Method for control and dynamic survey for the state of tympanic cavity according to preliminarily fulfilled opening

FIELD: medicine.

SUBSTANCE: one should carry out perforation of tympanic membrane with a laser beam at wave length being 0.97 mcm to fulfill an opening of about 2-3 mm diameter. The method provides prolonged terms for the survey and decreased traumatism in a child due to no necessity in conducting repeated tympanotomies in case of survey even during short period of time, moreover, the opening made should be remained for the terms up to 3-4 wk at their further independent closing without development of cicatricial alterations upon a patient's tympanic membrane.

EFFECT: higher efficiency of control and survey.

3 ex

 

The invention relates to medicine, namely to control and monitor the status of the tympanic cavity by a pre-made hole, and can be used in ENT clinics and ENT departments in the treatment of patients with diseases of the middle ear.

The known method of monitoring the condition of the tympanic cavity through the ear tubes, followed by the introduction in the section of Teflon tubes [Yakushenkova A.P. "Exudative otitis media in children (diagnosis and treatment), dis. CMN, Moscow, 1996, p.78-84].

The method requires a high level of proficiency in a microscopic technique, in order not to injure important in functional relation to the anatomical structures of the middle ear. Myringotomies incise not capable of long-term remain open, and the introduction of the shunt on long-term atrophy of the tympanic membrane, which loses its conductive properties and durability. Made incise and entered into the tube require special care, as it can clog the dried exudate. Sometimes the shunt spontaneously falls in the external auditory meatus. Furthermore, the method is quite traumatic.

The purpose of the invention is the increase of the period of observation of the tympanic cavity and reducing trauma b is rabanni membrane and the anatomical structures of the middle ear.

This objective is achieved in that the perforation of the eardrum carried out by a laser beam with a wavelength of 0.97 μm, with the formation of holes from 2 to 3 mm.

For a long time a hole in the eardrum, allowing to dynamically observe the tympanic cavity and to produce therapeutic measures in it. In addition, the method does not require the introduction of ventilation tubes.

The method is as follows.

Before carrying out the manipulation of the patient conduct a General analysis of blood and urine, the assessment of the flora of the nasopharynx, the definition of allergic status; endoscopic examination of the nasal cavity, nasopharynx and ear; audiological research, impedancometry and rhinomanometry.

After examination under mask anesthesia perform endoscopic laser tympanotomy with the formation of holes with a diameter of 2 to 3 mm, and the wavelength of the laser beam of 0.97 μm.

In the future, due to continued open within 3 weeks of the hole in the eardrum implemented dynamic observation of the tympanic cavity and have the best options conservative treatment.

Example 1.

The patient Svetlana M., age 8. Clinical diagnosis: Bilateral exudative otitis media. Adenoids 2 degrees.

Complaints of hearing loss is over 2 years old.

When otoscopy: eardrum drawn, dull, translucent yellow contents.

Endoscopic examination: in the lumen nasopharyngeal adenoid vegetations 2 degrees.

Audiogram: bilateral conductive hearing loss of 2 degrees.

Tympanogram: type "B".

The hospital conducted podnagotnaya endoscopic adenotomy.

In order to ensure the continuous monitoring of the condition of the tympanic cavity decided to make bilateral endoscopic laser media by the claimed method.

Operation:

After giving laryngeal mask anesthesia under the control of the rigid optics the patient underwent bilateral endoscopic laser media in the anterior-inferior tympanic membranes, after which a thin suction apparatus is made to aspirate fluid from the tympanic cavity. Then through the holes with a syringe in the tympanic cavity is entered in 1 ml hydrocortisone, and 1 ml of chymotrypsin.

On the 1st day after the operation, when otoscopy eardrum pale contours are visualized, no blood in the anterior-inferior quadrants foreseeable holes of 2 mm diameter, with sharp edges, tympanic cavity is not changed, ear bones and promontorium very well seen from two sides, no exudate.

On the 3rd day re-introduction b Rabanne cavity of the drug hydrocortisone at a dose of 0.5 ml, and the blowing of the auditory tube by Politzer pneumomassage eardrum; endoscopic examination membranes pale, holes remain open, accumulation of fluid in the tympanic cavity no. Marked improvement in hearing from two sides by 10-20 dB.

