Otoantrit — a combination of an acute purulent inflammation of a middle ear to inflammatory process in a cave of a mastoidal shoot (atruma). Develops at children up to 2 years as a complication of sharp average otitis. Depending on a clinical picture distinguish obvious otoantrit, followed by the strengthened gnoyetecheniye and inflammatory changes in zaushny area, and latent otoantrit at which the general symptoms and violations from somatic systems of an organism prevail. Diagnostic actions concerning an otoantrit include an otoskopiya, a X-ray analysis, diagnostic an eardrum, . Treatment of an otoantrit consists in antibiotic treatment, a medical paratsentez, improvement of drainage function of an acoustical pipe. At its inefficiency the antrotomiya is shown.
Emergence of an otoantrit is connected with distribution of inflammatory process at average otitis of a drum cavity in — a cave of a mastoidal shoot, the entrance to which is located in a back wall of a drum cavity. Otoantrit meets at chest and early children's age. The children's otolaryngology carries otoantrit to complications of sharp purulent average otitis. However some authors point that at small children purulent otitises practically are always followed by an inflammation of an antrum. It is connected with immaturity of pneumatic system of a mastoidal shoot. The diagnosis of an otoantrit is established to children of the first two years of life. At more advanced age the disease is treated as an inflammation of a mastoidal shoot — mastoidit.
Causes of an otoantrit
Etiologichesky factor of emergence of an otoantrit is also pathogenic microflora which was the reason of sharp average otitis. Most frequent it is Streptococcus pneumoniae, Streptococcus heamoliticus, Haemophilus influenzae. The local factors favoring to development of an otoantrit are age features: the increased blood supply of a bone, a wide entrance in , bystry development of hypostasis mucous at an inflammation, the immaturity of a vibrating epithelium of an acoustical pipe leading to a delay of inflammatory exudate in a drum cavity.
Spread of an infection to a cavity of an antrum with development of an osteoantrit can be promoted by the weakened condition of an organism of the child as a result of a hypotrophy, rickets, diathesis; frequent SARS, bronchitis, pneumonia; gastrointestinal diseases (sharp gastroenteritis); the got patrimonial trauma, prematurity, artificial feeding; the diseases transferred mother during pregnancy (toxicosis of pregnant women, flu, measles, a rubella and so forth). Emergence of an otoantrit can be connected with high virulent properties of the activators causing a disease even against the background of the normal state of protective forces of an organism of the child. Besides, otoantrit can become result of inadequate therapy of average otitis (irrational antibiotic treatment, overdue an eardrum).
Symptoms of an otoantrit
Depending on expressiveness of clinical manifestations distinguish 2 forms of an otoantrit. Otoantrit with a bright clinical picture it is classified as obvious. The hidden course of a disease without the expressed symptomatology is carried to a latent form of an otoantrit.
Obvious otoantrit, as a rule, arises for the 10-14th day of sharp average otitis. Its beginning actually falls on the recovery period after the postponed otitis and is characterized by sharp deterioration in a condition of the child. During an initial stage of an obvious otoantrit temperature increase of a body, emergence of symptoms of intoxication, sleep disorder and appetite is noted. The child is uneasy and cries much. At an obvious otoantrit the quantity purulent separated from an ear considerably increases. The symptom of "tank" - bystry emergence of pus in external acoustical pass, after its removal is characteristic. Reddening and infiltration of skin of zaushny area, local increase in its temperature in comparison with surrounding fabrics is typical for an obvious form of an otoantrit. Because of puffiness of fabrics the zaushny fold smoothes out. In certain cases the otoantrita behind an ear is noted a swelling and fluctuation.
Latent otoantrit usually develops at children with serious associated diseases and closely correlates with their expressiveness. Some authors also consider what latent otoantrit can be result of the "masking" effect of the antibiotic treatment which is carried out at treatment of average otitis. The bilateral nature of defeat is characteristic of a latent otoantrit. At the same time the local symptomatology is practically absent or is poorly expressed. The Zaushny area remains painless, without visible changes. Gnoyetecheniye is not observed. In a clinical picture of a latent otoantrit the system violations (bronchopulmonary, digestive, cardiovascular, neurologic) proceeding against the background of the general intoxication and a high hyperthermia which is followed by dehydration prevail.
