The effectiveness of the drug is due to the combination of anti-inflammatory and anti-allergic effects of dexamethasone with the antibacterial effect of two complementary antibiotics and the vasoconstrictive action of phenylephrine hydrochloride.

Inflammatory diseases  outdoor auditory canal  and methods for their treatment

Ph.D., prof. S.Y. Kosyakov, doctor-hordes. A.V. Kurlova

Inflammatory diseases for their treatment
S.YA. Kosyakov, A.V. Kurlova

Department of Otorhinolaryngology with a course of endorino-surgery (Head - Corresponding Member of the Russian Academy of Medical Sciences Prof. G.Z. Piskunov) of the Russian State Academy of Postgraduate Education of the Russian Medical Academy of Postgraduate Education of the Ministry of Health and Social Development, Moscow

Among inflammatory diseases of the external ear, immunological and infectious diseases are distinguished. Erythema, edema, itching of the skin of the external auditory canal are frequent symptoms in both cases. Use for the treatment of ointments may be limited due to the difficulties of their application. It is advisable to use drops containing neomycin sulfate and polymyxin B sulfate in combination with dexamethasone (polydex). Two components of the antibiotic preparation have a synergistic effect, affect different pathogenic microorganisms, while dexamethasone has a universal anti-inflammatory effect.
Keywords: external otitis, local therapy, neomycin, polymyxin B, dexamethasone.

Inflammatory diseases of the external auditory origin. In both cases, the auditory passage of the external auditory passage. The treatment with ointments is restricted by the difficulty of their application. The polymyxin B sulfate, and dexamethasone (polydexa) is more reasonable. The antibiotics have a synergistic effect when it comes to a universal anti-inflammatory agent.
Key words: external otitis, neomycin, polymyxin B, dexamethasone.

Inflammatory diseases of the external ear can be divided into immunological and infectious.

Among immunological diseases outer ear distinguish: atopic dermatitis, allergic contact dermatitis, recurrent polychondritis, and seborrheic dermatitis.

Atopic dermatitis  (eczema) is most common in families suffering allergic rhinitis, bronchial asthma  and other atopic diseases. The cause is an imbalance in the immune balance, in which Th2 cells synthesize IL 4,5,10 dominate. With psoriasis and allergic contact dermatitis  dominated by Th1 cells responsible for the secretion of interferon-gamma and tumor necrosis factor.

Clinical manifestations of atopic dermatitis are itching and redness of the skin. Vesicles filled with fluid (<0,5 см), которые могут сливаться в единую мокнущую поверхность. При исходе воспалительной реакции отмечается лихенизация и пигментация кожи. Кожа становится восприимчивой к вторичной инфекции, вызываемой Staphylococcus aureusvirus Herpes simplex, contagious mollusk. This sometimes makes it difficult to diagnose this disease and requires a selection of treatment.

When determining the laboratory parameters, an increased level of histamine in plasma, an increase in the level of IgE, and peripheral eosinophilia are noted.

The morphological picture is characterized by non-specific intracellular edema with perivascular lymphocytic insufficiency.

The treatment of this disease consists in moisturizing the skin, using topical corticosteroids (dexamethasone in drops). The use of corticosteroids in ointments has several disadvantages. First, the ointment is extremely difficult to apply on a wet surface. Secondly, a significantly narrowed ear canal may require the introduction of turunda with ointment, which causes additional irritation. And finally, the patient cannot perform such procedures independently.

In the international recommendations can be found topical application of tacrolimus (Prograf, Astellas Pharma Europe BV, the Netherlands). It is an immunosuppressant that reduces the production of IL-4,5,8 and IgE. However, in our pharmaceutical market this drug is not available.

The accession of a secondary bacterial infection occurs quite often. The patient’s first complaint is itching, which naturally causes him to resort to the use of ear sticks or any other means. As a result, scratches and microtraumas appear, which become the entrance gate for a secondary infection. As a rule, a combination of infectious external otitis and atopic dermatitis is determined at the initial admission. In this case, the most optimal is the appointment of ear drops containing a broad-spectrum antibiotic and a corticosteroid. An example of such drops is polydex (Laboratories of BUSHARA-RECORDATI, France): 1 ml contains neomycin sulfate 10 mg (6.5 thousand U), polymyxin B sulfate 10 thousand U, dexamethasone sodium metasulfobenzoate 1 mg. The presence of two antibiotics in the preparation creates an advantage, since Usually we do not have accurate data on the spectral composition of the flora, which caused secondary inflammation, which leads to the need to use a drug with more extensive antibacterial activity. Neomycin is active against most gram-positive and gram-negative microorganisms that cause inflammatory diseases of the ear. Polymyxin B shows the greatest activity against gram-negative bacteria: E. coli, Shigella, Pseudomonas aeruginosa, Aerobacter aerogenes, Klebsiella, H. Influenzae. When the combination of these antibiotics significantly expands the range of antimicrobial activity of the drug.

