Inflammatory processes in different parts of the ear lead to irritation of the nerves, swelling and severe pain. Treatment of otitis media must be started as quickly as possible, otherwise there may be serious consequences.
ALENA PARETSKAYA
Pathophysiologist, immunologist, member of the St. Petersburg Society of Pathophysiologists SVETLANA KOMAROVA Otolaryngologist, Deputy Chief Physician for CER at SM-Clinic
Acute pain in the ear is one of the most painful sensations. Many patients compare its strength with toothache and severe injuries, and women - with the process of childbirth. Most often, ear pain is due to otitis media.
Side effects
When using the drug, the following are likely:
- neurological symptoms: tremor, sleep disturbance, dizziness;
- feeling of dryness, itching in the sinuses, mouth or throat;
- nausea;
- delayed diuresis.
If adverse reactions occur, a dosage reduction or drug replacement is required.
Exceeding doses or improper use increases side effects, provokes the destruction of capillary vessels, and disruption of mucosal nutrition.
What is otitis media
Otitis is the general name for inflammatory processes in the ear area.
Inflammation can be acute or chronic, affecting various parts of the ear. If the inflammation is localized in the auricle and ear canal to the border of the eardrum, this is otitis externa; inflammation in the tympanic cavity is otitis media; if the area of the cochlea is affected, the inner part of the ear is internal otitis or labyrinthitis.
These pathologies are extremely painful, accompanied by fever, hearing impairment, and discharge from the external meatus. In addition, without treatment, otitis media can lead to serious complications - hearing loss or complete deafness, paresis in the area of the facial nerve, damage to the bones or brain.
How to use Rinofluimucil
The drug is used intranasally: it is injected into the nasal sinuses - into each nostril in turn. Recommended dose: 1-2 pumps once. You can repeat the procedure 3-4 times a day, depending on the severity of the symptoms. The aerosol promotes uniform distribution of the drug over the surface of the mucosa. This provides a quick healing effect.
Inhalation of the solution should not be carried out, as it is ineffective and can be dangerous. The spray is intended only to clear the nasal passages and is unable to affect infectious pathogens.
Rinofluimucil should be used for no more than 3-4 days in a row. The maximum permissible course is 1 week. Long-term use leads to disruption of the functions of the capillary network. Addiction to the drug may develop.
Rinofluimucil
Rinofluimucil (acetylcysteine + tuaminoheptane sulfate) is an anticongestant and mucolytic used to treat rhinitis and sinusitis. The most common cause of rhinitis (or, in common parlance, a runny nose) is a viral infection of the respiratory tract. Vasoconstrictors (anticongestants) play an important role in the treatment of this disease. They eliminate swelling of the nasal mucosa and facilitate nasal breathing. However, if the clinical picture suggests not only swelling of the mucous membrane, but also the presence of secretions, anticongestants are not so effective. To prevent stagnation of mucus in the nasal cavity and restore the protective functions of the ciliated epithelium, mucolytics are used - drugs that dilute sinus secretions and facilitate its evacuation from the nasal passages. Acetylcysteine is considered one of the most effective mucolytics. To optimize the therapeutic process, the best option in this case is the use of combination drugs, including an anticongestant and a mucolytic. One of these drugs is Rinofluimucil, which includes two active components: tuaminoheptane sulfate and acetylcysteine. The first is a mild vasoconstrictor, acting for 4-6 hours, during which the swelling of the mucous membrane is eliminated without excessive drying and development of addiction. Acetylcysteine, in turn, dilutes the mucopurulent secretion and facilitates its evacuation from the nasal cavity.
