Post-traumatic otitis media treatment. Questions. Other forms of otitis media

Based on the nature of occurrence and clinical course, two groups of traumatic mastoiditis can be distinguished. The first group includes inflammation of the mastoid process, which develops as a result of a fracture of the base of the skull and the walls of the tympanic cavity. Sometimes there may not be perforation of the eardrum; suppuration from the ear appears a certain period after the injury. Mastoiditis represents the further development and spread of purulent otitis, thus a secondary disease, and differs little from ordinary mastoiditis. However, fractures of the walls of the tympanic cavity facilitate the passage of infection into the skull. IN clinical picture Mastoiditis is usually dominated by symptoms of damage to the central nervous system. These patients do not end up in otolaryngology departments; often their ears are not even examined. Local changes usually do not have time to develop due to the rapid death of such patients.
Ulrich (1926) studied a lot of material surgical clinic. Only 2 patients progressed to mastoiditis and surgery.
Primary mastoiditis includes those when the injury directly damages mastoid. The most common type of such injury is a gunshot wound, a more rare type is a blunt blow with a fracture or damage to the appendix. In this group there is a closer relationship between the intensity of the injury and the nature of the lesion than in the first group. The degree of pneumatization of the mastoid process plays a known role.
Closed injuries are observed when the integrity of the soft tissue is not broken. The lesion may be limited only to the periosteum or cortical layer, but may also affect the process or temporal and even adjacent bones.
A distinctive feature of the second type is the introduction of infection into the damaged tissue of the appendix. Hemorrhages and sequestration create favorable conditions for the development of the inflammatory process. Infection of the appendix is ​​manifested by a number of clinical signs. Blunt blow to mastoid the process can cause partial or complete destruction and at the same time a fracture of the base of the skull.
Primary mastoiditis is often observed when wounded by shrapnel in war time; in case of occupational injury - rarely. Considering the significant interest of these cases, we present our following observations.
Sick D. A month ago - hit on the head with a felled tree. Loss of consciousness. Bleeding from both ears and nose. Vomit. Peripheral paralysis of the right facial nerve.
Upon admission to the clinic: complaints of pain behind the ear, purulent discharge from the right ear and decreased hearing. Severe headache, insomnia. Right ear: central perforation of the eardrum, copious purulent discharge. Soreness mastoid process when pressed. Weber to the right. Rinne - negative, whisper 0.2 m, sharp decrease in perception of all tuning forks, vestibular apparatus without changes.
On the radiograph: cells of the right mastoid process have an unclear structure and are poorly differentiated; a fracture of the base of the skull is not visible.
A week later, temperature 39°, sharp pain behind the ear; operation: the cortical layer is bluish in places, the bone is soft, easily removed with a spoon; pus and granulations; sequestra extending all the way to the dura mater were removed. Subsequently the flow is smooth. After 1.5 months, the facial nerve is restored.
Paresis of the facial nerve apparently developed as a result of an inflammatory process or hemorrhage into the canal, and not as a result of direct damage. This is supported by the relatively rapid restoration of its functions.
The large destruction found during the operation is largely due to the pneumatic type of structure of the process and the thinness of the cortical layer. With this structure, the local destructive effects of injury are more pronounced.
Patient A., 45 years old. A month and a half ago, a car wing hit my left ear. The auricle was crushed and the skin of the mastoid process was damaged. Bleeding from the ear. I didn’t lose consciousness. At the Sklifosovsky Institute of Emergency Medicine, most of the shell was removed and sutures were placed on the skin.
Upon admission: a large defect of the auricle, the bone of the posterior wall of the auditory canal is exposed over a considerable length, and is mobile during probing; fistula tract; the external auditory canal is deformed. The eardrum cannot be seen. Copious discharge of a bloody-purulent nature. The soft tissues of the mastoid process are inflamed. Hearing in the left ear is reduced. Tuning fork S4o9b does not perceive. Rinne's experience is negative. Accented whispered speech at the sink. Statics and kinetics - no changes.
Radical surgery of the left ear: the bone is a dirty green color; several sequestra, a large sequester includes almost the entire posterior wall of the ear canal, pus and granulations.
This patient has a primary traumatic mastoiditis. Open damage, destruction of bone tissue and sequestration created favorable conditions for the introduction of infection and the development of the inflammatory process.
Patient D.S., 21 years old, wagon coupler. During the coupling, he was hit on the right cheek bone by an iron bracket and was pressed against the carriage with the crown of his head. Damage to soft parts in the cheekbone area, bleeding. I didn’t lose consciousness. At the Sklifosovsky Institute of Emergency Medicine, bone fragments were removed and stitches were applied.

Acute otitis media is an acute inflammatory process that can develop in all parts of the ear, but in most cases this term refers to acute inflammation of the middle ear, i.e. acute otitis media.

Source: gorlonos.com

The ear is a complex organ that not only perceives sound vibrations, but is also responsible for the position of the body in space and the ability to maintain balance. The ear consists of three sections - outer, middle and inner. The outer ear is formed by the pinna and the auditory canal, which ends at the eardrum. The function of the outer ear is to capture sound signals and transmit them further to the structures of the middle ear. The middle ear consists of the tympanic cavity located between the eardrum and the opening of the temporal bone. The tympanic cavity contains the ossicles (hammer, incus and stapes). The function of this part of the ear is to conduct sound. The middle ear cavity is connected to the nasopharynx by the Eustachian tube, through which the pressure in the tympanic cavity and external atmospheric pressure are equalized.

The inner ear is formed by a system of canals (cochlea) located in the temporal bone. The cochlea is filled with fluid and lined with hair cells that convert mechanical vibrations of the fluid into nerve impulses, entering the corresponding parts of the brain along the auditory nerve. The function of the inner ear is to provide balance. Inflammation of the inner ear (otitis media) is usually called labyrinthitis.

A differential diagnosis of acute internal otitis with brain pathologies that can cause dizziness, including neoplasms, is required.

Acute otitis media can occur at any age, but children are more susceptible to it - in them it is the most common otorhinolaryngological disease. In the first years of life, about 80% of children experience acute otitis media, and by the age of 7 – up to 95%. In approximately 30% of cases, otitis media suffered in childhood is the cause of hearing loss in adults.

Causes and risk factors

The causative agents of acute otitis are most often staphylococci, pneumococci, Haemophilus influenzae, Klebsiella, Pseudomonas aeruginosa, Moraxella, microscopic yeast-like fungi of the genus Candida, and influenza virus.

Risk factors include:

• infectious and inflammatory diseases of the ENT organs;
• mechanical or chemical injuries to the ear;
• presence of a foreign body in the ear;
• water getting into the ear;
• improper ear hygiene;
• operations on the nasal cavity and/or nasopharynx;
• childhood and old age.

Forms of the disease

Depending on the nature of the inflammation of the middle ear, acute catarrhal otitis and acute purulent otitis are distinguished.

By origin, acute otitis occurs in the following forms:

• bacterial;
• viral;
• fungal (otomycosis).

Spicy otitis externa may be limited and diffuse.

Limited external otitis manifests itself in the form of inflammation of the hair follicle or the development of a boil in the external auditory canal.

Stages of the disease

The clinical picture of acute otitis includes the following stages:

1. Catarrh.
2. Purulent inflammation, which, in turn, is divided into pre-perforation and perforation stages.
3. Recovery or transition to a chronic form.

Source: okeydoc.ru

Symptoms of acute otitis depend on the form of the disease.

In acute otitis media, intense shooting pain in the ear, a feeling of ear fullness, and hearing loss first appear.

Local symptoms are accompanied by general malaise: weakness, lethargy, increased body temperature - usually to subfebrile, but sometimes to febrile levels. In some cases, acute inflammation of the middle ear is accompanied by a sore throat, nasal congestion, and nasal discharge.

Children in the first years of life with acute otitis media refuse to eat, as pain in the ear intensifies when sucking and swallowing. In addition, in children, acute otitis media is often accompanied by regurgitation, vomiting, and diarrhea.

A few days after the onset of the disease, the eardrum perforates and the serous (catarrhal otitis) and then purulent (in some cases bloody) contents leak out. At the same time, the patient's general condition improves. Body temperature returns to normal, ear pain subsides. Suppuration usually lasts no more than a week. After scarring of the perforation, hearing is usually restored. In the case of an unfavorable course of the disease, purulent exudate may not pour out, but spread into the cranial cavity with the subsequent development of meningitis or brain abscess. Spicy otitis media lasts on average 2-3 weeks.

In the absence of timely adequate treatment, acute otitis may become chronic, which is associated with high risk the appearance of hearing loss.

Acute internal otitis (labyrinthitis) is characterized by severe attacks of dizziness, which are accompanied by nausea, vomiting, tinnitus, and hearing impairment. Labyrinthitis in most cases is a complication of acute otitis media, so the appearance of vestibular disorders in acute otitis media should alert us to the deepening of the inflammatory process.

Source: okeydoc.ru

The manifestation of acute limited external otitis is first itching, and then pain in the ear canal, which can radiate to the upper and lower jaw, temple, and back of the head. The pain intensifies when chewing, as well as at night. Limited external otitis manifests itself in the form of inflammation of the hair follicle or the development of a boil in the external auditory canal. A boil can completely block the lumen of the ear canal, which causes hearing loss. When the boil is opened and its contents drain, the pain subsides and the patient's condition improves.

In acute diffuse external otitis, patients complain of a feeling of fullness, itching, and then severe pain in the ear, which intensifies during conversation, when chewing food, and palpation of the ear. There is hyperemia of the ear canal, its swelling and slit-like narrowing, and enlargement of regional lymph nodes. Discharge from the ear in acute diffuse external otitis is usually scanty, initially serous, and then purulent. The inflammatory process may spread to the soft tissues of the parotid region and the auricle.

To determine acute otitis, a history and complaints are collected, an objective examination is carried out, and, if necessary, instrumental and laboratory diagnostic methods are used.

If acute otitis is suspected, otoscopy is usually performed, which makes it possible to examine the eardrum, detect its thickening, hyperemia, injection, protrusion or perforation. X-ray examination of the temporal bones reveals a decrease in pneumatization of the middle ear cavities. Tympanometry is used to determine the ability of the eardrum and auditory ossicles to conduct auditory pressure waves. Audiometry is indicated to identify hearing impairment.

Acute inflammation of various parts of the middle ear, caused by trauma - a blow, a gunshot wound, a blast wave, along with the usual picture of inflammation, has features of the course that must be taken into account in diagnosis and treatment.

In case of these injuries, first of all it is necessary to recognize and evaluate damage to the skull, brain, spine and, depending on this, determine further diagnostic and treatment tactics together with a neurologist and neurosurgeon. The presence of symptoms of a fracture of the base of the skull or spine indicates the need for immediate fixation of the patient’s head and body. Ear injury is accompanied by rupture of the eardrum, which can lead to secondary infection of the tympanic cavity and the development of acute otitis media.

If the eardrum is intact after injury, infection can penetrate through the auditory tube. A decrease in tissue reactivity after injury can lead to the development of mastoiditis. An open wound of the mastoid process is always infected. In this regard, it is possible for the infection to spread into the tympanic cavity with the development of acute inflammation. Primary surgical treatment is always necessary for an open wound. Turunda is loosely introduced into the ear canal with boric alcohol; antibacterial therapy is prescribed.

A blast wave is always accompanied by a sharp increase in air pressure in the external auditory canal, which causes perforation of the eardrum and, in the very near future, acute otitis media. Since there is no accumulation of pathological discharge in the tympanic cavity (it flows out through the perforation), the pain in the ear is mild, the body temperature is low-grade or normal, and the reaction in the blood is insignificant. Discharge from the ear is initially serous-bloody, and then mucous. A sharp decrease in hearing indicates damage to the inner ear, as does dizziness, spontaneous nystagmus, which can be both peripheral (unilateral) and central (bilateral).

Treatment always involves the use of antibiotics. Imaginary well-being should not be a reason to stop treatment.

The development of gunshot mastoiditis is characterized by the fact that immediately from the moment of injury the bone is involved in the inflammatory process. Due to the open wound, the outflow of contents is usually good. The presence of cracks and fractures in the walls of the process contributes to the spread of infection to the contents of the skull and the development of intracranial complications.

Treatment for gunshot mastoiditis is surgical. The wound is opened, necrotic tissue and bone fragments are removed; the cracks are cleared and good drainage of the wound is created. The prognosis depends on the severity of the injury.

What is Mastoiditis? (Medical and doctor VIDEO 2018).

Traumatic otitis media is an acute inflammation of various parts of the middle ear after injury.

The presence of a fracture of the base of the skull in the patient, a possible injury to the spine, indicates an urgent need to fix the head and body of the victim. Trauma to the auricle is accompanied by rupture of the eardrum, which can lead to secondary infection and the development of acute otitis media.

After an injury, even if the eardrum is intact, infection can penetrate through the auditory tube. A significant decrease in tissue reactivity from the injury, as a rule, can lead to the development of mastoiditis.

An open wound of the mastoid auricular process is always infected. This is what can cause the infection to spread into the tympanic cavity with the subsequent development of acute inflammation.

The blast wave is often accompanied by a significant and sharp increase in air pressure in the external ear canal, immediately causing perforation of the eardrum, and subsequently acute otitis media.

With such injuries, the pain in the ear is slight, the body temperature is slightly elevated or normal, and the changes in the blood are minor. Discharge from the injured ear is initially serous-bloody, then transparent mucous.

A person observes a sharp decrease in hearing, indicating damage to the inner ear; dizziness and spontaneous nystagmus of a peripheral (unilateral) and central (bilateral) nature may be observed.

In the event of a middle ear accident, it is imperative to correctly recognize and evaluate the location of damage to the skull, spine, and brain. Depending on the diagnosis, the neurosurgeon and neurologist prescribe treatment.

In case of an open wound, primary surgical treatment is required, when loose turunda with boric alcohol is carefully introduced into the ear canal and antibacterial therapy is prescribed. Treatment of traumatic otitis and mastoiditis must necessarily include the use of antibiotics.

With the development and rapid spread of gunshot mastoiditis, it is characteristic that immediately from the moment of injury the bone is involved in the inflammatory process of the ear, but since the wound is open, the outflow of contents from the auricle is often good.

The presence of cracks and possible fractures of the walls of the process can contribute to the spread of infection to the contents of the skull and the occurrence of intracranial inflammation and complications. Treatment for gunshot mastoiditis is surgical.

OTITIS (otitis; Greek, us, ot ear + -itis) - inflammation of the ear. Depending on the location of the lesion, otitis externa is distinguished (see External ear), otitis media and otitis internal (see Labyrinthitis). Simultaneous involvement of all parts of the ear in the inflammatory process is called pannotitis.

Average O. can be acute and chronic. How special shape Acute O. is distinguished by catarrhal otitis media, in which the symptoms of impaired ventilation function of the Eustachian (auditory, T.) tube predominate, and therefore it is also called tubo-otitis (see).

Acute otitis media

The causes of acute secondary O. are hypothermia and inflammatory diseases of the upper respiratory tract. It develops against the background of acute respiratory diseases, various inf. diseases, with activation of the microflora of the oral cavity, injury to the eardrum.

The decisive role in the development of average O. belongs to the reactivity of the organism. Its development and course are also influenced by the condition of the nasopharynx and nasal cavity. With certain inf. diseases, as well as in acute respiratory diseases, the inflammatory process spreads to the mucous membrane of the Eustachian tube, as a result of which the ciliated epithelium dies. This creates conditions for the penetration of infectious agents into the tympanic cavity. There is also a hematogenous route of penetration of infectious agents (in sepsis, scarlet fever and other diseases) and a contact route of infection of the tympanic cavity in case of injury to the eardrum (mechanotrauma, barotrauma, etc.). Sometimes infectious agents penetrate into the middle ear from the cranial cavity through the internal auditory canal, the cochlear aqueduct, or perineurally - along the facial and auditory (cochlear part of the VIII pair of cranial nerves, T.) nerves. In these cases, the infectious agents first enter the inner ear, and then to the average. Rarely (usually in childhood) they penetrate from the cranial cavity into the middle ear through an unclosed stony-squamous fissure.

