JP5192231B2 - Artificial ear canal - Google Patents

Description

  The present invention relates to an artificial ear canal that can restore the function of a patient's ear canal by being embedded in the ear canal of a patient.

  The ear is composed of an outer ear, a middle ear, and an inner ear. The outer ear and the middle ear are partitioned by the eardrum located at the inner end of the ear canal. The middle ear consists of the tympanic chamber (middle ear cavity), which is the space that houses the ear ossicles (Tut bone, Kinuta bone and urn bone) that connect the eardrum and the vestibular window (which leads to the vestibule of the inner ear), and the pharynx extending from the tympanic chamber The ear canal is open to the The eustachian tube begins in the tympanic vestibule (the tympanic ear canal), and extends obliquely from the upper rear outer side to the lower front inner side and opens in the pharyngeal side wall (the ear canal pharyngeal mouth). The eustachian tube is about 33 mm long, the upper side about 1/3 passes through the temporal bone, and the lower side about 2/3 is wrapped with cartilage. The bony ear canal is once narrowed through the narrowed tympanic ear canal and then becomes thinner, becomes the thinnest at the entrance of the cartilage (the ear canal), and is normally closed at this position. Below the eustachian tube part, the eustachian tube gradually becomes thicker and opens in a trumpet shape at the pharyngeal mouth. One function of the eustachian tube is the ventilation function. This is because active contraction of the palatal canal muscle during yawning and swallowing causes the lower wall of the cartilage part to be pulled downward, causing the lumen of the canal to temporarily open, and air to flow from the pharynx into the tympanic chamber. It can be divided into a passive type and a passive type that is passively ventilated as the external pressure changes. In a healthy ear, the intratympanic pressure is kept equal to the external air pressure because of the ventilatory function of the eustachian tube, particularly the active ventilation function. The ear canal also has the function of excreting the secretions of the middle ear into the pharynx. The state in which these functions are impaired, that is, ear canal dysfunction, such as ear canal stenosis (ear canal obstruction), ear canal openness, ear canal insufficiency, exudative otitis media, cholesteatic otitis media, Adhesive otitis media and the like can be mentioned.

  Eustachian canal stenosis is a condition in which the expansion of the eustachian canal that occurs due to swallowing, distraction, etc. is impaired for some reason, and ventilation of the middle ear through the canal is impaired. The cause includes an organic stenosis of the eustachian tube due to inflammation of the nasopharynx and the like, and a functional stenosis due to a malfunction of the open canal muscle of the eustachian tube (palate scapularis) such as cleft palate. When ventral ventilation of the middle ear is obstructed due to stenosis of the ear canal, oxygen in the tympanic chamber is absorbed from the surrounding mucosa, resulting in a negative pressure in the tympanic chamber, and the tympanic membrane is indented. As a result, symptoms such as ear-closed feeling, hearing loss, and hearing loss are caused. In addition, if tubal stenosis persists, it may shift to exudative otitis media. This is a disease in which exudate leaks into the middle ear cavity as a result of persistent negative pressure in the tympanic chamber. The exudate fills the tympanic chamber and causes hearing loss and ear obstruction, as well as recurrent acute otitis media. It becomes easy to suffer from. In addition, when the tympanic chamber is placed in a chronic and irreversible negative pressure state, it is an adhesive otitis media that is an extremely intractable disease in which the tympanic membrane adheres to the middle ear wall, or in the mucous membrane of the middle ear cavity that is not originally epithelium. It also causes cholesteatogenic otitis media, a disease in which the keratinized squamous epithelium of the tympanic membrane proliferates and destroys the surrounding bone in the process.

  For the treatment of ear canal stenosis, so-called ear canal ventilation therapy, in which a catheter is inserted into the mouth of the pharyngeal cavity and ventilated, is frequently used. Other treatments include steroid hormone injection into the ear canal from the pharynx side or tympanic cavity side, and steroid hormone injection submucosal around the ear canal pharyngeal mouth, but the effect is objectively established. It has not been done. In conservative treatment by medication, systemic administration of anti-inflammatory enzyme preparations and drugs with antiallergic action and nasal steroids are performed, but long-term medication is required, and it is effective in cases of moderate or higher There is a problem that there are many cases where it cannot be obtained sufficiently. For cases where drug therapy is not effective, instillation of the tympanic tube is also performed to ensure ventilation of the tympanic chamber. The eardrum tube is a tube that is fitted into a perforation provided in the eardrum, and various sizes and shapes are commercially available. One of the most commonly used is a central constricted tube having a length of about 3 mm. However, although the tympanic tube can provide ventilation of the tympanic chamber, the ear canal stenosis itself is not sufficiently improved, and the ventilation and excretion function through the ear canal are not necessarily restored. In addition, the eardrum tube usually falls off naturally within a few months to a year as the perforation of the eardrum is repaired. Therefore, if ear canal stenosis is not improved, the eardrum tube is placed again to ensure ventilation. Is also required. Recently, a treatment method for cauterizing the mucous membrane in the ear canal from the pharyngeal mouth side using a laser (carbon dioxide laser, KTP laser) has been developed for cases that resist drug treatment. However, there are many unclear points about the effects on the surrounding tissues when cauterizing the inner part close to the canal canal, and sufficient anatomical knowledge and advanced surgical techniques are required to perform the canal cauterization. Mastering is indispensable and has not been done widely and easily.

  Eustachian tube is a condition in which the eustachian tube is always open. The patient's subjective symptoms include self-hearing due to his / her voice reaching the middle ear through the eustachian tube, Some people complain of dizziness because they can hear breathing sounds and have a feeling of ear closure. The patient's tympanic membrane is normal but is observed to move back and forth with breathing. Causes of eustachian tube include atrophy of the nasal mucosa due to aging and neurological diseases, atrophy of the peritubular mucosa due to weight loss, and scarring after adenoid surgery, but the cause is unknown.

  Examples of drug therapy for eustachian tube include bezort method in which mixed powder of boric acid and salicylic acid is sprayed into the ear canal with an ear canal catheter, injection of gelatin sponge solution into the ear canal lumen, etc. Surgical treatment includes injection of liquid silicone, ear mucosal cauterization, palatal scapular muscle movement, implantation of cartilage pieces or adipose tissue around the ear canal, collagen injection, etc. There is a problem that surgical treatment is required and surgical treatment is ineffective. In addition, as a device for treatment of eustachian tube and intubation insufficiency, a flattened eustachian pin with a taper that is placed in the middle ear canal lumen from the eardrum to about 5 to 15 mm deep is proposed. However, this works to close the cross section of the ear canal and cannot be applied to ear canal stenosis.

