Middle ear diseases, symptoms, causes, prevention. Otitis media

The human hearing aid is a complex system that has three main elements: external, middle and internal. It is the middle ear that plays the main function and thanks to it a person can hear sounds. All diseases that occur in it pose a direct threat to human life and health.

The middle ear is located deep in the temporal bone. It consists of several organs, each of which is presented as a system:

• Tympanic cavity. It contains devices that allow a person to hear music, voices and other sounds.
• Eustachian tube. A stream of air passes through it, which causes the eardrums to vibrate.
• Mastoid. Separates the back cranial fossa and antrum.

The middle ear is made up of several cavities, in the center of which is the tympanum. By appearance resembles a tambourine or a prism. It is separated from the skull by a wall.The cavity contains auditory ossicles, which perform the function of transmitting sound vibrations. The stirrup, incus and malleus are distinguished. The mechanism of their interaction resembles a system of levers.

One of important elements The middle ear is also an auditory tube that connects the tympanic cavity with the external environment.

In newborns it is much shorter and wider, which poses a great danger. Against the background of this feature, infants are most susceptible to developing middle ear diseases.

The mastoid process is located behind the temporal bone. Inside it there are cavities that are connected to each other by narrow cracks. This increases the acoustic properties several times.

The muscles in the middle ear are also located. Their main task is tension eardrum and stirrup. They also help keep the bones in weight and regulate them. Thanks to them, a person can hear loud and quiet sounds.The middle ear plays a big role not only in transmission, but also in signal amplification. Without it, a person would not have the ability to hear.

Classification of diseases

There are many various diseases, which affects the middle ear. In medicine, it is customary to divide them into three large categories:

1. Congenital. They are associated with the physiological and anatomical structure. They are often hereditary in nature, but may be a consequence of fetal developmental disorders. TO this type include hearing loss and microtia.
2. Traumatic. The cause of development is injuries resulting from an accident, traffic accident, blows to the temple area, and work-related injuries. A rupture of the eardrum can occur after a strong sharp noise, when the muscles do not have time to react correctly. Injuries are often the cause of improper ear cleaning.
3. Infectious. Accompanied by an inflammatory process. Its development is caused by viruses, bacteria, and fungi. It penetrates from the external auditory canal, as well as along with blood.

Every disease is dangerous to the life and health of the patient. This is due to the fact that the middle ear is located in close proximity to the brain. This can cause inflammation of the membranes and cause serious problems with its functioning.

Depending on the nature of the disease, the following are distinguished:

• Spicy. Symptoms increase rapidly and are always pronounced. Lack of therapy at this stage leads to the transformation of the disease into chronic form, which is difficult to treat.
• Chronic. They are characterized by the presence of alternating periods of remission and exacerbation. They have the ability to last for a long time without symptoms.

Only the attending physician can correctly diagnose the type and nature of the course of middle ear disease based on the diagnostic results.

Main diseases and their symptoms

Ear diseases are one of the most unpleasant pathologies, regardless of the reasons for which they arise. They pose a threat to the patient’s health and, if not treated in a timely manner, cause more than just hearing loss.

Inflammatory diseases are often diagnosed, the causes of which are bacteria and infections:

• . The symptoms are always pronounced. Patients complain of painful shooting sensations, decreased quality of hearing and the presence of purulent discharge from the ear canal. Without treatment, the disease progresses to chronic stage, which is difficult to cure.
• Mesotympanitis. The cause is inflammation of the lining of the eardrum. The main signs are hearing loss and purulent discharge. Often confused with purulent otitis media.
• Epitympanitis. It is characterized by ingrowth of the tissues of the external auditory canal into the cavity of the eardrum. The danger of the pathology is that there is a risk of damage to the bone structure. The main symptom is a decrease in the quality of hearing.
• Cicatricial otitis. It occurs against the background of limited mobility of the auditory ossicles. As a result, dense connective tissue begins to form. Patients complain of hearing loss.

Diseases of the middle ear, regardless of the cause of their occurrence, have one distinctive feature. Getting to the source of infection or inflammatory process is quite difficult, since it is located deep. Environmental conditions in the ear are favorable for the growth of bacteria, and they quickly attack healthy areas. Therefore, when the first symptoms occur, you should consult a doctor. Use folk method treatment is strictly prohibited.

Treatment methods

In case the reason painful sensations and other unpleasant symptoms have become an infection, therapy aimed at destroying the pathogenic flora is required.

For this purpose, antibiotics are prescribed in the form of tablets or ointments. Symptomatic therapy consists of prescribing:

1. Painkillers. NSAID drugs are used. They not only relieve pain, but also eliminate inflammation. The most effective is “”.
2. Antiviral. Help reduce the activity of the virus. “Arbidol”, “Kagocel”, “” are prescribed.
3. Anti-inflammatory. Helps relieve the inflammatory process. The use of Diclofenac or Ketoprofen is indicated.
4. Antihistamines. Necessary for relieving intoxication that develops against the background of life activity pathogenic microorganisms. Relieve nausea. Suprastin and Erius will help eliminate weakness, apathy and headaches.

If there is an accumulation of purulent masses in the middle ear cavity, a procedure is prescribed to force it out. It is called paracentesis and is performed by cutting the eardrum. The patient's condition improves significantly after the purulent masses come out. After the procedure, the ear cavity is treated with an antiseptic solution.

You can learn more about the structure and function of the ear from the video:

In severe cases, it is necessary to carry out surgical intervention. The operation is performed in the presence of neoplasms, necrosis or carious processes affecting bone tissue.

Regardless of the type of pathology, they are prescribed vitamin complexes to maintain immunity. Physiotherapeutic procedures are also useful. They help speed up the healing process and avoid complications.

What are the dangers of middle ear diseases?

The middle ear is located in close proximity to the brain. The inflammatory process that develops in the cavities can spread to the meninges.

