MD674Z - Method for treating exudative otitis media in children - Google Patents
Method for treating exudative otitis media in children Download PDFInfo
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- MD674Z MD674Z MDS20130044A MDS20130044A MD674Z MD 674 Z MD674 Z MD 674Z MD S20130044 A MDS20130044 A MD S20130044A MD S20130044 A MDS20130044 A MD S20130044A MD 674 Z MD674 Z MD 674Z
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- incision
- otitis media
- tympanic cavity
- inferior quadrant
- children
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- 206010033078 Otitis media Diseases 0.000 title claims abstract description 13
- 238000000034 method Methods 0.000 title claims description 15
- 210000000959 ear middle Anatomy 0.000 claims abstract description 25
- 230000001575 pathological effect Effects 0.000 claims abstract description 16
- 238000002695 general anesthesia Methods 0.000 claims abstract description 12
- 210000003454 tympanic membrane Anatomy 0.000 claims abstract description 8
- 238000001356 surgical procedure Methods 0.000 abstract description 4
- 239000003814 drug Substances 0.000 abstract description 3
- 210000000416 exudates and transudate Anatomy 0.000 description 8
- 230000001684 chronic effect Effects 0.000 description 7
- 210000001595 mastoid Anatomy 0.000 description 7
- 230000003287 optical effect Effects 0.000 description 7
- 230000003179 granulation Effects 0.000 description 5
- 238000005469 granulation Methods 0.000 description 5
- 238000010606 normalization Methods 0.000 description 5
- 208000005141 Otitis Diseases 0.000 description 4
- 208000019258 ear infection Diseases 0.000 description 4
- 206010010280 Conductive deafness Diseases 0.000 description 3
- 238000005273 aeration Methods 0.000 description 3
- 208000023563 conductive hearing loss disease Diseases 0.000 description 3
- 238000003745 diagnosis Methods 0.000 description 3
- 238000002578 otoscopy Methods 0.000 description 3
- 238000012076 audiometry Methods 0.000 description 2
- 230000008576 chronic process Effects 0.000 description 2
- 238000004140 cleaning Methods 0.000 description 2
- 210000000613 ear canal Anatomy 0.000 description 2
- 208000014674 injury Diseases 0.000 description 2
- 210000004911 serous fluid Anatomy 0.000 description 2
- 238000011477 surgical intervention Methods 0.000 description 2
- 230000008733 trauma Effects 0.000 description 2
- 208000032544 Cicatrix Diseases 0.000 description 1
- 238000009825 accumulation Methods 0.000 description 1
- 230000002421 anti-septic effect Effects 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 231100000749 chronicity Toxicity 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 230000008030 elimination Effects 0.000 description 1
- 238000003379 elimination reaction Methods 0.000 description 1
- 230000035876 healing Effects 0.000 description 1
- 230000007794 irritation Effects 0.000 description 1
- 239000007788 liquid Substances 0.000 description 1
- 230000007774 longterm Effects 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 210000004877 mucosa Anatomy 0.000 description 1
- 230000002980 postoperative effect Effects 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 231100000241 scar Toxicity 0.000 description 1
- 230000037387 scars Effects 0.000 description 1
- 238000004904 shortening Methods 0.000 description 1
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Abstract
Description
Invenţia se referă la medicină, şi anume la otorinolaringologia pediatrică şi poate fi utilizată pentru tratamentul chirurgical al otitei medii exudative la copii. The invention relates to medicine, namely to pediatric otorhinolaryngology and can be used for the surgical treatment of exudative otitis media in children.
