Go Labyrinthitis (inner ear inflammation) symptoms signs emergency care and treatment
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Labyrinthitis (inflammation of the inner ear)

Labyrinthitis - inflammation of the inner ear. Depending on the pathways of penetration of microorganisms or toxins into the inner ear, there is tympanogenic (from the middle ear ), meningogenic (from the meninges - with meningitis) and hematogenous labyrinthitis. The prevalence of the process - limited and diffuse forms. By the nature of the inflammatory process - serous and purulent labyrinthitis. Typical complaints are dizziness (feeling of objects rotating), nausea , vomiting (more often with a change in head position), tinnitus , and imbalance. With diffuse purulent labyrinth, these phenomena are more pronounced than with serous. There is a complete loss of the vestibular and auditory functions of the affected ear. In case of serous labyrinth - irritation or suppression of the vestibular function of the affected ear, a decrease in hearing of various degrees

A characteristic feature is spontaneous nystagmus (see). Functional disorders (finger-nose test, falling or staggering) occur in the direction of the slow component of nystagmus.

With limited labyrinthitis characteristic symptoms appear periodically, paroxysmal. Also so-called fistula symptom is noted (see. Vestibulometriya). When it appears nystagmus, dizziness. Patient labyrinthitis must be urgently hospitalized, ensuring maximum peace during transportation.

Inflammation of the inner ear is usually a severe complication of purulent otitis media. Occurs as a result of the penetration of infection into the inner ear. The way the infection spreads is different. She gets there from the middle ear with chronic (more rarely - acute) its inflammation (timpanogenny labyrinthitis), sometimes by the meninges at an epidemic (cerebro-spinal) meningitis, tuberculous and much less with influenza, scarlet, measles and typhoid meningitis (meningogenny labyrinthitis ). When a labyrinthitis occurs with any infection (epidemic parotitis), without signs of damage to the meninges, they speak of a hematogenous labyrinthitis.

The following main forms of labyrinthitis are distinguished: limited labyrinthitis, acute diffuse serous labyrinthitis, acute diffuse purulent labyrinthitis, chronic diffuse purulent labyrinthitis. The fourth form of labyrinthitis is also described as necrotic labyrinthitis. This form was observed in the past time with scarlet and tuberculosis, less often measles otitis media, with chronic cholesteatomas otitis, and also after a general obstruction of the ear in the presence of a fistula of the semicircular canal (limited labyrinthitis). In this form of labyrinthitis, sequestration is observed (the entire cochlea or one or two semicircular canals are sequestered, or almost the entire labyrinth massif is sequestered).

Symptomatology labyrinthitis . Acute labyrinthitis forms begin with the so-called labyrinth attack: a decrease or a complete disappearance of hearing, severe dizziness, an imbalance, accompanied by nausea and vomiting. The appearance of a labyrinth spontaneous nystagmus is characteristic.

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Limited labyrinthitis occurs mainly in chronic purulent otitis media, complicated by caries and cholesteatoma. To recognize this form of labyrinthitis, a history with a characteristic labyrinth attack, the presence of a so-called fistulous (fistula) symptom and a preserved, albeit reduced, hearing helps. A fistula symptom is caused by pressing a finger on the trestle or by squeezing breath in the ear canal through the Politzer balloon. When the air thickens in the external auditory canal of the patient's ear, nystagmus appears in the direction of the same ear, and when the air is rarefied, the nystagmus is directed in the opposite direction, that is, in the direction of the healthy ear. Labyrinth attack is the exacerbation of a limited labyrinthitis and the transition to acute serous. Only in this condition requires emergency care. Acute diffuse serous labyrinthitis can be observed with acute otitis media, but it can also occur during exacerbation of chronic purulent otitis media. In this form of labyrinthitis, hearing is sharply reduced and the excitability of the maze decreases. Spontaneous nystagmus is directed first toward the patient's ear and then goes into the healthy side. Labyrinth symptoms (hearing loss, dizziness, nausea, vomiting, imbalance, etc.) are usually pronounced. The patient is forced to lie on the side of the healthy ear, with his head slightly inclined anteriorly. When you change the position of the head, vertigo increases and is accompanied by vomiting.

