Tympanomastoidectomy versus parenteral antibiotic therapy for pediatric otorrhea.

OBJECTIVE: To evaluate the efficacy of tympanomastoidectomy versus parenteral antibiotic therapy for otorrhea as a result of chronic suppurative otitis media (CSOM) without cholesteatoma in the pediatric population. METHODS: A retrospective review of 221 patients treated for otorrhea at a tertiary academic pediatric hospital was performed to evaluate the impact of tympanomastoidectomy versus parenteral antibiotic therapy on resolution of otorrhea. Inclusion criteria were age 0-18 years, prior treatment with otic and/or oral antibiotic, prior history of tympanostomy tube placement for recurrent otitis media, history of otorrhea, treatment with tympanomastoidectomy or parenteral antibiotic therapy, and follow-up of at least 1 month after intervention. Time to resolution was compared between the two modalities adjusting for age, bilateral ear disease status, and comorbidities using a Cox proportional hazard model. RESULTS: Eighty-three ears from 58 children met the inclusion criteria. Ears that initially underwent tympanomastoidectomy had a significantly shorter time to resolution of symptoms (median time to resolution) 9 months (95 % confidence interval CI: 6.2-14.8) vs. 48.5 months (95 % lower CI 9.4, p = 0.006). On multivariate analysis, however, only bilateral ear disease status was independently associated with time to resolution of symptoms (hazard ratio 0.4, 95 % CI 0.2-0.9, p = 0.03). There was no statistically significant difference in the rate of treatment-related complications when comparing tympanomastoidectomy to parenteral antibiotic therapy (p = 0.37). CONCLUSION: When adjusting for age, bilateral ear disease status, and comorbidities, there does not appear to be a significant difference in time to resolution of symptoms when comparing parenteral antibiotic therapy to tympanomastoidectomy. An informed discussion regarding risks and benefits of each approach should be employed when deciding on the next step in management for patients with CSOM who have failed more conservative therapies.

Risk of hearing loss in the opposite ear after tympanomastoidectomy.

PURPOSE: The definitive treatment for chronic suppurative otitis media is surgery. Surgical technique and procedure varies according to individual case findings and pathology and may require mastoidectomies in which the canal wall is preserved or lowered to eradicate disease from mastoid air cells. Surgical treatment of chronic middle ear disease carries a risk of damage to the inner ear. The aim of this study was to investigate whether the noise produced by the tour system following chronic ear surgery causes sensorineural hearing loss, a condition for which not many studies have been published in the literature. METHODS: The study consisted of a total of 49 patients with type I, type II and type III canal wall preservation and 62 patients with tympanoplasty with canal wall preservation and lowering. Bone and air thresholds were compared before and after middle ear surgery. Changes in bone and air thresholds were compared according to the type of tympanoplasty. RESULTS: In the ICW-I, ICW-II and ICW-III tympanoplasties, and in the ICW and CWD tympanoplasties, the preoperative and postoperative values of the opposite ear hearing measurements were performed, and did not differ according to the type of surgery. There is no correlation drilling duration and hearing for the opposite ear. CONCLUSION: The prevention of postoperative sensorineural hearing loss depends on multiple factors, and assessing the magnitude of hearing loss in relation to these factors is important in determining the success of the surgery.

Surgery for chronic otitis media in the elderly.

PURPOSE: To evaluate the effectiveness and safety of surgery for chronic otitis media in elderly patients, compared to younger adults and children. METHODS: Patients with chronic otitis media with and without cholesteatoma formation were assessed. Patients aged 65 years and older were included and compared to adults aged 35-55 and to children. Effectiveness was evaluated by comparing postoperative dry and safe ears in ages groups, safety was assessed by comparing postoperative adverse events. RESULTS: Postoperative success and adverse events did not differ between age groups. Children had more recurrent cholesteatoma than adults. No difference in recurrent cholesteatoma between adults was observed. CONCLUSION: Surgical treatment for chronic otitis media with and without cholesteatoma in elderly patients is safe and effective. Age has no influence on postoperative adverse events and treatment outcomes in chronic otitis media. Cholesteatoma recurrence was not different between adult age groups.

