The invention relates to medicine, namely to otorhinolaryngology, specifically to methods for treating diseases of the middle ear.

There is a method of treatment of inflammation of the middle ear [5], wherein in the mastoid process of forming the hole, then from the cavity of the middle ear produces the evacuation of pathological content and enter the medicinal substance.

The disadvantages of this method is significant trauma to the tissues of the body, because in its essence is a kind of surgery that limits the scope of its application in individuals with contraindications to surgery. The method is technically difficult, because it requires some knowledge of the anatomy of the temporal bone and possession of surgical skills. Besides, as a kind of masticating, the method provides only a partial drainage of the mastoid process, leaving a large portion of cells without drainage [2], thereby reducing the effectiveness of the treatment.

Closest to the claimed is a method of treatment involves drainage of the auditory tube and tympanic cavity, followed by the introduction of drugs in these lesions using both negative and positive pressure, carried out with devices for diagnosis, treatment, prevention, DeNiro the project and/or administration of drugs [1].

The disadvantages of this method is the inability of the drainage and the introduction of drugs into the cells of the mastoid process and antrum - the use of the method is limited to the tympanic cavity.

Given an active part in the treatment of the patient, the use of the method is limited to adult patients. Children cannot explain the sequence of treatments, as well as to obtain reliable information about the changes in the tympanic cavity in the treatment process. This limits the scope of application of the device only in adult patients.

Also, if treatment is not taken into account the data of the microbiological examination detachable obtained from the cavities of the middle ear, which reduces the efficiency of this method.

New technical problem - increasing the effectiveness of treatment, at the expense of reduction of time, the expansion of the scope.

The set task is solved by a new method of treatment of diseases of the middle ear, which consists in draining the auditory tube and tympanic cavity, and subsequent introduction into the pockets of medicines, using negative and positive pressure, and conduct controlled drainage under visual control with the creation of negative and positive pressure with step stake the project from -75 mm Hg to +75 mm Hg, taking a deep faction pathological content of pneumatic cells of the middle ear, perform microbiological analysis and, further, the selected respectively received antibiotikogramma drug fill the cavity of the middle ear pressure -75 mm Hg

The method is as follows.

The first and second steps of the method is carried out in the position of a patient sitting on a chair. For carrying out manipulations are used, for example, the device of the original design, shown in figure 1, 2. In webbed-cartilaginous part of the external ear canal enter the funnel of Siegl (1) with a pre-worn obtenerse cuff (4), which is inflated by a syringe (6) to create a leak and hold in position a funnel of Sigl. A funnel put an optical attachment (2). On the side surface of the optical nozzle has a channel adapter (10), used to connect through a PVC tube (7) from tee to which through a PVC tube (7 and 8) attach the pressure gauge (5) and rubber cylinder (3) (figure 1). Making the pressure on the rubber cylinder under the control manometer to +75 mm Hg, check the tightness of the system. Forth from the crater of Sigl disconnect an optical attachment, rubber balloon squeeze on¹/₂volume, NASA is ku again hermetically attached to the funnel. Under visual control through an optical attachment monitor changes occurring in the ear canal and tympanic cavity. Constraining elastic return to the original volume of the wall of the cylinder, creating an adjustable negative pressure up to -75 mm Hg Performing additional pressure on the bladder, creating a positive pressure up to +75 mm Hg Striped controlled by the size and time of atmospheric pressure in the cavities of the middle ear results in the movement of the liquid and gaseous contents in the direction of the rubber cylinder and back. Content under the influence of negative pressure is evacuated from the cavity of the middle ear into the ear canal, draining on its lower wall. Further, when the alignment to atmospheric pressure available in the cavity of the middle ear is absorbed by the air from the ear canal. The fluid received in the external auditory meatus of the cavities of the middle ear, is removed through the funnel of Sigl ear padded jacket. Then an optical attachment newly added, the procedure is repeated until the maximum possible removal of the pathological content of the deep cavities of the middle ear.