Acute otitis media (banal)

Acute moderate O. is rare as a primary disease. There is no specific pathogen. It can develop in the presence of curvatures of the nasal septum and adenoids; its cause may be inflammatory diseases of the nose, its paranasal sinuses, and nasopharynx. Mixed microbial flora containing different kinds streptococci, staphylococci, pneumococci and other microorganisms.

Pathological anatomy

IN initial stage In acute middle ear infection, hyperemia of the mucous membrane of the middle ear is observed, which is caused by the expansion and overflow of blood in the vessels of the submucosa. Subsequently, the liquid part of the blood, and then its formed elements, sweat into the air cavities of the middle ear (see) - exudate appears. Initially, it has a serous character with a certain admixture of mucus, and then becomes purulent, less often hemorrhagic. In the exudate, in addition to a significant number of leukocytes, there is fibrin, desquamated epithelium, necrotic masses, microorganisms; small cell infiltration of the mucous membrane of the middle ear is noted. At a later date, hemorrhages occur in certain areas of the hyperemic mucous membrane; In some places, the epithelium is torn away, ulcerations form, and granulations begin to grow along the edges. The mucous membrane thickens sharply (20-30 times). The eardrum is also involved in the inflammatory process. The vessels of the eardrum become filled with blood and it thickens. The epithelium of its outer layer is macerated and desquamated. Sometimes hemorrhages occur under the epithelial layer, causing bloody blisters to appear on the surface of the eardrum. All these changes in the eardrum are accompanied by a change in its color and pattern. Subsequently, individual altered areas of the tympanic membrane may become necrotic, which leads to its perforation or complete destruction. In some cases, the bone walls of the tympanic cavity are involved in the inflammatory process with possible destruction. With a favorable course of the process, the inflammatory reaction gradually subsides, and signs of proliferation begin to predominate. The epithelium of the middle ear cavities is restored, the perforation hole in the eardrum is scarred. As a result of scarring, adhesions of the tympanic membrane to the medial wall of the tympanic cavity, ankylosis of the auditory ossicles (see Tympanosclerosis), and narrowing of the lumen of the eustachian tube can form. With insufficiently expressed regenerative processes a perforated hole with calloused edges is preserved.

Clinical picture

The onset of the disease is usually sudden and rapidly progressing. During acute secondary illness, three periods are distinguished. In the first period, the leading symptom is pain in the ear, initially in the form of tingling, then it takes on a shooting, paroxysmal character and, gradually increasing, becomes completely unbearable. The pain subsides or stops only for a short time, intensifies at night, depriving the patient of sleep, and can radiate to the teeth and neck. Ear pain is accompanied by headache in the parietal or parietotemporal regions. Body temperature rises to 38-39°; The patient is concerned about general weakness, sleep and appetite disorders. In weakened patients and with certain atypical forms of acute middle fever, body temperature may not rise. Congestion and noise appear in the ear. Hearing loss, as a rule, is significant: whispered speech is not perceived by the affected ear, spoken speech is heard at the auricle. During otoscopy (see), hyperemia of the eardrum is noted: first in its upper quadrants, then the vessels running along the handle of the malleus and in the radial direction are injected, and finally the entire eardrum becomes red. The pattern of the eardrum becomes blurred: the light cone disappears, only the short shoot hammer in the form of a yellowish dot. A protrusion of the entire eardrum or its individual parts appears as a result of the accumulation of fluid inside the eardrum. Purulent effusion in the tympanic cavity gives the eardrum a yellowish or, in combination with a hyperemic mucous membrane, a copper-red color. When percussing the mastoid process, its pain may be detected (due to the involvement of the mucous membrane of the mastoid cells in the inflammatory process). Sometimes yellow blisters are visible on the eardrum, which are formed due to the accumulation of exudate between the connective tissue and leathery layers. Due to the detachment of the epidermis, the eardrum may acquire a dirty white tint, masking its hyperemia. If perforation of the eardrum is imminent, then in some cases it is possible to determine its future location by the yellow tint of the most protruding part.

The transition of the disease into the second period is indicated by perforation of the eardrum.

With the appearance of perforation, the pain in the ear disappears, and otorrhea appears - discharge from the ear. In the first 1 - 2 days, the amount of discharge from the ear is small, the discharge is not purulent mixed with blood, then its amount increases, and it becomes mucopurulent. Body temperature returns to normal; Appetite appears, sleep and general condition improve. However, tinnitus and hearing loss still remain.

The perforation often has a slit-like or pinpoint shape and is usually almost indistinguishable during otoscopy. A pulsating reflex helps to detect it - a point of pus flickering synchronously with the pulse at the site of perforation.

The third period is characterized by a decrease in suppuration from the ear, scarring of the eardrum, and restoration of hearing. The duration of the disease is on average 2-3 weeks. General symptoms usually disappear earlier than local ones.

Acute moderate O. may have an atypical course. With a sharply reduced body resistance, cases of acute inflammation of the middle ear are possible, when suppuration and pronounced pain from the mastoid process appear in the first hours of the disease. The general condition of the patients is serious. In the blood there is a pronounced toxic granularity of neutrophilic granulocytes. Sometimes the lightning spread of the process from the middle ear to the cranial cavity ends in death, before perforation of the eardrum occurs and symptoms of mastoiditis appear (a feeling of pulsation or pulsating noise in the depths of the ear, pain in the mastoid region, profuse suppuration). In some cases, the symptoms characteristic of acute secondary O. are mild, and some of them may be absent. Thus, at the beginning of the disease there may be no pain, and the appearance of otorrhea is unexpected for the patient. Otorrhea can quickly stop when the inflammatory process in the ear is incomplete and sometimes progressing. Body temperature may not rise. Sometimes in the second period, instead of normalizing the temperature and changes in the blood, a secondary rise in temperature and deterioration of the general condition may be observed, which indicates the spread of the inflammatory process into the mastoid process or the cranial cavity.

An atypical course of O. can be observed in old age, with exhaustion, diabetes mellitus, and altered reactivity of the body.

Acute average O. can give complications such as mastoiditis (see), paresis of the facial nerve (see Facial nerve), labyrinthitis (see), intracranial complications, etc.

Diagnosis diagnosed on the basis of the patient’s characteristic complaints, a typical otoscopic picture, the results of a hearing test and X-ray data, studies using radiography of the temporal bones.

With audiometry (see), there is a decrease in the perception of sound through the air; bone conduction suffers little. In Weber's experiment (see Weber's experiment), the lateralization of sound towards the affected ear is determined. X-rays reveal, of varying intensity, an uneven decrease in transparency (darkening) of the cells and cavities of the mastoid process on the side of the diseased ear due to inflammatory thickening of the mucous membrane and accumulation of effusion or pus. At the same time, the image of the partitions of the cells and the walls of the cavities of the process remains clear. Only with osteoporosis, indicating a complication of acute moderate O. mastoiditis, the density of the cell partitions decreases, their contours become unclear. As the process progresses and foci of bone tissue destruction appear, the image of the septa on the x-ray disappears, the intensity and size of the darkening of the mastoid cells increases and it becomes structureless.

Differential diagnosis carried out with external O. Pain in acute middle O. is localized in the depths of the ear, has a pulsating character and is accompanied by decreased hearing and congestion in the affected ear. In acute external O., the pain intensifies from pressure on the tragus and pulling on the auricle; hearing usually does not decrease. Discharge from the ear in acute secondary O. is mucopurulent in nature, while in external O. it is purulent.

Prescribe bed rest, high-calorie foods rich in vitamins, antibiotics and sulfa drugs. The use of streptomycin, monomycin, kanamycin should be avoided, since they have a pronounced ototoxic effect. Duration of treatment is 10-14 days. For shooting pain in the ear and pronounced hyperemia of the eardrum, drops of 5-10% crystalline carbolic acid solution in anhydrous glycerin are prescribed, which are instilled into the ear for 2-3 days.

Physiotherapeutic procedures include heat irradiation with a Minin lamp, Sollux (1-2 times a day, 4-8 sessions), UV irradiation, UHF, and microwave therapy (microwave therapy). Excessive overheating should be avoided as this increases the pain. For deeper effects, condenser plates during UHF therapy are placed above the mastoid process and in front of the auricle. Microwave therapy is more effective when using an in-ear emitter. In a bilateral process, the procedures are carried out alternately (one day) for each ear with a total duration of UHF and microwave procedures of up to 15 minutes. Before the procedures, a thorough toilet of the ear is performed. Along with this, vasoconstrictors (ointments or drops with ephedrine, adrenaline, cocaine, etc.) are introduced into the nasal cavity to improve the drainage function of the Eustachian tube.

If, under the influence of treatment, the symptoms of inflammation do not subside within 4-5 days and the temperature remains high, resort to paracentesis (see). When otorrhea occurs, it is recommended to promptly remove pus by carefully washing the ear with warm disinfectant solutions or instilling 3% hydrogen peroxide solution into the ear, followed by thoroughly drying the skin of the external auditory canal with cotton wool or gauze pads. The restoration of hearing can be accelerated by careful blowing of the ear (see), but they should not be started earlier than 10-15 days after the restoration of the normal appearance of the eardrum.

Acute moderate O. in the vast majority of cases ends in recovery. In this case, the perforation hole closes, leaving a barely noticeable scar. In some cases, a dense scar forms at the site of perforation. Sometimes the tympanic membrane remains fused with the medial wall of the tympanic cavity between the auditory ossicles; The perforation of the eardrum may not close. In these cases, persistent hearing loss is noted.

Prevention acute middle respiratory tract is closely related to the prevention of acute respiratory diseases and consists of increasing the body's resistance, and also requires active treatment of inflammatory diseases of the upper respiratory tract, timely removal of adenoids, treatment of rhinitis, sinusitis, and elimination of deviated nasal septum.

Other forms of otitis media

Fusospirillous otitis media Caused by spindle bacillus and oral spirochetes. General symptoms are mild, the temperature is normal or low-grade, ear pain is absent or insignificant. There is a tendency for the process to spread to the mastoid process. Fistulas often form in the postauricular area. Characterized by extensive perforation of the eardrum, copious discharge with unpleasant smell, as well as the formation of bleeding polyps in the tympanic cavity.

Treatment: intravenous infusion of novarsenol, orally - potassium iodide, topically - hydrogen peroxide, powder with novarsenol, lubrication with 5-10% alcohol solution of iodine.

Secretory otitis media(syn.: exudative O., serous O.). It is especially common in children aged 1 to 7 years. Some researchers associate the occurrence of secretory O. with dysfunction of the Eustachian tube, but there are known cases of such O. with good patency. The disease is associated with the penetration of adenoviruses and parainfluenza viruses into the middle ear, with diseases of the nasopharynx, nose and paranasal sinuses. It is believed that secretory O. is a consequence of hyperfunction of the mucous glands, in its genesis important given to allergies. There is hypertrophy of the mucous membrane of the tympanic cavity with the presence of a large number of glands that produce mucus.

In the wedge, the picture of secretory O., the leading symptoms are mild pain in the ear, a feeling of ear fullness, decreased hearing, and heaviness in the head. They are caused by the presence of fluid in the tympanic cavity. In most cases, it is thick, viscous and therefore impairs the mobility of the auditory ossicles. Depending on the nature of the fluid in the tympanic cavity (watery or viscous), a greater or lesser degree of hearing loss is observed. During otoscopy, the eardrum can be from normal to intense blue in color, and its mobility is often limited.

Treatment is aimed at restoring the function of the eustachian tube by removing exudate from the tympanic cavity and exposing its mucous membrane to drugs. Catheterization of the Eustachian tube with an elastic catheter, transtubal evacuation of exudate, administration of proteolytic enzymes, glucocorticoids, tubotympanic aerosol therapy, meatotubotympanic pneumomassage (see). Transtube treatment methods are combined with general hyposensitizing, antibacterial, stimulating therapy, and sanitation of the upper respiratory tract. If these methods are insufficiently effective, the so-called shunting of the tympanic cavity, a cut, for example, according to Soldatov, is carried out without trauma to the eardrum - by cutting the skin of the external auditory canal, separating it together with the eardrum and introducing a polyethylene tube into the tympanic cavity.

Prevention consists of timely treatment of upper respiratory tract diseases.

Allergic otitis media- an inflammatory disease that develops against the background of altered reactivity of the body. In the occurrence of allergic secondary O., importance is attached to a variety of food allergens, especially in young children. N.A. Bobrovsky, V.G. Kupryunina associate the occurrence of allergic secondary O. in 10% of cases with the use of antibiotics. In the wedge, the leading signs of allergic secondary O. are mucous-watery or odorless mucous discharge from the ear, swelling and cyanosis of the eardrum. Perforation of the eardrum can usually be quite large. There is a tendency to form polyps. The course of allergic moderate O. is persistent, not amenable to conventional methods of treatment. There is a tendency to exacerbations, which are not accompanied by either ear pain or increased body temperature. The state of sensitization of the body in patients is revealed through a thorough wedge, examination, the use of an eosinophilic test (see) and skin tests with various allergens (see. Skin tests). Positive results of hyposensitizing therapy confirm the allergic genesis of the disease.

Treatment consists of the use of hyposensitizing agents (diphenhydramine, suprastin, tavegil, pipolfen). In order to thicken the mucous membrane of the tympanic cavity and reduce its permeability to bacteria and various irritating substances, solutions of silver nitrate and tannin are prescribed locally.

The prognosis for timely treatment is usually favorable. It is necessary to harden the body.

Idiopathic hematotympanum. It is assumed that the cause of idiopathic hematotympanum is acute hemorrhagic inflammation of the mucous membrane of all cavities of the middle ear. Its main symptoms are gradually increasing hearing loss and a blue coloration of the eardrum detected during otoscopy. Chocolate-colored liquid accumulates in the tympanic cavity. X-ray examination reveals a decrease in pneumatization of the mastoid process and destruction of the partitions between the cells. Treatment is surgical; during surgery, bloody contents are detected in the mastoid cells, and the bone may be black.

Acute otitis media in infectious diseases. ^ri inf. diseases (measles, scarlet fever, influenza, etc.), the course of acute secondary inflammation can be typical, but more often it has specific features characteristic of this inf. diseases.

Influenza acute otitis media occurs quite often. In the etiology of influenza O., the main role is played by a filterable virus that penetrates the tympanic cavity both through the Eustachian tube and by hematogenous route. A hemorrhagic form of inflammation is characteristic, which is manifested by a sharp dilation of blood vessels, the formation of extravasates in the external auditory canal, on the eardrum, in the cavities of the middle and inner ear. Individual pinpoint ecchymoses and bubbles with bloody contents may appear on the eardrum, which, when bursting, create the impression of a ruptured eardrum. When the eardrum is perforated, serous-bloody discharge appears in large quantities. As inflammation in the middle ear develops, the discharge from the ear becomes more abundant and becomes purulent in nature. Hearing is reduced not only due to impaired sound transmission, but also due to impaired sound perception, since hemorrhages are often observed along the VIII pair of cranial (cranial, T.) nerves, as well as due to intoxication. Patients complain of severe pain in the ear, accompanied by noise, dizziness, decreased hearing, and headache. Pain may radiate along the branches of the trigeminal and greater occipital nerves; Paresis of the facial nerve is sometimes observed. Body temperature is elevated and chills are common. On otoscopy, the eardrum appears red with hemorrhagic blisters. Often the eardrum is changed only in the unstretched part; the stretched part may be almost normal. Noise in the ear and decreased hearing may be irreversible due to the development of neuritis of the cochlear part of the VIII pair of cranial nerves. In case of influenza-like acute secondary inflammation, the development of mastoiditis, as well as intracranial complications, is possible.

