Aero otitis — the inflammatory changes of a middle ear resulting from sharp difference of atmospheric pressure. Most often aero otitis occurs at military pilots and professional divers, is more rare — at crew members and passengers of the plane. Symptoms of aero otitis and its duration depend on weight of defeat. Ear pain, decrease in hearing, vestibular violations are characteristic, at the complicated aero otitis — allocations from acoustical pass. Diagnosis of aero otitis is based on complaints, the anamnesis, data of an otoskopicheskogy research and a bakposev. Treatment of aero otitis is carried out depending on its weight. It can include an instillation of vasoconstrictive drops in a nose, the general antibiotic treatment, sanitation of a nasopharynx, reconstructive a middle ear operations.
Considerable changes of atmospheric pressure are capable to lead to a barotrauma of the bodies containing air (a drum cavity, additional bosoms of a nose, lungs). Aero otitis, aero sinusitis, injury of lungs with development of emphysema, pheumothorax, gas embolism can result. The most frequent barotrauma is aero otitis. The test pilots and military pilots connected with downhill racings and rises on the plane are most subject to its development; lacunar workers; testers in pressures chamber; the divers plunging deeply. In certain cases aero otitis is observed at certain passengers or crew members of the plane. Besides, the barotrauma got as a result of explosion, falling on an ear or blow to it can lead to development of aero otitis.
Mechanism of developing of aero otitis
Bystry change of pressure of air which is not in time is the main reason for developing of aero otitis it will be counterbalanced with corresponding change of pressure in a drum cavity. Sharp increase in external pressure leads to retraction of an eardrum, and sharp decrease — to its protrusion. The small difference of external and internal pressure is followed only by feeling of a congestion of ears. Practically all aero passengers are influenced by such symptom during take-off and a landing of the plane.
The big difference of pressure causes damage of structures of a middle ear from microinjuries and ruptures of an eardrum before violation of connections between acoustical stones and their change. At the same time weight of aero otitis directly depends on speed and extent of change of atmospheric pressure. As a result of a trauma inflammatory process on average to fish soup — otitis develops. Initially it has catarrhal character, but at accession of an infection passes into purulent average otitis.
Development of aero otitis can be promoted by the inflammatory diseases of a nose and the top airways worsening passability of an acoustical pipe: sinusitis, rhinitis, pharyngitis, chronic tonsillitis, adenoides. The acoustical pipe can partially compensate pressure difference in a drum cavity and the external environment, thereby preventing development of aero otitis. So, when falling atmospheric pressure there is an opening of the mouth of an acoustical pipe that promotes pressure decrease of air and in a drum cavity. The strengthened swallowing or yawning helps opening of an acoustical pipe. However at at puffiness or inflammatory changes of an acoustical pipe this mechanism does not work and aero otitis can arise even at insignificant pressure differences. Besides, at differences of atmospheric pressure more than 90 mm of mercury. spontaneous opening of the mouth of a pipe does not happen. In such cases blowing off of an acoustical pipe is effective.
Classification of aero otitis
Now the clinical otolaryngology subdivides aero otitis on uncomplicated and complicated — followed by inflammatory process. For uncomplicated aero otitis depending on the nature of damages allocate 4 degrees: I \reddening of an eardrum and an injection of its vessels is noted; II \hemorrhages in an eardrum are observed; III \rupture of an eardrum; IV \violation of a chain of acoustical stones takes place (and — without stirrup incomplete dislocation — with an incomplete dislocation).
The complicated aero otitis is classified by severity: easy — the II degree of aero otitis in combination with an acute serous inflammation; average weight — II or III degree of aero otitis with development of purulent average otitis; heavy — the IV degree of aero otitis complicated by purulent otitis; extremely heavy aero otitis is followed by transition of an inflammation to structures of a labyrinth and development of a catarrhal or purulent labirintit.
Aero otitis symptoms
Patients with aero otitis complain of ear pain. Expressiveness of a pain syndrome varies from not intensive, felt as some discomfort in an ear, to extremely severe and sharp pain of dagger character. Pain at aero otitis is followed by feeling of a raspiraniye in an ear, noise in it and decrease in hearing. It can irradiate in a corner of the lower jaw or zaushny area. The rupture of an eardrum is shown by sharp cotton and intensive pain. After it there comes the expressed relative deafness. At aero otitis with violation in a chain of acoustical stones, their change or an incomplete dislocation of a stirrup observes persistent deafness, the patient remaining after recovery. Often damages to system of acoustical stones lead to the vestibular dysfunction which is shown at patients with aero otitis in the form of intensive dizziness and an incoordination of movements.
At the complicated aero otitis the clinical picture of sharp average otitis with allocation from external acoustical pass of serous or purulent separated is added to above-mentioned symptoms. Purulent otitis is followed by temperature increase of a body and symptoms of the general intoxication.
Uncomplicated aero otitis of the I-II degree comes to an end with recovery and a complete recovery of hearing within the first week after the got barotrauma. Aero otitis of the III-IV degree with inflammatory complications can proceed several weeks and lead to education in a drum cavity of cicatricial unions with development of adhesive average otitis.
Diagnosis of aero otitis
Aero otitis is diagnosed by the otolaryngologist on the basis of complaints of the patient, existence in the anamnesis of the instruction to a barotrauma and given to the carried-out otoskopiya. The endoscopic research of an ear at aero otitis of the I-II degree reveals retraction and reddening of an eardrum, an injetsirovannost of vessels of a hammer, sometimes hemorrhages in membrane fabric. In more serious cases at aero otitis the rupture of an eardrum and the expiration through it serous, bloody and serous or purulent exudate comes to light.
At the complicated aero otitis in addition carry out bacteriological crops separated from an ear and dab from a pharynx with definition of an antibiotikochuvstvitelnost of the found pathogenic microorganisms. At patients with a nose congestion for an exception of the accompanying barotrauma of okolonosovy bosoms conduct their radiological research, at suspicion on the accompanying damage of pulmonary fabric — a X-ray analysis of lungs.
Treatment of aero otitis
Aero otitis of the I-II degree is, as a rule, allowed independently. For acceleration of process of recovery events for improvement of drainage function of an acoustical pipe (an instillation of vasoconstrictive medicines in a nose, treatment of diseases of a nasopharynx) and introduction to acoustical pass with boric alcohol are held. Hemorrhages in an eardrum resolve in a week from the moment of the beginning of aero otitis. In certain cases on their place the hem of whitish color is formed, but it does not exert negative impact on quality of hearing after recovery.
Uncomplicated aero otitis of the III degree the above described treatment is supplemented with system prescription of antibiotics for prevention of purulent otitis. At the same time introduction of any substances to acoustical pass is contraindicated. Therapy of the complicated forms of aero otitis is carried out by the general principles of therapy of sharp purulent otitis. For the warning of development of adhesive otitis to patients blowing off of an acoustical pipe on Polittsera is appointed. The aero otitis complication symptoms of a purulent labirintit is the indication to surgical opening of a labyrinth (labirintotomiya).
Ruptures of an eardrum are in most cases inclined to self-healing. If it does not occur, to the patient the miringoplastika or a timpanoplastika — surgical restoration of integrity of a membrane by imposing on the formed defect of a skin rag is carried out. At damage of acoustical stones treatment of aero otitis includes various reconstructive operations: stapedoplastika, implantation of artificial acoustical stones and t of the item.
Patients with aero otitis whose work is connected with flights, lacunar works, divings or stay in a pressure chamber have to be exempted from it for all the time of treatment. After the postponed aero otitis they are allowed to the work only in case of an absolute recovery and after the corresponding survey by medical commission.