Otitis in pregnancy: symptoms, types

Today, inflammatory processes in the ear area are increasingly found in otolaryngological practice. There is no such person who at least once in his life would not have encountered an inflammatory process in the ear. Otitis, tubo-otitis, which are accompanied by severe pain in the ear, ovulation of the ear, are most often observed. The greatest problem is otitis in pregnancy.

In this case, there are many problems, in particular, the problem of adequate treatment of the disease, because many drugs are contraindicated for pregnant women. At the same time, it is also impossible not to treat the disease, since complications that are unacceptable for a woman who carries a child can occur.

What is dangerous for otitis in pregnancy?

It is a serious problem, since otitis often has a bacterial origin. If it is started, the infection can spread throughout the body and provoke numerous complications. Especially dangerous is the spread of the infectious process to the deep ears and other areas.

On the eustachian tube, the infection and the inflammation provoked by it are transmitted to the nasopharynx, pharynx, brain. Usual ear pain or obstruction without adequate intervention develops into severe pneumonia, pleurisy and even meningitis, which inflames the meninges (a serious danger not only for the mother, but also for the fetus).

Epidemiology

The incidence of otitis media is 100%. During life, every person at least once in his life had otitis media of varying severity. Severe pain is the leading symptom of pathology, which also occurs in 100%. In children under the age of 3 years, the incidence of this pathology is 80%. It is established that during pregnancy a woman is exposed to otitis three times more than non-pregnant. At the same time, in 70% of cases, otitis media of the middle ear occurs.

[1], [2], [3], [4], [5], [6], [7]

Causes of the otitis in pregnancy

It should be borne in mind that the immunity of a pregnant woman is significantly reduced, so any unfavorable factor has a more powerful effect on the body. Therefore, a pregnant woman is easier to get sick, even under the slight influence of the etiological factor. The main cause is infection. It is often transmitted from the focus of infection when developing another inflammatory process in the body, that is, it is secondary. For example, often the infection is transmitted from the nasopharynx and pharynx into the ear through the duct and Eustachian tube.

The development of the infectious process can be facilitated even by the slightest hypothermia of the body, colds, lack of sleep, lack of nutrition. This is due to the fact that the body becomes very sensitive and sensitive due to a decrease in resistance and immune status. Also, the cause may be a viral infection. The cause can be chronic inflammation and foci of infection in the nasopharynx, sinusitis, tonsillitis, rhinitis, because between these organs, covered by the inflammatory process, and the ear, there is a direct relationship through the ducts. Infection thus freely penetrates into the ear.

In addition, during pregnancy, a large amount of the hormone progesterone, which significantly increases the permeability of blood vessels, delays fluid in the tissues. As a result, the mucous membranes undergo edema, which also contributes to puffiness. The blood pressure also rises. The reason for this is an increase in the amount of blood in the body. All these mechanisms in a complex and separately, promote increase of susceptibility of an organism to an infection.

An important cause contributing to the development of the inflammatory process is the edema of the mucous membrane, epithelial tissues. As a result, the mucous membrane significantly narrows. This leads to a violation of the ventilation function, as a result of which exudate accumulates in the ear cavity. If the pathology is not treated, the disease can progress and the usual serous exudate can turn pus, which leads to more severe inflammation.

Also, the reason is the lack of minerals, intoxication of the body, common infections.

Risk factors

Significantly increases the likelihood of getting a woman who already has chronic ear pathologies, congenital anomalies and there is a genetic predisposition. Significantly increased risk in the presence of congenital curvature of the septum, polyps, hypertrophy of nasal passages, sinuses, and other inflammatory processes and somatic diseases in the ear, nasopharynx.

As practice shows, when pregnant against a background of reduced immunity, the risk of ear infection increases about 3 times during pregnancy. This is facilitated by the natural physiological mechanisms that result from the development of the fetus. In particular, progesterone has a significant effect.

[8], [9], [10], [11]

Pathogenesis

In order to understand the essence of the pathological processes occurring in the body, one must first understand the features of normal anatomy and the physiology of the ear. Thus, the ear is represented by three sections: the outer, middle and inner ear. The outer ear provides reliable protection of the inner ear. An important place is given to the auditory ossicles, responsible for the transformation of the wave into a stimulus, perceived by the receptors. It is passed on to subsequent structures.