On the 6th day inspection of the tympanic membrane pale, the contours are determined, the hole diameter is 1.5 mm to the right and 1.7 mm to the left, the entrance to the tympanic cavity free from two sides, exudate in the middle ear cavity was not found.

On the 10th day when otoscopy tympanic membrane pale, diameter tympanoctomys holes to the right of 1.1 mm, left 1.3 mm, tympanic cavity without the negative dynamics; produced pneumomassage eardrum.

On the 16th day after the operation, the diameter of the holes in the ear-drum to the right and to the left is 0.2 mm and 0.4 mm, respectively, membranes clearly contribute, exudate absent.

Finally closing tympanostomy holes happened to the 21-th day; tympanic membrane pale, clear contours, cicatricial changes.

The course of treatment the patient was 21 days.

After treatment according to the audiogram hearing is restored to normal values, tympanogram - type ' a'; the child was discharged from outpatient hospital under observation.

Example 2.

The Patient Anatoly Is., 12. Clinical diagnosis:

The right recurrent otitis media.

History of frequent otitis, hearing loss.

When otoscopy: eardrum drawn to the right, dull, contours are not clear.

Endoscopic examination: the mouth of the auditory tube is covered with a tube tonsils.

Audiogram: right-sided conductive hearing loss 2 degrees.

The hospital conducted endoscopic laser destruction of the tubal tonsils.

In order to ensure the continuous monitoring of the condition of the tympanic cavity and holding of medication made right endoscopic laser media by the claimed method.

Operation:

Under the mask anesthesia, hard-optics produced right endoscopic laser media in the anterior-inferior quadrant of the tympanic membrane; then made through the hole made the drug fluimucil is an antibiotic in the dose of 1.5 ml.

On the 1st day after surgery when viewed eardrum without signs of inflammation in the anterior-inferior quadrant is visualized hole with a diameter of 2.5 mm; tympanic cavity anatomical structures of the middle ear intact mucosa of the middle ear several hyperamylasemia, pathological secret is not found.

On the 3rd day when otoscopy eardrum pale contours foreseeable, tympanoctomys hole with sharp edges, the tympanic cavity is well visible, hyperemia of the mucous sharply decreased, detachable none; re-introduction into the cavity of the middle ear through the remaining hole of the drug fluimucil is an antibiotic in a dose of 1 ml; also produced pneumomassage the eardrum to the right.

On the 5th day when endoscopic examination of the right ear marked reduction of the diameter of the holes of 0.6 mm, eardrum pale, contoured, tympanic cavity without evidence of inflammation, discharge does not contain. There has been improvement in hearing from the right by 10 dB.

On the 9th day when inspecting the diameter tympanoctomys hole is 1.4 mm, eardrum pale contours foreseeable, the mucosa of the tympanic cavity pink; re-introduction of fluimucil-antibiotic at a dose of 0.5 ml, and did the blowing off of the auditory tube by Politzer pneumomassage eardrums.

On the 12th day when otoscopy eardrum pale contours intact, the hole diameter is 1 mm, edges crisp, dry; tympanic cavity without evidence of inflammation. Produced by the blowing of the auditory tube and pneumomassage eardrums.

On the 16th day during the inspection. is fair membrane pale, contoured, diameter tympanoctomys hole is 0.4 mm Conducted the hearing blowing pipes and pneumomassage eardrums.

Final closure tympanostomy occurred on the 20th day of treatment, eardrum pale contours very well seen, cicatricial changes.

The treatment of the child was 20 days.

According to rerun the test the child's hearing is restored to normal values. The patient was discharged from the outpatient hospital under observation.

Example 3.

The patient Nicholas D., 7 years. Clinical diagnosis:

Left exudative otitis media. Adenoids 3 degrees.

History of frequent colds, ear infections, tinnitus, hearing loss.

When otoscopy: eardrum dull, paths cleared, her mobility is limited, translucent exudate.

Endoscopic examination: in the lumen nasopharyngeal adenoid vegetations of 3 degrees.

Audiogram: left conductive hearing loss 2 degrees.

Tympanogram: type "B".

The hospital conducted podnagotnaya endoscopic adenotomy.

In order to ensure the continuous monitoring of the condition of the tympanic cavity and holding her rehabilitation decided to make a left-endoscopic laser media by the claimed method.

