Allergic otitis - a slow inflammation of a middle ear of the allergic nature. Is followed by an unpleasant itch, deterioration in hearing, specific allocations from an ear cavity. Pain, typical at average otitis, usually are absent and can arise only at accession of secondary inflammatory process. Diagnosis of a disease is performed in common by the allergist and the otorhinolaryngologist on the basis of collecting the anamnesis, carrying out an otoskopiya and the analysis of results of allergologichesky tests. Treatment of allergic otitis generally comes down to elimination of causal and significant allergen and symptomatic therapy.
Allergic otitis – the allergic inflammatory process localized in a middle ear which is followed by puffiness of an Eustachian tube, cavity of a middle ear and the increased accumulation of an exudate in a drum cavity. In spite of the fact that this pathology is allocated as a separate disease, it is difficult to call its symptoms highly specific as they are more often are involved in the general inflammatory and allergic process. Allergic otitis often occurs at babies and children of younger age, usually after the postponed acute respiratory diseases, at persons with the reduced immunity, at workers of the chemical or any other industry connected with production or use in production of aggressive or allergenic substances. The disease threatens essential decline in quality of life in view of possible development of relative deafness. Experts in the field of allergology and otolaryngology are engaged in treatment of pathology.
Reasons of allergic otitis
The pathogenesis of this disease is defined allergic and inflammatory by processes. Allergic reaction is resulted by the pathological changes in mucous tissues of an eardrum promoting suppression of its immune properties. It makes it more available for infectious agents who can get to it in various ways, including with current of blood or a lymph. The described pathogenesis defines characteristic primary symptomatology – hypostasis of a drum cavity and cavity of an acoustical pipe of the allergic nature and a congestion of the exudate, specific on structure, containing eosinophils.
It should be noted that most often either respiratory, or contact allergens are the reason of allergic otitis. Because of an anatomic structure and an arrangement ears are more often subject to influence of bacterial, fungal, household allergens. Reaction of hypersensitivity can arise in response to influence of anti-genes of medicines, cosmetic products, and also chemically aggressive substances which are a part of means of household chemicals.
Factor of developing of allergic otitis, among others, is genetic predisposition both to allergic diseases in general, and to allergic otitis in particular. Violation of a structure of maxillofacial area of any origin increases individual risk of this disease. For this reason the Down syndrome is serious risk factor of development of this pathology. The congenital or acquired immunodeficiencies increase possibility of allergic diseases. Active or passive smoking is an important prerequisite to development of an allergopatologiya. Often allergic otitis develops at the patients having such associated diseases as adenoides, bronchial asthma, chronic allergic rhinitis, a small tortoiseshell.
Symptoms of allergic otitis
The patients having allergic otitis usually note a severe ongoing itch of acoustical pass, release of viscous slime, is frequent with pus from an ear cavity. Noise and feeling of a congestion in an ear, decrease in acoustical sensitivity brings to the patient discomfort. There can be a feeling of transfusion of liquid in an ear after change of position of the head. Body temperature is normal, is more rare subfebrilny that demonstrates inactive inflammatory process. The severe shooting pains are observed only at accession of secondary inflammatory reaction.
Owing to slow character of an inflammation, and also weak expressiveness and specificity of symptoms, allergic otitis can provoke very serious complications in the absence of timely diagnostics and treatment. The complicated allergic otitis threatens with decrease in auditory acuity and an autofoniya – one ear strengthened by perception of own voice.
Diagnosis of allergic otitis
Diagnostics is carried out by the analysis of symptoms, collecting the anamnesis regarding the accompanying allergic diseases, and also diseases which are risk factor for developing of allergic otitis. The otolaryngologist defines degree of mobility of an eardrum by an otoskopiya and estimates a condition of an ear cavity. Reddening, in certain cases - purulent allocations or bubbles with yellow contents – exudate is sometimes observed. When carrying out a puncture of an eardrum (paratsentez) mucous viscous liquid with the high content of eosinophils is emitted. A number of audimetrichesky tests allows to reveal relative deafness that is especially important at inspection of children, it is difficult to them to describe the state.