It is here that inflammation is most often formed, as the middle ear with the Eustachian tube connects to the nasopharynx. Hence, the infection also penetrates if the inflammatory process affects the nasopharynx. If the inflammation passes to the middle ear, and otitis develops. At the same time, the Eustachian tube also becomes inflamed, swollen and narrows. Normally, it should be open. A dangerous complication of otitis media is the penetration of the infection into the inner ear, in which the inflammatory process develops. This can lead to inflammation of the nerve. Infection can be transmitted to various structures of the brain, causing inflammation in them.

Inflammation of the outer ear is most often manifested in the form of furunculosis. Usually a large amount of pus is formed. In this case, not only the skin, but also the hair follicle, sebaceous gland becomes inflamed. It contributes to this microtrauma, the violation of metabolic processes, non-compliance with hygiene rules. The spread of the inflammatory process leads to a further spread of the inflammatory process to the inner ear. The average otitis most often occurs precisely against the background of ARI, and inflammation of the inner ear - against the background of infection from the middle ear.

[12], [13], [14], [15], [16]

Symptoms of the otitis in pregnancy

The pain becomes dull and weak, whereas in non-pregnant women the pain is sharp, sharp, which drowns out all other sensations. On the foreground is the stuffiness of the ear, the hearing is drastically reduced. Often there are incomprehensible uncomfortable sensations, ringing. All this can be accompanied by swelling. These are common features that are manifested in almost all forms and varieties. Often develops general malaise, deterioration of health, pain in the throat, nasopharynx. With further progression of the disease, there is a development of headache, feelings of stuffiness of one side of the head, heaviness in the eyes.

The earliest signs are ear congestion and hearing loss. And only then can the pain develop, and other uncomfortable sensations. This is the main difference, since non-pregnant with the main and leading sign is a sharp pain in the ear.

Ear hurts during pregnancy

The appearance of pain is a dangerous symptom that can indicate otitis. Less often - a sign of other diseases, but more often it is a symptom of otitis. For pregnant women it is very important to cure as soon as possible, to avoid progression and complications. Complications are much harder to cure, especially when you consider that pregnant women can not use most of the drugs that are used traditionally.

Prohibited antibiotic therapy, the use of many drops and ointments. Contraindicated even boric alcohol, which is used to quickly and effectively eliminate symptoms. Complications can be dangerous not only for women. Many drugs during pregnancy only worsen the condition, because the body has changed properties. Especially aggravated pathology swelling, which is often observed in pregnant women. They can change the properties of drugs and their mechanism of action on the body.

Doctors during the practice have already allocated a number of funds that help to quickly cure the disease, eliminate the main symptoms and pain. Many of them prefer vegetable preparations. But in this case there are some nuances: they can cause allergic reactions and side effects. Proven means is otipax, which is used in the form of drops. He quickly removes inflammation and stops the infection process. In severe disease, the use of certain antibiotics, for example amoxiclav, is justified. It is used in the most extreme case, if treatment can not be avoided, the disease begins to progress. As for folk remedies, they are also used, but a number of nuances need to be taken into account and the treatment should be under strict medical supervision.

Most doctors agree that otitis in pregnancy is not dangerous if timely action is taken, necessary treatment is carried out. At the same time, the earlier the measures are taken, the more chances for recovery without complications. The key is the right treatment. Otherwise, complications can develop, the disease will develop for a long time, it will be difficult to proceed and with complications.

For a pregnant woman, the main thing is to follow the doctor's recommendations, keep bed rest, and do not overcool. It is important to put on a hat when going out on the street in winter, because it is very easy to catch cold with reduced immunity, even from the slightest blow of the wind. The house must also not allow drafts.

[17], [18], [19],

Effect on fetal otitis in pregnancy

In itself, otitis for the fetus is not dangerous. Danger is the complications that arise if you do not take measures for the timely cure of the disease. The danger can be presented and medicines. So, when the form of pathology is neglected, antibiotics, antibacterial drugs that can affect the woman's body and, accordingly, on the fetus can not be avoided. Especially dangerous are drugs that can penetrate transplacental.

Especially dangerous is inflammation in the first three months of pregnancy. It is at this time that the main development of the embryo occurs. This is the period when all the basic organs and systems are laid, and the anatomical and physiological structures are laid. In the future, all these structures only grow and develop. Approximately in the second trimester, the placenta is already sufficiently formed, which provides fetal protection. Taking medication, although not recommended, but allowed, especially with the progression of the disease. The danger of this period is that drugs can penetrate the placenta, having a direct effect. It is very important to select carefully the preparations and to choose the ones that will maximize their benefits with a minimum of adverse effects on the fetus.

Antibiotics are the most dangerous substances that not only penetrate the placenta, but are also delayed by it. This they cause significant damage to the nervous system of the fetus, slowing its development. This effect persists throughout the pregnancy, as the nervous system is formed all 9 months.

