RU2485917C2 - Method of myringoplasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to otolaryngology, and can be applied in myringoplasty. Method lies in cleaning auditory canal and tympanic membrane, its de-epithelisation, measurement of perforation area, formation of pericondrial-chondral autotransplant and further covering of defect. Autotransplant is formed in form of truncated cone with angle at wide base 40°-50° and base dimension being 1 mm larger than dimension of tympanic membrane perforation. Transplant is installed into perforation with wide base directed towards tympanium. After that, perichondrium is placed on de-epithelisided surface.

EFFECT: application of the claimed invention makes it possible to fix autotransplant in tympanic membrane defect in a reliable way, and thus to avoid filling tympanic membrane with resorbable materials for flap support, which in its turn prevents development of commissures in middle ear.

2 dwg, 2 ex

Description

The invention relates to medicine, otorhinolaryngology, and in particular to methods of myringoplasty.

Perforations resulting from trauma or acute otitis media often lead to the formation of chronic perforated otitis media. Such a pathology is characterized by a decrease in hearing in the speech range according to the conductive type and is the entrance gate for infection in the middle ear cavity. Based on the physiology of sound conduction, depending on the violation of the function of certain elements of the tympanic cavity, various types of operations are performed. If the pathology is limited by perforation of the tympanic membrane without disturbing other elements of the sound-conducting circuit, then surgical reconstruction is performed, which is called myringoplasty. Meringoplasty can be both an independent operation and the final stage of tympanoplasty [1, 3, 7].

In the study of patent and research literature, a number of methods of myringoplasty have been identified [1-7]. In order to replace the defect, a variety of materials are used: canned amnion, bioplastics, spongostan, autogenous fibrin film, collagen sponge and others. However, the use of the above materials is not always clinically effective. Some of them contribute to the allergization of the body, others are not biologically inert enough, which leads to excessive development of connective tissue and sclerosis of the graft. In addition, artificial materials lack a vascular bed, which can lead to transplant rejection [1, 2, 7].

Long-term clinical experience has shown that the use of autografts is most effective in myringoplasty, since they provide complete immunological compatibility of tissues [6].

In most methods, in order to fix the transplant, filling the tympanic cavity with absorbable materials is used. The disadvantage of these methods is the irritation of the mucous membrane of the tympanic cavity, which can cause hypersecretion and the development of an acute inflammatory process in the tympanic cavity. In case of impaired function of the auditory tube, the material is not completely utilized, as a result of which there is a high probability of developing cicatricial changes in the middle ear [2, 7].

A known method of myringoplasty, the essence of which is to form a graft from the cartilage corresponding to perforation of the tympanic membrane, and the location of two fragments of the perichondrium, on the inner and outer surfaces of the tympanic membrane [3].

The disadvantages of this method are the implementation of tympanotomy in order to lay the perichondrium on the inner surface of the tympanic membrane, which in the future can cause the development of an adhesion process in the tympanic cavity. The disadvantages also include the lack of reliable fixation of the flap in the perforated hole of the tympanic membrane.

Closest to the claimed is the method of myringoplasty, in which the eardrum is restored perichondral-cartilaginous autogenous flap, the plasticity of which is given by the wedge-shaped strips cut out in the cartilaginous part of the graft [4].

The disadvantage of this method is the unreliable fixation of the graft from the inside of the eardrum, which increases the likelihood of the flap being displaced relative to the defect in the immediate postoperative period.

A new technical challenge is to reduce the complications associated with unreliable fixation of transplant.

To solve the problem in the method of myringoplasty, including cleaning the ear canal and eardrum, its epithelialization, measuring the perforation area, forming a perichondral cartilage autograft and subsequent closure of the defect, an autograft in the form of a truncated cone with an angle at the wide base of 40 ° -50 ° and with a base size exceeding 1 mm the size of the perforation of the tympanic membrane, while the graft is set into perforation with a wide base in the direction of the tympanic cavity, and the supra the puppy is placed on a de-epithelized surface.

The proposed method allows to reliably fix the perichondral-cartilaginous autograft in the defect of the tympanic membrane, and thereby avoid filling the tympanic cavity with absorbable materials to maintain the flap. This, in turn, leads to a decrease in postoperative complications.

The method is as follows. After infiltration anesthesia of the auditory canal and tympanic membrane with a solution of 2% lidocaine, the auditory canal and tympanic membrane are cleaned of desquamated epidermis and earwax. The surface of the eardrum is de-epithelialized. With the help of micro-tools, perforation is measured, with an irregular shape in 3-4 diameters. An autograft is formed, for which purpose perichondral cartilage tissue is taken from the tragus of the auricle, while on one side of the cartilage the perichondrium is removed, and a truncated cone is formed from the exposed part of the cartilage with an angle at a larger base of 40 ° -50 °, the smaller base of the cartilage plate is fixed to the perichondrium but not wide. The dimensions of the wide base should be greater than the perforation of the tympanic membrane by 1 mm (Fig 1.). To close the defect, the obtained autograft is inserted into the perforation with the wide base of the cartilage in the direction of the tympanic cavity, and fixation of the “latch” type occurs. The perichondrium is placed on the de-epithelialized surface and it further supports the cartilage from the ear canal. In this way, a solid fixation of the autograft is ensured, retention and displacement of the autograft relative to perforation in the immediate postoperative period is prevented. In this case, filling the tympanic cavity with absorbable materials in order to support the flap from the inside is not required.

The stages of the method are illustrated in figure 2, where 1 is the tympanic cavity, 2 is the tympanic membrane, 3 is the graft, 4 is the ear canal.

