Otitis media in pregnancy: symptoms, types

Today, inflammatory processes in the ear area are increasingly common in otolaryngological practice. There is no person who has not encountered an inflammatory process in the ear area at least once in his life. Most often, otitis, tubootitis are observed, which are accompanied by severe pain in the ear area, ear congestion. Otitis during pregnancy is the biggest problem.

In this case, many problems arise, 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 may arise that are unacceptable for a woman who is carrying a child.

Why is otitis dangerous during pregnancy?

It is a serious problem because otitis is often of bacterial origin. If left untreated, the infection can spread throughout the body and cause numerous complications. Of particular danger is the spread of the infectious process to the deep layers of the ear and other areas.

Through the Eustachian tube, the infection and the inflammation it causes are transmitted to the nasopharynx, pharynx, and brain. A simple earache or congestion without adequate intervention develops into severe pneumonia, pleurisy, and even meningitis, in which the meninges become inflamed (a serious danger not only for the mother, but also for the fetus).

Epidemiology

The incidence of otitis is 100%. During life, every person at least once in their life suffered from otitis of varying severity. Severe pain is the leading symptom of the pathology, which also occurs in 100%. In children under 3 years of age, the incidence of this pathology is 80%. It has been established that during pregnancy, a woman is three times more susceptible to otitis than a non-pregnant woman. In 70% of cases, otitis media occurs.

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Causes otitis media in pregnancy

It is necessary to take into account that the immunity of a pregnant woman is significantly reduced, therefore any unfavorable factor has a more powerful effect on the body. Therefore, it is easier for a pregnant woman to get sick, even under the insignificant influence of an etiological factor. The main reason is an infection. It is often transmitted from the source of infection during the development of another inflammatory process in the body, that is, it is secondary. For example, an infection is often transmitted from the nasopharynx and pharynx to the ear through the duct and the Eustachian tube.

Even the slightest hypothermia, cold, lack of sleep, and nutritional deficiencies can contribute to the development of an infectious process. This is due to the fact that the body becomes very sensitive and susceptible due to a decrease in resistance and immune status. A viral infection can also be the cause. Chronic inflammation and foci of infection in the nasopharynx, sinusitis, tonsillitis, rhinitis can be the cause, since there is a direct relationship between these organs affected by the inflammatory process and the ear through ducts. In this case, the infection freely penetrates the ear.

In addition, during pregnancy, a large amount of the hormone progesterone is produced, which significantly increases the permeability of blood vessels and retains fluid in the tissues. As a result, the mucous membranes are subject to edema, which also contributes to swelling. Blood pressure also increases. The reason for this is the increase in the amount of blood in the body. All these mechanisms, in combination and separately, contribute to an increase in the body's susceptibility to infection.

An important reason contributing to the development of the inflammatory process is the swelling of the mucous membrane, epithelial tissues. As a result of the swelling, the mucous membrane narrows significantly. 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 into pus, which leads to more severe inflammations.

Also the cause is a lack of minerals, intoxication of the body, general infections.

Risk factors

The probability of getting sick increases significantly in a woman who already has chronic ear pathologies, congenital anomalies and has a genetic predisposition. The risk increases significantly in the presence of congenital curvature of the septum, polyps, hypertrophy of the nasal passages, sinuses, and other inflammatory processes and somatic diseases in the ear and nasopharynx.

As practice shows, during pregnancy against the background of reduced immunity, the risk of developing an ear infection increases approximately 3 times during pregnancy. This is facilitated by natural physiological mechanisms that arise as a result of fetal development. In particular, progesterone has a significant effect.

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Pathogenesis

In order to understand the essence of pathological processes occurring in the body, it is necessary to first understand the features of normal anatomy and physiology of the ear. Thus, the ear is represented by three sections: the outer, middle and inner ear. The outer ear provides reliable protection for the inner ear. An important place is given to the auditory ossicles, responsible for converting the wave into an irritant perceived by the receptors. It is transmitted to subsequent structures.

This is where inflammation most often occurs, since the middle ear is connected to the nasopharynx via the Eustachian tube. This is where the infection penetrates if the inflammatory process affects the nasopharynx. If the inflammation spreads to the middle ear, otitis develops. In this case, the Eustachian tube also becomes inflamed, swells and narrows. Normally, it should be open. A dangerous complication of otitis is the penetration of infection into the inner ear, which causes an inflammatory process. Inflammation of the nerve can develop. The infection can be transmitted to various structures of the brain, causing an inflammatory process in them.

