RU2356521C1 - Technique of tympanic membrane lateralisation elimination - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to otorhinolaryngology, otology and can be used in chronic otopyosis surgery. Substance of the method consists in elimination of tympanic membrane lateralisation by natural pulling through combined with dissection of tympanic membrane to two layers - external epidermal layer dissected and positioned on bone walls of external acoustic meatus, and internal fibromucosal layer naturally pulled through.

EFFECT: application of the present invention allows forming the epithelial tegument of external acoustic meatus without additional skin transplantation, keeping viability of tympanic membrane due to preservation of fibrous layer and mucous membrane being extension of tympanic mucous membrane.

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Description

The invention relates to medicine, in particular to otorhinolaryngology, otiatrics, and can be used in the surgical treatment of patients with chronic purulent otitis media.

Currently, tympanoplasty is widely used in the surgical treatment of patients with chronic purulent otitis media. One of the stages of tympanoplasty is myringoplasty, which can also be performed as an independent operation to close the tympanic membrane defect (Preobrazhensky Yu.B., 1973; Fish U., 1994). The best functional results are obtained during the formation of the tympanic membrane at a natural level (Tarasov D.I. et al., 1988; Toc M., 2004). In some patients, unsatisfactory results of the operation are noted due to the lateralization of the tympanic membrane, that is, its formation outside the chain of the auditory ossicles (in particular, the handle of the malleus) and the tympanic ring (Preobrazhensky Yu.B., 1973; Tarasov D.I. et al., 1988 ; Fish U., 1994; Sperling NM, Kay D., 2000). With lateralization of the tympanic membrane, despite a good morphological result (whole tympanic membrane, closed tympanic cavity), the functional result (increase in hearing level), as a rule, is unsatisfactory due to the lack of contact between the tympanic membrane and the chain of auditory ossicles (Segal S., Winerman I ., Man A., 1981; Gyo K. et al., 2003).

Lateralization can be caused by improper placement of the transplant and its loose pressure on the receiving bed, excessive separation of the skin of the ear canal (especially its anterior wall), tympanic flap disease, when it thickens and sometimes becomes necrotic with subsequent scarring (Kulakova L.A., 1990; Kin T.I., 1990; Perrin A. et al., 1987). The lateralized tympanic membrane has an external epidermal layer (skin of the external auditory meatus), a middle fibrous layer and an internal mucous layer, which is a continuation of the mucous membrane of the tympanic cavity. With lateralization, the tympanic membrane, as a rule, thickens due to fibrosis and becomes stiff (Tarasov D.I. et al., 1988).

The elimination of lateralization of the tympanic membrane is not an easy task.

There is a known method of surgery on the ear, in which the tympanic membrane is excised, myringoplasty is performed by fascia of the temporal muscle at a natural level, and the bare bone of the external auditory meatus is covered with transplantation of a split skin flap (S. Segal, I. Winerman, A. Man, 1981; Gyo K. et al., 2003).

The disadvantage of this method is the need for re-graft (fascia of the temporal muscle) for myringoplasty, the possibility of its rejection. A split skin flap transplanted into the external auditory canal is often necrotic, which leads to subsequent scarring of the external auditory canal.

It was proposed to supplement the auditory ossicle chain with a prosthesis through which contact will be made between the lateralized tympanic membrane and the hammer (Fish U., 1994). The installation of a prosthesis between the hammer and the lateralized non-tympanic membrane is accompanied by the formation of an additional link in the sound-conducting system, which negatively affects the growth of hearing. In addition, with this method, the rigid tympanic membrane is maintained at an unnatural level.

The closest in technical essence and the achieved result to the claimed method is a method in which the epidermal layer is removed from the tympanic membrane, the fibrous tissue is excised from its thickness and the front sections of the tympanic membrane are reduced to a natural level (Tarasov D.I., Fedorova OK, Bykova V .P.Diseases of the middle ear: a Guide for doctors.M .: Medicine, 1988. - P.179-180).

The disadvantage of this method is the exposure of the bone wall of the external auditory canal when moving the tympanic membrane to a natural level. Granulation tissue grows on the exposed bone, which subsequently can lead to cicatricial narrowing of the external auditory canal, as well as a relapse of the lateralization of the tympanic membrane.

The novelty of the invention lies in the simultaneous formation of the tympanic membrane at a natural level and the formation of the epidermal cover of the external auditory canal to prevent its cicatricial narrowing.

The essence of the proposed method lies in the fact that the tympanic membrane is layered on the outer epidermal layer, which is crosswise dissected and covered with bone walls of the external auditory meatus, and the inner mucous-fibrous layer is reduced to a physiological level.

The inventive method allows you to form the epidermal cover of the external auditory canal with local tissues and does not require additional skin grafts. With this method, a viable tympanic membrane is preserved, which is achieved by preserving its fibrous layer and mucous membrane, which is a continuation of the mucous membrane of the tympanic cavity.