There is also evidence of the mutual potentiation of the effect of polymyxin B and neomycin. So, the study in vitro G. Tempera et al. showed that when using two antibiotics, the minimum overwhelming and minimal bactericidal concentrations are reduced by 3–4 times with respect to standard pathogens of external otitis compared to monotherapy. Neomycin with polymyxin B is 5–6 times more effective against neomycin alone against the Pseudomonas aeruginosa. A corticosteroid, by virtue of its universal anti-inflammatory effect, affects the inflammation of the skin of atopic and infectious genesis.

Allergic Contact Dermatitis  is a true, delayed hypersensitivity reaction upon contact of a sensitized individual with an allergen. Contact allergens are formed during the creation of a complex of a substance molecule with skin protein.

The clinical manifestations of allergic contact dermatitis are redness, swelling, weeping, papules, vesicles, exudation, and crusts. At the completion of an exacerbation, lichenization occurs as a result of chronic inflammation, as well as pigmentation.

Cosmetic products, hair care products, hearing aids, and cell phones can cause allergic contact dermatitis. Sometimes an allergic contact reaction can occur on topical medications, such as neomycin and other aminoglycoside antibiotics (for example, tobramycin, gentamicin), some local anesthetics (benzocaine). Paradoxically, allergic contact dermatitis can develop when wearing gold products. The composition of gold jewelry includes sodium thiosulfate gold. In particularly sensitive people, it can accumulate in macrophages, which leads to dense lymphocytic infiltration and the formation of pseudolymphomas.

The first thing that needs to be done in the treatment of this disease is to determine and eliminate contact with the agent causing the allergic reaction. It is advisable, for example, to use hearing aids in a silicone case, to wear stainless steel earrings until complete epidermization. To reduce the reaction of inflammation apply compresses with chilled saline solution, local corticosteroids (dexamethasone in drops, with the interest of the auricle - in ointments). In animal experiments, it has been found that blocking IL-18, 12 successfully affects the treatment of allergic contact dermatitis. When attaching a secondary infection, the use of drops with antibiotics in combination with corticosteroids is also recommended. Optimal is the appointment of ear drops containing an antibiotic and a corticosteroid (for example, polydex). As with atopic dermatitis, the patient first complains of itching, which often resorts to the use of ear sticks, scratching the skin of the external auditory canal. At the initial admission is determined by a combination of infectious external otitis media and allergic manifestations. The corticosteroid in the composition of polydexes, as already mentioned above, having a universal anti-inflammatory effect, affects the inflammation of the skin of an allergic and infectious nature. In a double-blind, randomized study of R. Mösges et al. in comparative otitis media treatment groups using polymyxin B sulfate with gentamicin sulfate and the same drugs with dexamethasone inclusion, it was found that the inclusion of dexamethasone significantly reduces edema and reduces the severity of inflammatory events in acute otitis externa. A prospective, randomized study of M. Johnston showed that, in combination with careful toilet of the ear, the combination of neomycin sulfate with dexamethasone is more effective than antibiotic monotherapy in the treatment of otitis externa.

Recurrent polychondritis refers to autoimmune diseases and is a cell-mediated immune response to cartilage proteoglycans and the production of antibodies to the cartilage matrix, as well as native and denatured type II collagen. The outer ear is affected in 88% of cases. When this occurs, the destruction of the cartilage of the external auditory canal, which leads to conductive hearing loss. It is also possible violation of the anatomy of the inner ear, which leads to sensorineural hearing loss. For correct diagnosis, at least three of the following symptoms should be present: a) auricle chondrite, b) nasal chondrite, c) non-erosive seronegative inflammatory polyarthritis, d) respiratory chondritis, e) audio vestibular disorders.

Morphologically, when stained with hematoxylin and eosin, pink coloration, neutrophilic infiltration, then infiltration of cartilage and perichondral tissues are determined by neutrophils, eosinophils and lymphocytes, and eventually loss of cartilage matrix and fibrosis at early stages.

In the treatment of this disease, systemic corticosteroids, nonsteroidal anti-inflammatory drugs, cytostatics and immunosuppressants (dapsone, methotrexate, cyclosporine, cyclophosphamide, azathioprine) are used.

