Otitis of the external ear: acute, chronic, purulent, diffuse

Otitis externa is an inflammation that is characterized by damage to the external auditory canal, including the tympanic membrane, or the auricle.

[1], [2],

Epidemiology

Statistics show that an external type of otitis from a thousand people of the population suffers every four to five. Of these, a chronic stage of the pathological process is revealed in three to five percent.

[3], [4], [5], [6], [7], [8]

Causes of the otitis externa

The basis for the onset of inflammation of the external ear is infection. 

In addition, open wounds for infection can be: any small wounds, scratches and cuts that may occur during the cleaning of the ear from sulfur by unsuitable items (matches, toothpicks, pins, handles, etc.)

Most often the causative agent of external inflammation of the ear becomes staphylococcus.

Besides him, hemophilic and pseudomonas aeruginosa, Moraxella, Streptococcus pneumoniae, and Candida fungi can become provocateurs of this pathology .

[9], [10]

Risk factors

Occurrence of external ear damage is facilitated by:

1. Children's age (in this case promotes this eczema, for which the characters peeling and the occurrence of erosion);
2. Cork from sulfur (since it increases the likelihood of cleaning it yourself);
3. Narrow auditory canals;
4. Inflammation of the middle ear of a chronic nature (because of this in the auditory canal is consistently detected pus);
5. Reduced immunity (for example, diabetes mellitus).

[11], [12], [13],

Pathogenesis

Often, external otitis becomes a complication of acute respiratory disease (viral or bacterial). Pathogens ARD penetrate the ear cavity and contribute to the occurrence of inflammation. But it does not always happen. Sometimes the pathogens of ear inflammation and at the same time of inflammation of the nose and sinuses, pharyngeal tonsillitis and pharynx are absolutely different. This can happen because, against the background of a weakened ORZ of the body, a person becomes sensitive to different microorganisms (cocci, Klebsiella pneumonia, Pseudomonas aeruginosa ), which in a healthy person will not cause any symptomatology.

[14], [15], [16], [17]

Symptoms of the otitis externa

The occurrence of the following symptoms is an occasion for immediate contact with a doctor:

1. Pain in the ear, of varying intensity. It can intensify if you press on the tragus (the outgrowth of the cartilage that restricts the entrance to the acoustic channel) or pull the patient by the ear;
2. Feeling of congestion;
3. Decreased acuity of hearing. Feeling of "water in the ear";
4. Allocations from the auditory canal. Sometimes they can be purulent, or even with blood veins;
5. Puffiness of the ear is very strong, impossibility to use ear plugs.
6. Unpleasant odor from the ear;
7. Poor general health, increased body temperature (can reach up to 39C);
8. The ear is inflamed and significantly enlarged in size;
9. The ear can be covered with small pimples of red color, scratches or boils.

Ears hurt with external otitis

Pain symptom is the main sign of ear loss. Its expression can be different: from a small, almost imperceptible to a very strong, almost intolerable. Manifestation is pulsation or "shooting." To distinguish pain from inflammation of the external ear from the middle without consulting medical personnel is almost impossible. The only difference can be that information that with external otitis sensations of pain should be manifested by contact with the skin at the entrance to the acoustic channel.

Temperature with external otitis

It can not be said that the inflammatory process that affects the external ear passes without temperature. After all, it is with this pathological state of health that the "growth" of body temperature is very often revealed, becoming a symptom indicative of a worsening of a person's condition.

If the formation of the furuncle, which is a characteristic feature of the limited form in the external auditory canal, is identified , then there will most likely be an increase in temperature to 38 38.5 C. Children will have a feverish reaction.

In the case of the diffuse form of external otitis, the temperature here is mainly at the subfebrile level (up to 37.9C). The general condition of the patient is practically not broken. And the temperature is not the main (predominant) complaint.

Swelling in inflammation of the external ear

Inflammation, which occurs after infection, contributes to the appearance of edema of external tissues of the external acoustic canal, and this is the source of the emergence of other characteristic symptoms.

Stuffing of the ear

People say that with this pathology they have feelings of ear congestion and a decrease in its functionality. They complain that they have a deafening hearing. This is due to the fact that due to the damaging process, there is a swelling of the auditory process, as well as an increase in lymph nodes located in the ear region.

External otitis in pregnancy

If there is a possibility of an inflammatory process of the external ear in a woman who is in the gestational period, she needs to immediately contact the doctor.

