RU2165751C1 - Method for applying postoperative tamponade in performing operations on the middle ear - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves using physiological salt solution as working medium. The solution is delivered to a flexible reservoir after its being arranged in the mastoid cavity. The solution is introduced in the amount 1.5 times as large as the mastoid cavity volume. Then a portion of the solution is removed retaining the quantity corresponding to the postoperative cavity. A half of the physiological salt solution quantity is removed from the flexible reservoir before taking off the tampon. EFFECT: accelerated treatment course. 2 dwg

Description

 The invention relates to medicine, in particular to otorhinolaryngology. It is intended for tamponade after sanitizing auditory-sparing operations on the middle ear with exacerbations of chronic purulent otitis media.

 Surgical operations on the middle ear are carried out in various modifications, the basic principle of all these operations is the removal of pathological masses from the mastoid cavity, revision of the tympanic cavity, plastic with a meatal graft, and the final stage is a dense tamponade of the postoperative cavity with gauze turunda or tampons (see "Atlas of operations otorhinolaryngology "under the editorship of prof. V.S. Pogosov - M .: Medicine, 1983, p. 75-98) [1].

 The disadvantage of this method of tamponade using gauze turundas or tampons is the traumatic effect on the wound. When they are removed, the leukocyte-necrotic layer, which is important for wound healing, is destroyed.

 In addition, after 4-6 hours, the gauze turns into a “plug”, completely losing the drainage function, and prevents the outflow of wound discharge.

 All of the above has a negative effect on the healing process of the wound and, thereby, lengthens the treatment time.

 There is a method of plugging the postoperative cavity in sanitizing hearing-preserving operations on the middle ear, which consists in the use of foam swabs that are sterilized and impregnated with drugs before administration (see V. V. Fursov. Abstract on the degree of KMN "Healing of trepanation wounds of the middle ear" - M .: 1988, p. 49-51) [2].

 The disadvantage of this method is the difficulty of introducing a tampon through the external auditory canal, caused by its low mobility, resulting in uneven pressing of the tampon to the surface of the postoperative cavity.

 There is also known a method of postoperative tamponade during operations on the middle ear, the closest in technical essence and the number of common features, which in this regard is accepted as the closest analogue. This method includes the introduction through the removed back wall of the external auditory canal into the formed mastoid cavity of the tampon in the form of an elastic container, its laying, filling with a working fluid, which is used as foam, and the subsequent removal of the tampon during dressings (see A.A. Mironov Abstract for the degree of KMN "Sanitizing auditory preservation operations in destructive forms of chronic purulent otitis media" - M .: 1992, p. 83-86) [3].

 The method [3] partially avoids the disadvantages inherent in the method [2], namely, to prevent pieces of foam rubber from sticking to the walls of the postoperative cavity, causing inflammation around them and the growth of pathological loose granulations that impede the healing process. The use of foam rubber as a working fluid, which fills an elastic container in the form of a rubber glove finger, leads to significant pressure in the tampon when introduced and removed into the mastoid cavity and as a result, to sharp pain requiring premedication with analgesics. In addition, the rubber glove finger filled with foam rubber has low mobility, poorly changes shape, that is, is not very mobile when placed in the postoperative cavity, which leads to incomplete distribution of the tampon over the entire surface of the cavity, which, in turn, leads to uneven compression of the meat flap.

 From the mentioned source [3] there is also known a device for postoperative tamponade during operations on the middle ear, containing a tampon in the form of an elastic container with a working fluid in the form of foam inside. This device is the closest in design and the number of common features with the declared, which is why it is accepted as the closest analogue.

 Its disadvantage is the inconvenience during operation, which consists in the inability to control the process of pressing the tampon to the surface of the postoperative cavity. The fact is that the foam rubber used as a working fluid, having certain elastic properties, does not have fluidity. This dramatically reduces the mobility of the swab.

 The task, which is claimed by the claimed method and device, is to reduce the treatment time and reduce the pain of dressings, especially in the early postoperative period, as well as to improve the quality of healing of the postoperative cavity.

 The technical result from the use of the method is to preserve the leukocyte-necrotic layer and reduce the colonization of the postoperative cavity in the early postoperative period and create good conditions for the outflow of wound discharge after surgery.

 The technical result when using the device lies in its ability to change its shape in a mobile manner, which allows for a uniform fit of the tampon over the entire surface of the postoperative cavity.

