[Piriform aperture as a cause of nasal obstruction. Part 2. A systematic review of the methods of surgical treatment]. / Grushevidnaya apertura kak prichina nazal'noi obstruktsii. Chast' 2. Sistematicheskii obzor sposobov khirurgicheskogo lecheniya.

The article presents a systematic review of publications on the methods of piriform aperture (PA) surgery in the treatment of nasal obstruction. Various surgical techniques are reviewed critically in terms of topographic anatomy and the effectiveness of the method. The contradictory opinions about the access to the piriform aperture and the methods of its correction are revealed. The topic of surgery of the PA as an area of the internal nasal valve in the treatment of nasal obstruction is equally interesting for ENT and plastic surgeons. The analysis of the literature showed the effectiveness and safety of operations to expand the PA. None of the authors in the studied works notes any changes in the appearance of the nose during observation in the postoperative period. The biggest challenge in understanding PA surgery, which has yet to be understood, is determining the indications for a particular method of surgery, which justifies the continuation of the search, taking into account the clinical features of the patient and the topographic level of the disorder. In the future, we need studies with objective measurements, control and long-term careful observation to better study the effect of the expansion of the piriform aperture on the relief of nasal obstruction.

[The practice of stapes surgury in Russia]. / Praktika khirurgii stremeni v Rossii.

The aim of this study - to investigate the practice of stapes surgery in Russia using a special questionnaire (Appendix 1). Thirty-three questionnaires were sent to specialists dealing with stapes surgery in various Russian medical institutions. Responses were received from all ENT specialists, of whom 75.7% use stapedotomy as a technique. In most cases, colleagues perform more than 30 operations per year, there were also reports of performing about 100 operations per year and in one case 370 operations annually. 45.5% of respondents preferred a combination of general and local anesthesia for stapes surgery. According to the results of the survey, the titanium K-piston prosthesis is most frequently used. Analysis of the survey results showed that to date there is no unanimous opinion concerning some aspects of stapes surgery; however, in many issues the approaches of Russian surgeons coincide with the general world trends.

[Combination of CT and MRT in the diagnostic of middle ear cholesteatoma. Fusion technology is precise localization tool]. / Sovmeshchenie rentgenovskoi komp'yuternoi i magnitno-rezonansnoi tomografii v diagnostike kholesteatomy srednego ukha. Tekhnologiya Fusion ­ instrument tochnoi lokalizatsii.

Computed tomography (CT) and magnetic resonance imaging (MRI) methods of the middle ear cholesteatoma diagnostic have its advantages and disadvantages. Fusion technology is a post-processing process of CT and MRI images. Its main advantage is the localization of MR-hyperintensive cholesteatoma within the bony anatomical structures obtained on CT, which provides the surgeon with important information both before planning the primary surgical intervention and during a second revision for recurrent cholesteatoma.

[Proteus syndrome in the practice of an otorhinolaryngologist: a clinical case]. / Sindrom Proteya v praktike otorinolaringologa: klinicheskii sluchai.

Described a rare clinical observation of a patient aged 18 years with chronic left-sided otitis media against Proteus syndrome. By this age, the patient underwent a large number of operations regarding the removal of lymphangiomas, hemlimfangiomas, angiokeratitis of the body, as well as several sanitizing surgery on the left ear. A review of domestic and foreign literature showed that this case can be considered unique.

[Complications caused by hearing aid mold impression material - clinical case and literature review]. / Oslozhneniia protsedury sniatiia slepkov naruzhnykh slukhovykh prokhodov - klinicheskii sluchai i obzor literatury.

The procedure of taking an impression of the external auditory canal for the manufacture of individual earplugs in the ear canals can be associated with complications in some cases. The article describes the clinical case of ingestion of the impression mass during taking the impression of the external auditory canal in the patient with chronic otitis media. The presence of pronounced hearing loss has become the basis for the selection of a hearing aid. As a result, during taking a cast of the external auditory canal, the material fell into the middle ear cavity. Despite contacting specialists, the patient experienced earache with periodic suppuration during the year. When contacting our clinic, perforation of the tympanic membrane was detected and a CT of the temporal bones revealed a foreign body in the tympanic cavity. The patient underwent surgical treatment. The clinical case we are observing and the literature data show how important it is collect to carefullythe anamnesis and conduct otorhinolaryngological examination before the procedure for taking an impression of the external auditory canal when selecting a hearing aid.

