What is the structure of the human inner ear and its functions? Labyrinthitis (internal otitis). Causes, symptoms, signs, diagnosis and treatment of pathology

Symptoms and treatment of internal otitis

Internal otitis is called inflammation of the inner ear area (labyrinth). The labyrinth itself consists of three semicircular canals, the function of which is to control balance. In most cases, inflammation of the inner ear is caused by a viral, less often bacterial, background.

Internal otitis media cannot appear on its own. Most often it occurs as a result of a complication of chronic or acute otitis, as well as against the background of a severe general infectious disease (for example, tuberculosis). In addition, a common cause of the disease is inflammation of the upper respiratory tract - flu, colds. Trauma is also a cause of otitis media of the inner ear.

The main symptoms of internal otitis are:

As for dizziness, this symptom can be a sign of many diseases. In the case of internal otitis, dizziness appears after 1-2 weeks of bacterial infection. During this time pathogens penetrate with the bloodstream into the cavity of the inner ear, causing inflammatory process.

It is worth noting that severe attacks of dizziness may be accompanied by symptoms such as nausea and vomiting. From the outside, this course of the disease strongly resembles “sea sickness.” As a rule, dizziness goes away after a few days or weeks. But, if there are sudden movements of the head, dizziness may return again.

In addition to the main signs, the following symptoms are distinguished:

• imbalance;
• fever - this symptom is characteristic of any inflammatory processes;
• eye twitching;
• The purulent form of internal otitis is characterized by persistent hearing loss, leading to its complete loss.

Infection can enter the inner ear in a variety of ways. With a favorable course of the disease, the exudate (inflammatory fluid) resolves. In case of complications, fluid (pus) accumulates, which subsequently leads to complete loss of hearing.

Dizziness with internal otitis

Diagnostics

If the above symptoms and characteristic complaints of the patient are present, an examination is performed, which includes a clinical blood test. Also, to find out the true cause of dizziness, special tests are performed.

If the doctor cannot fully determine the cause of dizziness, the following studies are carried out:

• Electronystagmography - this study records the movement of the eyeballs. The movement is recorded by electrodes. Dizziness, which is caused by otitis media of the inner ear, causes a certain type of movement of the eyeballs. Dizziness caused by another cause is characterized by different types of movement.
• MRI, CT - computed tomography, as well as magnetic resonance imaging allows you to visualize the brain and make visible any of its pathologies (for example, tumors, strokes, etc.).
• Hearing test - this research method is carried out in order to identify the presence of any hearing abnormalities.
• Response Test - This test examines the auditory parts of the brainstem to determine whether the auditory nerve, which runs to the brain from the inner ear, is functioning normally. If this test reveals hearing loss, Meniere's disease is confirmed.
• Audiometry - determined subjectively using audiometry. how well a person hears. The study includes behavioral testing as well as behavioral tone audiometry.

The doctor conducts an examination

In most cases, the symptoms of otitis media of the inner ear go away on their own. In cases where labyrinthitis was caused by a bacterial infection, antibiotic therapy is prescribed. In cases of viral infection, antibiotics are not prescribed.

It is worth noting that drug treatment of internal otitis is similar to the treatment prescribed when Meniere's disease is detected. This kind of treatment can be called symptomatic - aimed at reducing the manifestation of the disease.

The following drugs are prescribed:

• antiemetics - data medications aimed at eliminating symptoms such as dizziness, nausea, vomiting. These include phenegran, cerucal, compazine.
• Antihistamines are also prescribed to reduce dizziness, vomiting, and nausea. These are drugs such as suprastin, diazolin, diphenhydramine, etc.
• Steroids - prescribed to reduce the inflammatory process. These drugs include methylprednisolone.
• Sedatives - to reduce vomiting, nausea, and various types of anxiety. These include drugs such as lorazepam, diazepam.

Scopolamine is also used in practice - a special patch form that is glued behind the ear. The drug is also aimed at reducing nausea and vomiting. Used for internal otitis, Meniere's disease.

But not always even the most adequate and timely treatment can completely eliminate a symptom such as dizziness. This happens with bacterial inflammation. But over time, the dizziness goes away completely and no longer bothers the patient.

In some cases, the patient is prescribed surgery, simultaneously on the labyrinth and on the middle ear. The operation is prescribed for a purulent form of labyrinthitis with an intracranial complication.

Internal otitis: how to treat?

Labyrinthitis: causes and manifestations

Like other types of otitis, inflammation of the inner ear is most often associated with infection, and sometimes with injury. Sources of infection can be:

• purulent inflammation of the middle ear;
• viral diseases (flu, sinusitis, measles, mumps, etc.);
• general infectious diseases such as staphylococcal infection, tuberculosis, syphilis, etc.

The main symptoms of internal otitis are not always perceived as inflammation, especially since the ear does not always hurt. They can easily be mistaken for promotion blood pressure or extreme fatigue. These include:

• dizziness varying degrees intensity;
• noise and ringing in the ears;
• visual disturbance with characteristic “flickering”, “floaters”;
• disturbance of the sense of balance;
• inability to concentrate on anything;
• nausea of ​​varying intensity, as well as vomiting;
• unilateral weakening or complete loss of hearing.

The inner ear can become inflamed not only in adults, but also in children. IN childhood the main risk factors are complications of diseases, in particular rubella, tonsillitis, mumps. Children cannot always tell what is hurting them; they may feel dizzy, ringing in the ears, and involuntarily look away towards the healthy ear.

These unpleasant symptoms associated with the accumulation of exudate in the area of ​​the inner ear. They intensify when moving the head, trying to stand up, which forces the patient to remain only in a supine position. Uncomplicated inflammation can last a week or more, after which labyrinthitis either goes away or goes into a purulent stage. Final recovery takes several weeks. All this time, symptoms associated with poor coordination appear to one degree or another.

Such people cannot drive a car, work at heights, have difficulty concentrating, are constantly disoriented in their surroundings, and experience ringing in their ears. It is even more dangerous when the inflammation turns into a necrotic form, which can lead to general sepsis. Thus, inflammation of the inner ear in adults and children is a disease that needs to be treated very seriously and professionally.

Diagnosis and treatment

If the symptoms described above appear regularly, this is a reason for examination by an ENT specialist. In addition to examining the patient, the diagnosis " internal otitis» is established based on a survey using:

• audiometry, showing hearing acuity and the ability to distinguish tones;
• electronystagmography, which can determine the cause of dizziness by the type of movements of the eyeballs;
• magnetic resonance and computed tomography, which determine the presence of brain pathology;
• ABR - testing the brain's response to a sound stimulus.

In some cases, a consultation is carried out with a neurologist, neurosurgeon, dermatovenereologist, infectious disease specialist and other specialists. After establishing the diagnosis and the extent of damage to the inner ear, appropriate treatment is prescribed, which is carried out in a hospital. In most cases, it is recommended to treat labyrinthitis symptomatically, that is, use drugs that reduce the symptoms of this disease.

If labyrinthitis was caused by a bacterial infection, then antibiotics are prescribed in large doses, primarily Azithromycin and Ceftriaxone injections. Specific therapy for other types of pathogens is usually not carried out. According to indications, funds from such groups as:

• antihistamines (Betagistin, Suprastin, Diazolin, etc.);
• antiemetics (Cerucal, Phenegran, and Scopolamine patch);
• sedatives (Diazepam, Lorazepam, etc.);
• steroids (Medrol and other Prednisolone derivatives);
• diuretics (Furosemide).

Non-drug treatment

However, even the most effective remedies cannot always cope with problems of the vestibular system. To reduce dizziness and improve coordination, special exercises are recommended. They can be performed at home after learning with medical staff. The most common types of rehabilitation exercises are:

1. In a sitting position, then standing, fix your gaze on a stationary object and turn your head without taking your eyes off the selected point.
2. Sitting on the edge of the bed, turn your head towards the sore ear and quickly lie down. After the symptoms of dizziness stop, you should sit down again, wait for the dizziness to stop and repeat the exercise in the other direction.

It is recommended to perform such exercises twice a day, gradually increasing their total duration to twenty repetitions (about half an hour). In many cases, the symptoms of dizziness are significantly reduced after the first workout, and otitis media itself goes away much faster.

• general sanitation of all parts of the ear;
• removal of abscess and necrotic tissue;
• cleaning the cochlea, its vestibule and circumferential canals.

Are there any folk remedies for labyrinthitis?

Inflammation of the inner ear is one of those types of diseases for which self-treatment is excluded. Moreover, it is recommended to treat the patient in a hospital so as not to miss the moment when inflammation turns into purulent form. It should also be remembered that it is impossible to instill medicinal drugs into the inner ear, and widespread folk traditions of treating the ears by heating threaten that labyrinthitis will go into the purulent stage.

The main folk remedies that can help with this disease belong to the same groups of drugs as the medications that doctors use to treat labyrinthitis. These are herbal medicines that have antibacterial, anti-inflammatory, diuretic properties, as well as herbs that help reduce nausea.

The most common folk remedies with a wide range of antiseptic, anti-inflammatory and regenerating properties are honey and garlic.

It is recommended to eat as much of them as possible, especially for diseases of the nasopharynx, sinuses and middle ear. Many herbs have the same properties.

A collection of equal parts has a good effect on all internal inflammations:

• eucalyptus;
• yarrow;
• calendula;
• sequences;
• licorice root.

A tablespoon of this collection is brewed with a glass of boiling water, allowed to brew for half an hour, then drunk several times a day.

Mint, lemon balm, and dried ginger help cope with nausea and vomiting. They can be brewed separately or mixed to taste. To prepare a glass of tea you will need one or two teaspoons of dry raw materials. Drink a glass of this tea a day, adding honey and lemon to taste.

Algorithm of actions for internal otitis

Internal otitis (labyrinthitis) is an acute or chronic inflammatory process of the vestibular apparatus of the ear. The disease is rare, affects the deep structures of the hearing organ, and sometimes causes a brain abscess. Dizziness, loss of balance and hearing loss (hearing impairment) are the main symptoms of the disease. Labyrinthitis is often caused by purulent otitis media, sometimes occurring after injuries and surgical interventions. Concomitant symptoms and treatment of internal otitis depend on the causes and stage of the pathological process.

The inner ear contains important structures: the labyrinth, the cochlea, and the auditory nerve. They form the vestibular-auditory apparatus, which is responsible for the balance of the body and the transformation of hearing. These organs are located inside the temporal bone, close to the brain, which plays a special role in the spread of inflammation. The signs of acute internal otitis are more pronounced with unilateral lesions than with both sides. The following symptoms of the disease are distinguished:

1. Dizziness. It occurs due to the fact that the brain receives different information about the position of the head from the healthy and affected auditory organ. Patients complain of constant “rotation” of objects in front of their eyes and the inability to stay in one body position. Such sensations last from 5-10 minutes to several hours.
2. Nystagmus. This symptom is important for a doctor who can determine the side of the ear lesion and distinguish other brain diseases.
3. Impaired coordination and walking occur when the nerve and cochlea are damaged. The gait becomes shaky and uncertain.
4. Hearing loss or deafness is caused by pathology of the auditory nerve. Bilateral processes lead to deafness, the correction of which requires the installation of a hearing aid. Patients do not hear whispers, constantly listen to the interlocutor, watch TV with maximum volume.
5. Nausea and vomiting begin due to dizziness and damage to the vestibulo-cochlear nerve. These symptoms can be disturbing for 10-20 minutes a day, or they can be present constantly until the disease is cured.
6. Tinnitus is caused by inflammation of the auditory nerve and disruption of the auditory ossicles. Often the symptom appears after suffering from otitis media. Sometimes patients hear a thin ringing, squeaking or buzzing sound.
7. Ear pain. The symptom is characteristic of a purulent process, when the accumulated exudate has no way to exit the cavity of the inner ear. The pain is constant and debilitating.

General symptoms of internal otitis are associated with disruption of the conduction of impulses along the nerves, the outflow of endolymph (fluid) into the ventricles of the brain, and inflammation of the labyrinth cells. Patients with internal otitis experience increased sweating and frequent headaches. Bradycardia (rare pulse) leads to pain in the heart, general weakness, fatigue, which is caused by insufficient blood flow to the head. If the purulent process in the inner ear spreads to the membranes of the brain, then spasms of the neck muscles, chills appear, and body temperature rises to 40 degrees. Celsius.

