[Clinical and radiological classification of otosclerosis]

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.

[Therapeutic areas of the Republic of Tyva]

The need to expand the resort and recreational potential in the Siberian Federal District is due to the growing need for sanatorium treatment and rehabilitation of the population. Balneological studies conducted in different regions of Siberia make it possible to position these territories as promising for resort and recreational activities.

OBJECTIVE

Comprehensive integral assessment of the resort and recreational potential of the treatment areas of the Republic of Tyva.

MATERIAL AND METHODS

Taking into account the requirements of the guidelines "Bioclimatic passport of the medical and recreational areas" No. 96/226, approved by the Ministry of Health of Russia on February 7, 1997, an integral medical and climatic assessment of the territories of the medical and recreational areas of the Republic of Tyva was carried out. The assessment of the quality of water resources was carried out in accordance with the criteria of the methodological recommendations "Control of the quality and safety of mineral waters by chemical and microbiological indicators" No. 96/225, approved by the Ministry of Health of Russia on 07.04.1997. The typification of water resources is given in accordance with GOST R 54316-2011 "Natural mineral drinking waters".

RESULTS

The territory of the Republic of Tyva has the richest reserves of unique therapeutic hydro-mineral resources, and the existing features of landscape and climatic conditions determine the prospects for their widespread use. The surveyed areas are located on mid-mountain and low-mountain landscapes with favorable bioclimatic conditions for the organization of climate treatment and recreation, especially in the warm season. The prospects for the development of climate-balneological and climate-mud resorts in Tuva are shown, especially in terms of medical and health tourism.

CONCLUSION

A detailed database has been developed on the components of the resort and recreational potential (bioclimate, mineral waters, therapeutic mud) of the treatment areas of Tuva. The data obtained formed the basis of proposals for updating the register of resorts and health-improving areas of the Siberian Federal District, which is formed on the basis of the results of many years of research.

[Application of semiconductor LED laser generators in otorhinolaryngology]

The review article provides brief data on the classification of lasers in medicine, the history of the use of therapeutic lasers. The problems of the use of semiconductor lasers in inflammatory diseases of various etiologies, as well as in various diseases of ENT organs, in particular, in diseases of the middle ear are considered.

[Persistant dysfunction of the eustachian tube: solving the problem]

Each person experienced an unpleasant sensation of congestion of the ear during a flight or in rhinorrhea, which is caused by dysfunction of the Eustachian tube (ET). People with persistent ET dysfunction live with this sensation for months and years. Persistent ET dysfunction in children reaches 40%, in adults it is up to 5%. Most of the pathological conditions of the middle ear, leading to socially significant hearing loss, and the main reasons for failures in hearing-improving operations are associated with persistent ET dysfunction. The effectiveness of various methods of treating this pathology, despite their large quantity, still remains doubtful due to the lack of clear criteria and golden standard for diagnosis, indications for specific methods and long-term results of treatment. According to the aim of the study a diagnostic and treatment algorithm was developed for persistent ET dysfunction in adults and children. We researched this problem for more than 10 years, and the effectiveness of the proposed diagnostic and therapeutic measures has been statistically proven, both by a large sample of patients and by a long period of observation. Researchers of L. I. Sverzhevsky Research Institute of Otorhinolaryngology have developed a diagnostic algorithm for persistent ET dysfunction, optimized the treatment of persistent dysfunction and recurrent concomitant secretory otitis media, and also determined the indications and methods for conducting ET balloon dilatation in adults and children with persistent ET dysfunction. We improved the functionality results of hearing-improving operations (tympanoplasty) in patients with persistent ET dysfunction. All of the above allowed us to reduce the treatment time for this group of patients by up to 50%, to achieve high clinical efficacy in up to 100%, and to obtain a lasting functionality in hearing-improving operations in 93% of cases.

[Middle ear osteoma: case report and literature review]

The short literary review of frequency of occurrence, complaints, results of diagnostics and surgical treatment of patients about osteomine is presented to a drum cavity in article. Two own cases of clinical inspection and surgical treatment of patients about osteomine of a drum cavity are described.

[The medical-recreational and balneotherapeutic regions of the Krasnoyarsk Territory]

BACKGROUND

the creation of the efficient system of the spa and health resort-based health care for the population of the entire territory of the Russian Federation requires the systematic evaluation and protection of the natural resources of country as a basis for the further development of the health resort and recreation facilities in different regions.

AIM

The objective of the present study was to estimate the possibilities of expansion of the health resort and recreational activities based on the rational exploitation of the natural resources of the medical-recreational and balneotherapeutic areas of the Krasnoyarsk Territory.

