Infectious diseases of the auricle: etiology, diagnosis, treatment

Infectious diseases of the auricle are localized inflammation of the skin and underlying tissues (hair follicles, subcutaneous fatty tissue, muscles, cartilage with cartilage).

Classification

Infections of the ear drum:

• Auricular Dew;
• Perichondritis of the auricle;
• Herpetic infection of the ear drum;
• Auricular abscess.

Etiology

The etiologic factor in the development of outer ear infection is a mixed flora (bacterial, viral, fungal).

The presence of predisposing factors such as:

• Traumatization and maceration of the skin;
• Reduction of local acidity;
• Decrease in the general reactivity of the body;
• Presence of extra-organ pathology (metabolic disorders), including immunodeficiency states.

Among the bacterial pathogens, the predominant ones are:

• Staphylococci (St.aureus, St.epidermidis, St.saprophyticus);
• Streptococci (β-hemolytic group A);
• Escherichia coli.

The most severe infection is caused by:

• Pseudomonas aeruginosa (Pseudomonas aeruginosa);
• Protea (Proteus mirabilis);
• Klebsiella.

Herpes infection is caused by herpes simplex virus type 1 (Herpes simplex) and type 3 (Varicella zoster).

Anatomy

Auricular dew

Ear rust (Latin erysipelas) is an acute infectious disease of the skin and subcutaneous fatty tissue of the auricle (including the earlobe).

The affected area more often extends beyond the auricle, extends to the neck, temporal and cheek regions, is demarcated from healthy tissue by a demarcation line, the skin is hyperemic, infiltrated, glossy, the auricle is sharply edematous, nearby lymph nodes are involved with the formation of regional lymphadenitis. In some cases, blisters with serous or serous-hemorrhagic contents may form on the skin, which subsequently open and crust over.

Perichondritis of the auricle.

Perichondritis of the auricle – diffuse inflammation of the auricle cartilage, the skin is involved, the earlobe remains intact.

As a rule, this pathology develops when infection enters through damaged skin, or due to suppuration of undrained hematoma or seroma of the auricle after trauma. In some cases, inflammation may develop as a complication of otitis externa. Locally, hyperemia, heterogeneous infiltration of the auricle is determined, the process does not spread beyond it and to the earlobe.

Auricular abscess

Auricular abscess is a delimited accumulation of purulent contents between the cartilage and cartilage of the auricle.

It develops in the absence or inadequate treatment of perichondritis, infection of auricular hematoma, as well as in the presence of immunodeficiency conditions. On the background of hyperemic and edematous auricle, a voluminous cavity filled with purulent content is localized, the skin is tense, fluctuation can be detected.

Herpetic infection of the ear drum

Herpetic ear infection is a recurrent skin lesion with herpes viruses type 1 or 3.

After infection, the herpes virus remains in the nerve ganglia in a latent phase (remission period). When exposed to a number of factors (weakened immunity, stress, UV radiation, progression of chronic diseases, etc.) the virus becomes active and spreads along the course of nerve fibers with characteristic manifestations on the skin (exacerbation phase). On the background of erythematous swollen skin appear numerous vesicles, which open on 2-3 days and covered with crusts, then the crusts fall off, there is complete healing. Scratching the vesicles or crusts may cause bacterial infection, which complicates and prolongs the course of the disease.

When affected by HPV type 1 (Herpes simplex), rashes spread chaotically without a clear localization. When affected by herpes virus type 3 (Varicella zoster), the disease initially occurs as chickenpox, more often in childhood, and then, after a long phase of remission and reactivation of the virus, shingles (Herpes zoster oticus) occurs. A large area of skin in the projection of a nerve (dermatome) is affected, most often the facial nerve, and its paresis or paralysis occurs; when the patellar ganglion is affected, Ramsey-Hunt syndrome develops; in rare cases, the process may spread to the trigeminal or vestibulo-cochlear nerves.

In addition to the skin of the auricle and external ear canal, the process may spread along the facial nerve to the tympanic membrane. In severe cases, the process involves the CNS with the development of meningitis, encephalitis. In the presence of immunodeficiency states, the herpes virus spreads everywhere with the development of generalized infection, is difficult to treat, often relapses.

