What is the catheterization of the auditory pipe. Middle Otitis - Treatment

Manifestations of Middle Otita

The main symptom of Middle Otitis is a strong pain in the ear. In addition, this pain can be given to the corresponding half of the head.

With a purulent average, otitis marks the temperature increase, the worsening of the hearing "noise and shooting in the ears".

Diagnosis of Middle Otita

The diagnosis of medium otitis is based on the data of the otoscopy - inspection of the eardrum using ENT tools.

During the otoscopy during the exudative Otitis, there is a dumping emancipation, its hyperemia is the processed circuit. Also, this research method allows diagnosing the perforation of the eardrum and the isolation of the middle of the pus.

Complications of infectious processes in the middle ear

Complications of infectious processes in the middle ear, though rare, but can still meet.

Disturbances

Usually these violations are manifested in the form of minor or moderate hearing loss. Such violations are most often temporary. Less often, the impairment of hearing can last long.

Breakpoint breakfast

In the case of exudative Middle Otitis, when pus accumulates in the cavity of the middle ear, it can break through the eardrum. As a result, it remains a small hole that heals usually, for 2 weeks.

Transition of an infectious process in chronic

The main manifestation of this complication is the periodic purulent separated from the middle ear through the eardrum. Many children suffering from chronic purulent average otitis note some hearing impairment.

Choleosteatoma

The choleosteatoma is the growth of a special type of fabric behind the drummeal. With excessive growth of this tissue, it can completely block the middle ear and cause hearing impairment.

Treatment of this state of surgical.

Destruction of small hearing bones of the middle ear

The destruction of small hearing bones of the middle ear (Spirit, hammer and anvil).

Transition of the infectious process to the bone

A rare complication of medium otitis - the transition of an infectious process to the bone located behind the ear is a precedine process.

Meningitis

Transition of the infectious process on brain shell - Meningitis.

Treatment of Middle Otita

The overwhelming majority of cases of medium otitis are treated at home. Hospitalization is necessary only if heavy purulent complications are suspected - mastoiditis, meningitis, etc.

Medical therapy:

Antibiotics (in tablets or injections)

Antipyretic and painkillers

Expectant tactics and observation

The combination of everything is listed

Treatment depends on many factors: age, medical history, as well as on concomitant diseases.

At medium otitis, the bed regime is prescribed, according to the testimony of antibiotics, sulfonamide preparations, antiseptics.

For high temperatures amidopin, acetylsalicylic acid.

Severe compresses, physiotherapy (Solux, Toki UHF) are used.

To reduce pain in the ear, he buried 96% alcohol in warm form. When poverty appears, the instillation in the ear is stopped.

Treatment of Middle Otitis still remains controversial.

Basically, the discussion unfolds around the use of antibiotics and their application.

If the middle Otitis is observed in a child, his condition is severe, it is younger than 2 years or he has a risk infectious complicationsThe doctor appoints antibiotics.

With easier the course of the disease and age for more than 2 years, the range of used money is wider. Some doctors immediately prescribe antibiotics, as it is quite difficult to find out whether this infection will pass independently or not.

In some cases, the doctor may recommend to observe the child for several days, since in 80% of cases the medium ear infection is independently without any treatment. In addition, it is worth paying attention to possible complications and side effects by the antibiotics themselves.

The expectant tactics are appropriate, if:

Child older than two years

Patient only one ear

Symptoms are expressed soft

The diagnosis requires clarification

Another factor of limiting the use of antibiotics when otitis is the fact that with frequent use of these funds, the so-called microbi resistance to antibiotics is noted.

To facilitate pain - the most basic manifestation of medium otitis - anti-inflammatory drugs are used, such as Tylenol, Tempalgin, Ibuprofen, etc. should not be given to children as an anesthetics or antipyretic aspirin due to the danger of severe development allergic reaction In the form of the syndrome, Reia.

To facilitate pain, it is also possible to use locally warm in the form of a heating or compress. It is not recommended to leave the heating on the night due to possible burns.

Currently there are special ear dropsthat help reduce ear pain. However, in view of the fact that these drugs cannot be used during perforations (opening openings) in the eardrum, apply them only to ambassador consultation with the ENT doctor.

