Generality
Ear catarrh is a clinical sign caused by increased secretion of mucus in the ear.
This disorder occurs most commonly in children due to the anatomical conformation of the auditory system, but can also affect adults.
What is phlegm?
Unlike mucus secreted under normal physiological conditions, having the functions of lubricating the walls and facilitating the elimination of external agents, which penetrate the body, the phlegm is more abundant, dense and sticky .
The presence of this "abnormal" mucus at the level of the tympanic cavity of the ear is related to various pathological conditions. In most cases, the accumulation of phlegm is a form of congestion secondary to an inflammation .
The medical evaluation makes use of the direct vision of the auditory canal and the tympanic membrane (otoscopy), and of performing instrumental examinations (audiometry and tympanometry) which confirm the presence of phlegm.
Ear anatomy (in short)
To understand the nature of this manifestation, it is necessary to remember some notions about the structure of the auditory organ.
The ear can be anatomically divided into three parts:
- EXTERNAL EAR: formed by the auricle, made up of skin and cartilage, and of the external auditory canal. Thanks to its structure, the external ear conveys the sound waves towards the outside of the tympanic membrane, which provides the useful surface for sound collection and vibrates in response.
- MIDDLE EAR : it is a small cavity placed between the eardrum and the inner ear, to which it transmits the mechanical vibratory energy of the sound through a system of three auditory ossicles (in sequence: hammer, anvil and stirrup). These transfer the sound waves in modified form to the oval window, an opening in the bony wall of the middle ear cavity. At this level, there is also a conduit - the Eustachian tube (or auditory tube) - which connects the auditory organ with the nasopharynx (portion of the pharynx behind the nose).
In the middle ear, the EUSTACHIO TRUMPET performs multiple functions:
- Ensures that there is a change of air trapped in the middle ear;
- It allows external pressure to be compared to internal pressure, to avoid problems of a pressor-like nature on the tympanic membrane;
- It favors the drainage of the mucus that is normally produced at the level of the lining of the ear.
- Inner ear : consists of a complex series of structures (vestibular apparatus and cochlea) contained deep in the bones of the skull. The function of the cochlea is acoustic and consists in transforming the sound waves transmitted by the middle ear into electrical impulses which, through the acoustic nerve, are sent to the brain. The vestibular apparatus, on the other hand, is involved in maintaining balance.
What's this
The catarrh in the ear is a manifestation that can be found when there is an accumulation of mucus at the level of the Eustachian tube, without any possibility of spontaneous drainage of the same through the nasopharynx.
The increase in mucus in the auditory organ typically results from an inflammatory pathology.
Causes
Catarrh in the ears is a clinical sign that recognizes multiple causes.
Otitis media
The tubal catarrh is a manifestation that is usually found in the effusive or catarrhal otitis media. In this case, the liquid or purulent secretions that collect in the middle ear may depend on the action of viruses, bacteria or other pathogens from a neighboring site (such as the throat and upper respiratory tract).
Often, inflammation of the middle ear is supported by subjective factors (age, immune status, etc.) and local factors (such as adenoid hypertrophy, structure of the Eustachian tube or malformations of the palate).
Congenital malformations
The predisposition to the formation of phlegm may depend on a particular conformation of the ear (structural or functional anomaly). This includes the slightly accentuated inclination of the Eustachian tube or their size (diameter or length) lower than normal. The congenital malformations that can predispose to the excess of mucus in the auditory organ are also the anomalies of the palate and the dysfunction of the tensor muscles of the pendulous veil.
Other causes
The catarrh in the ears can refer to other diseases, including:
- Cold (inflammation of the respiratory tract);
- Sinusitis (inflammation of the nasal and paranasal sinuses).
Among the conditions that may occlude the outlet of the tuba in the nasopharynx include:
- Gastroesophageal reflux;
- Cancer of the auditory canal;
- Nasopharyngeal tumor.
The production of mucus can be increased even in the presence of:
- Allergies (excessive or abnormal reaction of the immune system towards harmless substances such as dust, plants, animals, food, etc.);
- Cholesteatoma.
Risk factors
The tubal catarrh is a more frequent condition in the following cases:
- Pediatric age : the accumulation of mucus at the tubal level occurs mainly for anatomical reasons . In children under the age of 2, in fact, the Eustachian tube is thinner and shorter than that of an adult, in addition to having an inclination that is not yet definitive; the combination of these characteristics makes the flow of mucus from the middle ear to the nasopharynx more difficult. Furthermore, during childhood, the immune system is still developing: this makes the child more susceptible to infections .
The anatomical conformation of the ear predisposes to the development of inflammatory processes also due to the concomitant tendency to adenoid hypertrophy (correlated to recurrent infections), able to favor the occlusion of the outlet point of the Eustachian tube. Another risk factor to be considered is related to the tensor muscle of the pendulous veil, which seems to contract less effectively in the child; this, like the other parameters, compromises the opening of the Eustachian tube.
- Smoking habit : the formation of phlegm in the ears of smokers is related to the harmful effects of nicotine on hearing cells. This substance, in fact, stiffens the walls of the blood vessels that supply the auditory system, worsening the local microcirculation and reducing the supply of oxygen. It should also be considered that smoking is in itself an irritating and harmful factor, as it stimulates greater mucus production, amplifying the normal drainage mechanisms that can be implemented at this level.
