[Choristoma of the middle ear]. / Khoristoma srednego ukha i sostsevidnogo otrostka.

Choristoma is one of the varieties of congenital developmental anomalies, where one or another normal tissue of the body is located in an atypical place for itself. The short literary review of choristoma of middle ear is presented in article. A rare clinical cases of salivary gland choristoma of the middle ear (5-year-old girl with left-sided conductive hearing loss of III degree) and glial choristoma of the mastoid (19-year-old man with signs of chronic suppurative otitis media of the right ear) are described.

[Jugulotympane paraganglioma associated with polysegmentary congenital hemangioma]. / Yugulotimpanal'naya paraganglioma, assotsiirovannaya s polisegmentarnoi vrozhdennoi gemangiomoi.

The describes a clinical observation of a combination of jugulotympanic paraganglioma of the left temporal bone with multifocal congenital hemangioma. The interest of the case is that such a combination of pathologies is extremely rare. A comprehensive study and surgical treatment of a patient with this clinical diagnosis was carried out. In the diagnosis, objective otorhinolaryngological studies, otomicroscopy and MSCT of the temporal bones and MRI of the middle ear with contrast were used. Surgical intervention was performed under multicomponent anesthesia with tracheal intubation, transmastoid access. The postoperative management of the patient after surgical treatment is described.

[Clinical case for removal supralabyrinthine petrous bone cholesteatoma with improvement of hearing function]. / Klinicheskii sluchai udaleniya supralabirintnoi kholesteatomy piramidy visochnoi kosti s uluchsheniem slukhovoi funktsii.

The article presents the clinical case of supralabyrinthine petrous bone cholesteatoma. We have analyzed the preoperative examination of the patient for identification method of surgical treatment with preservation the facial nerve, improvement hearing function and reducing risk of recurrent cholesteatoma, perioperative findings and the end result of surgical treatment.

[Functional results of surgical treatment of patients with various types of acquired cholesteatoma]. / Funktsional'nye rezul'taty khirurgicheskogo lecheniya patsientov s razlichnymi tipami priobretennoi kholesteatomy.

OBJECTIVE: To study the long-term functional results of surgical treatment of patients with acquired cholesteatoma, their dependence on the age of patients, the type of cholesteatoma and the type of surgery. MATERIAL AND METHODS: The article presents the results of a dynamic comparison of the functional results of surgical treatment of 332 adults and 104 children with various forms of acquired middle ear cholesteatoma who underwent both closed and open surgical procedures. RESULTS: There were no statistically significant differences in hearing function into two age's groups depending on the type of cholesteatoma acquired. Average air conduction in adult patients for all types of cholesteatoma were ranked within 34.55-44.19 dB, air-bone gaps - 24.14-31.12 dB; in children - 33.72-39.16 dB and 27.33-34.95 dB, respectively. The exception was a group of adult patients with secondary cholesteatoma of the pars tensa. In the postoperative period, in patients of both age groups with all types of cholesteatoma, an improvement in the average values of air conduction by 18-20 dB and a decrease in the average values of the air-bone thresholds by 17-21 dB were noted. Analysis of the results of open surgical interventions showed a somewhat worse functional efficiency on 5-9 dB for air conduction average and 18-20 dB for air-bone gaps, both for adults and children. The stability of the achieved level of auditory function at all stages of postoperative observation was also noted. CONCLUSION: Surgical treatment of children and adult with all types of acquired cholesteatoma can improve hearing function and achieve stable results when using closed or open types of operations.

[The experience in surgical treatment of hearing loss in Van der Hoeve patients]. / Opyt khirurgicheskogo lecheniya tugoukhosti u patsientov s sindromom Van-der-Khuve.

Despite the rare incidence of Van der Hoeve syndrome in the population, the problem of treating patients with this type of disease is important for modern science and practical medicine. One of the most difficult tasks in treatment is to improve the quality of hearing. The world scientific community lacks a unified coordinated approach to the methods of auditory rehabilitation of patients with Van der Hoeve syndrome. In recent years, there have been tendencies in the scientific literature to increase the frequency of non-surgical approach due to the low incidence of satisfactory results of surgical treatment. In this regard, we present our experience of complex treatment of patients with Van der Hove syndrome, based on the use of modern surgical technologies and conservative pathogenetically substantiated treatment.

[Predictors of recurrent pathology and prognosis of the results of surgical treatment of patients with acquired middle-ear cholesteatoma]. / Prediktory retsidiviruyushchei patologii i prognoz rezul'tatov khirurgicheskogo lecheniya patsientov s priobretennoi kholesteatomoi srednego ukha.

