Otitis media in diphtheria

Diphtheritic otitis rarely occurs on its own, most often it is a complication of diphtheritic sore throat or runny nose and occurs in closed groups of children during diphtheria epidemics. Diphtheritic otitis can also occur in adults, especially on wound postoperative surfaces in the mastoid process area.

Diphtheria is an acute infectious disease characterized by an inflammatory process in the pharynx, larynx, trachea, and less often in other organs with the formation of fibrinous films (plaques) and general intoxication with predominant damage to the heart and peripheral nervous system.

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Causes of otitis in diphtheria

The causative agent of diphtheria is the diphtheria bacillus (Corynebacterium diphtheriae), which produces a toxin (unlike the non-toxigenic diphtheria bacillus, which does not cause disease). The source of the infectious agent is a patient with diphtheria or a carrier of the toxigenic diphtheria bacillus, vegetating in the nose, nasopharynx and pharynx. The infection is transmitted by airborne droplets, through dishes and objects used by a patient with diphtheria. The patient becomes contagious in the last days of the incubation period (2-10 days) and continues to be so throughout the illness until liberation from the pathogen.

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Symptoms of otitis in diphtheria

The diphtheria bacillus, together with many other representatives of the coccal microbiota, can spread from the nasopharynx through the auditory tube into the tympanic cavity, mastoid cells, cause perforation of the eardrum and reach the external auditory canal. Purulent discharge containing fragments of grayish-brown false films is detected in the external auditory canal. The amount of pus and films gives an indirect idea of the volume and depth of destruction of the structures of the tympanic cavity.

Of particular note is the so-called false-film wound diphtheritic mastoiditis, described by German authors and observed in children hospitalized in the infectious diseases department who had undergone surgery for mastoiditis. This form of diphtheritic otitis is characterized by the accumulation of dark-gray false films in the postoperative wound, hemorrhages, and the presence of granulation tissue. Purulent discharge is foul-smelling and contains diphtheria bacilli. The reparation process in the postoperative wound is prolonged, and a sluggish inflammatory process persists in its environment. Discharge from such wounds infected with diphtheria bacilli is extremely contagious.

Complications of diphtheritic otitis include mastoiditis, thrombophlebitis of the sigmoid sinus and jugular vein (hence sepsis), labyrinthitis, meningoencephalitis. Destruction of sound-conducting structures and damage to the ear labyrinth leads to the development of various forms and degrees of hearing loss and vestibular dysfunction.

Diagnosis of diphtheritic otitis

The diagnosis of diphtheritic otitis is confirmed by bacteriological examination of discharge from the ear.

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Treatment of otitis in diphtheria

Local treatment corresponds to that for acute purulent inflammation of the spleen. General treatment is carried out by administering antidiphtheria serum and using massive doses of antibiotics, as well as measures for vitaminization and detoxification of the body.

Prognosis for otitis media in diphtheria

The prognosis is generally favorable with timely recognition and adequate treatment, but with the toxic form of diphtheria and its rapid development in relation to auditory function it is unfavorable.