Who underwent catheterization of the auditory tube? Catheterization of the auditory tube

ENT diseases - TREATMENT ABROAD - website - 2008

Functions of the auditory tube- it is drainage and ventilation, that is, it maintains the same pressure in the tympanic cavity as the external one. This is necessary for the normal conduction of sound vibrations in the middle ear. When swallowing, the lumen of the auditory tube expands, and air enters the tympanic cavity. During normal operation of the auditory tube, compensation is provided for the negative pressure that occurs in the middle ear due to the absorption of air by the mucous membrane. Excess pressure in the tympanic cavity can also be equalized during swallowing movements.

The condition of the auditory tube is of great importance in the diagnosis and prognosis of many diseases of the middle ear. Pathology of the auditory tube or the tissues surrounding it leads to disruption of the regulation of its lumen or to its closure. Consequently, the task of many diagnostic methods is to determine the patency of the auditory tube or its ability to conduct air.

The condition of the auditory tube is examined using various methods. They are divided into subjective and objective.

SUBJECTIVE METHODS

Otoscopy. This diagnostic method is carried out using an otoscope or an ear specula. The main sign of dysfunction of the auditory tube is a retracted eardrum. This occurs due to low pressure in the tympanic cavity.

Simple swallow test. If the patency of the auditory tubes is normal in the patient, then when swallowing he feels a “crackling” sound in the ears.

Toynbee test (swallowing with pinched nostrils). The patient pinches his nose and makes swallowing movements. With good patency of the auditory tubes, a “crackling” sound is also felt in the ears.

Valsalva maneuver (straining with pinched nostrils). The patient takes a deep breath, closes his mouth and nose and tries to exhale vigorously, during which air enters the auditory tubes. If they are passable, the same sensations arise as in the previous tests. In patients with good patency of the auditory tube and the presence of a perforation (hole) of the eardrum, air escapes through the hole in the eardrum. If there is swelling of the mucous membrane of the auditory tube, but some preservation of its patency, during straining the patient may feel squeaking, gurgling and other noises in the corresponding ear. In older people, this experience can cause an increase in blood pressure.

Politzer blowing. For this test, a special cylinder is used, which is a rubber bulb (capacity 300-500 ml) with a tube with a removable tip. The tip is inserted into the nose, after which it is clamped. The patient pronounces some words (steamboat, coo-coo, also-also). At this moment, the bulb is compressed, and air enters the nasopharynx and auditory tubes. If the muscles of the soft palate are weak, speaking words does not lead to the expected result. When blowing the auditory tubes for therapeutic purposes, the patient holds his head in an inclined position, face down, as a result of which the fluid in the middle ear descends to the auditory tube, and at the time of blowing, the patient should keep his head tilted forward, slightly turned face up, towards the diseased ear. With this position of the head, the patient's auditory tube faces down, and when blowing, fluid from the middle ear flows more easily into the nasopharynx. In rare cases, blowing the auditory tubes using this method can cause the patient dizziness, a feeling of heaviness in the forehead, severe pain in the ear at the time of blowing, and if the eardrum becomes scarred, it can even rupture.

These tests are called subjective, since the patency of the auditory tubes during their implementation is determined based on the sensations of the patient himself.

CATHETERIZATION OF THE AUDITORY TUBE

This research method is used in cases where a unilateral examination is necessary or it is impossible to blow out the auditory tubes using any of the methods described above.

Indications for blowing out the auditory tube using a catheter: failure of Politzer blowing, insufficiency of the soft palate, presence of a unilateral disease (so as not to injure the healthy ear).

The catheter is a metal tube, at one end it is curved in the form of a beak, while the other end has a funnel-shaped extension. Catheterization can be combined with the introduction of medications into the tympanic cavity.

Complications of catheterization of the auditory tube There may be: nosebleeds, dizziness, fainting, convulsions, rupture of the eardrum.

OBJECTIVE RESEARCH METHODS

Currently, objective hearing research methods for diagnosing various ear pathologies are becoming increasingly popular in otorhinolaryngology and audiology. In relation to the study of the auditory tube, the most common objective methods are the following:

• Otoscopy using a video otoscope. The resulting image can be viewed on a monitor, recorded on a VCR, and also stored in a computer database. The video otoscope turns otoscopy into an objective, fast and informative method.
• Ear manometry– an objective method for recording the patency of the auditory tubes.
• Determination of the drainage function of the auditory tube by measuring the time of passage of a 5% saccharin solution from the tympanic cavity to the nasopharynx. The experiment is carried out in the presence of perforation in the eardrum.
• Endoscopic examination of the condition of the pharyngeal opening of the auditory tube, nasopharynx and nasal cavity.
• Acoustic impedance measurement.
• Tympanometry.

