What causes benign paroxysmal positional vertigo. How do ear crystals contribute to dizziness. What are effective treatments for BPPV. Can loose ear crystals be prevented. How is BPPV diagnosed and managed long-term.

What Is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder that causes brief episodes of dizziness and a spinning sensation. It occurs when tiny calcium crystals in the inner ear become dislodged and move into one of the semicircular canals, disrupting the normal fluid movement that helps control balance.

BPPV episodes are typically triggered by specific changes in head position, such as:

• Rolling over in bed
• Tilting the head back
• Bending forward

These positional changes cause the loose crystals to move, sending false signals to the brain about head movement and resulting in vertigo.

The Role of Ear Crystals in Balance and Dizziness

To understand BPPV, it’s crucial to grasp the function of ear crystals in maintaining balance. The inner ear contains specialized structures called otolith organs, which include the utricle and saccule. These organs house tiny calcium carbonate crystals known as otoconia or otoliths.

How do ear crystals work to maintain balance?

Ear crystals are embedded in a gelatinous matrix atop hair cells. When you move your head, the crystals shift, bending the hair cells and triggering nerve impulses. These signals inform the brain about head position and movement, contributing to your sense of balance and spatial orientation.

In BPPV, some of these crystals become dislodged and migrate into the semicircular canals. This misplacement causes the brain to receive conflicting information about head movement, resulting in vertigo and dizziness.

Recognizing BPPV Symptoms and Triggers

The hallmark symptom of BPPV is brief episodes of vertigo triggered by changes in head position. Other common symptoms include:

• Dizziness
• Loss of balance
• Nausea
• Vomiting (in severe cases)
• Rapid, involuntary eye movements (nystagmus)

What situations commonly trigger BPPV symptoms?

BPPV episodes are often provoked by:

1. Lying down or sitting up in bed
2. Turning over while lying down
3. Tilting the head back to look up
4. Bending forward to pick something up
5. Quick head movements

It’s important to note that symptoms can vary in intensity and duration among individuals. Some people may experience severe vertigo lasting several minutes, while others might only feel a mild sense of imbalance for a few seconds.

Diagnosing BPPV: What to Expect

Diagnosing BPPV typically doesn’t require expensive tests or complex procedures. Healthcare providers can often identify the condition based on a patient’s reported symptoms and a physical examination.

How is BPPV diagnosed?

The diagnostic process usually involves:

1. Medical history review: Your doctor will ask about your symptoms, their duration, and any triggers you’ve noticed.
2. Physical examination: This may include observing your eye movements and testing your balance.
3. Dix-Hallpike test: This specific maneuver is used to provoke BPPV symptoms and observe characteristic eye movements (nystagmus).
4. Head impulse test: This evaluates the function of your vestibular system.

In some cases, additional tests may be recommended to rule out other potential causes of vertigo, such as inner ear infections or neurological issues. These might include:

• Audiometry (hearing tests)
• Videonystagmography (VNG)
• Magnetic Resonance Imaging (MRI) of the brain

Treatment Options for BPPV

The primary treatment for BPPV involves specialized maneuvers designed to guide the displaced ear crystals back to their proper location. These techniques are highly effective and can often provide immediate relief.

Epley Maneuver

The Epley maneuver is the most commonly used treatment for BPPV affecting the posterior semicircular canal. This series of head movements helps reposition the displaced crystals.

How is the Epley maneuver performed?

1. Sit upright on a bed with your legs extended.
2. Turn your head 45 degrees to the affected side.
3. Quickly lie back with your head still turned, allowing it to hang slightly off the edge of the bed.
4. Hold this position for 30 seconds or until dizziness subsides.
5. Turn your head 90 degrees to the opposite side.
6. Roll onto your side in the direction you’re facing.
7. Slowly sit up.

This maneuver can be performed by a healthcare provider or taught to patients for home treatment.

Semont Maneuver

The Semont maneuver is an alternative to the Epley maneuver and may be preferred for some patients. It involves rapid movement from lying on one side to the other.

Brandt-Daroff Exercises

These exercises involve repeatedly sitting up and lying down on each side. While not as effective as the Epley or Semont maneuvers for immediate relief, they can help prevent recurrence of BPPV.

Medications and Other Interventions for BPPV

While repositioning maneuvers are the primary treatment for BPPV, some additional interventions may be recommended in certain cases.

Are medications effective for treating BPPV?

Medications are generally not considered a first-line treatment for BPPV. However, in some situations, they may be prescribed to manage symptoms:

• Antihistamines: May help reduce dizziness and nausea
• Anti-emetics: Can help control severe nausea and vomiting
• Benzodiazepines: Might be used short-term to alleviate anxiety associated with vertigo

It’s important to note that these medications do not treat the underlying cause of BPPV and should be used cautiously due to potential side effects.

Vestibular Rehabilitation

For patients with persistent symptoms or those who have difficulty performing repositioning maneuvers, vestibular rehabilitation therapy may be recommended. This specialized form of physical therapy aims to:

• Improve balance and reduce dizziness
• Enhance gaze stability
• Increase overall function and quality of life

Preventing BPPV Recurrence

While it’s not always possible to prevent BPPV, certain strategies may help reduce the risk of recurrence or manage symptoms more effectively.

How can you minimize the risk of BPPV episodes?

1. Sleep with your head slightly elevated
2. Avoid sudden head movements, especially when lying down or getting up
3. Be cautious when bending over or looking up
4. Perform Brandt-Daroff exercises regularly if recommended by your healthcare provider
5. Stay physically active to maintain good balance and coordination

It’s also important to address any underlying factors that may contribute to BPPV, such as vitamin D deficiency or osteoporosis, which can affect calcium metabolism and potentially increase the risk of crystal dislodgement.

Living with BPPV: Long-term Management and Outlook

For many individuals, BPPV is a temporary condition that resolves with treatment. However, some people may experience recurrent episodes throughout their lives.

What is the long-term prognosis for BPPV patients?

The outlook for BPPV is generally positive. Most people respond well to repositioning maneuvers and experience significant improvement in symptoms. However, the condition can recur in about 15-50% of cases within one year.

Long-term management strategies include:

• Learning to perform repositioning maneuvers at home
• Regular follow-ups with a healthcare provider
• Staying aware of potential triggers and avoiding them when possible
• Maintaining overall health and balance through regular exercise

It’s important for individuals with BPPV to work closely with their healthcare providers to develop a personalized management plan. This may involve a combination of treatments, lifestyle modifications, and ongoing monitoring to ensure the best possible quality of life.

In conclusion, while BPPV can be a distressing condition, effective treatments are available. Understanding the underlying mechanisms, recognizing symptoms, and seeking prompt medical attention can lead to successful management and improved outcomes for those affected by this common vestibular disorder.

Why Loose Ear Crystals Make You Dizzy – Cleveland Clinic

You’re rolling over to your right side in bed, when suddenly the room starts rolling over, too. For a couple of days, the world spins each time you turn to the right — until the sensation fades away on its own.

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The condition, called benign paraoxysmal positional vertigo (BPPV), is downright scary because it takes you by surprise. And the dizziness, lightheadedness and nausea left in its wake will keep you from working and doing normal activities.

“Episodes of BPPV can last for a few seconds, a few days, a few weeks or a few months,” explains neurologist Neil Cherian, MD, an expert on dizziness. “Because BPPV is so common and so fleeting, it’s hard to get good data on its incidence. ”

What are ear crystals?

At the root of the problem are tiny calcium crystals that sense gravity, found within the chambers of the inner ear.

“Imagine a hill with blades of grass, and on top of each blade is a crystal,” explains Dr. Cherian. “Together, these crystals form an interconnected matrix. Whenever the blades of grass move, so do the crystals.”

