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"code": "H60",
"name": "Наружный отит",
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"lead": "Нарушение здоровья, относящееся к группе болезни наружного уха",
"description": "Наружный отит — отит, при котором поражаются ткани наружного слухового прохода (а также барабанной перепонки) или ушной раковины. Является широко распространённым заболеванием, которому подвержены все возрастные группы. ",
"etiology": "<p>Наиболее часто в практической отриноларингологии встречаются наружные отиты, вызываемые бактериальной флорой, по данным литературы воспалительные заболевания наружного уха в 60 - 98% имеют бактериальную природу. Возбудителем ограниченного наружного отита чаще всего является пиогенный стафилококк. Диффузный наружный отит может быть вызван стафилококками, гемофильной палочкой, пневмококками, клебсиеллой, синегнойной палочкой, моракселлой. </p>\r\n<p>Кроме бактериальной флоры, существенную роль в развитии наружного отита играют патогенные грибы. В настоящее время выделяют до 150 видов возбудителей отомикоза. </p>",
"pathogenesis": "<p>Развитию воспалительного процесса в наружном ухе предшествует нарушение целостности кожного покрова, которое может быть вызвано многими причинами - травматическими повреждениями, длительное пребыванием во влажной среде, изменениями кожи на фоне нарушения обмена веществ, сахарного диабета, различных дерматитов, экзематозных процессов. Предрасполагают к возникновению наружного отита анатомические особенности строения - узкие наружные слуховые проходы, наличие экзостозов, а также ношение слухового аппарата, попадание воды в уши, недостаточность образования и изменение состава ушной серы, нарушение местного и общего иммунного статуса, лучевое воздействие. </p>\r\n<p>После инфицирования начинается воспаление и отёк поверхностных тканей наружного слухового прохода, что приводит к появлению соответствующих симптомов. В тяжёлых случаях инфекция может распространиться и привести к целлюлиту лица или шеи, либо лимфадениту. </p>",
"diagnostics": "<p>Диагностика включает: </p>\r\n<ul>\r\n<li>Общий анализ крови – исследование, которое помогает выявить наличие очага воспаления в организме. </li>\r\n<li>Отоскопия - осмотр наружного слухового прохода, во время которого врач оценивает его состояние, а также внешний вид и состояние барабанной перепонки. </li>\r\n<li>Исследование слуха. </li>\r\n<li>Бактериологическое исследование выделений из уха - помогает выявить возбудителя заболевания и назначить правильное лечение. </li>\r\n</ul>",
"treatment": "<p>В большинстве случаев острый наружный отит хорошо поддаётся лечению местными препаратами. Основой терапии является применение антибиотиковлибо комбинаций антибиотиков с кортикостероидами в форме ушных капель. В случае сильного отёка наружного слухового прохода в него с помощью небольшого зонда может быть введена ватная или марлевая турунда, обеспечивающая более эффективную доставку и удержание лекарственных средств в месте воспаления. При этом капли наносятся на наружный конец турунды, в результате чего она пропитывается используемым препаратом, расширяется из-за поглощённой жидкости и хорошо удерживается в слуховом проходе. После того, как отёк уменьшится и, соответственно, необходимость в использовании турунды пропадёт, она сама выпадет из ушного канала или может быть удалена вручную. </p>\r\n<p>Некоторым пациентам может понадобиться назначение анальгетиков (в случае жалоб на сильные боли) в первые несколько дней лечения. При аллергической природе отита применяется терапия антигистаминными средствами. </p>\r\n<p>В большинстве случаев наружного отита системного приёма антибиотиков (перорально) не требуется, за исключением ситуаций с осложнениями в виде целлюлита кожи лица или шеи, а также пациентов, у которых сильный отёк слухового прохода затрудняет применение местных препаратов. Также возможно применение пероральных антибиотиков у лиц с ослабленным иммунитетом. </p>",
"prevention": "<p> </p>\r\n<p>Для предупреждения инфицирования кожи слухового прохода с развитием наружного отита необходимо избегать расчесывания ушной раковины, травмирования уха и попадания в него инородных тел. При купании следует беречь ухо от попадания в него воды. Ни в коем случае нельзя самостоятельно пытаться удалить инородное тело уха, поскольку это часто приводит к травмированию кожи слухового прохода. Не следует очищать ухо от серы не предназначенными для этого предметами: шпилькой, зубочисткой, спичкой, скрепкой и т. п. Туалет уха должен производиться специальной ушной палочкой на глубину не более, чем 0,5-1 см от начала слухового прохода.</p>",
"clinical_picture": "<p>Симптомы и течение ограниченного наружного отита: сначала появляется боль пульсирующего характера, которая усиливается при жевании и разговоре. Боль в ухе усиливается при надавливании на козелок или при потягивании ушной раковины кзади. Слух, как правило, сохранен и нарушается лишь тогда, когда наружный слуховой проход полностью перекрыт. При осмотре уха видна гиперемия, отечность кожи на одной из стенок слухового прохода. Через некоторое время в центре выпячивания появляется размягчение, фурункул вскрывается и выделяется гной. <br class=\"SCXW46034744\" /> <br class=\"SCXW46034744\" />Симптомы и течение диффузного наружного отита: больные жалуются на незначительную боль в ухе, которая может сменяться зудом, иногда сильным. Температура тела обычно нормальная или незначительно повышена. Слух, как правило, сохранен, но в случае большого отека кожи и закрытия просвета слухового прохода может быть снижен. <br class=\"SCXW46034744\" /> <br class=\"SCXW46034744\" />При осмотре отмечается покраснение, отечность и утолщение кожи слухового прохода. Воспалительный процесс может распространяться на барабанную перепонку, тогда появляются незначительные прозрачные выделения из уха, снижается слух, барабанная перепонка гиперемирована. </p>",
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