Update: December 2018
- Ear anatomy
- Withчины отита
- Causative agents of the disease
- Clinical picture – symptoms of otitis
- General principles of diagnosis
- Treatment of otitis externa
- Treatment of otitis media and labyrinthitis in adults
- Otitis prevention
Otitis is an inflammation of the ear, a generic term for any
инфекционных процессов в органе слear. Depending on the affected
ear, allocate external, middle and internal otitis
(labyrinthitis). Otitis occurs frequently. Ten percent of the population
The earths during life were ill with external otitis.
709 million new cases are registered annually in the world.
diseases of acute otitis media. More than half of these episodes
children up to 5 years old, but adults also suffer
воспалением среднего ear. Labyrinth is usually
a complication of otitis media and occurs relatively rarely.
For a better understanding of the topic, it is necessary in brief
вспомнить анатомию органа слear. Components of the outer ear
are the auricle and the ear canal. The role of the outer ear –
улавливание звуковой волны и проведение ее к eardrum.
The middle ear is the eardrum, the tympanic cavity,
containing a chain of auditory ossicles, and an auditory tube.
In the tympanic cavity there is an increase in sound vibrations,
after which the sound wave goes to the inner ear. Function
the auditory tube connecting the nasopharynx and the middle ear – ventilation
The inner ear contains the so-called “snail” – complex
sensitive organ in which sound vibrations are converted to
electric signal. Electrical impulse follows hearing
nerve to the brain, carrying coded sound information.
External otitis – это воспаление слухового прохода. Он can быть
диффузным, а can протекать в виде фурункула. With диффузном
otitis externally affects the skin of the entire auditory canal. Boil –
это ограниченное воспаление кожи наружного ear.
With среднем отите воспалительный процесс происходит в барабанной
cavities. There are many forms and options for the flow of this
diseases. Он can быть катаральным и гнойным, перфоративным и
non-perforated, acute and chronic. With отите могут развиваться
The most common complications of otitis media include
mastoiditis (inflammation of the ear part of the temporal bone), meningitis
(inflammation of the lining of the brain), abscess (abscess) of the brain,
Internal otitis almost never independent
disease. Almost always it is a complication of inflammation.
среднего ear. Unlike other types of otitis, its main
симптомом является не боль, а снижение слуха и dizziness.
- После попадания загрязненной воды — чаще всего наружный
Otitis occurs when water containing the pathogen enters the ear.
diseases. That is why the second name of this disease is “ear
- Trauma to the skin of the external auditory canal – in addition to the presence in water
infection must be local conditions predisposing to
the development of inflammation: microcracks in the skin, etc. Otherwise, our each
contact with unboiled water would result in the development of inflammation in
- Осложнение ОРВИ, гайморита — в этом случае возбудитель
otitis media penetrates the tympanic cavity quite differently
the so-called rhinotubar way, that is, through the auditory
pipe. Usually the infection gets into the ear from the nose when the person is sick
ARVI, runny nose or sinusitis. With тяжело протекающем воспалении
среднего уха инфекция can распространиться на внутреннее
- With инфекционных заболеваниях, болезнях почек, сахарном
diabetes, hypothermia on the background of reduced immunity increases
риск развития воспаления в среднем ear. Blowing nose through 2 nostrils
(wrong), coughing and sneezing increase the pressure in the nasopharynx,
which causes infected mucus to enter the cavity of the middle
- Mechanical removal of earwax – it is protective
- High air temperature and high humidity.
- Eye contact with foreign objects.
- The use of hearing aids.
- Diseases such as seborrheic dermatitis on the face, eczema,
- Withчинами развития острого среднего отита являются также
genetic predisposition, immunodeficiency states,
Causative agents of the disease
The causative agents of external otitis can be bacteria or fungi.
Such microorganisms are especially common in the auditory canal,
as blue pus bacillus and staphylococcus. For fungi of the genus Candida and
The aspergillus skin of the ear canal is generally one of the favorite places in
In the body: it is dark there, and after swimming it is also wet.
The causative agents of otitis media, and therefore internal, may be
viruses and bacteria. Fungal lesion of the middle ear also
occurs, but much less frequently than outside. Most frequent
bacterial pathogens of otitis media – pneumococcus, hemophilia
Clinical picture – symptoms of otitis
- Pain is the main symptom of otitis. Pain intensity can
- from barely perceptible to unbearable
- character – pulsing, shooting
Very difficult, most often impossible to self-distinguish
pain during external otitis from pain when
inflammation of the middle ear. Единственной зацепкой can стать тот
the fact that with external otitis, pain should be felt when touching the skin
at the entrance to the auditory canal.