Consequences untimely treatment or its absence become:

• Sepsis.
• Inflammation of the facial nerve.
• Rupture of the eardrum.
• Full or partial.

Against the background of brain inflammation, a decrease in the quality of vision may occur, mental activity and the ability to perceive information in various volumes.

The middle ear is a complex mechanism consisting of many elements. EIts function is to convert air currents into sound. It is thanks to him that a person is able to hear sharp, strong, quiet, dull and voiced sounds. A slight disruption in the operation of the mechanism affects the quality of hearing. It may be completely or partially lost. In certain cases it cannot be restored.

There are a large number of diseases that affect the ear. The cause is infections and viruses. Pain can also occur due to injury. If symptoms appear, you should consult a specialist to determine exact reason occurrence of unpleasant symptoms. Self-medication and lack of therapy in this case can lead to dire consequences.

Middle ear diseases are considered very common in all age groups, especially in childhood. With an unfavorable course, these diseases often lead to persistent hearing loss, sometimes reaching a sharp degree. Due to the patho-physiological connection of the middle ear with the inner ear and its topographic proximity to the meninges, inflammatory processes in the middle ear can cause severe complications in the form of diseases of the inner ear, brain membranes and the brain itself. There are two main forms of inflammatory processes in the middle ear - catarrhal and purulent.

Catarrhal inflammation of the middle ear. In the anatomical sketch it was said that the tympanic cavity communicates with the nasopharynx through the auditory tube. Thanks to the presence of such a message, the pressure of the air in tympanic cavity, is equal to atmospheric pressure. And the eardrum thus experiences the same pressure both from the outside (from the side of the ear canal) and from the inside (from the side of the tympanic cavity). This situation is necessary for normal mobility eardrum.

Inflammatory processes in the nasopharynx that occur with a runny nose, flu, sore throat and other diseases can spread to the auditory tube and cause closure of its lumen due to inflammatory swelling of the mucous membrane. Closure of the lumen of the auditory tube can also occur with adenoid growths in the nasopharynx. Blockage of the auditory tube leads to the cessation of air flow into the tympanic cavity. The air in the middle ear is partially absorbed by the mucous membrane (due to the absorption of oxygen by capillary vessels), so that the pressure in the tympanic cavity decreases, and the eardrum, due to the predominance of external pressure, is drawn inward. Rarefaction of the air in the tympanic cavity leads, in addition, to the sweating of blood plasma from the vessels of the mucous membrane and to the accumulation of this fluid in the tympanic cavity (secretory otitis media). This fluid sometimes becomes viscous due to the formation of a large amount of protein in it, or becomes hemorrhagic in nature. Therefore, chronic catarrhal inflammation of the middle ear is described under the names mucous otitis, “sticky” ear, “blue” ear.

Connective tissue bridges sometimes form between the eardrum and the walls of the tympanic cavity.

As a result of impaired mobility of the eardrum, hearing loss occurs and noise in the ear appears. Acutely occurring catarrh of the middle ear, in the absence of timely and proper treatment, can become chronic. Chronic catarrhal inflammation of the middle ear can develop without a previous acute one, namely with chronic inflammatory processes in the nasopharynx and adenoids. In these cases, the process in the middle ear develops slowly, gradually and becomes noticeable to the patient and others only when the hearing loss reaches a significant degree.

Sometimes patients note some improvement in hearing, usually in dry weather, and, conversely, worsening hearing in damp weather and during a runny nose.

Catarrhal inflammation of the middle ear is especially often observed in preschool and younger children. school age as one of the main causes of persistent hearing impairment occurring at this age. The main role in its occurrence in children is played by adenoid growths in the nasopharynx.

Treatment is reduced to restoring the patency of the auditory tube. To do this, first of all, it is necessary to eliminate the reasons that caused its closure. The nose and nasopharynx are treated; if adenoid growths are present, they are removed. In some cases, these measures already lead to improved patency eustachian tube and to restore or improve hearing; but often, especially with prolonged catarrhs, one has to resort to special treatment ear - blowing, massage, physiotherapeutic procedures.

Blowing out the ear is done using a special rubber balloon. Air is blown into the auditory tube through the corresponding half of the nasal cavity. Blowing helps restore the patency of the auditory tube and leads to equalization of pressure in the middle ear.

Sometimes parents and educators are afraid that their child’s hearing will deteriorate as a result of blowing out the ears. This fear is unfounded, since blowing the ear, carried out in the presence of appropriate indications, not only does not worsen hearing, but, on the contrary, leads to improvement or restoration of hearing, although sometimes not immediately after the first blow, but only after several such procedures.

In some cases (in the presence of persistent retraction of the eardrum), in addition to blowing, pneumatic massage of the eardrum is performed: using special device cause rarefaction and condensation of air in the external auditory canal, as a result of which the mobility of the eardrum is restored.

To accelerate the resorption of inflammatory swelling of the mucous membrane of the auditory tube, various physiotherapeutic procedures are used. In cases of a persistent process, in the absence of the effect of conservative treatment, and also if the function of the auditory tube is not restored after adenoma, operations are currently performed. The eardrum is cut and a shunt is inserted into the hole. There is a possibility of outflow from the tympanic cavity and impact on its mucous membrane by administering drugs. In 2-3 months. The shunt is removed and the hole closes on its own.

Acute purulent inflammation middle ear (acute purulent otitis media). Acute inflammation middle ear infection occurs mainly due to the passage of infection from the nose and nasopharynx through the auditory tube into the tympanic cavity. Most often, acute otitis media develops in acute infectious diseases - influenza, sore throat, measles, scarlet fever, etc. More rare ways of introducing infection into the middle ear are the penetration of microbes from the outer ear through a damaged eardrum and the introduction of pathogens from other organs through the blood vessels.

