Diffuse otitis media: acute, otitis externa

Ear diseases are something that almost every one of us encounters, albeit not often. Moreover, most of us are familiar with this type of disease since childhood. Probably the most popular disease of the organ of hearing is considered to be otitis, by which we are accustomed to understand inflammation of the middle ear. In fact, the word "otitis" denotes an inflammatory process in the tissues of the ear, regardless of the depth of its penetration, and along with the middle, there is also internal and external otitis. The latter, in turn, according to the area of tissue damage, can be divided into limited and diffuse otitis, which promises a lot of trouble, but excessive release of sulfur from the ear is not the worst of them.

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Epidemiology

Speaking statistically, most of us suffered from otitis of varying severity at a tender age. But it must be said that this does not contribute to the development of immunity against otitis, which can have a lot of different pathogens. Therefore, many suffer from ear inflammation more than once during school years and even in adulthood. People whose activities can be complicated by frequent water entering the ear canal (swimmers, divers) are especially susceptible to ear diseases.

Cold water itself helps to wash out sulfur and weaken local immunity due to tissue hypothermia. Plus, it can be a source of infection, which, getting into the ear canal with water, often remains there. And if a person has a narrow ear canal, and the water is in no hurry to leave it, stagnation occurs, which only aggravates the situation and contributes to the spread of infection.

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Causes diffuse otitis media

When examining the pathogenesis of otitis externa, we encountered two types of problems that contribute to inflammation. These are infection and allergens. Infectious factors include not only bacteria, but also fungi or viruses. The latter can contribute to the transition of the disease to a chronic form, since they greatly weaken the immune system. And if the body does not fight, the disease proceeds unexpressed for a long time.

It should be noted that in approximately 60-70% of cases of diffuse otitis, its cause is a bacterial infection. These may be streptococci and staphylococci, Pseudomonas aeruginosa and other representatives of pathogenic and opportunistic microflora. About 10% of episodes of the disease are associated with a fungal infection (otomycosis). In other cases, we are talking about an allergic or viral nature of the ear pathology.

Most often, we ourselves bring bacteria into the ear when cleaning our ears, and we ourselves create favorable conditions for their reproduction by accidentally scratching the skin inside the ear canal, on the auricle, the skin in the tragus area. Then the infection acts without our help.

Bacteria choose moist places for their reproduction. Frequent exposure of the ear to water, which liquefies and removes earwax, and creates favorable conditions for the reproduction and spread of infection, can also be harmful to swimming and diving enthusiasts, and, of course, to professional swimmers.

Aspergillus and Candida fungi have the same penetration routes as a bacterial infection. But viruses can get into the wound not only from the outside, but also from the inside. ARVI, flu, viral tonsillitis are diseases that can easily be complicated by ear inflammation, because a viral infection spreads very quickly with the bloodstream and, against the background of weakened immunity, causes complications in various parts of the body.

As for the organ of hearing, inflammation of the middle ear is considered a complication of viral pathologies, but in the case of purulent inflammation with perforation of the eardrum, the exudate enters the external auditory canal, causing irritation and inflammation of the tissues of the outer ear, i.e. diffuse otitis.

External otitis can also develop against the background of some skin diseases (dermatitis, eczema, psoriasis, seborrhea ) of allergic or autoimmune nature. Most often, severe inflammation begins when a person begins to scratch the affected area in the ear and brings an infection there.

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Risk factors

Risk factors for the development of diffuse otitis can also be considered too frequent and thorough cleaning of the ears. Even if the skin is not damaged in this case, regular removal of the protective lubricant (wax) will not contribute to the health of the hearing organ. After all, in this case, there is no natural cleaning of the ear canal, and pathogenic bacteria and allergens are able to directly affect the skin, which is left unprotected.

Some readers may conclude that the best way to prevent otitis is earwax. But this is true for its moderate amount. Large accumulations of earwax will only contribute to congestion and hearing loss. Earwax is a serious obstacle to the removal of pathogens from the ear canal, and the result of its formation can be the same diffuse otitis.

Congestion in the ear is more common in people with such a constitutional feature as a narrow auditory canal. Earwax from a narrow opening comes out with difficulty on its own, but mechanical cleaning also causes certain difficulties and can be complicated by tissue trauma inside the ear.

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Pathogenesis

Every day, our skin, including the inside of the ear, is exposed to a variety of microorganisms (bacteria, fungi, viruses), dust, various allergens from the air, etc. Under certain conditions, all of them are irritants and can cause the development of inflammatory processes, but diffuse otitis, which is considered a generalized type of inflammation of the outer ear, does not always occur when bacteria or dust gets on the skin.

Inflammation, regardless of its localization, is always associated with a violation of general and local immunity, as a result of which the pathogen gets the opportunity to destroy the body's cells with impunity. For example, the same staphylococcus. It can live quietly on human skin for months without showing itself in any way. But as soon as the immune system fails, the opportunistic bacterium turns into a pathogenic one due to the ability to actively reproduce.

