It occurs due to the spread of infection from the purulent focus in the middle ear through the veins and sinuses of the temporal bone or as a result of direct contact of pus with the wall of the sigmoid sinus. It occurs mainly in young people. Most often, sepsis is observed in connection with the development of sinus thrombosis in patients with acute and chronic purulent otitis media. Symptoms common for sepsis.
Treatment . Local treatment – drainage of the purulent focus , which caused the septic process. Depending on the degree of damage to the middle ear, a simple or general cavity operation is performed. General treatment for sepsis.
COCHLEAR NEURITIS (auditory nerve neuritis).
Symptoms, course. A disease characterized by hearing loss (impaired sound perception) and a sensation of noise in one or both ears. The reasons are varied. The most important of them: infectious diseases (influenza, mumps, meningococcal infection, measles, scarlet fever, etc.), atherosclerosis, metabolic and blood diseases, intoxication with drugs (quinine, salicylates , streptomycin, neomycin , etc.), nicotine , alcohol, mineral poisons (arsenic, lead, mercury, phosphorus), noise and vibration injury. The diagnosis is based on the results of an audiological examination. Otoscopic picture without deviations from the norm. Differential diagnosis carried out with a mixed and cochlear form of otosclerosis.
Treatment. In acute cochlear neuritis, the patient should be hospitalized urgently to take all necessary measures to restore hearing. In acute intoxication of the auditory nerve, diaphoretic (pilocarpine), diuretics and laxatives are prescribed. If neuritis arose as a result of an infectious disease or during it, then antibacterial agents are prescribed ; intravenous infusion of glucose solution . Prescribe vitamins B1 (B2, A, nicotinic acid, iodine preparations, aloe extract, ATP, cocarboxylase , acupuncture . To reduce tinnitus, intranasal, intrameal blockade of novocaine is used. With the so-called chronic cochlear neuritis, treatment is ineffective. With severe hearing loss, it is shown that hearing loss is severely indicated.
Mechanical injury is the most common type of ear damage. The nature of the damage depends on the intensity of the injury. Not only the outer ear can be damaged, but also the middle, and even the inner ear (fracture of the base of the skull).
Bruises of the auricle are often complicated by a hematoma . More severe injuries may be accompanied by separation and crushing of the auricle. With severe trauma, both longitudinal (more often) and transverse fracture of the temporal bone pyramid are observed. A longitudinal fracture of the pyramid, in addition to general symptoms, is accompanied by rupture of the eardrum, the skin of the upper wall of the external auditory canal, bleeding from the ear, and often liquorrhea ; the facial nerve, as a rule, is not damaged in this case, the function of the vestibular apparatus is preserved, the hearing decreases (sound conduction is impaired). A transverse fracture of the temporal bone pyramid is accompanied by damage to the labyrinth and, as a rule, the facial nerve. In this case, the auditory and vestibular functions almost always completely disappear. The eardrum usually remains intact, no bleeding from the external auditory meatus. The nature of the bone lesions is established by X-ray examination of the skull.
Treatment . For small cuts and bruises pinna – lubrication of 5% alcoholic solution of iodine and aseptic dressing .Lechenie otgematomy . When crushing and detachment of the auricle – gentle primary surgical treatment, sutures on the edges of the wound, bandage. Administered tetanus toxoid by Alexandre Besredka and toxoid, administered by the testimony of antibiotics, sulfa drugs , physical therapy – ultraviolet irradiation, UHF currents. In case of bleeding from the external auditory canal (fractures of the base of the skull), a lump of sterile cotton should be inserted into the auditory canal and a sterile bandage should be applied. Cleaning the external auditory meatus and especially washing it are contraindicated. The patient is prescribed complete rest. If purulent otitis media develops, then it is treated according to general rules (see Otitis). Surgical intervention is performed with appropriate indications (non-stop bleeding from the ear, symptoms of intracranial complications).
