RU2254845C1 - Method for myringoplasty - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology.

SUBSTANCE: the present innovation deals with treating chronic perforating otitis at great defects of tympanic membrane. One should perforate a strip of tragus' autocartilage or concha auriculae to form a transplant as a netting at hole sizes being 2 mm, not more. The transplant obtained should be applied onto intact structures of ossicula and tympanic residues. The transplant should be covered with a temporal fascia to apply the residues of meatotympanic fragment above it. The method enables to simplify myringoplasty due to simplified preparation of a transplant.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, namely to otorhinolaryngology, and can be used in ENT hospitals for the treatment of chronic perforated otitis media with large defects of the tympanic membrane.

Chronic perforated otitis media is a fairly common disease, leading to a significant decrease in hearing, in some cases even to disability.

Known methods of surgical operations, in which the closure of the defect of the tympanic membrane with a graft (myringoplasty). When performing such operations, the graft is made either in the form of a mucocutaneous flap from the cheek mucosa, or from the cartilage of the nasal septum, or from a section of decalcified bone [1]. The disadvantages of the known methods are significant trauma, the relative technical complexity of the operation, as well as the relatively high likelihood of various complications in the postoperative period, lowering the functional result.

A known method of myringoplasty [2], in which the closure of the defect of the tympanic membrane is carried out by a graft made of auto-cartilage, which is taken from a tragus or auricle and subjected to processing by slow crushing with a Kocher clamp in the longitudinal and transverse directions to the desired thickness. A transplant made in this way, after crushing, becomes thin, mobile, solid, retains its intended shape, bends in all directions; under a microscope, it represents triangles connected by thin fibers. After surgical debridement of the middle ear, the autocartilage is superimposed on the preserved bone structure and on the walls of the external auditory meatus, the temporal fascia is placed on it, then the meatotympanal flap from the tympanic membrane or its remains is placed. A disadvantage of the known method of myringoplasty is the relative complexity of the mechanical treatment of auto-cartilage, which requires considerable time and lengthens the time of the operation, as well as the occurrence of complications associated with the tympanic membrane in the postoperative period.

The claimed invention solves the problem of simplifying the method of myringoplasty by simplifying the technique of harvesting a transplant from auto-cartilage while maintaining a good morphological and functional result.

This problem is solved by the fact that in the known method of myringoplasty, including the manufacture of a graft from a strip of auto-cartilage of a tragus or auricle, the imposition of the obtained graft on the stored bone structures and the remains of the tympanic membrane, the graft is coated with the temporal fascia and the remains of the meatotympanal flap are placed on it after harvesting the graft separating the cartilage strip from the tragus or auricle, it is perforated and as a result a graft from the cartilage with holes in the form of a mesh is obtained. Moreover, it was experimentally substantiated that the size of the mesh holes should be no more than 2 mm. A transplant prepared in such a way possesses the necessary qualities to replace the perforated eardrum, namely, elasticity, softness, can be easily modeled, is well adapted, in addition, this transplant creates good conditions for ventilation of the tympanic cavity, and improves microcirculation of the tissue fluid of the tympanic cavity in the postoperative period . Cartilage strips are perforated with a specially made perforator in one motion, which significantly reduces the time for performing myringoplasty.

Example 1

Patient A., 42 years old, was admitted to the ENT department with a diagnosis of right-sided total mesotypanitis, stage of remission. An otoscopy revealed an almost complete absence of the tympanic membrane with the retention of the rim, the mucous membrane is pale, the handle of the malleus protrudes into the tympanic cavity, the audiogram has a conductive form of hearing loss, an average bone-air rupture of 35-40 dB, right hearing - 0.5 m of whispering, spoken language - 1.5 m, on the left, hearing is within normal limits. Under local anesthesia, a myringoplasty operation was performed with attinoantrotomy behind the ear, where a sluggish inflammatory process was detected. The epidermisation of the remnants of the tympanic septum, audit of the chain of auditory ossicles that functioned was performed. A strip of auto-cartilage of a mesh type is laid on the epidermal remnants of the tympanic membrane and the handle of the malleus, the temporal fascia is placed on top, and the remains of the meatotympanic flap are placed. The postoperative period was uneventful. On the 16th day she was discharged home with a hearing improvement of 5-6 meters of whispering speech. The patient was examined after 6 months. Hearing within 6 meters. The eardrum is mobile, there is no regidity. Repeated audiometry shows the absence of a bone-air gap.