  Also, so-called floppy tubes have recently attracted attention from the viewpoint of ear canal function. The floppy tube is an ear canal that easily closes and also becomes open, and is brought into an open state of the ear canal due to yawning and swallowing. In order to eliminate these discomforts, patients often unconsciously sniff (which causes negative pressure in the tympanic chamber and closes the ear canal), but this becomes habitual and chronic and irreversible When placed under a negative pressure, as described above in relation to ear canal stenosis, it also causes exudative otitis media, adhesive otitis media and cholesteatoma otitis media.

  As described above, abnormalities of the eustachian tube function cause various diseases of the middle ear. However, it is possible to effectively and easily treat floppy tubes that cause both ocular canal stenosis, eustachian tube openness or both occlusion and openness. There is also a need for a reliable treatment method that can be used for the treatment of adhesive otitis media, prevention of tympanic membrane adhesion after surgery for exudative otitis media, prevention of recurrence of pearl species, and the like.

  For this purpose, the present inventor first developed a tube having a predetermined shape having an opening for ventilation on the tube wall. And this is inserted into the ear canal part from the tympanic membrane side through the tympanic membrane, and the tip is positioned in the ear canal, while the opening of the tube wall is positioned in the tympanic chamber, and the rear end of the tube is attached to the tympanic membrane. By fixing it through the tube, it is possible to connect the nasal cavity and the tympanic chamber to the ear canal stenosis (tubal obstruction) and restore the ventilation function and excretion function through the ear canal to a physiologically close state. In addition, it is possible to secure an appropriate communication between the nasal cavity and the tympanic chamber through the lumen of the tube by closing at least a part of the cross section of the tubal canal that is excessively widened against open canal and tubal insufficiency. I found it. Focusing on the fact that such a tube is extremely effective in the treatment of ear canal dysfunction and can be an "artificial ear canal", based on this, an artificial ear canal consisting of a tube of a predetermined form was developed. (International application date October 28, 2004: Patent Document 2).

Furthermore, the present inventor does not need to fix the rear end to the eardrum, thus allowing the perforation of the eardrum to be closed, and can bring about the same therapeutic effect while restoring the tympanic environment closer to a more physiological state. Two types of artificial ear canals that can be completely implanted have been developed, and patent applications and international applications have been filed for them (patent document 3 on November 5, 2004, international application date February 21, 2005). Japanese Patent Literature 4). Of these fully implantable artificial ear canals, the former is provided with a multi-stage annular projection at the site to be sandwiched between the ear canal, and the latter has a structure that fixes itself to the inner wall of the ear chamber at the rear end. It is provided or provided with a constricted portion (or a protrusion in front of the constricted portion) at a portion to be sandwiched between the ear canal portions. Each of these fully-embedded artificial ear canals has a smooth outer periphery such as a circle or an ellipse in the cross-section at the portion sandwiched between the canal canals, and therefore, contact with the inner wall of the canal canal Is closely attached to the surface.
JP 2002-224157 A PCT / JP2004 / 015959 PCT / JP2005 / 002724 Japanese Patent Application No. 2004-323016

  In the above background, the present invention is a fully implantable type artificial ear canal that is inserted into a patient's ear canal to normalize the flow of air and exudate between the tympanic chamber side and the nasal cavity side. An object of the present invention is to provide an artificial ear canal that can further enhance the efficiency of excretion of exudate in the tympanic chamber to the nasal cavity side.

  The inventor of the present invention has a smooth outer periphery such as a circle or an ellipse in a cross section at a portion sandwiched by the canal part in the above-described fully-embedded artificial ear canal. Therefore, the inner wall of the canal part We focused on the point of contact with the surface in the form of close contact between the surfaces. That is, since the exudate does not flow along the outer periphery of the artificial ear canal at the close contact portion between the inner wall of the canal and the outer canal of the artificial canal, the exudate flows exclusively through the lumen of the artificial ear canal. On the other hand, if the flow path in the front-rear direction can be secured around the artificial ear canal while maintaining the function of maintaining the position of the artificial ear canal in the portion sandwiched between the canal isthmus, The exudate outflow from the artificial ear canal can be further promoted. The present inventor can achieve this by securing a flow path in the front-rear direction between the projecting portions by providing a plurality of projecting portions dispersed around the outer periphery at the portion sandwiched between the ear canal portions. As a result, the present invention was completed. That is, the present invention provides the following.

(1) It has a distal end, a rear end, and a lumen. The distal end of the cartilage part is exposed to the cartilage part through the canal part from the bone part of the ear canal part. An artificial eustachian tube for insertion into
At least at the site to be sandwiched between the ear canal part, the outer peripheral surface is provided with a plurality of protrusions dispersed around the outer periphery,
The lumen is open to the outside through at least one distal opening, at the site of the artificial ear canal and / or closer to the distal end thereof,
An artificial ear canal characterized in that the lumen is opened to the outside through at least one rear opening behind the part.
(2) The artificial ear canal according to 1 above, wherein a plurality of protrusions are further dispersed in the longitudinal direction of the artificial ear canal on the outer peripheral surface at least at a portion to be sandwiched between the canal canal portions.
(3) The plurality of protrusions provided to be distributed around the outer periphery and in the longitudinal direction are such that the height of the tip as a whole decreases toward the tip side of the artificial ear canal. Said 2 artificial ear canal.
(4)
4. The artificial ear canal according to any one of 1 to 3 above, wherein the protrusion is a warped protrusion.
(5) Any of the above 1 to 3, wherein the protruding portion is a ridge extending in the longitudinal direction of the artificial ear canal and rising at the tip side while increasing in height toward the rear. An artificial eustachian tube.
(6) The above-described 1 to 3, wherein the projecting portion is a ridge extending in the longitudinal direction of the artificial ear canal, and the ridge has a plurality of notches on the upper edge in a lateral cross section thereof. Any artificial eustachian tube.
(7) The artificial ear canal according to 6 above, wherein the protrusion has a triangular blade shape in which a plurality of ridges are arranged in a lateral cross section.
(8) The artificial ear canal according to 6 or 7 above, wherein the protrusions reduce the height toward the rear on the rear end side.
(9) The artificial ear canal according to any one of 1 to 3 above, wherein the protruding portion is a rod-shaped protrusion protruding from the outer peripheral surface of the artificial ear canal.
(10) The artificial ear canal according to any one of 1 to 9 above, wherein a portion to be sandwiched between the ear canal portions is located within 20 mm from the tip of the artificial ear canal.
(11) The artificial ear canal according to any one of 1 to 10 above, wherein the protrusion is provided over a range of 5 mm or more in the longitudinal direction of the artificial ear canal.
(12) The artificial ear canal according to any one of 1 to 11 above, wherein the protrusion is provided on the rear side from a position 4.5 mm from the tip of the artificial ear canal.
(13) In any one of 1 to 12 above, the tip of the protruding portion is located within a radius of 0.3 to 3.0 mm from the central axis of the artificial ear canal Artificial ear canal.
(14) The annular constriction portion is included on the distal side of the artificial ear canal adjacent to the protruding portion provided behind and distributed from a position of 4.5 mm from the distal end of the artificial ear canal. The artificial eustachian tube of any one of 1 to 13.
(15) providing a flow path having an inner diameter of 0.2 mm or more through which the distal end side opening, the lumen, and the rear side opening communicate with the inside and outside of the artificial ear canal; The artificial ear canal according to any one of 1 to 14 above, wherein the flow path has a portion having an inner diameter of 0.9 mm or less.
(16) The artificial ear canal according to any one of 1 to 15 above, wherein the rear opening is open on a side wall of the artificial ear canal.
(17) The artificial ear canal of the above 16, wherein the rear opening is also opened at the rear end of the artificial ear canal.
(18) The artificial ear canal according to any one of 1 to 17 above, wherein the total length is 22 mm or more.
(19) The artificial ear canal according to any one of 1 to 18 above, which is made of a flexible resin.

