Sharp average otitis — quickly proceeding infectious and inflammatory damage of a cavity of a middle ear. The clinical picture of a disease includes the expressed pain syndrome, the general manifestations, feelings of a congestion and noise in an ear, a hearing impairment, emergence of a perforative opening in an eardrum with the subsequent gnoyetecheniye. Diagnosis of sharp average otitis are the cornerstone given clinical blood test, an otoskopiya, various researches of hearing, a skull X-ray analysis, rino-and faringoskopiya, inspections of an acoustical pipe. The general treatment of a disease is carried out by antibiotics, antihistaminic and anti-inflammatory medicines, local therapy consists in blowing off of an acoustical pipe, an instillation of ear drops, washing of a drum cavity, introduction to it of proteolytic enzymes and so forth.
Sharp average otitis
Sharp average otitis is widespread pathology both in the nursery, and in adult otolaryngology. Sharp average otitis is the most often found otitis form. With an identical frequency it is observed at women and at men. Recently tendency of sharp average otitis to more sluggish current at adults and to a frequent retsidivirovaniye at children is noted. Children of younger age in connection with features of a structure of an ear at sharp average otitis have an involvement in inflammatory process of an antrum at once — caves of a mastoidal shoot and the disease has character of an otoantrit. Sharp average otitis can arise as a complication of an evstakhiit, ekssudativny average otitis, aero otitis, injury of an ear, inflammatory diseases of a nasopharynx.
Reasons of sharp average otitis
To 65% of sharp average otitises are caused by a streptococcal infection. On the frequency of occurrence the pneumococcus and staphylococcus are on the second place. In rare instances sharp average otitis is caused by a diphtheritic stick, Proteus, mushrooms ().
Most often penetration of infectious agents into a drum cavity happens in the tubogenny way — through an acoustical (evstakhiyeva) pipe. Normal the acoustical pipe serves as the barrier protecting a middle ear from hit in it the microorganisms which are in a nasopharynx. However at various general and local diseases its function can be broken that leads to infection of a drum cavity with development of sharp average otitis. The factors provoking dysfunction of an acoustical pipe are: inflammatory processes of the top airways (rhinitis, ozena, pharyngitis, laryngitis, laryngotracheitis, quinsy, adenoides, chronic tonsillitis); benign tumors of a throat (angioma, fibroma, nevrinoma, etc.), nose cavity tumors; surgical interventions in cavities of a nose and throat; diagnostic and medical manipulations (blowing off on Polittsera, a kateterization of an acoustical pipe, a tamponad at nasal bleeding).
Development of sharp average otitis can happen at infection of a drum cavity with a transtimpanalny way — through the injured eardrum that happens at injuries and foreign matters of an ear. The hematogenic way of infection of a cavity of a middle ear with developing of sharp average otitis can be observed at the general infections (measles, flu, scarlet fever, a rubella, diphtheria, syphilis, tuberculosis). A casuistic case emergence of sharp average otitis in connection with penetration of an infection from a cavity of a skull or an inner ear is considered.
In developing of sharp average otitis the condition of the general and local immunity matters. At its decrease even the saprofitny flora getting into a drum cavity from a nasopharynx can become the reason of development of an inflammation. Relatively recently it was proved that in emergence of sharp average otitis not the last role belongs to a so-called ear allergy which is one of displays of a system allergy along with allergic rhinitis, ekssudativny diathesis, allergic dermatitis, asthmatic bronchitis and bronchial asthma. An important role in development of sharp average otitis is played by adverse factors of the external environment: overcooling, dampness, sharp differences of atmospheric pressure.
Symptoms of sharp average otitis
Sharp average otitis on average lasts about 2-3 weeks. During typical sharp average otitis allocate 3 consecutive stages: doperforativny (initial), perforative and reparative. Each of these stages has the clinical manifestations. At in due time begun treatment or high immunological resistance of an organism sharp average otitis can accept an abortive current on any of the specified stages.