Scarlet fever otitis causes a highly virulent scarlet fever pathogen that enters the tympanic cavity via tubogenic or, more often, hematogenous routes. Scarlet fever is usually bilateral. There are early and late scarlet fever. Early scarlet fever occurs simultaneously with the appearance of the rash and usually has a severe course. Late scarlet fever has a milder course and occurs from the 4th week. diseases. Often scarlet fever develops unnoticed and is detected only with the appearance of suppuration from the ear. This is explained by the fact that this disease affects the nerve fibers in the eardrum and the mucous membrane of the tympanic cavity, as well as the serious condition of the patient. The causative agent of scarlet fever causes toxic damage to the vascular wall and thrombosis of small vessels. As a result, blood circulation and trophism of ear tissues, including bone tissue, are disrupted, which leads to tissue necrosis. The eardrum and auditory ossicles are often completely destroyed. Discharge from the ear due to bone destruction has foul odor. Typically, perforation of the eardrum remains persistent, otorrhea periodically recurs, and hearing is sharply reduced. Necrotic scarlet fever, due to extensive destruction, rarely ends with recovery and restoration of hearing.

Measles otitis develops only in a small part of patients, mainly in the 1st and 2nd weeks of the disease. In this case, early measles O. is usually caused by the measles virus, and late O. is caused by secondary microflora. The course of the inflammatory process in the middle ear during measles has much in common with O. during scarlet fever; in some cases, necrotic O. is noted.

Tuberculous otitis media as a primary disease it is rarely observed. More often it occurs as a result of hematogenous introduction of Mycobacterium tuberculosis in tuberculosis of the lungs, lymph nodes, bones. Characteristic signs of tuberculosis O. are the almost complete absence of pain at the onset of the disease and multiple perforations of the eardrum, which can later merge into one extensive perforation. Discharge from the ear is creamy and, if bone is involved, foul-smelling. IN severe cases necrosis is observed in the walls of the cavities of the middle ear and auditory canal, and the auditory ossicles. Often these necrosis lead to the formation of fistulas, in which granulations or polyps appear, including in the area of ​​the facial nerve canal, which causes its damage. A sharp decrease in hearing in tuberculous O. is caused not only by a violation of sound conduction, but also by the early involvement of the inner ear in the process.

Treatment of infectious O. consists of treatment of the underlying disease, for example, with antituberculosis drugs, and treatment of acute moderate O. (see above).

Main importance in the prevention of severe infections. acute moderate O. requires timely, active treatment of the underlying disease, as well as careful care of the nasal and oral cavity. This achieves not only a reduction in the frequency of inf. acute O., but also a reduction in the number of chronics, average O., which are mostly associated with childhood infections and are accompanied by the development of hearing loss (see), and in children at an early age with bilateral damage - deaf-muteness (see).

Traumatic otitis media develops after blows, bruises, concussions due to explosions, falls, as a result of car and aircraft accidents and sports exercises, during thermal and chemical exposures. burns.

Infectious agents enter the middle ear through a wound canal in the bone walls of the tympanic cavity or through ruptures of the eardrum. Blood poured into the tympanic cavity is a good breeding ground for microorganisms and contributes to the rapid development of the inflammatory process. Discharge from the ear is first bloody and then purulent. The otoscopic picture of traumatic O. is very characteristic: the perforation of the tympanic membrane has an irregular, stellate shape, surrounded by hemorrhages. Damage to the external auditory canal and soft tissue around the ear is often observed.

Average O., caused by contusion, is accompanied by a significant decrease in hearing up to deafness, which is explained by injury to c. n. With.

Mareotitis is a disease of the middle ear, the occurrence of which is associated with water entering the ear through the Eustachian tube, or the impact of a wave on the eardrum during diving or jumping into the water.

Mareotitis is characterized by congestion and noise in the ear, decreased hearing and an unpleasant sensation due to the strong sound of one’s own voice (autophony). Treatment is carried out with vasoconstrictors (in the form of drops in the nose), and ear venting is prescribed.

Aerootitis occurs when the eardrum and mucous membrane of the middle ear are exposed to sudden changes in atmospheric pressure during air flights. With aerootitis, severe ear pain, ringing and noise in the ears, decreased hearing, and sometimes dizziness appear. Otoscopy reveals: hyperemia of the eardrum, hemorrhages, and with very strong exposure - rupture of the eardrum. Mildly expressed aerootitis does not require treatment.

In case of traumatic otitis accompanied by perforation of the tympanic membrane, therapeutic measures are limited to treating the wound surface and preventing infection of the tympanic cavity (for example, the introduction of turundas moistened with an antibiotic solution, insufflation of sulfonamide powder).

Acute otitis media in young children

Acute moderate O. is more common in young children than in children of older age groups and in adults. Its course is distinguished by its originality, which depends on the characteristics of the anatomical structure of the temporal bone, Eustachian tube, tympanic cavity, as well as immunol, characteristics of the child’s body. The Eustachian tube in newborns is shorter, wider and more horizontal than in adults. The lymphoid ridges at the pharyngeal opening of the Eustachian tube are poorly developed. The tympanic cavity contains embryonic myxoid tissue, which is a good breeding ground for microorganisms. The component parts of the temporal bone are not yet connected to each other by strong sutures, but are separated by gaps filled with fibrous tissue; There are also depressions and cracks in the roof of the middle ear cavities. The mastoid process is not yet formed, and the middle ear cavities are surrounded by spongy bone, consisting of cavities filled with bone marrow and richly vascularized; the eardrum is thicker. Due to these structural features of the temporal bone in a child, infectious agents easily enter the middle ear through the wide Eustachian tube and cause rapid development of inflammation in the tympanic cavity. The occurrence of acute secondary inflammation in newborns and infants is also facilitated by the predominant position of the child on his back, when mucus from the nose and nasopharynx, as well as vomit during regurgitation, easily enters the tympanic cavity through the Eustachian tube.

The causative agent of acute secondary O. in young children is often pneumococcus. Acute respiratory viral infections play a major role in its etiology. disease, and at the age of over 3 years - adenoids (see). The routes of entry of infectious agents are the same as in adults. The inflammatory process occurs as osteomyelitis and can easily spread through existing cracks to neighboring areas. This is also facilitated by the greater resistance of the eardrum. Myxoid tissue, which easily disintegrates under the influence of inflammation, leads to the formation of granulations in the cavities of the middle ear, which impede the outflow of pus through the hole in the eardrum formed during perforation or paracentesis, which leads to the spread of infection to the antrum (cave, T.) and surrounding diploetic bone with the development of the so-called. anthrita (see).

In the development of acute secondary O. in children there are the same periods as in adults. In the first period, the child is restless, often cries, sleeps poorly, wakes up screaming and cannot fall asleep for a long time, refuses to breastfeed or quits sucking with a scream, because sucking and swallowing increase pain in the ear. The child may shake his head from side to side, sometimes reaching out with his hand to the sore ear. Phenomena of meningism may be observed: convulsions, protrusion of the fontanel, throwing back of the head, fixed gaze, vomiting. Body temperature reaches 40° and above. The child's excitement can give way to depression, he becomes lethargic and sleeps a lot. After the appearance of suppuration from the ear, which indicates the transition of the disease to the second period, the child calms down and his general condition improves. The disease lasts from several days to 5 - 6 weeks. The hemogram reveals significant leukocytosis and changes in blood cells.

The diagnosis is made on the basis of the wedge, pictures and otoscopy data. When assessing the condition of the eardrum, it should be borne in mind that hyperemia may appear during crying or manipulation in the external auditory canal, and only repeated otoscopy can avoid errors. Importance is given to the tragus symptom - the child’s reaction when pressing on the tragus. However, a reaction when pressing on the tragus may be a manifestation of the child’s negative attitude towards touch, so this symptom should be compared on the other ear. Patients experience hearing loss of the type of sound conduction disorder. In Weber's experiment, the sound of the C-128 tuning fork is better heard by the affected ear. In early childhood, this is manifested by turning the eyes towards the affected ear. For diagnosis can be used: thermometry on the surface of the mastoid processes, antral puncture with bacteria, examination of punctate, radiography of the temporal bones. Differential diagnosis is carried out with external O.

Treatment is the same as for adults with an age-appropriate dosage of medications. Bromine preparations prescribed to a nursing mother and local heat in the form of warming pads and warm bandages effectively soothe pain in infants. In severe cases, paracentesis is indicated. One should not expect spontaneous perforation of the tympanic membrane, since pus accumulated in the tympanic cavity can quickly spread into the cranial cavity through existing dehiscence and cracks in the temporal bone.

Prevention mainly consists of the prevention of acute respiratory diseases and infections. diseases, hardening, proper feeding and proper nutrition of the child, as well as the mother’s observance of sanitary hygiene. baby feeding rules.

BCG otitis- quite a rare disease; occurs in young children. Its development is associated with the introduction of the anti-tuberculosis vaccine BCG. This is confirmed by the detection of BCG vaccine strain bacteria in ear discharge. It is characterized by an imperceptible onset at normal temperature, a sluggish long-term course, and the growth of abundant granulations in the tympanic cavity. Treatment: removal of granulations from the ear, injection of streptomycin solution into the ear, insufflation of PAS.

Chronic otitis media

Chronic middle ear is a sluggish disease, in which the inflammatory process in the middle ear seems to be limited. Under the influence of various provoking factors (cooling, infectious diseases of the upper respiratory tract, unfavorable living conditions, etc.), the inflammatory process may progress. The leading role in the pathogenesis of hron, middle ear is played by changes in the body's reactivity, as well as individual characteristics of the structure of the mucous membrane of the middle ear. The development of the disease is promoted by: patol, processes in the eustachian tube that disrupt its drainage and ventilation functions; narrowing of the external auditory canal, complicating the outflow of exudate from the tympanic cavity; frequent relapses of acute inflammation of the middle ear. In some cases, O. has a primary chronic course. Depending on the pathomorphology, changes and wedge, picture of the disease hron, average O. is divided into meso-tympanitis and epitympanitis.

Clinical picture

With chronic, average O., constant or periodic discharge from the ear, decreased hearing, sometimes dizziness, and headaches are noted for a long time.

With mesotympanitis, the mucous membrane of the tympanic cavity is involved in the inflammatory process, odorless mucous discharge from the ear appears with an admixture of pus, and central perforation of the eardrum may occur. Mesotympanitis lasts indefinitely, for decades, sometimes throughout the patient’s entire life. Suppuration may periodically stop or significantly decrease. As a result of scarring, adhesions may form between the eardrum and the medial wall of the tympanic cavity, the auditory ossicles, and fusion of the labyrinthine windows, which leads to persistent and significant hearing loss. The perforation of the eardrum in some cases is scarred, and in some cases it remains. The carious process in the ear sometimes causes the growth of granulation tissue and polyps in the tympanic cavity, which can cause retention of pus in the tympanic cavity and cause headaches and a feeling of pressure in the ear.

With mesotympanitis, the perforation hole is located in the stretched part of the eardrum and has a different size and shape. Through the large perforations, the altered mucous membrane of the medial wall of the tympanic cavity is visible; polyps and growths of granulation tissue can be detected.

With epitympanitis patol, the process is localized hl. arr. in attica. In this case, marginal perforation occurs in the anterior superior or posterosuperior quadrants of the tympanic membrane or a total defect is formed; the bone walls of the tympanic cavity and the auditory ossicles are affected; Purulent, unpleasant-smelling discharge from the ear appears. The most dangerous and frequent (up to 95%) complication of epitympanitis is cholesteatoma (see), which in the process of growth causes large destruction of the temporal bone and leads to intracranial complications, peripheral paresis or paralysis of the facial and abducens nerves, fistula formation in the bone labyrinth.

In case of epitympanitis, through the marginal perforation of the tympanic membrane, a Vojacek attic probe can be inserted into the supratympanic space and inspected. In this case, the roughness of the bone walls is detected due to their caries or choleste-atomic masses that fill the atticoantral cavity to a greater or lesser extent. Often, during probing, particles of cholesteatoma are removed in the form of white scales with putrid smell, small sequesters. In some cases, with chronic, purulent epitympanitis, a change in the external auditory canal is observed due to the overhang of its postero-superior wall, which happens when the bone is destroyed by cholesteatomy. When pressure is applied with a probe, cholesteatoma masses and pus are often forced into the middle ear.

With chronic, purulent O., the inflammatory process can spread to the chorda tympani or tympanic plexus, which is manifested by a taste disorder or pain in the ear area. During otoscopy, otorrhea of ​​a purulent or mucous nature is detected, and the amount of discharge does not always correspond to the patol changes. If the inflammatory process is limited to the mucous membrane, then the discharge is odorless, mucous in nature, sometimes mixed with pus; the appearance of blood in the discharge is associated with the development of granulation tissue; purulent discharge with an unpleasant odor indicates involvement in patol, the process of the bone tissue of the middle ear.

Decreased hearing in patients with chronic, purulent O. is caused not only by impaired sound conduction due to damage to individual parts of the sound-conducting apparatus, but also, to a lesser extent, by sound perception by toxins that have penetrated into the inner ear.

Diagnosis of hron, average O. is based on the patient’s complaints, medical history, otoscopy data, hearing test results, as well as special research methods, among which the most important is rentgenol. the study is based on identifying changes in the airiness of the mastoid cells, the size and transparency of the tympanic cavity and antrum, the appearance of sclerosis of the temporal bone, as well as destruction of the auditory ossicles and the walls of the attic. With mesotympanitis, due to damage only to the mucous membrane of the main cavities of the middle ear, the transparency of the tympanic cavity and antrum decreases, but their shape and outline remain normal. Sometimes the antrum appears to be significantly reduced, but due to the intactness of the bone walls, the originality of its shape is preserved. The auditory ossicles do not differ in the photographs due to the decrease in the airiness of the tympanic cavity. In case of epitympanitis, accompanied by damage to the bone walls of the middle ear cavities, the photographs reveal a defect in the outer wall of the attic and a sharp expansion of the entrance to the antrum, which looks like a wide light stripe connecting the attic and antrum. Due to the destruction of the walls, the sizes of the attic and antrum sometimes increase sharply until they merge with each other. With a long course of chronic. O. note a sharp disturbance in the pneumatization of the cells of the temporal bone and a decrease in the antrum. In persons with a well-developed cellular system of the temporal bone, it can remain relatively pneumatized, despite many years of chronic inflammation, accompanied by restructuring of the cells and thickening of their partitions. In this case, the size of the antrum may not change for a long time. To clarify the localization and in-depth characterization of changes in the bones that occur during epitympanitis and its complications, tomography is used (see).

Differential diagnosis sometimes carried out with tumors of the middle ear, which can be masked by inflammatory changes in the mucous membrane, as well as with changes in the ear observed with tuberculosis and syphilis. In these cases, serol is of great diagnostic importance. and bacterial, research, biopsy results.

Treatment of chronic, purulent secondary O. is divided into conservative and surgical. Mesotympanitis, as a rule, is treated conservatively; for epitympanitis, surgical treatment is mainly used.