On the second step of the method obtained deep faction pathological content of the cavities of the middle ear are taken for microbiological examination. Based on the antibiogram pick up the maximum is about effective drug, which will be introduced in the cavity of the middle ear during the third step of the method.

The third step of the method performed with the patient lying on his side, a sick ear upwards. On the receiver channel (3) put mobile cuff (1) so that its inner end protrudes from under the balloon cuff 1.5-2 mm. Collected system (figure 2) is introduced into membrane and cartilage Department of external ear canal. To the non-return valve (2) mobile cuff (1) attach the syringe (5) with 1 ml of air. Expanding, balloon cuff tightly secures the device in the ear canal. In a sterile syringe (4) enter 1 ml corresponding to antibiotikogramma drug warmed on a water bath until the temperature of the body. Attaching to the outer end of the tube channel (3) of the syringe (5), carry out the traction piston. Through dialed drug solution in the syringe starts flowing air in the form of bubbles. Then do a reverse movement of the piston to its original position. When this drug enters the ear canal and middle ear cavity. 5-7 reciprocating movements of the plunger of the syringe all the medicinal solution replaces the air contained in the cavities of the middle ear. Further, through the reciprocating motion of the piston of the syringe in the range of 0.2-0.8 ml from baseline, produce extra is, a deeper introduction the medicinal solution. When filling pneumatic cells of the middle ear further attempts at introducing the medicinal solution lead to a breach of containment system due to the buoyancy of the movable sleeve (1) together with the tube channel (3) of the ear canal. This proves the safety of the procedure for the patient.

The maximum pressure of 75 mmHg (10 kPa), created by the rubber balloon due to the elastic resilience of their walls, three times less than the average pressure, disrupting the integrity of the membrane of the round window [4], which is important for the safety of the procedure drainage on the first step of the method. At the same time, the pressure of 75 mm Hg at several times more than the average threshold passive disclosure of the auditory tube, which effectively eliminate the block its light.

On the second step of the method selection of deep faction pathological content of pneumatic cells of the middle ear is of great clinical value: 30% of the observed discrepancy in the species composition of the microflora of the superficial and deep exudate fractions, especially in the form of chronic otitis [6]. Microbiological analysis detachable allows you to apply etiological correct drug and efficiently act on the calling inflammatory the th process of the organism.

On the third step of the method, the penetration of the medicinal substances in the tympanic cavity, the cave and the cells of the mastoid process, a bony part of the auditory tube is provided a negative pressure in the system within 75 mm Hg This allows the drug to penetrate as deeply as possible in the pneumatic cells of the middle ear, at the same time this pressure is safe for delicate structures of the inner ear and is sufficient for disclosure tympanal the mouth of the auditory tube.

The proposed method of treatment is tested on the basis of the ENT Department and the office ENT-clinic MLPA "City hospital №3" Tomsk in the treatment of 20 patients with various types of perforated otitis: 12 patients with chronic purulent middle otitis, and 10 patients with acute purulent otitis media. The application of the proposed method allowed us to achieve the cessation of otorii for 3-4 procedures as in acute purulent and chronic suppurative otitis media. The treatment time was reduced on average by 4-6 days. Complications from the use of this device were observed. In all cases, without the use of surgical treatment has improved in the course of chronic illness or recovery from an acute process. The following clinical examples demonstrate the effectiveness of the method.

Example 1. Patient O., 2 years, asked for help to LOR-to the doctor with complaints of discharge from the right ear canal for three weeks, headache in the right temple and ear area, the noise and the feeling of heaviness, fullness of the ear fluid, some uncertainty when walking. At the beginning of the disease have a runny nose, cough and intense throbbing pain in his right ear. The intensity of pain decreased significantly after discharge from the ear canal on the second day from the disease. The patient was treated at the ENT doctor at the place of residence since the first days of the disease: naphazoline nasal drops, atinum - drops in the ear, bioparoks - inhalation in mouth, analgin headache. To the seventh day of the disease, overall health has improved, ear discharge was stopped, however, remained congestion and noise in the ear. On the 10th day in the evening, again pains, numbness in the right temporal region, the increased noise in the ear. At night amid the pulsing pain from the right ear canal appeared rich liquid discharge yellowish color. Was again forced to ask for help. During the examination, the doctor except for a perforation of the eardrum in sagnieres quadrant found no changes.

