Inflammation of the inner ear - labyrinthitis is an acute or chronic inflammatory process, predominantly bacterial in nature and characterized by diffuse or limited character. There is this serious disease is not so common. Its specific weight among all otites is not more than 5%.
The inner ear is the most deeply located department of the body of balance and hearing. It fits in the temporal bone. If we consider the anatomy of the entire auditory organ, then without exaggeration, we can say that this is the most difficult part of it. Due to its original form, the inner ear was called "labyrinth".
This anatomical formation consists of bone and membranous parts containing a special fluid called perilymph.
This article will examine the causes and types of labyrinthitis, the symptoms and treatment of this disease.
Causes of inflammation of the inner ear labyrinthitis
When talking about the causes that can lead to the development of the described ailment, one thing should be noted at once: the labyrinth is characterized by its internal location, and therefore the labyrinthitis disease can be formed solely due to the spread of the microbes themselves or the toxins released by them from other fociinfection.
Otitis media is the most common cause of the ailment in question. In this pathology in the connective tissue membranes that separate the middle ear from the inner one, processes of swelling and infiltration occur, due to which these structures become permeable to infectious toxins.
The resulting serous inflammation results in increased pressure within the labyrinth, and this can lead to breakthroughs of the above-mentioned membrane dampers into the tympanum, which will allow pathogenic microbes to enter the inner ear and provoke suppuration.
The labyrinthine causes may be hidden in the cranial cavity. In such cases, the infection reaches the inner ear through the internal auditory canal. In particular, for such reasons is meningitis.
General infectious diseases, such as epidparotitis, syphilis or herpes, can cause the described disease. In this case, the pathogens fall into the labyrinth through a drift with blood.
The occurrence of inflammatory processes in the inner ear is also possible as a result of the passage of infectious agents through a damaged eardrum due to trauma. And the trauma can be not only direct( foreign bodies, sharp objects), the membrane can be torn and with blunt cranial injuries of the temporal and parietal region.
Types and forms of the labyrinthite
In modern medicine, several varieties of the described disease are distinguished. The classification is based on different criteria.
Because of the appearance, the following types of ailment characterizing the process of labyrinthitis development are distinguished:
- hematogenous form of , in which infection from distant foci reaches the inner ear with blood flow;
- is the meningogenic type of the disease , when the organs of the central nervous system become the source of the pathogenic flora;
- is a tympanogenic variant of , characterized by the penetration of the pathogen into the labyrinth from the outer parts of the ear.
Taking as a basis the prevalence criterion, one can speak about the limited and diffuse types of the pathology under consideration.
In addition, there is a division of the labyrinthite into purulent and non-purulent. The first is a dangerous state with severe consequences, the second is much easier.
Finally, like many other diseases, inflammatory processes in the labyrinth can be acute or chronic.
Limited labyrinthitis as a consequence of chronic otitis
Limited labyrinthite , as a rule, is a consequence of chronic otitis media. In this case, the area of the labyrinth wall adjacent to the middle ear is involved in the inflammation process. The inflammation itself in this case is of a profound nature and is expressed in the form of ostitis and periostitis.
The bone wall of the inner ear is most intensely affected with cholesteatoma: the bone dissolves, atrophies, and when the destruction reaches the endosteum( the layer of connective tissue that lining the inner surface of the tubular bones) of the semicircular canal, i.e.in fact, an opening is formed in the bone wall, it swells( the endost), the vessels widen and the granulation processes take place with the gradual formation of the scar, which soon closes the aforementioned hole, preventing the penetration of the microflora.
Diffuse labyrinthite in serous, purulent and necrotic form
Diffuse labyrinthitis is nothing but inflammation affecting the entire labyrinth. This form of the disease arises as a consequence of the aforementioned limited process in the event that during its next exacerbation in the place where the hole of the bone wall was formed, the granulation barrier does not have time to fully form. Accordingly, no barriers are created on the path of infection, and it is easily inserted into the inner ear.
There are 3 main forms of this kind of described ailment: serous, purulent and necrotic.
The serous labyrinthite is characterized by the fact that only the toxins of the pathogen penetrate into the inner ear. This most often happens with inflammation of the middle ear. Endost with this variant of the disease thickens, perilymphatic fluid increases in volume, coagulation of some plasma proteins occurs with the formation of fibrous plaque and strands on the walls of the labyrinth.
One of the outcomes of serous inflammation can become purulent labyrinthite , the development of which usually happens when the membranes of windows break through. These breakthroughs occur from the inside, due to the progression of the serous process and a strong increase in pressure within the labyrinth. Inflammation of the purulent type contributes to the rapid death of auditory receptors located in the inner ear.
The necrotic form of the described disease develops as a result of vascular thrombosis and leads to severe eating disorders of tissues and necrosis of certain parts of the labyrinth.
Autogenous( tympanogenic) labyrinthite
Timpanogenous heogenous labyrinthite is the most frequent variant of the described disease. It appears to be a complication of mainly chronic, less frequent acute inflammatory lesions of the middle ear structures. Penetration of the infection is carried out through the membranes of the windows of the cochlea and the vestibule, which become passable for microbial toxins at the time of inflammation.
Developing serous inflammation of the inner ear proceeds with fluid transudation and increased pressure inside the labyrinth. As a result, it is possible to break the membrane of windows, penetrate into the inner ear of the microbes themselves and develop a purulent process.
Clinical picture of labyrinthitis and symptoms of acute disease
In patients with a diagnosis of labyrinthitis, the clinical picture includes a characteristic set of symptoms.