The blades of grass represent cilia, hair-like processes that are attached to tiny nerves in your inner ear. When the crystals move, it stimulates the nerves to fire, which tells the brain your head is moving.

This crystal matrix serves as a reliable motion-sensing map — until crystals break free, drifting into one of the ear’s three semicircular “balance” canals, and create havoc.

Why do loose crystals make you dizzy?

Normally, the fluid in the semicircular canals and the small, direction-sensing cupula in your inner ear move only when your head moves.

“When the crystals are all connected, the fluid in the canals settles down as soon as your head stops moving,” says Dr. Cherian. “But when the crystals are disconnected, they keep moving in the fluid for up to a few seconds afterward.

“Then your brain has to figure out, ‘Why is there movement when I don’t see it?’ And that is what makes you dizzy.” The fact that your eyes continue to move in response to this false cue gives doctors another way to confirm that you have BPPV.

Three factors make it more likely that ear crystals may loosen:

• If you’re 65 or older.
• If you’ve suffered a head injury.
• If you’ve suffered from chronic, viral inner ear infections.

You don’t need expensive tests to get a diagnosis of BPPV. Your doctor can diagnose it based on your pattern of symptoms and a medical evaluation.

How do you fix loose crystals?

A doctor or vestibular physical therapist (PT) can show you how to do self-repositioning BPPV exercises at home. Collectively called the Epley maneuver, they move the ear crystals back into place, and are easy to do on a bed or on the floor.

“When done in a medical setting, the success rate for these exercises is up to 90%,” says Dr. Cherian. “So doing them properly on your own can be quite effective for BPPV.” He adds that, once your BPPV clears, the exercises should stop.

If the Epley maneuver isn’t helping you, it may be because:

• You have too many loose crystals.
• Crystals have drifted into more than one semicircular canal.
• Both of your ears are affected.
• You’ve got technical issues (e.g., the wrong ear or wrong method of treatment).
• Your dizziness has a different cause.

In these cases, seek help from an ear, nose and throat (ENT) specialist — or go straight to a vestibular PT, who can diagnose and treat BPPV. They can put you through additional exercises to move the crystals back into place.

Do ear crystals always cause vertigo?

Having loose crystals in your ear doesn’t necessarily make the room spin, unlike vertigo.

“Many patients with BPPV don’t even feel dizzy — just lightheaded, unsteady or a bit ‘off’ — but when we test for crystals in the office, there they are,” says Dr. Cherian.

He notes that it’s possible to have leftover crystals without knowing it if you consistently avoid turning your head in the direction that triggered your symptoms. But the goal of the exercises is to get you back to fully normal function.

Is there a cure for BPPV?

Dr. Cherian tells patients that BPPV is like the common cold. “We can identify it, and we can get you out of it sooner, but we can’t prevent it,” he says.

The outlook for BPPV is hard to predict from one person to the next.

If symptoms are related to head trauma, and diminish as you heal, you may have fewer problems over time, he notes. If not, mastering the Epley maneuver will allow you to quickly stop the spinning sensations and lightheadedness when crystals get loose.

However, if you get so nauseous that you can’t hold down liquids, or if weakness, numbness, tingling or changes in vision occur, “seek help sooner rather than later,” stresses Dr. Cherian. “These could signal a more serious problem, such as stroke.”

Vertigo Treatment

Vertigo is an unpleasant feeling of spinning or movement. This may be experienced as though the room around you is spinning or that you are moving when you aren’t. With vertigo, it feels as if the room is spinning, or it can feel as if you are moving. Although many patients may describe their vertigo as being “dizzy”, vertigo is defined by the definite sensation of spinning – either the room (objective) or the person (subjective). Dizziness is a term that is loosely used to describe a sensation of light-headedness or feeling faint. These symptoms are common if you are ill or haven’t eaten for several hours

Causes and concerns

There are two types of vertigo to consider: subjective vertigo and objective vertigo. With subjective vertigo, you feel like you are actually moving. In some cases, you may actually be swaying slightly. If you have objective vertigo, you feel like your surroundings are moving. Causes of vertigo include:

• Benign paroxysmal positional vertigo (BPPV) –This is caused by a sudden movement of your head (if you were to turn your head).
• A migraine, usually with aura
• Inner ear infection (viral or bacterial)
• Meniere’s disease – This condition causes objective vertigo, hearing loss, pressure in the ear and tinnitus. Meniere’s disease can come and go and you may experience symptoms for several weeks or months.
• Acoustic neuroma –This is a tumor in the nerve tissue that causes vertigo. In addition, you will experience tinnitus (ring in the ears) and hearing loss with acoustic neuroma. Once the tumor is removed, the vertigo typically subsides.
• Neck injuries and head trauma – Once the neck or head injury has healed, the vertigo will typically disappear.
• Cerebellar hemorrhage – This is by far the most serious condition that can cause vertigo. A cerebral hemorrhage is a life-threatening condition and these occur during an accident (car accident, skiing accident, falls where you land on your head or hitting your head. )
• Hormonal changes such as experienced during pregnancy

Concerning Symptoms and signs

There are many symptoms and signs that can accompany vertigo. If you or someone you love has any of these symptoms, you should consider calling for an appointment with one of our competent ear specialists. Symptoms and signs that are concerning include:

• Abnormal eye movements
• Headaches
• Nausea and vomiting
• Nasal congestion and drainage
• Ringing in the ears
• Earache
• Hearing loss
• Frequent falls or prolonged imbalance

Solutions and options

Vertigo that is caused by cerebellar hemorrhage is a medical emergency, so you should seek healthcare immediately. If the vertigo is caused by an infection, then the doctor may give you oral or IV antibiotics or treat with steroids. For other causes of vertigo, there are a variety of solutions and options to consider. The treatment depends on the cause and some types of vertigo are self-limiting, meaning they may subside with time

With the exception of the cerebellar hemorrhage, most cases of vertigo are easily treated once the cause has been identified. If you or someone you love is experiencing vertigo, call today and make an appointment with one of our ear specialists. Let us help you find a solution to your symptoms.

Ear Balance Disorder Treatment – Infection, Hearing Loss Treatment in CA

Cholesteatoma

A cholesteatoma is an abnormal skin growth in the middle ear behind the eardrum. Although a cholesteatoma is not a tumor, it can increase in size and destroy the surrounding delicate bones of the middle ear leading to hearing loss, drainage from the ear, dizziness, and other complications due to injury to the surrounding structures. Repeated infections, a hole in the ear drum, or pulling inward of the eardrum from eustachian tube dysfunction can allow skin into the middle ear and form a cholesteatoma. The eustachian tubes convey air from the back of the nose into the middle ear to equalize ear pressure (ear popping when on a plane or with changes with altitude. )

Individuals with chronic or recurrent drainage from the ears, chronic ear infections, ear pain, hearing loss or dizziness will require an examination by an otolaryngologist. Our doctors at C/V ENT Surgical Group will perform a thorough ear exam and evaluation to determine the presence of a cholesteatoma. Initial treatment may consist of a careful ear cleaning, antibiotics, and ear drops. Initial treatment will aim to stop the drainage. A hearing test and a CT scan maybe performed to determine the hearing level in the ear and the extent of destruction caused by the cholesteatoma. Definitive therapy will usually require surgery. Cholesteatoma is a serious but treatable ear condition, which can be diagnosed only by medical examination. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and, rarely, death can occur.

Dizziness and Vertigo

Feeling unsteady or dizzy can be caused by a variety of factors such as poor circulation, inner ear disease, medications, trauma, infection, allergies, and/or neurological disease.