The auditory (Eustachian) tubes connect the tympanic cavity (middle ear) with the nasopharynx. One of the most important functions of the auditory tubes is to ensure outflow from the middle ear and the auditory tube itself, during which desquamated epithelial cells and mucus are removed. In a calm state, the exit of the tube into the nasal cavity is closed. When swallowing or yawning, the opening of the eustachian tubes opens.

Self-blowing of the auditory tubes, if the patient can carry it out, it helps to completely replace stagnant air (in the tympanic cavity - auditory tube system) with new, fresh air, as well as cleanse the eustachian tubes. Normally, the auditory tubes are easily blown when blowing your nose (there is a feeling of stuffiness in the ears).

You can blow out the auditory tubes using the Valsalva method: the nose is pinched and the patient blows hard into it, while achieving a feeling of stuffiness in the ears. In addition to the fact that this rather simple procedure cleanses the auditory tubes, air rich in oxygen enters close to the tympanic cavity, which is a good prevention of auditory neuritis.

If spontaneous blowing of the auditory tubes does not occur, you should pay attention to the condition of the nose and nasopharynx; You may need to seek help from an ENT doctor.

• Eustachian tube catheterization

Catheterization of the auditory tube is a therapeutic and diagnostic procedure, as a result of which a catheter is inserted into the Eustachian tube through the nasopharynx. This manipulation is aimed at assessing the ventilation capacity of the hearing organ. If this process is disrupted, a specialist carries out blowing.

Indications, contraindications and preparation for the procedure

You need to prepare for the procedure. There are no special recommendations. All manipulations are carried out in the doctor’s office; nothing needs to be done at home. The specialist irrigates the nasal cavity with special vasoconstrictor drugs. This allows you to reduce swelling and improve the result of the procedure itself. Before this, it is necessary to clean the nasal passages from excessive accumulation of mucus. It can interfere with the manipulation.

The main indications for catheterization of the Eustachian tube:

• assessment of ventilation and drainage functions;
• treatment of tubootitis;
• used as an auxiliary procedure in the absence of effect from polycerization.

Some people complain of "heavy breathing" through their nose. This may be due to impaired ventilation functions. Catheterization allows you to evaluate the functioning of the nasal passages. If tubootitis is present, medications are injected into the nasal passages using a catheter. This allows you to act directly on the site of the lesion, which speeds up the healing process. Finally, if the policerization procedure does not produce successful results, catheterization is used. This is due to the structural features of the Eustachian tube and palate.

The procedure is effective and fast, but not everyone can use it. There are a number of contraindications that you need to listen to. Thus, catheterization is inappropriate in the following cases:

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

In this case, the procedure entails a high risk of complications, so specialists try to choose alternative methods.

Technique

Blowing or cleaning the Eustachian tube is carried out using a special catheter, which is inserted into the nasopharynx. The device has a unique structure, so before inserting it it is necessary to raise the tip of the nose. The manipulation is carried out by an experienced doctor; it requires high concentration, otherwise there is a considerable risk of damage to the mucous membrane.

The catheter is inserted with the beak down and gradually moves towards the nasopharynx, then is slowly placed into the Eustachian tube. The procedure is unpleasant, but if it is performed by an experienced doctor, the pain is minimized. That is why you need to select a good clinic with an experienced specialist. Lack of special skill can lead to additional pain and damage to the nasal passages. To relieve discomfort, a 5% solution of novocaine is sprayed into the nasal lining.

In the presence of deviated septum, inserting a catheter is not so easy. The specialist must carefully avoid all obstacles and carefully rotate the device.

Jerking and rough movements are not allowed; this can lead to rupture of the mucous membrane and severe bleeding. An inexperienced specialist may confuse the nasopharynx with the mouth of the Eustachian tube, which will lead to serious complications. After all, blowing will only make the situation worse. Therefore, if the patient complains of acute pain, the manipulation must be stopped.

During an incorrect procedure, submucosal emphysema may occur. This entails the appearance of pain during swallowing and the feeling of a foreign object in the pharynx. During the examination, severe swelling of the palate is recorded.

In general, the procedure is harmless and uncomplicated; it is enough to find an experienced specialist with good dexterity.