Symptoms of acute inflammation of the middle ear are pain in the ear, decreased hearing; usually elevated temperature. Ear pain can be very sharp and sometimes becomes unbearable. It is explained by the accumulation of inflammatory fluid in the tympanic cavity and its pressure on the eardrum, which is very sensitive. The inflammatory process usually also involves the eardrum, its tissues loosen, and under the influence of pus pressure, the eardrum perforates. After a breakthrough, the fluid accumulated in the tympanic cavity receives a free outflow, and in connection with this, pain in the ear usually immediately subsides, and the temperature drops.

Sometimes, when mild degree inflammation, recovery occurs even without perforation of the eardrum. In these cases, the inflammatory fluid is partially absorbed by the mucous membrane of the tympanic cavity, and partially poured through the auditory tube into the nasopharynx.

If spontaneous perforation of the eardrum does not occur, and the patient’s condition does not improve, the pain in the ear does not subside or even increases, and the temperature does not decrease, then the doctor makes an incision of the eardrum (paracentesis), after which usually discharge from the ear and the patient’s condition immediately appear improving quickly.

Discharge from the ear is initially liquid, sanguineous, then becomes mucous, stretches out in the form of threads when rubbing the ear, then acquires a purulent character and becomes thick, sometimes creamy. Pus in acute otitis media has no odor.

With modern treatment methods, acute inflammation of the middle ear is most often cured. The duration of the disease usually does not exceed three to four weeks. The amount of discharge gradually decreases, then the suppuration stops, the hole in the eardrum closes with a gentle scar, and hearing is restored.

Acute otitis media in children is observed much more often than in adults, since it quite often complicates all childhood infectious diseases (measles, scarlet fever, whooping cough, mumps, rubella, etc.). Middle ear disease infants This is facilitated by constant lying on the back, which facilitates the flow of mucus and pus from the nose into the nasopharynx, as well as the presence of a short and wide auditory tube. IN infancy Otitis occurs most often with influenza, while other infections are complicated by otitis, usually in preschool and early school age.

In preschoolers and junior schoolchildren The development of inflammation of the middle ear often contributes to adenoid growths in the nasopharynx.

In infants, acute otitis may go unnoticed by others until a leak appears from the sore ear. However, if you carefully observe the child's behavior, you will notice some characteristic features diseases: the child becomes restless, sleeps poorly, cries out during sleep, turns his head, sometimes grabs his sore ear with his hands. Due to increased pain in the ear when swallowing and sucking, the child stops sucking or refuses the breast and pacifier. It is sometimes noted that the child is more willing to suckle at a breast that corresponds to his healthy ear (for example, with right-sided otitis - left breast): apparently, when lying on the side of the sore ear, sucking and swallowing are less painful.

The temperature in children, especially young children, is often very high - reaching 40° and above. Often, children with acute otitis media experience symptoms of irritation of the meninges - vomiting, convulsions, tilting of the head. After perforation of the eardrum or paracentesis, these phenomena usually disappear.

Acute inflammation of the middle ear - otitis(from the Greek otos - ear) is a very serious disease, therefore, at the first symptoms, you must contact an ear specialist and strictly follow the doctor’s instructions about the regimen and treatment.

Chronic purulent inflammation of the middle ear (chronic otitis media). Acute inflammation of the middle ear in most cases ends, as already mentioned, within 3-4 weeks with recovery. However, often under unfavorable conditions, acute otitis media takes a protracted course and becomes chronic: the perforation of the eardrum remains persistent, the inflammatory process in the middle ear does not end, suppuration from the ear sometimes continues continuously for many years or periodically renews, hearing remains reduced and even Transition gradually worsens acute otitis the severity of the infection and weakened general state body. Diseases of the nose and nasopharynx play a major role in maintaining the inflammatory process in the middle ear: chronic runny nose, polyps, adenoid growths, etc.

There are two forms of chronic suppurative otitis media. In the first form (mesotympanitis), the inflammatory process is limited only to the mucous membrane of the middle ear, without spreading to the bone walls of the tympanic cavity. This form is characterized by a benign course and, as a rule, does not cause complications. Pus in benign otitis usually has no odor, and if a foul odor appears, it is only due to poor care when pus lingers in the ear, mixes with rejected elements skin and undergoes putrefactive decomposition.

In the second form (epitympanitis), the inflammatory process spreads to the bone walls of the tympanic cavity, causing the so-called caries, i.e. necrosis (death) of bone tissue, proliferation of granulation and polyps and is accompanied by the release of pus with a sharp putrid smell.

Chronic purulent inflammation of the middle ear can sometimes occur almost unnoticed by the patient. The amount of pus is often very small, pain, as a rule, does not occur, hearing loss in some cases does not reach a sharp degree and does not inspire patients with much anxiety: meanwhile, chronic purulent otitis media, despite its apparent harmlessness, is a very serious illness and is fraught with the danger of serious complications, which will be discussed in more detail below.

With careful care and careful treatment, chronic purulent otitis media can result in recovery. However, only in a very limited number of cases is it possible to achieve real recovery, that is, healing of the eardrum and restoration of hearing. In most cases, recovery is relative: suppuration stops, but the perforation of the eardrum remains. Scars often form in the tympanic cavity, which limit the mobility of the auditory ossicles. In this case, hearing not only does not improve, but sometimes even worsens. Despite the relativity of such recovery, it is still a favorable outcome of chronic purulent otitis, since the elimination of a purulent focus in the ear protects the patient from dangerous complications. It is necessary, however, to remember that the presence of a perforation of the eardrum poses a constant threat of a new outbreak of inflammation due to the possibility of new penetration of infection through the external auditory canal. A particular danger is when contaminated water gets into the middle ear; Therefore, all patients with a perforated eardrum should be warned about the need to plug their ears with cotton wool, lubricated or soaked in some kind of fat (vaseline, petroleum jelly or other liquid oil) when washing their hair and when bathing.