Mastoid obliteration with hydroxyapatite vs. bone pâté in mastoidectomy surgery performed on patients with cholesteatoma and chronic suppurative otitis media: a retrospective analysis.

PURPOSE: To compare the efficacy and safety of hydroxyapatite vs. bone pâté as obliteration material in mastoidectomy surgery for patients with chronic suppurative otitis media and cholesteatoma. METHODS: This is a retrospective, multi-center, cohort study. All patients were followed up with micro-otoscopy, audiometry, and, if indicated, MRI with diffusion-weighted imaging. The following outcome parameters were analyzed: procedure safety (wound infections and complications), cholesteatoma recidivism rates (residual/recurrent), control of infection (Merchant's scale), and hearing results (pure-tone averages at 500/1000/2000/4000 Hz). RESULTS: Eighty-three cases were included: 45 obliterated with hydroxyapatite and 38 with bone pâté, with a mean follow-up time of, respectively, 25 and 24 months. Wound infections were only detected in the bone pâté group (4.8%) and successfully treated with oral or intravenous antibiotics and surgical drainage (p = 0.026). No other major surgical complications were observed in both groups. Cholesteatoma recidivism was observed in 15% using hydroxyapatite and 12% using bone pâté (p = 0.471). Complete control of infection (Merchant 0) was achieved in 76.2% using bone pâté and 86.8% using hydroxyapatite at 12 months postoperatively (p = 0.223). All patients showed good postoperative healing without complete failure to manage infection (Merchant 3). Pre- and postoperative audiometry showed significant improvement in hearing results in both groups. No significant difference between the obliteration materials was observed. CONCLUSIONS: Evaluation of mastoid obliteration reveals that hydroxyapatite and bone pâté are safe and effective obliteration materials, with high success rates in achieving a dry ear, low recidivism rates, and good hearing outcome, respecting the short-term limitation. In addition, our study shows that hydroxyapatite results in fewer postoperative wound infections compared to bone pâté.

Correlation of Eustachian tube function with the results of type 1 tympanoplasty: a prospective study.

OBJECTIVES: This study aims to evaluate Eustachian tube (ET) function tests and their impact on outcomes of tympanoplasty in patients with inactive chronic suppurative otitis media. MATERIALS AND METHODS: A prospective study was conducted involving patients diagnosed with chronic suppurative otitis media (CSOM) and having a central dry perforation. Assessment of the ET function was done for all included cases by three tests; pressure swallow equalization test, saccharine test and methylene blue test. The primary outcome is the graft success rate defined as intact graft without any residual perforation at 6 months postoperatively. Secondary outcomes include hearing assessment and possible associated complications. RESULTS: 64 patients were included in the study with an average age of 36.59 ± 11.96 years. All patients underwent assessment of the ET function by saccharine test, methylene blue test and pressure equalization test (PET) followed by microscopic post-auricular tympanoplasty. Successful tympanoplasty is achieved in 93.75% of cases with residual perforation in four patients. Mean air-bone gap is significantly improved from 23.73 ± 2.80 preoperatively to 10.93 ± 5.46 postoperatively. Results of Methylene blue test has no statistical impact on graft take rate (p value = 0.379), while saccharine test and pressure equalization test results have statistically significant correlation with graft success (p value ≤ 0.001). CONCLUSIONS: Saccharine and Pressure equalization tests have a good positive correlation with the graft healing in tympanoplasty, while methylene blue test was found to have no correlation with the success rate.

Cerebellar Abscess Induced by Cochlear Fistula due to Chronic Suppurative Otitis Media.