[20], [21], [22]

Stages

Otitis occurs in five stages. At the first stage, acute otitis develops, accompanied by all the main symptoms of the disease. This is the period when the discomfort from the disease is expressed as brightly as possible. There may be a ringing. The temperature is normal, but sometimes it can rise.

At the second stage, an acute catarrhal process develops. The pain becomes abrupt, the mucous membrane becomes inflamed, the noise and obstruction increase, the temperature rises substantially.

The third stage is the formation of pus. At this stage, there may be an irradiation of pain, in which the source is unclear. Gives in the neck, throat, other areas, the noise amplifies, the hearing continues to decline. At this stage, the decline can reach a critical level, up to complete loss of hearing. The temperature rises to a dangerous level. All signs of inflammation can be traced in the blood.

The fourth stage is postperforative. Pain is reduced. Stagnation, and other uncomfortable sensations still remain. The temperature is usually normal, but hearing can continue to decline.

The fifth stage is reparative, in which the inflammation stops, a scar appears. The main functions are gradually normalized. But this happens only with proper and timely treatment. If the treatment is not carried out, or if it is not carried out correctly, numerous complications develop.

[23]

Acute Otitis in Pregnancy

The danger of this form of the disease is not so much in the disease as in the medicines, and the possible consequences and complications of the disease. Drugs that are traditionally used to treat otitis media, in this case are prohibited, so you have to choose from a fairly narrow spectrum. The choice of drugs should only be done by a physician, since they must meet many requirements, in particular, not to affect the fetus and in a relatively short time to eliminate the pathology without causing side effects.

Most experts choose their medicinal products of plant origin. Traditionally, natural oils are used. In this case, nasal drops that have vasoconstrictive activity and are traditionally used for the treatment of otitis are contraindicated for pregnant women, since they can affect the placental blood flow. If they are appointed, then it is necessary to take into account a number of shortcomings and advantages, strictly follow the precautionary measures, follow an individually developed treatment regimen, which only the doctor can choose.

If otitis is usually treated with ear drops, then in this case even these drugs are also contraindicated. The only remedy that can be used in pregnancy is otipax. But even this drug has its own contraindications: it can not be taken if the tympanic membrane is damaged.

Experts are afraid of complications, since antibiotic therapy can not be avoided when they occur. And this can have negative consequences for the fetus. But nevertheless there are preparations which in case of extreme necessity appoint or nominate: it amoksitsillin, or amoksiklav, biseptolum. Most often they are used in the event that pus appeared, there is a sharp increase in temperature. Of course, take medication with all precautions. It is better to carry out an analysis in advance of antibiotic sensitivity, which will help determine the causative agent of the disease and choose an antibiotic that will be most effective. At the same time, you can choose the right dosage.

You can not allow the penetration of pus inside the ear, its congestion, because its excessive accumulation can develop. As a result, pus will put pressure on the eardrum. In some cases, pus comes out, but in the absence of holes and perforations, pus can accumulate. This may require surgical intervention, during which a puncture of the tympanic membrane is made and the pus is pumped out.

In most cases, if you do not allow complications and strictly follow all the recommendations of the doctor, you can get rid of the symptoms of the disease after 5-7 days, which does not mean that the inflammation has already been cured. Treatment is long enough and requires 10-14 days. Therefore, even if the symptoms do not bother, treatment should be continued. Otherwise, a relapse is possible.

[24]

Chronic otitis in pregnancy

During pregnancy, chronic diseases become inflamed often enough, as resistance and immunity decrease. Most often acute exacerbation of already existing otitis, which was not completely cured, especially if it was in the early stages of pregnancy. Often, which occurs before pregnancy, also often inflames.

For a chronic form, a latent, diffuse current is inherent. In this case, there is no severe pain. It usually appears periodically, has a hidden character, aching, languidly flowing. It is treated as a traditional, medicamentous way, and folk remedies. In this case, often there are other symptoms that are not always characteristic of the acute form of the disease: there is a headache, general weakness, malaise.

[25], [26]

Forms

There are three main types of disease: external, middle and internal otitis. Often there is swelling, inflammation of the Eustachian tube. The danger of this form of the disease is the penetration of the infection into the inner ear, and further.

Danger of inflammation of the auditory nerve.

Internal otitis is called labyrinthitis. It itself is rare. It is almost always a complication of other diseases, injuries.