Dizziness occurs during the onset of the pathology. Usually after a few weeks it disappears. However, this symptom may well return, even after a few months. Dizziness is provoked by sharp turns and incautious slopes of the head. Often this manifestation is associated with patients with an infection that was carried out 1-2 weeks before it occurred.
The next symptoms associated with the above are nausea and vomiting. As a rule, they arise at the height of dizziness and pass if it stops.
Symptoms of hearing loss that are characteristic of labyrinthine diseases are temporary. However, with the development of bacterial damage, disturbances can acquire a stable form.
One of the signs of the described ailment can be the so-called nystagmus, which is a rhythmic twitching of the eyes, which have distinctive features in the defeat of the inner ear. A similar symptom develops when the balance between labyrinths is disorganized. From the beginning, its appearance is noted from the side of the diseased ear, then the nystagmus is redirected towards the healthy organ of hearing.
In patients with acute labyrinthitis, the symptoms may be accompanied by the disappearance of the frontal folds and eyebrows, inability to close eyes, dryness of the optic apple and increased salivation. All this is a sign that the pathological process in addition to the labyrinth captured the facial nerve.
In addition, with the development of the disease under consideration, one of the manifestations is also the noise in the ears. It accompanies other symptoms of the disease.
Deterioration of the general condition, including with an increase in body temperature, is observed in case of a purulent disease acquisition.
Symptoms of labyrinthitis in adults, as well as in children, may include an equilibrium disorder: , the patient marks swaying when walking without support.
If it is timely to contact a specialist doctor and take the necessary adequate measures in time, the symptoms will usually subside after 5-7 days. In the case of a severe course of the described ailment, its manifestations persist and at the same time are expressed quite clearly for 15-20 days. In neglected situations, the auditory nerve receptors completely die and the hearing can not be restored.
If we talk about labyrinthitis in children, it should be noted about the possibility of the appearance of such a symptom as a positive fistula sample: if you press on the tragus, then in the external auditory canal the air pressure increases, which through the hole formed as a result of pathological processes between the middle and innerear, is transmitted to the perilymph, resulting in nystagmus and other signs of irritation of the labyrinth. A similar symptom can be detected quite unexpectedly, for example, with an ear toilet.
Consequences and complications of labyrinthitis
Consequences of labyrinthitis of limited type can become the development of a diffuse purulent process in the inner ear, as mentioned above, as well as the transition to a prolonged course accompanied by periods of exacerbation( chronic labyrinthitis), which usually occur with relapses of inflammatoryreactions in the middle ear.
The outcome of a purulent variant of the described disease may be loss of function of the inner ear, i.e.development of intracranial complications.
Termination of the inflammatory process proceeds with connective tissue regeneration, ingrowth in all cavities of the labyrinth of connective tissue and ossification.
In the case of serous labyrinthitis, the complications are reduced to persistent disturbances in the function of the auditory analyzer and the vestibular apparatus, as well as to the development of a purulent labyrinth with the functional death of all receptors in the inner ear.
Diagnosis and treatment of laryngitis
Diagnosis of labyrinthitis is based on careful collection of anamnesis, analysis of complaints made to patients, clarification of the features of the clinic of the disease.
In the case of an unclear disease etiology, and for the purpose of obtaining additional data, the following studies can be performed:
- audiometry ;
- Electronystagmography ( allowing the registration of eye movements with the help of electrodes);
- CT and MRI ( for the detection of pathology in the brain);
- test response of the auditory department of the brainstem ( to evaluate the passage of impulses through the auditory nerve).
Despite the fact that labyrinthitis is an inflammation that does not occur very often, it is not worth to deprive it of attention and let it slide. The disease is serious and can lead to irreparable consequences. Therefore, if you have any symptoms, you should seek medical help as soon as possible.
Treatment of labyrinthitis includes conservative therapies and surgical intervention.
Conservative treatment involves the use of antibiotics, the implementation of dehydration therapy, the normalization of local trophic disorders in the labyrinth, the reduction of pathological impulses from the ear, and the improvement of the general condition.
For antibiotic therapy, antibacterial agents with a wide spectrum of action are used, with the exception of ototoxic drugs. The most often in the course are drugs from the group of penicillins and macrolides. The first includes, for example, Amoxicillin, and the second - Erythromycin. But such drugs as Streptomycin, Gentamicin and other representatives of aminoglycosides are not recommended to be prescribed to patients not only with labyrinthitis, but also with diseases of the ears in principle, tk.these drugs have an adverse effect on the auditory organ.
In patients with a diagnosis of acute labyrinthitis, dehydration measures are composed of diets, diuretics and hypertensive solutions.
Dietary recommendations include restriction of salt and liquid intake. Of diuretic drugs you can apply fonurit. At the same time, it is necessary to prescribe potassium chloride as well.the above medicament removes from the body not only sodium, but also potassium. But it is better to give preference to potassium-sparing diuretics, such as Spironolactone.
Among the variety of hypertensive solutions, a wide distribution in the treatment of labyrinthitis received a 40% solution of glucose and 10% calcium chloride, which are administered intravenously, as well as intramuscular injections of a 25% solution of magnesium sulfate.
In the disease, labyrinthitis treatment by normalizing local trophic disorders consists in the administration of vitamins K, P, B6, B12, as well as ascorbic acid, rutin, ATP and cocarboxylase. Successfully used and blocking nerve impulses from the labyrinth through subcutaneous injections of Atropine or Scopolamine.
Surgical intervention is indicated for diffuse serous or purulent libi- rintite. The aim of the operation is to remove the purulent focus. In this case, before the operation for 5-7 days the patient should undergo a course of conservative treatment.