  According to the present invention configured as described above, a flow in the front-rear direction can be ensured at the contact portion between the artificial auditory canal and the canal canal portion in the portion sandwiched between the canal canal portions, and thus the lumen of the artificial ear canal is provided. In combination with the flow path, the discharge of exudate in the tympanic chamber to the nasal cavity side can be further promoted. Therefore, effective and simple treatment of floppy tubes that cause ear canal stenosis, ear canal or both obstruction and opening, treatment of adhesive otitis media, prevention of tympanic membrane adhesion after exudative otitis media, Provided is an artificial eustachian tube that can be used to prevent recurrence and has a further enhanced exudate excretion function.

The top view which looked at the artificial ear canal of Example 1 from the back somewhat. The top view seen from the back of the artificial ear canal of Example 2 a little Plan view of the artificial eustachian tube of Example 3 as seen from slightly behind The top view seen from the back of the artificial ear canal of Example 4 The top view of the artificial ear canal of Example 5 seen from a little rear The top view seen from the back of the artificial ear canal of Example 6 Conceptual diagram showing the principle of eustachian tube function testing by the pressure reduction method Conceptual diagram showing the principle of acoustic eustachian tube function test Conceptual diagram showing the principle of eustachian catheter air permeability test Chart showing results of preoperative acoustic eustachian tube examination in case 1 Chart showing the results of preoperative Valsalva ventilation in Case 1 Chart showing results of preoperative nasal deep breathing in case 1 Chart showing results of preoperative pressure reduction test in case 1 Chart showing results of postoperative acoustic eustachian examination in case 1 Chart showing test results of postoperative ear canal catheter ventilation in case 1

Explanation of symbols

1 = tubular body, 2 = small diameter portion, 3 = tip, 4 = opening, 5 ′ = opening, 6 = opening, 7 = projection, 8 = shaft side shaft portion, 9 = constricted portion, 11 = tubular body 12 = small diameter part, 13 = tip, 14 = opening, 15 = opening, 16 = opening, 17 = protrusion, 18 = shaft side shaft part, 19 = constricted part, 21 = tubular body, 22 = small diameter part, 23 = tip, 24 = opening, 25 = opening, 26 = opening, 27 = projection, 28 = tip-side shaft portion, 29 = constricted portion, 31 = tubular body, 32 = small diameter portion, 33 = tip, 34 = opening , 35 = opening, 36 = opening, 37 = protrusion, 38 = tip shaft portion, 39 = constricted portion, 41 = tubular body, 42 = small diameter portion, 43 = tip, 44 = opening, 45 = opening, 46 = Aperture, 47 = protrusion, 48 = tip side shaft, 49 = constricted portion, 51 = tubular body, 52 = small diameter portion, 53 = tip, 54 = open, 55 = open, 56 = open, 5 = Protrusion 5, 8 = tip side shaft portion, 59 = constricted portion, 141 = pressure transducer, 142 = amplifier, 143 = recorder, 151 = acoustic examination function analyzer, 161 = ear canal pressure sensor, 162 = ear canal catheter, 163 = Air pressure sensor

  The artificial ear canal of the present invention is inserted into the ear canal of a patient from the tympanic chamber side, with the tip facing the ear canal of the cartilage and the rear end as a rule positioned in the tympanic chamber (that is, inside the tympanic membrane) End up in the patient's ear canal. Considering ease of handling, the artificial ear canal of the present invention preferably has a total length of 22 mm or more. Usually, it can be used for most patients as long as the total length is 30 mm or more. On the other hand, since the artificial ear tube of the present invention may be used by appropriately excising the rear end side so as to have a length suitable for the size of the patient's middle ear when used, there is no particular upper limit on the total length. Although about 45 mm is sufficient for most patients, it may be determined as desired, such as 50 mm, 70 mm, etc. in consideration of the convenience of handling, including the part to be excised.

  The artificial ear canal of the present invention has an elongated shape as a whole because it is inserted into the ear canal of a patient from the eardrum side. The outer diameter of the rear part of the plurality of protrusions provided on the outer peripheral surface may or may not be constant, but it is usually preferable to stop the outer diameter to about 3 mm. However, since this part is arranged in a bone-like ear canal that expands toward the front side and a wider tympanic chamber, the outer diameter may be slightly larger than 3 mm as long as it has an elongated shape as a whole. Is done.

  The cross-sectional shape of the artificial ear canal of the present invention is not particularly limited. Usually, it may be circular, but since the cross section of the eustachian tube is flat, it may have a flat cross section such as an ellipse. In addition, the cross-sectional shape may be the same over the entire length of the artificial ear canal, but it may not be, for example, in the most part of the entire length, in a circular shape (for example, from the tip to the portion held between the ear canal) It may be elliptical, or may be elliptical in most of the entire length and circular in part (for example, from the tip to the portion sandwiched between the ear canal portions). Since the cross-section of the eustachian tube is a flat shape extending in the front-rear direction from the left and right, if the artificial eustachian tube has an elliptical cross-section, the protruding portion abuts most of the inner peripheral surface of the eustachian tube Increase the stability of the fixation of the artificial eustachian tube. In order to be able to handle various types of patients with the artificial ear canal with the fewest possible dimensional standards, the long axis / short axis ratio should be limited to 5 even in the case of a flat cross-sectional shape such as an ellipse. Is preferred. For example, it can be 5, 4, 3, 2, etc. The cross-sectional shape and dimensions of the artificial ear canal of the present invention are individually determined by the attending physician in accordance with the shape and condition of the patient's ear canal to be treated. In the case of a flat cross-sectional shape such as an ellipse, the “diameter” when referring to the “outer diameter” and “inner diameter” of the artificial ear canal of the present invention means the shorter diameter (short axis).

