Diseases of the middle ear symptoms. Ear diseases in adults. Symptoms and treatment with folk remedies, drops, procedures. Paracentesis of the tympanic membrane - an extreme measure

The human hearing aid has a rather complex structure. Its uninterrupted and well-established activity provides us with normal hearing acuity. And various diseases that affect this part of the body can greatly disrupt well-being. They require close attention and adequate timely therapy. Quite common disorders of this type are diseases of the middle ear, symptoms, causes, the prevention of which we will now consider.

There are quite a few ailments that can affect the middle ear area. The most common of these is otitis media. This is an acute inflammatory lesion that affects the tissues of the tympanic membrane, auditory tube, and mastoid process.

Why do middle ear diseases occur, what are their causes?

Inflammatory damage to the middle ear can be caused by attacks of various aggressive particles. Most often, doctors are faced with the problem of viral and bacterial otitis media.

Some genetic or family predisposition can provoke such a violation. Reduced immunity, the presence of certain structural features of the ear and nasal cavity can contribute to the development of otitis media. In addition, this condition can be triggered by malnutrition and vitamin A deficiency.

In most cases, an inflammatory lesion of the middle ear is provoked by streptococcus, a little less often by Haemophilus influenzae, and even more rarely by Moraxella. Much less often, the disease develops due to the attack of viruses: respiratory syncytial, influenza and parainfluenza viruses, rhinoviruses and adenoviruses.

Very rarely, doctors are faced with the problem of inflammation of the middle ear caused by tuberculosis or syphilis.

In children, the development of an inflammatory lesion in the middle ear can develop against the background of allergic rhinitis or bronchial asthma.

Pathogenic microorganisms can enter the middle ear through the auditory tube. A similar situation can be observed in inflammatory processes in the nose, as well as in the paranasal sinuses. The same provoking conditions include inflammation of the nasopharynx and adenoids. Much less often, the infection penetrates in the morning through the external auditory canal due to injuries (with a rupture of the eardrum), it can also penetrate the middle ear with blood (with influenza, measles and scarlet fever).

Scientists say that the likelihood of developing otitis media in children increases with artificial feeding and with the use of a pacifier. Also, this disease is often observed in patients exposed to nicotine, and in family members with a low standard of living.

The inflammatory process in the middle ear can be manifested by various health disorders. In the first stage of the disease, patients usually complain of pain, a feeling of congestion and noise in the ear. The pains are usually felt inside the ear and can vary in type, stabbing, boring, throbbing, or shooting. Unpleasant symptoms can become so painful that they deprive the patient of rest. Pain intensifies at night and significantly disrupts the quality of night rest. Painful sensations often radiate to the teeth and temple, as well as to the entire half of the head. Such symptoms increase during swallowing, sneezing and coughing. Hearing is significantly reduced. The general condition of the patient is severely disturbed, which is manifested by an increase in temperature up to 38-39C, weakness and loss of appetite.
During the examination, the doctor notes a strongly reddened and at the same time swollen eardrum. During the palpation of the region of the mastoid process, pain is noted.

The next stage of inflammation of the middle ear is perforation (in other words, rupture) of the eardrum, as well as suppuration. At the same time, the patient's pain decreases, the general condition improves significantly, and the temperature normalizes. In some cases, the eardrum cannot perforate on its own, so the doctor decides to perform a paracentesis - a small puncture. This measure helps to achieve recovery and restore hearing.

If inflammation of the middle ear proceeds according to the normal pattern, it proceeds to the recovery stage. The suppuration stops, the defect of the tympanic membrane closes. Hearing is restored.

In the absence of adequate therapy, inflammation of the middle ear can lead to the development of a chronic form of the disease. Also, the disease can be complicated by mastoiditis (inflammation of the mastoid process), labyrinthitis (), meningitis (inflammation of the meninges), brain abscess and sepsis.

How are diseases of the middle ear prevented, what is their prevention?

The main measure to prevent diseases of the middle ear is to increase immunity. Improving the body's defenses helps to avoid tonsillitis, colds, and tonsillitis. It is especially important to treat and detect such diseases in a timely manner, if a person is prone to otitis media, if he has flaws in the internal structure of the ear, for example, with minor dysfunctions of the Eustachian tube. It is necessary to pay special attention to the treatment of ailments that are accompanied by the formation of purulent masses - sinusitis, runny nose and tonsillitis. In childhood, for the prevention of otitis media, it is recommended to remove strongly overgrown adenoids, which are an excellent breeding ground for aggressive substances.

