Inflammation of the Eustachian tube: treatment and symptoms. How does acute and chronic inflammation of the Eustachian tube proceed?

Eustachitis (synonyms - tubo-otitis, salpingo-otitis, catarrh of the Eustachian tube, catarrh of the middle ear, serous otitis, sticky ear, nonpurulent otitis media, tubotympanitis, auditory tube dysfunction) is a non-purulent inflammation of the mucous membrane of the auditory ( eustachian) a tube that connects the middle ear with the nasal cavity.

This is the first time ear disease described the professor of surgery of the St. Petersburg Medical and Surgical Academy I.F. Bush, who outlined the symptoms and treatment of "constipation" of the Eustachian tube, leading to catarrh ( inflammation of the mucous membrane) middle ear. Today, this condition is called exudative otitis media.

There are more than 20 names for this disease. The presence of a large number of names of inflammation of the Eustachian tube is associated with an attempt to indicate its cause in the name of the disease.

Expert opinions about whether Eustachitis can exist separately often differ. Some authors believe that since the Eustachian tube is anatomically part of the middle ear, eustachitis should be attributed to otitis media ( ear infection). Other experts refer to eustachitis as sinusitis ( inflammation of the paranasal sinuses). Proposing to call the disease salpingo-otitis ( from the Greek word salpinx - trumpet), takes into account the fact that the violation of the patency of the auditory tube almost always causes the release of non-purulent inflammatory fluid in the middle ear. Therefore, today Eustachitis is considered as the cause of inflammation of the mucous membrane of the middle ear.

Eustachitis is most often seen in children. In 85% of cases, inflammation of the middle ear in children is bilateral. This is due to the anatomical proximity of the ENT organs, their functional immaturity, as well as frequent colds of the nasal cavity in childhood. Boys get sick more often. The incidence of eustachitis in children depends on age. At the age of 1 to 2 years, otitis media affects about 35% of the child population. Further, the incidence decreases sharply. In a child at 3-5 years old, the prevalence is 10-25%, at 6-7 years old - 5-10%, at 9-10 years old - less than 3%.

The chronic course of eustachitis is a risk factor for the development of hearing loss. In adulthood, eustachitis is much less common than in children. In 70% of adults, inflammation of the Eustachian tube is unilateral.

Eustachian tube anatomy and mucosal properties

The auditory tube together with the tympanic cavity and mastoid cells make up the middle ear. The tympanic cavity is the area located between the inner ear and the tympanic membrane. The mastoid process is part of the temporal bone and contains air cells. These cells communicate with the largest of them, which is called the cave and opens into the tympanic cavity. The cells are covered with a mucous membrane, which is a continuation of the mucous membrane of the tympanic cavity.

The Eustachian tube consists of the following parts:

• Pharyngeal cartilage- this is a long and wide section of the pipe ( 2/3 of the entire length of the channel), which opens on the side wall of the nasopharynx. The pharyngeal opening of the auditory tube has an oval or triangular shape. Above and behind the opening, the cartilaginous walls of the Eustachian tube form tubular ridges - elevations. The tubal ridges somewhat cover the opening of the auditory tube so that it does not gape.
• tympanic bone- short section 1/3 channel length), which is surrounded by the bones of the skull. As the cartilaginous section approaches the bone part, the lumen of the tube narrows. The narrowest section is called the isthmus, which is located at the junction of the cartilaginous and bone parts. Further, the channel expands again and ends in the form of an oval opening in the tympanic cavity.

• ventilation function ( barofunction) – is to equalize the pressure on both sides of the eardrum. The tympanic membrane is a sound-conducting organ, when it vibrates, the auditory ossicles begin to move and transmit a signal to the inner ear. But for good sound transmission, sufficient, but not excessive, tension of the eardrum is necessary ( so that the membrane can oscillate). To do this, it is necessary that the atmospheric pressure exerted on the membrane from the outside and the air pressure in the tympanic cavity are the same.
• drainage ( transport) function - ensures the removal of excess mucus from the membrane of the tympanic cavity ( as well as inflammatory fluid).
• Protective function - carried out due to the protective properties of the mucous membrane and lymphoid tissue located under the mucous membrane of the auditory tube. In addition, the air from the nasopharynx, passing through the Eustachian tube, is cleaned, heated and humidified.

In a healthy person at rest, the walls of the auditory canal in its cartilaginous section are in a collapsed state, and the pharyngeal opening of the canal is closed.

The opening of the pharyngeal opening of the Eustachian tube and the improvement of ventilation of the tympanic cavity occurs under the influence of the following factors:

• yawning, chewing, singing;
• swallowing
• sneezing, blowing your nose;
• deep nasal breathing;
• pronunciation of the vowels "e", "i", "o", "y".

• mucous membrane - consists of epithelial cells covering the auditory tube from the inside;
• submucosal layer- contains lymphoid nodules the closer to the nasopharynx, the more these nodules) and collagen fibers ( connective tissue), which envelop the auditory tube, especially in its cartilaginous region;
• glandular fat layer- contains pampiniform glands, vascular plexuses, adipose tissue;
• muscle layer- is present only in the membranous-cartilaginous part and consists of fibers that are part of the muscles that lift and stretch the upper palate.

• ciliated cells- about 200 cilia are located on the surface of each of the ciliated cells. The cilia of the mucous membrane of the Eustachian tube oscillate against the movement of the inhaled air, namely towards the nasopharynx;
• goblet glands- secrete mucus containing mucin ( moisturizes the mucous membrane), proteins, lipids. This mucus covers the epithelium of the auditory tube with a thin layer.
• Ciliated ( brush) cells- have short hairs. The function of these cells is to produce specific phospholipids ( surfactant). On the surface of these cells there are chemoreceptors ( nerve endings sensitive to chemicals).
• Basal cells- are sources of new cells.

The mucociliary apparatus performs the following functions:

• Drainage function or mucociliary transport- is carried out due to the coordinated movement of cilia ( about 15 vibrations per minute), which moves the mucous membrane along the epithelium from the tympanic cavity to the nasopharynx ( at a speed of 1 mm per minute).
• Protective function or mucociliary clearance ( cleansing) - consists in "gluing" foreign substances ( bacteria, viruses and so on) goblet cell mucus, followed by their removal from the auditory tube due to the movement of ciliated cells.

The surfactant of the mucous membrane of the Eustachian tube performs the following functions:

• contributes to the process of ventilation- reduces the tension of the mucus, thereby preventing the walls of the pipe from sticking together;
• improves drainage of the tympanic cavity- participates in mucociliary clearance, facilitating the movement of mucus to the nasopharynx;
• has an antioxidant effect- protects the mucous membrane of the Eustachian tube from the negative effects of free radicals produced during inflammation or allergies.

Immunoglobulin A performs the following functions:

• has antiviral and antimicrobial activity ( prevents the reproduction of viruses, reduces the ability of microbes to be fixed on the mucous membrane of the Eustachian tube);
• activates the compliment system blood serum protein system that destroys foreign substances). The compliment system, in turn, activates mucociliary clearance ( protective and drainage function of the mucous membrane);
• enhances the antibacterial effect of substances that are part of the mucus;
• activates the body's immune defense mechanisms;
• binds foreign substances and removes them from the body.

The mucus of the pampiniform glands contains the following substances:

• lysozyme- an enzyme that destroys the wall of bacteria and prevents the reproduction of fungi;
• lactoferrin- a protein that binds iron ionsneeded by some microbes for their vital activity;
• fibronectin- violates the process of attachment of microbes to epithelial cells;
• interferons- have an antiviral effect.

Causes of tube inflammation

Causes of Eustachian tube dysfunction

Pathogenesis(pathology development process)Eustachian explain the following theories:

• Theory of vacuum. Due to the closure or narrowing of the lumen of the Eustachian tube, the flow of new portions of air from the nasopharynx through the tube is disrupted. Violation of the ventilation function of the Eustachian tube leads to a drop in air pressure in the tympanic cavity. The air remaining in the tympanic cavity is quickly absorbed through the mucous membrane into small capillaries ( this happens even in the absence of inflammation, but the lack of air is normally quickly compensated). As a result, negative pressure is created inside the Eustachian tube and tympanic cavity ( vacuum), which retracts the eardrum. In addition, negative pressure causes swelling of the mucous membrane of the Eustachian tube and "pulls" the liquid part of the blood from the small vessels of the submucosal layer. This fluid is not yet inflammatory, therefore it is called a transudate ( from the Latin words trans - through, sudatum - to ooze). High negative pressure in the tympanic cavity causes a backflow of mucus from the nasopharynx into the tympanic cavity ( reflux). Bacteria and viruses that are constantly present there also move along with the mucus from the nasopharynx. Edema of the mucosa further narrows the lumen of the Eustachian tube.
• inflammatory theory. The inflammatory process spreads from the nasopharynx through the Eustachian tube into the tympanic cavity. Inflammation causes vasodilation and an increase in the permeability of their walls. The liquid part of the blood also sweats into the lumen of the auditory canal. Unlike a transudate, an inflammatory fluid contains more protein. Almost all substances that fight infection have a protein structure, in addition, the microbes themselves are composed of proteins. The inflammatory fluid is called exudate ( from the Latin word exsudo - I highlight). The more protein in the inflammatory fluid, the more gelatinous it becomes. Such mucus is hardly removed through the auditory tube into the nasopharynx ( impaired drainage function). The edematous mucous membrane of the Eustachian tube narrows its lumen and disrupts the ventilation function, causing a decrease in pressure in the tympanic cavity.
• Secretory ( excretory) theory. It is believed that negative pressure stimulates the secretion of mucus from the goblet cells. In addition, the number of these glandular cells in the mucous membrane of the tympanic cavity and the air cells of the mastoid increases dramatically. If the inflammatory process proceeds sluggishly, then the composition of the goblet cell mucus is disturbed ( it becomes less fluid), and the number of ciliated cells markedly decreases ( "baldness" of the epithelium). Violation of mucociliary clearance leads to impaired drainage function. Blockage of the auditory tube with viscous mucus disrupts the ventilation function and contributes to the chronic course of eustachitis.

• congenital immunodeficiency state;
• acute and chronic diseases that weaken the immune system;
• propensity to allergies;
• active or passive smoking;
• tamponade for nosebleeds insertion of a compression swab into the nasal cavity);
• mechanical removal of ear wax, which has bactericidal properties ( kills bacteria);
• hearing aid;
• foreign bodies in the outer ear in front of the eardrum);
• hypothermia of the body;
• high temperature and high humidity;
• scalp injury ( skin inflammation, psoriasis, seborrhea);
• bad ecology.

causative agents of eustachitis

Microbes enter the middle ear(tympanic cavity)in the following ways:

• tubogenic pathway- through the Eustachian tube from the nasopharynx;
• traumatic path- with a rupture of the eardrum or with a penetrating wound in the region of the mastoid process ( the process can be felt just behind the earlobe);
• hematogenous pathway- through the blood; in this way, microbes that can enter the bloodstream and spread throughout the body can enter the middle ear ( measles, tuberculosis, scarlet fever, typhoid and other blood poisoning);
• meningogenic or liquorogenic route- penetration of infection from the labyrinth of the inner ear into the tympanic cavity along with the cerebrospinal fluid ( ventricular fluid).