  In the present invention, “the part to be clamped in the canal part” means that the artificial ear canal of the present invention faces the tip of the cartilage part through the canal part from the bone part of the canal part and is held in the canal part. In consideration of the approximate length of the cartilage ear canal (about 2/3 of the entire ear canal) in consideration of the fact that it is an artificial ear canal for insertion into the patient's ear canal, What is necessary is just to set to the appropriate position which is not too close to the ear canal pharyngeal mouth. Usually, it may be set in the range of several mm to several tens of mm from the tip of the artificial ear canal. However, in the case of a patient having a large physique and a long ear canal, it may be a site about 20 mm away from the tip. Usually, it is preferably within 20 mm from the tip, and more preferably within 16 mm.

  In the present invention, the “plurality of projecting portions” are for holding the artificial ear canal in a fixed position by the drag received from the canal canal portion in contact with the ear canal portion. As long as it is, various forms can be adopted. Here, “dispersed around the outer periphery” means that a plurality of protrusions are provided with gaps when viewed in a cross section of the artificial ear canal. Accordingly, the “dispersion around the outer circumference” may be a radial uniform distribution or a non-uniform distribution. The gap between the plurality of projecting portions provided in a distributed manner is a front-rear direction between the inner wall surface of the eustachian tube portion and the outer peripheral surface of the eustachian tube in the state where the artificial ear tube of the present invention is sandwiched between the canal portion. It works to secure the flow path.

  In the present invention, when “a plurality of protrusions are provided with being dispersed in the longitudinal direction”, the groups of adjacent front and rear protrusions may be equally spaced or unequal. In addition, the group of protrusions provided dispersed around the outer periphery and the group of protrusions adjacent immediately after that may have the front and rear protrusions aligned at the same position around the outer periphery. They may be arranged in a staggered manner so that the rear protrusions are located in the gaps, or may be arranged at random.

  In order to be effectively sandwiched between the canal portions of various inner diameters, the protrusions are preferably provided over a range of 5 mm or more in the longitudinal direction of the artificial ear canal, and provided over a range of 6 mm or more. More preferably. Usually, the range may be about 5 to 10 mm.

  The plurality of protrusions provided dispersed around the outer periphery and in the longitudinal direction are such that the height of the tip as a whole decreases toward the tip of the artificial ear canal. This is because the size of the protrusion is made smaller toward the end of the prosthetic ear canal, or the outer peripheral surface on the front end side of the prosthetic ear canal where they are arranged is the same size. This can be achieved by tapering. By doing so, since the portion to be sandwiched between the canal canal portion becomes tapered when viewed as the entire projection group, it is easy to insert into the canal canal portion, and the insertion depth can be adjusted by adjusting the depth of insertion. Since the operator can feel the resistance with his / her hand, the region of the optimal thickness of the artificial ear canal can be sandwiched between the ear canal portions, and the stability of fixation is increased.

  The shape of the protruding portion is not particularly limited as long as it can leave the outer peripheral surface of the artificial canal and come into contact with the inner wall of the canal portion, but preferably does not have a sharp angle so as not to damage the tissue. An example of the projecting portion is a hemispherical shape, a stump shape, a cone shape, a truncated cone shape, a pyramid shape, a truncated pyramid shape, a cubic shape, and other polyhedrons, and the ratio of width to height is 1: 2 to 2: This is a protrusion having a relatively low height compared to the width in the range of about 1 (generally referred to as “warm-shaped protrusion” in the present invention). However, it is preferable to eliminate sharp corners by rounding the tip even in a conical or pyramidal shape. Further, these protrusions may be flexible.

  Another example of the protrusion is a protrusion extending in the longitudinal direction, which is a fin-shaped protrusion having a high height relative to the thickness, a protrusion having an arcuate shape with a thicker section, A protrusion having a rectangular cross section may be used. Such ridges may vary in height in the longitudinal direction, and in particular for the convenience of insertion into the eustachian tube, the height increases rearward on the tip side. Is preferred. Further, the protrusion may have a plurality of cutouts in the side cross section, and in that case, the cutouts engage with the curved surface of the inner wall of the eustachian tube part, and the position change in the front-rear direction of the artificial ear canal It works to increase resistance. A typical example of such a cutout is a series of V-shaped cutouts, which results in a triangular blade shape having a plurality of upper edges in a side section of the ridge. Further, when the upper edge has a plurality of cutouts, the artificial ear canal can be fixed by the cutout portions, so the height of the rear end side of the ridge may be appropriate, and the height decreases toward the rear. It may be a thing. Further, these protrusions may be flexible.

  Yet another example of the protrusion is a rod-shaped protrusion protruding from the outer peripheral surface. Here, the “rod-like protrusion” may extend straight or may be bent. Further, the thickness may be constant, but the thickness may change along the length, such as a taper. The rod-shaped projections may protrude perpendicularly from the outer peripheral surface in the radial direction, but for ease of insertion into the ear canal part and stabilization of fixation against backward slipping, they should be inclined backward. It is preferable to do this. The rod-like protrusion is preferably flexible.

  The outer diameter of the artificial eustachian tube is a matter that should be appropriately selected according to the inner diameter of the eustachian tube part affected by the state and physique of the canal stenosis (tubal obstruction), eustachian tube openness, etc. . In order to increase the versatility of one artificial auditory canal as much as possible with respect to the inner diameter of various canal canals, the tip of the projecting portion is usually the central axis of the artificial auditory canal at the part held between the canal canals. It is preferable to make it so that it may be located in the range of 0.3-3.0 mm in radius, and it is more preferable to create so that it may be located in the range of 0.3-1.8 mm.

  Since the distal end opening at the distal end of the artificial ear canal of the present invention is an opening for opening the lumen toward the cartilage canal side (that is, the nasal cavity), it may be opened in the axial direction of the lumen. However, the distal end side opening may be provided on the side of the distal end portion as a blind end in the axial direction. When the tip is blinded, when the artificial ear canal is inserted into the ear canal using a guide wire that passes through the lumen, there is no risk that the tip will hit the blind end of the artificial ear canal and stop moving forward. Since it becomes easy to remove only the guide wire after insertion of the artificial ear canal, the operation is simplified. However, even when the distal opening is provided at the distal end of the artificial ear canal in the same axial direction as the lumen, the distal end or the vicinity thereof (for example, the distal end, for example, the diameter of the distal opening is narrowed by 0.2 mm or more from the diameter of the lumen). Within the range of 5 mm or 10 mm or less), the diameter of the flow path is narrowed, and if the portion narrowed by 0.2 mm or more compared to the inner diameter of the lumen behind it is provided, By using the guide wire, it is possible to prevent the guide wire from being attached to the front, so there is no problem. In addition, when the distal end side opening is provided on the side of the distal end portion, the number of openings may be one, but a plurality of openings may be provided. For example, a pair of openings may be provided on both sides of the lumen. When the distal end side opening is provided on the side wall other than the distal end of the artificial ear canal, the position may be appropriately selected between the distal end of the artificial ear canal and the portion held between the ear canal.

