RU2165765C1 - Method for eliminating traumatic defects of the tympanic membrane - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves placing a piece of transparent film required size on the boundary of the traumatic defect after preliminarily deepithelizing the perforated hole edges. The film carries human allofibroblast culture. Hearing function is repaired during operation and within the following day active tympanic membrane tissue regeneration takes place. The restored tympanic membrane has no cicatricial deformities. EFFECT: enhanced effectiveness of treatment; prevented secondary infection of the tympanic cavity. 2 dwg, 1 tbl

Description

 The invention relates to medicine, namely to otorhinolaryngology, and touches on the important problem of hearing restoration in traumatic rupture of the eardrum.

 Numerous methods of surgical intervention are known for traumatic perforation of the eardrum. So, in particular, there is a known method for restoration of the eardrum using auto-, homotransplants (Kholmatov I. B., Bobodzhanov U.B. Our experience of emergency myringoplasty with traumatic ruptures of the eardrum. VII Congress of Otolaryngologists of the Ukrainian SSR, abstracts October 4-6. Odessa . 1989, p. 174.).

 It is also known that to restore the integrity of the eardrum, the edges of the traumatic perforation are repeatedly treated with trichloroacetic acid (Shuster M.A., Kalina V.O., Chumakov F.I. Emergency care in otorhinolaryngology. 1989, p. 10.).

 The closest prototype to this invention is the use for plastic purposes of a chicken amnion fixed to the tympanic membrane by cyacrine (Starodubtsev N.G., Lyutova E.M., Mager K.A. Systematic morphological processes in normal and pathological conditions. Features of the healing of defects of the tympanic membrane with xenotransplantation. 1990, p. 75-77). However, the disadvantage of this method is the duration of treatment, frequent rejection of the amnion until the integrity of the eardrum is restored.

 The aim of the invention is to develop the most gentle, relatively simple, restoring auditory function and shortening the treatment time of surgical procedures.

 This is achieved by the fact that the hearing is restored by closing the perforation with a culture of human allofibroblasts deposited on a polymer film, monitoring tissue regeneration for 2-3 weeks and after the complete restoration of the tympanic membrane, the polymer film is removed.

 In FIG. 1 and 2 show the audiogram of the patient before and after surgery using a culture of human allofibroblasts.

 The method is illustrated in the following specific clinical examples.

 Example 1. Patient B., 17 years old, came to the admission department of 1 GKB 04/01/98 with complaints of hearing loss in the left ear, left ear congestion, dizziness. According to the patient, she received a blow to the ear with her palm a day ago, she did not lose consciousness. On examination, the external auditory meatus is wide, there is no detachable, the eardrum is slightly hyperemic, there is an irregularly shaped perforation that occupies approximately 25% of the total membrane area and is located in the antero-lower quadrant. Performs coordination tests, hearing: the right ear is normal, the left ear is hearing reduced (whispering 4 meters, speaking 6 meters). When tonal threshold audiometry revealed conductive hearing loss of 1 degree. Based on the patient's complaints, medical history, visual examination, the diagnosis was made - traumatic rupture of the left tympanic membrane. In order to restore hearing and plastic closure of the eardrum defect, a culture of human allofibroblasts was applied.

 For anesthesia, a 2% lidocaine solution was used, 2 ml of which was injected into the posterior upper wall of the external auditory meatus. Under the microscope examined the eardrum, the mucous membrane of the promontorial wall. Hemorrhagic clots were removed from the tympanic cavity, the edges of the tympanic membrane turned upside down in the tympanic cavity were straightened. After deepithelization of the perforation edges, a cut out piece of a transparent film with a culture of human allofibroblasts applied to it was laid on the membrane surface, larger than the perforation itself. The film is closely adjacent to the eardrum. Additional film fixation was not performed. A film with an allofibroblast culture covers all perforation. The patient immediately noted a significant improvement in hearing. Over the next 3 days, the film loses its transparency due to the proliferation of allofibroblasts. After 12 days, the film was removed. The eardrum is fully restored, has the usual gray-pearl color, with the Valsalva sample it is mobile, with microscopy, the perforation boundaries are barely noticeable. With control audiometry, hearing is within normal limits, a tympanometric curve is type C, without negative dynamics during further observation for 10 months.