Conditionally pathogenic bacteria of the ENT organs include:

• actinomycetes ( found in carious teeth);
• lactobacilli;
• corynebacteria;
• bifidobacteria;
• Neisseria;
• spirochetes ( Treponema orale, Treponema macrodentium, Borrelia buccalis);
• fusobacteria;

The main causative agents of Eustachitis are:

• pneumococci ( Streptococcus pneumoniae) in 40% of cases;
• hemophilic bacillus ( haemophilus influenzae) 35% of cases;
• moraxella ( Moraxella catarrhalis) in less than 10% of cases;
• purulent streptococci ( Streptococcus pyogenes) in less than 10% of cases;
• Staphylococcus aureus ( Staphylococcus aureus) in less than 5% of cases.

The air, passing through the nasal cavity, is cleared of these microbes, thanks to the cilia of the epithelium and mucus ( mucociliary clearance). According to some reports, these potentially pathogenic bacteria are also present in the nasopharynx in healthy people in small quantities and form part of its natural microflora. However, the presence of these types of bacteria in children in the first three months of life is considered a risk factor for the development of inflammation of the ENT organs.

Eustachitis is a complication of such specific infectious(bacterial)diseases like:

• Scarlet fever- the causative agent is group A streptococci. The disease affects the tonsils. The inflammation is necrotic causes necrosis of affected tissues).
• Diphtheria- the causative agent is diphtheria bacillus ( Corynebacterium diphtheriae). With diphtheria, angina develops, hard-to-remove films are formed on the mucous membranes of the oropharynx, nasopharynx and larynx.

• the entry of the virus into the nasopharynx leads to an imbalance of its natural microflora;
• viruses have a damaging effect on the mucous membrane of the nasopharynx, paranasal sinuses, Eustachian tube and tympanic cavity ( violation of the protective function);
• the inflammation caused by the virus is to increase the production of viscous mucus, which the ciliated cells cannot move towards the nasopharynx ( violation of the drainage function);
• edematous mucous membrane swells and narrows the lumen of the auditory tube ( violation of the ventilation of the tympanic cavity);
• in response to the penetration of viruses, the immune system begins to secrete antiviral antibodies that cause allergization of the body;
• 4 days after the onset of inflammation, the virus in the mucous membrane is no longer detected, but the inflammatory process it has launched contributes to the active reproduction of bacteria.

Features of viral Eustachitis

Allergic diseases that cause eustachitis

The role of the allergic factor in the development of eustachitis is as follows:

• allergic reactions cause swelling of the mucous membrane of the Eustachian tube and disrupt its functions;
• a tendency to allergies creates a background for the attachment of a bacterial infection.

In addition, it is believed that any inflammatory process, with its protracted course, “activates” immune cells ( B-lymphocytes and T-lymphocytes) and eosinophils ( leukocytes involved in the allergic process). Immune cells and eosinophils secrete a large number of substances that activate the allergic process. They are called mediators intermediaries) allergies. Allergy mediators cause vasodilation and increase mucosal edema. At the same time, an allergic reaction is more difficult to stop than an infectious process. Immune cells continue to fight even when there are no foreign substances in the mucous membrane of the Eustachian tube. Such a reaction is due to the fact that a condition has arisen when the immune system responds with a hypersensitivity reaction ( allergies) to any external irritant and, at the same time, is not able to fully protect the body from bacteria. This altered human immune status includes two components - a tendency to an allergic reaction and a weakened immune response.

An allergic reaction can occur in relation to any foreign substance ( pollen, animal hair, dust and others), which at least once got on the mucous membrane of the auditory tube and came into contact with T-lymphocytes. T-lymphocytes transmit information about these substances to B-lymphocytes, and they "remember" these data. Upon repeated encounter with antigens, B-lymphocytes secrete protective immunoglobulins ( antibodies) to neutralize antigens.

Allergic otitis media is more often observed in children and is combined with other allergic diseases, such as allergic rhinitis, hay fever, atopic dermatitis, bronchial asthma. These diseases have the same mechanism of development - the release of specific class E immunoglobulins in relation to specific allergens ( antigens) and the development of allergic inflammation where their contact occurs.

Eustachitis with adenoids

Eustachitis with adenoids develops for the following reasons:

• Adenoids compress the auditory tube- an enlarged tubal tonsil covers the auditory tube and disrupts the opening of its pharyngeal opening. As a result, children begin to suffer from ear congestion. The increase in adenoids in children of preschool and primary school age is due to the active participation in the neutralization of infectious and toxic agents that enter the respiratory tract. By adolescence, the body already produces the necessary number of protective immune cells, and the need for the protective function of the tonsils decreases. This leads to the reverse development of the entire pharyngeal ring, so the symptoms of eustachitis can completely and completely disappear by puberty.
• Adenoids are the source of infection- in children with chronic eustachitis and otitis media in the lymphoid tissue of the tonsils ( adenoids) found a large number of potentially pathogenic bacteria.
• Adenoids produce inflammatory and allergic mediators- up to 5 years, little protective IgA is produced in the child's tonsils, but this is compensated by the production of IgE. If bacteria, viruses are neutralized precisely by IgE, then an allergic reaction is triggered, in contrast to the neutralization of IgA, in which processes aimed at destroying the pathogens themselves are stimulated. In children older than 3 years, the immune system begins to rebuild, and the lymphoid tissue begins to produce less IgE, but more IgA.

Inflammation of the Eustachian tube in violation of nasal breathing

The nasal cavity is divided into two halves by the nasal septum. On the side walls of each half there are three bone outgrowths - nasal conchas. Each concha divides the nasal cavity into three nasal passages. The nasal passages on the right and left open with two openings in the nasopharynx ( choanae).

Nasal breathing provides the following protective effects:

• Air warming- cold air leads to a rapid reflex expansion and filling of the turbinates with blood, while the turbinates increase and the nasal passages narrow. The inhaled air passes through the narrowed nasal passages more slowly and has time to warm up.
• Air humidification- The mucous membrane of the nose is covered with moisture, which saturates the stream of inhaled air.
• Air purification- large particles of dust are retained by hairs in the vestibule of the nose, and fine dust and microbes are retained by mucus and removed by the movement of the cilia of the epithelium during exhalation.
• Air neutralization- is carried out due to the presence of lysozyme, which kills bacteria.

Acquired causes of nasal breathing disorders

Congenital causes of eustachitis

Eustachian tube malformations include:

• congenital narrowness of the auditory tube ( usually in the skeletal region);
• underdevelopment of the auditory tube and tympanic cavity ( hypoplasia);
• Eustachian tube diverticulum protrusion of the wall in the form of a bag), which can cause its mechanical compression;
• persistent gaping of the pharyngeal opening ( due to muscle weakness or lack of fatty tissue in the cartilage region);
• Complete absence of the Eustachian tube aplasia).

• "Wolf's mouth" ( cleft soft palate) The soft palate is composed of soft tissues and separates the nasal cavity from the oral cavity. With " cleft palate"Eaten food, drunk liquid, as well as air that has not passed the nasal filter is freely thrown from the oral cavity into the nose, paranasal sinuses and the Eustachian tube. With a cleft of the soft palate, the function of the palatine muscles is also disrupted, with the contraction of which the opening of the pharyngeal canal of the Eustachian tube opens, and when relaxed, it closes. All these factors contribute to the development of eustachitis and inflammation of the tympanic cavity of the middle ear.
• Choan atresia- the absence of natural openings between the nasal cavity and the nasopharynx. The anomaly can be unilateral or bilateral. In this case, nasal breathing is difficult or completely absent. These children have frequent acute respiratory infections, as the child is forced to breathe through his mouth.
• Down syndrome- in children with Down's syndrome, hearing loss and the release of fluid into the tympanic cavity are often observed, which is explained by the narrowness and gaping of the Eustachian tube. When the mucus is thrown back from the nasopharynx into the Eustachian tube, its too narrow lumen is more easily clogged.
• Kartagener syndrome- this is a congenital combination of such symptoms as a defect in the function of the ciliated cells of the mucous membranes, the reverse or mirror arrangement of the internal organs ( partial or complete), rhinitis and sinusitis, bronchiectasis ( saccular local protrusions of the bronchial wall), male infertility ( immobile spermatozoa). Genetic disorders lead to the fact that the cilia of the ciliated epithelium either do not move at all, or move asynchronously. Normal mucociliary clearance is possible only if the cilia fluctuate simultaneously. The impaired drainage function contributes to the development and prolonged course of inflammation in those organs where the mucous membrane is covered with ciliated cells.

• hereditary causes- defects that arise as a result of mutations ( persistent changes in hereditary structures in cells);
• exogenous causes ( from the Greek word exo - outside, outside) - anomalies are caused by the impact of adverse external causes directly on the embryo or fetus.

• intrauterine infections- infections that are transmitted from a pregnant woman to the fetus through the placenta; most often these are mumps, rubella, herpes, chickenpox, influenza, and syphilis viruses;
• bad habits of a pregnant woman- smoking, alcohol, drugs;
• metabolic disorders in pregnant women- endocrine disorders hyperfunction of the thyroid gland, tumors synthesizing hormones, diabetes mellitus);
• medications- methotrexate ( inhibits cell division), captopril, enalapril, ( drugs that lower blood pressure), warfarin ( inhibits the blood coagulation system), antibiotics ( tetracyclines, aminoglycosides, etc.) and others;
• chemical substances– air and soil pollution by industrial waste;
• ionizing radiation- radioactive fallout, radiation therapy, radioactive iodine treatment ( especially in the first six weeks of fetal development).

