Diffuse otitis media: acute, external

Diseases of the ear - this is something with which, although infrequently, but almost every one of us is facing. And most of this type of disease is familiar from childhood. Probably the most popular disease of the organ of hearing is otitis, under which we are accustomed to understand the inflammation of the middle ear. In fact, the word "otitis" refers to the inflammatory process in the tissues of the ear, regardless of the depth of its penetration, and along with the middle one distinguishes between internal and external otitis. The latter in turn in terms of the area of tissue damage can be divided into a limited and diffuse otitis, which promises a lot of trouble, t excessive release of sulfur from the ear is not the most terrible of them.

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Epidemiology

Speaking in the language of statistics, most of us at tender age had otitis media of varying severity. But it must be said that this does not contribute to the development of immunity against otitis, which may have a bunch of different pathogens. Therefore, many suffer more than once the inflammation of the ear in school years and even in adulthood. Especially susceptible to ear diseases are people whose activities can be complicated by frequent entry into the ear canal of water (swimmers, divers).

By itself, cold water promotes the washing away of sulfur and the weakening of local immunity due to the supercooling of tissues. Plus, besides, it can be a source of infection, which often gets into the ear canal with water. And if, moreover, the person has a narrow auditory canal, and the water does not hurry to leave it, stagnation occurs, which only aggravate the situation and contribute to the reproduction of the infection.

[2], [3], [4]

Causes of the diffuse otitis media

By examining the pathogenesis of external otitis media, we are faced with two kinds of problems that contribute to inflammation. It's an 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, as greatly weaken the immune system. And if the body does not fight, the disease continues undeveloped for a long time.

I must say that approximately 60-70% of cases of diffuse otitis caused by bacterial infection. These can 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 it is a question of allergic or viral nature of ear pathology.

Most of the bacteria in the ear are recorded by us during the cleaning of the ears, and we ourselves create favorable conditions for their reproduction, accidentally scratching the skin inside the ear canal, on the auricle, the skin in the tragus region. Further, the infection already acts without our help.

For their reproduction, bacteria choose wet places. Frequent ingress of water into the ear, which dilutes and removes sulfur, and also creates suitable conditions for reproduction and spread of infection, can also serve unhealthy lovers of swimming and diving, and, of course, professional athletes to swimmers.

Aspergillus and fungi of the genus Candida have the same penetration pathway as the bacterial infection. But viruses can get into the wound not only from the outside, but also from the inside. ARVI, influenza, viral angina are those diseases that can easily be complicated by ear inflammation, because the virus infection spreads very quickly with the blood flow and against the weakening of immunity, it complicates in different parts of the body.

As for the organ of hearing, the complication of viral pathologies is  inflammation of the  middle ear, but in the case of purulent inflammation with  perforation of the tympanic membrane, the exudate exits into the external auditory canal, causing irritation and inflammation of the outer ear tissues, i.e. diffuse otitis media.

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

[5], [6]

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 grease (sulfur) 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 act directly on the skin, left without protection.

Some readers may conclude that the best way to prevent otitis is in the ears. But this is true for its moderate amount. Large accumulations of sulfur will only contribute to stagnant phenomena and worsening of hearing. Ear plug is a serious obstacle to the removal of pathogens from the auditory canal, and the result of its formation can be the same diffuse otitis.

Stagnant phenomena in the ear are more characteristic of people with such a constitutional feature as narrow narcosis. Sulfur from a narrow hole itself comes out with difficulty, but mechanical cleaning also causes certain difficulties and can be complicated by trauma of tissues inside the ear.

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Pathogenesis

Every day, many different microorganisms (bacteria, fungi, viruses), dust, various allergens from the air, etc. Settle daily on our skin, including the cover inside the ear. All of them under certain conditions are irritants and are capable of causing the development of inflammatory processes, but diffuse otitis, which is considered a generalized type of inflammation of the external ear, does not always occur when bacteria or dust get on the skin.

Inflammation, regardless of its location, is always associated with a violation of general and local immunity, as a result of which the causative agent is able to destroy cells of the body with impunity. For example, the same staphylococcus. He can safely spend months on the skin of a man, not manifesting himself in any way. But if the immune system fails, the conditionally pathogenic bacterium turns into a pathogenic bacterium because of the possibility of actively multiplying.

