Tubo-otitis in a child and adults: acute, chronic, bilateral

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

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

Is tubootitis contagious or not? This is a non-contagious disease that has synonymous names - eustachitis or tubotympanitis.

Causes tubo-otitis

What are the causes of tubootitis? In most cases, these are infections that penetrate the auditory tube from the nasopharynx and upper respiratory tract. The pathophysiology of inflammation may involve respiratory syncytial virus, influenza virus and adenovirus, rhinovirus infection in children, as well as bacteria Staphylococcus spp., Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. Rarely, 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 the Eustachian tubes and can lead to a decrease in mucociliary clearance. And in people with long-term nasopharyngitis and chronic sinusitis, tubootitis develops due to blockage of the tubes.

The auditory (Eustachian) tube opens when a person chews, swallows, or yawns, and during ascent and descent when traveling by plane or when diving; at other times, it is closed. Each person has two auditory tubes; the length of each in adults is about 35 mm with an average diameter of 3 mm, and in children in the first years of life, its length is about 20 mm. Since in early childhood the tympanic-pharyngeal tube is wider and passes from the anterior wall of the middle ear to the lateral wall of the nasopharynx at a smaller angle, inflammation of the middle ear and tubootitis occur more often in children than in adults.

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

Allergic conditions with swelling of the mucous membrane lining the auditory tubes also often provoke their inflammation, and then allergic tubootitis is diagnosed. Vasomotor rhinitis and tubootitis are often combined, which becomes its difficult-to-treat complication with persistent edema of the orifice of the Eustachian tube.

Risk factors

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

• chronic forms of rhinitis, chronic sinusitis or tonsillitis;
• hypertrophy of the pharyngeal tonsil - adenoids in children and adolescents;
• enlargement of the tubal tonsils (located near the pharyngeal openings of the Eustachian tubes);
• disruption of the structure (defects) of the nasal septum;
• the presence of neoplasms of various types in the nasopharynx (for example, choanal polyps);
• injuries to the internal structures of the ear, in particular due to a sharp change in pressure.

Clinical observations also 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.

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Pathogenesis

The main function of the auditory tubes is barometric and ventilation-drainage: to equalize the pressure in the tympanic cavity with the external one, to pass air and remove accumulated mucus and accidentally ingressed water.

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

The pathogenesis of tubootitis is associated with 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, tissue swelling leads to compression of nerve endings, which causes pain.

Next, there is a slowdown in local blood flow and a disruption in the blood supply to the mucous membrane of the auditory tube, followed by its partial or complete physiological dysfunction.

Symptoms tubo-otitis

The first signs characteristic of this disease are a feeling that the ear is blocked and a slight decrease in the level of sound perception associated with this.

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

In addition, symptoms of tubootitis are manifested by:

• tympanophony (receiving the sound of one's own voice into the ear);
• a sensation of liquid bubbling inside the ear;
• nasal congestion;
• periodically occurring headache.

Depending on the stage of the inflammatory process, the clinic distinguishes between: acute tubootitis (develops due to infection and is limited to several days); subacute tubootitis (lasts much longer than acute); chronic tubootitis (can manifest itself for years with exacerbations and weakening of symptoms, but persistent hearing loss).

If the disease is acute, otalgia (ear pain on the side of the inflamed auditory tube) is added to the symptoms already listed. ENT doctors can diagnose left-sided or right-sided tubootitis, or bilateral tubootitis, which in most cases begins as unilateral.

Subfebrile temperature with tubootitis, as well as general malaise, can be observed with acute inflammation in adults. And tubootitis in a child is accompanied by a more significant increase in temperature with fever.

When tubootitis develops, the ear itches for a completely different reason: itching in the ear canal is not one of the signs of inflammation of the auditory tube, but can occur with the accumulation of sulfur in the ear, with mycosis or dermatitis.

However, inflammation of the lymph nodes in tubootitis is not excluded, but most often the regional postauricular lymph nodes are affected in chronic serous or acute purulent otitis.

Forms

The most common and mild form of inflammation of the auditory tube is catarrhal tubootitis, which affects the upper layer of the mucous membrane. However, it can spread to large areas. Allergic tubootitis and acute eustachitis of viral etiology have a catarrhal nature.

If the inflammation continues to develop, exudate accumulates in the auditory tube, consisting of intercellular fluid, serum, fibrin, polymorphonuclear leukocytes, etc. This is exudative tubootitis, in which the tubes are filled with fluid, providing favorable conditions for the reproduction of pathogenic microorganisms. If the epidermis of the eardrum thickens and swells, then pain in the ear with hearing loss occurs. And at this stage, the disease is most often diagnosed as serous otitis media.