Many doctors say that in order to prevent inflammation of the middle ear, you must also observe proper oral hygiene. After all, carious teeth, the presence of plaque and inflammatory processes in the mouth are dangerous hotbeds of infection that easily penetrate the nasopharynx, as well as the ear.

Of course, in order to prevent serious lesions of the middle ear, it is necessary to treat the otitis media that has occurred under the competent supervision of an otolaryngologist.

Diseases of the middle ear - alternative treatment

Traditional medicine specialists offer several ways to treat otitis media. But the expediency of their use is extremely important to discuss with your doctor.

So patients with inflammation of the middle ear need to take a medium-sized bulb. Make a deepening in it and pour cumin seeds into it in the amount of one teaspoon. Cover the onion with a cut lid on top and bake for half an hour. After that, squeeze the juice from the vegetable and bury it in the affected ear, three drops immediately before a night's rest. Carry out the procedure within ten days.

Traditional medicine experts say that an ordinary bay leaf will help to promote recovery from inflammation of the middle ear. Brew five leaves with one glass of boiling water in an enameled container. Bring the future medicine to a boil, then remove the saucepan from the heat. Wrap it well and leave for two to three hours to insist. Use the strained medicine warm for instillation into a sore ear - eight to ten drops each. Also take it inside - two to three tablespoons. Repeat the procedure twice or thrice a day.

Traditional medicine experts say that propolis-based medicine can help treat inflammation of the middle ear. Purchase propolis tincture from a pharmacy. Combine a teaspoon of such a drug with the same amount of ordinary cool, pre-boiled water. Moisten a cotton turunda with this mixture and insert it into the ear canal for twenty minutes.

Excellent healing effect gives the use of onion juice. But in its pure form, it can burn strongly and cause irritation, so traditional medicine experts advise combining it with unrefined linseed oil, adhering to an equal ratio. Use this mixture to moisten a cotton turunda, which should then be placed in the ear. The duration of this procedure is three hours. After that, it is worth changing the turunda to a fresh one and holding it in the same way - three hours.

If you suspect the development of inflammation of the middle ear, it is better to seek help from an otolaryngologist as soon as possible. The specialist will make the correct diagnosis and help you choose the right treatment.

Inflammation of the middle ear- This is a disease of one or more parts of the ear cavity, which is caused by the ingestion of an infection. According to studies, young children most often suffer from the disease, but cases of the development of pathology occur in adults. At the first symptoms of otitis media, you should consult a specialist, because the negative consequences of late and improper treatment can occur in people of any age.

The middle ear is the part of the ear cavity that is located between the tympanic membrane and the cochlea (the part that recognizes and perceives sound vibrations). The main causative agents of the disease are a variety of bacteria and viruses that can easily enter the middle ear if a person has a cold.

The disease can develop and proceed in different ways, so there are three types of otitis media:

Spicy. It can last less than a month, its main danger is that the disease can smoothly flow into the chronic stage. This is facilitated by the late start of treatment or the use of folk remedies without contacting a qualified doctor.

Protracted.

Chronic - its duration is at least 3 months. If otitis media occurs against the background of any infectious disease, there is a high risk of complete destruction (rupture) of the eardrum and hearing loss. Chronic otitis is characterized by characteristic symptoms - hearing loss, the patient complains of periodic or constant flow of pus from the diseased ear.

Approximately 25-60% of adults at least once had otitis media of varying severity. It is not recommended to self-medicate if symptoms of the disease are detected, so serious complications can be avoided. Most modern medicines that a doctor prescribes for an illness are very effective if treatment is started immediately.

Symptoms of inflammation of the middle ear

The main symptom of otitis is pain - according to the sensations of a person, it can be weak or strong, shooting. The patient himself cannot determine which part of the ear is inflamed, only a doctor can state inflammation of the middle ear. Of the non-permanent symptoms, a slight hearing loss occurs, while the body temperature may be increased. The flow of pus from the ear canal can be observed if a hole has formed in the eardrum. If this did not happen, the patient will not complain about discharge from the ear.

Often there is a decrease in the perception of sounds, the patient may feel his own voice in his ears (autophony). Solely on the basis of this symptom, it is still impossible to make a diagnosis of "otitis media", because a similar phenomenon can be observed in the case of changes in atmospheric pressure.