Seborrheic dermatitis  - This is a chronic inflammatory process. This disease affects up to 3% of the population. There is a family predisposition. Violation associated with the location of the sebaceous glands The main etiological agent is lipophilic yeast: Pityrosporum ovale and Pityrosporum orbiculare (also known as Malassezia furfur).

Skin lesion is bordered, but not delimited, does not protrude above the surface of the skin, is moderately erythematous. The lesion site may look powdered or coated with fat. Often affects the scalp area, face and ears. Emotional stress, drugs and vitamin B deficiency can be triggered. Parakeratosis, follicular spongiosis, and perifollicular lymphocytic infiltration are histologically observed.

Treatment is identical to treatment for lesions of the scalp. Various shampoos containing zinc pyrithione, tar, selenium sulfide, gel 2% ketoconazole are used. Compresses with warm saline and topical corticosteroids, ketoconazole cream are also used.

Infectious diseases of the outer ear

External ear infections include external otitis, otomycosis (fungal otitis externa), eczematous external otitis, a furuncle of the external auditory canal.

Infectious external otitis - This is dermatitis, most often caused by the bacterial agent Pseudomonas aeruginosa (characterized by green-yellow discharge) and Staphylococcus. Among the clinical manifestations of the most important are erythema, swelling of the skin of the external auditory canal. The severity of these manifestations may be different.

The treatment of this disease consists in the active elimination of local infectious inflammation of the skin, in the application of an optimal composition of ear drops containing two antibiotics and a corticosteroid (for example, polydex).

The use of ointments has several disadvantages. Each subsequent application of ointment requires careful toilet of the external auditory canal, which is impossible without the participation of a doctor. Ointment is extremely difficult to apply to the entire surface of the constricted (due to inflammation) of the external auditory canal. The introduction of turundum (which are, in fact, foreign bodies) with both ointments and solutions may cause additional trauma. That is why the introduction of polydex drops is optimal. It is possible to use other drops (tsipromed, normax, otofa, anauran). But these drops have certain disadvantages. For example, cipromed drops contain, in addition to ciprofloxacin (it has limitations on age), propylene glycol, which leads to loosening (puffiness) of the skin, which, with external otitis, can significantly mask the clinical picture of the disease. In addition, against the background of inflamed skin, such an undesirable phenomenon as burning, reduces compliance with this drug. Normaks is better tolerated, but also has age restrictions. Anauran does not contain a corticosteroid, the meaning of which we have already spoken.

The R. Schwartz multicenter study demonstrated the same efficacy of polydex and ofloxacin in quickly resolving the painful symptoms of otitis externa in children. Similar results regarding the relief of pain in children, adolescents and adults were obtained in another multicenter randomized study - M. Drenobl - for ciprofloxacin. However, it must be remembered that the instructions for use of ear drops with ofloxacin and other fluoroquinolones indicated a restriction on the use of the drug to a certain age. At the same time, the potential ototoxicity of polydex is absolutely impossible with external otitis, and this drug has no age limit. A study by J. Dohar demonstrated the same efficacy of a mixture of polymyxin B + neomycin + hydrocortisone and ciprofloxacin + dexamethasone against S.aureus in 70 patients with otitis externa. On the other hand, in 481 patients with otitis externa caused by pyocyanic stick, the latter treatment regimen was somewhat more effective. These data suggest that it may make sense to use second-generation fluoroquinolones as reserve drugs for the treatment of resistant infections.

Otomycosis  - fungal infection of the external auditory canal, most often caused by Aspergillus  (42-91.5%). Of them: A. niger - 51-79,2%, A. Flavus - 11,5-29,1%, A. terreus - 6-14,6%, A. nidulans  - about 8%, A. candidus - 1-7,4%, A. fumigatus  - about 2.64%.

Most fungi are opportunistic saprophytes. Their carriage remains asymptomatic until, for whatever reason, there is a decrease in the immune status of the host organism. The following conditions may contribute to otomycosis: immunosuppressive therapy, diabetes mellitus, lymphoproliferative diseases, HIV infection, secondary immunodeficiencies, burns, irrational local therapy of acute or recurrent otitis externa antibiotics. Also, the cause may be various skin diseases: seborrheic and atopic eczema, contact dermatitis, psoriasis, eczema of the external auditory canal. Factors predisposing to the development of a fungal infection may be a narrowing of the external auditory canal, moisture in the ear canal, concomitant inflammation, drying of the stratum corneum of the epidermis, lack of earwax.

When viewed under a microscope, white deposits covered with black spheres or multiple dry scales can be detected. There is erythema of varying severity, swelling of the skin of the external auditory canal. Itching is often present.

