Otitis is an acute or chronic inflammation of the ear.
Complication common to many flu diseases, otitis is generally due to bacterial or viral insults.
Classification of otitis
Based on the involved auricular portion, it is possible to distinguish more forms of otitis:
- Internal otitis: inflammation involves the inner ear.
- Otitis media: probably the most common variant in pediatric children, is inflammation of the middle ear.
- Otitis externa: in addition to involving the external auditory canal, this form of otitis also tends to affect the eardrum. However, the eardrum is not always compromised.
- Myringitis : otitis takes on the precise connotation of myringitis when the infectious-inflammatory process affects exclusively the tympanic membrane.
The symptom that all the different forms of otitis have in common is earache (otalgia): the intensity of pain and the possible presence of other symptoms (eg loss of balance, dizziness, nausea, etc.) depends on the area of ear affected by inflammation.
Internal otitis (or labyrinthitis)
Causes
Although it is not possible to trace the cause with absolute certainty, internal otitis appears to be caused by:
- bacterial or viral infections, such as mumps (mumps) or acute otitis
- meningitis or meningoencephalitis: in these cases, internal otitis occurs in its purulent variant
- violent allergic reactions to substances / drugs (eg antibiotics)
- extreme stress
In addition to the alleged causes just listed, some possible risk factors that predispose the patient to internal otitis have been identified. Among the most probable, we mention: violent coughing, excessive effort and sudden movements.
Symptoms
Internal otitis usually begins with vertigo, always violent and acute. The clinical picture is completed by anxiety, confusion, difficulty maintaining balance, ringing in the ears (tinnitus), dizziness, nausea, nystagmus, stomach pain, pallor and hearing loss.
Internal otitis can therefore cause considerable discomfort, so much that it sometimes leads to depression and panic attacks.
Diagnosis and care
A suspicion of internal otitis can be confirmed by multiple diagnostic tests:
- Test of auditory response of the brainstem
- Electronistagmography (electronic recording of eye globes movement)
- Bacterial culture test
- TAC
- MRI (magnetic resonance tomography)
The cure for internal otitis depends on the cause that arises at the origins and the severity of the symptoms. Antiviral drugs and antibiotics are used in therapy when internal otitis depends, respectively, on viral and bacterial infections.
Anti-emetic drugs are indicated to remove vertigo-induced nausea, while anticholinergics are used to relax the affected patient. Benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) are also indicated to ward off anxiety and depression in patients with otitis interna. To reduce inflammation in the ear, corticosteroid drugs are recommended. When the medications are not sufficient to completely cure the disorder, internal otitis must be treated with surgery, aimed at correcting any damage to the ear.
Otitis media
Otitis media is an infection typical of childhood that occurs in the middle ear, precisely in the space between the tympanic membrane and the inner ear. The acute variant is probably the most common of all.
Causes
Most often, otitis media is diagnosed in children after a simple cold: infections of the respiratory tract, extending along the Eustachian tube, can in fact reach the middle ear, creating damage. Let us briefly recall that the Eustachian tube is a canaliculus which connects the nose with the middle ear.
In addition to colds, pharyngitis, allergies and adenoid enlargement can also predispose the patient to otitis media.
Symptoms
Otitis media is accompanied by pain and auricular inflammation, associated with the characteristic symptoms of the triggering disease: sore throat, fever / low-grade fever, nasal congestion (stuffy nose), cough.
In some cases, otitis media manifests itself in the purulent variant: in similar situations, ear pain is accompanied by the emission of purulent material (pus) from the ear canal. When otitis media is not accurately treated, it is possible that the clinical picture is aggravated by perforation of the eardrum, impaired hearing and severe tinnitus.
Diagnosis and therapy
Otitis media can be ascertained by multiple diagnostic tests:
- Visit with the otoscope (diagnostic investigation par excellence)
- Tympanometry: evaluates the movement of the eardrum and the pressure inside the middle ear
- Timpanogramma: evaluates the presence of liquid / mucus in the middle ear and the functionality of the Eustachian tube
- audiometric examination
- TC
The therapy depends on the triggering cause: antibiotics are indicated in case of proven bacterial infection, while antivirals - when necessary - are indicated for the treatment of virus infections. For pain control, the patient suffering from otitis media can take analgesic and anti-inflammatory therapeutic aids, useful for speeding up the healing time: paracetamol, ibuprofen and hydrocortisone (topical application, directly in the ear canal) are the most used.
Otitis externa
Otitis externa, also called otitis of the swimmer, is an acute or chronic inflammation of the external ear canal. Precisely, external otitis mainly involves the epithelium lining the external auditory canal; despite what has been said, the infection can extend even more deeply.
Causes
The pathogens involved in the etiopathogenesis of external otitis are mainly bacteria and viruses (in particular herpes viruses); sometimes, even some fungi can be involved.
Acute external otitis, typical of children, is often a consequence of eczema or purulent otitis media, responsible for the progressive maceration of the skin covering the external auditory canal. Otitis externa can be favored by some predisposing factors, such as cold, humidity, dryness of the ear canal or accumulation of wax (cork).
Chronic otitis externa is typical of those who are debilitated, immunocompromised, diabetic or suffering from serious vitamin deficiencies.
Symptoms
Otitis externa tends to begin with an annoying sensation of itching, which soon turns into more or less intense pain localized in external auditory structures. Auricular pain is accentuated during chewing or simply by touching the ear. Otitis externa may be accompanied by erythema, hyperemia (increased blood in the external ear), edema, altered hearing ability or otorrhea (purulent / serous secretion from the ear canal).
Diagnosis and treatment
External otitis can be ascertained with an otoscopy examination, useful for detecting the presence of edema and hyperemia. Also in this case, the most indicated therapy depends on the triggering cause: therapeutic aids (to relieve pain), antibiotics (in case of bacterial infection) and antiviral ones (if the cause of external otitis depends on viral insults).
