Otitis media ( middle ear infection ) Symptoms and Treatment
Otitis - this is a common definition of various inflammatory diseases of the ear.
middle ear - a system of pneumatic cavity include: tympanic cavity, auditory tube, the entrance to the cave, the cave and the mastoid opening it mastoid cells.
In inflammatory diseases of the middle ear in the pathological process usually involves all its departments, but the severity and localization of disturbances in various diseases differ.An important role in the pathology of play topographic and anatomical features of the middle ear.
upper bony wall of the tympanic cavity and the mastoid cave adjacent to the bottom of the middle cranial fossa, where the temporal lobe of the brain is located.This plate of bone in adults are dehiscence, and the children of the first years of life on the border of the rocky and squamous portions of the temporal bone in the tympanum of the roof has a cleft stone-scaled slot (fissura petrosquamosa).Contact the mucous membrane of the middle ear with the dura makes possible the spread
Medial (labyrinthine, promontorialnaya) wall separates the tympanic cavity of the inner ear, here are the window of the vestibule and the cochlea.Through the formation of membranous labyrinth windows infection can penetrate into the inner ear and cause the development of labyrinthitis.
Here, on the medial wall of the bone bed is the facial nerve canal (canalis n. Facialis), which passes its horizontal knee.The defeat of the facial nerve (paresis or paralysis) in various forms of otitis media may occur due to exposure to microbial toxins, direct compression of the nerve, or even the destruction of its trunk cholesteatoma.
Rear middle ear department presented mastoid (processus mastoideus), in which there are numerous pneumatic cells connected to the tympanic cavity mastoid cave - antrum (antrum mastoideum).Mastoid cave - pneumatic cell rounded, which is constantly present in the mastoid, regardless of its form and structure.It is a reliable anatomic landmark during ear operations.In infants mastoid is not developed, but the mastoid cave there at birth.In infants it is surface (at a depth of 2 - 4 mm) and somewhat above the ear canal.The development of the mastoid process of the child begins at the 2-year life and ends with the beginning of the 7th year, while the cave is gradually shifting backward and downward.
Depending on the number, size and location of the cells in the mastoid are several types of its structure: air, diploetichesky and sclerotic.The nature of the structure of the mastoid process depends largely on the nature of the emerging pathology.Thus, in its sclerotic structure of a person, a child suffering from chronic suppurative otitis media, is formed by underdeveloped mastoid;when the pneumatic structure of the appendix more likely to develop mastoiditis.
to the back surface of the mastoid is adjacent sigmoid sinus (sinus sigmoideus) - venous sinus, through which the outflow of blood from the brain to the jugular vein system.Under the bottom of the tympanum sigmoid sinus forms an extension - a bulb of the internal jugular vein.Sinus demarcated by a thin cell system of the mastoid process, but sufficiently dense bone plate (lamina vitrea).Evolving in the mastoid in certain diseases of the middle ear-destructive inflammatory process can lead to the destruction of the records, and the penetration of infection in the sinus and the posterior cranial fossa.
front wall of the tympanic cavity called a pipe, or sleepy wall (paries tubaria s. Caroticus).The upper half of the wall is occupied by two holes, the larger of which is called the Eustachian tube tympanic mouth (ostium tympanicum tubae auditivae).Above it opens the floor muscle channel, pulls the eardrum (m. Tensor tympani).In the lower part of the front wall is formed by a thin plate of bone that separates the tympanic cavity from the trunk of the internal carotid artery, passing in the same channel.This wall is riddled with thin canals through which the inflammatory process can go out of the tympanum on the carotid artery.
The mucous membrane of the tympanic cavity is a continuation of the mucous membrane of the nasopharynx and shows a single layer of flat and transitional ciliated epithelium with a few goblet cells.Covering ear bones and ligaments, mucous membrane forms a lot of communicating pockets and the sines, among which the most significant clinically drum and facial sinuses.Drum sinus (sinus tympani) is a pyramidal elevation and extends to the bulb of the jugular vein and snails window.Facial sinus (sinus facialis) limited medial facial nerve canal, behind - a pyramidal elevation and front - cape.
inflammation of the outer ear often due to infection and affects the skin of the outer ear, which includes not only the visible ear, but also part of the ear canal, leading to the inner parts of the ear.Sometimes the inflammation is localized.Although inflammation can be painful and unpleasant, it often responds well to treatment.However, in patients with diabetes, the elderly and people with weakened immune systems the disease can lead to malignant otitis of the outer ear, rare is not carcinogenic (despite the name) disease.How to treat otitis media in children, see here.
