RU59407U1 - DEVICE FOR TYMPANO-ENDOSCOPY, DIAGNOSTICS AND TREATMENT OF MIDDLE EAR DISEASES IN CONTROLLED BAR - Google Patents

Abstract

The utility model relates to medical equipment and can be used in otorhinolaryngology for research, diagnosis, treatment of otitis media, documentation of research results and treatment. The proposed device contains a tee connecting a rubber balloon to create pressure, a device for measuring pressure and the working channel of the obturating cuff, worn on an endoscope (otoscope) through its main channel. An obturating cuff is attached to the syringe through a non-return valve. The device for measuring pressure is a tympanic manovacuometer designed and having a scale for measuring: positive pressure from 0 to 80 mm Hg, negative pressure from 0 to (-80) mm Hg, drainage and ventilation function of the auditory tube. A video set-top box is attached to the endoscope, which can be connected to a VCR, monitor, or camera.

The advantages of the proposed device over the prototype through the use of a tympanic manovacuometer, endoscope and video box:

• increase of efficiency in diagnostics and treatment,

• improving safety during diagnostics and treatment;

• expansion of opportunities for use;

• increase of convenience in work for the ENT doctor;

• the ability to video document the results of research and treatment in the form of photographs and films.

Description

The utility model relates to medical equipment and can be used in otorhinolaryngology for research, diagnosis, treatment of otitis media, documentation of research results and treatment.

A device for tympanendoscopy is an otoscope (http://opencity.narod.ru/firm/ecomp/lor.html). Otoscopes allow you to inspect the tympanic cavity at an angle of 0 °, 30 °, 70 °. When connecting a video camera to an otoscope, you can zoom in up to 20 times. Connecting a camcorder, VCR or camera allows you to document the image.

This device allows inspection only in atmospheric pressure mode. Diagnostic and treatment options in this mode are limited.

Closest to the claimed utility model is a device for transmeatal drainage and aeration of the middle ear with purulent otitis media (Ageenko I.V. et al. Device for drainage and aeration of the middle ear: RF patent for utility model No. 51872; prototype). The prototype device is intended for the treatment of purulent forms of inflammation of the middle ear and allows, in the presence of perforation in the tympanic membrane, to diagnose the state of cavities and channels of the middle ear, to carry out their drainage and aeration.

The prototype device contains a tee connecting a rubber cylinder that creates pressure, a pressure gauge for measuring pressure and an optical nozzle attached to the Siegel funnel. A Siegling cuff is put on the Siegel funnel through its main channel. The cuff is connected through a non-return valve to a syringe for pumping air.

A disadvantage of the known device is the use in its composition of a manometer, usually used to measure blood pressure. This pressure gauge is designed to measure only positive values of air pressure from 0 to 300 mm Hg. and has a pitch of 2 mm Hg. There is no scale for measuring negative pressure. In connection with this circumstance, the use of a manometer when creating negative pressure has a number of disadvantages. In addition, there are no scales on the manometer to determine the amount of drainage and ventilation function of the auditory tube. The prototype device was not intended for the introduction of medicinal solutions into the cavities and channels of the middle ear. This device allows you to enlarge the image only 2.5 times. In addition, there is no way to inspect the tympanic cavity at an angle of 30 °, 70 °, which give otoscopes, as well as perform video documentation during the study and treatment.

Utility Model Disclosure

The proposed device for tympanendoscopy, diagnosis and treatment of middle ear diseases in a controlled bar mode contains a tee connecting a rubber balloon to create pressure, a device for measuring pressure and the working channel of the obturating cuff, which is worn through its main channel on an endoscope (otoscope) having one or another angle of view, and connected to the syringe through a non-return valve. The device for measuring pressure is a tympanic manovacuum meter designed and having a scale for measuring: (1) positive pressure from 0 to 80 mm Hg, (2) negative pressure from 0 to (-80) mm Hg (hereinafter, negative pressure is denoted by a negative number in parentheses), (3) the drainage function of the auditory tube and (4) the ventilation function of the auditory tube. A video set-top box is attached to the endoscope, which can be connected to a VCR, monitor, or camera.

The proposed device is presented in figures 1, 2, 3.

