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Otitis – an acute or chronic inflammation in various departments of an ear (external, average, internal). It is shown by the ear pain (pulsing, shooting, aching), the increased body temperature, a hearing disorder, noise in ears, mucopurulent allocations from external acoustical pass. Constitutes danger in development of complications: chronic relative deafness, irreversible loss of hearing, paresis of a facial nerve, meningitis, inflammation of a temporal bone, brain abscess.

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    Otitis

    Otitis – an acute or chronic inflammation in various departments of an ear (external, average, internal). It is shown by the ear pain (pulsing, shooting, aching), the increased body temperature, a hearing disorder, noise in ears, mucopurulent allocations from external acoustical pass. Constitutes danger in development of complications: chronic relative deafness, irreversible loss of hearing, paresis of a facial nerve, meningitis, inflammation of a temporal bone, brain abscess.

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    Ear anatomy

     The human ear consists of three departments (an external, middle and inner ear). The external ear is formed by an auricle and the acoustical pass which is coming to an end with an eardrum. The external ear catches sound vibrations and directs them to a middle ear.

    The middle ear is formed by a drum cavity which is between an opening of a temporal bone and an eardrum. Function of a middle ear – carrying out a sound. In a drum cavity three sound stones are located (a hammer, an anvil and ). The hammer is attached to an eardrum. The membrane fluctuates at impact on it of sound waves. Fluctuations are transferred from an eardrum to an anvil, from an anvil - to a stremechka, and from a stremechka – to an inner ear.

    The inner ear is formed by difficult system of channels (snail) in the thickness of a temporal bone. The interior of a snail is filled with liquid and covered by special voloskovy cages which will transform mechanical oscillations of liquid to nervous impulses. Impulses on an acoustical nerve are transferred in the relevant departments of a brain. The structure and functions of departments of an ear significantly differ. Inflammatory diseases in all three departments proceed too differently therefore allocate three types of otitises: external, average and internal.

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    External otitis

    External otitis can be limited or poured, in some cases extends to an eardrum, meets at elderly patients more often. Results from a mechanical or chemical injury of an ear. The patient with external otitis shows complaints to the pulsing ear pain which gives to a neck, teeth and an eye, amplifies at a conversation and chewing. Objectively reddening of acoustical pass, and sometimes – an auricle comes to light. Hearing is broken only when opening an abscess and filling acoustical pass with pus.

    Treatment of external otitis consists in introduction to acoustical pass spirit and washing by dezintsifiruyushchy solutions. Abscesses open. To the patient appoint physiotreatment (UVCh, ), at the expressed inflammation carry out antibiotic treatment.

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    Average otitis

    One of the most widespread diseases of ENT organs. Every fourth patient of the otolaryngologist – the patient with sharp or chronic average otitis. People of any age can be ill, however average otitis much meets at children under 5 years more often.

    Reasons of average otitis

    Average otitis can be caused by various pathogenic microorganisms: bacteria, viruses, mushrooms () and various microbic associations. Most often viruses of flu and a SARS, a pneumococcus and a hemophilic stick act as the infectious agent at average otitis. Recently increase in number of cases of fungal average otitis is noted.

    Mechanism of development of average otitis

    Pressure in a cavity of a middle ear to equally atmospheric is normal. Alignment of pressure and ventilation of a drum cavity is carried out by means of the Eustachian tube connecting a drum cavity to a throat.

    Some states (the strengthened formation of slime in a nasopharynx, "shmyganye" a nose, pressure difference during descent to depth at divers, etc.) lead to the fact that passability of an Eustachian tube is broken. Change of pressure in a drum cavity leads to the fact that cells of a mucous membrane of a cavity of a middle ear begin to produce inflammatory liquid actively. Increase in amount of liquid causes pain and a hearing disorder.

    The infection gets into a middle ear tubarno (through an Eustachian tube), transmetaalno (through an eardrum at its traumatic damage), a hematogenic way (with blood current at scarlet fever, measles, flu or typhus) or retrogradno (from a cavity of a skull or a mastoidal shoot of a temporal bone).

    Microbes quickly breed in inflammatory liquid then average otitis becomes purulent. Pressure in a cavity of a middle ear sharply increases, the eardrum is broken off, and pus begins to be emitted outside on acoustical pass.