For non-purulent and unilateral diseases of the auditory tubes, catheterization is one of the main methods of treatment and diagnosis. The organ is located in a hard-to-reach place, so it is not always possible to remove exudate or introduce medicinal substances into the cavity using other methods. In our medical center, the manipulation is carried out by experienced ENT doctors. Qualified specialists select tactics that will bring the least pain to the patient and be the most effective.

Description

Indications and contraindications for catheterization

Catheterization of the auditory tube for diagnostic purposes is carried out in cases where Politzer blowing is impossible due to the individual characteristics of the patient. Another purpose of the method is the administration of medications through the catheter cavity. Indications for manipulation are the following symptoms:

• ear pain due to otitis media;
• hearing impairment;
• distortion of sound perception.

With the help of catheterization, the doctor can evaluate the functioning of the auditory tubes - ventilation and drainage functions. The method is also used to combat complications of previously suffered tubo-otitis.

Catheterization is contraindicated in the presence of inflammatory diseases of the nasopharynx and oropharynx. In our medical center, the procedure is not performed for people suffering from neurological and psychiatric diseases. In patients with epilepsy or Parkinson's disease, catheterization may cause seizures or loss of consciousness.

How is catheterization performed?

If catheterization is performed by a doctor without the necessary qualifications, then the manipulation causes pain. Our medical center employs doctors with extensive experience in such actions, and anesthetic solutions are used for pain relief. Therefore, catheterization of the nasal cavity does not cause pain to the patient.

The procedure is carried out using three medical instruments:

• Politzer balloon;
• Lutze otoscope;
• Hartmann cannula.

This combination allows the doctor to diagnose the condition of the auditory tubes and, if necessary, introduce medications into the cavity.

After achieving an anesthetic effect, the doctor will carefully insert a Hartmann cannula into the nasal cavity. The instrument is inserted along the nasal passage with the beak down. As soon as the catheter touches the back wall of the nasopharynx, the doctor will turn it 900 and pull it until it touches the vomer (a bone plate located in the nasal cavity). The doctor then looks for the pharyngeal opening of the auditory tube. The manipulation is carried out under the control of X-rays or other imaging methods.

After the catheter is inserted into the opening of the auditory tube, air is supplied using a Politzer balloon. The doctor listens to the noise created when air passes through the Eustachian tube, determines the presence and type of pathology.

Further actions depend on the nature of the disease and the degree of complications. Medicines can be administered through a catheter and serous fluid can be removed.

Why you should contact us

The procedure for catheterization of the auditory tube, even with a highly qualified doctor, can cause discomfort. In some cases, emotional and impressionable people faint. Our medical center has the opportunity to use other diagnostic methods, including endoscopy. Replacing the research method allows the patient to avoid stress, which helps speed up recovery.

With inept catheterization, complications arise:

• nosebleeds;
• emphysema of the peripharyngeal tissue;
• mucosal injury.

Our doctors have experience in catheterizing the auditory tube and take into account the individual characteristics of the patient’s body. The risk of such complications is minimal.

Catheterization of the auditory tube is a therapeutic and diagnostic procedure in which a catheter is inserted into the auditory (Eustachian) tube connecting the middle ear cavity with the oropharynx. An ear catheter (Hartmann cannula) is a specially curved metal tube with a funnel-shaped expansion.

Preparation for the procedure

Immediately before blowing out the ears, the nasal cavity is prepared - it is cleared of mucus and irrigated with vasoconstrictor drugs to reduce swelling.

How is catheterization of the auditory tube performed?

Under the control of anterior rhinoscopy, a metal catheter is inserted into the nasal cavity along the lower nasal passage. The curved “beak” is directed downwards. The injection is carried out to the posterior wall of the oropharynx. After this, the catheter is turned with its beak towards the middle and pulled towards itself until the moment when it rests on the vomer (median nasal septum). Next, the beak is rotated 120-150 degrees to the lateral side. When it gets into the mouth of the auditory tube, a feeling of failure occurs.

The position of the catheter is controlled by carefully blowing air into the catheter - the patient feels a noise in the ear.

Interpretation of results

In the event that it was not possible to catheterize the auditory tube, the V degree of tube patency is set.

To assess the patency of the Eustachian tube after catheterization, a test with saccharin or dye (methylene blue) is used. These tests can only be performed if there is a perforation in the eardrum. During these tests, an appropriate solution is injected into the tympanic cavity. Normally, after 8-10 minutes, the injected substance appears in the nasopharynx, which is felt by the patient as the appearance of a sweet taste (when tested with saccharin) or the appearance of bluing in the oropharynx is noted (when tested with dye). A satisfactory test is considered to be the appearance of these signs after 10-25 minutes, an unsatisfactory test - after more than 25 minutes.