Inflammation of the outer ear most often manifests itself in the form of furunculosis. Usually, a large amount of pus is formed. In this case, not only the skin becomes inflamed, but also the hair follicle and sebaceous gland. This is facilitated by microtrauma, metabolic disorders, and non-compliance with hygiene rules. The spread of the inflammatory process leads to further spread of the inflammatory process to the inner ear. Middle otitis most often occurs against the background of acute respiratory infections, and inflammation of the inner ear - against the background of the transition of infection from the middle ear.

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Symptoms otitis media in pregnancy

The pain becomes dull and weak, while in non-pregnant women the pain is sharp, acute, which drowns out all other sensations. Ear congestion comes to the fore, hearing is sharply reduced. Often there are incomprehensible discomforts, ringing. All this can be accompanied by swelling. These are common features that appear in almost all its forms and varieties. General malaise, deterioration in health, pain in the throat, nasopharynx often develop. With further progression of the disease, headaches, a feeling of congestion on one side of the head, heaviness in the eyes develop.

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

Ear pain during pregnancy

The appearance of pain is a dangerous symptom that may indicate otitis. Less often, it is a sign of other diseases, but most often it is a symptom of otitis. For pregnant women, it is very important to cure it as quickly as possible, to avoid progression and complications. Complications are much more difficult to cure, especially considering that pregnant women cannot use most of the traditional remedies.

Antibiotic therapy, the use of many drops and ointments are prohibited. Even boric alcohol, which is used to quickly and effectively eliminate symptoms, is contraindicated. Complications can be dangerous not only for the woman. Many drugs during pregnancy only worsen the condition, since the body has altered properties. In particular, edema, which is often observed in pregnant women, aggravates the pathology. They can change both the properties of drugs and their mechanism of action on the body.

In the course of their practice, doctors have already identified a number of remedies that help to quickly cure the disease, eliminate the main symptoms and pain. Many of them prefer herbal preparations. But even in this case, there are some nuances: they can cause allergic reactions and side effects. A proven remedy is otipax, which is used in the form of drops. It quickly relieves inflammation and stops the infectious process. In severe cases of the disease, the use of certain antibiotics is justified, for example, amoxiclav. It is used in the most extreme case, if treatment cannot be avoided, the disease begins to progress. As for folk remedies, they are also used, but a number of nuances must be taken into account and treatment must be carried out under the strict supervision of a doctor.

Most doctors agree that otitis during pregnancy is not dangerous if measures are taken in a timely manner and the necessary treatment is carried out. At the same time, the sooner measures are taken, the greater the chances of recovery without complications. The key point is the correct treatment. Otherwise, complications may develop, the disease will develop over a long period of time, be severe and with complications.

The most important thing for a pregnant woman is to follow the doctor's recommendations, stay in bed, and avoid getting too cold. It is important to wear a hat when going outside in winter, since it is very easy to catch a cold with reduced immunity even from the slightest breath of wind. Drafts should also be avoided in the house.

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Effects of otitis during pregnancy on the fetus

Otitis itself is not dangerous for the fetus. The danger is in the complications that arise if measures are not taken to cure the disease in a timely manner. Medicines can also be dangerous. Thus, in advanced forms of the pathology, it is impossible to avoid the use of antibiotics, antibacterial drugs that can affect the woman's body, and accordingly, the fetus. Particularly dangerous are drugs that can penetrate transplacentally.

Inflammation is considered especially dangerous in the first three months of pregnancy. This is the time when the embryo develops most. This is the period when all the main organs and systems are laid down, and both anatomical and physiological structures are laid down. In the future, all these structures only grow and develop. Around the second trimester, the placenta is already sufficiently formed, which provides protection for the fetus. Taking medications, although not recommended, is allowed, especially as the disease progresses. The danger of this period is that medications can penetrate the placenta, exerting a direct effect. It is very important to carefully select medications and opt for those that will provide maximum benefit with a minimum of negative effects on the fetus.

Antibiotics are the most dangerous substances that not only penetrate the placenta, but are also retained by it. By doing so, they cause significant damage to the fetus's nervous system and slow down its development. This effect persists throughout pregnancy, since the nervous system is formed throughout the 9 months.

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Stages

Otitis occurs in five stages. The first stage is acute otitis, accompanied by all the main symptoms of the disease. This is the period when the discomfort from the disease is expressed most clearly. Ringing may occur. The temperature is normal, but sometimes it can rise.

At the second stage, an acute catarrhal process develops. The pain becomes sharp, the mucous membrane becomes inflamed, noise and congestion increase, and the temperature rises significantly.

The third stage is the formation of pus. At this stage, irradiation of pain may appear, with the source unclear. It radiates to the neck, throat, and other areas, the noise increases, and hearing continues to decline. At this stage, the decline can reach a critical level, up to complete hearing loss. The temperature rises to a dangerous level. All signs of inflammation are traced in the blood.

