Edema of the middle ear

How good it is to hear the morning singing of birds, murmurwater, rustle of leaves, how pleasant to listen to the whispered words of love; crackling, noise, screaming warns us of danger, the crying of the child is calling us to him. But how bad it all is not to hear.

The human ear is remarkably arranged,complex and at the same time simple apparatus for receiving sound waves, carrying out and amplifying these waves, converting mechanical oscillations into electrical nerve impulses.

To fulfill the above tasks in the ear, there are the following formations:

external ear - the auricle, the external auditory meatus;

middle ear - eardrum, middle ear cavityvolume up to 1 cm3 with a system of auditory ossicles (hammer, anvil, stapes); auditory, or Eustachian tube connecting the middle ear cavity with the nasopharynx;

inner ear - a snail (responsible for the transformation of mechanical sound waves into nerve impulses) and a system of labyrinths (responsible for human equilibrium).

The auricle has a bizarre structure,which can be seen by sticking out his ears and looking in the mirror. This structure allows you to direct and focus sound waves in the external ear canal.

Due to the fact that a person, likemost other animals, two ears, we can determine where the sound comes from, scientifically, it's the ototopic. A person with a single hearing ear hears a sound, but does not understand where he comes from. In ordinary life, such a poor fellow can easily get lost in the forest, orientation in space becomes sharply hampered.

Thus, the concentrated sound waves are included inexternal auditory canal. In simplified form - a tube length of about 2.5 cm in adults and 1.5 cm in children. This tube is lined with skin, in the thickness of which there are modified sweat glands, which produce not sweat, but sulfur.

Sulfur in the ear is not for dirt, as some people thinksubjects washing the ears, and for cleaning the air that gets into the ear (for example, on a dusty road), to enhance the reflection of sound waves from the walls of the ear canal, to fight microbes and fungi, and strive to cause inflammation.

As any of the functions of our body,the formation of sulfur is a strictly individual process. At someone it is too much, at someone - it is not enough. At someone it is dense, at someone, on the contrary, dry and fragile. Sometimes sulfur is so much that sulfuric cork is formed, and the person on the background of full health stalls on one ear, having bathed or bathed in the shower.

This process does not depend on cleanlinesssuddenly deafened. It just produces too much thick sulfur. By the way, you should not taste it, since you already understood that all the dirt that gets in your ear accumulates in the sulphate. This, of course, applies to young researchers.

Under the skin two thirds of the auditory canalis represented by a cartilage (it is rather soft to the touch), one third is occupied by a bone. The auditory meatus is slightly curved, therefore, in order to straighten it, children should slightly pull the auricle back and down, and in adults - back and forth. In children, the external auditory meatus is wider (in relative terms) than in adults.

Again, the ear is a great place forshoveling balls, castors, bearings and other things that are very suitable for this occasion. It's easy to shove, but sometimes it's very difficult to get it out. We have to do the operation.

And now the information is not for the faint-hearted. The outer auditory canal is very much liked by cockroaches and flies. When this creature gets into the ear, it immediately tries to get out, desperately moving all its limbs, while moving deeper and getting bogged down in the sulfur.

These manifestations of the life of a prisoner are veryare painful. A person literally goes mad, feeling very strong pain and hearing a loud whispering in his head. In this situation, people need to immediately fill in the ear with any liquid fat (but not hot!) - vegetable oil, vaseline, peach oil, at worst - a liquid baby cream. Then the insect suffocates. Water will not help, because insects are amphibians. Dead animals are not shaken, and already in a calm state you can reach the doctor who will remove the "interventionist".

We return to more calm topics. The middle ear begins with the eardrum, which can only be seen by a doctor using an ear funnel. This is a thin mother-of-pearl membrane, reminiscent of the membrane of the drum (hence the name). The tympanic membrane separates the external auditory canal from the middle ear. Its main function is to amplify the sound waves and transfer them to the auditory ossicles, which are attached to the membrane. And the normal tympanic membrane blocks the way to water and microbes.

Auditory ossicles - a hammer, an anvil,stapes - are so named because of the similarity with a hammer, anvil and stirrup. These are the smallest bones in our body. But we feel any malfunction in the chain of these bones in the form of hearing loss. The articulation of the auditory ossicles is a system of levers that amplify the sound wave many times, and also regulate the loudness of sound with the help of a very small muscle. This is protection against ear trauma by an excessively loud sound.

Even in the middle ear there is a very important auditorytrumpet. It connects the middle ear with the nasopharynx. This pipe was created to equalize the air pressure in the middle ear. It is her lay in an airplane or a deep immersion in the water. You know, the feeling is not very pleasant. To avoid this, it is recommended to chew gum or suck caramels on the airplane. Then you constantly swallow saliva, which means you move the muscles of the pharynx, thereby forcibly expanding the auditory tube. The effect is enhanced if you hold your mouth and nose when swallowing.

