Some aspects of diagnosis and treatment of vestibular disorders in neurological practice. What are the types of diseases of the human inner ear? Hydrocele of the inner ear symptoms

Meniere's disease (Meniere's syndrome). Causes, symptoms and diagnosis

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What is Meniere's disease and syndrome?

Meniere's disease, also known as endolymphatic hydrops or endolymphatic hydrops, is a distinct disorder of the inner ear. The problem is the excessive formation of a special fluid - endolymph, which normally fills the cavity of the inner ear. Increased formation of endolymph leads to increased internal pressure, disruption of the hearing organ and vestibular apparatus.

Meniere's syndrome has all the same manifestations as Meniere's disease. However, if the disease is an independent pathology with unknown causes, then the syndrome is a secondary manifestation of other diseases. In other words, some diseases (ear or systemic) cause increased formation of endolymph and lead to the appearance of similar symptoms. In practice, patient complaints and symptoms are almost the same for the disease and Meniere's syndrome.

This disease is considered relatively rare. Its prevalence varies between countries and ranges from 8 to 155 people per 100,000 population. There is an assumption that in more northern countries the disease is more common. This may be due to the influence of climate on the body, but there is no reliable data confirming this connection yet.

Meniere's disease occurs with equal frequency in men and women. Most often, the first signs begin to appear between 40 and 50 years, but there is no clear dependence on age. The disease can also occur in young children. Statistically, representatives of the Caucasian race are more likely to get sick.

Causes of the disease and Meniere's syndrome

To understand the causes of Meniere's disease, it is necessary to understand the structure of the inner ear. In general, this is the name given to the internal part of the human hearing aid. It is located deep in the temporal bone. This section communicates with the middle ear through a special opening - the window of the vestibule. Its lumen is closed by the stapes - one of the bones of the middle ear.

The inner ear has the following parts:

The vestibule. This is a small cavity located between the cochlea and the semicircular canals. The channels of both of these structures originate precisely in the vestibule. Sound waves are transformed into mechanical waves at the level of the middle ear and transmitted to the vestibule through the stapes. From here the vibrations propagate into the cochlea.

Snail. This part of the inner ear is represented by a bony spiral canal resembling a cochlea shell. The canal is divided by a membrane into two parts, one of which is filled with endolymph. This fluid is necessary for the transformation of sound waves and their transmission in the form of a nerve impulse. The part of the ear filled with endolymph is called the endolymphatic space.
Semicircular canals. The three semicircular canals are located at right angles to each other. They begin and end in the uterus, which connects to the vestibule. These channels are filled with liquid. They serve to orient the head and body in space. Changes in pressure in the channels are perceived by special receptors, transformed into a nerve impulse and deciphered in the brain. This process underlies the functioning of the vestibular apparatus.

The main cause of Meniere's disease is increased endolymph pressure. This deforms the membrane in the inner ear and interferes with the functioning of the auditory and vestibular apparatus. If normally the receptors in the inner ear are not irritated at rest, then during an attack of illness they actively send nerve impulses to the brain. Irritation occurs due to pathologically high blood pressure. The brain deciphers the impulses, and disorientation occurs. The balance organ sends signals that the body is moving in space, but the eyes do not confirm this information. There is a feeling of dizziness, loss of coordination. At the same time, the transmission of sound waves in the inner ear deteriorates, causing hearing acuity to decrease.

Meniere's disease is considered a disease of unknown etiology. In other words, modern medicine cannot answer what exactly leads to increased endolymph formation and the development of the pathological process. There are several theories, but none of them have been conclusively confirmed at this time.

The following disorders are considered possible causes of the development of Meniere's disease:

Vascular disorders. Endolymph is normally partially formed from blood. More precisely, part of the fluid leaves the vascular bed. This process is regulated by cells in the walls of blood vessels and in the vestibule of the inner ear. As the pressure in the vessel (labyrinthine artery) increases, more fluid passes through the wall and the volume of endolymph increases.
Innervation disorders. Vascular tone (expansion and narrowing of their lumen) is regulated by smooth muscle cells, and they, in turn, by nerve fibers. If there are disturbances in innervation, the tone of the vessels changes, the pressure in them can increase or decrease, which will affect the formation of endolymph. Long-term stress may play a role in these disorders.
Eating disorders. In this case, we mean the nutrition of cells in the vestibule area. Extremely sensitive receptors are located here. Lack of nutrients leads to disruption of endolymph filtration and regulation of its formation.
Infectious processes. Inflammatory processes in the middle ear, in the absence of qualified treatment, can spread to the inner ear. Then the receptors are damaged, vascular tone is disturbed, and the pressure in the cavities of the inner ear increases. This process can seriously disrupt the anatomical structure of tissues. After eliminating the infection and inflammation itself, the mechanisms responsible for the production of endolymph are damaged, and the patient suffers from Meniere's disease.
Allergic processes. Some allergic reactions occur with the formation of special antibodies that circulate in the blood. These antibodies enter all organs and tissues, but attack only some cells (depending on the structure of the antigen that caused the production of antibodies). If during an allergic reaction the area of the inner ear is affected, special substances begin to be released that dilate the blood vessels and increase the permeability of their walls. As a result, more endolymph is produced.
Hereditary factors. It has been noted that Meniere's disease occurs more often in blood relatives. This suggests that individual structural features of the vessels or receptors in the inner ear are responsible for the enhanced production of endolymph.
Professional factors. A number of occupational hazards (certain toxins, ultrasound, vibration, etc.) can cause damage to the inner ear and increase endolymph production. Moreover, violations do not always go away on their own, even after eliminating the external factor that caused them.

Thus, Meniere's disease can have many different causes. It is most likely that each patient with this pathology has one or another combination of causes (for example, hereditary predisposition and occupational factors). Meniere's syndrome has slightly different causes. In this case, all of the above factors may also occur. But other pathologies come to the fore. They are the ones who trigger the same mechanisms regulating the formation of endolymph. The result is also increased pressure in the inner ear with similar symptoms.

Meniere's syndrome can develop against the background of the following diseases:

Autoimmune diseases. A number of autoimmune diseases cause damage to connective tissue and blood vessels (vasculitis). As a result, endolymph production in the inner ear may increase.
Traumatic brain injuries. With traumatic brain injuries in the area of the temporal bone (less often in other areas of the skull), the outflow of lymph may be disrupted. This is a liquid that normally removes waste products from the body’s tissues. Overgrowth of lymphatic vessels after injuries or operations leads to overflow of the veins and increased pressure. Because of this, fluid stagnates and the amount of endolymph increases.
Increased intracranial pressure (ICP). In some cases, increased intracranial pressure can also lead to problems in the inner ear. Pressure inside the skull increases due to increased volume of cerebrospinal fluid. Since the cavities of the skull and ear are connected to each other (albeit through cellular barriers), the hydrostatic pressure in the endolymphatic space also increases.
Endocrine disorders. Various hormones take part in the regulation of vascular tone and blood pressure. In some endocrine diseases, hormonal imbalance leads to the release of fluid from the lumen of blood vessels. In rare cases, local swelling of the inner ear area occurs with the development of Meniere's syndrome.
Disturbances of water-salt balance. The water-salt balance of the blood is maintained due to the normal concentration of various ions, proteins, salts and other chemical compounds in the blood. Its violation leads to changes in blood properties (oncotic and osmotic pressure). The result may be easier release of fluid through the walls of blood vessels. The water-salt balance is often disturbed due to poisoning, kidney and liver diseases.
Ear neoplasms. One rare cause is gradually growing benign or malignant tumors in the middle or inner ear. The growth of the tumor puts pressure on the blood and lymphatic vessels, which can lead to poor fluid drainage and swelling.

It should be noted that Meniere's syndrome in the above pathologies develops quite rarely. This is a special case, a complication of a particular disease, which does not occur in all patients. That is why it is assumed that the inner ear is affected only if there is an existing hereditary predisposition, that is, with a combination of various factors.

Labyrinthopathies with Meniere's syndrome

Labyrinthopathies are a group of diseases of the inner ear in which there is no pronounced inflammatory process, but the functions of the organ are still impaired. Typically, labyrinthopathy develops due to poisoning with certain toxins or pharmacological drugs (quinine, streptomycin). Infectious diseases (through allergic and autoimmune processes) may also play a role. Some labyrinthopathy can lead to the development of Meniere's syndrome, but this outcome is not necessary.

Signs and symptoms of Meniere's disease

The disease usually has a chronic, relapsing course (with periods of subsidence and exacerbation of symptoms). During the period of remission, no manifestations are usually observed. The patient can normally tolerate even rapid changes in body position and not suffer from motion sickness in transport. However, such stress on the vestibular apparatus can lead to an exacerbation of the disease. An exacerbation or attack of the disease manifests itself differently in all patients. However, there are a number of classic symptoms (triad) that are observed in almost all patients.

The main symptoms of Meniere's disease are:

dizziness;
hearing loss;

Dizziness in Meniere's disease

Dizziness in this case is called labyrinthine. It is explained by compression of the receptors of the vestibular apparatus. Because of this, the brain cannot clearly determine its position in space. As a rule, dizziness is the first symptom of an attack. It appears suddenly (sometimes can be triggered by external factors) and lasts from a few seconds to several minutes. The attack is accompanied by severe disorientation in space and nausea. In this case, an attack of nausea and a gag reflex will have nothing to do with recently eaten foods; it can also occur on an empty stomach. After the first sudden attack, the dizziness usually subsides slightly, but continues to periodically intensify. This condition can last for several hours or even days.

Another important symptom associated with labyrinthine vertigo is nystagmus. These are involuntary rapid movements of the eyeballs. During an attack, they occur against a background of disorientation in space. The nerves that control eye movements are reflexively stimulated. Typically, during an attack of Meniere's disease, the pupils move horizontally (to the right and left). Much less often, patients experience vertical nystagmus (up and down) or circular movements. Fixing your gaze on some object can temporarily stop your movements. However, in a relaxed state, the frequency sometimes reaches 150 – 200 movements per minute.

Often dizziness during an attack has the following features:

sudden onset;
the patient falls or tries to immediately assume a horizontal position;
usually patients close their eyes (this eliminates the dissonance between visual information and sensations from the vestibular apparatus);
an attack can be triggered by physical or emotional stress (they cause changes in vascular tone);
changing body position (for example, trying to stand up) during an attack increases dizziness and nausea;
sometimes there is vomiting;
sharp and loud sounds also worsen the patient’s condition;
most often, attacks begin at night (if the patient is not sleeping) or in the morning, immediately after waking up, but there is no strict dependence on the time of day;
In older people, dizziness is less pronounced than in young people.

Hearing loss in Meniere's disease

Typically, hearing loss in Meniere's disease is progressive. At the very beginning of the disease, during the period of remission, hearing acuity is normal. However, during an attack, severe hearing loss appears. The patient complains that his ear suddenly becomes blocked. Sometimes a moderate decrease in hearing acuity precedes dizziness and the onset of an attack in general.

In most cases (approximately 80% of patients), hearing loss is unilateral. This is explained by the fact that pathological processes in Meniere’s disease are usually local, and there is no direct connection between the vestibular apparatus of the right and left ears. Bilateral hearing loss is observed more often with Meniere's syndrome. Then some disease or external cause (usually vibration disease, high intracranial pressure or poisoning) affects both ears approximately equally.

The patient may present various complaints and describe his condition differently. Sometimes it is a feeling of pressure or fullness in the ear, sometimes it is a feeling of stuffiness. During the period of remission, hearing acuity may return to normal. However, over time (after years of periodic attacks), hearing still deteriorates irreversibly. This is due to the gradual degeneration of nervous tissue.

Tinnitus in Meniere's disease

Patients hear tinnitus due to fluid squeezing the canal in the labyrinth. Normally, sound waves from the middle ear pass through here, but when compressed by excess fluid, these waves are generated randomly and are deciphered by the brain as noise. The noise is almost always one-sided, in the same ear that begins to hear poorly.

Other possible symptoms and complaints of Meniere's disease are:

sensation of rotation;
ear pain (optional symptom);
increased sweating (due to activation of the autonomic nervous system);
sudden redness or paleness of the skin - mainly on the face and neck;
increased blood pressure and headaches (these symptoms are observed more often with Meniere's syndrome and are associated with the underlying pathology that caused this syndrome).

In general, an attack usually lasts from several hours to several days. Gradually increasing hearing loss sometimes appears several days before a full-blown attack, and some symptoms persist for some time after its end. The period of remission between two attacks of Meniere's disease can last several weeks, months or even years. This depends on many factors. With Meniere's syndrome, the frequency of attacks depends on the intensity of the underlying disease. If, for example, you regularly take medications to reduce blood and intracranial pressure (provided that they were the root cause of the syndrome), then the frequency of attacks will significantly decrease.

Many experts distinguish the following stages during the course of Meniere's disease:

First (initial) stage. The disease appears for the first time, and its manifestations can be of varying degrees of intensity. Sometimes an attack manifests itself as goosebumps and darkening of the eyes. The dizziness usually does not last too long (a few hours), but can be very severe. During the period between attacks, no dizziness, no coordination problems, no hearing loss were observed. When examining a patient, signs of edema (hydropsus) of the inner ear can only be detected during attacks. It is almost impossible to diagnose the disease during remission.
Second stage. At this stage, the disease takes on a classic course. During an attack there is almost always a main triad of symptoms. During the period of remission, spontaneous hearing loss and a feeling of fullness in the ear may sometimes appear. To varying degrees, hydrops of the inner ear is constantly present, and it can be detected during a period of remission. An attack is only an even stronger increase in blood pressure than usual.
Third stage. At this stage, attacks of dizziness may no longer be so intense. More often, there is a constant, rather than periodic, lack of coordination of movements; the gait changes, becoming more unsteady and uncertain. At the same time, complaints of dizziness are less common. This is explained by irreversible changes at the level of receptors of the vestibular apparatus. In other words, the receptors are partially destroyed and no longer send nerve impulses to the brain.

With Meniere's syndrome, such a division into stages is usually impossible, since the manifestations of the disease, the intensity of attacks and the general condition of the patient depend not so much on the pathological process in the inner ear, but on the severity of the underlying disease.

Diagnosis of Meniere's disease

Diagnosing Meniere's disease can be quite difficult due to the nonspecific symptoms that are observed with this disease. However, periodic unexplained attacks of dizziness and ringing in the ears, combined with temporary hearing loss, should already suggest problems with the inner ear.

The diagnostic process usually occurs during an attack of illness in a hospital setting. The patient is admitted to the hospital so that doctors have more opportunities to find out the causes of the attack. Clinical examination methods and a number of special instrumental methods are used. Together, they provide insight into the structural integrity and functionality of the inner ear.

Clinical aspects of Meniere's syndrome

Clinical aspects mean information obtained by a doctor without the use of laboratory and instrumental methods. First of all, a thorough history is required. This is a normal conversation with the patient, during which many important details are clarified. Since Meniere's disease and syndrome are very difficult to detect, considerable importance is attached to collecting an anamnesis.

The most important details when interviewing a patient are:

previous head injuries;
previous ear infections;
presence of concomitant diseases;
whether the patient regularly takes any medications (the effects of some affect the hearing organ);
frequency and duration of attacks;
the conditions in which the attack occurs;
the patient’s place of work (are there any harmful factors contributing to the onset of the disease);
dependence of attacks and symptoms on the weather (in particular, changes in atmospheric pressure);
having an allergy to something.

