[Retrofacial approach to remove a rare chondromyxoid fibroma of the infralabyrinthine space]. / Udalenie redkoi khondromiksoidnoi fibromy infralabirintnogo prostranstva s ispol'zovaniem retrofatsial'nogo dostupa.

A very rare case of 46-yaer-old woman with chondromyxoid fibroma (CMF) of infralabyrinthine area of temporal bone was described in this article. The only manifestation of this disease was a severe temporary pain in the postauricular area with irradiation in the occipital bone and headache during the last 3 months. A detail description of the CT scan and MRI data was presented. Tumor removing was performed through the retrofacial approach with combination of the microscopic and endoscopic assistance technique, which allows to had a good visualization and controlling of tumor separation from the vital structures with hearing and facial nerve function preserve. Also, we presented a brief review of literature with differential diagnosis of the CMF of the temporal bone, which conducted to minimize the diagnosis mismatches in the otologic and head and neck practice and to optimize the treatment of patients with such tumor.

[Anatomical and functional results of ossiculoplasty with adjustable length titanium prostheses with and without hydroxyapatite]. / Anatomicheskie i funktsional'nye rezul'taty ossikuloplastiki s ispol'zovaniem titanovykh protezov s reguliruemoi dlinoi s gidroksiapatitom i bez nego.

OBJECTIVE: To compare the anatomical and functional results of the ossicular chain reconstruction with classic titanium adjustable prostheses and titanium adjustable prostheses with hydroxyapatite cap. MATERIAL AND METHODS: The 300 patients (360 cases) with chronic suppurative otitis media were examined and operated. The patients are divided into 2 groups. Group A included patients who received an ossicular prosthesis with a hydroxyapatite cap (90 cases with a partial prosthesis and 90 with a full one). Group B included patients who received prostheses without hydroxyapatitis (90 cases with a partial prosthesis and 90 with a complete one). The patients who received a prosthesis with a hydroxyapatite cap were divided into two subgroups, depending on the autotissue, which was placed between the prosthesis cap and the nontympanic membrane: this is an autocartilage plate or perichondrium/fascial graft. The follow-up period after surgery was 38.5±14.4 months (from 12 to 48 months). In the long-term postoperative period, the subjects were assessed the values of the bone-air gap (BAG), the consistency of the nontympanic membrane, and the presence of signs of extrusion of the prosthesis cap. Comparison of anatomical and functional results between patients with full and partial ossicular prostheses was performed separately. RESULTS: A good result in the form of a 20 dB or more dB BAG reduction was achieved in 82.2% of patients who received a partial prosthesis (85 patients in group A and 63 in group B), and in 57.8% of patients who received a complete prosthesis (45 patients in group A and 59 in group B). The BAG values in the long-term period after surgery did not statistically significantly differ between patients who received a prosthesis with a hydroxyapatite cap or a fully titanium one (p=0.939 for patients with full prostheses and p=0.745 for patients with partial prostheses). The placement of cartilage or perichondrium/fascial graft between the hydroxyapatite prosthesis cap and the nontympanic membrane also did not affect the functional outcome (with full prostheses - p=0.651, with partial prostheses - p=0.142). CONCLUSION: It is possible to use ossicular prostheses with a hydroxyapatite cap without placing an autocartilaginous plate between the nontympanic membrane and the cap of the prosthesis. In the long term period, functional and anatomical results with hydroxyapatite cap prostheses do not differ statistically significantly from those with all-titanium prostheses.

[The interdisciplinary approach to the rehabilitation of the patients presenting with congenital atresia of the external auditory canal and the concomitant microtia]. / Mezhdistsiplinarnyi podkhod k reabilitatsii patsientov s vrozhdennoi atreziei naruzhnogo slukhovogo prokhoda i mikrotiei.