The testing of this method of myringoplasty was performed in 12 patients at the Tomsk branch of the Federal State Institution Scientific and Clinical Center for Otorhinolaryngology of the FMBA of Russia.

Application examples of the method

Example 1. Patient L., 46 years old, was admitted on 10.11.2010 to the Tomsk branch of the Federal State Institution Scientific and Clinical Center for Otorhinolaryngology of the FMBA of Russia with a diagnosis of Right-sided chronic mesotympanitis, remission. He complained of hearing loss in his right ear. Five years ago he suffered a right-sided acute purulent otitis media, since then he has noticed hearing loss in his right ear, suppuration once every two years, the last suppuration has been noted seven months ago.

When examining the ENT - organs: AD - the auricle is normal. The skin is not changed, there is no pathological discharge in the ear canal. The eardrum is gray, the identification marks are clearly expressed. Perforation in the stretched part, 5 mm in diameter. The mastoid process is painless. From other ENT - organs without visible pathology.

Akumetria: SR AD - 4 m, AS - 6 m. Weber's experience of lateralization in the right ear. Patency of the auditory tube of the I-II stubble. X-ray of the temporal bones in the projections of Schuller and Mayer of bone-destructive changes was not detected. Audiometry right-sided conductive form of hearing loss II degree.

11/11/2010 performed myringoplasty by the proposed method. Conducted loose tamponade of the auditory meatus. The postoperative period was uneventful. November 16, 2010 the patient was discharged under observation on an outpatient basis. 12/02/2010 removed the tampon from the ear canal. There are no complaints. Objectively AD: non-otimal membrane of gray color, mobile, SR AD - 6 m. Repeated audiometry shows the absence of a bone-air interval.

Example 2. Patient S., 29 years old, was admitted on 08.12.2010 to the Tomsk branch of the Federal State Institution Scientific-Clinical Center for Otorhinolaryngology of the FMBA of Russia with a diagnosis of Right-sided chronic mesotympanitis, remission. Complained of hearing loss in the right ear. Two years ago, I independently performed the toilet of the ear canal with a match, I felt a sharp pain in my right ear, hearing loss in my right ear. The next day, she turned to an ENT doctor, and post-traumatic perforation of the right tympanic membrane was diagnosed. It was observed on an outpatient basis for two years; during the observation period, there was no tendency to restore perforation.

On examination of the ENT organs: AD - the auricle is normal. The skin is not changed, there is no pathological discharge in the ear canal. The eardrum is gray, the identification marks are clearly expressed. Perforation in the stretched part, with a diameter of 3-4 mm. The mastoid process is painless. From other ENT organs without apparent pathology.

Akumetria: SR AD - 4.5 m, AS - 6 m. Weber's experience of lateralization in the right ear. Patency of the auditory tube of the I-II stubble. X-ray of the temporal bones in the projections of Schuller and Mayer of bone-destructive changes was not detected. Audiometry right-sided conductive form of hearing loss I degree.

12/09/2010 performed myringoplasty using the proposed method. Conducted loose tamponade of the auditory meatus. The postoperative period was uneventful. 12/14/2010 the patient was discharged under observation on an outpatient basis. 12/29/2010 Tampon removed from the ear canal. Actively does not make complaints. Objectively AD: non-otimal membrane of gray color, mobile, SR AD - 6 m. Repeated audiometry shows the absence of a bone-air interval.

Thus, the above clinical examples illustrate that the application of the proposed method of myringoplasty is safe, highly effective in treatment, does not require large financial costs, simply performed. The proposed method allows you to reliably fix the peritoneal-cartilage graft in the defect of the tympanic membrane, and thereby avoid filling the tympanic cavity with absorbable materials to maintain the flap, which prevents the development of adhesions in the middle ear.

Sources of information used in compiling the description

1. Zabirov R.A. Meringoplasty in patients with chronic mesotympanitis. R.A. Zabirov, M.I. Anikin, P.P. Zabirov et al. // Materials of the 1st Congress of the Otorhinolar. Kyrgyz Republic. - Bishkek, 1999 .-- S.41-42.

2. Zabirov R.A., Rakhmatullin P.P., Anikin M.I. Meringoplastic swab // No. 2182017, B.I. 05/10/2002.

3. Mareev OV, Zhigalov VA, Rogova EG, Shuvalova LV, Mareev G.O. Method of tympanoplasty No. 2237443, B.I. 10/10/2004.

4. Mukhamedov I.T., Dayhes N.A. The method of formation of the tympanic membrane with tympanoplasty // No. 2342087, B.I. 12/27/2008.

5. Sushko Yu.A. Some variants of myringoplasty: Abstract. dis. Cand. honey. sciences / Sushko Yu.A. - К., 1966. - 15 p.

6. Shadyev Kh.D., Vishnyakov VV The experience of using perichondrium and cartilage of the tragus and fascia of the temporal muscle in tympanoplasty. Bulletin of Otorhinolaryngology 1997. N4. - C. 46-47.

7. Hirata, Keisuke Eardrum perforation patch and eardrum undersurface scraper // Patent No. 5501700, Date Issued: 03/26/1996.

Claims (1)

The method of myringoplasty, including cleaning the ear canal and eardrum, its epithelialization, measuring the perforation area, forming a perichondrium-cartilage autograft and subsequent closure of the defect, characterized in that the autograft is formed in the form of a truncated cone with an angle at the wide base of 40 ° -50 ° and s the base size exceeding 1 mm the size of the perforation of the tympanic membrane, while the graft is installed in the perforation with a wide base in the direction of the tympanic cavity, and the perichondrium is placed on a de-epithelized surface.

Images