With inflammation of the middle ear (medium otitis), the accumulation in the drum cavity of the liquid is sometimes marked. This leads to a violation of sound oscillations and some hearing loss. In addition, the presence of fluid in the drum cavity may cause the infectious process in the ear. This process It can be both one-sided and double-sided.

The space behind the eardrum is called the middle ear. It is usually connected to the nasopharynx through a thin pass - a hearing (Eustachiyev) pipe (from each lane). Normally, the opening of this tube opens at each act of swallowing, as a result of which the air from the nasopharynx falls into the drum cavity. In addition, any of the separated from the middle ear falls through this pipe into the nasopharynk.

In the violation of the outflow of separated from the middle ear through the hearing tube, the fluid is accumulated in it. At the beginning of the process, this liquid is water, but over time it becomes thick and for its consistency resembles glue.

Accurate cause of violation of the passability eustachian pipes not installed. In some children, the cause of the clogging of the passage of the auditory pipe can be adenoids.

The accumulation of fluid is pretty frequent cause Hearing disorders in school children.

Catheterization of the middle ear

The operation is carried out under general anesthesia.

Catheterization of the middle ear - This is an operation that is introduced into the middle ear of a thin tube - a catheter, a diameter of about 2 mm, through the same small incision in the eardrum.

Through this tube from the middle ear is evacuated by a thick liquid, as a result of which the hearing is improving. Usually the catheter remains in the middle ear for a period of six to twelve months.

As the hole in the drum cavity heals, the catheter is independently deleted. As it finds in the middle ear of the catheter, the permeability of the auditory pipe can recover. In this case, the accumulation of fluid in the drum cavity no longer occurs. If this did not happen, then the accumulation of fluid in the middle ear can reappear again. This may require new catheterization of the middle ear.

If the cause of the blockade of Eustachius pipe serves adenoids, the catheterization of the hearing pipe can be supplemented with their removal.

The goal of the catheterization of the middle ear - It is to give air to get into the drum cavity. This contributes to a normal fluid outflow from the drum cavity and hearing restoration.

The catheterization of the middle ear allows you to enter into the auditory pipe and the drum cavity medications (for example, antibiotics or steroid hormones, enzymes).

This procedure helps to improve the function of the hearing pipe and hearing restoration. It is also recommended to produce a finger massage of the pharyngeal opening of the hearing pipe. During this manipulation, you can estimate the condition of the pharyngeal mouth of the hearing pipe and eliminate the scars, spikes and lymphoid tissue around the mouth (adenoids), which may impede the function of the hearing pipe.

Drumpoint - Perforation of the eardrum

With united and unilateral diseases of auditory pipes, catheterization is one of the main methods of treatment and diagnosis. The body is B. hard to reach place, Therefore, remove exudate or introduce drugs into the cavity by other methods is not always possible. In our medical center Manipulation is carried out by experienced LOR doctors. Qualified specialists select tactics that will bring less painful sensations to the patient and will be the most efficient.

Description

Indications and Contraindications for catheterization

The catheterization of the auditory pipe is carried out in cases of diagnostic purposes in cases if it is impossible to purge the political officer due to the individual characteristics of the patient. Another purpose of the method is the introduction of drugs through the cavity of the catheter. The indications of manipulation are the following symptoms:

pain in the ears when otitis;
worsening hearing;
distortion of the perception of sounds.

With the help of catheterization, the doctor can evaluate the work of hearing pipes - ventilation and drainage functions. The method and when combating complications suffered earlier tobobotitis applied.

Catheterization is contraindicated in the presence of inflammatory diseases Nasopharynx and rotogling. In our medical center, the procedure is not carried out by persons suffering from neurological and psychiatric diseases. In patients with epilepsy or Parkinson's disease, catheterization can provoke convulsions or loss of consciousness.

How catheterization is carried out

If catheterization is conducted by a doctor without the necessary qualifications, then the manipulation causes pain. In our medical center, doctors working with extensive experiences of such actions, and anesthetic solutions are used for anesthesia. Therefore, the catheterization of the nasal cavity does not cause a patient painful sensations.

