Method for measuring area of pharyngeal opening of auditory tube

Abstract

FIELD: medicine; otorhinolaryngology.SUBSTANCE: using a recording device, the resulting endoscopic image of the pharyngeal opening of the auditory tube is recorded and saved in jpeg format. Then, using the computer program for image analysis and processing Image J, parameters such as the focal length of the endoscope, the size of the endoscope matrix, and the distance of the endoscope to the patient's tubular roller are set. Then, on the saved image, using the function for measuring the area of an irregular figure, the contour of the pharyngeal opening of the auditory tube is outlined and its area is measured, obtaining the result in absolute units, in pixels.EFFECT: method allows for increasing the accuracy and reliability of determining the condition of the auditory tube by obtaining patient-specific parameters of the area of the pharyngeal opening of the auditory tube, which are necessary and sufficient for assessing the quality of functioning.1 cl, 2 dwg, 1 ex

Description

[0001] The invention relates to medicine, namely to otolaryngology, and can be used to assess the condition of the pharyngeal opening of the auditory tube in patients with auditory tube dehiscence syndrome.

[0002] The auditory tube is a canal connecting the middle ear to the nasopharynx. It performs several important physiological functions: equalizing pressure on both sides of the eardrum, ventilation and drainage of the middle ear, and protection against infection. The auditory tube allows air from the pharynx to enter the tympanic cavity, thereby maintaining equilibrium between the pressure in this cavity and the external atmospheric pressure, which is necessary for the proper conduction of vibrations of the eardrum to the labyrinth.

[0003] The auditory tube consists of a bony and a membranous-cartilaginous section, opening into the tympanic cavity and the nasal part of the pharynx, respectively. The pharyngeal opening of the auditory tube (ostium pharyngeum tubae auditivae) is located on the lateral wall of the nasal part of the pharynx at the level of the posterior end of the inferior nasal concha and 1 cm posterior to it. The opening lies in a fossa, limited above and behind by a protrusion of the tubular cartilage (torus tubarius), behind which there is a depression - the Rosenmüllerian fossa. The mucous membrane lining the tube is a continuation of the mucous membrane of the tympanic cavity. It is thin, smooth, tightly attached in the bony section, and looser in the cartilaginous section. The epithelium of the mucous membrane of the tube is multi-row ciliated (the movement of the cilia is directed from the tympanic cavity to the nasal part of the pharynx).

[0004] The length of the auditory tube in adults is 33-39 mm, most commonly 36 mm (12 mm for the bony portion and 24 mm for the cartilaginous portion). The lumen of the auditory tube at its maximum opening in the bony portion is 5-6 mm high and 3-4 mm wide, while in the cartilaginous portion, the corresponding dimensions are 8-20 mm high and 5-6 mm wide.

[0005] Otomicroscopy can be used to diagnose Eustachian tube pathologies. It reveals the condition of the eardrum during tube dysfunction. With an intact eardrum, this method allows for an assessment of the condition of the middle ear based on the nature of its changes. Surgical microscopes from Karl Zeiss (Germany) and Miko-LOR-LOMO (Russia) can be used for otomicroscopy. Working magnification ranges from 10x to 25x. With an intact eardrum, specific areas of retraction, restricted mobility, and retraction pockets are relatively easy to detect. In exudative otitis media, changes in the shade of the eardrum depend on the duration of the process, as well as the color and consistency of the transudate. After successful inflation of the Eustachian tube, such patients experience bubbles of foamy exudate. If the exudate does not occupy the entire tympanic cavity, its level is visible, changing with changes in the position of the head.If the eardrum is intact and the ventilation function of the auditory tube is preserved, its characteristic movement is observed.

[0006] Pathological conditions of the auditory tube are often accompanied by impaired sound perception. Therefore, threshold pure-tone audiometry is used to examine hearing status, primarily the degree of conductive hearing loss, which is most characteristic of eustachian tube pathology. The average threshold of pure-tone perception is calculated according to the international classification of hearing loss in the speech frequency range (0.5; 1; 2 and 4 kHz), as well as the average air-bone gap (interval). However, given the significant number of ear diseases leading to conductive hearing loss, it should be noted that threshold pure-tone audiometry is valuable only in combination with other methods, such as tympanometry. Studies can be conducted using the Autotimp-GSI-37 by Grason-Stadler (USA) and the AZ-26 Impedanceometer by Interacoustics (Denmark). Tympanometry most accurately reflects the equipressor-ventilatory function with an intact eardrum.It was conducted dynamically (swallowing movements, Toynbee and Valsalva tests). The latter can be used to determine the Williams test (ETF1) in automatic or manual mode for imperforate eardrums. The data obtained allow for an assessment of the patency of the Eustachian tube. Tympanogram shapes, both normal and in various pathologies, vary somewhat. It is believed that the function of the Eustachian tube can be assessed by tympanometric examination based on the intratympanic pressure. Normal values ​​vary slightly – from -100 to +100 daPa. A decrease in intratympanic pressure below normal indicates tubal insufficiency. Based on this sign, tympanograms are classified as "C.1" (peak up to -199 daPa) and "C.2".