Conservative treatment consists of prescribing medications and physiotherapeutic procedures during an exacerbation. At the same time, treatment of diseases of the nose, nasopharynx and pharynx is necessary. Local treatment consists of systematic removal of pus from the external auditory canal followed by injection into the tympanic cavity to expose the mucous membrane to disinfectants and astringents(4% boric alcohol solution, 2-3% protargol solution, 3% Burov liquid solution, 1% zinc sulfate solution, furatsilin alcohol solution - 1: 1500, etc.). Antibiotics are used, before prescribing it is advisable to produce bacterial. study of microflora in the ear and determine its sensitivity to antibiotics. Alcohol solutions of antibiotics have a beneficial effect. Along with antibiotics and in combination with them, proteolytic enzymes (trypsin, chymotrypsin, lidase, deoxyribonuclease, hyaluronidase, etc.) are used, which liquefy discharge, soften adhesions and scars, and have an anti-inflammatory effect. It is advisable to carry out hyposensitizing nonspecific therapy with antihistamines (diphenhydramine, pipolfen, suprastin, diazolin, tavegil, delagil, etc.), as well as calcium preparations (calcium chloride, calcium lactic acid, calcium gluconate). Hormonal drugs should be used with great caution.

Physiotherapy is carried out outside of exacerbation in the form of general UV irradiation, air baths, showers, etc. Contraindications to physiotherapeutic treatment are deep-seated lesions of bone tissue and labyrinthine phenomena. Outside of exacerbation of the purulent process, electrophoresis of zinc, furatsilin, silver, UV irradiation of the tympanic cavity through a tube or UV irradiation of the collar zone, mud therapy of the ear and neck area are performed locally.

If there are granulations and polyps in the tympanic cavity, they should be removed using an ear conchotome and a curette or an ear polyp cutting loop. Small single granulations are often eliminated by using alcohol drops, as well as by quenching with 10-20% silver nitrate solution.

Surgical treatment

In case of epitympanitis, especially with cholesteatoma, with large bone destruction, conservative treatment is ineffective and cure can only be achieved surgically. Since the rapid development of life-threatening intracranial complications is possible, ear surgery is indicated not only for therapeutic, but also for preventive purposes. The question of timing of surgery should be decided on the basis of studying the dynamics of the disease. If there are symptoms of intracranial complications, then the operation is performed urgently for health reasons. The purpose of the operation is to remove the patol, the lesion and, instead of the complex system of the middle ear, to form a single intra-auricular bone cavity that communicates with the external auditory canal and has smooth skin-covered walls. This operation is called general cavity or radical. A typical radical operation consists of the following stages: a postauricular incision of the skin and soft tissues, separating them from the anterior surface of the mastoid process and from the posterior and posterosuperior walls of the bony auditory canal; removal of bone tissue to open the antrum and attic and knock down the posterior wall of the bony auditory canal along with the bridge; surgical treatment of opened cavities and the tympanic cavity (removal of carious bone, granulations, cholesteatoma, smoothing of protrusions, etc.); plastic surgery of the external auditory canal; suturing the wound. For each of these stages, many methods have been proposed, combinations of which provide a large number of options for radical surgery. Thus, the surgical incision can be made behind the auricle, inside the external auditory canal, in front between the helix and the tragus. In these cases, they talk about behind-the-ear radical surgery, intra-auricular or eidaural radical surgery, and anterior radical surgery. Among the options for this operation, there are those in which the auditory ossicles, remnants of the eardrum, etc. are kept intact; such options are called conservative radical surgery. If the operation removes only the necessary amount of bone substance, sufficient for a successful recovery, then this option is called sparing radical surgery.

In case of isolated damage to the attic and antrum, which is often observed with cholesteatoma, only the attic and antrum are opened; This operation is called radical atticoanthrotomy.

There are three options for opening the attic and antrum: the antrum is opened through the outer surface of the mastoid process, then the bone above the entrance to the cave is removed, the bridge is knocked down, and lastly the lateral wall of the attic is removed (according to Schwartz); Initially, the lateral wall of the attic is removed in the depths of the external auditory canal, then the bone above the entrance to the cave, and lastly the antrum is opened (according to Stacke); knock down the postero-superior wall of the bony external auditory canal towards the entrance to the cave, at the same time opening the entrance to the cave and the attic (according to Wolff).

There are also numerous methods of plastic surgery of the external auditory canal (see Otoplasty). You can cut out a large bottom flap or a large top one. Plastic surgery begins either with a longitudinal incision in the posterior wall or with a transverse incision. The flaps on the wall of the bone wound should lie freely, without tension. In some cases, to speed up the epidermization of the cavity walls, a flap (free or pedunculated) is cut out for plastic surgery from the postauricular area next to the incision. After plastic surgery of the external auditory canal, the wound is cleaned with antibiotic solution, and a gauze turunda is inserted into the tympanic cavity through the external auditory canal; The behind-the-ear wound is sutured. The operation ends with the application of a columnar bandage. In the normal course of the postoperative period, the first dressing is done on the 5th - 7th day, and the sutures are removed at the same time. Starting from the 8-9th day after surgery, dressings are done daily. The healing process after radical surgery lasts from 3 weeks. up to several months depending on the size of the ear wound, the size of the plastic flaps, the viability of the bone tissue, the general condition of the patient, proper care behind the wound, etc. A typical radical operation quite often leads to decreased hearing, since in this case the mechanism of sound transmission is grossly disrupted. In connection with the possibility of using an operating microscope (see), ear surgery is combined with plastic restoration of the sound conduction mechanism - tympanoplasty (see).

After surgery on the middle ear, with a pronounced inflammatory reaction in the first days, irradiation with a Sollux lamp and UV rays in suberythemal doses is prescribed; for sluggishly healing wounds - UHF until the wound is filled with granulations, UV irradiation first in hypererythemal and then in suberythemal doses and darsonvalization. After auditory operations to eliminate inflammatory reactive phenomena, more fast healing To prevent the formation of rough scars, microwave therapy and diadynamic currents are used.

In uncomplicated forms of meso- and epitympanitis, the prognosis is favorable if treatment is started in a timely manner. In the presence of cholesteatoma, timely treatment prevents the development of life-threatening intracranial complications.

Prevention chronic O. consists of timely and rational treatment of acute O.

Bibliography: Volfkovich M. I. Chronic purulent otitis media, M., 1967, bibliogr.; Voyachek V.I. Treatment (conservative and surgical) of chronic purulent otitis, in the book: Program reports at the 5th All-Union Congress of Otorhinolaryngitis, p. 77, M., 1958; 3 emtsovG. M. X-ray diagnosis of inflammatory diseases of the middle ear, M., 1965; JI and to about t-kina O. Yu. and Kovaleva JI. M. Clinic, microbiology and immunology of chronic otitis, JI., 1973, bibliogr.; Likhachev A. G. Handbook of otorhinolaryngology, M., 1971; Multi-volume guide to otorhinolaryngology, ed. A. G. Likhacheva, vol. 1, p. 573, M., 1960; Ratenberg M. A. Physiotherapy in otorhinolaryngology, M., 1973; Temkin Ya. S. Acute otitis media and its complications, M., 1955, bibliogr.; B&g and - n at R. Die Radikaloperation des Ohres, Lpz.-Wien, 1923; J a h n k e V. Diagnose, Differentialdiagnose und Therapie der Mittelohrentziinfung, Padiat. Prax., Bd 16, S. 419, 1976; Mittermaier R. Hals-Nasen-Ohren-Krankheit im Rontgenbild, Ein Atlas fur Klinik Praxis, Stuttgart, 1969; MundnichK. u. Frey K. Das Rontgenschichtbild des Ohres, Stuttgart, 1959; Psenner L. Die Rontgendiagno-stik des Schlafenbeines, Handb, d. medizi-nischen Radiol., hrsg. v. O. Olsson u. a., Bd 7, T. 2, S. 365, B. u. a., 1963; S h a m-b a u g h G. E. Surgery of the ear, p. 60 a. o., Philadelphia - L., 1959; Z i z m o r J. a. N o y e k A. M. Inflammatory diseases of the temporal bone, Radiol, clin. N.A., v. 12, p. 491, 1974.

N. I. Kostrov, V. P. Fomina-Kosolapova; M. I. Antropova (physiotherapist), A. N. Kishkovsky (rent.).

Traumatic otitis media, treatment

Traumatic otitis (damage to the walls of the external auditory canal or eardrum) can have different etiologies: as a result of cleaning the ear with various foreign objects, blows to the ear, contusion from a blast wave, getting hot scale or shavings into the ear canal at work, or attempting to independently remove a foreign object from the ear bodies, etc.

Traumatic injuries, dangerous in themselves, create favorable conditions for the addition of a secondary infection and the development of the inflammatory process. If there are blood clots in the ear canal, you should carefully remove them using a dry method, using a sterile cotton pad, and carefully examine the walls of the external auditory canal and the eardrum. Injuries to the outer ear can be accompanied by a fracture of the lower jaw joint, damage to the parotid salivary gland and nerve fibers. In case of contusions, injuries to the eardrum may be accompanied by damage to the inner ear and the development of temporary or permanent deafness and ringing in the ear.

Treatment of traumatic otitis consists of daily changing a sterile turunda in the external auditory canal. At the first signs of an incipient inflammatory process, one should proceed to active anti-inflammatory therapy. In case of dry perforation of the eardrum, the question of its closure (myringoplasty) can be raised. However, the drainage capacity of the auditory tube should be taken into account.

Traumatic injuries to the ear can also occur when foreign bodies and wax plugs are removed from the ear unskilled.

Foreign bodies are more common in children of preschool age, when they, while playing, stick various objects into their own and each other’s ears. Living ones are less common foreign bodies- insects that can crawl or fly into the ear in the forest, on vacation. They cause the patient unpleasant pain, tactile and noise sensations, forcing him to seek the help of a doctor at any time of the day or night.

Sulfur plugs are the result of improper hygiene measures, violations of the secretory function of the sulfur glands and the dust factor. Diagnosing them is not difficult. Trouble can be caused by inept actions when trying to remove wax plugs from the ear.

Traumatic otitis and mastoiditis

Based on the nature of occurrence and clinical course, two groups of traumatic mastoiditis can be distinguished. The first group includes inflammation of the mastoid process, which develops as a result of a fracture of the base of the skull and the walls of the tympanic cavity. Sometimes there may not be perforation of the eardrum; suppuration from the ear appears a certain period after the injury. Mastoiditis is a further development and spread of purulent otitis, thus a secondary disease, and differs little from ordinary mastoiditis. However, fractures of the walls of the tympanic cavity facilitate the passage of infection into the skull. In the clinical picture of mastoiditis, symptoms of damage to the central nervous system usually prevail. These patients do not end up in otolaryngology departments; often their ears are not even examined. Local changes usually do not have time to develop due to the rapid death of such patients.

Ulrich (1926) studied a large amount of material from a surgical clinic. Only 2 patients progressed to mastoiditis and surgery.

Primary mastoiditis includes those when the injury directly damages the mastoid process. The most common type of such injury is a gunshot wound, a more rare type is a blunt blow with a fracture or damage to the appendix. In this group there is a closer relationship between the intensity of the injury and the nature of the lesion than in the first group. The degree of pneumatization of the mastoid process plays a known role.

Closed injuries are observed when the integrity of the soft tissue is not broken. The lesion may be limited only to the periosteum or cortical layer, but may also affect the process or temporal and even adjacent bones.

A distinctive feature of the second type is the introduction of infection into the damaged tissue of the appendix. Hemorrhages and sequestration create favorable conditions for the development of the inflammatory process. Infection of the appendix is ​​manifested by a number of clinical signs. A blunt blow to the mastoid process can cause partial or complete destruction of it and at the same time a fracture of the base of the skull.

Primary mastoiditis is often observed when injured by shrapnel in wartime; in case of occupational injury - rarely. Considering the significant interest of these cases, we present our following observations.

Patient G. A month ago, she was hit on the head by a felled tree. Loss of consciousness. Bleeding from both ears and nose. Vomit. Peripheral paralysis of the right facial nerve.

Upon admission to the clinic: complaints of pain behind the ear, purulent discharge from the right ear and decreased hearing. Severe headache, insomnia. Right ear: central perforation of the eardrum, copious purulent discharge. Pain in the mastoid process when pressed. Weber to the right. Rinne - negative, whisper 0.2 m, sharp decrease in perception of all tuning forks, vestibular apparatus without changes.

On the radiograph: the cells of the right mastoid process have an unclear structure and are poorly differentiated; no fracture of the base of the skull is visible.

A week later, temperature 39°, sharp pain behind the ear; operation: the cortical layer is bluish in places, the bone is soft, easily removed with a spoon; pus and granulations; sequestra extending all the way to the dura mater were removed. Subsequently the flow is smooth. After 1.5 months, the facial nerve is restored.

Paresis of the facial nerve apparently developed as a result of an inflammatory process or hemorrhage into the canal, and not as a result of direct damage. This is supported by the relatively rapid restoration of its functions.

The large destruction found during the operation is largely due to the pneumatic type of structure of the process and the thinness of the cortical layer. With this structure, the local destructive effects of injury are more pronounced.

Patient A., 45 years old. A month and a half ago, a car wing hit my left ear. The auricle was crushed and the skin of the mastoid process was damaged. Bleeding from the ear. I didn’t lose consciousness. At the Sklifosovsky Institute of Emergency Medicine, most of the shell was removed and sutures were placed on the skin.

Upon admission: a large defect of the auricle, the bone of the posterior wall of the auditory canal is exposed over a considerable length, and is mobile during probing; fistula tract; the external auditory canal is deformed. The eardrum cannot be seen. Copious discharge of a bloody-purulent nature. The soft tissues of the mastoid process are inflamed. Hearing in the left ear is reduced. Tuning fork S4o9b does not perceive. Rinne's experience is negative. Accented whispered speech at the sink. Statics and kinetics - no changes.

Radical surgery of the left ear: the bone is a dirty green color; several sequestra, a large sequester includes almost the entire posterior wall of the ear canal, pus and granulations.

This patient has primary traumatic mastoiditis. Open damage, destruction of bone tissue and sequestration created favorable conditions for the introduction of infection and the development of the inflammatory process.

Patient D.S., 21 years old, wagon coupler. During the coupling, he was hit on the right cheek bone by an iron bracket and was pressed against the carriage with the crown of his head. Damage to soft parts in the cheekbone area, bleeding. I didn’t lose consciousness. At the Sklifosovsky Institute of Emergency Medicine, bone fragments were removed and stitches were applied.

What is barotraumatic otitis media?

Barotraumatic otitis is a complex of symptoms that arise in response to changes in the pressure of the environment surrounding a person. Classic situations leading to ear barotrauma are:

• Diving/ascent
• Airplane ascent/landing

Barotraumatic otitis media is related to the middle ear. It includes the Eustachian tube and the tympanic cavity, which is normally filled with air. The middle ear is separated from the outer ear by an impenetrable flexible eardrum. On the other hand, the exit of the Eustachian tube into the nasopharynx is also closed most of the time, which protects the tympanic cavity from the penetration of excess bacteria into it. Thus, the middle ear is a relatively isolated part of the ear system.

However, it cannot be completely isolated, because metabolic processes in the mucous membrane of the tympanic cavity lead to a rarefaction of the air present and a decrease in its pressure. As a result, the eardrum changes its curvature and loses sensitivity when perceiving external sound waves. To prevent this from happening, the mouth of the Eustachian tube sometimes opens slightly (when swallowing or artificially increasing the pressure in the nasopharynx), due to which a portion of air enters the tympanic cavity and equalizes the pressure.

Thus, the correspondence of the pressure in the middle ear cavity to the pressure environment is a fundamental condition for the proper functioning of the human auditory system, which is one of the most advanced among living beings.

Man and the species immediately preceding him evolved on land with a predominant sedentary nature of life. Therefore, our ears can distinguish hundreds of tones, but are absolutely not adapted to immersion in water and flying in the air.

