A method of treating mucositis middle ear

 

(57) Abstract:

The invention relates to medicine, namely to otorhinolaryngology. How is the impact on the pathological mucous membrane of the cavities of the middle ear pulse defocused beam holmium laser with certain modes, thus take into account different forms of mucositis. The method reduces the invasiveness of the method. 3 C.p. f-crystals.

The invention relates to medicine, namely to otorhinolaryngology and can be used in the treatment of pathological changes in the cavities of the middle ear, particularly mucositis.

The inefficiency of conservative treatment of otitis media is often caused by slow mucositis, which is a related syndrome in the various forms of otitis media, including reperforating and perforating secretory otitis media, any form of chronic suppurative otitis media. This pathology of the mucous membrane of the middle ear is one of the main reasons for the so-called "diseases of the operated ear," when, despite intensive conservative treatment, positive effect, i.e. the termination of otorii unable to achieve. Pathological studies revealed neobratimykh epithelial cysts.

Mucosity can be divided into secretory, hyperplastic and atrophic forms, each of which can move one to another, and purulent form. The outcome of mucositis is tympanosclerosis extreme cases of atrophic process, developing more after secretory form, and timpanogos (i.e., adhesive otitis media), which is the outcome of other forms of mucositis.

The last of the pathologic process in the tympanic cavity is very difficult both conservative and surgical treatment.

There is a method of surgical treatment of mucositis the middle ear, which produce separate Attico-antrotomy under the control of a modern operating optics, with long ear bridging cavities middle ear and instrumental removing the modified mucous membranes (Surgical treatment of mucositis in children. "News of otorhinolaryngology and logophilia", S.-Petersburg, No. 3, S. 114).

The disadvantage is that when running this way possible complications in the form of a labyrinth attack and bleeding.

Closest to the present invention is a method of treating mucositis middle ear, including the effects of laser sled removal of granulations in the cavities of the middle ear by laser," lasers in surgery and medicine. Proc. international. the Symposium. - M., 1989. - S. 230-231).

This method uses a radiation of YAG-Nd laser with a power density of 30-50 W/mm in the exposure of 0.3-0.5 C. this contact method using quac polymer fiber have a "drying" of granulations in the cavities of the middle ear. After what happen dystrophy granulation and necrobiosis with subsequent epithelialization.

However, this laser is quite "hard" in its effects, causes burns reactions to structures of the inner ear, which in turn slows down the healing process.

The objective of the invention is to develop a low-impact with low energy levels and is safe against burn reactions treatment of mucositis the middle ear.

To achieve this objective in the treatment of mucositis middle ear, including the effects of laser radiation on the pathological mucous membrane of the cavities of the middle ear, the impact of the carry pulse defocused beam holmium laser with a radiation energy of 0.3-0.8 j, the pulse frequency of 2-8 Hz within 10-20 minutes

Moreover, secretory form of mucositis impact with impact energy 0,5-0,8 j and a pulse repetition rate of 6-8 Hz;

in atrophic form mucositis impact energy of 0.3-0.5 j and a pulse frequency of 4-5 Hz.

In the proposed method using radiation YAG holmium laser (2,09 μm). This type of laser radiation is almost completely absorbed by the moisture-saturated tissues, including the diseased mucous membrane of the cavities of the middle ear resulting in the destruction of the pathologically changed tissues is virtually no burn reactions of the surrounding tissue and with a high degree of precisie. Peculiarities of interaction of radiation holmium laser with biological tissues also give the ability to use low levels of energy for the destruction of the diseased mucous membrane of the middle ear.

The method is as follows.

After sedation, given the age norm (morphine, atropine, diphenhydramine, in some cases, Relanium) and local application anesthesia with lidocaine or dikaina under the control of the operating microscope tonirovannym fiber which is enclosed in the guide - fragment needle Kulikovskii (for better fixation of the fiber and prevent damage to nearby structures of the middle and inner is alasti energy radiation from 0.3 to 0.8 j and the repetition rate of the pulse from 2 to 8 Hz for 5-15 minutes depending on the pathologic process. The degree of "revocationdate" is determined visually as "drying", poslednee the underlying tissue. For this purpose, the working face of the light guide is held at a distance of from 2 to 6 mm above the surface of the object. With the increase in distance increases the area of "machined" surface and decreases the depth of the impact, as it reduces the power density of laser radiation. For better visualization should be used during the intervention by the electric pump, which allows to aspirate products laser dezintegratsii. So, when the secretory form of mucositis in children applied laser radiation with energies of 0.3-04 j with a pulse frequency of 2-4 Hz.