The list of figures illustrative material:

Figure 1. A device for tympanendoscopy, diagnosis and treatment of middle ear diseases in a controlled bar mode without an unassembled video attachment

Figure 2. A device for tympanoendoscopy, diagnosis and treatment of middle ear diseases in a controlled bar mode without an assembled video device.

Figure 3. A device for tympanendoscopy, diagnosis and treatment of middle ear diseases in a controlled bar mode with a video attachment.

The proposed device for tympanendoscopy, diagnosis and treatment of middle ear diseases in a controlled bar mode consists of: an obstructing cuff (1) having a main and working channel, a non-return valve; 2 ml syringe (2); endoscope (3) with one or another angle of view (0 °, 30 °, 70 °); two plastic tubes (4) with an outer diameter of 5 mm, an inner diameter of 3 mm, a length of 27 mm for an airtight and stable connection of a rubber balloon with a short PVC pipe and the working channel of an obturating cuff with a short PVC pipe; two short PVC tubes (5) with an outer diameter of 7 mm, an inner diameter of 4 mm, a length of 30 mm; a rubber bottle (6) with a volume of 32 ml; plastic tee (7) for connecting the entire device into a single unit; a long PVC tube (8) with an outer diameter of 7 mm, an inner diameter of 4 mm, and a length of 200 mm; tympanic manovacuometer (9) with scales for measuring: positive pressure from 0 to 80 mm Hg, negative pressure from 0 to (-80) mm Hg, drainage and ventilation functions of the auditory tube; video consoles (10) to the endoscope (figure 1, 2, 3), which can be connected to a camera or video recorder with a monitor.

In the proposed device used otoscopes company "Olympus" (Kazan). Otoscopes of another company with a viewing angle of 0 °, 30 °, 70 ° can be used.

In the proposed device used endovideo consoles of the company Karl Storz. A video attachment to an endoscope of another company may be used.

As already mentioned above, the pressure gauge in the prototype is equipped with a scale for measuring only positive pressure from 0 to 300 mm RT.article. with a pitch of 2 mmHg

Using the tympanic manovacuometer, developed jointly with the Tomsk plant "Manotom", it is possible to measure positive and negative air pressure, determine the state of the air and ventilation function of the auditory tube. The tympanic manovacuometer of the proposed device contains four of the following scales:

1. on the left (when the observer is facing the dial) half of the dial clockwise is a scale for measuring positive pressure from 0 to 80 mm Hg. with a pitch of 1 mm Hg;

2. on the right half of the dial counterclockwise marked scale for measuring negative pressure from 0 to (-80) mm Hg with a pitch of 1 mm Hg;

Scales are designed for maximum pressure values of ± 80 mm Hg. for the reason that positive and negative air pressure in excess of ± 80 mm Hg can lead to destructive disorders in the mucous membrane of the middle ear. In the pressure gauge according to the prototype, there are 160 divisions per half circle of the dial, and 80 divisions in the tympanic manovacuometer. Due to the elongation of the scale and a more fractional step of division, the accuracy of pressure measurement and the convenience for the doctor when using the device increase;

3. on the left half of the dial clockwise in numbers and in color is a scale for measuring the drainage function of the auditory tube. The colors indicate the degrees of her condition:

- 1st degree (excellent condition of the drainage function) corresponds to a range of values from 0 to 15 mm Hg (not including 15 mm Hg). The numerical value corresponds to the magnitude of the generated pressure at which the auditory tube opens (Lebedev Yu.A., Shakhov V.Yu. Criteria for the quantitative assessment of tubular function in patients with secretory otitis media. // Bulletin of Otorhinolaryngology. - 1997. - No. 3. - C .30-34). This range is indicated in green;

- 2nd degree (good condition of the drainage function) corresponds to a range of values from 15 to 22 mm Hg (not including 22 mm Hg), this range is indicated in blue;

3rd degree (moderate violations of the drainage function) corresponds to a range of values from 22 to 29 mm Hg (not including 29 mm Hg), this range is indicated in yellow;

- 4th degree (severe violations of the drainage function) corresponds to a range of values from 29 to 37 (including 37) mmHg, the range is indicated in red;

- 5th degree (no drainage function) corresponds to a range of values above 37 mmHg to 80 mmHg, this range is indicated in pink;

