Tubo-otitis: symptoms and treatment in children andadults

Update: December 2018

Tubo-otitis – a disease of inflammatory nature with localization in
the area of ​​the auditory (Eustachian) tube and middle ear. Distinguish
acute (up to a month) and chronic (lasting 3-6 months and
more) shape. Tubo-otitis or Eustachitis often manifests dim
symptoms, which makes diagnosis difficult and requires
certain individual approaches and patience in treating
adults и детей.

Conditions and mechanisms of development

Through the auditory tube, the nasopharynx connects to
anatomical formation of the middle ear, located immediately behind
eardrum. The main purpose of the pipe is to maintain
equal pressure in intra-aural cavities and outside these structures (in
mouth, pharynx and nose areas).

With tubootitis infection spreads from the nose, mouth
or respiratory organs (bronchi, trachea) on the initial part of the auditory
tubes located in the throat area. Acute tubo-otitis develops,
as a rule, on the background of the height or when subsiding the main symptoms
viral (flu, acute respiratory infections) and bacterial (caused by streptococci,
staphylococcus disease). With nasal injuries and complications
operations in this area may cause bleeding and blood flow in
auditory tube. In response, inflammation also develops.

An important predisposing factor is the propensity to
allergic reactions (edema, increased production of mucous
secret and active inflammation).

The presence of younger children is shorter and more direct than
adults, слуховой трубы делает эту группу детей наиболее уязвимой
for pathology.

Chronic tubootitis occurs on the background of: Тубоотит симптомы и лечение

  • growths of mucous and glandular tissues of the pharynx and nasal passages
    (adenoids);
  • chronic foci of upper respiratory tract infections;
  • changes in the anatomical structure and shape of the nasal
    partitions;
  • tumor formations of the nasopharynx.

The provoking factors also include staying under water.
(scuba diving, being in a bathyscaphe) and take-off time and
landing when flying by plane.

In the Eustachian tube, the following are observed during inflammation
changes:

  • swelling and thickening of the mucous membrane;
  • reduction of its lumen;
  • disruption of normal air movement between cavities
    nasopharynx and middle ear.

As a result, the pressure inside the auditory tube decreases, and
the eardrum deforms and retracts inside
space. The walls of the pipe stick together, which leads to further
reduce the diameter of its lumen. In this case, the release of inflammatory
fluid in the cavity of the middle ear is not typical, there only occurs
moderate purulent inflammation.

With a long process (chronic tubootitis):

  • the shape of the eardrum and cavity of the middle changes
    ear;
  • disrupted tissue nutrition;
  • thinning mucosa;
  • connective tissue grows.

These processes interfere with normal sound transmission.
Significant hearing loss gradually develops, and bilateral
tubootitis leads to complete deafness.

Signs of illness

A distinctive feature of tubotitis is the presence of local
symptoms in the affected ear. At the same time, common symptoms:

  • temperature rise,
  • sweating
  • intoxication in the form of nausea, general weakness, loss
    appetite

usually absent or slightly pronounced.

The main symptoms of acute tubotitis:

  • congestion in the ears to the left with left and right with
    right side process;
  • the noise, ringing and strong echo of your voice;
  • moderate pain, heaviness and feeling of discomfort with the patient
    parties;
  • feeling of water in the ear, its transfusions when turning and
    head tilts;
  • hearing loss.

At the same time, hearing can be restored during swallowing, with
which pressure in the cavity of the middle ear momentarily comes in
the norm.

Симптомы евстахиита у детей такие же, как и у adults. but
if an older child can talk about the occurrence of noise,
congestion and pain in the ears, the disease in infants can
assume only by changing his state and behavior.

Main features in babies:

  • moodiness, anxiety of the child, poor sleep;
  • ухудшение appetite вплоть до отказа от груди;
  • sharp reaction and crying at any touch in the area
    больного ear;
  • temperature increase above 37.5-38 ° C, which is accompanied by
    chills.

Children of different ages may complain of dizziness and
headaches, hearing loss, they may not coordinate
movements. An older child may note that hearing for several
seconds recovers when sneezing, coughing or yawning. Also
possible discharge from the ear canal, swelling and rash in
auricle areas.

Symptoms of chronic tubotitis:

  • gradual impairment of hearing
    hear the whisper, and then – quiet speech and ordinary);
  • constant noise and crackling in the ears;
  • mild headaches;
  • increased congestion and transfusion of the ear
    sudden pressure drops (in an airplane or underwater
    swimming).

The chronic process leads to irreversible changes in
structure of the hearing aid and constant deafness. Are characteristic
exacerbations with increased local symptoms and periods of calm.

Complications

Tubo-otitis may lead to complications. Most significant:

  • transition of the inflammatory process to the inner ear with a violation
    coordination of movements, dizziness, instability in gait,
    decreased concentration;
  • inflammation of the mastoid process, which is located behind
    auricle (mastoiditis), which is manifested by acute pain in the area
    temporal bone, swelling and redness behind the ear;
  • meningitis (inflammation of the lining of the brain) is extremely dangerous
    disease with fever up to 40 ° C,
    severe headaches, loss of consciousness.

Diagnostics

Diagnostics тубоотита основана на оценке жалоб, других симптомов
and the results of the examination of the patient ENT doctor. With this drum
membrane when viewed swollen, turbid, deformed, retracted, with
separate areas of redness.