It is important to understand that some types of bacterial pathogens, such as Staphylococcus aureus, not only wait for a decrease in immunity, but can also provoke it themselves, as soon as they get into a favorable environment with high temperature and sufficient humidity.

Our body has everything to inactivate pathogens that have entered the body. The skin itself is already a protective barrier for more delicate internal tissues. And in the outer ear, which is limited by the auricle on the outside and the eardrum on the inside, there is also additional protection - a special viscous secretion called sulfur.

The face, body, arms and legs can be easily cleaned of all unnecessary things with water and soap. But the outer ear has a rather narrow (narrower than any finger) auditory canal, which is not protected from the penetration of microorganisms, dust, insects and other pests. It is not so easy to clean the ear further than the auricle from the outside, but this is facilitated by sulfur, which is secreted in the ear in limited quantities. Sulfur lubricates the skin inside the ear and everything that gets into the ear from the outside settles on this lubricant.

By removing earwax too thoroughly with improvised means, we not only risk weakening the protective barrier, but also damaging the delicate skin inside the ear. Once bacteria get into such a wound, they will not want to leave their “paradise” so easily. The infection will actively multiply, releasing substances that promote irritation and destruction of skin cells and subcutaneous tissue in the outer ear area.

In this case, the active release of serous secretion will indicate not so much the activation of the body's defenses, but the addition of inflammatory exudate to the sulfur, and possibly pus, depending on what pathogen caused the inflammation.

As we have already said, even the penetration of bacteria into the ear does not indicate a 100% development of diffuse otitis. Appropriate conditions are needed, and the main one is considered to be low immunity. And whose immunity is still initially weak? Of course, in children, because it takes years to form acquired immunity, and the innate one is not able to cope with a serious pathogen. Insufficient development of the immune system can also cause high sensitivity to non-infectious irritants - allergens, and skin allergic reactions are also accompanied by tissue inflammation.

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Symptoms diffuse otitis media

Since otitis is an inflammation of the ear, and any inflammatory process is characterized by redness and swelling of the tissues, the development of diffuse otitis can be judged precisely by these symptoms, which are the first signs of the disease.

Hyperemia and swelling of the tissues from the outside to the inside of the ear canal are external signs of the onset of the disease. Almost immediately, pain and itching join them. The intensity of the pain depends largely on the stage of the disease and the depth of tissue damage. The temperature of the tissues at the site of inflammation is always somewhat higher, so the patient may feel an unusual warmth in the diseased ear.

Speaking about the stage of pathology, it is necessary to understand that in the acute period of the disease the pain will be more pronounced. At first, painful sensations appear mainly when touching the affected area or pressing on the tragus, then they can be felt on a permanent basis, especially if the wound has begun to fester. The pain often intensifies during eating when performing chewing movements. In this regard, the patient begins to eat worse, giving preference to liquid food.

There may also be an increase in lymph nodes in the lower jaw and neck area. The lymph nodes increase in size and are painful when pressed.

In the chronic course of the disease, everything depends on the result of treatment of the acute condition. It should be said that chronic otitis becomes due to improper treatment of acute diffuse otitis or ignoring the problem. The absence of treatment against the background of reduced immunity can lead to the fact that the disease will subside for a while, and then worsen again with a high intensity of pain syndrome.

But let's get back to the swelling. While it is insignificant, the pain is not so strong that it allows disinfection and mechanical cleaning of the ear canal. When the swelling increases, the diameter of the ear canal can decrease so much that a person begins to hear worse, he has a noise in the ears, and there is an intense secretion of sulfur.

Some patients complain of ear congestion, a feeling similar to when water gets into the ear canal and stays there for a while. The feeling of constant discomfort in the ear can provoke headaches.

If we are talking about a wound, the addition of a bacterial infection contributes to the development of a purulent-inflammatory process. The discharge becomes purulent, crusts form on the wound, which periodically fall off, causing severe pain at the site of the lesion, an unpleasant odor appears from the ear canal. Such otitis in an acute form often occurs with an increase in temperature to 38 degrees and above. In the chronic course of the pathology, the temperature may be normal or slightly elevated during exacerbations.

The nature of the discharge depends on the type of otitis. For otitis of an allergic nature and some types of bacterial infection, transparent, odorless discharge is typical. But most often, bacterial otitis is characterized by mucous discharge with pus. With a fungal infection of the ear, the discharge has an unpleasant odor. A whitish, yellowish, and even black coating is observed on the skin.

Eczematous external diffuse otitis is exactly the situation when inflammation occurs against the background of dermatitis or eczema, which are complicated by the penetration of a bacterial infection into the wound. Most often, such pathologies occur in people prone to allergies, for example, when wearing earrings. In this case, purulent rashes are observed on the surface of the skin outside and inside the ear canal, the skin becomes bumpy with the formation of a stratum corneum, begins to peel and itches severely. With ordinary bacterial and viral otitis, itching is not as intense as with otomycosis and the eczematous type of inflammation.

