Evstakhiit — the inflammatory defeat of an acoustical pipe leading to deterioration in ventilation of a drum cavity with development of catarrhal average otitis. Evstakhiit it is shown by a congestion in an ear, feeling of the liquid which is poured in it, a hearing impairment, noise in an ear, autofoniy. Symptoms can have unilateral and bilateral character. Confirmation of the diagnosis of an evstakhiit is carried out by means of the comprehensive examination including an otoskopiya, a hearing research, a manometriya of an acoustical pipe and definition of its passability, an acoustic impedansometriya, a rinoskopiya, dab from a pharynx. Treatment of an evstakhiit is carried out by vasoconstrictive nasal drops, antihistamines, introduction of medicines directly to a cavity of a middle ear and an acoustical pipe, physical therapy methods.
The acoustical (evstakhiyev) pipe connects a drum cavity of a middle ear to a nasopharynx. It performs function of the channel on which there is pressure equilibration in a drum cavity according to external atmospheric pressure. Normal pressure in a drum cavity is a necessary condition for functioning of the sound carrying out device of a middle ear: eardrum and chain of acoustical stones.
Width of an acoustical pipe makes about 2 mm. With such small diameter even insignificant hypostasis of walls of an acoustical pipe as a result of an inflammation leads to violation of its passability with development of an evstakhiit. In the investigation of it air from a throat ceases to come to a cavity of a middle ear and there the catarrhal inflammation develops. Because of the combined inflammatory defeat of an acoustical pipe and a middle ear evstakhiit also call tubootity, tubotimpanity, salpingootity. On character of a current allocate sharp and chronic evstakhiit.
Causes of an evstakhiit
Spread of an infection from a nasopharynx and the top airways on the pharyngeal mouth and a mucous membrane of an acoustical pipe is the reason of a sharp evstakhiit. It can be observed at a SARS, flu, quinsy, sharp pharyngitis and rhinitis, scarlet fever, an infectious mononukleoz, measles, whooping cough. Viruses happen infectious agents of an evstakhiit at the same time most often, stafilo-and streptococci, children have pneumococci. In rare instances evstakhiit it can be caused by a fungal infection or specific microflora (causative agents of tuberculosis, syphilis, clamidiosis). Emergence of a sharp evstakhiit is connected with hypostasis of an acoustical pipe owing to an allergic disease (allergic rhinitis, ). The tamponada of a nose which is carried out for a stop of nasal bleeding can be complicated by development of a sharp evstakhiit.
Chronic evstakhiit develops against the background of chronic inflammatory processes in a nasopharynx: tonsillitis, adenoides, chronic rhinitis and sinusitis. Diseases at which normal air circulation on pneumatic ways is broken can be its cause: curvatures of a nasal partition, benign tumors of a cavity of a nose and new growth of a throat, atresia Joán, hypertrophic changes of the lower nasal sinks.
In the separate and rather seldom found form of an evstakhiit the otolaryngology carries dysfunction of an acoustical pipe at sharp changes of atmospheric pressure. Bystry decrease or increase in external pressure does not manage to be transferred on an acoustical pipe to a drum cavity. Results from the arising difference of pressure sdavleny mouths of an Eustachian tube and a travmatization of structures of a middle ear with development of aero otitis.
Mechanism of development of an evstakhiit
Full or partial violation of passability of an acoustical pipe at an evstakhiita leads to the lowered intake of air in a drum cavity or to complete cessation of its ventilation. At the same time the air remaining in a drum cavity is gradually soaked up, pressure in it goes down that is shown by retraction of an eardrum. The lowered pressure leads to sweating in a drum cavity of the transsudat containing protein and fibrin, and in later stages lymphocytes and neutrophils — the cages participating in inflammatory reactions. The catarrhal form of average otitis develops. Caused evstakhiity the existing violation of ventilation of a drum cavity, especially at persons with the weakened immunity is long, is capable to cause transition of a catarrhal inflammation in purulent, and also development of adhesive process with developing of adhesive average otitis.
Symptoms of an evstakhiit
Characteristic manifestations of an evstakhiit are the ear congestion, decrease in hearing, weight in the head, noise in an ear and an autofoniya — feeling of a resonance of the voice in an ear. Many patients with evstakhiity at turns and inclinations the head note feeling of the liquid which is poured in an ear. In certain cases patients with the evstakhiity ambassador have a proglatyvaniye of saliva or yawning there is a hearing improvement caused by expansion of a gleam of an acoustical pipe due to reduction of the corresponding muscles. The specified symptoms of an evstakhiit can be observed only in one ear or have bilateral character.
Ear pain is, as a rule, observed at the evstakhiit caused by pressure difference of atmospheric air. The feeling of a raspiraniye and pressure in an ear is also characteristic of it. Change of the general condition of the patient at an evstakhiita does not happen, body temperature remains normal. Rise in temperature and emergence of the general symptoms against the background of an evstakhiit demonstrate development of purulent otitis.