If a patient seeks help during a period of remission in the early stages of Meniere's disease, it is almost impossible to confirm the diagnosis. In this case, he is regularly monitored and the next attack is expected.

Laboratory examination for Meniere's syndrome

All research methods (in addition to clinical ones) can be divided into two large groups - instrumental and laboratory. Laboratory methods are aimed primarily at studying fluids and other biological materials taken from the patient. In most patients with Meniere's syndrome, these methods do not reveal any serious changes. However, they are mandatory when visiting a doctor.

Among the laboratory methods for Meniere's syndrome, the following tests may be useful:

General blood analysis. It can reveal signs of inflammatory (increased ESR - erythrocyte sedimentation rate, increase in the number of leukocytes) or allergic (increase in the number of eosinophils) processes. In both cases, one should suspect not the disease, but Meniere's syndrome and look for its causes.
Blood chemistry. A glucose tolerance test is mandatory for such patients. It has been found that the disease is more likely to occur in people with high blood sugar levels.
Thyroid hormone test. One possible cause of Meniere's syndrome is a malfunction of the thyroid gland. A test for thyroid-stimulating hormone, triiodothyronine (T3) and tetraiodothyronine (T4) is prescribed.
Serological methods. If an autoimmune cause of Meniere's syndrome is suspected, serological tests (tests) are prescribed. Autoimmune diseases are characterized by the presence of antibodies (autoantibodies) in the blood that damage the own structures of various organs and tissues (including the hearing organ). Serological tests can not only detect, but also determine the level of autoantibodies in the blood. Serological tests are also prescribed if certain infectious diseases are suspected (for example, neurosyphilis).

Thus, laboratory research methods help mainly in diagnosing Meniere's syndrome by detecting the underlying pathology. With Meniere's disease, any changes may be absent at all, or they may be caused by diseases not directly related to the pathology of the inner ear.

MRI for Meniere's syndrome

Quite often, if there is a history of mechanical head injuries, magnetic resonance imaging (MRI) is prescribed. It is prescribed to detect damage to both bone and brain tissue. In addition, MRI allows you to analyze brain structures for the presence or absence of other pathologies (oncological, anatomical, infectious), which may be the root cause of Meniere's syndrome.

MRI rarely detects inner ear swelling and endolymph accumulation itself. To do this, it is necessary that the study be carried out precisely in the acute period (during an attack). During the period of remission of the disease, this study is not advisable, since it will not reveal any structural changes, and its implementation is quite expensive.

Audiogram for Meniere's syndrome

An audiogram is the result of an instrumental audiometry method. It is aimed at functional testing of hearing in patients. An audiogram allows you to register in which frequency range hearing acuity decreases. In addition, there are a number of functional tests that send signals at a given frequency and evaluate hearing acuity after that. As a result, the ENT doctor has a complete picture of how the hearing organ functions. This examination can last from 15 – 20 minutes to several hours, may be unpleasant, but is always painless. It is carried out in a hospital, as it can sometimes provoke an attack of the disease.

An audiogram is required to set up a hearing aid or cochlear implant. It is also important to conduct this research before passing the commission to obtain a disability group. Considering that functional problems (decreased hearing acuity) are one of the earliest symptoms, it should be performed immediately at the first suspicion of Meniere's disease or syndrome. Based on the results of the audiogram, unfortunately, it is impossible to judge whether a primary (Meniere's disease) or secondary (Meniere's syndrome) process is occurring.

Dopplerography for Meniere's disease

For Meniere's disease, Doppler ultrasound is often recommended. It allows you to evaluate blood flow in the vessels of the brain. Transcranial Doppler ultrasound often reveals increased pressure in the arteries supplying the organ of hearing, as well as increased intracranial pressure. This test is completely safe and painless. The frequencies at which the study is carried out are not perceived by the hearing organ, so this test cannot provoke an attack of the disease.

Differential diagnosis for Meniere's disease

Differential diagnosis is the stage when doctors exclude other pathologies with similar manifestations, so as not to make a mistake when making a final diagnosis. Given that Meniere's disease or syndrome can manifest itself in different ways (sometimes, for example, only severe dizziness is present), other diseases should be taken into account.

Manifestations of Meniere's disease can be mistaken for the following pathologies:

vertebrobasilar insufficiency (problems with blood circulation in the vessels of the brain);
tumors in the cerebellum;
consequences of skull trauma;
inflammation of the auditory nerve;
acute or chronic otitis media (inflammation in the tympanic cavity).

To exclude most of these pathologies, consultation with various specialists (mainly a neurologist or neurosurgeon) and additional examinations will be required. Since Meniere's syndrome is quite difficult to detect in the early stages, sometimes a preliminary diagnosis is made simply by excluding other possible causes of dizziness. Before use, you should consult a specialist.

Meniere's disease is a fairly serious disease that mainly affects people of working age from 20 to 50 years and is manifested by episodes of severe systemic dizziness lasting up to 2-24 hours, loss of balance and noise in one and then in both ears. Gradually, the disease leads to hearing loss and the development of persistent noise on one or both sides.

Information for doctors. According to the international classification of diseases, Meniere's disease is coded H81.0. When making a diagnosis, it is necessary to indicate the frequency of attacks, the severity of hearing loss, indicating the location (left-sided, right-sided, bilateral).

Causes

The cause of true Meniere's disease is the so-called endolymphatic hydrops (an increase in the amount of fluid in the structures of the inner ear, the term hydrops is sometimes used). This condition is caused by a violation of the autonomic innervation of blood vessels, a violation of the reabsorption of endolymphatic fluid. There is also a point of view that these disorders are caused by changes in the functioning of the cells of the ear labyrinth and dysregulation of neurotransmitter systems.

Symptoms

Symptoms of Meniere's disease consist of four components: dizziness, imbalance, tinnitus, and hearing loss.

Dizziness with Meniere's disease is usually systemic (objects are spinning in front of the patient's eyes), paroxysmal. Such attacks are provoked by drinking alcohol, changing weather conditions, and psycho-emotional stress. The attack lasts a different amount of time for each patient and on average lasts from 2 to 10 hours. The frequency of attacks also varies significantly; in severe cases they can occur daily, while in favorable cases they develop once a year or even less frequently. During an attack, nausea and repeated vomiting are typical.

An attack of dizziness is almost always accompanied by imbalance. Patients may develop spontaneous falls; often, during an attack, a person cannot even sit. As the disease progresses, even in the interictal period, unsteadiness of gait and uncertainty when performing actions requiring the involvement of vestibular structures (riding a bicycle, etc.) may develop.

Tinnitus in this disease is typical during the interictal period. It has a low-frequency tonality, begins, as a rule, on one side, moves to both ears and then becomes a diffuse noise in the head and ears at the same time.

Hearing loss also develops on one side in most patients; as the disease progresses, bilateral hearing loss develops.

Diagnostics

Most researchers distinguish two stages of the disease - reversible and irreversible. In the irreversible stage, the patient is characterized by the presence of light intervals in the interictal period during which there are no persistent vestibular disorders. At the irreversible stage, the frequency and duration of each attack increase, the light intervals shorten over time, and persistent disorders develop: deafness, gait disturbance, tinnitus.

In the diagnosis of Meniere's disease, a test with glycerol plays a significant role. 1.5 grams of glycerin per kilogram of the patient’s body weight is diluted in equal proportions with water and drunk. Improvement in hearing and other manifestations of the disease indicates a positive result of the test and the presence of reversible hydrops of the inner ear, while deterioration of the condition indicates the irreversibility of the pathological process.

A joint examination by an ENT doctor and a neurologist also plays an important role in diagnosis. Also, if a disease is suspected, it is advisable to carry out neurophysical examination methods (structures of the inner ear in order to identify endolymphatic hydrops).

Treatment

Treatment of Meniere's disease is usually symptomatic. Almost all patients are prescribed betahistine (the original drug) in adequate doses for a long period (at least 6 months). Neuroprotective drugs are also widely used. All medications are used by patients for a long time. In the initial stages, diuretic therapy (mannitol, diacarb) may be prescribed. During an attack, it is possible to prescribe antiemetics (cerucal). It is also recommended that all patients avoid factors that can cause an attack of the disease (smoking, drinking alcohol, high doses of caffeine, etc.).

In case of severe disease, surgical interventions are possible. This method of treatment is a last resort, because destruction of the labyrinth by mechanical or chemical means leads to deafness and serves only to alleviate the manifestations of the disease (ringing, dizziness, vomiting).

In almost all cases, Meniere's disease sooner or later leads to disability. However, timely treatment of attacks, following a diet with limited alcohol and caffeine, and taking neuroprotective drugs can significantly lengthen the “light” period of patients’ lives.

Recently, the treatment of Meniere's disease with folk remedies has been gaining popularity. At the same time, various herbal infusions, laxatives, dried fruits, strict diets and other techniques are offered. Unfortunately, the effectiveness of these methods has not been proven and, most likely, people who guarantee a 100% cure using these methods are charlatans.

At the moment, there is no guaranteed method of curing this disease, as well as a guaranteed method of delaying the onset of deafness and disability in a person.

Video material by the author

is a unique system of channels that is responsible for the balance of our body and the transformation of sound waves into nerve impulses perceived by the brain. Inner ear pathologies are not uncommon in medical practice. Hearing loss, loss of balance, dizziness and weakness may indicate damage to the auditory or vestibular system.

Reference. Often the disease is unilateral, but in 15% of cases it can affect both auditory organs.

There is no clear answer to the question of what are the causes of the development of Meniere's disease in medical practice. But, presumably, diseases such as disturbance of water-salt balance in the body, allergies, syphilis, viruses, endocrine and vascular pathologies. Deformation of the bone canals can also play an important role in this.

X-ray of the jaw, dental examination or pharyngeal nasal reflex. To determine the possible causative agent of the infection, the doctor may also do a smear. Treatment for ear pain depends on the cause. If it is inflammation of the ear, the pain can be reduced with anti-inflammatory ointments. In severe cases, treatment with antibiotics is necessary.

When it is otitis media, treatment is usually anti-inflammatory and pain-relieving. Antibiotics are needed to eliminate pathogens, especially in children under 2 years of age. In certain circumstances, the doctor may need to make a small incision in the eardrum to drain pus from the ear.

Meniere's disease is characterized by paroxysmal course. During periods of remission, the patient may experience improvements in both hearing and general health. As for exacerbations, they correspond to very clear symptoms, which the patient should be aware of.

Hydrocele of the labyrinth of the inner ear has the following symptoms:

Diagnosis and treatment

In ear diseases in adults, symptoms and treatment vary markedly. In general, the structure of the ear in children and adults is unique. In addition to the auricle itself, located outside, there are two more sections of the hearing organ: middle and internal. In this case, diseases can affect any department.

Problems with the ears are different; they can affect different parts of the hearing organ. Let us recall that the external part includes the auditory canal and the auricle itself; the middle ear refers to the tympanic cavity with auditory-type bones, which is located in the inner part of the temple bone. In the inner part of the ear there is a system of bone canals that convert sound waves into nerve impulses and are responsible for the balance of the body.

Human ear diseases are quite common, with five percent of the world's population suffering from severe hearing loss. And these are only extreme forms of damage to the auditory organ. In this case, a moderately severe disease can occur in a person several times throughout life, regardless of age and lifestyle.

However, a certain category of people more often suffers from ear diseases. We are talking about workers in enterprises where hearing is subject to additional stress, swimmers, and patients with various chronic forms of diseases.

Because of such widespread prevalence, ear diseases in people need to be divided into types for easier diagnosis by doctors. Ear diseases in humans can be divided into:

traumatic;
fungal;
non-inflammatory;
inflammatory.

Causes of deaf-muteness

This pathology can be either congenital or acquired. Deafness is acquired before the age of three. With the congenital variant, pathology develops in the womb. This is most often due to exposure to harmful factors during pregnancy.

If we talk about the hereditary form of the disease, the middle and inner parts of the ear are most often affected. Acquired forms are characterized by the onset of deafness due to infections and ototoxic drugs. As a result of deafness, muteness also develops. It is worth noting that in this condition treatment is ineffective. Efforts are directed towards teaching verbal speech. For this, it is important to choose specialized institutions.

With the help of modern techniques, good progress can be achieved. There is also a variant of sudden deafness, which is most often associated with vascular disorders or viral infections. This condition occurs in blood diseases, syphilis, and in diabetics. In case of sudden deafness, immediate hospitalization cannot be avoided. Treatment requires the administration of special medications, most often intravenously. In this case, we must fight to restore hearing. This is real.

Miner's disease

One of the variants of non-inflammatory ear diseases is Minière's disease. It affects the inner part of the ear. It is characterized by periodic dizziness, nausea and vomiting, tinnitus, problems with balance, and increased irritability. These signs appear in fits and starts. The cause of the pathology is diseases of individual internal organs, including allergies, menopause, and hormonal imbalances.

The main problem of the disease is a severe disorder of vestibular function. After the attack is over, the condition stabilizes, but there is still hearing loss and noise in the ears. Gradually the disease can progress. Most often, Minière's disease affects one ear, and there is no specific treatment for the pathology, only methods aimed at eliminating unpleasant symptoms. Bed rest is recommended. It is important to adhere to a diet with a minimum amount of salt and take foot baths with mustard.

Syabro powder is used to stop acute symptoms; antiemetic drugs can prevent vomiting. Usually, during the period of remission, electrophoresis, special physical exercises, and acupuncture are prescribed. Any bad habits are prohibited; try not to sunbathe or swim in bodies of water where there is great depth. Sometimes surgical intervention using ultrasound or cryotherapy is proposed for treatment.

Additional options

Ear bleeding often results from serious pathologies. This can happen with fractures. Yes, there are bone areas in the ear canal, so a fracture is possible. Fractures often provoke damage to the eardrum. Often the causes are otitis media, which has turned into a purulent form. However, leakage can occur in both acute and chronic forms. The cause of bleeding may be mechanical damage in the middle and outer sections and the formation of tumors in them. Treatment in this case is selected depending on the underlying cause. However, the appearance of bloody discharge is a reason for immediate consultation with a doctor.

Another common disease is inflammation of the mastoid process, which is attached to the temple bone. Most often, you encounter this problem with acute otitis media as a complication. With mastoiditis, suppuration begins in the process mentioned above. The main danger in this case is intracranial complications, for example, meningitis.

If we talk about general symptoms, then mastoiditis is expressed by fever and headache. Changes are also demonstrated in the general blood test. Speaking about local symptoms, it is worth highlighting pain in the ear, which adapts to the person’s pulse, discharge of pus, swelling of the auricle, swelling and hyperemia in the area behind the ear. Pressing on the appendix increases pain.

However, many of these symptoms are also characteristic of other pathologies, so X-rays and diagnostic paracentesis, in which the eardrum is pierced, are indicated. The main therapeutic point is related to the need to remove all pus from the middle ear; the fight is carried out directly against inflammation. Sometimes surgical intervention is required. Most often this is due to the development of complications or lack of effectiveness of conservative therapy.

Due to its deep location in the temporal lobe of the head, symptoms of inner ear disease are quite difficult to recognize. Its infection most often occurs due to other foci of inflammation.