If, with chronic purulent inflammation of the middle ear, caries (cholesteatoma), the growth of polyps, etc. do not stop, or signs appear indicating the development of complications, then the need arises for the so-called radical surgery ear. As a result of this operation, the tympanic cavity, mastoid cave and external auditory canal are transformed into one wide open common cavity, which leads to the elimination of the purulent process. However, hearing improves after this operation only in rare cases. In most cases, hearing remains at the same level as before surgery, and sometimes even worsens.

In recent years, for chronic purulent otitis, operations have begun to be used in order not only to eliminate the purulent focus in the ear, but also to improve hearing. This is done by restoring the sound-conducting system, which normally consists of the eardrum, the chain of auditory ossicles and the membranes covering the windows of the labyrinth (oval and round). Such operations are collectively called tympanoplasty(from the Greek tympanon - drum, tympanic cavity). Tympanoplasty is based on the use of high optical technologies. They are produced using special surgical microscopes, under magnification up to 20-50 times, with the finest instruments. To restore the eardrum and auditory ossicles destroyed by the purulent process, both the patient’s own tissues (periosteum, skin, muscles, vessel walls) and alloplastic harmless chemical materials (polyethylene, Teflon, ceramics) are used. The success of such operations is achieved in 70-80% of cases. They can be carried out already in childhood, starting from 5-7 years, mainly with bilateral hearing loss, which complicates the development of the child. The determining condition for indications for tympanoplasty is sufficient preservation of the sound-perceiving function of the auditory analyzer. Tympanoplasty is an important part of a new direction - hearing-improving microsurgery.

Complications of acute and chronic purulent otitis media. In both acute and chronic purulent otitis media, the inflammatory process can spread to organs and tissues adjacent to the middle ear and cause severe, often life-threatening complications.

Such complications include: inflammation of the cells of the mastoid process (mastoiditis, from the Latin processus mastoideus - mastoid process), inflammation of the inner ear (labyrinthitis), paralysis of the facial nerve, inflammation of the meninges (meningitis, from the Greek meninx - meninges), abscess (abscess) of the brain or cerebellum, blood poisoning (sepsis). Most of these complications are considered fatal diseases. Currently, thanks to improved methods of diagnosis and treatment of acute and chronic otitis media, the number of these complications has noticeably decreased. As for the outcome of the complications themselves, with modern methods of surgical and drug treatment they have become much more likely to end in recovery.

Residual effects after inflammatory processes in the middle ear. In some cases, even with proper treatment, the end of the inflammatory process in acute and especially chronic otitis media is not accompanied by restoration of auditory function. Scars and adhesions formed as a result of inflammation (adhesive otitis) often deform the eardrum, attract it to the inner wall of the tympanic cavity and thereby deprive it of the ability to vibrate. Scars can also spread to the joints of the auditory ossicles, sometimes they capture the foot plate of the stapes, fixing it in the niche of the oval window, and in some cases they also block the round window. In all these cases, persistent hearing loss occurs, since airborne sound transmission is severely disrupted.

Hearing loss in such cicatricial processes, especially if they extend to the labyrinthine windows, can be very significant, without, however, reaching the degree of deafness, since bone conduction is preserved in these cases. Complete deafness after inflammation of the middle ear can develop only as a result of the transition of the purulent process from the middle ear to the inner ear.

Otosclerosis. This name refers to a peculiar process that develops in the bone capsule of the ear labyrinth and consists of the growth of spongy tissue, most often in the area of ​​the oval window niche. As a result of such growth, the stapes plate becomes immured in the oval window and loses its mobility. In some cases, pathological bone growth can spread to other parts of the labyrinthine capsule, in particular to the cochlear canal, and then not only the function of sound transmission, but also sound perception is impaired. Thus, otosclerosis is usually both a disease of the middle and inner ear. Otosclerosis most often begins at a young age (15-16 years), but isolated cases of the development of this disease have been observed in younger children. The disease consists of progressive hearing loss and tinnitus. It develops slowly, gradually, its onset often goes unnoticed, and patients usually consult a doctor already at the stage pronounced violation auditory function. Otosclerosis often leads to severe hearing loss or even complete deafness.

Conservative treatment can in some cases stop the process or even improve hearing slightly. IN Lately successfully applied surgical methods treatment of otosclerosis. The operation consists of removing the walled-up stapes and replacing it with a prosthesis made of synthetic materials (Teflon, metal-ceramics) or a bone fragment. The effectiveness of stapedoplasty is very high and reaches 90-95%.

• Which doctors should you contact if you have inflammatory diseases of the middle ear?

What is Inflammatory diseases of the middle ear

Middle ear diseases are one of the most important areas of pediatric otorhinolaryngology. These diseases are very common; there is practically no child who has not suffered from otitis media at least once in their life.

The disease can proceed rather violently, recur, often becomes chronic, and most importantly, it is complicated by severe intracranial diseases.

In most cases, the pediatrician has to diagnose acute otitis media in a child for the first time and decide on treatment and prevention issues. Not only the speed of recovery, but also the state of the child’s hearing in his future life, and sometimes life itself, can depend on the pediatrician and his knowledge.

What causes Inflammatory diseases of the middle ear

The occurrence, course and outcome of acute otitis media are very different.

Pathogenesis (what happens?) during Inflammatory diseases of the middle ear

General patterns of development of otogenic complications of inflammatory diseases of the middle ear.

In literature recent years the incidence of intracranial complications is discussed. Exists misrepresentation about reducing their number. This opinion is due to a number of circumstances.

Currently, children with intracranial complications are often admitted not to ENT departments, but to intensive care and neurosurgery departments, where antibiotics are used last generations, hemosorption, plasmapheresis, ultraviolet irradiation of blood and others modern methods treatment.

In some cases, such children, with the help conservative methods it is possible to stop the process at the stage of encephalitis or meningoencephalitis (additional abscess formation), serous meningitis(before it becomes purulent) or thrombosis of the sigmoid sinus (before the onset of the septic process).