Cochlear fistulas with cholesteatoma as the primary disease have been reported frequently in the relevant literature. However, there are no reports of cochlear fistula without cholesteatoma due to chronic suppurative otitis media with intracranial complications. We report a case of cochlear fistula due to chronic otitis media that was diagnosed after the onset of a cerebellar abscess. The patient was a 25-year-old man with severe autism. He was admitted to our hospital with otorrhea from his left ear, emesis, and impaired consciousness. Computed tomography (CT) of the head showed left suppurative otitis media, left cerebellar abscess, and brainstem compression due to hydrocephalus. Right extra-ventricular drainage and brain abscess drainage were urgently performed. The next day, foramen magnum decompression and abscess drainage with partial resection of the swollen cerebellum were performed for decompression purposes. He was subsequently treated with antimicrobial therapy, but magnetic resonance imaging of the head showed an increase in the size of the cerebellar abscess. Re-examination of the temporal bone CT scans revealed a bony defect in the left cochlear promontory angle. We assumed that the cochlear fistula was responsible for the otogenic brain abscess. Thus, the patient underwent surgical closure of the cochlear fistula. After the operation, the cerebellar abscess lesion gradually shrank, and his general condition stabilized. Cochlear fistula should be considered in the management of patients with inflammatory middle ear disease associated with otogenic intracranial complications in the middle ear.

Impact of Otorrhea and Positive Cultures on Tympanoplasty Outcomes.

BACKGROUND: Chronic suppurative otitis media is a long-standing middle ear infection with a perforated tympanic membrane. Tympanoplasty is the mainstay of treatment. Most surgeons prefer to operate on dry ears; however, this may be difficult to achieve. OBJECTIVES: To investigate the effect of otorrhea and positive cultures on the outcome of tympanoplasty. METHODS: This retrospective analysis reviewed patients with chronic suppurative otitis media who underwent tympanoplasty 2008-2015. Patients were divided into three groups: active discharge and bacterial growth, active discharge without bacterial growth, and no ear discharge. Surgical outcomes were compared among the groups. RESULTS: Among 101 patients included, 43 ears (42.6%) had discharge preoperatively, 58 (57.4%) were dry. Overall closure rate was 81.2% (82/101). Preoperative active discharge closure rate was 88.3% (38/43) and without discharge 75.9% (44/58). There were 38 positive cultures preoperatively and five negative cultures. Cultures were not obtained in 58 cases. Success rates were 89.5%, 80%, and 75.9%, respectively. No significant difference was found between patients who had positive or negative cultures before the procedure (P > 0.48) or among the three groups (P = 0.25). The most common bacteria were Pseudomonas aeruginosa (n=17), followed by Staphylococcus species (n=10). None was significantly associated with operative failure (P = 0.557). The postoperative air threshold difference was not affected by culture results (P = 0.3). CONCLUSIONS: Tympanoplasty success rates and postoperative air threshold differences were not affected by the presence of preoperative otorrhea or positive ear cultures. Surgery can be performed even when the ear is not dry.

[Partial sequestration of the labyrinth in a child with chronic suppurative otitis media with cholesteatoma]. / Chastichnaya sekvestratsiya labirinta u rebenka s khronicheskim gnoinym srednim otitom s kholesteatomoi.

A clinical case of a 16-year-old child with chronic suppurative otitis media with cholesteatoma complicated by partial labyrinth sequestration is presented. The case describes is a rare disorder. Computed tomography of temporal bones consistent with intraoperative data was decisive in establishing the diagnosis and the surgery extent.

Antibiogram guided optimized medical treatment in chronic otitis media: A useful interventional strategy before surgery?

