Inflammation of the ears in humans

  

Introduction

In general, inflammation of the ears in humans and animals is referred to as otitis. A distinction is made between different forms of otitis, which differ in their localization. The two major subgroups of otitis are otitis media and otitis externa, which are explained in more detail below with regard to their causes, symptoms and therapy.

Otitis externa

Synonyms: otitis externa, "external ear infection" / in animals: ear compulsion

Classification according to ICD-10: H60 otitis externa

Definition: Otitis externa is an inflammation of the skin and subcutaneous fatty tissue (subcutis) in the area of the outer ear. These include the external auditory canal (meatus acusticus externus) and the auricle. This ear canal inflammation is triggered by allergies and microorganisms.

In otitis externa, different forms are distinguished.

Below you will find a list of the different inflammations.

Severe inflammation of the ear canal - otitis externa maligna

Synonyms: otitis externa necroticans, osteomyelitis of the temporal bone; English: Malignant otitis externa (MOE))

Definition: This otitis is an inflammation with a severe course of the disease. It is a necrotizing inflammation that can spread to the bones of the skull and cranial nerves and damage them. Necrotizing means that the tissue dies inflammatory.

Cause: Such otitis is the result of infection of the external auditory canal, especially with the pathogen Pseudomonas aeruginosa. As a rule, immunosuppressed patients are affected.

Symptoms: Necrotizing otitis is manifested by severe pain of the affected person. There is a secretion from the external auditory canal. Fluid leaks from the ear. In the course of the disease, the inflammation spreads to the cranial nerves. A very striking symptom is facial palsy. This damage to the so-called facial nerve manifests itself as a disorder of the patient's facial expressions. Other cranial nerves can also be affected. In this otitis, those affected generally do not feel well. They are plagued by severe pain and a general weakness.

Diagnostics: Increased levels of inflammation (e.g. CRP) are detectable in the blood. In further diagnostics, magnetic resonance imaging, computed tomography and bone scintigram are performed.

By means of a trial excision, it is ensured that it is not a carcinoma, ie a malignant tumor. Here, a little inflamed tissue is removed and pathologically examined.

Therapy: Treatment of otitis externa maligna depends on the severity of the course of the disease. First of all, there is daily cleaning of the external auditory canal. The inflammation is combated with the help of antibiotics. On the one hand, these are applied locally, i.e. they are applied to the inflamed area and, on the other hand, a systemic administration takes place. The duration of therapy varies between 6 weeks and 6 months, but can also last up to a year in the case of a very severe course of the disease.

Since it can lead to damage and detachment of small bone parts, so-called bone sequesters, surgical removal of these may be necessary. Abscesses on the ear are surgically opened and cleaned.

During therapy, the inflammation values, such as CRP, should be checked again and again. This ensures the success of the therapy. Since in such a disease the tissue ultimately dies (necrotizes) due to lack of oxygen (hypoxia), oxygen therapy can be considered if the disease is resistant to therapy. In this way, the dying tissue is supplied with oxygen. The oxygen is usually administered by means of a nasogastric tube. In extreme cases, it may be necessary to surgically remove the destroyed bone area or at least parts of it.

Diffuse inflammation of the ear canal - otitis externa diffusa

Synonyms

ear canal phlegmon, auditory canal eczema; English: diffuse otitis externa

Definition

Otitis externa diffusa, also called auditory canal phlegmon or auditory canal eczema, is an inflammation of the skin and subcutaneous fatty tissue (subcutis) of the external auditory canal. A dry form is distinguished from a weeping form, which differ in their clinical symptoms.

Causes

This form of otitis is usually based on an infection with bacteria or fungi. The most common pathogens are Pseudomonas aeruginosa, Staphylococcus aureus and Proteus. An allergy, for example directed against cosmetics or hair shampoo, is also a cause of ear canal eczema.

The external auditory canal becomes susceptible to the penetration of such pathogens, first of all, by cleaning the ears with cotton swabs or the finger. Other risk factors are metabolic diseases, such as diabetes mellitus, or delayed chronic otitis media.

Symptoms:

Dry form:

Auditory canal eczema manifests itself in a dandruff of the skin and an unpleasant itching (pruritus).

Weeping form:

Since in this form of otitis externa diffusa a secretion escapes from the ear, it is called weeping. These secretions are greasy and are also called fetid. This means that they smell foul. The unpleasant smell is caused by bacterial decomposition products, which are sulfur compounds. Secretions from the middle ear are mucous rather than greasy, which allows a distinction to be made.

