Otitis with scarlet fever

Scarlet fever is found in childhood most often between the 3rd and 5th years of life in approximately 20-25% of cases of scarlet fever.

It can occur at the onset of the disease, at the height of its development with a pronounced inflammatory necrotic reaction in the pharynx and in the nose, and also after 2-3 weeks in the period of peeling and convalescence.

Scarlet fever is an acute infectious disease caused by beta-hemolytic streptococcus of group A-Str. Pyogenes, - flowing cyclically with intoxication, angina, small-to-small rash on the skin and possible complications of hematogenous nature (pronounced lymphadenitis, otitis, mastoiditis, sinusitis, etc.). The main way of transmission of pathogens of infection is airborne. Infection occurs from patients with scarlet fever (throughout the disease), streptococcal angina and nasopharyngitis, from carriers of beta-hemolytic streptococcus group A.

[1], [2], [3], [4], [5], [6], [7],

Symptoms of otitis in scarlet fever

There are three forms of scarlettic otitis - the early super-sharp, necrotic and late.

Early Form

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

[8], [9], [10], [11], [12], [13],

Necrotic otitis media

It is a severe form of early scarlet fever otitis. As the etiological factor is most often hemolytic streptococcus. The onset is not so sudden and rapidly progressing as in the previous form, always accompanied by pronounced destructive changes in tympanomastoid structures; the tympanic membrane is turbid, its hyperemia is not so pronounced, it is focal, the perforation occurs quickly and covers the entire tympanic membrane. With paracentesis, the needle meets no resistance and gives the impression that it penetrates through soft paper. Necrotic process encompasses the auditory ossicles, which can spill out through the extensive perforation of the tympanic membrane in the form of sequesters. The same process destroys the medial wall of the tympanum and the facial canal, causing the appearance of an acute purulent labyrinthitis and paralysis of the facial nerve. Purulent discharge is not heavy, dark yellow, fetid. The propagation of the necrotic process ceases spontaneously and is limited to a demarcation zone corresponding to the boundaries characteristic for surgical intervention (for "natural" RO).

This form of otitis is characterized by a significant and persistent hearing loss, more pronounced than with banal otitis. With this form, there is also a toxic lesion of the vestibular apparatus, manifested by indications of induced labyrinthosis (dizziness, spontaneous nystagmus, nausea, vomiting). Violations of the functions of the labyrinth, once emerged, remain persistent.

Late form of scarlet fever otitis

It occurs more often than other forms. Occurs during the recovery from the underlying disease. Symptoms and course of the disease correspond to those with the usual acute otitis media.

With respect to auditory function, the prognosis is unfavorable in the first two forms. Bilateral lesion of the ears leads to deafness, and the occurrence of up to 3 years of age leads to deafness.

Treatment of otitis in scarlet fever

Treatment of otitis with scarlet fever is to carry out the earliest possible paracentesis, the administration of massive doses of antibiotics (penicillin), the use of which continues after recovery, even for several days. With intolerance to penicillin preparations, erythromycin, oleandomycin is prescribed.

If there is a suspicion of mastoiditis, anthotomy and mastoidotomy, ensuring a reliable drainage of the postoperative cavity and frequent washing through the drainage tube with a solution of penicillin, bicillin-3, furacilin. Bed rest, high-grade vitamin-enriched diet, plentiful drink, hyposensitizing and detoxification therapy on the basis of immunocorrectors (thymalin).

Prevention of otitis in scarlet fever

In case of scarlet fever, early treatment of the underlying disease by the aforementioned means and sanitizing procedures of the pharynx and nasopharynx, one should not recommend frequent forced throat rinses, which contribute to the destruction of microthrombi and their spread by hematogenous way. Rinsing the throat effectively replaces the abundant drinking of warm tea with lemon or ascorbic acid, broth of rose hips. On recovery, control tests of blood and urine are mandatory.

Prognosis for otitis in scarlet fever

At present, due to the use of highly active antibiotics, severe forms of scarlet latin otitis occur extremely rarely and, as a rule, in weakened people suffering from common diseases, violating immunity (blood diseases, HIV infection, drug addiction, etc.).

For life, the prognosis for early form of scarlet fever otitis is very serious. The disease can be docked only with timely recognition of the disease, massive antibiotic therapy and early paracentesis. The necrotic form is also dangerous for life, with the complication of which meningoencephalitis, thrombophlebitis of the sigmoid sinus, sepsis, leading to an unfavorable outcome may occur. Prognosis in late form - as in the usual acute otitis media.