Sulfuric stopper at the child
Sulfuric stopper at the child – a partial or full obturation of external acoustical pass by a congestion of own secret (ear sulfur) and slushchenny epidermis. The problem of sulfuric traffic jams is rather widespread in adult and children's otolaryngology. Annually sulfuric stopper is diagnosed for 4% of the population, including for children. The sulfuric stopper can be formed even at the child of chest age, and 20% of babies need a sulfuric stopper the children's otolaryngologist at a distance.
Ear sulfur is the secret of the tseruminozny (sulfuric) glands located in skin of webby and cartilaginous department of external acoustical pass, mixed with a secret of sebaceous glands and a slushchenny epithelium. The main biochemical components of sulfur are presented by lipids, cholesterol and nonsaturated fatty acids. Antifungal and antibacterial activity is provided with sour reaction (rn-4-6), enzymes, fatty acids, lizotsimy and immunoglobulins. The main function of ear sulfur consists in natural clarification of acoustical pass from the died-off cages, dust particles; to protection against various exogenous biological and physical and chemical influences; moistening and obstacle to drying of an epithelium of acoustical pass and eardrum.
Normal removal of ear sulfur happens spontaneously, thanks to the movements of temporal and mandibular joints when chewing, swallowing, a conversation. However under certain conditions clarification of external acoustical pass at the child is at a loss, and the accumulated secret is transformed to a so-called sulfuric stopper.
The reasons of formation of a sulfuric stopper at the child
Excess secretion of sulfur, change of its consistence, anatomic features of acoustical pass can contribute to formation of a sulfuric stopper at the child.
The increased formation of ear sulfur foreign matters of an ear, otitises at children can provoke, hit in water ears, eczema, dermatitis, carrying the hearing aid, frequent use of earphones. The special role in hyper secretion of ear glands and formation of a sulfuric stopper belongs to excessively diligent attempts to clean the child's ears by means of Q-tips. It leads to irritation of sulfuric glands, increase in production of sulfur, and also pushing through, an utrambovyvaniye and fixing of already available secret in bone department of acoustical pass. Except the increased risk of formation of a sulfuric stopper, such "hygiene" is fraught with traumatizing acoustical pass and injury of an eardrum which in 70% of cases are caused in children by misuse of Q-tips.
The congestion of sulfur can be promoted by anatomic narrowness and tortuosity of external acoustical pass which the child can have hereditary, as well as a problem of sulfuric traffic jams. Recidivous formation of dry sulfuric traffic jams at the child can be connected with insufficient humidity of air in the nursery.
Types of a sulfuric stopper at the child
Depending on a secret consistence, the following types of sulfuric traffic jams occur at children:
- pastopodobny – have light or dark yellow color, a soft consistence;
- plastilinopodobny – have brown color and a viscous (plasticine) consistence;
- firm (dry) – color varies from dark brown to almost black; the consistence is rigid.
Soft and friable in the beginning, over time the sulfuric stopper can get dense and even stony consistence from the child. An independent phenomenon is the epidermalny (epidermoidalny) stopper formed by mainly slushchenny scales of a horn layer of epidermis. It has the stony density, whitish or gray color; densely adjoins walls of acoustical pass that can lead to formation of decubituses in bone department.
Sulfuric masses at the child can fill a part of external acoustical pass (a pristenochny sulfuric stopper) or to occupy all acoustical pass entirely (an obturiruyushchy sulfuric stopper).
Symptoms of a sulfuric stopper at the child
The sulfuric stopper at the child can exist a long time asymptomatically until it does not block acoustical pass more than for 70%. Usually swelling of sulfur and a full obturation of external acoustical pass by sulfuric masses is preceded by hit in a water ear when bathing the child. In this case there is a congestion and noise (a rumble, a ring), ear pain; sometimes feelings of an itch of external acoustical pass, an autofoniya (the strengthened resonance of own voice).
Characteristic sign of a sulfuric stopper is decrease in hearing which can not be felt by the child, but to be noticed on some signs (the child does not respond to call, often asks again, shudders at appearance of strangers in the room etc.). The concern, continuous attempts to touch, scratch, rub an ear can be signs of a sulfuric stopper at the baby.
At an arrangement of a sulfuric stopper in bone department and pressure upon an eardrum there can be reflex symptoms including cough, nausea, dizziness, a headache; seldom – disorders of warm activity and paralysis of a facial nerve.
Diagnostics of a sulfuric stopper at the child
The sulfuric stopper can be found by the pediatrician at visual survey of an external ear in the child. However for exact identification of the reasons and associated diseases, and also performing treatment of a sulfuric stopper the child needs consultation of the children's ENT specialist.
When carrying out an otoskopiya the sulfuric stopper is visible to the child as the brownish or black weight covering an eardrum. At inspection by means of the pugovchaty probe the consistence of a sulfuric stopper at the child is defined. In the course of an audiometriya characteristic decrease in hearing is found.
The sulfuric stopper at the child needs to be differentiated from a foreign matter of acoustical pass, sensonevralny relative deafness, an otomikoz, the holesteatoma which sprouted in external acoustical pass.
Treatment of a sulfuric stopper at the child
Attempts of independent extraction of a sulfuric stopper at the child by means of tweezers, a pin, a Q-tip are inadmissible. The decision on a way of removal of a sulfuric stopper is made by the expert on the basis of results of endoscopic survey.
Most often at children removal of a sulfuric stopper is made by washing of the external acoustical channel. For this procedure the solution of Furacilin or weak solution of permanganate of potassium which is warmed up to body temperature (in order to avoid reaction of a vestibular mechanism), the syringe of Zhane or the disposable syringe on 20 ml without needle is used. During the procedure of washing it is important to record well the child to exclude possible damages of external acoustical pass. By means of the syringe the doctor under pressure gives a liquid stream to a cavity of acoustical pass of the child which washes away a sulfuric stopper.
If the sulfuric stopper at the child has a dense consistence, it is previously softened within 2-3 days an instillation in external acoustical pass by 3% of solution of peroxide of hydrogen. To destination the children's doctor it can be recommended (dissolution of a sulfuric stopper at the child) by means of special medicines (A-Tserumen, Remo shoe-polishes).
In the presence in the anamnesis of the child of perforation of an eardrum, external otitis or resistant relative deafness, tool removal of a sulfuric stopper by means of tweezers or a hook probe under visual control is made (curettage). The soft sulfuric stopper can be an aspirirovana from external acoustical pass by means of an electrosuction.
After removal of a sulfuric stopper at the child it is necessary to be convinced by any way by means of an otoskopiya of its full extraction, to drain acoustical pass and at several o'clock to close it a wadded tampon.
The forecast and prevention of sulfuric traffic jams at the child
After removal of a sulfuric stopper at the child, as a rule, hearing is restored at once and unpleasant subjective feelings disappear. A part of children has a repeated formation of sulfuric traffic jams. Removal of a sulfuric stopper washing extremely seldom (1:1000 cases) can be complicated by nausea, vomiting, bleeding, a rupture of a membrane.
If the child has an increased tendency to formation of sulfuric traffic jams, it is necessary to visit the otolaryngologist at least 1 time in 6 months. It is strictly forbidden to use for cleaning of acoustical passes Q-tips, and also other injury-causing objects; for extraction of surplus of sulfur from the acoustical channel it is recommended to use zhgutika from sterile cotton wool. As a sulfuric stopper – not a rarity even at babies, the pediatrician needs to perform routine inspection of an external ear at children of this age category.