Labyrinthitis (internal otitis)

Labyrinthitis is an inflammatory disease of the inner ear that affects the vestibular and auditory receptors. Labyrinthitis accounts for no more than 5% of the total number of diagnosed otitis media. The main pathogens are bacteria (staphylococci, streptococci, mycobacterium tuberculosis, meningococci, pneumococci, Treponema pallidum). Mumps and influenza viruses can also activate the process.

Based on the initial focus of the lesion and the route of entry of the pathogen into the cochlea, the following forms of labyrinthitis are distinguished:

Tympanogenic. Infection spreads through the swollen membranes of the cochlear window or vestibule from the middle part of the auditory organ if there is an infection there. The outflow of pus is complicated, so the pressure inside the labyrinth increases.
Meningogenic. Infection occurs from the meninges in various types of meningitis (tuberculosis, influenza, measles, typhoid, scarlet fever). Often both ears are affected, which can lead to acquired deaf-muteness.
Hematogenous. Introduced by blood or lymph flow during illnesses such as syphilis or mumps. Very rare.
Traumatic. Develops as a result of damage to the eardrum by a foreign body (needle, pin, match) as a result of improper hygiene procedures. May occur with traumatic brain injuries complicated by a fracture of the base of the skull.

Inflammatory disease of the inner ear, symptoms:

noise and pain in the ears;
dizziness (appears a week and a half after a person has suffered a bacterial infection and is regular, lasting from several seconds to hours);
hearing loss (especially high-frequency sounds);
imbalance;
reflexive frequent vibrations of the eyeballs (starts from the side of the diseased organ);
sometimes vomiting, nausea, pallor, sweating, discomfort in the heart area.

With sudden movements of the head, bending, or procedures on the hearing organs, the symptoms intensify.

From the labyrinth, the inflammatory process on the affected side can reach the trunk of the facial nerve and cause its paralysis. Signs of this are:

fixed corner of the mouth;
asymmetry of the tip of the nose;
absence of folds on the forehead when raising the eyebrows;
inability to completely close the eye;
increased salivation;
dry eyeball;
change in some taste sensations.

If there are symptoms of labyrinthitis, an in-depth examination is carried out to establish an accurate diagnosis: blood test, magnetic resonance therapy, audiometry, electronystagmography (study of eyeball reflexes), bacteriological examination. An otolaryngologist or neurologist can diagnose diseases of the inner ear, the symptoms of which are not clearly expressed.

Treatment of labyrinthitis can be carried out using conservative and surgical methods. Drug therapy is used in cases where there are no purulent formations and the disease is not widespread.

Antibiotics of the cephalosporin and penicillin series are prescribed.

To dehydrate the body, it is prohibited to take liquid (daily intake - no more than 1 liter) and salt (up to 0.5 g). Glucocorticoids and diuretics are taken, and intravenous injections of magnesium sulfate and calcium chloride are given. Unpleasant symptoms are relieved with the help of antiemetics (cerucal), antihistamines (fenistil, suprastil) and sedatives (lorazepam, diazepam). Vitamins C, K, B, P, cocarboxylase, as well as intravenous atropine prevent the occurrence of trophic disorders.

In the case of a complicated purulent form of internal otitis, pus is removed by general cavity trepanation after conservative treatment. Labyrinthectomy is very rarely performed. Timely surgical intervention can prevent the diffuse form of labyrinthitis and preserve the patient’s hearing.

Meniere's disease

The etiology of this disease is unknown. The main signs of the disease are periodic attacks of dizziness, decreased perception of sounds and tinnitus. With each attack, hearing gradually deteriorates, although for a long period it may remain in a state close to the normal limit.

The suspected causes of the disease at different times were considered to be: disturbances in the ionic balance of fluids, water and vitamin metabolism, vegetative-vascular dystonia, and vasomotor disorders. By far the most common variant is intralabyrinthine edema due to increased endolymph.

Clinical picture:

progressive hearing loss in one or both ears;
regular attacks of dizziness, accompanied by loss of balance, vomiting and nausea;
tinnitus (one or two, usually at low frequencies)
tachycardia.

The patient's head may feel dizzy either often (1-2 times a week) or very rarely (1-2 times a year). Often, as a result of this, a person is unable to stand on his feet.

Temporary memory loss, drowsiness, forgetfulness, and fatigue are possible.

Based on these signs, the disease is diagnosed. For a more accurate diagnosis, audiometry, computed tomography or MRI, brain stem response test, and electronystagmography are used.

For conservative therapy, the following is used:

Surgical intervention has several techniques:

endolymphatic shunting (a tube is inserted to drain fluid into the endolymphatic sac);
decompression of the endolymphatic sac (a piece of bone is removed to increase the volume of the sac);
dissection of the vestibular nerve (the part of the nerve responsible for balance is cut, hearing is not lost, but the operation is fraught with errors);
labyrinthectomy (the labyrinth is removed, resulting in hearing loss).

There are other treatment methods, but they have a number of disadvantages and are therefore used only in certain clinics.

Otosclerosis

Otosclerosis is a degenerative disease that affects the bone capsule of the labyrinth, in which bone tumors are localized. The causes of the disease are unclear; doctors believe that heredity plays an important role here, since the disease can be traced in several generations. About 85% of patients are women, and their disease progresses during pregnancy and childbirth. The first manifestations are usually recorded at 20-40 years of age.

The main symptoms are decreased conductive hearing and tinnitus. Over time, neuritis may occur.

Hearing loss begins in one ear, and much later the other becomes involved. In this case, the enlarged cochlea interferes with the normal movement of the ossicles of the hearing aid.

Drug treatment can only provide a noise reduction effect. Therefore, if hearing deteriorates by 30 dB, the situation is corrected surgically, this helps more than 80% of patients. Surgical intervention consists of installing a stapes prosthesis in each auditory organ, one at a time, at intervals of six months. In some cases, the only option for the patient is a hearing aid.

Sensorineural hearing loss

Sensorineural hearing loss is a lesion of the organs responsible for the perception of sound. In this regard, the sound is received weakly and in a distorted form. The reasons may be:

Meniere's disease;
age-related changes;
injuries to the temporal part of the head;
neuritis of the auditory nerve.

If detected at an early stage, therapy is carried out with drugs, electrical stimulation, and physiotherapy. In other cases, it is necessary to resort to hearing aids.

The inner ear is a unique system of canals that is responsible for balancing our body and converting sound waves into nerve impulses perceived by the brain. Pathologies of the inner ear are not uncommon in medical practice. Hearing loss, loss of balance, dizziness and weakness may indicate damage to the auditory or vestibular system.

Let's take a closer look at what types of diseases of the inner ear there are, their symptoms, causes, and also talk about the prevention of these diseases.

Types of inner ear diseases: symptoms and causes

The most common types of inner ear diseases are:

labyrinthitis;
Meniere's disease;
sensorineural hearing loss;
otosclerosis.

Reference. In most cases, with timely consultation with a doctor, pathologies of the inner ear can be treated conservatively.

However, the need for surgical intervention cannot be ruled out, because sometimes this may be the only chance to restore a person’s hearing. How exactly diseases affect the organ of hearing and how to check the inner ear for pathology, we will try to figure it out further.

Magnetic resonance imaging of the inner ear does not harm the patient and does not require special preparation

Labyrinthitis

Labyrinthitis is an inflammatory disease that occurs as a result of injury or infection of other parts of the ear. The main cause of labyrinthitis is otitis media..

During inflammation, the density of the membrane wall decreases, and pathogenic microflora begins to penetrate through it. With a long course of the disease, a membrane rupture occurs, followed by purulent damage to the auditory receptors.

It can also provoke the development of inflammation meningitis, syphilis, herpes virus and mumps. Somewhat less common is traumatic labyrinthitis of the inner ear due to rupture of the eardrum with a sharp object or a traumatic brain injury with a fracture.

Important! Banal hypothermia can provoke an inflammatory disease of the inner ear and the death of nerve endings. For prevention, it is recommended not to be exposed to cold, sharp winds for a long time.

Main symptoms of acute labyrinthitis:

nausea and dizziness, worsening during physical activity;
impaired balance and coordination of movement;
change in complexion (redness or excessive pallor of the skin);
increased sweating.
hearing loss, tinnitus.

One of the distinguishing signs of labyrinthitis is sudden dizziness, occurring several weeks after the infection.

The attack can last quite a long time, up to a month. In addition, the symptom most often persists for several weeks even after treatment.

Meniere's disease

Meniere's disease, or, as it is also called, hydrocele of the labyrinth of the inner ear, is a non-purulent disease. During its development, the amount of fluid in the labyrinth increases and internal pressure increases.

Reference. Often the disease is unilateral, but in 15% of cases it can affect both auditory organs.

Hydrocele of the labyrinth of the inner ear has the following symptoms:

gradual deterioration of hearing with sudden temporary improvements;
attacks of dizziness;
constant ringing in the ears;
disorientation in space, loss of balance;
nausea and vomiting;
pale face;
sweating;
decrease in temperature.

Attention! At risk are mainly people aged 30 to 50 years.

Sensorineural hearing loss

Sensorineural hearing loss is commonly called hearing loss due to damage to the sensitive nerve endings of the inner ear and the auditory nerve itself. Factors that can trigger the development of the disease include: viral infections such as influenza and ARVI, vascular pathologies (hypertension, atherosclerosis) and even stress.

Medicines (salicylates, diuretics, aminoglycoside class antibiotics) and industrial chemicals can also become a provoking factor. In addition, the cause of sensorineural hearing loss is various types of injuries: mechanical damage, acoustic, barotrauma.

Vestibular dysfunction in sensorineural hearing loss is not uncommon. Therefore, the following symptoms are added to hearing loss:

noise in ears;
dizziness;
lack of coordination;
attacks of nausea;
vomit.

Reference. With properly selected treatment for sensorineural hearing loss, the prognosis for the patient is quite favorable.

A cochlear implant is a medical device, a prosthesis, that allows one to compensate for hearing loss in some patients with severe or severe sensorineural hearing loss.

Otosclerosis

Otosclerosis is a pathological condition characterized by the proliferation of bone tissue and changes in its composition in the hearing system, in particular in the inner ear. To date, the true causes of the development of this disease have not been established.

But anyway experts are inclined to believe that this is a congenital anomaly of the auditory organ. At the same time, one should not discount the hereditary factor.

Inner ear diseases and dizziness always go hand in hand. And otosclerosis is no exception. This symptom is especially disturbing when turning the head or bending. However, the main sign of the development of the disease is tinnitus, the intensity of which increases with its course.

At the third stage of otosclerosis, complaints of tinnitus are complemented by severe headaches, sleep disturbances, memory impairment, and decreased concentration.

Prevention of inner ear diseases

The ability to hear is a most valuable gift that must be protected. Modern medicine has developed methods for prosthetic hearing organs, but such methods cannot become a full replacement for the lost sense. So prevention of hearing aid pathologies should become an integral part of every person’s lifestyle.

Do not listen to music too loudly through headphones, as this may cause hearing loss

The following recommendations will help prevent diseases of the inner and middle ear:

Cover your head during the cold season. No matter how ridiculous you look with a hat or hood pulled almost over your eyes, it is the least you can do to maintain your health.
Right clean your ears. Do not use improvised means or sharp objects to remove wax from the ear canal. Caution must also be exercised when using ordinary cotton swabs, with which you can accidentally seal the plug, pushing it towards the eardrum.
Use soundproofing accessories with constant exposure to loud sounds on the hearing organs.
Buy earplugs if you swim or just like to visit the pool periodically. Infection entering the ear through contaminated water is quite common.
Don't neglect qualified help in the treatment of diseases of the throat and nasopharynx. Even a common runny nose can cause otitis media.

And remember, the importance of healthy ears and good hearing cannot be underestimated!

Symptoms and treatment of internal otitis

Internal otitis is called inflammation of the inner ear area (labyrinth). The labyrinth itself consists of three semicircular canals, the function of which is to control balance. In most cases, inflammation of the inner ear is caused by a viral, less often bacterial, background.

Internal otitis media cannot appear on its own. Most often it occurs as a result of complications of chronic or acute otitis, as well as against the background of a severe general infectious disease (for example, tuberculosis). In addition, a common cause of the disease is inflammation of the upper respiratory tract - flu, colds. Trauma is also a cause of otitis media of the inner ear.

The main symptoms of internal otitis are:

As for dizziness, this symptom can be a sign of many diseases. In the case of internal otitis, dizziness appears after 1-2 weeks of bacterial infection. During this time, pathogenic microorganisms penetrate through the bloodstream into the cavity of the inner ear, causing an inflammatory process there.

It is worth noting that severe attacks of dizziness may be accompanied by symptoms such as nausea and vomiting. From the outside, this course of the disease strongly resembles “sea sickness.” As a rule, dizziness goes away after a few days or weeks. But, if there are sudden movements of the head, dizziness may return again.

In addition to the main signs, the following symptoms are distinguished:

imbalance;
fever - this symptom is characteristic of any inflammatory processes;
eye twitching;
The purulent form of internal otitis is characterized by persistent hearing loss, leading to its complete loss.

Infection can enter the inner ear in a variety of ways. With a favorable course of the disease, the exudate (inflammatory fluid) resolves. In case of complications, fluid (pus) accumulates, which subsequently leads to complete loss of hearing.

Dizziness with internal otitis

Diagnostics

If the above symptoms and characteristic complaints of the patient are present, an examination is performed, which includes a clinical blood test. Also, to find out the true cause of dizziness, special tests are performed.

If the doctor cannot fully determine the cause of dizziness, the following studies are carried out:

Electronystagmography - this study records the movement of the eyeballs. The movement is recorded by electrodes. Dizziness, which is caused by otitis media of the inner ear, causes a certain type of movement of the eyeballs. Dizziness caused by another cause is characterized by different types of movement.
MRI, CT - computed tomography, as well as magnetic resonance imaging allows you to visualize the brain and make visible any of its pathologies (for example, tumors, strokes, etc.).
Hearing test - this research method is carried out in order to identify the presence of any hearing abnormalities.
Response Test - This test examines the auditory parts of the brainstem to determine whether the auditory nerve, which runs to the brain from the inner ear, is functioning normally. If this test reveals hearing loss, Meniere's disease is confirmed.
Audiometry - determined subjectively using audiometry. how well a person hears. The study includes behavioral testing as well as behavioral tone audiometry.

The doctor conducts an examination

In most cases, the symptoms of otitis media of the inner ear go away on their own. In cases where labyrinthitis was caused by a bacterial infection, antibiotic therapy is prescribed. In cases of viral infection, antibiotics are not prescribed.

It is worth noting that drug treatment of internal otitis is similar to the treatment prescribed when Meniere's disease is detected. This kind of treatment can be called symptomatic - aimed at reducing the manifestation of the disease.

The following drugs are prescribed:

antiemetics - these medications are aimed at eliminating symptoms such as dizziness, nausea, and vomiting. These include phenegran, cerucal, compazine.
Antihistamines are also prescribed to reduce dizziness, vomiting, and nausea. These are drugs such as suprastin, diazolin, diphenhydramine, etc.
Steroids - prescribed to reduce the inflammatory process. These drugs include methylprednisolone.
Sedatives - to reduce vomiting, nausea, and various types of anxiety. These include drugs such as lorazepam, diazepam.

Scopolamine is also used in practice - a special patch form that is glued behind the ear. The drug is also aimed at reducing nausea and vomiting. Used for internal otitis, Meniere's disease.