The objective of the present study was to develop and introduce into the clinical practice the method for the combined aesthetic and functional rehabilitation of the patients presenting with congenital atresia of the external auditory canal (CAEAC) and the concomitant microtia. A total of 8 patients at the age from 6 to 21 years with unilateral CAEAC and microtia were given the surgical treatment. During the intervention, atresia was resolved using the trans-mastoid approach, tympanoplasty of autofasciae and ossiculoplasty making use of the partial titanium prosthesis and the placement of cranial osteointegratable titanium implants. At the second stage of the surgical intervention the 3D silicone prosthesis of the auricle shaped on an individual basis were used. The long-term follow-up observations have demonstrated the stable formation of the tube of the external auditory canal, with the bone-air interval amounting to 15-20 dB. The auricular prosthesis was the mirror image of the natural ear and completely concealed the congenital defect.

[The 'major' complications of cochlear implantation]. / 'Bol'shie' oslozhneniia kokhlearnoi implantatsii.

AIM: The objective of the present study was to improve the selected surgical stages of cochlear implantation (CIP) taking into consideration the results of the analysis of the outcomes of re-operations. MATERIAL AND METHODS: A total of 53 patients (4 adults and 49 children) were referred to our clinic for re-operations deemed to be required for the management the major complications following CI during the period from 2014 to 2017. Primary cochlear implantation was performed in other clinics. Re-operations were carried out at different time intervals after the primary surgical intervention under the guidance of a single experienced surgeon. RESULTS: The technical malfunction of the inner part of the implant prevailed among the causes behind the major complications of CI. It accounted for 47% of the total number of complications and required the replacement of the device. The next most frequent form of the complications (that accounted for 15% of all the cases) was the introduction of an active electrode into the cells of hypotympanum. The remaining complications occurred only in isolated cases. The detailed analysis of all the revealed complications was undertaken with the description of their causes and variants and the surgical strategy chosen for the management of each concrete patient. The decision about the necessity of either the removal or the substitution of the implant was taken on an individual basis. The successful outcome of the surgical treatment of all the operated patients with the major complications of cochlear implantation was achieved. CONCLUSION: The frequency and severity of the major complications of cochlear implantation are directly dependent on the patient's anatomical features, surgeon's qualifications, the quality of the implants, and lifestyle factors (e.g. head trauma, etc.). Cochlear implantation continues to be the only method for hearing rehabilitation in the patients suffering from severe sensorineural impairment of hearing. In the cases of cochlear implantation with the prospects of delayed re-implantation, leaving the active electrode in the scala tympani of the cochlea is a necessary measure to prevent synechiae.

[The results of bilateral cochlear implantation in the children who survived meningitis]. / Rezul'taty bilateral'noi kokhlearnoi implantatsii u detei, perenesshikh meningit.

The objective of the present study was the prospective analysis of the results of bilateral cochlear implantation (CI) in the children presenting with bilateral ossification of the cochlea after they had survived meningitis. A total of 15 patients underwent the surgical intervention. In those exhibiting bilateral ossification of the basal cochlear helix over the 5 mm segment (up to first bend of the cochlear turn) and partial ossification of the second helix (in 6 children), the affected portions were removed with the placement of two choleostomies, the lower one (from the ossified membrane of the cochlear window) and the upper one (toward the second helix). Activation of the speech processors of the CI systems was carried out within 4-6 weeks after surgery. The hearing abilities of the children were evaluated in accordance with the 'Estimation of the auditory perception categories', 'Estimation of the child's apprehension capacity', and 'Analysis of speech intelligibility rating' guidelines. In all the children with ossification over less than 5 mm of the basal cochlear helix, it proved possible to introduce the whole intracochlear electrode grid whereas only half of the electrode array was implanted in the cases of overall ossification of the basal helix. The first results obtained by telemetry and surdopedagogical testing gave evidence of the possibility of identifying various sources of non-verbal and speech stimuli in all the treated children at a small (up to 3 meters) distance.

[Acquired atresia and stenosis of the external acoustic meatus]. / Priobretennye atreziia i stenoz naruzhnogo slukhovogo prokhoda.

