External otitis — an inflammation of an external ear of diffusion or limited character. Limited external otitis is shown by formation of a furuncle with sharply expressed pain syndrome in a stage of infiltration and a possibility of development of a furunkulez at its opening. Diffusion external otitis is characterized by the poured inflammation of acoustical pass which is followed by pain and a raspiraniye in an ear, serous, and then purulent separated. For the purpose of diagnosis of external otitis inspection and a palpation of parotid area, an otoskopiya, an audiometriya, separated from an ear is performed. Medical actions at external otitis consist in washing of acoustical pass by antiseptics, a mortgaging in it with medicines, performing the general antibiotic treatment, the anti-inflammatory and immunostimulating treatment.
The external ear is a peripheral part of the hearing aid of the person. It consists of the external acoustical pass having cartilaginous and bone speak rapidly, and an auricle. From a cavity of a middle ear the external ear is separated by an eardrum. At a local inflammation of external acoustical pass speak about limited external otitis. It represents pyoinflammatory process in the field of a hair follicle — a furuncle. The poured inflammation of acoustical pass covering its cartilaginous and bone part in otolaryngology carries the name of diffusion external otitis. Diffusion external otitis is characterized by inflammatory changes both in skin, and in hypodermic fatty cellulose of acoustical pass, can be followed by an eardrum inflammation.
Causes of external otitis
Infection of skin of external acoustical pass is the reason of external otitis. The causative agent of limited external otitis most often is piogenny staphylococcus. Diffusion external otitis can be caused by stafilokokka, a hemophilic stick, pneumococci, a klebsiyelly, sinegnoyny stick, morakselly, sort Candida fungi, etc. Most often the infection drift in acoustical pass with development of external otitis is observed at a gnoyetecheniye from the punched eardrum at sharp and chronic purulent average otitis, a purulent labirintit.
To penetration of the activator in the integument covering external acoustical pass it is carried out in places of damages and microinjuries. In turn traumatizing skin of acoustical pass is possible at an ear injury, existence in it of a foreign matter, hit of aggressive chemicals, the wrong carrying out hygiene of an ear, independent attempts of extraction of a sulfuric stopper, combing of an ear at the itching dermatosis (eczema, urticaria, atopic dermatitis, allergic dermatitis) and diabetes.
Developing of external otitis is promoted by constant moistening of acoustical pass by the water getting to it which leads to decrease in barrier function of skin. A favorable background for development of external otitis also is decrease in the general protective forces of an organism that is observed at avitaminosis, immunodeficiency (for example, at HIV infection), chronic infections (tuberculosis, syphilis, chronic tonsillitis, chronic pyelonephritis), strong overfatigue (a syndrome of chronic fatigue).
Limited external otitis
Symptoms of limited external otitis
Limited external otitis passes the same stages, as a furuncle on the surface of skin in the development. However the closed space and plentiful innervations of acoustical pass in which the furuncle at external otitis settles down cause some features of his clinical picture. Usually limited external otitis begins with feeling of a severe itch in acoustical pass which then develops into pain. Increase in the sizes of a furuncle of an ear in a stage of infiltration leads to a sdavleniye of nervous receptors and bystry increase of a pain syndrome.
Ear pains at limited external otitis surpass the pains which are noted at sharp average otitis in the intensity. They irradiate in a temple, a nape, the top and lower jaw, take all half of the head from a sore ear. Strengthening of a pain syndrome when chewing is noted that in certain cases forces the patient to refuse with external otitis meal. Increase in intensity of pains is characteristic at night in this connection there is a sleep disorder. Infiltration at limited external otitis can reach considerable volume. At the same time the furuncle completely blocks a gleam of acoustical pass and leads to decrease in hearing (relative deafness).
Opening of a furuncle at external otitis is followed by the expiration of pus from an ear and sharp reduction of a pain syndrome. However when opening a furuncle often there is an obsemeneniye of other hair follicles of acoustical pass to formation of multiple furuncles and development of the furunkulez differing in a persistent current and resistance to the carried-out therapy. Multiple furuncles at external otitis lead to a full obturation of acoustical pass and strengthening of clinical symptoms of a disease. Regionarny lymphadenitis develops. Emergence of puffiness in zaushny area and an auricle ottopyrivaniye is possible that demands a differentiation of external otitis from a mastoidit.
Diagnosis of limited external otitis
First of all the otolaryngologist performs inspection of an ear and an otoskopiya. During survey the doctor makes procrastination of an auricle that at external otitis leads to emergence of sharp pain in an ear. Developing of pain when pressing on a trestle of an ear speaks about localization of limited external otitis on a forward wall of acoustical pass. Sharp morbidity at a palpation behind an ear demonstrates that the furuncle settles down on the back and top wall of acoustical pass. At external otitis in the field of the lower wall the palpation over a corner of the lower jaw is sharply painful.