Given the lack of improvement in the disease, was admitted to the ENT hospital of the city hospital №3. When otoscopy right eardrum gray with swelling and redness in her loose parts, perforation in sagnieres quadrant to 0.3 cm in diameter. The skin in the ear natural color, with pressure and this in the field site mastoid notes mild pain. When x-ray examination of the temporal bones in the projection of Cullera and Meyer, right, was found to reduce pneumatization and veiled cells of the mastoid process. Was diagnosed with right-sided acute purulent perforated otitis media, complication - serous mastoiditis, neuralgia facial nerve.

Patients received treatment with use of the method described above. During the implementation of the first phase was obtained about 3 ml of serous-purulent liquid without odour. During the second step of the method a portion of the deep divisions of the middle ear discharge was sent for bacteriological examination, sensitivity identified microflora to antibiotics. At the end of this step the patient noted a decrease noise in the ear, hearing better, the disappearance of pain and feeling of fullness in the ear. When creating a positive pressure of 75 mm Hg air vent through the auditory tube in the nasopharynx was not, indicating that the expressed violation of the patency of the auditory tube. During the execution of the third stage of the method available in middle ear cavity was entered RA is a creation of medicines, consisting of dioksidina, dexamethasone phosphate and adrenaline. Treatment: ampicillin intramuscularly; claritin, paracetamol, askorutin per os; Xylometazoline nose drops.

Second day. The patient noted that the night was a small purulent fluid from the ear, pain in the ear, noise has increased slightly, insecurity when walking there. Parasthesia in the face almost completely disappeared. Retried the above method of treatment with drainage, aeration and introduction of medicinal mixture. Received 1.5 ml of serous-purulent fluid, the patency of the auditory tube is missing.

On the third day, the patient noted that the hearing had improved somewhat, Muco-purulent discharge from the ear canal bothered at night. The results of the microbiological examination - Proteus vulgaris, with a maximum sensitivity to Cefotaxime. Performed local treatment received 0.2 ml separated from the tympanic cavity. In the ear entered the solution of Cefotaxime; the permeability of drugs through the auditory tube is missing. Ampicillin replaced with Cefotaxime injection.

The fourth day. Mood, appetite and sleep good, noises in the ear, pain and paresthesia in the right temporal region is not disturbed. Carried out the above method of treatment, discharge from the tympanic cavity is obtained, the air vent in the nasopharynx was p and 15-10 mm Hg, when performing the second stage occurred the free flow of drugs into the nasopharynx.

During the fifth and sixth days of treatment, the flow of air in the nasopharynx occurred while creating positive vnutrimembrannogo pressure by 8-10 mm Hg, the permeability of drugs in the nasopharynx good.

In the following days, the treatment was carried out without application of the method. When discharged on the 8th day was found epidermization perforation of the eardrum. When viewed through the month had no complaints, audiometric hearing study was normal.

Example 2. Patient M., aged 6, in the last 3 years have seen the ENT-clinic regarding sickness from the ear, hearing loss and noise in the left ear. Last exacerbation occurred six months ago. Then for the first time separated from the external ear canal was taken for microbiological examination. After 5 days was the result: microflora was not found. The next two biopsy specimens from the ear also did not reveal any microorganism that causes slow the inflammatory process in the middle ear.