Acute diffuse purulent labyrinthitis is the most severe and dangerous form of this disease. The onset of the disease is turbulent and causes very fast loss of maze function; often it is preceded by an acute serous labyrinthitis. From the characteristic signs of the disease in the first hours there is noise in the ear, spontaneous nystagmus toward the patient's ear, and subsequently there is complete deafness on the diseased side and spontaneous nystagmus into the healthy side. Labyrinth attack, as a rule, is accompanied by a subjective feeling of dizziness, an imbalance, and the patient for this reason is forced to lie in a supine position. The disease does not always end with complete loss of hearing and vestibular function on the diseased ear.

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Diffuse purulent labyrinthitis is observed both in acute otitis media and in chronic purulent otitis, especially epitimpanitis, accompanied by cholesteatoma. To identify deafness in a sore ear, you should silence a healthy ear (with Barani's rattle, etc.) before examining hearing with speech. At least insignificant hearing preservation indicates the absence of a purulent process in the maze. The appearance of fever, headache, meningeal symptoms that are not characteristic of purulent labyrinthitis, is a signal of the onset of intracranial complications.

Meningogenic labyrinthitis is most often purulent; occasionally serous and, as a rule, affects both ears. In most cases, persistent complete deafness and loss of excitability of the maze. Usually affects young children. Such children become deaf and deaf-and-dumb, because lack of hearing prevents them from mastering speech.

First aid In acute labyrinthitis it is necessary to provide the patient with complete rest, strict bed rest, the use of antibiotics. Immediately show the patient ENT. In the presence of symptoms of any acute labyrinthitis, emergency hospitalization is always indicated in an otolaryngological hospital. Over long distances such a patient is best transported by air, as less traumatic.

In case of serous labyrinthitis, bed rest, hospitalization, subcutaneous injection of 0.2–0.5 ml of 1% solution of pilocarpine hydrochloric acid, administration of aeron tablets (1 tablet 3 times a day), intravenous infusions of 5–10 ml of a 40% solution of hexamine and antibiotic treatment. A mixture of Korneev has a cupping effect during a labyrinth attack: Amynasini 2.5% - 1.0; Dimedroli 2,5% -1,0; Ephedrini 0,25% —0,5 - intramuscularly.

In some cases, the need for a surgical intervention in the form of an unloading operation (for example, an antrotomy, an aural radical operation) or opening a labyrinth (which must be remembered by emergency doctors) is not excluded.

Inflammation of the inner ear is often a serious complication of purulent otitis media; it results from the penetration of the infection into the inner ear. The way the infection spreads is different. More often, it gets there from the middle ear in acute or chronic inflammation (tympanogenic labyrinthitis), sometimes from the meninges during epidemic (cerebrospinal) meningitis, with tuberculosis, and much less often with influenza, scarlatinalis, measles, and meningitis, and much less often with influenza, scarlatinoid, measles, and meningitis, and much less frequently in cases of influenza, scarlatinoid, measles, and meningitis, and much less often in cases of influenza, scarlatinal, measles, and meningitis. When a labyrinthitis occurs with any kind of infection (epidemic parotitis) without signs of damage to the meninges, they speak of a hematogenous labyrinthitis. This is observed very rarely. Even more rarely there is the so-called lymphogenic labyrinthitis, which is described as a complication of otitis externa during a furuncle of the external auditory canal.