[0007] Various technical solutions are known in the area under consideration.

[0008] For example, Russian Federation Patent for Invention No. 2630352 (IPC A61M 25 / 00, published September 7, 2017) is known. The patient's nasal mucosa is first anesthetized by administering 0.6 ml of a 0.05% xylometazoline solution over 4 minutes. An endoscopic examination is performed in the nasal cavity and nasopharynx to determine structural features, the presence or absence of a deviated septum, the size of the inferior and middle turbinates, and the width of the common nasal meatus. The lateral wall of the nasopharynx is examined by inserting a rigid endoscope into the side of the nose opposite the one being examined, and the location and structure of the tubular ridge are assessed. A metal guidewire, an elastic catheter, and a flexible endoscope are inserted into the nasal cavity from the side of the ear being examined and advanced to the pharyngeal orifice of the auditory tube, where they are catheterized. The elastic catheter is advanced 1.5-2 cm into the lumen of the auditory tube. A microendoscope is inserted into the lumen of the elastic catheter to its distal end.An elastic catheter and microendoscope are advanced through the lumen of the auditory tube to a depth of 2.5 cm. Transillumination is performed from the side of the eardrum of the ear being examined, and the position of the distal end of the microendoscope is determined by the glow. The elastic catheter and microendoscope are advanced to the tympanic orifice of the auditory tube, and the tympanic cavity is examined. During the removal of the elastic catheter with the microendoscope installed inside at the distal end and the formation of a widening of the lumen of the auditory tube, the endoscopic image of the lumen is assessed. Pathological formations in the form of scars, adhesions, mucous discharge, and polypous changes in the mucous membrane are identified. The microendoscope and elastic catheter are reinserted into the tympanic orifice, and a control transillumination is performed. The microendoscope is removed from the elastic catheter. The condition of the eardrum is determined using an endoscope with a 0° field of view and a diameter of 2.7 mm. A 10 cm syringe is used. 3, connected to the transition cone of the elastic catheter, the auditory tube and tympanic cavity are washed with sterile 0.9% sodium chloride solution in the amount of 15 ml and treatment is carried out by introducing 5 ml of a medicinal solution consisting of 0.5 ml of 0.1% dexamethasone solution and 4.5 ml of 0.9% sodium chloride solution, whereby 2.5 ml of the solution is introduced into the area of ​​​​the tympanic opening, and 1.25 ml into the area of ​​​​the isthmus and pharyngeal opening of the auditory tube. The elastic catheter is removed from the lumen of the auditory tube, and the metal device from the nasal cavity. The condition of the auditory tube is assessed 24, 48, 72 hours after the manipulation. Acoustic impedancemetry is used to determine the condition of the auditory tube on the 7th, 14th, 28th day.

[0009] Russian Federation Patent for Invention No. 2706027 (IPC A61B1 / 00, published November 13, 2019) is known. The ventilation function of the eustachian tube is assessed using functional tests. The cartilaginous portion is examined by luxating the inferior tubular ridge, thereby opening the orifice of the eustachian tube. The examination is conducted in several stages: an endoscopic examination, functional tests with video recording, such as the Lutzer otoscope test, the Toynbee test, the Valsalva test, and determining the time and degree of eustachian tube opening.

[0010] Russian Federation Patent for Invention No. 2388406 (IPC A61B 5 / 12, published May 10, 2010) is known. This method is an objective method for assessing the patency of the Eustachian tube, more accurate due to the very high sensitivity of the laser autodyne used as a recording device and the absence of an influence on the measurement of the condition of the nasal cavity and nasopharynx. The method is also simpler and more convenient, since it does not require invasive manipulations (insertion of a catheter or sound guide into the Eustachian tube). Empty throat tests, Toynbee tests and Valsalva tests are performed, during which a probing sinusoidal sound signal with a frequency of 1000-1500 Hz and an intensity of 85 dB is fed into the external auditory canal and a spectrogram of the tympanic membrane vibrations is recorded using the laser autodyne method, in which the peaks of the fundamental tone and harmonics that are multiples of the fundamental tone are recorded.After which, a spectrogram is recorded when the subject performs an empty swallow, the Toynbee test, and the Valsalva test, and in the event of a change in the clearly visible peaks of the fundamental tone and harmonics of the spectrogram to a chaotic appearance when performing an empty swallow, patency of the auditory tube of the first degree is diagnosed, and with the same change in the spectrogram when performing the Toynbee test, patency of the second degree is diagnosed, and with the same change in the spectrogram when performing the Valsalva test, patency of the third degree of the auditory tube is diagnosed, and in the absence of changes in the spectral picture of the autodyne signal when applying the probing signal and performing all three of the indicated tests, obstruction of the auditory tube is diagnosed.