  The artificial eustachian tube of the present invention is opened to the outside via at least one opening (referred to as “rear opening” in the present specification) behind the portion to be sandwiched between the ear canal portions in addition to the front end side opening. Yes. The posterior opening may be provided on the side wall of the lumen, may be the end of the axially open lumen, or may include both. Providing an opening in the side wall of the lumen has the advantage of facilitating the discharge of exudate into the nasal cavity through the lumen when there is exudate in the tympanic chamber. When the posterior opening is provided in the side wall of the lumen, the position and the number thereof may be appropriate. For example, immediately behind a group of protrusions provided in a portion to be sandwiched between the canal isthmus or the tip of the artificial ear canal From about 20 to 25 mm. One opening may be provided on the side wall, but a plurality of openings may be provided, or a pair of openings may be provided on both sides of the lumen. Further, the artificial ear canal of the present invention has an opening (for example, a slit-like opening extending over the entire length of the part, or a longitudinal direction of the part between the group of protrusions provided in the part to be sandwiched between the ear canal parts. It is also possible to further provide one or a plurality of apertures arranged. When such an opening is added, the flow and ventilation of the exudate are further promoted in conjunction with the swallowing movement, and a more preferable effect is obtained. Such an additional opening can be provided separately from the rear opening. However, if the rear opening is provided immediately behind the group of protrusions, the additional opening may be integrated with the rear opening. Good.

  The insertion of the artificial ear canal into the patient of the present invention typically involves inserting a guide wire from the rear end side through the lumen into the inner lumen while supporting it, and inserting the distal end portion into the ear canal portion. Then, after the tip is made to face the cartilage ear canal, only the guide wire is removed, and the artificial ear canal is left in a state where the rear end portion is disposed in the tympanic chamber or the bone ear canal. Therefore, typically, at the time of insertion, it is preferable that the lumen is opened as it is at the rear end of the artificial ear canal. However, when the artificial ear canal is formed of a sufficiently strong material, the use of a guide wire is not essential, and the rear end can be closed.

  The distal opening, lumen, and posterior opening allow air (and exudates) to flow between the cartilage ear canal (ie, the nasal cavity) and the tympanic chamber in cooperation with the outer protrusion gap. Thus, a flow path that functions as a natural ear canal of the patient is formed. The flow path preferably has an inner diameter of at least 0.20 mm. This is because, if the diameter of the lumen is too narrow, resistance to the flow of air (and possibly exudate) therein may occur, but there is substantially less concern over 0.20 mm or more. On the other hand, if the inner diameter of the flow path is too large over the entire length, the voice may be conducted in the tympanic chamber. In order to prevent this, the inner diameter of at least any part of the flow path is preferably 0.9 mm or less, more preferably 0.8 or less. By providing such a portion, even when the diameter of the remaining portion of the flow path is larger, the voice is surely prevented from being conducted to the tympanic chamber.

  One object of the artificial ear canal of the present invention is to achieve communication between the tympanic chamber of the patient and the cartilage ear canal via the lumen of the artificial ear canal and ensure ventilation between the tympanic chamber and the nasal cavity. . Therefore, the insertion of the artificial ear canal into the patient is such that the artificial ear canal engages with the orbital canal or its surrounding tissue so that the tip of the artificial ear can face the cartilage ear canal and the distal opening is the cartilage ear. It is done to open into or towards the tube. The artificial ear canal inserted into the patient's ear canal is excised if there is an excess in the length of the rear end part, and is typically located with the rear end inside the eardrum and in the tympanic chamber And stay in the patient.

  The artificial ear canal of the present invention can include a shaft portion (referred to as a “tip-side shaft portion”) that extends forward from the plurality of protrusions, although it is not essential. Since the distal end side shaft portion serves as a guide during insertion, it is usually preferable to have the distal end side shaft portion. Considering the strength and the inner diameter of the lumen, the outer diameter of the distal shaft portion is usually preferably 0.6 to 2 mm, but it should be reduced to about 0.4 mm for patients with a narrow canal area. Is also possible. Except for these points, the outer diameter of the distal end side shaft portion may be determined as appropriate in relation to the height of the most distal end side protruding portion adjacent thereto. Further, the length of the distal end side shaft portion may be determined as appropriate, for example, about 4.5 to 6 mm.

  When the prosthetic ear canal of the present invention includes the distal end side shaft portion, the distal end side shaft portion includes an annular constricted portion, that is, a portion with a reduced outer diameter, adjacent to the distal end side of the plurality of projecting portions. Can do. The annular constricted portion is preferably one having a width of 0.5 to 2.5 mm in the longitudinal direction. Depending on the size of the patient's canal, it can be used to engage an annular constriction with the canal. The annular constricted portion may be smaller by 0.1 to 0.4 mm than the outer diameter of the distal end side shaft portion adjacent to the portion.

  The material constituting the artificial ear canal of the present invention is flexible, that is, biocompatible, that is, does not cause a foreign body reaction harmful to the living body, and does not cause decomposition or deterioration in the living body. The material is preferred. As such a material, various materials that have been conventionally used for in-vivo implantation or indwelling in medical applications can be appropriately used for the production of an artificial ear canal. Examples of the flexible synthetic resin include, but are not limited to, vinyl chloride, silicone, polyethylene, polypropylene, polypentene, polyurethane resin, and the like. A metal (for example, titanium) or a ceramic can be used for a part (for example, the constricted portion). In addition, resin designed to increase softness when heated to body temperature is easy to handle because it can maintain moderate hardness during insertion, but it becomes softer at body temperature after insertion, giving the patient a foreign body sensation It is more preferable because there is no fear. Furthermore, by using autologous cartilage formed by culturing as a biomaterial, an artificial ear canal having superior safety can be obtained.

    Hereinafter, the present invention will be described more specifically with reference to typical examples. However, the present invention is not intended to be limited to the examples.

