RU2391918C1 - Method of tympanic cavity draining with placement of drainage tube under meatotympanak flap into bone bed created in lower wall of external acoustic meatus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to otolaryngology and can be applied in patients with chronic exudative otitis media and perforated otitis media with mucositis. Essence of method lies in the following: after tympanotomy with tympanic cavity revision, removal of exudate out of it or performance of tympanoplasty autofascia is used as transplant. Drainage tube is introduced into hypotympanum, placed under meatotympanal flap into bone bed specially created in lower wall of external acoustic meatus.

EFFECT: application of claimed invention allows to terminate occurrences of chronic exudative otitis media and chronic perforated otitis media with mucositis in patients, obtain positive result of tympanoplasty.

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Description

The invention relates to medicine, namely to otorhinolaryngology.

There are various methods of drainage of the tympanic cavity in patients with exudative otitis media (ESR). In this case, various surgical interventions are used (tympanopuncture, myringotomy, myringostomy, tympanotomy and tympanotomy) with or without drainage materials. Drainage tubes (shunts) made of various materials (teflon, silicone, polyethylene, titanium, etc.) are used to drain and summarize drugs. If with acute or subacute ESF it is possible to use minimally invasive techniques (tympanopuncture, myringotomy, myringostomy with the introduction of a shunt), then in chronic ESF it is necessary to perform an audit of the tympanic cavity (tympanotomy) or anthrum (anthrotomy) with the installation of a shunt or ventilation tube. In addition, temporary summing of ventilation tubes is necessary for tympanoplasty in patients with chronic mesotympanitis and catarrhal inflammation of the mucous membrane of the tympanic cavity (mucositis), which are used to introduce medicinal solutions into the cavity with the aim of stopping inflammation, draining and ventilating it.

The prototypes of this invention are a method for shunting the tympanic cavity in patients with ESO, proposed in 1954 by B. Armstrong (Armstrong B. A new treatment for chronic secretory otitis media. Arch. Otolaryngol. 1954; 59: 653-654); Method of metatympanal shunting of the tympanic cavity in patients with ESO, the disadvantage of which is the need to fix the drainage tube to the skin of the ear canal (Palchun V.T., Magomedov M.M., Luchikhin L.A. Otorhinolarynology. M., "Medicine", 2002, p. 388-389). "A method for the surgical treatment of exudative otitis media" (patent No. 2003135534/14 dated 06.10.2005, authors Vakhrushev SG, Zyryanov MM, Pronina Yu.V.) based on the fact that under the control of an endoscope connected to video camera, after cutting the eardrum and examining the tympanic cavity, its pathological contents are removed through two metal tubes inserted into the external auditory meatus, and the quality of the shunt installation is assessed. The disadvantage of the latter method is the lack of direct visual control over the state of the tympanic cavity during rehabilitation and the inability to control the effectiveness of its implementation. "A method for the treatment of diseases of the middle ear" (patent No. 2005103029/14 dated 12.10.2006, Davydov A.V., Ageenko I.V., Starokha A.V., Shilov M.V., Knipenberg A.E., Isaev P.Yu.) is characterized by the fact that a hole is formed in the mastoid process, after which pathological contents are evacuated from the cavities of the middle ear and drugs are introduced into them. The disadvantage of this method is significant trauma to the structures of the mastoid process.

The purpose of the invention is to increase the efficiency of surgical treatment of patients with chronic exudative otitis media and chronic mesotympanitis with mucositis.

The methodology for the implementation of our proposed method is as follows. Under local anesthesia, the skin of the external auditory canal with a fibrous ring is separated by an intrameal (intracanal) approach according to Rosen. After opening the tympanic cavity and removing the exudate there, an audit of all its departments is carried out. A grooved groove of 3.0 × 3.0 mm is made with a chisel or boron in the lower wall of the bony section of the external auditory canal, a drainage tube made of silicone is placed in it (length - 15-20 mm, diameter - 3.0 mm), the proximal end of which located in the hypothympanum, and the distal in the external auditory canal. The previously separated meatotympanic flap is returned to its original place. The operation is completed by laying rubber bands along the cut line and tamponade of the ear canal with cotton balls with antibiotic.

In various variants of tympanoplasty in patients with chronic perforated otitis media, the bed for the drainage tube is prepared before the transplant is installed, the tube after the tympano (ossiculo) plastics is inserted into the hypothympanum under the meatotympanic flap. The operation is completed by laying on the formed eardrum of rubber strips and tamponade of the auditory meatus with balls from a gelatin sponge with an antibiotic.

In the postoperative period, exudate from the tympanic cavity is sucked daily through a drainage tube, mucolytics (acetylcystine, etc.) and hormonal preparations (prednisone, dexamethasone) are administered. The drainage tube is removed on average 7-10 days after the cessation of discharge from the tympanic cavity and restoration of the function of the auditory tube.

The method was applied in 105 patients with chronic ESO and in 99 patients with chronic perforated otitis media with mucositis aged 15 to 70 years. This technique of temporary drainage of the tympanic cavity allows stopping the phenomena of exudative otitis media in 96% of patients and in 78% of patients with chronic perforated otitis media with mucositis to achieve a positive result of tympanoplasty.

