[Diagnostics of endolymphatic hydrops].

The objective of the present work was to analyse the methods for diagnostics of endolymphatic hydrops associated with Miniere's disease most frequently employed in clinical practice using both the data from the world scientific literature and our own 25-30 year experience based on the observation of more than 500 patients. Camertonal studies of hearing acuity estimated from the results of air conduction measurements and relevant acoumetric curves were considered. The main methods of research are discussed including such as tonal threshold audiometry, ultrasound testing, loud sound lateralization, dehydration test, extratympanic electrocochleography, otoacoustic emission, and functional computed stabilometry. It is concluded that none of the above methods is as reliable as to yield the comprehensive information being sought. All the data obtained by the application of these techniques need to be supplemented by the medical history data, the patients' complaints, clinical signs and symptoms of the disease if the definitive diagnosis of endolymphatic hydrops is to be made.

[The results of laser-assisted piston stapedoplasty in the patients with otosclerosis].

The objective of the present study was to compare the immediate result of laser-assisted piston stapedoplasty with the use of prosthetic stapes of different diameter in the patients with otosclerosis. The patients of both (study and control) groups underwent the measurement of the bone conduction (BC) auditory threshold before, 10-12 days, and 1 month after surgery. The bone-air interval (BAI) was measured in the same time periods. A CO2 laser was used to form a hole 0.5 mm in diameter at the base of the stirrup bone in the patients of group 1; titanium prostheses (Heinz Kurz GmbH) were 0.4 mm in diameter and 4.25 mm in length. The patients of group 2 were treated similarly, but the hole at the base of the stirrup bone had a greater diameter of 0.7 mm while the prostheses were 0.6 mm in diameter and 4.25 mm in length. The BC auditory thresholds were not significantly different after surgery in the patients of A and B subgroups (mixed forms I and II of otosclerosis, respectively). The postoperative BAI values in the patients with a larger hole at the base of the stirrup bone and prostheses of greater diameter were significantly lower than in the patients of the other group (p≤0,05). These data suggest that the use of prostheses of greater diameter has certain advantages for stapedoplasty by the methos employed in the present study.

[The retrospective clinical study of labyrinthine fistula associated with chronic suppurative otitis media and their treatment].

The objective of the present retrospective study was to estimate the efficacy of various surgical techniques employed to treat the patients presenting with chronic suppurative otitis media (CSOM) and concomitant cholesteatoma complicated by labyrinthine fistula. The authors present an overview of the literature concerning diagnostics and results of the surgical treatment of labyrinthine fistula (LF) in the patients with CSOM and concomitant cholesteatoma. The original studies included 157 patients with this condition complicated by labyrinthine fistula. The latter was diagnosed based on the data from medical histories, subjective complaints of the patients, results of otomicroscopy, the presence of fistula symptom verified by the pressure test, results of audiological and vestibulometric studies, and computed tomography (CT) of the temporal bones. Late outcomes of the surgical treatment in the patients presenting with CSOM and concomitant cholesteatoma complicated by LF. All the patients underwent sanitation surgery on the middle ear and revision of the mastoidal portion of the cavity. In 48 of them, cholesteatoma matrix on the fistula in situ was preserved (group 1), in 56 ones the removal of the matrix was followed by plastic correction of labyrinthine fistula using various autogenous tissues (group 2), in 53 patients the cholesteatoma matrix was either removed or preserved with the subsequent sealing of the semicircular canal and selective laser destruction of the labyrinth (LDL) (group 3). 79% of the patients in group 1 had no complaints of dizziness during the postoperative period. There were 78.5% and 96.5% of the patients without such complaints in groups 2 and 3 respectively. The elevation of the hearing threshold following the surgical treatment was documented in 10 (6.4%) patients; it resulted in the deafness in 5 (3%) patients.

[The results of stapedoplasty with the use of an auricular autocartilage as a stapes bone prosthesis in the patients presenting with a mixed form of otosclerosis].

