myringotomy tube placement

Chronic non-suppurative otitis media is a frequently-occurring disease, common disease, more common in children. The impact on hearing is so severe that it affects children's intellectual development and learning. It is characterized by obstruction of the eustachian tube, causing tympanic effusion. The tympanic effusion is caused by diseases such as catarrhal otitis media, secretory otitis media, barotitis media, and aviation otitis. Drainage of tympanic effusion is one of the important measures for the treatment of non-suppurative otitis media. The commonly used method is the insertion of grommet. The cannula can be inserted into the inner tympanum through the external auditory canal and tympanic membrane. Treatment of diseases: chronic otitis media Indication 1. Tympanic effusion, due to dysfunction of the Eustachian tube or obstruction of the anterior and posterior gorges, the tympanic cavity is under negative pressure. 2. After radiotherapy for nasopharyngeal carcinoma, the eustachian tube is blocked. Contraindications 1. Initially suffering from secretory otitis media, tympanostomy can be performed first. 2. Jugular spheroid tumor (tympanic type). 3. People with severe heart disease or blood diseases. Preoperative preparation 1. Prepare surgical instruments. The basic instruments are a set of otoscopes, tympanic membrane incisors, rolled cotton, and thin suction tubes. 2. It is best to have a surgical microscope. 3. The instrument should be fitted with a pointed or flat-necked pliers for the snorkel or a cannula. 4. Select snorkels of different calibers for use. The size of the ventilating drainage tube is different, the inner diameter of the tube is 1.2, 1.5, 2.0 mm, and the tube length is about 8.0 ~ 10 mm. The ventilating drainage tube with different caliber should be selected according to the viscosity of the effusion. The greater the viscosity, the larger the lumen of the application should be. The material of the snorkel is stainless steel, gold-plastic polyethylene plastic tube, Teflon and silicone rubber. All of these materials have good biocompatibility. The Teflon vent tube is the most reliable, rarely infected, and the lumen is not easy to block. At present, the clinical application of Teflon or silicone snorkel is the most widely used. The silicone tube is soft, elastic, bendable, pulled and compressed, and is easy to insert into the tympanic membrane incision. The snorkel is less irritating to the tissue and the lumen is not easy to scar. Blockage, less rejection, easy to dye, easy to identify. However, it has also been reported that the silicone tube is placed on the tympanic membrane for a long time to produce granulation. The incidence of residual perforation of the tympanic membrane of stainless steel snorkel is high There are many types of ventilated drainage tubes, which are designed according to the principle of easy placement and not easy to escape. Different types of snorkels differ mainly in their front and rear ends. The domestic silicone rubber vent pipe adopts a taper shape, which is easy to install and is not easy to fall off. There are three types of large, medium and small, with inner diameters of 1.0, 1.5 and 2.0 cm, which are most commonly used with medium size. The Paperella NO2 snorkel has a large inner flange and a wider lumen, which is not too long. However, the installation of the snorkel is complicated, and it is not easy to self-exit, and it is often necessary to remove the tympanic membrane. Shepared and Armstrong snorkels are generally used abroad. If the snorkel is expected to remain for more than 2 years, it is best to choose Goode T-tube, but the incidence of residual perforation is high. The snorkel can also be made by itself. A section of polyethylene tube with a length of about 4.0 to 5.0 mm is cut vertically. The two ends of the tube are heated and placed on the blade to pressurize the tube end, so that the tube end bulges into a ring, but the tube cannot be blocked. After confirming that the lumen is unobstructed, put it into 75% ethanol for disinfection. Surgical procedure 1. Disinfect the ear canal and disinfect the external auditory canal with thiomersal (1:1000). 2. Under the operating microscope, fix the otoscope with your left hand and suck the liquid with the suction tube in your right hand. 3. Cut the tympanic membrane with a sharp tympanic membrane in front of the anterior or posterior tympanic membrane. The length of the incision is about 2.0 to 4.0 mm. The arcuate incision or longitudinal incision is made parallel to the annular fiber. The size of the incision is equivalent to the outer diameter of the snorkel. . 4. Absorb the tympanic effusion with a suction tube. 5. Hold the end of the snorkel with a cleavage pliers, and insert the vent tube into the tympanic membrane incision like a button to make the tympanic membrane opening between the two ends. For the Goode T-type snorkel, after completing the tympanic membrane incision, the inner flanges on both sides are clamped with straight crocodile jaws and fed into the tympanic cavity through the tympanic membrane incision. The author applied YG laser to tympanic membrane perforation under local anesthesia, power 8 ~ 12W, time 1s. It can be applied to children over 6 years old and adults. complication 1. The snorkel falls into the tympanic cavity. 2. Middle ear inflammation. 3. The vent tube is prolapsed. 4. The snorkel is blocked.

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