Causes and diagnosis

Otolaryngologists identify various causes for the development of internal otitis. In children and adults, the disease appears after the progression of purulent inflammation of the middle ear. In this case, bacteria penetrate the labyrinth and cochlea, damaging the receptor cells. Primary damage to the meninges (meningitis) is caused by pathogenic bacteria and viruses that can enter the inner ear. But also pathology of the vestibular apparatus can be provoked by herpes viruses, tuberculosis and typhus bacteria.

Labyrinthitis (inflammation of the inner ear): how to treat, causes

Labyrinthitis is an inflammatory process localized in the inner ear, in which damage occurs nerve receptors, perceiving sounds and regulating balance. Accordingly, the main symptoms of labyrinthitis are hearing loss and dizziness (cochleovestibular disorders).

A little anatomy

The ear is not only the auricle that we see and can touch. The ear is a most complex apparatus, an organ of hearing and balance, the function of which is to perceive sounds and signals of the body’s position in space, conduct them, transform them into nerve impulses, which subsequently passes to the brain. The ear is divided into 3 parts:

• Outer ear(auricle and external ear canal).
• Middle ear(the tympanic cavity, which contains the 3 smallest bones of our body that conduct sound vibrations).
• Inner ear.

The inner ear is located deep in the temporal bone. This is a system of intraosseous spaces communicating with each other. The following sections of the inner ear are distinguished: cochlea, vestibule and 3 semicircular canaliculi. Because of its intricate shape, this system is called the bony labyrinth. The lumen diameter of each tubule is up to 0.5 mm. Inside the bony labyrinth there is a membranous labyrinth. It is in it that receptors are located - sensitive cells that perceive signals from the external environment. Sound receptors are located in the cochlea, and structures of the vestibular apparatus, that is, the organ of balance, are located in the vestibule and tubules.

Causes of labyrinthitis

The main cause of labyrinthitis is infection. Infection penetrates into the inner ear in different ways. Accordingly, labyrinthitis is distinguished according to its distribution paths:

According to the course, labyrinthitis can be acute and chronic, according to the prevalence of inflammation - limited and diffuse, according to the nature of the inflammatory exudate - serous, purulent or necrotic.

Serous tympanogenic labyrinthitis is the most common. With purulent otitis media, the membrane separating the middle ear from the inner ear becomes permeable to inflammatory exudate - serous inflammation occurs in the inner ear. Sometimes, due to the accumulation of exudate, the pressure increases very strongly, which leads to rupture of the membrane, breakthrough of pus, and then purulent labyrinthitis develops.

For chronic otitis media pathological process affects the bone labyrinth, with the formation of a fistula (fistula) in the semicircular canal, infection from the bone wall spreads to the internal structures of the labyrinth.

Symptoms of labyrinthitis

According to the physiology of the inner ear, symptoms of its damage appear. This is hearing loss and dizziness. The severity and rate of increase in symptoms depend on the severity of the process and the nature of the inflammation.

In acute cases, a so-called labyrinth attack occurs: hearing suddenly decreases or disappears, severe dizziness, balance is disturbed. The slightest movement of the head worsens the condition, the patient is forced to lie motionless on his side on the side of the healthy ear.

Labyrinthine vertigo is defined by the patient as an illusion of rotation of surrounding objects or rotation of the person himself. There may be nausea and vomiting. This kind of dizziness is called systemic. There is also non-systemic dizziness with damage to the cortical (cerebral) parts of the vestibular analyzer. It manifests itself as a feeling of instability, sinking when walking.

The duration of a labyrinth attack ranges from several minutes to several hours, sometimes days. During the purulent process, the stage of suppression of the affected labyrinth then begins, and signs of asymmetry of the labyrinths appear, which are revealed during a routine neurological examination.

Acute labyrinthitis may manifest as a single labyrinthine attack. In the chronic course of the disease, attacks of dizziness recur periodically.

Other less specific symptoms of inner ear inflammation: tinnitus, headache, sweating, palpitations. A possible complication is neuritis of the facial nerve, the trunk of which passes between the vestibule and the cochlea of ​​the inner ear. Also, when the infection spreads to the mastoid process of the skull, mastoiditis can develop. And the most dangerous complication of purulent labyrinthitis is meningitis, encephalitis or brain abscess.

Diagnosis of labyrinthitis

If there are typical complaints of paroxysmal systemic dizziness, hearing loss and indications of ear pain 1-2 weeks before the disease, it is not difficult to suspect a diagnosis of labyrinthitis. With a limited process and chronic course, clinical manifestations may be erased. Vestibular tests and detection of hidden nystagmus help in making a diagnosis.

Nystagmus is an involuntary oscillatory movement of the eyeballs. This is the main objective syndrome when the labyrinth is affected (although there are many other causes of nystagmus). It is detected during a routine examination or during a fistula test.

They also help in diagnosing labyrinthitis:

• Otoscopy (examination of the external auditory canal and eardrum).
• Audiometry.
• Electronystagmography.
• X-ray of the temporal bone.
• CT scan of the temporal bone.

Treatment of labyrinthitis

In cases of acutely developed labyrinthitis, urgent hospitalization is indicated. Such a patient must be provided with bed rest and complete rest.

Basic principles of conservative treatment of inflammation of the inner ear:

If labyrinthitis occurs as a complication of purulent otitis media and there is no improvement from conservative treatment within 4-5 days, surgical treatment is indicated. The purpose of the operation is the rehabilitation of a purulent focus in tympanic cavity, revision of its medial wall, which borders the inner ear. If there is a fistula of the semicircular canal, plastic surgery is performed using a portion of the periosteum. The operation is performed using a special operating microscope.

Emergency surgery is indicated in the presence of intracranial complications. And a very rarely performed operation these days is labyrinthectomy. It is performed for purulent or necrotic labyrinthitis.

Outcomes of labyrinthitis

In general, the outcome of labyrinthitis is favorable. All symptoms (hearing loss, attacks of dizziness) are reversible and stop fairly quickly with timely treatment.

Only in purulent forms (which, fortunately, are extremely rare), is partial or complete irreversible hearing loss possible, which subsequently requires hearing aids or cochlear implantation. The function of maintaining balance, even if the labyrinth is completely destroyed, is restored over time.

Prevention

The main prevention of labyrinthitis is timely treatment of otitis media. Any pain in the ear is a reason to immediately contact an ENT doctor. In turn, the infection enters the middle ear through the auditory tube from the nasopharynx. Therefore, it is necessary to take the treatment of any runny nose more seriously.

Internal otitis: symptoms characteristic of the disease

Otitis interna (also known as labyrinthitis) is a disorder resulting from an infection that affects the tissues of the inner ear. Inflammation of the inner ear disrupts the transmission of sensory information from the ear to the brain.

• Often labyrinthitis occurs due to viral diseases such as sinusitis, influenza, etc. Less often - against the background of measles, mumps or glandular fever. Viral labyrinthitis affects women more often than men.
• Sometimes the cause is a bacterial infection or damage to the ear due to a head injury.

The labyrinth is located deep in the ear, where it connects to the skull. It includes the so-called “cochlea,” which is responsible for hearing, and the fluid-filled vestibular apparatus, which is responsible for balance.

When internal otitis occurs, symptoms may be as follows:

• Mild or severe dizziness.
• Nausea, vomiting.
• Feeling of instability.
• Noise in ears.
• Partial or total loss hearing in the affected ear.
• "Twinkle" in the eyes.
• Impaired concentration.

Sometimes symptoms can be so severe that they affect the ability to climb or walk. These symptoms are often triggered or worsened when the person moves their head, sits up, lies down, or looks up.

Symptoms of otitis internal can last for several days or even weeks depending on the cause and severity of the disease. Sometimes symptoms of the disease still appear within a week after recovery. So people who have had labyrinthitis should be careful when driving, working at heights, or performing other responsible and strenuous work.

It is worth noting

It is extremely rare that inner ear disease can last a lifetime, as is the case with Meniere's disease. In this case, the patient is bothered by tinnitus and hearing loss with dizziness.

If a bacterial infection is the cause of the disease, the risk of permanent hearing loss is quite high. The damaged organ cannot recover, but the brain compensates for the damage by learning to “tune” the conflicting information received from both ears.

If otitis ear symptoms were caused by a viral infection, full recovery is more likely.

Chronic otitis of the inner ear and its symptoms

After a period of gradual recovery, which may last several weeks, some people are completely cured of labyrinthitis.

However, some people suffer from chronic dizziness if the virus has damaged the vestibular nerve.

Many people with chronic labyrinthitis find it difficult to describe their symptoms and often appear healthy on the outside but feel unwell.

Without knowing the symptoms of otitis media of the inner ear, they may find that daily activities have become tiresome or inconvenient.

For example, patients with chronic labyrinthitis find it difficult to:

• go shopping;
• work on computer;
• be in a crowd;
• stand in the shower with your eyes closed;
• turning your head to talk to another person at the dinner table.

Symptoms of chronic labyrinthitis include:

• Abnormal sensation of movement (dizziness). Unlike acute labyrinthitis, dizziness goes away after a few minutes.
• Difficulty focusing the eyes due to involuntary eye movements.
• Hearing loss in one ear.
• Loss of balance.
• Lightheadedness and vomiting.
• Ringing or other noises in the ears.

Some people find it difficult to work due to a constant feeling of disorientation, as well as difficulty concentrating and thinking.

If symptoms such as dizziness or unsteadiness persist for several months due to otitis media of the inner ear, your doctor may suggest vestibular exercises (a form of physical therapy) to evaluate and retrain the brain's ability to adapt to vestibular instability. As a rule, thanks to such exercises, the brain can adapt to the changed signals coming into it from the ear as a result of labyrinthitis.

Diagnosis of inner ear disease in children and its symptoms

Labyrinthitis, although rare, still occurs in children. The disease typically reaches the inner ear through one of three routes:

• Bacteria can enter from the middle ear or from the meninges.
• Viruses, such as those that cause mumps, measles, and strep throat in children, can reach the inner ear. Rubella virus can also cause labyrinthitis in children.
• The disease can be triggered by toxins, a tumor in the ear, excessively high doses of medications, or allergies.

In case of inner ear disease, the symptoms in children are as follows:

• Dizziness and hearing loss, along with a sensation of ringing in the ears. Dizziness is due to the fact that the inner ear controls the sense of balance as well as hearing.
• Some children complain of vestibular disorders (nausea, vomiting) and spontaneous eye movements in the direction of the ear that is not affected by the disease.
• Bacterial labyrinthitis can cause discharge from the infected ear.

If any of the above symptoms appear, you should consult a specialist.

Diagnosis of labyrinthitis is based on a combination of symptoms of inner ear disease and medical history, especially history of recent upper respiratory tract infection. The doctor will test your child's hearing and may order tests, such as a CT scan or magnetic resonance imaging scan, to rule out others. possible reasons dizziness (for example, tumors).

If a bacterium is suspected to be the cause of labyrinthitis, a test will be ordered on the blood or any fluid that is leaking from the ear. This is necessary to determine what type of bacteria is present.

Labyrinthitis (internal otitis). Causes, symptoms, signs, diagnosis and treatment of pathology

The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor.

• Inflammation of the inner ear can be caused by an infectious disease such as tuberculosis.
• In rare cases, labyrinthitis occurs due to influenza.
• The cavity of the inner ear is shaped like a labyrinth.
• A strong whistle directed directly into the auricle can cause acoustic trauma to the ear and lead to labyrinthitis;
• In some cases, dizziness with labyrinthitis is so severe that a person cannot raise his head.

Anatomy of the inner and middle ear

• outer ear;
• middle ear;
• inner part of the ear.

Outer ear

Middle ear

• Hammer is the first auditory ossicle of the middle ear. The malleus is directly adjacent to the eardrum and is involved in transmitting sound vibrations to other auditory ossicles.
• Anvil transmits sound vibrations from the malleus to the stapes. The incus is the smallest of all the auditory ossicles.
• Stirrup ( stirrup) is the third auditory ossicle. This bone got its name because it looks like a stirrup. The stapes transmits sound vibrations to the inner ear. It is worth noting that the hammer, anvil and stirrup amplify the sound approximately 20 times ( this occurs due to an increase in sound pressure on the oval window of the inner ear).