When immersed in water, a person is exposed to increased pressure from a medium denser than air. Water pours into the ear and puts pressure on the eardrum from the outside. The eardrum is an elastic membrane. The degree of its elasticity varies among people: for some it is thin, for others it is quite dense. The elasticity parameter changes with age: for example, in young children the membrane is very thick. In addition, it may have defects and thinning resulting from previous otitis media. In the presence of predisposing factors, force on the membrane with increased pressure in some cases can lead to its perforation and the flow of water into the middle ear cavity.

The symptoms that a person feels during barotraumatic stress develop in the following sequence:

• Increasing sensation of pressure in the ear.
• Ear congestion.
• At first, a mild, ongoing pain, then a sharp one.
• Coldness in the depths of the ear is the result of water penetrating into the tympanic cavity.
• Severe itching, urge to sneeze, ear irritation.

The described scenario may threaten the general condition of the diver. There is a possibility of disorientation, vomiting, dizziness, and loss of consciousness.

Post-traumatic symptoms of water flowing into the tympanic cavity manifest themselves in the development of otitis media in a purulent form. It is characterized by:

It should be noted that membrane rupture during immersion is a rare occurrence. More often, barotraumatic otitis develops according to the second scenario.

As is known, in order to avoid traumatic otitis when immersed in water, they resort to equalizing the pressure in the tympanic cavity in the following ways:

• You can yawn or swallow saliva.
• It is possible to create an area of ​​increased pressure in the nasopharynx with the nose closed, due to which the passage to the Eustachian tube will open and air will penetrate into the tympanic cavity (the so-called “blowing”).

The second option is the most effective, but in some cases it carries danger. If a person is sick with a respiratory disease and has a pathogenic environment in the nasopharynx, by blowing, he risks throwing infectious agents into the Eustachian tube, which will cause at least otitis in the catarrhal stage with a transition to an exudative form or, in the future, purulent otitis media.

Traumatic symptoms at the initial stage:

• Ear congestion
• Creaking, wet sounds in the ear when swallowing
• Hearing loss
• No pain

Over time, symptoms will intensify and change. Depending on the course of the disease, they can take the following form:

• Severe pain
• Temperature increase
• Feeling of pressure in the ear
• Feeling of fluid in the ear
• Ear discharge (usually purulent)
• Significant hearing loss

All of the above about barotraumatic otitis media is true not only for diving situations, but also applies to airplane flights.

The term “barotraumatic” indicates the cause that influenced the occurrence of otitis media. In terms of its content, post-traumatic otitis due to pressure drop is a standard otitis media of the middle ear with its characteristic treatment methods.

For the treatment of catarrhal stage use:

• drugs that relieve swelling of the mucous membrane of the Eustachian tube (for example, Tavegil),
• anti-inflammatory drugs (eg Erespal),
• agents that increase the secretion of mucous membranes (eg, Sinupret).
• vasoconstrictors (eg Nazivin).

Physiotherapeutic heating and blowing are of great importance for healing. To prevent further spread of the infectious environment from the nasopharynx, treatment of barotraumatic otitis should involve treatment of primary inflammation of the upper respiratory tract.

For the purulent form of traumatic otitis, the first-line drugs are antibiotics: local (Otipax drops, Tsipromed, etc.) and systemic (tablets Amoxicillin, Ketocef, Clarithromycin, etc.). At purulent discharge collateral successful treatment is to thoroughly clean the ear.

Prevention

The following recommendations should be considered preventative:

1. Visit an otolaryngologist before diving.
2. Do not dive under water or fly in an airplane if you have respiratory problems.
3. Learn to equalize the pressure in the middle ear using “blowing” and use this method when immersed in water and when landing an airplane (but not during ascent and takeoff).
4. Do not use earplugs when scuba diving: they may worsen pressure imbalances.

By following these rules, you don’t have to worry about barotraumatic otitis media.

Traumatic otitis media and mastoiditis

This is an acute inflammation of various parts of the tympanic cavity and mastoid process, caused by trauma.

Along with the usual picture of inflammation, traumatic otitis media may have features that should be taken into account in diagnosis and treatment: it can be combined with damage to the skull, brain, and spine. In this case, diagnostic and treatment tactics are determined together with a neurologist and neurosurgeon. The presence of symptoms of a fracture of the base of the skull or spine indicates the mandatory need to fix the patient’s head and body. Ear trauma is sometimes accompanied by a ruptured eardrum, which can lead to secondary infection of the tympanic cavity and the development of acute otitis media. If the eardrum is intact, the infection can enter the middle ear cavity through the auditory tube. A decrease in tissue reactivity after injury can cause the development of mastoiditis. An open wound of the mastoid process is always infected, and therefore it is possible for the infection to spread into the tympanic cavity with the development of acute inflammation.

If the middle ear is injured, the auditory ossicles may be damaged. There may be a fracture of the malleus, incus, their dislocation, displacement and dislocation of the base of the stapes. Such changes are also observed with injuries of the skull and lower jaw. It is possible to diagnose damage to the auditory ossicles using otoscopy and otomicroscopy, and with an intact eardrum - using impedancemetry, when a type D tympanogram is detected. However, most often the nature of the damage and disruption of the chain of the auditory ossicles are recognized during tympanotomy and tympanoplasty.

Treatment. For an open wound, primary surgical treatment is performed. Turunda with boric alcohol is loosely introduced into the ear canal, and antibacterial therapy is prescribed. In case of traumatic damage to the chain of auditory ossicles and the eardrum, after the inflammation subsides, various types of tympanoplasty are performed in order to restore the transformation mechanism in the tympanic cavity.

Post-traumatic otitis media

Otitis media occurs not only as a complication after viral infections. Various types of injuries can serve as a harbinger and provocateur of the disease. Which are accompanied by damage to the outer and inner parts of the ear cavity. Traumatic otitis media is considered in terms of the formation of a focus of inflammation, hearing impairment, and additional penetration of bacteria. This form of the disease may be associated with changes in the functioning of nerve fibers, parotid glands and joints.

What is post-traumatic otitis media

Traumatic otitis media, caused by damage to the ear cavity during cleaning, blow, bruise, fall, industrial injury, with the ingress of foreign small objects or substances.

Typically, this form of the disease provokes an acute inflammatory process, accompanied by infection, damage to the eardrum, hearing loss or deafness.

The consequences resulting from damage to the external ear cavity and inner ear are identified by specialists as post-traumatic otitis media.

External injuries usually occur in adults. Children love to insert foreign objects into their own and each other's ear canals.

First signs

After an injury, the first sign of the disease is extraneous noise in the ears. The following is a set of key symptoms characterizing traumatic otitis media:

• dizziness accompanied by nausea,
• acute headache,
• increase in body temperature,
• imbalance.

In this state, appetite disappears, hearing deteriorates and constant weakness in the body prevails. The extreme symptomatology of the disease is bloody and mucous discharge from the ear.

One type of traumatic otitis is baratraumatic otitis. It occurs when diving under water and surfacing (important for divers), during takeoff and landing of an airplane. This injury occurs due to changes in external pressure. Characteristic symptoms:

• congestion in one or both ears,
• feeling of increasing pressure inside,
• pain varies in scale from slightly noticeable to acute,
• itching in the ear canal.

Dizziness, disorientation, and even loss of consciousness are also possible.

Whatever the injury that foreshadows post-traumatic otitis media, without waiting for the above symptoms, you should seek medical attention.

How to treat the disease

After the examination and depending on the severity of the disease, the doctor selects a treatment option. With a mild form of post-traumatic otitis, you can get by with less aggressive intervention than with visible complications.

In any case, the external auditory canal must be disinfected and closed to prevent infection, using a sterile cotton-gauze swab.

To prevent the formation of massive purulent accumulations, warming procedures are performed in the form of compresses. When you need to remove the already accumulated pus, you should rinse the ear canal and insert a flagellum moistened with a solution of boric alcohol into the cavity. Swelling of the nasopharynx is relieved by vasoconstrictor drops in the nose. And in order to prevent the pus from spreading further and reaching the brain, the doctor decides to puncture the eardrum and thereby free the ear canal from fluid. The patient loses his hearing, but it will recover after a while.

To remove the source of inflammation and reduce pain, the doctor prescribes antibacterial drugs. It is possible to use antihistamines.

Surgical intervention is applicable in urgent cases, if there is an urgent need. When the patient needs hearing restoration both after the injury itself and as a result of the consequences of disease progression.

Folk remedies act only auxiliary element. Rinsing the ear canals and warming the cavities is performed only with the permission of a specialist, so as not to aggravate the current situation.

The progressive purulent form of traumatic otitis requires the intervention of antibiotics.

Consequences and complications

When untimely or unskilled assistance was provided for post-traumatic otitis media, or when the patient himself did not properly follow all instructions, a number of protracted processes may occur that worsen the state of health.

Traumatic otitis can easily turn into acute or catarrhal. Acute - occurs when the ear canal is completely blocked by fluid. Accompanied by hearing loss, a feeling of fluid moving from side to side, and general congestion. Catarrhal otitis with inflammation of the eardrum appears due to the presence of pathogens streptococci and staphylococci.

The occurrence of mastoiditis is characterized by purulent infection of the mucous membrane and bone tissue of the temporal bone. Otogenic sepsis, with the same purulent formations that can spread through the veins, leads to damage to the blood vessels of the brain, joints, and kidneys.

Meningitis is a common problem. The disease is an inflammation of the membranes of the brain and spinal cord.

Prevention

The main rule of prevention is to avoid and prevent any injuries. If such a situation could not be avoided, you should immediately seek medical help, determine the severity of the injury, learn about the possible consequences and begin treatment. To avoid post-traumatic otitis media, you should show your ear canal during examination to a specialist and pay attention to your sensations.

Any hypothermia, viral infections, vitamin deficiencies, kidney problems, and a number of serious diseases such as diabetes are provocateurs. It is worth avoiding crowds of people so as not to become infected with ARVI, and to monitor the current condition and stage of existing diseases. Support immunity with a standard and basic complex: balanced nutrition, physical activity, healthy sleep and fewer stressful situations.

Otitis media

Otitis media is a disease in which the middle part of the ear - the space behind the eardrum, consisting of thin auditory ossicles - becomes inflamed.

Most often, the disease manifests itself in children, as well as in people with weakened immune systems.

Otitis media is accompanied by pain (usually in one ear canal, but bilateral pain also occurs), increased body temperature, feeling unwell, sleep disturbance. If the disease is not treated, otitis media can develop into hearing loss, spread to neighboring organs and cause a number of other complications.

Types of otitis media

Acute infectious purulent otitis

Most often it occurs as a result of various diseases of the upper respiratory tract.

• congestion and discomfort in the ear canal;
• temperature increase;
• painful sensations;
• discharge of pus;
• noise in the ear.

Acute infectious exudative otitis media

When an infection gets into the ear canal, pus may begin to form, which leads to purulent otitis media. The disease also occurs due to a decrease in pressure in the tympanic cavity and as a result of a blockage in the passage of the auditory tube. The disease can manifest itself due to a violation of the outflow of fluid (exudate) from the auditory tube.

Symptoms of acute infectious exudative otitis media:

• there may be a feeling that the ear is blocked or there is fluid in it;
• Ear pain may occur as a result of fluid accumulation;
• if left untreated, hearing loss may begin to develop;
• During a medical examination, it is discovered that the eardrum has become gray and the vascular network increased.

Acute hemorrhagic otitis media

Hemorrhagic otitis media is an inflammation of the mucous membrane of the middle ear, resulting in the accumulation of bloody fluid (hemorrhagic exudate) and significantly increasing the permeability of the vessels of the eardrum.

Signs of acute hemorrhagic otitis media:

• a medical examination reveals a bluish tint of the eardrum;
• progressive hearing loss occurs;
• ear stuffiness is felt;
• slight pain is observed during palpation;
• A reddish (bloody) inflammatory fluid is visible in the tympanic cavity.

Acute traumatic otitis media

The cause of traumatic otitis media is various minor injuries, including thermal effects (burn, frostbite), chemical, and mechanical. Through a damaged eardrum or a crack in the temporal bone, the infection reaches the middle ear. Sometimes, in case of injury, blood enters the cavity of the middle ear, forming suppuration.

The disease can be recognized by the following signs:

• there are visible hemorrhages on the eardrum, the hole has torn edges;
• hearing decreases;
• Bloody or purulent discharge comes out of the ear.

Chronic allergic exudative otitis media

The disease appears as a result of a disruption in the release of fluid from the middle ear during respiratory and allergic diseases, as well as due to improper treatment of the ear with antibiotics. The longer the purulent exudate is in the tympanic cavity, the thicker it becomes, making it difficult and increasing the duration of treatment.

• feeling of ear fullness;
• a feeling of “transfusion” of fluid in the ear cavity;
• hearing loss;
• The eardrum appears cloudy and retracted.

Chronic infectious suppurative otitis media

The infection progresses over a long period of time, causing inflammation to last for several weeks or even months.

Chronic infectious suppurative otitis media is characterized by:

• purulent discharge with an unpleasant odor from the ear canal;
• significant hearing loss.

In some cases, the disease may proceed unnoticed and as a result, a scar forms on the eardrum or adhesions occur, leading to hearing impairment.

Chronic adhesive otitis media

The disease develops during a long stay of fluid in the middle ear cavity, worsening the patency of the auditory tubes, which leads to the formation of connective tissue from which adhesions are formed, impeding the mobility of the auditory ossicles. As a result, sound conduction deteriorates and hearing decreases.

Main signs of the disease:

• rapid hearing loss;
• noise in ears;
• feeling of stuffiness in the ear.

Traumatic otitis and mastoiditis

The presence of a fracture of the base of the skull in the patient, a possible injury to the spine, indicates an urgent need to fix the head and body of the victim. Trauma to the auricle is accompanied by rupture of the eardrum, which can lead to secondary infection and the development of acute otitis media.

After an injury, even if the eardrum is intact, infection can penetrate through the auditory tube. A significant decrease in tissue reactivity from an injury, as a rule, can lead to the development of mastoiditis.

An open wound of the mastoid auricular process is always infected. This is what can cause the infection to spread into the tympanic cavity with the further development of acute inflammation.

The blast wave is often accompanied by a significant and sharp increase in air pressure in the external ear canal, which immediately causes perforation of the eardrum, and subsequently acute otitis media.

With such injuries, the pain in the ear is slight, the body temperature is slightly elevated or normal, and the changes in the blood are minor. Discharge from the injured ear is first serous-bloody, then transparent mucous.

A person experiences a sharp decrease in hearing, which indicates damage to the inner ear; dizziness and spontaneous nystagmus of a peripheral (unilateral) and central (bilateral) nature may be observed.

In case of middle ear injuries, it is imperative to correctly recognize and evaluate the location of damage to the skull, spine, and brain. Depending on the diagnosis, the neurosurgeon and neurologist prescribe treatment.

In case of an open wound, primary surgical treatment is required, when loose turunda with boric alcohol is carefully introduced into the ear canal and antibacterial therapy is prescribed. Treatment of traumatic otitis and mastoiditis must necessarily include the use of antibiotics.

With the development and rapid spread of gunshot mastoiditis, it is characteristic that immediately from the moment of injury the bone is involved in the inflammatory process of the ear, but due to the fact that the wound is open, the outflow of contents from the auricle is often good.

The presence of cracks and possible fractures of the walls of the process can contribute to the spread of infection to the contents of the skull and the occurrence of intracranial inflammation and complications. Treatment for gunshot mastoiditis is surgical.

Otitis of the middle ear is an inflammatory process of an infectious nature that affects the middle ear and the cavities connecting to it. The disease occurs in both adults and children, although children get sick more often, which is associated with anatomical and physiological characteristics internal structure ear. Men and women are equally susceptible to this pathology, and people with chronic infections oropharynx and nasopharynx - tonsillitis, caries, sinusitis, sinusitis, etc.

