[Clinical case of tuberculous otitis media in early childhood]. / Klinicheskii sluchai tuberkuleznogo srednego otita v rannem detskom vozraste.

Nowadays, the incidence of tuberculosis remains high all over the world, despite the vaccination, medical support, social policy. The main reasons for this are the high level of migration, the prevalence of bad habits, the prevalence of immunodeficiency conditions, the formation of resistance to antimicrobial drugs, the tendency to refuse vaccination. At the same time, great difficulties arise in the diagnosis of extrapulmonary forms of infection. The purpose of this publication is to remind about the peculiarities of the course and diagnosis of tuberculous otitis media. According to the literature, the main characteristic features of tuberculous of the middle ear are prolonged suppuration without pronounced pain syndrome, inefficiency of standard antibacterial therapy, the anamnestic data about contacts or violation of the vaccination schedule, multiple perforations and a pronounced granulation process during otoscopy, a pronounced destructive process in the temporal bone during X-ray examination. The article presents a clinical case of the development of tuberculous otitis media in a young child with delayed diagnostics and the development of mastoiditis with required emergency surgical treatment. Verification of the etiology of the disease and the specific treatment carried out made it possible to achieve complete relief of ear symptoms, restoration of the tympanic membrane and ventilation of the middle ear.

[Acute purulent otitis media in children]. / Ostryi gnoinyi srednii otit u detei.

OBJECTIVE: Improving the effectiveness of inpatient care for children with acute purulent otitis media. MATERIAL AND METHODS: 100 children at the age from 0 to 18 years were inspected from January to August 2021. The main diagnostic methods included otoscopy, pharyngoscopy, rhinoscopy. Bacteriological examination of the pus from the ear was done for all patients. RESULTS: Acute purulent otitis media is a common cause of hospitalization in children aged 0 to 3 years. The main causative agents of the disease in toddlers are Staphylococcus aureus and pneumococcus (38%), in preschoolers and primary school children - pyogenic streptococcus and pneumococcus (30%), in high school students - Staphylococcus aureus.

[Effectiveness of baloon dilation of Eustachian tube in children with otitis media with effusion]. / Effektivnost' ballonnoi dilatatsii slukhovoi truby u detei s khronicheskim ekssudativnym srednim otitom.

Otitis media with effusion is one of the most common ENT diseases in childhood. Absence of acute symptoms, prevalence of pathology among preschoolers, who often cannot complain on discomfort in the ears and hearing loss, lead to late diagnosis and treatment. Standard surgery is highly effective, but it is not able to help all patients. A new, minimally invasive technique of surgical treatment of otitis media with effusion - balloon dilation of the Eustachian tube provides additional opportunities in solving these problems. OBJECTIVE: To evaluate the effectiveness and possibilities of its increasing in balloon dilation of the auditory tube in children with chronic otitis media with effusion. 34 children with chronic otitis media with effusion were under observation, who underwent 54 operations using a balloon catheter for the auditory tubes. The mismatch between the pressure value and the baloon diameter has been experimentally shown, and therefore a technique for intraoperative control of the effectiveness of the procedure has been developed. The effectiveness of balloon dilation in the study was 30.8-64.3%, depending on the following factors: the stage of otitis media at which the treatment was carried out, the combination of balloon dilation with tympanostomy, the use of intraoperative efficiency control technique. The high safety of the operation and the possibility of its effective implementation in patients with an operated cleft-palate are shown.

[Treatment of chronic eczematous otitis externa]. / Lechenie khronicheskogo ekzematoznogo naruzhnogo otita.

Otitis externa is a common disease. The article discusses the anatomical and physiological features of the structure of the outer ear, the epidemiology of otitis externa. Acute inflammation is characterized by the presence of significant microflora, and most often it is preceded by the impact of various physical factors. With chronic inflammation, more changes from the skin are recorded, while the microflora is not always isolated. The authors consider the problem of chronic inflammation of the outer ear. They provide their own data on the etiology of inflammation. Particular attention is paid to local treatment, including their own experience of using the combined drug Candiderm. As a result of the treatment, the skin changes of the external auditory canal were completely resolved in all patients by day 28, the itching in the ears completely stopped after 10-14 days of therapy. Stable remission was achieved in 89% of patients.

[The cochlear implantation in patients with syndromic deafness. Clinical examples]. / Osobennosti provedeniya kokhlearnoi implantatsii u patsientov s sindromal'noi glukhotoi.

