RU2085164C1 - Method for surgical treatment of otitis media chronica - Google Patents

Abstract

FIELD: medicine; otorhinolaryngology; audition-improving surgical operations. SUBSTANCE: proposed method resides in implanting auditory ossicle prosthesis made of human tooth into middle ear to replace in same place chain of auditory ossicles destroyed by pathologic process. Prosthesis is made in form of arc having arms 4-5 mm and 6-7 mm long, between which angle 80-85 deg. is comprised. One arm of prosthesis is placed onto basal plate of stirrup, while its other arm is placed onto place of natural contact of temporal bone with anvil at bottom of entry to antrum. EFFECT: method ensures maximum acoustic bone conduction nearest to natural bone conduction; maximum preservation of natural middle ear tissues after surgical intervention.

Description

 The invention relates to medicine, namely to otorhinolaryngology, and may find application in carrying out hearing-improving operations.

 Currently, the most widely used methods of surgical treatment of otitis media are general open surgery with tympanoplasty in the open type and functional reconstructive surgery in the closed type on the temporal bone. The first type of operation is performed in the presence of large destruction of the middle ear cholesteatoma and makes it possible to improve hearing in patients with chronic otitis media. The second type of surgery is performed with less damage to the tissues of the middle ear by a chronic purulent process and during reconstruction of the auditory circuit provides greater efficiency for improving hearing.

 In view of the insufficient effectiveness of restoration of hearing function in both cases, as well as their underestimation of vestibular disorders in chronic otitis media, these methods do not satisfy either surgeons or patients.

 The invention relates to reconstructive methods of treatment.

 A number of methods are known for the surgical treatment of otitis media by replacing artificial ossicles in the middle ear of the auditory ossicles destroyed by the pathological process.

 Closest to the proposed is a method for improving hearing in chronic otitis media by implantation of an auditory ossicle prosthesis described in application for invention No. 9301336/1 of 03.15.92.

 As follows from the publication of the application, the prosthesis of the auditory ossicles is prepared intraoperatively from two fragments of the flat bones of the human fetus, one of which is modeled to the form of a supporting double-L-construction, the other is converted into the functional part. Such a prosthesis allows one to improve and maintain hearing, improve the stability of the supporting part of the prosthesis in the antrum and mastoid cavities, deepen the non-tympanic cavity created in the conditions of the mastoid cavity, and eliminate the retreat into the mastoid transplant cavity of the non-tympanic membrane.

 The use of such a prosthesis is possible with a hearing-improving operation, requiring the creation of a cavity in the temporal bone. The prosthesis, in our opinion, is extremely complex and requires additional surgical interventions in the middle ear tissue to install it. In addition, such a prosthesis cannot solve the problem of transmitting vibration from the temporal bone to the inner ear, since its design of 4 petals is able to repay it. It is vibration that is the basis of the sound-conducting and vestibular function of the inner ear. Therefore, such a prosthesis is unable to sufficiently improve the sound conduction function.

 The technical result of the invention is to improve the sound conduction function.

This result is achieved by the fact that in the known method of treating chronic otitis media by sanitizing the temporal bone cavity with subsequent tympanoplasty, according to the invention, tympanoplasty is performed by means of an anvil prosthesis of the middle ear made of enamel and dentin of a human tooth in the form of an arch with cone-shaped shoulders, one of which has a length of 6 to 7 mm, other 4 to 5 mm, and the angle between them of 80 85 ^o, wherein one arm is mounted on the plate of the stapes pasture, other in place of the natural contact of the anvil with Viso hydrochloric bone, after which the prosthesis is fixed neotimpanalnuyu membrane.

 The use of an anvil during surgical intervention allows you to restore the auditory circuit interrupted by the pathological process in the middle ear and thereby ensure the transmission of sound energy.

 Installing one shoulder of the prosthesis on the foot plate of the stapes, and the other on the site of natural contact of the anvil with the temporal bone, restore the interrupted auditory circuit and thereby ensure maximum transmission of sound energy.

 Fixation of the prosthesis with a non-tympanic membrane from the temporal fascia further improves the direct sound-conducting system.

 The essence of the method is as follows.