The middle ear cavity is not isolated and through a small canal ( Eustachian tube) has a connection with the nasal part of the pharynx. Through the Eustachian tube, the average air pressure is equalized both outside and inside the eardrum. If the pressure changes, it is felt as “stuffing” of the ears. IN in this case this reflexively leads to yawning. Pressure equalization also occurs during swallowing movements. The Eustachian tube constantly supports normal pressure in the cavity of the middle ear, which is necessary for the normal conduction of sound vibrations.

Inner ear

• vestibule;
• semicircular canals;
• snail.

vestibule The labyrinth is a small cavity that has an irregular shape. On the outside ( lateral) the wall of the bone labyrinth has two small windows - oval and round, which are covered with a thin membrane. It is the oval window that separates the vestibule of the labyrinth from the tympanic cavity of the middle ear. The round window of the vestibule opens into the cochlea ( at the beginning of the spiral canal of the cochlea). This window is covered on top with a membrane ( secondary tympanic membrane) and is necessary in order to reduce the sound pressure that is transmitted to the oval window. The vestibule of the bony labyrinth communicates with the semilunar canals through five small openings, as well as with the cochlea through a relatively large opening leading into the cochlear canal. On the inner wall of the vestibule there is a small ridge that separates the two depressions. In one recess there is a spherical sac ( sacculus), and in the second - an elliptical pouch ( utriculus). These bags are filled with a special liquid ( endolymph), which is the internal environment of the organ of balance. Endolymph is also necessary to create the electrical potential that is needed to provide energy for the process of amplifying sound vibrations.

Causes of labyrinthitis

Otitis media

• acute otitis;
• chronic otitis media

Acute otitis media begins with an increase in body temperature to 38 - 39ºС. The main complaint is pain in the depths of the ear, which can be stabbing, drilling or pulsating in nature. The pain intensifies in the afternoon and can significantly disturb sleep. The pain can spread to the temple, lower and upper jaw. Increased pain is observed during swallowing, sneezing, and also when coughing. Temporary deafness is often noted. Patients also complain of congestion and tinnitus. After a few days, the disease enters the second stage, which is characterized by perforation ( integrity violation) eardrum. As a rule, purulent contents are released from the ear cavity. Body temperature drops to 37ºС, and the patient’s general condition most often improves. Subsequently, the inflammatory process subsides - suppuration stops, and the damaged eardrum is scarred. As a rule, the duration of acute otitis media does not exceed 14–20 days. It is worth noting that otitis media does not lead to hearing loss. This complication observed only if destruction of the auditory ossicles in the tympanic cavity occurs.

Inner ear injury

• acute;
• chronic.

Acute acoustic ear injury occurs due to short-term exposure to extremely strong sounds on the auditory analyzer. The cause of injury can be a shot from a firearm that occurs in close proximity to a person’s ear. In this case, hemorrhage occurs in the cochlea, and the cells of the spiral organ ( organ of corti) are significantly damaged. Subjectively, exposure to an excessively strong sound stimulus is accompanied by severe pain in the ear. Depending on the distance to the sound source, acute acoustic trauma to the ear can lead to temporary or permanent deafness.

Viral and bacterial infections

• influenza virus;
• mumps;
• syphilis;
• tuberculosis.

Influenza virus causes acute infectious disease of the respiratory tract. There are 3 types of influenza - A, B and C. Influenza virus type A most often causes epidemics. Type B can cause outbreaks of influenza and only in some cases entire epidemics, and type C can cause only isolated cases of influenza. Once in the upper or lower respiratory tract ( nasopharynx, trachea, bronchi), the virus multiplies and leads to the destruction of epithelial cells ( cells that line the mucous membrane) respiratory tract. In some cases, inflammation of the inner ear may occur due to the flu. As a rule, labyrinthitis occurs in children or the elderly due to weakened immunity. The influenza virus can enter the inner ear through the cochlear aqueduct or through the internal auditory canal.

Symptoms of labyrinthitis

Diagnosis of labyrinthitis

The following methods for diagnosing labyrinthitis are distinguished:

Vestibulometry

• caloric test;
• rotation test;
• pressor test;
• otolith reaction;
• finger-nose test;
• index test.

Caloric test involves slowly pouring water, which can be warm, into the external auditory canal ( 39 – 40ºС) or cold ( 17 – 18ºС). If you use water at room temperature, then the involuntary eye movements that occur are directed towards the ear being examined, and if you pour in cold water - in the opposite direction. This nystagmus occurs normally, but is absent when the inner ear is damaged. It is worth noting that the caloric test is carried out only with an intact eardrum, so as not to lead to the entry of a large amount of water into the middle ear cavity.

Audiometry

• pure tone audiometry;
• speech audiometry;
• audiometry using a tuning fork.

Pure-tone audiometry carried out using special audiometers, which consist of a sound generator, telephones ( bone and air), as well as a regulator of sound intensity and frequency. It is worth noting that pure-tone audiometry is capable of determining both air and bone sound conductivity. Air conduction- this is the effect of sound vibrations on the auditory analyzer through air environment. Bone conduction refers to the effect of sound vibrations on the bones of the skull and directly on the temporal bone, which also leads to vibration of the main membrane in the cochlea. Bone sound conduction allows us to evaluate the functioning of the inner ear. To assess airborne sound conduction to the test subject via telephones ( headphones through which sounds are played) a fairly loud beep sounds. Subsequently, the signal level is gradually reduced in steps of 10 dB until the perception disappears completely. Then, in steps of 5 dB, the level of the sound signal is increased until it is perceived. The resulting value is entered into the audiogram ( special schedule). Bone sound conduction is produced by analogy with air conduction, but a bone vibrator is used as a device through which sound is supplied. This device is installed on the mastoid process of the temporal bone, after which sound signals are sent through it. It is worth noting that during pure-tone audiometry it is necessary to completely exclude the influence of extraneous noise, otherwise the results may be incorrect. At the end of the study, the doctor receives a special audiogram, which allows you to judge the function of the hearing organ.

Electronystagmography

• radiography;
• CT scan;
• magnetic resonance imaging.

X-ray of the temporal bone used to assess the condition of the bone structures of the outer, middle and inner ear. X-rays can be taken in 3 different projections. It is worth noting that radiography of the temporal bone is increasingly used in diagnosing lesions of the inner ear due to the low resolution of this method compared to computed tomography and magnetic resonance imaging. The only contraindication for x-rays of the temporal bone is pregnancy.

Internal otitis

Otitis

Otitis– acute or chronic inflammation in various parts of the ear (outer, middle, inner). It manifests itself as pain in the ear (pulsating, shooting, aching), elevated body temperature, hearing loss, tinnitus, mucopurulent discharge from the external auditory canal. It is dangerous in the development of complications: chronic hearing loss, irreversible hearing loss, facial nerve paresis, meningitis, inflammation of the temporal bone, brain abscess.

Anatomy of the ear

The human ear consists of three sections (outer, middle and inner ear). The outer ear is formed by the auricle and the auditory canal, ending with the eardrum. The outer ear picks up sound vibrations and sends them to the middle ear.

The middle ear is formed by the tympanic cavity, which is located between the opening of the temporal bone and the eardrum. The function of the middle ear is to conduct sound. The tympanic cavity contains three ossicles (the malleus, the incus and the stapes). The malleus is attached to the eardrum. The membrane vibrates when exposed to sound waves. Vibrations are transmitted from the eardrum to the incus, from the incus to the stapes, and from the stapes to the inner ear.

The inner ear is formed by a complex system of canals (cochlea) in the thickness of the temporal bone. The inside of the cochlea is filled with fluid and lined with special hair cells that convert mechanical vibrations of the fluid into nerve impulses. Impulses are transmitted along the auditory nerve to the corresponding parts of the brain. The structure and functions of the ear sections differ significantly. Inflammatory diseases in all three sections also occur differently, so there are three types of otitis: external, middle and internal.

Otitis externa

Otitis externa can be limited or diffuse, in some cases it spreads to the eardrum, and is more common in elderly patients. Occurs as a result of mechanical or chemical trauma to the ear. A patient with otitis externa complains of throbbing pain in the ear, which radiates to the neck, teeth and eyes, and intensifies when talking and chewing. Redness of the ear canal, and sometimes of the auricle, is objectively detected. Hearing is impaired only when the abscess is opened and the ear canal is filled with pus.

Treatment of external otitis involves injecting alcohol turundas into the ear canal and rinsing with disinfectant solutions. Abscesses are opened. The patient is prescribed physiotherapy (UHF, Sollux), and in case of severe inflammation, antibiotic therapy is administered.

Otitis media

One of the most common diseases of the ENT organs. Every fourth patient of an otolaryngologist is a patient with acute or chronic otitis media. People of any age can get sick, but otitis media is much more common in children under 5 years of age.

Causes of otitis media

Otitis media can be caused by various pathogenic microorganisms: bacteria, viruses, fungi (otomycosis) and various microbial associations. Most often, influenza and ARVI viruses, pneumococcus and Haemophilus influenzae are the infectious agents in otitis media. Recently, there has been an increase in the number of cases of fungal otitis media.

Mechanism of development of otitis media

Normally, the pressure in the middle ear cavity is equal to atmospheric pressure. Pressure equalization and ventilation of the tympanic cavity are carried out using the Eustachian tube, which connects the tympanic cavity to the pharynx.

Some conditions (increased formation of mucus in the nasopharynx, sniffing, pressure drop when divers descend to depth, etc.) lead to the patency of the Eustachian tube being impaired. A change in pressure in the tympanic cavity leads to the fact that the cells of the mucous membrane of the middle ear cavity begin to actively produce inflammatory fluid. Increased fluid levels cause pain and hearing loss.

The infection penetrates into the middle ear tubarically (through the Eustachian tube), transmetally (through the eardrum when it traumatic injury), hematogenously (through the bloodstream during scarlet fever, measles, influenza or typhoid) or retrograde (from the cranial cavity or mastoid process of the temporal bone).

Microbes quickly multiply in the inflammatory fluid, after which otitis media becomes purulent. The pressure in the middle ear cavity rises sharply, the eardrum ruptures, and pus begins to leak out through the ear canal.

Risk factors

Otitis media rarely develops as an independent disease. In the vast majority of cases, it is a complication of diseases of other ENT organs of an inflammatory nature. There are general and local factors that increase the risk of developing otitis media.

• Local risk factors for the development of otitis media

Inflammatory and allergic diseases of the nose and nasopharynx cause swelling of the mucous membrane, leading to a deterioration in the patency of the Eustachian tubes. Microbes that enter the middle ear from the source of inflammation increase the risk of developing purulent otitis media. To the group local factors Risk also includes conditions after surgical interventions in the nasopharynx and nasal cavity, accompanied by a deterioration in the patency of the Eustachian tubes.

Otitis media develops more often in children, due to the characteristics anatomical structure children's middle ear. The Eustachian tube in children is narrower than in adults, therefore the likelihood of violations of its patency increases. In children, adenoids often enlarge, compressing the Eustachian tube. Children often get sick with ARVI and other colds, often cry and actively sniffle at the same time.

• Common risk factors for otitis media

The likelihood of developing otitis increases with congenital and acquired immunodeficiency conditions.

Symptoms of otitis media

Acute otitis media is characterized by severe hyperthermia, which is accompanied by shooting pain in the ear. Children who cannot yet speak cry when the pain intensifies and calm down when it subsides.

After 1-3 days from the onset of the disease, a rupture forms in the eardrum, and suppuration begins. The patient's condition improves. Body temperature returns to normal, ear pain decreases or disappears. Subsequently, the rupture in the eardrum heals and does not cause hearing impairment.

If the disease develops unfavorably, pus may break out not outward, but inward, spreading into the cranial cavity and leading to the development of a brain abscess or meningitis. Since the disease is fraught with dangerous complications, you should consult a doctor at the first signs of acute otitis media.

As a rule, it is the outcome of acute purulent otitis. There are two forms of chronic suppurative otitis media, which differ in both severity and clinical course.

In 55% of cases, chronic otitis media occurs in the form of mesotympanitis, in which the inflammatory process covers the mucous membrane of the auditory tube, lower and middle parts of the tympanic cavity. The eardrum has a perforation at the bottom. Part of the membrane remains stretched.

With mesotympanitis, patients complain of decreased hearing, constant or periodic discharge of pus from the ear, and extremely rarely - dizziness and noise in the ear. Pain appears only during exacerbation of otitis media, in some cases accompanied by hyperthermia. Mesotympanitis progresses quite favorably and relatively rarely causes severe complications. The degree of hearing loss is determined by the preservation of the function of the auditory ossicles and the activity of the inflammatory process.