Often the inflammatory process is localized on one side, but in children, acute otitis media progresses rapidly, and both ears are affected.

Causes

The middle ear has a connection with other parts of the auditory system, and they, in turn, communicate with the outside world, the nasopharynx and oropharynx, which means that infection can enter in any way - with diseases such as, etc.

Viral or infectious diseases in the acute stage can also lead to the development of pathology such as acute otitis media. The infection spreads through the mouth or nasopharynx. The reason may also lie in an allergic reaction, in which, due to swelling, the flow of air into the ear cavity is disrupted, which contributes to the development of congestion and the proliferation of bacteria. Acute otitis media can also be caused by catarrhal otitis, the treatment of which is not started in a timely manner.

Chronic pathologies with a decrease in the body’s defenses can also cause the spread of infection throughout the body and damage to this organ, with the development of inflammation in it.

Predisposing factors are:

• general hypothermia of the body (also leads to local hypothermia, giving an excellent opportunity for bacteria to actively multiply);
• decrease in protective forces due to physical and emotional overload;
• poor nutrition (lack of nutrients) also leads to a decrease in defenses;
• Infections dormant in the body, under favorable conditions, can be activated and cause pathology of the middle ear.

In young patients, the causes of this pathology may be associated with:

• anatomically shortened auditory tube, which allows infection to more easily penetrate inside the hearing aid;
• the fact that the cavity is lined with embryonic tissue, which is an excellent breeding ground for microorganisms;
• infants being in a horizontal position, which is why they more often develop congestion;
• proliferation of adenoid tissue, which closes the Eustachian tube from the oropharynx;
• unformed immune system of babies.

Varieties

Depending on the severity, there are several types of this disease. The most pronounced symptoms are acute otitis media, which occurs when infected with viruses. Usually, along with this lesion, other viral diseases are observed in adults and children.

If the infection is bacterial, acute suppurative otitis media occurs. Sometimes a viral pathology without proper treatment also develops into, as it joins bacterial infection– This most often occurs in young patients. It is important to distinguish between these two forms, since treatment for bacterial pathology requires taking antibiotics, while for viral pathology other drugs are used.

When acute suppurative otitis media is not treated promptly, the pus spreads to other cavities adjacent to the middle ear, causing purulent or acute otitis media. Pus has proteolytic properties, which means that it is capable of dissolving tissue, so its accumulation in the tympanic cavity can lead (without treatment) to the dissolution of the membrane with the formation of holes of different diameters through which the contents will flow out. In addition, pus can penetrate into the meninges. That is why acute purulent otitis media is often complicated, especially in young children. Treatment of this pathology must be timely to avoid complications.

Catarrhal otitis media is a form that is dangerous for its complications, in which complete hearing loss may occur. The causes of a disease such as catarrhal otitis media are frequent respiratory diseases in children and adults. It is not difficult to recognize catarrhal otitis - the pain with it is of a shooting nature and radiates to the temple and teeth.

There is also a form of the disease known as exudative otitis media, which occurs as a consequence of impaired ventilation due to tissue swelling. The accumulation of serous exudate in the tympanic cavity in this form of the disease leads to hearing impairment and causes pain in the area of ​​the affected organ, resulting from increased pressure in it.

With a disease such as exudative otitis media, the density of the fluid in the tympanic cavity increases over time, which can cause partial or complete otitis media. To extract the exudate, surgical treatment is performed.

Another type is chronic suppurative otitis media. They talk about it when the membrane breaks and pus flows out of the patient's ear. Sometimes there can be a lot of discharge, sometimes a little, but in any case, in the chronic form, the symptoms of the disease are not expressed - the pain subsides, the temperature drops, etc. But chronic purulent otitis media is terrible for its complications, because as a result of the rupture of the membrane, scars subsequently form on it, which interfere with the normal passage of sounds, which leads to the development of hearing loss, which is already irreversible.

Signs

In the acute form, adults experience the following symptoms:

• severe pain in the area of ​​the affected ear, which either subsides or becomes stronger;
• swelling of the neck on the affected side;
• hearing loss, subsequently with the development of persistent hearing loss;
• (38–39);
• (weakness, headache, etc.);
• the appearance of purulent exudate in a form of pathology such as chronic purulent otitis media.

Depending on the stage, the disease can manifest itself in different ways. There is an initial stage, in which all the symptoms described above are present, and the patient may also complain of severe pain on the affected side (shooting in nature). Treatment of the pathology is carried out precisely during this period of the disease and gives good results, but if the disease is not treated, the second stage develops - perforative. As the name implies, at the second stage a breakthrough of the tympanic membrane occurs, after which the symptoms weaken - the temperature drops, the pain decreases, and the condition stabilizes. And the third is reparative, in which the exudate completely drains and the membrane heals with the formation of scars, leading to hearing impairment.

The symptoms of such a pathology are similar to those indicated, with the only difference being that the membrane does not melt, so the exudate has nowhere to flow out and the person experiences severe pain that is not relieved by analgesics.

If the exudate (serous or purulent) spreads deeper, complications develop, the symptoms of which may vary depending on the affected organs. A person may experience nasal congestion, an inflammatory formation behind the ear, characterized by pain (mastoiditis). The most serious complication is meningitis, in which pus enters the brain, causing neurological symptoms in adults and young patients.

The symptoms of this disease in very young children are as follows:

• refusal to eat (from the breast or bottle);
• irritability and tearfulness;
• sleep disturbance;
• severe pain when pressing on the base of the ear.

Catarrhal and other forms, including chronic suppurative otitis media, are not the only pathologies that can cause similar symptoms in children, so before starting treatment, you need to examine the child and make sure that the cause of the manifestations lies precisely in this disease.

Diagnostics

The diagnosis can be made by a visual examination, during which a protruded or, conversely, retracted eardrum, its redness and severe pain in the ear are noted.

Instrumental research methods are also used, namely otoscopy. With a disease such as chronic suppurative otitis media, the doctor can see a hole of different diameters in the membrane and pus pouring out of the cavity behind it. Hearing examination allows us to identify such pathology as exudative otitis media, since visible signs it is not present, except for the protrusion of the eardrum.

Features of treatment

Treatment of pathology begins with the treatment of the diseases that caused it, if any. In adults, this is a sore throat, tonsillitis, or viral rhinitis, sinusitis. In children, otitis media often becomes a complication of diseases such as tonsillitis and scarlet fever.

Treatment includes taking medications, the main ones being antibiotics. In such forms of the disease as exudative otitis media, acute purulent and chronic purulent otitis media, taking penicillin drugs, as well as cephalosporins, is indicated. In their absence, macrolide antibiotics are prescribed.

In other forms, glucocorticoids are prescribed that can reduce inflammation, antihistamines, removing swelling, vasoconstrictor. Drug treatment is combined with special procedures for washing and blowing out the middle ear cavity. As mentioned above, if the patient has exudative otitis media, surgery is indicated - myringotomy.

Surgical treatment is indicated when the disease does not respond to conservative therapy, progresses rapidly, or when complications develop.

There are two types surgical treatment– paracentesis and antrotomy. Most often, paracentesis is performed, which involves opening the eardrum and draining the contents of the cavity. Antrotomy is performed only in cases of severe mastoiditis in adults or anthritis in young children.

Otitis media is an acute infectious disease manifested by specific symptoms. The disease must be treated, as it is dangerous for the development of complications. No person is immune from the disease, so it is necessary to be able to recognize otitis media in time, the symptoms and treatment of which depend on the form of inflammation.

The disease is an infectious disease and occurs in the form of acute or chronic inflammation. Pathology develops due to the entry of pathogenic microorganisms into the Eustachian tubes, and from there into the middle ear.

Ear inflammation is one of the most common diseases.

Causes:

• infection of the ear by bacteria or viruses;
• complication after influenza or acute respiratory viral infection;
• inflammation of the nasopharynx;
• sinusitis;
• mechanical damage to the ear.

Otitis is considered more of a childhood disease, as it is rare among adults. In children, this disease most often results from a too narrow Eustachian tube. Any inflammation in the nasopharynx or nasopharyngitis leads to the spread of infection through the Eustachian tube into the ear.

In adults, otitis media in the vast majority of cases develops against the background of a general decrease in immunity. The disease is often a complication of inadequate therapy for infectious and viral diseases, including sinusitis.

The risk group includes adults with chronic sinusitis, patients with immunodeficiency and patients with diabetes.

Middle ear disease is accompanied by severe symptoms and requires timely treatment.

Symptoms and signs of the disease

Otitis media is an inflammatory disease with an acute onset and rapid progression of symptoms.

If your ear hurts, you should immediately consult a doctor.

Classic clinical picture:

• high temperature and fever;
• acute “shooting” pain in the ear;
• hearing loss, feeling of congestion;
• discharge from the external auditory canal.

Usually, with otitis media, nasal congestion and inflammation of the nasopharynx are observed. This is due to the structural features of the ENT organs, the work of which is closely interconnected. Otitis may be a consequence of inflammation of the maxillary sinuses or nasopharyngitis, but if it acts as an independent disease, it necessarily entails a general deterioration in well-being and the spread of the pathological process to nearby organs.

Types and stages of otitis media

There are two forms of otitis media – acute and chronic. Against the background of the inflammatory process, exudate accumulates. Based on the type of fluid, otitis media is divided into purulent and catarrhal.

If treated incorrectly or untimely, the disease can lead to serious complications.

In the vast majority of cases, the cause of ear inflammation is cocci (staphylococcus, pneumococcus) and other opportunistic microorganisms. Their activation is due to a decrease in immune defense, or occurs against the background of severe inflammatory processes in the nasopharynx. The causes of the development of acute and chronic diseases are the same, only the severity of the symptoms differs.

Acute otitis media

Acute inflammation of the middle ear is characterized by a rapid increase in body temperature and pain. The main signs of the disease are severe pain and high body temperature. IN pathological process surrounding tissue may be involved, leading to spread pain syndrome over the entire affected part of the head.

A characteristic feature of acute inflammation is sharp, excruciating pain, the so-called “lumbago”. After some time, the inflammatory process resolves, the pain subsides, and purulent fluid begins to ooze from the ear canal.

Noise, pain and pulsation in the ears - characteristic features inflammation.

Acute otitis media occurs in 3 stages:

• Stage 1: acute eustachitis;
• Stage 2: acute catarrhal inflammation;
• Stage 3: acute purulent inflammation.

Acute eustachitis is accompanied by tinnitus, a feeling of pulsation and congestion, and a slight increase in temperature (up to 37-37.4). This stage lasts up to several days, and then turns into acute catarrhal inflammation, which is accompanied by severe pain and an increase in temperature to subfebrile levels. In this case, there is aseptic inflammation of the middle ear, strong noise and pulsation in the ears, severe congestion, accompanied by hearing impairment.

Acute purulent inflammation is next stage diseases. This is accompanied by severe pain that radiates to the teeth, lower jaw, eyes and temporal region. The pain intensifies when swallowing and when trying to blow your nose to clear the nose. Body temperature rises to 39-400 C. After some time, the eardrum is perforated, a wound is formed, through which pus flows out. At this stage, symptoms begin to subside.

Acute purulent inflammation will be accompanied by pain until the discharge finds a way out. If this does not happen for a long time, the otolaryngologist makes a puncture through which the purulent masses are removed.

After complete cleansing of the inflamed cavity and removal of the purulent contents, the perforation gradually heals and the disease completely resolves.

Chronic otitis media

Chronic otitis media is a consequence of inadequate treatment of acute inflammation. It develops in two cases: with frequent relapses of acute inflammation with the formation of perforation and discharge of discharge, or as a result of lack of treatment for acute inflammation.

The disease can lead to temporary or permanent hearing loss.

Each time the eardrum ruptures to drain purulent contents from the middle ear to the outside, a small perforation is formed. Over time, it heals, but a scar appears in its place. In the case of chronic otitis, these scars become inflamed or do not heal completely due to the small amount of residual purulent masses in the perforation.

As a rule, the acute form of the disease does not cause pathological hearing impairment. Ear congestion and hearing loss are temporary symptoms that disappear after the integrity of the eardrum is restored. Chronic otitis media can lead to irreversible hearing impairment, but we are talking specifically about weakening, but not complete loss of the ability to hear.

Diagnostic measures

An experienced ENT doctor can easily determine the cause of the ailment.

There are no problems with making a diagnosis. An experienced doctor only needs to interview the patient and examine the ears using an endoscope and otoscope to suspect the cause of the ailment. To confirm the presence of purulent inflammation, an X-ray of the temporal bone or a computed tomography scan is prescribed.

Treatment of otitis media in adults at home

Otitis media should be treated on an outpatient basis. The treatment regimen depends on the form and stage of inflammation. In the absence of purulent discharge, therapy is carried out by local means using ear drops. If an abscess is present, antibiotic therapy is prescribed. There are also traditional methods of treatment, but they are recommended to be used as an auxiliary, and not the main one. therapeutic agent.

Incorrect treatment can lead to deafness!

Chronic otitis media of the middle ear requires complex therapy; self-medication in this case is unacceptable. Inadequate therapy is dangerous for the development of hearing loss.

The most effective drops for otitis media

Antiseptics and antibacterial drugs in the form of drops are used for treatment.

Popular medicines:

• Sofradex;
• Tsipromed;
• Otipax;
• Normax.

The medicine is prescribed by a doctor; you should not self-medicate.

Sofradex is a combination drug based on a corticosteroid and an antimicrobial agent. Ear drops are effective at the initial stage of the disease, before pus begins to accumulate in the middle ear. The product is used 2-3 drops up to four times a day. The course of treatment takes on average 4-5 days.

Quite a popular drug in the practice of ENT doctors.

Tsipromed drops contain the fluoroquinolone ciprofloxacin. This is a broad-spectrum antimicrobial agent that quickly relieves inflammation caused by opportunistic microorganisms. The drug is used in ophthalmological and otolaryngological practice. Drops are used up to 3 times a day, 1 drop in each ear.

Before use, you should consult a specialist.

Otipax is a drug with analgesic and anti-inflammatory effects. The drug contains phenazone and lidocaine. Drops are used for acute otitis media to reduce pain. In case of severe suppuration, the drug is combined with antibiotics. The product can be used 4 drops 4 times a day.

Use with caution!

Normax is an effective antimicrobial agent based on the fluoroquinolone norfloxacin. This drug is characterized by broad antimicrobial activity and rapid action. It is used 5 drops three times a day for 4-5 days.

Antibiotics for otitis media in adults

For otitis media, broad-spectrum antibacterial drugs are used. The combination of ear drops with antibiotic tablets helps to minimize the risks of complications and the disease becoming chronic.

The doctor will prescribe a course of treatment and dosage.

The following groups of drugs are most often prescribed:

• penicillins (Amoxicillin, Amoxiclav, Augmentin);
• fluoroquinolones (Tsipromed, Norfloxacin)
• cephalosporins (Ceftriaxone)
• macrolides (Sumamed, Azithromycin).

The first-line drugs of choice are penicillins. Amoxicillin, Amoxiclav or Augmentin are prescribed. Fluoroquinolones are broad-spectrum antimicrobial agents used in cases of intolerance or ineffectiveness of penicillins. Cephalosporins or macrolides are also prescribed as substitutes for penicillin intolerance.

The dosage and duration of antibiotic treatment is selected individually for each patient.

Treatment with folk remedies

Traditional treatment of otitis media is an extremely dubious measure that cannot replace conservative drug therapy. Such methods can be used as additional ones, but only after consultation with a doctor. It is important to remember that improper treatment of otitis media can lead to hearing loss.

Incorrect treatment can lead to hearing loss.

