RU2192830C1 - Surgical method for treating hypoacusis in the cases of chronic middle ear otites - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves removing epidermis from tympanic membrane edges in the perforation zone. Transplant is placed and fixed. Before placing the transplant, micro flora spectrum is determined in exudate taken from the patient ear. Lyophilized allobrepho-dura mater selected as plastic material is saturated in ultrasonic bath with preselected antibiotic and fungicide preparation solution during 1 min. The lyophilized allobrepho-dura mater fragment saturated with corresponding antibiotic and fungicide preparation is placed in perforation projection and fixed with gauze turundas with synthomycin emulsion. EFFECT: enhanced effectiveness of treatment.

Description

 The invention relates to medicine, namely to otorhinolaryngology.

 A known method of treating chronic suppurative otitis media by laying a bone allograft with fascia, in which, in order to improve hearing, an allograft from the mastoid part of the temporal bone is placed in the hypothympanum and the area of the niche of the cochlea window. (Copyright certificate 1827231, MKI: A 61 F 11/00, published in Bulletin 26 of 1993).

The closest in technical essence and the achieved result is a method of allobrefotransplantation with bone tissue and the dura mater of the human fetus of the trepanation cavity, closure of defects of the tympanic membrane in the surgical treatment of chronic otitis media (Tsurikova T.V. sciences / Kuibyshev State Medical Institute named after D.I. Ulyanov. - Kuibyshev, 1984. - p.3)
In the known method, an allobre material for mastoid tympanoplasty in the surgical treatment of chronic otitis media is used as a graft.

 The transplant was fixed with a foam rubber swab and the skin of the bones of the external auditory meatus of the patient, which created the condition for the administration of drugs without removing the fixing foam swab. The absence of suppuration from the ear even for 5-6 months cannot guarantee the passivity of microflora in the postoperative period.

 For all the advantages of the known method, it should be noted that as a result of the application of this method of treatment of chronic purulent otitis media, it is not possible to fully achieve a good morphological and functional result, since there is a possibility of an activation of the inflammatory process.

 The technical result, the achievement of which the creation of this invention is directed, is to increase the effectiveness of treatment by eliminating the pathological process in the tympanic cavity.

 The technical result is achieved by the fact that in the method of surgical treatment of hearing loss in chronic otitis media, which consists in de-epidermization of the edges of the tympanic membrane in the field of perforation, placement of the graft and its fixation, after determining the microflora spectrum of the patient’s ear and its sensitivity to antibiotics, selected as the plastic material, the lyophilized allobref-dura mater is saturated in an ultrasonic bath for 1 minute with a solution of a previously determined ibiotika or fungicide formulation, lyophilized and then the resulting saturated appropriate antibiotic or antifungal drug moiety allobrefo-dural perforation lay in the projection and fixed with gauze turundy sintomitsinovoy emulsion.

 Dura mater is taken from fetuses of 20-24 weeks of gestation during termination of pregnancy in healthy women examined for viral hepatitis B, viral hepatitis C, HIV infection, syphilis (serological blood test by ELISA) within a day after termination of pregnancy.

 In the process of manufacturing a bioimplant, the dura mater of the fetus is disinfected, which ensures the recipient is safe from the transmission of viruses, including Kreifeld-Jakob, which causes rabies in cows.

 Next, lyophilization of the dura mater is carried out in a sublimation unit LZg of the company Frigera, gamma sterilization.

 The result is a plastic material - lyophilized allobref-dura mater, which has antibacterial and antimycotic properties.

 The method is as follows.

 Before surgery, a fragment of lyophilized allobref-dura mater is saturated in a Pro-sonic ultrasonic bath for 1 minute with an antibiotic solution (1,000,000 units of cefazolin per 100 ml of physiological saline) or a fungicidal preparation (2 mg of fluconazole per 100 ml of saline), or an antibiotic and a fungicidal preparation, taking into account the previously determined spectrum of microflora, which is separated from the patient’s ear, and its sensitivity to antibiotics.