BACKGROUND: Chronic otitis media is a middle ear cleft disease presenting with tympanic membrane perforation and discharge. Wet ear after tympanoplasty and discharging mastoid cavity are problematic in clinical practice. MATERIAL AND METHODS: 1050 patients of age 10 to 50 years presenting with active ear discharge and clinically diagnosed with unilateral chronic suppurative otitis media were included in the study. The patients were equally divided into two equal groups, Group ET, and AT. All patients were prescribed topical ciprofloxacin, oral levocetirizine 5 mg and n-acetyl cysteine 600 mg BD for one week. Swabs of ear discharge were collected in ET groups for antibiogram. Both groups were evaluated on next visit and treatment changed in AT groups and result observed in next visit. Surgical outcome was evaluated at end of 2 yrs. RESULT: A total of 1158 organisms were isolated in culture out of which, 69.94 % were aerobes, 13.47 % anaerobes and 16.58 % were fungi. On the second visit in group AT, treatment of 85.14 % patients was changed in accordance with culture sensitivity report. In patients with mucosal disease, only 46.87 % patients of group ET had a favorable outcome in comparison to 90.28 % patients of group AT while in patients with squamosal disease, 17.56 % patients of group ET and 28.99 % patients in group AT had a dry ear. Surgeries in AT group were found to have statistically significant higher success rate as compared to ET group.

[Changes in the type and amount of bone collagens in chronic suppurative otitis media]. / Izmenenie tipovogo i kolichestvennogo sootnosheniya kollagenov kostnoi tkani pri khronicheskom gnoinom srednem otite.

OBJECTIVE: Comparative assessment of the collagen-tissue interaction in the bone tissue of the middle ear structures in patients with chronic suppurative otitis media (CSOM). MATERIAL AND METHODS: A prospective study of 42 patients aged 16-60 years with CSOM admitted for reconstructive sanitizing surgery was performed. To study the collagen-tissue interaction, intraoperative samples of the bone tissue of the middle ear were used. A software calculation of vascular-stromal areas and ratios of various types of bone tissue collagen was carried out during histomorphological examination. RESULTS AND DISCUSSION: The quantitative and qualitative parameters of bone tissue collagen obtained intraoperatively in patients with CSOM were studied. The cavities of the middle ear are in the phase of a chronic purulent process, when the bone structures are morphologically disorganized according to the pathological type, and sclerosis with overgrowth of the cellular structure of the mastoid process is considered a favorable outcome for delimiting the focus of inflammation in the pyramid of the temporal bone. CONCLUSIONS: Changes in the processes of collagen remodeling of bone structures contribute to the maintenance of inflammation of the middle ear in all clinical forms of CSOM. Pathological osteogenesis can serve as an indicator of the progressive course of a purulent-destructive process in the cavities of the middle ear, which makes it possible to reliably determine the rate of bone tissue transformation to predict relapse after reconstructive and sanitizing surgery.

[Case of diagnosis and surgical treatment of intracranial cholesteatoma]. / Sluchai diagnostiki i khirurgicheskogo lecheniya intrakranial'noi kholesteatomy.

The article provides a brief overview of the epidemiology of congenital and acquired intracranial cholesteatoma, the theory of its pathogenesis, classification, and clinical features. The most common localization of congenital and acquired intracranial cholesteatoma is described and various surgical approaches are presented that allow total removal of the formation. A clinical case of diagnosis and surgical treatment of acquired intracranial cholesteatoma caused by chronic suppurative otitis media is presented. A clinical example indicates the possibility of a long asymptomatic course of acquired intracranial cholesteatoma. The use of a combined (extradural subtemporal and transmastoid) surgical approach made it possible to completely remove the acquired cholesteatoma of the temporal lobe of the brain in a patient with chronic suppurative otitis media.

[A case of hearing preservation during surgical treatment of distributed fistula labyrinth in a patient with chronic purulent means otitis and cholesteatoma]. / Sluchai sokhraneniya slukha pri khirurgicheskom lechenii rasprostranennoi fistuly labirinta u bol'noi s khronicheskim gnoinym srednim otitom i kholesteatomoi.