Damage to the middle ear as a result of sudden changes in atmospheric pressure. Occurs during the explosion, work in caissons, for pilots and divers. With an increase in atmospheric pressure, if it does not timely level out in the middle ear through the auditory tube, the eardrum retracts with a decrease – it bulges out. Sudden changes in atmospheric pressure are transmitted through the eardrum and the chain of auditory ossicles to the inner ear and adversely affect its function. Barotrauma can even be accompanied by rupture of the eardrum. Symptoms, course . At the time of barotrauma, there is a sharp “blow” to the ear and severe pain. There is a decrease in hearing, sometimes dizziness, noise and ringing in the ears. If the eardrum ruptures, bleeding from the external auditory canal. With otoscopy, hyperemia, hemorrhage in the eardrum, sometimes its rupture, are visible. With hemorrhage in the tympanic cavity through a whole eardrum, you can see a characteristic dark blue translucency. Treatment . If there is no rupture of the eardrum, then a lump of sterile cotton is introduced into the external auditory canal. If the membrane ruptures, gently inject sulfonamide powder or antibiotics , apply a sterile bandage to the ear. With damage to the inner ear, the treatment is the same as with cochlear neuritis.
OTOSCLEROSIS ( otospongylosis ) .
Focal lesion of the bone capsule of the labyrinth of unknown etiology. Progressive hearing loss is a consequence of fixation by the otosclerotic focus of the foot plate of the stapes in the oval window. In some cases, pathological bone proliferation extends to the cochlear canal. The disease usually occurs during puberty or in the coming years after it. Sometimes found in childhood (8-10 years). Women get sick more often than men.
Progressive hearing loss (usually in both ears), which occurs most often for no apparent reason, is tinnitus.
Often, tinnitus is the main complaint of patients, and in a noisy environment the patient hears better, the disease usually develops slowly .. Pregnancy and childbirth usually speed up the process. With otoscopy, unchanged tympanic membranes are visible.
The diagnosis is based on anamnesis, clinical and audiometric data. With a typical tympanic form of otosclerosis, hearing loss is observed as a violation of the function of the sound-conducting system. A mixed form of otosclerosis is characterized by moderate, and cochlear – by a significantly expressed involvement in the process of the sound-sensing system. In these cases, it is necessary to carry out a differential diagnosis with cochlear neuritis. Surgical
treatment ( stapedoplasty ) .
This disease is caused by the development of molds of various types on the walls of the external auditory canal (sometimes on the eardrum). This is facilitated by a humid environment, preceding purulent otitis media, prolonged irrational use of antibiotics, etc.
Symptoms, course . Pain, itching in the ear canal, increased sensitivity of the skin of the ear canal and auricle, headache on the side of the affected ear, noise in the ear, feeling of fullness and stuffiness of the ear. When examining the ear, the ear canal is narrowed throughout, its walls are macerated and hyperemic (less than with bacterial otitis media). The detachable auditory meatus in most cases is moderate, can have a different color (gray-black, black-brown, yellowish or greenish) and depends on the type of fungus that caused the disease; it is usually odorless. The eardrum in most patients is hyperemic, infiltrated, with indistinct identification points. Sometimes a hole is visible in the eardrum (the result is only a fungal infection without involvement in the middle ear process). In rare cases, the pathological process can spread beyond the external auditory canal and even the outer ear (skin of the face, neck). After clinical recovery, relapse of the disease may occur. The diagnosis is established on the basis of otoscopy and mycological examination of the external auditory canal. A differential diagnosis must be carried out with candidiasis (damage by yeast) and dermatitis of the outer ear of a different etiology. Treatment Treatment is strictly individual, taking into account the general condition of the patient, especially the clinical picture of the disease and the type of fungus. A good effect is obtained when prescribing topically antifungal drugs: grisemin , lutenurin or nystatin emulsion , as well as alcohol solutions of flavofungin , fungifen or chinosol . According to indications, desensitizing treatment is carried out . The prognosis for timely diagnosis and intensive antifungal therapy is usually favorable.