Text C. Chronic Otitis Media

Chronic otitis media is a long-standing infection caused by a permanent hole (perforation) in the eardrum.

Perforation of the eardrum can be caused by acute otitis media, blockage of the eustachian tube, injury from an object entering the ear or from sudden changes in air pressure, or burns from heat or chemicals.

Symptoms depend on which part of the ear­drum is perforated. If the eardrum has a central perforation (a hole in the middle), chronic otitis media may flare up after an infection of the nose and throat, such as the common cold, or after water enters the middle ear while bathing or swimming. Usually, flare-ups are caused by bac­teria and result to a painless discharge of pus, which may be malodorous, from the ear. Persis­tent flare-ups may result in the formation of pro­truding growths called polyps, which extend from the middle ear through the perforation and into the ear canal. Persistent infection can destroy parts of the ossicles, the small bones in the middle ear that conduct sounds from the outer ear to the inner ear, causing conductive hearing loss.

Chronic otitis media caused by marginal perfo­rations (holes near the edge) in the eardrum also may result in conductive hearing loss and wors­ening ear discharge. Serious complications such as inflammation of the inner ear (labyrinthitis), facial paralysis, and brain infections are more likely to occur with marginal perforations than with central perforations. Marginal perforations are frequently accompanied by cholesteatomas (accumulations of white skinlike material) in the middle ear. Cholesteatomas, which destroy bone, greatly increase the likelihood of a serious com­plication.

Treatment

When chronic otitis media flares up, a doctor thoroughly cleans the ear canal and middle ear with suction and dry cotton wipes, then instills a solution of acetic acid with hydrocortisone in the ear. Severe flare-ups are treated with an antibiotic, such as amoxicillin, given by mouth. After the bacteria causing the infection are identified, an­tibiotic treatment is adjusted accordingly.

Usually, the eardrum can be repaired in a pro­cedure called a tympanoplasty. If the ossicle chain has been disrupted, it may be repaired at the same time. Cholesteatomas are removed sur­gically. If a cholesteatoma isn't removed, repair of the middle ear may not be possible.

Note:

flare up – вспыхнуть

Text D. Inner Ear Disorders

 

Inner ear disorders produce symptoms such as hearing loss, vertigo, tinnitus, and congestion. These disorders can have many causes, such as infection, injury, tumors and drugs.

 

Part I. Herpes Zoster of the Ear

Herpes zoster of the ear (Ramsay Hunt's syndrome) is an infection of the auditory nerve by the herpes zoster virus, producing severe ear pain, hearing loss, and vertigo.

Small fluid-filled blisters (vesicles) form on the outer ear and in the ear canal. Blisters also may form on the skin of the face or neck supplied by the infected nerves. If the facial nerve is com­pressed because it's infected and swollen, the muscles of one side of the face may become par­alyzed temporarily or permanently. Hearing loss may be permanent, or hearing may return par­tially or completely. Vertigo lasts from a few days to several weeks.

The preferred treatment is the antiviral drug acyclovir. Analgesics are given to relieve pain, and diazepam to suppress vertigo. When the facial nerve is compressed, surgery to enlarge the open­ing through which the facial nerve leaves the skull (surgical decompression) may be performed. This procedure occasionally relieves facial paral­ysis.

Part II. Sudden Deafness

Sudden deafness is severe hearing loss, usually in only one ear, that develops over a period of a few hours or less.

Every year, about 1 out of every 5,000 people develop sudden deafness. It's usually caused by a viral disease such as mumps, measles, influenza, chickenpox, or infectious mononucleosis. Less commonly, strenuous activities such as weight lifting place severe pressure on the inner ear, dam­aging it and resulting in sudden or fluctuating hearing loss and vertigo. An explosive sound may be heard in the affected ear when the damage first occurs. Sometimes no cause is identified.

Usually, the hearing loss is severe. However, most people completely recover their hearing, usually within 10 to 14 days, and others partially recover it. Tinnitus and vertigo may accompany sudden deafness. Vertigo usually subsides in sev­eral days, but tinnitus often persists.

No treatment has proved to be valuable. Corti­costeroids by mouth are frequently prescribed, and bed rest is usually advised. In certain cases, surgical procedures may be useful.