From Big Medical Encyclopedia

OTOSKOPIYA (grech, us, ot[os] an ear + skopeo to consider, investigate) — an endoscopic method of survey of outside acoustical pass, a tympanic membrane, and at its destruction — a labyrinth wall of a drum cavity and the educations which are in it. By the lake it is developed A. F. Troltsch.

The light source, a frontal mirror and a set of ear speculums are necessary for O. (see. Otorhinolaryngological tools ).

As a light source use daylight, but artificial lighting, in particular light reflected from a frontal mirror is more often. A number of models of reflectors is developed for O., in to-rykh there is a bulb strengthened just before the mirror reflecting rays of light. As this reflector (unlike applied in neurosurgery) at survey is just before a face of the doctor, according to eyes in it dredging or openings is made. There are also special devices with autonomous lighting (the electric battery is inserted into the handle, and light from a bulb goes to an ear speculum) and the increasing lens.

A set of endoscopic mirrors for otorhinolaryngologists with the lighting block is developed and is produced in lots, from to-rogo a beam of light on the light guide goes to an auricle.

Fig. 1. Position of hands of the right and left ear of the patient investigating at survey by means of an ear speculum.

At O. the doctor and the patient sit against each other. The light source is in area of the right ear of the patient. The patient turns the head approximately on 90 ° aside, opposite to the inspected ear. After external examination and a palpation of an auricle, a mastoid, a trestle and adjacent areas straighten outside acoustical pass. For this purpose at children of advanced age and adults the auricle is delayed by kzad and up. At O. of babies the auricle for a lobe is delayed down. Having directed light from a reflector, examine an entrance and an initial part of outside acoustical pass. Having convinced of lack of any education interfering introduction of an ear speculum (e.g., a furuncle), carefully, easy rotary motions enter it into outside acoustical pass. At survey of the right ear the ear speculum is fixed I and II fingers of the right hand, and the auricle is delayed the left hand (fig. 1). At survey of the left ear — on the contrary. It is not necessary to enter an ear speculum more deeply than 1 — 1,5 cm since it is impossible to expand a bone part of outside acoustical pass. Introduction to this department of a funnel is sharply painful. Directing light of a reflector to an ear speculum, consistently examine deep departments of outside acoustical pass and a tympanic membrane.

Skin of outside acoustical pass is slightly more pale, than the skin covering other departments of the person. Distinguish two parts of a tympanic membrane — tense and loose (flabby). The tense part of a normal tympanic membrane of grayish-bluish color with pearly luster. However color varies it depending on the applied light source. So, e.g., during the use of an oil lamp it is yellowish. The loose, upper part of a tympanic membrane concluded in drum cutting, more pale. In the center of a tympanic membrane there is a deepening — a navel. Between it and anteroinferior edge of a tympanic membrane the so-called light reflex (a light cone) appearing only during O. as a result of reflection of rays of light from a concave surface of a tympanic membrane (an episeme, important from the clinical point of view) is formed. Kperedi and up from a navel is visible the handle of a hammer translucent through periblasts of a tympanic membrane, the cut departs from an upper part a side (short) shoot of a hammer. The front and back folds of a hammer which are border between the tense and loose parts depart from a side shoot of a kpereda and a kzada tympanic membrane (see).

Limited, sharply painful swelling and dermahemia of webby and cartilaginous department of outside acoustical pass are observed at a furuncle. The diffuse hyperemia, a swelling, a scanty discharge, desquamation of an epithelium testify to a diffusion inflammation of outside acoustical pass. At development of inflammatory process in a tympanic membrane the light reflex disappears or the injection (expansion) of blood vessels, then more or less expressed hyperemia is deformed, develops. At acute purulent average otitis, in addition, protrusion of a tympanic membrane, further its perforation is noted; through a perforation opening pus is emitted. At hron, a purulent inflammation of a middle ear the perforation opening in a tympanic membrane remains a long time, through it pus is emitted. Granulations, polyps, a cholesteatoma are quite often visible.

Nek-ry specialists apply usual lenses with increase in Zkh to more detailed survey — 8kh, to-rye establish before an ear speculum.

Detailed survey and definition of mobility of a tympanic membrane make, applying a pneumatic funnel of Zigle. This funnel (a wide part it is hermetically closed by a lens) is densely entered into outside acoustical pass. By means of the rubber bulb connected to a funnel in outside acoustical pass alternately raise and lower pressure. The movements of a tympanic membrane observe through the built-in lens.

Fig. 2. Survey of an ear of the patient by means of an operative microscope.

More carefully O. can be made with the help operative microscope (see). Position of the doctor, patient and a technique of introduction of an ear speculum at the same time same as at a research using a frontal mirror, however use the light source which is available in a microscope (fig. 2).

Under O.'s control make a toilet of an ear, removal of foreign bodys from outside acoustical pass, and also various operative measures — paracentesis (see), tympanotomy, removal of polyps, granulations etc. By means of a microscope, in addition to the specified operative measures, carry out a stapedectomy, a stapedoplasty, a tympanoplasty, a tympanotomy, etc.

Bibliography: The multivolume guide to otorhinolaryngology, under the editorship of A. G. Likhachev, t. 1, page 263, M., 1960.

Yu. B. Preobrazhensky.