But not always even the most adequate and timely treatment can completely eliminate a symptom such as dizziness. This happens with bacterial inflammation. But over time, the dizziness goes away completely and no longer bothers the patient.

In some cases, the patient is prescribed surgery, simultaneously on the labyrinth and on the middle ear. The operation is prescribed for a purulent form of labyrinthitis with an intracranial complication.

Internal otitis: how to treat?

Labyrinthitis: causes and manifestations

Like other types of otitis, inflammation of the inner ear is most often associated with infection, and sometimes with injury. Sources of infection can be:

purulent inflammation of the middle ear;
viral diseases (flu, sinusitis, measles, mumps, etc.);
general infectious diseases such as staphylococcal infection, tuberculosis, syphilis, etc.

The main symptoms of internal otitis are not always perceived as inflammation, especially since the ear does not always hurt. They can easily be mistaken for increased blood pressure or extreme fatigue. These include:

dizziness of varying degrees of intensity;
noise and ringing in the ears;
visual disturbance with characteristic “flickering”, “floaters”;
disturbance of the sense of balance;
inability to concentrate on anything;
nausea of varying intensity, as well as vomiting;
unilateral weakening or complete loss of hearing.

The inner ear can become inflamed not only in adults, but also in children. In childhood, the main risk factors are complications of diseases, in particular rubella, tonsillitis, mumps. Children cannot always tell what is hurting them; they may feel dizzy, ringing in the ears, and involuntarily look away towards the healthy ear.

These unpleasant symptoms are associated with the accumulation of exudate in the inner ear. They intensify when moving the head, trying to stand up, which forces the patient to remain only in a supine position. Uncomplicated inflammation can last a week or more, after which labyrinthitis either goes away or goes into a purulent stage. Final recovery takes several weeks. All this time, symptoms associated with poor coordination appear to one degree or another.

Such people cannot drive a car, work at heights, have difficulty concentrating, are constantly disoriented in their surroundings, and experience ringing in their ears. It is even more dangerous when the inflammation turns into a necrotic form, which can lead to general sepsis. Thus, inflammation of the inner ear in adults and children is a disease that needs to be treated very seriously and professionally.

Diagnosis and treatment

If the symptoms described above appear regularly, this is a reason for examination by an ENT specialist. In addition to examining the patient, the diagnosis of “internal otitis” is established based on examination using:

audiometry, showing hearing acuity and the ability to distinguish tones;
electronystagmography, which can determine the cause of dizziness by the type of movements of the eyeballs;
magnetic resonance and computed tomography, which determine the presence of brain pathology;
ABR - testing the brain's response to a sound stimulus.

In some cases, a consultation is carried out with a neurologist, neurosurgeon, dermatovenereologist, infectious disease specialist and other specialists. After establishing the diagnosis and the extent of damage to the inner ear, appropriate treatment is prescribed, which is carried out in a hospital. In most cases, it is recommended to treat labyrinthitis symptomatically, that is, use drugs that reduce the symptoms of this disease.

If labyrinthitis was caused by a bacterial infection, then antibiotics are prescribed in large doses, primarily Azithromycin and Ceftriaxone injections. Specific therapy for other types of pathogens is usually not carried out. According to indications, funds from such groups as:

antihistamines (Betagistin, Suprastin, Diazolin, etc.);
antiemetics (Cerucal, Phenegran, and Scopolamine patch);
sedatives (Diazepam, Lorazepam, etc.);
steroids (Medrol and other Prednisolone derivatives);
diuretics (Furosemide).

Non-drug treatment

However, even the most effective remedies cannot always cope with problems of the vestibular system. To reduce dizziness and improve coordination, special exercises are recommended. They can be performed at home after learning with medical staff. The most common types of rehabilitation exercises are:

In a sitting position, then standing, fix your gaze on a stationary object and turn your head without taking your eyes off the selected point.
Sitting on the edge of the bed, turn your head towards the sore ear and quickly lie down. After the symptoms of dizziness stop, you should sit down again, wait for the dizziness to stop and repeat the exercise in the other direction.

It is recommended to perform such exercises twice a day, gradually increasing their total duration to twenty repetitions (about half an hour). In many cases, the symptoms of dizziness are significantly reduced after the first workout, and otitis media itself goes away much faster.

general sanitation of all parts of the ear;
removal of abscess and necrotic tissue;
cleaning the cochlea, its vestibule and circumferential canals.

Are there any folk remedies for labyrinthitis?

Inflammation of the inner ear is one of those types of diseases for which self-treatment is excluded. Moreover, it is recommended to treat the patient in a hospital so as not to miss the moment when the inflammation turns into a purulent form. It should also be remembered that it is impossible to instill medicinal drugs into the inner ear, and widespread folk traditions of treating the ears by heating threaten that labyrinthitis will go into the purulent stage.

The main folk remedies that can help with this disease belong to the same groups of drugs as the medications that doctors use to treat labyrinthitis. These are herbal medicines that have antibacterial, anti-inflammatory, diuretic properties, as well as herbs that help reduce nausea.

The most common folk remedies with a wide range of antiseptic, anti-inflammatory and regenerating properties are honey and garlic.

A collection of equal parts has a good effect on all internal inflammations:

eucalyptus;
yarrow;
calendula;
sequences;
licorice root.

A tablespoon of this collection is brewed with a glass of boiling water, allowed to brew for half an hour, then drunk several times a day.

Mint, lemon balm, and dried ginger help cope with nausea and vomiting. They can be brewed separately or mixed to taste. To prepare a glass of tea you will need one or two teaspoons of dry raw materials. Drink a glass of this tea a day, adding honey and lemon to taste.

Algorithm of actions for internal otitis

Internal otitis (labyrinthitis) is an acute or chronic inflammatory process of the vestibular apparatus of the ear. The disease is rare, affects the deep structures of the hearing organ, and sometimes causes a brain abscess. Dizziness, loss of balance and hearing loss (hearing impairment) are the main symptoms of the disease. Labyrinthitis is often caused by purulent otitis media, sometimes occurring after injuries and surgical interventions. Concomitant symptoms and treatment of internal otitis depend on the causes and stage of the pathological process.

The inner ear contains important structures: the labyrinth, the cochlea, and the auditory nerve. They form the vestibular-auditory apparatus, which is responsible for the balance of the body and the transformation of hearing. These organs are located inside the temporal bone, close to the brain, which plays a special role in the spread of inflammation. The signs of acute internal otitis are more pronounced with unilateral lesions than with both sides. The following symptoms of the disease are distinguished:

Dizziness. It occurs due to the fact that the brain receives different information about the position of the head from the healthy and affected auditory organ. Patients complain of constant “rotation” of objects in front of their eyes and the inability to stay in one body position. Such sensations last from 5-10 minutes to several hours.
Nystagmus. This symptom is important for a doctor who can determine the side of the ear lesion and distinguish other brain diseases.
Impaired coordination and walking occur when the nerve and cochlea are damaged. The gait becomes shaky and uncertain.
Hearing loss or deafness is caused by pathology of the auditory nerve. Bilateral processes lead to deafness, the correction of which requires the installation of a hearing aid. Patients do not hear whispers, constantly listen to the interlocutor, watch TV with maximum volume.
Nausea and vomiting begin due to dizziness and damage to the vestibulo-cochlear nerve. These symptoms can be disturbing for 10-20 minutes a day, or they can be present constantly until the disease is cured.
Tinnitus is caused by inflammation of the auditory nerve and disruption of the auditory ossicles. Often the symptom appears after suffering from otitis media. Sometimes patients hear a thin ringing, squeaking or buzzing sound.
Ear pain. The symptom is characteristic of a purulent process, when the accumulated exudate has no way to exit the cavity of the inner ear. The pain is constant and debilitating.

General symptoms of internal otitis are associated with disruption of the conduction of impulses along the nerves, the outflow of endolymph (fluid) into the ventricles of the brain, and inflammation of the labyrinth cells. Patients with internal otitis experience increased sweating and frequent headaches. Bradycardia (rare pulse) leads to pain in the heart, general weakness, fatigue, which is caused by insufficient blood flow to the head. If the purulent process in the inner ear spreads to the membranes of the brain, then spasms of the neck muscles, chills appear, and body temperature rises to 40 degrees. Celsius.

Causes and diagnosis

Otolaryngologists identify various causes for the development of internal otitis. In children and adults, the disease appears after the progression of purulent inflammation of the middle ear. In this case, bacteria penetrate the labyrinth and cochlea, damaging the receptor cells. Primary damage to the meninges (meningitis) is caused by pathogenic bacteria and viruses that can enter the inner ear. But also pathology of the vestibular apparatus can be provoked by herpes viruses, tuberculosis and typhus bacteria.

Labyrinthitis (inflammation of the inner ear): how to treat, causes

Labyrinthitis is an inflammatory process localized in the inner ear, which damages the nerve receptors that perceive sounds and regulate balance. Accordingly, the main symptoms of labyrinthitis are hearing loss and dizziness (cochleovestibular disorders).

A little anatomy

The ear is not only the auricle that we see and can touch. The ear is a most complex apparatus, an organ of hearing and balance, the function of which is to perceive sounds and signals of the body’s position in space, conduct them, convert them into nerve impulses, which subsequently pass to the brain. The ear is divided into 3 parts:

Outer ear(auricle and external auditory canal).
Middle ear(the tympanic cavity, which contains the 3 smallest bones of our body that conduct sound vibrations).
Inner ear.

The inner ear is located deep in the temporal bone. This is a system of intraosseous spaces communicating with each other. The following sections of the inner ear are distinguished: cochlea, vestibule and 3 semicircular canaliculi. Because of its intricate shape, this system is called the bony labyrinth. The lumen diameter of each tubule is up to 0.5 mm. Inside the bony labyrinth there is a membranous labyrinth. It is in it that receptors are located - sensitive cells that perceive signals from the external environment. Sound receptors are located in the cochlea, and structures of the vestibular apparatus, that is, the organ of balance, are located in the vestibule and tubules.

Causes of labyrinthitis

The main cause of labyrinthitis is infection. Infection enters the inner ear in different ways. Accordingly, labyrinthitis is distinguished according to its distribution paths:

Tympanogenic. The pathogen enters the labyrinth from the tympanic cavity of the middle ear during its purulent inflammation. The most common form of the disease.
Meningogenic. Spread through the meninges with meningitis.
Hematogenous. The infection enters the bloodstream during the complicated course of certain infectious diseases (measles, scarlet fever, mumps, tuberculosis). This process is usually bilateral and can lead to complete deafness.
Traumatic. Infection occurs directly during injury.

According to the course, labyrinthitis can be acute and chronic, according to the prevalence of inflammation - limited and diffuse, according to the nature of the inflammatory exudate - serous, purulent or necrotic.

Serous tympanogenic labyrinthitis is the most common. With purulent otitis media, the membrane separating the middle ear from the inner ear becomes permeable to inflammatory exudate - serous inflammation occurs in the inner ear. Sometimes, due to the accumulation of exudate, the pressure increases very strongly, which leads to rupture of the membrane, breakthrough of pus, and then purulent labyrinthitis develops.

In chronic otitis media, the pathological process affects the bone labyrinth, with the formation of a fistula (fistula) in the semicircular canal, the infection from the bone wall spreads to the internal structures of the labyrinth.

Symptoms of labyrinthitis

According to the physiology of the inner ear, symptoms of its damage appear. This is hearing loss and dizziness. The severity and rate of increase in symptoms depend on the severity of the process and the nature of the inflammation.

In acute cases, a so-called labyrinth attack occurs: hearing suddenly decreases or disappears, severe dizziness occurs, and balance is disturbed. The slightest movement of the head worsens the condition, the patient is forced to lie motionless on his side on the side of the healthy ear.

Labyrinthine vertigo is defined by the patient as an illusion of rotation of surrounding objects or rotation of the person himself. There may be nausea and vomiting. This kind of dizziness is called systemic. There is also non-systemic dizziness with damage to the cortical (cerebral) parts of the vestibular analyzer. It manifests itself as a feeling of instability, sinking when walking.

The duration of a labyrinth attack ranges from several minutes to several hours, sometimes days. During the purulent process, the stage of suppression of the affected labyrinth then begins, and signs of asymmetry of the labyrinths appear, which are revealed during a routine neurological examination.

Acute labyrinthitis may manifest as a single labyrinthine attack. In the chronic course of the disease, attacks of dizziness recur periodically.

Other less specific symptoms of inner ear inflammation: tinnitus, headache, sweating, palpitations. A possible complication is neuritis of the facial nerve, the trunk of which passes between the vestibule and the cochlea of the inner ear. Also, when the infection spreads to the mastoid process of the skull, mastoiditis can develop. And the most dangerous complication of purulent labyrinthitis is meningitis, encephalitis or brain abscess.

Diagnosis of labyrinthitis

If there are typical complaints of paroxysmal systemic dizziness, hearing loss and indications of ear pain 1-2 weeks before the disease, it is not difficult to suspect a diagnosis of labyrinthitis. With a limited process and chronic course, clinical manifestations may be erased. Vestibular tests and detection of hidden nystagmus help in making a diagnosis.

Nystagmus is an involuntary oscillatory movement of the eyeballs. This is the main objective syndrome when the labyrinth is affected (although there are many other causes of nystagmus). It is detected during a routine examination or during a fistula test.

They also help in diagnosing labyrinthitis:

Otoscopy (examination of the external auditory canal and eardrum).
Audiometry.
Electronystagmography.
X-ray of the temporal bone.
CT scan of the temporal bone.

Treatment of labyrinthitis

In cases of acutely developed labyrinthitis, urgent hospitalization is indicated. Such a patient must be provided with bed rest and complete rest.

Basic principles of conservative treatment of inflammation of the inner ear:

Elimination of the pathogen, that is antibiotic therapy. Broad-spectrum antibiotics are used except ototoxic ones (aminoglycosides).
Dehydration. These are measures aimed at reducing swelling and reducing pressure inside the labyrinth. For this purpose, limit the intake of salt and liquid, the introduction of hypertonic solutions (40% glucose solution, 25% magnesium sulfate solution, 10% calcium chloride solution). Diuretics (Diacarb) and glucocorticosteroid hormones are also prescribed.
Antiemetics. In case of an acute attack of dizziness, a labyrinthine attack, Atropine, Pilocarpine, Omnopon, Aminazine are injected subcutaneously. Aeron is prescribed orally in tablets.
Drugs that suppress impulses from the vestibular analyzer and thus reducing dizziness. These drugs include Betahistine.
Drugs that improve the trophism of affected tissues(B vitamins, Ascorbic acid, Cocarboxylase, Trimetazidine).

If labyrinthitis occurs as a complication of purulent otitis media and there is no improvement from conservative treatment within 4-5 days, surgical treatment is indicated. The purpose of the operation is the sanitation of a purulent focus in the tympanic cavity, revision of its medial wall, which borders the inner ear. If there is a fistula of the semicircular canal, plastic surgery is performed using a portion of the periosteum. The operation is performed using a special operating microscope.

Emergency surgery is indicated in the presence of intracranial complications. And a very rarely performed operation these days is labyrinthectomy. It is performed for purulent or necrotic labyrinthitis.

Outcomes of labyrinthitis

In general, the outcome of labyrinthitis is favorable. All symptoms (hearing loss, attacks of dizziness) are reversible and stop fairly quickly with timely treatment.