OBJECTIVE: To describe clinical observations of patients with syndromic deafness. RESULTS: Deaf patients with CHARGE, Crouzon, and Wildervanck syndromes were monitored at the Russian Research Clinical Center for Audiology and Hearing Rehabilitation (Moscow) in different years. All of them were diagnosed having bilateral congenital deafness. After collecting anamnesis, evaluating the results of computed tomography of the temporal bones, and audiological examination, it was decided to conduct the cochlear implantation. CONCLUSION: The only method that allows patients with bilateral congenital deafness to gain hearing is the cochlear implantation. The malformations of the tympanic cavity structures, an abnormal course of the facial nerve canal lead to technical difficulties during the surgical stage of cochlear implantation. The navigation equipment, monitoring of the facial nerve makes it easier to find anatomical structures, as well as to avoid injuries.

[Peculiarities of preparing a patient with a cochlear implant for a magnetic resonance imaging]. / Osobennosti podgotovki patsienta s kokhlearnym implantatom k provedeniyu magnitno-rezonansnoi tomografii.

OBJECTIVE: To develop an algorithm of actions aimed at preparing a patient with a cochlear implant for magnetic resonance imaging (MRI). MATERIAL AND METHODS: A deaf patient after bilateral cochlear implantation (CI) came to St. Vladimir Children's City Clinical Hospital (Moscow) with symptoms of the demyelinating disease for MRI of the brain and spinal cord. Magnet were removed for MRI, then new magnets were installed. CONCLUSION: The temporary removing magnet for MRI of the brain and spinal cord allows to significantly reduce artifacts of MRI images.

[The main steps in treatment of the children with otitis media with effusion]. / Osnovy okazaniya meditsinskoi pomoshchi pri ekssudativnom srednem otite.

MATERIAL AND METHODS: 361 children at age from 11 months to 18 years with otitis media with effusion (OME) were inspected after tympanostomy during 2013-2018 years. Treatment was carried out in accordance with the stages of OME: secretory, mucous, fibrous. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, computed tomography. Surgical treatment may be required already at the secretory stage of the disease, as well as in all cases with mucous and fibrous stages of OME. RESULTS: In children with recurrences of OME and in patients with congenital cleft lip and palate, it is preferable to use long-wearing ventilation tubes and balloning of the auditory tubes. The effectiveness of surgical treatment of OME was 97.6%. CONCLUSION: The authors recommend dispensary observation of patients with OME for 12-24 months.

[The main steps in treatment of the children with otitis media with effusion]. / Osnovy okazaniya meditsinskoi pomoshchi pri ekssudativnom srednem otite.

THE AIM: Of the investigation was to establish the standard and improve the treatment of otitis media with effusion (OME) in children. 361 children at age from 11 months to 18 years were inspected after tympanostomy during 2013-2018 years. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, CT. MATERIAL AND METHODS: Treatment takes into consideration the reveal of OME: surgical initially. The tympanostomy preferable place is anterior-inferior quadrant. RESULTS: In cases with cleft palate or reccurence OME long-term tubes and balloonisation of ET are preferable. CONCLUSION: Authors received normalization of the hearing thresholds in 97.6% cases, but after surgery the patients have to be followed-up during 12-24 months.

[The management of patients with congenital malformations of the external and middle ear]. / Algoritm vedeniia bol'nykh s vrozhdennymi porokami razvitiia naruzhnogo i srednego ukha.

Rehabilitation of the patients suffering from with congenital malformations of external and middle ear is a specific area of medicine requiring special knowledge and skills of the audiologists and ear surgeons. This article highlights the issues of epidemiology, classification and methods for the rehabilitation of patients presenting with this pathology that reflect our own experience and the methodology based on it for all phases of both functional and aesthetic surgical inerventions. Special attention is given to the assessment of the effectiveness of the treatment, as part of the evaluation of the quality of medical services. The results were demonstrated in 56 patients aged from 5 to 17 years. 32 of them underwent reconstructive, hearing improving surgery (meatotympanoplasty), 24 patients were managed by means of the implantation of the bone-anchored hearing systems. The assessment of the effectiveness of the treatment was conducted according to the algorithm developed by the authors, including free field pure tone audiometry and validated questionnaires for the assessment of the quality of life (the Glasgow Children's Benefit Inventory).

[Changes of the auditory function in he children with chronic kidney failure]. / Izmeneniia slukhovoi funktsii u detei s khronicheskoi bolezn'iu pochek.

