[Surgical rehabilitation of patients presenting with chronic suppurative otitis media].

The purpose of the present study was to elucidate the character of complications following divided atticoanthrotomy with tympanoplasty in patients presenting with chronic suppurative otitis media (CSOM) and mucositis in the late postoperative period. It was shown that the most common causes of hearing impairment were atelectasis and perforation of the neotympanic membrane within 5 years after surgery, formation of retraction pockets and even cholesteatoma at later time points in the postoperative period. Adequately scheduled rehabilitative measures including conservative and surgical treatment made it possible to restore hearing in 76% of the previously operated patients. Those who applied for medical aid at a later time (6-15 years after surgery) and developed, in addition, retraction pockets and cholesteatomas or experienced elevation of the acoustic perception threshold failed to reach the level of hearing they had had soon after primary surgery. It is concluded that patients who underwent closed-type sanation reconstructive surgery should be referred for dispensary observation in order to prevent the development of cicatrization processes in the tympanic cavity, retraction of the tympanic membrane, and reactivation of the inflammatory catarrhal process in middle- ear cavities.

[Combined approaches to diagnostics and treatment of traumatic otitis].

A total of 216 patients with the injured tympanic membrane were examined and treated during the last 5 years. 198 (91.6%) patients presenting with traumatic otitis were found to have pathological changes in the nose and paranasal sinuses. In patients who applied for medical aid soon (within 1-2 weeks) after injury to the tympanic membrane, the resulting perforation was closed with the use of hen's egg amniotic membrane. Audiological examination demonstrated that 84.7% of traumatic tympanic membrane ruptures were associated with acute sensorinerual loss of hearing.

[Functional results of "open" and "closed" surgery on the middle ear].

This paper was designed to evaluate functional results of "open" and "closed"-type surgery on the middle ear in 186 patients presenting with chronic suppurative otitis media. Audiological examination was performed 1, 3, and 5 years after surgery. Analysis of outcomes of "open" and "closed"-type operations did not reveal significant differences in the degree of improvement of hearing and speech perception. It means that neither intact posterior wall of the auditory passage nor its removal has appreciable effect on the hearing function.

[Effectiveness criteria for the topical application of glucocorticosteroids to the treatment of exudative otitis media associated with allergic rhinitis].

We undertook comparative analysis of ciliotoxic effect of glucocorticosteroids frequently used for catheterization of the eustachian tube in patients presenting with exudative otitis media and concomitant allergic rhinitis. It was shown that the recovery of transport function of ciliary epithelium and appreciable clinical effect of the treatment were achieved by the application of mometasone furoate. Dexamethasone was next to mometasone in terms of efficiency whereas hydrocortisone produced much lower beneficial effect. It is concluded that, taking into account high bioavailability of dexametasone and hydrocortisone (> 80%) and contraindications to their intranasal administration, the preference should be given to medications with lower bioavailability.

[Assessment of immune disorders in patients presenting with various forms of chronic suppurative otitis media in the postoperative period].

The present study was designed for immunological examination of 46 patients presenting with various forms of chronic suppurative otitis media. All the patients underwent surgical intervention on mastoid process (processus mastoideus). It was shown that exacerbation of catarrhal inflammation provoked a significant decrease of the total lymphocyte, T-helpers, and B-lymphocyte (CD22) count whereas the concentration of T-suppressors increased. In patients with the distractive form of chronic suppurative otitis media, the absolute number of total lymphocytes, T-lymphocytes, T-helpers, and B-lymphocytes was also reduced while the concentration of IgG was elevated. The level of serum cytokines (IL-1-beta, IL-6, TNF-alpha) increased in both forms of the disease although the rise in case of catarrhal inflammation was much more pronounced. These data suggest beneficial effect of supplemental corrective immunotherapy.

[Peculiarities of the treatment of patients presenting with chronic suppurative otitis media associated with Gram-negative microorganisms].

The objective of the present study was to determine the absolute and relative numbers of T-lymphocytes, B-lymphocytes, T-suppressors, T-helpers, phagocytes, immunoglobulins A, M, and G in blood sera of patients presenting with chronic suppurative otitis media who had undergone sanation surgery. The study included tests for the evaluation of immunological efficiency of combined treatment with imunofan and myelopid in 89 patients divided into two groups. Pretreatment immunological status of all patients was characterized by reduced B-lymphocyte, T-helper, and phagocyte counts coupled to the elevated levels of IgM and T-suppressors. Patients of group 1 received conventional antibacterial therapy, those in group 2 were treated with a combination of imunofan and myelopid. Conventional therapy failed to correct immune deficiency. Additional treatment with a combination of imunofan and myelopid following sanation surgery proved to be much more efficacious. This observation was confirmed by the results of clinical, cytological, and immunological studies.

[Efficiency of combination therapy for acute otitis media].

The clinical efficiency of treatment was evaluated in 60 patients aged 18 to 60 years with protracted acute otitis media (AOM) who had residual tympanic membrane inflammation and exudates in the tympanic cavity. The patients were divided into 2 groups of 30 each, who received equal basic medical treatment; Group 1 patients were additionally given eurespal (fenspiride) 80 mg thrice daily for 2 weeks. The patients were examined by clinical, endoscopic, and audiometric studies; the transport function of the nasal ciliated epithelium was also explored. The findings suggest the benefits of the additional use of eurespal in the treatment of the catarrhal stage of AOM.

[Combined therapy of sensorineural loss of hearing].

