RU2207094C1 - Method for treating inflammations of middle ear - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: an opening is formed in mastoid process in any point within desired triangle developed from the top - by horizontal line made at the level of superior edge of auditory canal, in front - by vertical line being 5 mm backwards against posterior wall of auditory canal, and at the rear - by bisecting line of angle formed by the top, anterior and posterior edges of mastoid process. One should carry out evacuation of pathological content out of middle ear cavities followed by injecting medicinal preparations there. The suggested method enables to conduct therapy despite patient's age, perform manipulations under polyclinic conditions, it, also, provides an opportunity for prolonged drainage. EFFECT: higher efficiency of therapy. 1 ex

Description

 The invention relates to medicine, namely to otorhinolaryngology, and can be used to treat inflammation of the middle ear.

 There is a method of treating purulent inflammation of the middle ear and mastoid process - anthropuncture, taken by us as a prototype [1]. It is made as follows. On the mastoid process determine the recess corresponding to the projection of the site of the mastoid process. Under the temporal line, retreating 2-3 mm posterior to the place of attachment of the auricle, a special needle with a mandrin is installed perpendicular to the surface of the mastoid process. Directing it upward, anteriorly and inward, a puncture is made to a depth of 0.5-1 cm. After feeling a failure, the contents of the cave are sucked out. Then, the middle ear cavity is washed with an isotonic sodium chloride solution and a drug substance is administered.

 But this method has the following disadvantages: the inability to perform anthropuncture in adults (performed only in children under 2 years old), the need for accurate penetration into the cave of the mastoid process, the impossibility of prolonged drainage and the introduction of drugs into the middle ear cavity.

 The purpose of the invention is to increase the effectiveness of treatment.

 This goal is achieved by the fact that in the method of treating inflammation of the middle ear, including the formation of an opening in the mastoid process, evacuation of pathological contents from the cavities of the middle ear with the subsequent introduction of drug substance into them, the opening is performed by trepanation of the mastoid process within an imaginary triangle formed by a horizontal line from above drawn at the level of the upper edge of the auditory meatus, in front - with a vertical line passing 5 mm posterior to the posterior wall of the external about the auditory meatus, and behind - the bisector of the angle formed by the front and rear edges of the mastoid process.

 Our proposed method is as follows. Pre-produce a rograph of the mastoid process according to Schuller and Stenvers, computed tomography of the temporal bone to determine the structure of the mastoid process and the location of the sieve sinus. According to indications, paracentesis of the tympanic membrane is performed. Then determine the boundaries of the safest triangle, where the mastoid process will be trepanated. The posterior border of this triangle is the bisector of the angle formed by the front and rear edges of the mastoid process, the upper border is a horizontal line at the level of the upper wall of the external auditory canal, the front border is the vertical line posterior to 5 mm from the posterior wall of the bone part of the external auditory canal. The posterior border of the imaginary triangle is in 97% of cases the front border of the sigmoid sinus, therefore, during trepanation posterior to this border, trauma to the sigmoid sinus is possible. The upper border borders the cranial cavity, the front border with the external auditory canal. If the upper border is violated, trepane can penetrate into the cranial cavity, if the front is violated, trepane can penetrate the external auditory canal.

 After determining the boundaries of the safest triangle and previously performed infiltration anesthesia, a skin incision is made with a length of not more than 0.5 cm. Using a trepan, taking into account the thickness of the cortical layer, a bone canal is formed with a diameter of 0.3-0.5 cm and a depth of 1.0-1 , 5 cm. A metal cannula is introduced into it for the administration of medicinal substances. Ischemia of the tympanic membrane and through the cannula - the mucous membrane of the cavities of the middle ear. Then, the cavities of the middle ear are washed with an isotonic sodium chloride solution, and a drug substance with a volume of about 3 ml is driven. It was experimentally established that with the introduction of more than 3 ml of a medicinal substance, it penetrates the dura mater. To avoid this, you should not enter more than 3 ml of the drug. A drug substance is administered daily, twice a day. At the end of treatment, the cannula is removed. With the introduction of the drug into the cells of the mastoid process after trepanation according to the claimed method, the drug penetrates into all cells of the mastoid process, which allows creating high concentrations of the drug in the bone "depot" at close proximity to the focus of inflammation and to ensure the gradual flow of drugs into this focus.

 We give a specific example of the method.

 1. Patient Ch., 15 years old, was admitted to the clinic of ear, nose and throat diseases on the basis of the ENT department of the Central Clinical Hospital, Donetsk, with a diagnosis of Right-sided acute purulent otitis media. Mastoid reaction on the right. Sick 3 weeks before admission after acute respiratory viral infection. Suppuration from the right ear for about 2 weeks.

 Otoscopy: in the right external auditory canal, an abundant amount of mucopurulent discharge, b / membrane is hyperemic, perforation in the central departments. In the department, the patient underwent trepanopuncture of the mastoid process. A solution of cefazolin and hydrocortisone was introduced into the cannula.

 Otoscopy three days after the start of treatment: in the right external auditory canal: the eardrum is pink, the contours are smooth, the perforation is closed, there is no discharge.

 After 5 days from the start of treatment, the cannula was removed from the mastoid process.

Objectively at the time of discharge:
Otoscopy: in the right external auditory canal is dry, the eardrum is gray, the contours are clear.

The advantages of the proposed method:
1. Treatment of patients regardless of their age.

 2. Manipulation is performed technically more simply than previously proposed methods, which makes it possible to perform manipulation in a clinic.

 3. The proposed method gives higher efficiency in the treatment of inflammation of the middle ear and the formation of the mastoid due to the fact that the cannula is placed in the cells of the mastoid and when a drug is introduced into them, a “depot” of drugs is created in the bone part of the mastoid.

 4. The technique allows long-term drainage and administration of medicinal substances into the ear cavity.

Sources of information
1. Lyulko V.K., Marchenko V.M. Atlas of ear surgery. Kiev: Health'' 1989, pp. 76-78.

Claims (1)

 A method for treating middle ear inflammation, including forming an opening in the mastoid process, evacuating pathological contents from the middle ear cavities, administering drugs therein, characterized in that the opening is made at any point within an imaginary triangle formed from above by a horizontal line drawn at the level of the upper the edges of the auditory meatus, in front - a vertical line passing 5 mm posterior to the back wall of the external auditory meatus, and behind - the bisector of the angle formed erhushkoy, front and rear edges of the mastoid process.