Indications

Catheterization is performed to assess the ventilation and drainage functions of the auditory tube. During catheterization, as well as other tests (Valsalva, Toynbee), when blowing the ears according to Politzer, the ventilation capacity of the Eustachian tube is assessed.

Catheterization is also indicated in the treatment of the consequences of tubo-otitis. Medicines can be administered through the catheter.

Catheterization is performed when policerization is unsuccessful, or the anatomical features of the soft palate make it impossible to perform blowing.

Contraindications

Acute inflammatory diseases of the nose, nasopharynx and oropharynx, due to the high probability of infection in the middle ear cavity, which can lead to purulent otitis media.

Neurological and mental diseases in which intense impact on the hearing organ can provoke loss of consciousness or convulsions. Such diseases include epilepsy and Parkinson's disease.

Complications

The most common complications:

• bleeding;
• trauma to the mucous membrane of the nasopharynx;
• emphysema of the peripharyngeal tissue.

The success of catheterization depends on several factors. First of all, this is the experience of the doctor performing the procedure. The result is least affected by anomalies of the nasal septum - its curvature, the appearance of scars on it. The procedure is complicated by narrow nasal passages and nasal polyposis.

More information about catheterization

The disadvantages of catheterization include the invasiveness of the method. This procedure is quite unpleasant and in sensitive people it can lead to fainting. Recently, catheterization is used quite rarely, mainly in hospitals. To diagnose diseases of the hearing organ, objective research methods come to the fore: otoscopy using a video otoscope, endoscopy of the internal opening of the auditory tube.

Catheterization is complemented by dynamic tympanometry, which makes it possible to quantify the pressure in the tympanic cavity and calculate its gradient during various tests.

Owners of patent RU 2609288:

The invention relates to medicine, namely to otorhinolaryngology, physiotherapy, and can be used in the treatment of patients with auditory tube dysfunction. Catheterization of the auditory tube is performed, during which the tip of the catheter is inserted into the mouth of the Eustachian tube. Air is injected into the tympanic cavity, followed by 1 ml of dexamethasone and 1 ml of 25% dimethyl sulfoxide solution. Transtube electrophoresis is performed, for which part of a cotton swab soaked in a mixture of solutions of dexamethasone and 25% dimethyl sulfoxide - 1:1 is placed in the ear canal. The other part of the tampon is placed in the auricle and the anode is placed on it. The cathode is applied to the occipital region. The current density is selected depending on the procedure, namely: 1st procedure - 0.15 mA/cm2, 2nd procedure - 0.13 mA/cm2, 3rd procedure - 0.11 mA/cm2, 4th procedure - 0.9 mA/cm2, 5th procedure - 0.7 mA/cm2. Duration of exposure is 10 minutes. After electrophoresis, pneumomassage of the eardrums is performed for 10 minutes. The course of treatment is 5 daily procedures. The method makes it possible to increase the effectiveness of treatment, reduce the number of relapses of the disease by summing up the therapeutic effect of the drug and physical factors, and prolong the therapeutic effect of the drug by creating its depot in the tissues. 2 salary f-ly, 2 ave.

The invention relates to the field of medicine, in particular to otorhinolaryngology, physiotherapy, and can be used in the treatment of patients with auditory tube dysfunction.

Eustachian tube dysfunction often leads to various pathological changes in the middle ear cavity - from latent tubo-otitis to exudative, and subsequently adhesive otitis media, which are important links in the development of many forms of hearing loss (Boboshko M.Yu. Issues of pathogenesis, diagnosis and treatment of auditory tube dysfunction: Abstract of thesis... Doctor of Medical Sciences, St. Petersburg 2006, Petukhova N.A. Dysfunction of the auditory tube and endothelial dysfunction: a modern view of the problem. Bulletin of Otorhinolaryngology. No. 4. 2012. 88-92). Long-term disruption of the ventilation function of the auditory tube with a pronounced decrease in intratympanic pressure contributes to the formation of retraction pockets, the development of acute purulent otitis media and its transition to chronic, as well as the formation of epitympanitis with cholesteatoma (McNamee L.A., Harmsen A.G. Both Influenza-Induced Neutrophil Dysfunction and Neutrophil-Independent Mechanisms Contribute to Increased Susceptibility to a Secondary Streptococcus pneumoniae Infection. Infect Immun 2006; 74: 12: 6707-6721. 7. Nell M. J., Grote J. J. Endotoxin and TNF-alpha in middle ear eff usions: in relation with upper airway infection. Laryngoscope 1999; 109: 1815-1819; Nell M. J., Grote J. J. Endotoxin and TNF-alpha in the middle ear effects: in relation with upper airway infection. Laryngoscope 1999; 109: 1815-1819).

