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Tubootitis in children and adults: acute, chronic, bilateral

 

What is turbohotit? It is an inflammation of the Eustachian tube, which is the passage connecting the organs of hearing and breathing, that is, the middle ear (drum cavity) and the back of the nasopharynx.

Some otolaryngologists consider this disease to be the initial stage of catarrh of the middle ear (otitis), but the inflammation of the auditory (Eustachian) tube has a separate code H68.0 according to ICD-10.

Is TB infectious or not? This is an infectious disease that has a synonymous name - eustachyte or tubothympanitis.

Causes of the tubotite

What are the causes of tubootitis? In most cases, these are infections that enter the auditory tube from the nasopharynx and upper respiratory tract. In the pathophysiology of inflammation, respiratory syncytial virus, influenza virus and adenovirus, rhinovirus infection in children, as well as bacteria Staphylococcus spp., Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis are involved  . Occasionally, the disease is provoked by a fungal infection, Chlamydia trachomatis, Mycobacterium tuberculosis or Treponema pallidum.

According to most experts, viruses directly damage the mucous epithelium of eustachian tubes and can lead to a decrease in mucociliary clearance. And in people with long-flowing nasopharyngitis and  chronic sinusitis,  tubo-otitis develops due to blockage of the tubes.

The auditory (eustachian) trumpet  opens when a person chews, swallows or yawns, as well as during climb and descent when traveling on an airplane or while submerging under water; the rest of the time it is closed. Each person has two auditory tubes; the length of each adult is about 35 mm with an average diameter of 3 mm, in children of the first years of life its length is about 20 mm. Since in early childhood the drum-pharyngeal tube is wider and runs from the anterior wall of the middle ear to the side wall of the nasopharynx at a smaller angle, the inflammation of the middle ear and tubo-otitis in the child occur more often than in adults.

In addition, many children blow their noses at once from both nostrils, resulting in reflux of the nasal secretion at the mouth of the auditory tube, where pathogenic bacteria or viruses continue to multiply.

Allergic conditions with swelling lining the auditory tubes of the mucous membrane also often provoke their inflammation, and then allergic tubo-otitis is diagnosed. Often combined  vasomotor rhinitis  and tubo-otitis, which becomes its hard-to-treat complication with persistent edema of the eustachian tube mouth.

Risk factors

Risk factors and the most likely causes of the inflammatory process in the auditory tubes also include:

  • chronic forms of rhinitis,  chronic sinusitis  or tonsillitis;
  • hypertrophy of pharyngeal tonsils -  adenoids  in children and adolescents;
  • an increase in the tubal tonsils (located near the pharyngeal openings of the Eustachian tubes);
  • violation of the structure (defects) of the septum of the nose;
  • the presence in the nasopharynx of neoplasms of a different nature (eg, choanal polyps);
  • trauma of the internal structures of the ear, in particular, due to a sharp pressure drop.

Clinical observations confirm the possibility of inflammation of the Eustachian tubes due to a decrease in the pH level in the nasopharynx in patients with gastroesophageal reflux.

Pathogenesis

The main function of the auditory tubes is barometric and ventilation-drainage: equalize the pressure in the tympanum with the external, pass air and remove the accumulating mucus and accidentally trapped water.

The mucous membrane of the auditory tubes in their osseous part is represented by ciliated epithelium, and in the cartilaginous part there is a loose mucous epithelium with mucin producing glands, as well as a considerable amount of adenoid tissue near the mouths of the tubes.

The pathogenesis of tubo-otitis is related to the fact that the infectious agent causes an inflammatory reaction, one of the manifestations of which is swelling of the mucous membrane, as a result of which the lumen in the auditory tube narrows and the passage of air is blocked. In addition, swelling of the tissues leads to compression of the nerve endings, which causes pain.

Further, there is a slowing of the local blood flow and a violation of the blood supply to the mucous membrane of the auditory tube, and then a partial or complete physiological dysfunction follows.

Symptoms of the tubotite

Characteristic for this disease, the first signs - the feeling that the ear is laid, and associated with this a slight decrease in the level of perception of sounds.

Almost all patients hear tinnitus, many complain of mild dizziness or a feeling of heaviness in the head.

