What is catheterization of the auditory tube. Catheterization of the auditory tube with and without medication, complications

ENT diseases - BORDER TREATMENT - site - 2008

Eustachian tube functions- it is drainage and ventilation, that is, it maintains the same pressure in the tympanic cavity with 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 negative pressurewhich occurs in the middle ear due to the absorption of air by the mucous membrane. Excessive pressure in the tympanic cavity can also be leveled out 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 surrounding tissues leads to a dysregulation 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 ear funnel. The main sign of dysfunction of the auditory tube is retraction tympanic membrane... This is due to the low pressure in the tympanic cavity.

Simple swallow test.If the patency of the auditory tubes in the patient is normal, then when swallowing he feels a "crackle" in the ears.

Toynbee's test (swallowing with pinched nostrils). The patient pinches his nose and makes swallowing movements. With good patency of the auditory tubes, there is also a "crackling" in the ears.

Valsalva test (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 previous tests. In patients with good patency of the auditory tube and a perforation (hole) of the tympanic membrane, air exits through the opening in the membrane. With edema of the mucous membrane of the auditory tube, but some preservation of its patency, during straining, the patient may feel a squeak, gurgle and other noises in the corresponding ear. In older people, this experience can cause high blood pressure.

Blowing over Politzer.For this sample, a special balloon is used, which is a rubber bulb (with a capacity of 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 (steamer, cuckoo, also-also). At this point, the pear is compressed and air enters the nasopharynx and auditory tubes. With weakness of the muscles of the soft palate, pronouncing words does not lead to the expected result. When blowing through the auditory tubes for therapeutic purposes, the patient keeps his head in a tilted position, face down, as a result of which the fluid in the middle ear goes down to the auditory tube, and at the moment of blowing the patient should keep his head tilted forward slightly turned face up towards the sore ear. With this position of the head, the patient's auditory tube is directed downward, and when blowing out, the liquid from the middle ear flows more easily into the nasopharynx. In rare cases, blowing through the auditory tubes with this method can make the patient dizzy, a feeling of heaviness in the forehead, severe pain in the ear at the time of blowing, and with cicatricial changes in the eardrum, even its rupture may occur.

These tests are called subjective, since the patency of the auditory tubes during their performance is determined based on the patient's own feelings.

CATHETERIZATION OF THE HEARING TUBE

This research method is used in cases where a one-sided examination is necessary or it is impossible to blow through the auditory tubes using any of the above methods.

Indications for blowing through the auditory tube using a catheter:unsuccessful blowing according to Politzer, insufficiency of the soft palate, the presence of a one-sided disease (so as not to injure a healthy ear).

The catheter is a metal tube, at one end it is bent in the form of a beak, while the other end has a funnel-shaped expansion. Catheterization can be combined with insertion into the tympanic cavity drugs.

Complications of catheterization of the auditory tubemay be: nosebleeds, dizziness, fainting, convulsions, ruptured eardrum.

OBJECTIVE RESEARCH METHODS

Currently, in otorhinolaryngology and audiology, objective methods of hearing examination for the diagnosis of various ear pathologies are becoming increasingly popular. With regard 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 registering the patency of the auditory tubes.
• Determination of the drainage function of the auditory tube by measuring the transit time of 5% saccharin solution from the tympanic cavity into the nasopharynx.The experiment is carried out in the presence of perforation in the tympanic membrane.
• Endoscopic examination of the state 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) to the nasopharynx. One of the most important functions of the auditory tubes is to provide an outflow from the middle ear and the auditory tube itself, during which desquamated epithelial cells and mucus are removed. In a resting 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 a new, fresh one, as well as to cleanse the Eustachian tubes. Normally, the auditory tubes are easily blown out during blowing out (there is a feeling of stuffiness in the ears).

You can blow through the auditory tubes using the Valsalva method:the nose is pinched and the patient blows strongly into it, while achieving a feeling of stuffiness in the ears. In addition to the fact that during this rather simple procedure, the auditory tubes are cleaned, oxygen-rich air enters 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.

• Catheterization of the auditory tubes

Catheterization of the auditory tube is a diagnostic and treatment 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 disturbed, the specialist carries out a blowdown.