4. on the right half of the dial counter-clockwise is plotted in numbers and in color for measuring the ventilation function of the auditory tube. The color indicates the degree of her condition. The degree is determined as follows. Create a negative pressure equal to (-22) mm Hg, the patient performs sequentially with an interval of 30 seconds. 5 empty sips and, if occurs:

- equalization of air pressure in the tympanic cavity to 0, which means the ventilation function is in excellent condition (this is the first degree, it is not shown in color);

- equalization of air pressure in the tympanic cavity to any value in the range of (-7) -0 mm Hg (excluding 0) means

ventilation function in good condition (2nd degree, this range is marked in blue);

- equalization of air pressure in the tympanic cavity to any value in the range of (-15) - (- 7) mm Hg, excluding (-7) mm Hg, which means there are moderate violations of the ventilation function (3rd degree, this range is marked in yellow);

- equalization of air pressure in the tympanic cavity to any value in the range (-22) - (- 15) mm Hg (excluding (-22) mm Hg), then there are pronounced violations of the ventilation function (4th degree, the range is marked in red);

- no alignment - that means there is no ventilation function (5th degree).

When studying the ventilation function, the initial negative pressure is created equal to (-22) mm Hg. The creation of a higher negative pressure leads to increased closure of the walls of the auditory tube in the membranous-cartilaginous region, and therefore the indications of the ventilation function will be unreliable. To indicate this, the range of scale values is from (-22) to (-80) mmHg. marked in pink.

Due to the presence of a tympanic manovacuometer, the device can be used not only for drainage and ventilation, but also to conduct a qualitative study of the ventilation and drainage functions of the auditory tube, to track the dynamics of their changes during treatment.

In addition, the device can be used to introduce medicinal solutions into the cavities and channels of the middle ear. Previously, a device for the treatment of middle ear diseases was used to administer medicinal solutions (utility model RU 46429 by I. Ageenko et al.). The disadvantage of this device is that when a medicinal solution is introduced into the cavities and canals of the middle ear with a syringe, the magnitude of the negative and

the doctor judges the positive pressure in the cavities and canals of the middle ear by the divisions on the syringe. One division of the scale on the syringe (0.1 ml) corresponds to 15-30 mm Hg. Calculations were preliminarily carried out and a correspondence table was created between the displacement of the syringe piston and the pressure created by it. However, firstly, the correspondence was approximate (since it is impossible to accurately determine the volume of the ear canal and air cavities of the middle ear), and secondly, the indirect determination of pressure using tables is inconvenient. Thus, when using RU 46429, it is not possible to precisely control the pressure created.

The proposed device due to the above-described tympanic manovacuum meter solves this problem.

In addition, when using the device according to RU 46429 there is no visual control over the movement of the drug solution in the ear canal and tympanic cavity. In case of pressure overdose, mucosal damage is indicated by the appearance of blood in the syringe.

In the proposed device, you can visually control the nature of the movement of the injected drug solution, its color and transparency when creating variable pressure, which is important for monitoring the safety and effectiveness of the treatment procedure.

The advantages of the proposed device over the prototype through the use of a tympanic manovacuometer, endoscope and video box:

• increasing efficiency in the diagnosis and treatment. According to the indicators of the tympanic manovacuometer, it is possible to accurately dose the positive and negative air pressure in the cavities of the middle ear, to accurately establish the indicators and the degree of violation of the drainage and ventilation functions of the auditory tube. The endoscope and video attachment give a larger increase, the ability to examine the tympanic cavity from different angles of view, to see the severity of inflammation in various parts of the tympanic cavity, which is detached from the cave of the mastoid process, which is imperceptible when viewed through the Siegel funnel. Moreover,

the proposed device allows this to be done both in the mode of zero (atmospheric) pressure and in the modes of negative and positive pressure up to ± 80 mm Hg. When using the device, the treatment time for the disease is reduced, complications from the middle and inner ear, intracranial complications are prevented, the financial costs of the patient and the hospital are reduced;

• improving safety during diagnostics and treatment;

• expansion of opportunities for use;

• increase of convenience in work for the ENT doctor;

• the ability to video document the process and results of research and treatment in the form of photographs and films. The inventive device allows the doctor to monitor the changing picture in the tympanic cavity not only directly through the endoscope (otoscope), but also on the screen of a computer monitor or video system.

The device operates as follows.