The risk factors that contribute to the development of hearing loss in the children with chronic kidney failure (CRF) are complications and/or manifestations of the disease itself as well as the side effects of its treatment. There are many similarities between the anatomical, physiological, and pharmacological features of the nephron and the striavascularis of the cochlea. The objective of the present study was the evaluation of the status of the auditory function in the children presenting with CRF. MATERIAL AND METHODS: A total of 62 children with CRF were examined. 40 patients were on peritoneal dialysis and 9 on hemodialysis whereas 13 children did not receive hemodialysis. Kidney was transplanted in 7 patients. The registration of transient evoked otoacoustic emission (TEOAE) was performed in all the children. For patients without TEOAE complex underwent the audiological examination. RESULTS: The TEOAE was not registered in 17 of the 62 examined children. According to the results of the comprehensive audiological examinations, 13 children suffered from the hearing loss of different forms and severity while 5 children presented with bilateral deafness. As the duration of CRF progressed, the patients became more prone to develop hearing impairment. Hearing loss is possibly genetically determined. Among the etiological factors underlying the development of the hearing loss the high doses of immunosuppressants and aminoglycosides are considered to be the principal ones.

[Reoperations after cochlear implantation]. / Reoperatsii pri kokhlearnoi implantatsii.

The objective of the present study: the improvement of the quality and effectiveness of the surgical stage of cochlear implantation on the basis of the comprehensive analysis of performed reoperations. PATIENTS: 84 patients of the 2413 ones who had undergone cochlear implantation were re-examined by revision surgery within various periods after the first intervention. MAIN RESULTS: In certain patients, the correction of the intracochlear electrode array position was performed and in 72 cases the replacement of the implant was done. The most frequent cause of the replacement of the implant was the failure of the device. In the case of the extrusion and inflammation, the two-stage surgical treatment was applied. The exposure of the different parts of the cochlear implant with the duration up to 2 weeks was considered as a complication which could be adequately corrected. The surgical treatment of such patients was carried out in a single stage. The reparation processes at the place of the first intervention were strongly expressed, especially in children. Standardization of the cochlear implantation surgical stage based on the determination of its optimum volume in our Center led to a decrease in the number of reoperations and made the learning process easier to master for young otosurgeons. CONCLUSION: It is can be concluded that the reoperation after primary cochlear implantation is a highly effective technique and, taking into account the listed features, doesn't present difficulties for the qualified otosurgeon.

[The role of computer and magnetic resonance imaging in patients with deafness]. / Rol' komp'yuternoi i magnitno-rezonansnoi tomografii u patsientov s glukhotoi.

The objective of the present study was to evaluate the potential of CT and MRI for diagnostics of congenital and acquired pathology of the inner ear in the deaf patients. Two groups of the patients were examined. The first group consisted of 75 patients with congenital or acquired deafness etiology. The second group was comprised of 75 patients with deafness associated with acute bacterial meningitis suffered in the preceding period. All the patients were examined by CT and MRI of temporal bones. The results of the study provided a basis for the development of indications for the application of CT and MRI to examine the patients presenting with hearing loss and deafness. CONCLUSION: CT and MRI make it possible to identify individual features of the temporal bone structure significant for the surgical treatment. MRI appears to have an advantage over CT for diagnostics of early obliteration of the cochlea. Both CT and MRI are the optional methods for the examination of the patients with deafness developing after meningitis.

[The impact of implantable technologies on the quality of life in the patients with hearing loss]. / Vliyanie implantatsionnykh tekhnologii na kachestvo zhizni patsientov s narusheniem slukha.

The improvement of the effectiveness of the rehabilitation of the patients with hearing disorders is a priority task for an audiologist. One part of the present work was to assess satisfaction of the patients treated with the use of the hearing aids, drug therapy, and the surgical operations. The aim of the study was to evaluate the influence of the implantation of the Baha bone conduction system on the quality of life of the treated patients. The Russian-language versions of the Glasgow Benefit Inventory and Glasgow Children Benefit inventory questionnaires were used. The survey was conducted among the patients with bilateral moderate and moderate-to-severe conductive hearing loss due to congenital malformation of the external and middle ears or chronic suppurative otitis media followed by canal-down operation. A total of 47 patients took part in the present multicenter study. The results demonstrate the high effectiveness of rehabilitation with the use of the implantable bone conduction system. The beneficial effect of the treatment was especially well apparent in the children. The results are comparable with the data of the similarly designed investigations reported in the literature. Peculiarities of the data obtained in the present study and statistical characteristics made it possible to validate the Russian-language versions of the Glasgow Benefit Inventory and Glasgow Children Benefit inventory questionnaires.

[Cholesteatoma of the external and middle ear in the childhood].

