Otitis of the inner ear: signs and how to treat

Internal otitis is an inflammatory lesion of the inner ear. Because of its peculiar structure, the inner ear is called a labyrinth, and its inflammation is called a labyrinthite. 

[1], [2], [3], [4]

Epidemiology

Statistics of this disease is 5% of all types of otitis media.

[5], [6], [7], [8], [9]

Causes of the otitis media

Internal otitis occurs due to the penetration of pathogenic microorganisms and toxins into the cavity of the inner ear. Depending on the cause of internal otitis, several of its types are distinguished:

1. Timpanogenous otitis media is a complication of otitis media. The cavity of the inner ear from the middle ear is separated by membranes consisting of connective tissue. Inflammation of the middle ear causes swelling and infiltration of membranes, which increases the likelihood of infectious agents entering the labyrinth of the ear.
2. Meningogenic internal otitis develops as a complication of meningitis. In the case of inflammation of the membranes of the brain, pathogenic microorganisms can penetrate into the inner ear from the cranium. Risk factors in this case are infectious diseases (influenza, measles, pneumococcal and meningococcal infections, tuberculosis and others), against which the development of meningitis is likely.
3. Traumatic internal otitis media. Infection occurs in the cavity of the inner ear with damage to the membrane as a direct method (penetration of a foreign object), and as a result of craniocerebral trauma.
4. Hematogenous otitis media is a complication of viral or bacterial infectious diseases. With such etiology, infectious agents can be introduced into the labyrinth of the ear through blood.

[10], [11], [12], [13], [14], [15]

Symptoms of the otitis media

For timely recognition of the disease, it is necessary to pay attention to the first signs of the disease, among which:

• Dizziness (often has a systemic nature and duration from a few seconds to several hours).
• Noise in the ears.
• Loss of coordination and balance.
• Nausea.
• Vomiting.
• Hearing loss.
• Spontaneous nystagmus (mainly from the side of the diseased ear).
• Increased sweating.
• Change the complexion.

Symptoms of internal otitis, their severity and the time of their appearance depend on the etiology and form of the disease. If the cause is an infectious disease, the first signs are noted 1-2 weeks after the illness. In the case of injuries, the first symptoms of the disease can be observed within 24 hours after the injury.

Internal otitis in children is a rare disease, but due to the fact that serious consequences and complications are possible, it is important to pay attention to the alarming symptoms in a timely manner. Children develop complaints of dizziness, tinnitus, loss of hearing, nystagmus and discharge from the patient's ear (with a bacterial form). In case of occurrence of such symptoms it is necessary to address immediately to the expert.

Forms

Based on the nature of the course of the disease, different forms of internal otitis are distinguished according to the following criteria:

1. Severity of symptoms

• acute (associated with penetration of the ear maze of toxins from the tympanic cavity);
• chronic (occurs and develops due to destruction of the osteal capsule of the labyrinth of the ear).

2. Prevalence of the pathological process

• limited (deep inflammatory processes develop on a limited area of the labyrinth wall);
• diffuse (generalized or diffuse form, in which inflammation spreads to the entire inner ear).

3. Pathomorphological features

• serous (secretion of lymph of the ear maze increases and exudate is formed, which is the cause of increased blood pressure)
• suppurative (exudate is formed, consisting mostly of neutrophilic leukocytes, the inflammatory process affects the cellular formations of the inner ear);
• necrotic (it is characterized by the direct action of toxins on the inner ear and can lead to partial necrosis of the capsule of the labyrinth).

4. Type of pathogen

• viral;
• bacterial;
• fungal.

[16], [17],

Complications and consequences

Purulent otitis of the inner ear can lead to irreversible vestibular disorders and hearing loss. However, over time, the body partially adapts to these complications by establishing a balance between the healthy and affected labyrinth of the ear. If the inflammatory process has acquired a severe form, complete loss of hearing is possible.

In case of inadequate treatment or its interruption, there is a possibility of complications in the form of:

• Encephalitis.
• Meningitis.
• Mastoidite.
• Abscess of the brain.
• Petrosita.

To prevent unfavorable outcomes of internal otitis, you should contact an ENT specialist for any problems with the vestibular apparatus, hearing, painful sensations and general malaise. With timely treatment to the otolaryngologist and proper treatment of the disease, it is possible to minimize the risks of development of consequences and complications.

[18], [19], [20], [21], [22], [23], [24], [25]

Diagnostics of the otitis media

Diagnosis of internal otitis media is carried out by an otolaryngologist. Based on the pathogenesis of the disease, the patient can additionally examine a traumatologist, neurologist, venereologist or infectious disease specialist.

To establish a reliable diagnosis, the patient must pass a general blood test and undergo instrumental and differential diagnosis.

Instrumental diagnostics includes such studies:

• Tonal threshold audiometry (for assessing the functioning of the hearing aid).
• Electronastagmography (for quantitative and qualitative assessment of nystagmus and determination of the nature of dizziness).
• MRI.
• CT.

[26], [27], [28], [29], [30], [31]

Differential diagnosis

Internal otitis differs from other diseases according to certain criteria.

• Inflammatory process in the labyrinth of the ear and hearing impairment ( hearing loss, tinnitus) distinguishes the disease from benign paroxysmal positional vertigo and vestibular neuronitis.
• The presence of a focus of inflammation distinguishes the disease from Meniere's disease, a labyrinth of the ear maze.
• Symptoms of inflammation and hearing loss distinguish the disease from vestibular epilepsy and vestibular migraine.
• Inflammatory process and prolonged attacks of dizziness distinguish the disease from vestibular paroxysmia.