Dizziness can be described in many ways. Vertigo is a specific type of dizziness. Vertigo is a false feeling of motion with sensation as if you or the room is spinning. Some experience dizziness in the form of motion sickness described as a nauseating feeling brought on by the motion. Dizziness, vertigo, and motion sickness all relate to the sense of balance and equilibrium. Your sense of balance is maintained by a complex interaction between different systems in the body including the inner ear, the eyes, the pressure and sensory receptors in the joints, and the brain. The symptoms of motion sickness and dizziness appear when the brain receives conflicting messages from the other systems.

The sensation of vertigo is usually due to an issue with the inner ear. A vertigo attack may cause sudden nausea, vomiting and heavy sweating. Severe vertigo causes a loss of balance and can cause you to fall. During vertigo, small head movements and changes in body position will often make the symptoms worse. An episode of vertigo may last seconds, minutes or hours. Once you are over the first episode, it may never return. However, sometimes symptoms may recur off and on over several weeks or longer, depending on the cause. There may be ringing in the ears or hearing loss, which may be temporary or permanent.

Common causes of vertigo include: Benign Positional Vertigo, Meniere’s disease, migraine, infection, injury, and allergy.

Our experts at C/V ENT Surgical Associated will obtain a thorough history and examination and guide the treatment of your vertigo. A hearing test is often required to evaluate the function of the ear. Treatment will depend on the likely cause of your dizziness.

Middle Ear Infection

Otitis media refers to inflammation of the middle ear. An acute otitis media occurs when there is accumulation of pus and mucus behind the eardrum. A cold, allergy, or upper respiratory infection can lead to the blockage of the Eustachian tube and the resultant fluid accumulation behind the ear drum. Fluid can remain in the ear for weeks to many months. When the fluid in the middle ear persists or repeatedly returns, the condition is called chronic middle ear infection. The fluid in the middle ear will cause pressure, sensation of fullness in the ear, and decreased hearing. In children, the hearing loss from chronic ear infections can present with difficulty with speech development.

Hearing Loss

There are 2 types of hearing loss: conductive and sensorineural. One or both kinds can occur.

A conductive hearing loss occurs when sound waves do not reach the inner ear. Sound waves may be disrupted before they reach the inner ear due to a variety of conditions. The ear canal can be blocked by wax, infection, a tumor, or a foreign object. The eardrum can be injured or infected. Abnormal bone growth, infection, or tumors in the middle ear can block sound waves.

A sensorineural hearing loss occurs when sound waves are not processed correctly by the inner ear, the 8^th cranial nerve, or central nervous system.

Our specialists at C/V ENT Surgical Group will perform a thorough examination to determine the type and cause of your hearing loss and discuss treatment accordingly.

Hyperacusis

Individuals with hyperacusis have difficulty tolerating sounds which do not seem loud to others. Hyperacusis is a condition that arises from a problem in the way the brain’s central auditory processing center perceives noise. It can often lead to pain and discomfort.

Many people experience sensitivity to sound, but true hyperacusis is rare, affecting approximately one in 50,000 individuals. The disorder can affect people of all ages in one or both ears. Individuals are usually not born with hyperacusis, but may develop a narrow tolerance to sound.

Individuals who suspect they may have hyperacusis should seek an evaluation by one of experts. There are no specific corrective surgical or medical treatments for hyperacusis. However, sound therapy may be used to “retrain” the auditory processing center of the brain to accept everyday sounds.

Perforated Eardrum

A hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear, is called a perforated eardrum. A perforated eardrum is often accompanied by decreased hearing and sometimes liquid discharge. The perforation may be accompanied by pain, if it is caused by an injury or becomes infected. A perforation can occur from injury, infection, or chronic Eustachian tube disorders.

Traumatic causes include direct trauma such as with use of a bobby pin or Q-tip, skull fracture, or slap to the ear. Middle ear infections may lead to spontaneous rupture of the eardrum with infected or bloody drainage from the ear. In patients with chronic Eustachian tube problems, the ear drum may become progressively weakened and a perforation to occur. On some occasions, a small hole may remain in the eardrum after a previously placed pressure-equalizing tube falls out or is removed.

Most eardrum holes resulting from injury or an acute ear infection heal on their own. The chance of a perforation healing on its own depends on the size of the perforation. If the perforation does not spontaneously heal, then surgical options can be considered.

Our specialists at C/V ENT Surgical Group will advise you regarding the proper care of a hole in the eardrum.

Swimmer’s Ear/Otitis Externa

Swimmer’s ear or acute otitis externa is a painful condition resulting from inflammation, irritation, or infection of the outer ear canal. These symptoms often occur after water gets trapped in your ear, with subsequent spread of bacteria or fungal organisms. When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing infection of the ear canal.

Other causes of otitis externa include:

• Contact with polluted water
• Excessive cleaning of the ear canal
• Damage to the skin of the ear canal following water irrigation to remove wax
• A cut in the skin of the ear canal
• Other skin conditions affecting the ear canal, such as eczema

Our ENT surgeons at C/V ENT Surgical Group will examine your ears, carefully clean your ear canal and typically prescribe eardrops that inhibit bacterial or fungal growth and reduce inflammation. If the ear canal is swollen shut, a wick may be placed in the canal so the antibiotic drops will enter the swollen canal more effectively. Follow-up appointments are very important to monitor improvement or worsening, to clean the ear again, and to replace the ear wick as needed. At C/V ENT Surgical Group, we have specialized equipment and expertise to effectively clean the ear canal and treat swimmer’s ear.

Tinnitus

Tinnitus is the perception of sound without an external source being present. The noise might be a ringing, clicking, hiss, or roar. It can vary in pitch and may be soft or quite loud. For some people, tinnitus is a minor nuisance. But for others, the noise can make it hard to hear, work, and even sleep. About one in five people with tinnitus have bothersome tinnitus, which distresses them and negatively affects their quality of life. Tinnitus may be an intermittent or continuous sound in one or both ears. Prior to any treatment, it is important to undergo a thorough examination and evaluation by our specialists at C/V ENT Surgical Group as an essential part of the treatment will be your understanding of tinnitus and its causes.

Tinnitus may be caused by different parts of the hearing system. In the outer ear, excessive ear wax can result in tinnitus. Middle ear problems including middle ear infections may lead to tinnitus. Most subjective tinnitus associated with the hearing system originates in the inner ear. Damage and loss of the tiny sensory hair cells in the inner ear may be commonly associated with the presence of tinnitus. In certain cases, tinnitus may develop with loud noise exposure even before hearing loss. Medications can also damage inner ear hair cells and cause tinnitus. As we age, the incidence of tinnitus increases.

Tinnitus may also originate from lesions on or in the vicinity of the hearing portion of the brain. These include a variety of uncommon disorders including vestibular schwannoma (acoustic neuroma) and damage from head trauma.

Another category is pulsatile tinnitus that sounds like one’s heartbeat or pulse. Infrequently, pulsatile tinnitus may signal the presence of cardiovascular disease or a vascular tumor.

3 Ways ENTs Treat Vertigo

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While many people think of vertigo as a condition, it is always a symptom of something else, usually in the inner ear. Vertigo is a very common symptom for people experiencing inner ear infections, vestibular migraines and a few other conditions.

Vertigo is often described as dizziness, but you may also experience sickness, the sensation that the world is tilting or that you are being pulled in one direction. If you experience vertigo for more than a day or you are having regular bouts that are affecting your daily life, you should go and see your ENT to get help alleviating the symptoms and to find out what the cause could be.

Treating the symptoms

For many people experiencing vertigo and its related symptoms, the cause is a viral infection and the best course of action is to wait for the virus to go, just as you would with any other. This is because most viruses don’t last much longer than a few weeks, and once they are gone, the vertigo symptoms will also disappear. In the vast majority of cases, people who have vertigo will make a full recovery.