The procedure is carried out using three medical instruments:

political cylinder;
otoscope Lutza;
kanuel Gatmanana.

This combination allows the doctor to diagnose the state of auditory pipes and, if necessary, introduce medicinal products in the cavity.

After reaching a anesthetic effect, the doctor gently introduces into nasal cavity Kanunu Martmanna. The tool is entered on the nasal go to the beak down. As soon as the catheter touches back wall Nasopharynk - the doctor will turn it on 900 and pulls out to the touch to the soul (the bone plate located in the nasal cavity). The doctor is then looking for a sip of a hearing pipe. Manipulation is carried out under the control of X-ray or other visualization methods.

After the catheter is introduced into the hole of the hearing pipe, the air is supplied using a political cylinder. The doctor listens to noises created when air passes through the Eustachius pipe determines the presence and type of pathology.

Further actions depend on the nature of the disease and the degree of complications. Drugs can be introduced through the catheter, serous fluid is removed.

Why should you contact us

Procedure Catheterization of the auditory pipe, even with high qualification of the doctor, can cause discomfort. In some cases, emotional and impressionable people are fainted. In our medical center there is an opportunity to use other methods of diagnosis, including endoscopy. Replacing the research method allows the patient to avoid stress, which contributes to the acceleration of recovery.

With inept catheterization, complications arise:

nose bleeding;
emphysema of the regional fiber;
injury mucosa.

Our doctors have the experience of conducting the catheterization of the auditory pipe, take into account individual characteristics The body of the patient. The risk of such complications is minimal.

The catheterization of the auditory pipe is a medical-diagnostic procedure, as a result of which a catheter is injected into Estarchye through the nasopharynk. This manipulation is aimed at estimating the ventilation ability of the hearing body. If this process is broken, the specialist conducts purging.

Indications, contraindications and preparation for the procedure

The procedure must be prepared. There are no special recommendations. All manipulations are held in the doctor's office, do not need to do anything at home. Specialist irrigates a nasal cavity with special vesseloring drugs. This allows you to reduce swelling and improve the result of the procedure itself. Before that, it is necessary to clean the nasal moves from the excessive accumulation of the mucus. It can interfere with the manipulation.

Main readings for catheterization Evstachiye pipe:

evaluation of ventilation and drainage functions;
treatment of tobobotitis;
used as an auxiliary procedure in the absence of a political separatorization effect.

Some people complain about "heavy breathing" through the nose. This may be due to violation of ventilation functions. Catheterization allows you to evaluate the work of the nasal moves. If there are tubobotitis with a catheter in nasal moves, drugs are introduced. This allows you to act directly to the place of lesion, which speeds up the process of recovery. Finally, if the political separatorization procedure did not give successful results, catheterization is applied. This is due to the peculiarities of the structure of the Eustachius pipe and the sky.

The procedure is effective and fast, but it is not necessary to apply it. There are a number of contraindications to which you need to listen. So, catheterization is inappropriate in the following cases:

in the presence of sharp inflammatory processes;
in neurological diseases;
with mental disorders;
in Parkinson's disease;
with epilepsy.

In this case, the conduct of the procedure entails high risk The development of complications, so specialists try to choose alternative techniques.

Technique for holding

Thinking or cleaning Evstarchy pipes is carried out using a special catheter, which is introduced into the nasophal. The device has a kind of structure, so before its introduction it is necessary to lift the tip of the nose. The experimental doctor conducts manipulation, it requires high concentration, otherwise the considerable risk of damage to the mucous membrane remains.

The catheter is introduced by the beak down and is gradually moving towards the nasopharynx, then the pipe is slowly placed in Eustachiyev. The procedure is unpleasant, but if an experienced doctor is performed, then painful sensations are minimized. That is why it is required to select a good clinic with an experienced specialist. The absence of special skill can lead to additional painful sensations and damage to the nasal moves. To relieve discomfort in the nose shell spray 5% novocaine solution.

In the presence of septal curvatures, enter the catheter is not so simple. The specialist must accumulate all the obstacles and carefully check the device.

