increase in body temperature, as well as childhood eustachitis - a child’s temperature can rise to 38 ° C;
- cases of otitis media are significantly increasing.
A characteristic manifestation of acute tubootitis is relief of symptoms after yawning and swallowing movements.
Chronic form
- Of the symptoms of acute tubo-otitis, only one remains: a persistent decrease in hearing acuity, often progressive;
- a feeling of fullness in the ears, noise and autophony appear during moments of pressure changes - taking off or landing on an airplane, diving under water;
- a long course of chronic tubootitis causes thinning of the mucous membranes of the auditory tube and tympanic cavity, as well as deformation of the eardrum - symptoms detected during examination by a doctor.
Diagnostics
The key point in diagnosing the disease “tubo-otitis” is to study the medical history. If the patient complains of a feeling of transfusion in the ears, hearing loss and other symptoms of eustachitis, the doctor finds out whether the patient had any cases of ARVI, sore throat, pharyngitis, etc. shortly before the complaints appeared. If the answer is affirmative, a more detailed diagnosis is prescribed, including:
- otoscopy;
- audiometry;
- laboratory examination of a smear to determine the nature of eustachitis: allergic or infectious.
In cases where tubootitis is caused by an allergy, the otolaryngologist prescribes an additional examination by an allergist, who identifies the allergen substance and prescribes treatment aimed at reducing the immune response.
Treatment begins after determining the cause of eustachitis and the presence/absence of concomitant diseases of the nasopharynx.
Treatment
In the treatment of tubo-otitis disease, various techniques are used, which can be prescribed both as independent therapy and in combination.
Drug treatment
To relieve inflammation and swelling (causes of obstruction of the auditory tube), the following groups of drugs are prescribed for tubo-otitis:
- antihistamines (Suprastin, Tavegil, Claritin, etc.) are used for the allergic origin of eustachitis, as well as to reduce intoxication during infectious inflammation of the mucous membranes;
- vasoconstrictor nasal drops (Nazivin, Sanorin, Tizin) reduce swelling at the mouth of the auditory tube, restoring its patency;
- hormonal drugs (Hydrocortisone, Prednisolone, etc.) reduce the degree of the immune reaction, “calming” inflamed tissues. Prescribed for insertion into the cavity of the Eustachian tube through a catheter.
In addition to medications intended for the treatment of tubo-otitis, medications are prescribed that eliminate the cause of the disease - sore throat, vasomotor rhinitis, etc. The allergic nature of eustachitis requires joint treatment by an otolaryngologist and an allergist: identification of the allergen substance and adequate therapy will speed up recovery.
Treatment of the chronic form of tubootitis (eustachitis) is prescribed depending on the degree of dysfunction of the auditory tube, damage to the mucous membranes and other factors. First of all, treatment is aimed at getting rid of diseases that support the inflammatory process in the tympanic cavity and auditory tube.
Physiotherapy and hardware treatment
After the acute symptoms of tubootitis have been relieved, physiotherapeutic and hardware procedures are prescribed to promote tissue regeneration and restoration of the functions of the auditory tube:
- pneumomassage of the eardrum helps remove excess fluid from the tympanic cavity;
- electrical stimulation restores the muscles that regulate the width of the lumen of the auditory tube;
- UHF and UV rays promote the healing of tissues damaged by inflammation.
Important: if left untreated, tubo-otitis can cause permanent hearing problems and progressive deafness. Fluid that accumulates in the tympanic cavity penetrates the cochlea and causes irreversible damage to the auditory nerve.
Prevention
Preventing tubo-otitis is a fairly simple task, which consists of following several recommendations:
- carry out systematic hardening: this will reduce the frequency of acute viral diseases and, accordingly, the risk of developing tubo-otitis;
- teach children to “use” their nose correctly (blow their nose alternately with one and then the other nostril; close their nose when diving, etc.);
- promptly treat any ENT diseases, as well as diseases of the nasopharynx and upper respiratory tract;
- If you are prone to allergies, it is extremely important to identify the allergen substance. Avoiding contact with the allergen will help reduce the frequency of relapses of tubo-otitis to a minimum.