Complications and consequences

Due to ear congestion and the sound of one's own voice being reflected into it, psychosomatics may be observed with tubootitis. Some patients find it unpleasant to hear their own voice "from the inside", and this bothers them greatly, forcing them to speak very quietly. In addition, in some cases, breathing becomes more frequent, which causes a rush of blood to the muscles as with physical exertion.

When tubootitis does not go away for a long time, the inflammatory process continues, and in the absence of outflow from the auditory tube, the mucus produced by goblet cells accumulates. The bacterial or viral infection contained in it affects the mucous membrane of the tympanic cavity 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 possibility that hearing after tubootitis may weaken exists. More information in the article - Hearing impairment

Diagnostics tubo-otitis

Diagnosis of tubootitis is carried out by an ENT doctor, who will first find out the patient’s medical history and listen to his complaints.

The diagnosis of eustachitis is established on the basis of otoscopy (examination of the eardrum using an ear funnel) and determination of the patency of the auditory tube by blowing it out. The doctor also examines the nasal cavity, the condition of the pharynx and palatine tonsils.

Tests - a swab from the throat or nasal cavity - help to clarify the nature of the infection and, if bacterial flora is detected, prescribe antibiotic treatment. It should be noted that this test is not prescribed often.

Instrumental diagnostics are carried out: hearing impedance analysis (assessment of the condition of the middle ear hearing apparatus), fluoroscopy (to identify defects of the nasal septum or anomalies of the nasopharynx).

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

Differential diagnosis

In cases of inflammation of the Eustachian tube, differential diagnostics are important, allowing one to distinguish it, for example, from serous otitis or sensorineural hearing loss.

What is the difference between tubootitis and otitis? With otitis, the inflammation is localized in the tympanic cavity of the middle ear. And the main difference between tubootitis and sensorineural hearing loss lies in the etiology of hearing loss. Sensorineural hearing loss is caused by either a conduction disorder of the vestibulocochlear nerves of the skull, or damage to the nuclei of the auditory analyzer in the cortex of the cerebral hemispheres.

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Treatment tubo-otitis

The shock method, which is often used to begin the treatment of acute tubootitis, is intranasal catheterization of the Eustachian tube with Acetylcysteine, Amoxicillin and corticosteroids; Dexamethasone is most often used for tubootitis.

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

Ear drops are used for tubootitis:

• Otipax drops containing phenazone and lidocaine for tubootitis should be instilled into the external auditory canal 3-4 drops three times a day for no longer than a week. They are contraindicated for use if the eardrum is damaged.
• drops with the antibiotic rifampicin Otofa for tubootitis of staphylococcal etiology are prescribed five drops in the ear for adults and three drops for children - two or three times a day. Their use can cause itching in the ear and rashes on the skin around it.

In clinical otolaryngology, aminoglycoside antibiotics (neomycin, gentamicin, kanamycin, etc.) are in poor standing. Firstly, due to the rapid development of microbial resistance to them, as well as due to their accumulation in the tissues of the inner ear and damage to cochlear cells and vestibulocochlear nerve receptors. The latter factor is what causes the toxicity of these antibiotics for the ears.

However, combined drops of Polydex are prescribed for tubootitis, which contain antibiotics (neomycin and polymyxin B) and the corticosteroid dexamethasone. Like the two previous drugs, Polydex can only be used if the eardrum is intact. Adults are recommended to instill 3-4 drops into the ear twice a day, and children - 1-2 drops. In addition to an allergic skin reaction, a fungal infection may occur.

Drops Anauran for tubootitis are used similarly. Their active ingredients are neomycin, polymyxin B and lidocaine. Their use is contraindicated for children. And the drug Sofradex for tubootitis (with dexamethasone, neomycin and gramicidin) is intended for the treatment of inflammation of the outer ear cavity.

If otitis or tubootitis occurs during pregnancy, it is strictly forbidden to use these drops! Read more about ear drops in the publication - Drops for otitis

Decongestant nasal drops for tubootitis are used to relieve nasal congestion, which contributes to obstruction of the auditory tube. These are drops Sanorin, Naphthyzinum (Naphazoline), Nazivin, Nazol, Vibracil, etc. Decongestant and swelling-relieving nasal mucosa Rint spray for tubootitis (with oxymetazoline) is effective; it is injected into the nasal passages (one dose twice a day for five days). However, this remedy is not used in cases of nasal mucosa atrophy, severe arterial hypertension and increased intraocular pressure, as well as hyperthyroidism; it is contraindicated for children under six years of age.

