labyrinthitis

labyrinthitis

Labyrinthitis is a group of inflammatory diseases of the inner ear, characterized by limited or diffuse damage to the peripheral parts of the auditory and vestibular testers.

Etiology

• • All types of microbial flora found in the middle ear cavity in its acute and chronic purulent inflammation
  • Weakening of the body’s reactivity.

Pathogenesis

• • In acute otitis media, toxins enter the inner ear through the windows of the labyrinth – changes develop according to the type of diffuse serous labyrinthitis (in the future it can turn into acute purulent labyrinthitis); with a rapid flow, the membranous labyrinth is quickly destroyed and all neuroepithelial formations of the inner ear die
  • In chronic purulent otitis with caries or cholesteatoma, a fistula is formed in the bone capsule of the labyrinth (most often in the ampulla of the lateral semicircular canal, less often in the region of the promontory of the tympanic cavity and the base of the stirrup)
  • Fistulas can be single or multiple, closed by a protective granulation shaft, therefore such labyrinths are called limited
  • With a favorable course, the granulation shaft can turn into bone tissue, with an unfavorable course, chronic diffuse purulent labyrinthitis develops, accompanied by the death of nerve formations, which occurs more slowly than in an acute process.

Classification

• • According to the etiological factor:
  • Non-specific
  • Specific (tuberculous, syphilitic)
  • By pathogenesis:
  • Tympanogenic (otogenic)
  • Meningogenic
  • Hematogenous _
  • According to the course and expression of clinical manifestations:
  • Acute
  • Chronic (obvious, latent)
  • According to the length of the inflammatory process:
  • Limited
  • diffuse
  • According to pathomorphological characteristics:
  • Serous
  • Purulent
  • Necrotic.

Clinical picture

• • Symptoms of hearing loss
  • Symptoms of damage to the vestibular tester
  • With serous labyrinthitis – mixed type hearing loss, mainly with damage to the sound-receiving apparatus, irritation of the vestibular apparatus or inhibition of vestibular function
  • In acute diffuse purulent labyrinthitis, pronounced symptoms of acute vestibular dysfunction in the form of systemic dizziness, imbalance, accompanied by sudden autonomic disorders and spontaneous nystagmus. The complete destruction of the receptor endings of the auditory and vestibular testers quickly begins. The likelihood of developing internal complications (meningitis, cerebellar abscess) is high
  • With limited labyrinthitis, the main symptom is fistula syndrome (appearance of systemic dizziness, pressor nystagmus during the toilet of the external auditory canal or pressure on the tragus).

Treatment:

Diet. Restriction in the diet of foods rich in sodium (restriction of salt, the use of salt-free bread, salt substitutes -KS1, MH4S1). Conservative treatment – antibacterial, dehydration, detoxification agents. Surgery

• • Elimination of the focus in the middle ear
  • performing unloading operations such as antromastoidotomy or radical sanitizing surgery
  • The need for surgical intervention in the labyrinth almost never arises at present, with the exception of sequestration of the labyrinth and labyrinthogenic abscess of the cerebellum.

Forecast

• • After purulent labyrinthitis, persistent complete deafness traditionally remains with loss of function of the vestibular apparatus
  • After serous labyrinthitis, auditory and vestibular functions are preserved.

Prevention – timely diagnosis and rational treatment of purulent diseases of the middle ear. also Otitis media acute, Otitis media purulent chronic ICD

• H83.0 Labyrinthitis
• H83.1 Labyrinth fistula