However, these patients are not recovered, and as long as they have a chronic purulent process in the ear, there is still a risk of developing intracranial complications, with a mortality rate of 50-80%.

Complications of acute and chronic purulent otitis media can develop within the temporal bone (anthritis, mastoiditis, zygomatitis, facial paralysis, limited and diffuse labyrinthitis), and also spread deep into the skull (extra- and subdural abscesses, meningitis, sepsis, abscess of the brain substance and cerebellum). They are united by otogenic origin.

The mechanism of development of complications, danger, tactics, choice of treatment method and consequences differ significantly in acute and chronic processes.

The main route of spread of the inflammatory process in acute purulent otitis media is hematogenous, with chronic otitis media- contact or by continuation of the process ).

With epitympanitis, complications develop very often, since in this case the upper wall (roof) of the tympanic cavity or cave is destroyed mastoid process. Main role plays cholesteatoma, which leads to exposure of the dura mater in childhood in 32% of cases, the sigmoid sinus - in 39%, the bone wall of the horizontal semicircular canal is involved in the process in 20% of cases, the facial nerve - in 9%.

With mesotympanitis, such complications occur much less frequently. The ratio of the incidence of complications in acute and chronic processes is 1:3.

Ways of spread of purulent process from the middle ear. Process propagation upward, to the middle cranial fossa. In this case, the roof of the tympanic cavity or mastoid cave is destroyed first. In infants and at an early age, dehiscence generally persists in this area due to the destruction of the stony-squamous fissure. The pus thus enters under the dura mater and occurs extradural abscess.

Subsequently, when the dura mater is destroyed, it develops subdural abscess. In this case, two options for the propagation of the process are possible. In the first, the pia mater is involved in the purulent process with the development of leptomeningitis, sometimes spreading along the base of the brain - the so-called basal meningitis. In the second variant, the purulent process spreads deep into the temporal lobe of the brain, encephalitis occurs, then an abscess, which sometimes also affects the parietal lobe.

To some extent, these pathological processes are naturally not isolated. Symptoms of meningitis in some cases are combined with clinical picture brain abscess.

Process propagation by direction posteriorly In this case, as a rule, purulent mastoiditis occurs first, then the inner wall of the mastoid process adjacent to the sigmoid sinus is destroyed.

Since the sigmoid sinus is a duplication of the dura mater, then, by analogy with an extradural abscess, its particular variant arises in this place - perisinous abscess. Subsequently, the sinus wall is involved in the process and develops phlebitis.

Inflammation of the vessel wall slows down the flow venous blood in the sigmoid sinus, red blood cell aggregation occurs, which leads to sinus thrombosis (shustrombosis). At this stage of the “red thrombus”, purulent emboli can enter the vessels of the pulmonary circulation (lungs) or the brain, i.e. develops septicemia (“white thrombus”). In some cases, the blood clot becomes infected, spreading down the jugular vein, and the dissemination of purulent emboli leads to the development of a severe complication - septicopyemia.

A purulent thrombus from the sigmoid sinus may advance and inwards (distal), into the cranial cavity. Then the inner wall of the sigmoid sinus melts and the purulent process spreads to the adjacent cerebellar hemisphere, causing cerebellar abscess.

The spread of the process from the tympanic cavity sometimes occurs inwardly, medially. In this case, the bone wall of the facial nerve canal running along the medial labyrinthine wall of the tympanic cavity is first destroyed. Pus or cholesteatoma compresses the facial nerve until it is destroyed, paresis occurs, and then facial nerve paralysis.

The inward spread of the process can also lead to the destruction of the ampulla of the horizontal semicircular canal of the labyrinth located on the inner wall of the tympanic cavity. Most often, a punctate fistula forms here and occurs limited labyrinthitis.

In some cases, the carious-purulent process does not stop there, but spreads to the entire labyrinth, causing diffuse purulent labyrinthitis. Since the cerebellum is adjacent to its inner wall, the development of an abscess is not excluded. Such an abscess is called labyrinthogenic, in contrast to the sinusogenic cerebellar abscess that occurs with sinus thrombosis.

Common to all these severe complications is an otogenic origin, which is why they are referred to as otogenic meningitis, otogenic abscess of the brain and cerebellum, otogenic sepsis, etc.

Symptoms of Inflammatory Diseases of the Middle Ear

Acute otitis media occurs in two forms: catarrhal and purulent. The occurrence of the catarrhal form is associated in most cases with dysfunction of the auditory tube and the resulting formation of transudate in the tympanic cavity.

The disease is relatively mild, but, unfortunately, due to underestimation of its consequences, it often develops into a chronic form, especially common in childhood - chronic exudative otitis media.

Acute purulent inflammation of the middle ear, as a rule, is a complication of infectious or viral diseases. Timely diagnosis and proper treatment usually lead to complete recovery with the disappearance of general symptoms, closure of the perforation of the eardrum (if there was one) and full restoration auditory function. However, this is, unfortunately, not always the case. One of the options for the course of the disease is the emergence and development of adhesive (adhesive) otitis media as a result of the preservation of exudate in the tympanic cavity, its subsequent organization with the formation of adhesions.

Recovery is quite often apparent, general symptoms disappear, the endoscopic picture of the eardrum is normalized, perforation, if there was one, closes and scars, hearing is restored almost to normal. However, over the next few months or a year, all symptoms reappear. With active treatment, it would seem that the inflammatory process in the middle ear is quickly eliminated, but it reappears with the formation of a new perforation. This course of the disease is interpreted as recurrent otitis media. Danger similar shape The disease, in addition to persistent hearing loss, consists in the fairly frequent formation of permanent perforation of the eardrum, which becomes the main sign of the transition of the disease to chronic purulent otitis media. Suppuration from the ear can occur with such dry perforation after a certain period of time or be observed constantly, but these are already variants of the course of chronic purulent otitis media.