Chronic otitis media, which occurs in the form of purulent epitympanitis, mainly affects the epitympanic space. The perforation is located at the top of the eardrum, so natural drainage of the cavity is often insufficient. The severity of the flow is also determined by the peculiarities of the anatomical structure of this area, which is replete with winding narrow pockets.

The temporal bone is often involved in the inflammatory process, and the pus becomes foul-smelling. Patients complain of a feeling of pressure in the ear, periodic pain in the temporal region, and sometimes dizziness. This form of chronic otitis media is usually accompanied by a sharp decrease in hearing.

Both forms of chronic otitis media can occur with a predominance of certain pathological processes.

Chronic catarrhal otitis media can develop with chronic eustachitis, after suffering scarlet fever or acute otitis. Sometimes it is of an allergic nature. In the absence of suppuration, it proceeds quite favorably.

Chronic purulent otitis media is usually the outcome of a protracted acute process and develops against a background of decreased immunity. With good drainage of the tympanic cavity, purulence from the ear is sometimes not accompanied by other symptoms. Erased clinical symptoms leads to patients rarely seeking help. The purulent process tends to spread gradually and can affect the auditory ossicles, periosteum, surrounding bone structures and labyrinth.

Acute and chronic purulent otitis media may be complicated by the development of chronic adhesive otitis media. With adhesive otitis media, adhesions actively form in the tympanic cavity, leading to hearing loss. Adhesive otitis often has few symptoms, and patients do not associate heavy sweats, chills and hyperthermia that appear during an exacerbation with ear disease. With adhesive otitis, complications may develop.

Complications of otitis media

Acute otitis media can be complicated by mastoiditis (inflammation of the mastoid process of the temporal bone), brain abscess, labyrinthitis (inflammation of the inner ear), meningitis, cerebral sinus thrombosis and sepsis. With purulent epitympanitis, cholestetoma often occurs - a tumor formation consisting of decay products of the epidermis. Cholestetomas destroy the temporal bone, forming granulations and polyps.

Chronic otitis media can cause damage to the facial nerve passing through the tympanic cavity. Neuritis of the facial nerve is accompanied by flattening of the nasolabial fold, drooping of the corner of the mouth and lagophthalmos (the eye on the affected side does not close). With chronic otitis media (purulent epitympanitis), as with acute otitis, labyrinthitis, meningitis or meningoencephalitis, brain abscess, sinus thrombosis and epidural abscess can develop.

Diagnosis of otitis media

The diagnosis of acute otitis media is based on medical history, otoscopy results and characteristic symptoms (general intoxication, ear pain, suppuration). To determine the sensitivity of the microflora, culture of the discharge from the ear is performed.

In case of chronic otitis media, to assess the condition of the bone structures, in addition to the listed studies, radiography of the temporal bone is performed. Otoscopy in chronic otitis reveals clouding and sharp retraction of the eardrum. The hammer handle appears shortened. The location of the perforation is determined by the shape of the otitis media.

Treatment of otitis media

• Treatment of acute otitis media

Patients with acute otitis media are recommended to rest in bed, undergo antibacterial therapy, and in case of hyperthermia, antipyretics are prescribed. Physiotherapy (UHF, Sollux) and warming compresses are used locally. For decreasing pain syndrome Warm 96% alcohol is instilled into the ear (only until pus appears). If the tympanic cavity does not drain on its own within the first three days, dissection of the eardrum is indicated. In cases where hearing loss persists after scarring of the eardrum, blowing, UHF and pneumatic massage are prescribed.

• Treatment of chronic otitis media

The primary task is to ensure sufficient drainage of the tympanic cavity. To do this, polyps and granulations are removed from the middle ear cavity. The cavity is washed and proteolytic enzymes are introduced into it. The patient is prescribed sulfonamides and antibiotics, immunity is corrected, and foci of infection in the ENT organs are sanitized. If allergic otitis is suspected, use antihistamines. Electrophoresis and microwave therapy are used locally.

If there is no effect, anthrodrainage is performed (a hole is formed in the area of ​​the mastoid process of the temporal bone and followed by drainage). For cholesteatomas, the spread of the process to the bone and internal structures, surgical removal of the source of inflammation is indicated. If possible, sound-conducting structures are preserved; if not, tympanoplasty is performed. If the tympanic ring is intact, it is possible to restore the eardrum (myringoplasty).

Prevention of otitis media

Preventive measures include normalization immune status, prevention of ARVI and other infectious diseases of the ENT organs. Patients with chronic otitis should protect the ear canal from hypothermia and water ingress.

Internal otitis (labyrinthitis)

Has a bacterial or viral nature. Usually a complication of otitis media or meningitis.

A characteristic symptom of internal otitis is a sudden severe attack of dizziness that develops 1-2 weeks after the infectious disease. The attack may be accompanied by nausea or vomiting. Some patients with otitis interna complain of tinnitus or hearing loss.

Otitis media must be differentiated from brain diseases that can cause dizziness. To exclude tumors and strokes, MRI and CT scans of the brain are performed. Electronystagmography is performed and special study to assess auditory brainstem response. To identify hearing impairment audiometry is performed.

Treatment of internal otitis is mainly symptomatic. To eliminate nausea and vomiting it is prescribed antiemetics(metoclopramide), antihistamines (mebhydrolin, chloropyramine, diphenhydramine). Scopolamine patches are used locally. Steroids (methylprednisolone) are used to reduce inflammation, and sedatives (lorazepam, diazepam) are used to relieve anxiety. For internal otitis of a bacterial nature, antibiotic therapy is indicated. Symptoms of the disease usually gradually disappear over one or several weeks.

If conservative treatment of internal otitis is ineffective, surgical intervention is performed: labyrinthotomy, opening of the pyramid of the temporal bone, etc.

How to treat internal otitis

Internal otitis (labyrinthitis): causes, symptoms, diagnosis, treatment

Internal otitis- inflammation of the inner ear - labyrinth. This department is located close to the brain and is responsible for the vestibular-auditory function.

Although internal otitis occurs quite rarely, this form of the disease poses the greatest danger - with neglected treatment there is a high risk of complete hearing loss.

Internal otitis (labyrinthitis): causes and characteristic symptoms

Usually, internal otitis does not develop independently, but occurs as a relapse of otitis media. In addition, infection can be introduced into the labyrinth from other organs through the blood circulation.

First of all, labyrinthitis manifests itself through a violation vestibular function, deterioration of coordination of movements, loss of balance.

After a few days they appear rest characteristic features illnesses:

• Dizziness;
• Vomiting, nausea;
• Noise in ears;
• Gradual deterioration of hearing;
• Cardiac disorders.

Depending on the causes of its appearance, labyrinthitis is distinguished:

1. — Tymponogenic– recurrent form of otitis media. The infection comes from the middle ear.
2. — Meningogenic as a consequence of relapse of meningitis.
3. — Hematogenous- manifests itself under the influence of an infection that penetrates the labyrinth during blood circulation.
4. — Traumatic– as a consequence of traumatic brain injury and ear damage.

Forms of internal otitis: pathogens and symptoms

Based on the type of inflammation, the following forms of labyrinthitis are distinguished:

1. — Necrotic. It is characterized by circulatory disorders in areas of the labyrinth due to thrombosis of a branch of the auditory artery. Such inflammation is typical for people suffering from tuberculous otitis media, less commonly scarlet fever. Usually the disease is asymptomatic and unnoticeable, but leads to absolute hearing loss, as well as to the possible occurrence of complications in the form of brain abscesses. For treatment necrotizing otitis It is necessary to perform a surgical operation to open the inner ear and remove all parts of the labyrinth.
2. — Serous. It is characterized by redness of the walls of the inner ear and changes in the composition of the lymphatic fluid in the cochlea. On practice serous labyrinthitis most often a recurrent form otitis media. In this case, hearing loss occurs gradually, the patient feels tinnitus, as well as all other signs of labyrinthitis. With timely treatment, it is possible to restore partial hearing loss.
3. — Purulent. It is characterized by the formation of purulent fluid in the cavity of the labyrinth. It is the most dangerous form of labyrinthitis and can lead to various complications, such as meningitis, brain abscess, cerebral hemorrhage, auditory neuritis, and complete deafness. The symptoms of purulent labyrinthitis are pronounced - the patient feels a sharp decline hearing, attacks of dizziness, nausea.

According to the nature of its course, labyrinthitis is divided into:

1. — Spicy. Symptoms of internal otitis are pronounced and develop quickly.
2. — Chronic. Symptoms appear periodically, the disease progresses slowly.

Diagnosis of internal otitis

Diagnosis of labyrinthitis Various categories of doctors are involved - neurologist, otolaryngologist, traumatologist, venereologist and others based on patient complaints. To identify a diagnosis, a number of measures are carried out:

1. - General blood analysis.
2. — Audiometry (tone, speech) to check hearing acuity.
3. — Testing of the vestibular apparatus (rotational, pointing test, etc.).
4. - Otoscopy - examination of the eardrum for perforation.
5. — Radiography makes it possible to assess the condition of the bone structures of various parts of the ear.
6. - Computer (CT) and magnetic resonance imaging (MRI) - allow you to analyze the bone and soft tissue structures of the temporal bone.

Treatment of internal otitis

Treatment of labyrinthitis carried out strictly under the supervision of a specialist in compliance with bed rest:

1. — To suppress the source of infection, antibiotics are prescribed: Amoxicillin, Ceftriaxone, Oxacillin, Erythromycin and others.
2. — To reduce inflammation: Diclofenac, Naklofen, Dicloran.
3. — To reduce the level of intoxication, diuretics are prescribed, for example, Furosemide or Fonurit.
4. — To relieve the symptoms of vomiting (Cerucal), nausea (Scopolamine patch) and dizziness (Betahistine).
5. — In order to improve blood circulation, a specialist can prescribe drugs such as Betahistine, Bellataminal, Alfaserc.
6. — For general restoration of immunity, vitamins K, P, B6, B12, and ascorbic acid are prescribed.
7. — In the treatment of serous and purulent labyrinthitis, it is inevitable to carry out an operation to eliminate the purulent focus: sanitizing - on average, labyrinthotomy - in the cavity of the inner ear, with the development of pathologies and serious complications of the labyrinth - labyrinthectomy, which involves removing the labyrinth.

Thus, internal otitis is a serious disease that, if left untreated, can lead to complete hearing loss and relapses. It should be remembered that if there is any sign of this disease, you must immediately contact a specialist who will prescribe a course of treatment. For some forms of labyrinthitis, surgical intervention is necessary.

Otitis of the inner ear

The inflammatory process can affect the structures of the inner ear; this disease is called labyrinthitis, or otherwise the disease is called internal otitis. Due to the peculiarities anatomical location of this section of the sound analyzer, the disease occurs as a result of complications of other processes. More often these are inflammatory phenomena spreading from neighboring organs or head injuries.

Classification of labyrinthitis

Depending on the origin of internal otitis, there is the following classification:

Labyrinthitis is classified according to the type of pathogen:

• viral;
• bacterial (specific and nonspecific);
• fungal.

According to pathomorphological signs, inflammatory phenomena are:

The acute course of labyrinthitis lasts about 3 weeks. It may end in recovery or become chronic. The latter usually has protracted course, symptoms increase gradually, or may be completely absent.

A little about the pathogenesis of the disease

The causes of tympanogenic labyrinthitis are acute or chronic otitis media in the acute stage. The process spreads from the tympanic cavity through the membranes of the round or oval window bordering the inner ear. With induced inflammation, the process is aseptic in nature, since it is not pathogens that penetrate into the labyrinth, but their metabolic products and toxins.

The inner ear consists of the cochlea, vestibule and semicircular canals. The first section contains the organ of Corti, which is responsible for sound perception. The second two perform a vestibular function

Serous inflammation progresses, and a lot of transudate is formed. Due to the folding of plasma proteins sweating through the vessels, the structures of the labyrinth are fulfilled fibrous cords. A large amount of peri- and endolymph increases the pressure inside the cavity. This condition often leads to rupture of the window membrane, which opens the gate for bacterial flora to enter from the middle ear into the inner ear. This is how purulent labyrinthitis occurs. The outcome of this process is loss of function of this part of the ear, as well as intracranial complications.