There are a number of known methods for treating Eustachian tube dysfunction. Among them, invasive techniques can be distinguished - using a functional shunt (Kryukov A.I., Garov E.V., Sidorina N.G., Tsarapkin G.Yu., Zagorskaya E.E., Akmuldieva N.R. Method of treating dysfunction auditory tube using a functional shunt // Medical Council, 2013, No. 3, pp. 37-39). To install it, a tympanotomy is performed. Most often, this procedure is performed after rhinological operations, which eliminates long-term dysfunction of the auditory tube and prevents the development of exudative otitis media in the long-term postoperative period. This method has disadvantages: the need for surgical intervention with subsequent care of the shunt and a procedure for removing the shunt at the end of treatment.

Among the non-invasive methods of treating Eustachian tube dysfunction, the following treatment methods are the most common:

1) Politzer method (T.P. Mchelidze. Otorhinolaryngological Dictionary. 2007, St. Petersburg, p. 270) - a method of treating auditory tube dysfunction by sharply increasing air pressure in the nasal cavity. The disadvantages of this technique are: the effect of increased air pressure affects both ears, including the healthy ear in a unilateral process; there is a risk of pathological discharge from the nasal cavity entering the tympanic cavity during the procedure with the development of even greater inflammation, including in the healthy ear.

2) Method of catheterization of the auditory tube with the introduction of decongestants, hormones, mucolytics or enzymes (E.S. Yanyushkina Conservative treatment of the secretory stage of exudative otitis media // Abstract of the candidate's thesis, 2010) Catheterization is carried out using an ear catheter for the Eustachian tube according to Hartmann , which is a cylindrical tube 15-18 cm long, one end of which is expanded in the form of a bell, and the other is bent at an angle of 140-150° and has the shape of a rounded beak. Catheters are available with different lumen widths from 1 to 3 mm and wall thicknesses from 0.5 to 1 mm. A Politzer ear balloon, which holds 200-250 ml of air, is used to pump air.

The known method of catheterization of the auditory tube using a catheter for the Eustachian tube according to Hartmann (T.P. Mchelidze. Otorhinolaryngological Dictionary. 2007, St. Petersburg, p. 123). Catheterization is performed with the patient in a sitting position. His head should be leaning against a solid support in a vertical position. Before catheterization, the patient must blow his nose. Preliminary anesthesia of the nasal mucosa is carried out with a solution of lidocaine 10% - 2 ml.

Catheterization technique

Under the control of anterior rhinoscopy, the catheter is inserted with the beak down into the lower nasal passage. Sliding along the bottom of the nasal cavity, the catheter should enter the nasopharynx. Then it is advanced until it touches the posterior wall, rotated 90° so that its beak is directed towards the ear of the opposite side, and pulled towards itself until its beak hits the posterior edge of the septum, and the catheter is turned 180° in side of the ear being examined so that its ring faces the outer-superior corner of the orbit of the catheterized side. Then the beak of the catheter enters the mouth of the Eustachian tube. You can, without turning the beak of the catheter, remove it until it comes into contact with the soft palate and then turn the beak towards the mouth of the Eustachian tube. After this, the tip of the balloon is inserted into the socket of the catheter and air is injected several times, removing the balloon after each injection. The entry of air into the tympanic cavity is controlled through a rubber auditory tube, one end of which is inserted into the patient’s ear, and the other into the doctor’s ear. To treat eustachian tube dysfunction, 10 procedures are usually performed, depending on the improvement in the degree of patency of the eustachian tube.

One of the methods for treating auditory tube dysfunction is transtube electrophoresis (V.N. Tkachenko. On the issue of treatment of patients with secretory otitis media. Journal of ear, nose and throat diseases, Kiev, No. 4, 2007 pp. 33-38). The above method is closest to the invention we propose.

Electrophoresis is an electrokinetic phenomenon of movement of dispersed phase particles (colloidal or protein solutions) in a liquid or gaseous medium under the influence of an external electric field (Parfenov A.P. Electrophoresis of medicinal substances. L., 1973). But as a method of physiotherapeutic treatment of dysfunction of the auditory tube, its use has recently been practically discontinued due to the traumatic nature of the technique due to the fact that a metal catheter is used for its implementation.

