The article focuses on the surgical treatment of the patients with the new-onset cochlear form of otosclerosis, and the patients, in which, according to the tonal threshold audiometry, a significant sensorineural hearing loss had occurred after stapedotomy. This article provides an algorithm of differential diagnostic of the primary (true) and the secondary (false) sensorineural hearing loss, comprising the sensorineural hearing loss component revealed in the patients with the cochlear form of otosclerosis. The authors present detailed description of the method of stapedectomy with substitution of a part of perilymph with physiological saline solution, providing its theoretical substantiation and the preliminary functional results of the surgery.
Van der Hoove syndrome is an inherited genetically determined generalized connective tissue disorder characterized by the formation of „pathologically immature type I collagen“. The literature describes the results of cochlear implantation in patients with van der Howe syndrome, after which there are often complications both intraoperative and postoperative. This article describes two clinical cases of van der Howe syndrome with severe hearing loss and deafness. In cases described: preoperative diagnosis and features of the surgical stage of cochlear implantation and postoperative results. Diagnostic features – thinning of bone tissue according to CT of temporal bones, expansion of cochlear duct, deafness according to tonal threshold audiometry. Cochlear implantation performed with the use of the endotracheal anesthesia under the control of the microscope, straight electrode grids were used, testing was normal. A distinctive feature of this syndrome is the softness of the cochlea’s bone tissue, the danger is that when the electrode array is inserted, it may fall outside the cochlea. Also, during the first connection or later, there may be pathological stimulation of the facial nerve.
The article describes the pathophysiological mechanisms of negative pressure in the middle ear cavity due to persistent auditory tube dysfunction; we also demonstrated the compensatory mechanisms opposing at initial stages to the increase of negative pressure in the middle ear, where the main role is played by the mucosa of the retro-tympanic parts. In all cases of negative tympanic cavity pressure the base of stapes gets pulled towards the vestibular window and the secondary round window membrane protrudes into the tympanic cavity; the article explains the theoretical basis of these processes.
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