It should be understood that some types of bacterial pathogens, for example, Staphylococcus aureus, do not just wait for a decrease in immunity, but they themselves can provoke it, it's only necessary for them to get into a favorable environment with a high temperature and sufficient humidity.

In our body, everything is provided for the inactivation of pathogens that enter the body. By itself, the skin is already a protective barrier for the more tender inner tissues. And in the outer ear, which is limited by the auricle from the outside and the eardrum inside, additional protection is also provided - it is a special viscous secret called sulfur.

The face, body, arms and legs from all unnecessary can be easily cleaned with water and soap. But the outer ear has a rather narrow (already any finger) auditory passage, not covered by the penetration of microorganisms, dust, insects and other pests. Clearing the ear further than the auricle from the outside is not so simple, but it is promoted by sulfur, which in limited amounts stands out in the ear. Sulfur lubricates the skin inside the ear and on this lubricant everything that gets into the ear from the outside settles.

Removing sulfur from the ear too carefully with improvised means, we not only risk loosening the protective barrier, but also damage the tender skin inside the ear. It is worth the bacteria to get into such a rank, and they will not want to leave the "heavenly place" so easily. Infection will actively multiply, releasing substances that promote irritation and destruction of skin cells and subcutaneous tissue in the area of the external ear.

At the same time, the active secretion of the serous secretion will indicate not so much the activation of the protective forces of the organism, but the addition of an inflammatory exudate in the sulfur, and possibly of pus, depending on which pathogen the inflammation was caused.

As we have already said, even penetration into the ear of bacteria does not indicate a 100% development of diffuse otitis. We need appropriate conditions, and the main one is low immunity. And who has immunity from the beginning is weak? Of course, in children, because the formation of acquired immunity takes years, and the congenital can not cope with a serious pathogen. Insufficient formation of the immune system can cause and high sensitivity to non-infectious irritants - allergens, and skin allergic reactions are also accompanied by inflammation of the tissues.

[8], [9], [10]

Symptoms of the diffuse otitis media

Since otitis is an inflammation of the ear, and for any inflammatory process redness and swelling of the tissues are characteristic, it is possible to judge the development of diffuse otitis just by these symptoms, which are the first signs of the disease.

Hyperemia and swelling of tissues outside the inside of the ear canal are external signs of the onset of the disease. Almost immediately they are joined by pain and itching. The intensity of 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 can feel unusual warmth in the diseased ear.

Speaking about the stage of pathology, you need to understand that in the acute period of the illness the pain will be more pronounced. First,  pain sensations  appear mainly when you touch the place of injury or pressure on the tragus, then they can be felt on an ongoing basis, especially if the wound begins to fester. Pain often increases with eating while exercising 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 area of the lower jaw and neck. Lymph nodes increase in size, when pressed on them, pain is felt.

In the chronic course of the disease, everything depends on the result of the treatment of an acute condition. It must be said that chronic otitis media is due to improper treatment of acute diffuse otitis media or ignoring the problem. Absence of treatment against a background of reduced immunity can lead to the fact that the disease will temporarily subside, and then exacerbate again with a high intensity of the pain syndrome.

But 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 intensifies, the diameter of the auditory stroke can decrease so much that the person begins to hear worse, it develops a noise in the ears, and an intensive release of sulfur is observed.

Some patients complain of the stuffiness of the ear - a feeling similar to when the water enters the ear canal and stays there for a while. The feeling of constant discomfort in the ear can provoke headaches.

If it is a wound, attachment of a bacterial infection contributes to the development of a purulent-inflammatory process. Allocations become purulent, on the wound are formed crusts, which periodically fall away, causing severe pain in the place of injury, an unpleasant odor from the auditory canal. This otitis in the acute form often occurs with an increase in temperature to 38 degrees and above. In chronic course of the pathology, the temperature can be normal or slightly elevated during exacerbations.

The nature of the discharge depends on the type of otitis media. For otitis allergic nature and some types of bacterial infection, clear odorless discharge is characteristic. But most often bacterial otitis is characterized by mucous secretions with pus. In case of fungal damage, ear secretions have an unpleasant odor. On the skin there is whitish, yellowish and even black coating.