    Risk factors

    Average otitis seldom develops as an independent disease. In overwhelming number of cases is a complication of diseases of other ENT organs of inflammatory character. Allocate the general and local factors increasing risk of development of otitis.

    • Local risk factors of development of average otitis

    Inflammatory and allergic diseases of a nose and nasopharynx cause hypostasis of mucous, leading to deterioration in passability of Eustachian tubes. The microbes getting from the inflammation center into a middle ear increase risk of development of purulent otitis. The states after surgical interventions in a nasopharynx and a nasal cavity which are followed by deterioration in passability of Eustachian tubes also concern to group of local risk factors.

    Otitis develops at children more often that is caused by features of an anatomic structure of a children's middle ear. An Eustachian tube at children already, than at adults therefore the probability of violations of its passability increases. At children the adenoides squeezing an Eustachian tube often increase. Children often have a SARS and other catarrhal diseases, often cry and at the same time actively sniff.

    • General risk factors of development of otitis

    The probability of development of otitis increases at the congenital and acquired immunodeficiency.

    Symptoms of average otitis

    The expressed hyperthermia which is followed by the shooting ear pain is characteristic of sharp average otitis. Children who are not able to speak yet cry when strengthening pain and calm down at its subsiding.

    In 1-3 days from the moment of the beginning of a disease the gap in an eardrum is formed, the gnoyetecheniye begins. The condition of the patient at the same time improves. Body temperature is normalized, ear pains decrease or disappear. In the subsequent the gap in an eardrum begins to live and does not cause deterioration in hearing.

    At adverse development of a disease pus can break not outside, and inside, spreading in a cavity of a skull and leading to development of abscess of a brain or meningitis. As the disease is fraught with emergence of dangerous complications, at the first symptoms of sharp otitis it is necessary to see a doctor.

    • Chronic average otitis

    As a rule, is an outcome of sharp purulent otitis. Allocate two forms of chronic purulent average otitis which differ both on weight, and on a clinical current.

    In 55% of cases chronic average otitis proceeds in the form of a mezotimpanit at whom inflammatory process covers a mucous membrane of area of an acoustical pipe, the lower and average departments of a drum cavity. The eardrum has a perforative opening in the lower part. A part of a membrane remains tense.

    At a mezotimpanita patients show complaints to a hearing impairment, the continuous or periodic expiration of pus from an ear, is extremely rare – on dizziness and noise in an ear. Pains develop only in the period of an exacerbation of otitis, in some cases are followed by a hyperthermia. Mezotimpanit flows rather favorably and rather seldom becomes the reason of development of heavy complications. Extent of decrease in hearing is defined by safety of function of acoustical stones and activity of inflammatory process.

    The chronic average otitis proceeding in the form of a purulent epitimpanit mainly affects nadbarabanny space. The perforative opening is located in the top part of an eardrum therefore natural drainage of a cavity often happens insufficient. Weight of a current is caused also by features of an anatomic structure of this area which abounds with twisting narrow pockets.

    The temporal bone is quite often involved in inflammatory process, at the same time pus becomes fetid. Patients complain of pressure sense in an ear, periodic pains in temporal area, sometimes – on dizziness. This form of chronic otitis, as a rule, is followed by a sharp hearing impairment.

    Both forms of chronic average otitis can proceed with prevalence of these or those pathological processes.

    Chronic catarrhal average otitis can develop at a chronic evstakhiit, after the postponed scarlet fever or the postponed sharp otitis. Sometimes has the allergic nature. In the absence of suppuration proceeds rather favorably.

    Chronic purulent average otitis usually is the result of the dragged-out sharp process and develops against the background of decrease in immunity. At good drainage of a drum cavity the gnoyetecheniye from an ear sometimes is not followed by other symptoms. The erased clinical symptomatology leads to the fact that patients seldom ask for the help. Purulent process tends to gradual distribution, can strike acoustical stones, a periosteum, surrounding bone structures and a labyrinth.

    Sharp and chronic purulent otitis can be complicated by development of chronic adhesive average otitis. At adhesive otitis in a drum cavity the solderings leading to decrease in hearing are actively formed. Adhesive otitis quite often proceeds malosimptomno, and patients do not connect the pouring sweats appearing in the period of an aggravation, oznoba and a hyperthermia with an ear disease. At adhesive otitis development of complications is possible.