[0011] Russian Federation patent for invention No. 2342072 is known (IPC A61B 5 / 12, published 12 / 27 / 2008). Nasopharyngeal pressure is measured with a gradual increase in pressure in the nasopharynx during sequential performance of functional tests for patency of the auditory tube: swallow tests, Toynbee test, Valsalva test, and in addition, the passage of air through the auditory tube is determined by changing the compliance of the tympano-ossicular system using an acoustic impedance meter in the Decay Reflex Test mode with switched off or subthreshold stimulation, and the nasopharyngeal pressure recorded at the moment of changing the compliance of the tympano-ossicular system is noted as the opening pressure of the auditory tube and if the opening pressure of the auditory tube is more than 450 mm H20, a disease of the auditory tube is diagnosed, the severity of which is proportional to the measured pressure.

[0012] Based on the combination of essential features, the closest technical solution to the proposed one, and accordingly accepted as a prototype, is Russian Federation Patent for Invention No. 2719926 (IPC A61B 5 / 08, A61B 5 / 107, published on April 23, 2020). A method for assessing the condition of the internal nasal valve, intended for patients with pathology of the vestibular part of the nasal cavity, includes an examination of the internal nasal valve during treatment using video systems, measuring its area from the obtained images and comparing images before and after treatment, an endoscopic examination is performed before, during and after surgery using a rigid endoscope of 0 degrees., which is placed inside the nasal cavity 1 cm from the vestibule of the nose, using a DVD recording device, the resulting endoscopic image of the internal nasal valve is recorded, saved in jpeg format, and then on a computer, after which, using the computer program for analyzing and processing images NoseSpace, first set such parameters as the focal length of the endoscope, the size of the endoscope matrix, the distance of the endoscope to the patient's internal nasal valve, then on the saved image, using the function for measuring the area of ​​​​an irregular figure, outline the contour of the internal nasal valve and measure its area, obtaining the result in absolute units, in mm. 2 .

[0013] The known invention has a major drawback - the inability to measure the area of ​​the pharyngeal opening. The known solution is only applicable for assessing the condition internal nasal valve.

[0014] The technical problem in the area under consideration, which is the shortcoming of the known solutions, is the lack of the ability to measure the area of ​​the pharyngeal opening, which does not allow for an accurate assessment of the condition of the auditory tube and the making of informed decisions regarding the need for surgical treatment or conservative therapy.

[0015] For timely diagnosis of Eustachian tube dysfunction, a comprehensive set of modern diagnostic methods is necessary, including dynamic endoscopy of the nasal cavity and nasopharynx, otomicroscopy, audiometry, and tympanometric examination. Tympanometry more accurately records changes in the middle ear than audiometry. Optical endoscopy of the nasal cavity and nasopharynx is a mandatory and essential requirement for the modern diagnosis of various pathological conditions of the Eustachian tube. It is indicated for various types of Eustachian tube dysfunction. This ensures clear visualization of pathological processes, which should be recorded by video, allowing for the dynamic monitoring of the effectiveness of the treatment.

[0016] The technical result of the proposed invention consists in increasing the accuracy and reliability of determining the state of the auditory tube, due to obtaining individual patient-specific parameters of the area of ​​the pharyngeal opening of the auditory tube, necessary and sufficient for assessing the quality of functioning.

[0017] The technical result is achieved by the fact that in the method for measuring the area of ​​the pharyngeal opening of the auditory tube using a recording device, the obtained endoscopic image of the pharyngeal opening of the auditory tube is recorded, saved in jpeg format, and then, using a computer program for analyzing and processing images Image J, first such parameters are set as the focal length of the endoscope, the size of the endoscope matrix, the distance of the endoscope to the patient's tubal ridge, then on the saved image, using the function for measuring the area of ​​an irregular figure, the contour of the pharyngeal opening of the auditory tube is outlined and its area is measured, obtaining the result in absolute units, in pixels.

[0018] The essence of the proposed invention is explained by the following figures: Fig. 1, explaining the proposed method, Fig. 2, relating to a clinical case.