The hemorrhagic form of otitis externa is characterized by the appearance of microscopic bruises on the inflamed skin. As a result, the mucous discharge acquires a pinkish tint or contains blood inclusions.

It is important to remember that there are two types of external otitis: limited and diffuse. If a small pustule or furuncle appears in the ear, we are talking about limited otitis, which is most often of bacterial origin. But if the inflammation is diffuse, diffuse otitis is diagnosed.

In viral otitis against the background of ARVI, both general symptoms are clearly expressed: headaches, weakness and sweating, malaise, hyperthermia, and local symptoms characteristic of the inflammatory process.

The human organ of hearing is a paired organ. But this does not mean that the disease should simultaneously affect both ears. It can be right-sided, left-sided diffuse otitis or damage to both ears simultaneously.

Unilateral otitis externa is an inflammation of the left or right ear up to the eardrum. Most often, the disease occurs due to trauma to the ear tissue. Bilateral diffuse otitis is an inflammation of the ears on both sides, which is most often observed in swimmers, both of whose ears are equally exposed to water.

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Complications and consequences

It would seem that external otitis is not such a terrible disease as inflammation of the middle or inner ear, in which the process threatens to move inside the head to the meninges or deprive a person of hearing when the eardrum is perforated. And the probability of external otitis turning into middle otitis is very small. Nevertheless, some danger still remains, inflammation is not something to joke about.

Firstly, otitis is always accompanied by pain in the ear, and nothing throws a person off track like pain in the head. As a result, work capacity decreases, memory and thinking suffer. Constant pain exhausts a person and causes irritation, which subsequently results in conflicts in the family and at work.

Secondly, if we consider that diffuse otitis is a pathology that, even in the acute stage, lasts a long time (2-3 weeks) and is often accompanied by nutritional deficiencies, then during the illness the body can become so weakened that it simply becomes unable to fight its pathogens, which is fraught with various complications.

Chronic inflammation in the ear (we are talking about inflammation that lasts for a month or more) often leads to the lumen of the ear canal gradually narrowing. This, of course, affects the quality of hearing. Over time, the ear canal can narrow so much that the patient is diagnosed with hearing loss in one or both ears. A child with hearing impairment will have to study in a specialized institution in order to keep up with his peers, and for adults, hearing loss creates problems both in communication and at work, limiting the choice of profession and career opportunities.

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Diagnostics diffuse otitis media

Quite often, the symptoms of otitis externa are obvious. Ear pain, redness and swelling of the tissues outside and inside the ear canal speak volumes about the inflammatory process. But the same symptoms can also be caused by a common furuncle maturing in the ear canal.

An otolaryngologist diagnoses ear diseases. First, he will ask the patient about all the symptoms, examine the tissues around the ear, palpate the regional lymph nodes, and measure body temperature. Then he will conduct instrumental diagnostics using a special device - otoscopy, which allows you to assess the condition of the ear canal and eardrum. In this way, the doctor will see how deeply the inflammatory process has spread and will be able to choose the most effective procedures.

As for laboratory tests, conventional blood and urine tests in the case of diffuse otitis provide little information about the disease. It makes sense to prescribe them in connection with therapeutic procedures to assess the possibility and safety of their implementation in various health disorders.

But it will be very useful to study the existing discharge from the ear already at the diagnostic stage. The doctor takes a scraping of the affected tissues and sends them for laboratory testing. This will help identify the pathogen in case of a bacterial or fungal infection, and in some cases, determine the allergen.

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Differential diagnosis

In the process of differential diagnosis of otitis, the doctor excludes pathologies with similar symptoms: furunculosis, eczema, ear dermatitis, and determines the cause of the inflammation and its connection with other diseases, for example, viral infections.

Treatment diffuse otitis media

Since diffuse external otitis is not a life-threatening pathology and does not pose a danger to others, even in the case of a bacterial infection, the treatment of the disease in most cases is carried out on an outpatient basis. That is, the doctor prescribes the necessary medications and procedures that the patient must take and perform at home. However, some physical procedures may require a visit to a medical facility.

What to do if you have otitis?

Since otitis is associated with tissue inflammation, anti-inflammatory drugs are considered the main drugs in the treatment of pathology. Preference is given to external agents containing antimicrobial components. But in case of infection, it is very important to know its nature. In case of bacterial infection, antibiotics are indispensable, in case of otomycosis, antifungal agents are used (Miconazole, Exoderil, nitrofungin solution, etc.), in case of viral infection, antimicrobial agents can be prescribed only as a preventive measure against bacterial complications, but vitamins and immunomodulators are considered the main drugs.

Antihistamines (Loratadine, Diazolin, Citrine, etc.) are well suited to relieve tissue swelling that causes hearing loss. They can be prescribed for any type of otitis, but for eczematous otitis, such drugs are mandatory.