The main symptoms by which otitis media can be diagnosed are:

Pain in and around the ear.

Hearing problems.

A foreign object is felt in the ear or a noise is felt.

Causes of inflammation of the middle ear

Inflammation can most often occur after infection has penetrated there from neighboring parts of the ear cavity, so otitis media at the level of the middle ear is called a secondary infection. The occurrence of the disease can contribute to many factors that weaken the body's defenses.

Here are the main ones:

Body cooling. A decrease in temperature contributes to a sharp narrowing of blood vessels in the body. Under such conditions, bacteria begin to develop intensively, the result of which is an inflammatory process.

Unbalanced nutrition. Too few fruits and vegetables in the diet reduce a person, so the risk of infection is high.

Infections of the nasal cavity, nasopharynx, etc. They may not be completely cured and become active at the right time, against this background, the infection can spread all the way to the middle ear.

Some diseases can cause the transition of otitis media into an acute form, which is very dangerous to health. These include eustachitis - in the case of this disease, the inflammatory process takes place in the tube that connects the nasopharynx and the tympanic cavity. Bacteria that provoke the development of eustachitis can first cause, and other diseases. In the case of inflammation of the nasal cavity or infection, the entrance to the auditory tube is also open.

Another disease - mastoiditis, is often not only the cause of inflammation, but also a complication of otitis media. Bacteria in the presence of concomitant chronic diseases can easily penetrate the mastoid process that communicates with the middle ear, thereby causing otitis.

In an adult, the risk of otitis media increases several times if:

Violations of the integrity of the tympanic membrane.

A person's immune system is weakened, the work of the endocrine system is disrupted.

Rapid hypothermia.

Various pathologies of the hearing organs, due to which natural ventilation of the auditory tube is impossible.

Inflammatory diseases of the ears, nasopharynx and throat.

You can do treatment at home, if you first consult with a specialist and purchase the necessary medications.

An experienced doctor provides treatment in several directions at once:

In order to reduce swelling of the nasopharyngeal mucosa and restore the functionality of the auditory tube. For this, nasal drops are used (Nafthyzin, Galazolin, etc.).

Reduce pain. A cotton swab moistened with medicine can be injected into the ear or solutions are instilled a few drops directly into the ear.

Lowering the temperature, for this, drugs based on paracetamol are used. Additionally, the patient's body must be strengthened with the help, which should be started after consultation with an experienced specialist.

It is strictly forbidden to use heat and drops in the ear during treatment if pus is released from the ear cavity. In this case, all secretions must be removed in a timely manner, preventing blockage of the ear canal. Already at the recovery stage, thermal compresses and physiotherapy procedures (UHF, electrophoresis and ear warming) can be used.

In the case of inflammation of the middle ear, it is occasionally necessary to use antibiotic drugs, the dosage and selection of which is carried out by the doctor. Azithromycin, Amoxiclav, etc. are mainly used, which are taken orally or in some cases administered intramuscularly. Antibiotic treatment is carried out very carefully, because in some cases, prolonged use of various drugs makes the virus completely insensitive to the antibiotic used. Therefore, an experienced doctor will definitely make a sample of pathogenic microorganisms from a diseased ear and find out their sensitivity to a particular type of antibiotic.

The chosen strategy for the treatment of otitis in adults is selected depending on two factors:

How advanced the disease is.

What stage of development is it at?

At the initial stages of the disease, the use of vasoconstrictive nasal drops is indicated. To get rid of pain in the ear canal, you can use special drops. It is possible to avoid the opposite effect in the form of increased pain several times if all the drugs are slightly warmed up before being instilled into the sore ear. The use of warm bags or warm compresses of vodka or alcohol is allowed only if no pus is released. You should first talk to your doctor and find out the feasibility of such procedures. It is possible to improve the outflow of pus after piercing the eardrum if you regularly clean the ear canal from accumulated pus. It is better to entrust this procedure to an experienced ENT specialist, who, at the end of the removal of the contents of the ear, will put a cotton swab inside, which is moistened with an anti-inflammatory drug. It is contraindicated at this stage of the course of the disease to use alcohol-based ear drops.

Education: In 2009 he received a diploma in the specialty "Medicine" at Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in the specialty "Otorhinolaryngology" (2010)

There are three main routes of infection:

Tubal - from the nasopharynx through the auditory tube.