This is a very interesting arranged organ, answeringand for the hearing, and for our balance and a sense of gravity. The inner ear consists of a bone, inside is filled with a dense liquid in a volume of less than 1 cm3, half of which is an exact copy of the shell of a cochlea in 2.5 curls, that's why it is called a snail. The other half is represented by bone ducts in the form of semirings located in mutually perpendicular planes. Therefore, in whatever position in space we are, we understand this.

Harder for astronauts. In space, as you know, weightlessness, so the liquid inside the bone snail and labyrinths does not crush anywhere, does not shimmer, and cosmonauts do not feel with their eyes closed, where the floor is, where the ceiling is. Surely this is a rather painful feeling, to which one must get used.

Inside the cochlea, an almost magical transformation of the sound wave transmitted by the auditory ossicles to the liquid inside the cochlea occurs, into a nerve impulse.

There are many theories of this process, but one of themseems to me the most believable. Imagine strings in a piano or harp. Each string is responsible for its sound: the thicker and shorter the string, the lower the sound, the thinner and longer the higher the sound. For simplicity of understanding: the male voice is a low sound, female and childish - a high sound.

So, these strings are stretched across the cochlea,and it turns out as a spiral staircase, tapering upward. Each string is connected to a nerve fiber. At this level, the generation of a mechanical wave into an electrical wave occurs. Accordingly, if a string or nerve fiber is damaged, a person ceases to hear a particular sound.

DISEASES OF EAR, OVERALLLY REDUCED TO REDUCE HEARING

Well, now, knowing the anatomy, you can start the disease. Let's start again outside.

The most unpleasant disease of the auricle isperihnondritis, that is inflammation of the cartilage, which is located under the skin of the auricle. This happens most often because of an injury. Especially relevant this pathology was in the early 90-ies of the twentieth century, when a bunch of earrings entered the fashion.

But the consequences of such inflammation are veryunpleasant, especially for those who consider their ears to be beautiful. If the inflammation was strong, and the cartilage melted, then the ear wrinkles and deforms. Manifestations of perichondritis: redness and swelling of the ear (the ear looks like a red dumpling), severe pain in the ear, but hearing is not reduced. To be treated better in the hospital with the help of injections of antibiotics and physiotherapy.

Inflammation of the skin of the external auditory canalis called external otitis. It can be a limited inflammation, i.e. a furuncle, and can be and a diffusive or diffuse inflammation, i. inflammation of the entire ear canal. This causes severe pain in the ear, hearing decreases, the ear can itch, often the body temperature rises.

As you remember, the external ear canal -a relatively long and narrow tube, and when the skin swells, a closed space is created, hence the pain and hearing loss, since the sound simply does not go inside.

Very often, otitis externa is caused by fungi,which are normally present in the ear, and against a background of reduced immunity multiply well. Fungi love warmth, dampness and darkness. All these conditions are present in the ear.

Therefore, if you have such a misfortune, it is better to immediately go to a doctor, or better still take a smear for mushrooms, if it is, of course, possible.

Treatment is most often localthe use of ointments (bacteroban, clotrimazole, nitrofungin, polyginacs), drops (sfradex, anauran, otofa, etc.), physiotherapy (in particular, ultraviolet irradiation - UFD), if necessary (with furuncle), antibiotics (augmentin, amoksiklav, sumamed, rulid, supraks). The disease in general is not dangerous, taking place with competent treatment without consequences.

Very unpleasant disease. She is unpleasant with pain, sometimes intolerable. For the development of acute otitis media, the auditory tube is of great importance-a narrow, long tube that connects the nasopharynx with the middle ear.

Most often the scenario of development of acute otitis is as follows: on the background of a runny nose or sore throat (ie edema of the nasal mucosa and nasopharynx), the swelling of the auditory tube develops, which causes the ear to become obstructed. Then the mucous membrane of the middle ear flows (this is a cavity of 1 cm3), so there are pains in the ear of a shooting character. Edema builds up, and mucous and mucopurulent discharge appears and accumulates inside the ear, the pain intensifies, the body temperature increases, the patient, especially the child, starts to howl and "climb on the wall."

Then one day the drumthe membrane melts under the action of pus, which, in turn, flows through the external auditory canal, and the patient has a sharp relief of the condition - terrible ebbing pains in the ear go away. At the end of the disease, the hole in the eardrum becomes overgrown, and the patient is recovering.

Very dangerous time for the development of acute otitis -Hot Summer. Heat-waking adults and children bathe and supercool in cool ponds. Also in the risk group are drivers constantly driving with an open window. Therefore, they have a weak spot in their left ear (while the English and Australians have the right ear). Also very often otitis media develops in babies, because the auditory tube is wide and short, and any infection from the nose directly enters the middle ear.

So, the symptoms of otitis media are as follows: shooting pain in the ear, ear congestion, decreased hearing on the affected side, in the middle of the disease there is a purulence from the ear; high body temperature, sharply reduced ability to work.