[0019] The pharyngeal orifice of the Eustachian tube is examined dynamically during treatment using video systems. Its area is measured using the obtained images, and the images before and after treatment are compared. An endoscopic examination is performed before, during, and after the procedure using a rigid 0-degree endoscope, which is positioned inside the nasal cavity at a distance of 1 cm from the tubal ridge. Using a DVD recorder, the resulting endoscopic image of the pharyngeal orifice of the Eustachian tube is recorded, saved in JPEG format, and then stored on a computer. Then, using the Image J image analysis and processing software, parameters such as the endoscope focal length, the endoscope matrix size, and the endoscope distance to the patient's tubal ridge are set.Then, on the saved image, using the function for measuring the area of ​​an irregular figure, the contour of the pharyngeal opening of the auditory tube is outlined and its area is measured, obtaining the result in absolute units, in pixels.

[0020] The following parameters were taken into account: endoscope focal length - 24.5 mm (f' = 24.5 mm), distance to the object - 1 cm, matrix size - 1 / 3. On the endoscopic image, using the built-in "measurement of the area of ​​​​an irregular figure" tool located on the taskbar, outline the contour of the pharyngeal opening of the Eustachian tube, selecting it with the mouse cursor in the Image J program. After selecting the area contour, return to the taskbar in the "Measure" section and after clicking the "Analyze" button, automatically obtain the output data for the area of ​​​​the pharyngeal opening of the Eustachian tube in pixels.

[0021] The proposed method can be easily integrated into existing diagnostic protocols, ensuring its widespread use in otolaryngology practice. Measuring the area of ​​the pharyngeal orifice allows for a more accurate assessment of the Eustachian tube and informed decisions regarding the need for surgical or conservative treatment. High accuracy is achieved through the use of modern endoscopic technologies and associated software. Unlike subjective assessment methods, this method provides standardized measurements, which increases the reproducibility and reliability of the obtained data. This is important for dynamic monitoring of the patient's condition and assessing the effectiveness of treatment. The procedure is performed during standard nasopharyngeal endoscopy without the need for additional invasive interventions, reducing the risk of complications and facilitating the procedure for the patient.The use of digital technologies and image analysis algorithms allows for the automation of the measurement process, reducing time costs and eliminating the human factor in data interpretation.

[0022] Clinical case

[0023] Patient M., 32, presented to the clinic with complaints of autphonia, noise in the left ear, and hearing loss on the left side. These complaints have been present for the past three years.

[0024] According to the endoscopic examination of the nasopharynx with visualization of the opening of the auditory tube before surgical treatment, the area of ​​the opening of the auditory tube according to measurements and analysis of the recorded image in the Image J program was 81502 pixels, which made it possible to establish a clinical diagnosis: Syndrome of dehiscence of the auditory tube.

[0025] Under transnasal endoscopic control (0° and 30°) and local application anesthesia with Sol.Lidocaine 10%-2.0, tubal fold augmentation was performed by submucosal injection of 0.2-0.3 ml of a hyaluronic acid-based preparation using a B.Braun Sterican 21G (0.80 x 1.20 mm) injection needle. Hemostasis was stable by the end of the procedure. The patient was discharged home one hour after the procedure.

[0026] A follow-up was conducted the following day and then at 1, 3, 6, and 12 months. At each stage, the patient underwent a series of examinations, including an endoscopic examination of the nasopharynx with measurement of the area of ​​the pharyngeal opening of the Eustachian tube using endoscopic pixel images.

[0027] A - Endoscopic image of the dehiscence of the Eustachian tube. The yellow outline indicates the area for calculating the area of ​​the pharyngeal opening of the Eustachian tube before augmentation.

[0028] B - Endoscopic image of the dehiscence of the Eustachian tube. The yellow outline indicates the area for calculating the area of ​​the pharyngeal opening of the Eustachian tube after augmentation.

[0029] The results of this study demonstrate the high efficiency of the tubal ridge augmentation method using the injection of a hypoallergenic hyaluronic acid-based drug in patients with eustachian tube dehiscence syndrome.

[0030] Objective measurements of the area of ​​the pharyngeal orifice of the Eustachian tube showed a significant reduction after the intervention (from 81,502 pixels to 51,464 pixels), indicating a reduction in dehiscence and, consequently, improved Eustachian tube function. These data are consistent with clinical results and confirm the effectiveness of the augmentation method.

[0031] Thus, thanks to the proposed invention, the accuracy and reliability of determining the state of the pharyngeal opening of the auditory tube is increased, due to obtaining individual parameters for the patient of the area of ​​the pharyngeal opening of the auditory tube, necessary and sufficient for assessing the quality of functioning.

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