Eustachitis symptoms

The main complaints in eustachitis are:

• Feeling of fullness in the ear- occurs due to retraction of the eardrum ( after the cessation of air from the nasopharynx into the middle ear, a vacuum is created there).
• Hearing loss A retracted eardrum does not conduct sound well to the inner ear. It is characteristic that hearing acuity in eustachitis is variable. The more liquid, the worse the sound transmission. When the position of the head changes, the fluid in the tympanic cavity moves and hearing improves. Also, hearing can be restored for a while after sneezing or blowing your nose, while the auditory tube is blown.
• autophony- hearing one's own voice in the affected ear ( "voice in ear"). This phenomenon is due to the fact that the fluid accumulated in the tympanic cavity is a good resonator for your own voice. In addition, with a gaping Eustachian tube, the vibrations of the vocal cords can penetrate into it and reach the membrane, which catches them from the inside. Autophony decreases when breathing through the mouth ( when this occurs, the pharyngeal opening of the Eustachian tube is covered), take a horizontal position or lower your head between your knees ( blood flow causes a thickening of the mucous membrane, a decrease in the lumen of the tube and adhesion of its walls).
• Noise in ears- develops due to self-listening processes occurring in the middle ear.
• Feeling of heaviness in the head- due to oxygen starvation of the brain, which occurs when nasal breathing is disturbed. There are several explanations for this. In the nasal cavity, gas exchange occurs, and part of the inhaled oxygen is absorbed into the blood vessels of the nasal cavity. In addition, the jet of inhaled air is so powerful that it causes fluctuations in cerebral pressure ( reflex constriction and dilation of blood vessels), promoting the movement of cerebral fluid. With a runny nose, the entire surface of the nasal cavity ceases to participate in gas exchange, and the body ( especially the brain) receives less oxygen, and the absence of nasal breathing slows down the movement of cerebral fluid. This explains the lethargy during a runny nose.
• Sensation of overflowing fluid in the ear when turning the head- occurs when fluid has accumulated in the tympanic cavity.

The general condition with eustachitis suffers little, body temperature is usually normal or subfebrile ( up to 37.5°C). If the main cause of eustachitis is an acute infectious disease, then fever, symptoms of intoxication of the body ( nausea, vomiting, feeling unwell, pain in muscles, joints) and typical signs characteristic of a particular disease ( true croup in diphtheria, Filatov spots in measles and more).

After the symptoms of rhinitis, laryngitis or sinusitis disappear, the function of the Eustachian tube is restored, and the symptoms of eustachitis disappear. If the cause of Eustachitis affects the mucous membrane for too long, then the inflammation of the Eustachian tube takes a protracted course ( symptoms persist for 3 to 12 months) or becomes chronic.

The following factors contribute to the protracted course of eustachitis:

• Due to prolonged and pronounced edema, the mucous membrane becomes thicker;
• Permanent infiltration ( flood) of the submucosal layer stimulates the processes of fibrosis ( scar tissue growth).
• Sclerosis ( seal) small vessels of the Eustachian tube leads to a decrease in their blood supply and malnutrition of the mucosa.
• With prolonged retraction of the eardrum, the muscle that regulates its tone is damaged.
• Allergization of the body contributes to the maintenance of damage to the mucous membrane of the Eustachian tube after the disappearance of the infection.
• The number of goblet cells that secrete mucus increases. In this case, the mucus becomes more viscous and less fluid and can clog the Eustachian tube. This is also facilitated by a decrease in the number of ciliated cells.

Complications of Eustachitis

The following complications of Eustachitis are possible:

• Acute catarrh of the middle ear- inflammation prevails with the formation of a large amount of mucus. There is a feeling of fullness in the ear, tinnitus and hearing loss, earache (due to irritation of the pain endings by the fluid accumulated in the tympanic cavity).
• Acute purulent inflammation of the middle ear- if an infection penetrates through the auditory tube into the middle ear, then the fluid in the tympanic cavity becomes purulent. Purulent fluid contains a large number of dead neutrophils ( leukocytes), killed microbes and cells of the mucous membrane of the Eustachian tube. The pain in the ear gets worse. Pus contains many proteolytic ( protein-destroying) enzymes that secrete both microbes and the body's own protective cells.
• Perforation ( gap) tympanic membrane - the constant pressure of pus on the tympanic membrane and the action of these enzymes cause the gradual destruction of the tympanic membrane and its rupture. Through the hole formed, pus enters the external auditory canal from the middle joint, while the body temperature returns to normal, and complaints become less pronounced.
• "Glue Ear"- very often, especially with chronic or prolonged eustachitis, the mucus becomes less fluid. This is due to a change in the goblet cells of the mucous membrane of the tube and tympanic cavity.
• Adhesive otitis media- The longer the inflammation lasts, the more the mucous membrane changes and the more its function suffers. In such cases, the body prefers to “close” the focus of chronic inflammation with scar tissue. There is no metabolism in the scar tissue, there are no living cells, and therefore there can be no inflammation there. However, with cicatricial changes ( also called degenerate) the function of the organ is impaired, and then the only method of treatment is surgical intervention.
• Hemorrhages in the tympanic cavity and tympanic membrane- if vessels are involved in the inflammatory process, then small blood clots form in them, which leads to hemorrhage.

Diagnosis of Eustachitis

The main methods for diagnosing eustachitis

The following degrees of violation of ventilation function are distinguished(barofunctions)auditory tubes:

• I degree barofunction disorder- the auditory tubes are passable during normal swallowing;
• impaired barofunction II degree- the auditory tubes are not passable during the test with an empty sip, but are passable during the Toynbee test;
• III degree barofunction disorder- the auditory tubes are purged during the Valsalva maneuver;
• IV degree barofunction disorder- the patency of the auditory tube is detected when blowing the auditory tube with an ear balloon;
• violation of barofunction of the 5th degree- Eustachian tubes are passable only when blown through an ear catheter.

Ultrasound procedure ( echotympanography, sonography) allows you to clearly determine whether there is exudate in the tympanic cavity.

Endoscopic examination for inflammation of the Eustachian tube reveals:

• pathological reflux ( reflux- mucus from the nasopharynx into the pharyngeal opening of the Eustachian tube;
• "gaping" auditory tubes;
• the specific cause that caused the blockage of the Eustachian tube ( thickened nasal concha, adenoids, granulations, tumors).

Radiation diagnosis for eustachitis includes:

• Fluoroscopy- determines the state of the air cells of the mastoid process ( their "airiness" decreases with inflammation of the middle ear), as well as fluid in the paranasal sinuses ( sinusitis) and deviated septum.
• X-ray contrast study- after tympanopuncture piercing the eardrum with a needle) introduce iodolipol ( contrast agent that can be seen on an X-ray) and watch it pass through the Eustachian tube. A contrast agent can also be injected into the pharyngeal opening of the Eustachian tube. In this case, you can observe how the substance reaches the tympanic cavity, and identify narrowed places ( violation of ventilation), as well as trace the process of its movement in the opposite direction ( drainage function assessment). With a normal drainage function, the reverse movement process ( evacuation) starts in 10-20 minutes. With impaired function, yodolipol is retained in the tube for an hour or more. X-ray contrast examination can be combined with purging of the Eustachian tube ( simple sip test, Toynbee test) to study their effect on speeding up the evacuation process.
• Computed tomography- allows you to identify fluid in the tympanic cavity, which is characterized by "gravitational dependence" ( when the position of the head changes, the fluid changes its location and occupies the lower parts of the middle ear). However, this phenomenon is absent if the mucus is very viscous or fills the entire tympanic cavity.
• Magnetic resonance imaging- more informative than computed tomography for detecting fluid and pus in the middle ear. In addition, MRI can detect granulations and neoplasms that could cause eustachitis.

There are the following methods of audiometry:

• Speech audiometry- the doctor pronounces different words in a normal voice and in a whisper at a distance of 6 meters from the subject, who then must repeat them.
• Pure tone audiometry Sounds are sent through headphones to the patient's ear. If a sound is heard, the patient presses the button. The result is given in the form of a graph - an audiogram.
• Computer audiometry- the most objective method, since it does not depend on the actions of the patient. Computer audiometry is based on reflexes that occur during auditory stimulation.

Acoustic impedancemetry in eustachitis

The procedure is absolutely painless, lasts about 15 minutes, has no contraindications. No special preparation for the study is required it is enough to clean the ear canal from sulfur).

First, the auricle is closed with a special insert to ensure the tightness of the ear, after which a rubber probe is inserted through the external auditory canal and brought to the eardrum. Sound signals are emitted from the apparatus through this probe. Signals reach the eardrum, and it begins to vibrate. The sound pressure that comes from the eardrum during the reflection of the signal is captured by the microphone connected to the device. All these data are displayed in the form of a graph on the device ( tympanogram).

The test for assessing the ventilation function of the auditory tube is carried out as follows:

• record a control tympanogram at a normal level of pressure in the nasopharynx;
• a second tympanogram is recorded with increased pressure in the nasopharynx, which occurs when the patient exhales forcefully with the nose and mouth closed ( Valsalva test);
• the third tympanogram is recorded during reduced pressure in the nasopharynx, which is created during swallowing with a closed nose and mouth ( toynbee test).

The next important indicator is the pressure in the tympanic cavity. In violation of the ventilation function of the Eustachian tube, the pressure in the tympanic cavity ( behind the eardrum) is lower than the pressure in the external auditory canal ( anterior to the tympanic membrane). The tympanic membrane can oscillate, that is, perform its sound-conducting function, only if the pressure on both sides of it is the same. The pressure regulator built into the tympanometry apparatus can change the pressure in the external auditory canal relative to ambient atmospheric pressure. First, the pressure in the ear canal is lowered, then increased and returned to the level of atmospheric pressure. Tympanogram peak ( maximum oscillation of the tympanic membrane) will correspond to the pressure in the tympanic cavity.

Eustachitis treatment

Medical treatment of eustachitis

Medical treatment of eustachitis

Antibiotics are prescribed only if the nasopharyngeal swab or middle ear exudate ( which was taken during a puncture of the eardrum or stood out after its rupture) detect bacteria, especially those that cause purulent inflammation. The use of antibiotics for a viral infection as a prophylaxis is advisable in immunodeficiency states or frequent exacerbations and protracted course of eustachitis. It is worth considering the fact that with allergic inflammation of the Eustachian tube, many antibiotics can exacerbate allergic reactions.

Physiotherapeutic procedures for eustachitis

Physiotherapy treatment of eustachitis

Mechanotherapy for Eustachitis

To restore the patency of the Eustachian tubes, the following methods of mechanotherapy are used:

• blowing the auditory tubes with an ear balloon;
• catheterization of the auditory tube and its blowing ( 10 – 12 procedures);
• pneumatic massage of the tympanic membrane.

Pneumatic massage of the tympanic membrane is a type of massage based on pumping air into the auditory tube and pumping it out with the help of a special apparatus. In fact, pneumomassage of the tympanic membrane is the training of its muscle, as well as the muscle that opens the opening of the Eustachian tube.

The device for pneumomassage or vacuum massage is called "APMU-compressor" and consists of a compressor and a double-acting pump. The principle of operation of the device is the alternation of increasing and decreasing air pressure. The degree of suction and air injection is regulated by means of special valves. The procedure itself is carried out using a massage tip, which is inserted into the ear.

Pneumomassage of the tympanic membrane has the following contraindications:

• purulent otitis ( pus contributes to the rupture of the eardrum);
• barotrauma ( with barotrauma, there are small or large ruptures of the eardrum).