- Seasonal variations : the formation of thick mucus in the ear is more frequent in winter, due to exposure to cold and the greater risk of incurring air blows. Furthermore, the colder temperatures tend to weaken the immune defenses: viruses and bacteria pass more easily from the throat to the ear, through the Eustachian tubes. In the summer, however, the catarrh in the ears can result above all for the recurrent contact with the sea water (dips, ears perennially moist and / or wet etc.).
Symptoms and complications
Usually, the catarrh in the ears manifests itself with:
- Rumble of noises or sense of rumble felt while speaking (autophony);
- Sensation of auricular fullness (/ Symptoms / Orecchie_tappateorecchie capped or clogged);
- Secretion from the external auditory canal of thick mucus (in case the tympanic membrane is broken or permeable);
- Redness of the affected ear or increase in its temperature.
The patient's sense of discomfort is caused by the production of phlegm itself, as well as by the activation of all those mechanisms that fall within the scope of the inflammatory cascade.
Depending on the underlying cause, excess mucus in the auditory organ may be accompanied by various other symptoms, including:
- Otalgia (ear pain);
- Enlarged lymph nodes behind the ear or in the neck;
- Local itching;
- Nausea, dizziness or alterations in the perception of balance (related to the propagation of inflammation also at the level of the inner ear);
- Tinnitus (perception of sounds similar to buzzing);
- Hearing loss;
- Otorrhagia (blood from the ear);
- Fever (especially in the case of infections or tumor phenomena);
- Chewing pain;
- Headache;
- Accentive tear in the eyes;
- Cough, sore throat and runny nose (generic symptoms due to cold or flu);
- Perception of one's heart rate at ear level.
In most cases, the phlegm in the ears is never severe and can regress completely. In a small percentage of cases, however, if the causal pathology is particularly serious, there is a risk of incurring a reduction in permanent hearing.
Diagnosis
The evaluation of catarrh accumulation in the ears can be performed initially by your primary care physician . If he deems it necessary, he can advise the patient to undergo an otorhinolaryngological examination, which includes the patient's medical history and physical examination.
The medical examination makes use of the direct vision of the ear canal ( otoscopy ) to look for the reddening of the eardrum membrane, the local temperature increase or the possible mucus secretion; neighboring areas can be palpated to check their tenderness.
During the visit, moreover, the otolaryngologist must research the signs and symptoms suggestive of possible causes, including otalgia and reddening of the eardrum (otitis), fever and facial pain (sinusitis), lacrimation, itching to the eyes (allergies) and sore throat, general malaise, fever and cough (viral infection of the upper respiratory tract).
In more complex cases, it may be indicated to perform other investigations, such as the impedometric test, whose purpose is to evaluate the elasticity of the tympanic membrane and the degree of movement of the internal ossicles (hammer, anvil and stirrup).
Finally, when it is suspected that the auditory function is compromised, it is possible to resort to audiometry . During this investigation, sounds are emitted, which can be perceived by the patient through headphones and the help of an isolated environment, and it is evaluated up to what intensity the noises are heard.
The differential diagnosis of catarrh in the ears must be placed against conditions that produce similar symptoms, such as:
- Plug of earwax;
- Barotrauma (effect of rapid changes between external and internal pressure compared to the pressure eardrum);
- Residues of cotton buds or penetration of other foreign bodies;
- Ménière syndrome (characterized by recurrent attacks of vertigo, tinnitus and hearing loss);
- Otosclerosis, a degenerative disease that results in a progressive hearing loss.
Treatment
Regarding the treatment, the interventions vary depending on the type of disorder responsible for the catarrh in the ears.
If the trigger is a bacterial infection, for example, the doctor may indicate the intake of specific antibiotics; when the origin is viral, however, it is possible to resort to a pharmacological treatment aimed at mitigating the symptoms.
Once the basic problem is managed, it is possible to physically remove the phlegm from the ear. For this purpose, the patient can undergo steam inhalation to thin the mucus and make it easier to expel it.
It is possible to use nasal and / or ear decongestants, aerosol therapy with mucolytics, NSAIDs or corticosteroids (anti-inflammatories) to facilitate drainage of the phlegm and clear the middle ear and the Eustachian tube.
Surgery
In cases of failure of all medical options, it can be considered a surgical approach. In adults, to allow the elimination of the stagnant phlegm, a microdrenage can be applied to the tympanic cavity. In children subject to recurrent infections, the adenotomy, sometimes associated with a tonsillectomy, may be indicated in cases of evident adenoid hypertrophy.
Some advice
In the presence of catarrh in the ears, several precautions can be useful to facilitate the healing process:
- Drinking plenty of water and / or herbal teas, broths and soups of hot (non-boiling) vegetables during the day maintains proper hydration and helps to make the ear secretions less dense;
- Undergo thermal cycles of aerosol based on sulphurous waters to facilitate nasal breathing and ventilation of the middle ear.
- Avoid sudden changes in temperature and try not to expose yourself to drafts;
- Sleep with the head slightly raised to help the spillage of the phlegm.