Clinical manifestations of ear infections

For rusty inflammation of the auricle is characterized by local changes and the presence of pronounced general intoxication. Against the background of an increase in body temperature to febrile values, there is weakness, headache, there may be vomiting. Locally, pronounced hyperemia and swelling of the auricle, including its lobe, in some cases the process spreads to the surrounding areas (neck, behind the ear and cheek areas), the lesion area is clearly delineated from healthy tissues. On palpation there is a sharp soreness, the skin is hot to the touch, glossy. Regional lymph nodes are enlarged: painful, elastic, not adherent to the surrounding tissues. Perichondritis of the auricle proceeds with characteristic general changes, the skin becomes hyperemic and irregularly edematous in the projection of the cartilage of the auricle, the process never spreads to the earlobe and adjacent areas.

The auricle is sharply painful, the pain is aching, attack-like, the behind-the-ear region is not changed. General intoxication is not characteristic, there may be subfebrile in rare cases. In the absence of adequate treatment, the process may spread deeper with the development of an abscess of the auricle. As an outcome, even with adequate treatment, a cauliflower-like scar deformity is possible.

Abscess of the auricle, as mentioned above, develops against the background of previous traumatization of the ear. It is characterized by tension, soreness and change in the shape of the auricle, more often in the triangular and navicular fossa, accompanied by symptoms of general intoxication (weakness, increased body temperature, chills). The cavity with purulent contents is surrounded by a capsule, swells, fluctuates on palpation, may be so large that the lumen of the external auditory canal is not visible. In the absence of treatment, it may open on its own on the 3-4th day with the discharge of abundant purulent discharge.

Herpetic infection caused by HPV type 1 is manifested by local changes in the affected area. In exacerbation, on the background of hyperemic skin there are abundant vesicular rashes, which are accompanied by severe itching, painful manifestations are not characteristic. On 2-3 days vesicles open with the formation of erosions, which are then covered with crusts, on 5-7 days they fall off and the skin heals. General manifestations are not characteristic, rarely may be observed subfebrile a few days before the appearance of rashes, headache. This form of herpetic infection is prone to frequent recurrences.

Shingles caused by Varicella zoster has some differences in the clinical picture. As mentioned earlier, it is the second phase of the disease, which occurs after chickenpox, more often occurs in the elderly and immunocompromised individuals. In exacerbation, at the beginning of the disease, is characterized by pronounced itching, burning and throbbing sharp pain at the site of future rashes, there may also be fever to febrile values, chills, headache. Local changes appear on the 2-3 day, on the background of hyperemic skin vesicles are formed, spreading along the course of the affected nerve, corresponding to a certain dermatome, which can merge, the process is always unilateral, sometimes affecting several adjacent dermatomes. Severe itching and marked soreness do not subside, in some cases there is anxiety and insomnia, patients may scratch the elements of the rash to hemorrhagic crusts, often joined bacterial infection. On 5-7 days, the vesicles open, with the formation of erosions, which are then covered with crusts and after a few days fall off, in this place may remain areas of depigmentation. Shingles is characterized by postherpetic neuralgia, in which painful sensations along the affected nerve persist for several months, in rare cases – several years.

Diagnosis

To make a diagnosis, it is necessary to clarify the history of the disease and perform an examination of the affected area, otoscopy.

From the clinical and laboratory indicators used the study of general and biochemical blood tests (assess the level of inflammation, glycemia), in the presence of detachment perform bacteriological culture to determine the causative agent and determine sensitivity to drugs.

The viral infection is determined by PCR, ELISA or serologic analysis. In case of complications, CT and MRI scans are performed; additionally, blood culture for sterility and lumbar puncture may be ordered.

Treatment of ear infections

The treatment of ear infections (with the exception of herpetic infection) is dominated by the administration of systemic antibiotic therapy, either orally or parenterally, at the discretion of the treating physician.

The drugs of choice are penicillin antibiotics, may be prescribed in combination with fluoroquinolones, according to the results of microbiological studies, treatment correction is carried out.

Locally treat the affected area with drying antiseptic preparations. Abscess of the auricle should be opened, evacuate the purulent contents and install drainage, then an aseptic dressing is applied and daily dressings are performed until the cessation of pathological discharge. During the recovery period, regenerating and wound-healing drugs are used.

Antiviral drugs such as acyclovir, valacyclovir and famciclovir (the drug of choice) are used to treat herpetic infection. Symptomatically prescribe antihistamines, NSAIDs, infusion therapy, in severe cases – glucocorticosteroid drugs. Antiseptic drying solutions are used topically to treat the affected area.

To control pain syndrome, including postherpetic neuralgia, metamizole, gabapentin, pregabalin, tricyclic antidepressants, in severe cases opioid analgesics (tramadol, morphine) are used.