For the treatment of this disease using local antimycotic drugs. Prescribing systemic antifungal drugs is not required, except for generalized forms, which often develop in patients with significant immunosuppression, such as HIV infection and the like.

Boils of the ear canal  - This is a staphylococcal infection of the hair follicle of the external auditory canal. Inflammation occurs in the lateral part of the cartilaginous part of the external auditory canal and may go into an abscess or imitate diffuse inflammation of the external auditory canal.

In the initial stages, drops are used that have a dehydrating effect, i.e. reduce swelling and infiltration of the skin, thereby reducing pain (for example, otipax). Locally drops with an antibiotic are not very effective, since through the skin almost do not penetrate. When abscessing a boil, an abscess dissection is shown. It is after opening that it is advisable to use drops of polydex containing an antibiotic and a corticosteroid.

Differential diagnosis of diseases of the external auditory canal is quite complex and includes diseases caused by bacterial flora, viruses, fungi, allergens. These diseases can be both benign and malignant. The latter includes external necrotic otitis. With its course and manifestations, it is often masked as diffuse external otitis, chronic suppurative otitis media, mastoiditis, sigmoid sinus thrombosis and tumor processes and can be fatal. Patients with a history of long-term, insulin-dependent diabetes mellitus, or patients receiving immunosuppressive therapy for a long time are usually susceptible to this disease. The most frequent pathogen is Pseudomonas aeruginosahowever, other bacteria, such as staphylococcus, are also detected. The causative agent is not only bacterial monoinfection, but also often a fungal infection accompanying it.

Necrotizing or "malignant" otitis was first described by P.E. Meltzer and G. Kelemen in 1959. This disease spreads through the vascular and soft tissue surfaces and penetrates to the structures of the base of the skull. In the latter stages of the disease, various types of cranial nerve neuropathies and septic thromboembolic complications can be observed. The main principles of management of patients with necrotic otitis media are early diagnosis, subsequent prolonged antibiotic therapy and limited surgical treatment. Treatment with hyperbaric oxygenation sessions is also recommended, which is believed to contribute to faster healing and elimination of inflammatory events. In the first place in the treatment of this disease is the intravenous fluoroquinolone.

Thus, drops of polydex containing neomycin sulfate and polymyxin B sulfate in combination with dexamethasone have been used to treat many diseases of the external ear for a long time. The reason for such a long life of the drug in the successfully selected formula of its components. Above, we talked about the synergistic effect of two antibiotics and the importance of adding dexamethasone. In addition, with respect to polydexes, clinical studies have been carried out repeatedly. Thus, the antibacterial activity of polydex drops was evaluated in comparison with separately taken neomycin and polymyxin B, as well as with a combination of these drugs in order to identify a possible synergistic effect in relation to the most frequently encountered agents of ear infections. Used the method of serial dilution and the method of disks. The results showed the absence of any antagonism between the two components of antibiotics - neomycin sulfate and polymyxin B with respect to the pathogenic cultures studied. Since the components of antibiotics complemented each other, the effect of the drug had a wide spectrum of antibacterial activity against weakly sensitive and resistant strains, which was repeatedly confirmed by clinical studies later.

Another study concerned the determination of the toxicity of droplets and their components, the harmlessness of the drops and their local tolerance. The results were obtained in experiments on rats and rabbits. Macroscopic studies and autopsies did not reveal any general toxic changes associated with the use of polydex ear drops.

The results of a clinical study by H. Muller, which included 125 patients with various ear pathologies (otitis externa, eczema of the external auditory canal, non-perforated and perforative forms of acute otitis media, the postoperative period after aural operations, both sanitizing, and tympanoplastic and stapedoplastic), indicate marked anti-inflammatory effect of polydex ear drops in case of infectious pathology of the external auditory canal in 87% of cases, and in allergic lesions of the skin of the external auditory canal in 81% of cases. Unfortunately, it is impossible to take into account the results of treatment of patients with acute otitis media without perforation (100% result), since It is known that in 80% of cases acute otitis media can resolve spontaneously. The results of treatment of patients with perforated acute otitis media showed 81% success. However, taking into account the ototoxicity of neomycin, we do not consider it possible to introduce it in the presence of perforation and sound hearing, which, by the way, is indicated in the instructions for the preparation. With regard to the treatment of exacerbations of chronic otitis media, this study does not detail the degree of closeness of the tympanic cavity, and therefore there is no certainty that this drug can be used because of the ototoxicity of one of the components.