Hematogenous - with blood flow in infectious diseases

Traumatic - through a damaged eardrum

2.1. Acute tubo-otitis (Eustacheitis or salpingo-otitis)

This is inflammation of the mucous membrane of the auditory tube and, as a result, aseptic inflammation of the tympanic cavity. The mucous membrane of the auditory tube swells, which leads to a violation of the ventilation of the tympanic cavity and the accumulation of fluid (transudate).

The reasons: mechanical closure of the lumen of the auditory tube (adenoids in children, hypertrophy of the turbinates, polyps, tumors of the nasopharynx); acute rhinitis

Clinical manifestations:

Congestion in one or both ears

Noise in the ear and in the head, sensation of overflowing liquid

Hearing loss

The general condition is satisfactory, the temperature is normal.

Treatment:

Treatment of the cause (treatment of nasopharyngeal diseases or mechanical obstructions)

The introduction of vasoconstrictor drops into the nose to penetrate the auditory tube (when instilled, tilt the head towards the ear)

Thermal procedures on the ear - compress, UVI

Blowing of the auditory tubes according to Politzer (rubber balloon) or catheterization of the auditory tube with the introduction of anti-inflammatory drugs (hydrocortisone)

Pneumatic massage of the tympanic membrane with a Sigle funnel to restore mobility

Restorative and desensitizing drugs

2.2. Acute otitis media

This is an inflammation of the middle ear with the involvement of all three sections in the process, but the predominant lesion of the tympanic cavity. It is common, especially in children.

The reasons:

Acute and chronic diseases of the nasopharynx, colds

· Infectious diseases;

ear injury;

Allergic conditions;

Unfavorable environmental factors (hypothermia, etc.);

Decreased immunity.

Three routes of infection (see above). In the tympanic cavity, the infection multiplies, serous exudate appears, and then mucopurulent. During the course of the disease, 3 stages are distinguished.

Clinical manifestations by stages:

The stage is infiltrative.

· Pain in the ear of a shooting nature, radiating to the temple, teeth, head;

Ear congestion, noise;

Hearing loss by type of sound conduction disorder;

· Symptoms of general intoxication.

At otoscopy, the tympanic membrane is sharply hyperemic, edematous.

Stage perforative.

Rupture of the eardrum and suppuration;

Reduction of ear pain and headache;

· Improvement of the general condition.

During otoscopy, there is pus in the external auditory canal, the tympanic membrane is hyperemic, thickened, purulent contents pulsate from the perforation.

recovery stage.

cessation of suppuration;

Restoration of hearing;

· Improvement of the general condition.

With otoscopy - a decrease in hyperemia of the tympanic membrane, scarring of the perforated hole.

Treatment depending on the stage.

1st stage: bed rest, vasoconstrictor nasal drops; in the ear "Otinum"; ear warming compresses, analgesics, antihistamines, antibiotics other than aminoglycoside antibiotics (eg, streptomycin, kanamycin).

In the absence of improvement within a few days and the presence of 3 characteristic symptoms - severe pain in the ear, high temperature, severe protrusion of the eardrum - a dissection of the eardrum is performed - paracentesis. The procedure is performed under local anesthesia using a special paracentesis needle. Thus, an exit is opened for purulent contents from the tympanic cavity.

For paracentesis, the nurse should prepare: a sterile paracentesis needle, a local anesthetic (usually lidocaine), a sterile furatsilin solution, an ear mirror, an ear probe, a kidney tray, sterile wipes and cotton wool.

2nd stage: toilet of the external auditory canal (dry - using an ear probe and cotton wool or washing with antiseptics with Janet's syringe); introduction into the external auditory canal of a 30% solution of sodium sulfacyl, "Sofradex"; antimicrobials (antibiotics), antihistamines.

3rd stage: blowing the auditory tubes according to Politzer, pneumomassage of the tympanic membrane, FTP.

Features of acute otitis media in early childhood:

Anatomical and physiological features of the middle ear lead to a rapid infection from the nasopharynx, ingestion of food when regurgitation, impede the outflow of fluid from the tympanic cavity

Low resistance leads to frequent complications on the mastoid process, the occurrence of meningeal symptoms at any stage of the disease

Tragus symptom - soreness when pressing on the tragus (the bone part of the ear canal is missing)

2.3. Mastoiditis.

This is an inflammation of the mucous membrane and bone tissue of the mastoid process.