[27]

External otitis in pregnancy

The skin is affected, on which inflammation develops, furuncles appear. There is pain, puffiness increases, the ear canal narrowing, resulting in stiffness and hearing loss. The pain can be amplified in the event that you pull the auricle. Sometimes the pain intensifies when the woman opens her mouth, or chews, when talking.

[28], [29]

Otitis media during pregnancy

More dangerous form. Often carries purulent character. It is important to begin treatment at an early stage, which lasts from a few hours to 2-3 days. You can not allow the transition to the next stage.

Usually there is a rupture of the tympanic membrane, which is accompanied by the release of pus outwards, after which the condition is markedly improved. If the pus does not come out, it is a serious danger, as the accumulation of pus can lead to inflammation in the inner ear. If the pus go to the head, or other sites, this will have even more serious consequences.

If the disease is cured in a timely manner, the pus will come out, the inflammation will be removed, the pain will go away. It takes about 7-10 days to restore the hearing. All this time it is necessary to carry out treatment, even if the symptoms are no longer noted, otherwise after a few days the disease will return again. When recovering, the perforation closes itself.

A scar is formed, which quickly disappears.

Purulent otitis in pregnancy

Inevitably, pus is formed. With the formation of pus, you must inevitably take antibiotics. They can be picked up by a doctor, since they should have minimal impact on the fetus. When pregnancy is prescribed amoxicillin, flemoxin and biseptol. In addition, drops are prescribed. The only drug that is allowed during pregnancy is otipax. It is important that the pus come out. If it is impossible to exit, you may need to pierce the ear (pump out the liquid).

Epitimpanoidal otitis in pregnancy

Complicated form. Both mucous membrane and bone structures are affected. With this form there is a strong pain, sharply reduced hearing, until the total loss. For example, intracranial complications, severe damage to the auditory ossicles. Treatment is very complex, often requiring surgical intervention, and urgent. In this case, there are symptoms of systemic effects: temperature, headache, persistent migraine, nausea.

[30]

Catarrhal otitis in pregnancy

There is a lot of pain. Antibiotic therapy is required (if there is no effect of treatment within 48-72 hours). Applied intra-ear microcompression, in which the ear canal is injected turunda with a special drug. Sometimes there is a need to introduce painkillers.

[31], [32]

Complications and consequences

The consequences can be dangerous for both the woman and the fetus. Complication can become deafness. Chronic otitis is dangerous by frequent relapses and a more severe course (most often in the absence of treatment or incomplete cure of the disease).

Danger is the adhesive process, the penetration of infection into other departments and organs, especially in the nasopharynx, the inner ear. Infection of the nasopharynx can result in inflammation of the upper and lower respiratory tract. The greatest danger is pneumonia, pleurisy. With the further spread of infection, generalization of infection, the emergence of new foci (bacteremia, septicemia, sepsis) may occur.

The danger is the penetration of infection from the inner ear into the brain, which results in inflammation of the meninges (meningitis, thrombosis). This can have serious consequences, including disability and death. Infection presents a serious threat to the fetus, as it can penetrate the placenta, causing intrauterine infection. Danger and drugs that can not be avoided in severe forms of the disease (the threat of birth defects, defects, functional disorders, miscarriage or premature birth).

[33], [34], [35], [36]

Diagnostics of the otitis in pregnancy

In order to make a diagnosis, you need to see a doctor - an otolaryngologist. He will interview the patient, examine the ear, and also the throat and nasal cavity, and draw the appropriate conclusions. Usually the subjective sensations of the patient and the data of the examination of the ear (otoscopy) are sufficient for the diagnosis. But sometimes there is a need for additional methods to clarify the diagnosis. In this case, the doctor can appoint additional laboratory and instrumental methods of research.

[37], [38], [39]

Analyzes

The main analysis, which is most often prescribed for suspected otitis media, is a clinical blood test. Also, if necessary, can assign a clinical analysis of urine, an immunogram. If you suspect otitis of an allergic nature, allergic tests, immunoglobulin E, histamine are prescribed.

A clinical blood test provides an opportunity to determine the cause of the disease and roughly predict its further course. A very informative indicator is the number of leukocytes. Thus, leukopenia, that is, a decrease in the number of leukocytes, may indicate the development of leukemia, malignant neoplasms. An increase in the number of leukocytes can occur against the background of acute and chronic infectious and inflammatory processes. A sharp increase in the number of leukocytes may indicate that the infection spread from the ear to other areas, in particular, to the nasopharynx, pharynx. The higher the number of leukocytes, the higher the extent of the pathological process. The indicator over 70 000 leukocytes indicates the development of sepsis.