Surgical methods for the treatment of auditory tubes

The following operations help to restore the ventilation of the middle ear in chronic eustachitis:

• Removal of a formation that compresses the pharyngeal opening - with very large adenoids or polyps, with a tumor or abscess, as well as excision of enlarged tubal ridges.
• eardrum puncture ( synonyms - tympanopuncture, tympanocentesis, myringotomy) and shunting of the tympanic cavity is the insertion of a drainage tube ( shunt) from bioinert material ( non-repugnant) through an incision in the eardrum into the middle ear. Through this shunt, drugs can be administered, as well as fluid accumulated in the tympanic cavity can be removed. This method is used in cases where the drainage and ventilation functions of the auditory tube are not restored within 1 to 2 weeks, and fluid begins to accumulate in the tympanic cavity. The drainage is left until the function of the Eustachian tube is restored, after which it is removed and the eardrum is sutured.
• balloon dilatation ( extensions) auditory tube is a new method of treatment. It is performed endoscopically, that is, using an instrument at the end of which there is a camera. No cuts are made. The endoscope is inserted through the nose into the nasopharynx. In the same way, a catheter is inserted ( thin metal conductor) with a balloon and introduce it through the pharyngeal opening of the auditory tube into its cartilaginous part. After that, the balloon is inflated and kept in the lumen of the auditory tube for 2 minutes. The whole procedure takes 15 minutes.

Folk remedies for the treatment of eustachitis

Aloe vera ( synonyms - agave, centennial tree) is a houseplant that is used not only among the people, but also in traditional medicine. Its widespread use is due to the fact that aloe has bactericidal properties ( kills bacteria) in relation to such pathogens of eustachitis and infections of the upper respiratory tract as streptococci, staphylococci, diphtheria bacillus.
Aloe leaves contain a large amount of essential oils, enzymes, vitamins, amino acids, minerals, phytoncides and salicylic acid. Therefore, aloe can eliminate inflammation, speed up healing, and boost immunity. For the treatment and preparation of medicines, aloe juice, fresh leaves, extract and sabur are used ( condensed aloe juice).

Aloe can be used in the following ways:

• With a cold, aloe juice is used in the form of drops. Freshly squeezed juice is instilled 2-3 drops into each nostril 3 times a day. The course of treatment is 7 - 8 days.
• If the throat hurts, then gargles can be done with aloe juice. To do this, the juice must be diluted with an equal amount of water. The same solution can be used to irrigate the nasal cavity. After rinsing, you can drink warm milk by adding one teaspoon of aloe juice to it.
• Aloe can also be instilled into the ear. You need to mix 4 drops of aloe with 4 drops of water. The resulting mixture is instilled into the ear every 4-5 hours for 5-7 days. The same solution can be moistened with gauze turunda and inserted into the external auditory meatus at night.
• Aloe effectively fights herpes. Rashes should be lubricated with juice from aloe leaves 5 times a day, while the juice should be fresh, so with each procedure you need to break off a new fresh aloe leaf.
• To increase immunity use tincture of aloe. To prepare it, you need to cut off the lower leaves of aloe ( at least three years of age), wrap in dark paper and refrigerate for 1 to 2 weeks. After staying in the refrigerator, the leaves should be crushed, poured with vodka or 70% alcohol in a ratio of 1: 5 and infused in a closed container, put in a dark, cool place for 10 days. Tincture should be used 30 minutes before meals, one teaspoon 2-3 times a day.

• fever - body temperature above 37.5 ° C;
• irritation of the skin around the ear;
• purulent inflammation of the ear.

• Raw onion- you can make a gruel from onions, which must be wrapped in gauze turunda and placed in the external auditory canal. Fresh onion juice can be dripped into the nose.
• Warmed onion- a quarter of the onion should be wrapped in cheesecloth and heated in a pan for several minutes, then squeeze the juice. For treatment, you need to drip juice into your nose, and squeezed onions in gauze - insert into your ear.
• Garlic- Pass a few heads of garlic through a meat grinder. Pour the resulting slurry with vegetable oil, put in a warm place overnight. Bury every evening 2-3 drops in the ear.
• Potato steam- potato inhalations are effective for the treatment of eustachitis and acute respiratory infections.
• Propolis- Mix 30% propolis tincture with unrefined vegetable oil in a ratio of 4:1. Moisten the gauze turunda with the resulting emulsion and put in the ear 1 time per day ( no longer than 10 hours). The emulsion must be shaken before use.
• Beet- peel the beets, boil, squeeze the juice out of it, instill in the ear 3-4 drops 5 times a day.
• herbal collection- Mix equal amounts of dried eucalyptus leaf, dandelion root, lavender and yarrow. Pour all this with warm water so that all the herbs are covered with water, let it brew. Take for 2 weeks, 50 ml per day.

Treatment of eustachitis with the methods of oriental medicine

Oriental medicine offers the following treatments for Eustachitis:

• Magnetotherapy- impact on biologically active points by an alternating or constant magnetic field, with the help of special elements - magnetophores or magnetoelasts. These magnetic elements are placed on the skin in the region of the point to be acted upon and fixed with adhesive tape or special adhesive plates. Magnetic clips are used for ear magnetotherapy. This procedure does not cause any skin irritation. Magnetotherapy is contraindicated in acute purulent and non-purulent inflammations, people with cardiovascular diseases, dysfunction of the autonomic nervous system, and tumors ( benign and malignant).
• Stone therapy- heating of bioactive points with the help of special stones. Heating can also be done with wormwood sticks.
• Acupuncture- according to Chinese folk medicine, acupuncture normalizes the flow of Qi energy along the meridians. With insufficient energy in a particular organ, the mechanical effect on biological points enhances its influx, and with excess energy, it eliminates its excess. From a scientific point of view, when a needle is inserted into the skin, muscles are stimulated, which begin to send nerve impulses to the central nervous system, where endorphins are produced ( happiness hormones), which have an analgesic effect. Response nerve impulses directed to the injection site of the needle dilate blood vessels and stimulate tissue repair processes.
• Auriculotherapy is a type of acupuncture that stimulates points located in the auricle. The teaching of oriental medicine says that the auricle is similar in shape to a human embryo, and it has projections or zones of all internal organs.
• Medical massage– biological points are also activated during the massage.
• cupping therapy– during cupping massage, a vacuum is created inside the cup, which irritates the skin receptors. This method has almost the same contraindications as magnetic therapy.

• eliminates swelling and congestion in the nasopharynx;
• improves drainage and ventilation of the tympanic cavity;
• inflammation in the Eustachian tube is eliminated;
• increases general and local immunity;
• increased blood flow in the middle ear, which leads to resorption of the exudate;
• effective prevention of infectious inflammation.

How to fly in an airplane with eustachitis?

In case of eustachitis during the flight, the following recommendations should be followed:

• Use vasoconstrictor nasal drops or sprays ( naphthyzine, afrin, otrivine and others) before flight to prevent swelling of the tube mucosa, which causes narrowing of its lumen.
• As an airplane takes off, the atmospheric pressure decreases and the pressure in the tympanic cavity becomes higher. To equalize the pressure, you need to remove excess air from the middle ear. To do this, press the wings of the nose to the nasal septum and swallow. During this technique, the pressure in the nasopharynx becomes negative. Negative pressure has a suction effect, like a vacuum cleaner vacuum. This draws excess air out of the tympanic cavity, reducing the pressure in it.
• During the flight, it is recommended to periodically yawn, chew gum or suck on candy. The muscles that are involved in the process of chewing, swallowing and chewing open the opening of the auditory tube, equalizing the pressure on both sides of the eardrum.
• You can use special earplugs, especially during takeoff and landing.
• 45 minutes before planting, reapply vasoconstrictor drops.
• During landing, atmospheric pressure begins to rise sharply, while in the middle ear it remains low. To increase the pressure in the tympanic cavity, you need to blow air into the Eustachian tube. To do this, close your mouth and nose and blow the air out of your lungs.

Why is eustachitis more common in children?

The following factors contribute to the development of eustachitis in childhood:

• The structure of the Eustachian tube. In early childhood, the tube is shorter, wider and almost horizontal. Thus, the reflux of infected mucus from the nasopharynx into the tube in children is easier.
• The presence of myxoid tissue in the tympanic cavity in children of the first year of life. Myxoid tissue is a loose gelatinous connective tissue that contains a large amount of mucus and few vessels. After the birth of a child, it begins to gradually dissolve. Myxoid tissue is an ideal breeding ground for bacteria.
• Low body resistance in young children- due to the fact that maternal protective antibodies that crossed the placenta at the end of pregnancy have already been removed from the child's body, and its own immunity is still being formed.
• Throwing breast milk into the tube. Infants do not yet know how to hold their heads on their own, therefore, they are mostly in a horizontal position. When regurgitation, milk easily enters the middle ear through the Eustachian tube, and with it the gastric enzymes that damage the mucous membrane, and bacteria from the nasopharynx. To prevent reflux of milk into the middle ear, after breastfeeding, the baby should be held upright while he burps.
• Children's infectious diseases. Many infectious diseases, such as measles, diphtheria, scarlet fever, affect children and often cause complications in the form of eustachitis and otitis media.
• Adenoids. In children older than 5 years, local immunity is actively formed, which for ENT organs is presented in the form of a pharyngeal ring consisting of 6 tonsils ( synonyms - adenoids, lymphoid tissue) - two palatine, two tubal, one pharyngeal and one lingual. The tubal tonsils are located in the region of the nasopharyngeal openings of both Eustachian tubes. These tonsils produce immune cells and protective antibodies ( immunoglobulins), which in children are actively involved in protection against infection. It is because of this that the tonsils or adenoids often increase, covering the Eustachian tube and disrupting its function.
• Tendency to allergies. The younger the child, the more immune system is focused on allergic reactions and less on protection against germs. Therefore, in children, the cause of eustachitis and otitis media is often an allergy. Gradually, the body accumulates information about its own and foreign cells, and it begins to respond adequately.

What causes bilateral eustachitis?

Some causes of eustachitis affect both tubes at once. Such reasons include the influence of atmospheric pressure drops during takeoff and landing of an aircraft, during ascent and descent, as well as water pressure during deep-sea navigation.

Allergic eustachitis is also usually bilateral, especially if combined with diseases such as allergic rhinitis, allergic conjunctivitis, bronchial asthma, atopic dermatitis. This is due to the fact that the same class of allergic antibodies, immunoglobulins E, is involved in the implementation of allergies in all these diseases. These antibodies are fixed on immune cells called mast cells, and together with them enter the mucous membranes and skin. As soon as the irritating substance or allergen enters the mucous membrane, it is immediately neutralized by immunoglobulins E, but an allergic reaction is triggered. Such a reaction in the nasal cavity and nasopharynx very easily spreads to the mucosa of the Eustachian tubes.

