[Choristoma of the middle ear]

Choristoma is one of the varieties of congenital developmental anomalies, where one or another normal tissue of the body is located in an atypical place for itself. The short literary review of choristoma of middle ear is presented in article. A rare clinical cases of salivary gland choristoma of the middle ear (5-year-old girl with left-sided conductive hearing loss of III degree) and glial choristoma of the mastoid (19-year-old man with signs of chronic suppurative otitis media of the right ear) are described.

[Clinical case for removal supralabyrinthine petrous bone cholesteatoma with improvement of hearing function]

The article presents the clinical case of supralabyrinthine petrous bone cholesteatoma. We have analyzed the preoperative examination of the patient for identification method of surgical treatment with preservation the facial nerve, improvement hearing function and reducing risk of recurrent cholesteatoma, perioperative findings and the end result of surgical treatment.

[Jugulotympane paraganglioma associated with polysegmentary congenital hemangioma]

The describes a clinical observation of a combination of jugulotympanic paraganglioma of the left temporal bone with multifocal congenital hemangioma. The interest of the case is that such a combination of pathologies is extremely rare. A comprehensive study and surgical treatment of a patient with this clinical diagnosis was carried out. In the diagnosis, objective otorhinolaryngological studies, otomicroscopy and MSCT of the temporal bones and MRI of the middle ear with contrast were used. Surgical intervention was performed under multicomponent anesthesia with tracheal intubation, transmastoid access. The postoperative management of the patient after surgical treatment is described.

[Predictors of recurrent pathology and prognosis of the results of surgical treatment of patients with acquired middle-ear cholesteatoma]

A retrospective analysis of the results of surgical treatment of 436 patients (332 adults and 104 children under the age of 15 years) with acquired middle ear cholesteatoma was performed to identify possible predictors of relapse of the process and a prospective assessment of the results of surgical treatment. It was revealed that the leading factors in the development of residual pathology were: the presence of cholesteatoma in the area of destruction of the bone wall of the canal of the facial nerve, cholesteatoma of the hypothympanum, cholesteatoma in the place of destruction of the bone wall of the posterior cranial fossa. The key reasons for the formation of recurrent pathology were: children under 15 years of age, closed surgery, pathological changes in the tympanic orifice of the auditory tube and the presence of cholesteatoma in its lumen. Performing a closed operation in adults with pathology of the tympanic orifice of the auditory tube increases the risk of recurrent cholesteatoma by 18.6%, and in children by 20%. The choice of a closed method of surgical intervention for the epitympanic type of the disease can increase the risk of residual pathology by 17.2% in adults and 27.8% in children.

[Characteristics of diagnosis and surgical treatment of various forms of congenital temporal bone cholesteatoma]

OBJECTIVE

To conduct a retro- and prospective analysis of the clinical characteristics and results of surgical treatment of patients with congenital temporal bone cholesteatoma.

PATIENTS AND METHODS

On the basis of the SPb Scientific Research Institute of ENT of the Ministry of Health of Russia 23 patients were diagnosed with congenital temporal bone cholesteatoma for the period from 2011 to 2018. There were 11 men (47.8%), 12 women (52.2%), the age of patients - from 2 to 44 years. The M.J. Levenson criteria were used to verify congenital middle ear cholesteatoma. (1986). According to intrasurgery findings, we identified congenital cholesteatoma of the middle ear stages according to the ChOLE classification. Other types of congenital temporal bone cholesteatoma included the patients with congenital atresia of the external auditory opening, combined with congenital temporal bone cholesteatoma; we found a patient with exostoses obstructing the external auditory canal combined with congenital cholesteatoma of the middle ear; and a patient with congenital cholesteatoma of the temporal bone pyramid.

RESULTS

An increase in the incidence of congenital temporal bone cholesteatoma was noted, which is probably due to increased awareness of specialists and the wider use of imaging research methods. A relationship was revealed between the stage of congenital cholesteatoma according to the ChOLE classification and the necessary volume of surgical intervention. Of the total number of cases of congenital temporal bone cholesteatoma, 26.1% were the patients with anomalies in the development of the outer and middle ear.

CONCLUSIONS

All patients with suspected congenital temporal bone cholesteatoma require a temporal bone MSCT and middle ear MRI in DWI mode.

[Clinical case for removal infralabyrinthine petrous bone cholesteatoma with preservation the facial nerve]

The article presents the case report of infralabyrinthine petrous bone cholesteatoma. We have analyzed the preoperative examination of the patient for identification method of surgical treatment with preservation the facial nerve and reducing cholesteatoma risk, perioperative findings and the end result of surgical treatment.

[Sanation of petrous bone cholesteatoma in the otosurgical practice]

The present article reports the clinical cases of the surgical intervention on 20 patients presenting with petrous bone cholesteatoma. We have identified several clinical variants of petrous bone cholesteatoma based on the results of multispiral computed tomography (MSCT) of the temporal bones and categorized them into the following types in accordance with the classification proposed by Moffat-Smith an M. Sanna for this pathological condition: supralabyrinthine (n=8), supralabyrinthine-apical (n=2), infralabyrinthine (n=3), infralabyrinthine-apical (n=5), massive (n=1), and massive - apical (n=1). The surgical sanation of petrous bone cholesteatoma was performed in all the 20 patients in the absence of the pronounced bone destruction in the walls of the temporal bone pyramid and of the subdural expansion of cholesteatoma. In all the cases, the trepanation cavity remained open till its complete epidermization. The follow up period was around 3 years in duration on the average. The post-surgical analysis of the clinical conditions of each of the 20 patients was performed with special reference to the surgical technique applied for the removal of petrous bone cholesteatoma and the final outcome of the radical treatment.

Intraoperative identification of the facial nerve by needle electromyography stimulation with a burr

The purpose of this research is to improve the safety of surgery for patients with a pathology of the middle and inner ear by preventing damage to the facial nerve by conducting intraoperative monitoring of the facial nerve by needle electromyography with continuous stimulation with a burr.

PATIENTS AND METHODS

The clinical part of the prospective study was carried out on 48 patients that were diagnosed with suppurative otitis media. After the surgery with intraoperative monitoring, the facial nerve with an intact bone wall was stimulated electrically in the potentially dangerous places of damage. Minimum (threshold) stimulation (mA) of the facial nerve with a threshold event of 100 μV was used to register EMG events. The anatomical part of the study was carried out on 30 unformalinized cadaver temporal bones from adult bodies. The statistical analysis of obtained data was carried out with parametric methods (Student's t-test), non-parametric correlation (Spearman's method) and regression analysis.

RESULTS

It was found that 1 mA of threshold amperage corresponded to 0.8 mm thickness of the bone wall of the facial canal. Values of transosseous threshold stimulation in potentially dangerous sections of the injury to the facial nerve were obtained.

CONCLUSION

These data lower the risk of paresis (paralysis) of the facial muscles during otologic surgery.