The Doperforativny stage of sharp average otitis can take only several hours or 4-6 days last. It is characterized by the sudden beginning from intensive ear pain and the expressed general symptoms. Ear pain is caused by quickly accruing inflammatory infiltration of the mucous membrane covering a drum cavity therefore there is an irritation of the nervous terminations of yazykoglotochny and trigeminal nerves. Ear pain at sharp average otitis carries sharp painful and sometimes intolerable character, leads to a sleep disorder and a loss of appetite. It irradiates to temporal and parietal areas. The pain syndrome at patients with sharp average otitis is followed by noise and a congestion in an ear, decrease in hearing. These symptoms are connected with the fact that because of inflammatory changes mobility of the acoustical stones which are in a drum cavity which are responsible for sound carrying out decreases.
The general displays of sharp average otitis consist in temperature increase of a body to 39 °C, the general weakness, a fever, fatigue and weakness. Influenzal, skarlatinozny and clumsy sharp average otitis often proceed with simultaneous involvement in inflammatory process of an inner ear with development of a labirintit and a hearing impairment due to disorders of sound perception.
The perforative stage of sharp average otitis comes when the congestion in a drum cavity of too large number of purulent contents is resulted by a rupture of an eardrum. Through the formed opening also bloody allocations begin to come out mucopurulent in the beginning, then purulent, and sometimes. At the same time the health of the patient with sharp average otitis considerably improves, ear pain abates, body temperature gives. Gnoyetecheniye usually proceeds no more than a week then the disease passes into the following stage.
The reparative stage of sharp average otitis is characterized by sharp reduction and the termination of a gnoyetecheniye from an ear. Most of patients in this stage has a spontaneous scarring of a perforative opening in an eardrum and a complete recovery of hearing. At the amount of perforation more than 1 mm the fibrous layer of an eardrum is not restored. If overgrowing of an opening nevertheless happens, then the place of perforation remains atrofichny and thin as it is formed only epitelialny and mucous by layers without fibrous component. Big perforation of an eardrum are not closed, on their edge the external epidermalny layer of a membrane grows together with internal mucous, forming omozolely edges of a residual perforative opening.
Sharp average otitis not always proceeds with a typical clinical picture. Initially long and ill-defined character of symptoms, lack of a spontaneous rupture of an eardrum is in certain cases observed. On the other hand, perhaps extremely heavy course of sharp average otitis with the expressed symptomatology, with the temperature up to 40 °C, a headache, nausea and dizziness. The delay of formation of perforation of an eardrum in such cases leads to bystry spread of an infection to a skull cavity with development of intra cranial complications. In cases when after perforation of an eardrum improvement of a state does not happen, aggravation of symptomatology after some improvement is noted or the long gnoyetecheniye (more than a month) is observed, it is necessary to think of development of a mastoidit.
Diagnosis of sharp average otitis
The diagnosis of sharp average otitis is established by the otolaryngologist on the basis of complaints of the patient, the characteristic sudden beginning of a disease, results of an otoskopiya and mikrootoskopiya, a hearing research. In clinical blood test at patients with the typical course of sharp average otitis comes to light moderated and unsharp acceleration of SOE. Severe forms of a disease are followed by the expressed leykotsitozy with shift of a formula to the left, considerable acceleration of SOE. The adverse sign demonstrating development of a mastoidit is lack of eosinophils.
The Otoskopichesky picture of sharp average otitis depends on a disease stage. In an initial stage the injection of radial vessels of an eardrum comes to light. Then hyperaemia gets poured character, infiltration and protrusion of a membrane towards acoustical pass is noted, sometimes there is a whitish raid. In a perforative stage at an otoskopiya slit-like or roundish perforation of an eardrum is visible, the pulsing light reflex — a pulsation of the pus, synchronous with pulse, seen through perforation is observed. The prolapse through a perforative opening of the mucous drum cavity reminding granulyatsionny fabric is in some cases observed. In a reparative stage of sharp average otitis at an otoskopiya the zarashcheniye of perforation or its organization in the form of consolidation and an omozolelost of edge can be noted.
