Otitis media of the inner ear: signs and how to treat it

Internal otitis is an inflammatory lesion of the inner ear. Due to its unique structure, the inner ear is called a labyrinth, and its inflammation is called labyrinthitis.

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Epidemiology

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

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Causes 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. Tympanogenic otitis interna is a complication of otitis media. The cavity of the inner ear is separated from the middle ear by membranes consisting of connective tissue. Inflammatory damage to the middle ear causes swelling and infiltration of the membranes, which increases the likelihood of penetration of infectious agents into the labyrinth of the ear.
2. Meningogenic internal otitis develops as a complication of meningitis. In 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 (flu, measles, pneumococcal and meningococcal infections, tuberculosis and others), against which the development of meningitis is likely.
3. Traumatic internal otitis. The infection appears in the cavity of the inner ear when the membrane is damaged either directly (by penetration of a foreign object) or as a result of craniocerebral trauma.
4. Hematogenous internal otitis is a complication of viral or bacterial infectious diseases. With this etiology, infectious agents can be introduced into the ear labyrinth via blood.

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Symptoms otitis media

To recognize the disease in a timely manner, it is necessary to pay attention to the first signs of the disease, among which are:

• Dizziness (usually systemic in nature and lasting from several seconds to several hours).
• Tinnitus.
• Loss of coordination and balance.
• Nausea.
• Vomit.
• Hearing loss.
• Spontaneous nystagmus (mainly on the side of the affected ear).
• Increased sweating.
• Change in complexion.

Symptoms of internal otitis, their severity and 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 disease. In 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 alarming symptoms in a timely manner. Children complain of dizziness, tinnitus, hearing loss, nystagmus and discharge from the diseased ear (in the bacterial form). If such symptoms appear, you should immediately contact a specialist.

Forms

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

1. Severity of symptoms

• acute (associated with the penetration of toxins from the tympanic cavity into the labyrinth of the ear);
• chronic (occurs and develops as a result of the destruction of the bone capsule of the ear labyrinth).

2. Prevalence of the pathological process

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

3. Pathological signs

• serous (the secretion of lymph from the ear labyrinth increases and exudate is formed, which causes increased pressure)
• purulent (an exudate is formed, consisting largely of neutrophilic leukocytes, the inflammatory process affects the cellular formations of the inner ear);
• necrotic (characterized by the direct effect of toxins on the inner ear and can lead to partial necrosis of the labyrinth capsule).

4. Type of pathogen

• viral;
• bacterial;
• fungal.

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Complications and consequences

Purulent otitis media 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 become severe, complete hearing loss is possible.

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

• Encephalitis.
• Meningitis.
• Mastoiditis.
• Brain abscess.
• 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 contact with an otolaryngologist and proper treatment of the disease, it is possible to minimize the risks of developing consequences and complications.

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Diagnostics otitis media

Diagnosis of internal otitis is performed by an otolaryngologist. Based on the pathogenesis of the disease, the patient may be additionally examined by a traumatologist, neurologist, venereologist or infectious disease specialist.

To make a reliable diagnosis, the patient must take a general blood test and undergo instrumental and differential diagnostics.

Instrumental diagnostics includes the following studies:

• Pure tone audiometry (to assess the functioning of the hearing aid).
• Electronystagmography (for quantitative and qualitative assessment of nystagmus and determination of the nature of dizziness).
• MRI.
• CT.

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Differential diagnosis

Otitis interna differs from other diseases according to certain criteria.

• The inflammatory process in the labyrinth of the ear and hearing impairment ( deafness, 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 and infarction of the ear labyrinth.
• Signs of inflammation and hearing loss distinguish the disease from vestibular epilepsy and vestibular migraine.
• The inflammatory process and prolonged attacks of dizziness distinguish the disease from vestibular paroxysmia.

Treatment otitis media

Conservative treatment includes bed rest and drug therapy.