The fourth stage is post-perforative. The pain decreases. Congestion and other discomforts still persist. The temperature usually normalizes, but hearing may continue to decline.

The fifth stage is reparative, when the inflammation is stopped and a scar appears. The main functions are gradually normalized. But this only happens with correct and timely treatment. If treatment is not carried out, or is carried out incorrectly, numerous complications develop.

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Acute otitis during pregnancy

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

Most specialists opt for herbal medicines. Traditionally, natural oils are used. At the same time, nasal drops, which have a vasoconstrictor effect and are traditionally used to treat otitis, are contraindicated for pregnant women, since they can affect the placental blood flow. If they are prescribed, then it is necessary to take into account a number of disadvantages and advantages, strictly observe precautions, and follow an individually developed treatment regimen, which only a doctor can select.

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

Specialists are afraid of complications, because if they occur, antibiotic therapy cannot be avoided. And this can have negative consequences for the fetus. But there are still drugs that are prescribed in case of emergency: amoxicillin, or amoxiclav, biseptol. Most often, they are used if pus appears, there is a sharp increase in temperature. Of course, you need to take drugs with all precautions. It is better to conduct an antibiotic sensitivity test in advance, which will help to identify the causative agent of the disease and select the antibiotic that will be most effective. At the same time, you can select the necessary dosage.

Pus should not be allowed to penetrate into the ear, to accumulate, as excessive accumulation may develop. As a result, the pus will put pressure on the eardrum. In some cases, the pus comes out, but in the absence of holes and perforations, the pus can accumulate. This may require surgical intervention, during which the eardrum is punctured and the pus is pumped out.

In most cases, if you do not allow complications and strictly follow all the doctor's recommendations, you can get rid of the symptoms of the disease in 5-7 days, which does not mean that the inflammation is already cured. The treatment is quite long and requires 10-14 days. Therefore, even if the symptoms no longer bother you, the treatment should be continued. Otherwise, a relapse is possible.

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Chronic otitis during pregnancy

During pregnancy, chronic diseases become inflamed quite often, as resistance and immunity decrease. Most often, existing otitis that was not completely cured becomes aggravated, especially if it occurred in the early stages of pregnancy. Often, otitis that occurred before pregnancy also becomes inflamed.

The chronic form is characterized by a latent, diffuse course. There is no severe pain. It usually appears periodically, is latent, aching, and sluggish. It is treated both traditionally, with medication, and with folk remedies. At the same time, other symptoms often appear that are not always characteristic of the acute form of the disease: headache, general weakness, and malaise.

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Forms

There are three main types of the 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 infection into the inner ear, and further.

Inflammation of the auditory nerve is dangerous.

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

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Otitis externa during pregnancy

The skin suffers, inflammation develops, boils appear. Pain appears, swelling increases, the auditory canal narrows, resulting in congestion and hearing loss. The pain may increase if you pull the auricle. Sometimes the pain increases when a woman opens her mouth, or chews, or talks.

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Otitis media during pregnancy

A more dangerous form. Often purulent. It is important to start treatment at an early stage, which lasts from several hours to 2-3 days. It is impossible to allow the transition to the next stage.

Usually, the eardrum ruptures, which is accompanied by the release of pus, after which the condition improves significantly. If the pus does not come out, this is a serious danger, since the accumulation of pus can lead to inflammation in the inner ear. If the pus goes to the head or other areas, this will have even more serious consequences.

If the disease is treated in a timely manner, the pus will come out, the inflammation will subside, the pain will go away. It will take about 7-10 days to restore hearing. All this time, treatment must be carried out, even if the symptoms are no longer observed, otherwise the disease will return again in a few days. During recovery, the perforation closes on its own.

A scar is formed, which disappears fairly quickly.

Purulent otitis during pregnancy

Pus inevitably forms. When pus forms, antibiotics must be taken. A doctor can select them, since they must have a minimal effect on the fetus. During pregnancy, amoxicillin, flemoxin and biseptol are prescribed. Additionally, drops are prescribed. The only drug that is allowed during pregnancy is otipax. It is important that the pus comes out. If it cannot come out, an ear puncture may be required (the fluid is pumped out).

Epitympanoantral otitis during pregnancy

Complicated form. Both the mucous membrane and bone structures are affected. This form causes severe pain, hearing is sharply reduced, up to complete loss. For example, intracranial complications, severe damage to the auditory ossicles. Treatment is very complex, often requiring surgical intervention, and urgently. In this case, symptoms of systemic effects appear: fever, headache, persistent migraine, nausea.