 Then produce epidermization of the edges of the tympanic membrane in the area of perforation.

 Then, a fragment of the lyophilized allobrepho-dura mater, saturated taking into account the previously determined sensitivity of the microflora of the antibiotic or fungicidal preparation separated from the patient’s ear, is placed in the projection of the perforation of the tympanic membrane, isolating the epidermal edges. Then the plastic material is fixed with gauze turundas with a syntomycin emulsion.

 Example 1

 Patient K., 38 years old, was treated at the ENT clinic of Samara State Medical University. Diagnosis: Left-sided chronic purulent otitis media, exacerbation, with caries, polyps, granulations.

 Stacke atticoantrotomy was performed (65), tympanoplasty type 3 was lyophilized allobrepho-dura mater saturated with cefazolin on the left (66). The postoperative period was uneventful.

 At discharge: non-tympanic membrane formed, mobile. Hearing in the left ear: before the operation, whispering speech - 0, colloquial speech - 2.5 m, subjective ear noise ++; at discharge: whispering - 1.5 m, colloquial speech - 6 m, no noise in the ear. According to tonal threshold audiometry, lowering the thresholds of sound perception through air conduction to speech frequencies during discharge by an average of 23.74 dB.

 Example 2

 Patient X., 18 years old, was admitted for treatment at the ENT clinic of Samara State Medical University on November 20, 2000. Diagnosis: Two-sided chronic purulent epimesothympanitis. Otomycosis.

 Surgery performed: Revision of the tympanic cavity, aditus ad antrum, tympanoplasty type 4 lyophilized allobrepho-dura mater saturated with cefazolin and fluconazole on the left (582).

 At discharge: a non-maximal membrane formed, mobile. Hearing in the left ear: before surgery, whispering speech - 1.5, colloquial speech - 2 m; at discharge: whispering - 3 m, speaking - 5 m, no noise in the ear. According to tonal threshold audiometry, lowering the thresholds of sound perception through air conduction by speech frequencies during discharge by an average of 15 dB.

 The use of a lyophilized allobrefotograft with a directed (taking into account the microflora detached from the patient’s ear) antimicrobial action avoids activation of the inflammatory process in the postoperative period, creates favorable conditions for the healing of a plastic flap, and helps to optimize the morphological and functional results of auditory repair operations.

 The analysis of the prior art by the applicants, including a search by patent and scientific and technical sources of information and identification of sources containing information about analogues of the claimed invention, allowed us to establish that the applicants did not find an analogue characterized by signs identical (identical) to all the essential features of the claimed invention.

 The determination from the list of analogues of the closest technical solution (prototype) made it possible to identify a set of essential distinguishing features with respect to the technical result seen in the claimed method for the surgical treatment of hearing loss in chronic otitis media set forth in the claims.

 Therefore, the claimed invention meets the criterion of "novelty."

 To verify the compliance of the claimed invention with the criterion of "inventive step", the applicants conducted an additional search for known solutions to identify signs that match the distinctive features of the proposed method for the surgical treatment of hearing loss in chronic otitis media.

 The search results showed that the claimed invention does not follow explicitly from the prior art as determined by the applicants.

 Therefore, the claimed invention meets the criterion of "inventive step".

 The criterion of "industrial applicability" is confirmed by the fact that the proposed method for the surgical treatment of hearing loss in chronic otitis media can be successfully, with great efficiency, used in ENT clinics in Russia and the CIS.

Claims (1)

 A method for the surgical treatment of hearing loss in chronic otitis media, including epidermalization of the edges of the tympanic membrane in the area of perforation, the laying of plastic material and its fixation, characterized in that lyophilized allobref-dura mater, which is preliminarily saturated in a Pro-sonic ultrasonic bath, is used as plastic material for 1 min, cefazolin solution 1 000 000 units per 100 ml of physiological saline and fluconazole 2 mg per 100 ml of physiological saline and put it in a design ii perforation fixed.