Defeat of the labyrinth in infectious diseases: causes, symptoms, diagnosis, treatment

Lesion of the labyrinth in some infectious diseases. Acute infectious diseases, especially in children, are often the cause of severe damage to the inner ear, leading to partial or complete deafness, imperfection of the function of the vestibular apparatus. Such diseases include epidemic cerebrospinal meningitis, epidemic parotitis, influenza, typhus and childhood infections, botulism, malaria, herpes, tuberculosis, syphilis, etc. Sometimes acute bilateral disconnection of the ear maze occurs after a short infectious disease such as acute respiratory disease or influenza. An example of this excess can be the Voltolini syndrome, consisting of bilateral deafness in children after a short-term acute infection that occurs without meningeal symptoms; At the same time as the appearance of deafness, it is also impossible to provoke the vestibular apparatus.

Epidemic cerebrospinal meningitis. Epidemic cerebrospinal meningitis is caused by meningococcus (Neisseria meningitidis). The source of infection is a patient with meningococcal nasopharyngitis, the transmission route of infection is airborne. The disease begins acutely with a tremendous chill, a rapid rise in body temperature to 38-40 ° C with a rapid deterioration of the general condition. Clinical manifestations and meningeal symptoms are typical for severe meningitis. From the cranial nerves are affected the visual, oculomotor, diverting, facial and pre-vertebral-cochlear. Epidemic cerebrospinal meningitis in infants has a number of peculiarities: it is lethargic with mild or no meningeal symptoms on the background of general toxic symptoms. One of the common complications of epidemic cerebrospinal meningitis is meningococcal labyrinthitis, which occurs during violent vestibular symptoms with early and persistent deenergia of the auditory function.

The treatment is carried out under stationary conditions. When nasopharyngitis is shown, rinsing of the nasopharynx with a warm solution of boric acid (2%), furacilin (0.02%), potassium permanganate (0.05-0.1%). With severe fever and intoxication prescribe levomitsetin (2 g / day for 5 days), sulfonamides or rifampicin. In generalized forms of epidemic cerebrospinal meningitis and with meningococcal labyrinthitis, antibiotics and hormonal drugs are used; To combat toxemia, a sufficient amount of liquid is injected, polyionic solutions (quartrel, trisol, regidron), blood-substituting fluids (rheopolyglucin, gemodez). At the same time, dehydration is carried out using diuretics (lasix, furosemide, diacarb, veroshpiron), multivitamin mixtures, antihypoxants, neuroprotectors are prescribed.

The prognosis for a general recovery with timely and correct treatment is favorable, but sometimes, in case of generalized forms with severe course, especially in children of the first days of life, deaths are possible. Such severe organic lesions like hydrocephalus, dementia and oligophrenia, amaurosis, are extremely rare. With labyrinthitis, pronounced hearing loss or deafness is often retained.

Parotitis. With epidemic parotitis, auditory and vestibular disorders occur quite often. The filtering mumps virus (Pneumophilus parotidis) affects the parenchyma of the parotid salivary gland and penetrates into the meninges and spinal fluid, causing more or less pronounced effects of limited meningitis in the MM region with the emergence of viral toxic-infectious neuritis located in this region of caudal nerve nerves and scutellum fascicle. Auditory and vestibular disorders usually occur 5-10 days after the onset of the disease. They start with increasing ear noise and light dizziness and can reach a high degree of severity with complete exclusion of auditory and vestibular functions on the side of the defeat of the parotid salivary gland.

The most often sick children aged 5-15 years. The disease begins with an increase in body temperature to 38-39 ° C, a slight chill, a swelling and soreness of the parotid salivary gland on one and then on the other side, because of which the patient's face acquires a special form, giving the disease the name "mumps". The source of the disease is a sick person from the last days of the incubation period to the 9th day of the disease. Infection is transmitted with saliva by airborne droplets. With a favorable course of auditory and vestibular disorders gradually disappear and the hearing returns to normal.

Treatment is symptomatic; depending on the severity and prevalence of a viral infection, it is carried out either at home with appropriate preventive measures, or in conditions of an infectious disease. To prevent labyrinthine disorders, detoxification therapy, neuroprotectants, antihypoxants, antihistamines, and others are used.