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

The hemorrhagic form of external otitis is characterized by the appearance on the inflamed skin of microscopic bruises. As a result, the mucosal discharge becomes pinkish or contains a splotch of blood.

It should be remembered that external otitis can be of 2 kinds: limited and diffuse. If a small abscess or furuncle appears in the ear, it is a limited otitis, most often bacterial in nature. But if the inflammation has a diffuse nature, a diffuse otitis is diagnosed.

When viral otitis on the background of acute respiratory viral infection, general symptoms are distinct: headaches, weakness and sweating, malaise, hyperthermia, and local, characteristic of the inflammatory process.

The human organ of hearing is a paired organ. But this does not mean that the disease must simultaneously cover both ears. It can be  right-sided, left-sided diffuse otitis  or defeat of both ears at the same time.

Unilateral external otitis is the inflammation of the left or right ear to the eardrum. Most often, the disease occurs because of an injury to the ear tissues. Bilateral diffuse otitis  is an inflammation of the ears from two sides, which is most often observed in swimmers, both of whose ears are equally prone to water ingress.

[11], [12],

Complications and consequences

It would seem that otitis externa is not as bad a disease as an inflammation of the middle or inner ear, in which the process threatens to move inside the head to the meninges or deprive the person of hearing when perforating the tympanic membrane. Yes, and the probability of transition of external otitis media is very small. Nevertheless, some danger still remains, with inflammation do not joke.

First, otitis is always accompanied by pain in the ear, and nothing so does not knock a person out of the rut as pain in the head. As a result, working capacity decreases, memory and thinking suffer. Constant pains exhaust the person and cause irritation, which subsequently results in conflicts in the family and at work.

Secondly, if you consider that diffuse otitis is a pathology that even in the acute stage lasts for a long time (2-3 weeks) and often with a disruption of nutrition, during the period of illness the organism can weaken so much that it will simply be unable to fight its pathogens, which is fraught with various complications.

The chronic course of the inflammatory process in the ear (and we are talking about inflammation, which lasts for a month or more) often leads to the fact that the lumen of the auditory meatus gradually narrows. This, of course, affects the quality of the hearing. Over time, the ear canal is narrowed so much that the patient is diagnosed with hearing loss for one or both ears. A child with hearing impairment will have to study in a specialized institution to keep up with peers, and for adults, hearing loss creates problems both in communication and in work, limiting the choice of profession and career opportunities.

[13], [14], [15]

Diagnostics of the diffuse otitis media

Quite often, the symptoms of external otitis are visible. Pain in the ear, redness and swelling of the tissues outside and inside the auditory canal without words indicate an inflammatory process. But after all, the same symptoms can cause a common boil, ripening in the ear canal.

Diagnosis of ear diseases is performed by an otolaryngologist. First he will ask the patient about all the symptoms, examine the tissues around his ear, conduct palpation of regional lymph nodes, measure body temperature. After conducting instrumental diagnostics using a special device - otoscopy, which allows to assess the condition of the ear canal and tympanic membrane. Thus, the doctor will see how deeply the inflammatory process has spread and will be able to choose the most effective procedures.

As for laboratory studies, the usual blood and urine tests in case of diffuse otitis give little information about the disease. They are worthwhile to appoint in connection with therapeutic procedures to assess the possibility and safety of their conduct in various health disorders.

But here to study available allocation from an ear will be very useful already at a stage of diagnostics. The doctor takes a scraping of the affected tissues and sends them to a laboratory test. This will help to identify the causative agent 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 physician excludes pathologies similar in symptoms: furunculosis, eczema, ear dermatitis, finding out the cause of inflammation and its connection with other diseases, for example, with viral infections.

Treatment of the diffuse otitis media

Since diffuse otitis externa is not 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 performed 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 institution.

What to do with otitis?