1. Antibiotics for internal otitis are prescribed first. Only a doctor can prescribe an antibiotic based on the diagnostics. Most often, cephalosporins and penicillins are prescribed, for example, Ceftriaxone - an antibiotic of the cephalosporin group, which is used intramuscularly and intravenously. For intramuscular use, 0.5 g of the drug is diluted in 2 ml of sterile water and injected into the gluteal muscle. For intravenous injections, 0.5 g of the drug is diluted in 10 ml of sterile water and administered over 3-4 minutes. Contraindications to the use of Ceftriaxone are hypersensitivity to antibiotics of the penicillin and cephalosporin group, the first trimester of pregnancy, lactation, and liver and kidney disease. In rare cases, side effects are observed in the form of allergic reactions, local reactions, from the gastrointestinal tract and those associated with blood clotting.
2. Dehydration therapy is prescribed using diuretics, intravenous administration of glucose solution, maintaining a diet with limited fluid intake and the amount of salt consumed.
3. Anti-inflammatory drugs are used. Diclofenac in tablets is often prescribed, 50 g 2-3 times a day (the maximum daily dose of the drug should not exceed 150 g). Diclofenac in tablets is 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 tolerance, duration of use and dose size.
4. To improve blood circulation in the ear labyrinth and reduce symptoms from the vestibular apparatus, histamine preparations such as Betahistine and its analogues (Vestibo, Tagista, Betaserk and others) are prescribed. The standard dosage of Betahistine is 2-3 tablets per day of 8 mg. No more than 48 mg of the drug should be taken per day. The effect is observed within two weeks of taking the drug. Betahistine is not prescribed to patients under 18 years of age and to the elderly.
5. To normalize trophic disorders, vitamins P, B, C, K are prescribed. The patient is given Cocarboxylase intramuscularly or intravenously, dissolving the contents of the ampoule in water for injection before administration. An adult patient is given up to 100 ml of the drug per day. 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, physiotherapy treatment is carried out, which includes:

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

In some cases, surgical treatment is performed. Indications for surgical intervention are:

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

Traditional medicine can be used as an adjunct therapy to drug treatment.

1. Mix freshly squeezed juice of one onion with vegetable oil. Apply the resulting mixture to a cotton swab and keep it in the ear canal for 2-3 hours.
2. Boil 5 bay leaves in 200 ml of water, leave for several hours. Put 3-4 drops of the decoction into the ear 2-3 times a day.
3. Finely chopped garlic should be poured with olive oil (proportions in volume 1:1). The resulting mixture is infused in the sun for 10 days, after which it should be filtered and 2-3 drops of glycerin or eucalyptus oil should be added. Garlic oil prepared in this way is recommended to be instilled once a day, 3-4 drops in the ear. The resulting product should be stored in the refrigerator in a dark container, the shelf life is 3 months.

Herbal treatment is also adjunctive and cannot be used as an independent therapy.

1. Mix in a 4:2:3 ratio: calendula flowers and celandine herb; yarrow herb and licorice root; eucalyptus leaf. Infuse the resulting mixture in a ratio of 200 ml of boiled water per 1 tbsp of herbs and drink the decoction throughout the day.
2. Infuse the root of the medicinal burnet at the rate of 2 tbsp. of the herb per 2 glasses of boiled water. Take the ready decoction 3-4 times a day 1 tbsp.

Homeopathic preparations may be used. Homeopathic doctors recommend taking Oscillococcinum, 1 dose in the morning and evening 15 minutes before meals, to reduce symptoms of internal otitis associated with viral diseases and flu. They also recommend taking diluted Chamomilla (common chamomile), Hepar Sulphur (sulfur liver) and Aconite, three grains every four hours. Contraindications to all homeopathic medicines include individual sensitivity to the components of the preparation.

Prevention

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

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

When otitis media occurs and develops, adequate treatment must be carried out to prevent pathogenic microorganisms from entering the inner ear.

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

You should also maintain ear hygiene, harden and strengthen your body, avoid dangerous situations and undergo preventive medical examinations.

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Forecast

Approximate periods of disability range from 3 weeks to 3 months. Consequences and complications depend on the nature of the disease.

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

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