Predisposing factors:

The structure of the mastoid process

Frequent acute otitis media

Irrational prescription of antibiotics in acute otitis media

Delayed paracentesis

Clinical manifestations:

Deterioration of the general condition, fever

Severe pain in the ear and behind the ear, pulsating noise, hearing loss (triad of symptoms)

Hyperemia and infiltration of the skin of the mastoid process

The smoothness of the behind-the-ear fold, the auricle protrudes anteriorly

Thick pus in the external auditory canal (suppuration of a pulsating nature)

Treatment:

Toilet ear (rinsing with a solution of furatsilina), to ensure the outflow of pus.

Antibiotics, desensitizing drugs

Heat on the ear in the form of compresses (m / s should know the technique of applying compresses to the ear)

The introduction of drugs into the nose

In the absence of the effect of conservative treatment, the development of a subperiosteal abscess, the appearance of signs of intracranial complications, surgical treatment is performed. The operation is called a mastoidectomy.

Care after mastoidectomy includes: daily dressings with irrigation with antibiotic solutions, wound drainage, antibacterial and stimulation therapy.

2.4. Chronic suppurative otitis media.

This is a chronic inflammation of the middle ear, which is characterized by three signs:

Persistent perforation of the tympanic membrane

Persistent or intermittent suppuration

Persistent hearing loss

The reasons:

1. Indolent or difficult to treat acute suppurative otitis media

2. Reducing the body's defenses

3. Condition of the upper respiratory tract (nose, adenoids, paranasal sinuses, tonsils)

4. Concomitant diseases (diabetes mellitus, rickets in children, blood diseases)

According to the clinical course and localization of perforation, chronic suppurative otitis media is divided into two forms: mesotympanitis and epitympanitis.

2.4.1. Mesotympanitis- otitis media with central perforation in the stretched part of the tympanic membrane. The process involves the mucous membrane of the middle sections of the tympanic cavity.

Monitor the condition of the upper respiratory tract, especially the nose

In case of exacerbation, treatment is carried out as in an acute process:

2.4.2. epitympanitis- otitis media with marginal perforation in the loose part of the tympanic membrane. The process affects the mucous membrane and bone tissue and is localized mainly in the epitympanic space.

Treatment can be conservative and includes washing, the introduction of drugs into the tympanic cavity, FTP. Such treatment is often ineffective and then surgical treatment is performed - a radical operation is performed to remove the pathological contents, and then hearing-improving operations.

Previous articles have discussed the importance of the otological and neurological history and examination of the patient. for clinical diagnosis. A brief overview of common or important otologic and neuro-otologic diagnoses is provided below.

a) Sensorineural hearing loss. The etiology of sensorineural hearing loss is extremely diverse. Presbycusis and noise-induced hearing loss are the most common. Other causes of sensorineural hearing loss are presented in the tables below. Diagnosis of both rare and common causes ultimately depends on a thorough history and physical examination.

b) Noise induced hearing loss. Approximately 28 million people in the United States suffer from hearing loss, with 10 million at least partially due to noise exposure. Sound loud enough to damage the inner ear can cause hearing loss that is not amenable to either conservative or surgical treatment. Sounds less than 75 dB, even after prolonged exposure, do not cause hearing loss. Sounds greater than 85 dB with 8 hours of exposure per day tend to result in permanent hearing loss.

in) Conductive hearing loss. 20-30% of the 28 million people in the United States with hearing loss have conductive hearing loss. Patients with conductive hearing loss are generally younger than patients with sensorineural hearing loss, do not suffer from cognitive impairment, and do not have other sensory deficits. The etiology of conductive hearing loss is shown in the table below.

G) Sudden sensorineural hearing loss. Sudden sensorineural hearing loss is a hearing loss of at least 30 dB, with at least three consecutive manifestations within three days. Some diseases, such as schwannoma, may begin with sudden hearing loss. In most patients with sudden sensorineural hearing loss, the exact cause will not be determined. Thus, in some cases, this term denotes a symptom, while in other, idiopathic cases, a diagnosis. Perhaps the etiological causes of idiopathic sudden sensorineural hearing loss are viral infections, vascular diseases, and inflammatory processes.