Acquired atresia of the external acoustic meatus is a rare pathological condition characterized by obliteration of the medial part of the external acoustic canal by a soft fibrous plug. The present article presents an overview of a series of cases of acquired atresia and stenosis of the external acoustic meatus with the description of etiology, pathogenesis, and methods for the treatment of this condition. In the majority of the cases, atresia develops at the final stage of granulation external otitis with or without an accompanying dermatological pathology. Another common cause of the acquired atresia of the external acoustic meatus is the fracture of the temporal bone as well as extensive ear surgery, radiation therapy and a neoplasm in the auditory passage. The surgical strategy for the management of the acquired atresia and stenosis of the external acoustic meatus consists, besides the excision of the fibrous plug, of the application of the cutaneous flaps and/or transplants to cover the bare parts of the bone portion of the affected external canal. In spite of such treatment, the state of the external acoustic canal remains unstable, and a relapse of its atresia and stenosis can not be wholly excluded.

[Optimization of the approach to the spiral (Rosenthal's) canal of the cochlea in the patients presenting with cochlear-vestibular abnormalities].

The objective of the present study was to improve the effectiveness of cochlear implantation (CI) in the patients presenting with cochlear-vestibular abnormalities based on the development and practical application of the algorithm for the insertion of an electrode arrayinto the spiral (Rosenthal's) canal of the cochlea taking into consideration the specific anatomical features of the middle and inner ears. The study included 25 patients with congenital malformations of the inner ear and bilateral grade IV sensorineural loss of hearing or deafness selected for CI. Indications for drilling a cochleostomy were the high localizationof the jugular bulb and the absence of its bone wall (5 patients, 20%). In the remaining cases, it proved possible to identify the round window and perform the transmembrane insertion of the active electrode. In 15 (69%) patients, the surgical intervention provoked intraoperative leakage of the cerebrospinal fluid that was successfully stopped by the careful tamponade of either the cochleostoma or the round window niche with the use of an automuscular flap. Taken together, good visualization of the round window and the transmembrane insertion of the active electrode into the spiral (Rosenthal's) canal of the cochlea in the patients presenting with cochlear-vestibular abnormalities made it possible to reduce to a minimum the injury to the spiral organ of the cochlea, control liquorrhea, and improve auditory performance in the postoperative period.

[PECULIARITIES OF ANESTHESIA DURING COCHLEAR IMPLANTATION IN PEDIATRICS.]

THE AIM: analysis of the use of laryngeal mask in anesthesia for cochlear implantation. MATERIALS AND METHODS: 10 patients aged from 1 year to 5 years were operated on according to the classical method KI with the use of laryngeal masks. As anesthesia was performed a balanced multimodal anesthesia by Sevoflurane and Fentanyl. RESULTS: The use of laryngeal masks in all 10 cases have gave the possible to avoid the use of muscle relaxants and to clear the threshold of detection of acoustic reflexes ofstapes musclestendon, and to reduce time of surgical intervention. A short time surgery provided rapid awakening of the patient, absence of nausea and vomiting in the early postoperative period. CONCLUSION: use of laryngeal mask airway is reduces the time of surgery, minimize the patient's trauma, reduce input anesthetic drugs and get good results intraoperative audiological testing.

[About the surgical treatment of vestibular window abnormalities].

The objective of the present study was to develop the sparing strategy for the surgical treatment of the patients presenting with malformations of the vestibular window based on the results of the evaluation of synopty of the main clues of the internal and middle ears. This article contains the analysis of the effectiveness of the surgical treatment of 17 patients with malformations of the vestibular window operated during the period from 2008 till 2013. It presents the results of investigations into the topographic relationships between the principal structures of the internal and middle ears of special importance for the assessment of the possibilities for the surgical treatment of such patients with the minimal risk of development of postoperative complications. The results of the surgical treatment were estimated based on the data of audiological studies in the early and late postoperative periods. It was shown that none of the patients developed the symptoms of dizziness, unstable gait or sensorineural impairment of hearing in the immediate postoperative period. Good functional results in the form of the reduced bone-air interval (15.2±1.0 dB) were achieved in 13 patients. Nevertheless, the considerable decrease in the sound conductivity in the late postoperative period observed in 64.7% of the patients related to the closure of the vestibular fistula dictates the necessity of developing the novel techniques for its prevention.