Only in purulent forms (which, fortunately, are extremely rare), is partial or complete irreversible hearing loss possible, which subsequently requires hearing aids or cochlear implantation. The function of maintaining balance, even if the labyrinth is completely destroyed, is restored over time.

Prevention

The main prevention of labyrinthitis is timely treatment of otitis media. Any pain in the ear is a reason to immediately contact an ENT doctor. In turn, the infection enters the middle ear through the auditory tube from the nasopharynx. Therefore, it is necessary to take the treatment of any runny nose more seriously.

Internal otitis: symptoms characteristic of the disease

Otitis interna (also known as labyrinthitis) is a disorder resulting from an infection that affects the tissues of the inner ear. Inflammation of the inner ear disrupts the transmission of sensory information from the ear to the brain.

Often labyrinthitis occurs due to viral diseases such as sinusitis, influenza, etc. Less often - against the background of measles, mumps or glandular fever. Viral labyrinthitis affects women more often than men.
Sometimes the cause is a bacterial infection or damage to the ear due to a head injury.

The labyrinth is located deep in the ear, where it connects to the skull. It includes the so-called “cochlea,” which is responsible for hearing, and the fluid-filled vestibular apparatus, which is responsible for balance.

When internal otitis occurs, symptoms may be as follows:

Mild or severe dizziness.
Nausea, vomiting.
Feeling of instability.
Noise in ears.
Partial or complete hearing loss in the affected ear.
"Twinkle" in the eyes.
Impaired concentration.

Sometimes symptoms can be so severe that they affect the ability to climb or walk. These symptoms are often triggered or worsened when the person moves their head, sits up, lies down, or looks up.

Symptoms of otitis internal can last for several days or even weeks depending on the cause and severity of the disease. Sometimes symptoms of the disease still appear within a week after recovery. So people who have had labyrinthitis should be careful when driving, working at heights, or performing other responsible and strenuous work.

It is worth noting

It is extremely rare that inner ear disease can last a lifetime, as is the case with Meniere's disease. In this case, the patient is bothered by tinnitus and hearing loss with dizziness.

If a bacterial infection is the cause of the disease, the risk of permanent hearing loss is quite high. The damaged organ cannot recover, but the brain compensates for the damage by learning to “tune” the conflicting information received from both ears.

If otitis ear symptoms were caused by a viral infection, full recovery is more likely.

Chronic otitis of the inner ear and its symptoms

After a period of gradual recovery, which may last several weeks, some people are completely cured of labyrinthitis.

However, some people suffer from chronic dizziness if the virus has damaged the vestibular nerve.

Many people with chronic labyrinthitis find it difficult to describe their symptoms and often appear healthy on the outside but feel unwell.

Without knowing the symptoms of otitis media of the inner ear, they may find that daily activities have become tiresome or inconvenient.

For example, patients with chronic labyrinthitis find it difficult to:

go shopping;
work on computer;
be in a crowd;
stand in the shower with your eyes closed;
turning your head to talk to another person at the dinner table.

Symptoms of chronic labyrinthitis include:

Abnormal sensation of movement (dizziness). Unlike acute labyrinthitis, dizziness goes away after a few minutes.
Difficulty focusing the eyes due to involuntary eye movements.
Hearing loss in one ear.
Loss of balance.
Lightheadedness and vomiting.
Ringing or other noises in the ears.

Some people find it difficult to work due to a constant feeling of disorientation, as well as difficulty concentrating and thinking.

If symptoms such as dizziness or unsteadiness persist for several months due to otitis media of the inner ear, your doctor may suggest vestibular exercises (a form of physical therapy) to evaluate and retrain the brain's ability to adapt to vestibular instability. As a rule, thanks to such exercises, the brain can adapt to the changed signals coming into it from the ear as a result of labyrinthitis.

Diagnosis of inner ear disease in children and its symptoms

Labyrinthitis, although rare, still occurs in children. The disease typically reaches the inner ear through one of three routes:

Bacteria can enter from the middle ear or from the meninges.
Viruses, such as those that cause mumps, measles, and strep throat in children, can reach the inner ear. Rubella virus can also cause labyrinthitis in children.
The disease can be triggered by toxins, a tumor in the ear, excessively high doses of medications, or allergies.

In case of inner ear disease, the symptoms in children are as follows:

Dizziness and hearing loss, along with a sensation of ringing in the ears. Dizziness is due to the fact that the inner ear controls the sense of balance as well as hearing.
Some children complain of vestibular disorders (nausea, vomiting) and spontaneous eye movements in the direction of the ear that is not affected by the disease.
Bacterial labyrinthitis can cause discharge from the infected ear.

If any of the above symptoms appear, you should consult a specialist.

Diagnosis of labyrinthitis is based on a combination of symptoms of inner ear disease and medical history, especially history of recent upper respiratory tract infection. The doctor will test your child's hearing and may order tests such as a CT scan or magnetic resonance imaging scan to rule out other possible causes of dizziness (such as a tumor).

If a bacterium is suspected to be the cause of labyrinthitis, a test will be ordered on the blood or any fluid that is leaking from the ear. This is necessary to determine what type of bacteria is present.

Labyrinthitis (internal otitis). Causes, symptoms, signs, diagnosis and treatment of pathology

The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor.

Inflammation of the inner ear can be caused by an infectious disease such as tuberculosis.
In rare cases, labyrinthitis occurs due to influenza.
The cavity of the inner ear is shaped like a labyrinth.
A strong whistle directed directly into the auricle can cause acoustic trauma to the ear and lead to labyrinthitis;
In some cases, dizziness with labyrinthitis is so severe that a person cannot raise his head.

Anatomy of the inner and middle ear

outer ear;
middle ear;
inner part of the ear.

Outer ear

Middle ear

Hammer is the first auditory ossicle of the middle ear. The malleus is directly adjacent to the eardrum and is involved in transmitting sound vibrations to other auditory ossicles.
Anvil transmits sound vibrations from the malleus to the stapes. The incus is the smallest of all the auditory ossicles.
Stirrup (stirrup) is the third auditory ossicle. This bone got its name because it looks like a stirrup. The stapes transmits sound vibrations to the inner ear. It is worth noting that the hammer, incus and stirrup amplify the sound approximately 20 times (this happens by increasing the sound pressure on the oval window of the inner ear).

The middle ear cavity is not isolated and through a small canal (Eustachian tube) communicates with the nasal part of the pharynx. Through the Eustachian tube, the average air pressure is equalized both outside and inside the eardrum. If the pressure changes, it is felt as “stuffing” of the ears. In this case, this reflexively leads to yawning. Pressure equalization also occurs during swallowing movements. The Eustachian tube constantly maintains normal pressure in the cavity of the middle ear, which is necessary for the normal conduction of sound vibrations.

Inner ear

vestibule;
semicircular canals;
snail.

vestibule The labyrinth is a small cavity that has an irregular shape. On the outer (lateral) wall of the bone labyrinth there are two small windows - oval and round, which are covered with a thin membrane. It is the oval window that separates the vestibule of the labyrinth from the tympanic cavity of the middle ear. The round window of the vestibule opens into the cochlea (at the beginning of the spiral canal of the cochlea). This window is covered on top by a membrane (secondary eardrum) and is necessary in order to reduce the sound pressure that is transmitted to the oval window. The vestibule of the bony labyrinth communicates with the semilunar canals through five small openings, as well as with the cochlea through a relatively large opening leading into the cochlear canal. On the inner wall of the vestibule there is a small ridge that separates the two depressions. In one recess there is a spherical sac (sacculus), and in the second - an elliptical sac (utriculus). These sacs are filled with a special fluid (endolymph), which is the internal environment of the balance organ. Endolymph is also necessary to create the electrical potential that is needed to provide energy for the process of amplifying sound vibrations.

Causes of labyrinthitis

Otitis media

acute otitis;
chronic otitis media

Acute otitis media begins with an increase in body temperature to 38 - 39ºС. The main complaint is pain in the depths of the ear, which can be stabbing, drilling or pulsating in nature. The pain intensifies in the afternoon and can significantly disturb sleep. The pain can spread to the temple, lower and upper jaw. Increased pain is observed during swallowing, sneezing, and also when coughing. Temporary deafness is often noted. Patients also complain of congestion and tinnitus. After a few days, the disease enters the second stage, which is characterized by perforation (violation of the integrity) of the eardrum. As a rule, purulent contents are released from the ear cavity. Body temperature drops to 37ºС, and the patient’s general condition most often improves. Subsequently, the inflammatory process subsides - suppuration stops, and the damaged eardrum is scarred. As a rule, the duration of acute otitis does not exceed 14–20 days. It is worth noting that otitis media does not lead to hearing loss. This complication occurs only if the auditory ossicles in the tympanic cavity are destroyed.

Inner ear injury

acute;
chronic.

Acute acoustic ear injury occurs due to short-term exposure to extremely strong sounds on the auditory analyzer. The cause of injury can be a shot from a firearm that occurs in close proximity to a person’s ear. In this case, hemorrhage occurs in the cochlea, and the cells of the spiral organ (organ of Corti) are significantly damaged. Subjectively, exposure to an excessively strong sound stimulus is accompanied by severe pain in the ear. Depending on the distance to the sound source, acute acoustic trauma to the ear can lead to temporary or permanent deafness.

Viral and bacterial infections

influenza virus;
mumps;
syphilis;
tuberculosis.

Influenza virus causes acute infectious disease of the respiratory tract. There are 3 types of influenza - A, B and C. Influenza virus type A most often causes epidemics. Type B can cause outbreaks of influenza and only in some cases entire epidemics, and type C can cause only isolated cases of influenza. Once in the upper or lower respiratory tract (nasopharynx, trachea, bronchi), the virus multiplies and leads to the destruction of epithelial cells (cells that line the mucous membrane) of the respiratory tract. In some cases, inflammation of the inner ear may occur due to the flu. As a rule, labyrinthitis occurs in children or the elderly due to weakened immunity. The influenza virus can enter the inner ear through the cochlear aqueduct or through the internal auditory canal.

Symptoms of labyrinthitis

Diagnosis of labyrinthitis

The following methods for diagnosing labyrinthitis are distinguished:

Vestibulometry

caloric test;
rotation test;
pressor test;
otolith reaction;
finger-nose test;
index test.

Caloric test implies a slow infusion of water into the external auditory canal, which can be warm (39 - 40ºC) or cold (17 - 18ºC). If you use water at room temperature, then the involuntary eye movements that occur are directed towards the ear being examined, and if you pour in cold water - in the opposite direction. This nystagmus occurs normally, but is absent when the inner ear is damaged. It is worth noting that the caloric test is carried out only with an intact eardrum, so as not to lead to the entry of a large amount of water into the middle ear cavity.

Audiometry

pure tone audiometry;
speech audiometry;
audiometry using a tuning fork.

Pure-tone audiometry is carried out using special audiometers, which consist of a sound generator, telephones (bone and air), as well as a regulator of sound intensity and frequency. It is worth noting that pure-tone audiometry is capable of determining both air and bone sound conductivity. Air conduction is the effect of sound vibrations on the auditory analyzer through the air. Bone conduction refers to the effect of sound vibrations on the bones of the skull and directly on the temporal bone, which also leads to vibration of the main membrane in the cochlea. Bone sound conduction allows us to evaluate the functioning of the inner ear. To assess airborne sound conduction, the test subject is given a fairly loud sound signal through phones (headphones through which sounds are played). Subsequently, the signal level is gradually reduced in steps of 10 dB until the perception disappears completely. Then, in steps of 5 dB, the level of the sound signal is increased until it is perceived. The resulting value is entered into the audiogram (special graph). Bone sound conduction is produced by analogy with air conduction, but a bone vibrator is used as a device through which sound is supplied. This device is installed on the mastoid process of the temporal bone, after which sound signals are sent through it. It is worth noting that during pure-tone audiometry it is necessary to completely exclude the influence of extraneous noise, otherwise the results may be incorrect. At the end of the study, the doctor receives a special audiogram, which allows you to judge the function of the hearing organ.

Electronystagmography

radiography;
CT scan;
magnetic resonance imaging.

X-ray of the temporal bone used to assess the condition of the bone structures of the outer, middle and inner ear. X-rays can be taken in 3 different projections. It is worth noting that radiography of the temporal bone is increasingly used in diagnosing lesions of the inner ear due to the low resolution of this method compared to computed tomography and magnetic resonance imaging. The only contraindication for x-rays of the temporal bone is pregnancy.

Internal otitis

Otitis

Otitis– acute or chronic inflammation in various parts of the ear (outer, middle, inner). It manifests itself as pain in the ear (pulsating, shooting, aching), elevated body temperature, hearing loss, tinnitus, mucopurulent discharge from the external auditory canal. It is dangerous in the development of complications: chronic hearing loss, irreversible hearing loss, facial nerve paresis, meningitis, inflammation of the temporal bone, brain abscess.

Anatomy of the ear

The human ear consists of three sections (outer, middle and inner ear). The outer ear is formed by the auricle and the auditory canal, ending with the eardrum. The outer ear picks up sound vibrations and sends them to the middle ear.

The middle ear is formed by the tympanic cavity, which is located between the opening of the temporal bone and the eardrum. The function of the middle ear is to conduct sound. The tympanic cavity contains three ossicles (the malleus, the incus and the stapes). The malleus is attached to the eardrum. The membrane vibrates when exposed to sound waves. Vibrations are transmitted from the eardrum to the incus, from the incus to the stapes, and from the stapes to the inner ear.

The inner ear is formed by a complex system of canals (cochlea) in the thickness of the temporal bone. The inside of the cochlea is filled with fluid and lined with special hair cells that convert mechanical vibrations of the fluid into nerve impulses. Impulses are transmitted along the auditory nerve to the corresponding parts of the brain. The structure and functions of the ear sections differ significantly. Inflammatory diseases in all three sections also occur differently, so there are three types of otitis: external, middle and internal.

Otitis externa

Otitis externa can be limited or diffuse, in some cases it spreads to the eardrum, and is more common in elderly patients. Occurs as a result of mechanical or chemical trauma to the ear. A patient with otitis externa complains of throbbing pain in the ear, which radiates to the neck, teeth and eyes, and intensifies when talking and chewing. Redness of the ear canal, and sometimes of the auricle, is objectively detected. Hearing is impaired only when the abscess is opened and the ear canal is filled with pus.

Treatment of external otitis involves injecting alcohol turundas into the ear canal and rinsing with disinfectant solutions. Abscesses are opened. The patient is prescribed physiotherapy (UHF, Sollux), and in case of severe inflammation, antibiotic therapy is administered.

Otitis media

One of the most common diseases of the ENT organs. Every fourth patient of an otolaryngologist is a patient with acute or chronic otitis media. People of any age can get sick, but otitis media is much more common in children under 5 years of age.

Causes of otitis media

Otitis media can be caused by various pathogenic microorganisms: bacteria, viruses, fungi (otomycosis) and various microbial associations. Most often, influenza and ARVI viruses, pneumococcus and Haemophilus influenzae are the infectious agents in otitis media. Recently, there has been an increase in the number of cases of fungal otitis media.

Mechanism of development of otitis media

Normally, the pressure in the middle ear cavity is equal to atmospheric pressure. Pressure equalization and ventilation of the tympanic cavity are carried out using the Eustachian tube, which connects the tympanic cavity to the pharynx.