Since otitis is associated with tissue inflammation, the main drugs in the treatment of pathology are considered to be anti-inflammatory drugs. Preference is given to external agents containing in their composition antimicrobial components. But in case of infection it is very important to know her character. When bacterial infection can not do without antibiotics, with otomycosis - using antifungal agents (Miconazole, Exoderil, a solution of nitrofungin, etc.), with a viral infection, antimicrobial agents can be prescribed only as a prophylaxis of bacterial complications, but the main drugs are vitamins and immunomodulators.

For removal of tissue edema, causing hearing loss, suitable antihistamines ( "loratadine", "Diazolin" "Citrine," et al.). They can be prescribed for any type of otitis, but with eczematous such drugs are mandatory.

With bacterial infection in the early stages of the pathology, you can remove the inflammation even using usual antiseptic creams and solutions, as well as NSAIDs for systemic use (Nimid, Nimesil, Ibuprofen, etc.). Usually, non-steroidal agents help to relieve pain. If this does not happen, the doctor can prescribe effective analgesics (Analgin, Ketanov, Codeine, etc.).

With severe inflammation and eczematous otitis, hormonal preparations in the form of drops and ointments ("Flucinar", " Oxycorte ", "Dokakorten", hydrocortisone ointment, betamethasone cream, etc.) are preferred, which are used topically, which gives a better effect than systemic therapy of NSAIDs, and does not have a negative effect on internal organs. Steroid drugs better than others help fight inflammation and itching of affected ear tissues. In severe inflammation, corticosteroids can also be administered orally (Prednisolone, Hydrocortisone, etc.).

Obligatory procedure for external otitis include washing the patient's ear with disinfectant solutions (miramistin, saline or saline solution, mineral water, light pink solution of potassium permanganate, weak iodine solution, chlorophyllipt solution, etc.). To purify the ear of the discharge, hydrogen peroxide and a solution of furacilin are also suitable. And, despite the fact that the sick ear loves heat, the temperature of the solution should not be high.

Better, of course, that the procedure was conducted by an experienced doctor. But being careful, it can be done independently with a disposable syringe (without a needle) and a warm antiseptic solution. We collect the prepared solution in a syringe, tilt the head to one side, so that the sick ear looks into the sky, and slowly (under no circumstances under pressure) pour the solution from the syringe into the auditory meatus. After waiting a little while for the sulfur and films in the ear to soften, we tilt our head in the opposite direction, allowing the liquid to calmly leave the auditory motion.

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

If drops and solutions (chlorophyllipt, penicillin, miramistin) can simply be instilled in the ear, then with ointments it is a little more difficult to introduce them into the auditory meatus with the help of turund (twisted piece of bandage or cotton swab). The ointment is applied directly to the turuncas and placed in the diseased ear for several minutes, leaving a small "tail" outside to facilitate removal of the turunda from the ear.

If the local treatment of bacterial diffuse otitis does not give tangible results, the doctor prescribes antibiotics for oral or parenteral administration, which in a short time will normalize the patient's condition. But with the appointment of such drugs, you always need to consider the causative agent of infection. Otherwise, the treatment may not be useful, but promote the actualization of the problem of the development of antibiotic resistance of pathogenic microorganisms.

After acute symptoms are removed, physiotherapeutic treatment can be prescribed  . Most often, these are thermal procedures for warming tissues with UHF currents, combating bacterial infection with ultraviolet radiation, and magnetotherapy.

Surgical treatment is usually indicated with limited otitis with the formation of a furuncle (ulcer) because of the danger of breakthrough pus and getting it into the middle ear and brain area.

Effective with otitis ear drops

Treating diffuse otitis is quite difficult, not for nothing that treatment is often delayed by two or more weeks. But there is no way to treat the disease either, otherwise it will pass into a chronic form or the worse the purulent process will spread into the ear. 

Read also:

• Drops with otitis
• Drops with otitis in children

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

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Otinum

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

An additional component in the composition of the drug is glycerol. It also has a beneficial effect, contributing to the softening of the earwax and its removal to the outside.

Drops "Otinum" can be used both with external and with average otitis. They can be used after washing the ears or before the treatment and hygiene procedure, because they will help clear the auditory canal from sulfur and inflammatory exudate.

If the ears have accumulated sulfur and formed a stopper for its removal, the drug should be dripped twice a day for 3-4 drops in one ear. The course of treatment is 4 days.

