Otomikoz - a fungal infection of an ear which can affect structures of an external and middle ear, and also a postoperative cavity of a mastoidal shoot after a mastoidotomiya. Otomikoz has no specific symptoms. It can be shown by pain, noise and a congestion in an ear, decrease in hearing as conductive relative deafness, the expiration of allocations from external acoustical pass. The diagnosis of an otomikoz is exposed on the basis of data of the microscopic research separated from an ear and results of its crops on fungal environments; the otoskopiya and a research of hearing have auxiliary value. Treatment of patients with otomikozy is based on the general and local application of antimikotichesky means: klotrimazola, ketokonazola, nystatin, Burov's liquid, hinozol, etc.
According to the generalized data of the researches conducted in otolaryngology in the general structure of otitises makes 18% at adults and to 27% at children. In a moderate climatic zone the fungal etiology caused about 10% of external otitises. In the countries meets with roast and humid tropical climate considerably more often. Emergence of an otomikoz is equally possible at persons of both floors. At people of middle age it is observed a little more often than in other age categories. Risk group concerning development of an otomikoz are the people who are engaged in swimming, transferred a mastoidotomiya or using the hearing aid. As a rule, has unilateral character, only at 10% of patients with otomikozy bilateral defeat is noted.
Causes of an otomikoz
As the activator of an otomikoz the fungal flora of saprofitny character i.e. which normal is on various parts of the body and which is not showing virulent properties usually acts. Most often in dab from an ear at patients with otomikozy Aspergillus niger is defined. The second place in the countries with a temperate climate is taken by Candida mushrooms, and in the tropical countries — mold fungi of the sort Aspergillus: A.terreus, A.flavus and A.fumigatus. It should be noted that mushrooms of the sort Candida can be brought in an external ear at presence at the patient of genital candidiasis or candidiasis of skin. In some cases it is caused by actinomycetes or dermatophytes.
Foreign matters of an ear, ear injury, the increased sweating, constant combing of an auricle and acoustical pass at the itching dermatitis (allergic contact dermatitis, atopic dermatitis, eczema, a pochesukha) can become the reason of development of an otomikoz of an external ear. Pollution, the wrong hygiene or alkalization of the environment of external acoustical pass, its narrowness and existence of ekzostoz can cause . Emergence of an otomikoz is possible as a result of local dysbacteriosis — violation of healthy balance in saprofitny microflora of an ear that can be observed after the postponed otitises: external otitis, sharp average otitis, chronic purulent average otitis. Development of the dysbacteriosis leading to an otomikoz can be promoted by the general antibiotic treatment, washings of a middle ear and acoustical pass by antibiotics, metabolic frustration (diabetes), allergy, decrease in immunity.
Classification of an otomikoz
Otomikoz is classified by localization of inflammatory changes. It agrees with it allocate: external , mikotichesky average otitis, fungal miringit and a postoperative cavity. According to various data external occupies from 20 to 50% of all cases of an otomikoz. Average otitis of a fungal etiology makes 10-20% of otomikoz.
In the clinical current has 3 stages. The stage of harbingers is characterized by an itch and feeling of a congestion of an ear, sometimes without visible objective changes. The sharp stage of an otomikoz is followed by all signs of sharp inflammatory process: reddening, puffiness, pain, existence separated from an ear (otorey). The chronic stage of an otomikoz has less expressed inflammation symptoms, differs in a long and sluggish current with the periods of improvement and the repeating aggravations at which ear pains and renew.
Symptoms of an otomikoz
External usually begins with disappearance of the fatty film covering skin of acoustical pass that can be connected with the increased humidity and chronic microtraumatizing skin. At the same time some puffiness of acoustical pass is observed, there can be an obstruction of glands which are in his skin. In this stage the patient complains of an itch in an ear and its congestion. At emergence of such symptoms many people consider that there was a congestion of sulfur or pollution of external acoustical pass. Attempts to independently clear an ear various objects lead to violation of integrity of skin and penetration into it of a fungal infection. As a result the sharp stage of an otomikoz with the expressed hyperaemia and puffiness of skin of an external ear develops.
In a sharp stage of an otomikoz allocations from acoustical pass which volume gradually increases are observed. In certain cases because of the expressed puffiness there is a full overlapping of a gleam of acoustical pass that is followed by noise in an ear and the expressed relative deafness in connection with violation of carrying out sounds to an eardrum. External differs in quite intensive pain syndrome, amplifying when swallowing and shaving. The hyper secretion of mucous resulting from an inflammation leads to emergence of allocations from an ear. Together with separated from an ear there can be molds containing cells of epidermis and a mycelium of fungi.
Inflammatory process at an otomikoza of an external ear can be followed by regionarny lymphadenitis and extend to a temporal and mandibular joint and parotid gland. In most cases it is limited to skin of an external ear. But sometimes there is a penetration of a fungal infection into a cavity of a middle ear that is more often observed at patients with diabetes or leukemia.