In case of a bacterial infection at the initial stage of the pathology, inflammation can be relieved even using conventional antiseptic creams and solutions, as well as NSAIDs for systemic use (Nimid, Nimesil, Ibuprofen, etc.). Usually, non-steroidal drugs also help relieve pain. If this does not happen, the doctor can prescribe effective analgesics (Analgin, Ketanov, Codeine, etc.).

In severe inflammation and eczematous otitis, preference is given to hormonal drugs in the form of drops and ointments (Flucinar, Oxycort, Docacorten, hydrocortisone ointment, betamethasone cream, etc.), which are used locally, which gives a better effect than systemic NSAID therapy, and does not have a negative effect on internal organs. Steroid drugs are better than others in helping to combat inflammation and itching of the affected ear tissues. In severe inflammation, corticosteroids can also be prescribed orally (Prednisolone, Hydrocortisone, etc.).

A mandatory procedure for external otitis is considered to be washing the diseased ear with disinfectant solutions (miramistin, saline or physiological solution, mineral water, light pink solution of potassium permanganate, weak iodine solution, chlorophyllipt solution, etc.). Hydrogen peroxide and furacilin solution are also suitable for cleaning the ear from discharge. And, despite the fact that the diseased ear loves warmth, the temperature of the solution should not be high.

It is better, of course, for the procedure to be performed by an experienced doctor. But if you are careful, you can do it yourself using a disposable syringe (without a needle) and a warm antiseptic solution. Fill the syringe with the prepared solution, tilt your head to the side so that the sore ear faces the sky, and slowly (never under pressure) pour the solution from the syringe into the ear canal. After waiting a little for the wax and films in the ear to soften, tilt your head back, allowing the liquid to calmly leave the ear canal.

Washing is carried out 3 or 4 times a day, as prescribed by the attending physician. They are considered a preparatory procedure for more serious treatment. Local anti-inflammatory and antibiotic therapy is carried out using ointments (Levomekol, Vishnevsky ointment, Triderm, Celestoderm, Bactroban, Altargo, Neomycin, etc.) and drops (Otinum, Candibiotic, Sofradex, etc.).

If drops and solutions (chlorophyllipt, penicillin, miramistin) can simply be dripped into the ear, then with ointments it is a little more complicated - they are inserted into the ear canal using turundas (a piece of bandage twisted into a tourniquet or a cotton swab). The ointment is applied directly to the turundas and placed in the sore ear for several minutes, leaving a small "tail" outside to facilitate the removal of the turunda from the ear.

If local treatment of bacterial diffuse otitis does not give tangible results, the doctor prescribes antibiotics for oral or parenteral administration, which normalize the patient's condition in a short time. But when prescribing such drugs, it is always necessary to take into account the causative agent of the infection. Otherwise, the treatment may not be beneficial, but contribute to the actualization of the problem of the development of antibiotic resistance of pathogenic microorganisms.

After the acute symptoms have been relieved, physiotherapy treatment may be prescribed. Most often, these are thermal procedures for warming up tissues with UHF currents, combating bacterial infections with ultraviolet light, and magnetic therapy.

Surgical treatment is usually indicated for limited otitis with the formation of a furuncle (abscess) due to the risk of pus breaking through and getting into the middle ear and brain area.

Effective ear drops for otitis

Treating diffuse otitis is quite difficult, it is not for nothing that treatment often drags on for two or more weeks. But it is also impossible not to treat the disease, otherwise it will become chronic or, even worse, the purulent process will spread inside the ear.

Read also:

• Drops for otitis
• Drops for otitis in children

In order to relieve pain and inflammation in the outer ear as quickly as possible, it is not necessary to use hormonal drugs. First, you can try using effective antiseptic agents, which include the now popular drug "Otinum", produced in the form of ear drops.

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Otinum

The main active ingredient of the drops is a substance obtained as a result of a chemical reaction involving salicylic acid - choline salicylate. It is due to it that the drug relieves inflammation well and stops ear pain. The active ingredient of the drug reduces the activity of enzymes that activate inflammatory processes.

An additional component in the composition of the medicine is glycerin. It also has a beneficial effect, helping to soften earwax and remove it.

Otinum drops can be used for both external and middle otitis. They can be used after washing the ears or before the treatment and hygiene procedure, because they will help cleanse the ear canal from sulfur and inflammatory exudate.

If earwax has accumulated in the ears and formed a plug, the medicine should be dripped twice a day, 3-4 drops in one ear, to remove it. The course of treatment is 4 days.

For medicinal purposes, drops are used in the same dosage 3 or even 4 times a day.

After instilling the drops, it is recommended to lie down for a little while if the procedure was carried out in a lying position, or sit for a few minutes, holding the ear up so that the liquid does not flow out.

The drug is intended for the treatment of adult patients. There is no information about its effect on children. However, the instructions indicate that during pregnancy, the use of such a drug can be potentially dangerous, although when applied locally, it is not absorbed into the blood.