Bilateral eustachitis often develops in childhood infectious diseases, for example, with measles, scarlet fever, diphtheria.

What gymnastics is useful for eustachitis?

There are the following breathing exercises for the Eustachian tube:

• The exercise is performed while standing. You need to take a deep breath through your nose flare and flare the nostrils), the diaphragm must participate in breathing ( abdominal breathing, belly protrudes). Exhale slowly through your mouth, drawing in your belly.
• The exercise is performed while standing. Taking a deep breath through the nose nostrils flared and tense), the abdomen protrudes. After inhalation, the breath is held, the torso is tilted forward, the arms are lowered relaxed down and exhaled.
• The exercise is performed while sitting. Take a deep breath in through your nose, exhale through your nose.
• Open your mouth wide and yawn, then swallow.
• Open your mouth wide, take a deep breath, close your mouth, swallow.

• Open your mouth and make a "sail" out of your tongue. To do this, the tip of the tongue must be raised and placed on the tubercles behind the front upper teeth ( alveoli). Then, with the tip of the tongue, slowly draw back and forth across the sky, as if sweeping the sky with the tongue.
• Open the mouth, pull the tongue back to the larynx, then move the tongue forward to the lower front teeth, then rise to the alveoli and draw back across the soft palate. The same exercise should be repeated with the mouth closed.

• open your mouth wide, stick out your tongue as low as possible, then bend the tip of the tongue, trying to point it as high as possible;
• open your mouth wide, stick out your tongue as low as possible, then pull your tongue into the mouth, closing your throat with it;
• open your mouth, bend the tip of the tongue behind the alveoli, without touching the upper teeth.

• the lower jaw is gently pushed forward ( lips should be tightened, and the upper lip should be lifted);
• move the lower jaw to the right and left;
• open and close jaws put fingers on both sides between the behind-the-ear area and the angle of the lower jaw to control the process).

• stretch lips with a tube;
• stretch the lips in a smile so that the teeth become visible, while you need to feel how the lips and neck muscles tighten; alternate these two exercises;
• "crooked" smile ( on one side only) right left.

• puff out both cheeks, tightly closing your lips, open your cheeks with a smack;
• inflate alternately the left and right cheeks;
• retract cheeks;
• puff out the cheeks and retract the cheeks without opening the mouth;
• open your mouth as wide as possible.

• inhale through one nostril and exhale through the other;
• blowing air through closed lips you can blow up balloons);
• exhale with closed mouth and nose;
• drink liquid through a straw.

What ear drops can be used for eustachitis?

There are the following types of ear drops:

• anti-inflammatory drops otipax, otinum);
• antibacterial drops ( tsipromed, normax, otofa);
• combination drops containing several drugs ( anauran, polydex, garazon, sofradex);
• solutions with antiseptics ( okomistin, furatsilin);
• antifungal drops ( candibiotic).

• Otipax– contains phenazone ( non-steroidal anti-inflammatory drug) and lidocaine ( local anesthetic). Otipax can be used for otitis media at the time of inflammation, for otitis after influenza, for barotraumatic edema ( accumulation of fluid in the tympanic cavity due to a sharp increase or decrease in atmospheric pressure). The drug can be used not only by adults, but also by children, pregnant women and breastfeeding mothers. Drops should be instilled into the external auditory canal, 4 drops 2-3 times a day for 10 days ( but no more, as there is addiction to the drug). Before use, the bottle must be warmed in the palms so that the solution is not cold. The bottle is equipped with a transparent pipette, so it is very easy to calculate the number of drops. Ear pain disappears 15-30 minutes after instillation. Otipax is contraindicated in case of sensitivity to the components of the drug ( allergic reaction to lidocaine) and rupture of the eardrum ( if the membrane ruptures, the drug can get not into the middle ear, but into the inner ear, causing damage to the auditory nerve).
• Otinum- contains choline salicylate ( non-steroidal anti-inflammatory drug), which has a local analgesic and anti-inflammatory effect, in addition, otinum has an antimicrobial and antifungal effect. It is used for otitis media, otitis externa ( especially after removal of foreign bodies from the ear canal) and to dissolve sulfur plugs. Ear drops are instilled into the external auditory canal 3-4 drops 3-4 times a day for no longer than 10 days. Children can be instilled in the same dose. Before use, the bottle is warmed in the palm of your hand. Otinum should not be used in people who are allergic to aspirin ( bronchial asthma, urticaria, allergic rhinitis) and rupture of the eardrum. During pregnancy, breastfeeding and in children under 1 year old, Otinum should be used with caution.
• Tsipromed- contains the antibiotic ciprofloxacin, which has a wide spectrum of action against many microorganisms. The drug is used for acute and chronic otitis media, instilling 5 drops into each ear canal 3 times a day until the symptoms disappear ( and 2 more days). After instillation, you need to keep your head tilted for 2 minutes ( you can close the ear canal with a cotton turunda). Tsipromed is contraindicated during pregnancy and lactation, children under 15 years of age, with allergies to the components of the drug.
• Normax- contains the antibiotic norfloxacin, which also acts as cypromed ( ciprofloxacin). Indications and contraindications are the same as for tsipromed. Normaks apply 1 - 2 drops into the external auditory canal 4 times a day.
• Anauran- contains antibiotics polymyxin B, neomycin and lidocaine ( has a local anesthetic effect). Polymyxin fights Haemophilus influenzae ( haemophilus influenzae) and whooping cough stick ( Bordetella pertussis). Neomycin is an aminoglycoside. It destroys pneumococci Streptococcus pneumoniae), opportunistic staphylococci ( constituting the natural microflora of the oral cavity). Thus, these two antibacterial drugs are effective against the main pathogens of acute respiratory bacterial infections, eustachitis and otitis media. Anauran is prescribed for acute and chronic otitis media ( in the absence of tympanic membrane rupture). Using a special pipette, anauran is instilled into the external auditory canal for adults 4-5 drops 2-4 times a day, for children 2-3 drops 3-4 times a day. After instillation, you need to keep your head tilted for some time. The course of treatment should not exceed 7 days ( long-term use may cause toxic effects on the ears and kidneys). Anauran is contraindicated in case of sensitivity to the components of the drug. During pregnancy and lactation, as well as in children under 1 year of age, the drug should be used only if absolutely necessary and always under the supervision of a physician.
• Otofa- contains a broad-spectrum antibiotic rifampicin. The drug is active against the main pathogens of otitis media and eustachitis. It is used for acute and chronic otitis ( including with persistent rupture of the eardrum). The adult dose is 5 drops 3 times a day, for children - 3 drops 3 times a day. The duration of treatment is not more than 7 days. Before use, warm the bottle in the palm of your hand. Otofa should not be used if you are sensitive to rifampicin. During pregnancy, use with caution.
• Sofradex- contains gramicidin ( antiseptic with antimicrobial action), framycetin ( aminoglycoside antibiotic) and dexamethasone ( hormonal anti-inflammatory drug). Gramicidin inhibits the growth of bacteria that cause acute respiratory infections ( streptococci, staphylococci, pneumococci and others), thereby enhancing the anti-staphylococcal effect of framycetin and complementing its antibacterial action ( framycetin is not active against streptococci). Dexamethasone has anti-inflammatory and antiallergic effects. The drug is instilled 2-3 drops into the external auditory canal 3-4 times a day. You can soak gauze turunda in the solution and put it in your ear. The duration of treatment is no more than 7 days ( sometimes the doctor may increase the duration of treatment if he sees a pronounced improvement in the condition). The disappearance of external manifestations of otitis media and eustachitis under the influence of dexamethasone does not always mean that the infection has been destroyed. Often, improper use of the drug leads to the fact that bacteria become resistant to antibiotics. Sofradex is contraindicated in viral ( especially herpes), fungal infections, tuberculosis, during pregnancy and lactation, children under 1 year old. In older children, the drug should be used with great caution, since dexamethasone can penetrate into the bloodstream and cause adrenal suppression ( dexamethasone is an analogue of adrenal hormones).
• Polydex- contains dexamethasone ( has anti-inflammatory and anti-allergic effect) and the antibiotics polymyxin B and neomycin. Adults instill 1-5 drops 2 times a day, and children over 5 years old - 1-2 drops 2 times a day. Duration of admission is 6 - 10 days. Polydex should not be used in case of damage or infection of the eardrum and hypersensitivity to the components of the drug. During pregnancy should be used with caution. Do not use simultaneously with other antibiotics, as the risk of side effects increases.
• Garazon- contains a broad-spectrum antibiotic gentamicin ( aminoglycoside group) and betamethasone ( corticosteroid anti-inflammatory and antiallergic drug). The drug is instilled 3-4 drops 2-4 times a day. You can moisten a cotton or gauze turunda with a solution and insert it into the external auditory canal. Every 4 hours, the swab should be moistened again with the solution. You need to change your tampon once a day. With a decrease in the symptoms of the disease, the dose of the drug is gradually reduced, and when the manifestations disappear, the intake is stopped. Garazon is contraindicated in viral or fungal infections, after vaccination, in case of rupture of the eardrum, in children under 8 years of age, pregnant women and nursing mothers.
• Candibiotic- contains beclomethasone ( hormonal anti-inflammatory and antiallergic drug), chloramphenicol ( antibiotic), clotrimazole ( antifungal drug) and lidocaine ( local anesthetic). The drug is used for inflammatory and allergic processes in the Eustachian tube and middle ear, instilling 4-5 drops into the external auditory canal 3-4 times a day. Visible improvement occurs 3-5 days after the start of application. The course of treatment is 7 - 10 days. Candibiotic should not be used in case of sensitivity to the components of the drug, in case of rupture of the eardrum, in children under 6 years of age, it is not recommended to take during pregnancy and lactation.
• Furacilin- This is an alcohol solution containing the antiseptic nitrofural. In the inflammatory process, it is necessary to instill 5-7 drops into the external auditory canal for an adult and 2-3 drops for children. Do not use during pregnancy and lactation and children under 6 years of age.
• Okomistin- an antiseptic that is active against pathogens of eustachitis and otitis media ( pneumococci, staphylococci). In addition, okomistin has antifungal and antiviral effects ( kills the herpes virus). The drug is instilled into the external auditory canal 5 drops 4 times a day or moistened with a cotton or gauze turunda in solution and injected into the auditory canal ( need to be wetted every 4 hours). The duration of treatment is 10 days. Okomistin is contraindicated during pregnancy and lactation, children under 3 years of age, with sensitivity to the components of the drug.