Some conditions (increased formation of mucus in the nasopharynx, sniffing, pressure drop when divers descend to depth, etc.) lead to the patency of the Eustachian tube being impaired. A change in pressure in the tympanic cavity leads to the fact that the cells of the mucous membrane of the middle ear cavity begin to actively produce inflammatory fluid. Increased fluid levels cause pain and hearing loss.

The infection enters the middle ear tubarically (through the Eustachian tube), transmetally (through the eardrum when it is traumatically damaged), hematogenously (through the bloodstream during scarlet fever, measles, influenza or typhus) or retrogradely (from the cranial cavity or mastoid process of the temporal bone) .

Microbes quickly multiply in the inflammatory fluid, after which otitis media becomes purulent. The pressure in the middle ear cavity rises sharply, the eardrum ruptures, and pus begins to leak out through the ear canal.

Risk factors

Otitis media rarely develops as an independent disease. In the vast majority of cases, it is a complication of diseases of other ENT organs of an inflammatory nature. There are general and local factors that increase the risk of developing otitis media.

Local risk factors for the development of otitis media

Inflammatory and allergic diseases of the nose and nasopharynx cause swelling of the mucous membrane, leading to a deterioration in the patency of the Eustachian tubes. Microbes that enter the middle ear from the source of inflammation increase the risk of developing purulent otitis media. The group of local risk factors also includes conditions after surgical interventions in the nasopharynx and nasal cavity, accompanied by a deterioration in the patency of the Eustachian tubes.

Otitis media develops more often in children, which is due to the peculiarities of the anatomical structure of the children's middle ear. The Eustachian tube in children is narrower than in adults, therefore the likelihood of violations of its patency increases. In children, adenoids often enlarge, compressing the Eustachian tube. Children often suffer from ARVI and other colds, often cry and actively sniffle.

Common risk factors for otitis media

The likelihood of developing otitis increases with congenital and acquired immunodeficiency conditions.

Symptoms of otitis media

Acute otitis media is characterized by severe hyperthermia, which is accompanied by shooting pain in the ear. Children who cannot yet speak cry when the pain intensifies and calm down when it subsides.

After 1-3 days from the onset of the disease, a rupture forms in the eardrum, and suppuration begins. The patient's condition improves. Body temperature returns to normal, ear pain decreases or disappears. Subsequently, the rupture in the eardrum heals and does not cause hearing impairment.

If the disease develops unfavorably, pus may break out not outward, but inward, spreading into the cranial cavity and leading to the development of a brain abscess or meningitis. Since the disease is fraught with dangerous complications, you should consult a doctor at the first signs of acute otitis media.

As a rule, it is the outcome of acute purulent otitis. There are two forms of chronic suppurative otitis media, which differ in both severity and clinical course.

In 55% of cases, chronic otitis media occurs in the form of mesotympanitis, in which the inflammatory process covers the mucous membrane of the auditory tube, lower and middle parts of the tympanic cavity. The eardrum has a perforation at the bottom. Part of the membrane remains stretched.

With mesotympanitis, patients complain of decreased hearing, constant or periodic discharge of pus from the ear, and extremely rarely - dizziness and noise in the ear. Pain appears only during exacerbation of otitis media, in some cases accompanied by hyperthermia. Mesotympanitis progresses quite favorably and relatively rarely causes severe complications. The degree of hearing loss is determined by the preservation of the function of the auditory ossicles and the activity of the inflammatory process.

Chronic otitis media, which occurs in the form of purulent epitympanitis, mainly affects the epitympanic space. The perforation is located at the top of the eardrum, so natural drainage of the cavity is often insufficient. The severity of the flow is also determined by the peculiarities of the anatomical structure of this area, which is replete with winding narrow pockets.

The temporal bone is often involved in the inflammatory process, and the pus becomes foul-smelling. Patients complain of a feeling of pressure in the ear, periodic pain in the temporal region, and sometimes dizziness. This form of chronic otitis media is usually accompanied by a sharp decrease in hearing.

Both forms of chronic otitis media can occur with a predominance of certain pathological processes.

Chronic catarrhal otitis media can develop with chronic eustachitis, after suffering scarlet fever or acute otitis. Sometimes it is of an allergic nature. In the absence of suppuration, it proceeds quite favorably.

Chronic purulent otitis media is usually the outcome of a protracted acute process and develops against a background of decreased immunity. With good drainage of the tympanic cavity, purulence from the ear is sometimes not accompanied by other symptoms. The erased clinical symptoms lead to the fact that patients rarely seek help. The purulent process tends to spread gradually and can affect the auditory ossicles, periosteum, surrounding bone structures and labyrinth.

Acute and chronic purulent otitis media can be complicated by the development of chronic adhesive otitis media. With adhesive otitis media, adhesions actively form in the tympanic cavity, leading to hearing loss. Adhesive otitis often has few symptoms, and patients do not associate heavy sweats, chills and hyperthermia that appear during an exacerbation with ear disease. With adhesive otitis, complications may develop.

Complications of otitis media

Acute otitis media can be complicated by mastoiditis (inflammation of the mastoid process of the temporal bone), brain abscess, labyrinthitis (inflammation of the inner ear), meningitis, cerebral sinus thrombosis and sepsis. With purulent epitympanitis, cholestetoma often occurs - a tumor formation consisting of decay products of the epidermis. Cholestetomas destroy the temporal bone, forming granulations and polyps.

Chronic otitis media can cause damage to the facial nerve passing through the tympanic cavity. Neuritis of the facial nerve is accompanied by flattening of the nasolabial fold, drooping of the corner of the mouth and lagophthalmos (the eye on the affected side does not close). With chronic otitis media (purulent epitympanitis), as with acute otitis, labyrinthitis, meningitis or meningoencephalitis, brain abscess, sinus thrombosis and epidural abscess can develop.

Diagnosis of otitis media

The diagnosis of acute otitis media is based on medical history, otoscopy results and characteristic symptoms (general intoxication, ear pain, suppuration). To determine the sensitivity of the microflora, culture of the discharge from the ear is performed.

In case of chronic otitis media, to assess the condition of the bone structures, in addition to the listed studies, radiography of the temporal bone is performed. Otoscopy in chronic otitis reveals clouding and sharp retraction of the eardrum. The hammer handle appears shortened. The location of the perforation is determined by the shape of the otitis media.

Treatment of otitis media

Treatment of acute otitis media

Patients with acute otitis media are recommended to rest in bed, undergo antibacterial therapy, and in case of hyperthermia, antipyretics are prescribed. Physiotherapy (UHF, Sollux) and warming compresses are used locally. To reduce pain, warm 96% alcohol is instilled into the ear (only until pus appears). If the tympanic cavity does not drain on its own within the first three days, dissection of the eardrum is indicated. In cases where hearing loss persists after scarring of the eardrum, blowing, UHF and pneumatic massage are prescribed.

Treatment of chronic otitis media

The primary task is to ensure sufficient drainage of the tympanic cavity. To do this, polyps and granulations are removed from the middle ear cavity. The cavity is washed and proteolytic enzymes are introduced into it. The patient is prescribed sulfonamides and antibiotics, immunity is corrected, and foci of infection in the ENT organs are sanitized. If allergic otitis is suspected, antihistamines are used. Electrophoresis and microwave therapy are used locally.

If there is no effect, anthrodrainage is performed (a hole is formed in the area of the mastoid process of the temporal bone and followed by drainage). For cholesteatomas, the spread of the process to the bone and internal structures, surgical removal of the source of inflammation is indicated. If possible, sound-conducting structures are preserved; if not, tympanoplasty is performed. If the tympanic ring is intact, it is possible to restore the eardrum (myringoplasty).

Prevention of otitis media

Preventive measures include normalization of immune status, prevention of acute respiratory viral infections and other infectious diseases of the ENT organs. Patients with chronic otitis should protect the ear canal from hypothermia and water ingress.

Internal otitis (labyrinthitis)

Has a bacterial or viral nature. Usually a complication of otitis media or meningitis.

A characteristic symptom of internal otitis is a sudden severe attack of dizziness that develops 1-2 weeks after the infectious disease. The attack may be accompanied by nausea or vomiting. Some patients with otitis interna complain of tinnitus or hearing loss.

Otitis media must be differentiated from brain diseases that can cause dizziness. To exclude tumors and strokes, MRI and CT scans of the brain are performed. Electronystagmography and a special study are performed to evaluate the auditory response of the brainstem. Audiometry is performed to identify hearing disorders.

Treatment of internal otitis is mainly symptomatic. To eliminate nausea and vomiting, antiemetics (metoclopramide) and antihistamines (mebhydrolin, chloropyramine, diphenhydramine) are prescribed. Scopolamine patches are used locally. Steroids (methylprednisolone) are used to reduce inflammation, and sedatives (lorazepam, diazepam) are used to relieve anxiety. For internal otitis of a bacterial nature, antibiotic therapy is indicated. Symptoms of the disease usually gradually disappear over one or several weeks.

If conservative treatment of internal otitis is ineffective, surgical intervention is performed: labyrinthotomy, opening of the pyramid of the temporal bone, etc.

How to treat internal otitis

Internal otitis (labyrinthitis): causes, symptoms, diagnosis, treatment

Internal otitis- this is inflammation in the inner ear - labyrinth. This department is located close to the brain and is responsible for the vestibular-auditory function.

Although internal otitis occurs quite rarely, this form of the disease poses the greatest danger - with neglected treatment there is a high risk of complete hearing loss.

Internal otitis (labyrinthitis): causes and characteristic symptoms

Usually, internal otitis does not develop independently, but occurs as a relapse of otitis media. In addition, infection can be introduced into the labyrinth from other organs through the blood circulation.

First of all, labyrinthitis manifests itself through disturbances in vestibular function, deterioration in coordination of movements, and loss of balance.

After a few days they appear other characteristic signs of the disease:

Dizziness;
Vomiting, nausea;
Noise in ears;
Gradual deterioration of hearing;
Cardiac disorders.

Depending on the causes of its appearance, labyrinthitis is distinguished:

- Tymponogenic– recurrent form of otitis media. The infection comes from the middle ear.
- Meningogenic as a consequence of relapse of meningitis.
- Hematogenous- manifests itself under the influence of an infection that penetrates the labyrinth during blood circulation.
- Traumatic– as a consequence of traumatic brain injury and ear damage.

Forms of internal otitis: pathogens and symptoms

Based on the type of inflammation, the following forms of labyrinthitis are distinguished:

- Necrotic. It is characterized by circulatory disorders in areas of the labyrinth due to thrombosis of a branch of the auditory artery. Such inflammation is typical for people suffering from tuberculous otitis media, less commonly scarlet fever. Usually the disease is asymptomatic and unnoticeable, but leads to absolute hearing loss, as well as to the possible occurrence of complications in the form of brain abscesses. For treatment necrotizing otitis It is necessary to perform a surgical operation to open the inner ear and remove all parts of the labyrinth.
- Serous. It is characterized by redness of the walls of the inner ear and changes in the composition of the lymphatic fluid in the cochlea. On practice serous labyrinthitis most often a recurrent form otitis media. In this case, hearing loss occurs gradually, the patient feels tinnitus, as well as all other signs of labyrinthitis. With timely treatment, it is possible to restore partial hearing loss.
- Purulent. It is characterized by the formation of purulent fluid in the cavity of the labyrinth. It is the most dangerous form of labyrinthitis and can lead to various complications, such as meningitis, brain abscess, cerebral hemorrhage, auditory neuritis, and complete deafness. The symptoms of purulent labyrinthitis are pronounced - the patient experiences a sharp decrease in hearing, attacks of dizziness, and nausea.

According to the nature of its course, labyrinthitis is divided into:

- Spicy. Symptoms of internal otitis are pronounced and develop quickly.
- Chronic. Symptoms appear periodically, the disease progresses slowly.

Diagnosis of internal otitis

Diagnosis of labyrinthitis Various categories of doctors are involved - neurologist, otolaryngologist, traumatologist, venereologist and others based on patient complaints. To identify a diagnosis, a number of measures are carried out:

- General blood analysis.
- Audiometry (tone, speech) to check hearing acuity.
- Testing of the vestibular apparatus (rotation test, pointing test, etc.).
- Otoscopy – examination of the eardrum for perforation.
- Radiography makes it possible to assess the condition of the bone structures of various parts of the ear.
- Computer (CT) and magnetic resonance imaging (MRI) - allow you to analyze the bone and soft tissue structures of the temporal bone.

Treatment of internal otitis

Treatment of labyrinthitis carried out strictly under the supervision of a specialist in compliance with bed rest:

- To suppress the source of infection, antibiotics are prescribed: Amoxicillin, Ceftriaxone, Oxacillin, Erythromycin and others.
- To reduce inflammation: Diclofenac, Naklofen, Dicloran.
- To reduce the level of intoxication, diuretics are prescribed, for example, Furosemide or Fonurit.
- To relieve symptoms of vomiting (Cerucal), nausea (Scopolamine patch) and dizziness (Betagistine).
- In order to improve blood circulation, a specialist may prescribe drugs such as Betahistine, Bellataminal, Alfaserc.
- For general restoration of immunity, vitamins K, P, B6, B12, and ascorbic acid are prescribed.
- In the treatment of serous and purulent labyrinthitis, it is inevitable to carry out an operation to eliminate the purulent focus: sanitizing - on average, labyrinthotomy - in the cavity of the inner ear, with the development of pathologies and serious complications of the labyrinth - labyrinthectomy, which involves removing the labyrinth.

Thus, internal otitis is a serious disease that, if left untreated, can lead to complete hearing loss and relapses. It should be remembered that if there is any sign of this disease, you must immediately contact a specialist who will prescribe a course of treatment. For some forms of labyrinthitis, surgical intervention is necessary.

Otitis of the inner ear

The inflammatory process can affect the structures of the inner ear; this disease is called labyrinthitis, or otherwise the disease is called internal otitis. Due to the peculiarities of the anatomical location of this section of the sound analyzer, the disease occurs as a result of complications of other processes. More often these are inflammatory phenomena spreading from neighboring organs or head injuries.

Classification of labyrinthitis

Depending on the origin of internal otitis, there is the following classification:

Labyrinthitis is classified according to the type of pathogen:

viral;
bacterial (specific and nonspecific);
fungal.

According to pathomorphological signs, inflammatory phenomena are:

The acute course of labyrinthitis lasts about 3 weeks. It may end in recovery or become chronic. The latter usually has a protracted course, symptoms increase gradually, or may be completely absent.

A little about the pathogenesis of the disease

The causes of tympanogenic labyrinthitis are acute or chronic otitis media in the acute stage. The process spreads from the tympanic cavity through the membranes of the round or oval window bordering the inner ear. With induced inflammation, the process is aseptic in nature, since it is not pathogens that penetrate into the labyrinth, but their metabolic products and toxins.

The inner ear consists of the cochlea, vestibule and semicircular canals. The first section contains the organ of Corti, which is responsible for sound perception. The second two perform a vestibular function

Serous inflammation progresses, and a lot of transudate is formed. Due to the folding of plasma proteins sweating through the vessels, the structures of the labyrinth are filled with fibrous cords. A large amount of peri- and endolymph increases the pressure inside the cavity. This condition often leads to rupture of the window membrane, which opens the gate for bacterial flora to enter from the middle ear into the inner ear. This is how purulent labyrinthitis occurs. The outcome of this process is loss of function of this part of the ear, as well as intracranial complications.