Indications, contraindications and preparation for the procedure

You need to prepare for the procedure. There are no specific 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 reduces the swelling and improves the result of the procedure itself. Before this, it is necessary to cleanse 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 tubo-otitis;
• used as an auxiliary procedure in the absence of the effect of politcerization.

Some people complain of "heavy breathing" through the nose. This may be due to impaired ventilation functions. Catheterization allows you to assess the work of the nasal passages. In the presence of tubo-otitis, drugs 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 politcerization procedure is not successful, 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 apply it. There are a number of contraindications that you need to listen to. So, catheterization is inappropriate in the following cases:

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

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

Technique

The blowing or cleaning of the Eustachian tube is carried out using a special catheter that is inserted into the nasopharynx. The device has a peculiar structure, therefore, it is necessary to raise the tip of the nose before inserting it. The manipulation is carried out by an experienced doctor, it requires a 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 slowly placed into the Eustachian tube. The procedure is unpleasant, but if it is performed by an experienced doctor, the painful sensations are minimized. That is why it is required to select good clinic with an experienced specialist. Lack of special dexterity can lead to additional painful sensations and damage to the nasal passages. To relieve discomfort in the nasal membrane, spray a 5% solution of novocaine.

If there is a curvature of the septum, it is not so easy to insert the catheter. The technician must carefully bypass all obstacles and carefully turn the device.

Jerks and rough movements are not allowed, this can lead to rupture of the mucous membrane and severe bleeding. An inexperienced specialist can confuse the nasopharynx with the mouth of the Eustachian tube, which will entail serious complications. After blowing only will aggravate the situation. Therefore, if the patient complains about sharp pain, the manipulation must be stopped.

Submucosal emphysema may occur during the wrong procedure. This entails the appearance pain while swallowing and feeling a foreign object in the pharyngeal area. During the examination, a strong swelling of the palate is recorded.

In general, the procedure is safe and easy, it is enough to find an experienced specialist with good skill.

With 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, therefore, remove exudate or enter medicinal substances into the cavity by other methods is not always possible. In our medical center the manipulation is carried out by experienced ENT doctors. Qualified specialists select tactics that will bring the patient less painful sensations and will be most effective.

Description

Indications and contraindications for catheterization

Catheterization of the auditory tube for diagnostic purposes is carried out in cases where blowing according to the Politzer is impossible 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 for manipulation are the following symptoms:

• ear pain with otitis media;
• hearing impairment;
• distortion of the perception of sounds.

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

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

How is catheterization performed

If the 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, nasal catheterization does not cause pain in the patient.

The procedure is performed using three medical instruments:

• balloon of Politzer;
• otoscope Lutze;
• hartmann's cannula.

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

After the anesthetic effect is achieved, the doctor will gently insert the 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 posterior wall of the nasopharynx, the doctor will turn it by 900 and pull it up 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 guidance of X-ray or other imaging methods.

After the catheter is inserted into the opening of the auditory tube, air is supplied using the Politzer balloon. The doctor listens to the noises 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 injected 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. In our medical center, it is possible to use other diagnostic methods, including endoscopy. Replacing the research method allows the patient to avoid stress, which helps to accelerate recovery.

With inept catheterization, complications arise:

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

Our doctors have experience in performing catheterization of the auditory tube, take into account the individual characteristics of the patient's body. The risk of such complications is minimal.

With untimely treatment, often end in hearing impairment, a feeling of rolling water or persistence of pain. Catheterization for eustachian tube dysfunctions is a way to identify and diagnose ear problems and deliver medication to the site of inflammation. it efficient method treatment of eustachitis and otitis media of various types.

A catheter is a tube that is used to enter the body cavities in order to clear them of pus and fluids, flush them, and deliver medicine or instruments to the right place. Manipulators are made from different materials, they can be flexible or metal. Catheterization is the insertion of an instrument to treat or identify the causes of an illness. The ear and nasopharynx are connected by a complex system of passages. A specially shaped instrument can be passed through these passages from the nose to the middle ear.

Reference: Eustachian tube catheterization is used to penetrate the middle ear to correct hearing problems and cleanse the cavity.