Other contraindications to the use of the drug include individual sensitivity to its components and damage to the eardrum, which serves as the border between the outer and middle ear.

During the use of the drug for the treatment of diffuse otitis, the following unpleasant symptoms may be observed: redness and itching of the skin at the site of application of the liquid, allergic reactions. If the eardrum is damaged, a fairly toxic drug can adversely affect the patient's hearing.

Drops can also be used to combat bacterial infections. In this case, the drug used must contain an antibiotic that is effective against the identified bacterial strains.

Ciprofarm

A long-known drug for the treatment of infectious and inflammatory diseases of the eyes and ears, in which the active substance is an antibiotic from the fluoroquinolone group - ciprofloxacin. This substance has a pronounced bactericidal effect on most anaerobic bacteria that can cause inflammation in the outer ear. It is also effective against mycobacteria.

When applied locally, the medicine does not penetrate deeply into tissues and does not have the known toxic effect. Just like Otinum, it can be used to treat purulent otitis media and otitis externa.

Antibacterial drops "Tsiprofarm" can be used in the therapy of adults and children from 1 year. For babies, after cleaning the ear, 3 drops of the drug are instilled into the ear canal, for adults - 4 drops. The interval between procedures should be 12 hours. After instillation, it is recommended to lie down for 10 minutes so that the medicine penetrates inside and does not flow out after getting up.

At the very beginning of treatment for acute symptoms, 6 (for children) or 8 (for adults) drops of the medicine can be introduced into the ear canal once, closing the exit from the ear with a cotton swab. Then use the recommended doses.

The drug is not usually prescribed to patients with intolerance to quinolone antibiotics or hypersensitivity to auxiliary components of the drug. The drug is prescribed to children from the age of one year. During pregnancy, it can be used only in cases of severe purulent inflammation that poses a threat to the expectant mother.

Side effects are not varied and manifest themselves in the form of tissue irritation and itching, which should be reported to the doctor. After all, such symptoms may indicate intolerance to the components. In severe cases of hypersensitivity, anaphylactic reactions are possible, which are rarely observed when treating ears.

When using Ciprofarm, the interval between its use and the use of other medications should be at least a quarter of an hour. The drug can increase sensitivity to sunlight, so during treatment with it, you should avoid being outdoors in sunny weather, visiting a solarium, and UV procedures.

To treat diffuse otitis, it is necessary to prescribe many different drugs, which is not very convenient, and frankly speaking, expensive for patients. Especially if the treatment does not give results and after a week the drug used has to be replaced with another.

The use of complex preparations, in which the anti-inflammatory effect is combined with antimicrobial and even antifungal, makes otitis therapy a little easier. It is precisely these preparations, produced in the form of drops, that we will now talk about.

Garazon

An anti-inflammatory and antibacterial drug in the form of a medicinal solution, the main active ingredients of which are betamethasone and gentamicin. The basis of the drug is a combination of a corticosteroid and an antibiotic.

• Betamethasone is an anti-inflammatory component of the drug, considered a strong corticosteroid with a fast and long-lasting effect. It relieves inflammation and itching, has a vasoconstrictor effect.
• Gentamicin is an antibiotic from the aminoglycoside group, which has a pronounced bactericidal effect even against those bacteria that are not sensitive to other antibiotics. Unfortunately, many strains of streptococci are not sensitive to it, and this must be remembered when prescribing the drug.

Drops "Garazon" as a potent drug are usually prescribed in cases where the pathogen is resistant to other antibiotics.

Before using the drops, the diseased ear is cleaned of wax and exudate. Then the patient lies on his side so that the diseased ear is on top. 3-4 drops of the medicine are introduced into the ear canal per application and wait 10-15 minutes to allow it to penetrate deep inside. The procedure can be repeated 2 to 4 times during the day.

When the inflammation decreases, the dose of the drug and the frequency of administration are also reduced. Treatment with the drug is stopped when the symptoms of the disease go away.

The drops can be used in another way. Wet a cotton swab with them and insert it into the ear for a longer period. As soon as the medicine dries, the swab is moistened again or replaced with a new one.

The drug has certain contraindications for use. As usual, the drug is not prescribed for hypersensitivity to its components. Other contraindications for the treatment of diffuse otitis include: herpes, keratitis, chickenpox, damage to the integrity of the eardrum or its absence. The drug is also not prescribed for the treatment of fungal forms of ear diseases.

During pregnancy, the drug is not recommended for long-term use. The possibility of treating children with the drug is determined by the doctor, but it should be taken into account that studies of the drug's safety on children under 12 years of age have not been conducted.

Side effects of the drug when applied to the skin in the ear area include slight burning, redness and the development of contact dermatitis, as manifestations of an allergic reaction.

The drug contains the antibiotic gentamicin, which is famous for its ototoxic effect, i.e. it can negatively affect the functioning of the hearing organ, therefore it is not recommended to use the combined drug for a long time. The antibiotic has good penetrating abilities, as a result of which it can be partially determined in the blood.