The doctor will carefully study the patient's medical history, as well as specify the duration of pregnancy and examine the patient. The doctor will check whether there is deformation of the ear, the degree of pain and the presence of secretions. In addition, this doctor will assess the lymph nodes of a woman.

To establish an accurate diagnosis, a woman will need to take an analysis from the ear, for later planting it on the flora and determining susceptibility to antibacterial drugs. If this pathology (severe course) occurs not for the first time, it is also worth the blood test for sugar and HIV.

[18], [19], [20],

Otitis externa in childhood

Determine the appearance of external otitis in a child can be on the following grounds:

• he complains of pain in his ear;
• whimsical;
• crying for no reason;
• he has a fever;
• from the patient side, lymph nodes can be enlarged;
• if the child press on the tragus or pull the auricle pain intensify.

The diagnosis is made by the doctor on the basis of complaints and questioning of the baby.

Symptoms in this pathology are quite specific, so the doctor (especially after an otolaryngological examination) will not have difficulties with the diagnosis.

But it is worth bearing in mind that in order to avoid complications and determine the cause of the pathology, swabs from the ear, urine and blood tests can be taken. This will most accurately diagnose the child. If the test reveals an allergy, as the cause of external otitis media, a doctor with a specialization as an allergist will join the treatment.

A baby with this pathology will also become restless, it will be bad for the breast to suck, or it may completely stop eating.

Stages

External otitis takes place in three stages:

1. Acute - lasting up to three weeks;
2. Subacute - duration from three weeks to one month;
3. Chronical - the duration of more than one month.

[21], [22]

Forms

In adults, in most cases of the disease, one-sided otitis is detected from the right or left side. Symptoms and treatment scheme from the side of defeat do not depend.

[23]

Bilateral otitis externa

Adults mostly suffer from unilateral external ear lesions. Bilateral lesion is most often detected in children up to the age of three. This is due to the fact that the ear of the child up to this age is still being formed, and has not acquired those protective functions that are inherent in the adult ear.

Otitis externa has quite a few species. This helps to better differentiate this pathology and apply effective therapy. There are such types of disease:

1. Diffuse - is characterized by a global lesion of the tissues of the auditory canal, sometimes it is involved in the inflammatory process and the tympanic membrane.
2. Fungal is a rare pathology (about ten percent of all types of this pathology). A distinctive feature for this pathology is the usual state of health of the patient, who only feels an itchy or not pronounced painful sensation in the ear. Upon examination, the doctor will detect fungal contents of white or black.
3. Limited - a characteristic form of pathology in this case is carbuncle or furuncle. This is due to damage to the sebaceous glands or infection of hair follicles or abscesses (local), which can occur due to damage. The causative agent in this case is Staphylococcus aureus.
4. Malignant - another name for this species is necrotizing. This is a very serious disease that affects not only the skin, but also the cartilage of the outer part of the ear. 
5. Purulent - is characterized by the appearance of discharge from the ear. At the beginning of the disease, there is little pus, but as it develops, the amount of pus increases significantly.

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

Acute otitis externa

An acute period of inflammation of the external ear is characterized by severe pain. The patient can get body temperature and stuffiness of the ears.

[28]

Chronic otitis externa

Such a diagnosis can sound for the patient if the duration of the pathology is more than a month, or during the year there were more than four relapses.

In the chronic stage, pathology can develop spruce, and adequate treatment has not been carried out in acute form. Sometimes this can be facilitated by an excessive amount of cleaning the ears with cotton buds, as this helps to destroy the protective layer of sulfur and damage the tissues of the acoustic channel.

[29], [30]

External otitis of the diffuse type

External diffuse otitis - spread to the entire auditory canal, with the capture of the subcutaneous layer and tympanic membrane, purulent inflammation.

Symptoms:

• itching inside the ear;
• increased painfulness with pressure;
• Reduction of the outer opening of the acoustic channel;
• purulent discharge;
• body temperature increase;
• the general or common morbid status.

These symptoms will be mild or almost absent if the diffuse lesion becomes chronic. The patient in this case can feel only a small discomfort in the ear.

The function of hearing in this type of pathology is not violated. This distinguishes him from the inflammation of the middle ear, in which the drum cavity is affected.

[31]

External bacterial otitis

This type of pathology of the external part of the ear is a purulent lesion, the location of which is in the region of the external acoustic channel. He, like the fungus with allergic otitis, refers to the diffuse type of pathology. But its cause in this case will be bacterial.

Bacterial otitis of the external ear can occur in two stages - acute and chronic.

