[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.

[Neuroendocrine adenoma middle ear]. / Neiroendokrinnye adenomy srednego ukha.

Neuroendocrine adenoma (NEA) is an extremely rare pathology and accounts for less than 2% of all ear tumors. The article provides an overview of the diagnosis, classification, treatment methods and algorithm for monitoring patients with NEA of the middle ear. 6 cases of NEA of the tympanic cavity are described in detail, which were diagnosed and treated in GBUZ NIKIO named after N.N. L.I. Sverzhevsky DZM for the last 5 years. Diagnosis of NEA of the middle ear is possible when performing high-resolution multislice computed tomography of the temporal bones and magnetic resonance imaging with contrast enhancement, however, the neoplasm can be verified only after a histological examination with the determination of the immunophenotype. Differential diagnosis of NEA of the tympanic cavity with other processes of the middle ear must be carried out at each stage of the diagnostic path. Surgical treatment, depending on the volume of education, allows you to remove it completely and improve the auditory function.

[Diagnosis and surgical outcomes in the management of petrous bone cholesteatoma]. / Diagnostika i effektivnost' khirurgicheskogo lecheniya kholesteatomy piramidy visochnoi kosti.

OBJECTIVE: To evaluate the effectiveness of surgical treatment of patients with petrous bone cholesteatoma (PBC) depending on the localization of the pathological process. MATERIAL AND METHODS: The analysis of surgical treatment using various surgical approaches and its results in 32 patients with PBC, depending on the type, localization in petrous bone and intraoperative findings, is presented. Patients with supralabirint PBC underwent extended atticoantromastoidotomy with tympanoplasty and mastoidoplasty with automaterials (n=19), labyrinthectomy (n=4), subtotal petrozectomy with labyrinthectomy and suturing of the external auditory meatus (EAM) (n=2). In infralabirint and infralabirint-apical PBC, a transotic approach was used with Rambo suturing of EAM (n=9). The pre-sigmoid approach was performed in 1 patient. With an extradural subtemporal approach, PBC of apical localization was removed in 1 case. RESULTS: After surgical treatment, hearing remained at the same level in 15 (47%) patients, 14 of them had deafness. In the early postoperative period, a temporary increase in bone conduction hearing thresholds by 10-20 dB was detected in 14 (44%) patients with their gradual recovery over 3 months. Deafness in the postoperative period developed in 3 (9%) patients after removal of supralabirint cholesteatoma. In the early postoperative period, 3 (9%) patients developed systemic dizziness, which was stopped after 3 months. In 25 (78%) patients, the function of the facial nerve in the early postoperative period remained at the same level, of which 14 (44%) were normal, and 11 (34%) had the same degree according to the House-Brackmann (HB) classification. Improvement of function by one degree of HB classification was observed in 4 (12.5%) patients on average 5 months after surgery. CONCLUSION: An adequate personalized choice of surgical treatment methods allowed mainly to preserve the function of hearing and facial nerve. In cases of deterioration of facial nerve function in the postoperative period, gradual improvement was observed for 3-10.5 months with further positive dynamics.

[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.

[Congenital cholesteatoma of the mastoid process: cases of diagnosis and surgical treatment]. / Vrozhdennaya kholesteatoma sostsevidnogo otrostka visochnoi kosti: sluchai diagnostiki i khirurgicheskogo lecheniya.

A brief review of the epidemiology and pathogenesis of congenital cholesteatoma (CC) of the temporal bone pyramid is presented, classifications reflecting the degree of spread or localization of the process are considered. Variants of local CCs of the mastoid process don't fit into these classifications, as well as there is no statistics on the frequency of their detection and treatment due to the rarity of this pathology. Clinical cases of diagnosis, surgical treatment of CC of the mastoid process and its results are described. Clinical examples indicate a long-term asymptomatic course of CC of the mastoid process, accompanied by a pronounced destructive process in the mastoid process. Early surgical treatment makes it possible to remove the neoplasm as radically as possible and preserve hearing function.

Features of the Formation of Communities of Microorganisms Adapting to the Existing Conditions in Different Types of Agrophytocenoses.

The article is devoted to studying the features of the formation of communities of microorganisms, adapting to the conditions of existence in various types of agrophytocenoses. The study was carried out on model weed plant species, the most common in agrophytocenoses of the Belgorod region. Two nutrient media were prepared for microbiological examination: nutrient agar (BPA - the number of mesophilic aerobic and facultative anaerobic microorganisms) and ENDO - an elective medium for CB (Escherichia coli bacteria). It was found that up to 80% of the total numbers of epiphytes are Erwinia herbicola (Pseudomonas herbicola) cells. The most common among the epiphytic bacteria of terrestrial higher weeds are traditional representatives of cosmopolitan bacteria such as Pseudomonas fluorescens, Ps. furbicolaaurum, Ps. putida, Pantoea agglomerans, Arthrobacter flavescens, A. album, Lactobacillus Plantarum, Васillus subtilis, В. megaterium, Klebsiella rosea, Agrobacterium.