At the same time, the drug reduces the amount of pathogenic microflora, stimulates the ciliated epithelium, and exhibits an antioxidant and anti-inflammatory effect. Rinofluimucil has a gentle and gentle effect on the mucous membrane without causing systemic adverse reactions, which allows the drug to be used, incl. and in pediatric practice in patients aged 3 years and older. The drug is very convenient to take: the bottle is equipped with a nozzle with which you can accurately dose the spray. The combined composition of Rinofluimucil provides rapid relief from the symptoms of rhinitis and sinusitis. Due to its complexity, the drug can be used at any stage of the disease (acute, chronic). Dressed in the form of a fine aerosol, it is evenly distributed on the mucous membrane of the nasal cavity and easily penetrates even the most inaccessible areas. The duration of use of Rinofluimucil should not exceed one week. Frequency of use: 3-4 times a day. The drug can be used both as monotherapy and in combination with antibacterial drugs. During pregnancy and lactation, Rinofluimucil should be used with caution, only after a careful assessment of the benefit/risk ratio. Rinofluimucil can only be administered intranasally. When used together, it may slightly impair the effectiveness of medications used for hypertension.
What antibiotics are effective for otitis media?
“Systemic antibacterial therapy is indicated in all cases of moderate and severe acute otitis media,” says otolaryngologist Svetlana Kovaleva, “as well as in patients with immunodeficiency conditions.
If otitis is mild (no pronounced symptoms of intoxication, pain, hyperthermia up to 38 ° C), you can refrain from prescribing antibiotics. However, if there is no positive dynamics within 48 hours, antibiotic therapy should be resorted to. For otitis, broad-spectrum antibiotics are prescribed that are effective against typical pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, Staphylococcus aureus.
The drug of choice is Amoxicillin.
Alternative drugs for allergies to β-lactams are modern macrolides (Josamycin, Azithromycin, Clarithromycin). In case of ineffectiveness, as well as in patients who have received antibiotics for a month, for patients over 60 years of age, it is advisable to prescribe a complex - amoxicillin + clavulanic acid. Alternative drugs are II-III generation cephalosporins (Cefuroxime axetil, Ceftibuten) or fluoroquinolones (Levofloxacin, Moxifloxacin).
For mild to moderate cases, oral antibiotics are indicated. In severe and complicated cases of otitis, begin with intravenous or intramuscular administration of the drug, and then continue treatment orally.
The duration of antibacterial therapy is 7–10 days. For complicated otitis – 14 days or more.
You should not use antibiotics on your own; you should consult an otolaryngologist. Otitis media can be caused by fungal flora or herpes infection. The use of antibiotics in this case can worsen the course of the disease.
Diagnostics
The diagnosis can be suspected based on typical complaints, but the doctor will ask in detail where and how the ear hurts, press on the tragus, pull the earlobe down to determine whether there is pain. In addition, the otorhinolaryngologist will examine the ear using instruments and lighting to specifically examine the ear canal, eardrum, and determine whether there is pus or perforation in it. To determine sensitivity to antibiotics, flora culture is performed. The doctor may also prescribe:
- blood tests (general, biochemistry) to determine the nature of inflammation;
- X-ray of the paranasal sinuses, if a connection with sinusitis is suspected;
- X-ray of the temporal bone in chronic otitis media.
All this data is needed in order to determine treatment tactics, the need for antibiotics, surgical interventions (membrane perforation or other interventions).
Causes of otitis media in adults
The most common causes of otitis externa are injuries, infections of the skin and underlying tissues in the ear canal area.
Chemical trauma to the ear, irritation and inflammation due to wax plugs, water getting into the ear, and the formation of boils are also possible. Otitis media is the most common form of the disease. It is usually provoked by bacterial infections, less commonly by viruses, pathogenic fungi, and mixed infections. The most common pathogens:
- Pneumococcus;
- hemophilus influenzae;
- influenza virus;
- various pathogens of ARVI.
In recent years, cases of fungal otitis media have become more frequently reported.
Risk factors that increase the likelihood of otitis media include sniffing and excess mucus in the nasopharynx. pressure difference when diving, diving to depth. Often, otitis media becomes a complication of a cold, ENT pathologies (adenoiditis, tonsillitis, pharyngitis, rhinitis). The risk is higher in people with immunodeficiencies.
