RU2341224C2 - Method of treatment of exhausting giddiness and cypylolithiasis at endolymphatic hydrops - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: influence with radiation of the neodymium laser on an osteal wall of an ampoule of the horizontal semicircular channel. Power of radiation totals 12 J/cm². Duration of impulses totals 2.5 - 4 ms. Thereat after creation of punching in a wall of the channel and perilympha occurrence immediately in a channel lumen, influence laser impulses until the boring nystagmus will not change on an oppression nystagmus.

EFFECT: provides relief of patients from giddiness of peripheric character and otolithic symptomatology.

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Description

The invention relates to medicine, namely to otorhinolaryngology.

Known methods of treating patients suffering from bouts of debilitating systemic dizziness, a feeling of lack of solid soil under their feet and failure due to persistent endolymphatic hydrops, by various surgical interventions. At the same time, various surgical techniques are used: laser-, cryo- and ultrasonic destruction of the labyrinth, neurectomy of the vestibular portion of the cochleovestibular nerve. However, the above methods of treatment do not always relieve patients from dizziness and otolithic disorders, even with loss of auditory function. In addition, destructive operations are often complicated by paresis of the facial nerve, cerebrospinal fluid, arachnoencephalitis, meningitis.

The prototypes of this invention are the "Method of turning off the vestibular apparatus" (copyright certificate No. 563751 of 03/09/1977), the "Method of treating diseases of the vestibular apparatus" (copyright certificate No. 1600056 of 05/27/1988) and the "Method of treating chronic purulent otitis media with the labyrinth fistula" [patent No. 2071305 from 10.15.1993 (ROSPATENT)], characterized in that the pulsed laser effect has a depressing effect on the ampullar receptors of the horizontal semicircular canal, without affecting the otolith receptors of the vestibule and the cochlear snail receptors.

The purpose of the invention is to increase the effectiveness of surgical treatment of debilitating dizziness and cupulolithiasis with endolymphatic hydrops.

The technique of the operation is as follows. Anthrotomy is performed under local anesthesia behind the ear. Using a surgical microscope, the outer bone wall of the horizontal semicircular canal is exposed. With a microcurette or scraper, it becomes thinner. A quartz optical fiber is fed to the bone wall of the channel, and it is contacted with pulses of laser radiation (wavelength 1.06 μm, pulse duration 2.5-4 ms, power up to 12 J / cm ² ) of an optical quantum neodymium generator in the direction of the channel ampoule. The reactivity of the ampullary receptors during laser exposure is controlled by electron-histogram. With each pulse of laser energy, an irritation nystagmus is recorded on an electron-histogram. After the formation of perforation in the channel wall and the appearance of the perilymph, they are directly affected by the laser pulses in the channel lumen until the irritation nystagmus changes to oppression nystagmus. The operation ends with plastic fistula of the canal and suturing of the behind the wound.

The method was applied in 6 patients aged 25 to 70 years with debilitating bouts of dizziness and otolithic symptoms due to endolymphatic hydrops. This technique allows you to completely save patients from dizziness of a peripheral nature and otolithic symptoms with loss of auditory function due to the destruction of the ampullar receptors of the canal and otolith receptors of the vestibule as a result of thermohydrodynamic shock. The effectiveness of the proposed method for the treatment of dizziness and cupulolithiasis was observed in patients under observation for 6 years.

Two case histories can serve as an illustration of the effectiveness of the applied method of treatment.

Patient F., 57 years old, was admitted to the Audiological Department of Clinical Hospital No. 52 with a diagnosis of Meniere's disease with lesions of the right labyrinth and otolithic symptoms.

At admission, she complained of systemic vertigo with severe vegetative impairment, hearing loss in the right ear, noise in this ear, feeling of stuffiness, insecure gait, feeling of falling through and unsteadiness underfoot.

Since 1981, the patient began to notice a decrease in hearing in the right ear of a fluctuating nature. The first attack of systemic dizziness occurred suddenly on 08/18/1984, it lasted 1.5 hours. Since 1987, attacks have become more frequent. She was treated and examined in various neurological and ENT departments. The diagnosis of Meniere's disease was made in 1991.