Complications can occur at any stage of acute or chronic otitis media. They can be conditionally divided into 2 groups: complications included in group 1 are associated with the involvement of formations located in the temporal bone in the pathological process: this is how facial nerve paralysis and labyrinthitis occur. Complications of the 2nd group develop when a purulent carious process spreads to formations lying in close proximity to the temporal bone: the meninges (meningitis), the temporal or parietal lobe of the brain (encephalitis, brain abscess), the sigmoid sinus (sepsis), the cerebellar hemispheres (abscess). cerebellum). All these complications are united by otogenic origin.

Chronic purulent otitis media (otitis media purulenta chronica)

This disease is a continuation of an acute purulent process in the middle ear. Its occurrence is due to the virulence of the microflora at the site of inflammation, the weakness of the immune defensive reactions body, irrational treatment, suffered general diseases, the presence of adenoids, insufficient function of the auditory tube.

The disease can drag on for years, decades and requires compliance with many mandatory conditions during the treatment period. Often chronic inflammation of the middle ear is associated with otitis media suffered in childhood, especially with scarlet fever, measles, and influenza. The causative agent and supporting factor for persistent inflammation in the ear is the coccal flora, but the process caused by Proteus and Pseudomonas aeruginosa is especially persistent.

Clinically, there are two forms of chronic suppurative otitis media - mesotympanitis and epitympanitis.

Mesotympanitis is characterized by prolonged pus discharge from the ear, sometimes with remissions. The pus is viscous, sticky, viscous, in large quantities, odorless. As a rule, mesotympanitis does not cause complications. Perforation of the central type occupies part of the pars tensa, has different sizes, but its edge does not reach the edge of the eardrum, its rim remains.

Hearing may be reduced due to impaired sound conduction (deterioration of hearing low sounds, lateralization of sound towards the worse hearing ear, Rinne’s negative experience, bone conduction curve may be normal, air conduction curve drops to 40-60 dB).

Mesotympanitis typically affects only the mucous membrane of all parts of the middle ear.

Epitympanitis

An X-ray of the temporal bones reveals destruction in the area of ​​the supratympanic space.

Epimesotympanitis

Treatment

In addition to alcohol solutions boric acid, use collargol, protargol, sofradex, dioxidin, solutions and powders of antibiotics, a weak solution (0.25%) of formalin, a solution of furatsilin, a 0.25% solution of silver nitrate, ozone preparations are also successfully used (ozone gas and ozonated isotonic sodium solution chloride). The latter are especially indicated for patients who have multidrug-resistant pathogenic microflora to antibacterial drugs or are intolerant to them ( allergic reactions) etc. It is often necessary to restore the function of the auditory tube. To do this, use Politzer ear blowing and tubal catheterization.

To evacuate contents from the upper floors of the tympanic cavity, the outflow from which can be difficult, the method of washing the supratympanic space is used. In this case, together with a washing liquid introduced under a certain pressure (furacilin, isotonic sodium chloride solution, alcohol solutions boric, salicylic acids) are washed away with thick pus, dense masses of cholesteatoma. Washing should be carried out with warm solutions to avoid irritation of the labyrinth repeatedly. The rinsing liquid plays the role of not only a means of evacuating pus, but also providing healing effect on the tissue of the ear.

Polyps are removed under local anesthesia(solution of trimecaine, dicaine, etc.) with a small loop, special forceps.

Most patients with epitympanitis require surgical intervention on the temporal bone. Operations can be economical ("gentle" surgery on the ear) and "radical", "whole cavity", combining the mastoid cavity, the tympanic cavity and the external auditory canal. The purpose of "radical" or economical surgery is to prevent the possibility of severe complications epitympanitis (meningitis, otogenic sepsis, brain and cerebellar abscess, labyrinthitis, facial nerve paresis).

During a gentle operation, when a patient has “pure” epitympanitis, an atticoantrotomy is performed, trying to preserve the elements of the sound transmission system of the middle ear, and therefore preserve hearing.

During a “radical” operation, all the smallest foci of bone tissue necrosis are carefully removed under a microscope and plastic surgery of the resulting cavity is carried out using the surrounding skin tissue in order to achieve lining of the entire wound surface with the epidermal layer. Only complete epidermization of the walls of the ear cavities allows us to hope for the cessation of pus and the progression of the destructive process.

IN postoperative period persistent follow-up treatment is required using vitamin therapy, local use of antibiotics, enzymes, physiotherapeutic methods - ultraviolet irradiation, UHF, helium-neon laser therapy.

In the case of epimesotympanitis, depending on the degree of destruction in the ear, the activity of the inflammatory process, the nature of the discharge, combined treatment methods are used (rinsing the epitympanic space, removing granulations, cauterization, extinguishing the mucous membrane with appropriate drugs), and also resorting to radical surgery.

Cavity in the mastoid process after “radical” surgery. Covers the cavity of the auditory canal, mastoid process and tympanic cavity. The posterior wall of the ear canal is removed

After a successful sanitizing operation and the cessation of purulent discharge from the ear, in some cases, an operation to improve hearing - tympanoplasty - is indicated. This operation is applicable for all three types chronic inflammation middle ear.

