[Features and results of surgical rehabilitation of hearing loss in osteogenesis imperfecta]. / Osobennosti i rezul'taty khirurgicheskogo lecheniya tugoukhosti pri nesovershennom osteogeneze.

Osteogenesis imperfecta (OI) is a form of congenital osteoporosis. Depending on the type of OI, patients experience various types of hearing loss. Depending on the type and degree of hearing loss, various methods of hearing rehabilitation are used in this category of patients. OBJECTIVE: To evaluate the features and results of surgical rehabilitation of hearing loss in patients with osteogenesis imperfecta. MATERIAL AND METHODS: During the period from 2009 to 2022, 2221 primary stapedoplasty was performed in the department, of which 23 (1.04%) in 21 patients were performed in patients with OI. There were 14 women and 7 men. According to TPA, bilateral hearing loss was detected in 19 patients and unilateral in 2. Conductive hearing loss was observed in 9 cases and mixed - in 14. The average thresholds for bone conduction (BC) were 22.7±8.04 dB, and the bone-air interval (ABG) - 36.1±5.3 dB. According to CT of the temporal bones, all patients showed a bilateral and symmetrical decrease in the density of the auditory ossicles, and in 7 patients there were extensive areas of non-uniform decrease in the density of the bone labyrinth up to +500 - +1000 HU.21 patients underwent 23 operations: in 21 cases stapedoplasty with laser assistance and in 2 cases ossiculoplasty. RESULTS: BC thresholds 6 months after surgery averaged 24.6±8.2 dB, and ABG - 12.1±2.9 dB. Closing of ABG ≤10 dB at spoken frequencies was detected in 30.5%, ABG ≤20 dB - in 95%. After 12 months or more after the operation, no change in the audiological parameters was noted. CONCLUSIONS: Stapes surgery for conductive and mixed hearing loss in OI patients is functionally effective. The best results are achieved after therapy with bisphosphonates with preparations of sodium fluoride, calcium and vitamin D, performing the operation when the density of demineralization zones reaches 1000 HU and using laser assistance. Taking into account the demineralization of the bone structures of the temporal bone, it is recommended to use autocartilaginous stirrup prostheses to restore sound conduction or to cover the attachment area of other prostheses with autologous tissues to prevent necrosis of the long stalk of the incus and stabilize long-term functional results.

[Clinical and radiological classification of otosclerosis]. / Kliniko-rentgenologicheskaya klassifikatsiya otoskleroza.

The article presents various classifications of forms of otosclerosis (OS), which change with the development of diagnostic methods. At the same time, according to the literature, a unified OS classification has not yet been adopted. All existing classifications are imperfect to some extent. The classification of clinical forms of OS according to TPA data makes it possible to determine the indications for surgical treatment and to suggest its possible effect, but not the localization of OS foci. X-ray classifications of localization of OS foci indicate their diversity, distribution, and do not always correlate with the type of hearing loss. At the same time, modern diagnostics of OS should be based on audiological data, localization of foci and their density according to the results of X-ray methods of examination. Based on the examination and treatment of 1532 patients with various forms of OS, a modern clinical and radiological classification of the disease is proposed, based precisely on these provisions. This classification, in our opinion, will improve the quality of diagnosis of various forms of OS, will allow to differentiate the tactics of treating patients with this disease to stabilize hearing loss, indications for surgical treatment, suggest its effectiveness with a reduction in the risk of surgical failures and possible further rehabilitation of the patient.

[Tendoplasty and its effectiveness in the rehabilitation of hearing loss in patients with otosclerosis]. / Tendoplastika i ee effektivnost' pri khirurgicheskoi reabilitatsii patsientov s tugoukhost'yu, obuslovlennoi otosklerozom.

The article briefly presents the physiology of the stapes muscle tendon (SMT), and features in its defeat. Its length was studied using high-resolution multispiral computed tomography of the temporal bones. We also studied the possibility of its restoration using the author's method of tendoplasty using metallized stapes prostheses. Tendoplasty with stapedoplasty was performed in 74 patients with otosclerosis (OS), and 48 patients had stapedoplasty without tendoplasty. As a result of research, the average length of the SMT was 2.38±0.02 mm, which explains the need to use a 3 mm long venous autograft for tendoplasty. The author's method of tendoplasty for stapedoplasty allows restoring the acoustic reflex in 54.1% of OS patients using artificial stapes prostheses. The preservation of the vascular bed in the thickness of the restored tendon can improve the trophy of the long incus process and reduce the risk of its dystrophic changes in the postoperative period. In addition, this fact confirms the importance of the stapes muscle in the acoustic reflex.