Adults more likely to occur hyperplastic form of mucositis. Here it is necessary to produce laser mucosectomy with broader parameters defocused beam from 0.5 to 0.8 j, 6-8 Hz. In atrophic form of mucositis in adults - laser radiation with a lower power density is 0.3 - 0.5 j, 4-5 Hz.

This method allows you to pause, and in some cases to arrest the inflammatory process in the postoperative cavities of the middle ear after sanitizing (radical, conservative-radical operations).

Ognia operations on the middle ear (tympanoplasty).

Using this method produced 23 surgical interventions in the middle ear. Postoperative dizziness phenomena of the facial nerve is not marked.

Example 1. Patient Vlasov, A. P., age 14, East. disease 1186. The patient is suffering from chronic suppurative otitis media in 6 years. Sickness up to 3 times a year, lasting up to 3 weeks. The conservative local treatment effect is not brought (washing ear antiseptic solutions, instillation into the ear of dioksidina solution, sofradex on a background of antibacterial therapy). When admitted to the ENT Department of MONICA when otoscopy: BTE region is not changed, the ear canal is free, perforation of the eardrum in epitympanic part, moderate purulent discharge from the tympanic cavity. When x-ray examination of the temporal bones on Scullery, Mayer revealed moderate degradation in Attico-antral region, the decline of pneumatization mastoid. On the audiogram hearing loss on the affected ear conductive type by presence of bone-air interval 50 dB at normal bone conduction. The child had radical surgery on the middle ear, which antrum, Aditya, partly in bar the config period was uneventful. Discharged in a satisfactory condition, with almost entirely epidermization postoperative cavity. Postoperative care the postoperative cavity of the middle ear was not made. 6 months after radical surgery on the middle ear sickness was renewed for up to 2 weeks, the nature of the discharge is mucopurulent. Conservative treatment in the form of digging into the ear of solutions of antiseptics effect is not brought. When this arrives otoscopes: postoperative cavity of the middle ear konturirovany not fully epidermization. There is a sharply thickened mucosa in the area promontories wall of the tympanic cavity and polypose-thickened mucosa in Batticaloa this cavity.

25.01.2000, under local anesthesia with a solution of 10% of lidocaine under the control of the operating microscope produced by the treatment by the proposed method. The effect on the mucous membrane was carried out by defocused beam holmium laser with a radiation energy of 0.4 j, a frequency of 4-6 Hz, within 12 minutes

Dizziness, reactions on the part of the facial nerve is not marked in the early and distant polomer the ez week with minor reactive phenomena in the postoperative middle ear cavity, almost without otorii. Dynamic observation of the patient for 8 months postoperative cavity konturirovany, epidermization, geethani was not observed. Indicators of auditory function in the preoperative level.

Example 2. Sick Kildibaev R. C., 18 years. East. disease 623, suffer from chronic suppurative otitis media in early childhood, presumably after suffering rubella. In the last two years marked a rare, intermittent discharge from the ear Muco-purulent character, lasting about 1-2 weeks. When admitted to the ENT Department MONICA - otoscopes - Subtotal perforation of the eardrum, thickened, crowneplaza mucosa promontories wall of the tympanic cavity, scant mucoid discharge. When x-ray examination of the temporal bones on Scullery, Meier - destructive changes in the cavities of the middle ear is not revealed. The audiogram is a hearing loss in conductive type, with the presence of bone-air interval 55 dB 20.01.2000 produced treatment under the proposed method. This impacted on the mucous membrane of the defocused beam holmium laser energy radiation 6-8 j, a frequency of 8 Hz for 20 minutes

The use of this invention will provide for traumatic operation, which in turn will lead to faster healing of wounds in the middle ear cavity.

1. A method of treating mucositis middle ear, including the effects of laser radiation on the pathological mucous membrane of the cavities of the middle ear, characterized in that the impact of the carry pulse defocused beam holmium laser with a pulse energy of 0.3-0.8 j, the pulse frequency of 2-8 Hz, within 10-20 minutes

2. A method of treating mucositis middle ear under item 1, characterized in that during the secretory form of mucositis is affected with a pulse energy of 0.3-0.4 j and a pulse frequency of 2-4 Hz.

3. A method of treating mucositis middle ear under item 1, characterized in that when the hyperplastic form mucositis, work with the pulse energy of 0.5-0.8 j, and the pulse repetition rate of 6-8 Hz.

4. A method of treating mucositis under item 1, characterized in that in atrophic form of mucositis is affected with a pulse energy of 0.3-0.5 j and a pulse frequency of 4-5 Hz.

 

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