[Bacterial microbiota in exacerbation of chronic purulent otitis media in children]. / Bakterial'naya mikrobiota pri obostrenii khronicheskogo gnoinogo srednego otita u detei.

OBJECTIVE: To study current spectrum of bacterial pathogens that cause exacerbation of chronic suppurative otitis media (CSOM) in children, who live in Moscow region, and to investigate sensitivity of isolated strains to various antibacterial drugs. MATERIAL AND METHODS: The results of microbiome's bacterial cultivation of purulent discharge from tympanic cavities collected from 269 children with CSOM aged from 1.5 to 18 years for the period from 2017 to 2021 yr. were analyzed. The majority of examined subjects (70.6% from 190 children) had CSOM with cholesteatoma. RESULTS: Monoculture was received in 62.5% of examined patients, bacterial associations - in 25.7%, bacterial-fungal associations - in 2.6%, and there was no growth in 9.2% of subjects. Staphylococcus aureus, which was found in 36.1% of children, dominated among agents. Pseudomonas aeruginosa was the second most frequently diagnosed agent, revealed in 12.3% of patients. Candida spp. (7.1%) was prevalent in bacterial-fungal associations. The article presents the results of isolated strains' sensitivity to antibacterial drugs. The high resistance to oxacillin, cefoxitin and antipseudomonal drugs was found among strains collected from children with CSOM and cholesteatoma. CONCLUSION: S. aureus (36.1%) and P. aeruginosa (12.3%) remain the most common causative agents for exacerbation of chronic suppurative otitis media in children. Pathogenic fungi are not isolated separately, and Candida spp. (6.7%) dominates in bacterial-fungal associations. It is generally recognized and confirmed by our research, that topical fluoruquinolones (ciprofloxacin) are the most effective drugs for exacerbation of chronic suppurative otitis media treatment. Systemic antibiotics, of which fluoruquinolones (ciprofloxacin) are the most effective, are recommended in severe exacerbation, severe and destructive forms of chronic suppurative otitis media.

[Congenital dermoid cyst of the middle ear with invasion into the external auditory canal in a 1 year 10 month old child]. / Vrozhdennaya dermoidnaya kista srednego ukha s prorastaniem v naruzhnyi slukhovoi prokhod u rebenka 1 goda 10 mesyatsev.

The article presents a casuistic clinical observation of the treatment of a child aged 1 year 10 months with a dermoid cyst of the middle ear. The diagnosis was established on the basis of computed tomography and histological examination of the mass. Surgical treatment was performed in the volume of a separate attic-anthromastoidotomy with removal of the formation and one-stage type III tympanoplasty. In the catamnesis, the child's condition is satisfactory, the otoscopic picture shows no signs of inflammation.

[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.

[Features of bacterial microbiota in acute purulent otitis media in children]. / Osobennosti bakterial'noi mikrobioty pri ostrom gnoinom srednem otite u detei.

PURPOSE OF THE STUDY: The purpose is to study the spectrum of bacterial pathogens that cause acute purulent otitis media (APOM) in children of the Moscow region in modern conditions and assess their sensitivity to the main groups of antibiotics. MATERIAL AND METHODS: The study included 1.864 children who underwent examination and received treatment in the otorhinolaryngological department of Morozovskaya Pediatric Municipal Clinical Hospital in the period from 01 July 2018 to 31 June 2020 with a diagnosis of APOM. RESULTS: The study showed that the leading bacterial pathogens of APOM are Streptococcus pneumoniae (28.0%), Staphylococcus aureus (27.2%), Streptococcus pyogenes (22.2%), Haemophilus influenzae (7.8%), and Pseudomonas aeruginosa (6.5%). Attention is drawn to the increase in the level of resistance of S. pneumoniae to oxacillin (11.64%). CONCLUSIONS: The data obtained indicate the feasibility and prospects of vaccination against pneumococcal infection as one of the ways to curb the spread of resistance of S. pneumoniae to antibacterial drugs.

[The algorithm of the treatment and diagnostic strategy for the treatment the children presenting with acute mastoiditis]. / Algoritm lechebno-diagnosticheskoi taktiki lecheniia detei s ostrym mastoiditom.

This article was designed to report the results of the analysis of the cases of chronic otitis media complicated by mastoiditis in the children admitted to the Morozovskaya City Children's Clinical Hospital for the examination and treatment during the period from 2009 till 2017. The objective of the present study was to evaluate the clinical significance and the optimal time schedule of computed tomography (CT) of the temporal bones in the patients with suspicion of mastoiditis for the determination of the indications for their surgical treatment. All the patients were divided into three groups differing in the severity of clinical manifestations of the disease. A special algorithm of the treatment and diagnostic strategy was developed for the management of the patients included in each group that made possible the structured approach to the choice and performance of the treatment and diagnostic procedures.

[The role of the endoscopic assistance in the surgical treatment of the children presenting with chronic suppurative otitis media and cholesteatoma]. / Éndoskopicheskaia assistentsiia v khirurgicheskom lechenii detei s khronicheskim gnoinym srednim otitom s kholesteatomoi.

