RU1821141C - Method for diagnosing latent antritis - Google Patents

Abstract

The invention relates to medicine, namely to a gentle slope. The method allows to increase the accuracy of the diagnosis of latent antithete. To do this, otoscopy, radiography and, optionally, tympanometry are carried out, and when the amplitude of oscillations of the tympanic membrane is reduced compared to normal, anthritis is diagnosed. 2 ill.

Description

The invention relates to otorinol ringology, and in particular to methods for diagnosing middle ear diseases.

An object of the invention is to increase detectable ™ antrit. not accompanied by suppuration from the ear.

The goal is achieved in that the diagnosis of anthritis in the contingent of inpatient infants, the otorhinolaryngological, neurological and somatic departments is carried out using a set of techniques taken in the following sequence: otoscopy, radiography of antrum and impedance (automatic) tympanometry. I. Prerequisites for otoscopy are the complete removal of the external auditory canal from the seroepidermal layers for complete visibility of the eardrum and the use of the Slegle magnifier. Otoscopy takes into account such small, but persistent, inflammatory signs as dullness, fuzzy identification marks, smooth contours, especially the platy infiltrate, and the eardrum in its posterior regions. The described persistent changes in the eardrum

different intensities are usually determined on both sides. In older children, these changes in the eardrum, combined with the obstruction to the ventilation function of the auditory tube, defined by the pharyngeal mouth, are treated as manifestations of tubo-otitis. By eliminating the causes of tubo-otitis (adenoidotoneilectomy, septum surgery, etc.), the treatment effect of tubo-otitis can be achieved. In infants, obstruction of the pharyngeal orifice of the auditory tube has not yet been acquired to perform its ventilation function. The otoscopic picture characteristic of tubo-otitis should orient us towards the search for the cause, taking into account that in infants, the sensitivity of anthrums is characteristic. The tympanic membrane, as a window of the tympanum cavity in equal contact with the auditory tube and antrum, can reflect the presence of the inflammatory focus in the cave with its persistent erased inflammatory changes. The determination of the otoscopic picture characteristic of tubo otitis is, therefore, a necessary technique for identifying children with suspected antritis from the general

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number of patients. Taking into account that the changes in the otoscopic picture with hidden antritis sometimes differ little from the norm, and the receipt of this information is accompanied by the restless behavior of the child during the procedure of cleansing the ear canal from the epidermal layers, which also changes the initial appearance of the eardrum to some extent, the result of otoscopy cannot be completely reliable. Having established, during otoscopy, the erased inflammatory changes in the eardrum and suspecting the presence of an inflammatory focus in the mastoid cavity (antrum). proceed to the X-ray examination of antrum. We use the well-known method of targeted transorbital radiography of K. Gefferth antrum, which we perform under medical euthanasia of the child. The X-ray diffraction pattern is compared with a reference standard representing airiness, a delicate net shadow, and clear contours of the antrum. One degree or another of a decrease in airiness (veiled ™), up to a clear darkening, absence or abrasion of the mesh shadow of the intercellular ligaments, blurred contours, in the complex, are signs of damage to the mast system of the mastoid cavity, i.e. mastoiditis. In the X-ray diffraction pattern, these changes of different intensities are detected on both sides. Since technical errors in taking the image also affect the clarity of the image of the antrum, the degree of reliability of the method is not one hundred percent. Although a successful x-ray with a large degree of objectivity represents a noticeable lesion of the mast system of the mastoid cavity and on which side it is predominant. In addition, the method confirms that the effects of tubo-otitis established during otoscopy are the result of transtubar mastoidorrhea, which is regular for mastoiditis. Since the viscous cavity separated from the cells of the mastoid cavity is drained into the pharynx through the tympanic cavity, we must determine its presence in it as well as the reflection of the phenomenon (internal mastoidia) on the sound conduction state. As a rule, due to the viscosity and scarcity of the secret, paracentesis can give a negative result. 3. A decisive technique, filling in the missing information about the functional state of the middle ear, objectifying the readings of the first two methods for diagnosing anthritis, is automatic tympanometry. For its implementation, we use the Danish impedance meter of the brand Madsen 073 intended for this purpose, the headband, which is difficult to fix to the head of the infant, is removed during the procedure.

The obturator for the external auditory canal, the short-necked and metal connector with the elastic duct, prevents it from moving deeper into the external auditory canal,

0 until sealing is achieved (item I, Fig. 1). For this purpose, we replaced it with an obturator with a long neck from the hearing aid (item I, Fig. 1). A degree of decreased mobility (or increased

5 impedance) of the tympanic membrane is recorded in the form of curves B or C. A type 8 curve on one or both sides (curves I, Fig. 2), indicating the presence of exudate in the tympanic cavity, indirectly reflects a decrease in hearing through sound conduction. The control tympanometry after surgical treatment allows to determine a gradual improvement in the function of the middle ear by stating type C curves (curves II, Fig.

5 2), and subsequently type A (curves 111, Fig. 2), which is a criterion for the correctness of the proposed integrated diagnostic method for latent antrit (i.e., mastoiditis of infants).

0 Thus, only as a whole, all of the above methods give a reliable clinical picture of the secretive mastoiditis of infants, called anthritis.

5 ....: ..

Example 1. Patient 4 months. hospitalized about the district hospital with a diagnosis; Acute respiratory infection. A course of antibacterial therapy. In view of

0 treatment failure was sent to the intestinal diagnostic department of the City Children's Clinical Hospital at the Ministry of Health of the Republic of Moldova with a diagnosis of enterocolitis of unknown etiology. Carried out

5 complex therapy, including a broad-spectrum antibiotic, also remained without effect. The child remained restless, not gaining weight. Consultation with an otorhinolaryngologist.

0. Slab-expressed inflammatory changes of the tympanic membranes, detected as a result of otoscopy, such as dullness, smoothness of the contours, retraction, were indicative for X-ray examination of anthrums. In the image, the antrum is airy, but the contours are fuzzy, and the image of the mesh system in the form of a delicate net shadow is not traced. Automatic tympanometry detected on both sides of a curve of type B (curves I,

FIG. 2). With bilateral mastoidectomy, a purulent-destructive process in the cellular system of both anthrums is determined. It is discharged with recovery after suturing on the seventh day after the second one-session. Type C control tympanograms were obtained after 2 months (curves II, Fig. 2).

PRI me R 2. Patient 3 months. from this section, which failed to correct the function of the gastrointestinal tract, some dullness and retraction of the tympanic membranes were determined by otoscopy. On the roentgenogram of the antrum, veiled, blurred contours are noted when tracking the net shadow. Curves of type A are determined by an impedance meter. Mastoiditis is thus excluded.

As a result, the application of the proposed integrated method for the diagnosis of latent antrit, including automatically

tympanometry, we detect and undergo surgical intervention, on average, 100 patients with latent mastoiditis in infants per year. To demonstrate the increase in detectability, we present the coefficient of the ratio of the latent form of anthrite to the apparent, which, according to our results, is 16: 1 (or 94: 6), while the rate for V.V.Dukchuk is -2: 1 (or 132: 68). .

Formulas of the invention

A method for diagnosing latent anthritis by means of otoscopy and radiography of antrum, in which, in order to increase accuracy, tympanometry is additionally performed, and if the amplitude of vibrations of the tympanic membrane is reduced compared to normal, the antithesis is diagnosed.

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