METHODS

The inspection of the medical-recreational and balneotherapeutic regions of the southern part of the Krasnoyarsk Territory with the evaluation of the medicinal and raw materials resources of the spa and health resort facilities located in this area. The comprehensive assessment of the landscape and climatic conditions of the territory was performed in compliance with the methodological recommendations No 96/226 «The bioclimatic passport of the medical-recreational and balneotherapeutic region» approved by the Ministry of Health of the Russian Federation as of 7 February 1997. The quality of water bodies/sources was carried out in conformity with the criteria envisaged by the methodological recommendations No 96/225 «Quality and safety control of mineral waters based on their chemical and microbiological characteristics» approved by the Ministry of Health of the Russian Federation as of 7 April 1997. Water typing was performed in accordance with GOST R 54316-2011 «Natural drinking mineral waters».

RESULTS

The medical-recreational and balneotherapeutic regions in southern part of the Krasnoyarsk Territory are notable for the great variety of mountainous, forest and steppe landscape forms with their favorable bioclimatic conditions and unique resources of therapeutic muds and mineral carbonic waters. The area is characterized by the great potential for the further development of the climatic spa and health resort facilities, and the improvement of the health care service for both children's and adult populations based on the rational use of the local landscape and climatic factors available at the territories occupied by the spa and health resort facilities of the balneotherapeutic profile. The prospects for the further expansion of medical and recreational tourism are discussed.

CONCLUSIONS

This article was designed to systematize the available data characterizing the balneotherapeutic and recreational conditions of the medical-recreational regions of the southern part of the Krasnoyarsk Territory with special reference to the value of their natural resources, such as bioclimate, mineral waters, therapeutic muds, etc., for their inclusion in the registry of the areas possessed of the great health-improving potential based on the rational nature use and environmental management programs.

[The application of stapedoplasty for the treatment of hearing loss in the patients suffering from obliterative otosclerosis]

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]

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%.

[Atypical inflammation of the middle ear]

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 prospects for the further development of the Belokurikha spa and health resort territory in the Altai Krai (region)]

We undertook a balneological survey of the Belokurikha spa and health resort territory with the purpose of distinguishing and identifying the potential health-improvement areas most promising for the extension and optimization of the therapeutic, tourist and recreational activities. The assessment was focused on the characteristic of the landscape and climatic conditions of the territory, the possibilities for the development of the existing resources of mineral waters and therapeutic muds as well as for the discovery of the potential new ones. The recommendations are proposed to promote the development of different forms of tourism with special reference to its medical and health-improvement aspects. It is suggested that the territory of the «Belokurikha» resort», «Belokurikha-2» and «Belokurikha-3» health-improvement areas should be integrated into a single spa-and-health resort district of federal importance.

[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 clinical manifestations and diagnostics of otitis media caused by tuberculosis]

The objective of the present study was to clarify the characteristic pathognomonic features of middle ear lesions associated with tuberculosis and the approaches to their diagnostics under the present-day conditions. The study included 11 cases (18 ears) of tuberculosis otitis media and the related lesions of the mastoid process diagnosed with the use of clinical, roentgenological, cytological, bacteriological, pathomorphological, and molecular-genetic methods (including PCR diagnostics). The primary localization of tuberculosis in the middle ear was documented in 6 patients; in 5 patients, it was associated with pulmonary involvement. Five patients presented with smoldering exudative otitis media and the remaining six ones with suppurative perforating otitis media. The tuberculous process was diagnosed with the use of various methods including clinical examination, bacteriological (9%), cytological (27.3%), pathomorphological (18%) studies, and PCR diagnostics (55%). Diagnosis was made within a period from 1 month to 1.5 years after the application of the patients for medical assistance which suggests the difficulty of verification of tuberculous etiology of the disease of the middle ear. It is concluded that the high index of suspicion in the case of smoldering middle ear pathology facilitates its early diagnostics and successful treatment.

[The prospects for the development of therapeutic and health-promoting tourism in Gorny Altai]

The present balneological survey made it possible to identify the promising areas with a high potential for the health resort, recreational and touristic activities including the foothill, low-mountain, mid-mountain valleys and hollows of Northern, Northwestern, Central and Eastern bioclimatic provinces of Mountainous Altai. Recommendations have been proposed for the development of therapeutic and health-improving tourism in the Shebalinsk, Ust'-Kansk and Ulagansk districts of the Altai Republic.

[Analysis of the effectiveness of tympanoplasty in the patients presenting with chronic otitis media complicated by perforation]

AIM

The objective of the present study was to analyse the causes behind reperforation of the tympanic membrane in the patients presenting with chronic otitis media (mesotympanitis) after type I--III intrameatal tympanoplasty. Characteristic of the patients and methods of investigation. Intrameatal type I--III tympanoplasty with the use of autotransplants was performed in 652 patients presenting with chronic otitis media complicated by perforation of the tympanic membrane (CPOM). Fifty (7.6%) of these patients suffered recurrent perforation within one year after the primary treatment. The analysis of the medical histories, the character of secondary perforations, and intraoperative findings in 50 patients provided the data for the elucidation of the causes of poor anatomical and morphological outcomes of the surgical treatment.