[The role of stapedoplasty in the treatment of hearing impairment in the patients presenting with tympanosclerosis]. / Stapedoplastika v lechenii tugoukhosti u bol'nykh timpanosklerozom.

The present study included the examination and surgical treatment of 50 adult patients presenting with tympanosclerotic fixation of the stirrup. The patients comprising the first subgroup (n=25) underwent the two-stage treatment during the period from 1990 to 2009. The final phase of the treatment consisted of the implantation of different kinds of stirrup prostheses placed on the venous autograft that closed the oval window of the vestibule following partial or total instrumental stapedectomy. The second subgruop was composed of the patients (n=25) who were given the two- or three-stage surgical treatment during the period from 2009 till 2014 the final phase of which was performed following the same procedures as in the first subgroup but with the use of the surgical CO2-laser instead of the conventional instrumental methods. The pathomorphological studies carried out at different stages of the surgical treatment have demonstrated the necessity of isolation of the vestibular fluid for the purpose of implantation of the stirrup prostheses with a view to preventing cochlear complications. The results of the present study give evidence of the efficiency of stapedoplasty with the application of the autocartilaginous prostheses of the stirrup implanted on the venous autografts to close the oval window of the vestibule with the reduction of the bone-air interval down to less than 20 dB. The performance of this procedure with the use of the instrumental technique produced a favourable outcome of the treatment in 71.4% of the patients presenting with tympanosclerosis. The use of the laser-assisted approach further increased the efficiency of the treatment up to 76%. Moreover, the latter method allows to avoid the reaction of the inner ear to the surgical intervention during the early postoperative period and results in the faster averaged reduction of the bone-air interval in comparison with the patients treated with the application of the instrumental technique.

[An acute acoustic injury during the early postoperative period following stapedoplasty]. / Ostraia akusticheskaia travma v rannem posleoperatsionnom periode posle stapedoplastiki.

This article was designed to report a clinical case of an acute acoustic injury inflicted by a discharge of the lightning ball during the early postoperative period in a female patient following surgical stapedoplasty. The acoustic impact resulted in a marked deterioration of hearing in the operated ear with simultaneous elevation of the threshold of bone sound conduction to above the preoperative value. It is concluded that the patients who had undergone the stapedoplastic surgical intervention should be advised to avoid strong acoustic impacts during the postoperative period.

[The application of stapedoplasty for the treatment of hearing loss in the patients suffering from obliterative otosclerosis]. / Stapedoplastika v lechenii tugoukhosti u bol'nykh obliteriruiushchim otosklerozom.

This article presents the results of analysis of the data obtained during the examination and the surgical treatment of the patients presenting with the obliterative form of otosclerosis and suffering from hearing impairment with special reference to the intraoperative findings, technical aspects of stapedoplasty, and its effectiveness. A total of 14 patients (17 ears) were recruited for the participation in the present study including 10 women at the mean age of 38.8±6.2 years and 4 men (mean age 44.8±3.9 years). The duration of the hearing loss in the period preceding the surgical treatment in 7 (50%) patients was more than 8 years. According to the results of tonal threshold audiometry (TTA), the mean bone conduction (BC) threshold for conductive hearing loss in the frequency range from 0.5 to 4.0 kHz was 24.9±8.1 dB with the mean bone air gap (BAG) equaling 38±5.1 dB. Computed tomography (CT) of the temporal bones revealed grade 1 obliterative otosclerosis in 4 patients, grade II of the same condition in 6 patients, and grade III in 7 ones. These findings were confirmed intraoperatively. In 15 cases, stapedostomy was carried out with the use of the non-contact CO2 laser-based system, in the remaining cases a microdrill was employed. Five patients underwent laser-assisted piston stapedoplasty while in 11 others the stapes prosthesis was placed on the autovein. One patient was treated by the same method with the use of the autocartilaginous prosthesis. The functionally acceptable results within 1 year after the surgical intervention were obtained in all the treated patients with the mean bone air gap equaling 13.2±3.4 dB. The best outcome (the reduction of the BC threshold and BAG by 7 dB and 25.9 db on the average respectively within 1 year after surgery was achieved in the patients with grade III obliterative otosclerosis.