A retrospective analysis of the results of surgical treatment of 436 patients (332 adults and 104 children under the age of 15 years) with acquired middle ear cholesteatoma was performed to identify possible predictors of relapse of the process and a prospective assessment of the results of surgical treatment. It was revealed that the leading factors in the development of residual pathology were: the presence of cholesteatoma in the area of destruction of the bone wall of the canal of the facial nerve, cholesteatoma of the hypothympanum, cholesteatoma in the place of destruction of the bone wall of the posterior cranial fossa. The key reasons for the formation of recurrent pathology were: children under 15 years of age, closed surgery, pathological changes in the tympanic orifice of the auditory tube and the presence of cholesteatoma in its lumen. Performing a closed operation in adults with pathology of the tympanic orifice of the auditory tube increases the risk of recurrent cholesteatoma by 18.6%, and in children by 20%. The choice of a closed method of surgical intervention for the epitympanic type of the disease can increase the risk of residual pathology by 17.2% in adults and 27.8% in children.

[Characteristics of diagnosis and surgical treatment of various forms of congenital temporal bone cholesteatoma]. / Osobennosti diagnostiki i khirurgicheskogo lecheniya razlichnykh form vrozhdennoi kholesteatomy visochnoi kosti.

OBJECTIVE: To conduct a retro- and prospective analysis of the clinical characteristics and results of surgical treatment of patients with congenital temporal bone cholesteatoma. PATIENTS AND METHODS: On the basis of the SPb Scientific Research Institute of ENT of the Ministry of Health of Russia 23 patients were diagnosed with congenital temporal bone cholesteatoma for the period from 2011 to 2018. There were 11 men (47.8%), 12 women (52.2%), the age of patients - from 2 to 44 years. The M.J. Levenson criteria were used to verify congenital middle ear cholesteatoma. (1986). According to intrasurgery findings, we identified congenital cholesteatoma of the middle ear stages according to the ChOLE classification. Other types of congenital temporal bone cholesteatoma included the patients with congenital atresia of the external auditory opening, combined with congenital temporal bone cholesteatoma; we found a patient with exostoses obstructing the external auditory canal combined with congenital cholesteatoma of the middle ear; and a patient with congenital cholesteatoma of the temporal bone pyramid. RESULTS: An increase in the incidence of congenital temporal bone cholesteatoma was noted, which is probably due to increased awareness of specialists and the wider use of imaging research methods. A relationship was revealed between the stage of congenital cholesteatoma according to the ChOLE classification and the necessary volume of surgical intervention. Of the total number of cases of congenital temporal bone cholesteatoma, 26.1% were the patients with anomalies in the development of the outer and middle ear. CONCLUSIONS: All patients with suspected congenital temporal bone cholesteatoma require a temporal bone MSCT and middle ear MRI in DWI mode.

[Clinical case for removal infralabyrinthine petrous bone cholesteatoma with preservation the facial nerve]. / Udalenie infralabirintnoi kholesteatomy piramidy visochnoi kosti s sokhraneniem funktsii litsevogo nerva.

The article presents the case report of infralabyrinthine petrous bone cholesteatoma. We have analyzed the preoperative examination of the patient for identification method of surgical treatment with preservation the facial nerve and reducing cholesteatoma risk, perioperative findings and the end result of surgical treatment.

[Single-stage open tympanoplasty in the form of tympanosclerosis with fixation of the stapes]. / Odnoétapnaia timpanoplastika pri otkrytoi forme timpanoskleroza s fiksatsiei stremeni.

We used several variants of one-stage tympanoplasty, including our own method, according to which, in the absence of an anvil and malleus after mobilisation of the stapes, ossiculoplasty with partial or complete ossicular prosthesis and myringoplasty simultaneously preventively created a support (neo-malleus) in the thickness of the neotympanic membrane. To assess the effectiveness of different variants of single-stage tympanoplasty, the long-term functional results were compared in terms of 6 to 12 months after the intervention with preoperative indicators. Standard methods of statistical estimation with calculation of descriptive statistics and methods of statistical hypothesis testing based on nonparametric Wilcoxon criterion for related samples were used. All the variants of one-stage tympanoplasty used in the fixation of the stapes are effective and, in general, make it possible to achieve an improvement in auditory function. In the present study, this result was achieved in 61 of 86 patients with tympanosclerosis (71% (65%; 74%) of 95% CI). The functional results of tympanoplasty according to the developed method do not differ from the results of traditional variants with the use of prostheses, but the implementation of this variant of tympanoplasty in the absence of an anvil and hammer allows for the fixation of the stapes during the reoperative stapedotomy using a prosthesis of the piston type without additional surgical stage of the formation of the neomaleus.

[The peculiar clinical features of different types of acquired cholesteatoma of the middle ear]. / Klinicheskie osobennosti priobretennoi kholesteatomy srednego ukha.