The first option to use the proposed device

This option is used for drainage of cavities and canals of the middle ear, for performing baromassage of the mucous membrane of the middle ear, for pneumo-pumping. Using endoscopes with a different angle of view, the doctor, if there is a sufficient amount of perforation of the eardrum, examines not only the mobility of the eardrum, the change in its color, the nature of the discharge through perforation, but also assesses the condition of the mucous membrane of the tympanic cavity in its various departments, its vascular reaction. When performing the procedure according to the first use of the invention, the doctor identifies the main focus of inflammation, structural disturbances and destruction in the tympanic cavity; examines the condition of the tympanic orifice of the auditory tube and, if possible, the entrance to the cave of the mastoid process; evaluates the drainage and ventilation function of the auditory tube according to the testimony of the tympanic manovacuometer;

assesses the patency of the entrance to the cave of the mastoid process; reveals a block of the epitympanum due to inflammatory changes in the tympanic diaphragm, the presence of cholesteatoma, polyps, granulations hidden from examination during ordinary otoscopy; establishes whether or not there is a liquid pathological content in the pockets or sinuses of the epitympanum, the cave and the aerosol cells of the mastoid process, the airways that communicate with the meso- and hypothypanum; assesses the mobility of the auditory ossicles chain, the condition of the niche of the round window of the cochlea, reveals signs of a hidden fistula of the labyrinth.

In the position of the patient sitting in the membranous-cartilaginous part of his ear canal, an endoscope (3) is inserted with a cuff cuff (1) previously put on him through its main channel; a syringe (2) with pre-drawn air is connected to the non-return valve of the cuff. The cuff air balloon is inflated until a tight seal is created between the cuff and the ear canal, cuff and endoscope. To the working channel of the obturating cuff through a free channel of a plastic tee (7), the pre-assembled rest of the device is connected. The rest of the device is assembled as follows. A rubber balloon (6) is attached to one channel of the tee (7) through a short PVC pipe (5), to which a plastic tube (4) is attached in advance. A tympanic manovacuometer (9) is connected to the other channel of the tee through a long polyvinyl chloride tube (8). Squeezing gradually with the thumb of the right hand a rubber balloon, a positive air pressure of up to 75 mm Hg is created in the ear canal and tympanic cavity, thereby checking the tightness between the ear canal and the assembled device. The device is ready for use.

The procedure begins with the fact that the tympanic manovacuometer is disconnected from the device. The rubber balloon is squeezed to ½ of its volume and, while maintaining the pressure of the thumb, the created volume

in the cylinder, the hermetically tympanic manovacuometer is reattached. Through an endoscope or monitor through a video set-top box (10), changes occurring in the ear canal and tympanum are monitored. By restraining the elastic return of the wall of the rubber container to the original volume, a negative pressure of up to (-75) mm Hg is created. Providing additional pressure on the cylinder, create a positive pressure of up to 75 mm Hg. Creating alternating air pressure: from (-75) mmHg up to 0 mmHg, or from (-75) mmHg up to 75 mm Hg, or from 0 to 75 mm Hg, the doctor observes through the endoscope for changes in the tympanum.

In the presence of liquid contents in the epitympanum, cave, airway cells of the mastoid process and tympanum, alternating negative and zero pressure are generated, and the pathological contents are evacuated from them into the ear canal. The liquid content is evacuated from the cavities and canals of the middle ear into the auditory meatus under the influence of negative pressure, draining under the influence of gravity on its lower wall. So that there is no reverse suction of the liquid pathological contents into the cavities and channels when the air pressure is equalized to atmospheric pressure (up to 0 mm Hg), their mouths must be passable for air and should be located above the evacuated liquid. The discharge received in the external auditory canal is removed with an ear pad, after removing the endoscope together with the cuff from the ear canal. Then the endoscope is reintroduced into the ear canal and the procedure is repeated until the pathological contents are removed from the middle ear cavities as much as possible.

By creating air pressure in the cavities and canals of the middle ear within ± 75 mm Hg, the doctor, under the control of endoscopy and tympanic manovacuometer indicators, performs drainage and aeration of the middle ear cavities, mucosal massage, and pneumatic pumping of the auditory tube.

The second option to use the proposed device

This option is used for treatment with medicinal solutions, the introduction of radiopaque substances for subsequent x-ray studies.