At the same time, in the postoperative management of patients after otic operations, the drug has proven to be effective and safe. A study of D. Poetker, which included 306 patients, showed that the use of drops with neomycin and polymyxin B after the shunt was installed reliably reduced the incidence of otorrhea. When comparing this mixture with ofloxacin, no statistically significant differences were found.

Clinical trials of polydex drops were also conducted in Russia. Thus, it was shown that when using the drug in patients with diffuse otitis externa, furuncle of the external auditory canal infected with eczema of the external auditory canal, acute otitis media in the non-perforative stage, by the 3rd day of treatment, all patients reliably decreased pain and congestion, as well as hyperemia and infiltration of the skin of the ear canal. The study, which included 25 children with external diffuse otitis, showed that with the use of Polydex ear drops, 96% of the patients underwent recovery on the 8-10th day, repeated seeding on the growth flora was not given. In conclusion, we would like to emphasize once again that Polydex ear drops are an effective and safe means of treating many diseases of the external ear.

Literature:
1 - Tempera G., Mangiafico A. et al. In vitro evaluation of the synergistic activ- ity of neomycin-polymyxin B is responsible for otitis externa. Int J Immunopathol Pharmacol 2009; 22: 2: 299-302.
  2 - Mösges R., Schröder T., Baues C.M., Sahin K. Dexamethasone phosphate bacterial otitis externa. Curr Med Res Opin 2008; 24: 8: 2339-2347. Epub 2008 Jul 4.
  3 — Johnston M.N., Flook, E.P., Mehta D., Morocore S.Carcous acidic acidic acid versus acidic acid and neonomycinoscale acid. Clin Otolaryngol 2006; 31: 6: 504-507.
  4 - Schwartz R.H. Once-daily ofloxacin otic solution of sulfate / polymyxin sulfate / hydrocortisone otic suspension: a multicenter, randomized, enter. Curr Med Res Opin 2006; 22: 9: 1725-1736.
  5 - Drehobl M., Guerrero J.L. et al. Comparison of efficacy and safety of cipro-floxacin otic solution 0.2% versus polymyxin B-neomycin-hydrocortisone in the treatment of acute diffuse otitis externa. Curr Med Res Opin 2008; 24: 12: 3531-3542.
  6 - Dohar J.E., Roland P. et al. Differences in bacteriologic treatment failures between ciprofloxacin / dexamethasone and neomycin / polymyxin B / hydrocortisone: results of a combined analysis. Curr Med Res Opin 2009; 25: 2: 287-291.
  7 - Meltzer P.E., Kelemen G. Pyocutaneous osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope 1959; 169: 1300-1316.
  8 - Balea T. Polydexa ear drops: a toxicologic and pharmacologic study (anti-inflammatory activity). L.A.R.A.C. Research & Control Laboratories. Paris 1971.
  9 - Muller H. Polydexa ear drops: report of a clinical trial. Paris 1972.
  10 - Poetker D.M., Lindstrom D.R. et al. Ofloxacin otic drops vs neomycin-pol- ymyxin B otic drops as a prophylaxis against early postoperative tympanostomy tube otorrhea. Arch Otolaryngol Head Neck Surg 2006; 132: 12: 1294-1298.
  11 - Luchikhin LA, Magomedov M.M., Gorbachev V.A. The effectiveness of otof and polydex ear drops in the treatment of inflammatory diseases of the ear Vestn otorinolar 1999; 4: 130-132.
  12 - G. Balyasinskaya Ear drops otofa and polydex in the treatment of children with acute otitis media and external otitis. Vestn Otorinolar 2003; 3: 53-54.

Otitis (from the Greek. Ous, otos - ear) - is an inflammation of the ear. There is otitis externa (inflammation of the external auditory canal and auricle), (inflammation of the auditory tube and the tympanic cavity) and internal otitis, or labyrinthitis (see).

External otitis. Two forms are observed - limited (external auditory canal) and diffuse. Limited external otitis  develops as a result of the penetration of the infection into the hair sacs and sebaceous glands of the skin of the fibro-cartilaginous part of the external auditory canal. Sometimes the process extends to the parotid tissue. The development of boils contribute to minor injuries (for example, during manipulations in the external auditory canal), especially in persons suffering from purulent inflammation. Symptoms: severe pain in the ear, extending to the head, teeth, neck. The pain is exacerbated by chewing, pressing on the trestle, stifling the auricle. If the lumen of the external auditory canal is closed with a boil or pus, it decreases. On examination (sometimes directly at the entrance to the external auditory meatus) a furuncle is visible (see). Treatment: tampons moistened with boer liquid or boric alcohol are injected into the external auditory canal; warming compresses on the auricle, lamp Sollux,. Sometimes produce. In case of pronounced general phenomena, antibiotics are prescribed. In prolonged cases, autohemotherapy is used (see).