We have undertaken the analysis of the specific clinical manifestations of acquired cholesteatoma of the middle ear in 437 chronic patients suffering from this pathology. 96.1% of them presented with primarily acquired cholesteatoma of the middle ear (including 53.3% having attic cholesteatoma, 22.8% with sinus cholesteatoma, and 19.9% of tensa retraction cholesteatoma). 3.9% of the patients exhibited a different mechanism of development of cholesteatoma. The secondary acquired mesotympanic cholesteatoma formed in association with the long-term chronic inflammation of the middle ear, concomitant perforation of the tympanic membrane and epithelial invasion from the edge of the tympanic membrane perforation and middle ear cavity. Typmanosclerosis of different degree and localization played an important role in the enhancement of the prevalence of this condition. All types of acquired cholesteatoma were found to extend beyond the point of origin of the disorder. The maximum destruction of the ossicular chain was documented in the patients presenting with sinus cholesteatoma. Those with secondary acquired cholesteatoma showed the worst functional capacity as a result of rigid fixation of the auditory ossicles. The overall cholesteatoma relapse rate (including both residual and recurrent cholesteatoma) was estimated to be 15.6%. It is concluded that the surgical strategy should be chosen on an individual basis for each concrete patient. The long-term observation of the treated patients with the application of the up-to-date radiological techniques is believed to be the indispensable prerequisite for the successful management of the complicated pathology under consideration.

[Sanation of petrous bone cholesteatoma in the otosurgical practice]. / Sanatsiia kholesteatomy piramidy visochnoi kosti v otokhirurgicheskoi praktike.

The present article reports the clinical cases of the surgical intervention on 20 patients presenting with petrous bone cholesteatoma. We have identified several clinical variants of petrous bone cholesteatoma based on the results of multispiral computed tomography (MSCT) of the temporal bones and categorized them into the following types in accordance with the classification proposed by Moffat-Smith an M. Sanna for this pathological condition: supralabyrinthine (n=8), supralabyrinthine-apical (n=2), infralabyrinthine (n=3), infralabyrinthine-apical (n=5), massive (n=1), and massive - apical (n=1). The surgical sanation of petrous bone cholesteatoma was performed in all the 20 patients in the absence of the pronounced bone destruction in the walls of the temporal bone pyramid and of the subdural expansion of cholesteatoma. In all the cases, the trepanation cavity remained open till its complete epidermization. The follow up period was around 3 years in duration on the average. The post-surgical analysis of the clinical conditions of each of the 20 patients was performed with special reference to the surgical technique applied for the removal of petrous bone cholesteatoma and the final outcome of the radical treatment.

Intraoperative identification of the facial nerve by needle electromyography stimulation with a burr.

UNLABELLED: The purpose of this research is to improve the safety of surgery for patients with a pathology of the middle and inner ear by preventing damage to the facial nerve by conducting intraoperative monitoring of the facial nerve by needle electromyography with continuous stimulation with a burr. PATIENTS AND METHODS: The clinical part of the prospective study was carried out on 48 patients that were diagnosed with suppurative otitis media. After the surgery with intraoperative monitoring, the facial nerve with an intact bone wall was stimulated electrically in the potentially dangerous places of damage. Minimum (threshold) stimulation (mA) of the facial nerve with a threshold event of 100 µV was used to register EMG events. The anatomical part of the study was carried out on 30 unformalinized cadaver temporal bones from adult bodies. The statistical analysis of obtained data was carried out with parametric methods (Student's t-test), non-parametric correlation (Spearman's method) and regression analysis. RESULTS: It was found that 1 mA of threshold amperage corresponded to 0.8 mm thickness of the bone wall of the facial canal. Values of transosseous threshold stimulation in potentially dangerous sections of the injury to the facial nerve were obtained. CONCLUSION: These data lower the risk of paresis (paralysis) of the facial muscles during otologic surgery.

[The methods of surgical sanation of the difficult to access parts of the middle ear in the patients presenting with chronic suppurative otitis media and concomitant cholesteatoma]. / Sposoby khirurgicheskoi sanatsii trudnodostupnykh otdelov srednego ukha u bol'nykh khronicheskim gnoinym srednim otitom s kholesteatomoi.

