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Lecture notes, cheat sheets
Лор-заболевания. Болезни наружного уха (конспект лекций)
Directory / Lecture notes, cheat sheets Table of contents (expand) Lecture number 2. Diseases of the outer ear Among inflammatory diseases of the external ear, there are limited and diffuse external otitis media. In the first case, we are talking about a boil, and in the second - about a large group of inflammatory diseases of bacterial, fungal, viral origin or dermatitis, characterized by severe allergic reactions. Diffuse otitis media includes otitis externa, otomycosis, eczema, dermatitis, erysipelas, herpes, and perichondritis of the outer ear. 1. Furuncle of the external auditory canal The furuncle of the external auditory canal is considered limited external otitis, which occurs only in the membranous-cartilaginous part of the auditory canal, where there are hair and sebaceous glands. Etiology, pathogenesis Most often, a staphylococcal infection is introduced into the glands and hair follicles due to skin trauma when picking the ears with nails or various objects, as well as due to the outflow of pus from the middle ear. The furuncle of the ear canal is a manifestation of general furunculosis due to certain diseases (diabetes mellitus, hypovitaminosis). Clinic Characterized by severe pain in the ear, radiating to the eye, teeth, neck, sometimes throughout the head. The pain depends on the pressure of the inflamed infiltrate on the perichondrium, which is closely soldered to the skin and richly supplied with sensitive nerve fibers. The pain is aggravated by movements of the jaw, chewing, touching the tragus and pulling the auricle. In this regard, otoscopy is carried out carefully with a narrow funnel. The furuncle is localized on any wall of the ear canal. Hearing is not changed, but when the ear canal is obstructed, conductive hearing loss occurs. The furuncle can resolve itself by resorption of the infiltrate or, more often, by opening a pustule in the ear canal. Initially, a yellow dot is noted at the top of the pustule, then a purulent core is formed, after which a crater-shaped opening is determined. The tympanic membrane is not changed. Tissue infiltration may extend to the parotid region, the posterior surface of the auricle, and the mastoid region. Often, the lymph nodes are enlarged and painful on palpation in front, below and behind the auricle, depending on the location of the boil. Body temperature is often subfebrile. The average duration of the disease is 7 days. A furuncle on the anterior or lower walls can be complicated by mumps due to the infection passing through the santorini cracks. A recurrent boil may be associated with diabetes, so a urine and blood test is performed for sugar content. Differential diagnosis With severe behind-the-ear lymphadenitis, the furuncle is differentiated from mastoiditis, which is a complication of acute otitis media. Its difference is changes in the tympanic membrane and hearing loss, as well as a characteristic symptom of mastoiditis - the overhang of the posterior bone wall of the auditory canal. The furuncle is localized in the cartilaginous part of the auditory canal. With the introduction of a thin funnel behind the obturating ear canal, the furuncle restores hearing. Sometimes it is possible to differentiate these diseases only by dynamic observation of the patient and by radiography of the temporal bones. Treatment At the onset of the disease, antibacterial drugs are used: penicillin 500 IU 000 times a day intramuscularly or ampicillin, oxacillin, ampiox 6 g 0,5 times a day, erythromycin or tetracycline 4 IU 100 times a day inside. A turunda soaked in 000% boric alcohol is introduced into the ear canal, and after the furuncle is opened, a turunda soaked in a hypertonic solution of sodium chloride and a solution of penicillin in novocaine is introduced. Assign acetylsalicylic acid, analgin. Good results are given by physiotherapeutic methods of treatment: UHF, SHF and UFO. Surgical treatment of a boil is rarely resorted to when infiltration of surrounding tissues is expressed, regional lymphadenitis and a boil are complicated by mumps. The furuncle is opened under local infiltration anesthesia with an eye scalpel in the region of the tip of the rod. Having expanded the incision, the purulent rod is removed and turunda with hypertonic sodium chloride solution is introduced into the ear canal. With recurrent furunculosis, it is advisable to use autohemotherapy, brewer's yeast, general UVI. In some cases, an autovaccine, staphylococcal toxoid is prescribed. 2. Diffuse purulent otitis externa Purulent inflammation of the skin of the ear canal also extends to the bone part of the ear canal, the subcutaneous layer, and often to the eardrum. Etiology, pathogenesis The cause of diffuse otitis is infection of the skin of the ear canal with mechanical, thermal or chemical trauma, purulent otitis media, influenza, diphtheria. Contributes to the introduction of infection maceration of the skin. Metabolic disorders and allergic manifestations in the body favor the development of infection. Clinic Otitis externa occurs in acute and chronic forms. In the acute stage, diffuse hyperemia, infiltration of the walls of the ear canal, pain during otoscopy, and pressure on the tragus are noted. The process is more pronounced in the cartilaginous part, but extends to the bone part and the tympanic membrane, causing a narrowing of the ear canal. Itching, discharge of desquamated epidermis and pus with a putrid odor are noted. With influenza, hemorrhagic vesicles are observed on the walls of the auditory canal, with diphtheria, dirty gray fibrinous plaques are formed with difficulty. In the chronic course of external otitis, the symptoms are less pronounced, but the skin of the ear canal is thickened, the tympanic membrane