Treatment of the otitis media

Conservative treatment includes bed rest and medication.

1. Antibiotics for internal otitis are assigned first. An antibiotic can be prescribed only by a doctor, based on the diagnosis performed. The most commonly prescribed cephalosporins and penicillins, for example, Ceftriaxone - antibiotic cephalosporin group, which is used intramuscularly and intravenously. For intramuscular administration, 0.5 g of the preparation is diluted in 2 ml of sterile water and injected into the gluteus muscle. For intravenous injection, 0.5 g of the drug is diluted in 10 ml of sterile water and injected for 3-4 minutes. Contraindication to the use of ceftriaxone is increased sensitivity to antibiotics penicillin and cephalosporin group, the first trimester of pregnancy, lactation and liver and kidney diseases. In rare cases, side effects are observed in the form of reactions of allergic, local, gastrointestinal and blood coagulability.
2. Dehydration therapy is prescribed with the use of diuretics, the introduction of an intravenous solution of glucose, maintenance of a diet with a restriction of drinking and the amount of salt consumed.
3. Used anti-inflammatory drugs. Often prescribe Diclofenac in tablets, 50 g 2-3 times a day (the maximum daily dose of the drug should not be more than 150 g). Diclofenac tablets are used with caution in pediatrics from the age of 6 years. Side effects from the use of this drug (reactions from the gastrointestinal tract, urinary, respiratory, hematopoietic systems) depend on individual tolerability, duration of use and dose size.
4. To improve blood circulation in the labyrinth of the ear and reduce symptoms on the part of the vestibular apparatus, histamine preparations such as Betagistin and its analogs are prescribed (Vestibo, Tagista, Betaserc and others). The standard dosage of Betagistin is 2-3 tablets per day for 8 mg. A day should not take more than 48 mg of the drug. The effect is observed within two weeks of taking the drug. Betagystine is not prescribed for patients under the age of 18 and for older people.
5. For the normalization of trophic disorders, vitamins P, B, C, and K. Are prescribed. The patient is administered a drug of Co-carboxylase intramuscularly or intravenously, dissolving the contents of the ampoule in water for injections before injection. Adults per day injected to 100 ml of the drug. Side effects depend on the person's sensitivity to cocarboxylase and can manifest as allergic and local reactions.

To improve microcirculation in the inner ear and reduce inflammation, a physiotherapeutic treatment is carried out, which includes:

• KUF irradiation;
• infrared laser therapy;
• galvanic collar;
• transcranial electroanalgesia.

In some cases, surgical treatment is performed. The indications for an operative intervention are:

• development of purulent internal otitis media;
• persistent processes of hearing impairment;
• labyrintogenous intracranial complications associated with the penetration of infection from the labyrinth of the ear into the brain;
• combination of the disease with mastoidite and petrositis.

As an auxiliary therapy in the course of drug treatment, alternative treatment can be used.

1. Mix freshly squeezed juice from one onion with vegetable oil. The resulting mixture is applied to a cotton swab and keep in the ear passage for 2-3 hours.
2. Boil 5 bay leaves in 200 ml of water, infuse for several hours. 2-3 times a day to dig in the ear for 3-4 drops of broth.
3. Finely chopped garlic should be poured with olive oil (proportions in the volume of 1: 1). The resulting mixture is infused on the sun for 10 days, after which it must be filtered and add 2-3 drops of glycerin or eucalyptus oil. Garlic oil, cooked this way, is advised to instill once a day for 3-4 drops in the ear. Store the product you need in the refrigerator in a dark container, shelf life - 3 months.

Herbal treatment is also ancillary and can not be used as an independent therapy.

1. In a 4: 2: 3 ratio, mix: marigold flowers and herbaceous alternatives; grass yarrow and licorice root; eucalyptus sheet. The resulting mixture is infused in the proportion of 200 ml of boiled water per 1 tbsp. L. Herbs and eat a decoction throughout the day.
2. The root of the medicinal hemorrhage should be insisted on at the rate of 2 tbsp. L. Herbs for 2 cups of boiled water. Take a ready-made broth 3-4 times a day 1 tbsp. L.

The use of homeopathic medicines is possible. Homeopathy physicians with internal otitis associated with viral diseases and influenza are advised to take Ocillococcinum 1 dose in the morning and evening 15 minutes before meals to reduce symptoms. Also advised to take in the form of diluted preparations Hamomilla (chamomile), Gepar Sulfur (sulfur liver) and Aconite for three grains every four hours. Contraindications to all homeopathic medicines is individual sensitivity to the components of the drug.

Prevention

Prevention of internal otitis mainly consists in preventing infectious diseases that can cause inflammation.

Among the main preventive measures are vaccination against meningococcal and pneumococcal infections, measles, influenza, tuberculosis and other diseases. If infectious processes occur in the body, appropriate treatment should be performed to avoid possible consequences and complications.

When an average otitis occurs and develops, adequate treatment should be provided to prevent the entry of pathogenic microorganisms into the inner ear.

An important preventive measure is the timely diagnosis and administration of appropriate therapy.

Also it is necessary to adhere to hygiene of ears, to temper and strengthen an organism, to avoid traumatic situations and to pass preventive medical examinations.

[32], [33], [34], [35], [36], [37]

Forecast

Approximate terms of incapacity for work are from 3 weeks to 3 months. The consequences and complications depend on the nature of the disease.

Acute serous internal otitis with adequate treatment does not lead to consequences and ends with complete recovery.

[38], [39], [40]