Inflammatory lesion of the auditory tube, leading to a deterioration in the ventilation of the tympanic cavity with the development of catarrhal otitis media. Eustachitis is manifested by congestion in the ear, a sensation of liquid overflowing in it, hearing loss, noise in the ear, autophony. Symptoms can be unilateral or bilateral. Confirmation of the diagnosis of eustachitis is carried out with the help of a comprehensive examination, including otoscopy, hearing test, manometry of the auditory tube and determination of its patency, acoustic impedancemetry, rhinoscopy, culture of a throat swab. Treatment of eustachitis is carried out with vasoconstrictor nasal drops, antihistamines, administration of drugs directly into the middle ear cavity and auditory tube, and physiotherapy methods.

General information

The auditory (Eustachian) tube connects the tympanic cavity of the middle ear with the nasopharynx. It performs the function of a channel through which the pressure inside the tympanic cavity is balanced in accordance with the external atmospheric pressure. Normal pressure in the tympanic cavity is a necessary condition for the functioning of the sound-conducting apparatus of the middle ear: the tympanic membrane and the ossicular chain.

The width of the auditory tube is about 2 mm. With such a small diameter, even a slight swelling of the walls of the auditory tube as a result of inflammation leads to a violation of its patency with the development of eustachitis. As a result, air from the pharynx ceases to flow into the middle ear cavity and catarrh develops there. Due to the combined inflammatory lesions of the auditory tube and middle ear, eustachitis is also called tubo-otitis, tubotympanitis, salpingo-otitis. According to the nature of the course, acute and chronic eustachitis are distinguished.

Causes of Eustachitis

The cause of acute eustachitis is the spread of infection from the nasopharynx and upper respiratory tract to the pharyngeal orifice and mucous membrane of the auditory tube. This can be observed with SARS, influenza, tonsillitis, acute pharyngitis and rhinitis, scarlet fever, infectious mononucleosis, measles, whooping cough. Infectious agents of Eustachitis in this case are most often viruses, staphylo- and streptococci, in children - pneumococci. In rare cases, eustachitis can be caused by a fungal infection or specific microflora (causative agents of tuberculosis, syphilis, chlamydia). The occurrence of acute eustachitis is associated with swelling of the auditory tube due to an allergic disease (allergic rhinitis, hay fever). The development of acute eustachitis may be complicated by nasal tamponade, which is carried out to stop nosebleeds.

Chronic eustachitis develops against the background of chronic inflammatory processes in the nasopharynx: tonsillitis, adenoids, chronic rhinitis and sinusitis. It can be caused by diseases in which the normal circulation of air through the airways is disrupted: deviated septum, benign tumors of the nasal cavity and neoplasms of the pharynx, choanal atresia, hypertrophic changes in the inferior turbinates.

In a separate and rather rare form of eustachitis, otolaryngology refers to the dysfunction of the auditory tube with sudden changes in atmospheric pressure. A rapid decrease or increase in external pressure does not have time to be transmitted through the auditory tube into the tympanic cavity. As a result of the resulting pressure drop, the mouth of the Eustachian tube is compressed and the structures of the middle ear are traumatized with the development of aerootitis.

The mechanism of development of eustachitis

Complete or partial violation of the patency of the auditory tube with eustachitis leads to a reduced flow of air into the tympanic cavity or to a complete cessation of its ventilation. At the same time, the air remaining in the tympanic cavity is gradually sucked in, the pressure in it decreases, which is manifested by retraction of the tympanic membrane. Reduced pressure leads to sweating into the tympanic cavity of a transudate containing protein and fibrin, and in later stages, lymphocytes and neutrophils - cells involved in inflammatory reactions. A catarrhal form of otitis media develops. A long-term violation of the ventilation of the tympanic cavity caused by Eustachitis, especially in people with weakened immunity, can cause the transition of catarrhal inflammation to purulent, as well as the development of an adhesive process with the onset of adhesive otitis media.

Eustachitis symptoms

Typical manifestations of eustachitis are ear congestion, hearing loss, heaviness in the head, noise in the ear and autophony - a feeling of the resonance of one's voice in the ear. Many patients with eustachitis, when turning and tilting their heads, note a feeling of fluid overflowing in the ear. In some cases, in patients with eustachitis, after swallowing saliva or yawning, there is an improvement in hearing due to the expansion of the lumen of the auditory tube due to the contraction of the corresponding muscles. These symptoms of eustachitis can be observed only in one ear or be bilateral.

Pain in the ear, as a rule, is observed with eustachitis, caused by a pressure drop in atmospheric air. It is also characterized by a feeling of fullness and pressure in the ear. There is no change in the general condition of the patient with eustachitis, the body temperature remains normal. The rise in temperature and the appearance of general symptoms against the background of eustachitis indicate the development of purulent otitis media.

Symptoms of acute eustachitis often occur against the background of a respiratory infection or in the recovery stage after it. If there is a focus of chronic infection in the nasopharynx, a tumor, anatomical changes that exacerbate ventilation disorders of the auditory tube, acute eustachitis takes a protracted course and can become chronic. Chronic eustachitis is characterized by recurrent exacerbations with severe symptoms of acute eustachitis and periods of remission, during which a slight tinnitus and reduced hearing may persist. Over time, a persistent decrease in the diameter of the auditory tube and adhesion of its walls develops, which leads to the permanent nature of the symptoms of eustachitis.

Diagnosis of Eustachitis

Forecast and prevention of eustachitis

As a rule, with adequate treatment, acute eustachitis resolves within a few days. However, in the presence of concomitant diseases that impair the ventilation of the auditory tube, it can transform into chronic eustachitis or adhesive otitis media, the treatment of which is more difficult.

Prevention of eustachitis consists in the timely treatment of infectious and allergic diseases of the nasopharynx, the use of decongestants (nasal vasoconstrictor drops, antihistamines) for respiratory diseases accompanied by nasal congestion.

The cavity between the eardrum and the nasopharynx is called the Eustachian tube. It serves for ventilation, removal of mucus, and connection with the surrounding atmosphere to create normal pressure in the cochlea of ​​the middle ear. To remove microparticles of dust and pathogenic bacteria, special mucus is secreted in the nasopharynx, which binds them and is then removed through the nose when sneezing. If the body's immunity is weakened, then a failure in the Eustachian tube system may occur. In this article, we will consider what symptoms and methods of treatment exist when such an important organ in the nasopharynx fails.

Causes that contribute to inflammation

The disease can occur after colds, when the general immunity of the body is weakened. The weakening of the body can be caused in the autumn - winter period due to temperature changes, high humidity, lack of vitamins in the pre-spring time. Being in the same room with patients with acute respiratory diseases also contributes to a large penetration of pathogenic microbes into the mucous membrane.

Usually the disease begins quickly, especially after an untreated acute respiratory disease. As a rule, the patient feels nasal congestion, which makes it impossible to breathe. You may feel the presence of fluid in the ear canal, accompanied by a characteristic gurgling. There may be dizziness, unpleasant pain inside the ear. All this is caused by severe swelling of the mucous membrane inside the Eustachian tube. Because of this, the passage is blocked and there is no connection with atmospheric air, the pressure balance is disturbed. There is insufficient pressure inside, which draws the eardrum into the internal passage. According to these characteristic symptoms, inflammation of the Eustachian tube can be judged. Diagnosis is carried out by an otolaryngologist, who makes the final diagnosis.

Diseases associated with inflammation of the Eustachian tube

Inflammation of the Eustachian tube and eardrum is called turbootitis. It can be expressed in two forms: acute and chronic. An acute form caused by a strong narrowing of the passage due to swelling of the mucous membrane, which leads to strong discomfort and a decrease in pressure in the inner ear. The patient complains of tinnitus, dizziness, hearing loss.
The doctor, based on the examination, the results of the tests, makes a diagnosis and prescribes treatment. If the treatment is ineffective or the patient avoids it, then the acute form of the disease can become chronic.

Treatment

The effectiveness of treatment depends on the severity of the patient. All medical procedures are aimed at returning the functions of the mucous membrane and reducing its swelling. Assign vasoconstrictor drugs, antimicrobial drugs, warming compresses, washing the nasopharynx with decoctions of medicinal herbs. It is also necessary to take care of prescribing drugs to increase the protective functions of a weakened organism.

During treatment, so that the mucus with microbes does not flow into the internal auditory canal, it is necessary to remove the mucus without effort, that is, it is forbidden to blow your nose strongly. Fluid can sometimes be removed from the nasopharynx with special catheters.

When the nasal mucosa has already recovered, and hearing is still reduced, ear blowing or the introduction of special medications into the interior is prescribed. Thus, pathogenic moisture is removed from the ear canal through the nasopharynx.

All treatment procedures are carried out under the supervision of a doctor who evaluates the effectiveness of the impact of a particular method.

Inflammation of the Eustachian tube can lead to hearing loss. Do not ignore it and seek help from a specialist in a medical institution in a timely manner, who will correctly diagnose and prescribe an effective treatment for the disease.

In the medical literature, the Eustachian tube is described as a channel that connects the nasopharyngeal cavity with the tympanic region. It got its name in honor of the Italian who first described it in 1564. Its length is about 35 mm, and the diameter does not exceed 2 mm. Despite its small size, the functions and significance of the auditory tube are really great.

It's an infection of the eardrum. Also called otitis media, the tympanic membrane is the middle ear. This, therefore, is an acute inflammation of an infectious origin. It is the most common infection in children aged 6 to 24 months. This pathology is the result of an infection from the nasopharynx through.

In children, it is more common in children living in the community, in urban areas, especially those with secondhand smoke, especially those who are not breastfeeding. It is more common in autumn and winter. In acute congestive otitis media, viruses are responsible for more than 90% of infections.

During each visit to the ENT doctor, you can hear about the need for surgical treatment of any pathological changes in the ears. If this is not done, then the viral agent, using the oblong organ, will spread its negative impact further.

Characteristic functions of the organ

The throat and the body as a whole are under attack. That is why, with any viral or infectious pathologies, the doctor always tries to avoid the further spread of the disease. This can be done, given the main functions that the auditory tube performs:

In the case of opium otitis media, bacteria are usually involved. An otoscopic examination will make the diagnosis knowing that both ears need to be examined. Up to two years, antibiotic therapy should be systematic in the face of any suppurative otitis for eight days.

Paracentesis is sometimes mandatory in cases of severe pain. Frequent recurrences of acute otitis media pose the problem of adenoid ablation. Vaccination may also be considered. External pain usually presents with relatively severe pain, with little or no purulent discharge that may reach the turbinate. In some cases, the painful sensation may extend to nearby ear structures and increase palpation. The inflammatory process is often characterized by the presence of one or more cells that indicate the success of the immune response.