[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.

[Isolated malleus handle fracture: cases report and literature review]. / Izolirovannyi perelom rukoyatki molotochka. Obzor literatury i klinicheskie sluchai.

The isolated malleus handle and neck fractures are rare pathology which demands detailed diagnosis and individual treatment plan in every case. Sometimes it could heal without surgery, but in most part of cases surgical treatment is indicated. The short literature review and 2 clinical cases of this pathology are presented in this article. We describe our own variants of surgery repair with autologous cartilage with good results.

[A case of obliteration of a round window in otosclerosis]. / Sluchai obliteratsii kruglogo okna pri otoskleroze.

The article presents a brief review of the literature on the anatomy and physiology of the round window (RW) niche, the causes of occlusion, the diagnosis of this pathology, the features of auditory disorders and tactics when it is detected in patients with otosclerosis (OS). A clinical case of diagnosis and effective surgical treatment for obliteration of RW in a patient with advanced OS, which occurred in 2019 in 0.7% of cases, is described. Removal of RW niche obliteration was carried out with a curette and microcresis by smoothing the canopy over RW until partial visualization of the secondary membrane. It was this stage of the operation that made it possible to restore the normal hydrodynamics of the inner ear fluids and contributed to a functional result. Thus, the diagnosis of RW obliteration in patients with OS is difficult, but possible when using computed tomography of the temporal bones and assessing the mobility of the RW membrane or analyzing changes in hearing at the end of the operation, if it is performed under local anesthesia. The simultaneous performance of stapedoplasty and the removal of bone obliteration of RW makes it possible to safely achieve functional rehabilitation in patients with OS.

[Acoustic neurinomes of childhood]. / Nevrinoma preddverno-ulitkovogo nerva u detei.

The article presents a review of the literature on the vestibular schwannoma of childhood, the features of its clinical manifestations, diagnostic methods, methods of treating education and indications for their use.

[A case of diagnostics and surgical treatment of a patient with a neuroma of the facial nerve]. / Sluchai diagnostiki i khirurgicheskogo lecheniya patsienta s nevrinomoi litsevogo nerva.

The article provides a brief overview of the epidemiology of facial nerve neuromas (FNN, schwannomas), its clinical signs, methods of diagnostic and treatment and indications for their use. A rare clinical case of diagnostics, surgical treatment of FNN with intracranial spread and its results are described in detail. The presented case demonstrates a possible low-symptom course of FNN with intracranial spread. The use of a combined surgical approach (translabyrinthine and extradural subtemporal) in conjunction with neurosurgeons makes it possible to remove FNN with intracranial spread with simultaneous intratemporal neuroplasty of the nerve trunk from the tympanic part of the canal to the bottom of the internal auditory canal with a fragment of the sural nerve with an improvement in the function of the affected nerve.

[Artificial temporal bone]. / Iskusstvennaya visochnaya kost'.

This article presents assembly technology and the main stages of dissection on artificial temporal bone. This sample of artificial temporal bone is a domestic product. The use of this material makes it possible to develop basic dissection skills, such as anthromastoidotomy, posterior tympanotomy, and facial nerve decompression. Artificial temporal bone can be used as a teaching tool for students, residents and postgraduate students who train otosurgical skills in the form of basic stages of dissection work on complex structures of the temporal bone.

[Variants of treatment of the head direction at the festulars of the labi-rint of inflammatory genesis]. / Varianty lecheniia golovokruzheniia pri fistulakh labirinta vospalitel'nogo geneza.

PURPOSE: To analyze the effectiveness of various methods of treating dizziness with fistulas of the labyrinth (FL) of inflammatory genesis. An analysis of the surgical treatment of 216 patients with chronic suppurative otitis media (CSOM) with cholesteatoma complicated by FL using a variety of FL treatment methods is presented. All patients underwent a debridement operation on the middle ear or revision of the postoperative cavity: in 48 patients with a matrix of cholesteatoma in situ on the fistula, in 109 patients with matrix removal followed by plastic repair or FL filling with various autotissues, in 59 patients with matrix conservation, plastic removal or filling FL and SLD labyrinth. In the last two groups, filling of a semicircular canal (SC) defect was performed in 33 patients, and mastoidoplasty - in 47. CONCLUSION: All used FL treatment techniques are effective in the treatment of peripheral vestibular disorders. Careful treatment of SC fistula after removal of all pathological conditions in the absence of active inflammation and the appointment of hormone therapy in the postoperative period are the main factors in preserving the functions of the labyrinth in any surgical technique. Filling of the lumen of the SC and mastoidoplasty in patients with CSOM with FL can eliminate peripheral dizziness.

[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.

[The medical assistance seeking behaviour of the patients presenting with suppurative chronic otitis media and their treatment in Moscow]. / Obrashchaemost' i lechenie bol'nykh khronicheskim gnoinym srednim otitom v Moskve.

