Edema of the Eustachian tube
Usually the Eustachian tube is closed and its wallsadjoin one to the other; at the moment of the act of swallowing due to the combined action of the muscles of the soft palate of the Eustachian tube opens and the air penetrates into the middle ear. In this way, a continuous aeration of the middle ear occurs.
If the aeration is broken for some reason, the air,located in the middle ear, is gradually resorbed and external atmospheric pressure begins to prevail over the intra-tympanic: as a result, the position of the tympanic membrane changes, it "retracts", that is, it approaches the wall of the promontory.
All diseases accompanied by hyperemia andcatarrhal changes from the nose or nasopharynx, can lead to simultaneous damage to the Eustachian tube. Acute or chronic runny nose, hypertrophy of the posterior ends of the lower shells, adenoid vegetations, nasopharyngeal tumors, frequent tonsillitis, hypertrophy of the tonsils, pushing the soft palate and closing the lumen of the Eustachian tube, all this causes secondary changes in the Eustachian tube.
Pathological changes are reduced to hyperemia and swelling of the walls of the tube; with chronic inflammation, the walls of the tube become densified, leading to fibrous stenosis of the tube.
Sick children complain of stuffy ears, poor hearing, tinnitus and in the head. Because of a decrease in hearing, school-age children begin to learn badly.
Otoscopic picture. The retraction of the tympanic membrane is expressed: 1) a sharp stand of the short process of the malleus and the posterior fold (the short process is moved anteriorly and downward); 2) apparent shortening of the handle of the malleus; 3) by changing the normal shape of the light cone: it becomes thinner, shorter, sometimes takes the form of a stick or a point; at the same time, other luminous points appear on the atypical site of the tympanic membrane.
Due to a violation of the ventilation of the drumcavity and decrease in it of atmospheric pressure there is a serous transudation. The transudate does not occupy the entire tympanic cavity, the line of the transudate sometimes has the form of an arch facing concavity upward, and the lower part of the tympanic membrane has a yellowish tide.
Hearing is characterized by symptomsdamage to the sound-conducting apparatus, ie, low tones are poorly perceived, the hearing is not changed with respect to high tones, in other words: with Weber's experience, lateralization in the diseased ear, the Rinne experience is negative, with the Schwabach experience, lengthening of bone conduction. The otoscopic examination must be supplemented with anterior and posterior rhinoscopy. With anterior rhinoscopy, attention should be paid to acute phenomena from the mucous membrane of the nose, to the patency of the nose; with posterior rhinoscopy - on the presence of adenoid vegetation, on the increase of the posterior ends of the lower shells, on the condition of the mucous membrane of the nasopharynx.
Distinguish the following clinical forms: 1) acute - after acute rhinopharyngitis; 2) chronic - as a result of often recurring acute rhinopharyngitis, sometimes developing imperceptibly for others and suddenly appearing at once; 3) a recurring form that manifests itself in the spring and autumn (in summer and winter the child hears well and does not complain about anything).
Diagnosis put on the basis of the otoscopic picture of posterior rhinoscopy and hearing research.
Treatment has two purposes: 1) to restore the patency of the pipe; 2) remove the causes that support tubar catarrh.
In the acute stage, swelling should be reducedmucous membranes, nasal membranes, nasopharynx, and consequently, the Eustachian tube and affect the infectious agent. To do this, you should appoint a solution of penicillin in ephedrine in the form of drops. These drops contribute to the restoration of nasal breathing, proper ventilation of the Eustachian tube and act bacteriostatically or bactericidal for the infectious beginning. Drops poured into the nose until the acute rhinopharyngitis passes. After this, blowing the ears should be done.
In the treatment of recurrent or chronic formsit is necessary to eliminate the underlying disease, i.e., to remove adenoid vegetations, with indications - and the rear ends of the lower shells. Additional treatment consists in blowing the ear 2-3 times a week before restoring the patency of the Eustachian tube. The blowing can be carried out with a bottle of the Politorzer or with the aid of an ear catheter.
During the act of swallowing the air in the nasopharynxis separated from the air in the oral cavity by a soft sky; Therefore, if at this time cause a sharp increase in pressure in the nasopharynx by increasing the external pressure, then this air must enter the Eustachian tube and the drum cavity. Such a sharp increase in pressure is achieved by a simple blowing. On the threshold of the nose one by one, on each side, an oval tip of the balloon (olive) is inserted so that it tightly closes the entrance to the nasal cavity. The thumb and middle finger of the left hand hold the tip, and the forefinger is pressed by the wing of the nose of the other side to the septum. The doctor holds the balloon with his right hand. The child should inflate his cheeks or swallow a sip of water; at this point, you should press the cylinder; Air usually enters through the Eustachian tube into the ear. However, it may happen that the moment of compression of the balloon, i.e., the injection of air into the nasopharynx, does not coincide with the moment of swallowing - in this case the air will not penetrate the tube and the purging should be resumed. If, despite all attempts, air does not enter the pipe, it means that the pipe is narrowed.
About ingress of air into the tympanum throughthe pipe will be recognized: 1) by subjective sensation - the child immediately indicates an improvement in hearing; 2) on the otoscopic picture - the light cone changes and becomes triangular, the tympanic membrane slightly reddens; 3) using an otoscope, one end of which is inserted into the ear of the child, and the other - into the ear of the doctor to control the entry of air into the tympanic cavity of the patient.
The blowing up of Politzer is the best waythe introduction of air in young children, because with the troubled behavior of the child to enter a catheter through the nose is very difficult. Blowing can be made through the Eustachian tube infection into the tympanum, if produced with a runny nose. When there are discharge in the nose, therefore, blowing should be performed only after the ending of the common cold.
In older children, purging can beproduce through a catheter. The latter is a metal tube, one end of which is bent (beak), and the other is provided with a ringlet - the ring indicates the direction of the beak. The end of the catheter, provided with a ringlet, was funnel-shaped widened to insert the tip of the rubber balloon. The catheter is carefully inserted along the bottom of the nasal cavity to the posterior wall of the nasopharynx, then rotated 90 ° to the median line of the body and stretched until the beak touches the posterior edge of the nasal septum, after which the catheter should be turned 180 ° outwards.
Thus, the ring is directed first downward, then outwardly - as if to the outer corner of the child's eye; at this point the beak of the catheter enters the mouth of the Eustachian tube.
In order to hold the catheter still, itstake between the thumb and forefinger of the left hand, and the other three fingers for support are placed on the back of the child's nose. In the socket of the catheter insert the tip of the balloon and, squeezing it, pumped air through the catheter into the Eustachian tube. The control is carried out by means of the otoscope.
In order to remove the catheter, it is turned ringlet downward and carefully withdrawn from the nose in this position.
Introducing and withdrawing the catheter is recommended by pop eye control.
Blow through the catheter gives the followingAdvantages: 1) blow only the ear on which you need to work; 2) it is possible to dose the amount of air and the blowing force; 3) it is possible to control the degree of patency of the pipe; 4) nasal discharge can not enter the tympanum; 5) blowing through a catheter often succeeds when it is not obtained by Politzer.