Symptoms of otitis media in adults
With external otitis, the most common complaints are:
- pulsation in the ear, sharp pain radiating to the neck, eye or teeth;
- increased pain when chewing food, talking, closing the jaw;
- redness of the ear canal and auricle;
- hearing loss if there is discharge of pus into the ear canal area.
Acute otitis media begins with a rise in temperature along with shooting pain inside the ear.
It increases as mucus and pus accumulate in the cavity; after 2–3 days, the membrane ruptures, pus flows out of the ear and the condition improves. The temperature drops and the pain subsides. Then the rupture of the membrane heals without a trace. In the chronic form, mesotympanitis may occur - inflammation is localized in the area of the Eustachian tube and the lower, middle part of the tympanic cavity. A hole is formed in the membrane, but the membrane itself is stretched.
Key complaints:
- hearing loss;
- periodic appearance of pus from the ear;
- noise in the ear;
- dizziness;
- during exacerbation - pain and fever.
With the development of epitympanitis, a sharp decrease in hearing occurs, the release of foul-smelling pus, pressure in the ear, pain in the temples, and dizziness. Periods of exacerbation are followed by remissions, but hearing does not improve completely.
Modern methods of treatment
We asked otolaryngologist Svetlana Komarova to talk about how otitis in adults is treated today. According to her, drug therapy may include:
- drops in the ear containing the analgesic Phenazone and the local anesthetic Lidocaine - to relieve pain and reduce inflammation, if discharge from the ear appears, antibacterial drops containing Rifampicin or Ciprofloxacin should be used;
- vasoconstrictor drops containing Xylometazoline 0.1%, Oxymetazoline 0.05%, Naphazoline 0.1%, Phenylephrine 0.025% are instilled into the nose to reduce swelling of the nasopharyngeal mucosa around the mouth of the auditory tubes;
- if local drugs are ineffective, analgesics and non-steroidal anti-inflammatory drugs (Acetylsalicylic acid, Paracetamol, Tramadol, Ketoprofen, Ibuprofen) are prescribed orally;
- antipyretic drugs (Paracetamol) are used when the temperature rises above 38.5 C;
- antihistamines (Diphenhydramine, Clemastine, Chloropyramine) are prescribed to reduce swelling;
- broad-spectrum antibacterial drugs: penicillins, cephalosporins, macrolides, respiratory fluoroquinolones.
Non-drug treatment methods:
- procedures prescribed by an otolaryngologist: lavage of the external auditory canal, catheterization of the auditory tube, blowing of the auditory tubes according to Politzer, pneumomassage of the eardrum;
- physiotherapy: ultraviolet irradiation, UHF, microwave therapy, electrophoresis with anti-inflammatory drugs as prescribed by a physiotherapist.
Non-drug treatment methods help relieve pain, restore hearing and prevent complications.
In case of complicated otitis or the ineffectiveness of conservative therapy, surgical treatment (myringotomy, bypass of the tympanic cavity, radical surgery on the middle ear) is indicated, aimed at sanitizing the source of infection, restoring hearing, and preventing relapses.
Prevention of otitis in adults at home
To prevent otitis, it is necessary to avoid hypothermia, wash your hands after going outside, irrigate the nasal mucosa with sea water after visiting places with large crowds of people, exercise, exercise, and eat fresh fruits, vegetables, and dairy products every day.
If it so happens that you get sick and a runny nose begins to bother you, then you need to blow your nose extremely carefully, while freeing only one nostril, otherwise nasal discharge can get through the auditory tube into the ear and provoke otitis media.
Proper ear hygiene is essential. It is not recommended to use cotton swabs - they can introduce a bacterial or fungal infection into the ear. For ear hygiene, use drops consisting of a combination of surfactants (Allantoin, Benzetoin chloride) that clean, moisturize and protect the skin of the external auditory canal.