In addition, the symptoms of tubotitis are manifested:

  • tympanophonie (giving in the ear the sound of his own voice);
  • sensation of gurgling inside the ear fluid;
  • nasal congestion;
  • a recurring headache.

Depending on the stage of the inflammatory process in the clinic are allocated: acute tubo-otitis (develops due to infection and is limited to a few days); subacute tubo-otitis (proceeds much longer than acute); chronic tubo-otitis (may occur for years with exacerbations and weaknesses of symptoms, but persistent hearing loss).

If the disease is acute, then to the already listed symptoms otalgia is added (pain in the ear from the inflamed auditory tube). ENT doctors can diagnose left-sided or right-sided tubo-otitis, or bilateral tubo-otitis, which in most cases begins as a one-sided.

Subfebrile temperature at tubootitis, as well as general malaise, can be noted in acute inflammation in adults. A tubo-otitis in a child is accompanied by a more significant fever with fever.

When tubo-otitis develops, the ear is scratched for a different reason: itching in the auditory canal is not among the signs of inflammation of the auditory tube, or it may be with the accumulation of sulfur in the ear, with mycosis or dermatitis.

But inflammation of the lymph nodes with tubo-otitis is not excluded, but most often regional lymph nodes are affected in cases of chronic serous or acute purulent otitis.

Forms

The most common and easy type of inflammation of the auditory tube is catarrhal tubo-otitis, affecting the upper layer of the mucous membrane. However, it can spread to large areas. The catarrhal character is allergic tubo-otitis and acute eustachiitis of viral etiology.

If the inflammation continues to develop, the exudate accumulates in the auditory tube, consisting of intercellular fluid, serum, fibrin, polymorphonuclear leukocytes, etc. This is exudative tubo-otitis, in which the tubes are filled with a liquid that provides favorable conditions for the propagation of pathogenic microorganisms. If, at the same time, the epidermis of the tympanic membrane thickens, and it swells, there is pain in the ear with a decrease in hearing. And at this stage the disease is most often diagnosed as serous otitis media.

Complications and consequences

Due to the stuffiness of the ear and the return to it of the sound of one's own voice, psychosomatics can occur with tubo-otitis. Some patients are uncomfortable to hear their voice "from within", and this is very much hindering them, forcing them to speak very quietly. In addition, in some cases, breathing becomes quicker, which causes a rush of blood to the muscles as with physical exertion.

When the tube does not pass for a long time, the inflammatory process continues, and if there is no outflow from the auditory tube, the mucus produced by the goblet cells accumulates. Contained therein, a bacterial or viral infection affects the mucosa of the tympanum with the development of catarrhal and then serous and even acute purulent otitis.

In rare cases, the consequences and complications in the form of formed adhesions can lead to conductive hearing loss. That is, the probability that the hearing after the tubo-otitis may be weakened exists. More information in the article -  Hearing Impairment

Diagnostics of the tubotite

Diagnosis of tubotitis is carried out by an ENT doctor who, in the first place, will find out the patient's anamnesis and listen to his complaints.

The diagnosis of eustachyte is established on the basis of otoscopy (examination of the tympanic membrane with the aid of an ear funnel) and determination of the permeability of the auditory tube by purging it. Also, the doctor examines the nasal cavity of the pharynx and palatine tonsils.

Analyzes - a smear from the throat or nasal cavity - help to clarify the nature of the infection and, in case of detection of a bacterial flora, prescribe antibiotic treatment. It should be noted that the delivery of this analysis is rarely prescribed.

Instrumental diagnostics are carried out: impedance measurement of hearing (assessment of the condition of the auditory apparatus of the middle ear), fluoroscopy (for detection of defects of the nasal septum or anomalies of the nasopharynx).

And the level of hearing is checked by audiometry. As with other ear disorders that cause hearing problems, the audiogram with tubo-otitis in the form of a graphic image shows the sensitivity of the patient's hearing to fluctuations in sound waves of a certain frequency and intensity.

Differential diagnosis

In cases of inflammation of the Eustachian tube, differential diagnosis is important, which makes it possible to distinguish it, for example, from serous otitis or neurosensory hearing loss.