Sofradex

A combination drug based on two antibiotics and a hormonal anti-inflammatory component, used to treat the eyes and ears.

The antibacterial component of the drug is represented by the bacteriostatic antibiotic framycetin and the antimicrobial component called gramicidin, which can exhibit bacteriostatic or bactericidal action against various microorganisms. Both substances have a broad spectrum of antimicrobial activity.

The glucocorticosteroid dexamethasone acts as an anti-inflammatory component, which, in addition to its main effect, is characterized by a reduction in itching and other manifestations of allergies.

"Sofradex" is a specific drug that is prescribed in otolaryngology only for the treatment of external forms of otitis.

The drug is sold in a bottle with a dropper attached to it, which is secured before use. The dropper is then secured with a cap.

The drug is intended for the treatment of patients aged 7 years and above. Use in children under 7 years of age may result in decreased adrenal function.

A single dose of the medicine for one ear is 2-3 drops. The frequency of the instillation procedure is 3 or 4 times a day. The course of treatment is no more than 1 week.

The drug is not prescribed in case of hypersensitivity to its components or aminoglycoside antibiotics, viral and fungal tissue lesions, damage to the eardrum or its absence.

The drug does not cause any side effects that are not typical for other ear drops. Some patients may complain of itching, irritation and redness of the skin, the appearance of a rash and heat in the area of application, which also happens when using other medications for otitis.

Long-term use of the drug is not recommended due to the possibility of systemic action and the development of microflora resistance to antibiotics. In addition, intensive antibiotic therapy for diffuse otitis may cause ear damage by a fungal infection.

Candibiotic

A unique combination drug that combines the properties of an analgesic, antibiotic, antifungal and anti-inflammatory agent. Its action is based on a combination of 4 completely different substances:

• chloramphenicol is an antimicrobial component that is capable of combating most aerobes and some anaerobic bacteria, and has a bacteriostatic effect,
• Clotrimazole is an effective remedy against dermatophytes, mold and yeast fungi that can cause otomycosis and dermatitis of the outer ear, destroying the cellular structures of microorganisms,
• beclomethasone is a synthetic substance of hormonal nature that acts as an anti-inflammatory, antihistamine, antipruritic agent and helps reduce the secretion of inflammatory exudate,
• Lidocaine is a well-known anesthetic with a reversible effect that helps reduce pain.

The drug Candibiotic is used for allergic and infectious-inflammatory pathologies of the outer and middle ear.

The drops are approved for use in pediatrics from the age of 2. Children under 12 years of age are instilled 2 drops of the medicine into the ear with a frequency of application 4 times a day. For patients over 12 years of age, the dosage is increased to 3-4 drops. The instillation procedure is carried out 3 or 4 times a day.

The therapeutic course is usually limited to 5-7 days.

As with other drops, after instilling the liquid into the ear, you need to sit quietly with your head tilted so that the sore ear is raised up, or lie on the side opposite it for 10-15 minutes.

Contraindications to the use of the drug are not limited to hypersensitivity to the components of the multicomponent drug. It is not prescribed to patients with intolerance to amide anesthetics, with damage to the eardrum, chickenpox, herpetic lesions.

The use of the drug during pregnancy is limited, despite the fact that there is no information about its negative effects on the fetus or the course of pregnancy.

The drug has the same side effects as other drops used in the treatment of diffuse otitis.

Drops with antibiotics for external use seem quite safe, because they do not actually penetrate the blood, which means there is no need to be afraid of dangerous systemic effects. However, you should not take such drugs without a doctor's prescription. Firstly, it is very difficult for a non-specialist to figure out which drug is best suited to combat the existing type of pathogen. And using an ineffective drug, we only contribute to the spread of the problem of antibiotic resistance.

Secondly, uncontrolled use of even external antimicrobial drugs can contribute to disruption of the microflora in the ear and the development of a fungal infection (candidiasis), which will have to be treated in the future with equally strong antifungal drugs.

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Folk treatment of diffuse otitis

It should be said that in the treatment of external otitis, the use of antibiotics is not always justified. And even diffuse otitis, which is characterized by diffuse inflammation, in many cases does not require the use of such strong drugs. Often, treatment with good antiseptics, such as boric acid, is sufficient.

It would be wrong to call boric acid a purely folk remedy for treating otitis, because it was previously actively used in their practice by otolaryngologists. Later, less toxic drugs appeared, and boric acid was forgotten. Nevertheless, it is still popular with old-school doctors, as well as in folk treatment.

An alcohol composition with boric acid is used for ear drops. It can be used in pure form or diluted 1:1 with water or "Dimexide", which helps relieve inflammation and better penetration of boric alcohol into ear tissue. It is better to treat children's ears with a composition without dimexide due to its high toxicity.

Boric acid-based compositions should be administered into the ear using a pipette, 2-3 drops in one ear (for children - 1-2 drops). Wait a little and blot the entrance to the ear with a cotton swab.