Audiometriya, the threshold audiometriya and a research a tuning fork reveal conductive relative deafness. Data of an acoustic impedansometriya speak about the reduced mobility of acoustical stones. At suspicion on mastoidit and petrozit the skull X-ray analysis in the field of a mastoidal shoot, for an exception of intra cranial complications of MPT and KT of a brain is carried out. Detection of diseases of a nasopharynx which could be the reason of sharp average otitis is carried out by means of a rinoskopiya, a faringoskopiya, a laringoskopiya, definition of passability of an Eustachian tube, a X-ray analysis of okolonosovy bosoms.
Treatment of sharp average otitis
Sharp average otitis is treated depending on a stage and, as a rule, in out-patient conditions. At development of complications hospitalization of the patient is shown. For the purpose of knocking over of a pain syndrome in a doperforativny stage of sharp average otitis apply the ear drops containing anesthetics. The instillation of the drops which are warmed up to 38-39 °C with the subsequent closing of acoustical pass with cotton wool with vaseline which is extracted in several hours is effective. Use also the turunda moistened with spirit solution of boric acid. For removal of puffiness and improvement of drainage function of an acoustical pipe appoint antihistaminic medicines and nasal vasoconstrictive drops: , , naphazoline, , .
The general therapy of patients with sharp average otitis is carried out by anti-inflammatory medicines: diclofenac, ibufeny and so forth. In case of temperature increase of a body and an intensive pain syndrome antibiotic treatment is shown. Medicines of the choice are amoxicillin, , . Having begun reception of an antibiotic, it is necessary to spend on drink it within 7-10 days as the early termination of antibiotic treatment can lead to emergence of a recurrence and complications, synchronization of otitis, formation of solderings in a drum cavity.
The good effect in a doperforativny stage of sharp average otitis gives blowing off of an acoustical pipe on Polittsera and washing of a middle ear solutions of antibiotics in combination with glyukokortikosteroidny medicines. Protrusion of an eardrum against the background of the carried-out treatment says that despite all medical actions, in a drum cavity there is a congestion of a large amount of pus. Such state is fraught with development of complications and demands carrying out a paratsentez of an eardrum.
In a perforative stage of sharp average otitis along with application of antihistaminic, vasoconstrictive and antibacterial means carry out a toilet of an external ear and transtimpanalny introduction of medicines. For reduction of hypostasis and secretion mucous use , for fluidifying of a dense secret — mucolytics (, vegetable medicines). Appoint physiotherapeutic treatment: Ural federal district, UVCh and laser therapy.
Treatment in a reparative stage of sharp average otitis is directed to prevention of formation of solderings, restoration of functions of an acoustical pipe, increase in protective forces of an organism. Apply blowing off of an acoustical pipe, introduction through it to a drum cavity of proteolytic enzymes, pneumomassage of an eardrum, with gialuronidazy, vitamin therapy, reception of biostimulators (a uterine bee milk, a haemo derivative of blood of calfs).
Forecast of sharp average otitis
At timely and competent treatment, sufficient activity of immune mechanisms sharp average otitis comes to an end with an absolute recovery and 100% with hearing restoration. However the late address to the doctor, bad condition of immunity, adverse external effects and background diseases can the reason become perfect other outcome of a disease.
Sharp average otitis can be transformed to chronic purulent average otitis which is followed by the progressing relative deafness and a recurrence of a gnoyetecheniye. In certain cases inflammatory process leads to the expressed cicatricial and adhesive changes in a drum cavity breaking mobility of drum stones and which are the reason of development of adhesive average otitis with a persistent hearing impairment.
In hard cases sharp average otitis is followed by development of a number of complications: a purulent labirintit, a mastoidit, neuritis of a facial nerve, a petrozit, meningitis, thrombosis of a sigmovidny sine, abscess of a brain, sepsis some of which can lead to a lethal outcome.