What is the difference between tubo-otitis and otitis media? With otitis inflammation is located in the middle ear drum. And the main difference between tubotitis and neurosensory hearing loss lies in the etiology of hearing loss. Sensorine (sensorineural) hearing loss  is caused either by a violation of the conductivity of the vestibulocchlear nerves of the skull, or by damage to the cores of the auditory analyzer in the cortex of the cerebral hemispheres.

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Treatment of the tubotite

The shock method, which often begins treatment of tubo-otitis in acute form - intranasal catheterization of the Eustachian tube with acetylcysteine, amoxicillin and corticosteroids, is most often used with dexamethasone in tubo-otitis.

The medications prescribed for this disease include anti-inflammatory and decongestants to restore the ventilation function of the auditory tube and symptomatic therapy of respiratory infections accompanied by rhinitis.

Apply ear drops with tuboote:

  • containing phenazone and lidocaine drops Otypax in tubo-otitis should be instilled in the external auditory meatus 3-4 drops three times a day for not more than a week. They are contraindicated to use if the tympanic membrane is damaged.
  • drops with antibiotic rifampicin Otofa with tubofootic staphylococcal etiology are prescribed by five drops in the ear of adults and three drops of children - two to three times a day. Their use can cause itching in the ear and rashes on the skin around it.

In clinical otolaryngology, antibiotics-aminoglycosides (neomycin, gentamicin, kanamycin, etc.) are in bad shape. Firstly, because of the rapid development of resistance of microbes to them, and also because of their accumulation in the tissues of the inner ear and damage to the cells of the cochlea and receptors of the vestibulocchlear nerves. The last factor and caused the toxicity of these antibiotics to the ears.

Nonetheless, combined Polidex drops are administered with tubo-otitis, which contain antibiotics (neomycin and polymyxin B) and corticosteroid dexamethasone. Like the two previous drugs, Polydex can only be used with an intact tympanic membrane. Adults are recommended to instill in the ear 3-4 drops twice a day, and children - 1-2 drops. In addition to an allergic skin reaction, it is possible to attach a fungal infection.

Drops of Anauran are used in the same way. Their active substances are neomycin, polymyxin B and lidocaine. Use to their children is contraindicated. A means of Sophadex with tuboote (with dexamethasone, neomycin and gramicidin) is intended for treating inflammation of the cavity of the external ear.

If otitis or tubo-otitis occurs during pregnancy, these drops are strictly prohibited! Read more about ear drops in the publication -  Drops with otitis

Vasoconstrictive drops in the nose with tubootitis are used to eliminate nasal congestion, which contributes to the obstruction of the auditory tube. It is a drop of Sanorin, Naphthyzin (Nafazolin), Nazivin, Nazol, Vibracil, etc. Effective vasoconstrictor and swelling of the mucous membranes of the nose Rint spray from tubo-otitis (with oxymetazoline), which is injected into the nasal passages (one dose twice a day for five days). However, this drug is not used in cases of atrophy of the nasal mucosa, severe arterial hypertension and increased intraocular pressure, as well as hyperthyroidism; is contraindicated in children under six years of age.

Aerosol drug with corticosteroid mometasone - Nazonex with tubo-otitis - is used as an additional remedy for swelling if patients have an allergic rhinitis and chronic sinusitis in the acute stage.

Antihistamines are taken inside against the edema (Suprastin, Claritin, etc.). Fenspiride or Erespal in tubo-otitis is used for chronic rhinitis and nasopharyngitis of allergic origin: one tablet twice a day; children - syrup (two or three tablespoons). Possible side effects such as nausea, vomiting, heart rate disorder, increased drowsiness.

Homeopathy. It is not excluded the use of the homeopathic remedy Sinupret in tubo-otitis, if the patient has a cough with viscous sputum and simultaneously inflamed the paranasal sinuses. It is recommended to take two pills two or three times a day

If the treatment of tubootitis is delayed, pain in the ear does not go away and the general condition worsens - antibiotics are prescribed for tubootitis. Amoxicillin and its synonyms Amoxiclav, Augmentin, Klavocin, as well as Flemoxin soluteab - with tuboote are effective if the pathology is caused by staphylococcus and streptococci. The dose for adults is 0.25-1 g twice a day for a week; for children (depending on age) - 10-20 mg per kilogram of body weight two or three times a day. Among the side effects of this drug are skin allergies and diarrhea.