Hearing loss is the main symptom, but may be accompanied by dizziness, unsteadiness, ear congestion, and possibly even mild pain. There are no formalized guidelines for the differentiation of sudden sensorineural hearing loss and labyrinthitis. A patient with sudden unsteadiness who mentions unsteadiness in the interview is given a diagnosis of sudden sensorineural hearing loss, while a patient with sudden unsteadiness who mentions hearing loss is given a diagnosis of labyrinthitis. The treatment of sudden sensorineural hearing loss is currently being actively developed.

e) labyrinthitis. Inflammation of the labyrinth is defined as labyrinthitis. Bacterial (purulent) labyrinthitis is fulminant compared to non-purulent labyrinthitis, and begins suddenly with severe hearing loss and severe dizziness for several days, usually with nausea and vomiting. The disease requires urgent aggressive treatment, because the prognosis for hearing recovery is poor and the risk of meningitis is high. The instability, as in vestibular neuritis, may last for several months. However, unlike the latter, there are associated cochlear symptoms (hearing loss, ear congestion, otalgia, tinnitus). Serous labyrinthitis is inflammation in the labyrinth without actual infection of the inner ear. Viral labyrinthitis may be suspected in a patient with an abrupt onset of dizziness and sensorineural hearing loss in the absence of predisposing circumstances.

Other causes of labyrinthitis include infection of the perilymph with bacterial or inflammatory toxins, blood, and surgery (eg, stapedectomy). Otoscopy results should be normal. Symptoms associated with acute otitis media, cholesteatoma, chronic ear disease should be considered a complication of an existing ear disease with a need for urgent treatment. Nystagmus may be present in the direction opposite to the affected ear. Nystagmus towards the affected ear indicates irritation and is an ominous sign of middle ear injury. Non-otolaryngologists usually refer to a variety of otological conditions that cause vertigo, such as labyrinthitis; otolaryngologists usually take into account specific diseases like the one described.

e) Vestibular neuritis. Inflammation of the vestibular nerve enclosed in the bony internal auditory meatus, leading to nerve dysfunction and vertigo, is called vestibular neuritis. Isolated atrophy of the vestibular nerve with slight degeneration of the target organs is noticeable on histopathological examination and is considered to reflect the viral nature of the lesion. Dizziness with an abrupt onset, systemic, severe and usually accompanied by nausea and vomiting. Other otologic symptoms are also present, excluding ear congestion. The acute phase lasts 48-72 hours, followed by a period of imbalance and unsteadiness, usually lasting 4-6 weeks, but sometimes lasting up to several months. The recovery time depends on the degree of damage to the vestibular nerve and on the compensation of the injury.

and) Meniere's disease. Meniere's disease is a disease defined as idiopathic endolymphatic hydrops. With certainty, this diagnosis can be established only posthumously, by detecting endolymphatic hydrops during histopathological examination of the temporal bone. Over the course of a lifetime, the diagnosis is suggested on the basis of low-frequency fluctuating sensorineural hearing loss, tinnitus, ear congestion, and occasional dizziness. The AAO-HNS (Hearing and Balance Committee) has developed a definition of Meniere's disease for diagnostic and scientific purposes. The committee defined four levels of diagnostic criteria, which are presented in the table below.

Dizziness in Meniere's disease is systemic, severe, and disabling, often the most severe symptom. One variant of Meniere's disease is Lermoyer's syndrome, in which hearing loss and tinnitus improve with an attack of dizziness, and Tumarkin's otolytic crisis. in which vestibular dysfunction is manifested not by systemic dizziness, but by a sudden fall or syncopal vertebral syndrome. The terms "Ménière's cochlear disease" (hearing loss, tinnitus, ear congestion without vertigo) and "Ménière's vestibular disease" (vestibular symptoms without cochlear symptoms) are used to describe patients with an incomplete set of symptoms.
Although these terms are used clinically, the AAO-HNS recommends that they be abandoned in favor of the diagnostic criteria presented in the table below.

h) Benign paroxysmal positional vertigo. (BPPV) is a disease frequently encountered in neurological and otological practice. It is believed that the symptoms of the disease are caused by the movement of solid inclusions, specifically otoliths, in the labyrinth. Most often, the otoliths of the posterior semicircular canal are involved.

In its classical form, the disease must have a suitable history and appropriate examination findings. The patient should be disturbed by sudden intense attacks of dizziness. Attacks should be reproduced repeatedly in a certain position of the body, more often lying down and when turning to the affected side. Seizures are usually not accompanied by a feeling of fullness in the ear, tinnitus, or fluctuations in hearing. Typical seizures last less than one minute. Often, patients report that they stopped sleeping on the affected side to avoid seizures.

