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INVENTION
Patent of the Russian Federation RU2254845

METHOD OF MIRINGOPLASTICS

The name of the inventor: Ashmarin M.P. (RU); Ashmarin OM (RU)
The name of the patent holder: State Educational Institution "Institute for Advanced Training of Physicians" of the Ministry of Health of the Chuvash Republic
Address for correspondence: 428015, Cheboksary, Moscow Ave, 15, ChuvSU, Department of Intellectual Property, N.B. Shalunovoy
Date of commencement of the patent: 2004.02.03

The invention relates to medicine, otorhinolaryngology, can be used in the treatment of chronic perforated otitis with large defects of the tympanic membrane. Perforate the tragus of the tragus of the tragus or the auricle with the formation of a graft in the form of a grid with aperture size of no more than 2 mm. Apply the obtained graft to the stored bone structures and the eardrum remnants. Cover the transplant with the temporal fascia. Lay the remains of the meatotympanal flap on it. The method makes it possible to simplify miringoplasty by simplifying the graft preparation.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, namely to otorhinolaryngology, and can be used in ENT hospitals for the treatment of chronic perforated otitis with large defects of the tympanic membrane.

Chronic perforated otitis is a fairly common disease, leading to a significant decrease in hearing, in some cases even to disability.

There are known methods of surgical operations, in which the closure of the defect of the tympanic membrane by the graft (miringoplasty) is performed. When performing such operations, the graft is made either as a skin-mucosal flap from the mucous membrane of the cheek, or from the cartilage of the septum of the nose, or from the cut of the decalcified bone [1]. The disadvantages of the known methods are significant traumatism, relative technical complexity of the operation, and a relatively high probability of various complications in the postoperative period, which reduce the functional outcome.

A method of myringoplasty is known in which the closure of a tympanic membrane defect is accomplished by a graft made of autochondria taken from a tragus or auricle and subjected to treatment by slow crushing with a Kocher clip in the longitudinal and transverse direction to the desired thickness. The transplant so produced after crushing becomes thin, movable, integral, retains its intended shape, bends in all directions; Under a microscope represents triangles, connected among themselves by thin fibers. After surgical sanitation of the middle ear, the autochthy is superimposed on the preserved structures of the ossicles and on the walls of the external auditory canal, the temporal fascia is placed on it, then the meatotimpanal flap from the tympanic membrane or its remains is laid. The disadvantage of the known method of myringoplasty is the relative complexity of the mechanical treatment of the autochondria, which requires considerable time and lengthens the operation time, and the occurrence of complications associated with the repertoire of the tympanic membrane in the postoperative period.

The claimed invention solves the problem of simplifying the method of miringoplasty by simplifying the technique of harvesting the graft from the autochondria with maintaining a good morphological and functional result.

This problem is solved by the fact that in a known method of mirinoplasty, which includes the manufacture of a graft from a tragus of an autochthonous tragus or auricle, the application of the obtained graft to the stored bone structures and eardrum remnants, transplantation of the temporal fascia graft and the deposition of the remains of the meatotampal flap, Separating the cartilage band from the tragus or the auricle, it is perforated and, as a result, a cartilage graft with mesh apertures is obtained. It is experimentally justified that the dimensions of the grid holes should not be more than 2 mm. The graft so prepared has the necessary qualities to replace the perforated tympanic membrane, namely, elasticity, softness, easily amenable to any modeling, adapts well, in addition, such a transplant creates good conditions for the ventilation of the tympanic cavity, improves microcirculation of the tissue fluid of the tympanum in the postoperative period . The perforation of the cartilage band is performed by a specially made perforator in one motion, which significantly shortens the time of execution of myringoplasty.

Example 1.

Patient A., 42 years old, entered the ENT department with a diagnosis: right-sided total mesotypanitis, remission stage. With otoscopy, there is an almost complete absence of the tympanic membrane with preservation of the rim, mucous pale, the handle of the malleus appears in the tympanum, the audiogram has a conductive form of hearing loss, bone-to-air rupture on the average 35-40 dB, right ear 0.5 m of whisper speech, Conversational speech - 1,5 m, the left hearing is within the norm. Under local anesthesia surgery of myringoplasty with attinoanthrotomy was carried out by the BTE approach, where a slow inflammatory process was detected. Deepidermisation of the remains of the tympanum, auditing of the auditory ossicles, which functioned. Deepidermalized eardrum remnants and the hammer handle have a stripe of autochondrion of a mesh type, a temporal fascia is placed on top, then the remains of the meatotympanal flap are laid. The postoperative period proceeded smoothly. On the 16th day, he was discharged home with an improved hearing of 5-6 meters of whispered speech. The patient was examined after 6 months. Hearing within 6 meters. The tympanic membrane is mobile, there is no regimen. Repeated audiometry shows no bone-air rupture.

Example 2.