- Hearing loss is a non-persistent symptom. Он can присутствовать
как при наружном отите, так и при среднем, can отсутствовать при
both of these forms of ear inflammation.
- Increased temperature – most often an increase
body temperature, however, is also an optional feature.
- Discharge from the ear with external otitis are almost always.
After all, nothing prevents the inflammatory fluid to stand out
With otitis media, if the eardrum is not formed
perforation (hole), their ear discharge does not happen. Suppuration of
the auditory canal begins after a message appears between
middle ear and ear canal.
Акцентирую внимание на том, что перфорация can не образоваться
even with purulent otitis. Patients suffering from otitis often
ask where the pus will go if it doesn’t break out? Everything
very simple – it will come out through the auditory tube.
- Ear noise (see causes of tinnitus), ear congestion possible
in any form of the disease.
- With развитии воспаления внутреннего уха can появляться
Acute otitis media occurs in 3 stages:
Acute catarrhal otitis – the patient is in severe pain,
усиливающуюся к ночи, при кашле, чиханье, она can отдавать в
temple, teeth, stabbing, throbbing, drilling, hearing is reduced,
appetite, weakness and high temperature up to 39C.
Acute purulent otitis media – pus accumulates in the cavity
middle ear with subsequent perforation and suppuration, which
can быть на 2-3 день diseases. In this period the temperature drops
боль снижается, врач can произвести маленький прокол
(paracentesis), if there was no independent break of the drum
Recovery stage – suppuration stops, defect
eardrum closes (fusion of edges), hearing during
2-3 weeks restored.
General principles of diagnosis
In most cases, the diagnosis of acute otitis does not cause
hardships High-tech research methods are needed
infrequently, the ear is well visible eye. The doctor examines the drum
headband reflector (mirror with a hole in the middle)
through the ear funnel or a special optical device –
An interesting device for the diagnosis of otitis developed
famous corporation Apple. It is an otoscopic
nozzle for camera phone. It is assumed that using this
gadget parents will be able to photograph the eardrum
(or your own) and send photos for
advice to your doctor.
Diagnosis of otitis externa
Examining the ear of a patient suffering from otitis externa, the doctor sees
skin redness, narrowing of the ear canal and the presence of liquid
discharge in its lumen. Степень сужения слухового прохода can
be such that the eardrum is not visible at all. With
inflammation of the outer ear of other examinations other than examination usually
Diagnosis of otitis media and labyrinthitis
With остром воспалении среднего уха основным способом
establishing the diagnosis is also an examination. The main features
allowing to make a diagnosis of acute otitis media are
redness of the eardrum, limiting its mobility,
the presence of perforation.
- How is the mobility of the eardrum checked?
A person is asked to inflate his cheeks without opening his mouth, that is, “to blow
ears. This technique is called a Valsalva maneuver named
Italian anatomist, who lived at the turn of the 17th and 18th centuries. He is wide
used by divers and divers to equalize pressure in
tympanic cavity during deep-sea descent.
When the air stream enters the cavity of the middle ear, the drum
The membrane moves a little and this is noticeable with the eye. If drumming
the cavity is filled with inflammatory fluid, no air in it is
will fall and the movement of the eardrum will not. After the appearance
гноетечения из уха, врач can наблюдать наличие перфорации в
Иногда для уточнения характера болезни can понадобиться
audiometry (hearing test on the device) or tympanometry
(measurement of pressure inside the ear). However, these survey methods
hearing loss is most often used for chronic otitis.
The labyrinthitis is usually diagnosed when
otitis media suddenly sharpness of hearing decreases and appears
dizziness. Audiometry в такой ситуации обязательна. Also
Need a neurologist examination and consultation of an oculist.
- CT and radiography
The need for radiological studies arises,
when there is a suspicion of complications of the disease – mastoiditis or
intracranial infection. Fortunately, such cases
are rare. In a situation where the development of complications is suspected, usually
performed computed tomography of the temporal bone and head
- Bacterial culture
Do I need a otitis swab to determine the bacterial flora?
An unequivocal answer to this question is not easy to give. The problem is
that because of the nature of the cultivation of bacteria, the response given
examination will be received 6-7 days after smear collection, then
There is a time when otitis media is almost gone. Moreover,
with otitis media without perforation, smear is useless, since microbes
are behind the eardrum.
And yet a smear is better to do. In that case, if the application
first-line medication will not bring recovery
the results of the bacterial study can be adjusted
Treatment of otitis externa
The main treatment for otitis externa in adults is ear
drops. If a person does not have immunodeficiency (HIV infection, sugar
diabetes), an antibiotic pill is usually not needed.
Ear drops can only contain antibacterial drug
or combined – have an antibiotic and
anti-inflammatory substance. The course of treatment takes 5-7 days.