The Dix-Hallpike test (described above) will be positive when the condition is active; the diagnosis is established and the affected side of the posterior semicircular canal is identified. Nystagmus is pathognomonic for the disease - it lasts a few seconds (2-10), geotropic (directed towards the ground) and is horizontally rotary with a duration of no more than 30 seconds before weakening and weakening when the Hallpike test is repeated.

The literature describes variants of BPPV based on the influence of otoliths on the cupula of the opposite canal (cupulolithiasis, canalolithiasis) and on the presence of otoliths in the horizontal and superior semicircular canals. The demonstration of such options may be very different from the one described above. The modified Hallpike test is used to examine the horizontal semicircular canal. In this test, the patient lies on his back and his head is quickly twisted to one side (without stretching over the edge of the table), then the head is returned to its original position and turned to the unaffected ear. The nystagmus induced is horizontal, geotropic, or ageotropic and is less likely to be attenuated.

and) Syndrome of the gaping of the superior semicircular canal. The literature describes dizziness in response to sounds or changes in pressure caused by gaping of the superior semicircular canal. In patients with this pathology, loud sounds or actions that change pressure in the middle ear or intracranial pressure cause vertical torsional movements of the eyeballs corresponding to the plane of the superior semicircular canal. The diagnosis is established by the presence of vertical torsional nystagmus with a slow phase upward and away from the affected ear, following tragus pressure, a Valsalva maneuver, or a loud sound (110 dB). Ultra-high resolution CT of the temporal bone can visualize thinning or destruction of the bone of the superior semicircular canal.

to) Dizziness associated with migraine. Migraine is a neurological disease characterized by headache and/or other neurological symptoms that affects 6-18% of the US adult population. Migraine is a common but often undiagnosed cause of dizziness. In practice, in the treatment of patients with migraine, imbalance or periodic dizziness was noted in 33-72% of cases. Periodic systemic and non-systemic dizziness can be mistaken for Meniere's disease or other diseases of the vestibular apparatus. Interestingly, in the majority of patients, dizziness is not associated with headache, and many have no history of headache complaints.

l) Perilymphatic fistula. Inner ear fistulas include labyrinth fistulas, perilymphatic fistulas, and intramembranous communication. Although they all belong to the inner ear, each is a separate nosological form. A perilymph fistula is leakage of perilymph into the inner ear or mastoid process, or air from the middle ear into the inner ear. As a rule, even with a microscope, it is impossible to see the liquid. Causes include surgery, blunt trauma, penetrating trauma, barotrauma, infection, cholesteatoma, or sudden changes in pressure in the spinal canal that occur with exertion, blowing your nose, or a Valsalva maneuver. Congenital anomalies of the ear may predispose to perilymph leakage. Spontaneous perilymphatic fistulas are considered rare.

Clinical manifestations of perilymphatic fistulas range from mild to disabling. The most common symptoms are dizziness and unsteadiness. Hearing loss, tinnitus, ear congestion may occur. Careful history taking, finding out information about injuries, scuba diving, flights, physical activity is very important, since the symptoms are vague and coincide with the symptoms of other diseases of the vestibular apparatus. A patient with a suspected perilymphatic fistula should have a fistula test.

Another type of perilymph fistula is an abnormal communication between the endolymphatic and perilymphatic spaces. This type refers to intramembranous ruptures of the cochlear membrane and is considered the etiological cause of sudden (idiopathic) sensorineural hearing loss.

The term labyrinth fistula usually describes an inner ear fistula involving the semicircular canals. Usually the etiology of the pathology is trauma or infection. Erosion of the horizontal semicircular canal (rarely the posterior or superior canals) due to cholesteatoma or granulation tissue can lead to a labyrinth fistula if the integrity of the bony labyrinth is compromised. Inflammatory endothelial hypertrophy of the perilymphatic space usually prevents leakage of perilymph through the fistula, however, surgical disruption of the barrier precipitates perilymph flow. Patients with choleastomy and progressive imbalance are considered to have a labyrinth fistula unless proven otherwise.

m) Tumors of the cerebellopontine angle. Benign tumors of the cerebellopontine angle (vestibular schwannoma, meningioma) can cause unilateral (or asymmetric) sensorineural hearing loss, tinnitus, and imbalance. Even small tumors can cause significant symptoms by putting pressure on the seventh and eighth cranial nerves in the internal auditory canal. More rare symptoms are paralysis or paresis of the facial muscles, headache, involvement of the fifth cranial nerve (facial numbness and decreased corneal reflex), sixth cranial nerve (diplopia), ninth and tenth cranial nerves (hoarseness, dysphagia). As a rule, except for huge tumors, the presence of clinically proven weakness of the facial muscles indicates a tumor originating from the facial nerve.