Types of tympanoplasty (1–5)

In accordance with these principles, there are 5 types of tympanoplasty.
1. If the eardrum is destroyed, the chain of auditory ossicles is preserved, the auditory tube is passable, hearing loss is only of the conductive type, and there is no pus, then an artificial eardrum is recreated from various tissues (muscle fascia, perichondrium, periosteum, preserved tissues, such as the dura mater). It acts as a screen in relation to the cochlear window and concentrates pressure sound wave on the chain of auditory ossicles.
2. If the eardrum and malleus are destroyed, pus from the ear is eliminated, the auditory tube is patent and conductive hearing loss is detected, then the flap is placed on the remaining incus connected to the movable stirrup. The bone cavities of the epitympanic space and mastoid process are sanitized.
3. If the eardrum, malleus and incus are destroyed and a destructive process is observed in the bone structures of the mastoid process, then the flap is placed in the sanitized cavity so that it touches the head of the movable stapes and at the same time screens the window of the cochlea, creating a difference in sound pressure on the windows labyrinth
4. If the entire sound transmission system is destroyed and only the movable base of the stapes is preserved, the niche of the cochlear window is covered with a flap. The flap screens the niche, thereby ensuring a difference in sound pressure on the windows of the labyrinth.
5. In case of total destruction of the sound transmission system with the base of the stapes fixed in the niche of the vestibule window, in the first stages of the development of tympanoplasty, they resorted to creating a new “oval window” near the ampulla of the horizontal semicircular canal, and the round window, as in the fourth type of operation, was shielded with a tympanic flap. The newly created window in the semicircular canal is also closed with an elastic flap (fascia, vein wall).

The third type is considered the most common type of tympanoplasty. The fourth and fifth types of surgery are less effective in improving hearing than the types of surgery that preserve the auditory ossicles.

For all types of tympanoplasty, prerequisites are the preservation of the functions of the auditory tube (even its artificial restoration), as well as the preservation of the receptor part of the inner ear.

Cholesteatoma

Cholesteatoma was first described by Cruvelier (1836), who called it a “pearl tumor,” emphasizing the growth features of cholesteatoma in layers from the center to the periphery. Virchow described cholesteatoma in more detail and distinguished “primary” and “secondary” cholesteatoma. Secondary, as a rule, occurs against the background of chronic inflammation, and primary occurs in brain tissue. There are many theories about the formation and development of middle ear cholesteatoma. One of them explains its formation by ingrowth of the epidermis through the marginal perforation during epitympanitis, rejection of the epithelium, impregnation with pus, and steady growth. Another theory is that metaplasia of the epithelium into the epidermis and its rejection lead to the development of cholesteatoma. A third theory, the stray cell theory, suggests that epidermal patches present in the embryonic period form cholesteatoma in the middle ear cavities. An x-ray reveals a defect formed by cholesteatoma in bone tissue.

Treatment

Chronic exudative otitis media

Chronic exudative otitis media (gel-otitis, serous otitis, eustachitis) is characterized by the accumulation in the tympanic cavity, auditory tube and in the cells of the mastoid process of a large amount of sticky and viscous secretion. This jelly-like secretion disrupts the mobility of the chain of auditory ossicles, eardrum, and labyrinthine windows.

Patients are concerned about persistent hearing loss, tinnitus, and a feeling of fluid transfusion in the ear when moving the head. The disease occurs as a result of dysfunction of the auditory tube, which in turn is caused by pathology of the nasal cavity (adenoids, rhinitis, deviated nasal septum) and a sharp increase in the number of goblet cells near the tympanic opening of the auditory tube, producing a viscous secretion.

Otoscopy (including a pneumatic Siegle funnel) allows one to distinguish the level of fluid behind the eardrum and air bubbles in the fluid. The eardrum is yellowish to bluish in color.

An audiogram and tympanogram reveal middle ear dysfunction.

Treatment

Yu.M. Ovchinnikov, V.P. Gamow

The ear is the most important organ with which a person is able to perceive the sounds around him and have a complete understanding of the world as a whole. The structure of the ear is very complex: it consists of the smallest details, the coordinated work of which determines the acuity of hearing and human health.

Otitis media is an inflammatory disease of the ear that, if left untreated, can lead to complete deafness. Children are more likely to suffer from the disease due to their anatomical structure and failure to comply with safety and hygiene rules.

Classification of otitis media

It is customary to classify otitis media depending on the clinical picture:

1. Acute otitis media
2. Exudative acute otitis media
3. Chronic purulent otitis media

Acute otitis media is most often caused by a viral agent and is accompanied by an infectious disease of the upper respiratory tract. At improper treatment such otitis can become purulent when pus forms in the ear cavity.

The exudative form of otitis appears due to the fact that the lumen of the auditory tube becomes impassable and fluid accumulates in the ear cavity. Sometimes the disease is accompanied by ear loss, which is easily reversible after cutting the eardrum and removing the accumulated fluid.

Otitis becomes purulent chronic when purulent discharge from the ear and persistent impairment of auditory function are observed for several weeks.

Causes of the disease

The causes leading to the occurrence and development of an inflammatory process in the ear can be:

• Upper respiratory tract infections (tonsillitis, laryngitis, tracheitis)
• Fluid in the ear while swimming
• Improper ear cleaning
• Barotrauma during diving and mountaineering
• Hypothermia
• Decreased immunity
• Mechanical injuries and damage

Symptoms of the disease

Depending on the type of otitis media, the patient may be bothered various symptoms diseases. In acute otitis media, the patient is bothered by throbbing, stabbing or aching pain, which can radiate to the gums or the back of the head. There is a feeling of ear congestion, tinnitus, decreased hearing, and a general increase in body temperature.

Exudative otitis media is characterized by increasing pain in the ear, sharp deterioration patient's condition, decreased hearing acuity, unchanged sharp increase body temperature. Chronic suppurative otitis media is accompanied by decreased hearing and discharge from the ear cavity in the form of pus.

If any symptoms of the disease occur, you should consult a doctor for examination, diagnosis and appropriate treatment. You cannot independently diagnose and treat with drugs based on past personal experience, reviews from friends and advertising.

Diagnosis of the disease

With symptoms reminiscent of acute otitis media, you should immediately consult a physician or otolaryngologist. After examining the ear, nose and throat and taking a medical history, the doctor makes a diagnosis. If necessary, to clarify the diagnosis, a general analysis blood. To test the patient's hearing, audiometry is performed.