If thrombosis occurs, damage to the auditory artery or compression of its branches, the trophism of the corresponding area is disrupted, and this threatens necrotic tissue changes.

Meningogenic inflammation of the inner ear is less common than tympanogenic inflammation. The process spreads from the membranes of the brain to the labyrinth area through the internal auditory canal, along the aqueduct of the vestibule or cochlea. It is observed in meningitis caused by tuberculosis, scarlet fever, measles, and typhus. Characteristic is bilateral damage to the vestibulo-cochlear apparatus. If this pathological condition occurs in early childhood, then this is fraught with the appearance of acquired deaf-muteness.

Pathogens rarely penetrate into the inner ear by hematogenous route. Occurs in the case of mumps, other viral infections, and syphilis.

With injuries to the temporo-parietal part, in the area of the back of the head and the mamillary process, cracks form through which pathogens of inflammation can penetrate into the labyrinth space. The infection enters the inner ear when the eardrum and middle ear cavity are damaged by a sharp, long object.

Depending on the spread of inflammatory phenomena, the lesion can be localized, then limited labyrinthitis is diagnosed, or it can involve all structures of the inner ear with a diffuse nature.

How does inflammation of the labyrinth manifest clinically?

Symptoms associated with damage to the sound analyzer and vestibular function occur:

dizziness;
coordination disorders;
presence of nausea, vomiting;
the appearance of nystagmus;
hearing impairment;
ear noises.

Patients are bothered by systemic dizziness, manifested by an illusory sensation of rotation of the environment or one’s own body in one plane or direction. Sometimes the feeling of moving becomes unsystematic, patients note instability when walking, seeming to fall or fall through.

The main complaints of patients with inflammation of the labyrinth

The chronic course provokes this kind of vestibular disorders for several seconds or minutes. In the case of an acute process, the attack lasts 5–10 minutes; symptoms can last up to several hours or days.

An important sign is increased dizziness in a certain position or manipulation in the ear. Nausea and vomiting often occur, worsening with head rotation, and sweating increases. The skin is pale or reddened, the heart rate accelerates, but bradycardia also occurs.

Dizziness is systemic in nature, accompanied by nausea, vomiting and increased sweating

Another sign of vestibular disorders is nystagmus, which appears spontaneously. Involuntary twitching of the eyeballs is associated with a violation of the synchronous functioning of the labyrinths. The movements are usually small-caliber, in contrast to nystagmus of central origin. The direction is horizontal, sometimes horizontal-rotatory. At the beginning of the disease, the direction of the slow component of involuntary movements of the eyeballs is noted towards the inflamed ear, this is due to irritation of the labyrinth.

Symptoms of spontaneous deviation of the upper limbs and trunk in the direction opposite to nystagmus are observed. In this case, the directions change depending on the rotation of the head, which distinguishes labyrinthitis from central disorders.

The patient is unstable in the Romberg position, misses the side of the slow component of nystagmus, performing the finger-nose test. With a limited labyrinth with damage to the horizontal semicircular canal, a positive fistula symptom is determined. By condensing the air in the external auditory canal, nystagmus occurs in the direction of the diseased ear, dizziness in the opposite direction.

As the disease develops, the functions of the vestibular analyzer on the affected side are inhibited, and the direction of nystagmus changes in the other direction. The decline of labyrinth function can be confirmed by the lack of response to both auditory and statokinetic stimuli.

Disturbing high-frequency noise and ringing in the ears

On the part of the hearing organ, symptoms associated with the presence of noise and decreased perception of sound stimuli are noted. Patients complain of ringing in the ears, which intensifies when turning the head. More often the noise range is within the high tones.

Hearing impairment can recover within a few days; this process is characteristic of the serous nature of the course of labyrinthitis. Sometimes the purulent process provokes persistent deafness.

Diagnostics

The following studies are being carried out:

Vestibulometry (use rotational, pressor, otolith, finger-nasal, index tests; the caloric test, recommended by some authors, is dangerous due to the possibility of generalization of the process and the provocation of intracranial complications).
Audiometry (threshold and suprathreshold are used).
Electronystagmography (using electrodes, the characteristics of nystagmus, its fast and slow components, speed, frequency, amplitude are studied).
CT and MRI (to exclude or detect brain pathology).
Videonystagmography is one of the modern research methods.

Labyrinthitis leads to hearing loss

If there are symptoms of the disease, immediate consultation with an otolaryngologist is necessary. Timely diagnosis and competent treatment will help get rid of the disease in the early stages and prevent complications and serious consequences.

Therapy or surgery

Severe forms of labyrinthitis require hospitalization. The choice of therapy depends on the type of disease and its cause. Treatment of labyrinthitis should be comprehensive and include:

Based on the etiology, antiviral or antibacterial drugs are indicated. More often, the process is caused by bacterial flora; for this, cephalosporins of the second generation (Cefuroxime, Ceftin, Kefurox), third generation (Ceftriaxone, Tercef), and fourth generation (Maxipim) are used. In severe forms of meningitis or meningoencephalitis, fluoroquinolones are prescribed that can penetrate the blood-brain barrier (Ciprofloxacin, Tsiprinol, Cifran). Macrolides (Clarithromycin, Azithromycin) are used.
Anti-inflammatory, steroid drugs (Diclofenac, Dicloran, Methylprednisolone).
Dehydration therapy (Diacarb, Mannitol).
Vitamin therapy (K, P, B6, B12, C, Rutin).
Antihistamines (Suprastin, Tavegil).
Antiemetics (Cerucal, Phenegran, Dedalon, Bonin).
Sedatives (Lorazepam, Diazepam).
To improve blood supply to the inner ear and to reduce vestibular manifestations, Betaserc, Betagistin, Alfaserc are prescribed.

In some clinical situations, the only treatment for labyrinthitis is surgery.

Indications for surgery:

purulent labyrinthitis with a tendency to progress;
combination of labyrinthitis with inflammation of the skull bones;
entry of microorganisms into brain structures;
necrotic inflammation with sequestration phenomena;
persistent deafness.

For tympanogenic purulent labyrinthitis, sanitizing surgery on the middle ear, labyrinthotomy or tympanoplasty is prescribed. The presence of complications of inflammatory processes in the inner ear requires mastoidotomy or opening of the pyramid of the temporal bone. If the complications are intracranial, then a labyrinthectomy is performed. In the presence of persistent deafness after labyrinthitis, hearing aids and hearing restoration surgery (cochlear implantation) are performed.

Forecast and consequences

Timely diagnosis and treatment of acute serous labyrinthitis ensures recovery with complete restoration of vestibulocochlear functions. In favorable cases, the structures of the inner ear become overgrown with granulations, which are then replaced by fibrous and, finally, bone tissue.

If the course is unfavorable, labyrinthitis may become more complicated:

inflammation of the facial nerve;
mastoiditis;
petrositoma;
the occurrence of meningitis;
formation of intracranial abscesses;
encephalitis.

Inflammation of the facial nerve is one of the complications of labyrinthitis

After suffering purulent inflammation in the inner ear, persistent hearing and balance disorders may remain. Over time, adaptation processes partially occur due to the second labyrinth, the central nervous system and the organ of vision. However, complete restoration of the structures of the inner ear, functions of the cochlea, semicircular canals and vestibule is not possible.

Since the main cause of labyrinthitis is the presence of a focus of infection in the anatomical formations in contact with the inner ear, preventive measures should be aimed at:

timely diagnosis and treatment of otitis media, meningitis and infectious diseases;
sanitation of the nasal cavity, sinuses, mouth, pharynx;
avoiding injury to the ear and skull bones;
strengthening the immune system.

At the first signs or suspicion of labyrinthitis, you must immediately contact an ENT specialist for diagnosis and proper treatment. In the initial stages of development, the disease is completely curable. In an advanced stage, if treatment is not timely, irreversible changes occur in the inner ear and serious consequences with intracranial complications are possible. On the part of the sound perception system, complete hearing loss may occur with labyrinthitis.

Labyrinthitis - inflammation of the inner ear: signs and methods of treatment

The inflammatory process in the tissues of the inner ear is called labyrinthitis or internal otitis. Typically, the disease develops when various pathogenic bacteria enter the inner ear.

Causes

Features of the development of labyrinthitis

The development of an inflammatory process in the inner ear can be caused by various factors.

The main causes of internal otitis:

Otitis media
Bacterial or viral infections
Injury
Meningitis
Infections such as syphilis, mumps, influenza virus or tuberculosis can lead to labyrinthitis.

Typically, inflammation of the inner ear occurs against the background of complications of infectious processes occurring in the body.

In most cases, labyrinthitis develops as a complication of otitis media.

With this disease, purulent masses accumulate, which increases the pressure in the tympanic cavity. As a result, the purulent process spreads from the middle ear to the inner ear. Ear injury can be caused by injury from various sharp objects: knitting needles, hairpins, etc. Damage to the inner ear can be associated with traumatic brain injury.

More information about labyrinthitis can be found in the video.

Labyrinthitis can be caused by meningitis. Infection from the meninges enters the inner ear and causes inflammation. Meningogenic labyrinthitis is characterized by bilateral lesions. An infection in the inner ear can spread through the bloodstream, without being accompanied by damage to the meninges. This is observed with syphilis, mumps and other diseases.

Symptoms

Depending on the speed with which the inflammatory process spreads, the severity of symptoms appears.

With inflammation of the middle ear, the following symptoms may occur:

Dizziness
Impaired movement coordination
Hearing loss
Noise and pain in the ears

With the development of internal otitis, the patient experiences involuntary oscillatory eye movements.

Dizziness occurs due to damage to the semicircular canals.

Such attacks are short-lived and usually do not exceed 5 minutes. In some cases, dizziness may last for several hours. There may also be complaints of sweating and rapid heartbeat. If labyrinthitis has passed into a purulent or necrotic stage, then the patient completely loses hearing on the affected side.

Diagnostics

Methods for examining inflammation

To diagnose inflammation of the inner ear, the otolaryngologist will prescribe a series of tests. The doctor will examine the auricle, eardrum and the postauricular area of the external auditory canal using a special device - an otoscope.

Other instrumental methods for diagnosing labyrinthitis:

Audiometry. Audiometry can be used to determine hearing sensitivity and hearing acuity. The procedure is performed using an audiometer.
Vestibulometry - allows you to identify the condition of the vestibular apparatus.
Electronystagmography. Electronystagmography is used to study nystagmus, which occurs when the inner ear becomes inflamed.

To clarify the diagnosis, highly informative methods are used: magnetic resonance and computed tomography, radiography. In addition, the patient must undergo a blood test and ear discharge. This will help determine the viral or bacterial nature of the disease.

Drug treatment

Treatment of the disease with antibiotics and medications

With conservative treatment, if the disease is caused by a bacterial infection, then antibiotics are prescribed.

The treatment regimen for each is selected individually, depending on the cause and clinical manifestations of the disease:

From the group of penicillins, Oxacillin, Amoxicillin, Piperacillin are prescribed, and from macrolides, Erythromycin or Clarithromycin is prescribed for the treatment of the disease.
To improve blood supply in the inner ear, histamine drugs are prescribed: Alfaserc, Betahistine, etc.
To reduce dizziness, nausea and vomiting, Diazolin, Suprastin, Diphenhydramine, etc. are prescribed.
Anti-inflammatory drugs that have antipyretic and analgesic effects are also prescribed: Diclofenac, Dicloran, Naklofen, etc.
To normalize trophic disorders in the cavity of the inner ear, take vitamins C, P, K, as well as the drugs Cocarboxylase, Preductal.

If treatment is started on time, the prognosis is favorable. After therapy or surgery, vestibular functions and hearing are restored. In order to avoid re-development of the disease, it is necessary to promptly identify and treat diseases and infectious processes in the body. It is also important not to delay visiting a doctor at the first sign.

Traditional treatment

To reduce the symptoms of otitis media, you can use alternative medicine methods.

Drop a honey-based solution into the sore ear. Dilute honey in equal proportions in warm water and drop 2 drops into the ear. Instead of honey, you can use propolis tincture.
For labyrinthitis, you can make an ear swab. Take onions, squeeze out the juice and mix with vegetable oil in equal quantities. Then soak a tampon with the prepared solution and insert it into the sore ear overnight.
A fairly effective remedy is an infusion of burnet rhizome. Pour 2 tablespoons of rhizome into 400 ml of hot water, place in a water bath for half an hour and strain. Take a tablespoon orally 3 times a day.
It is useful to rinse the ear with a decoction of chamomile, lemon balm, and strong tea made from rosehip flowers.

Before using traditional methods of treatment, you should consult your doctor. Self-medication is prohibited, as it can worsen the course of the disease.

It is forbidden to use a heating pad when treating labyrinthitis - the heat generated by the heating pad can cause the spread of pus to healthy areas.

Traditional methods will help get rid of the symptoms of the disease, but cannot eliminate the true cause of the development of labyrinthitis. If you do not take action and consult a doctor, then the disease has a high probability of developing complications.

When is surgery needed?

Surgery for labyrinthitis is indicated if the disease has become purulent and occurs against the background of acute otitis media. Surgical treatment is carried out only when indicated, in severe cases when there is no effect from drug treatment.

The otosurgeon performs anthromastoidotomy, labyrinthotomy or abdominal surgery, depending on the indications. The main goal of surgery is to remove the purulent focus from the cavity of the middle and inner ear. A few days before surgery, conservative therapy is prescribed.

Labyrinthotomy is an operation that is performed for purulent inflammation, to eliminate pus and prevent infection from entering the cranial cavity. After surgery, the patient is prescribed antibiotics and dehydration therapy. In this case, the patient's condition is taken into account.

Antromastoidotomy is performed for complications of purulent internal otitis - mastoiditis.

During the operation, the mastoid process is opened and the pus is removed. During the operation, local anesthesia is used. Half an hour before the start of the manipulation, two turundas are moistened in a solution of cocaine or dicaine. The operation is performed under general anesthesia in rare cases. The recovery period after surgery can last up to 3 months.

Possible consequences

Complications due to improper treatment

Complications due to labyrinthitis occur when inflammation of the middle ear affects other organs. This develops in advanced cases and untimely treatment.

The purulent form of otitis of the inner ear can lead to meningitis, cerebral thrombosis, brain abscess, and sepsis. Also, purulent otitis media can cause the development of mastoiditis, petrositis, sensorineural hearing loss, and in more serious cases can lead to hearing loss. Complications are dangerous in both adults and children.

To avoid an unpleasant outcome, you should contact an otolaryngologist when the first symptoms appear.

With timely diagnosis and proper treatment, complications can be avoided. Any disease is easier to treat at the initial stage.

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One of the most dangerous pathologies is diseases of the inner ear. Their symptoms are generally similar, but the causes and characteristics of the course may be different. Prevention will help avoid such diseases. There is no way to protect yourself from congenital problems, but some of them can be treated. All these issues should be considered in more detail.