It is also necessary to evaluate the leukocyte formula. A shift to the left indicates the development of a very strong inflammatory reaction or infectious process, can be observed in sepsis, necrosis with sufficient resistance of the organism. However, in such a picture, the prognosis is unfavorable, as the disease progresses constantly, often faster than any therapy. The shift to the right indicates the course of the localized infectious process. At the same time, the outlook is favorable.

A very informative indicator is the level of neutrophils in the blood. A decrease in the number of neutrophils indicates the development of autoimmune diseases, in which inflammation is aggravated by aggression from the immune system. Elevated levels of eosinophils indicate the development of an allergic reaction, toxicosis, the development of parasitic infection, rheumatism, or the chronic course of the disease.

A slight increase persists in the recovery period after such serious diseases as croupous pneumonia, pleurisy, sepsis. A decrease in the number of eosinophils indicates sepsis, an extreme stage in the progression of the disease. Eosinopenia in combination with leukopenia indicates a decrease in the body's resistance against the background of these diseases, and is an unfavorable sign.

The decrease in the number of basophils also indicates an acute infectious process, hypothyroidism, stress. It should be borne in mind that the decrease in basophils occurs during pregnancy.

Lymphocytosis, that is, an increase in the number of lymphocytes, indicates the development of a viral disease. If there are no symptoms, this may indicate a persistence of it in the body. It is advisable to conduct additional virological diagnostics, as well as to pass an analysis for hidden infections. This will accurately determine the cause of the pathology and take measures to eliminate it.

Monocytosis (an increase in the number of monocytes) may indicate an exacerbation of chronic diseases, blood diseases, tumor development. Monocytopenia, that is, a decrease in the number of monocytes, indicates severe septic lesions and progression of the infectious-inflammatory process.

[40], [41], [42]

Instrumental diagnostics

Must be performed by an otolaryngologist on examination. The main method is otoscopy, without which it is impossible to diagnose and prescribe the appropriate treatment. So, for this special tools are used, which make it possible to examine the middle and inner ear.

If this is not enough, an X-ray method is used, with which you can visualize the bone system, identify possible pathological processes, including neoplasms, foci of inflammation.

A method of computer or magnetic resonance imaging has proved to be very good, which allows us to consider not only bones, but also soft tissues. The image is issued in several different projections, which allows to identify the pathology and evaluate it from various positions. This method makes it possible to identify any malignant and benign neoplasms even at the earliest stages of their development.

With the help of ultrasound it is possible to track the results in dynamics, which makes it possible to assess not only the condition of the organ, but also to predict the prospects for the further course of pathology.

Differential diagnosis

Otitis must be differentiated with tubootitis, which causes damage to the inner ear. A specific sign of tubootitis is a decrease in hearing, which is practically not observed with otitis. The main method is otoscopy.

Also, differential diagnosis implies the need to differentiate the different types of inflammatory process. To confirm the allergic nature of the disease, it is necessary to conduct an analysis for immunoglobulin E, which is the main indicator of an allergic reaction and increased sensitization of the body. On the otitis of allergic etiology indicates an increase in the level of immunoglobulin E in the blood.

In order to confirm the viral nature of the disease, a clinical blood test is usually performed. An increased number of lymphocytes in the blood indicates the presence of a viral infection. For its identification and quantification, virologic diagnostics are prescribed, as well as an analysis for hidden infections.

If there is a suspicion of the bacterial nature of otitis, an additional bacteriological study is carried out, which makes it possible to identify the microorganism, which became the causative agent of the infectious process, to determine its number.

Treatment of the otitis in pregnancy

In pregnancy, it is better to treat otitis locally, using drugs that have a local effect directly on the inflammation focus, that is, the ear. To do this, use a variety of ear drops, ointments. Compresses superimposed on the ear area help well. You can use physiotherapy procedures that are allowed during pregnancy, for example, warming up, electrophoresis, electroprocedures. Some folk recipes, homeopathic remedies and phytopreparations work well. But before using them, you should always consult your doctor. 

Prevention

Otitis during pregnancy can be prevented by observing basic preventive measures. They are reduced to the need to timely identify and treat existing diseases of the respiratory tract, ear, in the timely conduct of sanitation of the oral cavity. It is important to maintain immunity at a sufficient level. To do this, you need to observe the regime of the day, eat fully, do not overwork, do not overcool.

[43], [44]

Forecast

If timely and correct treatment of otitis in pregnancy, the prognosis may be favorable. The disease is fully cured, without causing complications, relapses. If you do not follow the doctor's recommendations, apply the wrong treatment, or do not treat the disease at all, serious complications can arise which can be a danger to the mother and fetus.

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