Depending on the nature of violations latent otoantrit can be shown by the speeded-up chair, vomiting, a diarrhea, intestines paresis, tsianotichesky coloring or pallor of integuments. From cardiovascular system tachycardia, muting of tones of heart, expansion of warm borders, changes of the ECG is possible. From TsNS at a latent otoantrit the giperesteziya, an adinamiya, vomiting, independent of meal, positive meningealny signs, an anizokoriya, a tremor of extremities, spasms, confusion of consciousness can be noted. Pathology of respiratory system is shown by cough and plentiful dry rattles in lungs.
Complications of an otoantrit
The long current of an otoantrit at its resistance to the performed conservative therapy can lead to a pus congestion in a cavity of an antrum and to its break through even drum and mastoidal crack, open at the child. Thus the purulent inflammation passes into a kortikalny layer of a temporal bone therefore subperiostalny abscess — the local purulent destruction of a bone tissue which is a serious complication of an otoantrit is formed.
Diagnostics of an otoantrit
In case of an obvious otoantrit diagnostics does not cause difficulties. It is based on complaints, data of the anamnesis (the previous sharp average otitis), existence of characteristic local symptomatology and results of additional researches. Diagnostics of a latent otoantrit, on the contrary, is very difficult and demands joint participation of the otolaryngologist and the pediatrician.
The Otoskopichesky picture of an obvious otoantrit is characterized by existence of perforation of an eardrum through which mucous, similar to granulyatsionny fabric, is visible. The corner smoothness between a zadneverkhny wall of acoustical pass and an eardrum is noted. Otoskopiya at patients with a latent otoantrit reveals turbidity of an eardrum and insignificant reddening in zadneverkhny department. In the field of the zadneverkhny angle of acoustical pass at a mikrootoskopiya the inflammatory roller is sometimes observed.
The radiological research at suspicion on otoantrit carry out transorbitalno for visualization of both mastoidal shoots and a possibility of their comparison at once. Decrease in lightness of a cave and change of its contour on the roentgenogram is characteristic of an otoantrit. Normal lightness of an antrum not always speaks about lack of an otoantrit as it can be result of destruction of cavernous cages.
At suspicion on latent otoantrit resort to a diagnostic paratsentez — an eardrum puncture. Diagnostic lack of "crunch" at the time of a puncture is significant that testifies to an eardrum infiltrirovannost. Gnoyetecheniye from the formed opening at a latent form of an otoantrit can begin in several hours or even days after a puncture. When receiving exudate make its bacteriological research.
In certain cases the otoantrita with the diagnostic purpose can be carried out an antropunktion — introduction of a needle through a bone to a cave cavity. Gnoyetecheniye from a needle when carrying out this inspection is confirmation of the diagnosis. However lack of pus not always disproves the diagnosis of an otoantrit as it can be caused by its too dense consistence which is not allowing to pass through a needle. Carrying out an antropunktion is dangerous by hit of a needle in an average cranial pole or a sigmovidny sine.
Treatment of an otoantrit
The basis of therapy of an otoantrit is made by effective antibiotic treatment and creation of good outflow purulent separated from an ear. Application of antibiotics according to results of definition of sensitivity to them the microflora revealed during a bakposev is necessary. In treatment of an otoantrit the most admissible doses of antibacterial medicines are appointed and the combined therapy is often applied: antibiotic + sulfanylamide.
Improvement of outflow of pus at patients with an obvious otoantrit is carried out by expansion of perforation of an eardrum and removal of a part of the mucous membrane which is in an opening gleam. At patients with hidden otoantrity make for outflow of pus with the subsequent expansion of the formed opening. In parallel carry out the actions directed to improvement of removal of pus on an acoustical pipe. Local treatment of an otoantrit can be carried out during an antropunktion and consists in washing of a cavity of an antrum and introduction of solutions of antibiotics to it.
Lack of improvement against the background of the carried-out conservative therapy of an otoantrit within 7-10 days, formation of subperiostalny abscess are the indication to surgical treatment. The antrotomiya — opening and drainage of an antrum, and also opening of abscess is carried out.