Systemic antibiotic Ciprofloxacin with tubo-otitis or Tsifran with tubo-otitis and sinusitis is taken internally-every 12 hours at 0.5-0.75 g. Pregnant and children under 16 years of age are contraindicated. Side effects are manifested by nausea, vomiting, diarrhea, abdominal pain, rashes on the skin, headache and dizziness.

Antimicrobial sulfanilamide preparation Biseptol for tubootitis and infections of all ENT organs is used in the treatment of adults and children from the age of 12 (one tablet 0.48 g twice a day, after eating, with plenty of water); children under 12 years can take Biseptol syrup - 1-2 scoops twice a day. Contraindications: renal failure, blood diseases and pregnancy. See also -  Antibiotics for otitis

Novocaine blockade with tubo-otitis (if it does not pass into acute otitis media or is complicated by chronic purulent inflammation of the middle ear), as a rule, is not required.

And surgical treatment concerns correction of defects of the nasal septum, as well as removal of neoplasms in the nasopharynx and adhesions in the Eustachian tube.

Physiotherapeutic treatment

Physiotherapeutic treatment of tubootitis is carried out with the help of popular electrotherapy methods.

Thus, electrophoresis is performed through the external auditory meatus (with calcium and zinc preparations).

Sessions of short-wave diathermy and UHF are prescribed for tubo-otitis on the area of the paranasal sinuses;

Darsonval with tubootitis (darsonvalization with alternating current) promotes activation of blood flow in damaged tissues and improvement of their trophism, as well as a decrease in otalgia.

Facilitates the state of ultraviolet and infrared radiation

Applied massage with tubootitis is a pneumomassage of the tympanic membrane, which helps maintain its elasticity.

By the way, you should know how to properly blow your ears with tubo-otitise to open the auditory tubes. You should take a deep breath, pinch your nose and close the rum, and then try to breathe out the air: some of it will go straight to the auditory tubes, removing the stuffiness of the ears.

Treatment of tubo-otitis in the home

As practice shows, folk treatment of tubotitis is carried out in the same ways as otitis treatment.

If the otitis is nigmoid, and the temperature is normal, then the patient's ear warms up. But is it possible to warm your ear with tuboititis? It is possible, but only under the same conditions - absence of purulent inflammation and fever. In particular, the blue lamp helps with tubo-otitisation (heating for 10 minutes followed by warming the patient's ear), as well as a warming vodka compress with tubo-otitis (which is applied around the auricle).

Traditionally, boric alcohol and boric acid are used for tubo-otitis (that is, 3% alcohol solution of boric acid): a moistened flagellum from bandage is inserted into the auditory canal, which is periodically replaced with a new one. Bury alcohol in the ear can not be! An alternative to boric alcohol can be an alcohol tincture of marigold or propolis.

When the inflammation of the auditory tube develops against the background of acute respiratory viral infection, nasopharyngitis or tonsillitis, warm-moist inhalations with tubooteitis are advisable: soda solution, alkaline mineral water, boiled potato pairs, etc.

Recommended herbal treatment:

  • take after each meal 50 ml of decoction from a mixture of flowers of meadow clover, immortelle, nettle and pine buds (in equal parts);
  • if the patient is prescribed antibiotics, then it is useful to drink a glass of broth prepared from the leaves of eucalyptus, dandelion root and yarrow and cypresse grass (all in the same amount, a tablespoon of the mixture for 0.5 liters of water, cook for 15 minutes, insist for three hours) ;
  • drink twice a day (after eating) 100 ml of decoction from the flowers of calendula (a tablespoon of a glass of boiling water).

Is it possible to walk at tubootitis? With increased temperature and pronounced otalgia, of course, it is impossible. If they are available, doctors give the sick leave to adults and release from school - to school-age children; the length of stay at home depends on the condition and effectiveness of the treatment.

Prevention

Recommendations otolaryngologists regarding preventive measures that can protect against this disease, have a general character. First of all, one should be treated for respiratory infections, and inflammations of the nasopharynx and the respiratory tract.

Forecast

The prognosis is usually good, especially if the treatment was started on time, and tubo-otitis did not give complications, for example, atrophy of the tympanic membrane and chronic hearing loss.

Last update: 25.06.2018
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Medical expert editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"

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