Otoskopiya at limited external otitis finds existence in acoustical pass of a furuncle. In an initial stage of external otitis the furuncle has an appearance of a swelling of red color. The ripened furuncle practically blocks acoustical pass, after its opening the otoskopiya reveals pus and existence of the crateriform opening at infiltrate top.
Audiometriya and a research of hearing determines by a tuning fork at patients with limited external otitis conductive type of relative deafness and a lateralization of sound carrying out towards the affected ear. For definition of the activator bacteriological crops of pus from a furuncle are carried out. It is necessary to differentiate limited external otitis from other types of otitis, epidemic parotitis, a mastoidit, eczema of an external ear.
Treatment of limited external otitis
Carry out a toilet of an external ear and processing of an affected area to stages of infiltration of limited external otitis by silver nitrate. Enter a turunda with antibacterial ointment into acoustical pass. The ear is dug in the ear drops containing an antibiotic (Neomycinum, and so forth). For removal of a pain syndrome appoint analgetics and anti-inflammatory medicines. UVCh-therapy application is possible. The ripened furuncle can be opened by means of a section. After its opening external acoustical pass is washed out solutions of antibiotics and anti-septic tanks.
At external otitis with multiple furuncles antibiotic treatment is shown. At confirmation of the staphylococcal nature of otitis apply anti-staphylococcal or a vaccine. For the purpose of increase in immunity vitamin therapy, immunokorregiruyushchy treatment, the UFOK or VLOK procedures, an autogemoterapiya is recommended.
Diffusion external otitis
Symptoms of diffusion external otitis
The diffusion form of external otitis begins with feeling of a raspiraniye, an itch and temperature increase in acoustical pass. There is soon a pain syndrome which is followed by irradiation of pain in all half of the head and its considerable strengthening during chewing. The expressed pain syndrome at diffusion external otitis leads to a sleep disorder and anorexia. Considerable puffiness of the inflamed walls of acoustical pass narrows its gleam and is the reason of decrease in hearing. Diffusion external otitis is followed by a small amount of allocations from an ear which at the beginning have serous character, and then become purulent. Increase in regionarny lymph nodes is noted. At the heavy course of a disease distribution of inflammatory process on an auricle and soft fabrics of parotid area is possible.
The sharp period of diffusion external otitis lasts 2-3 weeks. Then against the background of the carried-out treatment or there can spontaneously be a reduction of symptoms of a disease and an absolute recovery of the patient. Also diffusion external otitis can accept a long current and pass into a chronic form. Chronic external otitis is followed by formation of hems which reduce a gleam of acoustical pass and can become the reason of permanent decrease in hearing.
Diagnosis of diffusion external otitis
The expressed morbidity when pressing on a trestle, procrastination of an auricle, a palpation in zaushny area and over a corner of the top jaw testifies to the poured inflammation of acoustical pass. Otoskopiya at diffusion external otitis finds total reddening and puffiness of the integument covering acoustical pass, existence of erosion with serous separated. In later period of external otitis the obturation of acoustical pass because of the expressed hypostasis of its walls comes to light, the ulcers and cracks emitting chartreuse pus are visualized. Audiometriya testifies about existence of relative deafness on conductive type. Lateralization of a sound occurs to a sore ear. The bacteriological research separated from an ear allows to verify the activator and to establish its sensitivity to the main antibacterial medicines.
The differential diagnosis of diffusion external otitis is carried out with purulent average otitis, an ugly face, sharp eczema and a furuncle of acoustical pass.
Treatment of diffusion external otitis
Therapy of diffusion external otitis is carried out by system application of antibiotics, polyvitaminic and antihistaminic medicines. If necessary immunokorregiruyushchy treatment is performed. Local treatment of diffusion external otitis consists in maintaining in acoustical pass with yellow mercury ointment, Burov's liquid, antibacterial and hormonal ointments, an instillation of ear drops with antibiotics. Purulent character separated from an ear is the indication for washing of acoustical pass by solutions of antibiotics.
External otitis of a fungal etiology is treated by antifungal medicines system and locally applications.
Prevention of external otitis
For the prevention of infection of skin of acoustical pass with development of external otitis it is necessary to avoid combing of an auricle, traumatizing an ear and hit in it foreign matters. When bathing it is necessary to protect an ear from hit of water in it. It is impossible independently to try to remove at all a foreign matter of an ear as it often leads to traumatizing skin of acoustical pass. It is not necessary to clear an ear of sulfur the objects which are not intended for this purpose: hairpin, toothpick, match, paper clip, etc. The toilet of an ear has to be made by a special ear stick on depth no more, than 0,5-1 cm from the beginning of acoustical pass.