Types of diseases and their consequences

First you need to find out the main diseases of the inner ear. There are pathologies such as:

Labyrinthitis. This is the most famous and common disease. We are talking about an inflammatory process, that is, internal otitis. There are two main types: limited and spilled. In the first case, the infection does not extend beyond the affected sector and only partially damages the ear, and in the second, it covers the entire cavity of the inner ear and often leads to permanent deafness, including bilateral deafness. Serous and purulent inflammation are also distinguished. Serous is characterized by the accumulation of fluid, which is provoked by exposure to toxins and does not carry any special negative consequences. With purulent labyrinthitis, especially diffuse, bacteria multiply in the cavity of the inner ear, suppuration and destruction of the receptors and curls of the cochlea occur. The organ of Corti suffers the most, causing deafness.
Traumatic injuries. Various deformations of the labyrinth and cochlea, internal ruptures, fractures, displacements, hemorrhages in the ear, etc.
Underdevelopment of the organ. This type of anomaly is considered congenital. Depending on the degree and location of the disorders, in some cases it is possible to partially restore the ability to hear through surgery. If the ear is completely devoid of the cochlea or the organ of Corti, the problem cannot be solved.
Tumors and other neoplasms. Epithelial growths, cysts and tumors, including cancer, can form in one of the areas of the inner ear.
Cochlear neuritis. This is sensorineural hearing loss, which is predominantly a consequence of one of the primary diseases of the inner ear. The most important receptors in the auditory system, as well as the auditory nerve, are affected. As a result, dysfunction of the conductive analyzer is observed, that is, sound signals cannot be processed and transformed into a nerve impulse, which is then transmitted to the brain.
Otosclerosis. The growth of bone tissue in the cavity of the labyrinth, which blocks the ear and its functions and leads to deafness.
Pathologies of the vestibular apparatus. When an infection enters the vestibular apparatus, problems with coordination begin. Diseases associated with positional vertigo may also occur, which is caused by malfunctions of the semicircular canals or their damage. One of the most well-known problems is Meniere's disease, which is associated with an increase in the amount of endolymph in the inner ear.

The consequences of these diseases are hearing impairment at the neurosensory level. Hair receptors are destroyed and are unable to recover. When focal inflammation of the serous type occurs, it is possible to preserve the receptor islands. If modern methods of hearing restoration are used, a person can retain the ability to hear.

Purulent diseases are dangerous for the inner ear because necrotic processes and tissue decomposition enter into the process. As a result, the cochlea and the organ of Corti suffer. The sensory hairs die and deafness develops without the possibility of cure.

Symptoms and causes

When inflammation of the inner ear develops, the patient experiences the following symptoms:

pain in the ear and temporal bone, which can radiate to the back of the head or to the entire half of the head;
malaise and weakness;
dizziness, problems with coordination;
nausea and vomiting;
elevated temperature;
noise in ears;
tachycardia;
hearing loss.

When an organ is damaged, severe pain occurs, hearing is noticeably reduced, and symptoms of intoxication and disorientation are observed.

The following reasons can provoke various disturbances in the functioning and condition of the inner ear:

Congenital developmental anomalies. Underdevelopment of the fetus, the influence of heredity, bad habits of the mother, toxins and infections in the prenatal period.
Birth injuries. Difficult childbirth, use of forceps, deformation of the skull when passing through the birth canal.
Traumatic brain injuries. Any type of injury, especially severe blows or falls from a height, skull fractures, and gunshot wounds affecting the ear.
Internal ear damage. When foreign objects enter through the middle ear, during surgical procedures, barotrauma.
Infectious inflammations and viruses. Otitis media, mastoiditis, meningitis, as well as typhus, tuberculosis and other diseases.
Acoustic impact. Wear of receptors due to prolonged noise and sharp sounds.
Intoxication. The effect on the ear of waste products of bacteria, alcohol, drugs, some medications and other toxic substances, including the environmental situation.

Systemic pathologies, neurological and vascular, cervical osteochondrosis, and stress also affect.

There are three main ways of infection of the inner ear:

Otogenic. Through the hearing organs, mainly from the middle ear.
Meningogenic. From the brain, meninges and intracranial space to the ear.
Hematogenous. Through the bloodstream system when infection is introduced into the blood.

It is possible to establish the place of development of the pathology, its causes and the degree of violations that have occurred through special examinations. Diagnostics includes the following activities:

otoscopy;
blood and urine tests;
audiometry;
samples with tuning forks;
radiography;
CT and MRI.

When discharge appears from the ear, samples of the secretion are taken for analysis to determine the type of bacteria involved in the pathological process, as well as to select the most effective drugs.

Treatment and prevention

Not all inner ear problems can be cured. If the receptors die off or the organ of Corti becomes scarred, it is not possible to restore hearing. In some cases, cochlear hearing aids may help.

In general, the treatment of diseases of the inner ear is as follows:

Drug therapy. Used to eliminate inflammation and symptoms of intoxication. Medicines are used to stimulate neurological processes and the vascular system. It all depends on the specific diagnosis and cause of the problem.
Surgery. The symptoms of suppuration and its consequences can be eliminated by opening the labyrinth and its sanitation. Reconstructive surgeries and implantation are also performed.
Physiotherapy. Some types of procedures speed up tissue repair and improve organ function. Physiotherapy is often combined with the administration of medications directly into the ear.

Proper nutrition and a healthy lifestyle can help cope with problems. Avoid vitamin deficiency and weakened immunity.

To restore hearing and balance function, special exercises and breathing techniques are used.

To prevent the development of these diseases, it is necessary to maintain hearing hygiene, that is, to avoid negative influences, loud sounds and injuries. Consult a doctor in a timely manner for treatment of otitis media and other infectious diseases. If you notice symptoms that indicate one of the diseases mentioned, consult your doctor immediately.

Update: October 2018

Meniere's disease or syndrome is a disease characterized by damage to the structures of the inner ear, manifested by ringing in the ears, dizziness and transient hearing loss.

Studies have shown that this disease occurs in 1 person in 1000 (0.1%). This indicator approximately coincides with the incidence of multiple sclerosis.

Most of the patients are people over 40 years old. The incidence of development among men and women is the same. Meniere's disease (syndrome) affects approximately 0.2% of the entire world population. Most patients are elderly people over 50-60 years old. Women get sick 1.5 times more often than men.

The disease begins as a unilateral process, subsequently spreading to both ears. According to various studies, the disease becomes bilateral in 17-75% of cases within 5 to 30 years.

Every year, 46,000 new cases are diagnosed in the United States. Although no association with a specific gene has been identified, there is a familial predisposition to the development of the disease. In 55% of cases, Meniere's syndrome was diagnosed in relatives of patients, or the disease was present in their ancestors.

Meniere's disease in famous people

Alan Shepard, the first American astronaut and fifth man to land on the moon. The disease that grounded him after his one and only space flight was diagnosed in 1964. A few years later, experimental endolymphatic shunt surgery allowed Alan to fly to the moon as part of the crew of Apollo 14;
Jonathan Swift, the Anglo-Irish satirist, poet and priest, suffered from this disease;
Varlam Shalamov, Russian writer;
Su Yu, a People's Liberation Army general who won a number of significant victories during the Chinese Civil War, was hospitalized in 1949 with a diagnosis of Meniere's disease. The illness caused his removal from his post as commander by order of Mao Zedong during the Korean War;
Ryan Adams, an American musician, was forced to interrupt his creative activity for two years due to the rapid progression of the disease. After undergoing treatment, he returned to the stage without allowing the disease to take over.

Causes of Meniere's syndrome

The most common theory about the occurrence of the disease is a change in fluid pressure in the inner ear. The membranes located in the labyrinth gradually stretch as pressure increases, which leads to impaired coordination, hearing and other disorders.

The cause of increased pressure may be:

Blockage of the drainage system of the lymphatic ducts (as a result of scarring after surgery or as a congenital malformation);
Excessive fluid production;
Pathological increase in the volume of pathways conducting fluid in the structures of the inner ear.

Enlargement of the anatomical formations of the inner ear is the most common condition diagnosed in children of unknown origin. In addition, some patients have a coordination disorder, which can cause the development of Meniere's disease.

Since research has revealed that not all patients with Meniere's syndrome have increased fluid production in the labyrinth and cochlea, the immune status of the patient has become an additional factor causing the occurrence of the disease.

Increased activity of specific antibodies in the examined patients is detected in approximately 25% of cases. The same amount is detected as a concomitant disease, which confirms the role of immune status in the development of the disease.

According to the latest data, the causes of Meniere's disease in patients examined in 2014 remain unclear. Risk factors include:

Viral diseases of the inner ear;
Head injuries;
Congenital abnormalities of the structure of the hearing organs;
Allergies and other immune system disorders.

Symptoms of Meniere's syndrome

Symptoms characteristic of this disease include:

), often accompanied by nausea and vomiting. An attack of dizziness can be so severe that the patient has the impression that the entire room or surrounding objects are spinning around him. The duration of the attack lasts from 10 minutes to several hours. When turning the head, the severity of symptoms increases and the patient’s condition worsens;
Hearing impairment or loss. The patient may not perceive low frequency sounds. This is a characteristic symptom that allows one to distinguish Meniere's disease from hearing loss, in which the ability to perceive high-frequency sounds is lost. There may be increased sensitivity to loud noises, as well as pain in noisy rooms. In some cases, patients complain of “muffled” tones;
Ringing in the ears unrelated to the sound source. This symptom is a sign of damage to the auditory organs. In Meniere's disease, tinnitus is perceived as a "muffled, whistling sound," "cicada chirping," "bell ringing," or a combination of these sounds. Ringing in the ears intensifies before an attack. During an attack, the nature of the ringing can change significantly;
A feeling of pressure or discomfort in the ear due to fluid accumulation in the inner ear cavity. Before an attack, the feeling of fullness increases.

During an attack, some patients complain of headache, diarrhea and abdominal pain. Immediately before an attack, painful sensations in the ear may occur.

Harbingers of an attack include poor coordination when making sudden movements and increased ringing in the ears. Usually the onset of an attack is preceded by a feeling of “fullness” or “pressure” in the ear. During an attack, the patient experiences dizziness, loss of coordination, nausea and vomiting. On average, an attack lasts 2-3 hours. At the end of the attack, the patient feels a sharp loss of strength, fatigue and drowsiness. There are various data regarding the duration of symptoms (from short-term “bumps” to permanent disturbances in well-being).

A relatively serious manifestation of the disease, which can worsen the patient’s quality of life and determines the potential risk, is a sudden fall. Loss of coordination occurs due to sudden deformation of the structures of the inner ear, which leads to activation of the vestibular reflexes.

The patient feels that he is rocking from side to side or that he is falling (although at this time he can remain in an even vertical position), and involuntarily changes his position to maintain balance. This symptom is dangerous because it occurs without warning and can lead to serious injury. Often the only way to get rid of this problem is the so-called “destructive treatment” - labyrinthectomy or excision of the vestibular nerve.

Exacerbations can occur at short intervals in the form of “clusters” - a sequential series of attacks following one another. In other cases, the interval between attacks may last several years. Outside of an exacerbation, the patient does not notice any symptoms, or complains of a mild lack of coordination and a slight ringing in the ears.

Treatment

Is there a cure?

Currently, Meniere's disease remains an incurable disease, but symptomatic therapy has been successfully used to control symptoms and stop further progression. Some new treatment principles come very close to providing complete cure (eg, low-dose gentamicin).

The frequency and intensity of attacks can be significantly reduced using simple methods, even without the use of drugs. Patients are advised to follow a diet and a healthy lifestyle. It is necessary to give up alcohol, smoking, drinking coffee and other products that can worsen the symptoms of the disease.

To control the manifestations of the disease in patients diagnosed with Meniere's syndrome, treatment involves the use of anti-nausea medications, including antihistamines (meclozine, trimethobenzamide) and other groups (betahistine, diazepam). Particular attention is paid to betahistine, since it is the only drug that has a vasodilator effect on the vessels of the inner ear.

Preparations for long-term use

Diuretics can be used to reduce the amount of fluid retained. A common combination is triamterene and hydrochlorothiazide (Diazide). Taking diuretics reduces the amount of fluid in the body and normalizes pressure in the cavity of the inner ear.

Taking diuretics also promotes the excretion of large amounts of minerals (in particular potassium), so it is necessary to adjust the diet so that the potassium in it exceeds the minimum required daily dosage (add bananas, oranges, spinach, sweet potatoes).

Surgery

If symptoms continue to increase during treatment, more radical surgical treatment is used. Unfortunately, surgery does not provide a 100% guarantee of hearing preservation.

Organ-preserving operations are used to normalize the functioning of the vestibular apparatus without removing any anatomical structures. Typically, such operations are accompanied by the introduction of hormonal drugs (dexamethasone, etc.) into the middle ear.

To temporarily improve the patient's condition, surgical decompression of the endolymphatic sac is used. Most patients who undergo this operation note a decrease in the frequency and severity of dizziness without deterioration or loss of hearing. However, this method does not provide long-term improvement or complete cessation of attacks.

Radical operations are irreversible and involve complete or partial removal of functional parts of the auditory system within the affected area. All structures of the inner ear are removed through labyrinthectomy. After treatment, the symptoms associated with Meniere's disease significantly regress. Unfortunately, patients completely lose the ability to perceive sounds on the side of the operation.

An alternative is chemical labyrinthectomy, which is performed by injecting a drug (gentamicin) that causes the cells of the vestibular apparatus to die. This method has the same therapeutic effect as surgery, but allows the patient to preserve hearing.

Injections of drugs into the middle ear

A number of innovative methods have been developed to combat dizziness and other symptoms. Meniere's syndrome is treated by injecting various medications into the middle ear. Subsequently, they penetrate into the cavity of the inner ear and have an effect similar to surgery.

Gentamicin (an antibiotic with an ototoxic effect) reduces the ability to coordinate movements of structures on the affected side. As a result, the vestibular function is taken over by the healthy ear. The drug is administered under local anesthesia. After treatment, the frequency and severity of attacks decreases significantly, although there is a high probability of hearing loss;
Hormonal medications (dexamethasone, prednisolone) also help control the symptoms of the disease. The advantages of using steroids include a low incidence of hearing loss. The downside is that it is less effective compared to gentamicin.

Physiotherapy

For vestibular rehabilitation, methods are used to improve gaze fixation, reduce dizziness and improve coordination through special exercises and a specific lifestyle.

This complex of treatment techniques is called “vestibular rehabilitation”. With its help, a stable reduction in the severity of symptoms of the disease and an improvement in the quality of life of patients is ensured.

Forecast

Meniere's disease is incurable, but not fatal. Progressive hearing loss can be prevented with medication between attacks or surgery. Patients with moderate symptoms can successfully control the disease simply by following a diet.

Long-term consequences of Meniere's disease include hearing loss, increasing dizziness, or persistent dizziness.

Although the disease itself is not fatal, it can cause injuries from falls or accidents. Patients are recommended to exercise with moderate loads, while sports that require a healthy vestibular system (cycling, motorcycle riding, mountain climbing, some types of yoga) should be avoided. Patients are also prohibited from engaging in activities related to climbing stairs (construction, repairs and painting of premises, etc.).

Most patients (60-80%) regain lost functions, sometimes even without medical assistance. Patients with severe and complicated forms become disabled and subsequently require special care.

Hearing loss in the initial period is transient, becoming permanent over time. Hearing aids and implants are successfully used to improve the condition and restore hearing function. Tinnitus somewhat worsens the quality of life, but the patient quickly gets used to it.

Meniere's disease is a disease with an unpredictable prognosis. The frequency and intensity of attacks can increase or decrease, and when the patient loses vestibular functions, the attacks stop.