Este cunoscută o metodă de tratament al otitei medii exudative. Corespunzător metodei, în condiţii de anestezie generală se introduce un endoscop conectat cu videocamera în conductul auditiv extern, se efectuează incizia mică a membranei timpanice în cadranul postero-inferior şi spălarea cavităţii timpanice prin 2 tuburi mici metalice, fixate în conductul auditiv extern, prin introducerea soluţiei de antiseptic printr-un tub şi aspiraţia conţinutului patologic prin alt tub şi fixarea tubului timpanostomic prin această perforaţie mică în cadranul postero-inferior. Incizia trebuie să fie mică, corespunzător mărimii tubului timpanostomic [1]. A method of treating exudative otitis media is known. According to the method, under general anesthesia, an endoscope connected to a video camera is inserted into the external auditory canal, a small incision is made in the tympanic membrane in the postero-inferior quadrant and the tympanic cavity is washed through 2 small metal tubes, fixed in the external auditory canal, by introducing the antiseptic solution through one tube and aspirating the pathological content through another tube and fixing the tympanostomy tube through this small perforation in the postero-inferior quadrant. The incision should be small, corresponding to the size of the tympanostomy tube [1].
Dezavantajele acestei metode constau în aplicarea unei presiuni negative puternice în cadranul postero-inferior printr-o incizie mică care sporeşte riscul de traumare a ferestrelor ovală şi rotundă şi de iritare a mucoasei cavităţii timpanice, precum şi în imposibilitatea vizualizării cavităţii timpanice (partea mastoidică) prin incizie mică şi, respectiv, a aprecierii stadiului de cronicizare a otitei (granulaţii, aderenţe), totodată din cavitatea timpanică se elimină numai lichidele seroase, fiind imposibilă eliberarea completă şi rapidă a cavităţii timpanice (anume a părţii mastoidice) de conţinutul patologic vâscos (în caz de proces cronic) printr-o incizie mică şi cu utilizarea tubului aspirator subţire. În acelaşi timp, fixarea tubului timpanostomic în cadranul postero-inferior poate provoca traumarea lanţului osicular nu numai în timpul operaţiei, dar şi în perioada postoperatorie. The disadvantages of this method consist in the application of strong negative pressure in the postero-inferior quadrant through a small incision, which increases the risk of trauma to the oval and round windows and irritation of the tympanic cavity mucosa, as well as the impossibility of visualizing the tympanic cavity (mastoid part) through a small incision and, respectively, of assessing the stage of chronicity of otitis (granulations, adhesions), at the same time, only serous fluids are removed from the tympanic cavity, making it impossible to completely and quickly free the tympanic cavity (namely the mastoid part) from the viscous pathological content (in case of chronic process) through a small incision and with the use of a thin suction tube. At the same time, fixing the tympanostomy tube in the postero-inferior quadrant can cause trauma to the ossicular chain not only during the operation, but also in the postoperative period.
Este cunoscută, de asemenea, metoda de tratament al otitei medii exudative, numită timpanostomia. Corespunzător metodei, în condiţii de anestezie generală cu ajutorul microscopului optic se efectuează o incizie mică a membranei timpanice în cadranul antero-inferior, se aspiră exudatul lichid cu tubul aspirator fin din cavitatea timpanică şi se fixează tubul timpanostomic. Incizia trebuie să fie mică, corespunzător mărimii tubului timpanostomic [2]. There is also a known method of treating exudative otitis media, called tympanostomy. According to the method, under general anesthesia with the help of an optical microscope, a small incision is made in the tympanic membrane in the antero-inferior quadrant, the liquid exudate is aspirated with a fine suction tube from the tympanic cavity and the tympanostomy tube is fixed. The incision should be small, corresponding to the size of the tympanostomy tube [2].
Dezavantajele acestei metode constau în eliberarea cavităţii timpanice numai de eliminările lichide seroase, fiind imposibilă eliberarea completă şi rapidă a cavităţii timpanice (anume a părţii mastoidice) de conţinutul patologic vâscos (în caz de proces cronic) printr-o incizie mică cu ajutorul tubului aspirator subţire în lipsa controlului cavităţii timpanice (a părţii mastoidice), ceea ce poate provoca cronicizarea otitei. The disadvantages of this method consist in freeing the tympanic cavity only from serous fluid eliminations, making it impossible to completely and quickly free the tympanic cavity (namely the mastoid part) from the viscous pathological content (in case of a chronic process) through a small incision using a thin suction tube in the absence of control of the tympanic cavity (the mastoid part), which can cause chronic otitis.