[The results of surgical ablation of parathympanic spaces in the patients presenting with cholesteatoma]. / Rezul'taty khirurgicheskoi obliteratsii paratimpanal'nykh prostranstv u bol'nykh s kholesteatomoi.

INTRODUCTION: On the one hand, open-type surgical modalities have the advantage of the low frequency of relapses; on the other hand, they lead to the undesirable changes in the anatomical and physiological characteristics of the ear that in the long run create serious problems for both the doctor and the patient. In contrast, the closed-type surgical interventions are associated with a more favourable hygienic status and functional outcome but create a high risk of development of recurrent and residual cholesteatomas. The disadvantages of both types of cholesteatoma surgery motivated the surgeons for the development of the 'hybrid' approaches combining the advantages of open and closed strategies. The obliteration of the paratympanic spaces is one of them. AIM: The objective of the present study was to evaluate the results of the surgical treatment of recurrent and residual cholesteatomas and to optimize the algorithm of the postoperative control with the use of MRI in the non-EPI DWI regime. MATERIAL AND METHODS: The retrospective analysis of the available clinical materials covering the period from 2009 to 2014 included the results of the surgical treatment of the patients suffering from chronic otitis media and cholesteatoma with the use of the method for the obliteration of the paratympanic spaces. RESULTS: A total of 179 patients were operated using the obliteration technique. The patients were under observation for 34 months on the average. We used the otomicroscopy and MRI in the non-EPI DWI regime to examine the patients within 1, 2, and 3 years after surgery. The residual cholesteatoma was discovered in 15 (8.4%) patients out of the total 179 ones. The cases of recurrence of the cholesteatomas were not observed. The diagnostic effectiveness of MRI in the non-EPI DWI regime was estimated for the purpose of the postoperative control. Sensitivity of the method was 93.3%, specificity - 97.1%.

[The evaluation of the quality of life in the patients presenting with various forms of chronic otitis media]. / Otsenka kachestva zhizni patsientov s razlichnymi formami khronicheskogo srednego otita.

Chronic otitis media (COM) is a widespread pathological condition that affects up to 2% of the general population. Certain forms of this disease markedly deteriorate the quality of life of the patients which makes them overestimate the severity of harm to their health status and can be a cause of inflated expectations as regards the results of the planned surgical treatment. The linking element between the patient's expectations and the outcomes of the surgical intervention may be the recently developed questionnaires for the evaluation of the health-related quality of life (HRQoL). One of them, the COMQ-12 questionnaire, was devised to estimate the subjective reports by the patients concerning the deterioration of their quality of life attributable to chronic otitis media. The objective of the present study was to characterize the value of the 5-point Russian-language version of COMQ-12 for the evaluation of each of its 12 items concerning various aspects of health based on the personal opinions of the patients suffering from chronic otitis media The study included 108 patients 49 of whom were men and 59 women (45% and 55% respectively) at the age varying from 16 to 84 years. The COMQ-12 scores, according to the reports of individual patients, ranged from 4 to 43 of the 60 ones possible. The average score was 19.4 (SD=8.3). The overall median COMQ-12 score was 20, and the mode scored 14. The Cronbach-alpha index was equal to 0.860. The Russian-language version of the COMQ-12 questionnaire provides a reliable tool for the estimation of the quality of life in the patients presenting with various forms of chronic otitis media.

[The evaluation of the quality of life in a healthy population with the use of the COMQ-12 questionnaire]. / Otsenka kachestva zhizni v zdorovoi populiatsii s pomoshch'iu oprosnika SOMQ-12.

