Adhesive average otitis — the chronic inflammatory process on average to fish soup leading to formation of solderings and soyedinitelnotkanny tyazhy, causing violation of passability of an acoustical pipe and mobility of acoustical stones. Adhesive average otitis is shown by emergence of noise in an ear and the hearing impairment which is aggravated eventually. Obligatory diagnostic testings at suspicion of adhesive average otitis are survey of the ENT specialist, an otoskopiya, an audiometriya, a research of passability of an acoustical pipe, an impedansometriya. Medical actions at adhesive average otitis consist in introduction of proteolytic enzymes, lidaza, a hydrocortisone, carrying out physical therapy. At their inefficiency surgical treatment (a timpanotomiya, a timpanoplastika), hearing aid is shown.
Adhesive average otitis
The middle ear includes an acoustical pipe and a drum cavity in which there are acoustical stones (, a hammer and an anvil). The drum cavity is separated from an acoustical pipe by the eardrum transferring sound vibrations to acoustical stones. Further through stones vibration arrives to the structures of an inner ear which are responsible for sound perception and transfer of sound signals on an acoustical nerve in the relevant department of a brain.
Decrease in hearing at adhesive average otitis is connected with reduction of mobility of acoustical stones and an eardrum, leading to violation of the mechanism of sound carrying out from an eardrum to a snail of an inner ear. However over time it is long the proceeding adhesive average otitis can lead to violation of sound perception as a result of decrease in sensitivity of voloskovy cages to fluctuations of an endolymph and reduction of the impulsation proceeding from them to a brain.
Reasons of adhesive average otitis
The ekssudativny or catarrhal not perforative otitis preceding it is the most frequent reason of adhesive average otitis, chronic tubootit. Development of adhesive average otitis after these diseases can be provoked by irrationally carried out antibiotic treatment. As a result of permission of inflammatory process and a rassasyvaniye of the exudate which accumulated in a drum cavity, in it there are threads of fibrin and soyedinitelnotkanny solderings and cicatricial tyazh are formed. The last braid acoustical stones and fasten to an eardrum, blocking the mobility of these structures necessary for normal sound carrying out. At the same time solderings and tyazh of adhesive average otitis can be formed also in an acoustical pipe that leads to violation of its passability.
In clinical otolaryngology cases when adhesive average otitis arises without the previous sharp or chronic otitis are not rare. In such cases various pathological processes complicating passability of an acoustical pipe and interfering normal ventilation of a drum cavity are the reason of its development. Treat them: sharp diseases of the top airways (SARS, pharyngitis, tracheitis, laryngitis), chronic tonsillitis, adenoides, chronic inflammatory processes of okolonosovy bosoms and cavity of a nose (sinusitis, antritis, rhinitis), hypertrophic changes of the lower nasal sinks, tumors of a throat and cavity of a nose, curvature of a nasal partition.
Symptoms of adhesive average otitis
The main complaints which are shown by the patient with adhesive average otitis consist in gradual deterioration in hearing and existence of noise in an ear. At inquiry in the anamnesis of such patients it is possible to reveal noted earlier sharp or chronic otitises. The hearing research at adhesive average otitis determines the conductive nature of relative deafness — a hearing impairment by a sound carrying out cause of infringement.
Clinical symptoms of adhesive average otitis are not numerous and similar to a picture of other diseases of an ear. Therefore diagnostics of the reason of the revealed changes of hearing requires carrying out a number of diagnostic actions and an exception of other pathological processes resulting in conductive relative deafness (sulfuric traffic jams, traumatic damage of structures of a middle ear, tubootit, and so forth).
Diagnosis of adhesive average otitis
Diagnostic inspection at adgezidny average otitis includes visual survey of the otolaryngologist, definition of passability of an Eustachian tube, an otoskopiya, a mikrootoskopiya, an audiometriya, an impedansometriya, an endoscopic kateterization of an acoustical pipe.
Carrying out an audiometriya reveals at patients with adhesive average otitis decrease in hearing of various degree of expressiveness up to full deafness. For definition of passability of an acoustical pipe trial blowing off on Polittsera is carried out it. At adhesive average otitis it, as a rule, gives weak improvement of hearing or does not render any effect at all. However it not always unambiguously indicates the broken passability. For final confirmation of such violation resort to a pipe kateterization with otoskopichesky control.
The most important point in diagnosis of adhesive average otitis is identification of a characteristic otoskopichesky picture of a disease. Otoskopiya (simple and with increase) defines retraction of an eardrum, its turbidity and existence of the cicatricial changes in certain cases causing deformation of a membrane. In a cavity of an acoustical pipe tyazh and the solderings which sometimes are completely obliterating its gleam are also visualized.
The research of mobility of an eardrum and acoustical stones carry out during an acoustic impedansometriya. The research consists in a condensation and discharge of the air which is in an acoustical pipe therefore the eardrum is involved and straightened. At adhesive average otitis of the movement of a membrane are limited or absolutely are absent, acoustic muscular reflexes are not caused.
Treatment of adhesive average otitis
The first stage in treatment of adhesive average otitis is elimination of the factors leading to violation of passability of an acoustical pipe. Here sanitation of a nasopharynx and nasal bosoms, carrying out an adenotomiya at children, restoration of normal breath through a nose (elimination of a curvature of a nasal partition and hypertrophy of nasal sinks) belongs.
The positive effect at adhesive average otitis renders a course of blowings off on Polittsera in combination with pneumomassage of an eardrum. Transtubarny introduction through a catheter of a hydrocortisone, an atsetiltsistein, chymotrypsin, a gialuronidaza is applied. For stimulation of protective reactions of an organism parenteral application of an aloe, a vitreous body, vitamins of group B, ATP and so forth is recommended to patients with adhesive average otitis. Antihistaminic medicines are shown.
Medicamentous therapy of adhesive average otitis is usually supplemented with physiotherapeutic treatment. Apply UVCh, microwave therapy, ultrasonic massage of rollers of an acoustical pipe, mud cure. By an endouralny ultrafonoforez and an electrophoresis carry out introduction of iodide potassium and a gialuronidaza.
Often conservative treatment of adhesive average otitis is ineffective. In such cases and at the progressing relative deafness surgical treatment is shown. Carrying out a timpanotomiya with a section cicatricial and adhesive tyazhy and restoration of mobility of acoustical stones at adhesive average otitis often yields only temporary result as after operation in most cases there is a repeated formation of solderings. The timpanoplastika with replacement of acoustical stones by artificial is more effective. And at bilateral adhesive average otitis with the expressed decrease in hearing hearing aid is shown to elderly patients.
Forecast of adhesive average otitis
At adhesive average otitis prevalence and depth of the fibrinozno-cicatricial changes happening in structures of a middle ear has predictive value. Unfortunately, these changes have irreversible character and can only be stopped. The earlier it was succeeded to stop process, the less expressed will be the relative deafness of the patient which developed as a result of a disease. In the started cases, at the long course of a disease inadequate or out of time begun treatment of an outcome of adhesive average otitis there can be a full anchylosis (immovability) of joints of acoustical stones leading to deafness.