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

After instillation of drops, it is recommended to lie down a little more if the procedure was conducted in a lying position, or to sit for several minutes, keeping the ear on top so that the liquid does not leak.

The drug is intended for the treatment of adult patients. Information on its effect on the child's body there. But from the instruction it is known, that during pregnancy use of such medicine can be potentially dangerous, though at local drawing it is not absorbed into the blood.

Other contraindications to the use of the drug are individual sensitivity to its components and damage to the tympanic membrane, which serves as a boundary between the outer and middle ear.

During the application of the drug for the treatment of diffuse otitis, such uncomfortable symptoms can be observed: reddening and itching on the skin at the site of application of the liquid, allergic reactions. If the tympanic membrane is damaged, a rather toxic preparation can badly affect the patient's hearing.

Drugs in drops can also be used to combat bacterial infection. In this case, the drug used must contain an antibiotic that is effective against the detected strains of bacteria.

Tsiprofarm

A long-known drug for the treatment of infectious inflammatory diseases of the eyes and ears, in which the antibiotic from the group of fluoroquinolones - ciprofloxacin acts as an active substance. This substance with a pronounced bactericidal action against most anaerobic bacteria, which can cause inflammation in the external ear. It is also effective against mycobacteria.

With topical application, the medicine does not penetrate deeply into the tissue and does not have a known toxic effect. As well as "Otinum" can be used in the treatment of purulent middle and external otitis media.

Antibacterial drops "Ciprofarm" can be used in the therapy of adults and children from 1 year. Babies after cleansing the ear instilled in the ear canal for 3 drops of the drug, adults - 4 drops. The interval between the 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 lifting.

At the very beginning of treatment for acute symptoms, you can insert 6 (for children) or 8 (for adults) drops of medicine once into the auditory canal, closing the exit from the ear with a cotton swab. The recommended doses are then used.

The drug is not accepted for patients with intolerance to antibiotics of the quinolone group or hypersensitivity to the auxiliary components of the drug. The drug is prescribed for children from 1 year of age. In pregnancy, it can be used only in cases of severe purulent inflammation, which threatens the future mother.

Side effects do not differ in variety and are manifested in the form of irritation of the tissues and itching, which should be reported to the doctor. After all, such symptoms may indicate intolerance of the components. In severe cases of hypersensitivity, anaphylactic reactions are possible, which are rarely observed in the treatment of the ears.

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

To treat diffuse otitis, you have to prescribe a variety of different medications, which is not very convenient, and it is fair to say that it is costly for patients. Especially if the treatment does not work and after a week the used drug has to be replaced with another one.

The use of complex preparations, in which the anti-inflammatory effect is combined with antimicrobial and even antifungal agents, facilitates the treatment of otitis slightly. It is about such drugs, issued in the form of drops, we now talk.

Garazon

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 removes inflammation and itching, has a vasoconstrictive effect.
• Gentamicin is an antibiotic from the aminoglycoside group, which has a pronounced bactericidal effect even against those bacteria that are insensitive to other antibiotics. Alas, many strains of streptococci do not show sensitivity to it, and this must be remembered when prescribing a medicine.

Drops "Garazon" as a potent drug is usually prescribed in the event that the causative agent of the disease is resistant to other antibiotics.

Before applying drops, the ear is cleared of sulfur and exudate. Then the patient lies on his side so that the affected ear is on top. In the ear canal, 3-4 drops of medication are administered for one application and wait 10-15 minutes to allow it to penetrate deep inside. The procedure during the day can be repeated 2 to 4 times.

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

Drops can also be used in a different way. Wet them with a cotton swab and insert into the ear for a longer period. As soon as the medicine dries up, the tampon is again moistened 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 in the treatment of diffuse otitis are: herpes, keratitis, chicken pox, violation of the integrity of the tympanic membrane or its absence. Do not prescribe the drug and for the treatment of fungal forms of ear diseases.

During pregnancy, the drug is not recommended for a long time. The possibility of treatment with the drug of children is determined by the doctor, but it must be taken into account that drug safety studies on children under 12 years of age have not been conducted.