 The named technical result in the method is achieved due to the fact that during the postoperative tamponade, including the introduction through the removed posterior wall of the external auditory meatus into the formed mastoid cavity of the tampon in the form of an elastic container, its laying, filling with a working fluid and subsequent extraction, according to the invention, as working fluid use physiological solution, which in an amount of 2-5 ml is fed into an elastic container after its introduction into the mastoid cavity, and immediately after laying there Saline is administered in an amount exceeding 1.5 times the volume of the cavity mastoidalnoy then removed portion saline, leaving the volume corresponding to the post-operative cavity, and is removed from the flexible container before removing the tampon 0.5 part saline.

 In medicine, it is known to use a balloon catheter to remove calculi from the bile ducts in case of postcholecystectomy syndrome in endoscopic surgery (see OM Gorbunov et al. Article in the journal "Surgery" N 6, publishing house Medicine, 1996, p. 61 -63) [4]. However, it cannot be used to achieve the above technical result, since in the claimed method and device the balloon filled with physiological saline solves a completely different task, namely, it serves to ensure uniform pressing of the meat flap with the swab over the entire surface of the walls of the postoperative cavity. The use of a physiological saline solution as a working fluid, having fluidity and certain viscoelastic properties in combination with a certain quantitative-temporal sequence of its supply, and in combination with other essential features specified in the claims, allows to achieve the above technical result. In addition, in the event of a breakthrough of the balloon during laying or when removing the tampon, saline due to its neutral properties will not harm the patient's body. Therefore, the use of water or another liquid that does not have the properties of physiological saline as a working fluid is highly undesirable.

 The applicants have not found solutions containing a common set of essential features both in terms of the method and in the part of the claimed device, which allows us to conclude that the claimed technical solutions meet the criteria of the invention of "novelty" and "inventive step".

 To solve the problem with achieving a technical result, the claimed device containing a tampon in the form of an elastic container with a working fluid inside, according to the invention, is equipped with a connecting tube and a valve, the elastic container being a cylinder, the internal volume of which is 2-5 ml, and the external surface has a layer of impregnated drug treatment, while the working fluid is a physiological solution.

The claimed invention is illustrated by drawings, where:
in FIG. 1 - shows the stages of surgery on the middle ear with subsequent plugging;
in FIG. 2 - shows a General view of the device for the implementation of tamponade.

 The device contains a tampon in the form of a cylinder 1, which is an elastic container made of latex and an associated connecting tube 2, at the end of which an adjustable valve 3 is installed. The outer surface of the cylinder 1 has an impregnated layer with drug-lubricating impregnation (not shown in Fig.). As a working fluid, which fills the internal volume of the elastic container, physiological saline is used.

 Since the claimed method is implemented using the proposed device and is inextricably linked with it, a description of the operation of the device is given in conjunction with an example implementation of the method.

 The essence of the claimed method is as follows.

 After a sanitizing auditory-sparing operation on the middle ear, a balloon 1, previously disinfected and impregnated with an impregnated layer with medicinal additives, is introduced through the removed rear wall of the external auditory canal.

 The named balloon 1 is laid on the surface of the mastoid cavity. Then, in the cylinder 1 through the valve 3 through the tube 2 serves a physiological solution. A syringe can be used for this. The amount of working fluid supplied should be 1.5 times the volume of the mastoid cavity, which usually ranges from 2 to 5 ml due to individual characteristics of a person. The increased pressure created in this way allows you to press the tampon to the surgical wound and remove the wound discharge. Next, part of the physiological solution is removed from the cylinder 1, leaving in it such an amount of physiological solution that corresponds to the individual volume of the mastoid cavity. The valve 3 is closed and the swab is left until the next dressing, which is usually done after 2-3 days. When removing the swab, open valve 3 and half of the physiological saline, that is, 0.5 part of it, is removed from cylinder 1. This allows you to reduce the pain when removing the swab. Subsequently, tamponade is produced in the same sequence until the postoperative cavity is completely healed.

 The method is illustrated by the following specific examples of its implementation.