The article provides a brief overview of the epidemiology, diagnosis, clinical manifestations and surgical methods of treatment of labyrinthine fistulas (LF) in patients with chronic suppurative otitis media (CSOM) with cholesteatoma. The efficacy of various LF treatment techniques, their complications, and the principles of prevention of cochleovestibular disorders during surgical treatment are described. The prognostic criteria for the deterioration of bone conduction thresholds during LF surgery, which include a large LF size, the opening of the membranous labyrinth, and the extent of damage to the structures of the inner ear, are presented. A clinical case of surgical treatment of widespread LF in CSOM with cholesteatoma is presented, which proves the possibility of preserving the auditory and vestibular functions while observing the stages of sanitation, manipulations on the LF and obliteration of semicircular canals defects with auto tissues. Combined surgery of such a plan must certainly be accompanied by local instillation of solutions of hormonal preparations in case of a deficiency of perilymphatic fluid in the labyrinth and postoperative antibacterial and hormonal therapy.

Outcome of surgery for chronic suppurative otitis media with resistant Pseudomonas aeruginosa.

OBJECTIVE: To assess the effectiveness of surgical treatment of active chronic suppurative otitis media (CSOM) with ciprofloxacin-resistant Pseudomonas aeruginosa (P. aeruginosa) that failed comprehensive local and systemic treatment. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Eleven patients with ciprofloxacin-resistant P. aeruginosa CSOM that remained active despite comprehensive local and systemic treatment. All patients were operated by a single surgeon between February 2016 and July 2019 INTERVENTION(S): Tympanoplasty alone was performed in seven cases and accompanied by mastoidectomy in the other four cases. MAIN OUTCOME MEASURE(S): Resolution of infection and tympanic graft take on otoscopy. The secondary outcome measure is hearing. RESULTS: Tympanic graft take was successful and the infectious process was resolved in 8 out of the 11 cases, yielding a success rate of 73%. The average follow-up was 20 months. No surgical complications occurred. CONCLUSIONS: Tympanoplasty, with or without mastoidectomy, is safe and yields acceptable anatomical and functional success rates when intensive local and systemic treatment fails to stop the purulent discharge.

[Transcanal endoscopic middle ear surgery in children with chronic suppurative otitis media]. / Transkanal'nye endoskopicheskie operatsii na srednem ukhe u detei s khronicheskim gnoinym srednim otitom.

Otomicroscopic surgery remains the gold standard in the surgical treatment of patients with CHS. Endoscopic ear surgery is gaining more and more importance as an adjunct to microsurgery. Recently, thanks to the resolution of the endoscopic technique, endoscopic surgery can be used as an independent method. This article presents the results of endoscopic tympanoplasty, endoscopic removal of the tympanic cholesteatoma, performed on the basis of the otorhinolaryngology department of the Morozov Children's City Clinical Hospital. Research has shown that transcanal endoscopic surgery is an effective alternative to traditional otomicroscopic surgery. Advantage in minimal impact and improved visualization of all quadrants of the tympanic membrane, the anterior tympanomeatal angle of the NSP, and structures of the middle ear.

Cochlear Implantation in Patients with Chronic Suppurative Otitis Media: Surgical Outcomes and a Management Algorithm.

BACKGROUND: Chronic suppurative otitis media (CSOM) was considered as a contraindication of cochlear implantation (CI) in the past. Recently, various surgical options have been adopted for CI in CSOM patients with showing a low complication rate. OBJECTIVES: To evaluate surgical outcomes of CI in patients with CSOM and to propose a management algorithm for those patients. METHODS: Thirty-six consecutive patients with CSOM who underwent single stage or staged CI were enrolled. Speech performance, including Categories of Auditory Performance (CAP) test and sentence score, and complications were retrospectively analyzed. RESULTS: The average follow-up was 3.1 years (range 0.5-9.2 years). Postoperative median CAP and sentence scores were 6 and 78%, respectively. Three (8.3%) of the 36 patients had postoperative complications. One experienced breakdown of the ear canal closure. Recurrence of the pars tensa retraction was observed in another patient with adhesive otitis media who underwent CI and cartilage tympanoplasty as a single stage operation. Electrode extrusion occurred in another patient who underwent staged CI with maintenance of a previous open cavity. Subtotal petrosectomy and cavity obliteration were used to manage the latter 2 complications. All implant patients with good mastoid pneumatization exhibited no complications. There were no significant differences in postoperative speech performance and complication rates between single stage CI and staged CI. Based on these current findings, a management algorithm was proposed according to type of CSOM, presence of open cavity, and mastoid pneumatization. CONCLUSIONS: Patients with CSOM show good postoperative speech performance after CI. Proper surgical options according to type of CSOM, presence of open cavity, and mastoid pneumatization may help in reducing complications.

