A fistula in the ear is a thin tubule formed in the area of the auricle. Its inner surface is lined with tissues of cylindrical or squamous epithelium in several layers. According to research, every fourth case of ear fistula formation is associated with heredity.
General information and classification
Most often, the fistula is localized in the area of the tragus, the cartilaginous protrusion at the base of the shell. It opens outward with a punctate hole with a diameter of not more than 1 mm, sometimes it is hiddenly connected with the cartilage and perichondrium.
The cause of the fistula in the ear can be acquired or congenital:
- Acquired appears as a complication after an unsuccessful surgical operation, as well as as a result of a protracted purulent process with otitis media or mastoiditis. The more severe the inflammation, the wider and larger the hole can be.
- Congenital develops as a result of intrauterine developmental disorders or as a rudiment of the branchial arches (incomplete overgrowth of the first branchial cleft). The scientific name for this phenomenon is preauricular fistula.
According to the classification of the professor of the Russian Academy of Natural Sciences V.M. Bobrov, all fistulas are divided into 4 categories:
- Only the entry point or a small depression is observed. The move itself is not formed, so it cannot be probed.
- There is a visible opening above the tragus. A channel with a depth of 5-10 mm is formed in the form of a cylinder or a tube. The secret does not linger in them, so inflammatory processes are rare.
- The hole is noticeable, but its diameter is noticeably smaller than the diameter of the canal itself, which leads to the accumulation of secretions and frequent inflammation. The stroke length reaches 15-17 mm.
- The channel is long (over 17 mm), sometimes there are branches.
Important! Preauricular fistulas are usually short and end blindly, their cause is incomplete fusion of the auricle tubercles.
If they are a consequence of the remnants of the branchial clefts of the embryo, then the passages can be of great length and have exits to the middle ear, neck or oral cavity.
Symptoms of the appearance
Most often, a preauricular (congenital) fistula does not make itself felt in any way, and parents do not even suspect that this is a fistula in the ear when they notice a small dot. They are often revealed by accident during routine medical examinations or cosmetic procedures, sometimes only after a few years. From time to time, a little transparent or white secretion may come out of the inlet.
However, if an infection is ingested, an inflammatory process can begin, the main symptoms of which are:
- a noticeable hole near the organ of hearing;
- soreness;
- discharge of pus from the entry point;
- pain and swelling of tissues;
- increased body temperature;
- weakness and nausea.
If the fistula is the result of surgery, bump-like lumps and redness around the suture may appear.
If a child has chronic caries or otitis media, a fistula of the labyrinth bone tissue may occur. This process is accompanied by a feeling of pulsation in the affected part of the head, nausea, vomiting, dizziness, paleness, sharp flushes with increased sweating.
Diagnosis of the disease
In the presence of symptoms of the disease, it is necessary to consult an otolaryngologist, since the developing suppuration will only intensify the pain. The ENT makes a diagnosis by performing the following actions:
- palpation of the parotid region;
- visual study of the secreted secret;
- sounding the channel to find out its depth;
- fistulography or pressor test to determine the depth of long strokes and the presence of branches.
Important! A congenital fistula in the child's ear is carefully examined.
If he is short and blind, does not pose a danger to the health of the baby, then it is enough to observe him, regularly process and disinfect him in order to prevent suppuration.
Treatment methods
In the case when the canal becomes inflamed, causing suppuration and edema of the surrounding tissues, it is necessary to carry out treatment.
In the initial period of exacerbation, the doctor makes a small incision through which purulent contents flow out. After that, antiseptic and antibacterial drugs are used, such as chlorhexidine bigluconate solution and Levomekol ointment. At the end of the inflammatory process, the hole closes, but after a while the course may fester again. In the case of an inaccessible location of the entry point, general antibiotic therapy is carried out, eliminating inflammation, after which the fistula disappears.
In the presence of frequently recurrent fistulas, the problem is solved surgically after the mandatory fistulography. Such operations are carried out with great care by experienced specialists in a hospital setting, since the preauricular fistulas are located very close to the facial nerves. Surgical intervention is carried out during the period of remission not earlier than one month after conservative treatment. For adults, local anesthesia is mainly used, for children - general anesthesia.
Shallow fistulas are removed completely. For this, modern methods of splitting or destruction by galvanocaustic means are used. The long and branched canal is cut out completely together with the capsule.
This is a rather complicated and painstaking procedure, because if part of the capsule remains in the tissues, it can fester again. At the same time, if the operation is not performed properly, then the formed scar can hide the fistulous canal and greatly complicate the repeated operation.
Traditional medicine offers its own treatment options for this disease:
- dissolve the mummy in water and make lotions;
- put compresses from a strong decoction of St. John's wort;
- lubricate the hole at night with a mixture of vodka and olive oil, applying a cabbage leaf on top.
There are no methods for preventing congenital fistulas. Acquired fistulas can be avoided if purulent forms of ear diseases, such as mastoiditis or otitis media, are promptly treated.