    Complications of average otitis

    Sharp average otitis can become complicated mastoidity (an inflammation of a mastoidal shoot of a temporal bone), brain abscess, labirintity (an inflammation of an inner ear), meningitis, thrombosis of sine of a brain and sepsis. At a purulent epitimpanit often there is a holestetoma – the tumoral education consisting of products of disintegration of epidermis. Holestetoma destroy a temporal bone, form granulations and polyps.

    Chronic average otitis can become the reason of injury of the facial nerve passing in a drum cavity. Neuritis of a facial nerve is followed by a smoothness of a nasolabial fold, omission of a corner of a mouth and lagoftalmy (an eye on the party of defeat is not closed). At chronic average otitis (a purulent epitimpanit), as well as at sharp otitis, can develop labirintit, meningitis or an encephalomeningitis, brain abscess, a sine thrombosis and epiduralny abscess.

    Diagnosis of average otitis

    The diagnosis of sharp average otitis is based on data of the anamnesis, results of an otoskopiya and characteristic symptoms (the general intoxication, ear pain, a gnoyetecheniye). For definition of sensitivity of microflora carry out separated from an ear.

    At chronic average otitis for assessment of a condition of bone structures in addition to the listed researches the X-ray analysis of a temporal bone is carried out. On an otoskopiya at chronic otitis turbidity and sharp retraction of an eardrum comes to light. The handle of a hammer seems shortened. Localization of a perforative opening is defined by an otitis form.

    Treatment of average otitis

    • Therapy of sharp average otitis

    Recommend to patients with sharp average otitis a bed rest, carry out antibacterial therapy, at a hyperthermia appoint febrifugal. Locally apply physical therapy (UVCh, ) and the warming compresses. For reduction of a pain syndrome in an ear dig in warm 96% alcohol (only until emergence of pus). If the drum cavity is not drained independently within the first three days, the eardrum section is shown. In case after scarring of an eardrum decrease in hearing remains, appoint blowing off, UVCh and pneumatic massage.

    • Therapy of chronic average otitis

    Paramount task – to provide sufficient drainage of a drum cavity. For this purpose delete polyps and granulations from a cavity of a middle ear. The cavity is washed out, enter proteolytic enzymes into it. To the patient appoint sulfanylamides and antibiotics, carry out immunity correction, sanify the infection centers in ENT organs. At suspicion of allergic otitis use antihistamines. The place apply an electrophoresis, microwave therapy.

    In the absence of effect carry out (form an opening in the field of a mastoidal shoot of a temporal bone and with the subsequent drainage). At holesteatoma, distribution of process on a bone and internal structures surgical removal of the center of an inflammation is shown. If there is an opportunity, the sound carrying out structures keep if is not present – carry out a timpanoplastika. At a safe drum ring restoration of an eardrum (miringoplastik) is possible.

    Prevention of average otitis

    Preventive measures include normalization of the immune status, the prevention of a SARS and other infectious diseases of ENT organs. Patients with chronic otitis have to protect acoustical pass from overcooling and hit of water.

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    Internal otitis (labirintit)

    Has the bacterial or virus nature. Usually is a complication of average otitis or meningitis.

    Characteristic symptom of internal otitis – the sudden heavy attack of dizziness developing 1-2 weeks later after an infectious disease. The attack can be followed by nausea or vomiting. Some patients with internal otitis show complaints to noise in an ear or decrease in hearing.

    Internal otitis needs to be differentiated from brain diseases which can cause dizziness. For an exception of tumors and strokes it is carried out by brain MPT and KT. The elektronistagmografiya and a special research for assessment of the acoustical answer of a trunk of a brain is carried out. For identification of acoustical violations the audiometriya is carried out.

    Treatment of internal otitis, generally symptomatic. For elimination of nausea and vomiting appoint antiemetic medicines (), antihistamines (, , ). Locally use skopolaminovy plasters. To reduction of an inflammation apply steroids (methylprednisolonum), to removal of concern – sedatives (lorazepam, diazepam). At internal otitis of the bacterial nature antibiotic treatment is shown. Disease symptoms, as a rule, gradually disappear within one or several weeks.

    At inefficiency of conservative treatment of internal otitis carry out surgery: labirintotomiya, opening of a pyramid of a temporal bone, etc.

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    Otitis - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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