Circumferential Subannular Tympanoplasty: Panacea for revision tympanoplasty.

OBJECTIVE: To evaluate the role of Circumferential Subannular Tympanoplasty [CST] in cases of Revision tympanoplasty. METHODS: A retrospective statistical analysis of data of 81 patients who underwent revision tympanoplasty with CST technique [essentially Type I tympanoplasty] was done. An intact graft at the end of 6 months was regarded as a surgical success. RESULTS: Overall, we recorded a surgical success rate of 97.5% [79 out of 81 cases] with a 100% surgical success for anterior perforations. There was no impact of size or site of perforation on the outcomes of revision tympanoplasty by this technique. In addition, a statistically significant hearing improvement was recorded in the study. The mean pre-operative and post-operative ABG were 33.85 dB and 18.87 dB respectively. The mean ABG closure was 14.89 dB. The value of "p" by Chi square test was found to <.05. CONCLUSION: CST is an excellent technique for revision tympanoplasty and seems to address the shortcomings of conventional onlay and inlay techniques.

Preparing the surgical area for non-shaved ear surgery: a clinical assessment.

OBJECTIVE: To review the clinical experience for non-shaved middle ear/mastoid surgery and evaluate the proper method of preparing the postauricular surgical field. METHODS: This retrospective study reviewed medical records of cases where the non-shaved surgical procedure was carried out for middle ear/mastoid diseases. In all cases, middle ear and mastoid surgery was performed by one otologic surgeon without hair shaving to treat chronic perforation of tympanic membrane, as well as chronic suppurative otitis media, with or without mastoiditis during two years. The prevalence of surgical site infection (SSI) and bacterial culture of the surgical field was assessed just before the skin incision. RESULTS: In this review of 106 cases, the SSI rate was 1.6% for the non-shaved ear surgery. Bacterial colonisation was found on the prepared surgical field in 8.5% of cases and these bacteria was different from true pathogens. SSI of the skin incision occurred in two cases, although no bacterial colonisation of the non-shaved surgical field was found. The surgical exposure of postauricular area was enough to do tympanoplasty or tympanomastoidectomy, even though in cases where a hairline was close to postauricular sulcus. CONCLUSION: This study showed that when preparing the non-shaved ear surgery, the surgeons should not have to worry about skin contamination by hair. We suggest that the non-shaved ear surgery would appear to be preferable for the postauricular approach.

[Risk Factors for Postoperative Recurrence of Chronic Suppurative Otitis Media].