Flu. Influenza damage to the inner ear is manifested by infectious vasculitis of its structures and pre-collateral nerve cochlear. Often, these lesions are accompanied by acute otitis media influenza etiology, but can occur independently. The virus in the inner ear penetrates the hematogenous way, reaches the hair cells of the vestibular apparatus, reproduces in them and causes their death. Possessing high neurotropicity, the influenza virus affects other parts of the nervous system. With the influenza labyrinthitis, the same symptoms of internal ear damage occur as with ER, the difference is that the deafness that occurs with the flu remains stable and can progress for several years.

Treatment is carried out on the same principles as in epidemic parotitis.

Typhuses. Symptoms of diseases of the ear maze and the pre-door-cochlear nerve with different forms of typhoid infection have their own peculiarities.

With typhus and involvement in the infectious process of the ear maze, auditory and vestibular disorders manifest themselves in the first days of the disease. Vestibular symptoms are characterized by signs of irritation of the labyrinth (dizziness, spontaneous nystagmus towards the "causal" ear), and then its oppression. They grow, until the crisis period, and then disappear without any consequences. Hearing impairment in case of cochlear injury is manifested by a sharp noise in one or both ears, progressive hearing loss is predominantly at low frequencies, with a predominant lesion of the pre-cochlear nerve, hearing loss occurs at all frequencies. The resulting hearing impairment in typhus fever has a persistent perceptive character.

With typhoid, labyrinthine disorders occur in the 2-4 weeks from the onset of the disease, and sometimes even during recovery. They have a less pronounced character than with typhus, and pass without a trace. Persistent hearing impairment is rare.

With recurrent typhus, mainly hearing impairment occurs, sometimes accompanied by mild vestibular symptoms. Usually, hearing impairments develop after the second or third attack and occur in cochlear, neuritic and mixed forms. The most unfavorable prognosis for auditory function in cochlear and mixed forms, in which persistent deafness persists, in some cases progressing with years.

Treatment is specific anti-infection in combination with complex antineuritic therapy.

Children's infections. Measles, scarlet fever, diphtheria, rubella and some other diseases can be complicated not only by vulgar infection of the ear, but also by the toxic damage of its receptors, mainly the cochlear hair device. The appearance of signs of a disturbance of sound perception combined with dizziness and spontaneous nystagmus in this or that childhood infection and absence of inflammation in the middle ear indicates the involvement of the ear maze and the pre-cochlear nerve into the infectious process. For example, after diphtheria, there is often a persistent hearing loss on one or both ears with reduced excitability of one or both vestibular apparatus, which is apparently associated with diphtheritic neuritis of the pre-cochlear nerve. In diphtheria, it is sometimes possible to observe Dejerine's syndrome caused by a toxic polyneuritis, reminiscent of its spinal dryness and manifested by ataxia and a violation of deep sensitivity.

A special role in the occurrence of irreversible labyrinthine disorders belongs to rubella, whose virus has a high tropism for embryonic tissue, causing infection of the embryo and various malformations in the first 3 months of pregnancy. An example of such defects is Gregg's syndrome in newborns whose mothers during the first 3 months of pregnancy had rubella (congenital cataract, retinal abnormalities, optic nerve atrophy, microphthalmia, congenital nystagmus of the eye and deafness due to underdevelopment of internal ear structures, various developmental defects of the external and secondary ear, etc.). Children born with the developmental defects of the vestibular labyrinth lag behind in physical development, are not able to learn subtle locomotion and to acquire athletic-motor skills.

Treatment of labyrinthine dysfunctions in childhood infections is included in the complex of therapeutic measures taken in the treatment of a specific infection, and includes antineuritic, detoxicating, antihypoxic and other treatments aimed at protecting the receptors of the labyrinth and the pre-cochlear nerve from the toxic effects of the infection.

Tick-borne encephalitis. This acute neuroviral disease, in which the gray matter of the brain and spinal cord is affected. It manifests itself as paresis, muscle atrophy, impaired movement, intelligence, and sometimes epilepsy. In the neurological stage, especially with meningoencephalitic and poliomyelitis forms, there is a noise in the ears, a violation of speech and binaural hearing. Tone hearing suffers less. Vestibular disorders are of an unsystematic nature and are caused mainly by the defeat of vestibular centers consisting of neurons forming the gray matter of nuclear formations.