Clarifying the diagnosis and prescribing the correct treatment is accompanied by taking purulent discharge for bacterial analysis. Bacterial analysis allows us to understand the etiology of the pathogen and identify the antibiotic to which the pathogen is most sensitive. This analysis greatly facilitates diagnosis and treatment.

General principles of treatment

Treatment of otitis media must be comprehensive: it is necessary to act specifically on the sore ear, and, in general, on the body. Depending on the etiology of the pathogen, antibiotics or antiviral drugs are used. Widely prescribed symptomatic treatment antihistamines, vasoconstrictors, non-steroidal anti-inflammatory drugs, secretolytics.

If otitis media develops due to upper respiratory tract disease, the underlying disease is treated. Local treatment involves instilling drops into the external auditory canal, draining or massaging the eardrum, and blowing out the auditory tube. Otitis media is successfully treated with physiotherapy methods. Traditional medicine also boasts successful remedies for the treatment of otitis media.

Drug treatment

First of all, acute otitis media is treated with antibacterial or antiviral drugs that directly affect the causative agent of the disease. These drugs can be in the form ear drops, tablets or injections. Taking any antibiotics is accompanied by taking drugs for recovery intestinal microflora, which suffers under the influence of antibacterial agents.

Modern prebiotics Hilak Forte, Baktisuptil, Enterozermina and others will help to establish disturbed microflora and restore metabolic processes. To relieve swelling, the doctor prescribes antihistamines, which can quickly and effectively remove allergy symptoms. If the cause is diseases of the nasopharynx, then instillation into the nose would be advisable. vasoconstrictor drops, which will significantly alleviate the patient’s condition. Thus, it removes from the nasal cavity and auditory tube.

If there is a high body temperature, antipyretic drugs are prescribed, most often from the group of non-steroidal anti-inflammatory drugs based on paracetamol: Nise, Nurofen, Panadol, Ibuklin.

If the fluid accumulated in the auditory tube is not released, measures can be taken to restore its drainage function by instilling special drops. As a last resort, an incision is made into the eardrum to facilitate the drainage of pus or fluid from the cavity.

After the fluid begins to come out, the patient’s condition improves dramatically. You cannot use any medicines for the treatment of otitis without a doctor's prescription - only a doctor can choose correct methods treatment of any disease.

When consulting a doctor, you should inform about any medications you are taking, as they may react with each other into undesirable reactions.

Physiotherapeutic treatments

Physiotherapy is becoming an integral part of the treatment of any disease, and otitis media is no exception. Good results give UHF, microwave, Sollux lamp, semi-alcohol compresses on the affected ear, inhalations. Physiotherapy methods have anti-edematous, anti-inflammatory, antispastic, bacteriostatic, vasodilating, regenerative effects.

The penetration of pathogenic microorganisms slows down and toxic substances into the human body, blood counts improve. When treated with physiotherapeutic methods, recovery occurs much faster.

It should be remembered that treatment with physiotherapeutic methods should be carried out with caution for children, elderly people over 60 years of age, those who suffer chronic diseases cardiovascular, digestive systems, has a history mental disorders, stroke, heart attack, surgery.

Physiotherapy for otitis media should not be carried out during a high rise in body temperature or exacerbation of any chronic diseases.

Traditional medicine methods

Our ancestors have accumulated vast practical experience in the treatment of many diseases, including otitis media. Recipes traditional medicine can often complement medications. Before using any recipe from our grandmothers, you should consult your doctor, since some plant and animal components can cause severe allergic reactions.

• Traditionally, the first aid for ear pain is boric alcohol: you need to warm up a little liquid, moisten a piece of cotton wool in it and put it in the sore ear. You need to put dry cotton wool on top so that boric alcohol evaporates more slowly. Leave the medicine in the ear overnight, repeat if necessary.
• Take raw beets, grate them on a fine grater, add honey and place in a hot oven for 3 hours. The juice that is released during the process must be cooled and dripped into the sore ear.
• Douching the affected ear with a warm infusion of chamomile helps well with chronic otitis media. To do this, take 1 teaspoon of chamomile flowers with a glass of boiling water and leave for 1 hour.
• Infusion bay leaf is an excellent antiseptic and has wound healing properties. To prepare the medicine, you need to take a few bay leaves and pour a glass of water over them. Bring the liquid to a boil, wrap it warmly and leave to infuse for 2 hours in a warm place. The warm solution should be drunk two tablespoons a day and 6 drops instilled into the sore ear twice a day.

Disease prevention

To avoid getting otitis media, you must follow certain rules behavior. Avoid hypothermia, severe physical activity, overwork and stress. In the spring-autumn period, it is necessary to pay attention to maintaining immunity, using traditional medicine methods and modern pharmacological agents.

It is important to properly clean the nasal passages: you should not sharply draw in the discharge. You need to use gentle blowing movements to remove mucus from each nasal passage. Particular attention should be paid to cleaning the nasal passage for children, since due to their age they do not know how to blow their nose correctly.

Young children need to use a special bulb to clean their nose. When taking a bath, shower or swimming in open water, you should avoid getting water into the external auditory canal, as it can serve as a breeding ground for bacteria. Any disease of the upper respiratory tract must be treated in a timely manner, since it is known that the ear, throat and nose are closely connected and a disease of one organ leads to a disease of the other.

Should be carried out sufficient quantity time in the fresh air, doing gymnastics or sports, leading active image life, eat right. These rules will help avoid not only otitis media, but also any other disease.

Complications of the disease

If you suspect otitis media, you should immediately consult a doctor for qualified help and begin treatment, as the disease can lead to serious complications. Otitis media If left untreated, it can lead to hearing loss or complete hearing loss.

A middle ear infection can take on an ascending nature, then the surrounding tissues will become involved in the inflammatory process and meningitis and mastoiditis may develop. Inflammation may affect salivary glands, joint lower jaw. In the absence or improper treatment of otitis media, the process can take a chronic course, which is difficult to treat.