The most common cause of earache is acute otitis media (viral or bacterial); otitis externa and chronic otitis media are less common.
Among all diseases of the ear, average otitis make up about half, and in children their number is close to 70%.
Mechanisms of development of otitis media. The key role in the development of acute otitis media is played by the transition of the inflammatory process from the nasopharynx to the pharyngeal mouth of the auditory tube. As a result of obstruction of the auditory tube, a negative pressure develops in the tympanic cavity. This leads to the formation of effusion in the tympanum and to the ingress of mucus and bacteria from the nasopharynx into the middle ear. Thus, the main mechanism of infection in the middle ear cavity is tubogenic, i.e. Through the auditory tube.
There are other ways of penetrating the infection into the tympanum: a traumatic path, meningogenic, and finally, relatively rarely - hematogenous; it is possible with such diseases as sepsis, scarlet fever, measles, tuberculosis, typhus. Other etiological factors include immunoglobulin deficiency, HIV infection and, possibly, genetic predisposition.
Pathogens of otitis media. The main causative agents of acute otitis media are: S. Pneumoniae and untypable strains of H. Influenzae, less frequently M. Satarhalis. Much less often the disease is caused by S. Pyogenes, S. Aureus or associations of microorganisms, as well as viruses.
Acute otitis media is a disease with a fairly pronounced staging of the course. There are catarrhal, purulent and reparative (recovery) phases.
In adults and children are characterized by: malaise, weakness, fever, a feeling of stuffiness and earache, hearing loss. Isolation of pus speaks about the perforation of the tympanic membrane. After perforation, the pain in the ear is significantly weakened, the temperature decreases. In infants, the diagnosis is made on the basis of indirect signs: a decrease in appetite, screaming when sucking, crying when pressing on a tragus.
Terrible diseases that can cause pain in the ear: dental disease, osteoarthrosis of the cervical spine, lesion of the temporomandibular joint, epidemic parotitis ("mumps"), inflammation of the cervical lymph nodes, pharyngitis and tonsillitis. The cause of ear pain, especially in the elderly, can be herpesvirus infection (shingles), its rashes are often localized in the external auditory canal.
There are also a number of other conditions that can be accompanied by pain in the ear.
Sulfur plug, barotrauma, foreign bodies and pain in the ears
The gray cork. With excessive accumulation of sulfur, it is possible to form a sulfur plug. If the auditory canal is completely clogged, there are feelings of ear congestion and hearing loss, including resonance of one's own voice in the stuffed ear. These disorders develop suddenly, most often when you get into the external auditory passage of water during bathing, washing your head. Do not attempt to remove the sulfur plug yourself, as this can damage the eardrum and the walls of the ear canal. It is necessary to consult an otorhinolaryngologist.
Foreign bodies. Quite often (especially in children) foreign bodies enter the ear. Children, playing with various small objects (pebbles, cherry stones, beads, buttons, sunflower seeds, peas, paper balls, etc.), put them in your ear. In adults, foreign bodies can be part of a match, pieces of cotton wool. To extract them is most dangerous, because with inept attempts to extract a foreign body, it is possible to push it deeper and damage the eardrum. In the external auditory canal live foreign bodies can enter - insects, which cause very unpleasant sensations and pain. The first help in getting into the ear of insects is to infuse a few drops of liquid oil (vegetable, vaseline) or alcohol solution of boric acid into the ear canal. At the same time, the insect perishes and immediately discomforts cease. After this, the patient must be laid in such a way as to ensure the outflow from the ear to the "sick" side. Often, along with the liquid from the ear and removed foreign body. If the foreign body remains in the ear, the patient should consult an otorhinolaryngologist.
Barotrauma. Occurs when there is a sudden change in pressure in the external auditory canal with a closed auditory tube. Barotrauma is not uncommon for scuba divers, they also occur after air travel. Barotrauma is manifested by periodic or constant pain and noise in the ears, dizziness, hearing loss and, more rarely, secretions from the ear. For treatment, inhalations with menthol and analgesics are used. If the symptoms do not disappear after a few days, the patient is referred to an otorhinolaryngologist who performs blowing of the ears.
Suffering diseases of the nose, otitis media are not recommended to dive.
Mastoiditis. In the preantibiotics era, it occurred in 1-5% of cases as a complication of otitis media. With average otitis disturbed drainage from the middle ear cavity, it increases the pressure, and thin bony septums between the air cells of the mastoid process are destroyed. This process can continue for 2-3 weeks. Patients complain of pain, slight increase in body temperature, general weakness and loss of hearing.
Discharges from the ear, as a rule, have an unpleasant smell. The disease should be suspected in people who complain about discharge from the ear, lasting more than 10 days. When forming a subperiosteal abscess, a classical swelling behind the ear appears with a shift of the auricle downwards - this is the most characteristic feature of mastoiditis. The diagnosis can be excluded radiographically, when normal air cavities in the mastoid process are visible in the picture, whereas with mastoid or external otitis these cavities are not clearly visible.
Treatment begins with intravenous antibiotics (for example, 500 mg ampicillin every 6 hours), perform myringotomy (dissection of the tympanic membrane), and appropriate seeding should be done to select adequate antibiotics. If there is no improvement, then a mastoidectomy is necessary.
Bullous myringitis (inflammation of the tympanic membrane).
Viral infection (influenza), infection with Haemophilus influenzae and Mycoplasma may be accompanied by the formation of painful hemorrhagic blisters on the tympanic membrane and in the external auditory canal. The hemorrhagic fluid is also found in the middle ear cavity.
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