[Example 1]
FIG. 1 is a plan view of an example of an artificial ear canal (made of polyurethane) according to the present invention as seen from the rear side. In the figure, reference numeral 1 denotes a tubular body constituting the tube portion of the artificial ear canal, and is drawn with the length direction shortened due to the limitations of the figure. The tubular body 1 includes a small diameter portion 2 near the rear end. The narrow-diameter portion 2 is obtained by narrowing the protruding portion from the eardrum in case the artificial ear canal is inserted into the patient's ear canal and a part of the rear end is protruded via the eardrum for follow-up observation. However, it is not essential for the purpose of the present invention and may remain thick even if removed. In the tubular body 1, a lumen passes from the vicinity of the front end 3 to the rear end, and opens to the outside through the opening 4 (one of the rear openings) at the rear end. The opening 4 can be used when a guide wire is passed through the artificial ear canal when it is inserted, but is not essential when it can be inserted without using the guide wire, and is omitted (that is, the rear end is blind). And). The tubular body 1 is also provided with an opening 5 (which is one of the rear openings) on the side wall, and is open to the outside through this. In the drawing, only one opening 5 is drawn on the front side of the side wall of the tubular body 1, but the back side of the side wall of the tubular body 1 is further provided at a position symmetrical with respect to the central axis of the tubular body 1. An opening may be provided. Further, in addition to or instead of the opening 5, an opening 5 ′ may be provided at a position indicated by a broken line. The tubular body 1 further has an opening 6 (front end side opening) in the vicinity of the distal end 3, and a lumen is opened to the outside on the distal end side through the opening 6. Thus, the tubular body 1 includes a flow path communicating with the outside between the vicinity of the front end and the rear end side.

  The tubular body 1 is provided with a plurality of large and small protrusions 7 in a state of being distributed around the outer periphery of the tubular body in a region near the tip. In order to help understanding, the height of the protrusion 7 is somewhat exaggerated in the figure. In this embodiment, the projections 7 are provided in a state of being dispersed in the longitudinal direction of the artificial ear canal, and when the height is gradually increased from the front end side to the rear end side of the artificial ear canal, that is, as a whole The tips are arranged so that the height of the tips decreases (taperes) toward the tip side of the artificial ear canal. In the present embodiment, around the outer periphery of the artificial ear canal, five groups of four protrusions 7 (some of which are hidden behind the tubular body 1 and cannot be seen) are dispersed in the longitudinal direction and arranged in five groups. The protrusions of each group are arranged so that a part of the rear protrusions enter between the front protrusions. This interleaved staggered arrangement, coupled with the gradual increase in height between groups, enhances the compatibility of the prosthetic canal to various dimensions of the canal gorge and provides a variety of orientations between the protrusions 7. Provide a flow path. Each projection 7 has a parabolic cross section and rises while increasing in height from the distal end side of the artificial ear canal to the rear. This structure facilitates insertion of the artificial eustachian tube into the eustachian tube.

  Between the distal end of the artificial ear canal and the protrusion 7, the distal end side shaft portion 8 that is a part of the tubular body 1 extends without the protrusion 7. An annular constricted portion 9 is provided in a region adjacent to the protrusion of the distal end side shaft portion 8. The constricted part 9 is for holding this part between the canal part in a case where the canal part is particularly narrow, and is not essential for the purpose of the present invention, but the canal part having various dimensions. It is useful to increase the compatibility of the artificial ear canal with

  Each dimension of the artificial ear canal in the present embodiment can be variously determined in consideration of the inner diameter of the patient's ear canal and the length of the ear canal. As an example, the remaining length of the tubular body 1 excluding the thin diameter portion 2 is 30 to 32.5 mm, the length of the thin diameter portion 2 is 10 mm, the length of the distal end side shaft portion 8 is 6 to 8.5 mm, The length of the portion 9 is 1.5 to 2.5 mm, the outer diameter of the central portion of the tubular body 1 is 1.50 mm, the outer diameter of the thin portion 2 is 1.00 mm, the maximum diameter of the distal end side shaft portion 8 is 1.45 mm, The portion 9 has an outer diameter of 1.30 to 1.35 mm, and the protrusions 7 are provided in a range of 6 to 8 mm in the longitudinal direction of the artificial ear canal. The range is 2 to 0.6 mm.

[Example 2]
FIG. 2 is a plan view of another embodiment of the artificial ear canal according to the present invention as seen from the rear side. In the figure, reference numeral 11 denotes a tubular body constituting the tube portion of the artificial ear canal, and is drawn with the length direction shortened due to the limitations of the figure. The tubular body 11 includes a small diameter portion 12 near the rear end, and the purpose and function of the small diameter portion 12 are the same as those of the small diameter portion 2 of the first embodiment. In the tubular body 11, a lumen passes from the vicinity of the tip 13 to the rear end, and opens to the outside via an opening 14 (one of the rear openings) at the rear end. The purpose and function of the opening 14 are the same as the corresponding opening of the first embodiment. 15 is an opening (one of the rear openings) provided on the side wall of the tubular body 11, and 16 is an opening (tip side opening) provided near the tip. The openings 15 and 16 may be further provided at symmetrical positions on the back side of the tubular body 11.

  The tubular body 11 is provided with a plurality of protrusions 17 in a region near the tip in a state of being distributed around the outer periphery of the tubular body, and a gap between them forms a flow path in the front-rear direction. To aid understanding, the height of the protrusions 17 is somewhat exaggerated in the figure. The ridge 17 is a fin-like ridge having a high height relative to the thickness, and has a series of V-shaped cutouts N, and as a result, has a triangular blade shape (sawtooth shape). Further, the ridge 17 has a height that increases rearward on the front end side and a height that decreases rearward on the rear end side, and has the highest portion in the middle portion. The various height cutouts increase the compatibility of the prosthetic canal to the dimensions of the various canal canals and stabilize the fixation. The distal end side opening 13, the distal end side shaft portion 18, and the constricted portion 19 are the same as the corresponding portions in the first embodiment.

Example 3
FIG. 3 is a plan view of still another embodiment of the present invention as seen from the rear side. In the figure, reference numeral 21 denotes a tubular body constituting the tube portion of the artificial ear canal, and is drawn with the length direction shortened due to the constraints of the figure. The tubular body 21 includes a small diameter portion 22 in the vicinity of the rear end, and the purpose and function of the small diameter portion 22 are the same as those of the small diameter portion 2 of the first embodiment. In the tubular body 21, a lumen passes from the vicinity of the distal end 23 to the rear end, and opens to the outside through an opening 24 (one of the rear openings) at the rear end. The purpose and function of the opening 24 are the same as the corresponding opening of the first embodiment. Reference numeral 25 denotes an opening (one of the rear openings) provided on the side wall of the tubular body 21, and 26 denotes an opening (tip end opening) provided near the tip. The openings 25 and 26 may be further provided at symmetrical positions on the back side of the tubular body 21.

  The tubular body 21 is provided with a plurality of large and small curved rod-shaped projections 27 distributed around the outer periphery of the tubular body 21 and also in the longitudinal direction of the artificial ear canal in a region near the tip. . To aid understanding, the height of the protrusions 27 is somewhat exaggerated in the figure. The protrusion 27 gradually increases in height from the distal end side to the rear end side of the artificial ear canal, that is, when viewed as a whole, the height of the distal end decreases (taperes) toward the distal end side of the artificial ear canal. Are arranged as follows. These bar-shaped protrusions 27 having different heights enhance the compatibility of the artificial canal to various sizes of the canal canal, increase the resistance to backward withdrawal, and particularly enhance the stability of the fixation of the artificial canal. Increase. Between the protrusions 27, flow paths in various directions are provided. In the figure, for example, a group of 14 (six of which are hidden behind the tubular body 21 and not visible) 27 are distributed around the outer periphery so that they are distributed around the outer periphery. Typically, 6 to 14 protrusions 27 are provided in a distributed manner. The distal end side opening 23, the distal end side shaft portion 28, and the constricted portion 29 are the same as the corresponding portions in the first embodiment.