Problema pe care o rezolvă invenţia dată constă în elaborarea unei metode de tratament al otitei medii exudative cronice la copii, care ar permite evacuarea rapidă a conţinutului patologic vâscos din cavitatea timpanică, efectuarea reviziei otomicroscopice a cavităţii timpanice pentru aprecierea stadiului de otită şi aerarea îndelungată şi inofensivă a cavităţii timpanice. The problem solved by this invention consists in developing a method for treating chronic exudative otitis media in children, which would allow rapid evacuation of the viscous pathological content from the tympanic cavity, performing otomicroscopic revision of the tympanic cavity to assess the stage of otitis and long-term and harmless aeration of the tympanic cavity.
Esenţa invenţiei constă în aceea că sub anestezie generală se efectuează o incizie a membranei timpanice în cadranul antero-inferior, apoi se efectuează o incizie semiovală cu lungimea de 3…4 mm în cadranul postero-inferior, prin care se aspiră conţinutul patologic cu ajutorul aspiratorului, după care se efectuează revizia cavităţii timpanice, apoi sub ghidajul otomicroscopului se introduce şi se fixează o timpanostomă pentru o perioadă de 12…18 luni. The essence of the invention is that under general anesthesia, an incision is made in the tympanic membrane in the antero-inferior quadrant, then a semi-oval incision with a length of 3…4 mm is made in the postero-inferior quadrant, through which the pathological content is aspirated using an aspirator, after which the tympanic cavity is revised, then under the guidance of the otomicroscope, a tympanostomy is inserted and fixed for a period of 12…18 months.
Avantajele invenţiei constau în realizarea în condiţii de anestezie generală sub ghidajul otomicroscopului a unei incizii mari de formă semiovală în cadranul postero-inferior al membranei timpanice, prin care este posibilă evacuarea minuţioasă, completă şi rapidă a conţinutului patologic, spălarea şi revizia cavităţii timpanice (anume a părţii mastoidice), ce sporeşte efectul funcţional al operaţiei şi previne cronicizarea otitei medii. Asigurarea unui bun drenaj al cavităţii timpanice un timp îndelungat, printr-o incizie mică a membranei timpanice în cadranul antero-inferior cu introducerea şi fixarea tubului timpanostomic, permite aerarea inofensivă a cavităţii timpanice eliberate de conţinutul patologic vâscos şi previne recidivarea otitei şi acumularea exudatului. The advantages of the invention consist in the realization under general anesthesia under the guidance of the otomicroscope of a large semi-oval incision in the postero-inferior quadrant of the tympanic membrane, through which it is possible to thoroughly, completely and quickly evacuate the pathological content, wash and revise the tympanic cavity (namely the mastoid part), which increases the functional effect of the operation and prevents the chronicization of otitis media. Ensuring good drainage of the tympanic cavity for a long time, through a small incision of the tympanic membrane in the antero-inferior quadrant with the introduction and fixation of the tympanostomy tube, allows harmless aeration of the tympanic cavity freed from the viscous pathological content and prevents the recurrence of otitis and the accumulation of exudate.
Rezultatul constă în evacuarea completă şi rapidă a conţinului patologic din cavitatea timpanică şi restabilirea auzului, scurtarea timpului operator, prevenirea cronicizării otitei medii exudative prin minimalizarea riscului de formare a aderenţelor, cicatricilor în conţinutul patologic vâscos, prevenirea recidivelor otitei medii exudative prin aerarea îndelungată a cavităţii timpanice, îmbunătăţirea stării generale şi a calităţii vieţii pacientului prin excluderea necesităţii tratamentului repetat, inclusiv cel chirurgical. The result consists in the complete and rapid evacuation of the pathological content from the tympanic cavity and the restoration of hearing, shortening the operating time, preventing the chronicization of exudative otitis media by minimizing the risk of formation of adhesions, scars in the viscous pathological content, preventing recurrences of exudative otitis media by prolonged aeration of the tympanic cavity, improving the general condition and quality of life of the patient by excluding the need for repeated treatment, including surgical treatment.