The insertion instrument is a type of catheter called the Hartmann cannula. A cannula is a slightly curved tube about 15-18 centimeters long, with a diameter of 1 to 2 millimeters. One end is a small funnel, the other is slightly bent and looks like a beak. Air is injected with a special balloon, which is attached to the cannula after it has passed to the desired place.

Possibilities of Eustachian tube catheterization:

• assessment of the condition of the ear canal, taking samples;
• blowing channels;
• drug delivery to the middle ear.

Usually, this method of treating complicated ear diseases is used if other methods (blowing according to Politzer or pneumomassage) have failed.

Advantages and disadvantages of the method

And their complications often lead to hearing impairment, unpleasant sensations of water transfusion and foreign body... Catheterization is used when other treatments fail. Its advantages include:

• a high degree of efficiency in the delivery of drugs that fall on the surface of the Eustachian tube;
• quick recovery when blowing through the pipe;
• the most accurate regulation of air force during injection;
• hearing improvement, which sometimes occurs after 1-2 procedures;
• when hormonal agents (in particular Hydrocortisone) are injected, scars that interfere with the natural movement of air quickly dissolve.

Most patients report significant improvement after catheterization.

The disadvantages of this method of treatment and diagnosis of the auditory tube include:

1. The need for high qualifications and experience of the doctor who performs the procedure.
2. Method invasiveness. After catheterization, complications may develop due to the movement of a foreign body through the cavities of the nasopharynx and the auditory tube.

Patients note the unpleasantness of the procedure, pain and fear from the penetration of a metal object into the body. Some complain of a gag reflex and discomfort during and after the exercise. For treatment, a course of catheterization is often required.

Indications for conducting

The method is not the first in choosing a diagnosis, it is usually used when blowing according to the Politzer cannot be performed. Indications for conducting:

• persistent pain with ear inflammation;
• drop in hearing acuity;
• unnatural perception of your own voice;
• structural features of the soft palate, excluding the possibility of blowing;
• distorted perception of sounds.

For what diseases can catheterization be prescribed:

• eustachitis;
• otitis media - serous, acute medium, adhesive and others.

Catheterization helps assess the performance of both drainage and ventilation functions.

The manipulation results are:

• assessment of the condition of the auditory tube;
• ensuring the outflow of exudate;
• elimination of adhesions, scars, scars after treatment;
• restoration of air passage for normal hearing.

The number of required treatment procedures is determined after diagnosis.

Where is catheterization of auditory tubes performed?

Catheterization is one of the procedures that require a high qualification of a doctor, the presence of special devices and sterilization devices for processing instruments.

It is carried out in a hospital or treatment rooms of an otolaryngologist. When contacting such offices, you need to check the doctor's certificates and the right of the medical office to carry out this manipulation.

In addition to the doctor's special devices for rhinoscopy, the office should have:

• hartmann's cannula;
• otoscope Lutze;
• a Politzer balloon with a volume of 200-250 milliliters.

This kit is sufficient for diagnostics and drug administration.

Preparing for catheterization

The manipulation is carried out in a specially equipped office. Before performing, the nasal passages should be freed from mucus; for this, irrigation with cleaning solutions is carried out. Drugs that constrict blood vessels are instilled into the nose. This reduces swelling and increases the patency of the passages.

Select a catheter of the desired size. To reduce the soreness of the nasopharynx, a solution of Novocaine or Lidocaine is sprayed into the passages.

The patient is told to remain still to avoid injury.

Technique

Tool entry is monitored. The cannula is inserted into the lower nasal passage with the beak down. The manipulator should slide along the nasopharynx, reach the back wall and touch it. After that, the instrument is turned 90 °, pulled towards itself until it rests against the back of the septum. Further, the catheter is again turned 180 °, while it enters the Eustachian tube. A balloon is put on the outer part of the cannula and air is blown in. Before each new injection, the pear is removed to capture a new portion.

The doctor controls the air movement with a special tube inserted into the patient's ear. During listening, the specialist and the patient hear how the passage opens when the air moves. The doctor determines the degree of patency of the auditory tube by the characteristic noises.