While you are waiting for the virus to burn itself out, you can take travel sickness pills to mitigate the vertigo symptoms. These work by suppressing information passed from the inner ear to the brain making you feel less sick and dizzy as a result. You may also wish to do some exercises to help relieve the symptoms and your ENT will be able to demonstrate them for you to do at home.

Treating the underlying condition

If your vertigo is caused by a migraine, your ENT will begin by suggesting ways to minimize the number of migraines you have and their severity. This treatment might include working out what your triggers are and avoiding them, exercises to relieve tension in your neck and preventative medication to reduce the number of attacks you have.

Your diet is also a factor and people with Meniere’s disease may be advised to reduce their salt intake as well as minimizing alcohol and caffeine. As blood flow to the inner ear is thought to be important, your ENT may also prescribe a medication to reduce the pressure in your inner ear.

Performing surgery on the inner ear

In extreme cases where the severity of vertigo symptoms means that the patient is unable to live an ordinary life, an ENT may recommend that surgery is the last option. As surgery to the inner ear often results in partial or total hearing loss in that ear, patients who choose this option have usually tried all other means of treatment first.

There are always new lines of research for vertigo treatment and as researchers begin to understand more about vertigo and the underlying causes, more sophisticated methods of treatment are constantly in development. Ask your ENT for more information to help you make a fully informed decision about how to treat your own set of vertigo symptoms.

Introduction

There are several different types of ear infections depending on what part of the ear is infected. The ear is generally divided into three parts: the external ear, the middle ear, and the inner ear. The external ear includes the visible part of the ear and the ear canal. An infection of the ear canal is called otitis externa, commonly referred to as “swimmer’s ear”. The middle ear is the air-filled space between the eardrum (tympanic membrane) and the inner ear. The middle ear contains the ear bones and the Eustachian tube. Infections of the middle ear are called otitis media. The inner ear is located within the skull. It contains the hearing organ called the cochlea, and balance canals called semicircular canals. Infections of the inner ear are uncommon and are called labyrinthitis, vestibular neuritis, or sudden sensorineural hearing loss, depending on what part of the inner ear becomes infected.

Otitis Media

Otitis media is an infection or inflammation of the middle ear. Ear infections can either be of short duration (acute) or persistent (chronic). When most people refer to an ear infection, they are talking about acute otitis media.

Acute Otitis Media

Acute otitis media is an infection of the middle ear. It most often occurs when a virus or bacteria enters the ear and mucus, or pus build up behind the eardrum. Ear infections usually start with a cold or sinus infection but can occur on their own. The job of the Eustachian tube is to regulate pressure and drain the middle ear. An upper respiratory infection causes swelling of the Eustachian tube and the tissue around it. This prevents the fluid buildup from draining and causes pain and decreased hearing.

Although adults can get ear infections, they are most common in young children. A child’s eustachian tubes are narrower, shorter and more horizontally placed than an adults. This makes it easier for fluid to get trapped in the middle ear. In studies, 75% of children get at least one ear infection. They happen most often in the first year of life. By age 1, 60% of children will have had at least one ear infection and 17% will have had 3 or more.

There are two main types: acute otitis media (AOM), and otitis media with effusion (OME). Acute otitis media causes pain, fever, and difficulty hearing. If a child is too young to talk, signs of an ear infection can include crying, irritability, trouble sleeping, and pulling on the ears.

In OME fluid remains trapped in the ear. This leaves clear or straw-colored fluid behind the eardrum. This can result in a sense of the ear being plugged and muffled hearing, but rarely pain.

Risk Factors for Otitis Media

• Children under 7
• Daycare attendance
• Cold, flu or sinus infection.
• Allergies
• Exposure to cigarette smoke
• Family members with a history of frequent ear infections.
• Using a pacifier.
• Gastroesophageal reflux disease (GERD).

Treatment

• If a bacterial infection is present, your doctor may prescribe antibiotics. If your doctor prescribes antibiotics, be sure to give your child all the doses as prescribed. Patients treated with antibiotics can develop vomiting, diarrhea, or a rash. You should contact your prescribing physician for these symptoms.
• If the eardrum is ruptured (has a hole in it) your doctor may prescribe antibiotic ear drops instead of oral antibiotics. Current recommendations for patients with ear tubes or perforations present are to use antibiotic drops before oral antibiotics.
• Over the counter pain medications such as Ibuprofen or acetaminophen may be used. Before giving any medication to a child you should talk to your pediatrician.

Most acute ear infections resolve on their own. Antibiotics tend to be overused for treating ear infections. For this reason, children may develop bacteria resistant to antibiotics. The AAP and the American Academy of Family Physicians guidelines recommend taking a wait and see approach for 72 hours if:

• The child is older than 6 months
• The patient is otherwise healthy
• The person has mild symptoms or there is an unclear diagnosis.

Prevention is very important. You can reduce you or your child’s risk of ear infections by:

• NOT exposing your child to secondhand smoke.
• Always hold your infant in an upright, seated position during bottle feeding.
• Breastfeeding for at least 6 months can make a child less prone to ear infections.
• Avoid use of a pacifier.
• The pneumococcal vaccine (Prevnar) prevents infections such as pneumonia and meningitis, and studies show it slightly reduces the risk of ear infections in children.

Surgery (Myringotomy and Tube Placement)

In patients who have recurring ear infections or those who have fluid that remains in place for months without resolving your ENT physician may suggest putting in tubes. This are sometimes referred to as pressure-equalizing (PE) tubes or tympanostomy tubes. This surgery requires general anesthesia for children but can often be done in the office under local anesthesia for adults. The surgeon makes a small incision in the ear drum and then inserts a small tube into the eardrum. Fluid behind the eardrum can drain out, equalizing the pressure between the middle and the outside environment. The eardrum usually pushes the tubes out on their own over the ensuing 6-18 months.

Chronic Otitis Media (COM)

What is Chronic Otitis Media?

When an ear infection does not completely go away or returns often, it is referred to as chronic. If left untreated, chronic ear infections can lead to a variety of complications including hearing loss, damage to the eardrum, damage to the bones in the middle ear, chronic or recurring drainage from the ear, balance problems, a middle ear cyst called a cholesteatoma, facial paralysis and inflammation of the brain.

How Does Chronic Otitis Media Occur?

If the eustachian tube becomes blocked due to swelling or congestion in the nose, the middle ear cannot equalize pressure properly. Negative pressure then develops. If the eustachian tube blockage is prolonged, fluid or mucus can be drawn into the middle ear. As the blockage persists, the tissue in the middle ear begins to change. First, the mucus become thicker, and less likely to drain. Then the lining itself begins to thicken and become inflamed. The defense mechanisms of the eustachian tube and middle ear become compromised and bacteria normally present in the nose can track into the middle ear and otitis media.

The negative pressure in the middle ear or alternating periods of negative, normal, and positive pressure may deform the eardrum. Over time, the eardrum may become severely distorted, thinned, or even perforated. These changes may cause hearing loss and a sensation of pressure. When there is a hole in the eardrum, the natural protection of the middle ear from the environment is lost. Water and bacteria entering the middle ear from the ear canal can cause repeated inflammation and infection. Drainage from the ear is a common sign of a perforation.

Inflammation and infection in time can cause erosion of ear bones and the walls of the middle and inner ear. This can lead to hearing loss, imbalance, or weakness of facial movement. In rare cases, the infection may extend deeper into the head, causing meningitis or brain abscess.

How is Chronic Otitis Media Treated?