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

The drug contains an antibiotic gentamicin, which is famous for its ototoxic effect, i.e. Can adversely affect the operation of the hearing organ, therefore it is not recommended to use a combination medicine for a long time. The antibiotic has good penetrating ability, 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 preparation is represented by a bacteriostatic antibiotic with aramicetin and an antimicrobial component called gramicidin, which, with respect to various microorganisms, can exhibit bacteriostatic or bactericidal action. Both substances have a broad spectrum of antimicrobial activity.

As an anti-inflammatory component is a glucocorticosteroid dexamethasone, for which, in addition to the main action, it is characteristic to reduce itching and other manifestations of allergy.

"Sofraks" is a specific drug, which in otolaryngology is prescribed only for the treatment of external forms of otitis.

In the sale of the drug comes in a bottle with the dropper attached to it, which is fixed before use. In the future, the dropper is fixed with a cap.

The drug is designed to treat patients from the age of 7 years. The use in children younger than 7 years is fraught with a decrease in the function of the adrenal glands.

A single dose of a drug 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 not more than 1 week.

The drug is not prescribed for hypersensitivity to its components or antibiotics aminoglycoside group, viral and fungal tissue damage, damage to the tympanic membrane or its absence.

The drug does not cause any side effects unusual 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 during the application of other medications for otitis.

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

Candibiotics

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

• chloramphenicol - an antimicrobial component that can fight most aerobes and some of the anaerobic bacteria, has a bacteriostatic effect,
• Clotrimazole is an effective remedy for dermatophytes, molds and yeast fungi that can cause otomycosis and dermatitis of the outer ear, which destroys the cellular structures of microorganisms,
• beclomethasone is a synthetic substance of hormonal nature that acts as an anti-inflammatory, antihistamine, antipruritic agent and promotes a decrease in the release of inflammatory exudate,
• Lidocaine is a known anesthetic with reversible effect, which helps to reduce pain syndrome.

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

Drops are allowed for use in pediatrics from the age of 2 years. Children under 12 years in the ear instilled 2 drops of medication with a frequency of application 4 times a day. Patients from 12 years of age increase the dosage 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 the use of other drops after instillation of fluid into the ear, one should sit quietly with his head tilted, so that the ear is turned up, or lie on the side opposite to it for 10-15 minutes.

Contraindications to the use of the drug are not limited to hypersensitivity alone to the components of a multicomponent drug. It is not prescribed for patients with intolerance to amide anesthetics, with damage to the tympanic membrane, chicken pox, and herpetic lesions.

The use of the drug during pregnancy is limited, despite the fact that there is no information on its negative effect 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 media.

Drops with an antibiotic for external use seem quite safe, because they do not actually penetrate the blood, which means that you do not have to fear dangerous systemic effects. Nevertheless, it is not necessary to take such drugs not for the doctor's prescription. Firstly, it is very difficult for a specialist to find out what kind of preparation is best for combating the type of pathogen. And using an ineffective drug, we only contribute to the spread of the problem of antibiotic resistance.

Secondly, the uncontrolled use of even external antimicrobial drugs can contribute to impaired microflora in the ear and the development of fungal infection (candidiasis), which will later be treated with no less strong antifungal drugs.

[21], [22], [23]

Alternative treatment of diffuse otitis media

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

Boric acid would be incorrectly called a purely alternative treatment for otitis media, as previously it was actively used by otolaryngologists in its practice. Later, less toxic drugs appeared, and boric acid was forgotten. Nevertheless, the doctors of the old school, it is still popular, as, indeed, in folk medicine.

Apply alcohol composition with boric acid for instillation of ears. It can be used in pure form or diluted 1: 1 with water or "Dimexide", which helps to relieve inflammation and better penetration of boric alcohol in ear tissue. Children better to treat the ears of the composition without dimexide because of its high toxicity.

Formulations based on boric acid should be injected into the ear with a pipette 2-3 drops in one ear (children 1-2 drops). A little wait and blot in the ear with a cotton swab.

Adult boric alcohol can also be used to impregnate gauze turundum, which is injected into the diseased ear for several hours (preferably at night). After tyurunda administration, the ear is warmed from the outside. Such a compress will not only fight bacteria and inflammation, but also relieve pain, which is promoted by any thermal procedures. True, with purulent otitis, the effect of heat will have the opposite effect.