Patient P., 48 years old, entered the ENT department with a diagnosis: left-sided chronic purulent otitis media. Cavity after a radical operation, right-sided adhesive otitis. Complaints of hearing loss on the left ear. With microscopy in the left ear, a cavity has been found after a radical operation, the mucous membrane has been preserved in the tympanic cavity, pale, there are remnants of the stapes' foot, the foot plate functions, some remains of the tympanic membrane are retained in the anterior part of the tympanic cavity, the occlusal area is epidermis. A whisper speech is perceived near the auricle, a colloquial speech - 1 meter. The perforation of the auditory tube is preserved. On the right eardrum, scars. Whisper speech - 3 meters. On the audiogram, the bone-to-air rupture is determined on the left ear to 40-45 dB, on the right ear 25-30 dB, the conductive form of hearing loss. Under local anesthesia tympanoplasty with mastoidoplasty with a muscular periosteal flap was performed with restoration of the posterior wall of the external auditory canal. The operation was performed by a BTE approach, the epidermal-scar tissue of the occlusal region was removed. Deepidermisation of the eardrum remnants has been carried out, calumella has been installed according to the patent No. 21599595 on the footplate of the stirrup. Autochondria of the mesh type is superimposed on the remains of the tympanic membrane and calumella, the filling area is filled with a muscular periosteal flap, the posterior wall is restored with an autochthonous nasal septum, the top is covered with the temporal muscle fascia, and the ears are filled with epidermal scar tissue. The postoperative period proceeded smoothly, the epidermisation ended by day 25, that is, on the day of discharge. The whisper speech at the discharge was 4 meters. The patient was examined after 6 months, the eardrum was pale gray, mobile, the rear wall restored, a whisper speech up to 5 meters. On the audiogram, there is no bone-to-air rupture.

Example 3.

Patient A., 22, entered the ENT department with a diagnosis: right-sided chronic purulent mesotympanitis in remission, complaints of hearing loss. With otoscopy, there was a perforation of a round-shaped tympanic membrane in a stretched part 4x4 mm in size. The mucous membrane is pale, the permeability of the first-degree auditory tube. The audiogram revealed a conductive form of hearing loss with an osteochondral interval of 30-35 dB. Whisper speech on the right ear - 1 meter, colloquial speech - 3 meters. The cotton-gauze prosthesis, laid on the affect of the tympanic membrane, improves the hearing to 6 meters. Under local infiltrative anesthesia, the mousingoplasty was performed by the BTE. After removal of the epidermis from the remnants of the tympanic membrane of freshening the edges of the perforation, revision of the attic, the first layer is laid a reticular autochondria from the auricle, covered with a fascia of the temporal muscle. The postoperative period proceeded smoothly. The patient is discharged on day 14 with improvement of hearing to 6 meters of whisper speech. The patient was examined after six months, the eardrum was pale gray, mobile, signs of scarring, no retraction was found. On the audiogram, there is no bone-to-air rupture. Whisper speech - 6 meters.

Example 4.

Patient I., 35 years old, entered the ENT department with a diagnosis: left-sided posttraumatic otitis media with complaints of ear noise and hearing loss. With otoscopy, the presence of a subtotal defect of the tympanic membrane, mucous pale, permeability of the first-degree auditory tube, a cotton-gum prosthesis improves hearing to 6 meters, and without it - 0.5 meters. On the audiogram the bone-to-air rupture of 35 dB is determined. The patient was miringoplasty with a BTE approach. Removed epidermis from the remains of the tympanic membrane, after removal of the bone canopy, a chain of auditory ossicles is examined, the connection of which is not broken with the footplate of the stirrup. On the defect of the tympanic membrane is laid a strip of autochthonous from the auricle of the mesh type, on top is covered with the fascia of the temporal muscle, the hearing has improved on the operating table. The postoperative period proceeded smoothly. He was discharged home on the 14th day with hearing improvement up to 6 meters. Re-examination after 6 months: eardrum is pale gray, mobile, audiogram shows absence of bone-air rupture, whisper speech is 6 meters.

The proposed method is approved for 25 patients. The results of myringoplasty were positive, which allowed patients to restore the integrity of the tympanic membrane and auditory function.

In comparison with the prototype, the proposed method of myringoplasty is simple in execution, the operation time is reduced. In this case, the proposed method prevents the occurrence of complications in the postoperative period, namely, the repertoire of the tympanic membrane. These results are achieved due to the fact that the graft prepared in the manner described above successfully fulfills the function of a natural tympanic membrane and promotes the formation of an air cushion under the tympanic membrane, thereby creating conditions for accelerating the epidermis of the tympanic membrane. Thus, the proposed method provides restoration of the structure of the tympanic membrane and auditory function.

INFORMATION SOURCES

1. Patent of the Russian Federation No. 2045945, IPC ⁶ A 61 A 11/00. The method of myringoplasty.

2. Petrova LG, Romanova Zh.G., Gornostay II. Application of a cartilaginous graft in tyrannoplasty of the 1 st, 111 th type, Materials of the Russian Scientific and Practical Conference "Modern problems of upper respiratory tract and ear diseases", M., 2002, p.110-111.

CLAIM

The method of mirringoplasty, comprising the manufacture of a graft from a tragus of an autochthonous tragus or auricle, the application of the obtained graft to the stored bone structures and eardrum remnants, transplantation of the graft by the temporal fascia, and the deposition of the remains of the meatotimpanal flap thereon, characterized in that perforating the auto- The formation of a graft in the form of a grid with aperture size of not more than 2 mm.

print version
Date of publication 06.01.2007gg

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