An aerosol preparation with the corticosteroid mometasone - Nasonex for tubootitis - is used as an additional means to relieve swelling if patients have allergic rhinitis and chronic sinusitis in the acute stage.

Antihistamines (Suprastin, Claritin, etc.) are taken orally to combat edema. Fenspiride or Erespal is used for tubootitis in chronic rhinitis and nasopharyngitis of allergic origin: one tablet twice a day; for children - syrup (two to three tablespoons). Possible side effects include nausea, vomiting, heart rate disturbances, and increased drowsiness.

Homeopathy. It is possible to use the homeopathic remedy Sinupret for tubootitis if the patient has a cough with viscous sputum and at the same time the paranasal sinuses are inflamed. It is recommended to take two pills two or three times a day.

If the treatment of tubootitis is delayed, ear pain does not go away and the general condition worsens, antibiotics are prescribed for tubootitis. Amoxicillin and its synonyms Amoxiclav, Augmentin, Clavocin, as well as Flemoxin Solutab are effective for tubootitis if the pathology is caused by staphylococci 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. Side effects of this drug include skin allergies and diarrhea.

The systemic antibiotic Ciprofloxacin for tubootitis or Tsifran for tubootitis and sinusitis is taken orally - every 12 hours at 0.5-0.75 g. It is contraindicated for pregnant women and children under 16 years of age. Side effects include nausea, vomiting, diarrhea, abdominal pain, skin rashes, headache and dizziness.

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

Novocaine blockade for tubootitis (if it does not progress to acute otitis or is not complicated by chronic purulent inflammation of the middle ear) is usually not required.

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

Physiotherapy treatment

Physiotherapeutic treatment of tubootitis is carried out using popular methods of electrotherapy.

Thus, electrophoresis for tubootitis is carried out through the external auditory canal (with calcium and zinc preparations).

Sessions of short-wave diathermy and UHF are prescribed for tubootitis in the area of the paranasal sinuses;

Darsonval for tubootitis (darsonvalization with alternating current) helps to activate blood flow in damaged tissues and improve their trophism, as well as reduce otalgia.

Ultraviolet and infrared radiation provide relief

The massage used for tubootitis is a pneumatic massage of the eardrum, which helps maintain its elasticity.

By the way, you should know how to properly blow out your ears with tubootitis to open the auditory tubes. You should take a deep breath, pinch your nose with your fingers and close the rum, and then try to exhale the air: some of it will go straight to the auditory tubes, relieving ear congestion.

Treatment of tubootitis at home

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

If the otitis is not purulent and the temperature is normal, then the sore ear is warmed up. But is it possible to warm the ear with tubootitis? It is possible, but only under the same conditions - the absence of purulent inflammation and fever. In particular, a blue lamp helps with tubootitis (warming up for 10 minutes with subsequent warming of the sore ear), as well as a warming vodka compress with tubootitis (which is applied around the auricle).

Traditionally, boric alcohol and boric acid are used for tubootitis (i.e., a 3% alcohol solution of boric acid): a moistened bandage flagellum is inserted into the ear canal, which should be periodically replaced with a new one. Boric alcohol should not be instilled into the ear! An alternative to boric alcohol can be an alcohol tincture of calendula or propolis.

When inflammation of the auditory tube develops against the background of acute respiratory viral infection, nasopharyngitis or tonsillitis, then warm-moist inhalations for tubootitis are advisable: with a soda solution, alkaline mineral water, steam from boiled potatoes, etc.

Herbal treatment is recommended:

• take 50 ml of a decoction of a mixture of meadow clover flowers, immortelle, nettle and pine buds (in equal parts) after each meal;
• if the patient has been prescribed antibiotics, it is useful to drink a glass of a decoction per day made from eucalyptus leaves, dandelion root, yarrow and fireweed (all in equal quantities, a tablespoon of the mixture per 0.5 liters of water, boil for 15 minutes, leave for three hours);
• drink 100 ml of calendula flower decoction twice a day (after meals) (a tablespoon per glass of boiling water).

Is it possible to go for a walk with tubootitis? With a high temperature and severe otalgia, of course, it is impossible. In their presence, doctors give sick leave to adults and exemption from classes to school-age children; the duration of stay at home depends on the condition and the effectiveness of the treatment.

Prevention

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

Forecast

The prognosis is usually good, especially if treatment was started on time and tubootitis did not cause complications, such as atrophy of the eardrum and chronic hearing loss.