Narrowing and damage to the Eustachian tube create obstructions, and the sound is intermittent and intermittent. Pops are heard when exudate accumulates air bubbles and fluid noise. With an adhesive middle ear catarrh, the doctor hears a crackling sound from friction. Perforation is characterized by a whistling of escaping air. The specialist must have a good knowledge of the anatomy of the ear canals for successful insertion of the instrument, have extensive experience, a firm hand and be able to interpret the noises heard.

Checking the patency can be accompanied by the introduction of drug solutions delivered by a catheter to places that are very difficult to get into using other methods. Most often, to restore the patency of the pipe, a course of 10 procedures is carried out. During the execution, the dynamics of changes in the state of the ear canal and the effectiveness of the procedure are investigated. The course can be shortened.

In this way, delivery of various drugs is carried out:

• decongestants;
• enzymes;
• hormones;
• antibiotics;
• mucolytics.

The effect of catheterization can be enhanced using electrophoresis. For the treatment solution, a mixture of dimethyl sulfoxide with dexamethasone is used. The electrode is passed into the catheter, the second part is located in auricle... The cathode is applied to the back of the head.

With the help of electrophoresis, the drug effect on the affected tissues of the auditory tube is enhanced. With this treatment regimen, the course is reduced to 5 procedures. When replacing a metal catheter with a silicone one, the trauma risk of the method is reduced.

Interpretation of results

The patency of the tube can be completely impaired, the catheter cannot be inserted, in this case the V degree of patency is set. Drainage function is assessed in the presence of perforation of the tympanic membrane. To do this, a contrast agent is injected through a hole in the membrane and monitors its appearance in the nasopharynx.

Sweeteners or colored elements, in particular methylene blue, are used as substances. When using saccharin, permeability is detected by the appearance of taste; with dyes, the doctor monitors the color change in the nasopharynx.

Normal drainage function provides the appearance of the result in 10 minutes, the average - up to 25 minutes. If the result is obtained later, the function is assessed as unsatisfactory.

Contraindications

There are a number of contraindications for catheterization:

1. Inflammation of the mouth, nose, pharynx. When the cannula moves along the nasopharynx, there is a high risk of transferring the infection into the Eustachian tube.
2. Epilepsy, Parkinson's disease. Manipulation can cause convulsions, loss of consciousness. With diseases nervous system and mental disorders, the procedure is not recommended. The involuntary movements that are characteristic of these diseases make the procedure dangerous.

For children, catheterization is prescribed no earlier than 5 years of age. Because of discomfort, it is sometimes performed under general anesthesia.

Possible complications

Catheterization requires the skill and experience of an otorhinolaryngologist. Despite mucosal anemization medicines, the patient often feels pain and discomfort, which are aggravated by inept actions.

Curvature of the nasal septum, polyps serve as an additional source of difficulties with the introduction of the catheter. Sometimes you have to use another nasal passage to get into the tube. Jerks and sharp pushing of the catheter must not be allowed.

Among the complications from the procedure stand out:

• damage to the mucous membrane along the path of the catheter;
• bleeding;
• rupture of the tympanic membrane;
• emphysema is the accumulation of air in the submucous tissue.

These injuries can be caused by the physiological features of the structure of the ENT organs, the awkwardness of the doctor, or the patient's involuntary movements.

Important: going to the procedure, you need to mentally tune in to a short unpleasant manipulation, after which hearing will improve.

Catheterization of the ear canal is prescribed only if other methods of diagnosing and treating middle ear pathologies are ineffective. Otolaryngologists try to use more modern methods otoscopy using a video otoscope, endoscopic methods. The invasiveness of catheterization makes the procedure not the most popular method of treatment and diagnosis.

However, most patients note a significant improvement in their condition after the procedure - pain relief, hearing return. By choosing a good otolaryngologist and clinic, you can reduce discomfort and avoid negative consequences.

Catheterization of the auditory tube is one of the therapeutic and diagnostic procedures that allows you to insert a catheter into the nasopharynx. Such a manipulation makes it possible to assess the ventilation capacity of the hearing organs, as well as to introduce a medicine for the treatment of certain ailments. If there are some irregularities, then the doctor may conduct a blowing procedure.