The first step in treating chronic otitis media is a thorough evaluation by an ENT physician. This will include a history and examination of the ear, nose, and throat. Depending on the individual’s unique situation, further testing may include a hearing test, tympanometry (a pressure test of the middle ear), or CT scan.

Treatment depends upon the severity of the disease. In the beginning, the causes of eustachian tube obstruction should be treated to prevent progression of chronic otitis media. Many children and adults with chronic or recurrent ear infections have ventilation tubes inserted in their eardrums to allow normal air exchange in the middle ear until the eustachian tube matures or underlying causes of the eustachian tube dysfunction can be treated.

If the disease has progressed enough to cause damage to the eardrum or ear bones, more intensive treatment is usually needed. Once the active infection is controlled, surgery is usually recommended.

Acute Otitis Externa or Swimmer’s Ear

Acute otitis externa or swimmer’s ear is caused by an infection, inflammation, or irritation of the ear canal. It can affect children and adults. This condition usually result from water getting trapped in the ear (from baths, showers, swimming, sweat) but can also be the result of eczema, excess earwax, use of hearing aids or earbuds, trauma from Q tips or other objects being inserted into the ear canals.

What are the Symptoms of Otitis Externa?

• Itching inside the ear (common)
• Pain inside the ear that gets worse when you tug on the outer ear (common)
• Sensation that the ear is blocked or full
• Drainage from the ear
• Decreased hearing
• Redness or swelling of the skin around the ear

Recurring ear infections (chronic otitis externa) are also possible. Without treatment, infections can continue to occur or persist.

Bone and cartilage damage (malignant otitis externa) are also possible due to untreated swimmer’s ear. If left untreated, ear infections can spread to the base of your skull, brain, or cranial nerves. Diabetics, older adults, and those with conditions that weaken the immune system are at higher risk for such dangerous complications.

How is Otitis Externa treated?

Treatment for the early stages of swimmer’s ear includes careful cleaning of the ear canal and use of eardrops that stop bacterial or fungal growth and reduce inflammation. Before using any drops in the ear, it is important to be sure you do not have a perforated eardrum (an eardrum with a hole in it).

If the ear canal is swollen shut, your doctor may place a sponge or wick in the canal so the antibiotic drops will enter the swollen canal more effectively. Topical antibiotics are effective for infection limited to the ear canal. Oral antibiotics may also be prescribed if the infection goes beyond the skin of the ear canal.

Follow-up appointments are very important to monitor your condition, to clean the ear again, and to replace the ear wick as needed. Your ENT specialist has specific equipment and expertise to effectively clean the ear canal and treat swimmer’s ear. With proper treatment, most infections should clear up in seven to 10 days.

How can Otitis Externa be prevented?

A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture. Prevention tips include:

• Use ear plugs when swimming.
• Use a dry towel or hair dryer (from a distance) to dry your ears.
• Have your ears cleaned periodically by an ENT specialist if you have itchy, flaky or scaly ears, or extensive earwax.
• Do not use cotton swabs to remove ear wax. They may pack ear wax and dirt deeper into the ear canal, remove the layer of earwax that protects your ear, and irritate the thin skin of the ear canal. This creates an ideal environment for infection.

Inner Ear infections

Infections of the inner ear are uncommon. They usually occur from a virus. Symptoms include sudden onset of hearing loss and/or severe vertigo.

Sudden Sensorineural Hearing Loss

Sudden hearing loss is most often caused by a virus and involves only one ear. You should see an ENT (ear, nose, and throat) specialist urgently for treatment to try and recover some hearing. Symptoms may also include dizziness (spinning sensation, balance problems, or vertigo), ringing in the ear (tinnitus), feeling like your ear needs to pop.

How is Sudden Hearing Loss Diagnosed?

Your doctor will perform a complete ENT exam and review your medical history. A hearing test (audiogram) will be performed to determine if you do have hearing loss, what part of the ear is involved, and how sever the hearing loss is. Routine labs and Xrays are usually not recommended. Less than 1% of the time sudden hearing loss is due to a benign (non-cancerous) tumor on the hearing and balance nerve. Your doctor may order an MRI to look for this tumor.

How is Sudden Hearing Loss Treated?

There are many treatments for SSNHL. Treatment is most successful the earlier it is given. Treatment can include oral steroids or steroids injected directly into the ear (intratympanic steroid injections). If the first treatments do not work, your otolaryngologist should discuss “salvage therapy.” The benefits of treatment may include more quick and complete recovery of hearing, but there are also side effects of steroids that must be considered when choosing from the available options. Side effects of steroids may include sleep problems, anxiety, depression, or mood swings, increased appetite with possible weight gain, dizziness, jitteriness, high blood sugar, and/or high blood pressure. With intratympanic steroids risks include pain, dizziness, residual hole in the ear drum, and infection. In head-to-head comparisons, intratympanic injection of steroids causes much fewer side effects than oral steroids.

Watchful waiting may be recommended. This is because half of patients may get back hearing on their own—these are usually patients with mild to moderate degrees of hearing loss, but healthcare providers do not currently have a way to predict who will get better without treatment.

Will My Hearing Come Back?

Approximately half of patients with SSNHL recover at least some hearing without treatment. Patients have a 75 to 80 percent chance of recovery with steroid therapy given early. The earlier that treatment is begun, the better the chances for recovery. Patients with profound hearing loss, which is a complete or near complete loss of hearing, patients who experience dizziness (vertigo) with their sudden hearing loss, and individuals above age 65 have a much lower chance of getting their hearing back. In those cases, you and your healthcare provider should discuss aggressive treatments to try to bring your hearing back. Hearing can take months to return after treatment is finished.

If you do not experience full hearing recovery, you may want to talk to your otolaryngologist and audiologist about hearing aids or other devices you can use to make hearing easier.

Labyrinthitis

Labyrinthitis is a disorder associated with inflammation of the inner ear. The labyrinth is a fluid-filled compartment that consists of the hearing portion of the inner ear (cochlea) and the balance portion (semicircular canals).

Labyrinthitis has several different causes, and patients of any age and gender may be affected. Patients with labyrinthitis can experience hearing loss in the affected ear, imbalance, dizziness, and nausea.

Labyrinthitis is a self-limiting illness that usually gets better in several weeks. Symptom can begin suddenly and then gradually worsen over the course of hours to days. Failure to seek treatment may put patients at higher risk for permanent hearing loss and imbalance. Although uncommon, it is possible to have some permanent hearing loss despite treatment. While most patients with imbalance and mild dizziness with head movement recover, sometimes it may take months to years to fully recover. Patients with substantial balance issues may benefit from a special type of physical therapy called vestibular physical therapy.

What are the symptoms of labyrinthitis?

• Hearing loss, often in high frequency pitch range
• Decreased ability to understand speech
• Tinnitus, or ringing or buzzing sensation in the ear
• Imbalance and unsteadiness, falling or swaying to one side while walking
• Vertigo, or feeling like you are spinning when you are still
• Involuntary twitching or jerking of the eyeball, called nystagmus
• Nausea and vomiting

What are the causes of Labyrinthitis?

Viral infections—Viral infections of the inner ear or activation of a virus that is has hibernated within nerve endings are thought to be the most common cause of labyrinthitis. The specific virus that causes this is usually unknown in most cases. A unique type of labyrinthitis may be caused by reactivation of the varicella-zoster virus (Shingles), called Ramsay Hunt syndrome, or herpes zoster oticus. Patients may experience ear pain, facial weakness, and blisters around the ear, ear canal, and/or eardrum in addition to hearing loss and dizziness.