1. Mix Dimexide and boric acid solution in equal proportions, apply to cotton wool and place it in the ears for an hour. Repeat this manipulation three times a day.
2. Place 5 large bay leaves in a bowl and pour over a glass hot water and boil for 20 minutes. Then cover with a lid, wrap in a towel and leave to steep for another two hours. The product is taken one tablespoon three times a day, while 2-3 drops are instilled into the inflamed ear.
3. When the eardrum ruptures and pus is released, hydrogen peroxide is used, which is instilled with a pipette, or used in the form of an ear turunda. This helps to quickly clear the ear canal of purulent contents and avoid the transition of acute otitis into a chronic disease.

The only folk method used in modern medicine is hydrogen peroxide. The product has a number of limitations, and in rare cases can provoke the development of complications, but it really effectively clears pus and prevents its re-accumulation. However, it is recommended to consult a doctor before using peroxide.

Possible complications of the disease

Despite the frightening symptoms, acute otitis media practically does not lead to hearing loss if it is treated correctly and in a timely manner.

Timely and correct treatment will help you quickly cope with the disease.

Complications are characteristic of an advanced chronic form of the disease and manifest themselves:

• inflammation of the meninges (meningoencephalitis);
• damage to the facial nerve;
• sepsis, when purulent masses enter the general bloodstream;
• hearing loss.

Timely detected otitis media can be treated quite successfully. Typically, treatment for otitis media takes about one week. Pain and discomfort disappear on the second day after starting drug therapy.

Prevention of otitis media

Otitis in adults is often a consequence of problems with nasal breathing. This may be due to chronic inflammation of the maxillary sinuses or a deviated nasal septum. Otitis media can be prevented only through timely treatment of these disorders.

It is also important to prevent weakening of the immune system and promptly treat any viral and infectious diseases.

• Ear pain of varying intensity, which:
  • may be constant or pulsating;
  • may be pulling or shooting;
  • can radiate to the teeth, temple, and back of the head.
• Ear congestion.
• Hearing loss.
• Noise in the ear.
• Discharge from the ear.
• Enlarged and painful lymph nodes.
• Pain in the area behind the ear.

Symptoms may occur in one ear (unilateral otitis media) or both ears (bilateral otitis media).

Acute otitis media is often accompanied by symptoms of intoxication - general weakness, fever and others.

In acute otitis media, symptoms from other ENT organs are often observed:

• nasal congestion;
• nasal discharge;
• pain or sore throat.

Forms

• Catarrhal stage(catarrhal otitis media) – the initial stage of the disease.
  • Manifests:
    • ear pain;
    • ear congestion;
    • deterioration in general health.
  • When examining the ear:
    • the auricle is painless;
    • the external auditory canal is wide;
    • the eardrum is reddened, with no signs of fluid behind it.
  • Discharge from the ear is not characteristic of catarrhal otitis media.
  • Without treatment, acute catarrhal otitis media can turn into a purulent form.

• Stage of purulent inflammation(suppurative otitis media) in turn is divided into two stages.
  • Pre-perforation stage – in this case, pus accumulates in the middle ear cavity due to progressive inflammation, but the eardrum remains intact.
    • This stage is characterized by increased pain in the ear, increased congestion in the ear, and decreased hearing in the affected ear.
    • On examination, the eardrum is red, bulging, and sometimes purulent discharge can be seen behind it; there is no discharge from the ear.
  • Perforated stage – due to the growing pressure of pus in the middle ear cavity, the eardrum ruptures, and pus begins to flow out of the ear canal. In this case, the ear pain often becomes less intense.
    • On examination, there is purulent discharge in the ear canal and a violation of the integrity (perforation) of the eardrum.
    • When blowing out the ears (exhale through a tightly closed mouth, while pinching the nose with your fingers), pus leaks out through a perforation in the eardrum.

• Reparative stage(process resolution stage) – with adequate treatment:
  • inflammation in the ear is stopped;
  • the pain goes away;
  • discharge stops;
  • Perforation of the eardrum in most cases heals on its own.

In this case, periodic ear congestion may still persist for some time.

Upon examination, the appearance of the eardrum is normal.

Causes

• Contrary to popular belief, acute otitis media is not directly related to hypothermia, walking in cold weather without a hat, exposure to drafts, or water getting into the ear.

• Acute otitis media is caused by various pathogenic microorganisms - bacteria and viruses.
  • Most often they enter the tympanic cavity (middle ear cavity) through the auditory tube in inflammatory diseases of the nose, paranasal sinuses, nasopharynx, and throat.
  • When you blow your nose incorrectly (with both nostrils at the same time, with your mouth closed), the contents of the nose under pressure enter the middle ear, causing inflammation.

• Various conditions that make it difficult for the auditory tube to open and allow air to enter the middle ear, for example:
  • the presence of adenoids - overgrown tissue of the pharyngeal tonsil;
  • enlarged posterior ends of the nasal concha;
  • sharp curvature of the nasal septum;
  • pathology in the area of ​​the nasopharyngeal openings of the auditory tubes.

    Promotes disruption of ventilation of the middle ear and the development of inflammation in it, especially with concomitant viral infection.

• Acute otitis media can also develop when the pathogen enters the middle ear through the blood during various infectious diseases (for example, influenza).

• Inflammation of the middle ear can occur as a result of injury to the eardrum and infection entering the middle ear from the external environment.

Diagnostics

• Analysis of complaints and medical history:
  • pain, ear congestion;
  • hearing loss;
  • discharge from the ear;
  • increased body temperature;
  • deterioration in general health;
  • the presence of concomitant infections - influenza, ARVI, diseases of the nose, paranasal sinuses, adenoids (pathologically enlarged pharyngeal tonsil), - against the background of which ear complaints appeared.

• Ear examination:
  • changes in the eardrum are noted - its redness, bulging, change in mobility, defect in the form of a rupture;
  • the presence of pus in the ear canal.

For a more thorough examination of the ear, magnifying equipment is used - otoscope, otomicroscope, endoscope.

• If nasal breathing is difficult, the nasopharynx and the area at the mouth of the auditory tube (connecting the middle ear to the nasopharynx) should be examined using endoscopic techniques.

• In case of ear congestion and hearing loss - tuning fork examination (special tests with tuning forks, which allow you to find out whether hearing loss is associated with the development of inflammation in the middle ear or with damage to the auditory nerve).

• Tympanometry. The method allows you to evaluate the mobility of the eardrum and the pressure in the tympanic cavity.
  • It is carried out only in the absence of defects in the eardrum.
  • If there is fluid (pus) in the middle ear, there is a decrease or complete absence of mobility of the eardrum, which is reflected in the shape of the tympanogram curve.

• Audiometry is a hearing test.
• Consultation is also possible.

Treatment of acute otitis media

Treatment depends on the stage of the disease.

• At the initial stage of the disease, a warm compress is prescribed to the parotid area and physiotherapy. When a purulent process develops, any heating of the ear (compresses, blue lamp) is strictly prohibited.
• If there is no defect in the eardrum, anesthetic drops are prescribed in the ear. In such a situation, instilling antibacterial drops is not advisable, since they do not penetrate the eardrum.
• If there is a perforation (rupture) of the eardrum, antibiotic drops are prescribed in the ear.
  • It is important to avoid using drops that contain substances that are toxic to the ear, as well as alcohol, as this can lead to permanent hearing loss.
  • Self-medication in such a situation is extremely dangerous.
• Prescription of vasoconstrictor nasal sprays is mandatory.
• Painkillers, antipyretics if necessary.
• Treatment of diseases of the nose and nasopharynx.
• Immediate administration of systemic antibiotics is recommended for severe course otitis or the presence of severe concomitant pathology or immunodeficiency (immune disorder). In other cases it is recommended local treatment, observation for 2-3 days and only then deciding on prescribing an antibiotic.
• In the pre-perforative stage of acute purulent otitis media (there is an accumulation of pus in the tympanic cavity, but the eardrum is intact, accompanied by severe ear pain and increased body temperature), paracentesis is recommended (a small puncture of the eardrum under local anesthesia). This allows you to relieve pain, speed up recovery, and facilitate the delivery of medications to the ear.
• In the resolution stage, it is possible to prescribe physiotherapy, exercises for the auditory tube, and blowing out the ears.
• In acute otitis media, it is recommended to protect the ear from water, especially if there is a perforation of the eardrum.

Complications and consequences

In severe cases or in the absence of adequate treatment, the following complications may develop:

• mastoiditis (inflammation of the mastoid process of the temporal bone) – characterized by swelling, swelling of the postauricular area;
• intracranial complications (meningitis, encephalitis) - characterized by a severe general condition, severe headache, the appearance of brain symptoms (neck tension, vomiting, confusion, etc.);
• neuritis of the facial nerve (inflammation of the facial nerve) – manifested by facial asymmetry, impaired mobility of half the face;
• otogenic sepsis - a generalized infection spread to various organs and tissues through the bloodstream.

All of the above complications require immediate hospitalization.

Chronicization of the process and the development of persistent hearing loss (hearing loss) are also possible.

Prevention of acute otitis media

• Prevention of respiratory diseases:
  • avoiding hypothermia;
  • hardening of the body;
  • healthy lifestyle (giving up bad habits, playing sports, walking in the fresh air, etc.);
  • compliance with personal hygiene rules.
• Treatment of chronic diseases:
  • nose;
  • paranasal sinuses (sinusitis, sinusitis);
  • nasopharynx (adenoids);
  • throat (tonsillitis);
  • oral cavity (caries).
  
  

Restoring normal nasal breathing if it is difficult.

• With the development of acute respiratory infections with a runny nose - correct technique blowing your nose (each nostril in turn, mouth open) and rinsing your nose (with a smooth stream, followed by gentle blowing of your nose).
• Timely consultation with a doctor at the first signs of otitis media. Self-medication, independent use of ear drops (they may be ineffective or even dangerous), or warming the ear without a doctor’s prescription is unacceptable.

Additionally

The tympanic cavity of an adult has a volume of about 1 cm 3, it contains the auditory ossicles responsible for transmitting the sound signal:

• hammer;
• anvil;
• stapes.

The tympanic cavity is connected to the nasopharynx by the auditory (Eustachian) tube, with the help of which pressure is equalized outside and inside the eardrum: during swallowing movements, the auditory tube opens, the middle ear is connected with the external environment.

Normally, the tympanic cavity is filled with air.

Otitis - a disease accompanied by severe (both shooting, pulsating or aching) pain in the ears. Pain from otitis media can radiate to the teeth, temple, the corresponding side of the head and the back of the head. The patient experiences weakness, insomnia, and loss of appetite.

Depending on the nature of the disease, otitis may occur in acute And chronic form.

Acute otitis media is severe and characterized by severe pain.

Acute otitis is a signal for the patient that it is necessary to urgently consult a doctor! Acute ear pain cannot be tolerated; it can cause deafness! Chronic otitis of the ear is less pronounced, but also very dangerous! Otitis media does not go away on its own; after otitis media, the patient may lose hearing forever, so at the first signs of the disease, you should urgently contact a specialist.

Types of otitis

Depending on the direction of the pain, it is customary to distinguish 3 types of otitis media: external, middle And interior otitis.

Otitis externa appears most often as a result of mechanical damage to the auricle or external auditory canal. The following symptoms are characteristic of external otitis of the ear: aching, dull pain, swelling of the ear, and a slight increase in temperature.

Otitis media is an inflammatory disease of the air cavities of the middle ear: the tympanic cavity, the auditory tube and the mastoid process.

Internal otitis - this is untreated otitis media of the middle ear. With internal otitis, inflammation of the inner ear occurs and the entire vestibular apparatus is damaged.

Acute otitis media

According to disease statistics acute form Otitis media accounts for 30% of the total number of ENT diseases. Most often it occurs in preschool children.

Symptoms of acute otitis media

The disease is characterized by an acute onset with the appearance of the following symptoms:

• earache;
• ear congestion or hearing loss;
• increased body temperature;
• anxiety;
• disturbance of appetite, sleep;
• headache and toothache.

Causes of development of acute otitis media

In most cases, the disease can be caused by various pathogenic microorganisms - viruses, microbes, fungi, etc. Respiratory viruses are found in exudate obtained from the middle ear in 30-50% of cases. The most common cause of otitis media is parainfluenza viruses. , influenza, rhinoviruses, adenoviruses, enteroviruses, respiratory syncytial viruses, etc.

In 50-70% of patients with acute otitis media, bacteria are detected in the exudate from the middle ear (most often Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis).

Often the cause of otitis is a mixed (viral-bacterial) infection.

When making a diagnosis, a differential diagnosis is made with myringitis (inflammation of the eardrum) and exudative otitis media.

The occurrence of otitis media is directly related to the condition of the nose and nasopharynx: rhinitis and tonsillitis often provoke inflammation of the middle ear.

Otitis often occurs against the background of decreased immunity and immunodeficiency states.

Routes of infection

The most common route of infection into the middle ear is through the auditory tube during rhinitis and sinusitis.

It is possible that infection can penetrate through the blood during influenza, scarlet fever and other infectious diseases.

In rare cases, the infection enters the middle ear through the ear canal due to injury (rupture) of the eardrum.

Stages of acute otitis

There are 5 stages of the disease:

• stage of acute eustachitis: a feeling of stuffiness, noise in the ear, normal body temperature (if there is an infection, it may increase);
• stage of acute catarrhal inflammation in the middle ear: sharp pain in the ear, low-grade fever, inflammation of the mucous membrane of the middle ear, increased noise and congestion in the ear;
• pre-perforative stage of acute purulent inflammation in the middle ear: sharp unbearable pain in the ear, which radiates to the eye, teeth, neck, throat, increased noise in the ear and decreased hearing, increased body temperature to 38-39 degrees, the blood picture becomes inflammatory in nature;
• post-perforation stage of acute purulent inflammation in the middle ear: pain in the ear becomes weaker, suppuration appears from the ear, noise in the ear and hearing loss do not go away, body temperature becomes normal;
• reparative stage : inflammation stops, perforation is closed with a scar.

Treatment of otitis media

If you have otitis media, treatment can only be prescribed by an otolaryngologist. Treatment of otitis media depends on the stage of the disease and the patient’s condition.

At acute eustachitis Treatment of otitis is aimed at restoring the functions of the auditory tube. Sanitation of the paranasal sinuses, nose and nasopharynx is carried out in order to eliminate infection - rhinitis, sinuitis, etc.).

Vasoconstrictor nasal drops (otrivin, nazivin, etc.) are prescribed; in case of excessive mucous discharge from the nose, drugs with an astringent effect (collargol, protargol) are prescribed. Catheterization of the auditory tube is carried out using aqueous solutions of corticosteroids, and pneumomassage of the eardrums.

In progress acute catarrhal otitis media catheterization of the auditory tube is carried out with the introduction of aqueous solutions of corticosteroids and antibiotics (penicillins, cephalosporins) into the cavity of the middle ear. Appointed local anesthesia(otipax drops, anauran, otinum). An intra-ear endaural microcompress according to Tsytovich is carried out: a cotton or gauze turunda soaked in a drug with an analgesic and dehydrating effect is inserted into the external auditory canal. Painkillers with an antipyretic effect (nurofen, solpadeine, etc.) are also prescribed. If there is no effect from symptomatic therapy, antibiotic therapy is prescribed within 48-72 hours.

Purulent otitis media perforated acute stage requires the same set of procedures as in the second stage, but supplemented with the following measures:

• prescription of penicillin antibiotics (amoxicillin, etc.), cephalosporins or macrolides;
• paracentesis (incision of the eardrum) when the eardrum appears to bulge.

It is important to prevent complications of the disease at this stage. After spontaneous opening of the eardrum or paracentesis, the disease progresses to the next stage.

