Tannineh E. Clinical and morphologic substantiation of surgical treatment of patients with chronic suppurative epi-, epimesotympanitis

Dissertation is devoted to the issue of surgical management of chronic epi-, epimesotympanitis. New comparative data on the clinical course of chronic suppura-tive epi-, epimesotympanitis in patients with overt signs of mastoiditis and in cases of osteomyelitic course of mastoiditis were obtained. Presented are the detailed patterns of pathologic alterations in the cavities of middle ear in patients with chronic suppu-rative epi-, epimesotympanitis: in the attic, the prevailing alteration is a combination of cholesteatoma and caries/granulation process - (60,8 7,2% - 1,4 6,3% of cases), in the antrum and in the mastoid process, caries and granulation alterations prevail - (63,5 6,7% - 75,0 6,0% of observations). Using macro- and microscopic examina-tion of the bone tissue of the mastoid processes of patients with chronic suppurative epi-, epimesotympanitis revealed were combinations of osteosclerosis, osteomyelitis, decalcification of various degrees, slight osteogenic processes in the bone tissue. Itwas established for the first time that levels of ionized calcium in the blood sera of patients with chronic epitympanitis and epimesotympanitis could depend on the se-verity of osteosclerotic and destructive alterations of the mastoid bone, which can have a significant diagnostic importance when making decisions about earlier surgi-cal intervention. Studied was the significance of the optical density criterion for vari-ous pathologic alterations in the middle ear cavities: the presence of pus, encapsu-lated and suppurated cholesteatoma, fibrous tissue. For the first time the mastoido-plasty technique using connective tissue grafts on the nourishing stalk together with biocompatible ceramic hydroxiapatite, that facilitate reparative osteogenesis of the bone walls of the trepanation cavity and its further obliteration was developed. Posi-tive results were achieved in 92,8% patients compared to the traditional technique, in which osteal/periosteal graft on the stalk and debris of the cortical bone were used (71,9%).