Example 2

Patient P., 48 years old, was admitted to the ENT department with a diagnosis of left-sided chronic purulent otitis media. Cavity after radical surgery, right-sided adhesive otitis media. Complaints of hearing loss in the left ear. Microscopy revealed a cavity in the left ear after a radical operation, the mucous membrane was preserved in the tympanic cavity, pale, there were remains of the stapes legs, the foot plate was functioning, partially the remains of the tympanic membrane were partially preserved in the anterior part of the tympanic cavity, and the locking region was epidermized. She perceives whispering near the auricle, conversational - 1 meter. Patency of the auditory tube is preserved. On the right eardrum, scars. Whispering speech - 3 meters. On the audiogram, a bone-air gap in the left ear is determined up to 40-45 dB, in the right ear 25-30 dB, the conductive form of hearing loss. Under local anesthesia, tympanoplasty with mastoidoplasty with a muscular-periosteal flap with restoration of the posterior wall of the external auditory canal was performed. The operation was performed by the behind-the-ear approach; the epidermal-scar tissue of the locking region was removed. The epidermisation of the remnants of the tympanic membrane was carried out, the calyumella according to patent No. 2159095 was installed on the foot plate of the stirrup. The reticular auto-cartilage is superimposed with the first layer on the remnants of the tympanic membrane and the calyumella, the locking region is filled with a muscular-periosteal flap, the posterior wall is restored by the auto-cartilage of the nasal septum, the fascia of the temporal muscle is covered from above, and the behind-the-ear region is filled with epidermal-scar tissue. The postoperative period was uneventful, epidermization ended by day 25, that is, by the day of discharge. Whispering speech at discharge was 4 meters. The patient was examined after 6 months, the eardrum was pale gray, mobile, the back wall was restored, whispering up to 5 meters. There is no bone-air gap on the audiogram.

Example 3

Patient A., 22 years old, was admitted to the ENT department with a diagnosis of right-sided chronic purulent mesotympanitis in remission, complaints of hearing loss. When otoscopy revealed the presence of perforation of the eardrum of a rounded shape in the stretched part with dimensions of 4x4 mm. The mucous membrane is pale, patency of the auditory tube of the 1st degree. An audiogram revealed a conductive form of hearing loss with a bone-air interval of 30-35 dB. Whispering speech on the right ear - 1 meter, colloquial speech - 3 meters. A cotton-gauze prosthesis placed on the eardrum diffusion improves hearing up to 6 meters. Under local infiltrative anesthesia, the behind-the-ear approach produced myringoplasty. After removing the epidermis from the remnants of the tympanic membrane, refreshing the edges of the perforation, revision of the attic, the first layer is the mesh auto-cartilage from the auricle, the fascia of the temporal muscle is covered from above. The postoperative period was uneventful. The patient was discharged on day 14 with improved hearing to 6 meters of whispering speech. The patient was examined after six months, the eardrum is pale gray, mobile, signs of scarring, retraction were not found. There is no bone-air gap on the audiogram. Whispering speech - 6 meters.

Example 4

Patient I., 35 years old, was admitted to the ENT department with a diagnosis of left-sided post-traumatic otitis media with complaints of noise in the ear and hearing loss. An otoscopy revealed the presence of a subtotal eardrum defect, pale mucous membrane, 1st degree auditory tube patency, cotton-gauze prosthesis improves hearing up to 6 meters, and without it - 0.5 meters. On the audiogram, a bone-air gap of 35 dB is determined. The patient underwent myringoplasty by the behind-the-ear approach. The epidermis was removed from the remnants of the eardrum, after removing the bone canopy, the auditory ossicles chain was examined, the connection of which was not broken with the foot plate of the stirrup. A strip of auto-cartilage from the auricle of the reticular view is laid on the defect of the tympanic membrane, it is covered with fascia of the temporal muscle from above, hearing improved on the operating table. The postoperative period was uneventful. Discharged home on the 14th day with a hearing improvement of up to 6 meters. Re-examination after 6 months: the eardrum is pale gray, mobile, the audiogram shows the absence of a bone-air gap, whisper speech is 6 meters.

The proposed method is tested on 25 patients. The results of myringoplasty are positive, which allowed us to restore the integrity of the eardrum and auditory function in patients.

In comparison with the prototype, the proposed method of myringoplasty is simple to perform, the operation time is reduced. Moreover, the proposed method prevents the occurrence of complications in the postoperative period, namely, the tympanic membrane. These results are achieved due to the fact that the transplant prepared by the above method successfully performs the function of a natural eardrum and promotes the formation of an air cushion under the eardrum, thereby creating conditions for accelerating the epidermis of the eardrum. Thus, the proposed method provides restoration of the structure of the eardrum and auditory function.

Sources of information

1. RF patent No. 2045945, IPC ⁶ A 61 A 11/00. The method of myringoplasty.

2. Petrova L.G., Romanova Zh.G., Ermine I.I. The use of a cartilage graft in thymanoplasty of the 1st, 111th type, Materials of the Russian Scientific and Practical Conference "Modern problems of diseases of the upper respiratory tract and ear", Moscow, 2002, pp. 110-111.

Claims (1)

The method of myringoplasty, including the manufacture of a graft from a strip of auto-cartilage of the tragus or auricle, the imposition of the obtained graft on the stored bone structures and the remains of the tympanic membrane, the coating of the graft with the temporal fascia and the laying of the remnants of the meatotympanic flap, characterized in that during the manufacture of the graft, perforation is performed the formation of a graft in the form of a mesh with hole sizes of not more than 2 mm.