is infiltrated. Differential diagnosis Differentiate otitis externa with the average after a thorough toilet of the ear. With otitis externa, hearing acuity is not impaired. After exclusion of the furuncle of the external auditory canal, the main attention should be directed to the differential diagnosis of diffuse purulent external otitis media with eczematous, fungal and viral otitis media. To do this, the discharge from the ear is sown on the flora and its sensitivity to antibiotics, a study on fungi. Treatment A diet is prescribed with the exception of spicy and spicy dishes, rich in vitamins. Carry out hyposensitizing therapy. For this purpose, the following drugs can be prescribed: tavegil, diphenhydramine, pipolfen, claritin, as well as calcium preparations. In the acute form of the process, the ear is washed with a warm 3% solution of boric acid, a 0,05% solution of furacilin. With itching, a 2-5% white mercury ointment or 1-2% ointment with yellow mercury oxide, 1% menthol in peach oil is prescribed. Apply lubrication with a 3-5% solution of silver nitrate, 1-2% alcohol solution of brilliant green or methylene blue. A good effect is the use of hydrocortisone emulsion, 1% prednisolone ointment, oxycort, 1% synthomycin emulsion. UHF, microwave and ultraviolet radiation are combined with drug therapy. In the chronic form, staphylococcal toxoid, antiphagin and vaccines are effective. Polymyxin M (0,5-1% ointment or emulsion) is used to suppress Pseudomonas aeruginosa. With persistent, refractory diffuse external otitis media, laser therapy and X-ray therapy are used. To increase the body's resistance, autohemotherapy and multivitamins are prescribed. Antibiotics and sulfonamides are recommended only for deep and chronic pyoderma, taking into account the sensitivity of the microflora to them. 3. Perichondritis of the outer ear Perichondritis of the outer ear is a diffuse inflammation of the perichondrium involving the skin of the outer ear. Etiology, pathogenesis Perichondritis is caused by an infection, most commonly Pseudomonas aeruginosa. Pathogens penetrate during mechanical trauma, plastic surgery of the external auditory canal during radical surgery, thermal trauma (burns, frostbite), ear furuncle, sometimes influenza and tuberculosis. There are purulent and serous perichondritis. Clinic Pain, swelling and hyperemia appear in the area of the auricle, gradually covering its entire surface, with the exception of the lobe, which does not contain cartilage. With suppuration and accumulation of pus between the cartilage and the perichondrium, fluctuations and pain on palpation are noted. Body temperature is elevated. Then the cartilage is melted by a purulent process, dies, and cicatricial deformation of the shell occurs. Serous perichondritis is less violent than purulent. Differential diagnosis Perichondritis is differentiated with erysipelas and hematoma. With erysipelas, hyperemia covers not only the shell, but also its lobe, and also often extends beyond the outer ear. Othematoma occurs more often after injury, is localized in the area of the anterior surface of the upper half of the auricle, has a purple color, is not painful on palpation, and proceeds with normal body temperature. Treatment In the initial stage of the disease, local and general anti-inflammatory treatment is carried out. When Pseudomonas aeruginosa is detected, penicillin is ineffective. Assign polymyxin M (1% ointment or emulsion), inside tetracycline, oletethrin or oxytetracycline 250 IU 000-4 times a day, erythromycin 6 IU 250-000 times a day, streptomycin 4 IU 6 times a day day intramuscularly. The affected part of the shell is smeared with 5% tincture of iodine, 10% lapis. Physiotherapy is carried out in the form of UVI, UHF or microwave. In some chronic cases, X-ray therapy is used. With suppuration, a wide tissue incision is made parallel to the contours of the auricle, the necrotic parts of the cartilage are removed, the abscess cavity is scraped out with a spoon and a swab with antibiotics is injected into it. Dressings are done daily. If the auricle is deformed in the long-term period, plastic surgery is performed. 4. Exostoses of the external auditory canal Exostoses are bone formations resulting from osteodystrophic processes of the temporal bone. Exostoses grow slowly, often asymptomatically in the form of exostoses and hyperostoses. With obturation of the ear canal, tinnitus, hearing loss appear, the process of excretion of sulfur or pus in otitis media is disturbed. Two forms of exostoses are observed - pedunculated and flat. Pedunculated exostoses originate from the outer ring of the bony part of the ear canal. They are diagnosed by otoscopy and radiography, often as an incidental finding. Stem exostoses are easily knocked off with a flat chisel under local infiltration anesthesia endaurally. Relapses are not noted. Flat exostoses often occupy almost the entire length of one of the walls of the auditory canal. Sometimes they form in the region of the tympanic ring, causing thickening of the wall of the tympanic cavity. Flat exostoses are multiple and make otoscopy difficult. The decision to remove them comes with caution, since the operation is traumatic and does not always give positive results. The operation is partially performed behind the ear access. The tissue of exostoses is dense, and their removal with a chisel requires the application of force, which is associated with the possibility of damage to the structures of the middle ear and facial nerve. Authors: Drozdov A.A., Drozdova M.V. << Back: Ear examination. Otolaryngological examination. Ear developmental abnormalities (Ear examination. Otolaryngological examination. Anomalies of ear development) >> Forward: Diseases of the middle ear. Acute tubo-otitis. Acute serous otitis media
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