Example 4
FIG. 4 is a plan view of still another embodiment of the present invention as seen from the rear side. In the figure, 31 is a tubular body constituting the tube portion of the artificial ear canal, and is drawn with the length direction shortened due to the constraints of the figure. The tubular body 31 includes a small diameter portion 32 near the rear end, and the purpose and function of the small diameter portion 32 are the same as those of the small diameter portion 2 of the first embodiment. In the tubular body 31, a lumen passes from the vicinity of the tip 33 to the rear end, and opens to the outside through the opening 34 (one of the rear openings) at the rear end. The purpose and function of the opening 34 are the same as the corresponding opening of the first embodiment. 35 is an opening (one of the rear openings) provided on the side wall of the tubular body 31, and 36 is an opening (tip-end opening) provided near the tip. The openings 35 and 36 may be further provided at symmetrical positions on the back side of the tubular body 21.

  The tubular body 31 is provided with a plurality of large and small substantially straight rod-shaped protrusions 37 in a region near the tip and inclined rearward in a dispersed state around the outer periphery of the tubular body. In this embodiment, the protrusions 37 are provided in a state of being dispersed in the longitudinal direction of the artificial ear canal, and when the height is gradually increased from the front end side to the rear end side of the artificial ear canal, that is, as a whole. The tips are arranged so that the height of the tips decreases (taperes) toward the tip side of the artificial ear canal. In this embodiment, around the outer periphery of the artificial ear canal, four groups of projections 37 (some of which are hidden behind the tubular body 31 and cannot be seen) are dispersed in the longitudinal direction and arranged in four groups. In each group of protrusions, the rear protrusions are arranged between the front protrusions. These bar-shaped projections 37 having different heights enhance the compatibility of the artificial ear canal to various sizes of the canal canal, increase the resistance to backward withdrawal, and particularly enhance the stability of the fixation of the artificial ear canal. Increase. Between the protrusions 37, flow paths in various directions are provided. The distal end side opening 33, the distal end side shaft portion 38, and the constricted portion 39 are the same as corresponding portions in the first embodiment.

Example 5
FIG. 5 is a plan view of still another embodiment of the present invention as seen from the rear side. In the figure, reference numeral 41 denotes a tubular body constituting the tube portion of the artificial ear canal, and is drawn with the length direction shortened due to the limitations of the figure. The tubular body 41 includes a small diameter portion 42 in the vicinity of the rear end, and the purpose and function of the small diameter portion 42 are the same as those of the small diameter portion 2 of the first embodiment. In the tubular body 41, a lumen passes from the vicinity of the front end 43 to the rear end, and opens to the outside via an opening 44 (one of rear openings) at the rear end. The purpose and function of the opening 44 are the same as the corresponding opening of the first embodiment. 45 is an opening (one of the rear openings) provided on the side wall of the tubular body 41, and 46 is an opening (tip side opening) provided near the tip. The openings 45 and 46 may be further provided at symmetrical positions on the back side of the tubular body 41.

  The tubular body 41 is provided with a plurality of large and small hemispherical projections 47 in a distributed state around the outer periphery of the tubular body in a region near the tip. In this embodiment, the protrusions 47 are provided in a state of being dispersed in the longitudinal direction of the artificial ear canal, and when the height is gradually increased from the front end side to the rear end side of the artificial ear canal, that is, as a whole. The tips are arranged so that the height of the tips decreases (taperes) toward the tip side of the artificial ear canal. In the present embodiment, around the outer periphery of the artificial ear canal, protrusions 47 (four of which are hidden behind the tubular body 41 and cannot be seen) are arranged on the most distal side, and the rear end side. In FIG. 4, five groups of protrusions 47 (some of which are hidden behind the tubular body 41 and cannot be seen) are dispersed in the longitudinal direction and arranged in five groups. The rear projections are arranged between the projections. These protrusions 47 having different heights enhance the compatibility of the artificial ear canal to various sizes of the auditory canal, and increase the resistance to backward withdrawal, thereby increasing the stability of the fixation of the artificial ear canal. Between the protrusions 47, flow paths in various directions are provided. The distal end side opening 43, the distal end side shaft portion 48, and the constricted portion 49 are the same as the corresponding portions of the first embodiment.

Example 6
FIG. 6: is the top view seen from the back of another another Example which partially changed the artificial ear canal of Example 5. FIG. In this embodiment, the projections 57 are all the same size, but a tapered region is provided on the surface by partially expanding the outer diameter of the tubular body 51 (in this embodiment, the rear side The projection 57 is arranged on the tapered surface of the projection group 57 so that the projection group is tapered when viewed as a whole. The distal end side opening 53, the distal end side shaft portion 58, and the constricted portion 59 are the same as the corresponding portions in the first embodiment.

[Clinical trial]
Some of the results of clinical trials treated by inserting the artificial ear canal of the present invention into a patient are described below.

(Test method)
Eustachian tube function test: Eustachian tube function test was performed by the pressure-depressurization method, the acoustic eartube method and the eartube catheter ventilation method.
In the examination by the pressure-depressurization method, static pressure is applied to check the pressure at which the ear canal opens naturally (passive open pressure or reverse aeration pressure) by applying air pressure at a constant speed from the ear canal side through the eardrum to the ear canal. There are a test and a dynamic test in which a constant positive pressure or a negative pressure is applied to the middle ear from the ear canal side and the degree of opening of the ear canal by swallowing movement (active opening) is examined. According to the pressurization and decompression method, in the case of a healthy ear canal, even if the pressure of the tympanic chamber is increased from the outer ear side, the ear canal is opened by swallowing movement, so that recovery due to rapid decompression is observed. Even if the air pressure to be applied is gradually increased, the ear canal is passively expanded when the air pressure exceeds a certain level, and the air flows out (passive opening). In contrast, in ear canal stenosis, since the ear canal remains closed during swallowing, the tympanic pressure does not decrease even after repeated swallowing, and the tympanic pressure must not increase significantly. Passive dilatation of the eustachian tube does not occur. Passive opening pressure is considered to be abnormal when the average of normal ears is about 355 daPa and the standard deviation x2 is considered normal and exceeds 545 daPa.