External otitis is inflammation of the external auditory canal. This disease is not very serious and painful, like inflammation of the middle ear. In some cases, it goes away on its own, without any treatment, sometimes it is necessary to help a little with recovery.

External otitis is of two types:

1. Limited - in this case, inflammation occurs due to the formed abscess inside the ear canal. In this case, the person experiences pain, which disappears after the opening of the abscess and the release of pus from it.
2. Diffuse - in contrast to the limited otitis, the inflammatory process captures the entire auditory canal, and not just a small surface with an infection site located on it.

Why does external otitis appear?

In the case of limited otitis, the cause is inflammation of the hair follicle, as a result of which the boil develops. This process is no different from the development of a boil on any other part of the body (for example, see).

The appearance of diffuse otitis guilty:

• staphylococcus;
• streptococci;
• allergic reaction;
• fungal infection.

There are also several factors contributing to the development of the inflammatory process in the external auditory canal, namely:

1. Sores and scratches in the ear canal. They appear due to mechanical damage to the epithelium (when trying to clean the ear with some hard objects, such as a toothpick or a match) or eczema, causing peeling of the skin in the ear and the appearance of ulcers.
2. Prolonged presence of water in the ear canal. This happens in swimmers or in people with sulfur plugs in the ears that interfere with the normal outflow of fluid after swimming. The skin in the ear canal has a protective layer that prevents the development of infection. However, if water is constantly in the ear, this layer disappears and beneficial conditions for the pathogenic microflora appear.

Manifestations of otitis externa

Restricted and diffuse otitis have their own symptoms, but should consider the general manifestations of the disease, which can be observed with any type of otitis:

1. Eternal pain in the ear.
2. Increased pain when trying to pull back the auricle or press on the cartilage near the ear canal (it is called the tragus).
3. Swollen lymph nodes near the ear.
4. Swelling of the ear canal.
5. Hearing impairment. Typically, this symptom occurs with otitis media, if the boil closes the ear canal and this reduces hearing.
6. Itching in the auditory canal. As a rule, this phenomenon is most often observed with otitis of fungal origin. Itching can also be caused by eczema.

With limited otitis, there are specific signs:

1. At the onset of the disease, the pain is pulsating. At this time the ripening of the abscess occurs. The pain is especially strong when chewing, when trying to delay the auricle or to press on the tragus.
2. Puffiness and reddening are observed only on one side of the external auditory canal, in the place of furuncle maturation.

With diffuse otitis, the pain is not as strong as with limited, and it is often replaced by itching. The auditory canal is inflamed and swollen all over, and not just on one side. Since the disease, in most cases, causes an infection, it can easily spread to the eardrum. In this case, the person observed discharge from the ear canal and hearing loss.

Treatment of the disease

It used to be that with any pain in the ear, the best remedy was cotton swabs moistened with boric alcohol. People thought that by such warming they contribute to a speedy recovery. Recently, however, doctors forbid the use of boric alcohol for the treatment of otitis, and this is not surprising. After causing the alcohol solution to the inflamed surface, a person causes tissue burn, and it is a favorable factor for the appearance of severe irritation. Therefore, completely different methods of treatment of otitis are used now.

For different types of external otitis, there are different methods of treatment. To accelerate the recovery of a patient with otitis media, you will need:

1. Perform surgery to open the boil. After opening, the pus comes out, and the patient immediately begins to experience a significant improvement in the condition and a reduction in earache.
2.   . This will contribute to the rapid healing of the wound left after the boil.

Sometimes the patient has several boils. Such a phenomenon is no longer talking about the usual inflammation of the hair follicle, but about the presence of the pathogenic microflora in human blood. In this case, antibiotic treatment is prescribed not only topically, but also in the form of injections or tablets.

In the diffuse form, no operations are required. Here there is its own treatment regimen, namely:

1. General antibiotic treatment. What kind of drugs to take, the doctor must determine, since it depends on the causative agent of the disease.
2. Antiallergic medicines. They are necessary to relieve edema of the external auditory canal.
3. Antifungal drugs, if otitis is caused by a fungus. Again, the specialist must identify the origin of the disease. It is not recommended to draw any conclusions.
4. Non-hormonal anti-inflammatory drugs that not only relieve the inflammatory process quickly, but also reduce the pain in the ear. Usually prescribed Nurofen or Diclofenac.
5. Strengthening immunity with the help of multivitamins.
6. Ear instillation with antibiotic preparations. This will speed recovery. Sometimes doctors prescribe and antibacterial ointment. They are used with cotton swabs placed in the ear canal. Instead of antibacterial often use hormonal ointment.

