Atresia of acoustical pass – the congenital or acquired obliteration of the bone and cartilaginous channel connecting an auricle to a middle ear. Zarashcheny the acoustical course is followed by decrease in auditory acuity up to deafness. Congenital atresias are often combined with a mikrotiya and other anomalies of development. Diagnostics includes survey of the otolaryngologist with an otoskopiya, carrying out an audiometriya and computer tomography of a temporal bone. At bone zarashcheniye carry out a skull X-ray analysis. Treatment of pathology – surgical. During operation form the artificial channel by means of skin and cartilaginous rags; if necessary carry out a timpanoplastika. Anomalies of an auricle demand plastic reconstructive surgery.
Atresia of acoustical pass
The term "atresia" means total absence of natural channels and openings in an organism. Zarashcheny acoustical pass - a rare disease which can be combined with pathology of a middle and inner ear, an underdevelopment of auricles. Congenital anomaly meets in otolaryngology more often of acquired and makes 1 case on 10 thousand newborns. A ratio of boys and girls with this disease 1,5:1. Unilateral defeat arises by 3 times more often than bilateral. The atresia of acoustical pass to 11-17% of cases is combined with sensonevralny relative deafness (sound perception difficulty).
The reasons causing development of an atresia of the acoustical channel are divided into two big groups:
- Congenital. This pathology is connected with pre-natal violation of laying 1 and 2 of a branchiate arch. Development of anomaly in newborns is accompanied by the infections transferred the pregnant woman (a rubella, a cytomegalovirus, flu, chicken pox) with reception of the medicines having teratogenny effect, influence of radioactive radiation by it. In risk group there are children of mothers suffering from alcoholic, drug, tobacco addiction. The advanced age of the woman in labor (after 40 years), the is higher probability of development of an atresia of the external acoustical channel. Often anomaly is followed by bilateral defeat and is combined with defect of an auricle (mikrotiy).
- Acquired. Burns, wounds, injuries and fractures of a temporal bone often lead to formation of a bone atresia. The cartilaginous zarashcheniye is formed at recurrent purulent otitises and other inflammatory diseases.
The modern community of the operating otolaryngologists uses classification of the German doctor Mr. Shukhnekht. This division reflects correlation of pathological changes of acoustical pass and expressiveness of decrease in hearing. Classification allocates four main types of atresias:
- The A type — an obliteration of cartilaginous department of the external channel. Decrease in hearing of 1 degree is noted.
- The B type — a zarashcheniye arises in cartilaginous and bone departments. Decrease in sound perception reaches to 2-3 degrees.
- The C type — a full atresia of the channel which often is followed by an eardrum hypoplasia.
- The D type — a full zarashcheniye with anomaly of structures of an inner ear (a snail, stones), pathology of a facial nerve. At these changes do not carry out surgical correction, violation of sound perception has irreversible character.
Symptoms of a congenital atresia it is possible to notice during the first hours the newborn's lives. They are shown by change of a shape of an auricle (mikrotiy), narrowing of the acoustical channel. When carrying out an audiogramma unilateral or bilateral decrease in hearing is noted. Congenital anomalies are often combined with paresis of a facial nerve, asymmetry of the person, malformations of other systems and bodies (congenital heart diseases, retinopathies). At late diagnostics are possible an arrest of development of the speech, formation of imagination, memory and thinking.
The acquired atresia is shown by relative deafness development. At a complication of chronic purulent processes in connection with violation of outflow of purulent separated there are pain, temperature increase of a body, deterioration in the general condition of the patient. If in time not to take medical measures, development of intra cranial complications (meningitis, encephalitis) and osteomyelitis is possible. The incomplete zarashcheniye of acoustical pass can not give a clear clinical picture. However over time, at obstruction of the narrowed channel permanent decrease in hearing arises sulfur.
For diagnosis, exact definition of a form and a type of an atresia, definition of indications and volume of surgery it is necessary to carry out complex diagnostics of organs of hearing. For the purpose of detection of congenital anomalies of development in a fruit to women carry out screening ultrasonography on 20, 31-32 weeks of pregnancy. Diagnostics of different forms of an atresia takes place in several directions:
- Survey of the otolaryngologist with carrying out an otoskopiya. The otolaryngologist carries out assessment of passability of the external acoustical channel, appearance of an eardrum.
- Audiometriya. The expert defines auditory acuity, sensitivity of the hearing aid to sound waves of different frequency.
- KT of a temporal bone. Helps to define the obliteration reason, existence of purulent contents, and also development of complications. It is applied to specification of the diagnosis and scoping of operation.
- Skull X-ray analysis in 2 projections (direct and side). The technique is applied at bone zarashcheniye of acoustical pass. Fish soup can determine the defeat scale, liquid availability (pus, blood) by the roentgenogram on average.
Differential diagnostics of atresias of acoustical pass should be carried out with new growths of an external ear. In this case the anamnesis of a disease and additional methods of a research (a computer tomography, an otoskopiya) will help to define localization of the tumor closing a gleam of the channel. Diagnosis is carried out after consultation of the therapist or the pediatrician, the audiologist, in certain cases genetics.
The main method of treatment of atresias - surgical. Only at an initial stage of the acquired form of a disease resort to mechanical expansion of acoustical pass. After diagnosis the expert resolves an issue of a possibility of operation and the choice of the equipment. The purpose of intervention is restoration of a gleam of the acoustical channel for ensuring normal sound carrying out and sound perception. Correction of congenital anomalies consists of several stages. In the beginning carry out temporary hearing aid. For this purpose carry out individual selection, control acoustical devices and psychological assistance in social adaptation of the child. At integrity of an eardrum and inner ear (acoustical stones, a snail) pass to surgical treatment.
In the beginning operations carry out excision of pathological membranes and hems. Then start creation of the artificial course which walls cover with a skin rag or fragments of the cartilage taken from a rudimentary auricle. If necessary carry out a timpanoplastika, forming a new eardrum of a fastion of a temporal muscle. Because the atresia is often combined with anomaly of development of an auricle, besides reconstructive operation on acoustical pass, carry out plasticity of an auricle with formation of cartilaginous tissue.
Any intervention is followed by purpose of the antibacterial, anesthetizing and anti-inflammatory therapy. After operation observation of the audiologist, neurologist and logopedist is recommended to the child. Routine inspections of the otolaryngologist should be had at least 1 time in 2-3 months. For adaptation in society occupations with the psychologist are recommended.
The outcome of an atresia of acoustical pass depends on a type of a zarashcheniye (congenital and acquired, full and incomplete), weights of process. At congenital anomaly the forecast in most cases unfavourable since pathology most often is followed by damage of an inner ear and facial nerve. In the surgical way it is not always possible to return hearing to the patient completely. At pathology of external departments experts manage to achieve positive results in 70-75% of cases. The surgery of the acquired atresias often yields positive results and leads to increase in hearing and improvement of quality of life.