It is very important to conduct an immediatequality treatment, so as not to remain without hearing for life. The first is to remove the pain. This is achieved primarily by the use of painkillers (panadol, paracetamol, Tylenol, Solpadein, baralgin, Sedalgin, etc.).

Then the vasoconstrictor drops into the nose. In this case, the problem of the drops widens the pharyngeal mouth of the auditory tube in order to regulate the outflow and aeration of the middle ear as soon as possible. To do this, lie on your back and turn your head in the direction of the diseased ear, so that the droplets become caked as far as possible into the nasopharynx.

Must use antibiotics. These are the same augmentin, amoksiklav, sumamed, rulid, tavanik (it is categorically contraindicated for children, as the development of cartilaginous tissue in the whole body is disrupted).

A special item is a drop in the ear. As is clear from the above, there is a stage of acute otitis media before perforation (perforation) and after perforation of the tympanic membrane. Through the whole tympanic membrane, though inflamed, any medicinal substance penetrates with great difficulty. Therefore, the high efficiency of any drops in the ear at this stage is highly questionable.

The most effective use of a local compresson Tsitovich. On a wadded tourniquet, gently placed in the external auditory canal (in a child pulling the auricle back and forth, and in the adult - back and forth), a mixture of glycerin and 70 ° alcohol in a proportion of 1/1 is instilled. Outside, the auditory canal is closed with cotton wool greased with any fat (baby cream, sunflower or petrolatum oil) for hermetic sealing. All this design remains in the ear for 2-3 hours, then it is removed. Enough two compresses a day.

Thus, edema of the tympanic membrane is removed, and because of the high osmotic pressure of glycerin, the swelling of the mucous membrane in the tympanic cavity decreases.

I would like to warn against imposing the usualhalf-alcohol (vodka) compress on the parotid region. This compress has a strong heating and vasodilating effect, which is very dangerous in terms of purulent complications, sometimes fatal.

When the postperforative stage of the middleotitis, it makes sense to use local complex drops with antibacterial and anti-edematous effect. Sofraks, otofa, otinum, anauran combine an antibiotic and a hormonal drug.

There are also "pitfalls" here. Antibiotics, which are part of the drops, often have an ototoxic effect, i.e. after their use, hearing may be reduced. Therefore, the thoughtless use of such drops is not recommended.

It is safest to make a mixture ofseveral drops of hydrocortisone (emulsion of a hormonal drug) and 5 ml of dioxidine (an effective antimicrobial agent, to which the high resistance of microorganisms is not yet noted). Bury this mixture should lie on a healthy ear, in a warm form (for example, warm in the hand), like any other drops in the ear, so that there is no dizziness.

In general, the average otitis is better treated under the supervision of an ENT doctor, because it may require procedures that are beyond the control of other specialists, let alone doctors.

Exacerbation of chronic otitis media(perennial course, exacerbation more often than once a year) proceeds on the same principle, but is more dangerous than acute otitis media (which occurred for the first time in life or repeated many months or years later).

Chronic inflammation erodes the bone in the ear,as a water stone, thereby opening the way to severe complications: meningitis (inflammation of the meninges), encephalitis (inflammation of the brain tissue), brain abscess (abscess inside the brain), thrombosis of large intracranial vessels.

Very often chronic otitis media requiressurgical treatment. Often with chronic otitis media, persistent perforation in the tympanic membrane (constant hole) occurs, so doctors do not advise swimming, swimming in summer, and when taking a shower, it is recommended to put in the ear cotton wool soaked in any fat so that the middle ear does not get water and has brought pathogenic microbes which cause an exacerbation of an inflammation.

OTHER CAUSES FOR HEARING LOSSES

The least studied is the process of hearing loss due todamage in the inner ear and auditory nerve. Most often, patients say they have had ARVI (colds), or hearing has decreased against the background of rising blood pressure.

The auditory nerve and inner ear are supplied with bloodone thin artery. And if this artery is narrowed or clogged for some reason, there is an almost irreversible loss of hearing on the affected ear.

Experienced doctors developed a treatment regimensuch a ear disorder (sensorineural hearing loss), aimed at improving the ear's blood supply: slightly dilute blood, widen the vessels slightly, and improve nutrition of nerve cells with vitamins.

A good prognosis for the return of hearing in patientsafter ARI, immediately applied for qualified help. A worse prognosis is in patients with hypertensive disease, with sudden pressure jumps. In this case, the treatment is just stopping the hearing loss, and then not forever.

This is a summary of the most well-known andcommon ear diseases, most often leading to hearing loss temporary or permanent. But competent and timely treatment almost always leads to cure.

The review was prepared by Julia LUCHSHEVA, Research Fellow, Moscow Scientific and Practical Center for Otorhinolaryngology, CZ, Moscow