Other symptoms include severe earache, which intensifies with pressure on the tragus. Externally you can see a swelling of the ear canal. This swelling is accompanied by severe itching. Along with this, the eardrum can also be affected by inflammation (myringitis). The preauricular (localized around the auricle) lymph nodes are swollen and painful.

Diagnostics:

Clinical examination and evaluation of symptoms provides the final diagnosis. To determine the causative germ, smears are made. So then a suitable antibiotic can be prescribed. Furthermore, the patient is examined for allergies. Finally, an examination of the eardrum is carried out, as this can be affected.

Therapy:

Dry form:

Eczema is treated with the help of cortisone ointments. For the treatment of cracks (rhagades), silver nitrate solution (5%) is used to corrode them.

Weeping form:

First, the external auditory canal is cleaned, then antibiotics are applied locally. Of course, this only occurs in the case of bacterial infection. The antibiotics are applied in ointments or drops and only in very rare cases a systemic administration takes place. A flushing of the ear canal can be made.

In case of fungal attack, antifungal ointments or creams are placed on the external auditory canal in the form of rods in the ear canal.

Ear canal furuncle - otitis externa circumscripta

Synonyms:

ear canal boils; English: Meatal Furuncle, circumscribed otitis externa

Definition:

This extremely painful inflammation is an inflamed hair follicle in the external auditory canal; they are also called ear canal boils.

Causes:

Bacterial infections are often the cause of such hair follicle inflammation. The penetration of germs, often staphylococci, is favored by cleaning the ears or scratching.

Here, a metabolic disease, such as diabetes mellitus, is also a risk factor for the frequent occurrence of such ear canal boils.

Symptoms:

Externally, the preauricular and retroauricular lymph nodes (located around and behind the auricles) impress as enlarged. Swelling of the external auditory canal is visible. Clinical examination of the ear canal by means of an ear funnel is painful. The existing, severe pain is aggravated by pressure on the tragus and chewing.

Diagnosis:

The clinical examination of the patient provides the diagnosis.

Therapy:

For treatment, alcohol compresses and gauze strips soaked in alcohol are placed in the ear. Against the severe pain, painkillers (analgesics) are prescribed. In addition, cortisone and antibiotic-containing ointments are used for therapy.

Bloody ear canal inflammation - Otitis externa bullosa haemorrhagica

Synonym:

Flu otitis

Definition:

This otitis can occur in the context of flu (influenza and other viral infections). However, it occurs more frequently in otitis media and acute inflammation of the eardrum.

Causes:

The cause is viral pathogens.

Symptoms:

Symptoms include earache, as well as conductive hearing loss.

In addition, bloody blisters are visible in the ear canal and on the eardrum. Rarely, such otitis is associated with tinnitus or dizziness. This occurs especially when the inner ear is additionally affected. This can lead to hearing loss.

Diagnostics:

The two methods used for diagnostics are otoscopy and the threshold audiogram.

An otoscopy is an examination of the external auditory canal and the eardrum using an otoscope.

The threshold audiogram is used to test the competence of hearing.

Therapy:

The treatment is initially carried out by means of a tympanic tube. This serves to ventilate the tympanic cavity and the eardrum. In addition, infusion therapy may be prescribed.

Otitis media

Otitis media

Synonym:

Otitis media

Otitis media is an inflammation of the middle ear. Different forms of otitis media can be distinguished, which will be discussed in more detail below. According to the course of the disease, we first distinguish between acute and chronic otitis media.

Acute otitis media

Acute otitis media

Classification according to ICD-10:

H65 Non-purulent otitis media

H66 Purulent and unspecified otitis media

H67 Otitis media in diseases classified elsewhere

This is a very painful inflammation of the middle ear mucous membranes, which is infectious.

Causes:

An acute otitis media occurs as part of a bacterial or viral infection and is a very common disease.

Bacterial acute otitis media is the more common form. The bacteria enter the middle ear via the nasopharynx or the bloodstream and settle there continuously.

Viral Middle ear infections usually occur via the bloodstream and are associated with inflammation of the upper respiratory tract. A viral infection can be accompanied by a bacterial infection, or facilitate the outbreak of such. In the case of an existing drum perforation, pathogens can also enter the ear from the outside, for example during a visit to the swimming pool from the bath water.