The Allergologichesky anamnesis allows to take genetic predisposition to such diseases into account, and allergologichesky tests – to reveal the certain allergen causing hypersensitivity reaction. Laboratory diagnostics comes down to the analysis of peripheral blood and separated from an ear on the maintenance of eosinophils. Lack of effect of traditional treatment of an inflammation of a middle ear, improvement of a state against the background of reception of antihistaminic medicines also testify to the allergic nature of a disease. The allergologist can assume allergic otitis if the patient has such associated diseases as bronchial asthma or allergic rhinitis. The fact of existence of other allergic reactions, for example, of a small tortoiseshell, hypostases, an itch, will also help the expert to establish the right diagnosis.
Diagnosis of a disease at children is complicated by the fact that often the little patient is not able to describe the discomfortable feelings precisely. Some children define subjective symptoms as "crash", complain of feeling of fullness, liquid in ears. Parents or other adults who have an opportunity to communicate with the kid for an appreciable length of time can suspect allergic otitis. The carelessness, absent-mindedness, constantly increased voice loudness, a delay of speech development of the child can become a reason for visit of an office of the children's otolaryngologist.
Treatment of allergic otitis
The complex of therapeutic actions is selected the expert on the basis of a clinical picture, the course of a disease and character of the allergen which caused it. For identification of the reason by the allergologist special allergoproba are carried out. After definition of allergen according to indications specific desensitization (hyposensitization) – a long regular allergenspetsifichesky immunotherapy – injection introductions of gradually increasing concentration of allergen, since the minimum dose is performed.
Local glyukokortikosteroidny therapy will help to get rid of an unpleasant itch of an ear cavity: for this purpose use a hydrocortisone, kortikosteroidny ointments. Also antihistaminic medicines are appointed. Apply to washings of an ear cavity solutions of boric acid, hydrogen peroxide (3%), an etakridin of a lactate-1. The good nutrition saturated with vitamins is recommended to patients and if allergen is foodstuff – the diet excluding it. Treatment of the accompanying respiratory diseases of the allergic nature (vasomotorial rhinitis, a rinosinusopatiya) is shown to patients. In case of accession of a secondary infection antibiotics according to the scheme of treatment of chronic purulent otitis are appointed (choice medicines – erythromycin, amoxicillin, a combination of a sulfametoksazol with trimetoprimy).
The long absence of correctly picked up treatment can provoke such complications as paralysis of a facial nerve, an eardrum atrophy, development of a holesteatoma of an ear – the opukholevidny education consisting of the become lifeless epitelialny cages, pus, the exudate surrounded with the capsule from connecting fabric. Not to allow such serious chronic complications, appoint surgical treatment at long stay separated on average to fish soup. Perform obshchepolostny operation which is appointed for the purpose of knocking over of purulent process, the prevention of its progressing and development of life-threatening consequences. Such operation is accompanied by risk of relative deafness and possible need of carrying out the subsequent functional operations.
Forecast and prevention of allergic otitis
At allergic otitis the forecast at patients of any age is most often favorable. To avoid emergence of this pathology, first of all, it is necessary to minimize contacts with allergen, and it is better to exclude them absolutely. But in most cases to make it not easy, especially if it is about an allergy to seasonal pollen, to house dust, to hair of animals. It is simpler to the people suffering from food allergy to limit contact with allergen, having excluded an allergenic product from the diet.
Timely diagnosis of a disease of the expert and correctly picked up treatment will significantly reduce risk of emergence of complications and will help to avoid surgical intervention. It is whenever possible necessary to avoid self-treatment not only for prevention of complications, but also for prevention of development of resistance or initiation additional reaction of a sensitization at reception of incorrectly picked up antibiotics.