Given the lack of effect from conservative therapy, on January 27, 1993, an operation was performed on the right ear - an antrotomy with laser exposure to the ampullar receptors of the horizontal semicircular canal. After the operation, the dizziness stopped, the hearing in the right ear did not change. After some time, the patient developed otolithic symptoms (gait uncertainty, a feeling of falling and shaky surface under the legs, repeated paroxysmal dizziness during the day with a change in body position). On June 10, 1998, an operation on the right ear was repeated, an anthrotomy with laser destruction of vestibule otolith receptors. Repeated laser exposure was aimed at destroying the vestibule otolith receptors by exposing the horizontal semicircular canal to the open lumen after creating a deliberate laser fistula of the channel wall with the appearance of inhibition nystagmus. A few months later, gait disorders and paroxysmal dizziness disappeared. When observed after 6 years - there is no dizziness, the gait is stable, there is no hearing in the right ear.

Patient K., 41 years old, was admitted to the Audiological Department of City Clinical Hospital No. 52 on April 12, 2004 with a diagnosis of chronic left-sided cochlear neuritis, vestibulopathy, vertebrobasilar insufficiency, and a labyrinth fistula.

At admission, she complained of daily bouts of dizziness of a systemic nature with autonomic disturbances, an imbalance with a deviation of the trunk to the left, a feeling of failure and gender fluctuations under the legs, deafness in the left ear.

Considers herself a patient since June 1983, when the attack of systemic dizziness first occurred, which was accompanied by nausea and lasted 2-3 hours. Similar attacks were repeated on average 1 time per year. The patient has complete deafness in the left ear after mumps at the age of 7 years. From January 2002, dizziness attacks became more frequent (once every 10 days), became heavier (lasted 4 hours). At the same time, there was a feeling of falling through and fluctuating sex under the legs (otolithic symptoms). After a course of conservative therapy, there was a remission for 4 months. Since January 2003, attacks have resumed, began to occur 1-2 times a week. It was treated in various medical institutions - without effect. In connection with the ongoing vestibular symptoms and difficulties in independent movement, she was sent to the Audiology Department of Clinical Hospital No. 52.

When examining a patient, the department revealed: vestibular hypofunction of the left ear up to 75% of normal, vestibular FUNG, lack of reverse nystagmal reaction, which is typical for endolymphatic hydrops with otolithic disorders. According to computed tomography of the left temporal bone, a sharp expansion of the vestibule, bone cochlea of the cochlea and cerebrospinal fluid of the internal auditory canal were revealed.

Due to the lack of effect from conservative treatment of Meniere's disease and the changes found, on April 27, 2004, the patient underwent an audit of the left tympanic cavity, in which it was found that the auditory ossicles chain is mobile, the niche of the cochlea window did not differentiate. Then a behind-the-ear anthrotomy was performed. In the direction of the ampoule of the horizontal semicircular canal and the vestibule, they were affected by laser radiation pulses (λ 1.06 μm) with a pulse power of 8-12 J. The pulses initially showed a good response of the labyrinth (according to electron histograms - irritation nystagmus), with subsequent pulses the reaction decreased until practical areflexion. After opening the bone wall of the canal with a microcurette, it was exposed to a laser pulse of 8.5 J in response to which a spontaneous oppression nystagmus appeared. The operation was completed with fistula repair and suturing of the behind the wound.

During the month of monitoring the patient for a month there were no dizziness attacks, the sensation of failing and gender fluctuations under the legs disappeared, the patient walks on her own, confidently.

Claims (1)

A method for the treatment of patients with debilitating systemic dizziness and cupulolithiasis with endolymphatic hydrops, including exposure to neodymium laser radiation on the bone wall of an ampoule of a horizontal semicircular canal, characterized in that it is exposed to laser radiation with a power of up to 12 J / cm ² , pulse duration 2.5-4 ms, moreover, after the formation of perforation in the channel wall and the appearance of the perilymph directly in the lumen of the channel, they are affected by laser pulses until the nystagmus of irritation changes to a nyst um oppression.