If thrombosis occurs, damage to the auditory artery or compression of its branches, the trophism of the corresponding area is disrupted, and this threatens necrotic tissue changes.

Meningogenic inflammation of the inner ear is less common than tympanogenic inflammation. The process spreads from the membranes of the brain to the labyrinth area through the internal auditory canal, along the aqueduct of the vestibule or cochlea. It is observed in meningitis caused by tuberculosis, scarlet fever, measles, and typhus. Characteristic is bilateral damage to the vestibulo-cochlear apparatus. If this pathological condition occurs in early childhood, then this is fraught with the appearance of acquired deaf-muteness.

Pathogens rarely penetrate into the inner ear by hematogenous route. Occurs in the case of mumps, other viral infections, and syphilis.

With injuries to the temporo-parietal part, in the area of ​​the back of the head and the mamillary process, cracks form through which pathogens of inflammation can penetrate into the labyrinth space. The infection enters the inner ear when the eardrum and middle ear cavity are damaged by a sharp, long object.

Depending on the spread of inflammatory phenomena, the lesion can be localized, then limited labyrinthitis is diagnosed, or it can involve all structures of the inner ear with a diffuse nature.

How does inflammation of the labyrinth manifest clinically?

Symptoms associated with damage to the sound analyzer and vestibular function occur:

• dizziness;
• coordination disorders;
• presence of nausea, vomiting;
• the appearance of nystagmus;
• hearing impairment;
• ear noises.

Patients are bothered by systemic dizziness, manifested by an illusory sensation of rotation of the environment or one’s own body in one plane or direction. Sometimes the feeling of moving becomes unsystematic, patients note instability when walking, seeming to fall or fall through.

The main complaints of patients with inflammation of the labyrinth

The chronic course provokes this kind of vestibular disorders for several seconds or minutes. In the case of an acute process, the attack lasts 5–10 minutes; symptoms can last up to several hours or days.

An important sign is increased dizziness in a certain position or manipulation in the ear. Nausea and vomiting often occur, worsening with head rotation, and sweating increases. Skin pale or reddened, the heart rate accelerates, but there is also bradycardia.

Dizziness is systemic in nature, accompanied by nausea, vomiting and increased sweating

Another sign of vestibular disorders is nystagmus, which appears spontaneously. Involuntary twitching of the eyeballs is associated with a violation of the synchronous functioning of the labyrinths. The movements are usually small-caliber, in contrast to nystagmus of central origin. The direction is horizontal, sometimes horizontal-rotatory. At the beginning of the disease, the direction of the slow component of involuntary movements of the eyeballs is noted towards the inflamed ear, this is due to irritation of the labyrinth.

Symptoms of spontaneous deviation are observed upper limbs and torso in the direction opposite to nystagmus. In this case, the directions change depending on the rotation of the head, which distinguishes labyrinthitis from central disorders.

The patient is unstable in the Romberg position, misses the side of the slow component of nystagmus, performing the finger-nose test. With a limited labyrinth with damage to the horizontal semicircular canal, a positive fistula symptom is determined. By condensing the air in the external auditory canal, nystagmus occurs in the direction of the diseased ear, dizziness in the opposite direction.

As the disease develops, the functions of the vestibular analyzer on the affected side are inhibited, and the direction of nystagmus changes in the other direction. The decline of labyrinth function can be confirmed by the lack of response to both auditory and statokinetic stimuli.

Disturbing high-frequency noise and ringing in the ears

On the part of the hearing organ, symptoms associated with the presence of noise and decreased perception of sound stimuli are noted. Patients complain of ringing in the ears, which intensifies when turning the head. More often the noise range is within the high tones.

Hearing loss may recover within a few days; this process is typical serous in nature course of labyrinthitis. Sometimes the purulent process provokes persistent deafness.

Diagnostics

The following studies are being carried out:

1. Vestibulometry (use rotational, pressor, otolith, finger-nasal, index tests; the caloric test, recommended by some authors, is dangerous due to the possibility of generalization of the process and the provocation of intracranial complications).
2. Audiometry (threshold and suprathreshold are used).
3. Electronystagmography (using electrodes, the characteristics of nystagmus, its fast and slow components, speed, frequency, amplitude are studied).
4. CT and MRI (to exclude or detect brain pathology).
5. Videonystagmography is one of the modern research methods.

Labyrinthitis leads to hearing loss

If there are symptoms of the disease, immediate consultation with an otolaryngologist is necessary. Timely diagnosis and competent treatment will help to early stages get rid of the disease, will not allow complications and serious consequences to arise.

Therapy or surgery

Severe forms of labyrinthitis require hospitalization. The choice of therapy depends on the type of disease and its cause. Treatment of labyrinthitis should be comprehensive and include:

1. Based on the etiological moment, antiviral or antibacterial drugs. More often the process is caused by bacterial flora; for this, second generation cephalosporins are used (Cefuroxime, Ceftin, Kefurox), III generation(Ceftriaxone, Tercef), IV generation (Maxipim). In severe forms of meningitis or meningoencephalitis, fluoroquinolones are prescribed that can penetrate the blood-brain barrier (Ciprofloxacin, Tsiprinol, Cifran). Macrolides (Clarithromycin, Azithromycin) are used.
2. Anti-inflammatory, steroid drugs (Diclofenac, Dicloran, Methylprednisolone).
3. Dehydration therapy (Diacarb, Mannitol).
4. Vitamin therapy (K, P, B 6, B 12, C, Rutin).
5. Antihistamines (Suprastin, Tavegil).
6. Antiemetics (Cerucal, Phenegran, Dedalon, Bonin).
7. Sedatives (Lorazepam, Diazepam).
8. To improve blood supply to the inner ear and to reduce vestibular manifestations, Betaserc, Betagistin, Alfaserc are prescribed.

In some clinical situations with labyrinthitis, the only method is treatment with surgical intervention.

Indications for surgery:

• purulent labyrinthitis with a tendency to progress;
• combination of labyrinthitis with inflammation of the skull bones;
• entry of microorganisms into brain structures;
• necrotic inflammation with sequestration phenomena;
• persistent deafness.

For tympanogenic purulent labyrinthitis, sanitizing surgery on the middle ear, labyrinthotomy or tympanoplasty is prescribed. The presence of complications of inflammatory processes in the inner ear requires mastoidotomy or opening of the pyramid of the temporal bone. If the complications are intracranial, then a labyrinthectomy is performed. In the presence of persistent deafness after labyrinthitis, hearing aids and hearing restoration surgery (cochlear implantation) are performed.

Forecast and consequences

Timely diagnosis and treatment of acute serous labyrinthitis ensures recovery with complete restoration of vestibulocochlear functions. In favorable cases, the structures of the inner ear become overgrown with granulations, which are then replaced by fibrous and, finally, bone tissue.

If the course is unfavorable, labyrinthitis may become more complicated:

• inflammation of the facial nerve;
• mastoiditis;
• petrositoma;
• the occurrence of meningitis;
• formation of intracranial abscesses;
• encephalitis.

Inflammation of the facial nerve is one of the complications of labyrinthitis

After suffering purulent inflammation in the inner ear, persistent hearing and balance disorders may remain. Over time, adaptation processes partially occur due to the second labyrinth, the central nervous system and the organ of vision. However, complete restoration of the structures of the inner ear, functions of the cochlea, semicircular canals and vestibule is not possible.

Since the main cause of labyrinthitis is the presence of a focus of infection in the anatomical formations in contact with the inner ear, preventive measures should be aimed at:

• timely diagnosis and treatment of otitis media, meningitis and infectious diseases;
• sanitation of the nasal cavity, sinuses, mouth, pharynx;
• avoiding injury to the ear and skull bones;
• strengthening the immune system.

At the first signs or suspicion of labyrinthitis, you must immediately contact an ENT specialist for diagnosis and proper treatment. In the initial stages of development, the disease is completely curable. IN advanced stage, at untimely therapy Irreversible changes occur in the inner ear and severe consequences with intracranial complications are possible. On the part of the sound perception system, complete hearing loss may occur with labyrinthitis.

Labyrinthitis - inflammation of the inner ear: signs and methods of treatment

The inflammatory process in the tissues of the inner ear is called labyrinthitis or internal otitis. Typically, the disease develops when various pathogenic bacteria enter the inner ear.

Causes

Features of the development of labyrinthitis

The development of an inflammatory process in the inner ear can be caused by various factors.

The main causes of internal otitis:

• Otitis media
• Bacterial or viral infections
• Injury
• Meningitis
• Infections such as syphilis, mumps, influenza virus or tuberculosis can lead to labyrinthitis.

Typically, inflammation of the inner ear occurs against the background of complications of infectious processes occurring in the body.

In most cases, labyrinthitis develops as a complication of otitis media.

With this disease, purulent masses accumulate, which increases the pressure in the tympanic cavity. As a result, the purulent process spreads from the middle ear to the inner ear. An ear injury can be caused by injury from various sharp objects: knitting needles, hairpins, etc. Damage to the inner ear can be associated with traumatic brain injury.

More information about labyrinthitis can be found in the video.

Labyrinthitis can be caused by meningitis. Infection from the meninges enters the inner ear and causes inflammation. Meningogenic labyrinthitis is characterized by bilateral lesions. An infection in the inner ear can spread through the bloodstream, without being accompanied by damage to the meninges. This is observed with syphilis, mumps and other diseases.

Symptoms

Depending on the speed with which the inflammatory process spreads, the severity of symptoms appears.

With inflammation of the middle ear, the following symptoms may occur:

• Dizziness
• Impaired movement coordination
• Hearing loss
• Noise and pain in the ears

With the development of internal otitis, the patient experiences involuntary oscillatory eye movements.

Dizziness occurs due to damage to the semicircular canals.

Such attacks are short-lived and usually do not exceed 5 minutes. In some cases, dizziness may last for several hours. There may also be complaints of sweating and rapid heartbeat. If labyrinthitis has passed into a purulent or necrotic stage, then the patient completely loses hearing on the affected side.

Diagnostics

Methods for examining inflammation

To diagnose inflammation of the inner ear, the otolaryngologist will prescribe a series of tests. The doctor will examine the auricle, eardrum and the postauricular area of ​​the external auditory canal using a special device - an otoscope.

Other instrumental methods Diagnosis of labyrinthitis:

• Audiometry. Audiometry can be used to determine hearing sensitivity and hearing acuity. The procedure is performed using an audiometer.
• Vestibulometry - allows you to identify the condition of the vestibular apparatus.
• Electronystagmography. Electronystagmography is used to study nystagmus, which occurs when the inner ear becomes inflamed.

To clarify the diagnosis, highly informative methods are used: magnetic resonance and computed tomography, radiography. In addition, the patient must undergo a blood test and ear discharge. This will help determine the viral or bacterial nature of the disease.

Drug treatment

Treatment of the disease with antibiotics and medications

At conservative treatment If the disease is caused by a bacterial infection, then antibiotics are prescribed.

The treatment regimen for each is selected individually, depending on the cause and clinical manifestations of the disease:

• From the group of penicillins, Oxacillin, Amoxicillin, Piperacillin are prescribed, and from macrolides, Erythromycin or Clarithromycin is prescribed for the treatment of the disease.
• To improve blood supply in the inner ear, histamine drugs are prescribed: Alfaserc, Betahistine, etc.
• To reduce dizziness, nausea and vomiting, Diazolin, Suprastin, Diphenhydramine, etc. are prescribed.
• Anti-inflammatory drugs that have antipyretic and analgesic effects are also prescribed: Diclofenac, Dicloran, Naklofen, etc.
• To normalize trophic disorders in the cavity of the inner ear, take vitamins C, P, K, as well as the drugs Cocarboxylase, Preductal.

If treatment is started on time, the prognosis is favorable. After therapy or surgery, vestibular functions and hearing are restored. In order to avoid re-development of the disease, it is necessary to promptly identify and treat diseases and infectious processes in the body. It is also important not to delay visiting a doctor at the first sign.

Traditional treatment

To reduce the symptoms of otitis media, you can use alternative medicine methods.

• IN sore ear drip a honey-based solution. Dilute honey in equal proportions warm water and instill 2 drops into the ear. Instead of honey, you can use propolis tincture.
• For labyrinthitis, you can make an ear swab. Take onions, squeeze out the juice and mix with vegetable oil in equal amount. Then soak a tampon with the prepared solution and insert it into the sore ear overnight.
• A fairly effective remedy is an infusion of burnet rhizome. Pour 2 tablespoons of rhizome into 400 ml of hot water, place in a water bath for half an hour and strain. Take a tablespoon orally 3 times a day.
• It is useful to rinse the ear with a decoction of chamomile, lemon balm, and strong tea made from rosehip flowers.