Mikotichesky average otitis is usually observed as a result of accession of a fungal infection against the background of already existing inflammation of a drum cavity — chronic purulent average otitis. At the same time patients note the deterioration in the state which is characterized by emergence of intensive pain in an ear and plentiful separated, still big decrease in hearing, increase in noise and a congestion in an ear, a periodic headache.
Fungal miringit arises at distribution of fungal defeat from skin of acoustical pass on an eardrum. Fungal miringit is followed by the decrease in hearing caused by violation of mobility of an eardrum.
Otomikoz of a postoperative cavity is observed at patients to whom the radical mastoidektomiya — removal of cells of a mastoidal shoot was carried out at a purulent mastoidit. At the same time strengthening of pain in zaushny area and in an ear, excessively increased volume separated is noted. Postoperative can arise also after a timpanoplastika. It is promoted by long stay in acoustical pass of a tampon which is irrigated every day with the combined solution containing a glucocorticosteroid and an antibiotic. It is characteristic that most of patients with a postoperative otomikoz do not complain of ear pain, including it the normal state after the undergone operation.
Diagnostics of an otomikoz
The main role in diagnostics of an otomikoz belongs to a microscopic and cultural research of dab or separated from an ear. The otomikoza speaks well detection of threads of a mycelium and a dispute at microscopy, growth of colonies, characteristic of mushrooms, at crops. At candidiasis the microscopy reveals a large number of a pseudo-mycelium and the budding blastospor. Black color a dispute and a raid of colonies testify about existence in the material Aspergillus niger. However, in connection with saprofitny character of fungal flora, its allocation in crops cannot unambiguously indicate existence of an otomikoz. In turn lack of growth of mushrooms at crops can be connected with violation of correctness of an intake of material, its capture in insufficient quantity or not from the main center. Therefore laboratory diagnostics of an otomikoz can be considered only in total with clinical and anamnestichesky yielded, results of an otoskopiya and mikrootoskopiya. In certain cases precisely an otomikoz only trial antifungal therapy allows to establish or exclude the diagnosis.
At an external otomikoz the otoskopiya reveals moderate reddening and infiltration of skin of external acoustical pass, existence in it of pathological allocations and molds from the surface of skin. At a fungal miringit puffiness and reddening of an eardrum, a mycelium congestion is defined on its surfaces, disappearance of a light reflex. Otomikoz of a middle ear is characterized by perforation of an eardrum through which leaves pathological separated and the expanded granulyatsionny fabric prolabirut.
Diagnosis of a hearing disorder at patients with otomikozy includes: inspection with a tuning fork, a simple and threshold audiometriya, an acoustic impedansometriya, a research of passability of an acoustical pipe, otoakustichesky issue.
Treatment of an otomikoz
Therapy of an otomikoz consists in use of antimikotichesky medicines. First of all local antifungal treatment which consists in washing of a middle ear, external acoustical pass or a postoperative cavity of a mastoidal shoot solutions of antimikotichesky medicines is carried out: amfoteritsiny, hinozoly, Burov's liquid, klotrimazoly, nistatity, Castellani's liquid, etc. Washings at an otomikoza are made after an ear toilet — its cleaning of slushchenny epidermis, allocations, ear sulfur and a mycelium of fungi.
Antimikotichesky treatment of an otomikoz has to be followed by the actions directed to elimination of provocative factors, increase in immune forces of an organism and normalization of microflora of an ear. For this purpose appoint vitamin therapy and the all-strengthening treatment, whenever possible make cancellation of antibiotics, carry out treatment of background diseases. Because activators of an otomikoz have considerable allergenic properties, the desensibilizing therapy and use of the antimikotichesky means which are not leading to allergic reaction is necessary.
The general antifungal therapy is appointed in case of a recurrence of an otomikoz, at impossibility of cancellation of antibacterial therapy or elimination of provocative factors (for example, humidity, nekorregiruyemy increase in sugar of blood, an immunodeficiency at HIV infection). As a rule, at an otomikoza use medicines with fungicide activity: , or . As at an otomikoza the mixed character of microflora is often observed, in its treatment apply fungal and bacterial medicines which besides antifungal and antibacterial effect have anesthetic and anti-inflammatory effect.
Forecast of an otomikoz
Though treatment of an otomikoz is rather complex challenge, the forecast of a disease in most cases favorable. If during treatment it is possible to eliminate the contributing factor of an otomikoz and to pick up effective antimikotichesky medicine, then there comes the absolute recovery of the patient. At localization of an otomikoz on average to fish soup as a result of adhesive processes and development of adhesive average otitis decrease in hearing can have irreversible character.
In hard cases can become the reason of widespread mycosis of internals and fungal sepsis. Existence of a postoperative cavity worsens the forecast. According to some information about 15% of patients with postoperative mycosis suffer from a recurrence of a fungal inflammation.