Objective To analyze the risk factors for postoperative recurrence of chronic suppurative otitis media(CSOM) and explore the intervention measures to prevent postoperative recurrence of CSOM. Methods A total of 1066 patients with CSOM who underwent concurrent surgical treatment and achieved clinical cure in our hospital from January 2012 to December 2018 were enrolled.The clinical data and laboratory findings were reviewed by using an electronic medical record system and the patients were followed up for 1 year.The patients were divided into the non-recurrent group and the recurrent group.Chi-square test and multivariate logistic regression were used to compare the factors may contribute to the postoperative recurrence. Results The recurrence rate of CSOM was 6.38%.Multi-drug-resistant(MDR) infection before surgery(χ 2=16.338,P=0.000),aged ≥60 years(χ 2=5.182,P=0.023),frequency of occurrence ≥3 times/year(χ 2=4.388,P=0.036),duration of active period>7 d(χ 2=4.729,P=0.030),repeated upper respiratory tract infection>3 times/year(χ 2=11.913,P=0.001),accompanied by chronic sinusitis(χ 2=11.077,P=0.001),blood glucose>6.11 mmol/L(χ 2=15.327,P=0.000),postoperative serum procalcitonin(PCT)>0.5 µg/L(χ 2=8.337,P=0.004) were the risk factors for postoperative recurrence.The use of snorkel was a protective factor for postoperative recurrence(χ 2=5.308,P=0.021).Multivariate analysis showed that MDR infection(OR=3.373,95%CI:1.825-6.234,P=0.000),repeated upper respiratory tract infection>3 times/year(OR=2.727,95%CI:1.479-5.030,P=0.001),accompanied by chronic sinusitis(OR=2.980,95%CI:1.654-5.369,P=0.000),blood glucose>6.11 mmol/L(OR=3.219,95%CI:1.741-5.953,P=0.000),and postoperative serum PCT>0.5 µg/L(OR=2.085,95%CI:1.106-3.931,P=0.023) were independent risk factors for postoperative recurrence in CSOM patients. Conclusions Effective prevention and control of MDR infection,control of blood sugar,prevention of upper respiratory tract infection,and lowering the recurrence of chronic sinusitis are the main measures to reduce postoperative recurrence of CSOM.Monitoring of the infection marker PCT can help to achieve early intervention.

[The use of retinoids to stimulate the regenerative process in trepanation cavity after "open" sanitizing surgery on the middle ear]. / Primenenie retinoidov dlya stimulyatsii regenerativnogo protsessa v trepanatsionnoi polosti posle «otkrytoi¼ saniruyushchei operatsii na srednem ukhe.

INTRODUCTION: One of the methods of surgical treatment of patients with chronic purulent otitis media is an "open" sanitizing surgery on the middle ear. One of its important features is the formation of a wound surface that communicates with the external environment, which subsequently leads to infection, lengthening the time for epithelization, and in 13-30% of cases, the latter is incomplete with the development of a "trepanation cavity disease". OBJECTIVE: To establish the nature of the effect of retinoid-based drugs on the severity of the inflammatory process and the regeneration processes in the tissues of the trepanation cavity after sanitizing operations on the middle ear. MATERIAL AND METHODS: The subjects of the study were 78 patients who underwent the first "open" sanitizing operation on the middle ear. At the final stage, turunda with a 1% dioxin solution in combination with a sterile ointment of 13-cis-retinoic acid, concentration 0.05% was injected into the postsurgery cavity. 30 patients additionally took 13-cis-retinoic acid in tablet form. In the control group, retinoids were not used. CONCLUSION: The obtained data allow us to recommend the use of retinoid-based drugs as a means of suppressing the inflammatory reaction and stimulating the regeneration process in the trepanation cavity after an "open" sanitizing surgery on the middle ear.

[Paracentez]. / Paratsentez.

In this article, we present the analysis of the data of the specialized literature and the results of our own observations on the use of paracentesis in the treatment of acute suppurative otitis media. We highlight a method for diagnosing acute otitis media, which makes it possible to determine the rational algorithm of treating this disease - digital videootoscopy. Common methods of procedures aimed at draining the tympanum in acute purulent otitis media, such as tympanic membrane puncture, myringotomy, tympanostomy, tympanocentesis, and the differential approach to these methods of surgical treatment of the disease are discussed. The very concept of paracentesis is specified, the history of this surgical intervention is presented. Authors described the technique and features of paracentesis, a number of indications for its implementation, possible complications of surgical intervention and their causes. The risk of developing a chronic pathological process after the use of paracentesis or, conversely, due to the rejection of this manipulation during acute inflammation in the middle ear is assessed.