Bacterial infection—A bacterial infection of the middle ear (the space behind the ear drum) can spread to the inner ear and cause bacterial labyrinthitis. Children with inner ear deformities are at a higher risk for bacterial labyrinthitis either from a middle ear infection or from the spread of bacterial meningitis to the inner ear. Severe bacterial labyrinthitis can occur with ear pain, ear infection, drainage of pus from the ear, fevers, or chills. Patients may require hospitalization. This type of infection has a higher risk for permanent hearing loss and may also lead to labyrinthitis ossificans, where there is bone formation in the inner ear after the infection.

Autoimmune—Autoimmune labyrinthitis is a rare cause of labyrinthitis and may come and go. It is often associated with other autoimmune disorders such as systemic lupus erythematosus, inflammatory bowel disease, rheumatoid arthritis, or other autoimmune disorders.

Trauma and surgery—Inner ear trauma puts patients at risk for developing labyrinthitis. Fractures involving the inner ear, concussion of the head and inner ear, or bleeding in the inner ear can cause labyrinthitis.

How is Labyrinthitis Treated?

Treating most cases of labyrinthitis includes observation, bed rest, and hydration. Steroids, such as prednisone, are typically prescribed to minimize inner ear inflammation. In some cases, steroids may be injected through the eardrum into the middle ear space. Severe nausea and vomiting may be treated with anti-nausea medications. Vertigo may be treated with antihistamines or sedatives, such as benzodiazepines, although long-term use can prolong the recovery.

The treatment of bacterial labyrinthitis is to control the primary infection, which is usually a middle ear infection. This may require antibiotics, placement of an ear tube, or more advanced ear surgery. Treatment for autoimmune labyrinthitis addresses the underlying autoimmune condition with steroids or other immune modulating medications usually directed by the rheumatologist.

Dog Ear Infection & Dizziness

Overview
If you spin around in circles as fast as you can and then attempt to walk in a straight line, you’ll experience what your dog probably feels like if she’s suffering with vestibular disease. There are two types of vestibular disease: peripheral and central. In this article, we will discuss the peripheral form, which, with treatment, generally carries a good prognosis and is much more common than central vestibular disease, which attacks the central nervous system and brain.

Dogs with peripheral vestibular disease have a breakdown in communication between the inner ear and the brain, causing dizziness. Though this disease can be debilitating for your furry friend, it is not life-threatening. Peripheral vestibular disease generally affects senior and geriatric dogs over 8 years of age. Its most common cause is inflammation of the nerves that connect the ear to the brain, most often caused by chronic or recurrent ear infections. In some situations, vestibular disease can result from a lesion or infection in the brain, a stroke, or a head injury. In some older dogs, vestibular disease occurs suddenly, with no known underlying cause.

Symptoms
The most common symptom of vestibular disease is loss of balance. No, your pooch hasn’t been hitting the bottle…but it may look as though she has! If the disease only affects one ear, your dog may walk with a tilt or in circles.

Other symptoms might include:

• Inability to stand
• Falling
• Repetitive eye movement (nystagmus)
• Stumbling
• Incoordination (ataxia)

Diagnose/Treatment
Once consulted, your veterinarian will perform a thorough physical exam, looking carefully at your pet’s ears, and may recommend diagnostic tests to look for concurrent conditions and to rule out other disorders that mimic vestibular disease.

These tests could include:

• Chemistry tests to evaluate kidney, liver, and pancreatic function, as well as sugar levels
• A complete blood count (CBC) to rule out blood-related conditions
• Electrolyte tests to ensure your pet isn’t dehydrated or suffering from an electrolyte imbalance
• Urine tests to screen for urinary tract infection and other disease, and to evaluate the ability of the kidneys to concentrate urine
• A thyroid test to determine if the thyroid gland is producing too little thyroid hormone
• A cortisol test to rule out Addison’s disease
• Antibody/Antigen tests to rule out parasitic infections
• Ultrasound examination of the abdomen to rule out tumors

Treatment will depend on the discovery of any concurrent conditions or underlying causes, such as an ear infection. If no cause is detected, your veterinarian will suggest supportive care that you can provide for your dizzy pooch as she recovers. The good news: most cases resolve quickly, with dogs recovering within a few weeks.

Prevention
Keeping your pooch free of infection and clean will help to prevent vestibular disease caused by an inflammation of the nerves. Routine health care and physicals including diagnostic tests can identify—sooner rather than later—any underlying conditions that could possibly cause vestibular disease. Call your veterinarian immediately if your dog seems dizzy or “drunk”—vestibular disease can happen quickly and can be scary, for both you and your pet!

If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets.

Posttraumatic Vertigo Medication: Benzodiazepine, Vestibulosuppressants, Antiemetic

Author

Brian E Benson, MD, FACS Founding Chair, Department of Otolaryngology-Head and Neck Surgery, Hackensack Meridian School of Medicine at Seton Hall University; Chief, Division of Laryngeal Surgery, Interim Chair, Department of Otolaryngology-Head and Neck Surgery, Attending Surgeon, Hackensack University Medical Center; Co-Chief, Division of Head and Neck Oncology, The John Theurer Cancer Center at Hackensack University Medical Center

Brian E Benson, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, New York Head and Neck Society, New York Laryngological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Monika I Sidor, MD Resident Physician, Department of Surgery, University of Michigan at Ann Arbor Medical School

Monika I Sidor, MD is a member of the following medical societies: Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Soly Baredes, MD Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School; Director of Otolaryngology-Head and Neck Surgery, University Hospital

Soly Baredes, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Association, The Triological Society, American Medical Association, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society, New York Head and Neck Society, New York Laryngological Society, New Jersey Academy of Otolaryngology-Head and Neck Surgery, The New Jersey Academy of Facial Plastic Surgery, International Skull Base Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Peter S Roland, MD Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Clinical Center for Auditory, Vestibular, and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Chief of Pediatric Otology, Children’s Medical Center of Dallas; President of Medical Staff, Parkland Memorial Hospital; Adjunct Professor of Communicative Disorders, School of Behavioral and Brain Sciences, Chief of Medical Service, Callier Center for Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Neurotology Society, American Otological Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, The Triological Society

Disclosure: Received honoraria from Alcon Labs for consulting; Received honoraria from Advanced Bionics for board membership; Received honoraria from Cochlear Corp for board membership; Received travel grants from Med El Corp for consulting.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;Cliexa, eMedevents, Neosoma, MI10<br/>Received income in an amount equal to or greater than $250 from: , Cliexa;;Neosoma<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; for: Neosoma, eMedevents, MI10.

Additional Contributors

Jack A Shohet, MD President, Shohet Ear Associates Medical Group, Inc; Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, School of Medicine

Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Neurotology Society, California Medical Association

Disclosure: Medical Advisory Board Member, consultant for: Envoy Medical.

Acknowledgements

Rowley S Busino, MD Staff Physician, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Rowley S Busino, MD is a member of the following medical societies: American Society for Head and Neck Surgery

Disclosure: Nothing to disclose.

90,000 Otitis media treatment | Rinos Clinic

Otitis media is an inflammation of the ear, a general term for any infectious process in the organ of hearing. Depending on the affected ear section,

is isolated

• external,
• average
• otitis media (labyrinthitis).

Otitis is common. Ten percent of the world’s population have suffered from otitis externa during their lifetime. Every year 709 million new cases of acute otitis media are registered in the world.More than half of these episodes occur in children under 5 years of age, but adults also suffer from otitis media. Labyrinthitis is usually a complication of otitis media and is relatively rare.

Otitis externa is an inflammation of the ear canal. It can be diffuse, or it can flow in the form of a boil. With diffuse otitis externa, the skin of the entire ear canal is affected. A boil is a localized inflammation of the skin of the outer ear.

Otitis media

With otitis media, the inflammatory process occurs in the tympanic cavity.There are many forms and variants of the course of this disease. It can be catarrhal and purulent, perforated and non-perforated, acute and chronic.