The present study was designed to elucidate the possibilities for the application of angled endoscopes in the sanation of those compartments of the middle ear which are difficult to access for visual control with the use of a microscope, such as the retrotympanic structures (e.g. tympanic and facial retraction pockets), anterior epitympanum, etc. To this effect, we have undertaken the analysis of the results of surgical interventions on the children presenting with chronic suppurative otitis media and concomitant cholesteatoma. A total of 59 primary operations and 35 secondary ones were performed to treat recurrent cholesteatoma. In 41 cases, the surgical intervention was carried out without the endoscopic assistance whereas in the remaining 53 ones the microscopic observation of the difficult-to-access compartments of the middle ear were supplemented by the application of an angled endoscope. Whenever residual portions of cholesteatoma were identified, they were removed under the endoscopic control. The algorithm for the endoscopic assistance during such operations has been proposed, its advantages and limitations are considered. It is concluded that the combination of microscopic and endoscopic techniques for the examination of and operation on the middle ear creates the conditions for the more reliable (in comparison with the traditional otomicroscopic methods) removal of the residual cholesteatoma tissues and thereby allows to reduces the risk of development of residual cholesteatoma from 25% to 13.5%. The results of the present study have demonstrated the necessity of development of a universal approach to the identification of the clinically significant manifestations of chronic suppurative otitis media and cholesteatoma.

[Congenital parotid gland fistula in the children: diagnostics and surgical treatment].

The objective of the present study was to improve diagnostics and surgical treatment of congenital parotid gland fistulae. It involved 86 children presenting with this defect at the age varying from 4 months to 17 years who were admitted to the Department of Otorhinolaryngology of the Morozovskaya City Children's Clinical Hospital during the period from 2010 till 2014. It was shown that parotid fistula suppuration is an absolute indication for the surgical treatment of such children regardless of their age. The proposed diaphanoscopic technique was shown to produce good results and can be recommended for both diagnostics an intraoperative visualization of the fistulous passage.

[The comparative effectiveness of framycetin included in combined therapy of adenoiditis in the children].

The objective of the present study was to evaluate the effectiveness of framycetin included in combined therapy of adenoiditis in the children. The study involved 67 children at the mean age of 6.9±2.7 years. Group 1 was comprised of 35 children given framycetin as topical therapy, the patients of group 2 were treated by the endonasal administration of a 2% silver proteinate solution. It was shown that the use of framycetin as a component of combined therapy of adenoiditis enhances the effectiveness of the treatment and compliance to therapy in comparison with the same parameters in the case of the application of traditional topical antibacterial preparations.

[Certain peculiarities of the clinical picture of mastoiditis in the children].

The objective of the present study was to analyse the cases of acute otitis media complicated by mastoiditis in the children given the surgical treatment during the period from 2009 till 2012. A total of 46 patients underwent antromastoidotomy. The main clinical variants of the disease, their incidence, the age composition of the affected children, and the principal etiological factors were determined.

[Foreign bodies (disk batteries) in the nose].

This paper reports the results of analysis of the treatment of 8 children after the removal a disk battery from the nasal cavity. It was shown that the restoration of all the structures of the nasal cavity is possible if the foreign body remains in it during a short (up to 5 hours) time. The longer presence of such a body in the nasal cavity gives rise to post-traumatic defects, in the first place septal perforations and injuries to the inferior turbinated bone. In such cases, the foreign body must be immediately removed from the nasal cavity, and the child should be placed under thorough medical observation taking into consideration the long process of rejection of necrotic tissues and healing of the resulting defects.

[Destructive mastoiditis with thrombosis of the sigmoid sinus in a 8 year-old child presenting with concomitant chicken pox].

The specific clinical feature of mastoidities that developed in a patient presenting with chicken pox was the rapid progress in temporal bone destruction with partial thrombosis of the sigmoid sinusis in the absence of typical manifestations of mastoiditis. The pronounced destructive changes found in a series of CT images were regarded as the indications for urgent antromastoidotomy with the puncture of the sigmoid sinusis.

[Facial nerve in children with cholesteatoma of the middle ear].

Electroneuromyographic investigation of the facial nerve function was performed in children with long-lasting epitympanitis and cholesteatoma of the middle ear. Electroneuromyographic parameters were abnormal on the side of the affected ear in all the examinees. This points to the axonal type of the facial nerve impairment of different severity.

[Preoperative and postoperative management of patients with congenital defects of the external and middle ear]. / Osobennosti vedeniia bol'nykh s vrozhdennymi porokami razvitiia naruzhnogo i srednego ukha v predoperatsionnom i posleoperatsionnom periodakh.

Laser techniques introduction in preoperative and postoperative management of patients operated for congenital defects of the external and middle ear promotes retention of the graft and activation of regeneration, improves treatment results. More advanced methods of care for the postoperative cavity increase quality and duration of hearing-improving operative effects, shorten hospital stay, minimize risk of long-term complications.

[Surgical treatment of congenital defects of the external and middle ear in children]. / Khirurgicheskoe lechenie vrozhdennykh porokov razvitiia naruzhnogo i srednego ukha u detei.

Incidence of congenital defects of the external and middle ear in children is 1-2/10000. Surgical correction includes meatotympanoplasty followed by otoplasty. Surgical technique proposed by the authors provides persistant and satisfactory functional and cosmetic results.