There are three main forms of labyrinthitis: 1) limited labyrinthitis; 2) acute diffuse serous labyrinthitis and 3) acute diffuse purulent labyrinthitis. Also described is the fourth form of labyrinthitis - necrotic labyrinthitis. This form was observed in the past time with scarlet-like and tuberculosis, less often bark, otitis, with chronic cholesteatoma otitis, and also after a general obstruction of the ear in the presence of a fistula (limited labyrinthitis), when sequestering occurs (the whole cochlea or one or two semicircular canals are formed, either almost the entire labyrinth array). Since the appearance of antibiotics, necrotic labyrinthitis is extremely rare.

All the acute forms of labyrinthitis begin with the so-called labyrinth attack: severe dizziness, balance disorder, accompanied by nausea and vomiting. The appearance of spontaneous nystagmus and fistula (fistulous) symptom is characteristic.

A fistular (fistulous) symptom is caused by pressing a finger on the trestle or by compressing air in the ear canal through the Politzer cylinder. When the air is thickened in the external auditory canal of the patient's ear, nystagmus appears to the side of the same ear, when air is rarefied, the nystagmus is directed in the opposite direction, toward the healthy ear.

The appearance of a fistula symptom indicates the presence of a fistula (fistula) in the labyrinth capsule area.

Symptoms of tympanogenic labyrinthitis: limited labyrinthitis occurs mainly in chronic suppurative otitis, complicated by caries and cholesteatoma. To recognize this form of labyrinthitis, a history with a characteristic labyrinth attack, the presence of a fistulous (fistula) symptom and a hearing that has been preserved, albeit reduced, is sufficient. Dizziness manifests itself as a feeling of rotation of surrounding objects or of one’s own body in any one direction.

Acute diffuse serous labyrinthitis is more often observed with acute otitis media, but it also happens with exacerbation of chronic suppurative otitis. In this form of labyrinthitis, hearing is sharply reduced and the excitability of the maze decreases. Spontaneous nystagmus is directed at the very beginning towards the sore ear, then goes into a healthy side or is directed in both directions. Labyrinth symptoms (dizziness, nausea, vomiting, imbalance, nystagmus, etc.) are usually pronounced. In a certain period of the disease, a complete shutdown of the maze function can even be observed, which after the elimination of the inflammatory process in cases of serous labyrinthitis is restored (sometimes partially).

The patient is forced to lie on the side of the healthy ear, with his head slightly inclined anteriorly. When you change the position of the head, vertigo increases and is accompanied by vomiting.

Acute diffuse purulent labyrinthitis is the most severe and dangerous form of inflammation of the inner ear. It often leads to the occurrence of intracranial complications - purulent meningitis and cerebellar abscess. In addition, this disease ends with complete loss of hearing and vestibular function on the diseased ear. Diffuse purulent labyrinthitis is observed both in acute otitis media and in chronic suppurative otitis, especially epitimpanitis, complicated by cholesteatoma, characterized by a rapid onset and course in the first days. The main symptoms of this disease are severe dizziness, nausea, vomiting, sharp imbalances, complete loss of auditory and vestibular functions.

Due to the fact that the presence of hearing residues is an important differential diagnostic character, in order to identify deafness on a sore ear, you should silence a healthy ear (using Barani's ratchet or other method) before examining speech. At least slight preservation of hearing indicates a serous, not a purulent process in the labyrinth.

The appearance of fever, headache, meningeal symptoms that are not characteristic of purulent labyrinthitis, is a signal of the onset of intracranial complications.

In addition to tympanogenic, it happens, as stated above, meningogenic labyrinthitis; the latter is most often purulent, occasionally serous, and usually affects both ears. In most cases, persistent complete deafness and loss of excitability of the maze. Usually affects young children. Such children become deaf and dumb, because lack of hearing prevents them from mastering speech.

First aid. Provide the patient with complete rest, strict bed rest, use of antibiotics (penicillin, etc.) for 2–3 weeks. Immediately provide the patient with specialized otolaryngological care. With diffuse purulent labyrinthitis and especially in the presence of symptoms of intracranial complications, urgent hospitalization in an ENT hospital is always indicated.