  An eustachian function inspection apparatus ET-1000 manufactured by Nagashima Medical Instrument Co., Ltd. was used for the inspection by the pressure reduction method (conceptually shown in FIG. 7). When air pressure (positive pressure or negative pressure) is applied from the outer ear side of a tympanic membrane perforation patient and the ear canal is released (by swallowing or applied air pressure), the device channel is adjusted to the plot diagram of the pressurization and decompression method. The pressure change due to the increase in pressure was measured by the pressure transducer 141, amplified by the amplifier 142, recorded in the recorder 143, and evaluated.

  The acoustic eustachian method is a method for examining the open / closed state of the eustachian tube by projecting sound from a load sound source into the nasal cavity and monitoring the change in sound pressure during swallowing using a microphone attached to the ear canal. If the ear canal is enlarged during swallowing, the sound in the nasal cavity conducts air through the ear canal and reaches the outer ear. Therefore, the presence and extent of the ear canal stenosis is evaluated by the change in sound pressure captured by the microphone on the ear canal side. can do.

  For the examination by the acoustic eustachian tube method, an eustachian function test apparatus ET-1000 manufactured by Nagashima Medical Instruments Co., Ltd. was used (conceptually shown in FIG. 8). The channel of the device 151 was adjusted to the acoustic ear canal function test, and the swallowing motion and the sound pressure of the ear canal were simultaneously monitored to evaluate the presence or absence of the opening of the ear canal during swallowing.

  The test by the eustachian catheter aeration method is a method of measuring the change in the middle ear cavity pressure by increasing the aeration pressure of the catheter inserted from the nasal cavity side as conceptually shown in FIG. In normal cases, an increase in middle ear pressure is usually observed at a ventilation pressure of about 8 kPa. In the figure, 161 is an external ear canal pressure sensor, 162 is an ear canal catheter, and 163 is a ventilation pressure sensor. The aeration pressure at point A is the eustachian tube opening pressure (kPa).

(Case 1) A 16-year-old male patient. Right ear canal, almost always with the air in the ear and nose in circulation, and the acoustic method of the eustachian function test shows a ski slope-like curve with a long duration of eustachian canal ( FIG. 10), even when Valsalva ventilation with TTAG is performed, the ear canal opening pressure is abnormally low at 14 daPa (FIG. 11), and the middle ear pressure varies greatly even with deep nose breathing (FIG. 12). In the pressurization and decompression test (Fig. 13) through the tympanic membrane perforation before the operation, when the middle ear pressure rises to 10 daPa, the ear canal opens, the load pressure is released, and the ear canal is at a considerably low pressure. Open. All were findings of eustachian tube. An artificial eustachian tube having a triangular blade-like projection of the type of Example 2 was created and inserted. On the 10th day after the operation, subjective symptoms such as clogging of the ears and breathing sound are greatly improved, the ski slope-like curve disappears with the acoustic method, and the duration of opening of the ear canal during swallowing is normalized (FIG. 14). In the canal catheter aeration using a catheter, the open pressure of the ear canal was 9 kPa, which was in a normal range (FIG. 15). It should be noted that the eustachian tube open pressure is an objective measurement of the eustachian catheter air permeability. When the catheter ventilatory pressure is increased, the change in the middle ear cavity pressure is detected by the pressure sensor, which is normally around 8 kPa. In this case, the preoperative opening pressure of the eustachian tube was approximately 1 kPa, and it was clearly diagnosed as eustachian tube (FIG. 15).

  According to the present invention, an effective and simple treatment of a floppy tube that causes tubal stenosis, tubal openness or both occlusion and opening, treatment of adhesive otitis media, prevention of tympanic membrane adhesion after exudative otitis media surgery There is provided an artificial eustachian tube that can be used to prevent recurrence of pearls and pearls, which greatly enhances the function of exudate excretion.

Claims (15)

It has a distal end, a rear end, and a lumen, and is inserted into the patient's ear canal with the distal end facing the cartilage ear canal through the ear canal from the bony ear canal side and sandwiched by the ear canal portion. An artificial eustachian tube to keep
At least at the site to be sandwiched between the ear canal part, the outer peripheral surface is provided with a plurality of protrusions dispersed around the outer periphery,
The projecting portion is (a) a warped projection, or (b) a ridge extending in the longitudinal direction of the artificial ear canal, and stands up while increasing in height toward the rear at the tip side. A lateral cross section having a plurality of notches on the upper edge, or (c) a rod-like protrusion protruding from the outer peripheral surface of the artificial ear canal,
The lumen is open to the outside through at least one distal opening, at the site of the artificial ear canal and / or closer to the distal end thereof,
An artificial ear canal characterized in that the lumen is opened to the outside through at least one rear opening behind the part.   The prosthetic ear canal of claim 1, wherein the posterior opening is open in a side wall of the prosthetic ear canal.   The artificial ear canal according to claim 2, wherein the rear opening is also opened at the rear end of the artificial ear canal. At the site to be clamped to at least the ear canal isthmus, the outer peripheral surface, in the longitudinal direction of the plurality of the protrusions further the artificial ear canal are those provided by dispersing, any of the artificial ear canal of claims 1 to 3 .   The plurality of protrusions provided to be distributed around the outer circumference and in the longitudinal direction are such that the height of their tips as a whole decreases toward the tip side of the artificial ear canal. Artificial ear canal. The artificial ear canal according to any one of claims 1 to 5 , wherein the ridge has a triangular blade shape in which a plurality of ridges are arranged in a lateral cross section. The artificial ear canal according to any one of claims 1 to 6 , wherein the protrusion has a height that decreases rearward on the rear end side. The artificial ear canal according to any one of claims 1 to 7 , wherein a portion to be sandwiched between the ear canal portions is located within 20 mm from the tip of the artificial ear canal. The artificial ear canal according to any one of claims 1 to 8 , wherein the protruding portion is provided over a range of 5 mm or more in the longitudinal direction of the artificial ear canal. The artificial ear canal according to any one of claims 1 to 9 , wherein the protruding portion is provided on the rear side from a position of 4.5 mm from the tip of the artificial ear canal. The artificial ear according to any one of claims 1 to 10 , wherein a tip of the projecting portion is located within a radius of 0.3 to 3.0 mm from a central axis of the artificial ear canal in a portion to be sandwiched between the ear canal portions. tube. An annular constriction is included on the distal side of the artificial ear canal on the rear side from a position of 4.5 mm from the distal end of the artificial ear canal and adjacent to the projecting portion provided dispersedly. 11. The artificial eustachian tube of any one of 11 . The distal opening, the lumen, and the posterior opening provide a flow path through which the inside and outside of the artificial ear canal communicate with the inner diameter of at least 0.2 mm, and the flow The artificial ear canal according to any one of claims 1 to 12 , wherein the path has a portion having an inner diameter of 0.9 mm or less. The artificial ear canal according to any one of claims 1 to 13 , wherein the total length is 22 mm or more. The artificial ear canal according to any one of claims 1 to 14 , which is made of a flexible resin.

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