Before using traditional methods of treatment, you should consult your doctor. Self-medication is prohibited, as it can worsen the course of the disease.

It is forbidden to use a heating pad when treating labyrinthitis - the heat generated by the heating pad can cause the spread of pus to healthy areas.

Traditional methods will help get rid of the symptoms of the disease, but cannot eliminate the true cause of the development of labyrinthitis. If you do not take action and consult a doctor, then the disease has a high probability of developing complications.

When is surgery needed?

Surgery for labyrinthitis is indicated if the disease has become purulent and occurs against the background of acute otitis media. Surgical treatment is carried out only when indicated, in severe cases when there is no effect from drug treatment.

The otosurgeon performs anthromastoidotomy, labyrinthotomy or abdominal surgery, depending on the indications. primary goal surgical intervention– remove the purulent focus from the cavity of the middle and inner ear. A few days before surgery, conservative therapy is prescribed.

Labyrinthotomy is an operation that is performed for purulent inflammation, to eliminate pus and prevent infection from entering the cranial cavity. After surgery, the patient is prescribed antibiotics and dehydration therapy. In this case, the patient's condition is taken into account.

Antromastoidotomy is performed for complications of purulent internal otitis - mastoiditis.

During the operation, the mastoid process is opened and the pus is removed. Used during surgery local anesthesia. Half an hour before the start of the manipulation, two turundas are moistened in a solution of cocaine or dicaine. Operation under general anesthesia performed in rare cases. The recovery period after surgery can last up to 3 months.

Possible consequences

Complications due to improper treatment

Complications due to labyrinthitis occur when inflammation of the middle ear affects other organs. This develops in advanced cases and untimely treatment.

The purulent form of otitis of the inner ear can lead to meningitis, cerebral thrombosis, brain abscess, and sepsis. Also, purulent otitis media can cause the development of mastoiditis, petrositis, sensorineural hearing loss, and in more serious cases can lead to hearing loss. Complications are dangerous in both adults and children.

To avoid an unpleasant outcome, you should contact an otolaryngologist when the first symptoms appear.

With timely diagnosis and proper treatment, complications can be avoided. Any disease is easier to treat at the initial stage.

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The human hearing organs are always paired. They make it easy to perceive and analyze the entire variety of sounds in the surrounding world. It is thanks to hearing that every person can not only distinguish sounds, recognize their specific character and location, but also master the unique ability to reproduce speech.

Varieties of the auditory organ

There is an outer, middle and inner ear. The latter is known to many as the “labyrinth”. It is located in the pyramid near the tympanic cavity and the internal auditory canal. The so-called vestibulocochlear nerve, in turn, exits through it.

There are bony and membranous labyrinths, the latter of which lie in the middle of the former. Bone labyrinths are a collection of small, interconnected containers, the sides of which include compact bone. They have three main departments. These are the vestibule, semicircular canal and cochlea. These elements represent the main organs of the inner ear.

The structure of the vestibule - parts of the bony labyrinths

The vestibule is middle part bony labyrinths, which has small size and oval in shape, and is also connected by five openings with the semicircular canals and a separate large space with the cochlea.

The functions of the inner ear largely depend on the lateral walls of the vestibule, facing the tympanic cavities. They also have a hole that is occupied by a stirrup plate. Another space is covered by the secondary tympanic membrane and is located at the beginning of the cochlea. With the help of a ridge that runs inside the medial walls of the vestibule, its cavity is divided into a pair of depressions (the posterior one connects to the semicircular canals, and the anterior one lies closer to the cochlea).

The anterior recess begins with a small opening, which serves as the aqueduct of the vestibule, passing through the bony substance and ending behind it. Directly behind the posterior end of the scallop, at the bottom of the vestibule, there is a small fossa, which corresponds to the initial course of the cochlea.

Bone semicircular canals

The semicircular canals of the inner ear are three arcuate passages, which are located in three planes (mutually perpendicular). The anterior semicircular canals lie vertically and are at right angles to the axis of the temporal bone. The posterior semicircular canals are arranged in the same manner, but are almost parallel to the posterior surfaces of the pyramids. The lateral canals lie horizontally, while they rest against the side of the tympanic cavities.

All these canals have a pair of legs that open into the vestibule with the help of five holes, because the nearby ends of the anterior and posterior are connected by one common stalk. Immediately before its connection with the vestibule, it forms a certain expansion called the ampulla.

Snail and its features

The cochlea is formed by a spiral bone canal starting from

vestibule. Here it curls up like a snail shell, forming circular passages. The bone rods around which the cochlea's passages wrap lie horizontally. The functions of the inner ear are closely related to the work of the cochlea.

In its cavity, during all revolutions, a spiral plate emerges, which divides the canal into two sections - the scala vestibule and the scala tympani. Near such a window there is a small internal opening - the cochlear aqueduct, the outer end of which is located at the bottom of the temporal bone.

Membranous labyrinths and their structure

The structure of the inner ear, as a rule, is characterized by membranous labyrinths, which lie in the middle of the bony labyrinths and repeat their outlines. They contain peripheral sections of auditory and gravity analyzers. Their walls are a thin transparent membrane. In the middle, the membranous labyrinths are filled with a fluid called endolymph.

Due to the fact that the membranous labyrinths are much smaller in size than the bony labyrinths, there are small gaps between them (the so-called perilymphatic spaces “perilymph”). At the beginning of the vestibule of the bony labyrinths there are two membranous labyrinths (elliptical and spherical sacs). The inner ear consists of anterior, posterior and lateral membranous ducts.

The membranous labyrinths at the site of the semicircular ducts are suspended on the bone wall using a complex system of connecting threads. This prevents movement of the membranous labyrinths when there is significant movement. The perilymphatic and endolymphatic spaces are not closed from the external environment. The first is closely connected with the middle ear along the cochlear window and the vestibule canal. The second space is connected via the endolymphatic duct to the endolymphatic sacs lying in the cranial cavity.

Auditory receptor and sound vibrations

Due to the dependence of the location of the largest amplitude of traveling waves, frequencies are distributed through different parts of the organs of Corti. Their hair cells become maximally excited mainly in those places where the greatest displacement of the brainstem is observed. Therefore, sound tones of all frequencies act on

corresponding auditory receptor. Thanks to this, the first stage of analysis of sound frequencies occurs, based on the delimitation in space of different sections of the BM, which vibrate with different amplitudes under the influence of sound tones of a special frequency.

The structure of the inner ear also consists of hair cells, which are connected to nerve endings, and the fibers of the auditory nerves begin from narrow limited areas of the organ of Corti. There are also cases where they originate from a single hair cell.

Since the auditory receptors are located in a certain place and are excited by sounds of the required frequencies, all small groups of nerve fibers of the auditory nerves conduct corresponding impulses that serve as a response to sounds of basically the same frequency, called characteristic.

When the inner ear picks up sounds that are quite complex vibrations, absolutely all the fibers in the auditory nerves are fully activated, and their characteristic frequencies match the harmonic spectra of complex sounds. Therefore, according to auditory receptors, sounds are divided into a certain harmonic spectrum. The duration of sound signals is encoded by the time during which the activation of afferent fibers entering the auditory nerve occurs.

Blood supply to the inner ear

Thanks to the human auditory system, optimal perception of various sound vibrations is ensured, nerve impulses are supplied to the auditory nerve center, information is analyzed and adaptive reactions are organized. The inner ear plays an important role here.

Each artery of the inner ear begins from the labyrinth, which serves as a kind of branch from the main artery. The vein of the labyrinth, when it enters with the cochlear nerve inside the internal auditory canal, is divided into three main branches, manifested in the vestibular (supplies the posterior saccule and uterus), cochlear (thanks to it, the cochlea is nourished) and vestibular cochlear (supplies required quantity blood lower compartment of the cochlea and vestibule) arteries.

The accumulation of veins of the vestibule and semicircular canals creates the aqueductal artery of the vestibule, which flows into the transverse or sigmoid sinus. The arteries of the cochlea connect to the veins of the cochlear canal, which flows into the inferior sinus.

Meaning of the inner ear

Indeed, the human inner ear is a rather important element of the human body. In addition, its location plays an important role.

After all, quite important, according to surgery, formations are attached to it on all sides.

So, on top is the middle fossa of the skull, below it is the superior bulb of the jugular vein, in front lies the carotid artery, on the other side is the sigmoid sinus, on the surface is the tympanic cavity, and in the middle is the posterior fossa of the skull. Therefore, the inner ear is one of the most important and responsible organs of the human body.

The inner ear, otherwise called the labyrinth, is located between the internal auditory canal and the cavity of the drum. The inner ear is divided into a membranous labyrinth and a bony labyrinth, but the former runs inside the latter. The bony cochlea, located in the inner ear, is represented by small interconnected cavities and passages, the walls of which consist of light bones. This organ of the human inner ear includes the following sections:

• vestibule;
• duct (these are channels in the form of semicircles);
• the cochlea itself.

Why is this system needed?

The main functions of the inner ear are to conduct sound waves through the cochlear duct and convert them into electrical impulses for the brain. It also acts as an organ of balance, allowing a person to navigate in space. The inner ear is a rather complex organ, without which a person would not be able to correctly identify coming sounds and would incorrectly determine the direction from which these waves come. The inner ear is the main organ of balance. If something happens to him, the person will not be able to even just stand - he will feel dizzy and his body will tilt to the side.

The basis of the balance organs is made up of the following parts of the inner ear:

• membranous labyrinth, which runs inside the bone analogue and is slightly smaller in size;
• , forming a three-dimensional structure in space.

This entire apparatus serves to determine the position of the human body in space in relation to the source of gravity. This structure allows a person to hear well and navigate the environment.

How are the organ departments arranged?

The anatomy of the inner ear, as described above, is represented by three main parts: the vestibule, the cochlear duct, and the cochlea. At the same time, each of the indicated main departments of the organ in question consists of several smaller parts. Together they form a sound converter into electrical impulses for the brain. The structure of the inner ear allows a person to well capture a sound wave coming from any direction and send it to the concentration point of the nerve converters of sound into an electrical impulse. Let's look at the individual parts of this organ.

The vestibule is a small oval-shaped cavity. It is located in the middle part of the ear labyrinth. From it, through 5 holes on the back side you can get into the semicircular canals, and in the front there is a large exit to the main cochlear duct. There is a hole on the part of the vestibule that faces the drum. Inside it is the so-called stirrup - a thin bone plate. Another exit is covered with a membrane - it is located at the origins of the cochlea. On the inner part of the vestibule there is a scallop-shaped organ that divides the entire cavity into 2 parts: the back is connected to the semicircles, and the front is connected to the cochlea through a small canal passing through the bone. Under the posterior tip of the scallop there is a small depression that opens into the membranous cochlear duct.

The semicircular canals are three arched canals of bone that are set perpendicular to each other. The first of them is located at 90º in relation to the temple bone, and the second is parallel to the posterior surface of the pyramidal bone. The third passage is located in a horizontal plane and exits close to the drum. Each of these canals has 2 legs, which open on the wall of the vestibule in the form of 5 holes (the adjacent tips of the anterior and posterior canals are united and have a common exit). The legs that enter the vestibule expand at the ends - so-called ampoules are formed.

The structure of the cochlea is as follows: it is formed by a bone canal twisted in a spiral. This passage is connected to the vestibule and is folded like the auricle of the cochlea. 2 whole and 1/5 circular motions are formed. The bone lies horizontally - the rod on which the cochlea (or rather, its passages) is curled. A bone plate extends into the inner part of the organ from the supporting bone, which divides the cavity of the cochlea into sections - the scala vestibule and the drum. On the side of the latter there is a window connecting its skeletal part with the cochlear opening. Also near the scala tympani there is a small opening of the cochlear canal, the second exit of which lies on the pyramidal bone.

Other components of the inner ear

The membranous labyrinth runs inside the main bony labyrinth and has almost the same outline. It contains nerve endings that serve to convert sound waves into impulses for the brain and are responsible for the proper functioning of a person. The walls of the labyrinth consist of translucent tissue - membrane. Inside the labyrinth there is a fluid called endolymph. The membranous type labyrinth is smaller in size than its bony counterpart, so between them there is a small space called perilymphatic.