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Catarrhal otitis during pregnancy

Severe pain occurs. Antibiotic therapy is required (if there is no effect from treatment within 48-72 hours). An intra-aural microcompress is used, in which a turunda with a special medicine is inserted into the ear canal. Sometimes there is a need to administer painkillers.

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Complications and consequences

The consequences can be dangerous for both the woman and the fetus. Deafness can be a complication. Chronic otitis is dangerous due to frequent relapses and a more severe course (most often occurs in the absence of treatment or incomplete cure of the disease).

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

The danger is the penetration of infection from the inner ear into the brain, which ends with inflammation of the meninges (meningitis, thrombosis). This can have serious consequences, including disability and death. The infection also poses a serious threat to the fetus, as it can penetrate the placenta, causing intrauterine infection. Medicines are also dangerous, which cannot be avoided in severe forms of the disease (threat of congenital malformations, defects, functional disorders, miscarriage or premature birth).

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Diagnostics otitis media in pregnancy

In order to make a diagnosis, you need to see a doctor - an otolaryngologist. He will interview the patient, examine the ear, as well as the throat and nasal cavity, and draw the appropriate conclusions. Usually, the patient's subjective sensations and ear examination data (otoscopy) are enough to make a diagnosis. But sometimes there is a need to conduct additional methods to clarify the diagnosis. In this case, the doctor may prescribe additional laboratory and instrumental research methods.

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Tests

The main test that is most often prescribed when otitis is suspected is a clinical blood test. Also, if necessary, a clinical urine test and an immunogram may be prescribed. If otitis of an allergic nature is suspected, allergy tests, immunoglobulin E and histamine tests are prescribed.

A clinical blood test makes it possible 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 has spread from the ear to other areas, in particular, to the nasopharynx, pharynx. The higher the number of leukocytes, the higher the degree of spread of the pathological process. An indicator of 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 body. However, with such a picture, the prognosis is unfavorable, since the disease is constantly progressing, often faster than any therapy works. A shift to the right indicates the course of a localized infectious process. In this case, the prognosis 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 enhanced by aggression from the immune system. An increased level of eosinophils indicates the development of an allergic reaction, toxicosis, the development of a parasitic infection, rheumatism, or a chronic course of the disease.

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

A decrease in the number of basophils also indicates an acute infectious process, hypothyroidism, stress. It is necessary to take into account that a decrease in basophils also occurs during pregnancy.

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

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

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Instrumental diagnostics

It is mandatory to be performed by an otolaryngologist during an examination. The main method is otoscopy, without which it is impossible to make a diagnosis and prescribe appropriate treatment. So, special instruments are used for this, which make it possible to examine the middle and inner ear.

If this is not enough, an X-ray method is used, with the help of which it is possible to visualize the skeletal system, identify possible pathological processes, including neoplasms, foci of inflammation.

The method of computer or magnetic resonance tomography has proven itself well, which allows examining not only bones, but also soft tissues. The image is given in several different projections, which allows identifying pathology and assessing it from different positions. This method makes it possible to identify any malignant and benign neoplasms even at the earliest stages of their development.

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

Differential diagnosis

Otitis must be differentiated from tubootitis, which affects the inner ear. A specific symptom of tubootitis is hearing loss, which is almost never observed with otitis. The main method is otoscopy.

Differential diagnostics also implies the need to differentiate various types of inflammatory processes. 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. An increase in the level of immunoglobulin E in the blood indicates otitis of allergic etiology.

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. To identify and quantify it, virological diagnostics are prescribed, as well as an analysis for latent infections.

If there is a suspicion of a bacterial nature of otitis, an additional bacteriological study is carried out, which makes it possible to identify the microorganism that caused the infectious process and determine its quantity.

Treatment otitis media in pregnancy

During pregnancy, it is better to treat otitis locally, using products that have a local effect directly on the inflammation site, that is, the ear. For this, various ear drops and ointments are used. Compresses applied to the ear area help well. You can use physiotherapeutic procedures permitted during pregnancy, such as warming up, electrophoresis, and electrical procedures. Some folk recipes, homeopathic remedies, and herbal preparations work well. But before using them, you must consult a doctor.

Prevention

Otitis during pregnancy can be prevented by following basic preventive measures. They boil down to the need to promptly identify and treat existing respiratory and ear diseases, and to promptly sanitize the oral cavity. It is important to maintain immunity at a sufficient level. To do this, you need to follow a daily routine, eat well, not overwork, and not get too cold.

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Forecast

If you treat otitis during pregnancy in a timely and correct manner, the prognosis can be favorable. The disease is completely cured without causing complications or relapses. However, if you do not follow the doctor's recommendations, use the wrong treatment, or do not treat the disease at all, serious complications may arise that can pose a danger to the mother and fetus.

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