Exemplu de realizare a invenţiei Example of embodiment of the invention
Metoda se efectuează în modul următor: sub anestezie generală se efectuează o incizie a membranei timpanice în cadranul antero-inferior, apoi se efectuează o incizie semiovală cu lungimea de 3…4 mm în cadranul postero-inferior, prin care se aspiră conţinutul patologic cu ajutorul aspiratorului, după care se efectuează revizia cavităţii timpanice, apoi sub ghidajul otomicroscopului se introduce şi se fixează o timpanostomă pentru o perioadă de 12…18 luni. The method is performed as follows: under general anesthesia, an incision is made in the tympanic membrane in the antero-inferior quadrant, then a semi-oval incision with a length of 3…4 mm is made in the postero-inferior quadrant, through which the pathological content is aspirated using an aspirator, after which the tympanic cavity is revised, then under the guidance of the otomicroscope, a tympanostomy is inserted and fixed for a period of 12…18 months.
Exemplul 1 Example 1
Pacientul A., de 3 ani, a fost spitalizat cu diagnosticul: otită medie exudativă cronică, surditate de transmisie. A fost efectuată intervenţia chirurgicală în condiţii de anestezie generală (AG) cu ajutorul otomicroscopului prin metoda revendicată. Printr-o incizie de 3 mm a cadranului postero-inferior a fost posibil de aspirat complet şi rapid conţinutul patologic (exudat vâscos, gelatinos) în cantităţi mari. În timpul controlului otomicroscopic printr-o incizie semilovală s-a constatat prezenţa exudatului vâscos şi a granulaţiilor părţii mastoidice. După curăţarea cavităţii timpanice de conţinutul patologic, s-a fixat tubul timpanostomic printr-o incizie mică în cadranul antero-inferior. Peste 7 zile s-a constatat îmbunătăţirea auzului (subiectiv) şi a datelor otomicroscopice prin otoscopia optică; peste o lună s-a confirmat normalizarea auzului. Pe parcursul anului audiometria a confirmat normalizarea stabilă a auzului. Peste 12 luni, în timpul reviziei cavităţii timpanice efectuate sub anestezie generală cu ajutorul microscopului optic s-a confirmat lipsa schimbărilor cronice (exudat vâscos, granulaţii, polipi). Patient A., 3 years old, was hospitalized with the diagnosis: chronic exudative otitis media, conductive deafness. The surgical intervention was performed under general anesthesia (GA) using an otomicroscope using the claimed method. Through a 3 mm incision of the postero-inferior quadrant, it was possible to completely and quickly aspirate the pathological content (viscous, gelatinous exudate) in large quantities. During otomicroscopic control through a semi-oval incision, the presence of viscous exudate and granulations of the mastoid part was noted. After cleaning the tympanic cavity from the pathological content, the tympanostomy tube was fixed through a small incision in the antero-inferior quadrant. After 7 days, improvement in hearing (subjective) and otomicroscopic data by optical otoscopy was noted; after a month, normalization of hearing was confirmed. During the year, audiometry confirmed stable normalization of hearing. After 12 months, during the revision of the tympanic cavity performed under general anesthesia using an optical microscope, the absence of chronic changes (viscous exudate, granulations, polyps) was confirmed.