Postperforation stage of acute purulent otitis media suggests the following treatment regimen:

• started antibacterial therapy continues;
• catheterization of the auditory tube is performed with the introduction of corticosteroids and antibiotics;
• Every day a thorough toilet of the external auditory canal is carried out - cleaning it from purulent contents;
• transtympanic infusion of drops with an antibacterial and anti-edematous effect is prescribed (alcohol-based drops (otipax, 3% boric acid solution) are not used in this case).

IN stages of scarring spontaneous restoration of the integrity of the membrane occurs, and all functions of the ear are completely restored. However, this period requires mandatory observation by an otolaryngologist: there is a danger of chronic inflammation in the middle ear, its transition to a purulent form, or the development of an adhesive scar process in the tympanic cavity. It is also possible to develop mastoiditis.

In case of acute otitis media, timely contact with an otorhinolaryngologist is very important. The only measure to prevent complications is correct and timely diagnostic and treatment measures for otitis media. Sometimes the consequences of acute otitis media are adhesions in the tympanic cavity (adhesive otitis media), dry perforation in the eardrum (dry perforated otitis media), purulent perforation (chronic suppurative otitis media), etc. In addition, AOM can lead to such complications as such as mastoiditis, labyrinthitis, petrositis, meningitis, sepsis, venous sinus thrombosis, brain abscess and other life-threatening diseases of the patient.

Treatment of otitis media during pregnancy

If you experience ear pain during pregnancy, you should urgently see an ENT doctor. Remember that in this case you cannot apply heating pads or warm compresses to the sore spot! This can be very dangerous if purulent inflammation begins in the ear.

If the pain increases and greatly bothers a pregnant woman, and there is no way to see a doctor in the near future, you can take several independent steps. For example, you should put vasoconstrictor drops into your nose.

What is prohibited for otitis media

• Under no circumstances should foreign bodies be introduced into the ear (geranium leaves, ear phyto-candles). This will make diagnosis difficult and may lead to a worsening of the condition (for example, leaves that have not been removed begin to rot and become a source of infection).
• If the pain is severe, do not apply a heating pad to your ear or apply warm compresses. This is dangerous if purulent inflammation has begun in the ear. Compresses can only help at stages 1-2 of the disease.
• You should not put melted oil in your ear: if there is a perforation, the oil will end up in the tympanic cavity.
• You should not put camphor oil or camphor alcohol into your ear - it can burn the walls of the ear canal and irritate the eardrum, which will increase ear pain.

“MedicCity” will refuse you professional help for otitis media and other ENT diseases. Our otolaryngologists will conduct a comprehensive examination of the patient and prescribe a treatment regimen, depending on the cause and stage of the disease. However, the success of treatment depends no less on the patient himself: the sooner he sees a doctor, the more effective the result will be and the lower the likelihood of complications. It is also important to follow preventive measures. So, in the cold season, to prevent otitis media, it is important to wear a hat, protect your ears from drafts, and of course, boost your immunity!

Not everyone knows what otitis media is. This is a disease that affects the human ear. It consists of acute inflammation of the tissues that make up this important sensory organ. Thousands of people get sick with otitis media every year. different ages. And it is well known that otitis media cannot be called a harmless disease.

What is otitis media

To understand the principle of the occurrence of otitis, you need to remember what it is - the ear, what it is needed for and how it works. In fact, the ear is far from just the pinna, as some might think. The ear has a complex system hidden inside for converting sound waves into a form suitable for perception by the human brain. However, picking up sounds is not the only function of the ears. They also perform a vestibular function and serve as an organ that allows a person to maintain balance.

The three main sections of the ear are the middle, outer and inner. The outer ear is the pinna itself, as well as the auditory canal leading to the eardrum. Behind the eardrum is an air-filled tympanic cavity containing three auditory ossicles, the purpose of which is to transmit and amplify sound vibrations. This area makes up the middle ear. From the middle ear, vibrations enter a special area located in the temporal bone and called the labyrinth. It contains the organ of Corti - a cluster of nerve receptors that convert vibrations into nerve impulses. This area is called the inner ear. Also noteworthy is the Eustachian tube, the entrance of which is located behind palatine tonsils and which leads into the tympanic cavity. Its purpose is to ventilate the tympanic cavity, as well as to bring the pressure in the tympanic cavity into line with atmospheric pressure. The Eustachian tube is usually referred to as the middle ear.

It should be noted that otitis media can affect all three ear sections. Accordingly, if the disease affects the outer ear, then we talk about external otitis, if it is middle, then about otitis media, if the inner ear, then about internal. As a rule, we are talking only about one-sided lesions, however, with otitis media caused by infections of the upper respiratory tract, the disease can develop on both sides of the head.

Ear otitis is also divided into three types depending on the cause - viral, bacterial or traumatic. External otitis can also be fungal. Most common bacterial form diseases.

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How does the ear work?

Otitis externa - symptoms, treatment

Otitis externa occurs as a result of infection of the surface of the skin of the ear with bacteria or fungi. According to statistics, approximately 10% of the world's population has suffered from external otitis at least once in their lives.

Factors contributing to otitis in adults are:

• hypothermia of the auricle, for example, during walks in the cold;
• mechanical damage to the auricle;
• removal of wax from the ear canal;
• entry of water, especially dirty water, into the ear canal.

Bacteria and fungi “love” the ear canal because it is damp, dark and quite humid. It provides an ideal place for their breeding. And, probably, everyone would have otitis externa, if not for such a protective feature of the body as the formation of earwax. Yes, earwax- this is not at all a useless substance that clogs the ear canal, as many people think. It performs important bactericidal functions, and therefore its removal from the ear canal can lead to otitis media. The only exception is when too much sulfur is released and it affects the perception of sounds.

Inflammation of the external auditory canal usually refers to a type of skin disease - dermatitis, candidiasis, furunculosis. Accordingly, the disease is caused by bacteria, streptococci and staphylococci, fungi of the genus Candida. In the case of furunculosis, inflammation occurs sebaceous glands. The main symptom of external otitis is, as a rule, pain, especially aggravated by pressure. Elevated temperature with external otitis it usually does not occur. Hearing loss rarely occurs with external otitis, except in cases where the process affects the eardrum or the ear canal is completely closed with pus. However, after recovery from otitis media, hearing is completely restored.

Diagnosis of external otitis in adults is quite simple. As a rule, a visual examination by a doctor is sufficient. A more detailed method of diagnosing otitis involves the use of an otoscope, a device that allows you to see the far end of the ear canal and the eardrum. Treatment of otitis media consists of eliminating the cause of ear inflammation. When treating otitis externa in adults, antibiotics or antifungal drugs are used. The type of antibacterial therapy should be determined by the doctor. Typically, ear drops are used for otitis externa rather than tablets. When external tissues of the auricle not located in the area of ​​the auditory canal are affected, ointments are used. A frequent complication of external otitis is the transition of the inflammatory process to the middle ear through the eardrum.

Otitis media

Otitis media is an inflammation of the middle part of the hearing organ. This kind of ear inflammation is one of the most common diseases on Earth. Hundreds of millions of people suffer from ear infections every year. According to various data, from 25% to 60% of people have suffered from otitis media at least once in their lives.

Causes

In most cases, inflammation of the middle ear is not a primary disease. As a rule, it is a complication of external otitis or infectious diseases of the upper respiratory tract - tonsillitis, rhinitis, sinusitis, as well as acute viral diseases - influenza, scarlet fever.

How does an infection from the respiratory tract get into the ear? The fact is that she has a direct path there - this is the Eustachian tube. When you have respiratory symptoms such as sneezing or coughing, particles of mucus or phlegm may be pushed up the tube into your ear. In this case, both inflammation of the Eustachian tube itself (eustachitis) and inflammation of the middle ear can occur. When the Eustachian tube is blocked in the tympanic cavity, which is deprived of ventilation, stagnation processes can occur and fluid can accumulate, which leads to the proliferation of bacteria and the occurrence of disease.

The cause of otitis media can also be mastoiditis, allergic reactions that cause swelling of the mucous membranes.

Otitis ear has several varieties. First of all, a distinction is made between chronic and acute otitis media. According to the degree of development, otitis of the middle ear is divided into exudative, purulent and catarrhal. Exudative otitis media is characterized by the accumulation of fluid in the tympanic cavity. With purulent otitis media of the middle ear, the appearance of pus and its accumulation are noted.

Otitis media, symptoms in adults

Symptoms in adults primarily include ear pain. Pain with otitis media can be acute or shooting. Sometimes pain can be felt in the temple or crown area, it can pulsate, subside or intensify. With exudative otitis media, there may be a sensation of water splashing in the ear. Sometimes there is ear congestion, as well as a feeling of hearing one's own voice (autophony) or just a vague noise in the ear. Tissue swelling, hearing loss, fever, and headaches are often observed. However, an increase in temperature is often not a symptom of otitis media, but only a symptom of the infectious disease that caused it - acute respiratory infections, acute respiratory viral infections or influenza.

The most complex course is observed in the purulent form of otitis media. In this case, the main symptom of otitis media is the discharge of pus. The tympanic cavity is filled with pus, and the body temperature rises to +38-39ºС. Pus can thin the surface of the eardrum and form a hole in it through which it leaks out. However, this process is generally beneficial, since the pressure in the cavity drops, and as a result the pain becomes less acute. The process of draining pus takes about a week. From this moment, the temperature drops to subfebrile levels and wound healing begins. The total duration of the disease is 2-3 weeks with proper and timely treatment.

The chronic form of the disease is characterized by a sluggish infectious process, in which there are seasonal surges, during which the disease becomes acute.

Diagnostics

If you have suspicious symptoms, you should consult a doctor. Diagnosis is carried out by an otolaryngologist. The following can be used for this diagnostic sign. If an otolaryngologist’s patient puffs out his cheeks, then the immobility of the membrane indicates that air does not enter the tympanic cavity from the nasopharynx and, therefore, the Eustachian tube is blocked. The eardrum is examined using optical device– An otoscope also helps to identify some characteristic signs, for example, protrusion of the eardrum and its redness. Blood tests, computed tomography, and radiography can also be used for diagnosis.

Treatment

How to treat the disease? Treatment of otitis media is quite complex compared to treatment of external otitis. However, in most cases conservative treatment is used. First of all, in case of acute otitis media, it makes no sense to instill ear drops with antibacterial drugs, since they will not reach the site of inflammation. However, for inflammation of the middle ear, the focus of which is directly adjacent to the eardrum, anti-inflammatory and analgesic drops can be instilled into the ear. They can be absorbed by the eardrum, and the substance will enter the region of the middle part of the organ of hearing, into the tympanic cavity.

Antibiotics are the main method of treating otitis media in adults and children. Typically, medications are taken in tablet form. However, if the eardrum has ruptured, antibiotic ear drops can also be used. A course of antibiotics must be prescribed by a doctor. He also chooses the type of antibiotics, since many of them have an ototoxic effect. Their use can cause irreversible hearing loss.

The greatest effectiveness for otitis media of the middle ear was demonstrated by a course of treatment with penicillin antibiotics, amoxicillin, as well as cephalosporins or macrolides. However, cephalosporin has an ototoxic effect, so it is not recommended to inject it directly into the ear through a catheter or instill it into the ear canal in case of damage to the eardrum. Antiseptic agents, such as miramistin, can also be used for therapy.

When treating otitis media, it is often necessary to use painkillers. To relieve pain in diseases of the middle part of the hearing organ, drops with painkillers, for example, lidocaine, are used.

In case of membrane perforation, scar stimulants are used to speed up its healing. These include ordinary iodine solution and silver nitrate 40%.

Glucocorticoids (prednisolone, dexomethasone), as well as non-steroidal anti-inflammatory drugs, can be used as anti-inflammatory drugs and agents that can relieve swelling. In the presence of allergic processes or with exudative otitis, antihistamines are used, for example, suparastin or tavegil.

Also, for exudative otitis media, medications are taken to thin the exudate, for example, carbocisteine. There are also complex preparations, having several types of action, for example, Otipax, Otinum, Otofa, Sofradex. In case of purulent discharge, you should regularly clean the ear canal of pus and rinse it with a weak stream of water.

Is it possible to warm your ear? It depends on the type of disease. In some cases, heat can speed up healing, while in others, on the contrary, it can aggravate the disease. In the purulent form of middle ear disease, heat is contraindicated, and in the catarrhal stage, heat promotes blood flow to the affected area and speeds up the patient's recovery. Also, warmth is one of the effective ways reducing pain from otitis media. However, only a doctor can give permission to use heat; self-medication is unacceptable. If heat is contraindicated, it can be replaced with physiotherapeutic procedures (UHF, electrophoresis).

Often resort to surgical method treatment of the middle ear, especially in the case of a purulent variant of the disease and its rapid development, threatening severe complications. This operation is called paracentesis and is aimed at removing pus from the tympanic cavity. For mastoiditis, surgery can also be performed to drain the internal areas of the mastoid process.

Special catheters are also used to blow and clean the Eustachian tube. Medicines can also be administered through them.

Folk remedies for the treatment of middle ear inflammation in adults can only be used in relatively mild forms of the disease and with the permission of the attending physician. Here are some recipes suitable for treating otitis media.

Cotton wool is moistened with propolis infusion and inserted into the area of ​​the external auditory canal. This composition has wound healing and antimicrobial properties. The tampon must be changed several times a day. Plantain juice, instilled into the ear in the amount of 2-3 drops per day, has a similar effect. To get rid of infections of the nasopharynx and larynx, which provoke middle ear infections, you can use rinses based on chamomile, sage, and St. John's wort.

Complications

With proper therapy, otitis media can go away without leaving any long-term consequences. However, inflammation of the middle ear can cause several types of complications. First of all, the infection can spread to the inner ear and cause internal otitis media - labyrinthitis. It can also cause permanent or transient hearing loss or complete deafness in one ear.

Perforation of the eardrum also leads to hearing loss. Although, contrary to popular belief, the membrane can become overgrown, even after it is overgrown, hearing sensitivity will be permanently reduced.

Mastoiditis is accompanied acute pain in the parotid space. It is also dangerous due to its complications - the breakthrough of pus on the membranes of the brain with the appearance of meningitis or in the neck area.

Labyrinthitis

Labyrinthitis is an inflammation of the inner ear. Labyrinthitis is the most dangerous of all types of otitis. With inner ear inflammation, typical symptoms include hearing loss, vestibular disturbances and pain. Treatment of internal otitis is carried out only with antibiotics, no folk remedies in this case will not help.

Labyrinthitis is dangerous due to hearing loss as a result of the death of the auditory nerve. Also, with internal otitis, complications such as brain abscess are possible, which can lead to death.

Otitis ear in children

Otitis media in adults is much less common than this disease in children. This is due, firstly, to the weaker immunity of the child’s body. Therefore, infectious diseases of the upper respiratory tract are more common in children. In addition, the structural features of the auditory tube in children contribute to stagnant processes in it. It has a straight profile, and the expanded lumen at its entrance facilitates the entry of mucus and even pieces of food or vomit (in infants).

Careful treatment of otitis media in childhood is very important. If improper treatment is carried out, the disease can become chronic and make itself felt already in adulthood with chronic outbreaks. In addition, if otitis media is not cured infancy, then this may threaten partial hearing loss, and this, in turn, leads to a delay in the child’s mental development.

Prevention of otitis media

Prevention includes preventing situations such as hypothermia of the body, primarily the ear area, getting dirty water into the ear canal area. It is necessary to promptly treat inflammatory diseases of the upper respiratory tract, such as sinusitis, sinusitis, and pharyngitis. It is recommended to use a cap while swimming, and after being in the water, you should completely clear the ear canal of water. During the cold and damp seasons, it is recommended to wear a hat when going outside.