The most frequently used for the treatment of otitis media:
- Ciprofarm (Ukraine, ciprofloxacin hydrochloride)
- Normaks (100-140 rubles, norfloxacin)
- Otofa (170-220 rubles, rifamycin)
Corticosteroids + antibiotics:
- Sofradex (170-220 rubles, dexamethasone, framycetin,
- Kandibiotik (210-280 rubles., Beclomethasone, lidocaine, clotrimazole,
- Miramistin (250-280 rubles, with a spray)
The last two drugs also have antifungal
properties. If otitis externa is of fungal origin,
Antifungal ointments are widely used: clotrimazole (Candide),
Natamycin (Pimafucin, Pimafukort).
Помимо ушных капель, для лечения наружного отита врач can
recommend ointment with the active substance Mupirocin (Baktroban
500-600 rubles, Supirotsin 300 rubles). It is important that the drug does not have
negative effects on the normal microflora of the skin, and there is evidence
about the activity of mupirocin against fungi.
Treatment of otitis media and labyrinthitis in adults
The main means of therapy for otitis media is an antibiotic. but
antibiotic treatment of otitis media in adults is another controversial
the issue of modern medicine. The fact is that with this disease
very high percentage of self-recovery – more
There was a period of time at the end of the 20th century, when on the wave of enthusiasm
antibiotics were prescribed to almost all patients with otitis. but
is now considered valid the first two days after the onset of pain
do without antibiotics. If after two days there is no tendency to
improvement, then an antibacterial drug is already prescribed. With
All types of otitis media may require pain medication for
With этом, конечно, больной должен находиться под врачебным
by observation. The decision on the need for antibiotics is very
responsibly and only a doctor should take it. On scales with one
side of the possible side effects of antibiotic therapy, on the other –
the fact that every year in the world from complications of otitis dies 28
thousands of people.
The main antibiotics that are used in the treatment of secondary
otitis in adults:
- Амоксициллин – Оспамокс, Флемоксин, Амосин, Экобол,
- Aamoxicillin with clavulanic acid – Augmentin, Flemoklav,
- Цефуроксим – Зиннат, Аксетин, Зинацеф, Цефурус и другие
The course of antibiotic therapy should be 7-10 days.
Ear drops также широко назначаются при воспалении среднего
ear. It is important to remember that there is a fundamental difference between
drops that are assigned before perforation of the eardrum and
after her appearance. I recall a sign of perforation is
appearance of suppuration.
Before the occurrence of perforation, drops are prescribed with anesthetic
effect. These include drugs such as:
- Otinum – (150-190 rub) – choline salicylate
- Отипакс (220 руб), Отирелакс (140 руб) – лидокаин и
- Отизол – phenazone, бензокаин, фенилэфрина гидрохлорид
Drops with an antibiotic make no sense to bury in this
phase, since inflammation follows imperceptible tympanic
After the appearance перфорации боль проходит и уже нельзя капать
pain drops because they can harm sensitive
snail cages. With возникновении перфорации появляется доступ для
drops inside the middle ear, so you can bury drops,
containing antibiotic. but нельзя использовать ототоксические
antibiotics (gentamicin, framycetin, neomycin, polymyxin B),
препараты, содержащие phenazone, спирты или холина салицилат.
Antibiotic drops, which can be used for treatment
otitis in adults: «Ципрофарм», «Нормакс», «Отофа», «Мирамистин» и
Paracentesis or tympanotomy
В отдельных ситуациях при воспалении среднего уха can
need minor surgery – paracentesis (or
тимпанотомия) барабанной membranes. It is believed that the need for
paracentesis occurs if, against the background of antibacterial therapy on
three days the pain still continues to bother the person.
Парацентез performed под местной анестезией: специальной иглой в
the eardrum makes a small incision through which
pus starts to come out. This section grows well after
termination of suppuration.
Labyrinthitis treatment is a comprehensive medical
problem and is carried out in the hospital under the supervision of an ENT doctor and
a neurologist. In addition to antibiotic therapy are needed.
means improving microcirculation inside the cochlea,
neuroprotective drugs (protecting nerve tissue from
Prophylactic measures for external otitis are
thorough drying of the ear canal after bathing. Also
avoid trauma to the ear canal – do not use
wrenches and pins as ear tools.
For people who often suffer from inflammation of the outer ear,
there are drops based on olive oil that provide protection
skin when bathing in a pond, for example, “Vaxol”.
Prevention of otitis media consists of fortifying
activities – hardening, vitamin therapy, taking
immunomodulators (drugs that improve the immune system). Also важно
timely treat diseases of the nose that are major
причинным фактором воспаления среднего ear.