During the last treatment of the patient regarding exacerbation of chronic left-hand drive mesotympanic to treatment was applied to the above method: after drainage of the middle ear was obtained to 0.8 ml of Muco-purulent discharge from the deep divisions Wed is the last ear, which was taken for the study on the microflora. In the ear on the third step of the method introduced dioksidina solution with a suspension of hydrocortisone. In parallel was appointed - vasoconstrictor nasal drops and an antihistamine. 2 days after the above treatment the patient has improved somewhat: detachable occurred only in the morning, the noise decreased. When otoscopy remained Central perforated left eardrum to 0.5 cm in diameter. According to the results of the microbiological examination was discovered Staphylococcus aureus. During the third step of the method instead dioksidina in the composition of a medicinal mixture was introduced amoxicillin. On the fifth day of treatment by the patient and his parents, there was significant improvement of health: discharge from the ear is no longer worried about the noise occurred only at night, hearing improved. Objectively - dry perforation of the eardrum. Exacerbation did not occur during the subsequent six-month monitoring of patients. Observation demonstrates the effectiveness of the proposed method of treatment according to the received data microflora from deep faction pathological content of pneumatic cells of the middle ear.

The proposed method for the treatment of inflammatory diseases of the middle ear allows the first stage efficiency is used to remove pathological content of the deep pneumatic cells of the middle ear. When this occurs, the elimination or reduction of inflammatory block anastomoses, restored patency of the auditory tube. The remote on the first step of the method the air from poorly aerated cells enriched with oxygen, which also promotes healing. In the mucosa of the middle ear when the regulated pressure change from -75 to +75 mm Hg improves blood circulation and lymph flow [3]. As the pressure drops short and striped, this impact can be compared with the massage of the mucous membrane with the enhancement of metabolic processes, which leads to the elimination of inflammation. Subsequent topical introduction corresponding to antibiotikogramma the medicinal solution in the cavity of the middle ear on the third step of the method is superior to traditional methods of treatment for penetrating ability. During the procedure, it is possible to control the flow of drug solution in the deep pneumatic cells of the middle ear.

The advantages of the proposed method are as follows: the method is simple, safe, has a high efficiency in the treatment of various types of acute and chronic otitis externa with perforation of the eardrum. During the procedure there is the possibility to monitor the healing process and to monitor the status of the tympanic membrane and mucous oblock the tympanic cavity. When using the method reduces the treatment time of the disease. The application of the method can be recommended in clinical practice and in a hospital.

Sources of information

1. Stork I. a Device for diagnosis, treatment, prevention, drainage and/or injection of drugs // no 2205039, BI 27.05.2003.

2. Galochkin VI Masticating in complex therapy of inflammatory processes in the middle ear // Bulletin of otorhinolaryngology. - 2003, No. 3. - P.26-27.

3. Ioffe NS Therapeutic and diagnostic value of the vacuum in the outer ear channels // Journal of ear, nose and throat diseases. - 1968. No. 1. - C-84.

4. Lebedev Y.A., shahs V.Y., Polukhin T.A. Translatina hyperbaric aerosol in the treatment of some forms of chronic suppurative otitis media // journal of otorhinolaryngology. - 1999 - No. 4. - P.4-7.

5. Mr. Seleznev, Shchetinina E.A., S. Serdyuk. A method of treating otitis media // no 2207094, BI 27.06.2003.

6. Tarasov DI, Nasedkin A.N., Lebedev V.P. Hearing loss in children. - M.: Medicine, 1984. - 236 S.

A method of treating inflammatory diseases of the middle ear, including the drainage of the tympanic cavity and the introduction of medicines, using negative and positive pressure, characterized in that webbed-cartilaginous part of the external ear canal enter the funnel C is the Glu with pre-worn obtenerse cuff and an optical head and, attached to the optical nozzle, pressure gauge and rubber balloon; under the control of alternating negative and positive pressure increments fluctuations from -75 mm Hg to +75 mm Hg, resulting in the movement of the liquid and gaseous contents in the cavity of the middle ear, the contents are evacuated in the ear canal and removed, the procedure is repeated until the maximum possible removal of the pathological content of the deep cavities of the middle ear, while taking deep faction pathological content of pneumatic cells of the middle ear, perform microbiological analysis and providing a negative pressure within 75 mm Hg, introducing the drug, the appropriate pre-made antibiotikogramma.