The patient is laid on his side with a sick ear up, the plane of the sick ear is parallel to the horizontal plane. From 4-8 drops to 0.5-1.0 ml of a pre-prepared medicinal solution, heated to 37 ° C, are injected into the ear canal. An endoscope (1) is inserted into the membranous-cartilaginous part of the auditory meatus with a pre-worn cuff (3). The cuff balloon is inflated through a non-return valve with a syringe (5) until a stable tightness is created between the endoscope and the ear canal. The pre-assembled rest of the device is connected to the cuff working channel. Check its tightness and stability in the ear canal. The device is ready for use.

The procedure itself begins with disconnecting the tympanic manovacuometer from the device. The rubber cylinder is compressed to ½ of its volume, while maintaining the pressure created by the thumb of the thumb to create the volume in the cylinder, the hermetically tympanic manovacuometer is again attached. Through an endoscope, changes occurring in the ear canal and tympanum are monitored. By restraining the elastic return of the walls of the rubber balloon to a state of rest, alternating negative air pressure from (-40) - (- 75) mm Hg is created in the ear canal. up to 0 mmHg This allows you to evacuate air from the cavities of the middle ear. Due to the negative pressure created in the cavities of the middle ear during pressure equalization in the ear canal up to 0 mm Hg there is a suction in the middle ear cavity of the drug solution. After filling the cavities of the middle ear with a medicinal solution, alternating negative and positive pressure is created in the range from (-30) mm Hg. up to 30-75 mmHg In this case, the translational-backward movement of the drug solution from the ear canal to

the tympanic cavity and vice versa, by which an additional administration of the drug solution, hydromassage and washing of the internal structures of the tympanic cavity from pathological contents are achieved. In cases where there is patency of the auditory tube, creating alternating from 35-75 mm Hg up to 0 mmHg air pressure in the auditory canal, perform hydro- and then hydro-pneumobligation of the auditory tube.

The negative pressure created by a 32 ml rubber cylinder is three times less than the average air pressure, causing a violation of the integrity of the membrane of the round window of the cochlea [Lebedev Yu.A., Shakhov V.Yu., Polukhina T.A. Transmeatal hyperbaric aerosol therapy in the treatment of certain forms of chronic suppurative otitis media. // Bulletin of otorhinolaryngology. - 1999. - No. 4. - C.4-7], which is an additional condition for the safety of the drainage procedure.

The device and the methodology for performing the procedure were tested in the ENT department of the State Novosibirsk Regional Clinical Hospital of Novosibirsk State University, Novosibirsk, in the treatment of 48 patients with chronic and acute purulent otitis media in the perforation stage or after paracentesis: 18 patients with acute purulent otitis media, prolonged and 30 patients with chronic purulent otitis media, exacerbation. The duration of treatment was reduced by an average of 5-8 days. There were no complications when using this device. In all cases, the use of the device improved the diagnosis of the disease, the dynamics of its course during treatment and observation. In all cases, without the use of surgical treatment, it was possible to achieve remission or improvement during a chronic disease, or recovery in an acute process.

The following clinical examples demonstrate the effectiveness of the device.

Example 1. Patient P., 20 years old, complained of purulent discharge from the left ear canal, hearing loss and noise in the left ear, non-intense pain in the back of the ear at night. Discharge from the ear canal occurs mainly at night in the supine position on the side of the affected ear.

From the patient’s history: about 3 weeks ago after hypothermia, a runny nose and cough appeared, and a day later at night severe pains appeared in the left ear, the body temperature rose to 38 ° С. Early in the morning, liquid discharge from the ear appeared, the pain subsided, the body temperature dropped to 37.2 ° C. I was treated on my own, I did not contact an ENT doctor. I instilled 3% hydrogen peroxide, sofradex, otinum in my ear, took painkillers, amoxicillin 0.5, 1 tablet 3 times a day for 7 days. There was an improvement in overall well-being, the temperature returned to normal, the discharge decreased, but did not stop.