With this treatment, otitis media is much faster than if no action is taken. You also need to know that the lack of treatment can cause the spread of infection in the middle ear, and this is a more serious disease that has a severe course and causes serious complications.

Pain in the ear when you press the trestle can occur for various reasons. Most often, the painful sensations are the result of exposure to infectious agents. This symptom should not be ignored, since the consequences can be quite serious.

Trestle is the protrusion on the external region of the auricle, consisting mainly of cartilage tissue. Near the earlobe there is an anticeragonum, which is a paired organ of the tragus.

The tragus is the most important element of the auditory system, since it depends on it the normal perception of sounds coming from the source that is behind the person. Thanks to this body, a person has the ability to determine the direction of sound waves.

  The cause of pain in the area of ​​the tragus

The tragus is on the outside of the ear and the person can easily touch it. Sometimes such manipulations cause discomfort or pain. Why does the ear trestle hurt when pressed? The cause of this pathological phenomenon most often appears. Such a disorder is characterized by the development of inflammation in the outer ear.

There are limited and. The development of limited inflammation occurs as a result of the occurrence of a pustule inside the ear canal.

The course of the disease is accompanied by severe pain. The pain subsides after the integrity of the abscess and violation of its contents outside.

Diffuse otitis media develops when exposed to pathogenic elements: staphylococci, streptococci, fungi. Also, the violation may be due to a hypersensitivity reaction of the organism. In diffuse inflammation, the entire ear cavity and, consequently, the tragus are involved in the pathological process.

If the ear trestle is swollen and sore, the cause may be mechanical damage to the auricle. Quite often, cleaning the ear canal with unsuitable objects leads to a violation of the integrity of the epithelium. It is also possible the development of eczema, which is characterized by the formation of sores.

If your ear hurts when you press the trestle, it is possible that water is in the ear canal. This phenomenon is often observed in swimmers. Water washes away a layer of epithelium, which acts as a barrier against pathogenic microflora. As a result, pathogens have the ability to actively reproduce.

Both forms of inflammation of the outer ear have similar symptoms and are manifested by the following symptoms:

• pain on any contact with the organ of hearing;
• intense itching in the ear (most often observed with fungal lesions and eczema);
• hearing loss (this symptom is more characteristic of a limited form of inflammation, in which the abscess overlaps the Eustachian tube);
• hyperemia of the skin in the ear;
• an increase in the size of the nearby lymph nodes.

With limited otitis, the pain is pulsating in nature and increases as the follicle matures. When chewing, pressing on the trestle painful sensations become more intense. There is one-sided swelling and redness of the skin - from the localization of the abscess.

Diffuse inflammation is characterized by less intense pain. In this form of pathology, itching and full swelling of the Eustachian tube are more often noted.

Since in most cases the cause of the disease is an infection, there is a risk of the inflammatory process spreading to the eardrum. In such a situation, the hearing is noticeably disturbed and exudate is released from the ear cavity.

Not so long ago, boric alcohol was considered to be one of the most effective medicines for treating a sick ear. In this tool, a cotton turunda was moistened and inserted into the ear canal. Proponents of this method of treatment claimed that warming promotes healing.

Modern medicine offers more effective and safer treatments.

What to do if ear aches when pressing on the tragus? Therapeutic measures are assigned based on the type and stage of development of the pathological process. With limited otitis, an abscess is opened (the procedure is carried out exclusively by a specialist in a hospital), then antibacterial drops are used. During surgery, the auricle is cleansed of purulent masses, as a result, the painful sensations disappear and the general condition of the patient improves. The antibiotic, in turn, will contribute to the speedy healing of the wound and will prevent the development of a secondary infection.

There are cases when several boils develop in the ear cavity. This indicates the presence of pathogens in the blood. In such situations, not only local, but also systemic antibacterial agents are used.

If the ear trestle hurts due to a diffuse inflammatory process, the treatment is carried out using the following drugs:

• antibiotics of systemic action. Before using these medications, it is imperative to determine the pathogen and its sensitivity to antibiotics.
• antifungal drugs. Means of this group are prescribed for the fungal nature of the disease. The medicine is prescribed taking into account the type of fungi.
• antihistamines. These drugs allow you to remove the eustachian tube edema.
• nonsteroidal anti-inflammatory drugs. Such drugs allow you to quickly remove the pain and stop the further development of the pathological process.
• multivitamin complexes to strengthen the body's defenses.
• ear drops with antibacterial effect. Local antibiotic use allows you to quickly eliminate the symptoms of the violation. Alternatively, drops can be applied ointment with a similar effect, which are introduced into the ear cavity with cotton wool.