We set the task of developing a method of treating patients with pathology of the auditory tube that is devoid of these disadvantages.

The method we have developed allows us to achieve the following technical results: the quality of treatment improves, the treatment time and the number of procedures performed are reduced, and the number of disease relapses is reduced.

These results are due to the following. Dimethyl sulfoxide has the inherent ability to enhance the effect of drugs administered by electrophoresis, since it has a pronounced transporting property. We used DMSO, firstly, due to the fact that dexamethasone has low electrophoreticity and therefore, to ensure the required penetration depth, electrocutions with it are carried out using a dimethyl sulfoxide (DMSO) solution. Secondly, since the electrodes used have a small area (intratubal 2 mm 2, external 25 cm 2).

The maximum current density when performing electrophoresis on mucous membranes should not exceed 0.2 mA/cm 2 . To calculate the current strength, the formula J=σ⋅S is used, where J is the current strength, σ is the current density, S is the area of ​​the gasket or electrode. When using only an intratubal electrode with an area of ​​2 mm 2, the maximum possible power is I = 0.2-0.02-0.004 mA, which is not enough to carry out the electrophoresis procedure. Accordingly, we chose the technique of bipolar electrophoresis using an external electrode 5×5 cm = 25 cm 2. Since in bipolar electrophoresis the areas of the active electrodes are added up when calculating the power, we get 0.02 + 16 = 16.02 cm 2, which gives the maximum possible power of 0.2-25.02 = 5.004 mA, which ensures good penetration of the drug into the tissue. Since in some patients subjective sensations of achieving maximum power (a feeling of vibration, tingling in the area of ​​the electrodes) occurred at a power of 2-3 mA, the use of DMSO provided a guarantee that even at this power the drug would reach the tissues in sufficient quantities.

A positive aspect of the use of electrophoresis is that it combines the therapeutic effect of the drug and the physical factor, prolonging the therapeutic effect of the drug due to the creation of a depot in the underlying tissues with subsequent long-term release.

We have found that the integrated use of the above treatment methods gives the best effect than their isolated use. Catheterization of the auditory tube with the introduction of drugs is a generally accepted method of treating tubular dysfunction, since the injected drugs have an anti-inflammatory effect, improving the patency of the auditory tube and, as a result, the aeration of the middle ear. Electrophoresis, carried out after catheterization, allows you to create a depot of the drug in the tissues along the auditory tube, prolonging its effect up to 48 hours.

The method is carried out as follows.

A course of catheterization of the auditory tube is carried out using a catheter in the amount of 5 procedures once a day.

To do this, after local anesthesia with a solution of lidocaine 10% 2 ml and treatment of the nasal mucosa with adrenaline, a catheter is inserted into the nasal cavity under the control of a 0° endoscope to catheterize the auditory tube.

It is advisable to use catheterization using a catheter made of elastic material - silicone rubber, which reduces the risk of tissue injury.

The catheter is advanced until it comes into contact with the posterior wall of the nasopharynx and turned 90° towards the ear being examined. By pulling the catheter towards you, the tip of the catheter enters the mouth of the Eustachian tube. After this, the tip of the balloon is put on the catheter and air is pumped several times. The entry of air into the tympanic cavity is controlled through a rubber auditory tube, one end of which is inserted into the patient’s ear, and the other into the doctor’s ear. After ensuring that air passes into the catheter, 1 ml of dexamethasone and 1 ml of 25% dimethyl sulfoxide solution are injected. A metal conductor with a diameter of 1 mm with a rounded end is used as an active electrode (anode) to prevent injury to the tissues of the auditory tube. After catheterization and injection of the solution, the conductor is passed through the catheter to a predetermined length so that its end protrudes 2 mm from the end edge of the catheter, after which electrophoresis is performed.

In order to ensure a more effective effect of the drug, bipolar electrophoresis (transtubal electrophoresis) with a bifurcated electrode was used, for which part of a cotton swab soaked in a mixture of solutions of dexamethasone and 25% dimethyl sulfoxide -1:1 is placed in the ear canal, while the other part of the swab is placed in the auricle and place an electrode (anode) on it.

The cathode is applied to the occipital region (the location of the electrodes is standard - along the midline from C3 to C7). Current density varies during treatment. Start with 0.15 mA/cm2, as the maximum to achieve the best initial effect, since at the beginning of treatment the most pronounced swelling of the mucous membrane of the auditory tube is observed, which decreases as treatment progresses due to anti-inflammatory therapy and deposition of the drug in tissues due to electrophoresis, and gradually reduce according to the original scheme we developed:

1 procedure - 0.15 mA/cm 2,

2 procedure - 0.13 mA/cm 2,

3 procedure - 0.11 mA/cm 2,

4 procedure - 0.9 mA/cm 2,

5 procedure - 0.7 mA/cm2.

