Eustachian tube obstruction, otitis media and its complications, limiting driving
Eustachian tube obstruction
It is a syndrome that causes transmission deafness due to transient or permanent lack of patency of the Eustachian tube. The patient has a sensation of plugged ear and louder hearing of own voice.
In some cases, it is associated with chronic otitis perception injuries because the tube obstruction can act by reflex way or cause labyrinth events by action of the box pressure in the oval and round windows.
- In the acute phases it is important that the physician warns about all possible symptoms that can occur and that can limit driving.
- This information will enable the driver to be alert and stop driving if necessary.
- Even if there are no labyrinth symptoms, it must be recommended to drive short distances.
- If there are labyrinth events, driving is not permitted.
- When the cause and the condition have been solved, hearing ability must be assessed and reported together with its sequels to prevent risks while driving.
The inflammation of the tympanic membrane has an acute, very painful onset. It usually cures without sequels in a few days and its origin appears to be viral.
- During the acute symptomatic episode, driving is not permitted.
Simple acute otitis media without perforation is characterized by pulsatile pain in the ear irradiating to the head, and tinnitus. It is associated with progressive transmission hypoacusis and frequently fever. It cures without sequels.
Simple perforated acute otitis media is associated with much more severe pain, nocturnal, and irradiating to the face, with alteration of general condition and fever.
Sometimes, dizziness associated with vomiting occurs. Transmission deafness occurs, and there can be inner ear disorders. Immediate complications due to closeness are serious, including mastoiditis, facial paralysis, labyrinthitis, and endocraneal events such as meningitis and encephalitis.
Simple suppurated chronic otitis is characterized by central tympanic perforation, proliferative inflammation, suppuration and variable transmission hypoacusis.
It causes few subjective symptoms interfering with driving, but the sequel of perforation often requires surgery.
Cholesteatomatous suppurated chronic otitis does not show pain, but can be associated with dizziness and vomiting in the event of labyrinth complications.
Hypoacusis is of transmission, but it can be of mixed type or of perception, in case of labyrinth injuries. It can become more complicated with serious closeness infections.
Treatment is always is surgical to remove the injury in progress and attempting to rebuild entirely the ossicular tympanic system.
Chronic seromucous otitis with tympanic integrity is an inflammatory condition with mucous hypersecretion.
Frequently, long-lasting severe transmission hypoacusis occurs, with relapsing acute conditions and progression to fibrosis with adhesions.
- Obviously, driving is not permitted with these conditions.
- Drug therapy and sometimes drainage will improve the clinical condition, but the physician will advise the patient when to drive without risk, in the absence of symptoms and recovery without sequels limiting driving.
- Despite the adequate treatment, in some cases hearing is impaired, and should be evaluated throughout the disease to avoid problems when driving.
- The occurrence of labyrinth signs during an acute or chronic otitis makes driving unfeasible until the causal condition has subsided.
- In general, the sequels of all otitis share hypoacusis, in some cases associated with tinnitus. Deafness can be of transmission, pure or mixed if there was labyrinth injury during the otitis.
- Medical advice must be individualized and always confirming the good hearing capacity without labyrinth interferences, that make driving unfeasible.
- The detailed report on the hearing capacity of the patient by the specialist will allow for an adequate assessment to obtain or extend the driving license.
- Diffuse labyrinthitis: Perception deafness appears early, with nystagmus, worsening of tinnitus and often with dizziness associated with nausea and vomiting.
- Nystagmus: In acute diseases, the general condition is affected, with fever and sometimes fugax meningeal syndrome. It can eventually progress to meningitis.
- Localized labyrinthitis: It is frequently secondary to a labyrinth fistula associated with cholesteatoma. Dizziness sometimes does not occur. The outcome is variable and other complications can occur, such as facial paralysis and meningitis.
- Endocranial complications: Extradural abscess, otogenic meningitis, sinojugular thrombophlebitis, and otogenic encephalic abscess can occur.
- Driving is not permitted.
Advice on Localized labyrinthitis
- The physician should be alert to this possibility and recommend not to drive until the diagnosis is confirmed and the treatment established with a satisfactory outcome.
Advice on Endocranial complications
- They are serious conditions that make driving unfeasible until the condition shows a favorable outcome.
- Subsequently, the physician must specify the sequels and their possible interferences with driving.