The recurrent cholesteatomic process is one of the main causes of the poor outcome of the surgical treatment in the patients with acquired cholesteatoma of the middle ear. The relapse can be due to the incomplete removal of the cholesteatomic matrix especially from the difficult to access for visual control during the surgical intervention parts of the anterior epitympanic space, medial sinuses of retrotympanum, deep-lying portions of hypotympanum, and retrofacial part of the mastoid cavity. One more cause behind the recurrent process is the retention of the conditions for the secondary retraction of the neotympanic membrane, The objective of the present study was the improvement of the surgical modalities for better visualization and sanation of the difficult to access anatomically complex parts of the middle ear under the eye control, the creation of the conditions for the additional ventilation of the tympanic cavity and the reduction of the risk of development of residual and/or recurrent cholesteatomas. To this effect, we undertook the analysis of the results of 438 primary and 226 secondary (revisional) surgical interventions on the patients presenting with chronic suppurative otitis media and concomitant cholesteatomas. The study has demonstrated that the cause of 14.6% of the cases of residual cholesteatoma was the incomplete removal of its matrix from the anterior epitympanic space, medial sinuses of retrotympanum, deep-lying portions of hypotympanum, and retrofacial part of the mastoid cavity. The proposed surgical strategies reduced the risk of development of residual cholesteatoma from 8.2% to 3.9%. The newly developed method for the additional ventilation of the tympanic cavity allowed the frequency of recurrent cholesteatoma to be decreased from 2.5% to 1.6%.

[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.

[The objective method for recording stapedial reflex during surgery for cochlear implantation].

The purpose of the present study was to develop a method for the objective registration of the stapedial reflex at the contralateral ear during cochlear implantation surgery on the affected one. The excessive pressure in the middle ear (up to 500 daPa) was compensated by the administration of an additional air volume (1 liter) into the AA220 impedance meter pneumatic circuit. A syringe was used to measure variations of pressure in the new pneumatic circuit. Eight of the 12 patients demonstrated coincident visual and objective reflex thresholds. In the remaining 4 patients, the visually apparent stapedial reflex thresholds proved higher than those obtained objectively by the standard procedure of impedancemetry. It is concluded that the objective registration of the stapedial reflex excludes the effect of subjective factors interfering with its estimation and provides the possibility for comparative intra- and postoperative studies using one and the same instrument.

[Use of autotransplants and implants in ossiculoplasty].

The paper presents a comparative analysis of efficacy of ossiculoplasty (OP) using different transplants. A total of 202 operations were performed. Prostheses made of the fragments of the auditory ossicles, or a cortical layer of the temporal bone (n=81), of nail plate (n=56), titanium implants (n=65) were applied. A satisfactory result was achieved in 72-87% ossiculoplasties. Functional outcomes of OP did not vary significantly with type and material of the prosthesis. Main causes of poor OP results were fixation or displacement of the prosthesis with fibrous tissue; in case of titanium prostheses -- perforation of the tympanic membrane with prosthesis extrusion.

[Vestibular function after a reconstructive surgery improving hearing in patients after radical operation on the middle ear]. / Sostoianie funktsii vestibuliarnogo apparata posle rekonstruktivnoi slukhuluchshaiushchei operatsii u bol'nykh, perenesshikh redikal'nuiu operatsiiu na srednem ukhe.

The study included 62 patients who had undergone radical surgery (RS) on the middle ear. The patients were later operated to improve hearing according to the original reconstructive technique. Before the reconstructive surgery and 1-2, 3-6, 12 and 36 months after it combined vestibulometric examination, otomicroscopy, audiometry assessed the treatment efficiency. Perception of live speech was also investigated. Vestibular dysfunction occurred in 87.1% of the examinees with the history of RS. One of the main causes of the dysfunction was micropathological foci in the trepanation cavity located primarily on the medial wall. Surgical reconstruction creates a closed ventilated neotympanic cavity lined with mucosa. This promotes correction of vestibular dysfunction. Vestibular dysfunction late after radical surgery on the middle ear should be, along with hypoacusis, an indication for reconstructive hearing-improving surgery because the latter relieves or eradicates subjective and objective manifestations of the vestibular dysfunction in many previously operated patients.

[Barofunction of auditory tube in patients with central perforation of tympanic membrane]. / Osobennosti barofunktsii slukhovoi truby u bol'nykh s tsentral'noi perforatsiei barabannoi pereponki.

Patients with otitis media chronica with central tympanic perforation underwent glue myringoplasty or radical operation. In 52.2 and 33.3% of them an original technique developed by the authors, has discovered defect of barofunction of the auditory tube named inflation effect of the auditory tube. High intratympanic pressure observed in this effect should be taken into consideration in tympanoplasty as it underlies rupture or dislocation of the transplant in myringoplasty or dislocation of the neotympanic membrane in reconstructive surgery on the middle ear.

[On the clinical significance of the trephined cavity status in patients with radical surgery of the middle ear]. / O klinicheskom znachenii sostoianiia trepanatsionnoi polosti u bol'nykh, perenesshikh radikal'nuiu operatsiiu na srednem ukhe.

303 ears were examined otomicroscopically in 267 patients who had undergone radical operation on the middle ear (RO). Local and general symptoms in patients after RO were defined as "the operated ear disease". Otomicroscopic picture of pathomorphological changes in the trepanation cavity is provided. It is necessary to account for these changes in planning reconstructive surgery.