In acute serous otitis media, the tuba auditory (connection between the middle ear and the nasopharynx) is closed by swelling of the mucous membranes as part of a respiratory infection. Due to lack of ventilation of the middle ear a negative pressure, which ultimately leads to a tympanic effusion. Those affected hear worse and complain of a feeling of pressure.

Diagnostics:

The ear is examined otoscopically (with the ear funnel). Here you can see first a reddened, then a dedifferentiated eardrum. This means that no details can be seen on the eardrum and it bulges. There is a perforation from which pus leaks. These symptoms subside after 2 to 3 weeks.

Small blood and fluid-filled blisters (myringitis bullosa) may also be seen on the eardrum. A serous secretion can leak from them. This is the case with acute serous otitis media.

Symptoms:

A middle ear infection goes through different phases. In the first few days, the patient is plagued by severe earache, hearing loss, fever and throbbing ear noises. Nausea and vomiting may be accompanying symptoms. The pressure on the temple is painful.

While viral infections usually heal here, bacterial infections enter the defense phase in the next few days. Meanwhile, secretion escapes from the ear through an eardrum perforation and hearing is reduced. A purulent secretion speaks for a bacterial, a serous-bloody secretion for a viral infection. Antibiotics can shorten this phase and prevent eardrum rupturing. The fever subsides and after another two to four weeks, the middle ear infection is over.

Therapy:

Middle ear infections can heal even without treatment. Therefore, the first two to three days should be waited under medical supervision. As with any disease, the patient should spare himself.

Nasal sprays and anti-inflammatory painkillerssuch as ibuprofen are recommended. In the case of a bacterial infection, a CSF respirable antibiotic (e.g. amoxicillin, azithromycin and clarithromycin) is prescribed.

Chronic otitis media

This form of chronic otitis media affects the mucous membranes. It is a central tympanic membrane defect without inflammation of the bone.

Cause

The cause is usually a combination of repeated infections and a poorly ventilated tuba auditory. Traumatic or inflammatory diseases, as well as defects of the eardrum can also trigger this.

Symptoms

Those affected suffer from severe earache and purulent discharge from the ear. Hearing is reduced. The tympanic membrane is preserved at the edge, but damaged in central areas. During an inflammatory flare-up, the mucous membrane of the middle ear is reddened and thickened. Otherwise, it may appear grayish and dry.

Therapy

The perforated eardrum is closed as part of a so-called tympanoplasty. For this, dry conditions must be created and the ear canal is cleaned and disinfected.

Suppuration is treated with ear drops containing antibiotics. After the treatment, care must be taken to keep the ear dry (cotton wool closure when bathing, no diving or swimming) and to ventilate the tuba auditory sufficiently by means of nasal breathing.

Otitis media chronica epitympanalis

This is an inflammatory damage to the edge of the tympanic membrane; the bone is also affected by the inflammation.

Causes

The causes are the same as in otitis media chronica mesotympanalis.

Symptoms

In the context of eardrum damage, hearing loss (conductive hearing loss) occurs. The tympanic membrane damage is peripheral and foul-smelling pus comes out of the ear (otorrhea). At the same time, polyps can grow into the ear canal.

Since the bone (for example, the ossicles) is also affected by the inflammation, it can lead to inner ear damage and thus to neurological deficits. These include nausea, dizziness, facial palsy and numbness.

This form of chronic otitis media can pave the way for the formation of a cholesteatoma.

Therapy

First of all, the ear canal must be drained and antibiotics are applied locally or systemically to stop existing suppuration. In any case, surgical restoration of the tympanic membrane (tympanoplasty) and removal of the cholesteatoma are carried out.

Further inflammation of the ears

Perichondritis is an inflammation of the cartilage skin.

Causes

Such inflammation is bacterial (more often Pseudomonas and staphylococci). They reach the cartilage skin via injuries to the auricle (for example, during surgery or ear piercings).

Symptoms

The auricle is swollen and reddened. However, the earlobe is not affected because it does not contain cartilage. With advanced inflammation, necrosis can occur, i.e. tissue dies. Typically, the shape of the ear (cauliflower ear) changes.

Read more about the topic: Pain auricle

Therapy

To combat bacterial inflammation, antibiotics are administered orally. In late stages of the disease, infusions of antibiotics may be necessary. In addition, surgical removal of the necrotizing cartilage may be necessary.

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