Symptoms of a sharp evstakhiit quite often arise against the background of a respiratory infection or in a recovery stage after it. At existence in a nasopharynx of the center of a chronic infection, tumor, the anatomic changes aggravating violations of ventilation of an acoustical pipe sharp evstakhiit accepts a long current and can pass into chronic. Chronic evstakhiit it is characterized by periodically arising aggravations with the expressed symptomatology of a sharp evstakhiit and the periods of remission in which small noise in an ear and the lowered hearing can remain. Eventually permanent reduction of diameter of an acoustical pipe and adhesion of its walls develops that results in constant character of symptoms of an evstakhiit.
Diagnostics of an evstakhiit
Evstakhiit it is diagnosed by the otolaryngologist on the basis of complaints of the patient, data of the anamnesis (developing of a disease after or in the period of a respiratory infection, against the background of the broken nasal breath) and additional researches. In diagnostics of an evstakhiit the otoskopiya and a mikrootoskopiya, an audiometriya, a hearing research by a tuning fork, definition of passability of an Eustachian tube, an acoustic impedansometriya, an ear manometriya is applied.
During an otoskopiya at an evstakhiita the pulled-in eardrum decides on sharply acting hammer shoot, deformation or disappearance of a light cone. In some cases at an evstakhiita the injection of vessels of an eardrum is observed. Audiometriya and a research of hearing by means of a tuning fork at patients with evstakhiity reveal moderately expressed hearing impairment (to 20-30 dB) mainly in the range of low frequencies connected with sound carrying out violation.
Diagnostics of a condition of an acoustical pipe at an evstakhiita can be carried out by subjective and objective methods. Treat the first: test with an empty drink, Toynbee's test, Valsalva's test. At test with an empty drink of the patient ask to take the strengthened sip, at Toynbee's test during swallowing the patient has to clamp nostrils. Valsalva's test is carried out after a deep breath; the patient closes a mouth, clamps nostrils and tries to make an exhalation. Results of tests are estimated on the basis of feelings of the patient. Good passability of an acoustical pipe is characterized by emergence of "crash" in ears when conducting test. At pipe hypostasis, but preservation of some degree of its passability the patient notes gurgle, peep or other phenomena in the affected ear. The objective research of passability of an acoustical pipe at an evstakhiita is conducted by its blowing off after which by means of an audiometriya and an otoskopiya define result. Improvement of hearing and reduction of retraction of an eardrum after blowing off demonstrate communication of a disease with passability of an acoustical pipe.
Detection of infectious character of an evstakhiit and definition of an antibiotikochuvstvitelnost of the microflora which caused it is made at a microscopic and bacteriological research of dab from a pharynx. For detection of background diseases of a nasopharynx which can be the reason of an evstakhiit the rinoskopiya, a faringoskopiya, KT and a X-ray analysis of okolonosovy bosoms is carried out. At suspicion on allergic character of an evstakhiit carry out allergic tests.
Treatment of an evstakhiit
At an evstakhiita medical actions are directed to sanitation of a nasopharynx, puffiness removal, knocking over of an inflammation or allergic reaction. For decrease in puffiness of an acoustical pipe at an evstakhiita vasoconstrictive drops in a nose (, , naphazoline, ), antihistaminic medicines for intake are appointed (, , ). Improvement of passability of an acoustical pipe is promoted its kateterization with introduction of solution of a hydrocortisone or adrenaline. The good effect at an evstakhiita gives pneumomassage of an eardrum. For the purpose of fluidifying of the transsudat of a drum cavity which is formed at an evstakhiita introduction to it of proteolytic enzymes is applied, manipulation is carried out by a kateterization through an acoustical pipe.
Because of danger of throwing of the infected slime from a throat through an acoustical pipe in a cavity of a middle ear in the sharp period of an evstakhiit carrying out blowings off on Polittsera is not expedient. For the same reason the patient with evstakhiity is recommended to avoid too strong smorkaniye. It is necessary to clear serially each nostril without excess tension. In complex treatment of an evstakhiit physiotherapeutic techniques are applied: UVCh, microwave therapy, laser therapy, Ural federal district, electrostimulation of muscles which reduction expands a gleam of an acoustical pipe.
Treatment of an evstakhiit surely has to include elimination of the reason of its emergence. If necessary sanitation of the centers of a chronic infection is carried out: removal of adenoides, tonzillektomiya, system antibiotic treatment; restoration of nasal breath and ventilation of pneumatic ways of a nasopharynx: corrective operations on a nasal partition, removal of a benign tumor of a nose or throat, a resection of the lower nasal sink and so forth.
Forecast and prevention of an evstakhiit
As a rule, at adequate treatment sharp evstakhiit passes within several days. However in the presence of the associated diseases worsening ventilation of an acoustical pipe it can be transformed to chronic evstakhiit or adhesive otitis which treatment is more difficult.
Prevention of an evstakhiit consists in timely treatment of infectious and allergic diseases of a nasopharynx, application of antiedematous means (nasal vasoconstrictive drops, antihistaminic medicines) at the respiratory diseases which are followed by a nose congestion.