The COMQ-12 questionnaire has been elaborated to evaluate the deterioration in the quality of life of the subjects suffering from chronic suppurative otitis media (CSOM) based on the reports of the patients themselves. This questionnaire is of special interest in that it allows to register the complaints of the patients stated by them in the order of priority beginning from those that are responsible for the most pronounced manifestations of the impairment in the quality of life. It, in turn, helps the medical practitioner to rationally organize the treatment of a concrete patient taking into consideration his or her individual expectations. At the current stage of the development and adaptation of the COMQ-12 questionnaire, the main emphasis is placed on the search for the possible range of the key scores and their normal values allowing to characterize the quality of life in the healthy population. The objective of the present work was to estimate the potential of the COMQ-12 questionnaire for the evaluation of the quality of life among the subjects having no signs of chronic suppurative otitis media. A total of 60 healthy volunteers were recruited for the study and asked to fill up the questionnaire. The following information was selected for the subsequent analysis: sex and age of the respondents, experience with having any ear-related problems other than those related to chronic suppurative otitis media in the course of the lifetime. The patients presenting with chronic suppurative otitis media were excluded from the study. The score values ranged from 0 to 14 among the entire set of the respondents (mean 3.55). The resulting score of the respondents' condition was 5 and less in 75% of the cases; it achieved 10 and less out of the possible maximum of 60 scores in 95% of the participants of the study. It is concluded that the application of the COMQ-12 questionnaire helps to concentrate the attention of the medical specialists on the subjects whose health condition is characterized by score 5 or less and motivates them to carry out the thorough and comprehensive analysis for the interpretation of the data in favour of or against the prescription of the surgical intervention taking into consideration the personal expectations of the patients.

[The etiopathogenetic aspects of idiopathic sensorineural impairment of hearing]. / Étiopatogeneticheskie aspekty idiopaticheskoi neirosensornoi tugoukhosti.

The objectives of the present work were the overview of the results of the modern investigations concerning etiology of idiopathic sensorineural impairment of hearing as well as the analysis of the theory of microthrombus formation and its role in pathogenesis of hearing impairment.

[The remote post-graduate education in otorhinolaryngology: the first results and further prospects].

The objective of the present work was the retrospective analysis of the efficiency of two courses of remote education of otorhinolaryngologists in the real-time mode based on the results of the on-line questionnaire study. We analyzed the data obtained during the implementation of the pilot project of the remote post-graduate education at the Department of Otorhinolaryngology,Russian Medical Academy of Post-Graduate Education making use of the independent Internet resource for the professional training of otorhinolaryngologists. The two programs of remote education realized in 2012 and 2013 involved 7.9% of all otorhinolaryngologists practicing in the Russian Federation. The fraction of those who passed through all stages of the learning process increased almost two-fold, that is from 10% in 2012 up to 19% in 2013. About 14% of the participants made themselves familiar with all program modules; this result is in agreement with the data obtained in mass on-line remote teaching of the non-medical audience. It is concluded that the results of the present study provide a basis for the elaboration of the remote education programs for the training of specialists not only in otorhinolaryngology but also in other fields of medicine.

[The consensus view of the treatment of the retraction pockets of the tympanic membrane].

The objective of the present study was to formulate the consensus document «The treatment of the retraction pockets (RP) of pars tensa and pars flaccida¼ as well as to estimate the situation in this country pertaining to the treatment of the retraction pockets of the tympanic membrane. We undertaken a pilot study that involved 91 practicing otorhinolaryngologists based at in-patient and out-patient healthcare facilities in different regions of the Russian Federation. M. Yung's questionnaire for otorhinolaryngologistswas used to gain relevant information. The Delphi technology was employed to process the data obtained. 30% of those who agreed to participate in the study answered to the proposed questions although some of them aroused a discord among the respondents. The results of this questionnaire study provided a basis for the pilot consensus document and allowed for the preliminary conclusion as regards prospects for the further exploration of both the problem in question and the instruments for this purpose with special reference to the awareness of the otorhinolaryngologists.