Exemplul 2 Example 2
Pacientul B., de 4 ani, a fost spitalizat cu diagnosticul: otită medie exudativă cronică, surditate de transmisie, formă uşoară. A fost efectuată intervenţia chirurgicală în condiţii de AG cu ajutorul otomicroscopului optic prin metoda revendicată. Printr-o incizie de 4 mm în cadranul postero-inferior s-a efectuat aspiraţia completă şi rapidă a conţinutului patologic - exudat muco-purulent vâscos în cantitate mare. A fost fixat tubul timpanostomic printr-o incizie mică în cadranul antero-inferior. Peste 7 zile s-a constatat îmbunătăţirea auzului (subiectiv) şi a datelor otomicroscopice prin otoscopia optică; peste o lună s-a confirmat normalizarea auzului. În timpul controlului otomicroscopic printr-o incizie semilovală s-a constatat prezenţa exudatului vâscos şi a granulaţiilor în partea mastoidică. După curăţarea cavităţii timpanice de conţinutul patologic, a fost fixat tubul timpanostomic printr-o incizie mică în cadranul antero-inferior. Peste 7 zile s-a constatat îmbunătăţirea auzului (subiectiv) şi a datelor otomicroscopice prin otoscopia optică; peste o lună s-a confirmat normalizarea auzului. Pe parcursul anului, audiometria a confirmat normalizarea stabilă a auzului. Peste 18 luni, în timpul reviziei cavităţii timpanice efectuate sub anestezie generală cu ajutorul microscopului optic s-a confirmat lipsa schimbărilor cronice (exudat vâscos, granulaţii, polipi). Patient B., 4 years old, was hospitalized with the diagnosis: chronic exudative otitis media, conductive deafness, mild form. Surgical intervention was performed under conditions of GA using an optical otomicroscope by the claimed method. Through a 4 mm incision in the postero-inferior quadrant, complete and rapid aspiration of the pathological content - viscous muco-purulent exudate in large quantity was performed. The tympanostomy tube was fixed through a small incision in the antero-inferior quadrant. After 7 days, improvement of hearing (subjective) and otomicroscopic data was noted by optical otoscopy; after a month, normalization of hearing was confirmed. During otomicroscopic control through a semi-oval incision, the presence of viscous exudate and granulations in the mastoid part was noted. After cleaning the tympanic cavity from pathological contents, the tympanostomy tube was fixed through a small incision in the antero-inferior quadrant. After 7 days, improvement of hearing (subjective) and otomicroscopic data by optical otoscopy was noted; after a month, normalization of hearing was confirmed. During the year, audiometry confirmed stable normalization of hearing. After 18 months, during the revision of the tympanic cavity performed under general anesthesia using an optical microscope, the absence of chronic changes (viscous exudate, granulations, polyps) was confirmed.
Prin metoda dată au fost supuşi intervenţiei microotochirurgicale 32 de pacienţi cu diagnosticul: otită medie exudativă cronică, surditate de transmisie. Metoda s-a realizat în cadrul Clinicii ORL Pediatrice şi a Catedrei Otorinolaringologie a Universităţii de Stat de Medicină şi Farmacie „N.Testemiţanu” cu rezultate pozitive de vindecare. 32 patients with the diagnosis of chronic exudative otitis media, conductive deafness were subjected to microotosurgical intervention using this method. The method was performed within the Pediatric ENT Clinic and the Otorhinolaryngology Department of the "N. Testemiţanu" State University of Medicine and Pharmacy with positive healing results.
1. RU 2253384 C1 2005.06.10 1. RU 2253384 C1 2005.06.10
2. Cheng-Shun L., Hong-Sheng L. Tympanostomy tubes: use and problems. Operative techniques in Otolaryngology-Head and Neck Surgery, 1996, vol. 7, nr. 1, p. 9-15 2. Cheng-Shun L., Hong-Sheng L. Tympanostomy tubes: use and problems. Operative techniques in Otolaryngology-Head and Neck Surgery, 1996, vol. 7, no. 1, p. 9-15
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| MDS20130044A MD674Z (en) | 2013-03-07 | 2013-03-07 | Method for treating exudative otitis media in children |