With the timely treatment of otitis of the outer ear is well treated and does not lead to complications.

To speed up the healing process, treatment of the disease should be comprehensive. Many experts, in addition to the main treatment, recommend massaging the sore ear:

• pull the ear up, down, sideways, make circular motions;
• press your palms to your ear and sharply remove them;
• massage the trestle itself;
• cover the ear with your palm and knock the fingers of the other hand on the back of the head;
• rub his ear with energetic movements.

Regular execution of such a massage will not only allow you to quickly cope with the ear disease, but also has a beneficial effect on the state of the whole organism.

Otitis externa includes a number of inflammatory diseases of the auricle and the skin of the ear canal.

  Varieties of otitis externa

Due to the fact that the ear canal and the ear shell itself have a covering of the epidermis, respectively, the same inflammatory reactions take place there, which can occur in other areas of the skin. Inflammatory processes can be expressed in the form of eczema, dermatitis. As a result of inflammatory processes, a furuncle may be formed, as well as erysipelas. The skin often has a rash, which is caused by infections.

  Eczema

Quite often, the ear can suffer from such a disease as eczema. Eczema usually occurs on the surface of the skin at the ear canal. Eczema also occurs behind the auricle. Often, eczema can occur primarily outside, and then go inside the ear. The most severe form of eczema is that which penetrates deep into the ear canal. This can lead to inflammation of the eardrum, and cause deafness, as the ear canal becomes narrower.

Eczema in acute form affects the entire area of ​​the outer ear, while there is reddening of the skin and the ear canal becomes narrow. There is a feeling of severe itching, accompanied by a weak pain. The pain is not as strong compared with the sensations in the inflamed ear canal. Constant sensation of itching can lead to abrasions from scratching the ear. From this, the skin becomes wet, after which yellow crusts form, thus, the secret dries up. Often, inflammatory processes may be accompanied by the appearance of a furuncle or otitis.

  Perichondritis

The inflammatory process in perichondritis extends not only on the skin, but also captures the perichondrium, and even cartilage. Infection occurs by spreading the boil, which may be in the ear canal. Bruising can also affect infection. Swelling or swelling may form as a result of spreading the infection, which contributes to an increase in the auricle.

  Otgematoma

Otgematoma occurs as a result of injury to the ear. Auricle is affected. A blunt blow with a heavy object can cause an auricular hematoma. Also, permanent mechanical effects on the ear cause a hematoma. This disease occurs in people involved in wrestling or other traumatic sport. Otgematoma causes deformation of the auricle. People have long suffered from this disease, as indicated by ancient sculptures.

In the modern world of hematoma, a common disease of the auricle. Quite often, boxers suffer from this disease. Often the hematoma occurs in people who are deprived of movement, that is, paralyzed, and for a long time are without movement. Constant pressure of the pillow on the auricle can cause a hematoma. The essence of the disease is hemorrhage into the cavity between the perichondrium and cartilage.

  Boils of the ear canal

The main cause of boils in the outer ear can be called staphylococcus in the scalp, by scratching, using various things to comb the ear, such as hairpins, matches. The main symptom of the onset of the disease can be called a headache, causing insomnia or restless sleep at night.

The severity of headaches depends on how strong the pressure is on the pericarpus, which has tight contact with the skin, in which there are sensitive receptors. The greatest feeling of pain occurs when you press on the auricle. Depending on the location of the boil, pain occurs in different places. The pain may be worse when talking and when chewing. Often the swelling spreads to the surrounding tissue, especially to the back of the shell, and the swelling can even spread to the mastoid and eyelids.

  Otomycosis

The external auditory meatus is susceptible to fungal infections, but, unfortunately, this inflammatory process is not always detected on time. The peculiarity of the fungal infection can be called the fact that if it is formed in the external ear, it is not immediately recognized. When the fungus gets inside - the first symptoms appear. Signs of a fungal infection are expressed by itching, flaking of the upper skin. The auditory canal may slightly narrow, there is a slight pain.

Occurrence of a fungal infection can be caused by being in damp rooms, too high air humidity. Antibiotics can also cause fungal infections in the outer ear.

  Treatment of otitis externa

In our medical center, experienced otorhinolaryngologists provide fast recognition of any type of external otitis. After treatment, according to the individual scheme, taking into account the severity of the inflammatory process, a quick recovery occurs, and the disease relapses are prevented.