Motor pre-cerebellar disorders are masked by subcortical hyperkinesis, bulbar paralysis, flaccid paralysis of the musculature of the neck and upper limbs. With a favorable outcome, hearing and vestibular functions are restored to normal.

Treatment is carried out in the infectious department. In the first days of the disease, the introduction of specific donor y-globulin, interferon and other antiviral drugs is indicated. Detoxification and dehydration therapy, administration of ascorbic acid, trental, calcium preparations; when expressed signs of cerebral edema, corticosteroids are used. With progressive signs of respiratory failure, the patient needs to be transferred to the ventilator.

Malaria. This is an acute infectious disease caused by various species of plasmodia; characterized by paroxysms of fever, increased liver and spleen, anemia. Truly malarial labyrinth disorders can be observed at the height of the attack. They are manifested by noise in the ears and in the head, deafness in a mixed type, unexpressed transitory vestibular disorders in the form of dizziness, more often unsystematic nature. The quinine used to treat this disease can cause persistent perceptive hearing loss, while the anti-plasmodium preparation does not give this side effect.

Herpes zoster is caused by the virus Varicella-Zoster, which is the causative agent of chicken pox and actually herpes zoster. The latent state virus is found in the nerve ganglia (in 95% of healthy people), under appropriate adverse conditions (cold, intercurrent infection) is activated and, moving along the nerve trunks to the skin, causes along the nerve a characteristic ospopodobnye rashes. The defeat of the virus of the scrotal fasciculus is manifested by the syndrome of herpes zoster. The signs of this syndrome are determined by the degree of involvement of the nerves of the scrotal fasciculus (auditory, vestibular, facial and intermediate). A typical form of herpes zoster is manifested by the so-called Hunt syndrome, caused by the involvement of the knot in the process and including the following clinical periods:

1. the initial period (5-7 days) is manifested by general weakness, subfebrile condition, headache; the appearance of pain in the ear is associated with the transition of the disease to the stage of herpetic eruptions;
2. the period of herpetic eruptions is caused by viral damage of the knot node and is characterized by the appearance of herpetic eruptions on the auricle, in the external auditory canal and on the tympanic membrane, in the behind-the-ear region and on the soft sky along the nerve endings; herpetic eruptions are accompanied by burning pains, a disorder of taste sensitivity, lacrimation, hypersalivation, regional lymphadenitis;
3. period of total peripheral paralysis of the facial nerve, following the period of rashes; paralysis unstable, facial nerve functions are restored after 2-3 weeks after its defeat.

The most dangerous is the so-called generalized form (the true form of the herpes of the ear), in which paresis of the facial nerve is joined by the defeat of the pre-cochlear nerve, ie, cochleovestibular disturbances join Hunt's syndrome, and then this complex symptom complex is called the Sikar-Suke syndrome: ear noise, perceptual hearing loss or deafness on the side of herpetic damage to the ear, a pronounced vestibular crisis with a rapidly onset of vestibular function cutoff on the diseased side. Auditory and vestibular functions after recovery may be partially restored, but persistent deafness and unilateral deactivation of the vestibular apparatus are often preserved. Sometimes, during the herpes zoster, other cranial nerves are affected (triple, oculomotor, wandering, olfactory, nerves of taste and olfactory sensitivity).

Diagnosis does not cause difficulties in the typical manifestation of Hunt's syndrome, but it is always difficult for dissociated clinical manifestations, for example, in the absence of mimic disorders and the presence of a violation of taste sensitivity and hearing. The diagnosis is made on the basis of the presence of common infectious prodromes, typical small bubble rashes in the outer ear and along the nerve trunks on the background of hyperemic skin, severe otalgia in the form of stabbing, burning, radiating to neighboring areas, as well as complete peripheral paralysis of the facial nerve and a disorder of taste sensitivity on the side of the defeat.

Herpes zoster should be differentiated from herpes simplex, banal acute external otitis, with sudden hearing loss and deafness - from syphilitic damage to the hearing organ, with expressed vestibular syndrome - from an attack of Meniere's disease and vestibular neuronitis. Treatment is symptomatic and etiotropic; such as modern antiviral drugs such as acyclovir, famciclovir, isopropyluracil, interferon, etc., as the latter.