Complications may develop with otitis media. The most common complications of otitis media include mastoiditis (inflammation of the temporal bone behind the ear), meningitis (inflammation of the lining of the brain), brain abscess (abscess), labyrinthitis.

Labyrinthitis

Otitis media is almost never an independent disease.It is almost always a complication of otitis media. Unlike other types of otitis media, its main symptom is not pain, but hearing loss and dizziness.

Causes of otitis media

• After ingestion of contaminated water – most often otitis externa occurs after water containing the pathogen enters the ear. That is why the second name of this disease is “swimmer’s ear”. Injury to the skin of the external auditory canal – in addition to the presence of infection in the water, there must be local conditions that predispose to the development of inflammation: skin microcracks, etc.Otherwise, each of our contact with unboiled water would end in the development of inflammation in the ear.
• Complication of ARVI, sinusitis – in this case, the causative agent of otitis media penetrates into the tympanic cavity from a completely different side, the so-called rhinotubal route, that is, through the auditory tube. Usually, the infection enters the ear from the nose when a person is sick with ARVI, a runny nose or sinusitis. In severe middle ear infections, the infection can spread to the inner ear.
• With infectious diseases, kidney diseases, diabetes mellitus, hypothermia against a background of reduced immunity, the risk of developing inflammation in the middle ear increases.Blowing your nose through 2 nostrils (incorrect), coughing and sneezing increase pressure in the nasopharynx, causing infected mucus to enter the middle ear cavity.
• Mechanical removal of earwax – it is a protective barrier against infections.
• High air temperature and high humidity.
• Ingress of foreign objects into the auricle.
• Use of hearing aids.
• Diseases such as seborrheic dermatitis on the face, eczema, psoriasis.
• The reasons for the development of acute otitis media are also genetic disposition, immunodeficiency states, HIV infection.

Symptoms of otitis media.

Pain is the main symptom of otitis media. The intensity of pain can be different: from barely perceptible to unbearable character – pulsating, shooting. It is very difficult, more often than not, it is impossible to independently distinguish pain in otitis externa from pain in otitis media. The only clue may be the fact that with otitis externa, pain should be felt when the skin is touched at the entrance to the ear canal.Hearing loss is a variable symptom. It can be present in both otitis externa and average, it can be absent in both of these forms of ear inflammation.

Temperature increase – most often there is an increase in body temperature, however, this is also an optional sign.

Discharge from the ear with otitis externa are almost always. After all, nothing prevents the inflammatory fluid from excreting. With otitis media, if a perforation (hole) has not formed in the eardrum, there is no discharge from the ear.Suppuration from the ear canal begins after the appearance of a message between the middle ear and the ear canal. I focus on the fact that perforation may not form even with purulent otitis media. Patients suffering from otitis media often ask where the pus will go if it does not break out? It’s very simple – it will come out through the auditory tube.

Ear murmur , ear congestion is possible with any form of the disease. With the development of inflammation of the inner ear, dizziness may appear.

Acute otitis media occurs in 3 stages:

• Acute catarrhal otitis media – the patient experiences severe pain, intensifying towards night, when coughing, sneezing, it can be given to the temple, teeth, be stabbing, pulsating, boring, hearing, appetite decreases, weakness and high temperature appear up to 39C.
• Acute purulent otitis media – there is an accumulation of pus in the middle ear cavity, followed by perforation and suppuration, which can be 2-3 days of illness.During this period, the temperature drops, the pain decreases, the doctor can make a small puncture (paracentesis) if the tympanic membrane has not ruptured on its own.
• The recovery stage – suppuration stops, the defect of the tympanic membrane closes (fusion of the edges), hearing is restored within 2-3 weeks
  Treatment of external otitis media

The main treatment for otitis externa in adults is ear drops.

If a person does not have immunodeficiency (HIV infection, diabetes mellitus), an antibiotic in tablets is usually not needed.Ear drops can contain only an antibacterial drug or be combined – contain an antibiotic and an anti-inflammatory substance. The course of treatment takes 5-7 days. In addition to ear drops, for the treatment of otitis externa, the doctor may recommend an ointment with the active ingredient Mupirocin (Bactroban). It is important that the drug does not have a negative effect on the normal microflora of the skin, and there is evidence of the activity of mupirocin against fungi.

Treatment of otitis media and labyrinthitis in adults

Antibacterial therapy

The main treatment for otitis media is an antibiotic.However, antibiotic treatment for otitis media in adults is another controversial issue in modern medicine. The fact is that with this disease, the percentage of self-recovery is very high – more than 90%. There was a period of time at the end of the 20th century when, on a wave of enthusiasm, antibiotics were prescribed to almost all patients with otitis media. However, it is now considered acceptable to do without antibiotics for the first two days after the onset of pain. If after two days there is no tendency to improve, then an antibacterial drug is already prescribed.All types of otitis media may require oral pain relievers. In this case, of course, the patient must be under medical supervision. The decision on the need for antibiotics is very responsible and should only be made by a doctor. On the scales, on the one hand, the possible side effects of antibiotic therapy, on the other, is the fact that every year 28 thousand people die from complications of otitis media in the world.

The main antibiotics that are used in the treatment of otitis media in adults: Amoxicillin – Ospamox, Flemoxin, Amosin, Ecobol, Flemoxin solutab Aamoxicillin with clavulanic acid – Augmentin, Flemoklav, Ekoklav Cefuroxim – Zinnat, Axetin, Zinacef, others.The course of antibiotic therapy should be 7-10 days.

Ear drops

Ear drops are also widely prescribed for otitis media. It is important to remember that there is a fundamental difference between drops that are administered before and after eardrum perforation. Let me remind you that a sign of perforation is the appearance of suppuration. Before perforation occurs, drops with an analgesic effect are prescribed. After the appearance of perforation, the pain disappears and you can no longer drip anesthetic drops, since they can harm the sensitive cells of the snail.If perforation occurs, the drops can be accessed inside the middle ear, so drops containing an antibiotic can be instilled. However, ototoxic antibiotics (gentamicin, framycetin, neomycin, polymyxin B), drugs containing phenazone, alcohols or choline salicylate should not be used. Antibiotic drops, the use of which is permissible in the treatment of otitis media in adults: Ciprofarm, Normax, Otofa, Miramistin and others.

Paracentesis or tympanotomy

In some situations, with inflammation of the middle ear, minor surgical intervention – paracentesis (or tympanotomy) of the tympanic membrane may be required.It is believed that the need for paracentesis arises if, against the background of antibiotic therapy for three days, pain still continues to bother a person.

Paracentesis is performed under local anesthesia: a small incision is made in the tympanic membrane with a special needle, through which pus begins to come out. This incision is well overgrown after the cessation of suppuration.

Treatment of labyrinthitis is a complex medical problem and is carried out in a hospital under the supervision of an ENT doctor and a neurologist.In addition to antibacterial therapy, funds are needed to improve microcirculation inside the cochlea, neuroprotective drugs (protecting the nervous tissue from damage).

Prevention of otitis media

Preventive measures for otitis externa are to thoroughly dry the ear canal after bathing. You should also avoid traumatizing the ear canal – do not use keys and pins as ear instruments. For people who often suffer from external ear infections, there are drops based on olive oil that provide skin protection when swimming in a pond, such as Vaxol.

Prevention of otitis media consists of general strengthening measures – hardening, vitamin therapy, taking immunomodulators (drugs that improve immunity). It is also important to promptly treat nasal diseases, which are the main causative factor of otitis media.

90,000 Local antiseptics for chronic suppurative otitis media

What is the purpose of this review?