 Example 2. Patient V., 57 years old, turned to the admission department of the 1GKB 07/12/98 with complaints of hearing loss in the right ear, congestion of the right ear, noise in the ear. According to the patient, the above complaints within 3 days after cleaning the right ear with a match. On examination, the external auditory meatus is wide, with single hemorrhagic clots, the eardrum is slightly hyperemic, there is a triangular perforation, which occupies approximately 30% of the total membrane area and is located in the posterior-upper quadrant. Performs coordination tests, hearing: the left ear is normal, the right ear hearing is reduced (whispering 3 meters, speaking 5 meters). When tonal threshold audiometry revealed conductive hearing loss of 1 degree. He was diagnosed with a traumatic rupture of the right tympanic membrane. A human allofibroblast culture was used to close the eardrum defect. The operation was carried out as in example 1, the hearing was restored immediately during the operation, the postoperative period was uneventful. The polymer film was removed on day 10, the tympanic membrane was completely restored, with control audiometry, hearing was within normal limits, type C tympanometric curve, without negative dynamics during further observation for 10 months.

 Example 3. Patient K., 20 years old, came to the admission department of the City Clinical Hospital on 09/05/98 complaining of hearing loss in both ears, stuffy ears, dizziness. According to the patient, the above complaints within 2 days after receiving a blow to the ears. On examination: there is no spontaneous nystagmus, coordination tests are performed, the left ear has a wide external auditory meatus, there is no detachable ear canal, the eardrum is hyperemic, there is an oval perforation that occupies approximately 40% of the total membrane area and is closer to the posterior-upper quadrant; right ear - the external auditory meatus is wide, the tympanic membrane is moderately hyperemic, there is a hemorrhagic clot in the tympanic cavity, perforation of 25% of the total membrane area is in the central part of the membrane. Hearing: the left ear hearing is reduced (whispering 3 meters, speaking 4 meters); the right ear hearing is reduced (whispering 4 meters, colloquial speech 6 meters). When tonal threshold audiometry revealed bilateral conductive hearing loss of 1 degree. The diagnosis is a traumatic rupture of both tympanic membranes. In order to restore hearing and plastic closure of the eardrum defect, a culture of human allofibroblasts was used both on the left and on the right. The operation was carried out as in example 1, the hearing was restored immediately during the operation, the postoperative period was uneventful. The polymer film was removed on the left on day 12, on the right on day 13, the tympanic membranes completely recovered, with control audiometry the hearing was within normal limits, type C tympanometric curve, without negative dynamics during further observation for 10 months.

 In total in the ENT clinic of the RSMU them. N.I. Pirogov, we performed 47 operations using a culture of human allofibroblasts in the treatment of patients with traumatic defects of the eardrum. The treatment results are presented in the table.

 Comparison with known methods of treating patients with traumatic perforation of the eardrum shows that the developed invention reduces the treatment time, especially with significant defects. In contrast to multiple cauterization of the perforation edges with trichloroacetic acid, the treatment time is reduced by 2.7 times and 2.1 times when using chicken amnion.

 Despite the apparent simplicity of the developed method for the treatment of patients with traumatic perforation of the tympanic membrane, the invention is not obvious to qualified surgeons-otorhinolaryngologists working in the field of restoration of the tympanic membrane.

 A culture of human allofibroblasts was created and previously used exclusively for the treatment of significant burn injuries of the skin. The use of the culture of allofibroblasts in otorhinolaryngology for the plastic surgery of the eardrum was carried out by us for the first time. Simultaneously with the elimination of the membrane defect, the ear is restored immediately during the operation, and regeneration of damaged tissues is activated. The very possibility of a sharp reduction in treatment time, minimal invasiveness of the method, and obtaining a high social and economic effect are also completely unobvious. The culture of allofibroblasts does not require any additional tests and studies; the invention is ready for use directly as described in specialized departments of city hospitals.

 The way to eliminate the traumatic eardrum defect allows you to restore the integrity of the eardrum in a relatively short time, is relatively simple, actively affects the regeneration of the eardrum, prevents secondary infection of the eardrum, is effective in 92% of cases.

Claims (1)

 A method for eliminating the traumatic defect of the tympanic membrane, characterized in that the hearing is restored by closing the perforation with a culture of human allofibroblasts deposited on a polymer film, monitor tissue regeneration for 2 to 3 weeks, and after the tympanic membrane is completely restored, the polymer film is removed.

Images