The objective of the present study was to evaluate the efficiency of meatotympanal blockade by neuromedin (ipidacrine) included in the combined treatment of sensorineraul loss of hearing. This therapy was given to 95 patients with sensorineural hearing loss of vascular origin who reported strong tympanophony. Results of audiological examination and ultrasound dopplerography as well as the patients' subjective feeling provided data for the conclusion that medicamentous therapy of sensorineural loss of hearing produces the best effect if combined with meatotympanal blockade by 1 ml (15 mg) of a 1% neuromedine solution during 10 days.

[Blood group-dependent efficiency of immunological correction in patients with chronic purulent otitis media]. / Zavisimost' éffektivnosti immunokorrektsii ot grupp krovi u bol'nykh khronicheskim gnoinym srednim otitom.

Clinical and immunological investigations were performed in 300 patients with otitis media chronica purulenta. The patients, aged 16-65 years, received immunocorrectors in addition to basic postoperative therapy consisting of antibiotics and antihistamine drugs. The highest immunocorrective effect was registered in patients with blood group AI, the weakest in those with blood group AB(IV). Blood group B(III) and A(II) were the second and the third.

[Methods for assessing the efficacy of immunocorrection]. / Metody otsenki éffektivnosti immunokorrektsii.

The use immunocorrective remedies has become a topical problem due to the insufficient effectiveness of the treatment of many chronic diseases (including chronic purulent otitis), manifested by the suppression of initial immunological disturbances. Still the principles of the prescription of the above-mentioned remedies have not yet been sufficiently worked out. The present work deals with the use and approval of the methods for the evaluation of the effectiveness of immunocorrective therapy, the determination of the targets of action, the proper effect of modulation, changes in the degree of its manifestation.

[The efficacy of combined immunocorrection in patients undergoing a treatment for chronic epitympanitis]. / Effektivnost' kombinirovannoi immunokorrektsii pri lechenii bol'nykh khronicheskim épitimpanitom.

Ninety six patients with chronic epitympanitis treated surgically were examined immunologically and allocated in 4 groups. Suppressed T- and B-cell immunities were found. Patients of group 1 received antibiotics and antihistamine drugs (controls), patients of group 2, 3 and 4 were given in addition timontin, myelopid and timontin + myelopid, respectively. Monotherapy with timontin and myelopid improved immunological status of the patients who exhibited better outcomes of conventional treatment than controls. Combined use of the above immunomodulators corrected the immunological defects and resulted in good clinical response.

[Dependence of immunological reactivity on blood groups and microflora in patients with chronic purulent otitis media]. / Zavisimost' immunologicheskoi reaktivnosti ot grupp krovi i kharaktera mikroflory u bol'nykh khronicheskim gnoinym srednim otitom.

Immunological investigation (1-2 level tests with monoclonal antibodies) of 246 OMPC patients has discovered a relationship between the degree of immunological disorder, blood group and microflora. Patients carrying AII and ABIV, Pseudomonas aeruginosa, Staphylococcus aureus, Proteus were more immunologically compromised. These findings may help in the choice of profile immunocorrector.

[Correction of immunologic disorders in patients with chronic suppurative otitis media]. / Korrektsiia immunologicheskikh narushenii u bolnykh khronicheskim gnoinym srednim otitom.

The absolute and relative content of T- and B-lymphocytes, T-helpers (CD4), T-suppressors (CD8), phagocytosis, complement and immunoglobulins A, M, G in the blood serum was examined in patients with chronic purulent otitis media. The investigation also involved tests on immunological activity of tymoptin (T), sodium nucleinate (SN), prodigiosan (PR), the combination of SN with PR. 148 patients aged 15-56 years were subdivided into 5 groups. In pretreatment immunological status of all the patients the count of T- and B-lymphocytes, T-helpers, phagocytosis were reduced against increased counts of IgM and T-suppressora. All the patients received similar conventional treatment with adjuvant SN (group 2), PR (group III), SN + PR (group 4), T (group 5). The conventional conservative and especially surgical treatment aggravated immunodeficiency. The adjuvant immunocorrectors potentiated the treatment effects which appeared to be most beneficial in group V followed by by groups IV, II and III in diminishing order.

[The relationship of immunological reactivity to blood groups]. / Sviaz' immunologicheskoi reaktivnosti s gruppami krovi.

The relationship of blood groups and level of immunological reactivity was studied in 500 patients with different diseases and 246 healthy subjects. Distribution of genetic markers of blood groups in the healthy and patients showed certain characteristic features. It was found that the A (11) blood group in the healthy may be considered a marker of high levels of immunological reactivity resulting in a milder course of diseases in persons of this blood group. It was shown that different pathological states are characterized by variations of immunological reactivity depending on the blood group--on the content of populations and subpopulations of lymphocytes, immunoglobulin of different classes, normal antibodies, grade of immunodeficiency.

[Treatment of secretory otitis media]. / Lechenie sekretornykh srednikh otitov.

Blood serum of 38 patients with otitis media (14 men and 24 women), aged 16 to 55 years, was examined immunologically. The patients were subdivided into two groups that received identical traditional therapy. However the Group 2 patients were also given per os 0.5 g sodium nucleinate 3 times a day for 10 days. Before and after treatment all the patients underwent immunological tests which included measurements of T- and B-lymphocytes, T-helpers and T-suppressors as well as immunoglobulins M, A, G and complement. It was demonstrated that sodium nucleinate exerted beneficial clinical and immunological effects.