Since during the treatment the drug is deposited in the mucous membrane of the auditory tube, subsequent procedures can be carried out with less power, which reduces the risk of damage to the mucous membrane by electric current, and the use of DMSO ensures sufficient penetration of the drug into the tissue with lower current strength and density.

The duration of each procedure was 10 minutes. After electrophoresis, pneumomassage of the eardrums is performed for 10 minutes. Pneumomassage is preferably carried out after electrophoresis because as a result of the procedure, the patency of the auditory tube is restored and the mobility of the eardrum becomes better.

The course of treatment consists of 5 daily catheterization procedures of the auditory tube with the introduction of 1 ml of dexomethasone and 1 ml of 25% dimethyl sulfoxide solution, electrophoresis and pneumomassage of the eardrums.

The method of treating auditory tube dysfunction was tested on 20 patients with acute otitis media aged 18 to 57 years.

The effectiveness of the treatment method for Eustachian tube dysfunction can be illustrated by 2 case histories.

Clinical example N1

Patient O.N., 29 years old. I contacted the KDO NIKIO named after. L.I. Sverzhevsky with a diagnosis of dysfunction of the auditory tube on the left.

Upon admission, she complained of congestion in the left ear and a feeling of her own voice inside her head.

According to the patient, she has been sick for 5 days after suffering from acute respiratory viral infection. She was treated independently with the use of antiviral drugs; while taking the drugs, the symptoms of ARVI stopped, but congestion in the left ear appeared. Complaints arose for the first time. I have not noticed ear congestion before.

On otoscopy of the left ear, the external auditory canal is wide and free. The eardrum is gray and retracted. Identification marks have been shortened. Whispered speech is 5.5 m, spoken speech is more than 6 m. On otoscopy of the right ear, the external auditory canal is wide and free. The eardrum is gray. Identification marks are outlined. Whispered speech is 6 m, spoken speech is more than 6 m. When carrying out Weber's experiment, there is lateralization to the left ear.

The patient underwent a course of catheterization of the left auditory tube in the amount of 5 procedures. After local anesthesia with a solution of lidocaine 10% 2 ml and treatment of the nasal mucosa with adrenaline, a catheter was inserted into the nasal cavity under the control of a 0° endoscope to catheterize the auditory tube. The catheter was advanced until it came into contact with the posterior wall of the nasopharynx and turned 90° towards the ear being examined. By pulling the catheter towards you, the tip of the catheter entered the mouth of the Eustachian tube. After this, the tip of the balloon was inserted into the catheter and air was injected several times. The entry of air into the tympanic cavity was controlled through a rubber auditory tube, one end of which was inserted into the patient's ear, and the other into the doctor's ear. After ensuring the passage of air, 1 ml of dexomethasone and 1 ml of 25% dimethyl sulfoxide solution are injected into the catheter. A metal conductor 1 mm in diameter with a rounded end was used as the active electrode (anode). The conductor is passed through the catheter so that its end protrudes 2 mm from the end edge of the catheter, after which bipolar electrophoresis is carried out with a bifurcated electrode, for which dexamethasone is additionally administered through the external auditory canal - a cotton swab moistened with a solution of the medicinal substance is placed in the ear canal with the other end The auricle was filled and an electrode was placed on it. The cathode was applied to the occipital region. The first procedure started with 0.15 mA/cm 2 , the second procedure - 0.13 mA/cm 2 . The duration of each procedure was 10 minutes. After electrophoresis, pneumomassage of the eardrums was performed for 10 minutes.

After the second procedure of catheterization of the auditory tube on the left, the patient noted a decrease in congestion in the left ear. Complaints about autophony regressed.

The third procedure was carried out with the current density set at 0.11 mA/cm 3 , the fourth procedure at 0.9 mA/cm 2 , and the fifth procedure at 0.7 mA/cm 2 .

After the fifth procedure, the patient has no complaints. Upon objective examination: the external auditory canal is wide and free. The eardrum is gray. Identification marks are outlined. Whispering speech is 6 m, conversational speech is more than 6 m. When carrying out Weber's experiment, there is no lateralization.

Clinical example N2

Patient G.O., 32 years old. I contacted the KDO NIKIO named after. L.I. Sverzhevsky with a diagnosis of right-sided exudative otitis media, dysfunction of the auditory tube on the right.