As an illustration of the effectiveness of the applied method of treating patients with chronic exudative and perforated otitis media with mucositis, we present two observations.

Patient A., 36 years old, was admitted to the Audiological Department of City Clinical Hospital No. 52 on 04/07/2005 (medical history No. 2762) with a diagnosis of left-sided exudative recurrent otitis media.

At admission, he complained of hearing loss in his left ear, a feeling of the presence of fluid in it, ear noise. Sick for about 1.5 years, when the hearing was first reduced, there was a sensation of the presence of fluid in the ear. The auditory tube was catheterized with mucolytics. After the treatment, the hearing was restored. In February 2005, the same sensations appeared in the ear as before. Catheterization of the auditory tube was again performed with the introduction of mucolytics, but without a positive effect, in this regard, the patient was hospitalized for surgical treatment.

Upon admission, the general condition of the patient is satisfactory. When viewed from the nose, pharynx, larynx - without visible changes. With otoscopy, the auditory meatus is wide, the eardrum is cyanotic, retracted, exudate is visible through it. Hearing in the left ear is reduced: sp. - 1.5 m, river - 6 m. For endoscopic examination of the pharyngeal orifice of the auditory tube, tubular ridges are pale pink, pasty; when swallowing, transparent mucus is secreted from the mouth of the auditory tube, at the end of the act of swallowing it completely closes.

During a tuning study, a conductive type of hearing loss was detected, with tonal threshold audiometry, conductive hearing loss with a bone-air interval in the audiogram of 15-20 dB was detected. During acoustic impedancemetry, a tympanometric curve of type “B” was recorded; the acoustic reflex was not detected.

04/13/05, the patient underwent surgery on the left ear - tympanotomy with the introduction of a drainage tube into the tympanic cavity.

Under local anesthesia, the skin of the external auditory canal with the fibrous ring was separated by the intra-Ramen approach by Rosen. A revision of the tympanic cavity with removal of exudate was performed, the auditory tube was washed. A bed for the drainage tube was prepared, the latter was inserted into the hypothypanum, the meatotympanic flap was laid in its original place. The operation was completed by putting rubber bands on the eardrum and tamponade of the auditory meatus with antibiotic gelatin sponge balls. The drainage tube was removed on the 8th day after surgery. The patient’s hearing at discharge improved with complete closure of the bone-air interval. During the dynamic examination after 1 year, the eardrum is gray, thin, with identification points. There is no bone-air interval in the audiogram; a tympanogram of type “A” and an acoustic reflex are recorded.

Patient P., 33 years old, was admitted to the Audiology Department of City Clinical Hospital No. 52 on May 31, 2007 (medical history No. 4614) with a diagnosis of chronic left-sided perforated otitis media, mucositis.

On admission, she complained of hearing loss in the left ear, mucous discharge from it. Ear hurts since childhood. Exacerbations of otitis media are 2-3 times a year.

The general condition of the patient is satisfactory. When viewed from the nose, pharynx, larynx - without visible changes. With otoscopy, the auditory meatus is wide, there is a mucous discharge, a subtotal eardrum defect is determined; the mucous membrane of the tympanic cavity is hyperemic, thickened, moist (mucositis, II degree), patency of the auditory tube is difficult. Hearing in the left ear is reduced: sp. - ad concham, p.p. - 0.5 m.

A tuning study revealed a conductive hearing loss, according to tonal threshold audiometry - conductive hearing loss with a bone-air interval of up to 55 dB.

05/04/07, the patient underwent surgery on the left ear: tympanoplasty type I autofascial flap with dissection of the altered mucous membrane and drainage of the tympanic cavity.

Under local anesthesia after excision of the callous edges of the perforation of the tympanic membrane, the skin of the external auditory canal with a fibrous ring was separated by the Rosen method using an Rosen approach, an auditory examination of the tympanic cavity with dissection of the changed mucous membrane was performed, and the auditory tube was washed. A transplant was prepared (autofascia of the temporal muscle), a bed for a drainage tube, tympanoplasty of type I was performed using this graft, and a silicone tube was inserted into the hypothympanum under a meatotympanal flap. The operation was completed by laying rubber bands on the meatotympanic flap and tamponade of the auditory meatus with balls from a gelatin sponge with an antibiotic. Hearing at discharge improved, the bone-air interval in the audiogram did not exceed 20 dB.

During a dynamic examination, after a year, the non-nepimal flap was thin, without defects, the bone-air interval in the audiogram completely closed at all frequencies.

Claims (1)

A method of treating patients with chronic exudative otitis media and perforated otitis media with mucositis, characterized in that after tympanotomy with revision of the tympanic cavity, removal of exudate from it or tympanoplasty using autofasion as a graft, a drainage tube is inserted into the hypothympanum, placing it under the tympanum a flap in a bone bed specially created in the lower wall of the external auditory canal, which significantly improves the results of treatment of patients.