The aim of this Cochrane Review was to determine whether topical antiseptics are more effective than placebo or no treatment for chronic suppurative otitis media (CHM).The review also looked at whether some topical antiseptics are more effective than others. The authors of this Cochrane Review collected and analyzed all relevant studies to answer this question.

Key information

Due to an insufficient number of studies and a very low certainty of the evidence, the effectiveness of antiseptics in the treatment of chronic hepatitis C is unclear. Adverse effects have not been well reflected in studies.

What was learned in this review?

Chronic suppurative otitis media (CHOS) is a long-term (chronic) edema and infection of the middle ear, with discharge from the ear (otorrhea) through the perforated tympanic membrane (tympanic membrane). The main symptoms of HCV are discharge from the ear and hearing loss.

Topical antiseptics (antiseptics injected directly into the ear in the form of ear drops or in powder form) are sometimes used to treat chronic hepatitis C. Topical antiseptics kill or stop microorganisms that can cause infections.Topical antiseptics can be used on their own or added to other treatments for HCV, such as antibiotics or ear cleansers (ear toilet). Applying topical antiseptics can irritate the outer ear skin, which can lead to discomfort, pain, or itching. Some antiseptics (such as alcohol) can be toxic to the inner ear (ototoxicity), which means they can cause permanent hearing loss (sensorineural), dizziness, or ringing in the ear (tinnitus).

What are the main findings of this review?

We found five studies but were unable to say how many participants were included, as two studies only reported how many ears were treated. The studies used different types of antiseptics, some using ear drops and some using powders.

Topical antiseptic (boric acid) versus no treatment (with basic toilet ear treatment)

One study (254 children) compared the use of boric acid in alcohol ear drops versus no treatment with topical antiseptics.All children had their ears cleaned daily with cotton swabs (dry cleaning). The very low certainty of the evidence means that it is unclear whether antiseptic treatment results in faster resolution of otorrhea after four weeks or three to four months compared to the group that did not receive any topical antiseptics. This study reported no difference between the two treatment groups in hearing loss or suspected ototoxicity. No other outcomes were reported.

Comparison of local antiseptics

One study (93 participants) compared a single dose of boric acid powder with daily use of acetic acid ear drops. The very low certainty of the evidence means that it is unclear whether the use of boric acid results in faster resolution of otorrhea compared to daily use of acetic acid drops when evaluated after four weeks. It was unclear if ear discomfort was more pronounced in one group than in the other.No other outcomes were reported.

How relevant is this review?

Evidence is current to April 2019.

City Clinical Hospital No. 31 – Ear mushrooms

The otolaryngologist of the Moscow medical center “Clinic 31”, specialist in fungal diseases of ENT organs, doctor of medical sciences, professor Vera Yakovlevna KUNELSKAYA answers the readers’ questions about infectious ear diseases.
“Something is happening to my ears: I am worried about severe itching and stuffing, and when I press it, there is pain. Maybe I have otitis media or a sulfur plug? ”
Zinaida Voronova, Kaluga

Your complaints are most likely symptoms of another ear disease – otomycosis. It is an infectious disease that is caused not by microbes or viruses, but by microscopic fungi.

However, the very appearance of a fungus in the ear does not always cause illness. It becomes harmful only under certain conditions: when a person’s resistance is reduced, immunity is weakened.

This happens with metabolic disorders, vitamin deficiency, chronic diseases, more often with diabetes. Poor environmental conditions, food with various additives and an increased radiation background also affect the immune system. Long-term treatment with antibiotics and hormones becomes a predisposing cause of otomycosis. Ear injuries and a wet ear environment are the strongest risk factors. That is why, more often than others, mushrooms are “picked up” by those who like swimming in the sea, lake, pool.
“During the preventive examination, the doctor suggested that I have a fungal disease of the ears, although I hardly experience any unpleasant sensations.How dangerous is it not to be treated? ”
Eleonora Voskresenskaya, Vladimir region

Otomycosis is far from an innocent disease, although it starts with a rather “harmless” itch in the ear. Constant itching is usually accompanied by a feeling of stuffiness, noise. Discharges of black-brown, gray, greenish-yellow appear, depending on the type of mushroom.

And with an exacerbation, there are pains in the ears and in the head, dizziness. You may also feel that your hearing is getting worse.When otomycosis affects only the outer ear, pain is not very pronounced. But if there is a perforation of the eardrum, the disease reaches the middle ear. All this is fraught with serious complications. Therefore, treatment should always be started on time.
“My ear has become unbearably itchy and ache. Can I use ear drops and apply warming compresses? ”
Alla Dubrovina, Surgut

No, you can seriously harm yourself this way.Ear drops and compresses, which are used during otitis media, with otomycosis, at best, will not help, at worst, they will cause an exacerbation. This is because most ear drops contain antibiotics. And these drugs are contraindicated in fungal infections. They simply speed up the spread of “pests”.

Compresses cannot be done without specifying the diagnosis. Thermal exposure only enhances the growth of fungi. Camphor oil and alcohol have the same effect.
“At first my ears itched and hurt, but now my cheeks and neck are red.Which doctor should I go to – an allergist or a dermatologist? ”
Serafima Fofanova, Omsk

Since the ears were the first to suffer, you must first find out if you have otomycosis. After all, redness and skin rashes on the neck and face can be an allergic reaction to fungi “growing” in the ear. But an allergist and a dermatologist will not help here. You need to see an otolaryngologist. If the presumptive diagnosis is confirmed, in addition to antifungal therapy, you will have to undergo allergy treatment.
“I regularly wash my ears with soap and additionally clean them with cotton swabs. Can these measures protect me from fungal infection? ”
Ekaterina Terentyeva, Tambov

No, your protection methods are not entirely correct. Many people think that otomycosis comes from dirt. But this opinion is wrong. Self-cleaning takes place in a healthy ear. It is not necessary to remove earwax, as it is bactericidal and antifungal. Therefore, otomycosis just often overtakes clean people who, with careful hygiene, deprive the ears of their natural defenses.Wash only the pinna, not the ear canal.

When visiting the pool, wear a swimming cap. Swim above water whenever possible, not underwater. Never use a stick, match, or straw to clean your ears. So you can injure the skin and create a fertile ground for the introduction and reproduction of fungi.
“My husband was diagnosed with otomycosis. Can I get infected from him and in what way? ”
Faina Dotsenko, Moscow
Yes. For example, through a common pillow, towel, telephone receiver, hat.But, fortunately, this happens very rarely. To become infected with fungi, there must be a large number of fungal spores on the item. But if you have a strong immune system and you understand correctly the principles of ear hygiene, you should not be afraid of infection. So avoiding a patient with otomycosis is not at all necessary.
“My daughter has been treated for mycosis of the ears for half a year now. Have tried many different remedies, but nothing seems to work. Is it really impossible to get rid of the fungus?
Vera Kalashnikova, Pushkino
Otomycosis can be cured in 90-95% of cases.Only drugs should be correctly selected. Otomycosis is caused by different types of fungi. And each of them has its own specific treatment. And so-called universal antifungal agents can actually be treated for years.

Before prescribing a course of treatment, the doctor must conduct a special laboratory diagnosis.

But not all polyclinics have the necessary conditions for their implementation. If the funds are selected correctly, then recovery occurs in 2-3 weeks from the onset of the disease.And it happens that in 5 days. Moreover, these terms apply even to “neglected” patients.
“Several months ago I had a fungal ear infection. But now I am worried if the disease will happen again? ”
Lydia Krasnova, Moscow

Like all fungal diseases, otomycosis can recur. Fungal infections are insidious in that a person does not develop immunity to them, as, for example, happens with measles, chickenpox, scarlet fever. These diseases usually occur once.