Except in cases of compression and destruction of the vestibular nerves, instability is a relatively rare symptom; the gradual progression of vestibular dysfunction indicates compensation for the deficiency. Disbalance, if present, is unexpressed, true systemic dizziness is rare. Large tumors can cause balance disorders, ataxia, nausea, vomiting, and headache, indicating compression of the brainstem, cerebellum, fourth ventricle, or increased intracranial pressure. The list of pathologies affecting the vestibular system is given in the table below.

m) Systemic diseases affecting the ear and temporal bone. Systemic diseases can directly or indirectly affect hearing and balance. These diagnoses are difficult to make because many diseases are rare.4 In addition, some common diseases (diabetes mellitus) do not uniformly affect hearing and balance.

and) Eustachian tube dysfunction. Eustachian tube dysfunction is a common pathology, usually described by a feeling of fullness or pressure, or an intermittent “popping” sensation. The most common type of dysfunction leading to obstruction of the auditory tube. Dysfunction of the auditory tube can be caused by inflammation, mucosal edema, allergic rhinitis, rhinosinusitis, and tumors of the nasopharynx. Anomalies in the development of the facial skull, cleft palate, Down's syndrome, neuromuscular pathologies with dysfunction of the muscle that strains the palatine curtain and the muscle that lifts the palatine curtain also cause dysfunction of the auditory tube. Associated symptoms may include hearing loss, a slight feeling of "fullness" in the ear, and, less commonly, tinnitus. The feeling of "fullness" of the ear may disappear after the Valsalva test. Survey data vary depending on the severity of the disease.

With a mild degree of dysfunction, the tympanic membrane may appear normal, but with a more severe course, atelectasis and retraction of the tympanic membrane, cholesteatoma, are detected. In chronic or severe forms, a pronounced effusion may appear.

Much less often than insufficient opening, a gaping (or open) auditory tube occurs. This pathology is indicated by autophony (i.e., increased perception of one's own voice and breathing) in the diseased ear according to the anamnesis. Symptoms of obstruction and gaping of the auditory tube are remarkably similar, which causes difficulties in diagnosis. Patients with a gaping eustachian tube are more likely to experience a feeling of "fullness" in the ear, as a rule, they do not have allergic rhinitis, sinusitis, or other risk factors associated with obstruction of the eustachian tube. On examination, the tympanic membrane is normal, the diagnosis is confirmed by examining the lateral and medial displacement of the posterior part of the tympanic membrane when breathing through the nasal passage of the same name in the presence of clinical symptoms.

The symptoms of a gaping eustachian tube can be relieved by closing techniques such as tilting, which cause venous congestion in the eustachian tube area.

to) ear syphilis. Ear syphilis is mentioned because its diagnosis is still a problem. The diagnosis is established in patients with cochleovestibular dysfunction and positive results of serological tests (ELISA-Abs) or microhemagglutination tests. The manifestation of syphilitic cochleo-vestibular dysfunction is extremely variable. Hearing loss is the most common symptom (82% of cases), followed by dizziness (42%). Approximately a quarter of patients have symptoms consistent with endolymphatic hydrops. An accurate diagnosis of ear syphilis remains a diagnostic challenge due to the variability in symptoms and the low predictive value of ear serology. Establishing a diagnosis of ear syphilis requires the doctor's alertness; it is not for nothing that this disease is called the "monkey of all diseases."

Conclusion. Despite the many electrophysiological and tomographic techniques used in the diagnosis of ear diseases, history and examination remain the most informative. Relying only on the data of the anamnesis, it is possible to diagnose many conditions. Using the data of the anamnesis and a complete examination, it is possible to establish the diagnosis of any otological disease, minimizing the number of expensive tests and unnecessary studies. The chapter contains a discussion of all points of history and physical examination, supplemented by an overview of the pathological conditions of the ear encountered in clinical practice.