 Example 1

 Patient K., 30 years old, East. b-ni 45515. Clinical diagnosis: exacerbation of left-sided chronic purulent otitis media. He entered the ENT department on 11/16/98. Upon receipt of a complaint of suppuration from the ear, pain in the ear, hearing loss. Considers himself ill from the age of three. Exacerbations 1-2 times a year. The last aggravation worries since 09/30/98. Objectively: the left ear - the mastoid process is not changed, its palpation is painless, the external auditory meatus is wide, there is detachable in the amount of 1-2 padded jackets, the eardrum is cloudy, hyperemic, there is perforation in the posterior-upper sections. Radiological: there is a carious process in the attic-antral region of the left temporal bone. Audiologically: conductive hearing loss of 1-2 degrees with the phenomena of secondary cochlear neuritis.

 11/19/98 under anesthesia, a sanitizing auditory-sparing operation on the left ear was performed. Postoperative tamponade produced by a latex bulk swab, including a filling cylinder 1 for tamponade of the postoperative middle ear cavity; tubular connecting device 2 and valve device 3. Part of the balloon for tamponade in an unfilled state was inserted into the postoperative cavity through the external auditory meatus, the behind-the-ear wound was sutured, and then the balloon was filled with 3 ml of physiological saline.

 The balloon was removed on day 2 without sedation. Next, a daily tamponade was carried out with a bulk latex balloon. On the 10th day, a clean postoperative cavity with smooth granulations was noted. The epidermisation of the mastodial cavity was completed on the 30th day, suppuration ceased. Thus, in comparison with the average healing period of 40 days, a quite satisfactory and high-quality period of 30 days is achieved.

 Example 2

 Patient L., 16 years old, East. b-no 46344. Clinical diagnosis: exacerbation of right-sided chronic purulent otitis media. Received on November 16, 1998 in the ENT department. Upon receipt of complaints of periodic discharge from the right ear, hearing loss in this ear. The above complaints worry for 6 months, after suffering an acute respiratory viral infection, was treated on an outpatient basis without effect.

 Objectively: the right ear - palpation of the tragus, the behind-the-ear area is painless, the external auditory meatus is wide, hyperemic, there is a purulent discharge. The eardrum is muddy, without identification marks, there is perforation in the upper anterior section. X-ray: there is a blackout in the attic-antral region on the right. Audiologically: mixed hearing loss of 2 degrees with a predominance of the conductive component on the right. Bone-air gap 16 dB.

 11/30/98, under anesthesia, an operation was performed on the right ear using a latex balloon as a tamponade. Introduced 2.5 ml of physiological saline. The balloon was removed 3 days after surgery. On the 9th day, a cleansing of the cavity was noted, the epidermis was completed on the 28th day.

 Example 3. Patient M., 46 years old, East. b-ni 6730. Clinical diagnosis: chronic left-sided purulent epimesothympanitis. He entered the ENT department on 03/14/2000. Upon receipt of a complaint about periodic suppuration from the left ear, hearing loss in the left ear. Sick for 15 years, was treated on an outpatient basis, enrolled in a planned operation.

 Objectively: the left ear - the behind-the-ear area is not changed, it is painless. The external auditory meatus is wide, there is a mucopurulent discharge in the amount of 3 quilted jackets. Subtotal perforation of the eardrum. Radiological: bone-destructive process in the attic-antral region of the left temporal bone. Audiologically: conductive hearing loss of 1-2 degrees with the phenomena of secondary cochlear neuritis. On March 16, 2000, under anesthesia, an operation was performed on the left ear using a latex tampon in bulk as a postoperative tampon, which was removed on the 3rd day. On the 8th day, a cleansing of the cavity was noted, on the 25th day, complete epidermization was completed. The result of treatment can be recognized as quite satisfactory, fast and of high quality.

 In total, 17 patients have been operated on with this method of tamponade so far. Practice has shown that the developed method of tamponade can significantly reduce treatment time by an average of 30 days; reduce the morbidity and pain during the first dressings; improve the outflow of wound discharge. A significant reduction in the duration of treatment, trauma and pain was revealed.

Claims (1)

 The method of postoperative tamponade during operations on the middle ear, including the introduction through the removed posterior wall of the external auditory meatus into the formed mastoid cavity of the tampon in the form of an elastic container, its laying, filling with a working fluid and subsequent extraction, characterized in that physiological saline is used as a working fluid, which is fed into an elastic container after its introduction into the mastoid cavity, and immediately after laying the tampon, physiological saline is administered in an amount exceeding 1.5 times mastoidalnoy volume of the cavity, and then removing a part of physiological solution, leaving a volume corresponding postoperative cavity, and is removed from the flexible container before removing the tampon 0.5 parts saline.

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