RU2182017C2 - Myringoplastic tampon - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying silk ligature thread impregnated with antibiotic (silk ligature thread No 5 is considered to be optimum) in retaining myringoplastic material as myringoplastic tampon. When being in wound, this material does not change its total mass and is optimal in retaining the flap at required place. The tampon retains myringoplastic material in the prepared bed being the remnants of tympanic membrane in the external acoustic meatus. Tampon pressure is retained at the level enough for maintaining implant immobilization and at the same time it is not too hard. EFFECT: enhanced effectiveness of treatment; avoided blood vessel constriction and trophic disorders. 1 tbl

Description

 The invention relates to medicine, namely to otorhinolaryngology, and may find application in chronic suppurative mesothympanitis.

 Surgical interventions are increasingly recognized in the treatment of patients with chronic mesothympanitis. Most often, in the stage of remission of chronic mesothympanitis, myringoplasty is performed (Zabirov R.A. et al. - Results of surgical treatment of patients with chronic mesothympanitis .- // XI Scientific and Practical Conference of Otorhinolar. -Tez. Dokl., Orenburg - 1998 - p. 18- 19., Zabirov R.A. et al. - Miringoplasty in patients with chronic mesotympanitis. -. - // I congress of the otorhinolar. - Abstract. Bishkek - 1999 - p. 41-42).

 One of the important stages of the performed surgical intervention is the retention of the myringoplastic material on the prepared bed: the remains of the eardrum and the external auditory canal. The following condition is considered necessary for this: the pressure of the tampon should be sufficient to ensure immobilization of the graft and at the same time gentle to avoid vascular compression and trophic disturbance (Iskiv B.G. Comparative morphological characteristics of graft engraftment in tympanoplasty. - // Abstract of Cand. diss ... Kiev, 1968. - 16p.).

 The main requirements for the material from which the swab is made are: the ability to prevent secondary infection of the graft, not to be a medium for the development of pathogenic microflora and not to injure the graft when removing the swab from its surface (L. Kulakova, Surgical rehabilitation of patients with chronic purulent otitis media and its consequences (with the use of the film "encircled" and hyperbaric oxygenation // Author. Cand. diss. Moscow, 1968. - 21p.).

 Recently, a variety of materials have been used as tampons: bioplastics (Preobrazhensky N.A., Zuckerberg L.I. Ways of preserving or creating a tympanic cavity during hearing-enhancing operations // Herald of the Otorhinolar. 1973. - 5. - P.17-22), spongostan (Stary J., Prazak. Pozolni vysledku myringoplastic // Cs. Otolaryng. l974.23.04, - p.l99-203), autogenous fibrin film (Kuzko V.I. On the issue of spontaneous tympanoplasty using autofibrin. - // Mater. VIII republic.conf. Otorhinolar. BSSR. - 1975. - P.68-70), a collagen sponge soaked in antibiotic (Preobrazhensky N.A., Zuckerberg L. I. Ways of preserving or creating a tympanic cavity during hearing-improving operations // Vestnik otorinolar. 1973.- 5.-P.17-22), gauze swabs with preliminary falling asleep in the external auditory canal of a mixture of powders of boric acid and sulfonamides (Yashan I.A., Protasevich G.S. Hearing condition in bone conduction and indications for tympanoplasty in patients with chronic mesotympanitis. // Otorhinolaryngology. -vyp.6, Kiev, 1975.-S.33-38), a biological swab from lyophilized plasma (Bykova V.L. Use of low-energy laser radiation to stimulate engraftment of a non-tympanic transplant after tympanoplasty // Bulletin of otorinolar. 1984.- 1.- S.25-29).

 However, the use of the above materials is not clinically effective, as some of them contribute to the allergization of the body (plasma biotampon, spongostan), others are not biologically inert enough, which leads to excessive development of connective tissue and graft sclerosis (collagen sponge, autologous fibrin film); in addition, as the wound exudate is adsorbed, an increase in the mass of gauze swabs occurs, followed by “sticking” to the graft and its displacement from the edge of the prepared bed.

 As a prototype, a means of retaining the myringoplastic material was an iodine-shaped gauze swab (Zabirov R.A. et al. - Results of surgical treatment of patients with chronic mesotympanitis .- // XI Scientific and Practical Conference of Otorhinolar .- Tez dokl., Orenburg - 1998 - p. 18-19., Zabirov R.A. et al. - Miringoplasty in patients with chronic mesotympanitis. - // I Congress of the otorhinolar. - Abstract. Bishkek - 1999. - p. 41-42).

 Endoaurally prepare the bed for the transplant; with a microneedle and microspreader refresh the perforation edges; de-epidermization of the remains of the eardrum. The skin of the ear canal is mobilized 0.5 cm upward from the fibrous ring of the tympanic membrane. In some patients with a narrow external auditory canal, the operation is supplemented by a skin incision in its posterior wall. A graft is placed on the prepared bed, an iodine-shaped swab is inserted into the lumen of the ear canal over it.