Basic indications

Eustachian tube catheterization is performed for:

1. Evaluation of drainage as well as ventilation functions.
2. As an auxiliary procedure, if there is no effect of politcerization.

So, the procedure is performed if patients often complain of heavy breathing, especially through the nose. As a rule, this is due to a violation of drainage and ventilation functions.

In the presence of a disease such as tubo-otitis, catheterization of the auditory tube is performed with the introduction of drugs. This procedure allows you to evaluate the work of organs. In this case, the doctor can act directly on the affected area. This greatly speeds up the healing process.

Also, catheterization is carried out in the absence of the effect of such a procedure as politcerization. This is due to some of the structural features of the sky, as well as the Eustachian tube.

Preparation for the procedure

Catheterization of the auditory tube is carried out only in the office of a narrow specialist. It is impossible to carry out such manipulations at home. Before performing the procedure, the physician should prepare the patient. First of all, a specialist irrigates the nasal cavity with a special solution that has a vasoconstrictor effect. This allows you to improve the result of catheterization, as well as reduce tissue edema.

Special tool

How is catheterization of the auditory tube performed? The technique is quite simple. However, care must be taken during the procedure. All manipulations are carried out in the doctor's office. During the procedure, a specialist inserts a catheter into the nasopharynx, which has a peculiar shape. To perform all manipulations, the doctor must lift the tip of the patient's nose. Due to the special shape of the catheter, the procedure should be carried out by a doctor with great experience, since the process can damage the mucous membrane. In this case, a high concentration is required.

How the catheter is inserted

As already mentioned, catheterization of the auditory tube should only be performed by an experienced doctor. With this procedure, there is a risk of damage to the tissues of the mucous membrane. Therefore, the catheter is introduced gradually, "beak" down. This procedure is not very pleasant. However, if the doctor has sufficient experience, then the patient will practically not experience pain and discomfort. In addition, before the procedure, the tissues of the nasopharynx are irrigated with a 5% solution of novocaine.

Difficulties in catheterization of the auditory tube cause various curvature of the septa. In such situations, the doctor should carefully bypass all obstacles while turning the device. The risk of tissue damage due to curvature of the septum increases.

You should choose a clinic and a specialist in advance for such manipulations. This issue should be approached with full responsibility.

Effects

When performing a procedure such as catheterization of the auditory tube, rough movements and jerking are not allowed. Such manipulations can lead to serious rupture of the mucous membrane. This, in turn, can cause severe bleeding.

A doctor who does not have experience and skill may confuse the mouth of the Eustachian tube with the nasopharynx. It can also have serious consequences. In this case, blowing or administering the drug will only aggravate the patient's condition. If, during the procedure, the patient feels severe pain, then it is necessary to tell the doctor about this. In such cases, the specialist must stop manipulating.

If the procedure is not performed correctly, submucous emphysema may develop. This leads to painful sensations when swallowing. In addition, the patient will feel that there is a foreign object in the pharyngeal region. The presence of such a deviation is indicated by a strong swelling of the palate, which can be detected by visual inspection.

Contraindications

Catheterization of the auditory tube, reviews of which are mostly positive, although patients note discomfort, is carried out quickly and gives good results. However, there are a number of contraindications. This procedure is not carried out with:

1. The presence of an acute inflammatory process.
2. Neurological ailments.
3. Parkinson's disease.
4. Epilepsy.
5. Psychological disorders.

In such cases, the procedure can cause the development of serious complications. It is for this reason that many specialists rarely resort to catheterization of the auditory tube, but turn to alternative methods.

Disadvantages of the procedure

Catheterization of the auditory tube with Dexamethasone and other drugs is an effective procedure for a number of diseases. However, it also has some disadvantages. First of all, the invasive method should be highlighted. The procedure is not very pleasant. Often, impressionable people lose consciousness during the catheterization process.

In fact, the procedure is extremely rare, carried out in a hospital. For the diagnosis of diseases, objective research methods have recently been used, including endoscopy of the inner opening of the auditory tube and otoscopy using a video otoscope.