The authors present immediate and long-term results of stapedoplasty with the use of an auricular autocartilage as a stapes bone prosthesis in 52 patients presenting with mixed (types I and II) otosclerosis. The surgical procedure is described in considerable detail. The average bone-conduction auditory threshold was shown to slightly increase depending on the duration of the disease (less than and over 15 years): by 5 dB and 9 dB in mixed otosclerosis of types I and II respectively. Mean values of the bone-conduction auditory threshold before and after surgery were not significantly different depending on the localization of otosclerotic foci in patients with the mixed (types I and II) disease (affecting the annular ligament and the base of the stapes bone in 20 patients; annular ligament, base of the stapes, and promontory in 32 ones). The average bone-air gap (BAG) in the early and late observation periods did not exceed 10 dB in either form of otosclerosis which suggests high efficacy of the surgical treatment given to the patients in the present study.

[Differential atticoanthrotomy with type 1 tympanoplasty as the method of choice for the treatment of chronic perforating otitis media with expressed mucositis].

The authors report the results of surgical treatment of 37 patients (42 ears) presenting with chronic perforating otitis media and grade I-III mucositis. All the patients were treated by differential atticoanthrotomy with type 1 tympanoplasty. Most of them suffered seriously disturbed ventilation and drainage functions of the Eustachian tube. Mean bone conduction and air conduction audibility thresholds for the voice frequency (0.5-2 kHz) prior to surgery were 12.5 +/- 6.7 and 12.0 +/- 4.2, 14.2 +/- 4.6 and 45.1 +/- 11.7 dB, 46.2 +/- 8.4 and 58.4 +/- 8.6 dB, respectively. Large defects of the tympanic membrane necessitated the use of a composite flap (autofascia and autocartilage) as the tympanic membrane autograft. Excellent survival of the tympanic autograft was documented in 33 (78.6%) patients. The remaining 9 patients had perforations in the neotympanic membrane of different size. Mean bone conduction and air conduction audibility thresholds for the voice frequency upon discharge from the clinic were 14.3 +/- 4.2, 14.0 +/- 4.4, 16.2 +/- 4.2 and 35.9 +/- 12.4 dB, 36.2 +/- 10.4, 46.6 +/- 8.2 dB, respectively. The functional outcome of the surgical treatment further improved in half a year due to the fact that the sound-conducting system acquired a higher rigidity (mean audibility thresholds for air conduction became 32.6 +/- 8.4, 34.0 +/- 6.8, and 42.2 +/- 8.4 dB. Audibility thresholds for bone conduction remained practically unaltered compared with their vales upon discharge from the clinic.

[Diagnosis of labyrinthine fistula in patients suffering from otitis media purulenta chronica with cholesteatoma: informative value of different methods].

Informative content of different methods of labyrinthine fistulas (LF) diagnosis was assessed in 118 patients suffering from otitis media purulenta chronica (OMPC) with cholesteatoma which ran for 20 years and longer in 82.2% patients, 83.9% had fistula symptom. Unilateral hypoacusis was diagnosed in 68 (57.6%), bilateral--in 50 (42.4%) patients. Severity of vestibular disorders correlated positively with LF size and duration of the disease. Advanced LF was detected in 65 (55.1%) patients, multiple--in 7 (5.9%). Computed tomography of the temporal bone detected LF in all 29 OMPC examinees including "silent" fistulas. Thus, the disease history, clinically manifest fistula symptom and CT of the temporal bone are most informative for diagnosis of LF in OMPC with cholesteatoma.

[Treatment of patients with subjective noise in the ears].

Subjective noise in the ears arises in affection of different systems of a human body (cardiovascular, endocrine, CNS, etc.), but this noise may be also one of the earliest symptoms of different diseases of the ear accompanied, as a rule, with conductive or neurosensory hypoacusis. Phonometry is an indirect psychophysical method of measurement of subjective noise in the ear, and is one of the methods of differential diagnosis of this noise. Current methods of suppression of subjective noise in the ears in chronic neurosensory hypoacusis are sketched. A placebo effect was also achieved.

[A course of early Meniere's disease].

Clinical manifestations are described and examination data are provided for 120 patients with Meniere's disease (MD) running for one year and less (mean 5.2 months). The patients' age varied from 15 to 66 years (mean 39.8 years). Unilateral MD was diagnosed in 95% patients, cochlear MD - in 58.3%, classic one - in the rest patients. Minor or moderate hypoacusis was found in 85% examinees. Mean 18.6 dB bone-air interval at low frequency was detected in 75% patients. Vestibular reflex was reduced insignificantly in 52.5% patients, 45% patients had hypofunction of the third-fourth degree. Early MD was also characterized by ascending or horizontal audiometric curve, positive dehydration test in 85% cases, the acoustic reflex due to accelerated sound intensification in 95% cases, 100% speech intelligibility.