 A patient with chronic otitis media who is shown a sanitizing operation with hearing enhancement is first given a sanitizing stage of the operation on the temporal bone, removing its pathological contents, then a tympanoplasty stage, replacing the damaged part of the auditory ossicle chain with a prosthesis made in the form of a boomerang made of enamel and dentin of a human milk tooth . In this case, one shoulder of the prosthesis is installed on the foot plate of the stapes, the other on the temporal bone in the place of contact with the anvil at the bottom of the entrance to the antrum. A non-tympanic membrane or the remains of a tympanic membrane with a hammer are placed on the prosthesis. Perforation of the tympanic membrane is covered with fascia from the temporal muscle.

 Example 1. Patient S. born in 1951 medical history N 1926/95, was admitted to the ENT clinic of the Ivano-Frankivsk Medical Academy on 02.24.95 with a diagnosis of chronic otitis media on the right. Condition after general cavity surgery. From the anamnesis it is known that it has been sick since childhood. Complaints of suppuration from the right ear, hearing loss, noise in the right ear, pain in the temporal region on the right. General cavity surgery was performed in 1981.

 During a physical examination, the pressure is 230/80 mm Hg, vesicular breathing in the lungs, rhythmic heartbeat, systolic murmur at the apex, abdomen soft, painless, physiological functions are normal.

 When the otolaryngologist is examined, the postoperative scar on the skin behind the ear is 4 cm long. According to the results of otoscopy, there is no purulent discharge in the external auditory canal with an unpleasant odor, there is no single postoperative cavity with incomplete epithelization in the region of the demolished spur and near the vestibule. SR AD / AS auricle / 6 m. Audiometry N 169.95 from 02/23/95 increase sound perception in air at low tones -50 60 dB, on bone at high tones 60 65 DB.

 Based on the foregoing, the diagnosis of chronic suppurative otitis media on the right. Condition after general cavity surgery with incomplete epithelization of the postoperative cavity. Right hearing loss of the V degree.

02/25/95 sanitized reoperation was performed on the right temporal bone with tympanoplasty. After removing the carious bone in the area of the spur and the oval window, a boomerang-like anvil prosthesis was made from the tissues of the milk tooth with shoulders of 6 mm and 4 mm and an angle between them of 80 ^o . One shoulder of the prosthesis was installed on the foot plate of the stapes, the other on an elevation, on which the short leg of the anvil normally rests. The prosthesis was covered with fascia from the temporal muscle. Stitches to the skin behind the ear. Aseptic dressing. Postoperative dressings according to the usual scheme.

 When the patient was discharged from the clinic on 10.03.95, the General condition is satisfactory, no complaints. There is no discharge on the right in the external auditory canal, the retrotal tympanic cavity is covered with a delicate layer of pink epithelium. Non-tympanic membrane of a pale pink color, its integrity is preserved, a prosthesis is visible under it. ШР AD / AS 4,5 m / 6 m. With audiometry, the thresholds of sound conduction in the hand and in the air are within the age norm.

 When viewed after 6 months, in September 1995, the patient does not complain, resumed hearing (right ear). General condition is satisfactory.

 There was no otoscopy of blood pressure from the ear, complete epithelization of the postoperative cavity, non-tympanic membrane in satisfactory condition, bluish in color, an anvil prosthesis from the tooth tissue is visible under the membrane. SR AD / AS- 4,5 m / 6 m.

 In this way, 6 patients with positive results have been operated on to date.

 The proposed method in comparison with the known has several significant advantages.

 1. Due to the proposed form of the anvil prosthesis, due to the developed theory of sound conduction and closest to natural, the method ensures the restoration of maximum sound conduction.

 2. The method also provides maximum preservation of natural tissues of the middle ear.

 3. Use for implantation of a prosthesis made of enamel and dentin of human milk teeth provides reliability and immunotolerance.

 The method was developed by a team of scientists from the Ivano-Frankivsk Medical Academy and the St. Petersburg Research Institute of ENT and was tested on the clinical bases of both institutes with positive results.

Claims (1)

A method for the surgical treatment of chronic otitis media by sanitizing the temporal bone followed by tympanoplasty using an anvil bone prosthesis from a biomaterial, characterized in that the auditory bone prosthesis is made in the form of an arch with conical shoulders 4 5 and 6 7 mm long and an angle between them of 80 85 ^o , and the enamel and dentin of a human tooth are used as biomaterial, with one shoulder of the prosthesis mounted on the foot plate of the stapes, the other at the place of natural contact of the anvil with the temporal bone w, after which the prosthesis is fixed neotimpanalnuyu membrane.