Otitis media for scarlet fever

Scarlet fever otitis occurs in childhood most often between 3 and 5 years of age, accounting for approximately 20-25% of cases of scarlet fever.

It can occur at the beginning of the disease, at the height of its development with a pronounced inflammatory-necrotic reaction in the throat and nose, as well as 2-3 weeks later during the period of peeling and recovery.

Scarlet fever is an acute infectious disease caused by beta-hemolytic streptococcus group A - Str. pyogenes, - occurring cyclically with intoxication, sore throat, small-point rash on the skin and possible complications of a hematogenous nature (severe lymphadenitis, otitis, mastoiditis, sinusitis, etc.). The main route of transmission of pathogens is airborne. Infection occurs from patients with scarlet fever (during the entire illness), streptococcal sore throat and nasopharyngitis, from carriers of beta-hemolytic streptococcus group A.

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Symptoms of otitis in scarlet fever

There are three forms of scarlet fever otitis: early hyperacute, necrotic and late.

Early form

In this form, otitis occurs on the first or second day from the onset of the disease by the hematogenous route in the hypertoxic form of scarlet fever in the phase of scarlet fever enanthema. Signs of otitis are masked by the bright symptoms of the underlying disease and do not attract the attention of parents for some time. The body temperature rises to high values (39-40 ° C), the general condition indicates deep intoxication of the body, the inflammatory process covers all parts of the midbrain without any special external local signs of the disease. Often, the infection quickly spreads to the membranes and substance of the brain with the development of meningoencephalitis. The evolution of the disease occurs so quickly that any surgical intervention is impossible. In most cases, this form of scarlet fever otitis ends in death.

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Necrotic form of otitis

It is a severe form of early scarlet fever otitis. The etiologic factor is most often hemolytic streptococcus. The onset is not as sudden and rapidly progressing as in the previous form, always accompanied by pronounced destructive changes in the tympanomastoid structures; the eardrum is cloudy, its hyperemia is not so pronounced, is focal, perforation occurs quickly and covers the entire eardrum. During paracentesis, the needle does not encounter any resistance and it seems as if it is penetrating soft paper. The necrotic process covers the auditory ossicles, which can fall out through an extensive perforation of the eardrum in the form of sequesters. The same process destroys the medial wall of the tympanic cavity and the facial canal, causing the development of acute purulent labyrinthitis and facial nerve paralysis. Purulent discharge is not abundant, dark yellow, fetid. The spread of the necrotic process stops spontaneously and is limited to a demarcation zone corresponding to the boundaries characteristic of surgical intervention (for “natural” RO).

This form of otitis is characterized by significant and persistent hearing impairment, more pronounced than in banal otitis. In this form, toxic damage to the vestibular apparatus is also observed, manifested by signs of induced labyrinthine disease (dizziness, spontaneous nystagmus, nausea, vomiting). Disorders of the labyrinth functions, once they arise, remain persistent.

Late form of scarlet fever otitis

It is more common than other forms. It occurs during the recovery period from the underlying disease. The symptoms and course of the disease correspond to those of ordinary acute otitis media.

In terms of auditory function, the prognosis is unfavorable in the first two forms. Bilateral ear damage leads to deafness, and if it occurs before the age of 3, it leads to deaf-muteness.

Treatment of otitis in scarlet fever

Treatment of otitis in scarlet fever consists of performing paracentesis as early as possible, prescribing massive doses of antibiotics (penicillin), the use of which continues after recovery for several more days. In case of intolerance to penicillin preparations, erythromycin and oleandomycin are prescribed.

If mastoiditis is suspected - antrotomy and mastoidectomy, ensuring reliable drainage of the postoperative cavity and frequent washings through a drainage tube with a solution of penicillin, bicillin-3, furacilin. Bed rest, complete nutrition enriched with vitamins, plenty of fluids, hyposensitizing and detoxifying therapy while taking immunocorrectors (thymalin).

Prevention of otitis in scarlet fever

In case of scarlet fever - early treatment of the underlying disease with the above-mentioned means and sanitizing procedures of the pharynx and nasopharynx, while frequent forced gargling of the pharynx should not be recommended, which contributes to the destruction of microthrombi and their spread by hematogenous route. Gargling of the pharynx effectively replaces drinking plenty of warm tea with lemon or ascorbic acid, rosehip decoction. After recovery, control blood and urine tests are mandatory.

Prognosis for otitis media with scarlet fever

Nowadays, thanks to the use of highly active antibiotics, severe forms of scarlet fever otitis are extremely rare and, as a rule, occur in weakened individuals suffering from general diseases that impair immunity (blood diseases, HIV infection, drug addiction, etc.).

The prognosis for life in the early form of scarlet fever otitis is very serious. The disease can be stopped only with timely recognition of the disease, massive antibiotic therapy and early paracentesis. The necrotic form is also life-threatening, with complications that can lead to meningoencephalitis, thrombophlebitis of the sigmoid sinus, sepsis, leading to an unfavorable outcome. The prognosis for the late form is the same as for ordinary acute otitis media.