To identify the degree of hearing loss, as well as the dynamics of treatment and
determine the progression of chronic tubotitis apply
audiometry. Conducting a study of ear discharge or smear
gives information about the immediate nature of the disease: infectious
or allergic, which determines the main direction of treatment
events.

Treatment approaches

Treatment of tubootitis is carried out in the hospital with complications,
or at home under the supervision of an ENT doctor.

The main objectives of therapy:

  • infection control (prescribed for tubootitis
    antibiotics, antivirals and antimycotics by
    indications);
  • anti-inflammatory effect;
  • rapid reduction of puffiness and recovery of normal
    lumen of the auditory tube;
  • improvement of the processes of nutrition, blood circulation in the mucous
    affected ear and tissue repair;
  • cleansing the airways and nasopharynx from excess
    inflammatory secretion and mucus;
  • improving local and general protection mechanisms to prevent
    chronic disease;
  • prevention of complications.

In the presence of chronic inflammatory changes in the tonsils
nasopharynx, the development of polyps (benign growths
mucous membrane) it is necessary to resolve the issue of their operational
treatment, since foci of purulent infection, permanent obstacles to
normal ventilation of the auditory tube will be maintained or reopened
cause eustachitis.

Improved patency of the Eustachian tube, especially its
initial, located in the nasopharynx, the department can not be achieved
without the use of vasoconstrictor drugs. Most effective
являются Нафтизин, Санорин, Називин.

If there is an allergic predisposition, then the treatment
тубоотита как у adults, так и у детей включает применение
противоаллергических средств (Кларитин, Супрастин,
Гисманал, Цетрин
, см. лекарства от аллергии), а в тяжелых
cases with severe swelling and hormonal drugs
(Hydrocortisone, Prednisolone).

With the infectious nature of the disease, the doctor begins to treat tubo-otitis,
pre-identifying the pathogen or (until the results
studies) based on clinical signs of infection.

Essential Medicines

Are common Local

Antibiotics

  • Amoxicillin (Ospamox, Flemoxin, Amosin)
  • Azithromycin (Sumamed, Zitrolid, Hemomitsin, Azitroks,
    Azidrop)
  • Ceftriaxone (Rocephin, Cefaxone)
  • Cefixime (Supraks, Pancef)
  • Cephalexin
  • Normaks (norfloxacin)
  • Cipromed (ciprofloxacin)
  • Otofa (rifampicin)

Antiviral

  • Arbidol
  • Cycloferon
Nazoferon

Antifungal (antimycotics)

  • Fluconazole (Micomax, Flucostat, Mikosist, Diflucan)
  • Itraconazole (Irunin, Itrazol, Orungamin, Orungal)
Naftifine

If the common way to administer drugs is to take pills or
intramuscular injections, then topically with tubootitis very effective
drops. отипакс

  • So, except for the antibacterial component of the drug
    Отипакс содержит обезболивающее средство, что
    helps reduce pain in the ear and quickly relieves
    state.
  • Антисептик Мирамистин обладает широким
    spectrum of action and can be assigned if suspected
    the bacterial nature of the disease.
  • In addition, most fluoroquinolones (ciprofloxacin) and
    antivirals are contraindicated in the treatment of tubo-otitis
    young children though bury drops
    Нормакса можно и ребенку старше 1 года.

Given the development of tubootitis on the background of infections accompanied by
coughing and sneezing, as well as the need to clear the nose
(blow his nose), the patient must be warned of the danger
strong blowing your nose. It is recommended to clean the right and left alternately.
part of the nose, with minimal strain and blow your nose open
mouth 

An additional positive effect in the treatment have:

  • yawning;
  • massage the ear;
  • exhalation imitation with closed nasal passages (must be pressed
    the wings of the nose to the cartilaginous part of the nasal septum and strain,
    exhaling air).

These actions improve the air conduction of the auditory tube and
contribute to the improvement of blood circulation.

Self-blowing of ears is contraindicated, in which
air is introduced through the Eustachian tube into the cavity of the middle ear with
using a balloon. It is carried out under the direct visual
control of an ENT doctor using an otoscope.

Perhaps blowing off the auditory tube only after introduction to her
initial pharyngeal vasoconstrictor preparations (containing
adrenalin). These drugs dramatically reduce swelling of the mucous and
allow you to insert the catheter directly into the auditory tube to
release it from the resulting inflammatory mucous
a secret.

Physiotherapy

Physiotherapy позволяет ускорить процессы рассасывания и
restore normal mucosa. Apply:

  • ultraviolet irradiation;
  • UHF (ultrahigh-frequency therapy) on the nose area;
  • laser therapy of the pharyngeal region of the auditory tube;
  • air massage of the eardrum to improve it
    mobility.

With timely diagnosis and adequate treatment, acute
tubootitis will pass within 1-2 weeks. Chronic process
therapy may be longer. If tubootitis does not pass, then
It is necessary to pay attention to the possibility of the presence of factors
supporting chronic eustachitis.

First of all, foci of infection in the area of ​​the nose, oral
cavities and paranasal sinuses. Only complete and thorough execution
all doctor’s appointments can help recovery from acute
tubootite and maximizing compensation and prevention
progression in the chronic process.

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