Compresses in the ear for otitis : alcohol, vodka, warming, with dimexidum

For the treatment of external otitis, an effective antiseptic, such as hydrogen peroxide, which before application must be diluted with boiled or purified water (8 drops per 1 tablespoon water) is also suitable.

In the ear, 5 drops of the finished formulation are injected and retained for 15 minutes, after which allow the liquid to calmly flow out and clean the remaining moisture with fleece.

Diluted hydrogen peroxide can also be used to impregnate turundum, which is kept in the ear for several minutes or hours.

Burying of ears can be carried out 2-3 times a day, turundas apply once during the day.

Abuse of such drugs as boric acid and hydrogen peroxide is not worth it, and if any suspicious symptoms (burning, itching) or hearing loss occur, you should immediately stop treatment, giving preference to safer means.

For example, it helps to reduce the manifestations of external otitis known since childhood "zelenka". Only now it will need to be applied not on the maples, but on the affected areas of inflammation in the ear, using a cotton swab. After 5-6 procedures, you can feel a noticeable relief.

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

Onions and garlic should be crushed into a gruel. Any of the formulations will burn the skin hard, therefore, before using them, the ear is lubricated with vegetable oil or petroleum jelly. Kashitsu is also recommended to dilute with vegetable oil in the same proportions and use for compresses on the ear, imposed for 1-2 hours, or in the form of ointment, using twice a day.

Propolis must also be diluted before use, but with water in a ratio of 1: 2. In the composition, wet the turundas and put them in your ear for the night.

Some healers use decoction of bay leaves to treat external otitis. 4-5 leaves of spicy plants pour a glass of water, boil and insist for another two hours. Decoction is used to instill a patient's ear (3 drops with the frequency of the procedure 4 times a day) and oral administration (1 tablespoon 4-5 times a day).

Especially useful is the treatment for allergic inflammations and otitis, which develops against the background of viral infections that occur with a decrease in immunity.

Helps with external otitis and herbal treatment. To wash the ear before the treatment procedures can use decoctions and infusions of herbs chamomile, St. John's wort, marigolds, which have antiseptic and pronounced anti-inflammatory effect.

A popular means for otitis is also geranium - a flower that beautifies the habitation of many of us. It is necessary to take a leaf of geranium, to stretch it a little, put it in a gauze pouch and lay it in a sick ear for 2-3 hours.

Pain and inflammation in all kinds of diffuse otitis can be removed with the help of aloe (the age of the plant should be at least 1 year, but it is better to use a three-year-old flower), the juice of which contains various anti-inflammatory components. In this case, you can use the plant in different ways:

• squeeze gel-like juice and dig it 4-5 droplets into each ear,
• use juice for wetting turund,
• cut out the inside of the leaf, wrap it in gauze and apply to the ear for 20 or more minutes.

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

[24], [25], [26], [27]

Homeopathy with diffuse otitis

Homeopathic doctors also agree with alternative healers on the use of antibiotics to treat otitis media. First, the disease does not always have a bacterial nature, it is not unusual for cases of allergic, viral and fungal pathologies. Secondly, with external otitis, it is often enough to regularly process the ear canal and skin when entering the ear with antiseptics and use natural anti-inflammatory drugs. Antibiotics and corticosteroids should be medicines that are used only in severe cases of purulent inflammation or the transition of the process to the tympanic membrane, which is fraught with its perforation and the ingress of exudate into the middle ear.

There are several homeopathic remedies with which you can treat diffuse otitis in adults and children without the use of potent drugs.

The drug Akonit doctors appoint at the beginning of the acute period of the disease, when the temperature of the ear rises, there is a fever and pain in the area of the auditory canal.

Beladonna is used for severe acute or pulsating pain in the ear, strong reddening of the skin at the site of injury, increased excitability of the patient.

Hamomilla is characterized by the same symptoms: severe pain in the affected ear, irritability. Other symptoms may be a noise in the ears and sensation of a stuffy hearing organ.