At the beginning of the bony labyrinth there are spherical and elliptical sacs, which belong to the membranous structures. The elliptical cavity looks like a closed tube, which is attached to 3 semicircles at the back. The pear-shaped (spherical) cavity is connected at one end to an elliptical tube, and its other end is a blind extension in the shell of the pyramidal temporal bone.

Both considered sacs are surrounded by the perilymphatic space. These closed areas (spherical and elliptical sacs) are also connected by a small passage to the endolymphatic part of the ear.

The cochlea of ​​the inner ear is made of a relatively strong material - some scientists consider it one of the strongest in the entire human body.

INNER EAR(auris interna) - a system of canals of the temporal bone and the receptor apparatus of the auditory and statokinetic analyzers located in them. The complexity of the shape of the inner ear gave reason to call it also a labyrinth - labyrinthus.

In lower animals, the organ that serves to maintain balance is the static apparatus (statocyst). In coelenterates, it has the appearance of a freely protruding cone. A complication of the development of the statocyst should be considered a depression in the ectoderm, covered with epithelium with hairs and containing a statocyst or otolith (mineral calculus). A further complication is the transformation of the fossa into a closed vesicle with an otolith inside, called the “auditory vesicle,” which, however, has nothing to do with hearing and apparently reacts only to tactile stimulation. The ear labyrinth first appears in vertebrates. Already fish have well-developed semicircular canals, saccules and, in their infancy, a cochlea. The snail gets its characteristic shape only in mammals; it consists of 1.5-5 curls.

The first rudiment of V. u. in the human embryo it is detected by the end of the first month in the form of invagination of the ectoderm in depth on both sides and behind the hindbrain. A pit is gradually formed, the edges deepen and, plunging into the mesoderm, lace up in the form of a bubble. As the bubble sinks, it differentiates into the upper and lower sections. The membranous semicircular canals are formed from the upper section, and the cochlea is formed from the lower section. In places where the internal lining of the auditory vesicle comes into close contact with the fibers of the auditory nerve, the formation of stratified columnar epithelium occurs, from which the cuticular bodies of the receptor apparatus of the ampullae of the semicircular canals, sacs and cochlea are then formed. Bone capsule V. u. is formed by gradual ossification of the mesoderm around the membranous labyrinth.

Anatomy

1 - ganglion spirale cochleae; 2 - scala vestibuli; 3 - ductus cochlearis; 4 - scala tympani; 5 -pars cochlearis n. vestibulocochlearis; 6 - modiolus; 7 - organon spirale. Rice. 3. Cross section snail coil: 1 - membrane vestibularis; 2 - ductus cochlearis; 3 - membrane tectoria; 4 - stria vascularis; 5 -cellulae phalangae ext.; 6 - membrana basilaris with a spiral organ located on it; 7 - cellula pilaris ext.; 8 -cellula pilaris int.; 9 - pars cochlearis n. vestibulocochlearis; 10 - scala tympani; 11 - lamina spiralis secundaria; 12 - ganglion spirale.

Rice. 4. The right bony labyrinth (opened) and the membranous labyrinth contained within it: 1 - saccus endolymphaticus; 2 -ductus endolymphaticus; 3 - ductus semicircularis post.; 4 - crus membranaceum commune; 5 - n. ampullaris post.; 6 - ductus reuniens; 7 - v. labyrinthi; 8 - n. sacculars; 9 - ductus cochlearis; 10 - a. labyrinthi; 11 - pars cochlearis n. vestibulocochlearis; 12 - pars vestibularis n. acustici; 13 - sacculus; 14 - ductus utriculosaccularis; 15 - utriculus; 16 - ductus semicircularis ant.; 17 - dyctus semicircularis lat.

V. u., or ear labyrinth (color. Fig. 2-4), is located in the thickness of the stony part (pars petrosa) of the temporal bone and consists of a system of bone canals communicating with each other - the bone labyrinth (labyrinthus osseus), in which - The membranous labyrinth (labyrinthus membranaceus) is movably reinforced. The outlines of the bony labyrinth almost completely repeat the outlines of the membranous labyrinth, being, as it were, its capsule. The membranous labyrinth is a closed system of canals in which the terminal devices of the vestibulocochlear nerve are located (n. vestibulocochlear is). The space between the bony and membranous labyrinth, called the perilymphatic labyrinth, is filled with a fluid - perilymph, the composition of which is similar to the composition of the cerebrospinal fluid. The membranous labyrinth is, as it were, immersed in the perilymph, it is movably strengthened in its bone case with the help of a number of connective tissue strands and filled with a liquid - endolymph (endolymph), which is somewhat different in composition from the perilymph. The perilymphatic space (spatium perilymphaticum) is connected to the subarachnoid narrow bony canal called the cochlear aqueduct (aquaeductus cochleae, s. ductus perilymphaticus). The endolymphatic space does not have such communication with the subarachnoid space. From the endolymphatic space, a very narrow passage - the vestibular aqueduct (aquaeductus vestibuli, s. ductus endolymphaticus) - leads into a small closed reservoir - the endolymphatic sac (saccus endolymphaticus), embedded in the thickness of the dura mater on the posterior surface of the pyramid.

The bony labyrinth consists of three sections: the vestibule (vestibulum), semicircular canals (canales semicirculares ossei) and cochlea (cochlea).

The vestibule forms the central part of the labyrinth. Posteriorly and outwardly it passes into the semicircular canals, and anteriorly and inwardly into the cochlea. The inner wall of the vestibule cavity faces the posterior cranial fossa and forms the bottom of the internal auditory canal. Its surface is divided by a small bone ridge into two parts, one of which, the anterior-inferior one, is called a spherical recess (recessus sphaericus), and the other is an elliptical recess (recessus ellipticus). In the spherical recess there is a membranous spherical sac - sacculus, in the elliptical one - an elliptical sac - the utricle (utriculus), into which the semicircular canals flow at their ends. In the middle wall of both recesses there are groups of small holes that form flat elevations on the surface in the form of lattice spots - maculae cribrosae. They are intended for branches of the vestibular part (pars vestibularis) of the nerve. The outer wall of the vestibule faces the tympanic cavity and is mostly occupied by the window of the vestibule (fenestra vestibuli). The semicircular canals are located in three planes almost perpendicular to each other. One of the ends of each canal is expanded and is called the ampullary leg (crus osseum ampullare), the other - a simple leg (crus osseum simplex). According to their location in the bone, they are distinguished: upper - frontal, or anterior (canalis semicircularis ant.), posterior - sagittal (canalis semicircularis post.) and lateral - horizontal (canalis semicircularis lat.) canals. Both ends of each semicircular canal lead into the vestibule, only two simple legs of the posterior and superior canals are connected to each other, forming a common leg (crus osseum commune), and communicate with the vestibule through one common opening.

The bony cochlea is a convoluted canal extending from the vestibule; it spirals around its horizontal axis 2/2 times and gradually narrows towards the apex. The central bony core is called modiolus. A narrow bone plate spirals around the rod, to which a connective tissue membrane called the basement membrane (membrana basilaris) is firmly attached, forming its direct continuation. In addition, a thin connective tissue membrane - the vestibular membrane (membrana vestibularis), also called Reissner's membrane - extends from the bony spiral plate (lamina spiralis ossea) at an acute angle upward and laterally. The space formed between the basal and vestibular membranes is called the cochlear duct (ductus cochlearis), it is filled with endolymph. Above and below it are the perilymphatic spaces, forming two floors. The lower floor is called the scala tympani (scala tympani), the upper floor is called the staircase vestibule (scala vestibuli). The scalae at the top of the cochlea are connected to each other by a cochlear opening called the helicotrema. The cochlear shaft is pierced by longitudinal canaliculi (canales longitudinales modioli) for the passage of nerve fibers. Along the periphery of the rod, its winding canal (canalis spiralis cochleae) stretches spirally; nerve cells are placed in it, which form the spiral ganglion of the cochlea - ganglion spirale cochleae. The internal auditory canal (meatus acusticus internus) leads into the bone labyrinth from the skull, into which the vestibulocochlear and facial nerves. The cranial opening of the canal is located on the posterior surface of the pyramid, and the internal one ends with a bone plate, the edges are called the bottom of the internal auditory canal (fundus meatus acustici interni) and forms part of the medial wall of the vestibule and cochlea.

The membranous labyrinth consists of two vestibular sacs, three semicircular canals, the cochlear duct, the aqueducts of the vestibule and the cochlea. All these sections of the membranous labyrinth represent a system of formations communicating with each other. The elliptical sac is located in the upper part of the vestibule; it is connected to the medial wall of the vestibule by connective tissue bundles and fibers of the n. utricularis passing through the superior ethmoidal spot. Accordingly, the inner surface of the lower wall of the sac has an elevation formed by the sensitive epithelium, and is called the spot of the elliptical sac (macula utriculi). Three ampullary and two simple legs of the semicircular canals lead into the elliptical sac. The sacculus has the shape of a flat-convex lens and in the lower part it passes into the duct (ductus reuniens), connecting it with the cochlear duct (ductus cochlearis). The sacculus and utriculus communicate with each other by the endolymphatic duct (ductus endolymphaticus).

In the wall of the membranous labyrinth, the fibers of the vestibulocochlear nerve terminate in certain places. Three of them are located in ampoules and are called ampullary combs (cristae ampullares), two are in sacs and are called spots (maculae sacculi et utriculi), the last is the entire terminal nervous apparatus of the cochlea, known as the organ of Corti (organon spirale) .

The membranous cochlea is a spirally convoluted duct of triangular cross-section.

Arteries the inner ear originates from the labyrinthine artery (a. labyrinthi), the edges depart from the basilar artery (a. basilaris). The venous blood of the labyrinth collects in the plexus lying in the internal auditory canal. Venous blood flows from the vestibule and semicircular canals. arr. through the vein passing through the aqueduct of the vestibule into the transverse sinus of the dura mater. The veins of the cochlea carry blood to the inferior petrosal sinus. The inner ear receives innervation from the VIII pair of cranial nerves, each of which, upon entering the internal auditory canal, splits into 3 branches: upper, middle and lower. The upper and middle branches form the nerve of the vestibule - n. vestibularis, the lower corresponds to the nerve of the cochlea - n. cochlearis (see vestibulocochlear nerve).

Histology

Gistol, the structure of the wall of the membranous labyrinth is relatively simple. The wall of the vestibular section of the membranous labyrinth is lined with flat single-layer epithelium. This epithelium in the area of ​​ampullary ridges turns into cubic and cylindrical, located on the basement membrane, to which the connective tissue is adjacent to the outside. The network of tense perilymphatic bridges consists of connective tissue fibers that penetrate on one side into the Endoste, lining the walls of the bone labyrinth, and on the other into the connective tissue membrane of the membranous walls. Blood vessels pass through these bridges.

In their structure, the terminal nervous apparatus of the vestibular department is similar to each other. The receptor apparatus maculae sacculi et utriculi, located in the form of somewhat elevated spots, is also called the otolith apparatus (see). On these spots, the epithelial cover consists of supporting cells - sustentites (cellulae sustentantes), which are not related to the transmission of irritation, and hair (sensory epithelial) cells (cellulae pilosae), braided with nerve fibers and not reaching the basement membrane with their lower ends. Cell processes, intertwining with each other at the top, form a thin fibrous network located parallel to the upper surface of the epithelium and with its ends passing directly into the otolithic membrane (membrana statoconiorum). The latter consists of fibers, grains and numerous hexagonal crystals formed by impregnation of the protein skeleton with calcium and magnesium bicarbonate - otoliths, or statoconia. The space between the upper surface of the epithelium and the otolithic membrane is filled with a network of hairs and impregnated with a liquid mass.

Hair cells are divided into two types based on their ultramicroscopic structure. Cells of the first type have a rounded wide base, adjacent to which are nerve endings that form a cup-shaped case around it. On their outer surface there is a cuticle. 60-80 immobile hairs (steriocilia) approx. long emerge from it. 40 microns and one mobile kinocilium, the edges contain 9 peripheral and 2 central fibrils, starting from the basal bodies. The kinocilium is always located polar to the bundle of steriocilia. In the cytoplasm of cells lie mitochondria and membranes of the cytoplasmic reticulum, forming cisterns. Ribosomes lie on the surface of the membranes. Cells of the second type are cylindrical in shape and differ little in structure from cells of the first type, but are less well equipped with nerve endings.