Adults can also use boric alcohol to soak gauze turundas, which are inserted into the sore ear for several hours (preferably overnight). After inserting the turunda, the ear is insulated from the outside. Such a compress will not only fight bacteria and inflammation, but also relieve pain, which is facilitated by any thermal procedures. However, with purulent otitis, the effect of heat will have the opposite effect.

Ear compresses for otitis: alcohol, vodka, warming, with dimexide

Hydrogen peroxide, an effective antiseptic, is also excellent for treating external otitis. Before use, it should be diluted with boiled or purified water (8 drops per 1 tbsp. of water).

Place 5 drops of the prepared mixture into the ear and hold it for 15 minutes, then allow the liquid to flow out calmly and remove the remaining moisture with a cotton swab.

Diluted hydrogen peroxide can also be used to soak tampons, which are kept in the ear for several minutes or hours.

Ear drops can be used 2-3 times a day, turundas can be used once a day.

You should not abuse such products as boric acid and hydrogen peroxide, and if any suspicious symptoms (burning, itching) appear or hearing loss is observed, you should immediately stop treatment, giving preference to safer products.

For example, the well-known "brilliant green" from childhood will help reduce the manifestations of otitis externa. Only now it will need to be applied not to the cells, but to the areas of the ear affected by inflammation, using a cotton swab. After 5-6 procedures, you can feel noticeable relief.

Propolis, onion and garlic are considered excellent plant antibiotics, which can also be used to treat diffuse otitis. The main thing is to know how to do it correctly.

Onion and garlic should be crushed into a paste. Any of the compositions will strongly burn the skin, so before using them, lubricate the ear with vegetable oil or Vaseline. It is also recommended to dilute the paste with vegetable oil in equal proportions and use it for compresses on the ear, applied for 1-2 hours, or as an ointment, using twice a day.

Propolis also needs to be diluted before use, but with water in a ratio of 1:2. Turundas are soaked in the composition and placed in the ear overnight.

Some healers use a decoction of bay leaf to treat otitis externa. 4-5 leaves of the spicy plant are poured with a glass of water, boiled and infused for another two hours. The decoction is used for instillation into the sore ear (3 drops with a frequency of 4 times a day) and for internal use (1 tablespoon 4-5 times a day).

This treatment is especially useful for allergic inflammations and otitis, which develops against the background of viral infections accompanied by a decrease in immunity.

Herbal treatment also helps with external otitis. To wash the ear before treatment procedures, you can use decoctions and infusions of chamomile, St. John's wort, and calendula, which have an antiseptic and pronounced anti-inflammatory effect.

Geranium is also considered a popular remedy for otitis - a flower that decorates the homes of many of us. You need to take a geranium leaf, crush it a little, put it in a gauze bag and put it in the sore ear for 2-3 hours.

Pain and inflammation in any type of diffuse otitis can be relieved with aloe (the plant must be at least 1 year old, but it is better to use a 3-year-old flower), the juice of which contains various anti-inflammatory components. The plant can be used in different ways:

• squeeze out the gel-like juice and put 4-5 drops in each ear,
• use juice to wet turundas,
• cut out the inner part of the leaf, wrap it in gauze and apply to the ear for 20 minutes or more.

Treatment with aloe is carried out for at least 3-4 days. Additionally, you can drip juice into the nose, which will help prevent the spread of inflammation deeper into the middle and outer ear.

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Homeopathy for diffuse otitis

Homeopathic doctors also agree with traditional healers on the issue of using antibiotics to treat otitis. Firstly, the disease is not always bacterial in nature; allergic, viral and fungal pathologies are not uncommon. Secondly, with external otitis, it is usually enough to regularly treat the ear canal and the skin at the entrance to the ear with antiseptics and use natural anti-inflammatory agents. Antibiotics and corticosteroids should be drugs that are used only in severe cases of purulent inflammation or the transition of the process to the eardrum, which is fraught with its perforation and the ingress of exudate into the middle ear.

There are several homeopathic remedies that can be used to treat diffuse otitis in adults and children without the use of strong drugs.

Doctors prescribe the drug Aconite at the very beginning of the acute period of the disease, when the ear temperature rises, fever and pain in the ear canal appear.

Belladonna is used for severe acute or throbbing pain in the ear, severe redness of the skin at the site of the lesion, and increased excitability of the patient.

The same symptoms are typical for Chamomilla: severe pain in the affected ear, irritability. Other symptoms may include tinnitus and a feeling of congestion in the hearing organ.

Ferrum phosphoricum, like the above-described drugs, is prescribed at the very beginning of the disease (within 3 days from the appearance of the first signs). But its prescription is justified only in the case of slow development of inflammation.

In case of mild general symptoms of otitis, when acute pain appears only from touching the sore ear, the drug Gepar sulfur is prescribed. Its prescription is also justified in case of infectious nature of the pathology, when discharge from the ear has an unpleasant odor.