In the acute stage, the patient will complain about:

1. Itching of the skin;
2. Purulent discharge;
3. Sensitivity when touching, especially near the tragus;
4. Reduction of the auditory canal due to swelling.

Upon examination, the doctor in the depth of the canal can see a gruel-like mass. But because of soreness, it is almost impossible to conduct a patient's examination.

In the chronic course of the pathology, the symptoms will be less pronounced. Here, first of all, the skin thickening of the acoustic canal and the tympanic membrane will be noticeable .

The diagnosis - external bacterial otitis is based on:

1. Patient complaints;
2. Anamnesis;
3. Inspection.

To clarify the diagnosis, the doctor can conduct a microbiological study.

[32]

Fungal otitis externa

When the external ear is damaged by mold yeast-like fungi, fungal otitis occurs . Most often this species is struck - the walls of the auditory canal, the skin that lined the ear shell, the eardrum and the middle ear. Pathogens are mushrooms of a certain type, mainly mold fungi.

For the diagnosis, the doctor must conduct a visual examination. After spending it, he will see - infiltration, inflamed skin and pathological detachable.

The main symptom of a purulent lesion of the outer ear is the discharge of a different kind from the ear. They can differ among themselves:

• by color (for example, yellow, brown, gray);
• in count;
• by form (depends on the nature of the pathogen, which became the causative agent of this pathology).

In this case, unlike a purulent lesion, the secretions will not have a specific odor.

Restricted otitis externa

For this type of otitis of the external ear is characterized by the presence of inflammation of the hair follicle in the form of a furuncle. It is noteworthy that if you look, you can not see the boil from the outside. The patient can only experience discomfort due to his presence. A person will feel pain, which will increase when chewing or biting. After a few days, the abscess completely ripens and bursts, and the pain gradually disappears.

Eczematous otitis externa

This type of disease occurs as a result of dermatological damage to the skin of the skin of the outer ear. The only way this type of eczema occurs in people who suffer from various skin diseases (for example, psoriasis or seborrhea ).

Symptoms of defeat are:

• The onset of erythema;
• Exfoliate skin;
• Wet skin segments;
• Cracks on the skin of the auricle and inside the external acoustic passage.

In the event that the patient does not consult a doctor and begins treatment, the risk of infection and the worsening of the course of the disease is significantly increased.

For the treatment of this type of disease, Burov's liquid (r-p basic lead acetate) and hormonal preparations are usually used.

[33], [34]

Malignant external otitis media

Malignant type of disease is an inflammatory process that occurs as a result of infection or damage to the bones of the ear canal and the base of the skull.

Symptoms of malignant lesions of the external part of the ear will be:

1. Presence of a discharge from the ear from yellow to yellow-green, persistent with an unpleasant odor;
2. painful feelings that the patient feels deep in the ears, amplified by the movement of the head;
3. loss of hearing function;
4. the presence of itching in the auditory canal or in the ear;
5. temperature increase;
6. difficulty swallowing;
7. loss of voice.

In this case, the doctor will examine the ear to identify the symptoms of infection. Consultation on the neurological part can also reveal that the cranial nerves are not affected.

If you put the drainage tube and the doctor sees the discharge of their ear with blood or pus, he can send it to the lab for analysis. This is necessary for the detection of bacteria or fungi (most often pseudomonas).

The following procedures can also be used to diagnose this disease:

1. CT, MRI of the head;
2. radionuclide scanning.

Complications and consequences

Severe consequences in the defeat of the outer ear can be seen quite rarely. If the disease has been neglected, or if the patient has concomitant chronic diseases, the following pathologies may occur:

• Worsening of the function of hearing is temporary: The patient may complain of ear congestion, and in consequence this decrease in function. Usually this condition passes after recovery;
• Re-infection of the external part of the ear (the transition of the disease to the chronic stage): this can happen because of failure to comply with all the recommendations that the doctor gave and in the result of ineffective treatment. Also, this pathology is facilitated by a reduced immunity of the patient;
• The destruction of the bones and cartilage of the ear (necrotizing form of external otitis) - may occur as a consequence of the spread of infection, due to reduced immunity or the particular persistence of the pathogen that contributed to the onset of the disease. Most often occurs in the elderly category of patients, or suffering from a type of diabetes.
• Infection of other tissues. In a necrotizing form of the disease, the infection can pass to neighboring areas, including the brain.