• Moisture in the ear promotes fungal species and certain bacterial infectious diseases.Swimming, especially in contaminated water increases the risk of otitis external ear;bathing in the shower, hair washing or -nahozhdenie the rain hardly increase the risk of disease.
• Diseases of the skin, such as eczema or seborrheic dermatitis, can cause inflammation.
• Objects that are inserted into the ear, such as cotton swabs, can create small cuts that are vulnerable to infection.
• Excessive production of sulfur makes the ear more vulnerable to infection.
• Means for removing sulfur, hair dye, shampoos, paints or chlorinated water can irritate the ear canal.
doctor examines the ear canal using an otoscope.Analysis seeding liquid discharge from the ear can be done.
• Itching in the ear canal in the early stages.
• Pain in the ear, which can become severe.The ear becomes sensitive to touch, and the pain worsens when retracting the pinna.
• Allocation of fluid or pus from the ear canal.
• Redness and swelling of the ear canal skin (and sometimes the outer ear), which leads to occlusion of the ear canal.
• Small, painful lump or boil in the ear canal.
• Temporary hearing loss due to swelling and accumulation of pus in the ear canal.
• You can take painkillers sold without prescription.Children should take acetaminophen rather than aspirin.
• Your doctor may use a small suction device to remove fluid and pus from the ear canal.
• Antibiotics or antifungal ear drops may be prescribed to fight the infection;in addition to, corticosteroids are used to reduce inflammation.Spongy wick can be inserted into the ear to the drug penetrated deep into the ear canal.
• In severe infections can oral antibiotics.
• Surgical removal of dead tissue may be required in the treatment of severe otitis external ear.
• Codeine or drugs may be prescribed to reduce pain.
• Once symptoms disappear, avoid getting water in the ear canal for three weeks;Protect your ears when taking a shower, and do not swim.
• In the event of a repetition of the disease continue to use prescription ear drops to relieve symptoms.
• See a doctor if symptoms persist for more than a day or two.(People with diabetes should see a doctor at the first sign of an infectious disease of the ear.)
• Do not insert any objects in the ear, even cotton swabs or clean the ear with alcohol or solutions are sold without a prescription.Your doctor may remove sulfur.
• If you often experience itching in the ear canal, consult your doctor.Treatment of skin disease will help prevent secondary infection.
• Avoid swimming in water that may be contaminated.
• If you are swimming in the water, which could cause otitis external ear, ear rinse with water, acidified with vinegar;This may prevent infection.
Priority development of pathological changes in a particular section of the middle ear determines the existence of different clinical forms of the disease.Thus, the localization of disorders mainly in the auditory tube is treated as evstahiit or catarrhal otitis media;inflammation, which developed mainly in the tympanic cavity, denoted by the term "otitis media", and pathology in the mastoid cave and adjacent to it the cells is called mastoiditis.
Diseases of the middle ear are rarely primary.An important role in their development plays a dysfunction of the auditory tube, which is usually a reflection of the pathological changes of the upper respiratory tract.Therefore, therapeutic measures are aimed primarily at restoring the normal functioning of the auditory tube.
Because of the anatomical and morphological structure of the middle ear, developing it inflammatory changes characterized by a predominance of exudative inflammation, in which the microcirculation system responses predominate over the processes of alteration and proliferation.The amount of protein and cellular composition of exudate may vary depending on the degree of vascular permeability.
Among the different types of exudative inflammation of the mucous membrane of the middle ear are the most common catarrhal, serous and purulent.
Otitis media - a disease of the cavity between the eardrum and the delicate inner ear structures.Usually, it happens when the viruses that cause upper respiratory tract infection (eg, common cold), or bacteria migrate through the Eustachian tube (the passage between the nasal passages and the middle ear).Infection often leads to pipe blockage, preventing mucus, pus and other fluids generated during illness arising out of the middle ear.It hurts because these liquids are putting pressure on the eardrum and can break it.Infections of the middle ear is very common in children (because their Eustachian tube is less) and has a tendency to recur, especially in winter.With the rapid treatment, there are all possibilities for a full recovery.If left untreated, chronic otitis media can eventually cause serious structural damage ear and skull, which ends with irreversible hearing loss or weakness of the facial nerve.
• Viral infection of the upper respiratory tract is the most common cause.