The proposed method is as follows. The patient with lateralization of the tympanic membrane under anesthesia through the behind-the-ear incision soft tissues are separated. The tympanal membrane is stratified, the outer epidermal layer is separated from it. Due to the fact that the lateralized tympanic membrane is thicker than an ordinary eardrum, it is well stratified. The inner part, consisting of the mucous membrane of the tympanum and the fibrous layer, is reduced to a natural level with contact on the malleus and tympanic ring. The outer epidermal layer is dissected cruciformly in the middle and deployed, laying on the walls of the ear canal (figure 1, 2). Then the tamponade of the external auditory canal is performed. The behind-the-ear wound is sutured in layers.

We used this method in 9 patients with lateralization of the tympanic membrane. All patients in the past were operated on for chronic purulent otitis media - tympanoplasty of type 1 or myringoplasty was performed. The terms of the first operation ranged from 6 months to 6 years. The control group consisted of 8 patients with lateralization of the tympanic membrane, which eliminated lateralization by the traditional method (D.I. Tarasov et al., 1988). The treatment results were traced in the next 1-3 months and long-term (1-3 years). In the near and distant postoperative period in the main group, a good morphological and functional result (tympanal membrane formed at a natural level, hearing gain) was noted in 8 (88.9%) patients. In 1 (10.1%) patient, a dullness of the anteroposterior angle of the external auditory meatus and an unsatisfactory functional result were noted. In the control group, a good morphological and functional result was noted in the immediate postoperative period in 5 (62.5%) patients. In 3 (37.5%) patients, repeated lateralization of the neotympanic membrane and unsatisfactory level of hearing were noted. In the distant postoperative period, 4 patients of the control group (50.0%) showed good morphological and functional results, 3 (37.5%) showed lateralization of the neotympanic membrane with the development of cicatricial narrowing in one patient, and 1 (12.5%) of the patient showed blunting of the anteri-lower angle of the external auditory meatus.

The results obtained indicate the high efficiency of the proposed method for eliminating the lateralization of the tympanic membrane after tympanoplasty.

Thus, the proposed method for eliminating lateralization of the tympanic membrane can be applied in the surgical treatment of patients with chronic purulent otitis media and will improve the morphological and functional results of treatment.

Figure 1. The proposed method for eliminating lateralization of the tympanic membrane (top view).

The arrows indicate the directions of the sections of the tympanic membrane and the movement of the epidermis

1 - external auditory meatus;

2 - a tympanic cavity;

3 - a malleus;

4 - tympanal membrane;

5 - bone annulus tympanicus - physiological level of the location of the tympanic membrane.

Figure 2. The proposed method for eliminating lateralization of the tympanic membrane (top view).

1 - external auditory meatus;

2 - a tympanic cavity;

3 - a malleus;

4 - displaced internal mucous and fibrous layer of the tympanic membrane;

5 - displaced epidermal layer of the tympanic membrane.

LITERATURE

1. Kulakova L.A. Surgical rehabilitation of patients with chronic purulent otitis media and its consequences. Abstract. dis ... cand. honey. sciences .. - 1990. - 23 p.

2. Kin T.I. Meringoplasty with a three-layer graft in patients with chronic purulent otitis media. Abstract. dis. Cand. honey. sciences. - 1990. - 21 p.

3. Preobrazhensky Yu.B. Tympanoplasty. - M .: Medicine, 1973. - 262 p.

Prototype:

4. Tarasov D.I., Fedorova O.K., Bykova V.P. Middle Ear Disease: A Guide for Physicians. M .: Medicine, 1988 .-- 288 p.

5. Toc M. Middle Ear Surgery Guide. In 4 volumes. Volume 1. Approaches, myringoplasty, ossiculoplasty and tympanoplasty. Translation from English. / Edited by A.V. Starokhi. - Tomsk: Sib. Gos. Honey. University, 2004 - 390 p.

6. Fish U. Tympanoplasty, Mastoidectomy and Stapes Surgery. - New York: Thieme Medical Publishers, 1994 .-- 292 p.

7. Gyo K., Hato N., Shinomori Y., Hakuba N. Lateralization of the tympanic membrane as a complication of canal wall down tympanoplasty: a report of four cases // Otol. Neurotol. - 2003. - Vol.24, No. 2. - P.145-148.

8. Perrin A., Mendoza R., Baril Ch. et al. Resultats anatomiques a long-term des homogreffes tympaniques. A propos de 170 cas // Ann. Otolaryngol. Chir. Cervicovac. - 1987. - Vol. 104, No. 7. - P.535-539.

9. Segal S., Winerman I., Man A. Surgical correction of lateralized eardrum // J. Laryngol. Otol. - 1981. - Vol. 95, No. 7. - P.675-678.

10. Sperling N.M., Kay D. Diagnosis and management of the lateralized tympanic membrane // Laryngoscope. - 2000. - Vol. 110, No. 12. - P.1987-1993.

Claims (1)

A method for eliminating the lateralization of the tympanic membrane, including bringing the tympanum membrane down to a natural level, characterized in that the tympanic membrane is stratified into the outer epidermal layer, which is crosswise dissected and covered with the walls of the external auditory canal, and the inner mucosal fibrous layer is reduced to a natural level.

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