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Citations (8)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2002125525A (en) * | 2002-09-25 | 2004-03-27 | В чеслав Николаевич Лазарев | METHOD FOR TREATING CHRONIC PURULENT MIDDLE OTITIS IN CHILDREN |
| RU2253384C1 (en) * | 2003-12-05 | 2005-06-10 | Общество с ограниченной ответственностью "Клиника новых технологий" | Method for surgical treatment of exudative otitis |
| MD2579G2 (en) * | 2003-12-29 | 2005-07-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Method of treatment of the auditory tube function disorders in the medial suppurative chronic otitis |
| RU2006102403A (en) * | 2006-01-26 | 2007-08-10 | Владислав Петрович Шпотин (RU) | METHOD FOR SURGICAL TREATMENT OF CHRONIC PURULENT MIDDLE OTITIS |
| EA200800950A1 (en) * | 2005-09-26 | 2008-08-29 | ПЬЕДМОН ФАРМАСЬЮТИКАЛЗ ЭлЭлСи | METHODS OF TREATMENT AND PREVENTION OF AVERAGE OTITIS WITH THE APPLICATION OF IRON-SURFACE-ACTIVE SUBSTANCES TO FACILITATE TRANSMEMBRANE INTRODUCTION OF MEDICINAL EARS |
| RU2358743C1 (en) * | 2008-03-04 | 2009-06-20 | Андрей Валериевич Давыдов | Agent and therapy of exudative otitis media |
| RU2424821C1 (en) * | 2010-05-31 | 2011-07-27 | Государственное образовательное учреждение высшего профессионального образования "Сибирский государственный медицинский университет Федерального агентства по здравоохранению и социальному развитию" (ГОУ ВПО СибГМУ Росздрава) | Method of treating exudative otitis media in children |
| RU2011111673A (en) * | 2011-03-28 | 2012-10-10 | Государственное образовательное учреждение высшего профессионального образования "Сибирский государственный медицинский университе | METHOD AND MEANS FOR THE TREATMENT OF EXUSDATIVE MIDDLE OTITIS |
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2013
- 2013-03-07 MD MDS20130044A patent/MD674Z/en not_active IP Right Cessation
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| RU2002125525A (en) * | 2002-09-25 | 2004-03-27 | В чеслав Николаевич Лазарев | METHOD FOR TREATING CHRONIC PURULENT MIDDLE OTITIS IN CHILDREN |
| RU2238744C2 (en) * | 2002-09-25 | 2004-10-27 | Лазарев Вячеслав Николаевич | Method for treating chronic purulent otitis media in children |
| RU2253384C1 (en) * | 2003-12-05 | 2005-06-10 | Общество с ограниченной ответственностью "Клиника новых технологий" | Method for surgical treatment of exudative otitis |
| MD2579G2 (en) * | 2003-12-29 | 2005-07-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Method of treatment of the auditory tube function disorders in the medial suppurative chronic otitis |
| EA200800950A1 (en) * | 2005-09-26 | 2008-08-29 | ПЬЕДМОН ФАРМАСЬЮТИКАЛЗ ЭлЭлСи | METHODS OF TREATMENT AND PREVENTION OF AVERAGE OTITIS WITH THE APPLICATION OF IRON-SURFACE-ACTIVE SUBSTANCES TO FACILITATE TRANSMEMBRANE INTRODUCTION OF MEDICINAL EARS |
| RU2006102403A (en) * | 2006-01-26 | 2007-08-10 | Владислав Петрович Шпотин (RU) | METHOD FOR SURGICAL TREATMENT OF CHRONIC PURULENT MIDDLE OTITIS |
| RU2316269C2 (en) * | 2006-01-26 | 2008-02-10 | Владислав Петрович Шпотин | Method for surgical treatment of chronic purulent otitis media |
| RU2358743C1 (en) * | 2008-03-04 | 2009-06-20 | Андрей Валериевич Давыдов | Agent and therapy of exudative otitis media |
| RU2424821C1 (en) * | 2010-05-31 | 2011-07-27 | Государственное образовательное учреждение высшего профессионального образования "Сибирский государственный медицинский университет Федерального агентства по здравоохранению и социальному развитию" (ГОУ ВПО СибГМУ Росздрава) | Method of treating exudative otitis media in children |
| RU2011111673A (en) * | 2011-03-28 | 2012-10-10 | Государственное образовательное учреждение высшего профессионального образования "Сибирский государственный медицинский университе | METHOD AND MEANS FOR THE TREATMENT OF EXUSDATIVE MIDDLE OTITIS |
Non-Patent Citations (1)
| Title |
|---|
| Сheng-Shun L., Hong-Sheng L. Tympanostomy tubes: use and problems. Operative techniques in Otolaryngology-Head and Neck Surgery, 1996, vol. 7, nr. 1, p. 9-15 * |
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| MD674Y (en) | 2013-09-30 |
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