I went to the ENT doctor in the clinic. The patient is hospitalized. During otoscopy on the left through the ear funnel, the ENT doctor found a small amount of purulent deposits in the membrano-cartilaginous and bone parts of the auditory meatus, non-edge perforation of the tympanic membrane at the border of the posterior-upper and posterior-lower quadrants up to 0.3 cm in diameter. The eardrum is gray-pink in color on the handle of the malleus, the short appendix and its unstretched part. When otoscopy using the proposed device was able to identify the following: the mobility of the eardrum is preserved, but is significantly limited. The increase created by the video camera revealed that the mucous membrane of the tympanic cavity is hyperemic, swollen more along the posterior-lower wall, there are yellow overlays in the hypothympanum, purulent deposits on the medial wall of the tympanic cavity in its posterior sections. When creating alternating negative air pressure in the range of (-75) -0 mm Hg received mucous-serous-purulent discharge from the epitympanum in a volume of up to 0.3 ml, the overlays from the hypothympanum were evacuated.

The drainage tube patency is IV degree (manovacuometer reading is 35 mmHg), ventilation is also IV degree (manovacuum meter reading (-21) mmHg). To improve patency of the anastomosis, reduce swelling of the mucosa, a mucosal baromassage was performed in alternating mode of alternately negative and positive air pressure from (-20) mm Hg. up to 35-40 mmHg In the patient’s position, lying with the patient’s ear upside down after instillation in the ear canal of a solution of 1% dioxidine heated to a temperature of 37 ° С with dexamethasone phosphate using a device in the mode of creating alternating negative and zero air pressure in the range from (-40) mm Hg. Art. up to 0 mmHg a medicinal solution is introduced into the tympanic cavity. In the mode of creating alternating zero and positive pressure up to 30-45 mm Hg hydrobrushing of the auditory tube was performed. Additionally, traditional therapy of acute perforated purulent otitis media has been prescribed. Studies and treatment have been video-documented.

On the second day, according to the patient, there was no discharge from the ear at night. With otoscopy in the auditory canal, no overlap was found. When performing the procedure according to the first variant of using the proposed device, a meager amount of serous discharge was obtained through perforation from the epitympanum. The auditory tube patency is III degree (manovacuometer reading is 27 mmHg), ventilation duct is III degree (manovacuum meter reading (-14) mm Hg). The following is the procedure for the second embodiment of the device. The drug solution was reintroduced into the tympanic cavity, and the auditory tube was subjected to hydrobiasing.

On the third day, the patient noted a significant improvement in hearing, there was no discharge from the ear. With otoscopy, the ear canal is pink, there is no overlap, the eardrum is gray, perforation is up to 0.3 cm in

diameter. There are no overlays of the discharge in the auditory canal and tympanic cavity; when creating alternating negative and zero pressure, the discharge from the epitympanum was not obtained. Patency of the auditory tube drainage has a II degree (12 mm Hg), ventilation - II degree ((- 5) mm Hg). In the position of the patient lying on his side, the device introduced a medicinal solution in the cavity of the middle ear, performed hydrobrushing of the auditory tube. The research and treatment performed were video-documented.

On the fourth day, the patient did not complain; the rumor, in her words, is almost the same on both ears. When performing procedures, detachable from the tympanic cavity was not received, baromassage of the mucous membrane of the middle ear was performed by creating intratympanically alternating negative and positive pressure within ± 35 mm Hg. Drainage canal patency has an I-II degree (13-16 mmHg), ventilation - II degree ((-5) mmHg). In the cavity of the middle ear using the inventive device, a medicinal solution was introduced, hydrobrushing of the auditory tube was performed. Research and treatment performed are video documented.

In the following days, the procedures were not performed. On the 8th day from the moment of admission to treatment, the patient was discharged from the ENT department with recovery. Recommended myringoplasty of the left tympanic membrane in a planned manner.

Example 2. Patient O., 12 years old, was referred for treatment in the ENT department for discharge from the right ear over the past 3 weeks. Sick for about 5 years. He was treated repeatedly by an ENT doctor at the place of residence. In the last year, an exacerbation of the disease has occurred three times. The latter exacerbation is associated with hypothermia.

Otoscopic auditory meatus is wide, pink in color. In the lower part of it, in the bone section, purulent deposits of yellow color, hyperemia of the skin were found. Eardrum perforation -

subtotal, central type with calloused edges. In the tympanic cavity, the mucous membrane is hyperemic, edematous with uneven hypertrophy in the hypo- and mesotympanum. The impurities are purulent without a fetid odor. Patency of the auditory tube during the test A. Valsalva is absent. Diagnosis: exacerbation of left-sided chronic purulent otitis media, mesotympanitis.