The objective of the present work was to enhance the effectiveness of diagnostics of cholesteatoma of the external and middle ear in the children. The study included 66 patients presenting with chronic suppurative otitis media and one child having cholesteatoma of the external auditory meatus. All the patients were examined with the use of otoendoscopy and CT of the temporal bones. It was shown that the frequent occurrence of acute suppurative otitis media, exudative suppurative otitis media, and adhesive otitis media is the risk factor of the development of cholesteatoma of the external and middle ear in the children. The following CT features of cholesteatoma of the external ear were revealed: the sclerotic or mixed type of the mastoid process, the presence of pathological contents in the epitympanic space, homogeneous character of pathological contents in the antrum, widened aditus, caries of antrum walls, the presence of soft tissues around the auditory ossicles, destruction of the long process of the anval bone, and a soft-tissue structure in the external auditory meatus.

[Peculiarities of the treatment of the patients presenting with exudative otitis media].

The objective of the present study was to enhance the effectiveness of provision of medical assistance and to standardize the approaches to its realization for the patients presenting with exudative otitis media (EOM). A total of 67 children (103 cases) at the age varying from 11 months and 17 years were available for the examination after the surgical treatment. The secretory phase of exudative otitis media was diagnosed in 23.5% of the children, mucous phase in 68%, and fibrous phase in 8.5%. The results of the study indicate that diagnostics of EOM requires the application of such methods as otomicroscopy, endoscopy, and tympanometry. Computed tomography of temporal bones may be helpful to distinguish between the complicated cases of exudative otitis media and other diseases of the middle ear. Tympanostomy is possible to perform in the secretory phase of the disease and in all the patients at the mucous and fibrous stages. The preferred localization of tympanostomy is thea ntero-inferior quadrant of the tympanic membrane. It is recommended to place long-term ventilation tubes in the children presenting with recurrent EOM and labial or palatal cleft. The authors managed to achieve the 97.6% effectiveness of the surgical treatment of exudative otitis media. The 12-24 month long follow-up period is recommended.

[Novel possibilities for the rehabilitation of patients presenting with congenital external and middle ear malformations].

The objective of the present study was to estimate the advantages of cochlear Baha BIA 400 abutments in the intraoperative and early postoperative periods. A total of 10 implantations of the systems with the use of hydroxyapatite bone cement were performed in 9 patients of different age. Stability of the implants and intensity of skin reactions were evaluated. The data obtained indicate that the use of cochlear Baha BIA 400 abutments significantly simplifies and shortens the surgical stage of rehabilitation producing a good cosmetic result. The use of the Osstell instrument made it possible to estimate stability of the implants intraoperatively and evaluate the effectiveness of osteointegration during the follow-up period. Analysis of the results of the study provided a basis on which to improve the quality and shorten duration of the rehabilitative treatment of the patients presenting with congenital external and middle ear malformations. Moreover, the data obtained can be used to develop practical recommendations for the further work in this area.

[Canaloplasty in the rehabilitation of patients presenting with microtia]. / Kanaloplastika v reabilitatsii bol'nykh s mikrotiei

A total of 73 patients presenting with grade I, II, and III microtia were given surgical treatment, 35 ones were examined with the use of tympanometry and tonal threshold audiometry; computed tomography (CT) of the temporal bones was applied to examine 33 patients. Special attention in the analysis of CT data was given to 9 major anatomical structures. Indications for the surgical interventions to correct hearing disorders have been developed.

[Tympanic thermometry in diagnosis of exudative otitis media in children]. / Timpanicheskaia termometriia v diagnostike ékssudativnogo srednego otita u detei.

Tympanic and axillary temperatures were measured in 90 children (161 ears) with exudative otitis media (EOM) and 20 otologically healthy children (40 ears). It was discovered that in EOM patients the difference between tympanic and axillary temperatures is greater than in healthy children. This increased difference is caused by the state of the tympanic mucosa. The influence of surgical and conservative treatments on tympanic mucosa temperature and, therefore, on the difference between tympanic and axillary temperatures in these patients are outlined. It is recommended to use tympanic thermometry with consideration of case history data and otoscopic picture as a screening method for diagnosis of EOM in mass prevention examinations of children, in family physician practice and in selection of children for more comprehensive check-up in diagnostic centers as well as for control over treatment results in EOM children.

[A technique of esthetic rehabilitation of patients with microtia after meatotympanoplasty]. / Sposob ésteticheskoi reabilitatsii bol'nykh s mikrotiei posle ranee provedennoi meatotimpanoplastiki.

The paper presents peculiarities of surgical rehabilitation of patients with congenital malformation of the external and middle ear after meatotympanoplasty; demonstrates feasibility of using bioinert synthetic material, silicon, as implant in creating the frame of the floor of the auricle and cosmetic results with criteria of their assessment; characterizes auriculoplasty in lack of hairless skin above the acoustic meatus; outlines complications and their causes; reports a case of a male patient who has undergone a complete rehabilitation of microtia.