Rods and coarse movements are not allowed, it can entail a break of the mucous membrane and severe bleeding. An inexperienced specialist can confuse the nasopherler with the mouth of the Evstachiye pipe, which will entail serious complications. After all, blowing only aggravates the situation. Therefore, if the patient complains about acute pain, manipulation must be stopped.

During the incorrect procedure, submucous emphysema may occur. It entails the appearance of pain during swallowing and feelings. foreign object in the pharynge area. During the inspection, strong swelling of the sky is recorded.

In general, the procedure is not hazardous and simple, it is enough to find an experienced specialist with good skill.

Catheterization of the hearing pipe (CST)- Therapeutic and diagnostic manipulation, which is in the introduction of the cannula Gatman in the mouth of the organ. Used to assess the passability of the ear channel, as well as to introduce drugs into it (dexamethasone, antibiotics). Catheterization is carried out through the bottom nose. During the front rososcopy, the doctor introduces the tool to the rear wall of the throat, after which pulls up to itself, turns 180 ° and pushes into the hearing tube. The cost is calculated based on the qualifications of the otolaryngologist, the pricing policy of the medical organization used by consumables.

Indications

Catheterization of the auditory pipe has a limited number of indications. It is used in clinical otolaryngology with a diagnostic or therapeutic goal. Appointed in the following situations:

Suspicion of stenosis of an auditory passage. It is conducted in the presence of clinical signs of obstruction of the Eustachia channel: one-sided reduction in hearing, autofonia, the drawback of the eardrum. Allows you to establish the degree of obstruction and plan further treatment.
Tobetitis. The anatomical arrangement of the hearing pipe is such that only catheterization allows the introduction of drugs into it. With the help of this procedure, agenicization of the organ, infusion of etiotropic and anti-inflammatory agents is possible.

Contraindications

Since the catheterization of the hearing pipe is connected with the cannula in the deep structures of the nose and ear, it has a number of contraindications. These include:

Nasal infections, pharynx, oral cavity. In the presence of inflammatory diseases of the upper respiratory tract, there is a risk of pathogenic microflora in Eustachiyev, the pipe and the occurrence of superinfection. This makes the course of the disease heavier and complicates therapy.
Epilepsy.It is possible to provoke an epiproter even relatively weak pain. In addition, it may arise against the patient's psycho-emotional voltage during the procedure or before it.
Parkinson's disease . Incoming movements increase the risk of traumatizing the nasal stroke and the mouth of the Eustachius pipe. With severe pathology, catheterization becomes impossible.
Age less than 5-6 years.A small child is not able to keep a fixed position for a long time. The risk of involuntary jerks increases when pain occurs. In case of extreme need, the procedure is carried out under medication sedation.

Preparation for the catheterization of the hearing pipe

The procedure is carried out after certain preparatory activities. Before the start of catheterization, the patient is held:

Otolaryngological inspection. The doctor performs the front and rear rosicopy, the opposite. These procedures make it possible to confirm the availability of indications for the procedure, as well as assess the condition of the mouth of the pipe, nose and the nasal partition. With its curvature, catheterization is accompanied by technical difficulties.
Endoscopy of the nose. It is required only if the presence of bone spikes and scar changes in the lower nose, which may interfere with the cannula. In ordinary cases, it is not prescribed, as it is an additional injury factor.
Cleaning the nasal cavity. It is carried out directly in the doctor's office. The patient is asked to care thoroughly, the anemisizing drops are injected into the nose. This allows you to provide the undergoality of the lower nasal stroke necessary for the introduction of the catheter.
Anesthesia. Used applixation techniques anesthesia. The probe is introduced into the nose stroke, wrapped with a tampon with a 10% solution of lidocaine. The exposure time is 10-15 minutes.

Preparation for anesthesia is required if manipulation is supposed to be carried out in a state of medication sleep. In this case, the eve of the next morning, hunger is needed before the procedure. The patient is assigned a surgical complex of laboratory surveys.