Prescribed: antibiotics for injection; anti-inflammatory, desensitizing therapy, vitamins. For the diagnosis and treatment of otitis media, the proposed device was used. When performing tympanoendoscopy with an increase and at an angle of 30 ° in the epitympanum, purulent-cholesteatomic overlays were discovered that were invisible with conventional otoscopy. When performing the procedure according to the first variant of using the device, a serous-purulent discharge with cholesteatomic masses from the epitympanum in a volume of 0.5 ml was obtained. Confirmed the lack of patency of the auditory tube (drainage and ventilation function are absent). When performing the procedure according to the second variant of using the device, a solution of sodium hypochlorite at a concentration of 700-800 mg / l was introduced in the middle ear cavity, and no signs of drug passage into the nasopharynx were obtained. The study and treatment were video-documented.

Based on the results of the above procedures, the diagnosis was made: exacerbation of left-sided chronic purulent otitis media, epimesotympanitis with cholesteatoma growth. After the third session of the procedures for the first and second options for using the proposed device, the separation from the ear canal ceased. During otoscopy in the tympanic cavity, only superimposed serous color in a small amount was found, drainage patency of the auditory tube - IV degree, ventilation - IV degree.

After the 4th and 5th sessions of performing procedures using the device, there are no overlays in the tympanum, the mucous membrane is pink.

Drainage and ventilation patency of the auditory tube - III degree. Research and treatment performed are video documented.

When viewed on the 7th day from the start of treatment, the mucous membrane of the tympanic cavity is pink, there are no overlays. The procedure for the first use of the device is not separated. The ventilation function of the auditory tube is II degree, drainage - III degree. Research and treatment performed are video documented.

On the 10th day the treatment was completed, the patient was discharged under the supervision of an ENT doctor at the place of residence with a diagnosis of right-sided chronic purulent otitis media, epimesotympanitis, complicated by the growth of cholesteatoma, unstable remission. Parents were informed that the child was recommended surgical treatment in a planned manner after one month. According to extracts from case histories, outpatient records, the average hospitalization and outpatient treatment of a patient for this disease was earlier 16 days. The last course of therapy using the proposed device allowed to achieve a remission of the disease, while reducing 1.5 times the treatment time and the consumption of expensive drugs. Using the device in treatment made it possible to detect and suppurate a suppurative cholesteatoma from the epitympanum, achieve improvement during the disease, and prepare the patient for surgical treatment in a dry ear.

Thus, the proposed device allows under the control of vision (through an endoscope) and indicators of air pressure in the cavities of the middle ear (tympanic manovacuometer) to diagnose the condition of the middle ear, to carry out, in the presence of perforation, controlled deep drainage and aeration of the cavities of the middle ear. In this case, there is a reduction or elimination of the inflammatory block of anastomoses, the evacuation of liquid pathological contents from the airways of the middle ear with its replacement by atmospheric air. The device allows to detect pathological changes hidden in a routine examination and formation in

tympanic cavity, for example cholesteatoma, polyps in the epitympanum, the place of their growth in the meso- and hypothympanum; to carry out the collection of pathological contents from the deep sections of the middle ear for the study of microflora; to determine the degree of violation of the drainage and ventilation functions of the auditory tube, to trace the dynamics of their changes during treatment; perform baromassage of the mucous membrane of the middle ear; perform pneumo- and hydropneumobuzhdenie auditory tube, washing the mucous membrane and internal structures of the tympanic cavity from pathological contents; deeply inject the drug solution into the middle ear cavity.

The device has proven itself in preparing patients with chronic purulent otitis media for surgical treatment, in particular, for various types of myringo-and tympanoplasty.

The device can be recommended for use in both outpatient and inpatient settings.

Claims (1)

A device for tympanendoscopy, diagnosis and treatment of middle ear diseases in a controlled bar mode, including a tee connecting a rubber balloon to create pressure and a pressure measuring device, an obturating cuff connected to the syringe through a non-return valve, characterized in that the obturating cuff additionally has a working channel, attached to the tee, the main channel of the obstructing cuff is worn on an endoscope connected to a video set-top box, and the pressure measuring device is impanalny manovakuumetr designed and having a scale for measuring: a positive pressure of 0 to 80 mmHg, a negative pressure of 0 to (-80) mm Hg drainage and ventilation function of the auditory tube.