Ferrum phosphoricum as well as the above described drugs are prescribed at the very beginning of the disease (within 3 days from the appearance of the first signs). But his appointment is justified only in the case of a slow development of inflammation.

If the general symptoms of otitis are not expressed, when the acute pain appears only from touching the patient's ear, Gepar Sulfur is prescribed. His appointment is justified and with the infectious nature of the pathology, when discharge from the ear have an unpleasant smell.

With minor bacterial secretions of yellow or greenish color, with increasing pain at night and from heat, a homeopathic drug Pulsatilla can be prescribed.

If the onset of the disease was missed and the patient asked for help when regional lymph nodes began to increase, the 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 1 day, it makes sense to change the medicine for Mercurius solubilis.

To instill ears with diffuse otitis, you can use Verbaskum drops based on the Mullein plant. The drug is prescribed for pain and obstruction of the ear, the formation in the auditory circulation of scales without a purulent discharge.

If otitis is associated with a viral infection, antiviral drugs and immunomodulators should be taken. One of these drugs is the homeopathic remedy Aflubin. These drops can be ingested and buried in the ear. For instillation of 4-5 drops of the drug add to 1 ч.л. Pure vodka. After digging in, cover the ear with cotton wool and rub it until it turns red.

With fungal infections, Bioline Candida can be prescribed, and with eczematous otitis media, Nitrikum Acidum or Psorinum.

As anti-relapse agents we use the "Populina", "Ecorsol", "Todikamp", homeopathic remedy Silicea, etc.

In spite of the fact that homeopathic preparations are generally considered safe, it will be better that an experienced homeopath physician selects the medicine and its effective dosage.

Prevention

As you can see, joking with such a violation of health is still not worth it. And it's even better not to know him at all. But that the disease does not dare spoil your life, you still have to take certain preventive measures:

• In cold windy or wet weather, you need to wear a hat that covers your ears and prevents them from overcooling.
• During bathing, playing on the water, sports activities in the pool, etc. Ears should be protected from water ingress. This can be done by inserting into the ear canal special inserts or using a rubber cap.
• If you avoid getting water in your ear, you can not avoid it, you must always tilt it down and gently massage the tragus, helping the liquid to come out. After that, you need to dip your ear outside and inside with a dry soft clean cloth, curling it up like a turunda, or warming up with a hair dryer.
• In no case can you try to clean your ear canal inside your finger. Firstly, very few people wash their hands before such a procedure, and inside the ear can easily carry microbes. And secondly, the tender skin of the ear canal is very easy to injure with nails, and the microbes very quickly attack the fresh wound. And in general, once again you do not need to touch your ears unnecessarily.
• Do not get carried away and cleaning your ears with ear waxes. They can hardly hurt the skin. But these devices are not designed for daily use. Deep cleaning of the ears from sulfur and the accumulated "dirt" inside the ear should be done 2-4 times a month. Daily you can clean the water and towel only the area with the edge of the ear canal.
• If nevertheless it was not possible to protect the ear skin from damage, the wound must be treated with an antiseptic (hydrogen peroxide, a weak solution of manganese, zelenka, etc.).
• Prevention of otitis in people with allergies will be taking antihistamines and maintaining immunity. Strengthen immunity is necessary for everyone without exception, because in this way you can prevent not only otitis, but many other diseases.

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

• Particular care must be taken when there are signs of colds. Any pathology of ENT organs carries the danger 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 organs of hearing.

It would seem, how can the simplest preventive measures provide for all possibilities for the development of the disease? 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 wrong structure of the ear and the development of stagnant phenomena 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.

[28], [29], [30]

Forecast

Outer otitis is not the most terrible disease of the hearing organ, but still severe pains in the ears force us to take urgent measures to treat the disease. And this is good, because with timely and effective treatment, the prognosis of 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 completely curable. The main thing is to carry out the treatment to the end, and not just to remove the pain in the ear.

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

Moreover, persistent relapses, as well as lack of treatment, can lead to the fact that the inflammatory process will spread to the middle ear, and there it is already up to the brain to give. And if we talk about the fact that inflammation contributes to hearing impairment, the absence of treatment as such is fraught with its irreversible decline, deafness and deafness.

[31], [32]