Methodology

The catheterization of the auditory pipe is carried out in the position of the patient sitting or lying, after careful preliminary preparation. The procedure takes place in several stages:

Introduction catheter. The doctor conducts the tool with the beak down the bottom of the nasal cavity to the rear surface of the nasopharynx. Next, the cannula is rotated 90 ° in the direction of a healthy ear, pull up to contact with the couch, change its position 180 ° and introduced into the silence hole of the hearing pipe.
Check.The catheter in the mouth is accompanied by a feeling of capturing the tip of the instrument. With doubt, the position of the cannula is confirmed by radiography and other visualization methods.
Evaluation of the ventilation function. In the cannula, air is injected with a political cylinder. At the time of his passage for the auditory tube, the characteristic noise is listened through the lutz.
Evaluation of the drainage function. On the catheter, methylene blue is injected into the auditory. The time is noted that will be required for its passive penetration into the nasopharynx. With saved drainage ability it takes no more than 10 minutes.
Introduction of drugs. Through the cannula of the Hartmann with the help of a syringe, drugs are injected, contributing to the removal of inflammation and restoration of the channel's passability. The most commonly applied dexamethasone, thoroughbuilding medicines and antibiotics.
Removing the tool. The removal of the catheter is carried out in the reverse order of it. The doctor keeps special care so as not to damage the mucous membranes and the internal structures of the nose.

After catheterization of the auditory pipe

The patient takes some time to recover after the procedure. It usually does not take more than 10 minutes. If catheterization was performed under general anesthesia, the time period somewhat increases. There is no need for long-term observation. After restoring the consciousness and the final examination of the ENT organs, the patient can be released home for the presence of yathedral injuries.

Complications

The catheterization of the auditory pipe is invasive manipulation, which can be accompanied by some undesirable phenomena. These include:

Damage to mucous membranes. Accompanied by the development of nasal bleeding, soreness at the time of injury. Capillary hemorrhages are successfully fixed using local vasoconstrictors. Significant damage require surgical correction.
Emphysema of the regional fiber. Characterized by air penetration in soft fabrics. It is formed with improper installation of cannulas, followed by air injection. Space yourself after a few days.
Dizziness and noise in the ears. It occurs due to increased pressure in the drum cavity and irritating effects on the inner ear. Does not require medical care, It takes 15-30 minutes after removing the cannula.
Development of superinfection. It occurs if the catheterization was carried out in the presence of an infection of the VFI. Requires antibiotic therapy using drugs wide spectrum actions.

According to different sources, the frequency of complications varies from 1 to 2.5% of total Conducted procedures. Their probability is reduced in proportion to the growth of the professional experience of a specialist and the level of a medical organization.

ENT disease - treatment abroad - site - 2008

The functions of the auditory pipe- This is a drainage and ventilation, that is, it supports the pressure of the same with an external pressure in the drum cavity. This is necessary for normal sound oscillations in the middle ear. When swallowing, the clearing pipe is expanding, and the air is falling into the drum cavity. With the normal operation of the auditory pipe, the negative pressure compensation is ensured, which occurs in the middle ear due to air absorption of the mucous membrane. Excessive pressure in the drum cavity can also be aligned with swallowing movements.

The state of the hearing pipe is of great importance in the diagnosis and forecast of many middle-ear diseases. The pathology of the hearing tube or the surrounding tissues leads to a violation of the regulation of its lume or to its closure. Consequently, the task of many diagnostic methods is to determine the passability of the hearing pipe or its ability to carry out air.

The state of the hearing pipe is investigated using various methods. They are divided into subjective and objective.

Subjective methods

Otoscopy.This diagnostic method is carried out using an otoscope or ear funnel. The main sign of the violation of the function of the auditory tube is the rapacity of the eardrum. This is due to low pressure in the drum cavity.

Sample with simple swallowing.If the passability of the hearing pipes in the patient is normal, then when swallowing, he feels "cod" in the ears.

Toyanby sample (swallowing with hollow nostrils). The patient clamps the nose and makes swallowing movements. With good patency, the auditory pipes are also felt "crackle" in the ears.