1. Ventilation - the formation of a balanced pressure on both sides of the eardrum. Even a slight change can negatively affect hearing acuity. In a healthy person, the process is automatically regulated by moving air flows from the tympanic cavity to the nasopharynx.
2. Drainage - in a person without pathologies, the auditory tube removes excessively accumulated edematous fluid.
3. Protective - the most important of all the functional duties of an organ that guards human health. Throughout life, the Eustachian tube secretes mucus that has bactericidal characteristics. The immunoglobulin contained in it acts as a natural barrier to infections or viruses. In case of weakening of the body under the influence of external or internal factors, the production of protective mucus is reduced.

All of the above indicates the importance of the body for a full human life. In this regard, even during a preventive visit to the doctor, it is examined. For this, a special procedure is used - salpingoscopy. A painless examination allows the doctor to make sure that there are no pathological changes in the structure of the auditory tube.

Sometimes hearing is slightly altered. In children, this type of acute condition often results from a bath. In this case, otolaryngologists speak of bather's otitis media. In adults, inflammation of the ear canal is usually bacterial in origin. Usually, this specific structure of the atria has sufficient protection to repel pathogen attacks from the outside, but some environmental factors can change these characteristics and increase the sensitivity of the ear canal. This may be the case, for example, in a tropical climate, abusive use of a cotton swab, or the presence of an allergen.

If a patient is diagnosed with an ENT pathology of an infectious nature, then tympanomanometry is mandatory - a measurement of pressure in the eardrum. A simple procedure will show whether the auditory tube has undergone pathological changes. Based on the material collected during the diagnosis, a decision is made on the need for a therapeutic course.

Treatment of external otitis media

When the bacterial etiology of bacteria is proven, the use of appropriate antibiotic therapy acts as a first-line treatment. Typically, it involves locally applied ear drops associated with a disinfectant. Analgesic or even anti-inflammatory drugs may be used to relieve pain. It may be necessary to take a sample into the ear canal if therapy does not give good enough remission results. Bacteriological analysis will allow you to choose a more effective antibiotic molecule.

The Eustachian tube, being an organ sensitive to various infectious viral agents, requires immediate treatment in the presence of a focus of inflammation. Any delay will allow the disease to spread further, causing pathologies in the throat, ears, nose and lungs. The activity of the spread of the disease depends on the ability of the immune system to resist.

Since the ear canal is sensitive to external influences, it is highly recommended not to insert any object inside. The use of cotton swabs should be considered. Ear specialists recommend rinsing with water. For people who are prone to ear infections, it is better to refrain from hanging the head under water and, if not, take the time to properly drain the water contained in the ear canal to avoid maceration. The risk of recurrence of this type of otitis media is quite high. It is also possible to equip ear plugs to take full advantage of the pleasures of the water without risking otitis media.

close attention from the doctor

Depending on the pathology of the auditory tube, various types of disorders are distinguished. Opens the list of tubo-otitis, characterized by inflammation of the tube itself and the tympanic cavity. The cause should be sought in a failure in the drainage function, which leads to the accumulation of pus in the middle ear. The process is catalyzed by the nasopharynx, from where the pathogen enters the auditory tube.

Recurrent nasopharyngitis, often of viral origin, is responsible for otitis media in children, which can sometimes have consequences for hearing. Between 5 and 10% of children under the age of 7 have grey-mucous ear infections. Even mild hearing loss associated with this otitis media can have serious consequences for behavior or language.

It is very important to treat this type of recurrent otitis media, in particular its tubular component, in order to restore the function of the middle ear transmission system. Two factors are responsible for mucosal otitis media: Eustachian tube dysfunction and post-infectious inflammation.

In second place in terms of frequency of occurrence are pathologies caused by damage to this organ. In most cases, this happens as a result of exposure to foreign bodies when picking in the ears or breaking off a tiny part of the bougie - a research tool. It can be removed with a simple intervention within the doctor's office. Chronic diseases that cause atrophy are of great danger. In this case, the Eustachian tube loses the necessary muscle tone.

This dysfunction results in middle ear hypoventilation with reduced gas exchange responsible for endotypanic depression and modification of this gas mixture. The most common germs are haemophilus influenzae, streptococcal pneumonia, and mogrexeta catarrhal.

Diagnosis is often delayed because of the banality of the symptoms. Two main features are present: hypoacusis and recurrent otitis media. Hypoacusis is often bilateral. Sometimes we think of an inattentive child, while erroneous hearing is responsible for this state of inattention.

Gradual atrophy of nearby tissues provokes permanent tinnitus, but hearing acuity does not decrease.

For the most part, such a pathology does not bring discomfort to the patient, which explains the refusal to visit the doctor. It is possible to detect gaping by chance when the auditory tube is subjected to a preventive examination.

Sometimes it is the school teacher who attracts the attention of parents. Sometimes it can be a discreet language delay, phonetic confusion, delayed vocabulary acquisition. The recurrence of infectious phenomena ends up having consequences for the tympanic membrane, which is never normal in this pathology.

The tympanum no longer has the usual pearlescent, shiny, and translucent button appearance. It thickens, becomes dull, grayish or whitish with an expansion of the vasculature that overflows onto the adjacent skin of the ear canal. Occasionally, yellowish spots appear, reflecting retro-tympanic mucus clusters.

In the presence of a weakened immune system or a long absence of medical care, the half-canal of the auditory tube falls under attack. In its structure, it is the lower part of the musculo-tubal canal. Its main function is to stretch the eardrum. As an infectious or viral disease in the ears develops, the semi-channel copes worse and worse with its main function. In some cases, mandatory hospitalization is indicated.

This tympanum is also retracted with a ledge from the short process of hammer handle and leveling it. Sometimes, if retrotympanic fluid is abundant, the eardrum appears to bulge. Audiometry, achievable at 4 to 5 years of age, aims to convey hypoacusis between 25 and 30 decibels.

It is based on the removal of vegetation, which is very often the rule. Antibiotic and anti-inflammatory treatment should be used. It is recommended to use beta-lactamase resistant antibiotics for at least 15 days. The use of corticosteroids for the same period of time improves treatment outcomes. Prednisone or dexamethasone is used.

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In the conditions of a medical institution, the necessary tests are carried out to determine the true culprit of the problems that have arisen. If such changes are diagnosed at an early stage, then the entire recovery process takes from 3 to 6 months. Emphasis is placed on medications. More time and, possibly, local surgical intervention will be required in the chronic form of the changes that have occurred.

Installation of drum aerators is effective both in preventing episodes of superinfection and in the disappearance of retro-tympanic effusion and in improving transmission deafness. Requires deafness of 25 to 30 decibels or re-superinfection. Sometimes laying yo-yos is an emergency, for example, in the case of a large delay of the tongue, deafness of more than 30 decibels.

The most common complication of yoa laying is otorrhoea due to staphylococcus aureus or Pseudomonas. Use of antibiotic ear drops is necessary. Sometimes insufflation of the Eustachian tube can have good consequences. On the other hand, physiological cleansing of the nasal cavity several times a day in combination with local antiseptic and antibiotic therapy is important.

The importance of the auditory tube, which is one of the elements of the body's defense against pathogenic influences, cannot be overestimated. That is why you need to take care of your health.

Please note: this article is for informational purposes only and is not a guide to action. Only a doctor can diagnose the cause of the disease and prescribe the correct treatment. Therefore, at the first signs of the disease, we strongly recommend that you consult a specialist. Treatment should be carried out in a timely manner to avoid complications. Do not self-medicate, be sure to consult a doctor.

Prophylactic therapy is needed, combining anti-inflammatory drugs, mucolytics and drugs that aggravate the immune defense. Sometimes a high-dose gamma globulin injection may be required. Finally, thermal cures are often important adjuvants.

Finally, be aware that these recurring viral infections can cause or reveal respiratory allergies that can cause asthma. Then you can carry out preventive treatment. Recurrent nasopharyngitis, often of viral origin, is responsible for otitis media in infants, which can sometimes affect hearing. Between 5 and 10% of children under 7 years of age have otitis media. Even mild hearing loss associated with this otitis media can have severe behavioral or language impairments: Behavioral disturbances during learning: inattention, distraction, even hyperactivity.

Eustachitis is a pathology associated with impaired ventilation and inflammation of the middle ear, which results in hearing loss. Eustachian tube inflammation, treatment and symptoms which we will now consider, is considered the initial stage of catarrhal otitis.

Symptoms of inflammation of the Eustachian tube

This is the name of the canal in the ear that connects the nasopharynx with the tympanic septum. The job of the Eustachian tube is to exchange air in the middle ear during swallowing. The drainage function of the Eustachian tube is to remove various secretions from the middle ear. When swallowed, their middle ear fluid is pumped into the nasopharynx. To kill bacteria with the help of the developed mucus - this work is also performed by the Eustachian tube.

This serous otitis often results in hypoacoustic transmission, but it may be asymptomatic. Sometimes a swelling of the nasopharynx can be the cause of this serous otitis media. Important tonal and vocal audiometry is important as it will determine the hearing loss. An impedance meter will confirm the reduction in the tympanooscicular apparatus. A flat or domed curve will be obtained, confirming the diagnosis.

On the other hand, physiological cleansing of the nasal cavity several times a day is important in combination with local antiseptic and antibiotic therapy. Prophylactic therapy, combining anti-inflammatory drugs, mucolytics and drugs that increase the immune defense, will sometimes require injection of high doses of gamma globulins. Finally, thermal therapies are often non-essential adjuvants. This means that it is important to raise children outside of any tobacco-polluted atmosphere, because the sooner a child gets otitis media, the longer the illness will last and the more severe the relapse will be.

The main symptoms of inflammation of the Eustachian tube:

Hearing loss

Feeling of fullness in the ears

Sensations of water in the ears as symptoms of inflammation

Pain as a symptom of inflammation

Noise in the ear

As a result of inflammation, thickening of the mucous membrane occurs, and, as a result, the lumen decreases, and this leads to a decrease in ventilation of the tympanic cavity and a decrease in pressure there. Due to the decrease in pressure, the membrane begins to retract into the tympanic cavity, which causes discomfort in a person.

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Therefore, it is important to inform parents that the harmfulness of tobacco is very high, especially in the first years of a child's life. Usually in young children, ear infections are ear infections that can be mediated, internal or external. Usually, this inflammation requires effective medical management to prevent it from getting in. A more chronic form of a chronic disease. What are the risks of complications? Answers to these questions and more in this article.

Symptoms of inflammation of the Eustachian tube of different types

Inflammation of the Eustachian tube occurs in acute form and chronic.

Acute inflammation of the Eustachian tube commonly referred to as the primary disease. Most often, the symptoms of inflammation are caused by the action of pneumococci and streptococci, staphylococci and other infectious agents are less likely to cause it. In the absence of proper treatment, inflammation of the Eustachian tube can become chronic. Typical symptoms of inflammation of the Eustachian tube:

This type of otitis media is usually caused. This is the rarest, but also the most formidable type of otitis media. What are the symptoms of otitis media? The symptoms of otitis media vary depending on their nature. Thus, external ear infections mainly result in intense pain associated with redness and sometimes a white discharge. In otitis media, it is also characterized by a painful sensation of varying intensity with fever, discharge, indigestion, and the unpleasant impression of a clogged ear. Finally, interna's otitis media leads to a gradual decrease in visual acuity, dizziness and deterioration.

