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 objective of the present study was to evaluate the effectiveness of the administration of a medication into the middle ear structures during catheterization of the acoustic tube (AT) in the course of the contrast-enhanced X-ray salpingographic investigation. The study included 18 patients (18 ears) presenting with chronic otitis media and the perforated tympanic membrane without the disturbances of the ventilation function of the auditory tube. All the patients were allocated to two groups depending on the type of the Eustachian catheters being used. Group 1 was comprised of 9 patients treated with the use of traditional Giyot's catheter, group 2 was composed of another nine patients who were treated with the use of the Eustachian catheters having an original shape with a specific configuration of its distal part. The X-ray studies were carried out before and after catheterization of the acoustic tube with the administration of 1 ml of the hypaque contrast medium. The study has demonstrated that the X-ray contrast agent did not penetrate into the inner structures of the middle ear of the patients comprising group 1 whereas in the patients of the second group the contrast medium reached as far as the bony portion of the acoustic tube.
Хирургия стремени при его тимпаносклеротической фиксации остается спорной вследствие высокого риска развития сенсоневральных нарушений и рефиксации протезов из-за незаконченного воспаления и недостаточного кровоснабжения [1-7]. Стапедопластику у больных хроническим гнойным средним отитом (ХГСО) проводят в 0,3% случаев при тимпаносклеротической фиксации стремени и неэффективно-сти его мобилизации, массивном тимпаносклерозе (ТСК) и, как правило, вторым этапом у 89% пациентов после восстановления тимпанальной мембраны [5, 7-9]. Ранее наличие ТСК считали противопоказанием к операции на стремени [10]. Некоторые рекомендуют эту методику только в случаях тяжелой двусторонней кондуктивной тугоухости у больных, отказывающихся от слухового протезирования при сообщении о риске операции [6].
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