RESULTS

It was shown that the anatomical and morphological effectiveness of type I--III intrameatal tympanoplasty in the patients with CPOM amounted to 92.4%. The main causes of reperforation are an extensive defect of the tympanic membrane, tympanic cavity mucositis associated with the compromised function of the Eustachian tube, in-growth of epidermis into the structures of the tympanic membrane, and the combination of these conditions as well as technical difficulties inherent in the surgical intervention.

[Health and recreational localities in the republic of altai and prospects for the development of spa-and-resort services on their basis]

The objective of the present work was to explore low- and mid-altitude valleys and depressions in the northern and central bioclimatic provinces of Gorny Altai for the identification of the health and recreational localities most promising in terms development of spa-and-resort services. The integral estimation of landscape and climatic conditions in conjunction with the quality of hydromineral resources of therapeutic value provided the data that were used by the authors to propose recommendations for the creation of the system of mountain-climate health resorts and touristic-recreational complexes of regional and federal significance at the territory of the Republic of Altai.

[Sanation surgery for the treatment of chronic suppurative otitis media with cholesteatoma]

Results of the surgical treatment of 98 patients presenting with chronic suppurative otitis media (CSOM) and accompanying cholesteatoma. CSOM of large duration turned out to be associated with cholesteatoma in 31.3% of the patients regardless of localization of the tympanic defect. A variety of surgical interventions were undertaken depending on the extension of cholesteatoma including the intrameatal approach (n=75), endaural approach (n=16), postaural approach (n=6), and the combined approach (n=1). Forty two patients presenting with either central or peripheral peroration in the strained part of the tympanic membrane were operated with the use of the intrameatal approach. Perforation in the unstrained part of the tympanic membrane in 56 patients with chronic suppurative otitis media and cholesteatoma extending to the antrum and the cells of the mastoid process was corrected by sanation operation at different stages of the carious process using different surgical approaches. The early surgical intervention during the carious process in the patients presenting with CSOM and cholesteatoma in the phase of remission, taking into account structural peculiarities of the mastoid process and distribution of the inflammatory process, significantly reduced its extension and permitted to reconstruct the structure of the middle ear in 70% of the patients.

[Therapeutic factors of lake Tagarskoye]

The results of comprehensive long-term investigations of therapeutic factors of Lake Tagarskoye, Krasnoyarsk krai (territory) are presented. It is shown that, in addition to favourable climatic conditions, the area of interest has a variety of therapeutic hydromineral resources the structure and quality of which are subject to marked seasonal and annual variations. The thorough analysis made it possible to elucidate dynamics of these changes and monitor qualitative characteristics of the resources; also, it promoted the search for methods of their more extensive exploitation and the development of the rationale for designation of Lake Tagarskoye and the surrounding locations as a strictly protected natural area.

[Acoustic characteristics of resonance after cavity surgery on the ear and their usage in variants of reconstructive operations]

Acoustic measurements were made of the external and middle ear resonance in health and disease in patients after radical surgery on the ear and in chronic perforative otitis media. It is shown that the absence of the posterior wall of the acoustic meatus deteriorates hearing acuity in the frequency 4000 Hz. Reconstructive surgery of this wall normalizes acoustic resonance of the ear. The value of bone-air interval on pure tone audiogram is different after cavity operation and perforation of the tympanic membrane. Characteristics of acoustic resonance of the ear are decisive for choice of reconstructive surgery.

[Combined drug therapy in patients with chronic otitis media and mucositis]

The data of the authors own studies using conservative therapy in patients with chronic otitis media (COM) and mucositis are presented. The efficiency of treatment of these patients is shown depending on the method of treatment (the highest efficiency being noted in the main group of patients in whom the altered middle ear mucosa was concurrently exposed to autoserum (AS) and magnetic laser therapy (MLT). The efficiency of this or that conservative treatment was found to be related to the magnitude of altered middle ear mucosal changes: the more marked the signs of mucositis are, the more difficult it is to achieve a positive result. The results of treatment were assessed visually (under an operating microscope), bacteriologically, cytologically, and crystallographically. There was a correlation between the visual assessment of obtained treatment results and crystallographic findings. The high efficiency of the proposed treatment in patients with COM and mucositis is determined by the concurrent combined AS and MLT exposure of the entire thickness of the changed mucosa and by the stimulating action of MLT on AS. This conservative therapy can pretend to be the method of choice in treating patients with COM and mucositis.

[The experience of reconstructive surgery in patients after surgeries of the ear]

The article deals with the experience gained by the authors in reconstructive surgery after radical operations on the ear. Three variants of surgical interventions were used. Indications to them are presented based on pathomorphological characteristics of the postoperative cavity and function of the internal ear. Anatomic and functional results of the operation variants are compared.