Upon admission, she complained of congestion in the right ear, decreased hearing on the right, and pain in the right ear.

According to the patient, she was sick for 7 days after hypothermia (swimming in an ice hole). I went to the clinic at my place of residence, where the ENT doctor prescribed conservative treatment: Otipax drops in the right ear, vasoconstrictor drops in the nose, Politzer blowing on the right, pneumomassage. However, the patient did not notice a significant clinical effect. Complaints arose for the first time. There were no previous otitises.

Otoscopy of the left ear: the external auditory canal is wide and free. The eardrum is gray. Identification marks are outlined. Whispered speech is 6 m, spoken speech is more than 6 m. During otoscopy of the right ear: the external auditory canal is wide and free. The eardrum is hyperemic and bulging. Identification marks have been erased. Whispered speech is 4 m, spoken speech is 5 m. When carrying out Weber's experiment, there is lateralization to the right ear. Tympanometry: type “B” on the right, type “A” on the left.

The patient underwent a course of catheterization of the auditory tube on the right in the amount of 5 procedures. After local anesthesia with a solution of lidocaine 10% 2 ml and treatment of the nasal mucosa with adrenaline. A catheter was inserted into the right half of the nasal cavity under the control of a 0° endoscope to catheterize the auditory tube. The catheter was advanced until it touched the posterior wall of the nasopharynx and turned 90° towards the right ear. By pulling the catheter towards you, the tip of the catheter is inserted into the mouth of the Eustachian tube on the right. After this, the tip of the balloon was attached to the catheter and air was injected several times. The entry of air into the tympanic cavity was controlled through a rubber auditory tube, one end of which was inserted into the patient’s right ear, and the other into the doctor’s ear. After ensuring the passage of air, 1 ml of dexomethasone and 1 ml of 25% dimethyl sulfoxide solution were injected into the catheter. A metal conductor 1 mm in diameter with a rounded end was used as the active electrode (anode). The conductor is passed through the catheter so that its end protrudes 2 mm from the end edge of the catheter, after which bipolar electrophoresis is carried out with a bifurcated electrode, for which dexamethasone is additionally administered through the external auditory canal - a cotton swab moistened with a solution of the medicinal substance is placed in the ear canal with the other end The auricle was filled and an electrode was placed on it.

The cathode was applied to the occipital region. The first procedure started with 0.15 mA/cm2, the second procedure - 0.13 mA/cm2, the third procedure - 0.11 mA/cm2. The duration of each procedure was 10 minutes. After electrophoresis, pneumomassage of the eardrums was performed for 10 minutes.

After the third procedure of catheterization of the auditory tube on the right, the patient noted a decrease in pain in the right ear. Complaints of congestion and hearing loss on the right side regressed.

The fourth procedure was carried out with the current density set at 0.9 mA/cm 2 , the fifth procedure at 0.7 mA/cm 2 . After the fifth procedure, the patient has no complaints. Upon objective examination: the external auditory canal is wide and free. The eardrum is gray. Identification marks are outlined. Whispering speech is 6 m, conversational speech is more than 6 m. When carrying out Weber's experiment, there is no lateralization. The patient underwent control tympanometry: type “A” on 2 sides.

1. A method for treating auditory tube dysfunction, including catheterization of the auditory tube, during which the tip of the catheter is inserted into the mouth of the Eustachian tube, air is pumped into the tympanic cavity, and then 1 ml of dexamethasone and 1 ml of 25% dimethyl sulfoxide solution, after which transtubal electrophoresis is performed, for whereby part of a cotton swab soaked in a mixture of solutions of dexamethasone and 25% dimethyl sulfoxide - 1:1 is placed in the ear canal, while the other part of the swab is placed in the auricle and the anode is placed on it, the cathode is placed on the occipital region, and the current density is selected in depending on the procedure, namely:

1 procedure - 0.15 mA/cm 2,

2 procedure - 0.13 mA/cm 2,

3 procedure - 0.11 mA/cm 2,

4 procedure - 0.9 mA/cm 2,

5 procedure - 0.7 mA/cm2;

duration of exposure is 10 minutes, after electrophoresis, pneumomassage of the eardrums is performed for 10 minutes; The course of treatment is 5 daily procedures.

2. The method according to claim 1, in which local anesthesia is first carried out with a solution of lidocaine 10% 2 ml and the nasal mucosa is treated with a solution of adrenaline.

3. The method according to claim 1, in which catheterization is performed using a catheter made of elastic material.

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