• Allergic rhinitis or adenoids may cause blockage of the Eustachian tube.
• ruptured eardrum facilitates hit carriers of infection in the middle ear.
• Children with congenital anatomical defects of the face (such as "hare lip") or children with Down's syndrome
are at greater risk of middle ear infections.
• Some groups of people have a genetic predisposition to infectious diseases of the ear.
• Passive smoking increases the risk of infections of the middle ear in children.
• Repeated bacterial disease of the ear may be completed by chronic inflammation of the middle ear.
• Feeling of fullness of the ear, which eventually leads to severe pain.
• Temporary hearing loss in the affected ear.
• Nausea and vomiting.
• clicks or other sounds in the ear when moving jaw.
• Pain when retracting the pinna.
• The constant outflow of pus, and mild hearing loss often without pain in the ear (primary symptoms of chronic inflammation of the middle ear).
• The physician should examine the ear canal using an otoscope - a small instrument lighting.Analysis seeding liquid discharge from the ear can be done.
• Antibiotics may be needed to treat a bacterial infection.
• Aspirin or acetaminophen taken to relieve pain and fever.
• Your doctor may recommend decongestants or antihistamines.
• Can be made a small incision in the eardrum (myringotomy) to release the pus.This incision heals within two to three weeks.When myringotomy tube can be introduced to the middle ear to drain the fluid accumulation period.
• Enlarged adenoids can be removed surgically.
• Sometimes the infection touches the mastoid bone (the bone behind the ear), which has to be removed surgically.
• Contact your doctor if you or your child feel ear pain that persists despite treatment, especially if symptoms worsen or are accompanied by swelling around the ear, twitching of the face or severe earache that suddenly stops (indicating a breaktympanic membrane).
• Wash hands with soap and warm water should be mandatory for children and adults in schools and child care centers.
• House regularly wash bed linen, towels and heating pads to prevent re-infection from pus residues.Discard cotton balls after use.
Catarrh of the mucous membrane of the middle ear, which developed as a result of dysfunction of the auditory tube, termed "tubo-otitis," or "evstahiit".Free effusion in the tympanic cavity is usually not in this disease.The main role is played by the pathological process in the Eustachian tube, which leads to the breakdown of its functions, a violation of the ventilation of the tympanic cavity inflammation and moderately expressed in the latter.Infection of the mucous membrane of Eustachian tube occurs in acute respiratory diseases, flu, and children still in acute infectious diseases, accompanied by catarrh of the upper respiratory tract.Pathogens tubootitis are viruses, streptococci, staphylococci and others.
Tubarnaya dysfunction is more consistent with adenoid vegetations, various chronic diseases of the nasal cavity and paranasal sinuses (chronic suppurative or polypous rhinosinusitis, choanal polyps, a curvature of the nasal septum, hypertrophy of the posterior ends of inferior turbinateset al.), as well as nasopharyngeal tumors.The cause of some forms of tubootitis may be sharp differences of atmospheric pressure during the ascent and descent of the aircraft (aerootitis), immersion and emersion divers and submariners (mareotit).
case of violation of the ventilation of the tympanic cavity air contained in it is absorbed mucous membranes, and the completion of the air reserve is difficult due to the compression of the mouth of the pipe.As a result of pressure drops in the tympanic cavity, the air in it becomes sparse.This eardrum is retracted, and transudate may appear in the tympanic cavity.
Clinic. at tubo-otitis patient complains of a feeling of stuffiness in the ear, hearing loss, sometimes noise in the ear, syringmus (resonating own voice in the patient's ear).Nasal ear can occur during an acute respiratory viral infection or during recovery afterwards and after suffering a drop in atmospheric pressure, for example after a flight in an airplane.Ear pain is usually absent or expressed only slightly, the general condition suffers a little.
Diagnostics .At otoscopy can be observed retraction of the tympanic membrane, as indicated by the apparent shortening of the hammer handle, sharp vystoyanie towards the ear canal a short process, a clearly defined front and back pleats, disappearance or deformation of the light cone.Sometimes define radial injection of vessels along the eardrum hammer handle or circular injection of vessels in the annulus tympanicus.
Hearing in acute tubo-otitis decreased slightly (to 20 -30 dB) is mainly due to the sound conduction disturbances at low frequencies.Sometimes patients report improvement of hearing after yawning or swallowing saliva, which is accompanied by opening the lumen of the auditory tube.