[Laser destruction of labyrinthine receptors as a treatment for benign paroxysmal postural vertigo and otolith symptoms].

Outcomes of surgical laser treatment are presented for 15 patients with resistant to conservative therapy benign paroxysmal postural vertigo (BPPV) and otolith-related disorders. Nine patients with Meniere's disease with BPPV (n=3) and otoliths (in all the patients) were exposed to laser impulses on the bony wall of the horizontal semicircular canal. The impulse was directed in the lumen of the canal in 6 patients with BPPV and otolith symptoms. In Meniere's patients vertigo stopped, hearing was at the preoperative level. Neither threy had BPPV nor otolith problems. The same results were obtained in 6 patients with the other diseases. Vestibular excitability of all surgically treated patients decreased to the fifth degree.

[Mathematical modeling of laser-induced selective destruction of labyrinthine vestibular receptors].

Basing on mathematical modeling, we tried to investigate in humans the ability of laser energy to suppress the function of the ampullar receptors of the semicircular canels and otolith receptors; to elicit mechanism of action of laser energy on labyrinthine receptors. Modeling has shown that in 1 mm thickness of the canal wall laser impact raises temperature of the liquid to 120 degrees C. Temperature higher than 100 degrees C stands in it up to 120 ms. This induces a distinct hydrodynamic shock which suppresses function of labyrinthine ampullar and otolith receptors. The heat factor of the laser impact causes destruction of the receptor sensory cells lasting for about a year.

[Efficacy of conventional methods of treating otitis media purulenta chronica in patients with cholesteatoma and fistula of the labyrinth].

Efficacy of two routine surgical methods was compared in patients with otitis media purulenta chronica having cholesteatoma and fistula. Twenty five patients were operated on the middle ear with preservation of cholesteatoma matrix fragment on fistula of the labyrinth (FL). Forty five patients were operated with plastic reconstruction of the fistula with autotissues. The acoustic and vestibular functions were studied before and after the operation, 3 years later using roentgenography of the temporal bones and high performance computed tomography of the temporal bones. As the results of surgery in both groups of patients were similar, both techniques can be applied in detection of FL at operation. It is shown that in unaffected acoustic and vestibular functions in conditions of active inflammation in the middle ear, it is advisable while operating on the middle ear to preserve matrix of cholesteatoma on FL of any location.

[Treatment of subjective noise in the ear by impulse low-frequency electromagnetic field (preliminary results)]. / Lechenie sub''ektivnogo ushnogo shuma s pomoshch'iu impul'snogo nizkochastotnogo élektromagnitnogo polia (predvaritel'nye rezul'taty).

25 patients with subjective noise in the ears, primarily in neurosensory hypoacusis, were exposed to pulse low-frequency electromagnetic field (PLFEMF) generated by INFITA unit with attached device ELEMAGS. The noise complaints began 1 to 10 years before. The previous conservative therapy failed. PLFEMF eliminated the noise in 2 patients, reduced it noticeably (by 60%) or changed its tone in 19 patients. At 6-12-month follow-up positive effect persisted. The results of the study allow the authors to recommend PLFEMF for wide clinical practice.

[R-factor from the natural strain of Salmonella derby carrying a DNA-polymerase gene]. / R-faktor iz prirodnogo shtamma Salmonella derby, nesushchii gen DNK-polimerazy.

A R-factor which determines multiple stability to antibiotics (Cm, Pn, Sm) was found in a Salmonella derby strain isolated from the clinical material. The plasmid was eliminated by treatment with ethidium bromide; the DNA-polymerase activity in the antibiotic-sensitive derivatives measured under conditions optimal for DNA-polymerase I from E. coli was found to be decreased 10-50-fold. Plasmid DNA of S. derby K89 was fractionated by electrophoresis in agarose gel; individual zones I-IV were obtained, using a preparative technique. Upon transformation of S. derby K82 pol- cells, only plasmid DNA in zone II (designed as pSD Cm pol) gave Cm-resistant transformants, in which the DNA-polymerase activity decreased to the normal level. The experimental results pont to the binding of the DNA-polymerase gene to the S. derby plasmid.