 However, the use of iodine-shaped gauze swabs in some cases leads to fibrin adhesion of the transplanted flap and subsequent germination of the connective tissue elements into the structure of its gauze base, thereby impairing graft engraftment and injury when removing the swab. In addition, as the patient is in the surgical wound, the mass of the iodoform swab increases, which causes displacement of the transplanted flap from the prepared bed.

 The novelty of the proposed solution is that during compression retention with a myringoplastic swab, the increase in the mass of the swab is minimized.

 A significant difference is that they use a ligature silk thread, impregnated with an antibiotic, as a tampon for myringoplasty (to hold the transplanted flap on the prepared bed). The choice of ampicillin monosodium salt for soaking a myringoplastic swab is due to the fact that antibiotics of this group, selectively affecting the bacterial cell wall (Guidelines for medicine. - Merck, Sharp and Dome. - 1997. - T. 2. - P.17), are the strength of this is indifferent to somatic cells.

 The use of silk ligature thread (silk ligature thread 5 is most suitable) for retention of the myringoplastic material as a myringoplastic tampon is due to the fact that while maintaining biological inertness to the surrounding tissues, this material, while in the conditions of an operative wound, does not change its total mass and thereby most optimally holds the transplanted flap in the right place.

 We measured the mass of a gauze swab and silk ligature thread used as a swab before and after surgery. In this case, the results are shown in the table.

 As can be seen from the above data, the silk ligature thread used as a tampon, being in conditions of a wound discharge, does not significantly change its mass and thereby does not displace the transplanted graft from the prepared bed.

 The use of the proposed means of retention of the myringoplastic transplant was carried out as follows.

 To hold the myringoplastic material on the prepared bed, it is possible to use a silk ligature thread 4, 5, 6, but it is most optimal to use a silk ligature thread 5 in the required place for placement in the external auditory meatus and retention of the myringoplasty graft.

 On the eve of surgery, the silk ligature thread was placed for 2 hours in 3 ml of a solution of ampicillin monosodium salt (0.5 active ingredient).

 Endoaural with a microneedle and a microspreader, refresh the perforation edges, and make epidermisation of the remnants of the eardrum. Exfoliate the skin of the external auditory canal. A graft is placed on the prepared bed. The lumen of the auditory meatus is filled with ampicillin monosodium salt (0.5 active ingredient) with silk ligature thread 5 of a length of 20-25 cm. After surgery for 6 days, this thread is removed.

 The proposed silk ligature thread as a myringoplastic swab was used in the treatment of 30 patients with chronic purulent mesothympanitis.

 Compared with the control group using the proposed silk ligature thread as a tampon to hold myringoplasty material, earlier engraftment of the transplanted flap was noted (on average 5-7 days), no adhesion between the silk ligature thread and the graft was observed during otomicroscopy, in any clinical In this case, the adherence of a purulent infection was not determined and the hospital stay was reduced by an average of 3-5 days, in the long-term period of recurrence of the disease was not observed.

 When contact bacteriological culture of silk ligature thread used as a tampon, no growth of cultures was noted on 5% blood agar.

 Example. Agafonova E.P., 21 years old. Received April 12, 2000 in the ENT department of 1 municipal municipal emergency hospital in Orenburg for a planned operation - ear myringoplasty on the right.

 Notes periodic suppuration from the right ear during the last two years after acute acute right-sided otitis media, recurring after acute respiratory infections.

 When examining a patient in the clinic, the general condition is satisfactory. In a general blood test, indicators are within normal limits. Urinalysis is normal. No pathological changes in the nose, pharynx, larynx and left ear were detected.

 Right ear: the auricle and the area of the mastoid process are not changed, palpation-regional lymph nodes are mobile, not enlarged. When otoscopy: in the right ear canal without pathological discharge, the subtotal perforation of the tympanic membrane in the stretched part with calloused edges is determined, the mucous membrane of the medial wall of the tympanic cavity is pink. Diameter of perforation is 5 mm. Acuity of hearing: whispering 1.5 m, conversational 5 m. Rinne's experience is negative, Weber - lateralization of sound in the right ear.

 With tonal threshold audiometry in the speech frequency range, conductive hearing loss is detected. On X-ray of the temporal bone according to Schuller (04/13/2000 524) pneumatization of the temporal bone is preserved.

 Diagnosis: Chronic suppurative right-sided mesothympanitis. Remission.

 The patient underwent a planned operation - ear myringoplasty on the right. For retention of a myringoplastic transplant (patient’s autofascation), a silk ligature thread 5 of 25 cm length was used as a tampon, which was removed on the fifth day.

 In the postoperative period, there was a lack of attachment of a secondary infection, graft engraftment.

 Thus, the use of silk ligature thread as a myringoplastic swab leads to an increase in the effectiveness of ear myringoplasty.

Claims (1)

 The use of silk ligature yarn impregnated with an antibiotic as a tampon for myringoplasty.

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