Waltzalvali sample (fitting with hollow nostrils).The patient takes a deep breath, closes his mouth and nose and trying to make an energetic exhalet, while the air falls into the auditory pipes. If they are passing, the same sensations arise as in previous samples. In patients with good patency of the hearing pipe and the presence of perforation (holes) of the eardrum, air flows through the hole in the membrane. Under the edema of the mucous membrane of the hearing pipe, but some preservation of its passability, during the outsetting the patient can feel squeak, bouffaging and other noise in the appropriate ear. In the elderly, this experience can cause an increase in blood pressure.

Purpose by the politzer.A special cylinder is used for this sample, which is a rubber pear (with a capacity of 300-500 ml) with a tube with a removable tip. The tip is introduced into the nose, after which it is pressed. The patient utters some words (steamer, ku-ku, also too). At this point, the pear is squeezed, and the air falls into the nasopharynk and auditory pipes. With the weakness of the muscles of the soft sky, the pronunciation of words does not lead to the expected result. When blowing hearing pipes with therapeutic goal, the patient holds a head in a tilt position, face down, as a result of which the fluid in the middle ear descends to the hearing pipe, and at the time of purging the patient should be tilted forward to keep the head slightly turned face upwards, toward the patient's ear. With this position of the head, the patient's hearing tube is drawn down, and when blowing, the liquid from the middle ear flows into the nasophal. In rare cases, blowing the hearing tubes this method can cause dizziness in the patient, the feeling of gravity in the forehead, strong pain In the ear at the time of purging, and at the camp changes, the eardrum may even take place.

These samples are named subjective, since the permeability of hearing pipes with their implementation is determined on the basis of the sensations of the patient himself.

Catheterization of the auditory pipe

This research method is applied in cases where one-sided examination is needed or it is impossible to blow the auditory pipes in any of the above methods.

Indications for blowing the hearing tube with the help of a catheter:unfortunately blowing in the politzer, the insufficiency of the soft nose, the presence of one-sided disease (in order not to injure a healthy ear).

The catheter is a metal tube, at one end it is bent in the form of beak, the other end has a funnelized extension. Catheterization can be combined with the introduction of drugs into the drum cavity.

Complications of the catheterization of the auditory pipemay be: nasal bleeding, dizziness, fainting, cramps, breakpoint breaks.

Objective research methods

Currently, in otorinolaryngology and audiology are increasingly popular with objective methods of hearing research for the diagnosis of various ear pathology. In relation to the study of the auditory pipe, the most common objective methods are the following:

Otoscopy using a video motor.The resulting image can be viewed on the monitor, record on the VCR, and also stored in the computer database. The videootoscope turns the sound in an objective, fast and informative method.
Ear manometry- An objective method for registration of auditory pipes.
Determining the drainage function of the hearing pipe by measuring the passage time of a 5% saccharine solution from the drum cavity in the nasopharynk.Experience is carried out in the presence of perforations in the eardrum.
Endoscopic study of the state of the pharyngeal opening of the hearing pipe, nasopharynx and the nasal cavity.
Acoustic impedanceometry.
Tympanometry.

Hearing (Eustachiyeva) pipes associate a drum cavity (middle ear) with a nasopharynk. One of the most important functions of auditory pipes is to provide outflow from the middle ear and the actual hearing pipe, which removes the solid cells of the epithelium, mucus. In a calm state, the output of the pipe in the nasal cavity is closed. When swallowing or yawn, the opening of Evstarchian pipes opens.

Independent blowing of auditory pipes,if the patient can spend it, contributes to a complete replacement of stagnant air (in the system drum cavity - a hearing tube) to a new, fresh, as well as the purification of Eustachian pipes. Normally, the auditory pipes are easily blurred during the player (there is a feeling of congestion in the ears).

You can blow hearing pipes using the Waltasalva method:the nose is clamped and the patient blows into it strongly, while seeking the feeling of congestion in the ears. In addition to the fact that with this rather simple procedure, hearing pipes are cleared, in the drum cavity close to air, rich in oxygen, which is good prevention of auditory neuritis.

If the spontaneous blowing of auditory pipes does not occur, attention should be paid to the state of the nose and nasopharynx; Perhaps you will have to seek help from the ENT doctor.