The objective of the present study was the analysis of the medical assistance seeking behaviour of the patients presenting with suppurative chronic otitis media (CSOM) and their treatment in Moscow during the period from 2009 till 2016. The incidence of suppurative chronic otitis media in the city of Moscow in 2016 was estimated to be 0.14 per 1000 population, its prevalence 1.23 per 1000 population. The materials of the statistical reports of Moscow ENT clinics give evidence of the considerable growth in the number of the admitted patients suffering from ear diseases including suppurative chronic otitis media (mean 5.5). The surgical activity of the ENT clinics with respect to CSOM amounted to 46%. The overall increase in the number of surgical interventions is attributable to a rise in the frequency of reconstructive operations. These data give evidence of excellent continuity in the work of outpatient facilities and ENT clinics, intensification of their activities, and a change of the people's attitude toward the care for their health. Suppurative chronic otitis media is the commonest pathology encountered in the specialized ENT hospitals where it accounts for 59.8% of the total number of ENT diseases. The frequency of the surgical interventions performed for the treatment of CSOM amounts to 98.9%. The enhanced attention given to the patients with this pathology resulted in the two-fold increase of the specialized medical assistance provided to the patients presenting with suppurative chronic otitis media. The most frequently practiced form of the surgical treatment employed for the management of CSOM is tympanoplasty (in 72% of the patients on the average). The 'closed' variants of sanitizing operations are performed in 59.8% of the patients presenting with chronic suppurative otitis media and concomitant cholesteatoma whereas the 'open' interventions are used to treat 45.1% of the patients in need of tympano- and mastoidoplasty. On the whole, the priority surgical treatment of the patients with chronic suppurative otitis media in specialized medical facilities is reconstructive operations intended to simultaneously reach the beneficial sanative and functional effects without deterioration of the quality of life of the patients suffering from chronic suppurative otitis media.

[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.

[Atypical inflammation of the middle ear]. / Atipichnoe techenie vospaleniia v srednem ukhe.

The objective of the present study was to characterize the patients presenting with atypical inflammation of the middle ear and consider the currently available methods for their examination. A total of 20 patients at the age from 16 to 66 years were admitted to the Department of Ear Microsurgery during the period from 2008 and 2016 for the treatment of atypical inflammation of the middle ear. Eleven of them (18 ears) were found to have tuberculous lesions (TL) of the middle ear while the remaining 9 patients (11 ears) suffered giant cell vasculitis (GCV). All the patients underwent the general clinical and otorhinolaryngological examination, computed tomography of the temporal bones and the thoracic cavity organs, cytological, bacteriological, pathomorphological, and molecular-genetic studies including PCR diagnostics, rheumatological tests, as well as counseling by a phthisiotherapist and rheumatologist. The primary localization of TL in the middle ear was documented in 6 patients including its association with lung lesions in 5 cases. The clinical picture of the disease in 5 patients was that of smoldering exudative pathology and in 6 ones was accompanied by suppurative perforative otitis media. According to the laboratory analyses, bacteriological diagnostics proved efficient in 9% of the patients, pathomorphological and cytological diagnostics in 18% and 27.3% of the cases respectively while the effectiveness of PCR diagnostics was estimated at 55%. The diagnosis in individual patients was established within the period from 1 month to 1.5 years after they first sought medical advice in connection with complaints of the ear disease. Tuberculosis of the middle ear began to develop as exudative middle otitis that acquired the form of bilateral pathology in 4 patients. Three patients had a concomitant pulmonary disease. In 4 patuents, the diagnois of middle ear tuberculosis was established based on the presence of the specific antibodies and in 5 ones based on the results of the pathomorphological study. All the studies were carried out in duplicate. The period between the beginning of the disease and the establishment of the definitive diagnosis varied from 1 month to 1 year.

[The fistula of the round window of the cochlea]. / Fistula okna ulitki.

This article presents the data on the frequency, diagnostics, and variants of the surgical treatment of the fistula of the round window of the cochlea. A case of this pathology is reported with the special emphasis placed on the approaches to the diagnostics and surgical management of this condition.

[Multiple pneumocele associated with temporal bone hyperpneumatization]. / Mnozhestvennoe pnevmotsele pri giperpnevmatizatsii visochnoi kosti.

The authors consider in brief epidemiology, diagnostics, and variants of the surgical treatment of the rare clinical condition pneumocele and pneumoencephalocele of the temporal bone. Diagnostic and surgical modalities for the management of multiple pneumocele associated with temporal bone hyperpneumatization are discussed.

[The surgical treatment of cholesteatoma of the pyramid of the temporal bone].

This paper presents in brief the data on epidemiology, classification, diagnostics, and current tendencies in the surgical treatment of cholesteatoma of the pyramid of the temporal bone. A clinical case of diagnostics and the surgical treatment ofpetrous apex cholesteatomainthe temporal bone is described.