[A case of acute purulent otitis media complicated by atypical mastoiditis on the background of an unverified HIV infection]. / Sluchai ostrogo gnoinogo srednego otita, oslozhnennogo atipichnym mastoiditom, na fone neverifitsirovannoi VICh-infektsii.

According to the literature, acute otitis media is complicated by mastoiditis in 0.15-1% of cases. In turn, mastoiditis can be complicated by meningitis, encephalitis, abscess of temporal lobe of brain and cerebellum, epidural and subdural abscesses, facial nerve paresis, labyrinthitis, phlegmon of soft tissues of neck, as well as subperiosteal abscess, which makes 7% in the structure of mastoiditis complications. Nowadays, when doctors have a wide range of antibacterial preparations at their disposal, a complicated course of acute otitis media and further mastoiditis is caused both by an aggressive atypical infectious agent and immunocompromised status of a patient. The article deals with a clinical case of a prolonged course of acute otitis media complicated by mastoiditis and subperiosteal abscess against the background of outpatient courses of antibacterial therapy. The examination revealed an atypical pathogen of otitis media Pseudomonas aeruginosa and HIV-positive status of the patient, previously unknown. Timely surgical intervention and the right combination of antibacterial drugs, meropenem and ciprofloxacin, prevented the development of intracranial and septic complications, despite the presence of multiple foci of bone destruction of the mastoid process and temporal bone pyramid, bordering the middle fossa and sigmoid sinus, according to multispiral head computed tomography. As a part of additional examination in the Center for AIDS and Infectious Diseases Prevention and Control, the patient was diagnosed with HIV infection, clinical stage 4C, progressing phase on the background of absence of antiretroviral therapy, and the necessary amount of treatment was prescribed.

[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.

[A meta-analysis of clinical studies in otorhinolaryngology]. / Metaanaliz klinicheskikh issledovanii v otorinolaringologii.

THE OBJECTIVE: Of the work was to describe the basics of a meta-analysis with features for evaluating models with fixed and random effects, to present principles for interpreting the graphical results of a meta-analysis (forest plot or blobogram) of comparative reviews of randomized clinical trials (RCTs). MATERIAL AND METHODS: To illustrate the possibility of efficient use of the R software environment for meta-analysis, we used the results of RCTs of various tonsillectomy methods already published in the Cochrane Database review. RESULTS: The article provides explanations for the calculation of effect size, heterogeneity statistic, and other meta-analysis statistics and their interpretation for evaluating RCTs and recommendations for choosing a model depending on the on the general research concept. CONCLUSION: The described method allows meta-analysis and gives an idea of the principles for preparing the results of clinical trials with the expectation of their subsequent use in systematic reviews and meta-analysis.

[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.

[Sequential bilateral cochlear implantation with long interval between surgeries in deaf-blind patient]. / Posledovatel'naia bilateral'naia kokhlearnaia implantatsiia s dlitel'nym intervalom mezhdu operatsiiami u slepoglukhogo patsienta.

The efficacy of sequential bilateral cochlear implantation with long interval between surgeries (18 years) was investigated in deaf-blind patient (22 years old man, lost hearing and vision after meningitis at the age 2.5 years). At the age 4 years he got cochlear implant at right ear. His speech skills completely disappeared before the implantation. Auditory-speech rehabilitation with cochlear implant was successful - patient has good auditory, language, speech, cognitive skills. At the age 22 years patient made decision to get cochlear implant at the left ear after breakdown of internal part of cochlear implant at right ear in spite of successful reoperation. After activation of new processor (all electrodes were activated) the patient got daily auditory training with cochlear implant at left ear (Concerto/Opus 2, Medel) on the base of 'auditory' method, in daily life patient uses 2 devices. After 1 month of using cochlear implant at left ear the patient recognized environmental sounds and music instruments, words and sentences in close set tests EARS battery, the score for OLSA test in quiet was 90%, but the perception in noise was complicated. The balance of parameters of fitting for 1-st and 2-nd processors and special auditory training with two cochlear implants provided the development of initial binaural interaction. Perilinqually deaf patients can achieve high effect after sequential bilateral cochlear implantation with long interval between surgeries. The necessary conditions are - preservation of electrical activity of auditory nerve, intensive structured auditory training with new 'ear', patient's motivation of using of cochlear implant at 'new' ear.

[FEATURES OF OTOGENIC INTRACRANIAL COMPLICATIONS AT THE PRESENT STAGE].

A retrospective analysis of treatment was made in 127 adult patients with acute and chronic otitis media complicated by suppurative-inflammatory pathology of the brain. Purulent meningitis was revealed in 52 (40.9%) of hospitalized patients. Meningoencephalitis was often diagnosed in the cases of acute otitis media (15.4%) and in cases of chronic otitis (22.7%). The otogenic brain abscess was detected in 13.5% of otitis media cases and it was noted to be twice frequent (33.3%) in cases of purulent otitis media. The patients 124 (97.6%) have been operated. An extended mastoidotomy and antromastoidotomy were performed in the acute purulent otitis media. An extended radical operation on the ear was applied in case of chronic otitis media. Performance of craniotomy and complete removal of the abscess using modern systems of neuronavigation showed a higher clinical efficacy as compared with transtemporal approach during sanitizing intervention on the ear including the opening and abscess drainage in surgery of otogenic abscesses of the brain.