For minor bacterial discharge of yellow or greenish color, with increased pain at night and from heat, the homeopathic medicine Pulsatilla may be prescribed.

If the onset of the disease was missed and the patient sought help when regional lymph nodes began to enlarge, treatment with Aconite, Belladonna and Ferrum phosphoricum will be ineffective. In such cases, the drug of choice is Mercurius dulcis, but if improvement does not occur within 24 hours, it makes sense to change the drug to Mercurius solubilis.

For ear drops for diffuse otitis, you can use Verbascum drops based on the mullein plant. The drug is prescribed for pain and congestion in the ear, the formation of scales in the auditory canal without purulent discharge.

If otitis is associated with a viral infection, you need to take antiviral drugs and immunomodulators. One of these drugs is the homeopathic remedy "Aflubin". These drops can be taken orally and instilled into the ear. To instill, add 4-5 drops of the drug to 1 teaspoon of pure vodka. After instillation, cover the ear with cotton wool and rub until it turns red.

For fungal infections, the drug Bioline Candida may be prescribed, and for eczematous otitis, the drugs Nitricum Acidum or Psorinum.

As anti-relapse agents we use dietary supplements "Populin", "Ekorsol", "Todikamp", homeopathic remedy Silicea, etc.

Although homeopathic medicines are generally considered safe, it is best to have an experienced homeopathic physician select the medicine and its effective dosage.

Prevention

As we can see, it is not worth joking with such a health disorder. And it is even better not to know about it at all. But in order for the disease not to dare to ruin your life, you will still have to take certain preventive measures:

• In cold, windy or damp weather, you should wear a hat that covers your ears and prevents them from getting cold.
• When swimming, playing in the water, doing sports in the pool, etc., your ears need to be protected from water. This can be done by inserting special earplugs into the ear canal or using a rubber cap.
• If you can't avoid getting water in your ear, you should definitely tilt it down and lightly massage the tragus, helping the liquid to come out. After that, you should blot the ear from the outside and inside with a dry, soft, clean napkin, folding it like a turunda, or warm it up with a hair dryer.
• In no case should you try to clean the inside of the ear canal with your finger. Firstly, few people wash their hands before such a procedure, and it is easy to bring germs inside the ear. And secondly, the delicate skin of the ear canal is very easy to injure with nails, and germs very quickly attack a fresh wound. And in general, it is better not to touch your ears unnecessarily.
• You shouldn't get carried away with cleaning your ears with cotton swabs. They are unlikely to hurt the skin. But these devices are not intended for daily use. Deep cleaning of the ears from wax and accumulated "dirt" inside the ear should be done 2-4 times a month. Only the area at the edge of the ear canal can be cleaned daily with water and a towel.
• If you still cannot protect the skin of the ear from damage, the wound must be treated with an antiseptic (hydrogen peroxide, a weak solution of potassium permanganate, brilliant green, etc.).
• Prevention of otitis in people with allergies will be taking antihistamines and maintaining immunity. Everyone without exception needs to strengthen the immune system, because in this way you can prevent not only otitis, but also many other diseases.

What can be done to improve immunity? Eat more fruits and berries, rich in vitamins, they give the body the missing strength. At the end of winter and beginning of spring, there are few vitamins left in foods, so preference should be given to pharmaceutical drugs, immunomodulators and vitamin complexes.

• You need to be especially careful when signs of colds appear. Any pathologies of the ENT organs carry the risk of complications in the form of otitis. Bacterial, viral and fungal infections require rapid and effective treatment. This is the only way to avoid the spread of the process to the hearing organs.

It would seem, how can the simplest preventive measures foresee all the possibilities of the disease development? It is clear that it is very difficult to take into account all the nuances. In addition, diffuse otitis can be a consequence of the incorrect structure of the ear and the development of congestion in it. And yet, adhering to the above rules, you can make the probability of the disease minimal and protect yourself from the dangerous consequences of ear inflammation.

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Forecast

External otitis is not the most terrible disease of the hearing organ, but still severe ear pain forces us to take urgent measures to treat the disease. And this is good, because with timely and effective treatment, the prognosis for diffuse otitis, as well as the limited form of the disease, is quite favorable. The disease is treated for a long time, but it is quite curable. The main thing is to complete the treatment, and not just relieve ear pain.

In case of severe bacterial inflammation, you should not rely only on folk methods of treatment, because this is fraught with the transition of the infection into a chronic one. And then any cold snap or increased air humidity, as well as a natural decrease in immunity in the spring-winter period or under the influence of diseases will cause repeated inflammation in the outer ear.

Moreover, constant relapses, as well as lack of treatment, can lead to the inflammatory process spreading to the middle ear, and from there it is a stone's throw to the brain. And if we are talking about the fact that inflammation contributes to hearing loss, then the lack of treatment as such is fraught with its irreversible decline, hearing loss and deafness.

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