[35], [36], [37], [38], [39], [40]

Diagnostics of the otitis externa

When the patient is referred to a medical institution with complaints about the symptoms of inflammation of the external ear, the doctor, in order to diagnose, necessarily performs an otoscopy. It is done with the help of a special funnel, which is injected into the lumen of the auditory canal. To do this, the doctor pulls the ear shell up and back, thereby straightening the course of the auditory canal, and when he brings light, he examines it.

The doctor will be able to see the redness and swelling of the acoustic channel. Also, if the pathology is accompanied by a furuncle, you can see the pus emerging.

If the external otitis has passed to the chronic stage - the doctor will notice the perforation of the tympanic membrane, which emits pus.

Next, the doctor will take pus for examination and analysis for susceptibility to antibacterial agents.

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Examination

To clarify the diagnosis, the doctor may prescribe additional tests, for example:

1. Analysis of urine;
2. Analysis for glucose in the blood;
3. Sowing is separated from the external auditory canal.

[42], [43],

Instrumental diagnostics

In this case, such instrumental diagnostics can be used:

1. Ear X-ray;
2. CT;
3. Scanning is radioisotope;
4. Scintigraphy;
5. MRI.

Differential diagnosis

It is necessary to distinguish the external otitis from such diseases as:

1. Neuralgia of the cranial type;
2. Herpes zoster. Since this disease can be localized in the geniculate ganglion and exhibit symptomatology similar to external otitis media. With this pathology, a typical sign is vesicular eruption, which can only appear one to two days after consulting a doctor. The name of this rather exclusive pathology of herpes zoster is the Ramsey-Hunt syndrome. Paralysis of the facial nerve can also develop  .
3. Otomycosis can have such characteristic features: the strongest expression of the runaway in the ear, than the pain (in the case of bacterial invasion - everything will be exactly the opposite), a large layer of plaque on the surface of the acoustic channel (white or gray), in which, Discover hyphae or spores of fungi. To differentiate this type of pathology, a microbiological study of the detachable will be required.
4. Purulent otitis media of the middle ear with a breakthrough of the tympanic membrane or an established tympanostomy tube may be allowed to separate from the external acoustic channel. But in this case, the distinctive feature is the absence of puffiness and less pronounced pain. To differentiate these diseases in this case, pneumatic otoscopy is required.
5. With a necrotic type of pathology, characteristic symptoms will be pronounced, disproportionate ear pain. In addition, granulation can be seen on the wall of the external acoustic channel, and sometimes on the tympanic membrane. The patient will have fever and symptoms of general malaise.

For diagnostics, the following is necessarily done:

• laboratory tests of blood and urines (for determining diabetes);
• X - ray - radiological diagnostics;
• CT of the temporal and mastoid parts of the skull;
• MRI.

Differences in external from otitis media

To distinguish the inflammation of the outer ear from the middle, you need to pay attention to hearing loss. If the patient has otitis externa, hearing may decrease, but not disappear.

[44], [45], [46]

Otitis externa and furuncle

Due to infection (mainly staphylococcal), in the osteochondral area of the ear inflammation of the hair follicle or glandulae sebacea can develop, which manifests itself in the form of a furuncle. In this case, surgical intervention is required. Use of local antibacterial drugs will not be effective. 

Treatment of the otitis externa

Treatment of external otitis media is described in this article.

Prevention

Most often, external otitis passes without complications. The pain passes in two to five days, and completely the person recovers after seven to ten days. In some cases, for complete recovery and reducing the likelihood of a relapse, you may need to clean the outside of the ear with a doctor.

After two to three days after the start of the use of antibacterial agents, there comes an improvement. If this does not happen, the patient needs to go to the doctor again to drown the diagnosis.

If there is an abscess or a chronic form of the disease, surgical treatment may be necessary. Consultation of a doctor - dermatologist will be required for eczematous otitis media.

The probability of complications of external otitis media is quite low. There may be cellulite or lymphadenitis, which will require a course of systemic antibiotic therapy. The acute form of the disease can spread to the entire ear shell and go into chondrites, especially if the patient has recently undergone piercing.

The development of malignant external otitis is the only significant complication that occurs in diabetics, most often in conjunction with ketoacidosis of the diabetic type, and people with reduced immunity.

Basically, this type of pathology is characterized by the spread to the cartilage tissue of the shell of the ear of a bacterial infection, with the appearance of pain of intense intensity and swelling, which are accompanied by a "rise in temperature" and other characteristic symptoms. This category of patients needs treatment in a hospital using not only local therapeutic agents, but also antibacterial.

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