Operation:

After the issuance of the mask on the goat under the control of the rigid optics the patient underwent bilateral endoscopic laser media in the anterior-inferior quadrant of the tympanic membrane, then the electric pump with thin atticum probe made aspiration of thick fluid from the tympanic cavity and the introduction made through the hole with a syringe 1.5 ml hydrocortisone, and 1 ml of trypsin.

On the 1st day after surgery with endoscopic examination of the left ear is defined pale with indistinct contours eardrum with very well seen in the front-lower quadrant tympanocentesis hole diameter of 3 mm, the mucosa of the tympanic cavity hot pink, promontorium and ear bones intact, revealed a small accumulation of mucous discharge.

On the 3rd day after surgery with otoscopy eardrum pale contours are not defined, the hole in the eardrum wealthy, tympanic cavity without obvious signs of inflammation, contains a small amount of mucus; us re-aspiration of mucus and introduction to the tympanic cavity 1 ml hydrocortisone, and 1 ml of trypsin performed through tympanostomy.

On the 6th day inspection of the eardrum pale contours are visualized, the diameter tympanoctomys hole is 2.3 mm, smooth edge; mucosa of the tympanic cavity pink, not swollen; produced by injecting auditory tube by Politzer pneumomassage eardrum. According to the diagramme marked improvement in hearing left by 10-20 dB.

On the 10th day when otoscopy eardrum pale diameter tympanoctomys hole is 1.9 mm, the mucosa of the tympanic cavity pink, exudate does not accumulate; continuing through the hole into the cavity of the middle ear is entered 0.5 ml hydrocortisone; produced by injecting auditory tubes and pneumomassage eardrums.

On the 14th day inspection of the eardrum pale contours are determined, the diameter of tympanostomy is 1.5 mm, detachable no, tympanic cavity without inflammatory changes; produced by injecting auditory tubes and pneumomassage eardrums.

On the 18th day of observation at otoscopy diameter tympanoctomys holes is 1 mm, eardrum pale, contoured, detachable none; produced by injecting auditory tubes and pneumomassage eardrums.

On the 22nd day of the diameter of tympanostomy amounted to 0.4 mm, eardrum pale, clear contours; produced pneumomassage eardrums.

On the 25th day tympanoctomys hole closed completely; when otoscopy eardrum pale, clear contours, scarring us not identified.

The course of treatment the patient was 25 days.

These audiograms and tympanograms after treatment within normal limits. The child was discharged from the hospital with pollingstation hearing under outpatient supervision.

Despite its apparent simplicity, the method is very effective, does not require repeated surgical interventions, easily tolerated during the whole period of observation and treatment (up to 3-4 weeks)until full self-closing hole in the eardrum.

However, the claimed method of control and dynamic observation of the tympanic cavity is not obvious for specialists working in this field.

This, in particular, by the fact that even with a relatively simple surgical interventions on the tympanic cavity, if necessary, monitor the status of the repair process until the proposed method had repeatedly, and sometimes repeatedly perform the media due to self-close the hole in the eardrum.

Moreover, due to the frequently observed spontaneous closure of the hole in the eardrum, is accomplished by conventional incisio, often had to ReWire all the forced tympanopuncture and ear tubes, exposing the child to the risk of secondary bacterial complications.

Previously to prevent premature closure is made in the eardrum holes recommended to leave it for the required period shunt, i.e. thin tubes, specialno made for this purpose from titanium or plastic.

Currently, when the surgical intervention with the application of the proposed method such necessity is not present.

Not obvious for specialists working in this field, was the fact of spontaneous closure of the hole in the eardrum performed using a laser tympanostomy, without any scarring, while at repeated regular incised, as a rule, these changes take place.

In some cases these changes are serious enough and with the further growth and development of the child behave differently, until the dysfunction of the hearing.

Therefore, the absence of any scarring on the eardrum is very important in prognostic terms.

Despite the simplicity, the claimed method was developed to some extent unexpected, however, this in no way reduces its exceptional value for pediatric otorhinolaryngology.

The simple way available for implementation in the present description and will find, as we hope, the widespread use in pediatric otolaryngology.

Control method and dynamic observation of the tympanic cavity by a pre-made hole, characterized in that, to increase the observation time and reduce trauma, perforation is urabandai membranes carried out by a laser beam with a wavelength of 0.97 μm, with the formation of holes from 2 to 3 mm.



 

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