Ultramicroscopic structure of the receptor epithelium of the ampullary scallop: I - hair cell of the second type; II - supporting cell; III - hair cell of the first type; 1 - hairs of hair cells; 2 - granules in the supporting cell; 3 - microvilli of the supporting cell; 4 - nerve endings that look like a bowl; 5 and 7 - pulpy nerve fibers; b - nucleus of the supporting cell; 8 - basement membrane; 9 - intracellular mesh apparatus; 10 - hair cell mitochondria.

The nervous apparatus of the ampullae of the semicircular canals is somewhat different from that of the vestibule sacs. Crista ampullaris, in comparison with the macula, rises strongly above its base in the form of a narrow truncated cone protruding into the lumen of the ampulla. The cone is covered with hair (sensory-epithelial) cells, above which there are jelly-like formations - cupula, as if planted on the hairs of the epithelium. In the scallops, the sensory hairs extend straight up from their cells and only deviate slightly at the edges and penetrate into the cupula covering them, distributing them quite evenly. There is no otolithic membrane. The fine structure of the hair cells of the ampullar combs (Fig.) and their innervation are almost the same as the cells of the spots.

Gistol, the structure of the walls of the membranous canal of the cochlea is quite complex. The vestibular membrane has the simplest structure, consisting of connective tissue covered with a single layer flat epithelium, facing the endolymph, endothelium facing the perilymph. The outer wall of the ductus cochlearis is fused with the spiral ligament. Capillaries penetrate into it from the vascular network embedded in the spiral ligament, which form a significant thickening - the stria vascularis. The most complex structure is the lower wall with the nervous epithelium - a spiral organ - a receptor for auditory stimuli (see Organ of Corti).

Physiology

In V. u. receptors of the auditory and statokinetic analyzers are located.

The receptor (sound-perceiving) apparatus of the auditory analyzer (see) is located in the cochlea and is represented by hair (sensory-epithelial) cells of the spiral (Corti) organ. The cochlea and the receptor apparatus contained in it auditory analyzer called the cochlear apparatus. Sound vibrations arising in the air are transmitted through the external auditory canal, the eardrum and the chain of auditory ossicles to the vestibular window of the labyrinth, causing wave-like movements of the peri-lymph, which, spreading, are transmitted to the spiral organ (see Hearing). These fluid movements are possible due to the presence of the membrane of the cochlear window, the edges with each push of the stapes and the corresponding movement of the perilymph protrude towards the tympanic cavity. Transfer of vibrations from the environment to liquid media V. at. occurs directly through the bones of the skull (bone sound conduction). In the receptor cells of the spiral organ, the physical energy of sound vibrations is converted into the energy of nervous excitation - nerve impulses arriving through the conductive section of the auditory analyzer to its cortical section. With the help of electrophysiology, research has established that with sound stimulation, electrical potentials arise in the cochlea - cochlear currents, which in frequency and shape of vibrations correspond to the sound vibrations entering the ear. Cochlear currents, after amplification, can be transformed again into sound vibrations using a telephone and exactly repeat the sound entering the ear. This phenomenon, called the cochlear microphone effect, or the Wever-Bray phenomenon, reflects the function of the receptor apparatus of the cochlea. The cochlear current curve recorded on an oscilloscope (cochleogram) also allows one to judge the integrity of the cochlear receptor apparatus.

The receptor apparatus of the statokinetic analyzer (see Vestibular analyzer), located in the semicircular canals and sacs of the vestibule, is called the vestibular apparatus. Receptors located in the semicircular canals perceive angular accelerations that occur when turning the head or rotational movements of the whole body, and receptors in the vestibule respond to linear accelerations.

Research methods

Modern methods of studying the function of V. at. are very complex and consist in determining the state of both of its functions - auditory and vestibular. When studying auditory function, an adequate stimulus is used - sound of varying frequency and intensity in the form of pure tones, noise and speech signals. Tuning forks, audiometers (tone and speech), whispered and loud speech are used as a sound source. This set of studies makes it possible to determine the state of the function of the sound-conducting system, the receptor apparatus of the vocal tract, as well as the conductive and central departments auditory analyzer (see Audiometry).

When studying the function of the vestibular apparatus, the presence of balance disorders, spontaneous vestibular reactions (see), as well as the occurrence of motor and autonomic reflexes in response to various irritations of the vestibular apparatus (rotational, caloric, galvanic, pressor and other tests) are determined. The use of special equipment makes it possible to objectively assess the state of the function of the vestibular apparatus with a high degree of accuracy (see Vestibulometry).

Pathology

Developmental anomalies V. u. occur in the form of a complete absence of the labyrinth or underdevelopment of its individual parts. In most cases, there is underdevelopment of the spiral organ, often its specific apparatus - the hair cells; sometimes the underdevelopment of the hair cells of the spiral organ occurs only in certain areas, while the auditory function in the form of “islands of hearing” may be partially preserved. In the occurrence of congenital defects V. at. the pathological effect on the embryo from the mother’s body plays a role, especially in the first months of pregnancy (intoxication, infection, injury to the fetus). Genetic factors also play a role. V.'s damage should be distinguished from congenital developmental defects. during labor as a result of compression of the fetal head by the narrow birth canal or obstetric forceps during pathological childbirth.

Mechanical damage in isolated form in V. u. are rare. With fractures of the base of the skull, the crack may pass through the pyramid of the temporal bone. In transverse fractures of the pyramid, the crack almost always involves the V. at., and such a fracture is usually accompanied by severe impairment of auditory and vestibular functions up to their complete extinction.

Wounds V. u. occur with skull injuries accompanied by bone damage. In this case, the damage area usually also includes the outer and middle ear. The diagnosis is clarified using functional studies and radiography. Treatment mechanical damage V. u. carried out according to the rules surgical treatment skull injuries. Antibiotics are widely used to prevent intracranial complications.

Specific damage to the receptor apparatus of the cochlea occurs with short-term or long-term exposure to high-intensity sounds. Long lasting loud noise on V. u. may lead to occupational hearing loss (see Acoustic trauma, Hearing loss).

Pathological changes in V. at. also occur when the body is exposed to concussions (see Vibrotrauma). In case of sudden changes in external atmospheric pressure or pressure under water as a result of hemorrhage in the V. Irreversible changes may occur, up to the death of the receptor cells of the spiral organ (see Barotrauma).

Inflammatory processes arise in V. at., as a rule, secondarily, more often as a complication of acute or chronic, purulent otitis media (tympanogenic labyrinthitis), less often - as a result of the spread of infection in V. at. from the subarachnoid space through the internal auditory canal along the sheaths of the vestibulocochlear nerve in epidemic cerebrospinal meningitis (meningogenic labyrinthitis). In some cases in V. at. It is not microbes that penetrate, but their toxins; the inflammatory process that develops in these cases occurs without suppuration (serous labyrinthitis). The outcome of the purulent process in V. There is always complete or partial deafness (see); depending on the extent of the spread of the process after serous labyrinthitis, auditory function may be partially or completely restored (see Labyrinthitis).

Functional disorders V. u. (auditory and vestibular) can occur due to circulatory disorders and circulation of labyrinthine fluids, as well as as a result of degenerative processes. The causes of such disorders may be intoxication, including certain medicinal substances (quinine, streptomycin, neomycin, monomycin, etc.), vegetative and endocrine disorders, diseases of the blood and cardiovascular system, impaired renal function. Non-inflammatory diseases of V. u. united in a group called labyrinthopathy (see). In some cases, labyrinthopathy occurs in the form of repeated attacks of dizziness and progressive loss of hearing (see Meniere's disease). In old and senile age dystrophic changes in V. u. develop as a result of general aging of body tissues and impaired blood supply to the blood supply. (see Presbycusis).

V.'s lesions may arise for syphilis. With congenital syphilis, damage to the receptor apparatus in the form of a sharp decrease in hearing is one of the late manifestations and is usually detected at the age of 10-20 years. Characteristic for V.'s defeat. with congenital syphilis, Hennebert's symptom is considered - the appearance of nystagmus with an increase and decrease in air pressure in the external auditory canal. In acquired syphilis, the defeat of V.u. more often occurs in the secondary period and can occur acutely - in the form of a rapidly increasing decrease in hearing up to complete deafness. Sometimes V.'s disease begins with attacks of dizziness, tinnitus and sudden deafness. In the later stages of syphilis, hearing loss develops more slowly. Characteristic of syphilitic lesions of V. u. a more pronounced shortening of bone sound conduction is considered compared to air conduction. Damage to vestibular function in syphilis is observed less frequently. Dissociation of reactions during rotational and caloric tests is characteristic.

Treatment for syphilitic lesions of V. at. specific. In relation to dysfunctions of V. at. specific treatment the earlier it is started, the more effective it is.

Bibliography: Ermolaev V. G. and Levin A. L. Practical audiology, L., 1969, bibliogr.; Multi-volume guide to otorhinolaryngology, ed. A. G. Likhacheva, vol. 1-2, M., 1960; H e fi-man L. V. Anatomy, physiology and pathology of the organs of hearing and speech, M., 1970; U ndr and c V.F., Temkin Ya.S. and Neiman L.V. Guide to clinical audiology, M., 1962, bibliogr.; Zimmerman G.S. Ear and brain, M., 1974; Friedmann I. Pathology of the ear, Oxford, 1974; Hals-Nasen-Ohren-Heil-kunde, hrsg. v. J. Berendes u. a., Bd 3, T. 1-2, Stuttgart, 1965-1966; Werner G. F. Das Labyrinth, Lpz., 1940, Bibliogr.; W e v e r E.G. a. L a w r e n-c e M. Physiological acoustics. Princeton, 1954.

M. I. Volfkovich, L. V. Neiman

The ear is rightfully considered complex vestibular organ, which is responsible for performing two functions. It perceives sound waves, is responsible for maintaining balance and has the ability to hold the body in space in a certain position. The ear is a paired organ located in the temporal bone of the skull and limited externally by the auricles. The ear is represented by three sections, each of which is responsible for certain functions: external, middle and internal.

Inner ear. Structure.

The internal structure of the ears is a bit like a snail (which is why it has the same name), and is a complex tubular system that is filled with liquid. The inner ear is located deep in the temporal bone; it consists of two parts - the cochlea and the semicircular canals (the organ of balance).

These organs contain a sound-receiving apparatus that is responsible for the position of the body in space, for maintaining balance, as well as for muscle tone. Anatomical similarities between these two important systems is very important, and their imbalance can cause not only hearing problems, but also a disorder of vestibular function, the main symptom of which is vomiting, nausea, and dizziness.

Balance organ of the inner ear

Or the organ of balance consists of semicircular canals, which are located in three perpendicular planes, and two small sacs. Perilymph fills the canals, inside of which there are other tubules filled with endolymph, they communicate with the canals of the cochlea. Sensitive nerve endings generate impulses that respond to head tilts, and the brain calculates how the body is positioned in relation to the head.

There are situations when cells impulse for completely different reasons than head turns. A similar situation can occur with inflammation of the inner ear or with some other pathologies, for example, when too hot or too cold water gets into the ear canal. In such cases, a feeling of nausea and dizziness may occur, up to loss of orientation in space.

Hearing organ

The inner ear is responsible for hearing sensations. Sound waves enter the inner ear and cause fluid to move and tiny villi to vibrate. The villi convert vibrations into impulses that travel along the auditory nerve to the brain, and the brain subsequently converts them into auditory images.

The inner ear is responsible for frequency recognition, thanks to which a person is able to distinguish one sound from another. The complex chain of electromechanical processes in the inner ear involves all parts of the inner ear, so for hearing to be good, they all must function properly. If any of these mechanisms fails, hearing is impaired.

Hearing loss is the most common pathology of the inner ear

Sound in the ear is characterized by such features as amplitude and frequency. Amplitude is the force with which a sound wave exerts pressure on the membrane, frequency in turn determines the number of vibrations sound wave which she makes per second. Loss of the ability to distinguish sounds and detect certain frequencies is called hearing loss. Hearing loss can be conductive, sensorineural or mixed. represents a violation of the sensitivity of the cochlea, or a decrease in the functions of the auditory nerve. Conductive hearing loss is a conduction disorder between the outer and the outside, and mixed hearing loss represents both of these disorders.