• sensation of ringing in the ears,
• hearing loss,
• sensation of water overflowing in the ear when turning and tilting the head.

Pain symptoms are practically not typical for the acute form of the disease, general well-being suffers poorly, there is no rise in temperature.

The acute phase of inflammation occurs unexpectedly, congestion, noise in the ear, a feeling of fluid transfusion, hearing loss. If inflammation of the Eustachian tube lasts long enough, it becomes chronic.

Again, the management of ear infections depends mainly on its origin and location. Treatment of otitis usually requires the use of topical treatment based on auricular solutions or antibiotic drops. A topical disinfectant should also be applied regularly. Analgesic or even anti-inflammatory drugs may be recommended for pain relief. For its part, "otitis media is primarily treated with" the association of "antibiotic" anti-inflammatory and "nasal decongestant while" otitis media requires the creation of a specific antibiotic therapy associated with In the case of serous otitis, that is, in the presence of fluid behind eardrum, surgery may be required to insert a probe into the eardrum and drain the ear.

Chronic Eustachian tube inflammation develops due to improper treatment or its complete absence in acute eustachitis. In the chronic form of the disease, a persistent decrease in the diameter of the auditory tube is observed, the tympanic membrane is retracted inward. The patency of the Eustachian tube noticeably worsens, the walls stick together, which most negatively affects the quality of hearing. Chronic eustachitis can give rise to such a serious disease as adhesive otitis media, which should be understood as the inflammatory process of the middle ear.

Inflammation in the Eustachian tube and tympanic cavity is called tubo-otitis.

Eustachian tube inflammation treatment

It should be understood that inflammation of the Eustachian tube is an inflammatory process, and not just a mechanical blockage of the nasopharyngeal lumen of the Eustachian tube, as can occur with formed tumors or adenoids. That is why the treatment of inflammation is carried out with the use of antibiotic therapy, anti-inflammatory drugs and appropriate immunomodulatory drugs. In addition, to restore the function of hearing, drug treatment of inflammation is supplemented by methods such as pneumomassage and ear blowing.

Treatment of inflammation of the Eustachian tube with drugs

When painful processes began in the nose or nasopharynx, the Eustachian tube perceives this instantly. Treatment of inflammation aims to restore the drainage and ventilation capacity of this tube.

To reduce the swelling of the mucous membrane, use drops that promote vasoconstriction. To restore the resorption of the inflammatory fluid, make warm compresses, physiotherapy.

To exclude the possibility of leakage of infected mucus during inflammation, during a runny nose, from the nasopharynx, through the auditory tube into the tympanic cavity, a sick person should not blow his nose strongly.

If the nasopharynx and nose have already recovered, but the hearing has not recovered and the tube is still not passable, ear blowing is prescribed. This helps to remove moisture through the tube into the nasopharyngeal cavity. If an acute process occurs, then one to three procedures are carried out.

Sometimes, to clean the Eustachian tube, special catheters are injected into the tube and the tympanic cavity, therapeutic enzymes that help dissolve the hardened inflammatory fluid. To relieve inflammation, glucocorticoid drugs are administered.

Only a doctor can prescribe the correct treatment for inflammation of the Eustachian tube, identifying the root cause of the disease and the localization of inflammation. This inflammation is almost impossible to cure without physiotherapy, appropriate warming up and massage. The doctor may also prescribe painkillers and painkillers, depending on the degree of pain that the patient feels when the Eustachian tube is inflamed.

Why does the Eustachian tube become inflamed?

Inflammation of the Eustachian tube can occur for a number of reasons, such as:

Spread of the infectious process from the nasopharynx, nasal cavity

Acute or chronic sinusitis

The auditory (Eustachian) tube is a structural element of the ear 3.5 cm long, connecting the tympanic cavity with the nasopharynx. Its function is to maintain normal pressure, ventilation and protection against bacteria between the surrounding air and the middle ear.
In inflammatory processes of the tube, this function is disturbed, and a person develops tubo-otitis (eustachitis, salpingotitis).

Causes of the disease

The factors that cause inflammation of the auditory tube include staphylococcal and streptococcal bacteria. In childhood, pathogens are more often pneumococci, as well as viral diseases.

Infectious processes from the nose and throat pass to the Eustachian tube and into the middle ear. As a result, the patency of the tube decreases due to hyperemia of the mucous membrane, a favorable environment is created for the activation of pathogenic microorganisms.

If a person has a predisposition to allergic edema in the middle ear, increased secretory secretions, then the likelihood of the disease increases.

Among other reasons contributing to the development of inflammation of the auditory tube include:

• persistent infections of the nasopharynx;
• adenoids in children;
• defects in the anatomical structure of the nasal septum;
• tumors of the nasopharynx;
• sudden changes in atmospheric pressure.

Symptoms and clinic of the inflammatory process

Manifestations of inflammation of the auditory tube and the clinic depend on the form of the disease, which can be acute, chronic, allergic.

The occurrence of an acute form is more often observed against the background of viral colds that affect the upper respiratory tract.

In acute inflammation, the patient's general health is stable, the temperature usually does not rise above 38 degrees, there is no intense pain.

A person may complain about:

• hearing impairment (pro symptoms of tinnitus);
• congestion in the ear;
• increased perception of one's voice (feeling that it echoes);
• the apparent sensation of transfusion of water inside;
• intrusive noise;
• nasal congestion.

Externally, the auditory tube has swelling, its lumen is noticeably narrowed. The mucous membrane is hyperemic. The closure of the tympanic cavity leads to a decrease in pressure and expansion of blood vessels, the walls of which become more permeable.

This leads to transudation - leakage of blood through the capillaries..

Chronic inflammation of the auditory tube is characterized by atrophic transformations on the mucous membrane of the tympanic cavity and membrane. The membrane becomes cloudy, dead tissue (necrosis) may appear.

The symptoms of chronic tubootitis are as follows:

• deformation and retraction of the eardrum;
• stenosis (narrowing) of the lumen of the pipe;
• hearing impairment;
• redness in the area of ​​​​some local areas;

Diagnosis of manifestations of the disease, such as structural changes in the tympanic cavity and membrane, can only be carried out when examined by a specialist.

If a with acute eustachitis, the symptoms are temporary, and after a while pass, then in the chronic form they are permanent.

The structure of the ear canal in children has some differences from the adult: it is more straight and slightly shortened. Therefore, children are more prone to ear diseases.

Signs of inflammation of the auditory tube in children are the same as in adults: noise and congestion in the ears, hearing loss.

Hearing may temporarily improve with coughing or yawning. Due to the absence of pain, it is difficult to diagnose the disease on your own, you need to contact an otolaryngologist.

The allergic form of tubootitis occurs against the background of body reactions, and is accompanied by a runny nose and nasal congestion.

Treatment Methods

You can start any therapy only after a thorough diagnosis and clarification of the cause of inflammation.

Having determined the etiology of the disease, it is necessary to remove the pathogen so that the dynamics of recovery is positive.

Medical therapy

The treatment regimen is prescribed exclusively by a doctor. The main emphasis is on the appointment of medications that narrow the vessels of the Eustachian tube and nasopharynx.

This group of drugs includes:

• xylometazoline,
• Naphthyzin,
• Oxymetazoline,
• Sanorin and others.

They can be purchased at any pharmacy without a prescription. Drops are administered intranasally 2-3 times a day. You can take vasoconstrictors for no more than 5 days.

As additional means for treatment, antihistamines are used to relieve swelling: Suprastin, Erius, Claritin etc.

An acute inflammatory process in the auditory tube requires the use of anti-inflammatory and antimicrobial agents. These are ear drops and medicines in the form of tablets for oral administration.

Ear drops:

• Otinum- anti-inflammatory drops, which are instilled into the ear 3-4 drops 3 times a day;
• Otipax- local anesthetic, antiseptic. The required dosage is 4 drops 2-3 times a day. Duration of admission is not more than 10 days.

An alcoholic solution of furacilin and 3% boric acid are also used as local anti-inflammatory drugs.

For oral use, the doctor may prescribe antibiotics (Afenoxin, Amoxilillin, Cefuroxime). The dosage is determined based on the age of the patient. Take orally 250-500-750 mg in the morning and evening.

An effective method for tubo-otitis is blowing (catheterization) of the Eustachian tube. A suspension of hydrocortisone or adrenaline is injected into its lumen using a catheter.

To enhance the effect of treatment, physiotherapy procedures are additionally prescribed, as well as alternative methods ( warm compresses at home).

If the treatment was carried out correctly, then the inflammation disappears in a few days. If measures to eliminate the disease are taken late, then it can develop into a chronic form which is more difficult to treat.

When the inflammatory process is neglected with a predominance of a viscous fluid in the tympanic space, surgical intervention may be required. An incision is made in the eardrum, and a special ear catheter is placed to drain the fluid. The operation is performed under general anesthesia.

Folk remedies

As additional measures to speed up recovery, you can resort to alternative methods of treating eustachitis. It can be both local remedies and tinctures for internal use.

• Mix aloe juice with warm boiled water 1:1. Bury this remedy every 4-5 hours in the nose, and also moisten a cotton swab with it and inject it into the ear.
• Before going to bed, bury the nose with onion juice, and place a warm onion in the ear cavity. You need to be careful when using this remedy because of the high activity of the active ingredients in the onion.
• Take in equal parts), lavender, celandine, yarrow. Pour 2 tablespoons of the mixture with 0.5 liters of boiling water. Infuse the product in a thermos for 12 hours. Drink ¼ cup 3 times a day.

Possible Complications

In most cases, eustachitis with timely treatment passes without complications and complete recovery occurs. But due to the absence of pronounced symptoms at the onset of the disease, the patient does not always go to the doctor on time, which can lead to undesirable consequences. development of chronic tubootitis;

• sustained hearing loss ( about the treatment of hearing loss in children);
• chronic tubootitis;
• acute purulent otitis media;
• deformation of the membrane, its retraction into the tympanic cavity;
• the formation of scars and adhesions in the cavity of the middle ear.

If treatment is ignored, eustachitis leads to permanent hearing loss or deafness.

Finally

In order to prevent the occurrence of inflammatory processes in the auditory tube, it is necessary to detect and eliminate diseases that are factors in the development of tubo-otitis in time. It is necessary to constantly strengthen the immune system, not to abuse antibiotics, to give up bad habits.

To learn about effective prevention of hearing diseases, watch a short video.