[The prevalence of tympanosclerosis and the effectiveness of its surgical treatment]. / Rasprostranennost' timpanoskleroza i éffektivnost' ego khirurgicheskogo lecheniia.

The objective of the present study was to characterize the epidemiological variants of tympanosclerosis and the effectiveness of the surgical treatment of the patients presenting with this condition. We have undertaken the analysis of the results of 1965 surgical interventions on the patients suffering from different forms of chronic otitis media (COM) performed during the period from 2009 till 2014 with a view to determining the frequency of tympanosclerosis (TSC). In 542 cases, it proved possible to evaluate the intraoperative findings, stages and methods of reconstructive surgery, the anatomical and functional outcomes and effectiveness of the intervention. At present, the signs of tympanosclerosis are identified in 27.6% of the patients presenting with chronic otitis media including 88.7% and 11.3% suffering from the perforating and non-perforating forms of this pathology, respectively. In 74% of the cases its manifestations are diagnosed in the patients having the tubotympanic form of COM. In 53.3% of the patients TSC foci are responsible for the fixation of the ossicular chain whereas in 46.7% of the cases the auditory ossicles retain mobility. As many as 88.6% of the patients underwent the one-step surgical intervention, 10.7% were managed using two-step surgery, and 0.7% of the patients were given the three-stage treatment. Type I tympanoplasty was performed in 62% of the patients, type III tympanoplasty in 30.4%, and various types of stapedoplasty in 4.6% of the cases. The favourable anatomical and functional outcomes at the first stage of the surgical intervention with the use of the autogenous tissues for tympano- and ossiculoplastic surgery were achieved in 87.9% of the patients on the average (by means of the closure of the tympanic defect in 92.2% and by re-fixation of the selected elements of the ossicular chain in 17.3%of the cases). The anatomical and functional effectiveness of the second-stage surgical intervention was estimated at 93.1%.

[The original method for bypass surgery of the tympanic cavity to treat chronic dysfunction of the Eustachian tube].

The objective of the present study was to improve the effectiveness of the treatment of intractable dysfunctionof the Eustachian tube responsible for the relapses of catarrhal and exudative otitis media. The authors developed the diaphragmatic slot valve integrated into the silicone tympanic shunt tube. The proposed diaphragmatic slot valve was shown to counterbalance extra- and intratympanic pressure at the experimentally found compression threshold equaling 123.06 daPa. This original functional shunt ensured the continuous functioning of tensor tympani muscle and maintained tympano-tubal innervation. The comprehensive examination and treatment encompassed 104 patients (104 ears) presenting with long-standing dysfunction of the Eustachian tube. In 52 patients (52 ears), otitis media was treated with the use of the functional shunt tube and in the remaining 52 (52 ears) with the standard silicone shunt tube. The comparative analysis has demonstrated that the effectiveness of the treatment of intractable dysfunctionof the Eustachian tube can be increased by 13.3% using the functional tympanic shunt. Simultaneously, this method made it possible to totally normalize the ventilation function of the Eustachian tube in 51 (98.1%) patients. The duration of the treatment with the use of the functional shunt tube averaged 42.11±8.46 days (in the patients with catarrhal inflammation of the middle ear) and 59.03±7.17 days (in the case of exudative otitis media) which was 42.9% and 37.3% shorter respectively than the duration of the traditional treatment (p<0.5).

[The application of ultrasound for diagnostics of middle ear pathologies].

The objective of the present work was to summarize the results of the application of ultrasound tests for differential diagnostics of various diseases and lesions affecting the middle ear. Almost 7.000 threshold and suprathreshold studies were carried out in the patients presenting with various forms of sensorineural impairment of hearing. The ultrasound investigations were conducted with the use of the EKHOTEST-02 apparatus (Giperion, Moscow). The results of determination of threshold hearing sensitivity to ultrasound and lateralization of its threshold and suprathreshold values suggest their significance for the detection of even such a minimal disturbance in the cochlear function as the phenomenon of accelerated increase in loudness and the associated enhancement of the severity of the damage to the peripheral sensory system.